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How Arthritis Affects the Lungs

About 25 million people in the U.S. have asthma, a condition that causes your airways to get narrower, which makes it difficult to breathe. When an asthma attack occurs, the lining of the air passages swells and the muscles surrounding the airways become tight. It is like pressing on a straw when you’re trying to drink through it: The more you press, the less of your drink you can squeeze up through the straw. In the same way, less air can pass through tight airways into your lungs.

“Asthma attacks are not subtle,” says Neil Schachter, MD, professor of medicine, pulmonary, critical care, and sleep medicine at Mount Sinai Hospital in New York City. “The acute shortness of breath, wheezing, and coughing make their presence known quickly.” When symptoms ramp up during an asthma attack, you can literally feel like you’re suffocating.

Chronic obstructive pulmonary disease (COPD) occurs when airflow is reduced in the lungs because there is abnormal enlargement of air sacs in the lungs due to damage of lung tissue and/or inflammation of the small airways. COPD affects more than 35 million Americans and is a leading cause of death in the U.S. Usually linked to smoking, COPD causes the lungs and airways to undergo unhealthy changes known as remodeling, which impair breathing.  People with COPD have a chronic cough and are increasingly short of breath. Early COPD causes people to notice shortness of breath when climbing stairs or running. As the disease progresses, patients experience shortness of breath even when sitting still.

Both asthma attacks and COPD make it hard to breathe, which, not surprisingly, can make it scary to live with these chronic lung disases. Also scary: hearing that having asthma or COPD may put you at higher risk for getting very sick from COVID-19, which is short for “coronavirus disease 2019.”

Here, we talked to various specialists who treat lung diseases to understand how coronavirus affects the lungs, and what to do to protect your health and avoid complications if you have asthma or COPD.

How Coronavirus Affects the Lungs and Body

The virus that causes COVID-19 is a type of coronavirus, a large family of viruses that commonly circulates among people and usually causes mild to moderate upper-respiratory tract illnesses like the common cold. This particular virus strain is what’s known as a novel coronavirus, which means it has not been previously identified in people before. As a result, there is still much that isn’t known about it, says Sadia Benzaquen, MD, chair of pulmonary, critical care, and sleep medicine at Einstein Healthcare Network in Philadelphia, Pennsylvania.

What is known for sure, says Dr. Benzaquen, is that the coronavirus is distributed by respiratory droplets that are excreted when people cough, sneeze, talk, or merely exhale. They can then be transmitted to your eyes, mouth, or nose. The virus is also extremely contagious, far more so than the seasonal flu.

“This virus is more infectious because it lasts longer on surfaces, certainly several hours but potentially several days,” says Dr. Benzaquen. “People can then touch the contaminated surface and transfer the virus to their eyes, nose, or mouth.”

Once the virus gets into your body, the projections (or spikes) that protrude from its surface allow the coronavirus to attach to a receptor site on respiratory cells and gain entry into these cells. The coronavirus then travels through the cell to the nucleus (the center), where it binds with the cell’s genetic material (DNA) and takes over the processes of the cell.

“So, rather than the cell being able to take in nutrients and oxygen to stay healthy and survive, the cell now becomes a ‘slave’ to the virus and starts making new viruses,” explains Dr. Schachter. “These new viruses accumulate within the respiratory cell until they burst out and start attack other neighboring cells.”

Initially, the coronavirus will affect your upper airways, which is the area above your vocal cords. Depending on the viral load and your local immunity, you may be able to fight off the virus and recover in a couple of weeks. “You may — as in 80 percent of cases — have mild symptoms like a dry cough, stuffy nose, fever, and body aches,” says Dr. Benzaquen.

In other cases, however, the virus can spread down to the lower airway and attack the lungs, which sets the stage for pneumonia, or inflammation of the lungs. Pneumonia causes the air sacs that send oxygen to the blood and remove carbon dioxide from the blood to fill with mucous and fluid buildup, which makes breathing difficult. In severe cases, this can require ventilator support to help people breathe.

Eventually, the body reacts to the invading viruses and mobilizes the immune system to make antibodies to limit the growth and duration of the virus infection. In some patients, however, the immune system overreacts and produces so many inflammatory substances that the defense system starts to damage the body — what’s known as a “cytokine storm.” As inflammation spikes, blood vessels in the lungs become damaged and the heart may be affected, a condition known as acute respiratory distress syndrome (ARDS).

“At this point, people get extremely sick and, unfortunately, there may be a point of no return and the patient dies,” says Dr. Benzaquen.

