Asthma and COVID-19: How Does a COVID-19 Infection Affect People With Asthma?

Some people have a higher risk of severe illness from the virus that causes COVID-19. This is true for people over the age of 65. And it’s the case for people who have one or more chronic medical conditions, like chronic obstructive pulmonary disease (COPD). 

But what about the millions of people living with asthma? Asthma is one of the most common chronic lung diseases. It affects 1 in 12 people in the U.S. With asthma, the airways in your lungs become inflamed and swollen, making it harder to breathe. 

Just like the common cold and other upper respiratory tract infections, COVID can worsen symptoms of asthma. But it turns out that people with asthma don’t have a higher risk for worse outcomes from COVID compared to others. Here’s what the research shows.

How does COVID affect people with asthma?

Early in the pandemic, there was concern that the virus that causes COVID might affect people with asthma more severely. That’s because this is the case for people with other respiratory diseases, like COPD and idiopathic pulmonary fibrosis. 

But time and data have shown that most people with asthma don’t have a higher risk of a severe COVID illness. In fact, the American Academy of Allergy, Asthma, and Immunology points out that studies have found that people with asthma actually have a lower risk of severe disease with COVID. This means that mild asthma doesn’t make hospitalization or death from COVID more likely.

Asthma type and severity

People with allergic asthma, the most common type, have a lower risk for severe COVID compared with people who have nonallergic asthma. It’s possible that allergic asthma might even protect people from severe COVID compared to people who don’t have asthma.

Researchers are still trying to understand why. But there’s evidence that the type of inflammation that causes asthma can also work against COVID and prevent severe disease.

Asthma severity might also matter. People with mild, well-managed asthma tend to have better COVID outcomes than those with hard-to-control or severe asthma. A large review of studies found that people with severe asthma have a higher risk for worse COVID outcomes. But the researchers noted that the evidence is weak, and the mechanisms are poorly understood.

COVID effect on asthma symptoms

Any infection in your lung — including COVID — can trigger an asthma attack. During an attack, the smallest airways in the lungs tighten up and let very little air through. It’s this airway tightening that causes classic asthma symptoms like: 

• Shortness of breath

• Wheezing

• Chest tightness

• Coughing

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• Viral illnesses like COVID can make asthma worse. But it’s important to be aware of other asthma triggers too, like certain medical conditions and inhaled irritants.

Mild COVID infections cause symptoms similar to a cold such as stuffy nose, sneezing, and sore throat. People with mild COVID infections — including those with asthma — can usually manage their symptoms at home. 

But more serious COVID infections are possible. The virus can cause widespread lung inflammation, leading to pneumonia or damage to other organs.

If you have asthma, it’s important to stay on top of your symptoms as much as possible. Be sure to take your medications as directed, and be aware of increasing COVID infection rates in your community.

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Are people with asthma more likely to get COVID?

No, people with asthma don’t seem more likely to get COVID infection. An analysis of 150 studies found no increased frequency of COVID infections in people with asthma. It actually found that the risk of COVID in people with asthma might be lower. 

Another review of over 50 studies found that people with asthma had a lower risk of catching the virus that causes COVID in the first place, compared to those without asthma. 

There are several possible reasons for this surprising finding:

• There are fewer ACE2 receptors. These receptors are like docking stations that let the COVID virus enter your body’s cells and cause illness. People with asthma seem to have fewer ACE2 receptors in their lungs. Fewer receptors may mean that less virus enters your body.

• Inflammation may be protective. Chronic allergies (including allergic asthma) involve an immune pathway known as type 2 inflammation. While type 2 inflammation normally causes asthma symptoms, the cells involved may be especially effective against COVID. So, the chronic inflammation from allergic asthma might make it harder for the virus that causes COVID to replicate in your lungs. 

• Inhaled steroids may help. People with asthma often take inhaled corticosteroid medications. These treatments may also slow virus replication and reduce ACE2 receptors. But more research is needed to better understand this link.

Asthma and long COVID

Long COVID is when symptoms of COVID linger for weeks or months after the initial infection. When long COVID involves the lungs, some people experience shortness of breath, wheezing, and cough. Some research suggests that poorly controlled asthma might increase the risk of long COVID.

Can asthma get worse after COVID infection?

Getting COVID illness can make asthma symptoms worse in people with asthma. That’s the case even with mild to moderate cases of COVID illness.

One study found that people with asthma had more asthma flare-ups and needed more medication to manage their asthma compared to people who didn’t get COVID. A study from Hong Kong showed the same link. Another small study found that some children still had asthma symptoms and changes in lung function months after having COVID.

Can COVID cause new asthma?

There’s evidence of an increase in allergic conditions — including asthma — after COVID. This may be more likely in people with severe COVID infection and less likely in those who were vaccinated.

One study estimated that people who had COVID were 27% more likely to develop new asthma in the months after infection. But more research is needed on this “post-COVID asthma.” It’s not clear whether COVID is causing new asthma or if the breathing symptoms are part of long COVID.

Treating COVID and asthma

If you have a mild COVID illness, it’s important to continue your regular asthma medications. Let your healthcare team know if your symptoms get worse. This is when an asthma action plan comes in handy. It tells you how to manage your asthma on a daily basis, what to do when symptoms worsen, and when to get medical attention.

With a moderate to severe COVID infection, a person with asthma may need treatment in the hospital. This would include oxygen, nebulizers, and corticosteroids. Some people may also need specific therapies for COVID illness, like Paxlovid (nirmatrelvir / ritonavir).

Can an inhaler treat COVID symptoms?

If you’re already using an inhaled steroid for asthma and you get COVID, it’s best to keep using it. Inhaled steroids work by reducing inflammation in your airways and are important for asthma management.

Several clinical trials have looked at whether inhaled steroids could help improve COVID symptoms or severity for anyone (not just people with asthma). They found that inhaled steroids can help improve symptoms from COVID. But they don’t speed up recovery or reduce the risk of hospitalization.

Preventing a COVID infection when you have asthma

Everyone should take steps to prevent the spread of COVID. This includes people with asthma, even if the risk may not be as high as originally thought. Here are some tips to help lower your risk of COVID infection:

• Stay up to date with your COVID vaccines.

• Improve ventilation and spend time outdoors when possible.

• Wash your hands often with soap and water.

• Avoid contact with people who have, or may have, COVID.

• Wear a mask, especially in crowded settings.

• Avoid crowds during times of high spread of COVID in your community.

Regardless of how severe your asthma is, the best way to protect yourself if you get COVID illness is to actively manage your asthma and asthma symptoms. Follow these simple steps:

• Take your daily inhalers exactly as prescribed to prevent an asthma attack. 

• Keep your fast-acting bronchodilator (such as albuterol) with you every day in case your asthma symptoms get worse.

• Work with your healthcare team to have an emergency supply of medications. 

• Make sure you have an asthma action plan to help you recognize and manage asthma symptoms if and when you experience them.

• Use a peak flow meter (from a pharmacy) and keep a diary of your peak flow readings and symptoms. This can show how well your asthma is managed. It can also help your medical team if they need to assess you by phone or video.

• Anxiety and stress can make asthma symptoms worse. Take steps to help manage your emotions, too.

Why trust our experts?

Written by:

Karen Hovav, MD, FAAP

Karen Hovav, MD, FAAP, has more than 15 years of experience as an attending pediatrician. She has worked in a large academic center in an urban city, a small community hospital, a private practice, and an urgent care clinic.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. A pulmonologist and hospitalist, she practiced and taught clinical medicine at hospitals in London for a decade before entering a career in health education and technology.

Reviewed by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

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