Drop seen in asthma attacks in pandemic

To the surprise of public health experts, asthma attacks appear to have dropped significantly in many places hit by the pandemic, contrary to the conventional wisdom that asthma and COVID-19 will feed or exacerbate each other as they target the same respiratory system.

Asthma is a chronic condition in which the airways constrict, swell and produce more mucus in reaction to allergens or irritants inhaled. Irritation and difficult breathing trigger coughing, shortness of breath and a whistling sound (wheezing) when exhaling.

An asthma attack can be frightening all around. In fact, one sure way to get immediate action in a hospital is to scream (and act it out) that you can’t breathe. Most asthmatics, however, are able to handle the emergency by using an inhaler to deliver a dose of a “beta-adrenergic agonist.” Some people also inhale a corticosteroid.

(Don’t try pronouncing “beta-adrenergic agonist” and risk having lockjaw. Dr. Google says these are simply “medications that relax muscles of the airways, causing widening of the airways and resulting in easier breathing.”)

Statistics show that 12 percent of the Philippine population has asthma. More than half of asthmatics are children who are not yet included in the priority sectors being vaccinated against the COVID-19 virus that has infected more than 1,485,000 Filipinos.

The risk factors for developing asthma include exposure, especially in infancy, to allergens (such as cigarette smoke, pollen, dust mites, molds, pets and pests) and a family history of asthma or allergy.

The doctor tracks down the triggers and allergens making life miserable for the patient, recommends changes in his environment and addresses the symptoms. Given early medical attention, many children outgrow their allergies or have less frequent severe attacks.

We have no local research data to stand on, but our guess is that the strict pandemic protocols (like wearing masks and keeping distance) and the stepped-up cleaning of the surroundings, including reducing air pollution, may have helped scale down incidents of asthma attacks in many communities.

The good news we want to share below is from fairly recent reports abroad (which we hope we have not misread, mangled or cut too tightly) saying generally that asthma by itself should not be a risk factor for severe outcomes in COVID-19.

• Pandemic cuts down asthma attacks.

In an article posted July 9, The Atlantic said “the pandemic was a big social experiment that sent asthma attacks plummeting” and that “doctors may have been focusing on the wrong asthma triggers.”

Its health & science writer Sarah Zhang mentioned Nicole Lawson, a mother terribly worried about her five-year-old daughter Scarlett, whose asthma attacks were already landing her in the Emergency Room the next day or urgent care every few months.

With the coronavirus raging and respiratory viruses known to be triggering asthma attacks, the Lawson family in Ohio hunkered down quickly and masked up often to keep Scarlett healthy.

“The ensuing months, to everyone’s surprise, turned into this beautiful year,” Nicole said. “Scarlett has not had a single asthma attack. Not a single visit to the ER. Nothing. She’s breathing so much better, and all it took was a global pandemic that upended normal life.”

Zhang reported: “All around the country, doctors have spent the pandemic wondering why their patients with asthma were suddenly doing so well. Asthma attacks have plummeted. Pediatric ICUs have sat strangely empty.”

“We braced ourselves for significant problems for the millions living with asthma,” said David Stukus, Scarlett’s doctor at Nationwide Children’s Hospital. “It was the complete opposite. It’s amazing.” (Fears about people with asthma getting more severe COVID-19 infections have not been borne out either.)

Zhang said studies in other countries, including England, Scotland and South Korea, also found big drops in hospital and doctor’s office visits for asthma attacks.

The massive global experiment that is the pandemic is now leading doctors to rethink some long-held assumptions about the disease. Asthma is a chronic condition that occasionally flares up, leading to 3,500 deaths and 1.6 million emergency-room visits a year in the US.

• COVID, asthma don’t feed each other.

The online News Medical hub said that people with asthma develop infections of the lower respiratory tract more frequently than those without, and that episodes of infection are longer and more severe.

It noted that given its relationship with immune functioning and clinical severity in respiratory infection, asthma is inevitably identified as a risk factor for severe outcomes in COVID-19. It said, however, that initial case studies did not appear to implicate asthma as such:

“One of the first reports from Wuhan described the clinical characteristics of 140 cases of COVID-19, including 58 severe cases. Of this cohort, there were no self-reported diagnoses of asthma among patients. A similar study assessed the clinical features of 290 laboratory-confirmed cases, of which only one patient was asthmatic.

“As case series analyses progressed, asthma continued to present no additional risk factor for severe outcomes for COVID-19. However, the chronic respiratory disease had the third highest fatality rate after diabetes and cardiovascular disease.

“Analysis of a large cohort of patients in the US hospitalized with COVID-19 did demonstrate a high prevalence of asthma (14 percent). However, once other known risk factors were controlled for, including age, sex and comorbid diseases, no significant association between asthma and risk of hospitalization with COVID-19 was found.”

NM said studies to date have not demonstrated convincingly that asthma increases susceptibility to becoming infected with the coronavirus. Two US-based studies that compared clinical outcomes for people hospitalized with COVID-19, it added, have shown no difference in mortality rates between patients with asthma and without asthma.

*      *      *

NB: All Postscripts are also archived at ManilaMail.com. Author is on Twitter as @FDPascual. Email: [email protected]