Can someone clarify the asthma situation?

[Iremembertheelderlykoreanlady]

At first people with asthma were in group 6

Then they weren't

Now apparently people who use a brown preventer inhaler are back in group 6.

I used to use a brown inhaler but was using my blue one too much (asthma was not controlled) so they moved me to symbicort which is a combined inhaler.

So am I on the list for group 6 or not, as I don't use a brown inhaler anymore.

Does anyone know or could link to the guidance?

If your NHS hospital records have your SNOMED code for emergency asthma admission then you'll get a letter for group 6 direct from the NHS.

There is a chance your GP might not hold this information in their records if it was a long time ago. I know when the old paper systems became computerised it was a case of going through paper notes and inputting data manually. This must have been nearly 20 years ago now. But you still have a chance of being added via NHS hospital records.

I had my asthma review over the phone yesterday, (not very well controlled at the moment).

I was going to see if there was any way I could ask to be put into group 6 but the nurse says I’m already in it. Apparently they are working through the list alphabetically so it may be a while before I’m called.

If it’s true I am so happy, but confused. I have never been hospitalised, have had a number of prednisolone tablets but never more than one dose in a 3 month period. I have a few other health issues but none that are on the list and my BMI is under 40.

I guess I’ll have to wait & see if I get contacted....

It looks like the next wave of priorisation for vaccines is based on age. So I expect we are not being prioritised.

Asthma UK are disappointed that we're not being prioritised:

mobile.twitter.com/asthmauk/status/1365268539079335941

Well I'm in my 40s, so I should be in the next group anyway.

I take part in the Zoe symptom study and noticed that they use a different definition of 'severe asthma' to the government - interestingly I'm covered by the Zoe definition but not the government's:
covid.joinzoe.com/post/asthma-and-covid

I'd like to know why Zoe chose the definition they did and whether this is based on any particular evidence.

Thanks @Peakedin1997 - I hadn't seen that guidance before despite using the Zoe app daily to record my health. According to those criteria I also have severe asthma (unless you need to be taking all 3) as I take high dose inhaled corticosteroids and Montelukast.

I believe that the changes in the prioritisation is likely to be based on the large living risk prediction study that was published in the British Medical Journal (BMJ) last year. It is based on more than 2 million entries so I'd say the data are robust. Here you will see that asthma simply does not seem to be a significant risk, and most certainly not compared with many other conditions etc. If I had asthma, I would feel relieved that I'm not at increased risk (although there is a distinction made based on controlled vs uncontrolled asthma): www.bmj.com/content/371/bmj.m3731

@followthesciencebrickroad I'm not a medical person so I might not be reading that study correctly (especially not on a tiny phone screen), but it looks like asthma doesn't make you at higher risk of death (which is reassuring) but it does place you at slightly higher risk of hospitalisation.

Unfortunately (for me) the type of asthma medication I take is listed separately, and it looks like that medication does slightly increase the risk of both hospitalisation and death

@followthesciencebrickroad yes Asthma UK have said that the decision is based on that. My concerns are that 13% are asthmatic in that study, compared with the 8% of adults Asthma UK say currently receive treatment, so I suspect includes many very mild asthmatics, and that the study itself says a limitation may be people shielding/taking extra precautions, as I believe many asthmatics did in the first lockdown (and I think many were sent to work from home etc if in jobs like teaching).
I would feel more relieved if I could see similar data based only on asthmatics needing at least a steroid inhaler

Severe asthma is step 4 or 5 in GINA guidelines ginasthma.org/wp-content/uploads/2020/04/Main-pocket-guide_2020_04_03-final-wms.pdf

Moderate dose of steroid (over 400 a day budesonide/ beclometasone) plus LABA qualifies as severe. A significant minority, many more than the vaccine guidelines. I think the ship has sailed but hope that asthma uk will take this up if necessary for booster doses.

It must be worrying with uncertainty, but the vast majority of evidence/research so far point to there being no increase risk of Covid for those with asthma and it even seems not a particularly elevated risk for those with more severe forms of asthma (some studies suggest it might be a protective factor). I have friends who work in Covid wards and although anecdotal, they don't see many asthma sufferers and I believe there have been publications elsewhere about this. Seems the initial guidance was based on the fact that seasonal Corona (cold) viruses do affect asthma sufferers but appears this is not the case with the SARS-CoV-2 virus (like SARS-CoV and MERS-CoV, the two other pandemic coronaviruses):
www.aaaai.org/conditions-and-treatments/library/asthma-library/covid-asthma

I am.on the qvar and montelukast plus blue. My go categorically told me that because I have not been hospitalised overnight (just had nebulisers and got sent home) i am not group 6. She also told me children don't spread it and i'd be fine as a teacher. Bollocks.

She told me this over the phone, of course.

It must be very frustrating. I am in a group with increased risk (chronic heart condition). I was initially super careful but then looked into reams of data (here and abroad - at the time data in some other European countries were more accessible and granular) and from that I took that, actually, as a female with this condition and my age, I really wasn't at risk. Or at least that's what I read into it and so I relaxed - still within the rules - and was delighted. I was still called for a vaccine recently (I'm in my mid 50s) but I'm still convinced that I'm not at increased risk, and once the vaccine immunity kicks in, even less so obviously.

