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COVID-19 – your questions answered by a respiratory expert

We took your questions and spoke with an infectious diseases expert from the European Respiratory Society (ERS), Professor James Chalmers [1] and intensive care specialist, Professor Leo Heunks. This will give you up-to-date and respiratory-specific information about COVID-19. If you have any other respiratory health questions relating to the outbreak please get in touch info@europeanlung.org 

In many cases, the advice for people with lung conditions is the same regardless of condition. Because of this, unless the question clearly states a specific disease, the advice applies to multiple conditions. 

Disclaimer

The information provided on this page is advice only. It does not substitute for speaking with your doctor or your employer. You should always follow the advice given to you from your healthcare professional. We are not a government agency and cannot answer questions about your financial/employment situation.

We try to answer as many questions as we can, but we are unable to answer questions that are about your specific case. Please do not send us your medical reports, test results of photos or yourself. We are also unable to advise about conditions which are are not related to respiratory conditions.

The questions that we receive are often changed slightly to make them relevant to more people. Please read this page thoroughly to check for an answer to your question before sending it through to us.

Summary of advice for people with lung conditions 

 

Video interview with Prof. Tobias Welte

Prof. Welte is an infections expert from the European Respiratory Society and coordinator for the national German COVID-19 task force.This insightful Q and A was held online for the staff working for both the European Respiratory Society and the European Lung Foundation on March 25, 2020. Prof. Welte answered some of our questions about COVID-19 and we would like to share it with you all.

 

  • General

    I have a lung condition; am I at more risk of getting COVID-19 than somebody who doesn’t have a lung condition?

    No - the infection can be caught by anyone. However, people with underlying lung conditions might be more likely to show symptoms of the infection or to have a more severe infection than others.

    So far, most people that get COVID-19 have a mild viral illness, but some people develop a chest infection/pneumonia. We are not yet certain if people with lung conditions are more likely to get a chest infection after COVID-19, but it is likely since this is the case with other viruses like flu.

     

    Please can you provide detailed information about who is at high risk from a respiratory standpoint?

    Any severe respiratory condition is likely to place you at higher risk of complications, in particular:

    • Severe COPD
    • Severe asthma (meaning regularly requiring steroids for exacerbations, or taking a biological treatment of long-term corticosteroids)
    • Bronchiectasis, particularly if you experience frequent chest infections
    • Cystic fibrosis
    • Any other pulmonary condition where you are severely disabled by breathlessness (unable to leave the house due to breathlessness for example) or requiring long-term oxygen treatment
    • Lung cancer if currently active and being treated with chemotherapy or radiotherapy

    There are hundreds of different lung conditions and so it is not possible to list them all. Remember that being “high risk” means you have a slightly higher risk of complications of COVID-19 infection than other people, but you are still mostly likely, if you contract the virus, to have a mild illness or no symptoms at all.

     

    Are there any additional measures that I should take to limit my risk of getting sick as I have a lung condition?

    Follow the advice from your country’s health authorities - this will be slightly different in each country depending on how many cases there are in your country.

    There are things that everyone should do to limit their risk. If you have a lung condition, the following are important.

    • Avoid contact with anyone who is sick. Ask sick friends or relatives not to visit you and keep distance of at least 2 metres from anyone sick that you encounter in public.
    • Do not touch your mouth, nose or eyes with unwashed hands unless unavoidable.
    • Wash your hands thoroughly after touching surfaces that may be contaminated. Wash your hands with warm water and soap for 20 seconds.
    • Make sure you take all of your regular medications and keep up with your usual treatments to keep your lungs as healthy as possible.

     

    Should I consider self-isolating to avoid catching the virus?

    Self-isolating means staying indoors as much as possible and avoiding contact with others. The advice on self-isolation is different in different countries at the moment, but the following are sensible steps that apply to all countries in Europe:

    • If you have symptoms of fever, cough or a chest infection you should self-isolate.
    • If you do not have symptoms, avoid contact with anyone who is sick, even if they “just have a mild cold”.
    • Stay at home as much as possible, including working from home if this is feasible.
    • If you are in an area with a high number of COVID-19 cases, you may be asked to do a more strict isolation.

     

    Am I safe outside of the house provided I avoid crowded areas e.g. can I go to the park or walk outside?

    Yes. The virus is caught from people that have the infection and so there is no problem in going outside by yourself. What is important is to avoid contact with anyone who might be ill. Events outside where a large number of people are together have been cancelled around Europe and so you should not be attending any events or meetings where large numbers of people are coming together.

     

    Are people with respiratory disease more likely to die of COVID-19 than those without?

    So far, older age and the presence of underlying conditions - including lung conditions - have been risk factors for death. Nevertheless, it is important to emphasise that most patients, even those with underlying respiratory disease, have had mild infections and have fully recovered.

     

    As part of my condition, I regularly have a dry cough and fever – is there a way to distinguish these symptoms with those of COVID-19?

    No. There is nothing unique about the symptoms of COVID-19 and this is why most people who are tested for the virus do not have it. Their cough and fever are actually caused by something else.

