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  • We all are aware that coronavirus is a respiratory infection that can affect everyone

Here is the draft of the interview with Dr. Samir Garde.


Here is the draft of the interview with Dr. Samir Garde.


We all are aware that coronavirus is a respiratory infection that can affect everyone. However, people with comorbid conditions such as diabetes, heart disease and lung disease are slightly at a higher risk to suffer from serious complications as compared to healthy people. Ever since this information started circulating in groups and spread wide and far people with pre-existing health conditions started to panic. And more so were the people with respiratory conditions such as asthma, chronic bronchitis and chronic pulmonary obstructive disorder (COPD).


So to help you get the right information on COVID-19 and its impact on respiratory health, we spoke to Dr. Samir Garde, Pulmonologist and Lung Specialist, Global Hospital, Mumbai and here is what he has to say.


  1. Are people with asthma/other respiratory health conditions at higher risk of catching COVID-19?


People with asthma do not have a higher risk of suffering from COVID-19 infection as compared to healthy people. This reason being, if asthmatics follow proper treatment (which includes use of inhalers and medications such as bronchodilators and corticosteroids), the inflammation in the airways is taken care of. They mostly suffer from change in climate and triggers such as pollution.


However, those with chronic pulmonary obstructive diseases (COPD) have a high tendency to suffer from a severe infection, if they get infected with the coronavirus. This is because people with COPD already have weak lungs so lower respiratory infection caused by COVID-19 can further damage the lungs. If this happens, then there is a higher chance of the patient landing up on a ventilator as compared to those without any comorbid conditions.


Other respiratory conditions such as interstitial lung disease (also known as lung fibrosis) can increase your risk of coronavirus infection. In this condition, the oxygen carrying capacity of the lung is affected which compromises the gas exchange in the lungs. So if a person with lung fibrosis gets infected with COVID-19, then it can lead to severe infection and may also turn lethal.


  1. Do people with respiratory problems have poor disease outcomes when it comes to COVID-19?


There is no sufficient data to answer this question as of now. The data on the number of deaths due to coronavirus in India does not give any analysis on the comorbidities (if any). To get these details it may take another 2-3 months.


However, if we can extrapolate the data of COPD patients who suffered from H1N1 or other viral pneumonia over the years (COVID-19 is a viral infection and may follow the same set of pattern), then it can be said that around 80% of people with COPD may have poor disease outcome.

  1. Can COVID-19 reinfect an individual? And do the people with asthma or other respiratory disease conditions have more chances of getting reinfected?


It is less likely that COVID-19 can reinfect an individual because generally when a person suffers from a viral infection, the body develops antibodies against the virus. So if a person suffers from coronavirus and has recovered, the body develops enough immunity to protect a person for the rest of their life. This rule applies to those with comorbid conditions including the respiratory problems


  1. If you have asthma/COPD or respiratory disease, stay away from exercise as it ups the risk of COVID-19 infection. Is it true?


There is no scientific evidence to prove that exercising can up the risk of COVID-19 infection in people with respiratory conditions. If you suffer from asthma or COPD and your symptoms are under control, then there is no harm to try out simple breathing exercises such as pranayama.


Oxidative stress which is seen in people with COVID-19 can damage the lungs and may cause the patients to land up in hospitals. Hence, it is advised that a person should have enough fluid intake and eat at least 2 fruits, especially those rich in antioxidants, every day. Antioxidants are the compounds which help in eliminating free radicals from the body. Also, opt for a traditional Indian meal as it has all the essential nutrients that can protect the body from infections.


  1. Is there any long-term damage to the lungs after having COVID-19?


Well, this is too early to comment if COVID-19 can cause long-term lung damage. It is only a week or two that the people with coronavirus infection have started recovering and discharged from hospitals. It may require data for around 2-3 months to understand if there is any long term damage to the lungs. Moreover, it can also depend on the severity and condition of the person at the time of infection.


  1. People with asthma suffer from cough and difficulty in breathing. How to distinguish between these symptoms and those of COVID-19?


In any infection, fever is a classic symptom. So in people with asthma who suffer from runny nose, cough or throat irritation but no fever, it is less likely that the patient is having any infection. Also, headache, severe body ache and loss of smell are some of the common symptoms seen in COVID-19 patients. But if you have any of these symptoms, get in touch with a doctor who may recommend a swab test based on your condition and treat accordingly.


Also, as most people are spending time indoors, there is a high chance that people with respiratory problems might have a cough or runny nose. This could be due to dusting, cleaning, pollution or use of incense sticks. So if a person doesn’t have fever/headache/bodyache is not there, then there is no need to worry.