Why Lung Disease May Increase Your Risk for Severe COVID-19

People with asthma and COPD are more at risk for COVID-19 complications because they already have damage to their lung tissue and/or over-reactive airways, says Dr. Schachter. The natural immunity (the germ-fighting cells) in the airways of people with asthma and COPD is already impaired, notes Dr. Benzaquen. This can predispose patients to worse complications if they get pneumonia from COVID-19.

That said, there’s a big spectrum of lung disease, and your risk depends on the severity of your illness and how well controlled it is.

According to a recent study from the U.S. Centers for Disease Control and Prevention (CDC), people with underlying medical conditions like moderate to severe lung disease, particularly if their disease isn’t well controlled, are at high risk for getting very sick from COVID-19.

While most patients with respiratory illnesses will recover from COVID-19, this research suggests that having an underlying health condition might be one of the most significant risk factors for developing — and possibly dying from — a severe of coronavirus. The CDC scientists found that roughly 75 percent of adult COVID-19 patients who wound up in the hospital had at least one underlying health issue, including lung disease. (Other common diseases linked to COVID-19 complications requiring hospitalization were heart disease and diabetes.) The data showed that people with chronic lung disease were more than six times more likely to develop severe COVID-19 than people without it.

COPD patients tend to have more medical comorbidities (or co-occurring conditions), which could lead to more significant adverse outcomes should they contract COVID-19 than someone who is younger and overall healthier with mild-to-moderate seasonal allergies and asthma, notes Dr. Helfner.

Asthma and COPD Medications: What to Know

Keeping your asthma and COPD under control is so important right now because certain treatment used to manage flare-ups can impair the immune system’s ability to fight viruses and other infections.

“Often times, the way we treat asthma flare-ups is by giving oral steroids like prednisone,” explains Laura Helfner, MD, an allergist at ENT and Allergy Associates in Islandia, New York. “The studies are all showing that oral steroids can increase viral replication, which can put you at higher risk of having adverse outcomes from the virus.”

In other words, you want to try to avoid needing to use steroids regularly as part of your chronic disease management if you can.

Another concern about long-term use of oral steroids: According to an editorial recently published by the Endocrine Society, people taking glucocorticoids for conditions like asthma, allergies, and arthritis (some forms of which are sometimes associated with lung disease) on a routine basis may be unable to mount a normal stress response — and as a result, they may be more susceptible to COVID-19.

Another problem with experiencing lung disease flare-ups: Health care providers need to be able to discern whether you are having an asthma or COPD flare or whether it could be COVID-19-related pulmonary disease.

“The only way to determine that is by testing and doing chest imaging, so we may end up sending patients to the urgent care or the ER, which would then put them at higher risk of being exposed to coronavirus, which they might not otherwise have,” says Dr. Helfner. “We don’t want to end up in a situation like that either.”

To keep conditions like asthma under control, people with underlying health concerns are urged to keep at least a 30-day supply of medication on hand. Some areas of the country are experiencing shortages of albuterol inhalers due to their increased use in hospitals to help with respiratory issues among COVID-19 patients, according to the American College of Allergy, Asthma and Immunology (ACAAI).

These inhalers are a quick-relief or rescue medication used to decrease asthma symptoms. If you have trouble getting an inhaler, the ACAAI says not to panic. If your inhaler still has medicine (one canister should last for months), you can likely use it since it’s at least partially effective. If you can’t get a refill, contact your health care provider about other available options that they can prescribe.

How to Protect Yourself from COVID-19 if You Have Asthma, COPD, or Lung Disease

While everyone should be following social distancing and practicing good hand hygiene right now, it’s even more important to protect yourself if you have asthma or COPD. Consider these tips:

Stay at home as much as possible. To avoid being exposed to people who are sick right now, consider seeing your doctor via video visits or phone calls if you have a routine health issue. These ‘telehealth’ visits are now being covered by Medicare and many private insurers.

Practice social distancing. The CDC has been recommending for weeks now to avoid close contact with others — maintain a distance of at least six feet from others when possible — and activities that include large crowds, such as religious services, family gatherings, and shopping. More research is showing that people without symptoms may have coronavirus and can transmit it to others, even though they don’t yet look or seem sick. This new information makes social distancing all the more critical to avoid exposing yourself to coronavirus germs.

Wash your hands frequently with soap and water for at least 20 seconds, especially before eating and touching your face, and after going to the bathroom. If soap and water aren’t available, use an alcohol-based hand sanitizer that contains at least 60 percent alcohol.

