Asthma Amidst This Pandemic

Viral infections are one of the main triggers of asthma. Photo: Ramsay Sime Darby Health Care

The current Covid-19 pandemic caused by the SARS-CoV-2 virus has only been around since late December 2019. It has quickly spread globally and was declared a pandemic by the World Health Organization in March this year.

This frightening and unseen virus has caught the world population unprepared. Presently, there are already over three million people infected worldwide and more than 200,000 deaths recorded from this infection.

Experts from WHO and the US Centers For Disease Control And Prevention (CDC) warned very early that elderly patients and those with pre-existing health problems such as heart disease, diabetes and chronic lung conditions are at higher risk of severe complications and death.

A few months later, we are starting to understand a little bit more about how it affects different patient populations, including those with asthma and allergy. Asthma and allergy are usually grouped together because they are linked by the same hypersensitive reaction to certain triggers.

The history of asthma or respiratory problems have been described as early as 2,600 BC in China. The relationship between asthma and allergy has also been described for several centuries.

Jewish scholar Maimonides (1,135-1,204 AD), who was the physician to Sultan of Egypt and Syria Saladin (1,174-1,193 AD), treated the ruler’s son for asthma. His “Treatise On Asthma” prescribed rest, good personal hygiene, a healthy environment and a special diet.

Nuts, fruit, milk, cool vegetables and legumes – peanuts are a member of this family – were forbidden, while “the soup of fat hens” was considered beneficial.

Ancient physicians already recognised that certain foods may trigger allergy and asthma. Only in recent decades have scientists proven that asthma and allergy are in fact similar and genetically linked.

Covid-19 And Asthma Patients

Currently, we know that viral infections are one of the most important triggers in asthma. Not all viral infections trigger the bronchial spasms and inflammation with the same severity in asthma.

Some viruses like the flu virus (influenza) and common cold virus (rhinovirus) are more likely to trigger asthma attacks.

Although WHO and CDC have warned that asthma patients could be more likely to be severely affected by Covid-19, at the moment we are not seeing any data which shows increased mortality from Covid-19 due to asthma in the general population.

This could be because asthma patients are taking extra precautions or, some possible protective effect of inhaled steroids used to control asthma reduced the severity of lung inflammation associated with Covid-19. More clinical evidence is needed to explain this.

Covid-19 And Children

Published data from China and other parts of the world show that mortality rates are very small in children compared to adults.

The most recent data in the US, however, still shows that around 20% of children are hospitalised due to Covid-19 but the total numbers are still lower than the general adult population.

Therefore, overall, children seem to be less likely to be severely affected, except for very young infants who are under one year old. At the moment, the relationship between childhood asthma specifically and Covid-19 is still relatively unknown.

Managing Asthma

Asthma treatment such as bronchodilator (blue inhaler e.g. salbutamol), inhaled steroids (orange or purple inhalers e.g. flixotide, seretide) and oral medications (montelukast or singulair) should be continued as normal.

Children with asthma should always use a spacer or chamber with their inhaler. This is the most effective way to deliver the medication to the lungs.

Please check that the inhaler technique is correct when you visit the doctor or nurse, especially among young children. There is some evidence that nebuliser treatment, which produces aerosol, can increase the risk of transmission of respiratory viruses like Covid-19 in the surrounding area.

Extra precautions should be taken and in general we should avoid this and use the inhaler with a spacer to treat asthma attacks unless in very severe cases where they need to have respiratory support.

Asthma patients should continue to be careful by wearing a three-ply mask and avoid going out unless necessary.

Ensure that the influenza vaccine is updated annually because the risk of influenza remains present throughout the year in Malaysia. Pneumococcal vaccination is also important and must be up to date.

It is important to seek medical help urgently at the beginning of an asthma attack especially if it is getting worse or not being controlled by bronchodilator treatment at home.

I pray that we will have this pandemic under control soon. Until then, the best medical advice I can give is stay at home, stay safe, and let’s fight this pandemic together.

Kita mesti menang!

Dr Salehuddin Samsudin is a consultant paediatrician and neonatologist at ParkCity Medical Centre. Photo: Ramsay Sime Darby Health CareDr Salehuddin Samsudin is a consultant paediatrician and neonatologist at ParkCity Medical Centre. Photo: Ramsay Sime Darby Health Care

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