Chronic diseases affect the immune system, so they need specific management during the COVID-19 pandemic. Let’s find out how experts manage them.
Studies reported that patients having hypertension, diabetes, asthma, heart diseases, cancer, and other chronic conditions are at high risk of exposure to COVID-19 infection. So, these patients need special care from us. To simplify, let’s review each condition separately.
To manage hypertension, experts must understand it well. So let’s first discuss, what is hypertension?
Hypertension is an increase in the normal blood level (120/80 mm Hg) to an abnormal level (above 140/90 mm Hg). It occurs because of either a narrowing in the small blood vessels, an increase in blood volume, or an increase in blood vessels’ resistance.
It’s caused by either specific factor “secondary hypertension” or non-specific factor “primary hypertension”. Specific causes of hypertension include;
- Diseases in the kidney, blood vessels, and endocrine system
- Drugs like steroids, estrogens, erythropoietin, adrenaline, and non-steroidal anti-inflammatory drugs
How to Manage Hypertension During Normal Conditions
Hypertension management involves pharmacological and non-pharmacological interventions. Non-pharmacological interventions like weight loss, exercise, and other lifestyle modifications. Pharmacological treatments involve drugs that:
- Extend the blood vessels (vasodilators)
- Decrease cardiac output (beta-blockers and calcium channel blockers)
- Remove the excess blood volume (diuretics)
- Decrease resistance in blood vessels (acts on the renin-angiotensin system like ACE inhibitors and ARBs)
The selection of a suitable drug depends on the cause, presence of conditions, age, race, and other factors. If it is secondary hypertension, you need to manage the cause.
How to Manage Hypertension During COVID-19
Recent studies recommend that hypertensive patients avoid infection and keep their blood pressure controlled. So, they must adhere to COVID-19 prevention measures and continue in their prescribed treatment. Also, patients are recommended to maintain enough medication and continue their follow-up with their physicians.
Should You Continue on ACE Inhibitors and ARBs?
To enter human cells, studies found that COVID-19 needs to bind with a body molecule called Angiotensin-converting enzyme 2 (ACE2). Theoretically, ACE inhibitors and ARBs may increase this molecule. But recent studies found that their use is beneficial, so patients didn’t need to change them.
Diabetes is a condition of uncontrolled blood glucose levels. It resulted from the absence of controlling hormone “insulin” in the blood (type 1 diabetes). Also, it results from a decrease of insulin in the blood or a decrease in cell sensitivity to it (type 2 diabetes).
How to Manage Diabetes During Normal Conditions
To control blood glucose levels, experts use pharmacological treatments and lifestyle modifications. Pharmacological treatments include:
- Giving insulin to type 1 patients to substitute the absence
- Increasing insulin secretion in type 2 patients by Sulfonylureas, meglitinides, and incretin mimetics
- Increasing insulin sensitivity by metformin and pioglitazones
- Reducing glucose absorption by incretin mimetics and alpha-glucosidase inhibitors
- Reducing glucose reabsorption in kidneys by SGLT-2 inhibitors
- Appetite control by incretin mimetics
The selection of a suitable drug depends on the cause, blood glucose level, and presence of other conditions and factors.
How to Manage Diabetes During COVID-19
As in hypertension, experts advise diabetic patients to adhere to COVID-19 prevention measures to avoid infection, maintain enough medication, and continue in their prescribed treatment and follow-up with their physicians to keep controlled blood glucose levels. Also, patients using insulin injections should clean the injection site well.
How to Treat a Diabetic Patient Infected With COVID-19
Studies reported that:
- For noncritically ill patients with mild to moderate hyperglycemia, dipeptidyl peptidase-4 (DPP-4) inhibitors with basal insulin are recommended.
- For noncritically ill patients with type 1 or uncontrolled diabetes, basal insulin with rapid-acting insulin before meals are recommended.
- For critically ill patients, continuous insulin infusion with an hourly point of care (POC) glucose monitoring is recommended to control blood glucose levels within 140 – 180 mg/dL.
- If the patient developed mild to moderate diabetic ketoacidosis (DKA), subcutaneous insulin every 2 – 4 hours is recommended.
- If the patient developed severe diabetic ketoacidosis (DKA), continuous IV insulin infusion with potassium correction is recommended.
- Metformin should be monitored closely because lactic acidosis may occur. Other oral hypoglycemic agents are not recommended for COVID-19 patients.
Asthma is a chronic inflammatory condition that affects airways. It is associated with breathlessness, wheeze, and cough.
How to Treat Asthma During Normal Conditions
Since asthma is an inflammatory condition, experts use anti-inflammatory drugs to prevent inflammation and airways dilators to relieve the breathlessness. Also, they advise patients to avoid asthma triggers. Patients use asthma drugs for long periods of times, so experts must balance between drug doses and side effects. Asthma drugs include:
- Inhaled corticosteroids, leukotriene antagonists, monoclonal antibodies, oral corticosteroids, and steroid-sparing agents to prevent inflammation.
- Short-acting β-agonists, long-acting β-agonists, long-acting antimuscarinics, and theophylline preparations to relieve airway constriction.
How to Manage Athma During COVID-19
As in hypertension and diabetes, experts recommend asthmatic patients adhere to COVID-19 prevention measures to avoid infection, maintain enough medication, continue in their prescribed treatment, and follow-up with their physicians. If any signs of the attack appear, they should contact their physicians.
Should You Continue Using Steroids or Change Them?
Early reports proposed that steroids may increase the risk of COVID-19 infection because they affect immunity. Later, their use was found useful to decrease COVID-19 cytokine storm (a hyper-inflammatory condition associated with increased production of inflammation signaling molecules “cytokines”). So, patients are recommended to adhere strictly to COVID-19 prevention measures when using steroids and not change them.
Management of Other Chronic Conditions
Experts recommend patients with chronic diseases adhere to COVID-19 prevention measures because they have a higher risk of COVID-19 infection. If they get an infection, experts need to control their condition and the COVID-19 treatment measures to prevent complications and deterioration.
Generally, as we see, experts advise chronic disease patients to keep a healthy immune system, maintain enough medication, and continue in their prescribed treatment and follow-up with their physicians to control their condition. With persistent care, COVID-19 infections can be avoided. Always talk to your physician if you have concerns about your health.
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