  1. Should people with respiratory conditions wear masks when out in public places (even if they are not sick/caregiver)?


In certain cities, it has been made mandatory to use masks when out in public even if you are not sick. But as a rule, it is best to cover your nose and mouth with a mask when stepping out by everyone as a protective measure. You do not have to buy expensive masks but a simple cloth mask will do. It can not only protect you against pollution but also against airborne infection.


  1. Is using a homemade facemask better option as compared to surgical/N-95 masks?


There is a catch here. If you are a healthcare professional (doctor/nurse/etc) who is treating COVID-19 patients or are a caregiver of a COVID-19 patient, then it is advised to use a N-95 mask. For people who work in hospitals or healthcare settings but are not directly in contact with COVID-19, then it is in their best interest to use a surgical mask. For the general public (including the people with respiratory conditions), use of cloth masks is recommended. But if you are visiting a hospital where there are COVID-19 patients, then wearing a surgical mask is advised as the risk of cross infection is very high.


  1. Should I stop using nasal spray (as it may push the virus further up the nose)?


Nasal spray is recommended for asthmatics with allergic rhinitis and sinusitis and not for every individual suffering from respiratory condition. There is no scientific evidence to prove that using a nasal spray can push up the virus deep into the respiratory tract and up the risk of infection.


  1. If I use a nebulizer at home, am I at risk of COVID-19 infection (risk of the virus spreading through air)?


A COPD patient taking a nebuliser at home routinely can continue nebulization. The only care he/she needs to take is that the nebulization kit which has been used should be cleaned and replaced regularly. Ideally, the kit should be cleaned at least every week by keeping it in hot water for 30 minutes and drying under the sun. Thereafter, the kit must be replaced (or disposed of) every month with a new one.


However, if a COPD patient is tested positive for COVID-19, then the precautions for using nebulizer might differ. This is because it is believed that the use of nebulization in these people can generate more droplets which can be spread to other people. In such cases, it is recommended to use a metered-dose inhaler with a spacer where droplet generation is comparatively less and thus, the risk of spreading the infection.


  1. Do anti-allergic medications such as antihistamines (recommended in asthmatics/allergy) suppress the immune system and up the risk of viral infection?


People with runny nose or sore throat can use antiallergic medications as per the doctor’s prescription. There is no harm in doing so as this can only help in relieving the symptoms (and preventing worsening of the condition). Also, use of anti-allergic medications for a week or 10 days won’t suppress the immune system and won’t be of any problem.


  1. Should I increase my normal dosage of medication to protect myself from COVID-19? Is stocking up medications a good idea (If yes for how long)?


Not really. People with asthma or COPD who are on inhalers tend to be stable on a certain dose. Just because there is a scare of COVID-19, there is no need to increase the dose as doing so won’t offer any protection.


It is recommended to stock at least a month’s dose of medications (such as inhalers or any specific drugs) to be on a safer side. People with asthma or COPD are exposed to pollutants in the home which can trigger an infection and may require an increased dose. This can cause the inhaler to get over fast, so it is better to have routine medications handy. Do consult your doctor in case of change of medications or severity of symptoms for proper treatment of the condition.


  1. If I have already taken pneumococcal vaccine, am I protected against developing pneumonia (which is one of the complications caused by coronavirus)? If yes, then taking pneumococcal vaccine now offers protection from COVID-19?


Pneumococcal vaccine is exclusively against bacterial pneumonia, so taking this may not provide protection against viral infections. However, taking flu vaccination can offer partial or complete protection against any kind of viral invasion. Flu vaccine is meant for viral infections such as H1N1 and H1N3, etc but there could be cross immunity towards viruses like coronavirus and rotavirus. So taking the flu shot every year is recommended for everyone to provide protection against viral infections.


  1. What social distancing guidelines should people with asthma follow? Do these guidelines differ if anyone in my family/community tests positive for COVID-19?


There is no second thought that if someone has been diagnosed with COVID-19, he/she has to be in isolation. However, if there is a COPD patient in your family, then he/she should refrain from going near the patient for at least 14 days to prevent infection from a known covid patient.


  1. I am not an asthmatic patient but cleaning/dusting impairs my breathing (I feel breathlessness after an hour or two). What should I do in such a case?


These people should be given symptomatic treatment as per their doctor’s judgement. Also, it is advised to take a proper history of such a patient even if the patient says that he/she has never suffered from asthma because their symptoms can be leading towards asthma. It is not that if there is no family history of asthma, then you may not get asthma as it can occur at any stage right from childhood to elderly people. Based on the symptoms, the doctor can first give symptomatic treatment like bronchodilators and anti-allergic medications. However, if these medications fail to show any improvement, then the next course of asthma treatment in form of anti-asthma medications might be recommended. This may also be followed by a pulmonary function test, which is a breathing test that can help to decide if a person has asthma or not.


