Ask Dr. Tessa: Pregnancy & Asthma

HAVE A QUESTION FOR DR. TESSA?

Email her your question at askdrtessa@associatedhairprofessionals.com.
 

“I am pregnant and also suffer from asthma (I need a rescue inhaler and nebulizer on-hand). I'm concerned about returning to work. How does COVID affect those who are pregnant and/or have asthma?”

Based on current knowledge, it appears that pregnant women have the same risk of being infected by SARS-CoV-2 as adults who are not pregnant, however much remains unknown. It is not yet clear if pregnant women who become sick with COVID have a higher risk of severe infection than non-pregnant persons. We know that during the 2009 H1N1 influenza pandemic, pregnant women were more likely to develop complications than non-pregnant women.1 Similarly, pregnant women experienced more severe disease during the SARS coronavirus outbreak of 2002–2003.2 For this reason, the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) recommend that pregnant women practice social distancing, wash their hands often, wear cloth masks in public, and frequently clean and disinfect high-touch surfaces. 
 
I am concerned about your asthma as a risk category. People with moderate to severe asthma may be at high risk of getting severe illness if they get sick from COVID-19. Because COVID affects the respiratory tract, it could worsen your asthma, possibly leading to pneumonia or acute respiratory distress. If it is possible for you to not return to work, that would be the safest course of action. However, recognizing that not everyone has the option to abstain from the source of their livelihood, these are the steps that I would take:

• Do not skip your prenatal care appointments. If you have not done so already, talk to your doctor or midwife about how to follow your asthma action plan3 during your pregnancy. It is important to continue with your asthma medications, as recommended by your obstetric provider. If you don’t feel clear on which asthma medications you can safely taking during your pregnancy, be a strong self-advocate. Speak up and keep asking questions until you feel completely clear about how to manage your asthma, and what to do if it gets worse.
• Wear a mask at all times and change it between clients. Wash your hands before putting on the mask.  Take care that it is fully covering your nose and mouth. Do not touch the face mask once it is on and if you do, immediately wash your hands with soap and water for 20 seconds. Do what you can to maintain 6 feet of distance from others while at work. Obviously, this isn’t possible with your clients, but at least maintain this distance with your co-workers and other clients in the office.
• Very important—insist that your clients wear a mask. Ideally this is a practice of your office and the expectation is made clear at the pre-appointment conversation. To avoid putting you in an awkward position, try to designate a front-desk person to gently and politely correct your client should they take off their mask or pull it down during the appointment.
• The most important step you can take to protect yourself from infection at work (or anywhere else) is washing your hands frequently with soap and water for 20 seconds and the cleaning and disinfection of surfaces. Cleaning surfaces means wiping them down with soap and water. Disinfection means applying an EPA-approved disinfectant. Note that spraying the disinfectant in a poorly ventilated area is a trigger for your asthma, so ideally have someone else do this and leave the area for 10–15 minutes. It took me years to connect my asthma attacks to my cleaning attacks!
   

REFERENCE:

1. D. J. Jamieson, et al., “H1N1 2009 Influenza Virus Infection During Pregnancy in the USA,” Lancet 374 (2009): 451–8; A. M. Siston, et al., “Pandemic 2009 Influenza A(H1N1) Virus Illness Among Pregnant Women in the United States,” Journal of the American Medical Association 303 (2010): 1517–25
2. C. M. Lam, et al., “A Case-Controlled Study Comparing Clinical Course and Outcomes of Pregnant and Non-Pregnant Women with Severe Acute Respiratory Syndrome,” BJOG 111 (2004): 771–4
3. Centers for Disease Control and Prevention. “Asthma Action Plans,” accessed June 2020
    

AHP DISCLAIMER:

Please be sure to always work within your scope of practice as determined by your state and to adhere to all local and federal rules and regulations regarding COVID-19 protocols. To learn more about returning to your practice or to access free resources to assist you with reopening, access the AHP Back-to-Practice Guide!
 

About the Author:

Dr. Tessa Crume is an Associate Professor in the Epidemiology Department at the Colorado School of Health at the University of Colorado Anschutz Medical Campus. Her research focuses on the development and utilization of public health surveillance systems to understand the burden of disease. She has been an academic researcher since 2011, before which she worked for a decade as an applied epidemiologist at the state and federal level, analyzing surveillance data and evaluating public health impact. Dr. Crume has taught the core epidemiology class at the Colorado School of Public Health for nine years.
 

HAVE A QUESTION FOR DR. TESSA?

Email her your question at askdrtessa@associatedhairprofessionals.com.