If you have one or more chronic diseases like cancer or diabetes, you are more likely to become severely affected by an illness like COVID-19. This is especially true for people over 65 years of age who live with a chronic condition due to changes in their immune system brought on by aging.
But what does immunocompromised mean? Should you be concerned about COVID-19 if you have asthma?
This article will explain everything you need to know about asthma and COVID-19, including whether asthma can compromise your immune system.
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Most countries have an army to protect them from external threats. Your body has a similar defense mechanism in your immune system.
Your immune system protects you against infections (viruses and bacteria) and diseases. To achieve this, the immune system must have the capability to identify and provide enough weapons (antibodies) and soldiers (white blood cells) to fight off this foreign enemy (infection).
A person is immunocompromised if their body has a decreased ability to accomplish either of the two main functions of the immune system (identifying and fighting infection and disease). This means they're more likely to contract infections and get sicker from diseases than someone who isn't immunocompromised.
An immunocompromised condition is usually caused by chronic diseases such as:
Certain genetic disorders
Medications such as anticancer drugs or medicines used to suppress the immune system after an organ transplant can also compromise the immune system. But what is asthma immunocompromised?
Asthma is a chronic respiratory condition that affects your lungs by causing your airways to swell. If you have asthma, you may experience the following symptoms, depending on the severity of your asthma:
Shortness of breath
Chest stiffness or pain
About 7.7% or 1 in 13¹ among the US population has asthma. This translates to about 25 million patients in the US. Asthma affects children and adults. To control your asthma, you should stick to your medication plan and avoid asthma triggers such as pollen, smoke, and dust.
COVID-19² is a disease caused by the SARS-CoV-2 virus, which was first discovered in late 2019. SARS-CoV-2 is thought to mainly affect the respiratory tract, including the lungs. However, data suggests that the virus can infect almost every organ system, including the brain, kidneys, heart, and even blood vessels.
If you have flu-like symptoms or suspect you have been exposed to someone with COVID-19, it's wise to get tested. Now, treatments such as Paxlovid or Lagevrio can mitigate disease risk and progression in high-risk patients. Also, follow COVID-19 guidelines to protect yourself and others, including vaccinating against the virus.
The data linking asthma and severe COVID-19 is mixed. In June 2022, the US Centers for Disease Control and Prevention (CDC) identified asthma as a risk factor for severe COVID-19.
A meta-analysis (combination of multiple studies) on over 100,000 patients found that people with asthma had higher intubation rates (a tube inserted in the nose or mouth to aid breathing) and prolonged mechanical ventilation with COVID-19, particularly if their asthma was poorly controlled at baseline.
However, several studies, particularly of adult patients with well-controlled asthma, have not shown an increased risk of severe COVID-19. Nevertheless, patients with poorly controlled asthma would be expected to fare worse than those who manage the disease well.
Asthma itself doesn't make you immunocompromised or more likely to catch a viral respiratory disease, but there's ample evidence that those with asthma may be more affected by such viral diseases and be sick for longer. You may become immunocompromised if you use asthma-controlling drugs that suppress the immune system.
Your asthma is typically a sign that your immune system is overreacting. That's why you become over-sensitive to triggers like pollen, dust, or smoke.
Although asthma drugs containing steroids are beneficial in controlling asthma symptoms, they also reduce the immune system's efficiency by slowing its response. Such medications may include:
Inhaled corticosteroids (e.g., Flovent)
Daily corticosteroid tablets (e.g., Medrol)
Inhaled corticosteroids do not necessarily get into your bloodstream and would not make you immunocompromised. They work by suppressing the immune system locally in your lungs, unlike oral or systemic corticosteroids. Furthermore, there is no good evidence that inhaled steroids affect the course of COVID-19.
Biologics (non-steroid drugs made from components of living organisms) used in the treatment of asthma, such as Omalizumab, are not considered "immunosuppressive" concerning COVID-19.
If you're unsure whether your current asthma medication contains steroids, consult with your doctor. They may recommend non-steroid drugs or change your medicines to ones with less steroid dosage to help avoid weakening your immune system.
There is insufficient data to show that people with asthma have an increased risk of contracting SARS-coV-2.
However, a recent CDC report³ indicates that asthma is a risk factor for severe COVID-19. This is especially true for people with moderate to severe or poorly managed asthma. You're considered to have moderate to severe asthma if you:
Experience daily asthma symptoms
Have reduced lung capacity
Have limitations in physical activity
If you have asthma, practice extra caution when it comes to COVID-19. The expert opinion states that every effort should be made for people with asthma to avoid exposure to the SARS-CoV-2 virus and that all regular medications necessary to maintain asthma control should be continued during the COVID-19 pandemic. These include:
Biologic agents approved for asthma
If your child has asthma, they may be at risk of long-term effects if they contract a respiratory infection, including the SARS-coronavirus-2.
