Risk And Protective Factors Associated With Pediatric Asthma
Several mechanisms have been proposed to explain the lower morbidity of COVID-19 observed in patients with type 2 asthma.
As previously described, ACE2 is a host molecule used in cell entry by SARS-CoV-2 and other coronaviruses . Data from three different cohorts of children and adults have shown that asthma and respiratory allergy were associated with lower expression of ACE2 gene in airway cells , as type 2 inflammatory mediators and allergen exposures may decrease ACE2 expression in bronchial epithelial cells .
The South Korean nationwide cohort tested almost 220,000 adults for SARS-CoV-2, with 7340 positive cases, and information regarding asthma, allergic rhinitis and atopic dermatitis was obtained from the health insurance records. Asthma was associated with an increased risk of SARS-CoV-2 test positivity and severe COVID-19 infection . Interesting and of note, was the report that both risks were higher in non-allergic asthma, with no significant risk being found when allergic asthma was compared to the non-infected group .
Is Asthma Associated With Severity Of Covid
One review looked at risk of PICU admission with COVID-19 and found âscarcely any data.â In the one study they included that reported this outcome, of 46 children hospitalised with COVID-19, no differences in proportions admitted to general floor versus PICU /33 general, 3 /13 PICU) were found. One review evaluated ICU admission. Of the five studies they included which reported data on this outcome, three had data on < 200 participants. In one study with 200 hospitalised patients in Switzerland, the prevalence of asthma in those on mechanical ventilation was 2.7%. In 1000 hospitalised adult patients in the US, prevalence of asthma was 12.3% in those admitted to ICU. Neither of these figures clearly signal an increased risk of ICU admission in PWA with COVID-19, but no formal analyses were conducted. None of the five primary studies we included that tested for an association between asthma and admission to the ICU with COVID-19 detected a statistically significant one, but confidence intervals were wide in all analyses .
Table 2. Estimates from primary studies on the association between asthma and risk of ICU admission with COVID-19
Table 3. Estimates from primary studies on the association between asthma and risk of death with COVID-19
|Fully adjusted: HR = 1.11 95% 1.02â1.20||ââ|
Asthma And Your Risk Of Becoming Ill With Covid
How your asthma affects your risk of becoming ill with COVID-19 seems to be mainly linked to how well-controlled it is. People with well-controlled asthma that is not severe dont seem to be at higher risk of dying from COVID-19.
People at higher clinical risk are those who either:
- have severe asthma
- need regular or continuous oral steroids
- have a history of asthma attacks that have required an overnight stay in hospital.
As a result, many of these people will be in the clinically extremely vulnerable group.
However, if you have any type of asthma there is a small increase in the risk of needing to go to hospital if you get COVID-19. Although the risk of this happening is small, its still very important to manage your condition well.
Its also important to remember that your own level of risk is affected by many different interacting factors. Your asthma may play a part in your level of risk from coronavirus, but your risk is also affected by lots of other things too.
Public Health England has identified the main factors that increase the risk of catching and becoming seriously ill with coronavirus as:
- being older
- having an underlying health condition
- being a man
- your job your risk level is higher if you work outside your home and come in to contact with lots of people every day
- where you live – if lots of people in your area are infected with coronavirus, its more likely youll catch it. Find official coronavirus statistics for your area.
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What Should I Do If I Have Asthma
Take steps to protect yourself. Get a COVID-19 vaccine when it is available to you. Wear a mask that covers your nose and mouth. Stay at least 6 feet from people who dont live with you. Wash your hands with soap and water use hand sanitizer with at least 60% alcohol. Avoid crowds and poorly ventilated spaces.
What Activities Can I Do Safely If I Am Fully Vaccinated Against Covid
In May 2021, the CDC updated their guidelines for wearing a mask. When fully vaccinated, the CDC stated you can safely resume activities without wearing a mask and staying 6 feet apart.
But in July 2021 CDC provided new guidance due to the delta variant and rising COVID-19 cases. It is now recommended that everyone in areas of high transmission where a mask in public indoor places, even if they are fully vaccinated.