I do understand that children under 15 are roughly half as likely to pass it on as adults. This is due to the virus attaching to the ACE-2 receptors which children have a lot less of than adults, especially younger kids.

I don't know your personal situation at all, but I do know that some of my friends with very, very mild asthma have been left very worried. Some of them are anxious by nature and so it doesn't help whereas I'm probably not anxious enough (!) but it really has helped me during this pandemic. It's incredible how much scientists have learnt but let's listen to them and if we're handed a positive hand, let's roll with it!

@followthesciencebrickroad I can only speak for myself but I think the anxiety is a result of being told throughout the pandemic that you are at higher risk. Asthmatics are still listed as clinically vulnerable on the NHS website. If you did unfortunately die you would be classed as someone with an underlying condition (and the way that term is used in some parts of the media would suggest that your death was therefore not important). At one point the media was even reporting that people with underlying conditions would be lower down the priority list for treatment. I think that sort of rhetoric does inevitably make people more anxious and it is going to take time to undo that.

In terms of the actual risk based on everything I have read I think mild asthma probably doesn't pose much higher risk of death, However I'm not convinced that moderate / severe asthma doesn't, and I think the government's definition of severe asthma is too strict to cover everyone who is at higher risk.

I agree that age is a bigger risk factor and I think the fairest / simplest solution might have been just to vaccinate everyone who is eligible for a flu jab at the start of their respective age groups.

@Peakedin1997 Yes, I can see that the U-turn would worry people. I don't know about severe asthma but, again, as someone massively into data/stats, I did try to reassure some of my friends months back (in fact back in Aug/Sept) that there was no indication that non-severe asthma posed a higher risk from having read the risk data. The data was out there but I guess it's difficult to be convinced otherwise especially if people have 'invested' by being hyper-vigilant in the first lockdown. As I said, I was in a more high-risk group than asthmatics but looked at the data for me back in April/May and made my own mind up which resulted in me relaxing and living life as others - popping into shops, seeing people within the parameters set. I realise that not everyone would look into these kind of stats but I would highly recommend it because I then stopped 'shielding' in the sense that I had understood earlier. But I'm a natural born optimist! :)

I've just received a shielding letter for my asthma. I'm really confused as to why.

In the last month I've then been told I'm not at risk (JCVI guidelines) and couldn't be on the priority vaccine list.
Then told I'm moderate risk (group 6) when they changed the guidelines on February 13th.
Now I'm in the CEV group 4. I can't get my head around the difference in under a month.

Luckily I had my vaccination yesterday in group 6 before finding out when I got home I'm group 4.

Does anyone know what is going on? I can't find anything online to suggest I should be in group 4. I can't find the more comprehensive JCVI guidelines for group 4 asthma inclusion.

@purplebagladylovesgin that sounds really strange. The criteria for group 6 was supposed to be a certain dose of oral steroids and/or recent hospitalisation (although some asthmatics seem to be getting invited who don't meet the criteria so I guess gps have a certain amount of discretion, maybe it depends on vaccine supply level in your area?).

I don't know what the criteria was for shielding. Glad to hear you've had your jab though.

The latest shielding group were selected according to the qcovid risk (there is another thread about it). Having asthma reduced your risk below that of an age matched control so you would need quite significant other factors. There were loads of errors with shielding letters last time. Maybe check your risk on the calculator?

qcovid.org/

I'm categorised as uncontrolled asthma. Salbutamol and Duoresp Spiromax. I did have an emergency hospital admission as a child, but not under my current GP surgery. I have had courses of oral steroids many years ago but again not at this surgery. I had a phone call out of the blue last week, and was vaccinated two days ago. In my early 30s and no other reason to be called for one. My DM who has a heart condition under the same surgery hasn't been called yet.

@Peakedin1997 thank you, I was very relieved having had a rollercoaster of a month. I was booked in within a week of group six being called in our area, so quite fast.

@BungleandGeorge thank you for that link. I'm prediabetic so my risks may be higher as this wasn't an clickable option.

I'm 55/100 without diabetes so not as high as I'd thought for shielding. I'm on spireva which is a LAMA and this is a separate tick box.
I think my letter was due to the combinations of steroids and inhalers that's put me at risk. If I put diabetes in too i jump up to 76/100, so it's likely a GP has looked at all factors and decided I'm at risk.

It's a bit clearer now.

Asthma increases your risk on QCovid if you take add on treatments.

My risk was 16 based on my age, sex and ethnic background. When I said I had asthma but no add on treatments it dropped to 13.

However, when I told the truth that I am asthmatic and on add on treatments my risk increased to 17. Not a large increase but an increase nonetheless.

The risk has to be 10 times normal in the box above I think. I think it’s only LABA and antileukotriene that have a separate box to tick, I thought this added less than it had taken off for asthma for me but not sure!
They may have coded you as diabetic rather than prediabetic

My risk is 33 without including the LABA and antileukotriene (which I do take) but 37 with including it. Interesting. Being including on the shielding list wanged my score up as well.

Mine is 31. I’m not sure how the numbers interact because my risk of death is then under 1. I guess the shielding is done on your relative risk compared to someone of your age rather than how at risk you are overall