What should people with COPD and asthma do during the coronavirus outbreak?

COPD (Chronic Obstructive Pulmonary Disease) and asthma are lower respiratory tract diseases. COPD is common among smokers and is seen more often at older ages. Shortness of breath, cough, phlegm and wheezing are the most common symptoms and complaints in both COPD and asthma. Patients generally have poor lung function, which may sometimes be insufficient to raise blood oxygen levels.

COVID-19, the disease caused by the novel coronavirus, has a long incubation period (the time required to cause illness or produce symptoms). Therefore, viral pneumonia due to COVID-19 generally begins insidiously, and many of its signs and symptoms may be confused with COPD complaints. Coronavirus pneumonia, which may be recognized late, can also seriously impair lung function in a patient with COPD.

How should people with chronic lung disease protect themselves against COVID-19?

For people with chronic lung diseases such as COPD, asthma and bronchiectasis, there is no special additional method of protection against COVID-19 beyond the normally recommended precautions. However, it must be remembered that people diagnosed with COPD and asthma may develop bronchitis or pneumonia more easily, and that these respiratory tract infections may even be more severe in them. People with chronic lung disease therefore need to follow the generally recommended protective measures meticulously.

General recommendations for protection against COVID-19

• Hands should be washed regularly with soap for at least 20 seconds. If soap and water are unavailable, alcohol-based disinfectant solutions may be used.
• In all situations, touching the eyes, nose or mouth with unwashed hands should be avoided as much as possible.
• Close contact with people who have an infection should be avoided.
• People who are ill should stay at home as much as possible. When coughing or sneezing, they should cover their mouth and nose with a paper tissue if possible, then put the tissue in a waste bin. If a paper tissue is unavailable, covering the mouth and nose with the inside of the arms is recommended (the aim is to keep the hands relatively clean and prevent the virus from spreading through hand contact). Wearing a mask when ill also reduces virus dispersal and transmission.
• Regular cleaning of surfaces touched by an ill person is recommended. Disinfectants used to clean these surfaces, such as chlorhexidine and biguanides, may trigger narrowing of the bronchi in some people with asthma. People with asthma should therefore avoid using such substances as surface cleaners.

There are 2 main routes of transmission for the novel coronavirus:

1. Touching something that has the virus on it,
2. Transmission through coughing or sneezing

However, a 3rd route of transmission can also be mentioned: microparticles / microdroplets remaining suspended in the environment!.. The short documentary below shows why the risk of spreading the virus is higher in small, enclosed spaces.

On the other hand, for people with COPD and asthma, wearing a medical mask for protection may make respiratory distress and feelings of breathlessness more pronounced. In addition, mask use for protection is not generally recommended for people with COPD. Therefore, avoiding enclosed, crowded environments as much as possible, so that wearing a mask is unnecessary, will help protect against the outbreak.

It is particularly important to prevent sudden worsening (acute exacerbations) of COPD and asthma in an area where the outbreak is ongoing. At present, winter and spring are seasons when COPD exacerbations occur. During the outbreak, novel coronavirus pneumonia and acute exacerbations in people with COPD may easily be confused.

Acute COPD exacerbations can generally be prevented through smoking cessation, flu and pneumococcal vaccination, and the use of respiratory medications. Long-acting airway-opening treatments (bronchodilators and inhaled glucocorticoids/steroids) are most commonly used in COPD.

Regular use of medications and adherence to precautions may reduce acute COPD exacerbations and the length of hospital stays. Maintenance (ongoing) treatment for people with COPD is therefore particularly important during the novel coronavirus outbreak.

What to do when a person with COPD has an acute exacerbation during the pandemic

• People whose fever shows no sign of subsiding within 48 hours or who have respiratory distress (shortness of breath) need to seek care promptly at a healthcare facility
• Make sure you take personal protective measures at the facility where you receive medical help
• Give healthcare professionals detailed information about people with whom you have been in contact, including during your most recent travel
• People with COPD who have suspected or confirmed COVID-19 must either be quarantined or monitored in hospital
• To attempt treatment at home and avoid outpatient care, the person's own nebulizer should be used at home when needed.

COVID-19 Guidelines for People with COPD

People with COPD may be among those most severely affected by COVID-19. To minimize lung infection in people with COPD due to the pandemic, GOLD (the global initiative for COPD), which works with the World Health Organization, has published guidance:

• To minimize the likelihood of people with COPD contracting this infection, we recommend that they follow their country's advice on preventing infection and on when and how to seek help if symptoms of this infection begin.
• There is no scientific evidence that people with COPD should avoid using inhaled (or oral) corticosteroids during the COVID-19 pandemic.
• People with COPD should take their regular daily treatments.
• Standard recommendations for oxygen therapy should be followed.
• When new information becomes available, please continue to follow the recommendations of the health authority in your own country.
• For more information, go to the World Health Organization website.

The best thing people with chronic lung disease can do during the COVID-19 Pandemic is to protect themselves meticulously against the virus. It is important for people who smoke or use tobacco to stop as soon as possible. They should continue their regular medications and avoid preventive drugs and food supplements.

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