The joys of asthma/allergies in the Age of COVID - how to balance caution and realism?

Especially this time of year, I have crappy lungs (allergies/asthma). I take daily Claritin, which controls the worst of it, but sometimes I still cough. (Mold is my worst allergy, so especially when it’s been raining, as it has here the past couple of days, my lungs are not happy.)

I’ve been self-isolating pretty hard: groceries are delivered or obtained via curbside pickup in a mask, I wear a mask basically anytime I am going further than my front yard, and I haven’t set foot in a public building since March except for a brief medical appointment (provider and myself both masked).

So odds that I have picked up anything contagious ought to be pretty low, but nothing is zero. However, I’d never forgive myself if I got anyone else sick, and I have been volunteering at a free weekly veggie giveaway at a local community garden with a handful of other people (all outdoors and masked). What, if any, level of COVID testing would be reasonable in order to assure myself and others that any coughing is just my regular coughing? Assume for the sake of debate that I have no fever or other symptoms except congestion (which I also have regularly for the same reasons as the coughing). Testing is readily available where I live, but of course I don’t want to get tested just for the heck of it.

It is a conundrum. The only input I have is that you might want to contact your provider to discuss a step up on your maintenance plan (such as possibly going on a steroid inhaler) to better reduce having the asthma cough that puts you in this dilemma.

Normally if I take Claritin, the coughing is minimal. Historically I haven’t needed a maintenance med unless I am having a (rare) flare-up, usually in the aftermath of (ironically) some kind of respiratory infection. Maybe once every 2 - 3 years if that.

The most important thing is that your asthma symptoms are under control. If this does not require puffers except during bronchitis infections, your asthma is very mild. It may not even be asthma.

If allergy symptoms are cough, sneezing, watery eyes and runny nose - wearing a mask benefits others. In the absence of other symptoms or changes in symptoms, testing probably would not help. It is not unreasonable to do one test. But symptoms would possibly be worse with coronavirus.

I do have an albuterol rescue inhaler, which I use occasionally. But I don’t normally require other maintenance asthma drugs (Advair, steroids, etc.) unless something else is going on.

Obviously I am wearing a mask around anyone who does not live with me, even outdoors. Symptoms might well be worse with coronavirus, but my dad was completely asymptomatic even after my stepmother died of coronavirus in April. He only discovered he had been infected when unrelated bloodwork revealed he had antibodies. The antibodies weren’t a surprise, of course; the part where the 79-year-old asthmatic was asymptomatic throughout, however, is another story. If he could be asymptomatic, pretty much anybody can.

You can get a test. If it comes back positive, you isolate and continue your precautions. If it comes back negative, great. But there might be a temptation to retest in a month or two. If generally well and no change in symptoms, you should follow local advice and your desires. I would advise against testing if you were my patient; recognizing one test is quite reasonable especially if anxious.

I think she’s asking if she should live a life of perpetual isolation, as she can never be sure her cough isn’t COVID.

I wounder too. What are the ethics?

I don’t think she should, particularly if her asthma is mild. In the absence of changes there is no particular reason to believe a chronic habitual cough is corona. Her local situation and circumstances are doubtless unique and more complex than any Internet summary. A local doctor is well placed to give her personal advice.

I am not planning to live a life of perpetual isolation unless there is some reason it’s warranted. But I don’t want to gloss over the risk, however minimal, to myself and others. I am in Chicago, and in a zip code that has been quite impacted, if not the worst impacted. I think my choices have been on the cautious side of reasonable and am just wondering whether there is some consideration that I am missing.

FWIW the idea of being on maintenance is that in a normal season a minimal asthma cough that you occasionally use your rescue inhaler for is no problem, but now each time raises this issue. Fewer cough episodes, even mild ones, equals fewer times having to have this particular wrestling match over your ethics.

That makes sense. Maybe I will give my doc a call and see what he thinks. I am generally a fan of minimizing drugs, but when I go for my annual physical he often seems a tad surprised that I don’t do maintenance asthma drugs on a regular basis. (And he had to strong-arm me into taking regular allergy meds. After a string of drawn-out sinus infections, he told me, Eva Luna, you have allergies. Sinus congestion is cumulative. If you actually treat your allergies, you probably won’t keep getting sinus infections!" I finally gave in, and whaddaya know, he was right.)

If you’re coughing regularly, going on a low dose steroid inhaler would probably be advised even without coronavirus. They’ve been prescribed for decades and tested continuously - the side effects are minimal compared to the benefits.

WRT coronavirus, it should reduce your coughing, which would reduce the chances of transmission (even with a mask).

FWIW I cough a fair amount due to asthma, and always explain, through my mask (or without a mask, if it’s a delivery and I’m nowhere near the delivery person), that it’s asthma, not covid. They never seem concerned. I’m genuinely certainly about it being asthma, and it does sound like an asthmatic cough rather than a lung infection.

Outdoors transmission seems to be extremely low. Outdoors transmission with masks, not getting too close to people, is not going to be zero, but it’s going to be really close. I don’t think there’s anything more you can do to help other people, but helping yourself wouldn’t be a bad idea.

I was just coming in to say this, as someone with fairly mild asthma. I stopped taking a ‘preventative’ in haler for a while, and my asthma nurse and GP were quite cross with me - they basically said if you’re using your reliever fairly regularly and coughing a lot, then your asthma isn’t being managed correctly.

I too get bad allergies at this time of year (mould, I get you), so I also switched last year from over-the-counter antihistamines (clarytin and others) to prescription Fexofenadine, and I have to say it has been life transforming. I basically don’t experience allergies at all any more.