As Covid-19 continues to spread around the world, there are concerns that patients with asthma will be at higher risk or poorer outcomes. There is also concern about whether asthma treatments could worsen the risk of disease or severity.
Currently, asthma is not in the top 10 comorbidities associated with Covid-19 fatalities, obesity, diabetes and chronic heart disease are the most common.
There are questions of concern that relate to the effects that asthma medications may have on Covid infections. Inhaled steroids are the mainstay of treatment of persistent asthma and oral steroids are given during acute exacerbations.
Both the American College of Allergy, Asthma and Immunology and the American Academy of Allergy, Asthma and Immunology recommend that patients continue to use their maintenance asthma medications even during the pandemic. Continuation of therapy even with potential exposure to COVID-19 is extremely important because poorly controlled asthma is always the greatest risk factor for exacerbations with any viral illness.
With regard to biologics approved for asthma treatment on the risk of COVID-19, effects may differ.
Xolair (omalizumab), blocks an IgE antibody. Nucala (mepolizumab) and Cinqair (reslizumab) blocks Interleukin-5. Fasenra (benralizumab) blocks the IL-5 receptor and Dupixent (dupilumab) blocks the IL-4 receptor alpha, a receptor shared by IL-4 and IL-13. They all reduce asthma-related exacerbations and have been approved for the treatment of severe asthma. Approximately 80% of asthma exacerbations are related to viral infections. It is likely that these biologics will lessen the risk of severe asthma exacerbations with COVID-19, at least by reducing baseline airway inflammation and possibly through specific antiviral properties.
With the knowledge of how the currently approved biologics work, it does not seem that these medications would interfere adversely with any of the pathways or worsen an individual’s immune response to COVID-19. It is actually plausible that these biologics, by limiting Th2 skewing, may make the immune system better poised to clear SARS-CoV-2.
In conclusion, the currently approved biologic medications for severe asthma (Xolair, Nucala, Fasenra, Cinqair and Dupixent) do not increase the risk of disease or worse outcomes. On the contrary they lead to improvement of airway allergic and eosinophilic inflammation and bronchial responsiveness which could be advantageous in patients with asthma who are already taking these medications before contracting COVID-19.