Dr. Matt Dougherty isn’t waiting for his pediatric asthma patients or their parents to call him in a panic, frightened that a sudden cough or wheeze is due to the novel coronavirus. He’s reaching out to them, virtually, via telemedicine.
“I look through my patient files, identify the ones in the past that I know have had problems this time of year with allergies triggering their asthma and contact them before they have symptoms,” said Dougherty, who treats children with allergies and asthma at Esse Health in St. Louis, Missouri.
“I tell my patients, let’s maximize your lung health now,” he said. “Then in case you get unlucky enough to run into coronavirus, at least we’ve come into it with the best lung condition we can.”
Asthma vs. Covid-19 symptoms
Asthma is one of the underlying health conditions that puts one at higher risk for a more severe case of Covid-19, the disease caused by the novel coronavirus.
“During an asthma attack it’s almost like breathing through a straw because that inflammation is restricting the airway,” said Dr. Lakiea Wright, who specializes in allergies and immunology at Brigham and Women’s Hospital in Boston.
“You can imagine if a virus that causes extra inflammation gets in there, then that’s going to be worse,” Wright said. “Those are the patients who might end up on ventilators to help with breathing because Covid-19 is doing a lot of damage in the lungs.”
Many of the key signs of Covid-19, such as coughing, shortness of breath and chest tightness, are also typical symptoms of asthma.
Other potential Covid-19 signs, such as sneezing, runny nose, red eyes and fatigue, can mimic allergy responses.
That’s an issue because of the 25 million Americans who have asthma, two-thirds suffer from the allergic form of the disease, in which environmental allergens such as dust, insects, pets, mold and pollen will trigger their asthma.
The number is even higher in children, Wright said: “Up to 90% of children with asthma can have allergic asthma.”
So if the signs are so similar, how can one tell them apart?
“It can be very confusing to patients,” Wright said. “I tell my patients to look for things that would be more distinguishing symptoms of Covid-19 such as fever and body aches. Allergies or asthma alone would not cause those symptoms.”
Those with allergic asthma can try antihistamines and other allergy treatments, Dougherty said. If those treatments reduce their symptoms, that’s a sign that it’s just allergies.
As for asthma, he said, anyone experiencing an asthma attack will likely have a history of asthma, and would be able to compare their symptoms to their typical asthma event.
“I would not expect a person to have a first asthma event by getting coronavirus,” he said. “And even if you did have both coronavirus and an asthmatic event at the same time, your asthma symptoms should improve by using your rescue inhaler.”
If keeping lungs as healthy as possible is the goal, how does one do that?
Know your triggers. “Asthma doesn’t just show up out of the blue. Asthma has triggers and each person’s triggers are different – cigarette smoke might be your trigger or perhaps it’s exercise,” Dougherty said.
“I would hope every asthmatic would get a good understanding of the things that are more likely to bring on their asthma and try to avoid those,” said pulmonologist Dr. Albert Rizzo, chief medical officer for the American Lung Association.
That means analyzing your environment and using common sense, said pulmonary intensive care specialist Dr. Mitchell Glass, a spokesperson for the American Lung Association.
“This is the time to find a loved one who will clean the kitty litter,” Glass said. “As much as you love your cat, this may not be the time to have your cat in your lap. Minimize your exposure to dust, to noxious smells, to anything that might trigger an asthma attack.”
Keep a record. Asthmatics should use peak flow meters, devices that measure the strength of a breath, to monitor how well their airways are staying open, Rizzo said.
Then they should keep a daily record of that and other telltale signs.
“They should assess how often they’re reaching for their rescue medications. They should assess how often they’re waking up at night with a cough or a wheeze. These are the signs of some instability that might be occurring,” Rizzo said.
“It gives asthmatics a way to self-manage a little bit of a change in their breathing and gives information they can relay to their physician if the condition doesn’t reverse when they take their rescue inhaler,” he added.
You should also record your temperature on a daily basis, Wright said.
“Then when you’re talking to your doctors, you would have that sort of objective evidence,” she said.
Locate and check your medications. “I’ve definitely had some patients where I’ve asked them to go get their inhaler, and they can’t find it in their house,” Dougherty said.
“We have data that is suggesting you should have a rescue inhaler no matter what else you are taking at hand,” Glass said. “So that would be your albuterol or levalbuterol, the inhaler that is strictly for rescue if you have an acute attack.”
Then check the expiration dates and make sure they are still active, Glass said: “You really want to make sure that what you’re using is active and hasn’t been sitting on the shelf for two years because you ‘quote’ haven’t had an attack.”
Asthmatics who are on biologic medicines, which significantly lower immune response and make the user more susceptible to infection, should discuss their regimen closely with their doctor.
Know how to use inhalers correctly. Pediatrician Dougherty loves using a video telemedicine visit instead of a phone call because he can ask his patients to find their inhalers and correctly identify them.
“I make sure when they hold up their inhaler, they can identify it for me,” he said. “Is this an inhaler that they take as a preventative medicine to keep them from wheezing?”
Or is it their rescue medicine, the inhaler they use when they’re actually wheezing or in the midst of an asthmatic event?
“Misunderstanding that completely alters how an asthmatic does when they’re trying to treat themselves,” Dougherty said.
It’s also critical that asthmatics know how to properly use their inhalers and spacers (a device that helps deliver the medication more precisely).
“I have them get their inhalers and their spacer and demonstrate how they’re using it so I can make sure they’re using it correctly,” Dougherty said, adding that exactly how that is done may depend on the type of inhaler that is being used.
Use your asthma action plan. Because every asthmatic is different in both triggers and how their lungs respond, each person needs to work with his or her doctor to develop an individual action plan.
“That asthma action plan will help them decide, ‘Do I need to call my doctor and get any additional medication?’ And I emphasize calling a doctor because you don’t want to rush into the office or the emergency room unless you are in severe distress,” Rizzo said.
Dougherty makes it a point to go over each patient’s action plan during his telemedicine visit. Once he has done that, he asks them to go and repeat it.
“I tell them, ‘I want you to take this plan and then I want you to sit down and explain it to someone who wasn’t here at the visit,’” he said. “And if they can’t, I tell them not to be embarrassed. That simply means I didn’t explain it well enough. Call me back.”
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When it comes to pediatric asthma patients, it’s critically important that every adult in charge of caring for that child is also intimately familiar with the action plan, Dougherty said.
“Everybody who could care for that child in an emergency needs to know what to do and how to do it when the child’s breathing comfortably in front of you,” he said. “Don’t wait to read this plan and figure it out when the child is struggling to breathe.”
Feel good about being prepared. While this may sound like a lot of items to tick off a list, the experts CNN spoke to said that asthma patients shouldn’t let the fear of the virus overwhelm them. After all, they are now prepared.
“No one should be scared,” Rizzo said. “I think it’s important for asthmatics to understand they’re not at higher risk of getting the infection as long as they follow the social distancing and hand washing. They should stay on their medications and be in communication with their doctors. But I don’t think they should be scared.”