Clinical update

COVID-19 and severe asthma: what to advise patients

NICE guidance on managing severe asthma in adults and children during the pandemic
Asthma management during COVID-19 pandemic

NICE has produced guidance on managing severe asthma in adults and children during the pandemic

People with severe asthma are on the government's list of people who are extremely vulnerable
to severe illness with COVID-19  Picture: iStock

Essential information

Severe asthma is defined as requiring treatment with high-dose inhaled corticosteroids plus a second controller (and/or systemic corticosteroids) to prevent it from becoming uncontrolled, or which remains uncontrolled despite this.

People with severe asthma are on the government’s list of those who are extremely vulnerable to becoming severely unwell with COVID-19. 

About 200,000 people in the UK have severe asthma, according to Asthma UK.

What guidance is available?

Guidance on managing the care of adults and children with severe asthma during the pandemic was published by the National Institute for Health and Care Excellence (NICE) in April 2020.

The guidance emphasises encouraging patients to continue with their regular treatment to reduce the risk of their condition worsening, and checking action plans are up to date.

Nurses should be aware of the anxiety that COVID-19 is likely to cause for people with asthma and signpost them to sources of support for mental well-being.

Patients with severe asthma who have received a letter from the government warning them they are extremely vulnerable should be advised to follow shielding advice, NICE says.

View our COVID-19 resources centre

Clinicians should carry out bronchoscopy and most pulmonary function tests only for urgent cases and if the results will have a direct effect on patient care, because these tests have the potential to spread COVID‑19.

Nurses should advise patients to stick to infection prevention control actions, including washing their hands and cleaning equipment such as face masks, mouth pieces, spacers and peak flow meters regularly using a detergent, for example washing-up liquid.

Patients can continue to use their nebuliser as the aerosol comes from the fluid in the nebuliser chamber and will not carry virus particles.

Clinics should be adapted as much as possible to reduce risk, with face-to-face appointments avoided if possible, time in waiting rooms kept to a minimum, and people asked to bring no more than one person with them.

Patients shouldn’t be prescribed more than 30 days of asthma treatment. Prescribing larger quantities of asthma medicines puts the supply chain at risk, NICE says.

[CROSSHEAD] What is the guidance on COVID-19 vaccines for people with severe asthma?

A priority list for the COVID-19 vaccination programme was drawn by the Joint Committee on Vaccination and Immunisation (JCVI), which advises UK health departments on immunisation.

People classed as being extremely clinically vulnerable, which includes those with severe asthma, are in priority group 4.

The UK government set - and met - a target for people in the top four priority groups should to offered a first dose of a COVID-19 vaccine by 15 Feburary 2021.

Many people with severe asthma take biologics (known as mAbs, or monoclonal antibodies) alongside their usual asthma medicines. 

According to Asthma UK, there is no evidence to suggest that either the Pfizer/BionNTech or the Oxford/AstraZeneca COVID-19 vaccine is unsafe for people who take biologics.

However, patients are advised not to receive their COVID-19 vaccine and biologic on the same day and, if possible, leave 7 days between getting the COVID-19 vaccine and their asthma biologic.

Asthma UK advises these decisions should be made by a patient's specialist and that it is important a patient does not stop taking or change any of their medication without consulting them first.


Expert comment

Jane Scullion, respiratory nurse consultant, University Hospitals of Leicester NHS Trust:

‘The NICE guidance helps put the current thinking about managing severe asthma into practice and explains the key issues that nurses need to consider so that safe and effective care can be provided. 

‘During the COVID-19 pandemic, identifying people with severe asthma so they receive appropriate care, and helping patients manage anxiety are key areas for us to think about, especially when our usual contact with patients has changed. 

‘Life has changed considerably for people with asthma. Often classed as vulnerable unless their asthma is well controlled, they face isolation, reduced support from healthcare professionals, as well as the mental strain of coping with daily life during a pandemic.

‘But we have also seen fewer acute exacerbations as social contact has diminished and pollution levels have dropped considerably and, anecdotally, there seems to be an increase in adherence to therapies and action plans.’


Key points for nurses

  • Communicate with patients, their families and carers, and support their mental well-being. Signpost to charities such as the British Thoracic Society, Asthma UK and the British Lung Foundation to help alleviate any anxiety and fear.
  • On the day of a face-to-face appointment, screen patients by telephone to check that they have not developed COVID‑19 symptoms.
  • Tell all patients, or their parent or carer, to continue taking their regular medicines in line with their personalised asthma action plan. This includes those with COVID‑19, or with suspected symptoms. It is important that patients make sure their asthma is as stable as possible.
  • Ensure patients' action plans are up to date.
  • Tell patients that they should continue biological therapies for asthma because there is no evidence that they suppress immunity.
  • If the patient usually attends hospital to have biological treatments, consider whether they can be trained to self-administer, or if they could be treated at a community clinic or at home.
  • Tell patients not to share their inhalers and devices with anyone else.

Find out more

Erin Dean is a freelance health journalist



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