Cover your cough or sneeze with the inside of your elbow or a tissue, then throw the tissue in the trash.

Stock up on supplies. In addition to keeping at least a 30-day supply of medication on hand, people with underlying health conditions are urged to have a two-week supply of food. Consider online delivery services or ask friends and family members to help you stay stocked so you don’t have to leave your home.

“Be pretty obsessive about cleaning,” advises Dr. Benzaquen. Clean and disinfect frequently touched objects and surfaces like doorknobs, light switches, keyboards, toilets, faucets, and sinks using a household cleaning spray or wipe. Avoid disinfectants that can cause an asthma attack.

Stay away from alcohol and smoking. “The cilia in our nose and upper airways are tiny microscopic hairs that act like tiny brooms to sweep out harmful organisms that are trapped in mucus before they can invade the body,” Dr. Schachter explains. “They act as a first line of defense against bacteria and viruses.” Both alcohol and smoking can paralyze the cilia, so they can no longer sweep out viruses and bacteria. “This is one of the reasons that even young healthy alcoholics have repeated cases of pneumonia,” says Dr. Schachter.

Vaping is another risk factor, since it can contribute to deadly lung injuries. Anecdotal reports of COVID deaths in young men noted that they were vapers.

The Role of Face Masks in COVID-19 Prevention

What about wearing a face mask? Currently, the CDC recommend that masks only be worn by people who have COVID-19 and are showing symptoms, to protect people they come into contact with from getting infected. The current advice says that otherwise-healthy people who don’t work in health care settings and who aren’t taking care of an infected person at home don’t need to wear one. This is due in part to the concern about shortages of the most protective masks, known as N95 respirators, for first responders and medical personnel.

That advice may soon change, however. In light of the fact that up to 25 percent of infected people may never feel sick and may unwittingly spread COVID-19, the CDC is reportedly reviewing whether to modify its recommendation. New guidelines may recommend that everyone wear a protective face mask (not an N95 one, which needs to be conserved for health care workers) outside of the home. This wouldn’t necessarily protect the wearer from getting the virus if exposed, but it might help slow the spread of the coronavirus because of transmission from asymptomatic people.

Dr. Benzaquen believes the added level of protection can be beneficial. “Part of the success in South Korea [and certain other Asian countries] in slowing the spread of the virus was the widespread use of masks,” he says.

If you choose to wear a loose-fitting surgical-type mask (or to cover your nose and mouth with a scarf, shawl, or piece of fabric), be aware that none of these are designed to filter out or block the very small coronavirus particles as effectively as N95 respirators. They should NOT take the place of frequent handwashing and physical distancing efforts.

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A message to asthma sufferers about a shortage of albuterol metered dose inhalers. American College of Allergy, Asthma, and Immunology. March 20, 2020. https://acaai.org/news/message-asthma-sufferers-about-shortage-albuterol-metered-dose-inhalers.

Asthma. National Center for Health Statistics. U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/fastats/asthma.htm.

CDC COVID-19 Response Team. Preliminary Estimates of the Prevalence of Selected Underlying Health Conditions Among Patients with Coronavirus Disease 2019 — United States, February 12-March 28, 2020. Morbidity and Mortality Weekly Report (MMWR). March 31, 2020. doi: http://dx.doi.org/10.15585/mmwr.mm6913e2.

Chronic Obstructive Pulmonary Disease (COPD). American Lung Association. https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd.

Coronavirus Disease 2019 (COVID-19). Frequently Asked Questions. https://www.cdc.gov/coronavirus/2019-ncov/faq.html#anchor_1584386215012.

Interview with Laura Helfner, MD, an allergist at ENT and Allergy Associates in Islandia, New York

Interview with Neil Schachter, MD, professor of medicine, pulmonary, critical care, and sleep medicine at Mount Sinai Hospital in New York City

Interview with Sadia Benzaquen, MD, chair of pulmonary, critical care, and sleep medicine at Einstein Healthcare Network in Philadelphia, Pennsylvania

Kaiser UB, et al. Our Response to COVID-19 as Endocrinologists and Diabetologists. The Journal of Clinical Endocrinology and Metabolism. May 2020. doi: https://doi.org/10.1210/clinem/dgaa148.

 N95 Respirators and Surgical Masks (Face Masks). U.S. Food & Drug Administration. April 3, 2020. https://www.fda.gov/medical-devices/personal-protective-equipment-infection-control/n95-respirators-and-surgical-masks-face-masks.

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