If you have a condition or are taking medicines that weaken your immune system, talk with your doctor about which activities are safe to do.
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The Delta Variant Of The Coronavirus
The delta variant is a strain of the coronavirus that causes COVID-19. Most COVID-19 infections in the United States and in many other countries are currently from the delta variant. It is two times more contagious than earlier strains of SARS-CoV-2, meaning it is spreading very quickly. Some data suggest the delta variant might cause more severe illness in people who are not vaccinated.
It is possible for people who are fully vaccinated to get the delta variant. This happens much less in people who have their COVID-19 shot than people who do not. This is called a breakthrough infection. Symptoms of COVID-19 will be less severe in people who are vaccinated and their risk of being hospitalized or dying of COVID-19 are very low. They are also less contagious, and they will recover faster than people who are not vaccinated.
The CDC recently updated their COVID-19 vaccine recommendations for pregnant people and people who are immunocompromised.
The Direct Result Of Racism: Covid
The fact that Covid had a disproportionate effect in the African American population almost guaranteed that asthma was going to rise to the forefront as being kind of a comorbidity of concern, she said.
Theres a need for more research into whether other conditions that are common in people with asthma factor into why Black people are dying from the virus at heightened rates. Patel said she and her colleagues analyzed other conditions among the patients with asthma and found that obesity, hypertension, sleep apnea, and a slew of other conditions were more prevalent among asthmatics.
It was interesting to see that asthma patients, despite them having increased comorbidities, did not have an increased risk of hospitalization, she said. That is something that we would like to investigate further as to what role asthma could be playing among these different comorbidities.
Chinthrajah said she is confident more research can resolve that question and the other remaining riddles around the connection between Covid-19 and asthma.
We all feel compelled to find answers, she said.
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Coronavirus Vaccine And The Booster
All UK adults should have been offered the coronavirus vaccine. All teenagers aged 16 and 17 are now eligible for their first dose. Some children aged 12 to 15, who are at increased risk from COVID-19, are also being offered the vaccine.
All coronavirus vaccines are very effective at reducing your risk of becoming ill with the virus should you get COVID-19. Its also now known that being vaccinated reduces your risk of becoming infected with the virus. But it doesnt mean you cannot get the virus.
We know people have a lot of questions about the vaccine, which is why weve worked with our sister charity, the British Lung Foundation, to create a COVID-19 vaccine FAQ.
The JCVI has provisionally advised that booster vaccines should be offered from September 2021 to people who are most vulnerable to COVID-19 ahead of the winter months. They have advised that the booster vaccine should be offered in two stages.
If you are clinically extremely vulnerable, you will be offered the booster COVID-19 and a flu vaccine from September, under stage 1.
Stage 2 includes everyone aged 50-69 and adults aged 16-49 who are offered a free flu vaccine each year. People in these groups will be offered a booster COVID-19 vaccine as soon as possible and practical after stage 1. They will also be offered a flu vaccine, where appropriate.
What Doctors Are Saying
Wechsler said this information doesnt change his recommendations to people with or without asthma.
I am telling them what Im telling everyone else: masking, handwashing, social distancing, getting vaccinated. Those are all really, really important factors associated with preventing getting COVID-19, he said.
I also tell them that they should take their medications as prescribed because if they get COVID-19, then we want them to be as well controlled as possible so that asthma does not get worse, Wechsler said. So, they need to continue on their inhaled steroids or whatever other controllers theyre taking.
Always talk with your doctor about your medications, such as inhaled corticosteroids, which are often prescribed for asthma.
Theres the suggestion, Wechsler said, that the steroid component of this medication may reduce viral replication of the coronavirus.
So, if your airways are less compromised because youre taking your medication as prescribed, then youre less likely to develop a complication if you get COVID-19.
Dr. Joe Zein, a pulmonary medicine specialist at the Cleveland Clinic in Ohio, told Healthline that he assures his patients that asthma may not necessarily be a bad thing, and your risk is probably not higher than someone who doesnt have asthma.
Zein urges people with asthma to continue taking their prescribed medications and following all the recommended COVID-19 precautions.
