By: Sylvia Owusu-Ansah MD, MPH, FAAP & Franziska Rosser MD, MPH, FAAP
Many parents wonder if
COVID-19, which often affects the lungs, brings extra concerns if their child has asthma. Here are some common questions and ways to help keep children with asthma healthy during the pandemic.
Does having asthma put my child at higher risk of getting sick from COVID-19?
There is still a lot we don't know yet about COVID-19. What we are seeing is that people with chronic health conditions appear to have higher risk of more severe illness if they get COVID-19. It is not clear whether this is the case for asthma.
How important is it that my child's asthma is well controlled during this COVID-19 pandemic?
It is always important to have well controlled asthma. In the current COVID-19 pandemic it is especially important. We want to prevent children from needing emergency department care when possible. Having uncontrolled asthma is a risk factor for asthma attacks, so control is the goal. However, if your child is having an asthma emergency, don't delay seeking immediate medical care. Hospitals and urgent care clinics are still open and taking extra steps to keep patients and health care workers safe.
How do I know if my child's asthma is well-controlled?
If you're not sure your child's asthma is well controlled, call your pediatrician or other asthma care provider. Well controlled asthma usually means your child is:
coughing on no more than 2 days per week
waking up during the night from coughing no more than once per month (or no more than 2 nighttime awakenings for children 12 years and older)
needing 2 or less rescue treatments per week (this does not include pre-treating before exercise)
having no more than 1 course of oral steroids such as prednisone in the last 12 months
able to fully participate in regular activity without breathing limitations
This would be a good time to review your child's asthma control and management plan with your doctor. Many providers can check on your child's asthma and make changes to
asthma action plans or medications by telephone or telemedicine visits. Your pediatrician and other asthma providers want to know about your child's asthma concerns, so don't be shy about contacting them!
What if my child has an asthma attack during the pandemic?
For children with asthma, we recommend that parents and other caregivers make sure to have an asthma action plan. An asthma action plan will tell you what to do every day for asthma care and what to do if your child has asthma symptoms. It is important to manage asthma attacks in the same way as usual during the pandemic. Don't worry about using oral steroids, for example, if that is part of your child's action plan. This will not increase COVID-19 risks and illness. Make sure you tell your child's doctor about any questions concerns you have about your child's asthma medicine or action plan.
When should I seek emergency care for my child with asthma?
Go to the emergency room immediately or call 911 if your child is having symptoms that include:
can't catch their breath, speak in full sentences (if developmentally appropriate), or walk because of breathing difficulties
movement of the muscles in between the ribs, abdomen (sometimes called belly breathing) and/or in the neck
turning a bluish or grayish color around their mouth or fingernails,
making grunting noises, head bobbing, not responding to albuterol treatments
feeling drowsy or confused
Your child's emergency action plan can provide more details about when to seek immediate or emergency care.
Some children may not require emergency care, but need a change in treatment plan or closer monitoring. Call your pediatriciain or asthma care provider if your child is having any of the following symptoms:
increased coughing; chest pain, back pain
decreased ability to do usual activities
symptoms not responding to albuterol (but otherwise not in distress)
needing albuterol treatments more frequently than every 4 hours (but otherwise not in distress)
not getting better after 2-3 days of increasing albuterol
With COVID-19, what is the best form of asthma medication to give--an inhaler or nebulizer treatment?
Another important part of asthma care and control is knowing how to best take asthma medications. Now is a great time for anyone with asthma to review how to make sure they are using their medications correctly.
Using a nebulizer for albuterol treatments may increase the amount of virus in the air if the person has COVID-19. This could potentially spread the virus to others more easily, since the virus may stay in air droplets for up to several hours. It's important for people with asthma to talk with their health care providers about what delivery method is best for them.
Shortages of albuterol inhalers have been reported in some areas, and some insurances have not covered spacers. Best practices are probably going to be different based on location and a person's individual needs. Ask your pediatrician or asthma care provider what they recommend for your child.
How can I help prevent my child from having an asthma attacks during the pandemic?
Help your child follow their asthma management plan and take their
controller medications as prescribed. Know when to step up care and when to call your pediatrician or asthma care provider. In addition, there are other steps you can take:
Go smoke-free. People with asthma should avoid asthma triggers such as tobacco smoke. If a parent or caregiver
smokes or vapes, it is important to do it outside. Smoking in another room does not prevent the smoke from traveling. The 1-800-QUITNOW is a free nationwide number that helps people stop smoking. Many states provide free supplies such as nicotine replacement patches. Now is a great time to try quitting!
Avoid allergy triggers. Try to reduce exposure to known allergy
triggers, which can also aggravate asthma. For example, if a child with asthma is allergic to tree pollen, you might want to keep windows closed to reduce exposure. Cleaning is important to help reduce allergens, along with COVID-19 germs, but can be tricky for parents of children with asthma. If your child is sensitive to certain cleaning products, using them when your child is not in the room, turn on a fan, open a window, or try switching to less irritating products.
Reduce stress. Stress can be another trigger for asthma, and these are certainly stressful times. Take time to relax as a family, and use
positive parenting tips to help your child cope and build
resilience. Taking a walk
outside (still staying physically distanced) and keeping active can help to reduce stress.
What other precautions can families take who have children with asthma during the COVID-19 pandemic?
People with asthma should take extra care of their overall health. This includes physical distancing from people outside their households, isolating from people with symptoms, and avoiding asthma triggers. It's a good idea for people with asthma to make sure they have asthma medicines at home and to call for refills when the inhaler is getting close to empty. Many pharmacies will deliver medicine through the mail at no extra charge.
Having a plan and communicating with your asthma provider can give you more information--and less reason to panic--during these stressful times. We can all agree that preparation beats panic every time when it comes to keeping loved ones safe and healthy!
About Dr. Owusu-Ansah
Sylvia Owusu-Ansah, MD, MPH, FAAP, is a member of the American Academy of Pediatrics (AAP) Section on Emergency Medicine. She is an Assistant Professor of Pediatrics, University of Pittsburgh School of Medicine Department of Emergency Medicine. She also serves as EMS/ Prehospital Director for the UPMC Children's Hospital of Pittsburgh.
About Dr. Rosser
Franziska Rosser MD, MPH, FAAP, is an Assistant Professor of Pediatrics, Division of Pulmonary Medicine at the University of Pittsburgh School of Medicine and UPMC Children's Hospital of Pittsburgh. She is a member of AAP's Section on Tobacco Control.