People With Asthma May Not Have Higher Risk of Dying From COVID-19

People with asthma may not need to worry about their condition leading to a deadlier case of COVID-19.

Researchers from the George Institute for Global Health at the University of New South Wales found that people with asthma are not at a higher risk for dying from COVID-19. In a systematic review and meta-analysis, these researchers also discovered that people with asthma were 14% less likely to contract COVID-19 than people without asthma.

The researchers reviewed 57 studies that contained 587,280 people who were tested for COVID-19. About 7% of participants were asthmatic. The review was published in the Journal of Asthma online in February.

Asthma also did not increase the risk of worse outcomes for people who were considered to be high risk for other reasons. "In a study of electronic medical records of patients aged 65 years or younger with severe COVID-19, admitted to hospital in New York City, asthma diagnosis was not associated with worse outcomes, regardless of age, obesity, or other high-risk comorbidities," the researchers wrote.

Bita Nasseri, MD, a cardiothoracic anesthesiologist and co-founder of Euka Wellness, not involved in the research, tells Verywell it's not yet clear what may be causing these better outcomes for people with asthma who contract COVID-19. "While we would expect a substantially higher instance for asthma patients to be hospitalized with COVID-19, this has not been the case," she says. "The question is whether that is related to the medications or the susceptibility."

Asthma Related Risk Factors

Research has previously indicated that viruses that affect the respiratory system like influenza can have a more serious impact on people with asthma and worsen existing asthmatic symptoms. According to Kunjana Mavunda, MD, a pediatric pulmonologist and former medical director of Epidemiology and Disease Control at the Miami-Dade Department of Health, this extends to all respiratory viruses including COVID-19.

"These different mediators can lead to the increased reactivity, which causes bronchospasm and increased mucus," Mavunda tells Verywell. "Those three things lead to airway narrowing, [making] it more difficult for the patient to breathe." Asthma already causes people's airways to narrow, swell, and produce extra mucus, without other illnesses contributing to it.

While respiratory viruses can impact asthma, prior research has shown that people with asthma have responded differently to other types of coronaviruses. A 2004 study published in the journal Pediatric Allergy and Immunology found that the SARS outbreak between 2002 and 2004 did not worsen asthmatic symptoms in children who were previously diagnosed with asthma. However, a 2017 study published in the International Journal of Infectious Diseases found that underlying conditions that affect the lungs like asthma and chronic obstructive pulmonary disease (COPD) were associated with a relative risk of mortality for the Middle-East respiratory syndrome coronavirus.

Protective Social Behaviors

According to the review published in the Journal of Asthma, one of the reasons why people with asthma have a lower rate of COVID-19 infection may be due to a fear of severe COVID-19 illness. "Early in the pandemic, the uncertainty on the impact of asthma on COVID-19 and previous experience of viral infections triggering asthma exacerbations caused anxiety among patients and caregivers," the researchers wrote.

Other behavioral responses to COVID-19 may have also played a role in people with asthma contracting COVID-19 at a lower rate. A study published in the July-August 2020 edition of The Journal of Allergy and Clinical Immunology found that people with asthma and COPD were following their medication plan at an increased rate during the COVID-19 pandemic. The researchers wrote that they hoped the medication adherence "will have a positive effect on improving control of asthma and COPD and minimize the need for acute care for their primary respiratory disease."

How Asthma Medication May Help

One type of medication used for long-term management of asthma is inhaled corticosteroids. Corticosteroids are anti-inflammatory medications, which could suppress the immune system response. High doses of corticosteroids have been associated with elevated risks of infections, which has led researchers to support giving lower doses when necessary.

For people with asthma, experts who spoke to Verywell emphasized how people should continue taking their anti-inflammatory medication as prescribed. "The inhaled steroids decrease the reactivity of the receptors and may decrease the sensitivity when [COVID-19] is in the system," Mavunda says. "Patients with asthma who are not on inhaled steroids can still have some airway abnormality."

Inhaled steroids have also been found to help people who do not have asthma who are experiencing COVID-19 symptoms. A pre-print study from February found that the medication budesonide, which is commonly used to manage asthma, has reduced the recovery time and the need for hospitalizations for people who have COVID-19.

Nasseri recommends that people look at the positive aspects of corticosteroids when considering the risks of being on immunosuppressant medication for managing asthma. "Corticosteroids in high doses can reduce the immune system response," she says. "However, in smaller doses, they can actually help the lung inflammation related to COVID-19 and have been shown to do so in several hospital-based studies. "

In her practice, Mavunda has started to emphasize the importance of continuing asthma treatment, even if it includes immunosuppressant medication. "When patients are asymptomatic sometimes they don't understand the importance of taking preventive medications," she says. "Anybody who has a reactive airway disease on inhaled steroids should definitely be compliant with it."

Safety Precautions for Asthmatic People

While people with asthma may not have a higher risk of dying from COVID-19, people with moderate to severe asthma may have an increased risk of severe illness from COVID-19. The Centers for Disease Control and Prevention recommends taking the following actions if you do have asthma:

• Keep your asthma under control by following your asthma action plan
• Continue with your current medication and avoid asthma triggers
• Make sure that you have a 30-day supply of your medications
• Contact your healthcare provider if you start to feel sick
• Have another member of your household who doesn’t have asthma clean and disinfect your living space

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.