Another Coronavirus Health Threat: Too Few Asthma Inhalers

MONDAY, March 30, 2020 (HealthDay News) -- As hospitals give more and more COVID-19 patients albuterol to help them breathe, people with asthma may have a hard time getting an inhaler.

The American College of Allergy, Asthma and Immunology (ACAAI) said some areas of the United States are experiencing shortages of albuterol inhalers, and the shortage may spread.

But Dr. Michael Blaiss, executive medical director of the ACAAI, emphasized that it is "nothing to panic about."

Manufacturers are trying to keep up with the unexpected surge in demand, he said. Production issues are not to blame.

"No one should panic or hoard albuterol, though since you need a prescription, it's not possible to hoard like toilet paper. But don't put your albuterol asthma inhalers on autofill. If your asthma is under optimal control, an inhaler should last you more than a year," Blaiss said.

And, if you can't get an albuterol inhaler from your pharmacy, Blaiss said it's important to know there are other options.

Patients with COVID-19 infections were initially treated with nebulizers, a common way to treat breathing problems in hospitals, and sometimes at home. But recent research suggested that when aerosolized, the coronavirus could hang in the air for a while, and some nebulizers might aerosolize the virus particles, Blaiss explained.

So, out of caution, many hospitals have switched to the use of albuterol inhalers. Albuterol is a medication that helps open up the airways. It is considered a "rescue" medication. There are also preventive medications, including different types of inhalers for asthma.

The big difference between a nebulizer and an inhaler is the dose received. Typically, someone given an inhaler is advised to take two puffs during an asthma symptom flare. "A nebulizer treatment is equivalent to about 10 puffs of an inhaler," Blaiss said.

If you try to refill a prescription for an albuterol inhaler and can't, Blaiss recommended contacting your physician. Meanwhile, keep taking your preventive asthma medications.

"You really want to make sure your asthma is under optimal control, making sure your lungs are functioning as well as possible," he said.

Keeping your lungs as healthy as possible is critical right now, because people with asthma and other lung diseases are more likely to develop complications from a COVID-19 infection, according to the U.S. Centers for Disease Control and Prevention.

In a pinch, it's usually OK to use an expired inhaler, Blaiss said. But doctors don't know how far out from the expiration date an inhaler might work.

People also can use home nebulizers, and albuterol solution is available to use at home.

If you have been exposed to someone with COVID-19 or have any symptoms of infection -- fever, cough, non-asthma-related shortness of breath -- use your nebulizer in an isolated area, preferably outside, Blaiss recommended. If you must use it indoors, be sure no one else will be in that area for several hours at the least.

There are also inhalers that contain long-acting rescue medication that can ease wheezing and breathing difficulties.

Blaiss said anyone using an inhaler -- rescue or preventive -- should watch the counter on the device to be sure there is active medication in the canister.

Because the situation is still unfolding, Blaiss said he didn't know how long any shortage might last.

Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New Yorat U.S. officials have been using to guide their plans to battle coronavirus.

Travel advisory for states near New York City

In an unprecedented move on Saturday, the U.S. Centers for Disease Control and Prevention urged all residents of three states surrounding New York City -- New York, New Jersey and Connecticut -- to refrain from travel to other states over the next 14 days, to help stop the spread of COVID-19.

Although coronavirus hotspots continue to emerge throughout the country, New York City remains the epicenter of the American epidemic, with thousands of cases reported and area hospitals overwhelmed.

"The Governors of New York, New Jersey, and Connecticut will have full discretion to implement this Domestic Travel Advisory," the CDC said in a statement issued Saturday.

As the U.S. economy continues to falter, Trump signed a $2 trillion stimulus package into law last Friday.

The legislation will send $1,200 to millions of Americans, including those earning up to $75,000, along with $500 per child. It will also give an additional 13 weeks in unemployment aid and a four-month enhancement of jobless benefits, the Times reported.

The package also includes $377 billion in federally guaranteed loans to small businesses and the creation of a $500 billion government lending program for distressed companies. Hospitals on the front lines of the pandemic will also get $100 billion in aid, the Times reported.

New York City in crisis

The help comes not a moment too soon, as more than 250 million Americans in 29 states have been ordered by their state's governors to stay home, the Times reported.

New York state is the epicenter of the U.S. outbreak, with at least 67,174 cases and 1,200 deaths, according to the Times.

