We took your questions and spoke with an infectious diseases expert from the European Respiratory Society (ERS), Professor James Chalmers, and intensive care specialist, Professor Leo Heunks, to get answers for you.
This Q&A will give you up-to-date and respiratory-specific information about COVID-19. If you have any other respiratory health questions relating to the outbreak please get in touch.
In many cases, the advice for people with lung conditions is the same regardless of condition. Because of this, unless the question clearly states a specific disease, the advice applies to multiple conditions.
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No – the infection can be caught by anyone. However, people with underlying lung conditions might be more likely to show symptoms of the infection or to have a more severe infection than others. So far, most people that get COVID-19 have a mild viral illness, but some people develop a chest infection/pneumonia. The severity of COVID-19 infection can be greater if you have an underlying lung condition and so you should make every effort to avoid becoming infected.
Any severe respiratory condition is likely to place you at higher risk of complications, in particular:
There are hundreds of different lung conditions and so it is not possible to list them all. Remember that being “high risk” means you have a slightly higher risk of complications of COVID-19 infection than other people, but you are still mostly likely, if you contract the virus, to have a mild illness or no symptoms at all.
Follow the advice from your country’s health authorities – this will be slightly different in each country depending on how many cases there are in your country.
There are things that everyone should do to limit their risk. If you have a lung condition, the following are important.
Self-isolating means staying indoors as much as possible and avoiding contact with others. The advice on self-isolation is different in different countries at the moment, but the following are sensible steps that apply to all countries in Europe:
If you are in an area with a high number of COVID-19 cases, you may be asked to do a more strict isolation.
Yes. The virus is caught from people that have the infection and so there is no problem in going outside by yourself. It is important to avoid contact with anyone who might be ill. In some countries you may be asked to wear a face covering outside.
The rules for meeting other people outside or events where a large number of people are together are different around Europe so you should follow the guidance where you live. In some places the rules get relaxed when COVID-19 cases go down and are tightened again when they begin to increase. You should check what the guidance is before deciding to attend an event or to meet other people outdoors.
In general, the virus spreads more easily indoors than outdoors and so if you have to meet others for essential reasons, it is better to do this outdoors where possible.
No. There is nothing unique about the symptoms of COVID-19 and this is why most people who are tested for the virus do not have it. Their cough and fever are actually caused by something else.
If you have a cough that is typical for you and it has not changed you do not need to do anything differently from normal and do not need to isolate. If your cough changes or you develop new symptoms along with your cough, you should self-isolate and if testing for COVID-19 is available in your country, arrange a COVID-19 test.
Yes, older age and the presence of underlying conditions – including lung conditions – have been shown to be risk factors for death. Nevertheless, it is important to emphasise that most patients, even those with underlying respiratory disease, have had mild infections and have fully recovered.
The guidelines for masks or face coverings vary across Europe. You should wear a face covering if this is recommended by your local authority. There is no medical reason that means you cannot wear a face covering if you have a respiratory condition.
You may find that it makes it feel a little harder to breathe. If this is the case you can try to adapt to the face covering slowly at home or try a different material such as a scarf. You can read more information about wearing face coverings and masks, including the different types of masks and face coverings, here.
Cats and dogs have been found to have the virus but there is currently no evidence that humans can catch the disease from common household animals such as cats and dogs. At the moment cats and dogs have not been shown to experience severe symptoms.
There is no evidence that COVID-19 can be transmitted through smoke, but passive smoke exposure can still be harmful to people with lung conditions in other ways. It might be worth closing the windows if your neighbours are smoking.
Most people dying from COVID-19 have been aged over 80 years and have had advanced heart and lung conditions. They have had a combination of older age and severe pre-existing conditions. Most older people and most people with pre-existing conditions have had a mild viral illness and have fully recovered. Younger people with underlying conditions are more likely to suffer complications than younger people without underlying conditions. That is why it is important to be more cautious if you have underlying health problems, even if you are young.
The flu vaccination only protects against the flu (influenza virus) and does not protect against COVID-19, although it is still important to have your flu vaccine so you do not get the flu.
