Asthma:

Are people with asthma more likely to experience severe complications and require ventilation?

So far, we do not have any evidence that asthma patients are having severe complications with COVID-19. In the UK, the first report of intensive care unit admitted patients was released in mid-March and of 196 patients, only three had severe underlying lung conditions. This is lower than we would expect and suggests that most of the people being admitted with severe complications are not currently patients with lung conditions.

Are people with asthma who have had COVID-19 recovering?

Yes. So far there have been very few cases of severe COVID-19 infections in people with asthma and those that have been infected are recovering.

I have asthma and use my preventer inhaler. I know this has steroids and I’ve been told that this can make COVID-19 symptoms worse. What should I do?

What you have been told is wrong. Patients with asthma should never stop taking their preventer inhaler unless asked to do so by a medical professional. Stopping your steroid inhaler could put you at higher risk of complications with COVID-19 due to making your asthma worse. There is currently no reason to think that steroids make COVID-19 worse and research from China suggests steroids may make COVID-19 less severe. A UK trial is currently testing whether steroids work as a treatment here.

Are patients who are using anti-IL5 treatments or similar, that reduce eosinophils, at higher risk? Should they stop or modify dosages?

Do not stop or modify any of your asthma medications because of concern about COVID-19. There is a risk that doing that could make your asthma control worse, causing you to need medical treatment or hospital admission.

Anti-IL-5 should have no effect on the risk of getting COVID-19, and keeping taking it could theoretically reduce the risk of an asthma attack if you were to contract the virus.

I work in healthcare and have to wear a facemask; I started experiencing asthma symptoms. Is there evidence that masks may trigger asthma symptoms?

There is no specific evidence that masks make asthma worse, but triggers for asthma symptoms are not always obvious and not always identified. If you think that something at work is making your asthma worse it may be appropriate to talk to your doctor or to the occupational health department for advice.

Bronchiectasis:

Is there anything specific I should know about COVID-19 and my condition?

People with bronchiectasis might be at higher risk of complications if they get the COVID-19, so here are a few suggestions to reduce your risk of getting the infection and the risk of complications if you do:

Avoid contact with anyone who is sick. Ask sick friends or relatives not to visit you and keep distance of at least 2 metres from anyone sick that you encounter in public.

Do not touch your mouth, nose or eyes with unwashed hands unless unavoidable.

Wash your hands thoroughly after touching surfaces that may be contaminated. Wash your hands with warm water and soap for 20 seconds.

Make sure you take all of your regular medications and keep up with your usual treatments to keep your lungs as healthy as possible.

Specifically for bronchiectasis, ensure you do your airway clearance exercises regularly- this clears mucus from the lungs and reduces the risk of a flare-up (exacerbation).

If you develop a fever and cough, but feel well, try to increase the frequency of your airway clearance and take paracetamol to reduce fever. If you become more unwell, seek medical advice. If you have a home supply of antibiotics, as many patients with bronchiectasis do, only take this if your sputum (phlegm) increases in amount or becomes discoloured. Antibiotics will not work against a virus, but would treat a bacterial infection.

I have bronchiectasis. Should I be self-isolating? And I am I more at risk of severe illness?

Bronchiectasis is a very diverse condition from severe to mild, and so it is not possible to give one recommendation that covers everyone.

People with bronchiectasis, if it is severe, meaning that you have frequent chest infections and/or take a long-term preventative antibiotics, should practice “shielding”, meaning staying indoors for the next 12 weeks.

Patients with mild bronchiectasis, where you have only a mild cough and do not suffer from frequent chest infections might be ok to socially distance, meaning that you stay at home as much as possible but can still go outside for essential shopping or exercise.

We do not know if bronchiectasis patients are more likely to have complications but I would recommend playing it safe.

Are people with bronchiectasis getting over COVID-19?

I am currently only aware of one patient with bronchiectasis who has had confirmed COVID-19 and they have recovered well, but none of the published studies has so far included people with bronchiectasis.

Cancer:

I have had cancer and was treated with chemotherapy and radiation; this was some time ago but am I still at a higher risk of COVID-19?

It is difficult to comment on a specific case. The vast majority of people, even if they acquired COVID-19 and even if they have underlying conditions will have a mild illness similar to a cold or the flu. Severe heart disease and lung disease have been associated with worse outcomes, particularly in patients that are over the age of 80 years. Cancer, when successfully treated, is not usually a risk factor for worse outcomes in respiratory infections like COVID-19.