    If you have a cough and fever that is typical for you, and you are not unwell enough to need hospital treatment, you should self-isolate at home until the symptoms have resolved.

     

    Should I wear a mask to protect myself from the virus?

    For the general population wearing a mask is only recommended if you are experiencing symptoms, such as a cough or a fever, or if you are caring for someone with these symptoms.

    Wearing a mask if you have a respiratory condition is not recommended as this may make breathing more difficult. If you have a respiratory condition and are concerned about catching COVID-19, discuss this with your doctor.

    To prevent shortages of face masks it is important to only use them if needed. When wearing a mask, it is important to use and dispose of them in the correct way. The World Health Organization has useful information about this.  

     

    Can I catch COVID-19 from my pet?

    There is currently no evidence that humans can catch the disease from common household animals such as cats and dogs.

     

    My neighbours often smoke in their garden and the smoke comes into my house if the windows are open. Can COVID-19 be transmitted through exhaled smoke?

    There is no evidence that COVID-19 can be transmitted through smoke, but passive smoke exposure can still be harmful to people with lung conditions in other ways. It might be worth closing the windows if your neighbours are smoking.

      

    The news says that the worst affected by COVID-19 are the older age population and ‘people’ with pre-existing conditions. Are ‘people with pre-existing conditions’ also older or does this refer to people of any age?

    Most people dying from COVID-19 in the reports from China and other countries have been aged over 80 years and have had advanced heart and lung conditions. They have had a combination of older age and severe pre-existing conditions. The majority of both older people and people with pre-existing conditions have had a mild viral illness and have fully recovered.

     

    I had the flu vaccine this year, am I protected from this virus?

    The flu vaccination only protects against the flu (influenza virus) and does not protect against COVID-19. There is no vaccine for COVID-19 and it is not likely that one will become available during the current pandemic.

     

    What is being done to protect the vulnerable population (elderly, people with health conditions)?

    To protect older people and those with underlying health conditions, most European countries have adopted “social distancing” and self-isolation procedures. This means asking people to stay at home more than usual, practice good hand hygiene and keeping their distance in public to reduce transmission.

     

    What are organisations in Europe doing about the situation?

    The European Centre for Disease Prevention and Control is focusing on containing the virus by identifying and testing suspected cases as early as possible, and limiting the impact of the disease by securing preparedness services and personal measures such as hand washing. 

    The ERS and PREPARE have teamed up to produce a series of webinars about COVID-19 which you can watch here. 

     

    Should I inhale hot water vapour to prevent COVID-19?

    There is no reason to believe hot water vapour would be either helpful or harmful with COVID-19.

  • Work

    I work with vulnerable people (in a school, in a carehome, in healthcare). The people I work with are at high risk of COVID-19 and I am concerned that I could pass it on to them even if I feel well. What should I do?

    You should speak to your employer as the approach to this will be different in different settings and it is not possible to give definitive advice without more information. In general, if you are having contact with anyone who is at high risk for COVID-19, the advice would be as follows.

    • The virus can be transmitted by people who have no symptoms, so to protect yourself and others, keep physical contact to a minimum. Wherever possible, maintain a distance of 2 metres from others. This will not be possible where you have close caring responsibilities and so minimise contact as far as possible.
    • Wash your hands regularly with soap and water for 20 seconds (or if soap is not available, use hand sanitizer) regularly.
    • Avoid touching your face, mouth, eyes or nose wherever possible.
    • Strictly avoid contact with people who are showing symptoms of fever, cough or a viral infection (and if you have been in contact inform your employer immediately)

     

    I work in an environment with a lot of human contact (school, healthcare, etc.) I have a respiratory condition, so I am high risk if I catch COVID-19; what should I do?

    You should speak to your employer or occupational health department for advice with regards to self-isolation.

     

    I have a lung condition; would I be eligible for government support if I need to stop work?

    This is not something we can answer as the answer will be different in different countries across Europe. You should discuss with your employer or the appropriate government body for advice.

     

    My job has said that if you have a condition which means that you are at high risk then you should work remotely. What conditions would be considered to be at high risk?

    Different countries will have different standards for this, and you should look at the government advice for your country.  The high-risk conditions are likely to include:

    • aged 70 or older (regardless of medical conditions)
    • under 70 with an underlying health condition listed below (i.e. anyone instructed to get a flu jab as an adult each year on medical grounds):
      • chronic (long-term) respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema or bronchitis
      • chronic heart disease, such as heart failure
      • chronic kidney disease
      • chronic liver disease, such as hepatitis
      • chronic neurological conditions, such as Parkinson’s disease, motor neurone disease, multiple sclerosis (MS), a learning disability or cerebral palsy
      • diabetes
      • problems with your spleen – for example, sickle cell disease or if you have had your spleen removed
      • a weakened immune system as the result of conditions such as HIV and AIDS, or medicines such as steroids tablets or chemotherapy
      • being seriously overweight (a body mass index (BMI) of 40 or above)
    • those who are pregnant

    The list above was taken from the public health England advice page

     

    I have a family member who is high-risk and I work in a front-line position (hospital, care home, prison, school). I am concerned that working with patients I might get sick and pass this on to my high-risk family member. What should I do?