Vaccines are now available for COVID-19 and more are being researched. Many countries across Europe are now giving vaccines to their citizens. Each country will have slightly different criteria for who will be vaccinated first. Generally, people who are most vulnerable are being vaccinated first. It is fine to receive both the flu and COVID-19 vaccines.
To protect older people and those with underlying health conditions, most European countries have adopted “social distancing” and self-isolation procedures. This means asking people to stay at home more than usual, practicing good hand hygiene and keeping their distance in public to reduce transmission.
There is no reason to believe hot water vapour would be either helpful or harmful for COVID-19.
There are no specific breathing exercises to do if you get COVID-19. If you have a lung condition such as bronchiectasis where you need to regularly clear your chest then you should keep doing your regular breathing or airway clearance exercises.
The hospital should advise you and the family member about this when they are discharged from hospital. In general, once symptoms have stopped and it has been 10 days since the start of symptoms, patients are unlikely to be infectious. If the hospital advises you that the patient is still infectious when they come home, they should also advise on how to isolate within the home, which includes trying to maintain a distance of 2 metres apart in the home and not sharing beds or bathrooms if possible. Research has shown it is very rare for people to be infectious beyond 10 days from the onset of symptoms.
As the rules are being relaxed there has been specific guidance for high-risk groups. This varies from country to country, but it might be that rules have been relaxed for younger people and those without high-risk conditions first.
Socially distancing and wearing face coverings is now in place in most countries and it is still very important to continue with handwashing and avoid touching your face with unwashed hands.
Many countries have stopped doing spirometry tests at the moment to reduce the risks to staff of being exposed to the virus during the test.
You are not at risk of catching the virus from a spirometry test. Spirometry equipment has always been dealt with in a very hygienic way and measures to avoid transmission of the virus are being practiced in spirometry labs everywhere. The main risk of catching the virus is from other people, and therefore the biggest risk is when travelling to the test and coming back from the test. Remember to practice social distancing – staying 2 metres apart from others at all times.
In most cases, no. The cough is usually dry throughout COVID-19, but about 1 in 5 patients seem to develop a phlegmy cough. This is more common if you have COPD or bronchiectasis. If the sputum is green it suggests you may need an antibiotic and you should discuss this with your doctor.
In every country the advice will be slightly different and so you should follow the local guidance as far as possible. In general, as long as COVID-19 is circulating in the community, you should limit exposure to as small a group of people as possible to reduce the risk of infection.
Probably not. There has been some speculation from experts that we have not seen as many patients with asthma, bronchiectasis or cystic fibrosis getting severe COVID-19 as we perhaps expected at the start of the pandemic. This has not, however, been confirmed by subsequent research and so it is likely the risk is the same for all underlying conditions.
Always discuss problems such as chest pains with a healthcare professional, because although they can be caused by anxiety, there are also potentially serious health problems that can cause chest pain.
Anxiety is a very difficult problem and can cause issues such as breathlessness and chest pains as well as other symptoms which could be mistaken for COVID-19. It is understandable that many people are anxious at the moment. If you do develop symptoms, it is important not to dismiss them as being caused by anxiety, but to assume until proven otherwise that they could be caused by COVID-19. This means self-isolating if you have symptoms that could be caused by COVID-19 and seeking medical attention for testing or treatment if you have more severe symptoms.
If you are struggling with your mental health during this difficult time, we have developed a factsheet about managing your mental health with a lung condition which you can access here.
You should speak to your employer as the approach to this will be different in different settings and it is not possible to give definitive advice without more information. In general, if you are having contact with anyone who is at high risk for COVID-19, the advice would be as follows.
Testing for people without symptoms is available for some people working with vulnerable groups such as those working in care homes, and you should perform these tests if you are asked to do so by your employer.
You should speak to your employer or occupational health department for advice. They will be able to evaluate your level of risk, as well as whether it is possible for you to work from home.
This is not something we can answer as the answer will be different in different countries across Europe. You should discuss with your employer or contact the appropriate government body for advice.
Different countries will have different standards for this, and you should look at the government advice for your country. The high-risk conditions are likely to include:
The list above was taken from the Public Health England advice page and may not cover all relevant conditions.
You should discuss this with your employer. The most important thing to do is to practice good hand hygiene, have appropriate personal protective equipment if you are interacting with patients known to have or suspected of having COVID-19 and practice social distancing. This limits both your risk and the risk of your family member getting COVID-19.
