Asthma and COVID-19: What Every Patient Needs to Know in 2026

By Dr. Frank Hull, MD — Board-Certified Pulmonologist, Advanced Asthma Clinic, Plantation, FL | Updated June 2026

COVID-19 has permanently changed the respiratory health landscape. For the 25 million Americans living with asthma — including the hundreds of thousands across Broward County and South Florida — questions about COVID-19 risk, biologic safety, vaccine guidance, and the long-term effects of infection remain urgent and often unanswered in the exam room.

At Advanced Asthma Clinic in Plantation, FL, Dr. Frank Hull has guided patients with mild, moderate, and severe uncontrolled asthma through every phase of the pandemic and beyond. This guide consolidates what we know from clinical evidence, GINA guidelines, and real-world patient experience.

If you have specific concerns about your asthma and COVID-19, schedule an appointment for a personalized risk assessment and management plan.

Does Asthma Increase COVID-19 Risk?

The relationship between asthma and COVID-19 severity is more nuanced than early pandemic data suggested. Current evidence shows:

• Mild to moderate, well-controlled asthma does not significantly increase risk of severe COVID-19 outcomes compared to the general population.
• Severe or uncontrolled asthma — particularly disease requiring frequent oral corticosteroids or resulting in recent exacerbations — is associated with higher risk of hospitalization.
• Asthma with comorbidities (obesity, diabetes, cardiovascular disease, or chronic rhinosinusitis) compounds COVID-19 risk substantially.
• Type 2 (T2-high) allergic asthma may have a modest protective effect against severe COVID-19 in some studies, possibly because the eosinophilic inflammatory environment is less permissive to viral replication — though this finding does not eliminate risk and should not alter precautions.

The single most important protective factor is keeping your asthma well-controlled. Poorly controlled asthma at the time of COVID-19 infection is a consistent predictor of worse outcomes.

Risk Stratification: Which Asthma Patients Are at Highest Risk?

Consult your physician to determine your individual risk level and appropriate management strategy.

COVID-19 as an Asthma Trigger

Like influenza, rhinovirus, and other respiratory viruses, SARS-CoV-2 can directly trigger asthma exacerbations. The mechanisms include:

• Airway epithelial injury: The virus damages the cells lining the airways, disrupting the protective barrier and triggering inflammatory cascades.
• Bronchospasm: Viral-induced neurogenic inflammation can cause acute airway narrowing even in patients whose asthma has been stable for months.
• Mucus hypersecretion: Goblet cell activation increases mucus production, worsening airflow obstruction.
• Post-infectious airway hyperresponsiveness: Heightened bronchial sensitivity can persist for weeks to months after COVID-19 recovery.

Any asthma patient who tests positive for COVID-19 should:

1. Have their rescue inhaler (short-acting bronchodilator) readily available at all times.
2. Monitor peak flow twice daily if they own a peak flow meter.
3. Follow their written asthma action plan closely.
4. Contact their pulmonologist if symptoms are not responding to rescue bronchodilator or peak flow falls into the yellow zone (60-80% of personal best).
5. Call 911 or go to the emergency department if experiencing severe breathlessness, inability to speak in full sentences, or peak flow in the red zone (<60% personal best).

Biologic Therapy and COVID-19: Is It Safe to Continue?

This is one of the most common and important questions from patients at our Plantation clinic. The reassuring answer, supported by substantial real-world data, is: for most patients, continue your biologic during COVID-19.

Why Biologics Are Generally Safe During COVID-19

Asthma biologics are highly targeted therapies. They block specific cytokines or receptors — not broad immune function. Compare this to oral corticosteroids, which suppress broad immune responses and are associated with significantly worse COVID-19 outcomes.

Important exception: If you are hospitalized with severe or critical COVID-19, the timing of your next biologic dose should be discussed with your inpatient team and pulmonologist. For self-administered biologics (dupilumab), you may be advised to delay a dose until you have clinically improved. Never make this decision unilaterally — always consult your physician.

Oral Corticosteroids and COVID-19

Patients on chronic oral corticosteroids for asthma control face the highest COVID-19 risk. Systemic steroids impair neutrophil and T-cell function, blunting the body's ability to contain viral replication. This is one of the strongest arguments for pursuing biologic therapy — reducing or eliminating oral steroid dependence — in patients with severe asthma. Dr. Hull has helped many Broward County patients transition off chronic oral steroids through optimized biologic therapy.

COVID-19 Vaccines and Asthma: What the Evidence Shows

COVID-19 vaccination is safe and strongly recommended for all asthma patients. Key facts:

• Effectiveness: Updated mRNA vaccines significantly reduce risk of severe COVID-19, hospitalization, and death across all age groups. Asthma patients derive the same or greater benefit as the general population.
• Safety in asthma: No evidence of increased asthma exacerbation rates following COVID-19 vaccination. Rare reports of chest tightness in the hours following vaccination are generally transient and mild.
• Biologic therapy and vaccine response: Current evidence does not demonstrate clinically meaningful impairment of vaccine-induced immunity in patients on asthma biologics. However, patients on systemic immunosuppressive therapy beyond standard asthma biologics should discuss vaccine timing with their physician.
• GINA and CDC recommendation: Up-to-date COVID-19 vaccination is recommended for all people with asthma, including those on biologic therapy.
• Timing: Vaccination can be given on the same day as a biologic injection; there is no required interval between biologic dosing and COVID-19 vaccination for standard asthma biologics.

Patients with a history of allergic reactions to vaccine components should discuss their history with their allergist or pulmonologist before vaccination.