    You should discuss this with your employer. The most important thing to do is to practice good hand hygiene, have appropriate personal protective equipment if you are interacting with patients known or suspected of having COVID-19 and to practice social distancing. This limits both your risk and the risk of your family member of getting the infection.

     

    I’m a nurse, I have bronchiectasis and asthma. I work on a surgical ICU that is now the hospital's COVID-19 centre. Should I demand to wear a N95 respirator?

    You should discuss your bronchiectasis and asthma with your employer as some hospitals are redeploying patients with high-risk conditions away from roles where you would be in direct contact with patients with COVID-19. This is not the case everywhere and the decision of whether you should be working there depends on the severity of your underlying lung conditions and should be discussed with your employer.

    On the specific question of the mask, you should follow your local infection control guidelines. There is no need to wear a different mask because of your lung conditions.

  • Travel

    My partner has to travel by plane for treatment for his condition. What can we do to keep him safe?

    Travel for people with underlying conditions should be limited as much as possible and restricted to only essential trips. In this case, if the trip is essential, you should follow the steps outlined at the top of this page, including practicing good hand hygiene during every part of the trip. 

     

    Should I avoid using public transport? / what is the best type of transport to use?

    For patients with underlying lung conditions, we suggest limiting journeys as much as possible. Public transport, such as bus and train journeys, may be necessary, in which case the best way to reduce the risk of transmission is to wash your hands thoroughly before and after the journey, avoid touching your face, nose and eyes, and try to maintain a distance of more than 2 metres from other passengers if possible.

    Public transport with the fewest passengers or that limits your contact with potentially sick people is the best, but we recognise that some journeys are unavoidable.

  • Children

    Should I be worried about sending my child to school?

    Many countries in Europe have now closed schools in response to the outbreak. If your country has not yet closed schools, we recommend following the advice from your school and local government. Children can contract COVID-19, but most frequently have a mild viral illness. The risk to your child and any risk to you as a person with lung disease should be discussed with your school before a decision to take your child out of school is taken. 

    In the event that more widespread transmission and large outbreaks are detected in the country, schools in specific regions may be advised to close.

     

    My child has a lung condition; what should I be doing to protect them?

    If they are old enough, ensure they have been taught about how to wash their hands properly and to avoid touching their mouth, nose and eyes with unwashed hands. Consider social distancing measures, such as reducing out of school activities and avoiding events where they will be in contact with a large number of people. 

    Most importantly, the disease is generally mild in children, but could cause problems in children if their lung condition is not under good control. Make sure they are taking all of their regular medications, such as preventor inhalers for asthma, to reduce their risk of complications if they do get the infection.

     

    I have children and I have a lung condition; what should I do to ensure that I am still safe?

    Both you and your children should practice good handwashing with soap and water for 20 seconds regularly through the day and particularly after your child has come home from school (if applicable) and before meals. Both you and your children should avoid contact with anyone who is sick or who has been in contact with people potentially infected with COVID-19.

     

  • Medications

    I use an inhaler, can it become infected? What can I do to prevent it? Should I get a new inhaler or just clean my current one?

    Your inhaler should only be used by you, and it should be kept clean and stored in a safe place where it cannot be handled by others. In this way, you can avoid the inhaler being a source of infection. There is no need to get a new one.

     

    Is there a risk of my medication becoming infected if it is produced somewhere with a high rate of COVID-19?

    No - medications are manufactured according to very strict and very carefully controlled hygiene standards.

    Even if these systems were to fail for any reason, the virus is not able to survive for long periods on surfaces like cardboard (for medication packs) or plastic (for devices like inhalers). Therefore, by the time the medication has been shipped from the countries in question to the pharmacy and has been given to you, the virus would be dead.

     

    Can I increase my normal dosage of treatments to protect myself from COVID-19?

    It is very important not to make any changes to your treatment while the COVID-19 pandemic is ongoing. Your treatments help to keep your lungs healthy and any changes to your treatment that have not been recommended by a healthcare professional could put you at higher risk of a flare-up of your lung condition. The health service in many countries is likely to be overwhelmed over the coming months and so keeping everyone as healthy as possible is key to reducing the burden on doctors and hospitals. 

    Please take all of your medications exactly as prescribed.

     

    Should I be worried about medication shortages?

    Everything is being done to ensure that the supplies of essential medications are maintained. There is no cause for concern. The European Medicines Agency are monitoring the situation and to date have reported no shortage of essential medications.

     

    Are patients with asthma who are using anti-IL5 treatments or similar, that reduce eosinophils, at higher risk?  Should they stop or modify dosages? 

    Do not stop or modify any of your asthma medications because of concern about COVID-19. There is a risk that doing that could make your asthma control worse, causing you to need medical treatment or hospital admission. 