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An Overview Of Asthma And Covid
- 1Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
- 2Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
Coronavirus disease 2019 is a pandemic infectious disease caused by severe acute respiratory syndrome coronavirus SARS-COV-2. Aberrant innate immunity response and cytokine storm are responsible for the syndrome. Apparently, in asthmatic patients, the inadequate antiviral immune response and the tendency for asthma exacerbation evoked by common respiratory viruses could explain increased susceptibility to SARS-COV-2 infection. However, asthma has not been suggested to be a risk factor in COVID-19 patients. Therefore, in asthmatic patients some potential protective mechanisms against SARS-COV-2 have been hypothesized, like type 2 immune response, number of eosinophils, overproduction of mucus, and asthma treatment, along with behavioral factors not strictly related to asthma, such as social distancing, hygiene measures and wearing facemasks, that contribute to reduce the individual susceptibility to SARS-COV-2 infection. In this mini-review, we will describe the current literature regarding potential protective factors against COVID-19 in children with asthma based on the evidence available so far.
People With Underlying Medical Conditions Included In The Covid
Vaccine manufacturers report information from clinical trials, including demographics and underlying medical conditions of people who participated in COVID-19 vaccine trials. You can find additional information on COVID-19 vaccine clinical trials at clinicaltrials.govexternal icon, a database of privately and publicly funded clinical studies conducted around the world.
Find a COVID-19 Vaccine: Search vaccines.gov, text your ZIP code to 438829, or call 1-800-232-0233 to find locations near you.
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Reducing Your Risk Of Catching And Spreading Covid
There are lots of ways you can reduce the risk of catching and spreading the coronavirus, including:
- following the government guidance for where you live or work
- meeting outside where possible, or keeping inside well ventilated
- getting vaccinated and encouraging friends and family to do the same
- getting a PCR test if you develop symptoms
- self-testing regularly with a lateral flow test if you dont have symptoms
- self-isolating if you get positive test results
- washing your hands often, using soap and warm water, or hand sanitiser
- wearing a face covering to help protect others.
Coronavirus is a respiratory infection. If you smoke, you have an increased risk of contracting a respiratory infection and of having worse symptoms. This means that if you catch coronavirus, your symptoms may be worse than those of a non-smoker. Smokers also touch their mouth and face more, which increases the risk of transmitting the virus from hand to mouth.
Its important that if you smoke, you stop as soon as possible. As well as lowering your risk from coronavirus, your breathing becomes easier within days of stopping smoking.
Get advice on how to stop smoking.
Wear a face mask or face covering
We strongly encourage that everyone who can continues to wear a face covering in enclosed or crowded spaces.
We have more information and advice on wearing a face covering if you have asthma, including an exemption card if you can’t wear one.
Find the guidance for your area
How Can I Avoid Getting Covid
The following eight steps will help you avoid COVID-19, the flu, and other respiratory infections:
1. Get your vaccines. Vaccines can help protect you, your loved ones, older adults near you, teachers, and essential workers from getting a respiratory infection. They can also cut down your symptom severity if you do get sick. Vaccines reduce the burden on our health care system by reducing the number of people who get COVID-19 or the flu.
Everyone who 12 years and older can get the COVID-19 vaccines for free with no out-of-pocket costs in the United States. On Aug. 23, 2021, the FDA approved the Pfizer COVID-19 vaccine for ages 16 and older. It has been named Comirnaty . Experts expect the FDA to authorize more COVID-19 vaccines as they complete clinical trials.
Visit vaccines.gov to find out where you can get the COVID-19 vaccine near you. Most people can get the COVID-19 vaccine with no issues. Allergic and adverse reactions are rare. Talk with your doctor before you get a COVID-19 vaccine if you have a:
- Moderate or acute illness
- Current case of COVID-19
- History of severe allergic reactions to a vaccine or injectable medicine
- History of an allergic reaction to PEG or polysorbate
The following people can get a COVID-19 vaccine:
Your doctor may need to give you more information about the vaccine depending on your condition.
If you have a reaction to the first dose of an mRNA vaccine , talk with your doctor about your options.