Find more information about cancer and COVID-19 at www.womenagainstlungcancer.eu/emergenza-covid-19/#more

Chronic Obstructive Pulmonary Disease (COPD):

I have COPD, how will COVID-19 affect me?

We have learned that in about 50% of people who contract COVID-19, they experience no symptoms at all. Some people will experience a mild cold with running nose, sore muscles, fever and a cough. Others develop a more “flu-like” illness with worse fever, sore muscles and tiredness. In the most severe cases it causes a pneumonia with breathlessness and coughing in addition to the symptoms above.

Because COPD patients have lung problems to begin with, they may be more likely to experience breathlessness with COVID-19, and more likely therefore to need hospital treatment. Nevertheless, most people with COPD would experience no symptoms or just mild symptoms and make a full recovery.

What are the risks of COVID-19 for people with severe pulmonary emphysema?

Patients with severe COPD and emphysema are among those considered to be at higher risk of complications from COVID-19. This is because the lungs are affected by COVID-19, and if the lungs are already slightly damaged, they have less ability to fight the virus.

Cystic fibrosis:

Is there anything that I should not do as someone with cystic fibrosis?

Please follow guidance from your healthcare professionals and the local response to COVID-19.

We do not recommend self-isolation for all people with CF, but it may be appropriate to stay at home as much as possible.

Avoid places where there is likely to be an increased risk of exposure such as crowds - especially in poorly ventilated areas.

Currently there are no blanket recommendations about school attendance. This will depend on your local circumstances and individual advice from your local CF centre.

If you are employed, we recommend contacting your employer to consider what reasonable adjustments can be made to your working conditions to help protect you. Your local CF centre may be able to provide advice and support for this.

The information above was summarised from the Cystic fibrosis Trust. They are found here https://www.cysticfibrosis.org.uk/news/COVID-19-qa

UK CF Medical Association advise

Lung transplant:

I’ve had a lung transplant. Is there any specific advice that applies to me?

Your transplant team or specialist may already have a plan in place and if so you should follow their advice.

In general, if you develop symptoms that would be consistent with a viral infection it would be advisable to self-isolate at home and contact your local transplant team for advice. If you are unwell with problems such as difficult breathing you should seek medical attention urgently, as would be the case at any other time.

Pneumonia:

I am generally healthy, but have had pneumonia several times. Does this mean that I will be affected more severely?

No, previous infections do not increase the risk of more severe infections in future unless the previous infections were due to other diseases (such as severe heart or lung conditions, diabetes or conditions or drugs that suppress the immune system).

Tuberculosis:

I have TB; treatment is going well, but should I self-isolate?

You should follow the national guidelines in your country. In the UK this would mean social distancing, which is not the same as self-isolating. You should stay at home as much as possible, but you can go out once a day for shopping and/or exercise. You should stay away from anyone else who is not in your family (maintain a distance of at least 2 metres while you are out).

What about patients with TB on anti-TB treatment if they get infected with COVID-19? Is there any guidance of recommendation for treatment?

It is important to continue with your TB treatment even if you start to feel unwell. Keep taking your medications unless advised by a healthcare professional. TB should not have any effect on the severity of COVID-19 infection. Treatment of COVID-19 infection might be more complicated due to interaction between TB medications and other medications, so it is important you speak to a pharmacist or doctor before taking medication.

I had TB, I was treated and recovered, but have lasting damage to one of my lungs. Does this put me at a greater risk if I get COVID-19?

Possibly. Post-TB lung damage often puts you at a higher risk of picking up chest infections and so you might be at slightly higher risk of having a chest infection if you were infected with COVID-19. It is important to emphasise, however, that most people experience either a mild illness or no symptoms at all, even if you have underlying lung disease.

Alpha-1 Antitrypsin Deficiency

I have Alpha-1 Antitrypsin Deficiency; am I at high risk if I catch COVID-19?

Not necessarily. Patients with underlying lung conditions are at higher risk of complications if you have low lung function or severe breathlessness. If your alpha-1 antitrypsin deficiency has not caused COPD or significant emphysema there is probably no need to worry. Even if you have moderate or severe COPD, although you would be at higher risk of complications most patients are recovering well from COVID.