    Anti-IL-5 should have no effect on the risk of getting COVID-19, and keeping taking it could theoretically reduce the risk of an asthma attack if you were to contract the virus.

     

    I have concerns about taking my regular medication for lung infections (prednisolone and doxycycline for any lung infection) as I have been advised that they might make COVID-19 worse. What should I do?

    The advice you have received is wrong – there is no evidence that prednisolone and doxycycline can make COVID-19 worse. The World Health Organization says that steroids should still be used for people with COPD who have a flare up (exacerbation) with COVID-19. Antibiotics are part of the standard treatment when patients are admitted to hospital with COVID-19.

    In summary, if you get a flare up, you should follow your doctor’s advice and use your medication.

     

    Can you please provide advice for patients who are on omalizumab / xolair?

    In general it is important that you keep taking all of your usual asthma treatment, including Omalizumab, to avoid having asthma attacks during the coronavirus pandemic.

    If you are using Xolair, by definition you have severe asthma and so you should follow your government advice for people with severe asthma.

     

    I take Fostair and salamol inhaler. I’ve just been told that if I’m asthmatic and taking a steroid I should be self-isolating for the 12 weeks as I’m higher risk.

    If that is the medical advice you have received from a healthcare professional then you should follow this advice.

  • Ventilation

    I am worried about shortages of ventilators. Would you recommend any that I can use at home?

    Ventilation should only be provided by a trained specialist and is not something that you should acquire yourself without specialist supervision.

     

    What preventative measures should I take if I use oxygen at home / if I use a nebuliser?

    If you use oxygen at home, this usually indicates that you have quite a severe underlying lung condition and so you should take steps to reduce your risk of getting COVID-19. These include:

    • Avoid contact with anyone who is sick. Ask sick friends or relatives not to visit you and keep a distance of at least 2 metres from anyone sick that you encounter in public.
    • Avoiding touching your mouth, nose or eyes with unwashed hands.
    • Wash your hands thoroughly after touching surfaces that may be contaminated. Wash your hands with warm water and soap for 20 seconds.
    • Make sure you take all of your regular medications and keep up with your usual treatments to keep your lungs as healthy as possible.

     

    I have obstructive sleep apnoea and use CPAP, is there anything that I should be aware of regarding the impact of COVID-19? 

    You should continue to use your treatment as normal.

     

    I have several conditions and use CPAP overnight. I’m worried that if I get hospitalized, because of my other conditions, ventilation may be prioritized for someone who is healthier. What should I do?

    Please be reassured that the vast majority of people who get COVID-19 infection do not require ventilation. Most people experience a mild viral illness (similar to a cold) and recover fully. This includes people that have underlying conditions.

    Hospitals around Europe are receiving extra ventilators and additional trained staff to ensure as many patients as possible can receive ventilation if it is required.

    The most important thing you can do is to make every effort to avoid getting the virus. This means following strict social distancing measures. For now, you should reduce contact with people outside your household as much as possible and practice strict hygiene measures in addition to:

    • Avoiding contact with someone who is displaying symptoms of coronavirus (COVID-19). These symptoms, include high temperature and/or new and continuous cough
    • Avoiding non-essential use of public transport when possible.
    • Work from home, where possible. Your employer should support you to do this.
    • Avoid large and small gatherings in public spaces, noting that bars, restaurants, leisure centres and similar venues are likely to be shut as infections spread easily in closed spaces where people gather together.
    • Avoid gatherings with friends and family. Keep in touch using remote technology such as phone, internet, and social media.Use telephone or online services to contact your GP or other essential services.

     

    I use non-invasive ventilation (NIV) what should I do if I get infected?

    Most patients with COVID-19 experience only mild symptoms, including fever and coughing. This will not be different for patients using NIV. Depending on the medical indication for NIV you may be more likely to develop severe symptoms, including dyspnea (shortness of breath) or hypoxemia (low levels of oxygen in the blood). Contact your doctor early if symptoms deteriorate.

    Also, if you are diagnosed with COVID-19 you may be more likely to infect other people while using NIV, especially with air leak around the interface. The high flow generated by the ventilator may distribute virus particles in the area around the patient. Discuss additional protective measures with you doctor.

     

    I use continuous positive airway pressure (CPAP) what should I do if I get infected?

    Most patients with COVID-19 experience only mild symptoms, including fever and coughing. This will not be different for patients using CPAP.

    If you are diagnosed with COVID-19, you may be more likely to infect other people while using NIV. The high flow generated by the ventilator may distribute virus particles in the area around the patient. Discuss additional protective measures with you doctor.

     

    I use invasive ventilation what should I do if I get infected?

    Most patients with COVID-19 experience only mild symptoms, including fever and coughing. This will not be different for patients using invasive mechanical ventilation. Depending on the medical indication for invasive ventilation you may be more likely to develop severe symptoms, including dyspnea (shortness of breath) or hypoxemia (low levels of oxygen in the blood). Contact your doctor early if symptoms deteriorate. 