You should discuss your bronchiectasis and asthma with your employer as some hospitals are redeploying staff with high-risk conditions away from roles where you would be in direct contact with patients with COVID-19. This is not the case everywhere and the decision of whether you should be working there depends on the severity of your underlying lung conditions and should be discussed with your employer.
On the specific question of the mask, you should follow your local infection control guidelines. There is no need to wear a different mask because of your lung conditions.
Travel for people with underlying conditions should be limited as much as possible and restricted only to essential trips. In this case, if the trip is essential, you should follow the steps outlined at the top of this page, including practicing good hand hygiene during every part of the trip. Airlines and airports have introduced extensive new measures to reduce risk when travelling.
For patients with underlying lung conditions, we suggest limiting journeys as much as possible. Public transport, such as bus and train journeys, may be necessary, in which case the best way to reduce the risk of transmission is to wash your hands thoroughly before and after the journey; avoid touching your face, nose and eyes, and try to maintain a distance of more than 2 metres from other passengers if possible.
Public transport with the fewest passengers or that limits your contact with potentially sick people is the best, but we recognise that some journeys are unavoidable.
In most countries, there is now a recommendation to wear a face covering on public transport.
Many countries in Europe closed schools in response to the outbreak. In many places they are now re-opening schools. You should follow your local guidance about sending children to school.
Children can contract COVID-19, but most frequently have a mild viral illness. The risk to your child and any risk to you as a person with lung disease should be discussed with your school before a decision to take your child out of school is made.
In the event that more widespread transmission and large outbreaks are detected in the country, schools in specific regions may be advised to close.
If they are old enough, ensure they have been taught about how to wash their hands properly and to avoid touching their mouth, nose and eyes with unwashed hands. Consider social distancing measures, such as reducing out of school activities and avoiding events where they will be in contact with a large number of people.
Most importantly, the disease is generally mild in children, but could cause problems in children if their lung condition is not under good control. Make sure they are taking all of their regular medications, such as preventor inhalers for asthma, to reduce the risk of complications if they do get the infection.
Both you and your children should practice good handwashing with soap and water for 20 seconds regularly through the day and particularly after your child has come home from school (if applicable) and before meals. Both you and your children should avoid contact with anyone who is sick or who has been in contact with people potentially infected with COVID-19.
It is difficult to comment without more information. If anyone, including a child, is in a high risk group for COVID-19 they should follow the advice at the top of this Q&A regarding social distancing, hand hygiene and limiting contact with people outside their household. Staying in complete isolation was recommended in many countries early in the pandemic and is called “shielding”. This is difficult to do over a prolonged period of time and so we recommend following local government advice in your country.
Ventilation should only be provided by a trained specialist and is not something that you should acquire yourself without specialist supervision.
If you use oxygen at home, this usually indicates that you have quite a severe underlying lung condition and so you should take steps to reduce your risk of getting COVID-19. These include:
You should continue to use your treatment as normal. We do not know whether CPAP makes the virus spread more easily within a household. You may wish to distance yourself from vulnerable household members by changing bedrooms.
Please be reassured that the vast majority of people who get COVID-19 infection do not require ventilation. Most people experience a mild viral illness (similar to a cold) and recover fully. This includes people that have underlying conditions.
Hospitals in Europe are receiving extra ventilators and additional trained staff to ensure as many patients as possible can receive ventilation if it is required.
The most important thing you can do is to make every effort to avoid getting the virus. This means following strict social distancing measures. For now, you should reduce contact with people outside your household as much as possible and practice strict hygiene measures in addition to:
Most patients with COVID-19 experience only mild symptoms, including fever and coughing. This will not be different for patients using NIV. Depending on the medical reasons for needing NIV you may be more likely to develop severe symptoms, including dyspnea (shortness of breath) or hypoxemia (low levels of oxygen in the blood). Contact your doctor early if symptoms get worse.
If you are diagnosed with COVID-19 you may be more likely to infect other people while using NIV, especially via any air leak from the device. The high flow generated by the ventilator may distribute virus particles in the area around you. Discuss additional protective measures with you doctor. For example you may wish to distance yourself from vulnerable household members by changing bedrooms if you use NIV overnight, to reduce the risk of spreading infection.
