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?

@Lurkingforawhile I would be reassured by some peer reviewed research comparing outcomes asthmatics diagnosed with covid with other people in the same age group, showing similar rates of hospitalisation and long covid as well as deaths. But I haven't seen any so there's a nagging suspicion that we've been removed simply because there are too many of us for the government to meet its vaccine targets if they include us.

As a compromise I wonder whether they could create an extra group for asthmatics, after the clinically vulnerable but before the other under 50s.

@Peakedin1997 would agree with both of those points

Yes me too. But I think it will take public pressure to be at the front of the “group 10” queue.

Peaked i agree and think that too. It's about the numbers. If they included them they would have to consider when reopening stuff.

My non asthmatic (yet obviously it runs in our family as dsis has it too) dc coughed for 8w each.

I just think after the 50s they need to allow us to buy the vax. Offering it by job wont be acceptable to me as so many people are more exposed by their children than anyone is by their job. (No masks or distancing). So only really similar to teaching. My dc school has had 3cases now out of 400 students and 14 staff. All supposedly separately.
But if you assume it lives 5 days thats 15d its living on the school surfaces after those people stopped going in plus however long before realising they were ill plus the asymptomatic people. unless rates are less than 1/420 or so then there is likely someone with it at school. obviously there are also lots in say a supermarket but some of those will start to have been vaxxed etc. How many out of the say 600 parents will have been vaxxed. Maybe 40?

However when you do a risk calculator it subtracts 5y for women but only adds 1 for asthma.

This looks promising;

oxfordbrc.nihr.ac.uk/common-asthma-treatment-reduces-need-for-hospitalisation-in-covid-19-patients-study-suggests/

@Iremembertheelderlykoreanlady

Asthma UK posted this on Twitter this morning.

Is this the "clarification" they were hoping to provide this week?

Fucking ridiculous.

It's pretty shocking. They talk about the "confusion" as if they had no part in it.

@Lurkingforawhile @Peakedin1997

oxfordbrc.nihr.ac.uk/common-asthma-treatment-reduces-need-for-hospitalisation-in-covid-19-patients-study-suggests/

I will be interested to know if it's purely that particular brand of inhaler they used in the study or if as a group our steroid inhalers have a similar effect.

If so this means we have up to 90% protection from severe covid just by taking steroid inhalers every day.

This is by far the best news I've had in a while.

[quote Lurkingforawhile]@Peakedin1997 that would be the obvious conclusion. Whether there is an peer reviewed research on it is a different matter. I am worried asthmatics are underrepresented in the death figures because many in the CV category have chosen to shield (or close to it)[/quote]
I’m sure I’ve seen that somewhere as an expert criticism of some of the available evidence. I’m not sure how much validity it holds and it was last summer so I’ve no idea where I read it.

I wonder whether asthma is a bit too complicated for them to accurately subgroup, but there’s too many asthmatics for them to include them all in any risk assessment. Whether that’s shielding or vaccination.

It feels a bit like a replay of the debacle over who was included in the shielding group last March.

@purplebagladylovesgin that's interesting and in some ways it is reassuring, as someone who already takes inhaled steroids, to know that these might reduce the chance of a serious illness.

If that research is correct, then it suggests that the number of asthmatics being hospitalised would probably be much higher if it weren't for the fact that they are already taking steroid inhalers.

The downside of this for asthmatics is that if hospitals do start treating all covid patients with inhaled steroids, then asthmatic patients already taking steroids won't see any additional benefit, so outcomes for asthmatics will become relatively worse compared to the general population who will benefit from treatment with steroids.

I am worried asthmatics are underrepresented in the death figures because many in the CV category have chosen to shield (or close to it)

This. DH and I have locked down hard. We are both WFH and neither of us has been to a shop or supermarket since 15 March. We have bought everything online and only leave the house for walks.

We haven't had any socially distanced walks with another person, we didn't do eat out to help out (we aren't even risking a takeaway) and we haven't done any bubbles. The only contact either of us has had with others are 2 hospital appointments I needed and 1 work man to fix an urgent leak.

We have done this because at one point I was only 1 Fostair puff a day away from shielding.

My asthma has been good during this period - because I'm not getting on dirty germ ridden tubes and catching the colds/flu which trigger symptoms, not being exposed to London's dirty air, not sharing an office with smokers. So basically my current lifestyle avoids my 3 worst triggers.

I understand they struggled at the start. It was all new and they chose to use the medication list which apparently already existed as high risk, for shielding. But that was 10 months ago. But then maybe Asthma UK are a charity who are struggling with resources like everyone else. Maybe it should have been respiratory experts but then they are pretty busy too!

There will have been thousands - possibly 100s of thousands- of NHS staff, care staff, teachers etc with asthma who haven’t been working from home though, so I think it would still have shown up if moderate asthma was a high risk factor. I’ve been seeing patients face to face throughout (though as I said o came off home visits for a month or two at the start) and have had 3 non-covid mild exacerbations in that time, exactly the same as any other year.

There have definitely been less colds and flu circulating this year though. Traffic has also been lighter than usual. I would guess that asthmatics are statistically more likely to be working from home, avoiding crowded places and generally being careful than non asthmatics.

That's why I think we need to see figures comparing outcomes for people who have been diagnosed with covid, not just relying on death rates of asthmatics as a proportion of the general population. And I think it needs to be split by age and sex so that we can be sure that we are comparing like with like.

