Biologic Treatment Considerations for Asthma During the COVID-19 Pandemic and the Upcoming Flu Season - Episode 13
Stanley Goldstein, MD: In addressing some of those points about biologics, should you stop biologics? You mentioned, Shahzad, that they’re not immunosuppressive. Should you start a biologic during the COVID coronavirus period? In my own patient population, I say why not? If you want to get in better control, sure. As you mentioned, they’re not immunosuppressives, so there’s no reason to stop it. But during the COVID coronavirus period of time when I think our offices were closed, we weren’t seeing patients, we were only seeing them by telehealth, it was very important to educate these patients that they should continue their biologic, because what you don’t want to do is really result in an exacerbation and decrease in lung function, and then if they would get COVIDcoronavirus, I think they would be at higher risk of having problems.
But what are you seeing in your offices now, when you think about the workplace? Patients coming in saying my asthma is worse, I need a letter for my workplace to say that I have compromised lung function and a risk if I develop COVID coronavirus that I’ll have worse disease. What do you tell your patients? How do you decide what to do and whether you provide them a note or not a note? It’s a difficult situation, butsituation but tell me what your thoughts are about that.
Shahzad Mustafa, MD: Yeah, I can share my approach, and I do think there may be some various approaches depending on where you are in the country and what things look like locally for your COVID coronavirus rates. But generally, I do try to reassure my patients as the three of us have discussed….. the three of us, that asthma, especially well-controlled asthma, does not appear to be a risk for acquiring COVID coronavirus or COVIDcoronavirus-related complications. I think that’s important to tell people, to reassure people, because often people are nervous. From what you know, and again, Stan, you said the studies, that the science is changing quickly, but we know what we know. In asthmaAs of right now right now, I try to reassure them. With that being said, and as was touched by Dr. Mosnaim, a lot of the symptoms of allergies, upper airway symptoms, common colds overlap, but this is no time to be coughing in the workplace and sniffling. It raises eyebrows. So controlling Controlling the asthma is so important.
And thenThen for individuals who are concerned, we really do try to focus on even more adherence to wearing a masks and social distancing and hand hygiene. In my opinion, the vast majority of my asthmatics can go on with their regular occupations. A vast majority of my asthmatics can attend school, and that’s how I try to approach it, by maximizing in best controlling their asthma. I think it’s a very small percentage of individuals for outstanding circumstances or their specific occupation, that we may want to revisit that. But that’s been my general approach— reassurance, maximizing asthma care, excellent counseling because I do think from what we’re seeing in the community, at least here locally, again it may depend on your local COVID coronavirus rates, but it’s going fairly well.
I will say, I will chime in and say masks should not be exacerbating an individual’s asthma. Masks are safe to wear when you have chronic respiratory illness. They take getting used to, they’re uncomfortable. I don’t have asthma and they make me uncomfortable. Gyms in New York are requiring you to work out and exercise while wearing a mask. So thereThere is certainly getting used to it. But I do not think, and my opinion, again I’d love to hear you guys chime in, is I do not think having asthma or respiratory disease is a reason not to wear a mask. I actually can’t think of any real medical condition that should preclude you from wearing a mask. For many individuals with medical conditions, it’s even more important to wear a mask to protect yourself and the community around you. So that’sThat’s my approach with my patients.
Stanley Goldstein, MD: IJust want to chime in, I completely agree what you’re saying, Shahzad. But some other added points. First of all, in children, talk to pediatricians, they’ve seen less respiratory problems from children as far as viruses that turn on asthma, rhinovirus, for instance, so, therefore, less asthma. Why are they seeing less respiratory problems? Because the kids are not mixing with other kids, they’re not in school, they haven’t been in school. Now they are back in school, but up until this point in time, up until Labor Day this year, they weren’t in school. T So they had really very little respiratory infections. If they’re wearing masks in school, also a decrease in respiratory infections. That’s also helping keep patients who have asthma under better control. Besides taking their medications, they are also having less actual exposure to these viral infections.
Transcript Edited for Clarity