Impact of COVID-19 on people with asthma: a mixed methods analysis from a UK wide survey

Abstract

IntroductionThe impact of acute COVID-19 on people with asthma appears complex, being moderated by multiple interacting disease-specific, demographic and environmental factors. Research regarding longer-term effects in this group is limited. We aimed to assess impacts of COVID-19 and predictors of persistent symptoms, in people with asthma.MethodsUsing data from an online UK-wide survey of 4500 people with asthma (median age 50–59 years, 81% female), conducted in October 2020, we undertook a mixed methods analysis of the characteristics and experience of those reporting having had COVID-19.ResultsThe COVID-19 group (n=471, 10.5%) reported increased inhaler use and worse asthma management, compared with those not reporting COVID-19, but did not differ by gender, ethnicity or household income. Among the COVID-19 group, 56.1% reported having long COVID, 20.2% were ‘unsure’. Those with long COVID were more likely than those without long COVID to describe: their breathing as worse or much worse after their initial illness (73.7% vs 34.8%, p<0.001), increased inhaler use (67.8% vs 34.8%, p<0.001) and worse or much worse asthma management (59.6% vs 25.6%, p<0.001). Having long COVID was not associated with age, gender, ethnicity, UK nation or household income.Analysis of free text survey responses identified three key themes: (1) variable COVID-19 severity, duration and recovery; (2) symptom overlap and interaction between COVID-19 and asthma; (3) barriers to accessing healthcare.ConclusionsPersisting symptoms are common in people with asthma following COVID-19. Measures are needed to ensure appropriate healthcare access including clinical evaluation and investigation, to distinguish between COVID-19 symptoms and asthma.

Factors shaping the mental health and well-being of people experiencing persistent COVID-19 symptoms or ‘long COVID’: qualitative study

“…They echo work that has previously described symptoms, impact on daily life and interaction with healthcare providers. 14,22,31 However, our work extends previous findings by highlighting which features of long COVID are seen as most significant in shaping mental health and well-being from the perspective of people with lived experience. Our findings also improve understanding of how these features are experienced by people with long COVID, and as such, present potentially useful considerations for healthcare, self-management and wider society.…”

“…Feeling ignored or not believed by healthcare professionals, family members and friends has been commonly reported. 1 , 14 , 22 , 31 These experiences are similar to those described by people with myalgic encephalomyelitis/chronic fatigue syndrome. 35 Our findings suggest such experiences have particularly powerful negative effects on mental health.…”

“…33 Our findings identified the relevance of relapsing-remitting disease trajectories as important drivers of negative mental states because of related uncertainty about the future, which is well-established as a driver of anxiety and depression for people with various chronic diseases. 34 Other research, particularly from earlier on in the pandemic, also identified various barriers to healthcare, 1,14,22,31 including a lack of specialist service provision and limited understanding of the illness from healthcare professionals. Our study also shows that some people resorted to accessing private healthcare and therefore felt better supported to manage their symptoms.…”

“…In keeping with the growing body of research, our participants reported multiple, varied, relapsing-remitting symptoms often severely affecting their ability to engage in daily life, resulting in a reduced sense of achievement, meaning and purpose. 14 , 22 , 31 The PERMA theory of well-being posits that engagement in tasks and activities is vital to maintaining positive well-being, 17 therefore these limitations have strong negative effects on mental health through limiting participation in enjoyable and meaningful aspects of life and those that gave individuals their sense of identity, including work, leisure and social activities. Social identity theory suggests that we derive meaning and purpose from the roles we play within communities and groups, and that this positively affects individual health and well-being; 20 when participants in our study were no longer able to connect with their previous positive identities and these were replaced with illness-related identities, this posed a threat to well-being.…”

Smoking and socioeconomic factors linked to acute exacerbations of COPD: analysis from an Asthma + Lung UK survey

“…The COVID-19 pandemic has worsened this unmet need further, as people with respiratory disease have had trouble accessing healthcare. [7][8][9] Asthma + Lung UK survey data show that over 75% COPD patients report not receiving basic care during 2020/2021. 4 Switching to a digital by default model, further risks excluding deprived and older patients.…”