The
COVID-19 pandemic has brought a renewed focus on appropriate management of chronic respiratory conditions with a heightened awareness of respiratory symptoms and the requirement for differential diagnosis between an
asthma attack and
COVID-19 infection. Despite early concerns in the pandemic, most studies suggest that well-managed
asthma is not a risk factor for more severe COVID-related outcomes, and that
asthma may even have a protective effect. Advice on the treatment of
asthma and
asthma attacks has remained unchanged. This article describes some challenges faced in primary care
asthma management in adults and in teenagers, particularly their relevance during a pandemic, and provides practical advice on
asthma attack recognition, classification, treatment and
continuity of care. Acute attacks, characterised by increased symptoms and reduced lung function, are often referred to as exacerbations of
asthma by doctors and nurses but are usually described by patients as
asthma attacks. They carry a significant and underestimated morbidity and mortality burden. Many patients experiencing an
asthma attack are assessed in primary care for treatment and continuing management. This may require remote assessment by telephone and home monitoring devices, where available, during a pandemic. Differentiation between an
asthma attack and a
COVID-19 infection requires a structured clinical assessment, taking account of previous medical and family history. Early separation into mild, moderate, severe or life-threatening attacks is helpful for continuing good management. Most attacks can be managed in primary care but when severe or unresponsive to initial treatment, the patient should be appropriately managed until transfer to an acute care facility can be arranged. Good quality care is important to prevent further attacks and must include a follow-up appointment in primary care, proactive regular dosing with daily controller
therapy and an understanding of a patient's beliefs and perceptions about
asthma to maximise future self-management.