Tip Sheet – Asthma Care During COVID-19, Cold & Flu Season

What You Can Do Now:

• Pull a listing of your patients with Asthma. (Persistent Asthma ICD-10 Codes: J45.2x, J45.3x, J45.4x, J45.5x, J45.90x where x= 0 for uncomplicated, 1 for with exacerbation and 2 with status asthmaticus). Review criteria to assign patient risk scores for likelihood of having an asthma flair up/attack this season Follow-up now with an updated asthma action plan for those high-risk patients. Be sure to include any new updates related to the COVID Pandemic on the action plan. Below are links to some examples of Asthma Action Plans:

• Take a moment to check in with your asthmatic patients to be sure their medications are up-to-date, accurate, and not expired. If necessary, provide patient education on how to take medications properly. (Keep in mind some insurances won’t cover expensive controller medications if you have wheezing as your diagnosis). Below are some resources that we have heard other practices using to help get medications to their patients:

• Educate patients on possible Common Asthma Triggers (CDC) – Be sure to include cleaning agents during COVID and remind them to wear a mask (also in Spanish – Desencadenantes comunes del asma).

Points To Consider:

• Most major insurances cover at-home nebulizers. If a patient is eligible for the use of at-home nebulizer treatments, you can confirm their instrument is ready for use. If they don’t have one, now is the time to get it ordered.
• Check insurance coverage on other helpful at-home monitoring devices including Peak Flow Meters and Pulse Ox Machines.
• Asthma, Flu, and COVID have very similar symptoms. There are resources available to help you determine when to test for what: Multicare.org: Symptoms Chart, Family Allergy & Asthma: Allergy Symptoms vs. COVID, CDC: COVID-19 and Seasonal Allergies
• Laboratories are beginning to offer dual Flu and COVID-19 testing with one single collection sample. At the time of this publication, below are the quick links to laboratories offering dual testing
•  Quest Diagnostics: https://www.questdiagnostics.com/home/Covid-19/HCP/
• LabCorp: https://www.labcorp.com/coronavirus-disease-covid-19/news/labcorp-launches-first-combined-test-covid-19-flu-and-rsv-time-flu-season
• Consider offering telehealth visits. The American Academy of Allergy Asthma & Immunology (AAAAI) created a Telehealth Toolkit webpage to help guide you. The webpage includes videos, lessons learned, and billing information. A good practice to ensure proper infection control and ventilation  in-between patients is to consider scheduling alternating in-person and telehealth visits in your schedule. This will allow for extra time that the exam room will not be filled and provide more of a 30-minute disinfecting period. You can also check out the NC AHEC and the Office of Rural Health Telehealth Series and other resources on our Trello board: https://trello.com/b/hadwD0Rj/covid-19-updates.

• With the new infection control procedures in place, new cleaning routines could trigger asthma symptoms. Review the CDC site for Asthma Triggers (See section on Cleaning and Disinfection).

Patient Education Materials:

• CDC Website: Managing Asthma During COVID19
• Asthma and Allergy Network: COVID19 Infographics
• Asthma and Allergy Foundation of America: Wearing a mask when you have asthma
• Mayo Clinic: Asthma Overview – Signs/Symptoms/Causes/Prevention
• American Lung Association: Asthma Patient Resources and Videos - For Patients and Caregivers (Includes videos on how to use a nebulizer and how to use a peak flow meter)
• CDC Videos: Know How To Use Your Asthma Inhaler (English & Spanish videos are available, includes how to use a MDI with Spacer)

Clinical Resources:

Asthma and Allergy Foundation of America (AAFA):

• Asthma: COVID-19 (New Coronavirus): https://www.aafa.org/asthma/asthma-triggers/other-health-conditions/respiratory-infections/covid-19-new-coronavirus.aspx
• Toolkit for Schools: https://community.aafa.org/blog/managing-asthma-at-school-during-the-covid-19-pandemic

American Academy of Allergy Asthma & Immunology (AAAAI):

• The Relationship Between COVID19 and Asthma (9/4/20)
• Coronavirus Disease 2019 (COVID-19) with a Focus on Older Adults: A Guide for Allergist/Immunologists and Patients (9/23/20)
• Caring for Pregnant Patients With Asthma During the COVID-19 Pandemic (9/8/20)

Additional Resources:

• Elsevier Public Health Emergency Collection - Practical strategies for a safe and effective delivery of aerosolized medications to patients with COVID-19
• American College of Allergy, Asthma & Immunology (ACAAI) – Managing Your Asthma Patient During COVID (Free Webinar – 5/28/20)
• Article Abstract from The Journal of Allergy and Clinical Immunology: In Practice (11/1/19) –           The Good, the Bad, and the Unknown of Telemedicine in Asthma and Allergy Practice

Resource Links To Infection Control & Aerosol Generating Procedures:

• COVID-19 and Use of Nebulizers or Other Aerosol-Generating Procedures in a Clinic Setting (Blog/Q&A from AAAAI): https://www.aaaai.org/ask-the-expert/nebulizers
• Aerosolization of COVID-19 and Contamination Risks During Respiratory Treatments (Article): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7173638/pdf/fp-37-04-160.pdf
• High-Risk Aerosol-Generating Procedures in COVID-19: Respiratory Protective Equipment Considerations (Article): https://journals.sagepub.com/doi/pdf/10.1177/0194599820927335
• Aerosol-Generating Procedures and Patients with Suspected or Confirmed COVID-19 (Article): https://www.health.state.mn.us/diseases/coronavirus/hcp/aerosol.pdf
• Practical strategies for a safe and effective delivery of aerosolized medications to patients with COVID-19 (Article): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7172670/pdf/main.pdf
• Nebulizer Treatment for COVID-19 Infected Residents with Severe Respiratory Symptoms (DHFCA): https://www.dhcfa.org/wp-content/uploads/sites/314/2020/04/Nebulizer-Guidance.pdf