Do you recommend to patients receiving augmentation/replacement therapy for Alpha-1 Antitrypsin Deficiency that they should continue attending hospital to receive their treatment or is it better to go without for some weeks/months until the risk of infection diminishes?

You would have to discuss this with your doctor who will know whether your treatment is essential or could be delayed until infection rates start to decline where you are.

Pneumothorax (collapsed lung)

I have had pneumothorax; does this make me more at risk if I catch COVID-19? Am I more likely to get pneumonia?

Not unless you also have other underlying health conditions. Pneumothorax can occur in a completely healthy person, and in that case, you are not at any greater risk from coronavirus than anyone else. If your pneumothorax was a complication of COPD, cystic fibrosis or another lung condition, then it is the underlying lung condition that would put you at risk.

I have had pneumothorax; is my lung likely to collapse again if I get COVID-19?

There is no evidence that this is the case. Pneumothorax is a rare complication of viral infections and there is no evidence that previous pneumothorax would put you more at risk unless you have another underlying lung condition.

(Idiopathic) pulmonary fibrosis

I have (idiopathic) pulmonary fibrosis, am I more at risk if I get COVID-19?

Yes, the expert groups on idiopathic pulmonary fibrosis have said that the disease increases the risk of complications when patients develop COVID-19. Therefore, patients with idiopathic pulmonary fibrosis should make every effort to avoid infection. In some European countries, patients with IPF have been advised to “shield”, meaning not to leave the house for 12 weeks except in exceptional circumstances. Even though the risk is increased in patients with IPF, most IPF patients that develop COVID-19 will still have a mild infection and recover fully.

Other:

I currently have flu, should I be more worried?

If you have a confirmed influenza (flu) infection, then no, you don’t need to be more worried. Getting one virus does not make you more likely to get another infection.

I have pleural thickening, does this put me at a higher risk if I catch COVID-19?

No, pleural thickening would not affect the risk of catching COVID-19 and would not increase the risk of complications unless it is combined with other heart or lung conditions.

I have pleurisy, am I more vulnerable if I contact COVID-19?

No, unless the pleurisy is due to another underlying lung condition. The lung conditions that place you at greater risk are those that affect the airways or cause lower lung function, such as COPD, severe asthma, bronchiectasis, cystic fibrosis, pulmonary fibrosis or lung cancer.

I have had part of my lung removed – how will COVID-19 affect me?

If you are otherwise healthy, there is no reason to think that this would make COVID-19 infection more severe or more likely.

This information also applies to healthy people with smaller lungs caused for example, by scoliosis or kyphosis. It might cause some restriction of your lung volume and your risk would depend on how severe the restriction was, but in general you would not be at significantly increased risk of complications.

I have a pulmonary embolism, how will COVID-19 affect me?

Pulmonary embolism, if it has been treated with blood thinning medication and your oxygen levels are normal, would not be expected to have any effect on your risk of complications with COVID-19.

I am over 70 and have been diagnosed with Chronic Thromboembolic Disease and I am on lifelong Warfarin. What are the risks and should I remain in doors for 12 weeks?

The recommendations are different in different countries, but in the UK at the moment (for example) you would not be asked to remain indoors for 12 weeks. You would be asked to “Socially distance”, meaning:

Avoid contact with someone who is displaying symptoms of coronavirus (COVID-19). These symptoms include high temperature and/or new and continuous cough

Avoid non-essential use of public transport when possible

Work from home, where possible.

Avoid large and small gatherings in public spaces, noting that pubs, restaurants, leisure centres and similar venues are currently shut as infections spread easily in closed spaces where people gather together.

Avoid gatherings with friends and family. Keep in touch using remote technology such as phone, internet, and social media

Use telephone or online services to contact your GP or other essential services

Only those with severe underlying conditions such as immune problems, cancer or severe COPD, asthma and other lung conditions are being asked to stay indoors for 12 weeks. Chronic thromboembolic disease in not one of these conditions.

I have a chronic cough; am I at a higher risk if I catch COVID-19?

No, if you have a chronic cough that is not due to a severe lung condition like COPD or cystic fibrosis, you would not be considered to be at higher risk.

I have had VATS and pleurodesis, does this put me at a higher risk of severe illness?