Things are particularly dire in New York City, as hospitals that have become overwhelmed with COVID-19 patients and now face a shortage of many medical supplies, the Times reported.

Cuomo did offer up some good news last week, saying that social distancing measures might be working. The state's hospitalization estimations were down markedly, from a doubling of cases every two days to a doubling every four days.

And in New Rochelle, N.Y., drastic measures to contain a cluster there appeared to be paying off with a slowing in new cases, the Times reported.

But cases are just starting to spike elsewhere, particularly in the South: Louisiana, Florida and Georgia are facing alarming increases, with 12,751 cases and 359 deaths reported in those three states alone, the Times reported Tuesday.

And some health officials are warning that parts of Michigan and Illinois could be the next epicenters of the coronavirus pandemic, CNN reported.

Dr. Deborah Birx, the White House's coronavirus response coordinator, said last week that health officials are concerned that counties like Wayne County, Mich., and Cook County, Ill., are showing a "more rapid increase" in cases.

'Nowhere near ready'

"We are in for a bumpy ride for the next 12 to 18 months," Dr. Ashish Jha, director of the Harvard Global Health Institute, told CNN. "If we are aggressive now about stopping things, shutting down, building up a test regime, we can then open up again … and most places can go back to work. But only when we are ready. And we are nowhere near ready now."

Around the world, countries have taken drastic steps to slow the spread of coronavirus: India ordered a 21-day shutdown of a country in which 1.3 billion people live, while Japan's Prime Minister Shinzo Abe and International Olympic Committee (IOC) president Thomas Bach agreed to postpone the Summer Olympics in that country. On Monday, organizers announced the games will be held in July 2021, CNN reported.

The United Kingdom has also ordered a shutdown of its country, while Prince Charles, the 71-year-old heir to the British throne, was diagnosed with coronavirus on Wednesday, CNN reported. Prime Minister Boris Johnson was diagnosed with COVID-19 on Friday, CNN reported.

As different nations wonder what is in store for their citizens in the coming months, one glimmer of hope has emerged: Last week, China lifted travel restrictions on the Hubei province, which was hardest hit by coronavirus earlier this year. Public transportation was re-opened on Monday in Wuhan, the city that was the original epicenter of the outbreak, the Associated Press said.

On Tuesday, Chinese officials reported just 48 new coronavirus cases, claiming that all came from overseas travel, the Associated Press reported.

The good news in China stood in sharp relief to what is unfolding in Italy.

Italy has now passed China for coronavirus cases, reporting close to 101,379 cases and 11,591 deaths, a Timestally showed Tuesday morning. The virus has been especially deadly for older Italians. But the country has seen a slowing in the rate of new infections, the Times added.

States race to contain virus

In the meantime, the public lives of Americans have come to a halt, as the coronavirus pandemic has prompted officials across the country to close, cancel or postpone any event or activity that might foster the spread of COVID-19.

New York, New Jersey and California have been hard hit by coronavirus cases in the United States. New York has more than 67,000 cases, New Jersey has more than 16,600 cases and California's case count has topped 7,400 cases, according to the Times.

However, signs of hope emerged in Washington state, where strict social distancing measures may be contributing to a leveling off in new cases, the Times reported.

Meanwhile, officials in Florida have closed all beaches in the state after young spring breakers ignored social distancing guidelines and partied with abandon on the sand. Florida now has nearly 5,700 cases, with 71 deaths.

State officials planned to meet on Tuesday to decide whether to let the coronavirus-plagued cruise ship Zaandam dock in Port Canaveral after more than two weeks at sea, the AP reported. Dozens on the ship have reported flu-like symptoms and four people have died. The company said eight have tested positive for COVID-19, but 2,300 other passengers and crew are in good health, the wire service reported.

Gov. Ron DeSantis has already said the state's health care resources are stretched too thin to allow the ship to dock.

Worldwide, the case count passed 800,000 while the death toll neared 39,000 on Tuesday, according to a Johns Hopkins tally.

More information

The U.S. Centers for Disease Control and Prevention has more on the new coronavirus.

SOURCES: U.S. Centers for Disease Control and Prevention, news release, March 28, 2020; March 24, 2020, media briefing with President Donald Trump; CNN; Associated Press; The New York Times; CBS News

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