Category: Blog

It is likely that you have read or heard about chloroquine or hydroxychloroquine for prevention or treatment of COVID-10 infection. As there have been instances of people finding and ingesting non-pharmaceutical grade chloroquine phosphate, we wanted to provide a warning to our patients and the community that this should NOT be done under any circumstances. Unfortunately in one report of a couple who ingested chloroquine phosphate designed to be used in aquariums, both became very ill. One person died before arrival to the hospital and the surviving person was in critical condition for several days with cardiac and gastrointestinal complications. The CDC has reported that online sales of these non-pharmaceutical grade products has been increasing significantly, which raises concern that people may be planning to ingest them.

Unfortunately at this time, there are no medications that have been FDA approved for prevention or treatment of COVID-19. Pharmaceutical grade chloroquine phosphate and hydroxychloroquine sulfate are currently being studied as treatment for COVID-19 infection, however the efficacy of these drugs has not been established. These drugs are used to treat autoimmune diseases like Lupus and Rheumatoid Arthritis, as well as malaria prevention and treatment. They do have well known side effects such as cardiac arrhythmia (specifically prolonged QT interval), retinopathy (damage to the eye), gastrointestinal symptoms such as nausea/vomiting/diarrhea, and blood count abnormalities. More serious neurological symptoms have been noted (usually at higher doses) such as seizure, dystonia (repetitive muscle contractions), tremor, and ataxia (incoordination of movement and speech). Therefore, these medications should only be taken if prescribed by a doctor and should always be taken at the dose prescribed.

We understand that this is a scary time, and that people want to feel like they have something more definitive that can help prevent or treat COVID-19. However, we urge you to follow your common sense. Please do not take medications that were not prescribed to you. Please follow the instructions of medications you are prescribed. Please do not ingest non-pharmaceutical products. Please continue to wash your hands thoroughly and often, try to avoid touching your face, and follow stay-at-home orders/social distancing to protect your family and the people in your community.

-Meghan Garcia, MD

Resources:

https://emergency.cdc.gov/han/2020/han00431.asp

https://reference.medscape.com/drug/aralen-chloroquine-phosphate-chloroquine-342687

As the COVID-19 pandemic evolves, the medical community is adapting to the best ways to practice medicine in the face of this very contagious virus.   One concern has been the risk of spreading the virus during a nebulizer treatment. This has been especially important in the hospital setting because patients may have several healthcare workers in their room during or after a breathing treatment. Due to this concern, hospitals have switched entirely away from using nebulizers and instead are using metered dose inhalers to deliver medications such as albuterol.

There are questions about whether we should universally stop using nebulizers at home as well. The answer, like so many questions around COVID-19, is less clear.

For many patients using an albuterol inhaler delivered with a spacer device (or otherwise excellent technique) may result in the same symptom improvement as a nebulizer. Therefore, patients at home should start with albuterol given via the inhaler with a spacer. For our youngest patients, delivery of medications (albuterol or inhaled steroids) via an inhaler and spacer may or may not work well, but it is certainly worth trying an inhaler with spacer as our starting point.

Additionally, there are many other explanations and triggers for asthmatic symptoms, beyond COVID-19, which may necessitate the delivery of medications via a nebulizer.

At this time we recommend that when the MDI inhaler is NOT improving symptoms,  a nebulizer delivery may be tried with the following considerations:

• For patients who live alone, using a nebulizer would be at low risk for infecting others.
• For older children or adults, consider identifying a dedicated room with a door in which to use the nebulizer. Only the patient should use the room and other household members should avoid that room.
• For our youngest patients, we should consider a dedicated room as well (as described above) and then also choose a caregiver at the lowest risk. Specifically, we should avoid exposing caregivers whose age is greater than 60 years or who have other medical issues which would identify them as “high risk” for serious complications associated with COVID-19 infection.

We will continue to update our information as more current and possibly relevant data becomes available. As always, please feel free to contact our office directly with specific questions relating to your health.

– Lora Stewart MD

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

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

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.