    Also, if you are diagnosed with COVID-19 you may be more likely to infect other people while using mechanical ventilation, especially with air leak around the tracheostomy. The high flow generated by the ventilator may distribute virus particles in the area around the patient. Discuss additional protective measures with you doctor.

     

    Could CPAP machines be re-purposed as ventilators and if so is there a donation service I could give to?

    No, we would not use your CPAP machine in the hospital. It is important you carry on using your normal treatments during the coronavirus epidemic, including your CPAP.

  • Medical appointments

    I am experiencing symptoms of COVID-19; should I get tested?

    No. The current advice from public health is that if you are well enough to stay at home, you should self-isolate. Going out to get a test risks you passing the infection to someone else. You would only have a test if you are admitted to hospital or have to go to see a healthcare professional because your condition is getting worse.

     

    I have a lung condition and think that I have COVID-19, what steps should I take?

    If your symptoms are mild and you are managing okay at home, you should stay at home and “self-isolate” meaning you do not go out for at least 7 days. This is so that you do not risk passing the infection to anyone else. If you live with anyone else, they should not go out for at least 14 days. This is because the virus can be developing in them, and they might also risk infecting other people if they have caught it from you.

    Take paracetamol for any fever, and keep up with the usual treatments for your lung condition. Drink plenty of fluids as the fever can dehydrate you.

    If the symptoms worsen or are not improving, you can get advice from your healthcare professional. This works differently in different countries.

     

    I know that I should not go to the hospital if I think I am infected, but when should I seek medical attention if I have a pre-existing lung condition?

    If you think you have COVID-19 infection, ask yourself if you can manage the symptoms at home. Fever can be managed with paracetamol and drinking lots of fluids. If the symptoms are severe or you need additional advice, please contact your primary healthcare provider.

     

    I think I have COVID-19, I’m short of breath and my lungs feel constricted. What should I do? How can I manage the symptoms and when should I go to hospital?

    A useful question to ask yourself is “would I go to hospital the way I feel now if the coronavirus was not around?”. If the answer is yes, you should seek medical attention and may need treatment in hospital. The reasons for being admitted to hospital with COVID-19 are the same as for any lung infection. If you are too breathless to manage at home, the symptoms are worsening or not improving then you should get medical advice.

     

    I have a lung condition, I am experiencing symptoms of COVID-19 and I am unable to reach any medical specialists. I have been self-isolating for weeks and I’m scared. What should I do?

    It is important that you obtain medical help. If your condition has been going on for weeks and not improving, you should seek medical advice.

     

    Due to my condition, I usually get more ill when I go to hospital – should I avoid going to hospital to reduce my risk of catching COVID-19?

    Hospitals across Europe are likely to be very over-stretched in the coming months because of patients with COVID-19. If you can manage at home and do not need hospital treatment, please make every effort to avoid going to hospital. Use alternative services, such as community pharmacies and telephone services, wherever possible.

    Nevertheless, hospitals are there to help if you are ill enough to need hospital treatment and will be practicing very strict hygiene measures to avoid people catching COVID-19 from visits to hospital.

     

    Should I go ahead with scheduled appointments or should I avoid going to medical centres or hospitals?

    If your hospital is still running scheduled outpatient appointments, it would be a good idea to contact them and ask if you should still attend. Many places are cancelling routine appointments or conducting them over the phone wherever possible. There are certain conditions where face-to-face visits are still required and you should not miss a visit without first consulting your consultant, doctor, nurse or other healthcare provider.

    Only attend appointments if absolutely necessary.

  • Specific respiratory conditions

    Asthma:

    Are people with asthma more likely to experience severe complications and require ventilation?

    So far, we do not have any evidence that asthma patients are having severe complications with COVID-19. In the UK, the first report of intensive care unit admitted patients was released in mid-March and of 196 patients, only three had severe underlying lung conditions. This is lower than we would expect and suggests that most of the people being admitted with severe complications are not currently patients with lung conditions.

     

    Are people with asthma who have had COVID-19 recovering?

    Yes. So far there have been very few cases of severe COVID-19 infections in people with asthma and those that have been infected are recovering.

     

    I have asthma and use my preventer inhaler. I know this has steroids and I’ve been told that this can make COVID-19 symptoms worse. What should I do?

    What you have been told is wrong. Patients with asthma should never stop taking their preventer inhaler unless asked to do so by a medical professional. Stopping your steroid inhaler could put you at higher risk of complications with COVID-19 due to making your asthma worse. There is currently no reason to think that steroids make COVID-19 worse and research from China suggests steroids may make COVID-19 less severe. A UK trial is currently testing whether steroids work as a treatment here.

     

    Are patients who are using anti-IL5 treatments or similar, that reduce eosinophils, at higher risk?  Should they stop or modify dosages? 

    Do not stop or modify any of your asthma medications because of concern about COVID-19. There is a risk that doing that could make your asthma control worse, causing you to need medical treatment or hospital admission. 

    Anti-IL-5 should have no effect on the risk of getting COVID-19, and keeping taking it could theoretically reduce the risk of an asthma attack if you were to contract the virus.

