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Have a Condition That Can Affect Breathing? What You Need to Know About COVID-19.

April 03, 2020
by Julie Parry

For those who suffer from chronic pulmonary diseases, such as asthma, chronic obstructive pulmonary disease (COPD), or interstitial lung diseases (ILD), the news around the COVID-19 pandemic can be scary. But don’t fret. Experts at Yale School of Medicine (YSM) have guidance on how to protect against the virus.

To limit your risk of becoming infected with COVID-19, “It is important to be strict with your hand washing, and avoid contact with others,” said Charles Dela Cruz, MD, PhD, associate professor of medicine (pulmonary, critical care and sleep medicine) and director of Yale’s Center for Pulmonary Infection Research and Treatment. “Distance yourself from other people because someone could look healthy, but they might be carrying the virus.”

“We know that some patients are at a greater risk,” explained Naftali Kaminski, MD, Boehringer-Ingelheim Endowed Professor of Internal Medicine and chief of pulmonary, critical care, and sleep medicine. “The good thing is that once you recognize the risk, you can take steps to protect yourself.”

Asthma, COPD and Allergies

Allergy season is rapidly approaching, and while many people may start coughing and sneezing, it is important to remember the differences between COVID-19 symptoms, and those of an allergy sufferer, or someone with asthma or COPD.

“The thing to remember is that COVID-19 has a very particular clinical profile: fever, sometimes a high grade one, and a dry cough. Some have reported a loss of taste or smell,” said Christina Price, MD, assistant professor of medicine (immunology) and chief of allergy & immunology at the CT VA Healthcare System. “So if you're congested, you would have some of those similar symptoms if you have allergies, but if you had those symptoms without your regular itchy eyes, watery nose, congestion, then that would be of concern.”

Remember that allergies can exacerbate existing lung conditions. Price admits there is symptom overlap, but reminds patients that they know themselves best. “Where it's difficult is when people have asthma, because there's a component of shortness of breath and chest tightness too. One of the clinical pearls we tell people all the time is that you know yourself the best. If you typically feel a certain way in the springtime, or when you have allergy-related asthma exacerbation, that is probably what you have. If you have unusual symptoms, or something outside of the norm, that's when people should be concerned.”

Patients with a pulse oximeter or spirometer at home can monitor their breathing and lung function.

“If you have an exacerbation of your asthma or COPD and are not feeling well, call your physician or your primary care physician,” said Geoffrey Chupp, MD, professor of medicine (pulmonary, critical care and sleep medicine) and director of Yale’s Center for Asthma and Airways Disease. “The capacity for Telehealth visits is increasing and your doctor can determine if treatment is necessary. Most important is to continue taking your inhaled medications to prevent exacerbations, there is no risk these medications increase your risk of getting COVID-19.”

ILD such as Idiopathic Pulmonary Fibrosis (IPF) or Pneumonitis

Danielle Antin-Ozerkis, MD, associate professor (pulmonary, critical care and sleep medicine) and medical director of the Yale Interstitial Lung Disease Center of Excellence acknowledges that we are going through a challenging time.

“People with interstitial lung disease and pulmonary fibrosis are considered to be in a higher risk group for serious infection, said Antin-Ozerkis. “Follow the Center for Disease Control’s guidance on personal hygiene including frequent hand washing, covering coughs, wiping and disinfecting high-touch surfaces. Stay at home as much as possible and avoid crowds. It is not the time for travel or visitors to your home. If you need to see your doctor, many programs including ours are offering telemedicine visits.”

Kaminski wants to assure patients that IPF research will continue. “Although much research is stopped right now, the work into IPF and other ILD’s will not go away,” he said. “I feel that since COVID-19 is a pulmonary disease, research into pulmonary diseases will only increase.”

Cystic Fibrosis

Individuals with cystic fibrosis (CF) may have decreased lung function, which would put them at potentially greater risk if they contract COVID-19.

“From a preparedness perspective, individuals with CF are ready,” explained Jon Koff, MD, associate professor (pulmonary, critical care and sleep medicine) and director of Yale’s Adult Cystic Fibrosis Program. “CF patients understand staying six feet away and self-isolation. They often wear masks for personal protection too, and may use airway clearance therapies to help clear their lungs. All these steps will help them avoid viral infection.”

Providers at the Adult Cystic Fibrosis Program are contacting patients via Telehealth, phone calls, and a newsletter with information on how to stay healthy. In addition, Koff and the Adult CF Team are working on starting a virtual support group so that patients can share their experiences, and ask additional questions.

“I want to let patients know to keep doing what you are doing,” said Koff. “In addition to hand hygiene, using airway clearance therapies aggressively specific for your disease may help.”


While it is important for everyone to avoid catching an infection, people with these conditions may want to take extra precautions to stay healthy.

Dela Cruz suggests asking family or friends to complete tasks for you, like getting groceries.

“It is important to distance yourself from others during this time, especially for people with chronic lung diseases,” he explained. “We know that people with lung conditions are already at some disadvantage based on their lung function. They could also be more susceptible to these kind of infections, and if they get COVID-19, the severity could be worse.”

But if you were to develop symptoms of infection such as fever, new cough or shortness of breath beyond what is typical, they all advise to call first before rushing to the emergency room or doctor’s office. “Be aware of your symptoms and contact your doctor or the local hospital’s hotline,” said Dela Cruz.

While all this advice is important to preserve your physical health, don’t neglect your mental health.

“To manage stress, use an app such as Calm or Headspace, for guided meditation. If it is sunny outside, going for a short walk is good for your well-being. And make sure you are taking your medications for your chronic conditions,” said Kaminski.

Antin-Ozerkis echoes this sentiment. “Use FaceTime, Zoom and other video services to connect with others. Try to avoid too much news and social media. Stay optimistic and know that we will all get through this together.”

 

The Department of Internal Medicine is the largest department within the Yale School of Medicine and one of the nation's premier departments, bringing together an elite cadre of clinicians, investigators, and educators in one of the world's top medical schools. To learn more, visit Internal Medicine.

 

Submitted by Julie Parry on April 03, 2020