COVID-19: Expert calls for training of asthmatic patients to use preventive measures



Lagos, May 5, 2020

A Consultant Chest Physician, Prof. Gregory Erhabor, has called for the training of asthmatic patients on how to use preventive measures to live healthy during the COVID-19 pandemic.

Erhabor, a Professor of Medicine at the Obafemi Awolowo University, Ile-Ife in Osun, and also President, Asthma and Chest Care Foundation, made the call on Tuesday in Lagos.

It was in commemoration of the World Asthma Day, celebrated annually on May 5.

The World Asthma Day is an annual International event with the goals to improve asthma awareness and care around the world, with the theme of the 2020 celebration: “STOP for Asthma”.

According to Erhabor, during this pandemic, patients with asthma need to be trained by their physicians, by giving them a written self-management plan and teach them on inhaler techniques.

He said that asthmatic patients also need to know how to use the personalised peak flow meters, volumatics and nebulisers.

“This will reduce their presentation at the hospital, minimise their risk of exposure to infection and COVID-19, thereby preventing the worsening global burden of asthma,” the expert said.

He maintained that therapies used by patients with asthma could reduce the risk of infection or of developing symptoms leading to diagnosis.

Erhabor described Asthma as a chronic non-communicable respiratory disease with global impact.

He said that it was a heterogeneous disease, usually characterised by chronic airway inflammation with history of respiratory symptoms such as wheeze (noisy breathing).

According to him, others are shortness of breath, chest tightness and cough that varies over time and in intensity, together with variable expiratory airflow limitation.

He said that about 358.2 million individuals have asthma worldwide with over 500,000 hospitalisations annually, and about 400,000 deaths.

The expert said globally, the prevalence ranges from one to 18 per cent of the population, adding that by 2025, an estimated four hundred million people would be affected.

He expressed concern that Asthma prevalence was grossly under-reported and undertreated.

Erhabor said that in Africa, asthma prevalence ranges from high prevalence countries like South Africa, which has a prevalence of 33.1 per cent, to low prevalence countries like Gambia with 4.4 per cent prevalence.

“Studies done by scholars in Nigeria show that the prevalence ranges from five per cent to 18.7 per cent depending on the cohort being studied.

“In Nigeria, an estimated 15 million people are asthmatic,” he said.

The expert said that deaths from asthma were vastly preventable, noting that it was one of the commonest causes of presentation at emergency departments and the third leading cause of preventable hospitalisation.

“Asthma results from interplay of genetic and environmental factors. When individuals with genetic predisposition to asthma get exposed to certain triggers in the environment, they develop symptoms of asthma.

“In asthma, triggers are extremely small and lightweight particles transported through the air and inhaled into the lungs.

“They precipitate asthma attacks and are usually found in the environment,” he said.

The expert listed the triggers to include: pollens, house dust mite, cold air, spores, fumes, smoke, sprays; exercise and drugs, tobacco smoke, prolonged exposure to air pollution, and agents found at work place like chemicals, among others.

“The most common trigger still remains house dust mite. However, there is new interest in the role of obesity in the development of asthma,” he said.

Erhabor said that management of asthma requires partnership between the individual with asthma and the doctor.

On whether COVID-19 has any impact on asthmatic patients, he said, “though, viral inciters were established triggers of acute exacerbation of asthma, anecdotal evidence appears to be pointing to the fact that COVID-19 does not particularly worsen asthma.”

The expert said that this could possibly be due to the fact that COVID-19 mainly affects the lung parenchymal and not the airways.

“Also, the level of immunity among stable asthmatics is good.

“However, we still need to know whether some phenotypes of asthma could be affected by COVID-19.

“Perhaps, asthma protects against COVID-19 via a different immune response elicited by the disease.

“ACE 2 receptor expressed in respiratory epithelium have been documented as the route of entry of SARS-Cov2 (Coronavirus) in humans.

“However, asthma patients have a decreased expression of these ACE 2 receptors,” Erhabor said

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