     

    Bronchiectasis:

    Is there anything specific I should know about COVID-19 and my condition?

    People with bronchiectasis might be at higher risk of complications if they get the COVID-19, so here are a few suggestions to reduce your risk of getting the infection and the risk of complications if you do: 

    • Avoid contact with anyone who is sick. Ask sick friends or relatives not to visit you and keep distance of at least 2 metres from anyone sick that you encounter in public.
    • Do not touch your mouth, nose or eyes with unwashed hands unless unavoidable.
    • Wash your hands thoroughly after touching surfaces that may be contaminated. Wash your hands with warm water and soap for 20 seconds.
    • Make sure you take all of your regular medications and keep up with your usual treatments to keep your lungs as healthy as possible.
    • Specifically for bronchiectasis, ensure you do your airway clearance exercises regularly- this clears mucus from the lungs and reduces the risk of a flare-up (exacerbation).
    • If you develop a fever and cough, but feel well, try to increase the frequency of your airway clearance and take paracetamol to reduce fever. If you become more unwell, seek medical advice. If you have a home supply of antibiotics, as many patients with bronchiectasis do, only take this if your sputum (phlegm) increases in amount or becomes discoloured. Antibiotics will not work against a virus, but would treat a bacterial infection.

     

    I have bronchiectasis. Should I be self-isolating? And I am I more at risk of severe illness?

    Bronchiectasis is a very diverse condition from severe to mild, and so it is not possible to give one recommendation that covers everyone.

    People with bronchiectasis, if it is severe, meaning that you have frequent chest infections and/or take a long-term preventative antibiotics, should practice “shielding”, meaning staying indoors for the next 12 weeks.

    Patients with mild bronchiectasis, where you have only a mild cough and do not suffer from frequent chest infections might be ok to socially distance, meaning that you stay at home as much as possible but can still go outside for essential shopping or exercise.

    We do not know if bronchiectasis patients are more likely to have complications but I would recommend playing it safe.

     

    Are people with bronchiectasis getting over COVID-19?

    I am currently only aware of one patient with bronchiectasis who has had confirmed COVID-19 and they have recovered well, but none of the published studies has so far included people with bronchiectasis.

     

    Cancer:

    I have had cancer and was treated with chemotherapy and radiation; this was some time ago but am I still at a higher risk of COVID-19?

    It is difficult to comment on a specific case. The vast majority of people, even if they acquired COVID-19 and even if they have underlying conditions will have a mild illness similar to a cold or the flu. Severe heart disease and lung disease have been associated with worse outcomes, particularly in patients that are over the age of 80 years. Cancer, when successfully treated, is not usually a risk factor for worse outcomes in respiratory infections like COVID-19.

     

    Chronic Obstructive Pulmonary Disease (COPD):

    I have COPD, how will COVID-19 affect me?

    We have learned that in about 50% of people who contract COVID-19, they experience no symptoms at all. Some people will experience a mild cold with running nose, sore muscles, fever and a cough. Others develop a more “flu-like” illness with worse fever, sore muscles and tiredness. In the most severe cases it causes a pneumonia with breathlessness and coughing in addition to the symptoms above.

    Because COPD patients have lung problems to begin with, they may be more likely to experience breathlessness with COVID-19, and more likely therefore to need hospital treatment. Nevertheless, most people with COPD would experience no symptoms or just mild symptoms and make a full recovery.

     

    What are the risks of COVID-19 for people with severe pulmonary emphysema?

    Patients with severe COPD and emphysema are among those considered to be at higher risk of complications from COVID-19. This is because the lungs are affected by COVID-19, and if the lungs are already slightly damaged, they have less ability to fight the virus.

     

    Cystic fibrosis:

    Is there anything that I should not do as someone with cystic fibrosis?

    Please follow guidance from your healthcare professionals and the local response to COVID-19. 

    • We do not recommend self-isolation for all people with CF, but it may be appropriate to stay at home as much as possible.
    • Avoid places where there is likely to be an increased risk of exposure such as crowds - especially in poorly ventilated areas.
    • Currently there are no blanket recommendations about school attendance. This will depend on your local circumstances and individual advice from your local CF centre.
    • If you are employed, we recommend contacting your employer to consider what reasonable adjustments can be made to your working conditions to help protect you. Your local CF centre may be able to provide advice and support for this.

    The information above was summarised from the Cystic fibrosis Trust. They are found here https://www.cysticfibrosis.org.uk/news/COVID-19-qa

    UK CF Medical Association advise

     

    Lung transplant:

    I’ve had a lung transplant. Is there any specific advice that applies to me?

    Your transplant team or specialist may already have a plan in place and if so you should follow their advice. 

    In general, if you develop symptoms that would be consistent with a viral infection it would be advisable to self-isolate at home and contact your local transplant team for advice. If you are unwell with problems such as difficult breathing you should seek medical attention urgently, as would be the case at any other time.

     

    Pneumonia:

    I am generally healthy, but have had pneumonia several times. Does this mean that I will be affected more severely?

