In a study published in Allergy recently, researchers looked at 140 patients infected with the novel coronavirus in Wuhan, China. They identified several underlying illnesses in many of the patients, including eosinopenia and lymphopenia (types of low white blood cell count). But asthma wasn’t one of those conditions, suggesting that having asthma doesn’t make it more likely that you’ll become infected.
But what if you do become infected? So far, the data are limited but suggest that asthma isn’t a major risk factor for hospitalization. A recent study published in JAMA Internal Medicine looked at 201 patients in Wuhan with confirmed COVID-19 pneumonia. Of those, 66 patients had other comorbid chronic illnesses, including five with chronic lung illnesses. An even larger demographic study of over 1,000 patients in the New England Journal of Medicine makes no mention of asthma or chronic lung diseases as potentially worrying underlying conditions.
In a special article in The Journal of Allergy and Clinical Immunology: In Practice, the authors note that “there are relatively few data at this time to demonstrate a specific increased risk for COVID-19 from asthma, or an increased disease pathology in patients with asthma infected with [the new coronavirus].” However, they continue, this association could evolve. Ultimately, the authors recommend that those with asthma prioritize getting and keeping their asthma under control right now to help prevent a flare associated with the new coronavirus.
But even with limited research, experts tell us that asthma should be considered a high-risk condition based on what we know about it and how viral illnesses generally affect those with asthma. And, according to the Centers for Disease Control and Prevention (CDC), those with moderate to severe asthma may still be at a higher risk for developing severe COVID-19 symptoms if they do get infected.
“You can think of the COVID-19 disease process as a major insult to the respiratory status,” Enid Rose Neptune, M.D., pulmonologist and associate professor of medicine at Johns Hopkins University School of Medicine, tells SELF. Most people who don’t have an underlying condition like asthma have a “tremendous amount of respiratory reserve,” she says, meaning their lungs can handle more stress. So, even if they develop a serious condition like severe pneumonia or anaphylaxis, they are more likely to recover than those with chronic respiratory conditions.
But “any disorder that reduces your respiratory or ventilatory reserve [including asthma] would make you at higher risk of having an adverse outcome if you happen to develop [a COVID-19] infection,” Dr. Neptune says.
However, asthma can present in many, many different ways. It can be mild, moderate, or severe. It can be well controlled or uncontrolled. Someone can have many triggers or only a few, very specific triggers. Whether or not everyone with asthma—regardless of the individual’s specific symptoms—would have an equally increased risk for severe COVID-19 symptoms remains to be seen.
So far, the biggest worry is for those who have severe or uncontrolled asthma, Dr. Meadows says. “People with mild asthma are at some risk, but certainly those with severe asthma are at a higher risk,” he says. “These people can land in the ER with a common cold.” Additionally, those who have frequent flare-ups or frequently need to increase their medication usage should be considered high-risk as well, Dr. Neptune says, which are signs that their asthma may not be well controlled.
Unfortunately, if you have severe asthma you should consider yourself to be very high-risk for severe COVID-19 symptoms—even if it’s well-controlled. “We see asthmatics in our clinics that are on the correct medications, who know how to manage their disorder well, they monitor themselves very closely, they understand what their triggers are,” Dr. Neptune says. “In those cases one would like to assume they are protected from the worst outcomes with this pandemic, but unfortunately those are still people who are at higher risk of having adverse outcomes, being much more symptomatic, and needing more support in the event they have an infection.”
We need to also pay attention to racial disparities in asthma.
Additionally, we know that there is a distinct racial disparity when it comes to asthma prevalence and complications. People of color—particularly Black people—have higher rates of prevalence, emergency department admission, and deaths related to asthma than white people, according to data from the CDC. This, unfortunately, mirrors the racial disparity we are beginning to see in the hospitalization and death rates for those infected with COVID-19.