Asthma advice on cocooning during coronavirus

On Friday, March 27, An Taoiseach, Leo Varadkar announced to the nation, that people considered “extremely medically vulnerable”, including those with severe asthma and severe COPD, were required to practice “cocooning”. People in this extremely medically venerable category are considered to be at a higher risk of suffering complications if they do contract coronavirus.

Cocooning is a new term and means that people are over 70 years of age or who are “extremely medically vulnerable”, should stay at home at all times and avoid face-to-face contact with other people. More information on cocooning is available on the Asthma Society’s website – www.asthma.ie.

Immediately following this announcement, people with asthma in Ireland began contacting the Asthma Society of Ireland seeking clarity on what was meant by “severe asthma” to see if they themselves must cocoon.

Sarah O’Connor, CEO of the Asthma Society, said: “We were overrun by requests to our offices and to our Adviceline service looking for an exact definition of severe asthma. There was confusion as to what exactly classed someone’s asthma as severe asthma and who should cocoon. It is not simply a description of how a patient’s symptoms feel to them, as some patients believe. This makes it challenging for patients to know if they should cocoon, and they need our support to make this important health decision.

"We teamed up with our medical advisory group, made up of the top asthma experts in the country, to put together this definition for people with asthma and their concerned family members.

"Asthma exists on a spectrum. Severe asthma is a more difficult to manage form of the condition. Severe asthma is recognised by doctors through categorising the type, strength and dose of medication prescribed patient requires to keep their asthma in control and whether they have needed hospital treatment within the past 12 months. It can take months or years to diagnose a patient with severe asthma, as doctors may try different treatments to manage it.

"The full definition is available on our website at www.asthma.ie. The guidance we have prepared allows patients to work through a number of steps to establish if their medication strength and type indicates that they have severe asthma. If patients need any help in determining whether or not they should cocoon, we encourage you to contact our free call-back Adviceline service and speak to our specialist nurses who will be happy to help you.”

Marcus Butler, Medical Director of the Asthma Society of Ireland and Respiratory Specialist Consultant at St Vincent’s Hospital, said: “Severe asthma has only had an agreed definition internationally  since 2014. It is understandable that patients can find this hard to understand. We implemented a comprehensive definition of severe asthma to assist patients in ascertaining if they should cocoon, which is now available on the Asthma Society’s website. Patients should reach out to the Asthma Society Adviceline on 1800 44 54 64 and contact their GP or hospital consultant should they need additional information.

"The HSE is implementing appropriate measures to protect this group during the crisis and we recommend that guidance from the HSE and the Department of Health, including cocooning for severe asthma patients, is strictly adhered to.”

Experts consider severe asthma to be present in an adult or child in any if they meet specific criteria. People looking to find out if their asthma is considered severe asthma, should visit asthma.ie.  

Sarah O’Connor also said: “We are calling on all people with severe asthma to cocoon at least until Sunday 12 April, as recommended by An Taoiseach, Leo Varadkar, and possibly beyond should this date be extended by the government. People with severe asthma are considered at higher risk if they do catch coronavirus and for this reason, cocooning is advised for their own safety. Family, carers, neighbours and our public services will help ensure you have the support you need.

"If you are living with someone or caring for someone who is cocooning, please give them as much support as you can, while also avoiding all unnecessary face-to-face contact and maintaining physical distance.”

For people whose asthma does not fall within the definition published on the Asthma Society website for severe asthma, the HSE has still recommended that they stay home where possible, practice physical or social distancing, wash their hands often and take every precaution to ensure their asthma is well controlled. It is essential that patients follow this advice for their own safety. People with asthma should visit asthma.ie for asthma management tips.

Dr. Dermot Nolan, Clinical Lead for Asthma for the ICPG, said: “There is no data to suggest that people with asthma are more likely to get Covid-19, but they may struggle more with the virus if they do contract it, so they must be extra vigilant. There is every need to ensure that they adhere to all HSE and Department of Health guidelines and take sufficient care at this crucial stage.

