COVID-19 and Asthma: What People With Respiratory Conditions Should Know

Given that COVID-19 is a respiratory illness, it's a natural concern for the roughly one in twelve adults in the UK who live with asthma. The research picture that's emerged is more nuanced than a simple "asthma equals higher risk" conclusion and understanding the detail matters for how seriously different people should treat their individual risk.

What the evidence actually shows

Among more than 75,000 patients hospitalised with COVID-19 in the UK during 2020, people with asthma were around 1.2 times as likely to need critical care compared with patients without an underlying respiratory condition, a modestly increased but not dramatic risk. Notably, asthma overall hasn't been shown to be associated with a significantly increased risk of hospitalisation or worse outcomes from COVID-19 across the wider asthma population.

Severity makes a real difference

The picture changes for people with moderate to severe asthma specifically. Research has found this group faces a higher risk of experiencing severe symptoms if they catch COVID-19 and one study found patients aged 50 and over with severe asthma had an increased mortality risk compared with those not on asthma therapy at all. This distinction between well-controlled, milder asthma and moderate-to-severe asthma is one of the most important takeaways from the research.

Why control matters more than diagnosis alone

A key theme across the guidance from respiratory health bodies is that the best way for someone with asthma to protect themselves is to keep their asthma as stable and well-controlled as possible, rather than the diagnosis of asthma itself being the primary concern. Poorly controlled asthma, with frequent flare-ups or symptoms that aren't well managed by current treatment, appears to carry more risk than a diagnosis of mild, well-managed asthma.

Should you keep taking your usual asthma medication?

Yes. Health authorities have consistently advised people with asthma to continue their regular preventer and reliever inhalers as prescribed, since stopping or reducing asthma treatment during the pandemic created a real risk of flare-ups, which is a more immediate danger than any theoretical concern about the medication itself affecting COVID-19 risk. If you're at all unsure about your current asthma management plan, a review with your GP or asthma nurse is a better step than making changes on your own.

What about other respiratory conditions?

Conditions such as chronic obstructive pulmonary disease (COPD), bronchiectasis and other chronic lung conditions have generally been associated with a clearer increased risk from COVID-19 than mild asthma has, reflecting the greater baseline vulnerability of the lungs in these conditions. If you have one of these conditions, your respiratory team's specific guidance takes priority over general asthma-focused advice, since these conditions don't behave identically.

Recognising when symptoms need urgent attention

For anyone with asthma or another respiratory condition, it's worth being extra vigilant about the specific warning signs that COVID-19 symptoms have become serious: significantly worsened breathlessness, an inability to complete sentences due to breathing difficulty, or reliever inhalers becoming noticeably less effective than usual. These symptoms warrant urgent medical attention regardless of whether they're being caused by COVID-19, an asthma flare-up, or both together and it isn't necessary to work out which cause is responsible before seeking help. Call 999 or go to A&E if breathing difficulty is severe, your lips or face look blue, or you become too breathless to speak, rather than staying at home and simply waiting to see whether things gradually improve by themselves over the course of the next few hours.

Vaccination and antiviral treatment

People with more severe asthma and certain other chronic lung conditions are included among the groups prioritised for COVID-19 vaccination and, if eligible, for antiviral treatment following a positive test. Checking your specific eligibility with your GP, particularly if your asthma is moderate to severe or poorly controlled, ensures you're not missing protection you're entitled to.

Building a COVID-19 plan into your asthma action plan

Many people with asthma already use a written asthma action plan, agreed with their GP or asthma nurse, that sets out what to do as symptoms change. It's worth specifically discussing COVID-19 as part of that plan, covering questions such as when a change in breathing should prompt an urgent same-day GP contact rather than waiting, whether your current reliever and preventer doses are appropriate given your personal risk profile and what steps to take if you test positive while your asthma is already less than perfectly controlled.

Having this conversation before you're unwell, rather than during a flare-up, tends to lead to calmer, clearer decision-making if you do catch COVID-19. It also gives your GP or asthma nurse the chance to review your inhaler technique and current control level, since poor inhaler technique is a surprisingly common and easily fixable reason for asthma being less well controlled than it could be and correcting it can meaningfully improve day-to-day symptom control even outside the context of COVID-19 specifically, making it a worthwhile check-up regardless of the current level of virus circulating locally.

A quick recap

Mild, well-controlled asthma hasn't been strongly linked to worse COVID-19 outcomes, but moderate to severe asthma and asthma that isn't well controlled, does carry a meaningfully higher risk. Keeping asthma well managed with your existing prescribed treatment remains the most effective step you can take, alongside staying up to date with eligible vaccination.

Frequently asked questions

Does having asthma make me eligible for priority COVID-19 vaccination?

People with more severe asthma are generally included among groups prioritised for vaccination, though eligibility criteria can change, so it's worth checking current NHS guidance or asking your GP directly.

Can COVID-19 trigger an asthma flare-up?

Yes, like other respiratory infections, COVID-19 can trigger asthma symptoms to worsen, which is part of why keeping your regular asthma treatment stable is particularly important if you catch it.

Should I stop my inhaled steroid if I catch COVID-19?

No. Health guidance has consistently recommended continuing prescribed asthma medication, including inhaled steroids, during a COVID-19 infection unless your GP specifically advises otherwise.

Is childhood asthma treated the same as adult asthma for COVID-19 risk?

Children with asthma are generally at low risk of severe COVID-19 overall, in line with children's generally lower risk profile, though the same principle of keeping asthma well controlled still applies.

Does COPD carry a higher COVID-19 risk than asthma?

Chronic lung conditions like COPD have generally shown a clearer and stronger association with increased COVID-19 risk than mild asthma, reflecting differences in how these conditions affect baseline lung function.

Can I have a flu jab and COVID-19 vaccine at the same time if I have asthma?

Co-administration of both seasonal vaccines at the same appointment is generally offered where possible for eligible groups, including people with asthma and is considered safe by health authorities.

Does using a steroid inhaler regularly increase COVID-19 risk?

No, regularly prescribed inhaled steroids for asthma control aren't associated with increased COVID-19 risk and stopping them without medical advice is more likely to cause harm through poorly controlled asthma than any benefit from stopping. If you have concerns about your specific inhaler or its dose, raise them directly with your GP or asthma nurse rather than adjusting anything yourself, since even short gaps in regular preventer use can allow symptoms to worsen.