Long COVID and Asthma: Respiratory Effects and Management

Long COVID — formally termed Post-Acute Sequelae of SARS-CoV-2 (PASC) — affects an estimated 10-30% of COVID-19 survivors to some degree. For asthma patients, the respiratory manifestations of long COVID create a particularly complex clinical picture.

Common Respiratory Symptoms of Long COVID

• Persistent dyspnea (breathlessness) on exertion
• Chronic cough (dry or productive)
• Reduced exercise tolerance
• Chest tightness or chest pain
• Fatigue out of proportion to activity level
• Worsened asthma control despite unchanged therapy

Distinguishing Long COVID Symptoms from Asthma Flares

Separating long COVID respiratory symptoms from worsening underlying asthma requires objective testing. Symptoms alone are insufficient because both conditions cause breathlessness and chest tightness. Key assessments include:

At Advanced Asthma Clinic, Dr. Hull performs comprehensive pulmonary function testing including spirometry, diffusion capacity, and FeNO as part of post-COVID respiratory evaluation. For patients in the greater Fort Lauderdale, Davie, Miramar, Hollywood, and Pembroke Pines areas, this full diagnostic workup is available at our Plantation, FL location.

Management of Post-COVID Asthma Worsening

When COVID-19 worsens asthma control, the approach must address both the persistent inflammation and the additional burden of post-viral airway hyperresponsiveness:

• Step up asthma therapy temporarily under physician guidance — do not step down treatment until post-COVID stability is confirmed by objective testing.
• Reassess biologic eligibility: Patients who have never received a biologic may now meet criteria following COVID-19-induced disease worsening. Blood eosinophil counts and FeNO should be re-checked at least 4-6 weeks after acute infection.
• Pulmonary rehabilitation: For patients with significant post-COVID deconditioning and reduced exercise tolerance, supervised breathing and exercise rehabilitation improves functional outcomes.
• Investigate treatable comorbidities: Post-COVID GERD, upper airway dysfunction, and anxiety are common and can masquerade as asthma worsening.

COVID-19 Antiviral Therapy and Asthma Medications

If your pulmonologist or primary care physician prescribes an antiviral for COVID-19 — most commonly nirmatrelvir/ritonavir (Paxlovid) — be aware of clinically significant drug interactions with some medications used in asthma management:

• Ritonavir is a strong CYP3A4 inhibitor. It markedly increases plasma levels of drugs metabolized by this enzyme.
• Inhaled corticosteroids: Fluticasone furoate and fluticasone propionate are metabolized by CYP3A4. Ritonavir co-administration can increase systemic steroid exposure, potentially causing adrenal suppression. Discuss with your prescriber; beclomethasone is less affected and may be an alternative.
• Oral corticosteroids: Use the lowest effective dose; systemic steroid levels may increase with ritonavir.
• Biologics: No significant interaction with nirmatrelvir/ritonavir for standard asthma biologics.
• Montelukast: Minimal interaction concern.

Always provide your prescribing physician with a complete list of your asthma medications before starting any COVID-19 antiviral. At Advanced Asthma Clinic, we are available to assist with medication review and dose adjustments during COVID-19 treatment.

Preventive Strategies for Asthma Patients

Beyond vaccination, patients with asthma — especially those with moderate to severe disease — should consider the following ongoing precautions:

• Annual updated COVID-19 booster: As with influenza, annual boosters are recommended for higher-risk individuals including those with significant respiratory disease.
• Influenza vaccination: Flu remains a major asthma trigger and increases vulnerability to secondary bacterial pneumonia. Annual influenza vaccination is strongly recommended.
• Pneumococcal vaccination: PCV20 or PPSV23 is recommended for asthma patients aged 19-64 who smoke, and for all patients aged 65 and older. Discuss your vaccination status at your next appointment.
• RSV vaccination: For asthma patients aged 60 and older, RSV vaccination (Abrysvo or Arexvy) is now recommended — RSV is a significant cause of asthma exacerbations in older adults.
• Optimize asthma control proactively: Well-controlled asthma means better immune function, lower systemic steroid exposure, and better outcomes if a respiratory virus does strike.

When to Seek Immediate Medical Attention

If you have asthma and develop COVID-19, seek immediate medical care (call 911 or go to the emergency department) if you experience any of the following:

• Severe shortness of breath at rest or with minimal activity
• Inability to complete a sentence without stopping to breathe
• Peak flow below 60% of your personal best (red zone)
• Use of rescue bronchodilator every 1-2 hours with inadequate relief
• Persistent oxygen saturation below 94% on pulse oximetry
• Confusion, altered consciousness, or bluish coloring of lips or fingertips
• Inability to tolerate oral fluids or medications

Asthma and COVID-19 Care at Advanced Asthma Clinic, Plantation, FL

Dr. Frank Hull provides comprehensive asthma management for patients throughout Broward County, including Plantation, Fort Lauderdale, Davie, Miramar, Hollywood, Pembroke Pines, and Weston. Our clinic offers:

• Complete pulmonary function testing including spirometry, diffusion capacity (DLCO), and FeNO
• Post-COVID respiratory evaluation and management
• Biologic therapy initiation, monitoring, and switching
• Oral steroid reduction programs
• Comprehensive written asthma action plans
• Coordination with clinical trial opportunities for eligible patients

If your asthma has worsened since a COVID-19 infection, or if you have concerns about COVID risk on your current therapy, contact us today to schedule a comprehensive evaluation. You can reach us at 954-522-7226.