Primary Care Management of Asthma Exacerbations or Attacks: Impact of the COVID-19 Pandemic

Abstract

The COVID-19 pandemic has brought a renewed focus on appropriate management of chronic respiratory conditions with a heightened awareness of respiratory symptoms and the requirement for differential diagnosis between an asthma attack and COVID-19 infection. Despite early concerns in the pandemic, most studies suggest that well-managed asthma is not a risk factor for more severe COVID-related outcomes, and that asthma may even have a protective effect. Advice on the treatment of asthma and asthma attacks has remained unchanged. This article describes some challenges faced in primary care asthma management in adults and in teenagers, particularly their relevance during a pandemic, and provides practical advice on asthma attack recognition, classification, treatment and continuity of care. Acute attacks, characterised by increased symptoms and reduced lung function, are often referred to as exacerbations of asthma by doctors and nurses but are usually described by patients as asthma attacks. They carry a significant and underestimated morbidity and mortality burden. Many patients experiencing an asthma attack are assessed in primary care for treatment and continuing management. This may require remote assessment by telephone and home monitoring devices, where available, during a pandemic. Differentiation between an asthma attack and a COVID-19 infection requires a structured clinical assessment, taking account of previous medical and family history. Early separation into mild, moderate, severe or life-threatening attacks is helpful for continuing good management. Most attacks can be managed in primary care but when severe or unresponsive to initial treatment, the patient should be appropriately managed until transfer to an acute care facility can be arranged. Good quality care is important to prevent further attacks and must include a follow-up appointment in

Impact of COVID-19 pandemic on asthma exacerbations: Retrospective cohort study of over 500,000 patients in a national English primary care database

“…This is because no new pharmacological interventions (beyond what was available before the pandemic) were introduced during the pandemic and advice on asthma management and asthma exacerbations have remained unchanged. 35 These hypotheses all need more detailed investigation.…”

The Changing Asthma Management Landscape and Need for Appropriate SABA Prescription

“…This indicates that, unfortunately, there is often a lack of action by healthcare providers to address SABA overuse, when it occurs. In patients regularly taking ICS, high levels of SABA use should be viewed as an indicator of poor asthma control and prompt physicians to review their asthma management [9,42,48,[50][51][52].…”

“…An advantage of SABA reliever therapy is that the frequency of uptake is a helpful and commonly employed measure of asthma control [42,48,[50][51][52]. Indeed, the GINA assessment of asthma control considers frequency of SABA reliever use, alongside daytime symptoms, nighttime awakening, and activity limitation due to asthma [9].…”

Patients' and physicians’ perspectives on the burden and management of asthma: Results from the APPaRENT 2 study

“…For patients who remain uncontrolled on initial therapy, physicians were more likely to prescribe PRD with ICS/LABA with/without as-needed SABA than MART regimens; symptom worsening and exacerbations were the most common reasons for switching asthma medications. The recent review by Fletcher et al (2022) suggests that optimal asthma management following an exacerbation should, irrespective of care setting, involve prescribing PRD with controller therapy followed by a primary care visit within 2 weeks to evaluate patient response and maintain asthma control [27].…”