"The vast majority of people with respiratory conditions can continue to get out for fresh air and exercise once a day, and even to work if necessary. If you are an essential healthcare worker, we recommend that you discuss your workplace exposure risk and your asthma-related risk of severe illness from covid-19 with your occupational health department and/or your regular asthma doctor, as the context for each worker is different.

"Anyone with asthma or COPD should monitor their conditions carefully and telephone their doctor to let them know about any additional symptoms, such as a fever or new cough, as early intervention is crucial for these groups in particular.”

Sarah O’Connor, concluded; “The Asthma Society has been working extremely hard to bring people with asthma and COPD up-to-date and accurate information during these challenging times. We have sourced additional hours and staff members for our Asthma and COPD Adviceline, which is available for free on 1800 44 54 64 or via email at nurse@asthma.ie.

"We will not, unfortunately, be able to continue this work without your support. Please text “asthma” to 50300 to donate €2 to the Asthma Society or go to asthma.ie to make a donation. We’d like to thank all who have donated so far.

"Text costs €2. The Asthma Society of Ireland will receive a minimum of €1.80. Service Provider: LIKECHARITY. Helpline: 076 6805278.”

Full text of Asthma Society guidance on severe asthma and cocooning below:

Asthma Society of Ireland - Cocooning and Severe Asthma

The government of Ireland has recommended that certain groups of people must ‘cocoon’ themselves for 2 weeks from 27 March 2020. This period may be extended. This new restriction applies to people who are considered extremely medically vulnerable if they contract coronavirus. (It does not mean you are prone to contracting it, but that the symptoms may be more severe if you do.*)

What is cocooning and what does it involve?

Cocooning is a new term and means that, if you are over 70 years of age or are extremely medically vulnerable, you should stay at home at all times and avoid face-to-face contact with anyone. Even within your home, you should minimise all non-essential contact with other members of your household.

Family, carers, neighbours and our public services will help ensure you have the support you need.

It is essential to your health – and your life – that you follow this advice strictly.

More information is available on how to cocoon on the HSE website.

Who is considered extremely medically vulnerable?

The government has listed all the groups that are considered extremely medically vulnerable.

Important for our members and supporters:

Included in the group of extremely medically vulnerable people who are advised to cocoon themselves are people who have severe respiratory conditions including cystic fibrosis, severe asthma and severe COPD.

Those who have severe asthma and become unwell due to COVID-19 should inform their GP or hospital asthma team or hospital asthma nurse.

Our medical advisory group has put together an explanation of how ‘severe asthma’ is defined. This information is subject to change as more information about coronavirus becomes available.  

If any of these categories apply to you, you are advised to cocoon yourself for 2 weeks starting 27 March 2020, under new restrictions introduced by An Taoiseach Leo Varadkar.

 

ATTENTION HEALTHCARE WORKERS:

IF YOU ARE AN ESSENTIAL HEALTHCARE WORKER, WE RECOMMEND THAT YOU DISCUSS YOUR WORKPLACE EXPOSURE RISK AND YOUR ASTHMA-RELATED RISK OF SEVERE ILLNESS FROM COVID-19 WITH YOUR OCCUPATIONAL HEALTH DEPARTMENT AND/OR YOUR REGULAR ASTHMA DOCTOR, AS THE CONTEXT FOR EACH WORKER IS DIFFERENT.

 

What is severe asthma and do I have it?

Severe asthma, a high-risk form of asthma, can be defined in different ways.

Severe asthma is defined by experts as asthma that requires treatment with high-dose inhaled corticosteroids plus a second controller and/or systemic corticosteroids to prevent it from becoming ‘uncontrolled’ or that remains ‘uncontrolled’ despite this therapy. Patients with severe asthma are usually under the care of specialist centres and may be on long-term injection (“biological”) therapy.

