Why the pandemic was good news for many with asthma

People with lung diseases were considered vulnerable, yet lockdowns and mask wearing meant the number of attacks was dramatically reduced

Jerome Burne

Despite asthma being a Covid-19 risk factor, research has found that only 14 per cent of those hospitalised during the pandemic had asthma - and that these patients were more likely to survive than others

WHEN Covid-19 hit, asthmatics were warned to be extra careful. Since the virus typically damages the lungs and causes breathing problems, these patients were thought to be particularly vulnerable.

But research has found that during the pandemic, just 14 per cent of people hospitalised with Covid in the UK had asthma.

What's more, these patients were more likely to survive than others if they were infected by the virus.

And now it's been found that over the past 18 months, the number of asthmatics suffering an attack severe enough to need a visit from their GP was lower than in the previous four years.

"There has been a significant reduction in attendance to primary care for exacerbations [attacks] during the pandemic," says the study's lead author, Dr Syed Shah, a chancellor's fellow at the University of Edinburgh's asthma research centre.

Dr Shah and his team analysed the medical records of more than 100,000 asthma patients and found a 20 per cent drop in the number of GP visits for asthma attacks.

However, the number of attacks severe enough to need hospital treatment didn't change.

This phenomenon isn't limited to the UK. Something similar has been happening in the United States, where another large study found that the number of attacks suffered at home had dropped by 40 per cent compared with previous years.

So what has been going on? Explanations put forward so far include people's inability to get a face-to-face appointment, or even a reluctance to visit the doctor for fear of being exposed to Covid-19; that asthma medications offer some protection against the virus; and that the pandemic precautions - masks, distancing, isolation - have reduced the risk of exposure to other viruses known to trigger attacks.

It's certainly true that fear stopped people from seeing a doctor. "Many of our supporters told us they were afraid to seek help during the pandemic for fear of being exposed to Covid," says a spokesperson for the Asthma UK and British Lung Foundation Partnership.

Meanwhile, others simply couldn't get a face-to-face appointment with their GP.

But Professor Elliot Israel, a lung specialist at Brigham and Women's Hospital in Boston, who led the US study, has another theory for the decline in people seeking help for asthma.

He thinks experts may have concentrated too much on advising patients to avoid substances that trigger allergic asthma attacks, such as pollen, cleaning products or pollution, when it's other illnesses that may be more problematic.

"These things can trigger an attack, but what now looks more important is the ability of other viruses to cause these attacks," he says.

During the pandemic, people took precautions that reduced their risk of getting viral infections and, as a result, rates of these infections in general have dropped dramatically.

Normally, around 50,000 people die from flu in the US every year. In the past year, however, flu caused between 1,000 and 2,000 deaths, he says. The new findings have triggered a debate among experts.

"We can't assume that because GPs are seeing fewer patients with asthma attacks that people aren't having them," says the spokesperson for the Asthma UK and British Lung Foundation Partnership.

"We know that two-thirds of people who had an asthma attack dealt with it at home."

Two-thirds of people who had an asthma attack during lockdown dealt with it at home, according to asthma charities

In response, Professor Israel points out that his study, which involved 1,000 people with asthma, was designed to report specifically on what happened in their homes.

"They sent in weekly reports about how they were feeling, what medication they were taking and if they'd had an attack," he says. "As the reports came in it was clear the number of attacks had dropped."

His theory is backed by Dr Lauren Cohn, a lung specialist and an associate professor of medicine at Yale University.

"During the pandemic, my patients had fewer flare-ups than in past years," she says. "We think this is due to mask-wearing and limited human contact at work and school."

So what else could be cutting cases? Professor Geoffrey Chupp, director of the Center for Asthma and Airways Disease at Yale University, has found that asthmatics, who make up about 10 per cent of the Covid-19 patients in the US, were more likely to survive the virus.

"It's possible that some of the medications used for asthma helped to reduce the inflammation that Covid-19 causes," he told Health & Lifestyle.

This is because the puffers that people with asthma use to relieve the symptoms of an attack contain low doses of steroids that bring down inflammation, he says.

It's also possible that the medication down-regulates the ACE2 receptors found on cells throughout the body, and which the virus uses to get in, making access harder, suggests Professor Israel.

Dr Shah has another, more conventional, theory: "There is a lot of evidence that asthma improves if the environmental triggers - pollen, air pollution, cleaning products - are managed properly."

Air quality certainly improved temporarily in cities around the world during the lockdowns. One report found that as emissions from industry and transport fell in 2020, 65 per cent of the analysed global cities experienced better air quality compared to 2019.

"The cleaner air during the pandemic certainly helped, and as a preventative measure, more asthma patients got inhalers and were encouraged to use them if they had a flare-up," says Dr Shah. "So, the pandemic could be causing a drop in flare-ups because people are being more careful about self-management."

But Professor Israel disagrees. "I've had to rethink my long-held assumption that much of asthma is due to home and office allergens," he says.

"It doesn't fit with the fact that attacks didn't increase, but went down, when people were isolating in homes, which are a rich source of allergens.

"That's why giving a bigger role to viruses makes sense."

The fact there was no drop in the number of people referred to hospital suggests that those who didn't see their GP were having milder attacks.

Ironically, the stronger viral connection could mean that those with asthma may have to take physical precautions against the after-effects of the pandemic for longer.

"This is a rapidly evolving situation, and we are all trying to make sense of different aspects," says Professor Israel.

"The lifting of restrictions means that there is likely to be a rise in the number of all viral infections.

"Maybe precautions such as masks will have to be kept in place for longer to keep viruses out. They are pretty low-tech at the moment. I suspect there will be a big improvement in that technology soon."

© Daily Mail

Enjoy reading the Irish News?

Subscribe now to get full access