What counts as severe asthma?

Some confusion over who needs to cocoon
  • Deborah Condon

The Asthma Society of Ireland (ASI) has explained in full what severe asthma is, after many people were confused about who should be cocooning or not during the COVID-19 crisis.

People who are considered "extremely medically vulnerable", including those with severe asthma and severe COPD, were told to cocoon by the Taoiseach, Leo Varadkar, on March 27.

While this was to be until April 12, this date is widely expected to be extended.

People in this extremely medically vulnerable category are considered to be at a higher risk of suffering complications if they do contract COVID-19.

According to the ASI, since the announcement, people have been contacting it seeking clarity on what is meant by severe asthma.

"We were overrun by requests to our offices and to our Adviceline service looking for an exact definition of severe asthma. There was confusion as to what exactly classed someone's asthma as severe asthma and who should cocoon.

"It is not simply a description of how a patient's symptoms feel to them, as some patients believe. This makes it challenging for patients to know if they should cocoon, and they need our support to make this important health decision," explained ASI chief executive, Sarah O'Connor.

Working with its medical advisory group, the charity has put together the following definition for those with asthma and their family members.

"Asthma exists on a spectrum. Severe asthma is a more difficult to manage form of the condition. Severe asthma is recognised by doctors through categorising the type, strength and dose of medication prescribed that the patient requires to keep their asthma in control, and whether they have needed hospital treatment within the past 12 months.

"It can take months or years to diagnose a patient with severe asthma, as doctors may try different treatments to manage it," the ASI said.

It has compiled more information about this on its website and this guidance "allows patients to work through a number of steps to establish if their medication strength and type indicates that they have severe asthma".

"If patients need any help in determining whether or not they should cocoon, we encourage you to contact our free call-back Adviceline service and speak to our specialist nurses, who will be happy to help you," the charity explained.

According to Dr Marcus Butler, a respiratory consultant and ASI medical director, severe asthma has only had an agreed definition internationally since 2014.

He advised people to check the ASI website, speak to the ASI Adviceline, or contact their GP or consultant if they need further clarification.

"The HSE is implementing appropriate measures to protect this group during the crisis and we recommend that guidance from the HSE and the Department of Health, including cocooning for severe asthma patients, is strictly adhered to," Dr Butler added.

This was backed up by Ms O'Connor, who appealed to people with severe asthma to cocoon until at least April 12, and longer if advised.

"People with severe asthma are considered at higher risk if they do catch coronavirus and for this reason, cocooning is advised for their own safety. Family, carers, neighbours and our public services will help ensure you have the support you need.

"If you are living with someone or caring for someone who is cocooning, please give them as much support as you can, while also avoiding all unnecessary face-to-face contact and maintaining physical distance," she said.

Meanwhile, according to Dr Dermot Nolan, clinical lead for asthma for the Irish College of General Practitioners (ICGP), there is not data to suggest that people with asthma are more likely to get COVID-19, "but they may struggle with the virus if they do contract it, so they must be extra vigilant".

"There is every need to ensure that they adhere to all HSE and Department of Health guidelines and take sufficient care at this crucial stage.

"The vast majority of people with respiratory conditions can continue to get out for fresh air and exercise once a day, and even to work if necessary. If you are an essential healthcare worker, we recommend that you discuss your workplace exposure risk and your asthma-related risk of severe illness from COVID-19 with your occupational health department and/or your regular asthma doctor, as the context for each worker is different," he noted.

Anyone with asthma or COPD should monitor their condition carefully and telephone their doctor to let them know about any additional symptoms they may be experiencing, such as a fever or new cough.

For more information on cocooning and severe asthma, click here.

The Asthma and COPD Adviceline can be contacted on 1800 44 54 64.

 


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