New Clinical Recommendations For COVID-19 In Severe Asthma emphasise the importance of maintaining usual asthma therapy including monoclonal antibodies and oral corticosteroids when indicated.

The consensus document, from the Centre of Excellence in Severe Asthma in Newcastle, said there was no evidence to suggest that asthma or MAB therapy constituted an increased risk for acquiring COVID-19 or for more severe COVID-19 disease.

However they did recommend transfer of MAB administration from hospital and into the community – either via a GP, a nurse visit where supported by the pharmaceutical company or self-administration for the drugs with autoinjectors.

Professor Vanessa McDonald, a member of the writing team, told the limbic the transition process to community administration of MABs appeared to be relatively smooth for most patients.

“Pre-COVID we were increasingly getting people into the community to have their MABs administered and as part of the Centre of Excellence for Severe Asthma we also have previously published some recommendations about administration in primary care.”

During COVID-19, the approach was best supported by telehealth assessments.

Some of the other recommendations for people with severe asthma during COVID-19 included:

• self-isolation and physical distancing
• flu and pneumococcal vaccinations
• advice not to share inhalers – even amongst people living in the same households
• continuation of CPAP and NIV but with extra infection control measures
• avoiding the use of aerosol-generating nebulisers and sputum induction.

“The proportion of people who need nebulisers would be low, for example people who can’t use inhalers due to issues with cognition or dexterity, but certainly that is something we don’t recommend in usual practice and in the era of COVID, it’s an extra important recommendation,” Professor McDonald said.

She added that COVID-19 had no doubt exacerbated some of the usual stress and anxiety experienced by patients with severe asthma.

“It’s interesting that the data doesn’t suggest there is an increased risk of COVID-19 if you had asthma and yet that hoarding of pharmacotherapies was quite detrimental to people in terms of fear and anxiety around whether or not they could access their treatments.”

“Again, there was increased anxiety and fear about whether they should take their oral corticosteroids when there is no evidence to suggest that people who require oral corticosteroids should withhold them. We recommend that people continue to take their treatment as prescribed.”