No, VATS and pleurodesis treat the pleura - the lining of the lung. There is no evidence that COVID-19 affects the lining of the lung and so there is no reason to think this would make you more likely to get severe illness.

I have low IgM levels, what risks does this pose to myself and my family at this time?

Low levels of IgM, if they are not associated with low levels of IgG or IgA or another medical condition, would not be expected to greatly increase your risk of severe COVID-19 infection.

My mother was diagnosed with oesophageal palsy how might COVID-19 affect her? Is she at high risk?

It is hard to comment on individual cases, but this does not sound like a risk factor, in and of itself, for complications of COVID-19.

Is a punctured lung a high-risk condition?

No, not if the punctured lung has repaired itself , or has been repaired through treatment with a chest drain. You would not be at any higher risk of complications than the general population if your lungs are otherwise healthy.

I have primary ciliary dyskinesia syndrome (PCD), am I more at risk if I catch COVID-19?

Yes, we think that because primary ciliary dyskinesia makes it harder to clear the lungs, it could make COVID-19 more severe. For that reason, in many countries patients with PCD have been advised to stay in the house and pay extra special attention to hand hygiene, social distancing and avoiding visitors to the house.

I have more than 50% tracheal stenosis, am I more at risk if I catch COVID-19?

It is very difficult to comment on individual cases. You may be more at risk if this causes you to have frequent chest infections or to have lower lung function that normal. It is important to remember that even if you have a slighter higher risk, most people that catch COVID-19 recovery fully.

I have had whooping cough (pertussis), am I more at risk if I catch COVID-19?

No, not unless you have been left with permanent lung damage , such as bronchiectasis, as a result.

I have cysts in my lungs, am I more at risk if I catch COVID-19?

Probably not, unless the cysts in the lungs have caused a lower lung function or lower oxygen level than normal.

I have benign metastasizing leiomyomatosis, am I more at risk if I catch COVID-19?

This is quite a rare condition and so there will not be specific information about this condition and COVID-19. In general, we think that people are more at risk if they have very low lung function tests, get breathless easily (such as having to stop after walking 100 metres or less) or have frequent chest infections. If your condition is not causing these kinds of symptoms and signs, you are not likely to be at greatly increased risk.

I’ve had aspergillosis; am I at greater risk if I get COVID-19?

It depends on whether your aspergillosis is still active or not. If it has been successfully treated and you are feeling well you should be at no further risk. If you are very breathless, such as not being able to walk 100m without stopping, or have low lung function due to your aspergillosis, you would be at higher risk of complications. If this is the case, you should pay special attention to social distancing measures and may be advised to stay at home as much as possible.

I have left pulmonary agenesis; am I at greater risk if I get COVID-19?

It is difficult to comment without more information but it is quite likely. People with severe lung conditions are at higher risk such as patients that have low lung function and those who get breathless walking short distances such as 100m. You should discuss with your doctor whether you should be taking extra measures to protect yourself such as “shielding”.

Does a high IgE level increase my risk of COVID-19?

No, a high IgE level by itself would not increase your risk of COVID or complications if you get COVID-19. There is no evidence that IgE is involved in COVID-19.

I have a tracheostomy; am I at high risk if I catch COVID-19?

It is hard to say without further information but usually this would be a risk factor for breathing problems and therefore COVID-19 could be more complicated. In general, it is important to remember that most people who catch COVID-19, even if they have underlying conditions, experience just a mild flu like illness and recover fully.

Will people who have rhinitis and sinusitis be at risk of more severe COVID-19?

Probably not - we have not seen this come out as a risk factor in any of the analyses that have been conducted so far and there is not a strong reason to believe that this would be a risk factor either for catching COVID-19 or having a severe condition.

Neuroendocrine hyperplasia of infancy (NEHI) - does this increase risk of severe COVID-19?

This condition is too rare for there to be any reports of the risk in this condition. In general, children are at low risk of severe infection and, even the presence of underlying conditions, children seem to do very well with a low risk of severe disease.

Does having hypersensitivity pneumonitis put me at higher risk if I catch COVID-19

In general, patients with interstitial lung diseases such as hypersensitivity pneumonitis are thought to be at higher risk of complications from COVID19. It is not possible to comment on a specific case but hypersensitivity pneumonitis can be quite different for different people, from mild to very severe and the risk is likely to be highest in those with severe lung disease.