Coronavirus and flu in people with chronic lung diseases: A conversation with pulmonologist Prof. Dr. Fischer about risks and recommendations

A lot of people are concerned about the coronavirus right now. This includes people with chronic lung diseases such as asthma, COPD and cystic fibrosis – in fact they when it comes to COVID-19 coronavirus infection, they are considered a high-risk group. So we talked to pneumologist Prof. Dr. Rainald Fischer about the current situation. He provided some background and explained the risks and offered recommendations for lung patients.

NOTE: This interview with Dr. Fischer was done in early March 2020. The statements were made based on the information available at that time.

PARI-Blog: Why are people with chronic lung diseases such as asthma, COPD and cystic fibrosis considered high-risk patients when it comes to the flu and the coronavirus?

Prof. Dr. Rainald Fischer: It is more difficult for people with chronic respiratory diseases to fight viruses because the mucous membranes in their lungs have been weakened by the underlying disease. This is true especially for people with cystic fibrosis because they already always have a lot of bacteria in their lungs causing chronic low-grade lung infections.

The coronavirus primarily affects the upper and lower airways, so patients with an underlying lung disease are more at risk. In my view, the reason the coronavirus SARS-CoV-2 affects the lungs is not fully known. What we do know is that patients with underlying lung conditions are more likely to react with more severe courses if they get the coronavirus and unfortunately they are also more likely to die than healthy people.

PARI-Blog: Why are patients with lung problems more likely to have complications and more fatalities if they are infected with the coronavirus or even the flu?

Prof. Dr. Rainald Fischer: As I already mentioned, the mucous membranes in the lungs of patients with COPD or cystic fibrosis are chronically inflamed, so they are more susceptible to viral infections. At the same time the immune response in the mucous membranes in the lungs is decreased, so the viruses can spread more easily and inflict greater damage. The more damaged the mucous membranes in the lungs are, the easier it is for other pathogens, such as bacteria, to penetrate the mucous membrane.

PARI-Blog: Are all patients with chronic respiratory conditions at the same risk?

Prof. Dr. Rainald Fischer: Based on the information available today, not all lung diseases are equal. It is likely that patients with asthma are not at as high risk because their bronchial mucosa usually only has inflammation from allergies and they do not usually develop pneumonia. I would consider patients with COPD and cystic fibrosis to be more at risk because inflammatory processes occur, including those that are bacterial in nature, in the lungs more frequently, independent of viruses. In addition, pulmonary function is a potential indicator of risk. I would assume someone with a FEV1 value below 50% would be at greater risk. In contrast, patients with lung disease with a FEV1 value of over 90% are at only slight risk. These are only estimations, however. Currently, there are too few cases and numbers for the coronavirus. Evidence backed by research will unfortunately not be available for a few weeks or months when the current corona epidemic is over and being analysed.

PARI-Blog: Which virus is more dangerous for patients with lung disease: the flu or the coronavirus?

Prof. Dr. Rainald Fischer: Currently the main difference between flu viruses and the coronavirus is surely the possibility of getting vaccinated. The flu vaccine for the current flu season seems to be working well and offering good protection against the current influenza. There is no vaccine available yet for the COVID-19 virus.

Currently one cannot say with any certainty the extent to which the lethality, that is the probability of dying from the disease, is different for the flu and coronavirus. It is very difficult to tease this out right now based on the numbers from the Robert Koch Institute. But it appears that the lethality of the coronavirus is slightly higher.

PARI-Blog: The current coronavirus epidemic aside, people with chronic lung diseases are used to following the current hygiene recommendations and to avoid crowds. What else can they do to protect themselves?

Prof. Dr. Rainald Fischer: Of course it makes sense to adhere to the recommended hygiene guidelines. Masks are probably not a very effective way to protect oneself from viruses. Effective protection would require an FFP3 mask with a filter function. But they are very hard to come by right now. Furthermore, wearing this mask would also be uncomfortable for patients with lung disease because it makes breathing more difficult.

It is of course important that patients with respiratory problems do their prescribed inhalation therapy and take their medications consistently. That is always true, coronavirus or no. In my view there are no other preventative measures available.

The most important thing is to keep in mind that the number of infections is very low at the moment. The actual risk of infection for an individual patient with the coronavirus is not very high. Currently, there is a greater risk of infection with influenza.

PARI-Blog: Have you had any patients with the flu or coronavirus in the past few weeks?

Prof. Dr. Rainald Fischer: Several of our patients have had influenza in recent weeks. In contrast, we are unaware of any cases of the coronavirus. Only one patient had contact with two degrees of separation to a person who was infected with the coronavirus.

PARI-Blog: What do you advise concerned patients with lung diseases in the current situation?

Prof. Dr. Rainald Fischer: First and foremost: stay calm and do not become swept up by the panic. It is important not to seek medical treatment if for every little suspected symptom. As long as you don’t have severe symptoms such as shortness of breath, poor oxygen saturation, high fever for several days, don’t go to A&E. This is important because hospitals will otherwise be overrun with people not needing treatment and the really sick patients won’t be able to get care. Medications to treat coronavirus infection are now already being tested in studies. If these studies have positive findings, targeted therapies that combat the virus could be available in several weeks.

PARI-Blog: What lessons should we learn from the current situation?

Prof. Dr. Rainald Fischer: The lesson that all people, and especially those with chronic lung diseases, should take from the past few weeks is to get vaccinated next fall against the flu and against the coronavirus as well, if a vaccine is available. There are always a few patients with lung diseases who do not get the vaccine. Their argument against the flu vaccine is that they don’t tolerate the vaccine and they feel worn out afterward for a few days. This feeling of fatigue is nothing compared to what it feels like to actually have the flu. The flu is a serious illness with a potentially fatal outcome and people should easily and effectively protect themselves by getting the vaccine*.

*The flu vaccine has to be re-developed every year and adapted to the latest virus. Because of this, the vaccine is not always as effective or comprehensive every year. Flu viruses are always mutating.

Prof. Dr. Fischer, thank you very much for talking with us.


NOTE: This interview with Dr. Fischer was done in early March 2020. The statements were made based on the information available at that time.

The information in this blog post is not a treatment recommendation. The needs of patients vary greatly from person to person. The treatment approaches presented should be viewed only as examples. PARI recommends that patients always consult with their physician first and if they suspect they have an illness they should contact their doctor.

About Prof. Dr Rainald Fischer:

Prof. Dr. Rainald Fischer is a specialist for internal medicine in private practice, with a subspecialty in lung and bronchial medicine, specialty of emergency medicine, sleep medicine and allergy medicine in Munich-Pasing. Before that he worked as an internist and lung specialist, most recently as a senior physician at the Innenstadt Munich university hospital. Prof. Dr. Rainald Fischer is a founding member and president of the German Society for Alpine and Expedition Medicine, and a member of the cystic fibrosis physicians working group.


An article written by the PARI BLOG editorial team.

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