COVID-19 more serious in persons with asthma

Persons suffering from asthma should pay particular attention to SARS-CoV-2 precautionary measures such as social distancing, regular handwashing, and wearing of masks on top of keeping their asthma in control. This is because data collected so far paints a bleaker picture for asthmatics than the normal population should they catch COVID-19.

Speaking at a media briefing, Associate Professor Dr Pang Yong Kek, president, Malaysian Thoracic Society and senior consultant respiratory physician, University Malaya Medical Centre, said the long and short of it is that patients with chronic lung disease, including chronic obstructive pulmonary disease (COPD) and asthma are more likely to suffer from more serious disease and more likely to die should they contract COVID-19.

“We would like to stress the importance of controller medication use among patients, especially during this time when asthma patients face a higher risk of health complications,” said Pang. “Given the current pandemic, many patients are apprehensive about heading to the hospital or seeing a doctor. We believe that social media is the way to reach out to patients—we can help alleviate concerns and provide guidance on managing their asthma at home. By equipping themselves with the right information, asthma patients can reduce their risk of exacerbations and avoid visits to the hospital, thus reducing pressure on the healthcare system.”

While asthma control is paramount, there is also the issue of inhaler overuse, said Dr Helmy Haja Mydin, consultant respiratory physician and cofounder of Asthma Malaysia. Most asthma patients are prescribed a reliever medication containing short-acting beta2-agonist (SABA) for symptom relief on top of controller inhaler for maintenance. The reliever inhaler, sometimes known to patients as the ‘blue inhaler,’ may be overused as they provide quick relief. This, said Helmy, does not address the underlying cause of an asthma attack especially if the patient ignores their controller inhaler altogether. The end result leaves patients with poor control of their condition and even increases asthma-related mortality. [Allergy 2008;63:1567–1580]

Helmy said the effects of overuse and reliance on the blue inhaler are severe and include increased morbidity and mortality. He said: “Patients who reach for their reliever inhalers more than twice a week are considered not well-controlled and this poses an increased risk of a severe asthma attack. Furthermore, patients also suffer when they do not adhere to or comply with the use of their controller inhalers resulting in little control, prolonged asthma conditions, and increased complications.” [Available at www.globalasthmanetwork.org/Global%20Asthma%20Report%202018.pdf Accessed on 19 May]

The dangers of reliever inhaler abuse are reflected in the 2019 Global Initiative for Asthma (GINA) guidelines, which address the dangers of patient overuse of reliever inhaler. GINA no longer recommends reliever inhalers as monotherapy as their use can worsen airway inflammation when used in isolation. [Am J Respir Crit Care Med 2006;174:965–969] The latest GINA guidelines recommend a combination of inhaled corticosteroids to address the underlying inflammation, and the long-acting beta2-agonist (LABA), formoterol, which has a fast onset of action, as the preferred reliever.

According to Helmy, for the first time in 3 decades the 2019 update of the GINA guidelines has included the use of inhaled corticosteroids as needed. He added: “Studies have demonstrated that this treatment reduces the risk of severe exacerbations by about two-thirds, compared with SABA-only treatment. With these new guidelines in place, it is imperative that we reach out to patients to empower them with this knowledge so that they can better control and manage their condition.”

Asthma in Malaysia
Locally, asthma affects almost two million children and adults with respiratory diseases being the second most common cause of death within the Ministry of Health hospitals. [Available at https://mpaeds.my/wp-content/uploads/2018/03/MOH-Health-Facts-2017.pdf Accessed on 18 May] In the atmosphere of  COVID-19, there is an added concern for asthma patients because the virus can affect the respiratory tract (nose, throat and lungs), leading to an asthma attack and possibly pneumonia as well as acute respiratory disease. [Available at www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/asthma.html Accessed on 18 May]

Pang’s and Helmy’s presentations were part of Asthma Malaysia and AstraZeneca’s collaborative campaign to bring asthma management and empowerment to asthma patients at home. The campaign is called ‘Asthma Malaysia On Air’ and features videos and webinars with various healthcare experts.

Asthma Malaysia is a non-profitable organization established to provide credible information and raise awareness on the best standards of care in asthma. It also aims to empower patients with asthma in the management of their condition.

A series of infographics containing facts on asthma are available on the Asthma Malaysia Facebook page for patients’ easy reference. Patients are encouraged to participate in the Breathe EaSY Patient Counselling Programme by contacting Asthma Malaysia at their Facebook page.