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COVID-19 and Asthma: The truth about steroids

There has been a great deal of talk about steroids, asthma and COVID-19 infection.  Because COVID-19 is a respiratory infection, patients with asthma may be fearful that they will face more significant symptoms if they become infected.   Furthermore, the CDC (Centers for Disease Control) has stated that patients with moderate-severe asthma may be at higher risk for serious infection complications, but there is little evidence to support that asthma is a significant risk factor in the data which is currently available.  Rather, age and immune compromise seem to be the largest risk factors and other medical conditions including diabetes, heart disease, and other lung disease seem to compound these.

This post will try to clarify what we know and what we don’t know, and most importantly, what you should do if you have asthma.

TRUE or FALSE:  Steroids make infection with COVID-19 worse.

TRUE (maybe) – There is some early evidence related to serious COVID-19 infection (SARS-Cov-2) and older evidence related to SARS-Cov-1 (from 2002-4), that systemic steroids do not help and may, in some instances, make things worse. Systemic steroids are usually give by IV in a hospital or ICU setting.  Systemic steroids can also be high dose oral steroids like prednisone and methylprednisolone. The most important complication of COVID-19 infection is pneumonia leading to ARDS (acute respiratory distress syndrome).  ARDS is an endpoint to many respiratory infections, including bacterial pneumonia and influenza-associated pneumonia.  ARDS in general does not respond to treatment with systemic steroids.   For patients in the hospital for COVID-19, systemic steroids are NOT part of the currently recommended treatment.

TRUE or FALSE:  Stopping my inhaled steroids will help me fight COVID-19.

FALSE: There is no evidence that inhaled steroids, which are routinely used to treat asthma and COPD (chronic obstructive pulmonary disease), have a negative impact on COVID-19 infection.  In fact, having asthma and COPD under maximal control is likely to benefit a person if they were to be infected by COVID-19.  The purpose of inhaled steroids is to minimize inflammation in the lungs and help the lungs work as if they did not have asthma.  In the face of a serious respiratory infection, lungs which can work optimally makes a lot of sense. Additionally, it does not appear that COVID-19 infection typically causes asthma attacks or exacerbation.   So, if you have asthma DO NOT STOP YOUR INHALED STEROIDS.

TRUE or FALSE:  If I have an asthma attack, I should not take oral steroids right now. 

FALSE: During this time, both patients and doctors are rightfully concerned about possible infection with COVID-19.  That being said, there are many other causes of asthma exacerbation including other viruses, allergens, and air quality.  When treating worsening asthma symptoms, especially when there is no fever or other symptoms consistent with serious COVID-19 infection, oral steroids may be the best treatment option for a patient.  You and your doctor, who knows your personal history and your asthma, will need to review your current symptoms and discuss treatment options that are best for you.

– Dr. Lora Stewart

For more information, see the AAAAI.org website.  https://www.aaaai.org/conditions-and-treatments/library/asthma-library/covid-asthma

Update on our Office Protocol changes and Appointments

updated 3/25/2020

A note to all of our patients and friends:

These are truly unprecedented times for our country and for all of us.  At Allergy & Asthma Care and Prevention Center, we sincerely care for all of our patients and are working countless hours to maintain your access to us and to good healthcare.

My current focus is the health and well-being of my patients and my staff.   This has required my clinic to be somewhat fluid in response to the evolving pandemic and the recommendations nationally from the CDC and locally from CDPHE.  We have continued to modify the way we “practice medicine”.  We are now offering Telemedicine visits for many of our patients.  This is a live, interactive video conference visit between you and one of our providers.  Telemedicine serves several purposes right now:

  1. It allows sick patients to stay at home but still allows us to assess and give recommendations including medication prescriptions.
  2. It allows the ‘at risk’ patients to stay at home but still have access to us.
  3. It allows our clinic to be a safer and significantly less busy place – which in turn allows us to practice social distancing AND allows for necessary face-to-face visits to occur in a safer environment.

We have had several days worth of Telemedicine visits now, and overall the experience has been good for both patients and for us.  We are still having minor technical issues on occasion, so I ask for your patience and grace as we move forward.

For those that will need to come to our office, we have changed many of the logistics of checking in and the visits themselves.  This is all in an effort to protect you and to protect my staff.