    No, previous infections do not increase the risk of more severe infections in future unless the previous infections were due to other diseases (such as severe heart or lung conditions, diabetes or conditions or drugs that suppress the immune system).

     

    Tuberculosis:

    I have TB; treatment is going well, but should I self-isolate?

    You should follow the national guidelines in your country. In the UK this would mean social distancing, which is not the same as self-isolating. You should stay at home as much as possible, but you can go out once a day for shopping and/or exercise. You should stay away from anyone else who is not in your family (maintain a distance of at least 2 metres while you are out).

     

    What about patients with TB on anti-TB treatment if they get infected with COVID-19? Is there any guidance of recommendation for treatment?

    It is important to continue with your TB treatment even if you start to feel unwell. Keep taking your medications unless advised by a healthcare professional. TB should not have any effect on the severity of COVID-19 infection. Treatment of COVID-19 infection might be more complicated due to interaction between TB medications and other medications, so it is important you speak to a pharmacist or doctor before taking medication.

     

    I had TB, I was treated and recovered, but have lasting damage to one of my lungs. Does this put me at a greater risk if I get COVID-19?

    Possibly. Post-TB lung damage often puts you at a higher risk of picking up chest infections and so you might be at slightly higher risk of having a chest infection if you were infected with COVID-19. It is important to emphasise, however, that most people experience either a mild illness or no symptoms at all, even if you have underlying lung disease.

     

    Alpha-1 Antitrypsin Deficiency 

    Do you recommend to patients receiving augmentation/replacement therapy for Alpha-1 Antitrypsin Deficiency that they should continue attending hospital to receive their treatment or is it better to go without for some weeks/months until the risk of infection diminishes?

    You would have to discuss this with your doctor who will know whether your treatment is essential or could be delayed until infection rates start to decline where you are.

     

    Other:

     

    I currently have flu, should I be more worried?

    If you have a confirmed influenza (flu) infection, then no, you don’t need to be more worried. Getting one virus does not make you more likely to get another infection.

     

    I have pleural thickening, does this put me at a higher risk if I catch COVID-19?

    No, pleural thickening would not affect the risk of catching COVID-19 and would not increase the risk of complications unless it is combined with other heart or lung conditions.

     

    I have pleurisy, am I more vulnerable if I contact COVID-19?

    No, unless the pleurisy is due to another underlying lung condition. The lung conditions that place you at greater risk are those that affect the airways or cause lower lung function, such as COPD, severe asthma, bronchiectasis, cystic fibrosis, pulmonary fibrosis or lung cancer.

     

    I have had part of my lung removed – how will COVID-19 affect me?

    If you are otherwise healthy, there is no reason to think that this would make COVID-19 infection more severe or more likely. 

    This information also applies to healthy people with smaller lungs casued for example, by scoliosis. 

     

    I have had pneumothorax (a collapsed lung), does this make me more at risk if I catch COVID-19? Am I more likely to get pneumonia?

    Not unless you also have other underlying health conditions. Pneumothorax can occur in a completely healthy person, and in that case, you are not at any greater risk from coronavirus than anyone else. If your pneumothorax was a complication of COPD, cystic fibrosis or another lung condition, then it is the underlying lung condition that would put you at risk.

     

    I have had pneumothorax (a collapsed lung), is my lung likely to collapse again if I get COVID-19?

    There is no evidence that this is the case. Pneumothorax is a rare complication of viral infections and there is no evidence that previous pneumothorax would put you more at risk unless you have another underlying lung condition.

     

    I have a pulmonary embolism, how will COVID-19 affect me?

    Pulmonary embolism, if it has been treated with blood thinning medication and your oxygen levels are normal, would not be expected to have any effect on your risk of complications with COVID-19.

     

    I am over 70 and have been diagnosed with Chronic Thromboembolic Disease and I am on lifelong Warfarin. What are the risks and should I remain in doors for 12 weeks?

    The recommendations are different in different countries, but in the UK at the moment (for example) you would not be asked to remain indoors for 12 weeks. You would be asked to “Socially distance”, meaning:

    • Avoid contact with someone who is displaying symptoms of coronavirus (COVID-19). These symptoms include high temperature and/or new and continuous cough
    • Avoid non-essential use of public transport when possible
    • Work from home, where possible.
    • Avoid large and small gatherings in public spaces, noting that pubs, restaurants, leisure centres and similar venues are currently shut as infections spread easily in closed spaces where people gather together.
    • Avoid gatherings with friends and family. Keep in touch using remote technology such as phone, internet, and social media
    • Use telephone or online services to contact your GP or other essential services

    Only those with severe underlying conditions such as immune problems, cancer or severe COPD, asthma and other lung conditions are being asked to stay indoors for 12 weeks. Chronic thromboembolic disease in not one of these conditions.

     

    I have a chronic cough; am I at a higher risk if I catch COVID-19?

    No, if you have a chronic cough that is not due to a severe lung condition like COPD or cystic fibrosis, you would not be considered to be at higher risk.

