When the new coronavirus first took over the world last year, some medical experts suggested that people with asthma may be at higher risk of getting very sick. At the time, COVID-19 was thought to be primarily an upper respiratory infection. Since asthma is a disease that makes it harder to move air in and out of your lungs, it didn’t seem like a big leap. Plus, an early report from the Centers for Disease Control and Prevention (CDC) mentioned asthma as an underlying condition in hospitalized 18- to 49-year-olds.

But fortunately, much of the evidence over the past year has not supported that theory. Now the largest study review published to date provides even more reassurance.

Researchers from the University of Tennessee Medical Center reviewed 150 studies that included about 1 million people with confirmed COVID-19 infections in 30 countries. They found that having asthma did not increase the risk of severe COVID-19 infection. It also doesn’t increase your chances of being hospitalized or dying from the virus, according to the report, which was published in the American Journal of Respiratory and Critical Care Medicine. In fact, the results suggest a slightly decreased risk of death from COVID-19.

“A lot of viruses can exacerbate asthma, and the common cold is the main culprit,” says Rajiv Dhand, M.D., a pulmonologist and chair of internal medicine at the University of Tennessee Graduate School of Medicine in Knoxville. He is also the study’s lead author. “However, the inhaled corticosteroids used by asthma patients seem to be offering some protection. We don’t fully understand how. It’s possible that these medications inhibit the entry of the virus into cells. The immune response in patients with asthma may also counter the inflammation induced by COVID-19.”

That’s good news to be sure, but it does come with a caveat: Asthma needs to be well controlled to reap these benefits. And for more than 60% of people with asthma, that is not the case, according to the CDC.

“Medication compliance is often an issue,” notes Dr. Dhand. “This is especially true if they’re feeling well. They may not think they need their medication if they’re not experiencing symptoms.” (Find out if it’s time to switch up your asthma treatment plan.)

At a minimum, people with moderate-to- severe asthma need to use an inhaled corticosteroid daily to prevent airway inflammation. They need to have a short-acting rescue inhaler on hand, too. This medication relaxes the muscle spasms around the airway that occur during an asthma episode.

Some people with asthma benefit by adding a long-acting bronchodilator to the inhaled corticosteroid. This medication also relaxes the airway muscles. Others may also need allergy shots to suppress their allergic response, or they might need a short-term oral steroid, such as prednisone, to help control their asthma.

Red flags that your asthma may not be under control include:

  • Needing to use your rescue inhaler more than twice a week
  • Coughing and wheezing more during the day
  • Waking up at night with symptoms
  • Being unable to maintain your usual exercise routine
  • Regularly seeing peak flow meter readings below 80%
  • Often feeling short of breath
  • Constantly feeling chest tightness
  • Needing to take a breath while speaking
  • Missing school or work due to symptoms

If you are experiencing any of the above symptoms, it’s time to get to an allergist or pulmonologist who can work with you to tweak your asthma action plan. Now more than ever, people with asthma need to be extra vigilant about using their medications to control it.

Keep in mind that this news is not permission to drop your COVID-19 defenses. You still need to mask up, practice social distancing and get a COVID-19 vaccine as soon as it’s available to you. “If you have asthma and develop COVID-19 symptoms, don’t try to tough it out,” says Dr. Dhand. “Seek medical advice quickly, because one thing we know for sure is that this disease can be quite unpredictable.”

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