During this time of COVID-19, pulmonary specialists have begun to recommend some changes in how inhaled corticosteroids (i.e.: Flovent) and oral steroids (i.e.: prednisone) are used for the routine management of asthma. There is some specific concern that the use of high dose steroids, orally or inhaled, during the early stages of COVID-19 infection may increase the chances that a patient has worsening rather than improvement of their respiratory symptoms.
This COVID-19 specific concern about high dose steroid use must be balanced with the ongoing need to keep our asthma patients healthy. Routine asthma management often requires the use of inhaled steroid medications along with rescue inhalers such as Albuterol/ProAir. Most of our outpatient pediatric population does not use high dose inhaled steroids, but they do use low dose (i.e. Flovent 44 mcg/QVAR 40 mcg) and medium dose (i.e. Flovent 110 mcg/QVAR 80 mcg) inhaled steroids to help control their asthma. These medications are important and help patients to avoid flares and prevent emergency room visits and hospital admissions.
At this time, based on what we know about COVID and with the guidance of our pulmonary colleagues, Centre Pediatric Associates recommends the following changes to Asthma Action Plans (AAP):
- Children under 10 years DO NOT require any changes to their AAP Green or Yellow zone care.
- Children 10 years and older, The Green Zone of AAP :
- DO NOT start your child on an inhaled steroid if not necessary (mild intermittent, exercise induced asthma). If you do not currently have an AAP that uses daily inhaled steroids in the Green Zone – do not start use. Albuterol inhaler use should continue as needed.
- If in your Green Zone, you take 1-2 puffs, once or twice a day of Flovent 44 mcg or 110 mcg inhalers or QVAR 40 mcg or 80 mcg inhalers – CONTINUE to do so.
- If in your Green Zone, you take 2 puffs twice daily of Advair HFA 45-21 mcg or Advair 115-21 mcg – CONTINUE to do so.
- If your child tests positive for COVID-19, STOP steroid inhalers including Green Zone use for 7 days if asthma control allows or as a medical provider advises. Continue Albuterol use.
- Children 10 years and older, Yellow Zone of AAP:
- DO NOT INCREASE your inhaled steroid (Flovent, QVAR, Advair) to the Yellow Zone number of puffs! Continue with your Green Zone dosing, unless directed otherwise by a medical provider.
- DO CONTINUE your Albuterol/ ProAir inhaler every 4-6 hours as needed for cough/wheeze.
- DO CALL OUR OFFICE if your child is using Albuterol more often than every 4 – 6 hours or has increased cough/wheeze. This is the Red Zone.
- If your child has an exacerbation in symptoms that requires an oral steroid such as prednisone, it would now be prescribed at a lower daily dose and for fewer total days.
Please call our office if you have questions about these recommendations or any concerns about your child’s asthma or their management plan (AAP). We are here to help you!