2. Wear a mask.
The WHO recommends three layers:
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Protective Factors Against Sars
Some protective factors against SARS-COV-2 infection have been hypothesized in patients with allergic asthma, such as T2 immune response , overproduction of mucus, and asthma treatment .
Figure 1. Impact of T2 immune response on SARS-COV-2 infection susceptibility and severity. T2 immune response inhibits SARS-COV-2 entry into the cell through ACE2R down-regulation and helps to clear the viral load through activation of immune response orchestrated by eosinophils .
Management Of Asthmatic Children During The Sars
Objective evidence regarding the optimal management of asthmatic children during the SARS-CoV-2 pandemic is still limited and most available information is based on expert recommendations. Weak evidence supports that some asthma medications such as inhaled steroids, montelukast and bronchodilators may have SARS-CoV-2 and/or other coronavirus inhibitory action, or could be beneficial to reduce COVID-19-driven inflammation .
An ex vivo study of an asthmatics airway epithelial cells showed that inhaled steroids have suppressive effects on ACE2 and TMPRSS2 expression . A systematic review found no evidence of COVID-19-related adverse outcomes in patients with continuous or pre-morbid inhaled steroid use . This evidence reinforces the recommendation from the Global Initiative for Asthma and others that control medication for asthma, including inhaled steroids, should be maintained during the pandemic . The decision to reduce or to step down daily controller medication should be carefully considered . Oral corticosteroids were initially not recommended for patients with COVID-19 due to the potential risk of immune depression and a worse viral response . However, further studies have shown beneficial effects of systemic corticosteroids in reducing acute respiratory distress syndrome and systemic inflammation . For asthma exacerbations, a short course of oral steroids is recommendedaccording to clinical judgmentto prevent serious consequences .
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Indeed Could It Be Actually Protective
Asthma patients with confirmed COVID-19 were no more likely to require hospitalization or mechanical ventilation than patients without asthma, researchers found.
Moreover, the asthma patients were less likely to die from COVID, reported Lacey Robinson, MD, of Massachusetts General Hospital in Boston, at the virtual annual meeting of the American Academy of Allergy, Asthma & Immunology .
In a matched cohort analysis, 21% of asthma patients with COVID-19 were hospitalized compared with 18% of patients without asthma, and their mortality rates were 1% and 3%, respectively.
The study is the latest to suggest that asthma patients as a group are at no greater risk from SARS-CoV-2 infection than the general population, and that they may even have extra protection against developing severe disease.
These findings and those from other recent studies should reassure asthma patients, Robinson said.
“What we showed and what others have shown is that asthma alone really isn’t a risk factor for severe outcomes from COVID-19, and that is great news for asthma patients,” she told MedPage Today.
Robinson noted that the asthma cohort in the study did not include patients with chronic obstructive pulmonary disease or other respiratory diseases that have been linked to worse outcomes with COVID, but they did have more comorbidities and higher body mass indexes, on average, than patients without asthma.
Who Is At Risk For Severe Illness From Covid
Many studies to date show no increased risk of COVID-19 infection or severity of COVID-19 disease in people with asthma.3,4,5 A study published in âThe Journal of Allergy and Clinical Immunology: In Practiceâ found that people with well-controlled asthma have less severe COVID-19 outcomes than those with uncontrolled asthma.6 Now is the time to talk with your doctor to make sure your asthma is well-controlled.
The CDC continues to list moderate-to-severe asthma as a chronic lung disease that can make you more likely to have severe illness from COVID-19.
Based on existing evidence, the following adults can be more likely to get severely ill from COVID-19:
- Older adults
- People who are affected by long-standing systemic health and social inequities including:
- People who are Black, Hispanic/Latino, or American Indian/Indigenous American
- People with disabilities
- Solid organ or blood stem transplant
- Substance abuse disorders
Children can be infected with the virus that causes COVID-19 and some children develop severe illness. While some children may be at increased risk due to chronic medical conditions, there are no current data that show asthma is a risk factor for severe disease in children, either.
- Quick-relief medicine
- Inhaled corticosteroids
- Allergy shots
If you have any questions about asthma medicines and the coronavirus, talk with your doctor.
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