The need for new therapies and adaptations in treating severe asthma with SARS-CoV-2 circulating and COVID-19 a common respiratory illness are discussed in a review article prepared by the Precision Interventions for Severe and/or Exacerbation-Prone Asthma network. The article summarizes the available literature and product information and presents “considerations and plans for treating asthma within the context of … novel COVID-19–related therapies.”
“Pharmacologic interactions between established asthma therapies and novel drug interventions for COVID-19 infection, including antivirals, biologics, and vaccines, have emerged as a critical and unanticipated issue in the clinical care of asthma,” the authors write. “In particular, impaired metabolism of some long-acting beta-2 agonists by the cytochrome P4503A4 enzyme in the setting of antiviral treatment using ritonavir-boosted nirmatrelvir (NVM/r, brand name Paxlovid) may increase risk for adverse cardiovascular events. Although available data have documented the potential for such interactions, these issues are largely unappreciated by clinicians who treat asthma, or those dispensing COVID-19 interventions in patients who happen to have asthma. Because these drug-drug interactions have not previously been relevant to patient care, clinicians have had no guidance on management strategies to reduce potentially serious interactions between treatments for asthma and COVID-19.”