     

    I have had VATS and pleurodesis, does this put me at a higher risk of severe illness?

    No, VATS and pleurodesis treat the pleura - the lining of the lung. There is no evidence that COVID-19 affects the lining of the lung and so there is no reason to think this would make you more likely to get severe illness.

     

    I have low IgM levels, what risks does this pose to myself and my family at this time?

    Low levels of IgM, if they are not associated with low levels of IgG or IgA or another medical condition, would not be expected to greatly increase your risk of severe COVID-19 infection.

     

    My mother was diagnosed with oesophageal palsy how might COVID-19 affect her? Is she at high risk?

    It is hard to comment on individual cases, but this does not sound like a risk factor, in and of itself, for complications of COVID-19.

  • COVID-19

    Is there any long-term damage to the lungs after having COVID-19?

    The vast majority of people who are getting infection with COVID-19 are recovering fully with no lasting effects. Very severe infections or those that require ventilation in the intensive care unit can have effects on the lungs and muscles due to both the coronavirus and the effects of being in intensive care. Rehabilitation and support can help patients to get back to a normal life. This will only affect a small percentage of patients who get the infection.

     

    Will cases reduce when the weather warms up?

    The World Health Organization recently suggested this is not likely to happen. Although conditions like flu are more common in the winter, this might not be just because it is cold, but also because we spend more time together indoors in the winter and can transmit the virus more easily. The fact that big outbreaks of coronavirus have happened in countries that are much hotter than most of Europe suggests it spreads easily even in warm weather.

     

    How close are we to having a treatment?

    The first trials of treatment in China are already providing results and many trials are underway. Proof that some of the treatments for coronavirus are effective could come very soon, within months. A vaccine would be the most effective way to stop the spread of coronavirus and scientists are estimating that this is 12-18 months away. The first trials of a vaccine started this week (week commencing 16 March) .

     

    Can people catch COVID-19 more than once?

    The current research suggests that immunity to COVID-19 develops after the first infection and so it is not possible to catch it again. There are examples of viruses, like flu and the common cold, which can be caught more than once because of the way the virus changes over time. We won’t know for a while whether this can happen with COVID-19.

     

    Is COVID-19 airborne?

    SARS-CoV-2, the virus that causes COVID-19, is not airborne. It is spread by droplets. This means that it can travel a short distance if someone coughs or sneezes and releases droplets of water containing the virus. This is why we strongly recommend you stay at least 2 metres away from others at the moment, because this protects you from being affected by droplets.

     

    Is it still the case that for many who catch the virus, it will be little more than a mild flu like illness?

    Yes, for the vast majority of people if you catch COVID-19 you will experience no symptoms at all, or just mild symptoms.

     

    What is meant by mild symptoms?

    It can be as little as a runny nose and a headache, a mild fever, or a continuous cough for a few days. COVID-19 seems to be quite different for different people, but for the majority of people who have had it, it is mild and passes in a few days.

     

    If I have a common cold or the flu, can I still contract COVID-19 at the same time?

    If I can't contract COVID-19 when I have a common cold, should I get the cold as a preventative?

    You can get COVID-19 if you have other infections and there are reports from China and elsewhere of “co-infections” meaning two infections at the same time. Don’t catch the cold!

     

    How do you stop pulmonary fibrosis caused by COVID-19?

    We do not yet know that COVID-19 can cause pulmonary fibrosis. It is possible in some cases of what is called acute respiratory distress syndrome, that this could lead to fibrosis. This would affect only a very small percentage of overall cases of COVID-19. Research will be needed to find out how to prevent this. Several trials are happening across Europe to test treatments that might prevent this from happening.

  • Further Information

    [1] This information has been compiled with Professor James Chalmers, University of Dundee, Chair of the respiratory infection group (10.01) of the European Respiratory Society (ERS) and Deputy Chief Editor of the European Respiratory Journal (ERJ).

    Find out more and stay up-to-date on the latest news about COVID-19.

    We are working closely with respiratory experts from the European Respiratory Society (ERS) to answer as many questions related to COVID-19 as possible. If you have any other questions, you can contact us at info@europeanlung.org. We are receiving a large number of questions about COVID-19, so we are unable to respond directly to these emails. We will combine the questions that we receive, and these will be updated on the Q&A section of the website regularly.

    It is very important to ensure that you are accessing information from a trusted source. We would recommended that you go to: 

    COVID-19 materials produced by patient organisations

    Fundación Lovexair, España
    https://lovexair.com/covid-19-informacion-a-con-ciencia/
    https://happyair.org/enfermedades-respiratorias-y-coronavirus/

    Alfa-1 España
    https://alfa1.org.es/que-podemos-hacer-ante-el-covid-19/

    CF Europe
    https://www.cf-europe.eu/information/

    Pulmonale Hypertensie/ Dutch Pulmonary Hypertension Association
    https://stichtingpulmonalehypertensie.nl/antwoorden-op-vragen-over-corona-virus/

Materials are available in these languages:

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