Experts consider severe asthma to be present in an adult or child in any of the following 4 cases (numbers do not indicate severity of asthma):

You are prescribed a long term injection (“Biological”) treatment for your asthma, e.g. “Cinqaero” (reslizumab), “Fasenra” (benralizumab), “Nucala” (mepolizumab) or “Xolair” (omalizumab)

OR

You have ever ended up in intensive care with your asthma
OR

You had to stay overnight in an Emergency Department or were admitted to hospital with asthma in the past 12 months

OR

You are prescribed any of the medications listed below (to prevent your asthma from becoming ‘uncontrolled’ or that remains ‘uncontrolled’ despite this therapy):

High-strength versions of an inhalers, specifically:

The high-strength version of an inhaler called “Aerivio” (50/500) one puff twice daily
The high-strength version of an inhaler called “Airflusal” (50/500) one puff twice daily
The high-strength version of an inhaler called “Bufomix” (320/9) two puffs twice daily
The high-strength version of an inhaler called “DuoResp” (320/9) two puffs twice daily
The high-strength version of an inhaler called “Flutiform” (250/10) two puffs twice daily
The high-strength version of an inhaler called “Fostair” (200/6) two puffs twice daily
The high-strength version of an inhaler called “Relvar” (184/22) one puff daily
The high-strength version of an inhaler called “Sereflo” (25/250) two puffs twice daily
The high-strength version of an inhaler called “Seretide” (500/50) one puff twice daily or (250/25) two puffs twice daily
The high-strength version of an inhaler called “Sirdupla” (25/250) two puffs twice daily
The high-strength version of an inhaler called “Symbicort” (400/12) two puffs twice daily
Long term maintenance steroid tablets or steroid liquids, specifically:

A long term maintenance steroid tablet or steroid liquid for asthma called “Deltacortril”
A long term maintenance steroid tablet or steroid liquid for asthma called “Prednesol” (prednisolone)
Cocooning is advisable for any asthma patient who is not on long term maintenance steroids BUT HAS HAD FOUR OR MORE COURSES OF STEROID TABLETS/LIQUID IN THE PAST 12 MONTHS AS RESCUE TREATMENT FOR AN ASTHMA FLARE-UP
Long term maintenance medicine, specifically:

A long term maintenance medicine, often prescribed to be taken on a Monday, Wednesday and Friday, or once every day, called Azithromycin
A long term maintenance medicine, often prescribed to be taken on a Monday, Wednesday and Friday, or once every day, called Zithromax
Combination of a tablet and high strength version of an inhaled steroid, specifically:

The combination of a tablet called “Montelair” or “Montelukast” or “Singulair”
AND

a high strength version of an inhaled steroid.

Examples of a high strength version of an inhaled steroid include:

two puffs twice daily of “Alvesco” (the 80 mcg strength) or one puff twice daily of “Alvesco” (the 160 mcg strength)
two puffs twice daily of “Asmanex” (the 200 mcg strength)
two puffs twice daily of “Beclazone” (the 250 mcg strength)
two puffs twice daily of “Becotide” (the 250 mcg strength)
two puffs twice daily of “Flixotide” (the 250 mcg strength) or one puff twice daily of “Flixotide” (the 500 mcg strength)
two puffs twice daily of ”Novolizer Budesonide” (the 400 mcg strength)
two puffs twice daily of “Pulmicort” (the 400 mcg strength)
Important! Please note:

*Currently, there is no scientific literature that patients who have severe asthma are at a greater risk of developing more serious complications from COVID-19.

Medications are listed in alphabetical order; the order of the medications does not suggest any clinical preference or effectiveness.

Where specified, it is the prescribed daily number of puffs of the medication that indicates the asthma is severe.
Every controller/preventer inhaler is different. Whether they indicate you have severe asthma depends on:
The strength of your specific controller inhaler
The number of daily doses prescribed
Whether or not other controllers are prescribed to you
An asthma doctor has determined that your asthma requires such dosages to prevent your asthma from becoming ‘uncontrolled’ or that remains ‘uncontrolled’ despite this therapy.
Blue inhalers such as “Bricanyl”, “Salamol”, “Salbutamol”, and “Ventolin” are reliever inhalers (the medicine can also be used in a nebuliser) and are not taken into account in the definition of severe asthma.

Our cocooning and severe asthma information may be subject to change given the landscape we’re working in.