  1. Should people with asthma/respiratory problems cancel their trips (air travel specially)? If yes, for how long?


Given the current situation, it is best advised to not travel for at least 2-3 months unless it is an emergency. Even in such cases, it is advised to follow social distancing, use masks and wash hands regularly to prevent the infection. This rule applies for everyone right from those with respiratory problems to those with other comorbid conditions such as diabetes and heart disease. However, if you are planning for international travel it is better to prevent air travel for at least six months till the situation subsides completely all over the world.


  1. Do asthmatics and those with respiratory problems/lung disease continue staying indoors and taking extra precautions even after lockdown is uplifted?


Not really. Once the lockdown is uplifted and the government allows normal activity then outdoor exercises such as walking is highly recommended. However, if you still have to wear a mask after the lockdown is uplifted, then performing heavy breathing exercises is not advised. This is because wearing a mask and brisk walking can make a person more breathless. In such a case, opt for leisure walking.


  1. Is using an inhaler (even if I am not diagnosed with asthma but belong to a high-risk group) a good preventative measure?


If there is no diagnosis of asthma or no pulmonary function was done before, just giving an inhaler will not do any good. If you are having respiratory symptoms, then it is best to consult a respiratory physician. Your doctor will decide the treatment course and prevention measure based on your symptoms and diagnosis. Also, if a patient is complaining of breathlessness and has a heart disease or kidney disease, then consult his doctor (cardiologist or nephrologist) as these conditions can make a person feel breathless. So do not use an inhaler as a preventive measure but know the root cause of your symptoms for getting the right treatment plan.


  1. I use an inhaler, can it become infected? What can I do to prevent it? Should I get a new inhaler or just clean my current one?


If an asthmatic has coronavirus infection and he is using an inhaler then obviously he has to make sure that the inhaler is not shared (limited to himself only) and continue using that till the inhaler gets over. However, he should make sure to dispose of it off properly and buy a new inhaler.


  1. How different is the treatment for COVID-19 for asthmatics as compared to those without any comorbid condition?


There is no difference in the treatment of COVID-19 for people with respiratory problems and those without any comorbid condition. However, people with asthma/respiratory conditions need to follow their treatment module in addition to the treatment of COVID-19.


Also, unlike popular belief, there is no truth to the statement that the symptoms of COVID-19 in people with asthma are mild as compared to the general population which can prolong the diagnosis of the condition and nor does it worsen COVID-19 symptoms.


  1. Are smokers at higher risk of COVID-19 (because they are more likely to get pneumonia or respiratory infections) as compared to non-smokers?


Mucosa, which is the lining of the airways, keeps cleaning the airways. In case of smoking, this function is affected as the lining is damaged. This can make it easy for the virus to enter the respiratory tract and the other organs of the body causing an infection. Oxidative stress, which is seen in COVID-19 patients, is also much more in smokers as compared to non-smokers, which undoubtedly can up the risk of a respiratory infection and also lead to lung damage and failure.


So it is best to quit smoking, stay hydrated, try deep breathing exercises and get treated if you have symptoms of cough/breathlessness.


  1. I have a family member who is high-risk and I work in a front-line position (hospital, care home, prison, school). I am concerned that working with patients I might get sick and pass this on to my high-risk family member. What should I do?


There is no doubt that a person who falls sick has to follow isolation precautions without fail. The whole idea behind social distancing or not going out of the house is to prevent the spread of the infection in the vulnerable section of people. It is estimated that 80% of people do not suffer from corona symptoms. However, it is for the rest 20% who belong to the high-risk group and are more susceptible. So healthy people who fall sick should follow social distancing and quarantine to prevent the spread of the infection to those who are susceptible.


  1. Is self-isolation a better option for people with asthma to prevent COVID-19 infection? What tips to keep in mind in such a case?


There is no need unless a person is diagnosed with COVID-19. However, not stepping out of the house is important to prevent COVID-19 infection. Hence, it is advised to stay at home and try different activities to stay engaged in your house such as listening to music, trying out a new hobby, learning a new course or mingling with family because it is more important than self-isolation.


  1. Should I inhale hot water vapour/gargle with hot water to prevent COVID-19?

Most asthmatics and COPD patients are advised to gargle with hot water in addition to using an inhaler. So garling with hot water is not a bad idea. In fact, drinking hot water is also advised as it is believed drinking hot water can help in inactivating the virus which is known to lodge itself in the pharynx for a longer period. A simple home hold remedy like garling and drinking hot water (with/without lemon) the first thing in the morning is also good as it helps to keep the body alkaline and helps to prevent infections.