One study on complications in children from COVID-19 found that 41.5%⁴ of children developed long-term asthma-like symptoms, especially after recovering from a severe coronavirus infection. The study also concluded that children with a family history or previous history of asthma were at higher risk of developing asthma-like symptoms after COVID-19 hospitalization.
To keep your child safe:
Give their asthma medications as directed by their doctor
Ensure they're vaccinated according to guidelines for viral respiratory illnesses such as COVID-19 as well as influenza
Make sure that when present in high-risk places (poorly ventilated indoor spaces), they wear a tight-fitting mask, possibly in a respirator style (KN95, N95).
If you notice your child's asthma symptoms worsening, get in touch with their doctor and share your concerns.
A recent study by the CDC looking at outcomes of COVID-19 infection in children demonstrated that those aged two to four had a higher risk of an asthma diagnosis following a COVID-19 infection, among other increases in various diseases such as diabetes or cardiac arrhythmias.
The same finding was also true for adults aged 18+ and the relative risk was higher than kids aged two to four, almost double that of people who had never had COVID-19. However, these studies only show association; further observational studies are needed to properly evaluate causation.
Asthma affects the lungs, so any other infection that affects the respiratory system may worsen your asthma symptoms. Diseases such as the flu and COVID-19 can trigger asthma exacerbations (attacks). During an asthma attack, the airways become inflamed and swell, letting in little air, and causing you to wheeze, cough, or have trouble breathing.
If your coronavirus is mild, you're likely to experience symptoms similar to the common cold, such as sneezing, sore throat, or a stuffy nose, which you can easily manage from home.
A serious COVID-19 infection can cause pneumonia and other lung diseases, such as acute respiratory distress syndrome (ARDS), making it difficult to manage your asthma symptoms.
If you have been diagnosed with SARS-coV-2, contact your primary care physician (PCP) or lung specialist, as there are now treatments to minimize the risk of COVID-19 progressions, such as Lagevrio or Paxlovid.
If you have asthma, you should take extra precautions to guard against a respiratory illness like COVID-19. Apart from helping you manage your asthma, observing precautions may prevent you from contracting COVID-19 in the first place.
These precautions include:
Your prescribed asthma medications (rescue inhalers, steroid pills, steroid inhalers, biologics, and others) should not be skipped as they help avoid asthma attacks and improve the symptoms. You should always have a 30-day supply of your asthma medication with you.
According to the CDC, every asthma patient should have an asthma action plan.⁵ This is your personalized plan that you create with the help of your medical provider to help you manage and avoid asthma exacerbations.
The plan should include:
Ensuring you know how to correctly use your inhaler
Having a sufficient supply of asthma medication
Avoiding asthma triggers such as tobacco smoke, pet dander, dust mites, pollen, stress, polluted air, strong fragrances, mold, and others
Regularly disinfecting or cleaning 'touchy' areas like door handles and countertops
An inhaler like albuterol may best manage your symptoms if you have acute asthma attacks. Experts⁶ discourage using nebulizers while infected with COVID-19 unless necessary since they can aid in transporting the virus (SARS-CoV-2) in the air, potentially putting nearby people at risk.
If your asthma is moderate to severe, you may be at increased risk of worse outcomes from a COVID-19 infection. Therefore, it's prudent to follow the prevention measures, which include:
Wearing a tight-fitted, respirator-grade mask such as an N95 or above
Stay away from people who have tested positive or show flu-like symptoms
Where possible, avoid congregated indoor places with poor ventilation
Try to practice social distancing in outdoor settings
Get vaccinated against COVID-19
As mentioned earlier, your immune system is your defense. Taking steps to ensure that your immune system is functioning as well as it can is crucial to better fight COVID-19 or other diseases if you get infected.
Some of the habits you may want to start practicing to reinforce your immune system include:
Getting ample sleep
Learning to control and manage your stress and anxiety levels as much as possible
Incorporating vitamin-rich fruits and vegetables into your diet
Trying to sustain a healthy weight
Immunocompromised refers to a weakened immune system unable to effectively fight against infections and diseases. Immunocompromised people have a high risk of severe infections and diseases.
Asthma is not immunocompromised. However, according to the CDC, you should be extra cautious if you have asthma since it may be a risk factor for severe outcomes if you catch viral diseases like COVID-19.
The best way to manage your symptoms is to ensure that your asthma is always well controlled by taking medications and avoiding asthma triggers.
It's crucial to take precautions against COVID-19 if you have asthma. These include taking your medications as directed, avoiding asthma triggers, following COVID-19 prevention measures, and practicing healthy habits that ensure your immune system is functioning at its best.
If you experience worse asthma attacks or symptoms similar to those of COVID-19, you should seek immediate medical attention from your healthcare provider. This will help you better manage your asthma symptoms and control COVID-19 if you test positive.
Asthma | Centers for Disease Control and Prevention
Coronavirus disease (COVID-19) | World Health Organization
Science brief: Evidence used to update the list of underlying medical conditions associated with higher risk for severe COVID-19 | Centers for Disease Control and Prevention
Asthma action plans | Centers for Disease Control and Prevention