The latest NHS advice basically puts most asthmatics in 'moderate risk' category and that's about it. I'm hoping we might get rolled in next, I really do.

www.nhs.uk/conditions/coronavirus-covid-19/people-at-higher-risk/whos-at-higher-risk-from-coronavirus/

That is nicely written guidance. Very clear

@Peakedin1997

There have definitely been less colds and flu circulating this year though. Traffic has also been lighter than usual. I would guess that asthmatics are statistically more likely to be working from home, avoiding crowded places and generally being careful than non asthmatics.

That's why I think we need to see figures comparing outcomes for people who have been diagnosed with covid, not just relying on death rates of asthmatics as a proportion of the general population. And I think it needs to be split by age and sex so that we can be sure that we are comparing like with like.

Working in the NHS I’d also say that I have a risk assessment that involves being extremely stringent around social distancing at work and some small adjustments to my role.. There’s also more PPE which I wouldn’t normally be wearing and there are significantly fewer coughs and colds at work this winter. There’s also much fewer people on the bus to catch stuff from. And barely socialising at all for a year. Or going anywhere other than shops has reduced the risk too.

Asthma is definitely better this year. I don’t think i’m alone in going to work because I have to but doing very little else in terms of having contact with others.

I’m sure they’ve changed the headings on that list. It’s the same list that’s been in all the lockdown/ social distancing guidance since last March but it used to be very high risk and high risk.

Although that might fit with them giving up on giving separate guidance within the lockdown rules on what CV people should do. Now it just says ‘if you are clinically vulnerable you could be at higher risk of severe illness’ before moving on to talk about CEV.

That NHS list was updated yesterday, and due for review on 22nd so we'll see.

My asthma wasn't doing too badly last year, until I got Covid I wasn't hospitalised, but felt bad enough that I started to worry I might have to be), and I just keep wondering how much longer before I get back to 'normal'. I think all asthmatics should be in the priority list, even at the end of it before the gen pop.

DH had 'odds asthma , never has a wheeze or attack unless he has a virus

But he has bronchiectasis and spent 7 or so years being treated at Papworth

He didn't get a shielding letter and I rang upbthe surgery 4 or 5 times to be continually told we didn't need to shield. We shielded as his emergency lifeline nurse at Papworth said fgs yes you need to shield

At his 'asthma review' 3 weeks or so ago, the nurse realised his records hadn't been coded for the bronchiectasis, changed it and he had his first jab a week later - but apparently I should have phoned the surgery to tell them he had been missed.....

DD was one dose of inhaler off vulnerable in the first list but that changed I think

Its very confusing

[quote Seoirnbru]@Papyrus- it's the four courses of prednisolone (systemic steroids) that puts you in group 6, not your inhalers or montelukast.[/quote]
Sorry, just looking at the green book definition in table 3 again. I’m still not sure it makes sense.

CEV are in group 4. I might have missed anything excluding them so presumably that includes the shielding asthmatics. Who presumably are already on continuous or regular oral steroids in order to qualify for shielding.

So how is it the qualifying criteria for asthmatics in group 6? Surely most, if not all would have been vaccinated in group 4.

In theory, as someone who narrowly missed out on shielding and has a high dose inhaled steroid + LABA and 3 courses of steroids in 6 months I could have ended up not vaccinated while someone with a low dose brown inhaler but 4 courses did. Which seems a bit mad.

@Seoirnbru what about sodium cromoglicate inhaler? It’s a non steroid preventer. Rarely used I give you but has been around a long time so somebody must be on it!

JCVI have never had asthmatics in group 6, that is obviously inconsistent with government guidance for the entire length of the pandemic that asthmatics are at increased risk so no wonder people are confused. There are a lot of medical conditions in group 6, some quite tenuous so I expect there is some truth that asthma has been reviewed because of the number of sufferers. HCP with asthma (but not on the shielding list) have been in work so I suspect there would be some evidence if asthma was a huge risk factor.

At least the vaccination programme is going at such a pace that the difference between being in group 6 and a few groups lower is likely to only be a few weeks.

@RafaIsTheKingOfClay

I’m sure they’ve changed the headings on that list. It’s the same list that’s been in all the lockdown/ social distancing guidance since last March but it used to be very high risk and high risk.

Although that might fit with them giving up on giving separate guidance within the lockdown rules on what CV people should do. Now it just says ‘if you are clinically vulnerable you could be at higher risk of severe illness’ before moving on to talk about CEV.

It’s all inconsistent really as in the vaccination schedules they say ‘the overall risk of mortality for clinically extremely vulnerable younger adults is estimated to be roughly the same as the risk to persons aged 70 to 74 years’ Yet the over 70s and even over 80s have always been in the lower risk category!

I agree that severe asthmatics would be more likely to catch and so die. Because if they have a normal attack and go to hospital they catch covid there

And agree that many asthmatics will have been strictly socially distancing. However any with kids will have been exposed.
It's not right to say theyll be ok as they may need hospitalisation but would survive as going in obviously risks death as you are dependent on treatment and availability. We ll if all moderate asthmatics get it at once or at a peak then that increases chances of dying. It looks like restrictions will be eased after the 50yo leaving younger to catch it.
Basically 'i have young kids i dont want to be hospitalised at all. .
I dont trust gov to have beds available. they push everything to the limit and are probably saved by people who are more cautious.

Hopefully inhaled do provide some protection.

@IAmongstTheWorld

The shielding advice I remember was either (it was changed)

Four or more courses of oral steroids
Steroid inhaler plus oral medication (ie monteleukast)
OR
Any Critical Care Admission

(at least this is what my GP used - I had all three)

If that's true then I should be shielding as I had an ICU admission in 2004. I have been shielding but I'm not on the list.