COVID-19: Medication tips to help patients with COPD and asthma

People of all ages with underlying medical conditions, such as COPD and asthma, are at high-risk for severe illness from COVID-19, particularly if not well controlled. In addition to everyday precautions, such as frequent handwashing and the cleaning and disinfecting of high-touch surface areas, adhering to their maintenance medication regimen is another vital step patients with asthma or COPD can take to protect themselves from poor outcomes.

Below are some medication tips for helping patients with asthma or COPD:

• In the current pandemic, the best thing a patient with asthma or COPD can do is to keep their condition under control by adhering to their treatment plan. Asthma or COPD exacerbations may lead patients to seek emergency treatment and put them at risk for exposure to COVID-19.    
• As the spring allergy season approaches, it’s important patients with asthma understand there is no evidence that asthma medications used to prevent symptoms (inhaled corticosteroids, oral steroids, montelukast, biologics) increase the risk of contracting COVID-19.
• Patients who smoke are more vulnerable to COVID-19. In addition to reduced lung capacity, the act of smoking, where the fingers encounter the lips, increases the possibility of transmitting the virus from hand to mouth. If any of your patients with asthma or COPD smoke, now may be a good time to asses readiness to quit.
• If one of your patients has been diagnosed with COVID-19 or suspects he or she may have COVID-19 and currently uses a nebulizer, it’s important to advise the patient to administer the nebulized medication in a location that minimizes exposure to other members in the household, as the virus may persist in droplets in the air for one to two hours. In addition, if possible, choose a location where air is not recirculated in the home like a patio, porch or garage, and make sure to clean area surfaces once treatment is completed.
• Certain areas of the country are experiencing shortages of albuterol inhalers. The shortage is occurring because of the increased use of albuterol inhalers in hospitals for COVID-19 and suspected COVID-19 patients to help with respiratory issues. There is concern using nebulized medication in the hospital could transmit the virus in the air. The concern is only for hospital use and patients using their nebulizer at home should continue to do so following the instructions above. To help address this potential albuterol HFA shortage with patients, here are some recommendations to consider:

• For patients with asthma needing a refill of their albuterol inhaler, assess their current regimen. Is the patient using his or her “quick relief inhaler” more than two times a week? Is the patient filling a “quick relief inhaler” more than two times per year? If so, it may be time to add an inhaled corticosteroid to control asthma symptoms. 
• For patients with COPD needing a refill of their albuterol inhaler, review patient dyspnea and exacerbation risk, and assess inhaler technique and adherence. If the patient is requiring frequent use of rescue short-acting bronchodilators for symptom relief, it may be time to add a long-acting bronchodilator for better control.
• Remind patients that having and adhering to the right maintenance regimen will help reduce the need for quick relief medication. 

• Ensure your patients with asthma or COPD have an action plan to follow if symptoms arise and advise when to contact their doctor

Blue Cross is also taking steps to ensure our members are not in jeopardy of running out of their needed medications:

• Waiving early medication refill limits on maintenance medications.
• Encouraging use of 90-day mail order benefits. Through this benefit, members can get up to 90-day supply of most prescription drugs delivered right to their door with free standard shipping.
• Encouraging drive-through services offered at many retail pharmacies.
• Promoting local courier options for many retail pharmacies that may be available in members’ area for home delivery free of charge.

 If you have questions about this article, e-mail RxQualityPrograms@bcbsm.com.

This information is current as of April 7, 2020. Blue Cross Blue Shield of Michigan is continuously monitoring information and recommendations as they are made during the ongoing COVID-19 pandemic.

1. Information for Healthcare Professionals: COVID-19 and Underlying Conditions. (2020, April 4). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/hcp/underlying-conditions.html*
2. COVID-19 and Asthma: What Patients Need to Know: AAAAI. (n.d.). Retrieved from https://www.aaaai.org/conditions-and-treatments/library/asthma-library/covid-asthma *
3. During COVID-19 pandemic, normal allergy and asthma medications should be continued. (2020, March 27). Retrieved from https://acaai.org/news/during-covid-19-pandemic-normal-allergy-and-asthma-medications-should-be-continued *
4. A message to asthma sufferers about a shortage of albuterol metered dose inhalers. (2020, March 23). Retrieved from https://acaai.org/news/message-asthma-sufferers-about-shortage-albuterol-metered-dose-inhalers *
5. Q&A on smoking and COVID-19. (n.d.). Retrieved from https://www.who.int/news-room/q-a-detail/q-a-on-smoking-and-covid-19 *

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