We are also receiving a high volume of phone calls and web portal messages. We will return all phone calls and messages, please be patient, I promise we are working through the messages as fast as we can.

We are hearing from many patients that have not been seen in over a year, and in some cases, several years.  We want to be helpful to all patients that contact our office, but please know that we must balance this with practicing good, sound medicine.  If we have not seen a patient in more than 12 months, we will not necessarily be able to provide prescriptions refills or documentation.  Most of these issues can be resolved with a Telemedicine visit within a weeks time.

Unfortunately, the pandemic is unlikely to improve quickly and therefore we will continue to work hard for your health and well-being.

Thank you trusting in us, I am humbled each day by my interactions with so many wonderful patients and by my hard-working team members.

In good health, Dr. Stewart

Telemedicine has arrived at Allergy & Asthma Care!

Update for Immunotherapy (allergy shots) Office Protocol during COVID-19 Pandemic

updated 3-25-2020

We continue to work to balance your access to vital treatment and providing a safe environment for all of our patients.

We have now had nearly a week of scheduled allergy shots, and it continues to go well.  Thank you to every patient who has called or texted us for a time slot.  We appreciate your efforts to help us maintain social distancing and to maximize the safety of all of our patients and our staff.  We will continue this plan for now.

We would like to reiterate, that for some patients, temporarily stopping allergy shots for the next 4-8 weeks is a reasonable option. If you choose to temporarily stop allergy shots, we will simply adjust your dose at the time you restart and then allow you to build back to maintenance dosing. We recommend patients over age 65 and those with compromised immune systems strongly consider this option.

For those of you who to continue to receive allergy shots, we will continue to schedule allergy shot visits every 10 minutes during our clinic time and will have all allergy shot patients wait in private rooms for their 20 minute post-injection observation. This will allow a minimal amount of patients in the allergy shot and waiting room areas at any given time.

 

To schedule an allergy shot appointment:               CALL 303-706-9923 or TEXT 720-476-1885.

 

In your voice or text message, please include your name and date of birth and 2-3 approximate times and dates that you would prefer.

Example text or voice message:

     Jane Doe, dob 1/1/2001, Tues 3/24 between 10-4 pm.

     John Doe, dob 2/2/1992, anytime Thurs 3/26.

We will call or text you a confirmation.

Thank you for your patience and understanding as we move forward. The recommendations for safety and to decrease the spread of COVID-19 are evolving quickly. We will get through this but we need to work together!

 

Sincerely and in good health,    Lora Stewart MD and Meghan Garcia MD

Have you used our SECURE PATIENT PORTAL YET?

Our office changes in response to current COVID-19 situation in our Community as off 3-16-2020

We realize that many of our patients are very concerned and even a little scared about the current situation with the coronavirus, COVID-19. At Allergy & Asthma Care, we are taking this very seriously but are hoping to be a source of valid information and reassurance.

Because of the nature of our specialty, being cautious of infection is nothing new. We have longstanding protocols of handwashing and disinfecting, as well as sterile technique when it comes to many procedures. We have made a few adjustments by providing hand washing stations in our waiting area and our allergy shot area. We are also disinfecting our waiting area throughout the day, disinfecting pens and clipboards after single use, and have removed all toys and all magazines. Finally, we have no employees that are currently ill or have any recent travel to high risk areas. You will also see that all the staff will be in scrubs, including the doctors and mid-level providers, this is an effort to protect our employees and their families from possibly sick patients seen during the day.

We are also working on transitioning many office visits to TeleMedicine visits in the next week. We will be contacting patients and announcing this on our website in the near future.

In all, we very comfortable that our office is safe and a low risk environment.   We have no plans to close our office in the upcoming weeks and will continue to offer appointments for food allergies, hives, asthma and seasonal allergies. We will be modifying our allergy shot protocols in order to keep patient distance from other patients. We will be posting our specific protocols later today and contacting many of our patients by phone. We are screening all patients for illness and other risk factors and are not currently seeing patients with confirmed COVID-19 infection. We do not offer testing for COVID-19 in our office.

We feel strongly that routine and “well” visits, including food and drug challenges, can be completed in our office in the next few days. Ultimately, though, it is your decision on whether you would like to reschedule. We do ask that you give us 24 hour notice for all cancellations and rescheduled appointments. We hope to have a TeleMedicine option by the end of this week.

As always, our primary concern is you and your family’s health and well-being.

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