Colder temperatures have always been problematic for people with chronic lung diseases, and this fall and winter promises to be no exception, as a new mix of COVID-19 variants hits Canada. Currently Omicron and its sub-lineages are the primary variants circulating throughout the country. Given that they are highly transmissible, rapidly spreading from person to person, what does this mean for people with respiratory conditions?
Impaired lung clearance
Omicron is milder than Alpha and Delta, earlier versions of the virus. Unlike these variants, Omicron manifests itself primarily in the upper respiratory tract: the nose, throat and trachea. Mucociliary clearance (MCC) is one of the most critical defenses of the upper airways, trapping potentially dangerous pathogens and keeping them from entering the lungs. As a result, evidence suggests that Omicron does much less damage to the lungs, versus the previous variants which would often cause scarring and serious breathing difficulties.
Having an underlying respiratory condition, however, can damage the mucociliary clearance of the upper airways. So, individuals with these issues may be at increased risk of developing infection in the lower airways. Compounding the problem is that many people with respiratory illnesses have other comorbidities as well. For example, an individual with Chronic Obstructive Pulmonary Disease (COPD) may also have cardiovascular disease and diabetes, increasing the likelihood of having a severe outcome requiring hospitalization and/or ventilation.
Going from reactive to proactive care
During the stringent lockdowns, many people were unable to see their family doctor. Consequently, their conditions haven’t been well managed over the past couple of years. As healthcare starts to shift from very reactive care during the first waves of the pandemic to the start of more proactive care, a big priority for healthcare providers is getting people’s respiratory conditions under control. Let’s look at the most common conditions.
COPD, a progressive lung disease, is characterized by low grade lung inflammation and airway obstruction. While there is no clear evidence that COPD increases one’s susceptibility to COVID-19, it can be a risk factor for more severe illness requiring hospital admission.
Differentiating between COPD and COVID-19 can be difficult as they both share similar symptoms of cough and dyspnea. That is why testing is so important. If the individual develops COVID-19, the Canadian Thoracic Society (CTA) recommends continuing maintenance therapy and intensifying it as needed. Maintenance inhaled therapies have been shown to improve lung function and decrease the risk of future exacerbations precipitated by viral infections. This includes long-acting bronchodilators (LAMA and/or LABA) and if indicated then ICS/LABA combination inhalers. Although there have been concerns, there is no current evidence that inhaled corticosteroids increase the risk of getting COVID-19.
Asthma is an inflammatory condition in which the airways swell and narrow, causing hypersensitive airways that are sensitive to allergens. Although getting COVID-19 doesn’t appear to be an increased risk for people with asthma, developing an infection can trigger asthma exacerbations.
The CTA recommends that people with asthma continue to use their inhaled corticosteroids to improve their asthma control. If their asthma worsens, they will need to step up their therapy. As with COPD, there are concerns that prednisone may prolong viral replication, although evidence is inconclusive. Following the conclusions of a Chinese study which weighed the benefits and harms of using corticosteroids, the CTA recommends that they be used prudently and on a short term basis in the following: critically ill patients with 2019-nCoV pneumonia and patients with hypoxemia who regularly use corticosteroids.
When it comes to drug delivery devices, it is recommended that nebulizers be replaced with
spacing devices or dry powder inside healthcare facilities and nursing homes to reduce the risk of aerosol spread of virus particles. People already using nebulizers for home therapy should continue to do so until they can talk to their healthcare provider about an alternative method.
Respiratory medications won’t work if they don’t get into the lungs
It’s a well-known fact that many people do poorly with respiratory conditions because of medication non-adherence. A major reason is that they don’t know how to use their inhalers properly, so they tend not to use them. Healthcare providers, particularly pharmacists have an important role to play in helping people learn correct inhaler techniques through either virtual or in-person visits. This would also be an opportune time to discuss developing an action plan for preventing or managing a COVID-19 infection.
Ultimately prevention is better than treatment. While the variants of the virus may have changed over the years, the guidelines for protecting against COVID-19 remain the same—staying up to date with vaccines and boosters, wearing a high-quality mask, physical distancing and avoiding crowded indoor spaces especially during local surges.
To learn more about how healthcare professionals can help reduce the disease burden in people with respiratory conditions, watch our webinar, Protecting the lungs from COVID-19 – Strategies to reduce the disease burden in your patients, on demand.
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