Most patients with COVID-19 experience only mild symptoms, including fever and coughing. This will not be different for patients using CPAP.
We do not know whether CPAP makes the virus spread more easily within a household. You may wish to distance yourself from vulnerable household members by changing bedrooms.
Most patients with COVID-19 experience only mild symptoms, including fever and coughing. This will not be different for patients using invasive mechanical ventilation. Depending on the medical reasons for you needing invasive ventilation, you may be more likely to develop severe symptoms, including dyspnea (shortness of breath) or hypoxemia (low levels of oxygen in the blood). Contact your doctor early if your symptoms get worse.
If you are diagnosed with COVID-19 you may be more likely to infect other people while using mechanical ventilation, especially via any air leak around a tracheostomy. The high flow generated by the ventilator may distribute virus particles in the area around you. Discuss additional protective measures with you doctor.
No, your CPAP machine could not be repurposed for use in a hospital. It is important you carry on using your normal treatments during the coronavirus pandemic, including your CPAP.
Your inhaler should only be used by you, and it should be kept clean and stored in a safe place where it cannot be handled by others. In this way, you can avoid the inhaler being a source of infection. There is no need to get a new one.
No – medications are manufactured according to very strict and very carefully controlled hygiene standards.
Even if these systems were to fail for any reason, the virus is not able to survive for long periods on surfaces such as cardboard (for medication packs) or plastic (for devices such as inhalers). Therefore, by the time the medication has been shipped from the countries in question to the pharmacy and has been given to you, the virus would be dead.
It is very important not to make any changes to your treatment while the COVID-19 pandemic is ongoing, unless your doctor advises you to. Your treatments help to keep your lungs healthy and any changes to your treatment that have not been recommended by a healthcare professional could put you at higher risk of a flare-up of your lung condition. The health service in many countries is likely to be overwhelmed over the coming months and so keeping everyone as healthy as possible is key to reducing the burden on doctors and hospitals.
Please take all of your medications exactly as prescribed.
Everything is being done to ensure that the supplies of essential medications are maintained. There is no cause for concern. The European Medicines Agency are monitoring the situation and to date have reported no shortage of essential medications.
Do not stop or modify any of your asthma medications because of concern about COVID-19. There is a risk that doing so could make your asthma control worse, causing you to need medical treatment or hospital admission.
Anti-IL-5 should have no effect on the risk of getting COVID-19, and keeping taking it could theoretically reduce the risk of an asthma attack if you were to contract the virus.
The advice you have received is wrong – there is no evidence that prednisolone and doxycycline can make COVID-19 worse. The World Health Organization says that steroids should still be used for people with COPD who have a flare up (exacerbation) with COVID-19. Antibiotics are commonly used when patients are admitted to hospital with COVID-19. Trials giving antibiotics such as azithromycin and doxycycline to people with COVID-19 in the community and in hospitals did not find any evidence of harm.
In summary, if you get a flare up, you should follow your doctor’s advice and use your medication.
In general it is important that you keep taking all of your usual asthma treatment, including omalizumab, to avoid having asthma attacks during the coronavirus pandemic.
If you are using Xolair, by definition you have severe asthma and so you should follow your government advice for people with severe asthma.
No, there is no evidence that histamine is involved in the response to COVID-19 and so no reason to believe antihistamines would have any effect.
You should always follow the instructions of your doctor and they will have a good reason for having given you this medication. You should not stop taking any medicine without discussing it with your doctor.
For people in hospital who need oxygen or help with their breathing dexamethasone has been shown to be very beneficial, reducing the risk of death by up to 1/3. There is no evidence that steroids can make the condition worse.
This will depend on the guidelines in your country. The general advice is to be tested if you have symptoms of COVID-19. In some countries you will need to attend a specific testing centre, in others they will come to your door. If you leave the house for testing you should make sure that you wash or sanitise your hands regularly, wear a face covering and do not come into close contact with anyone other than when asked to at the test centre. You should not travel to a test centre using public transport (including taxis).
You should follow the same advice as for anyone else in your country. In most countries this means that you should self-isolate, meaning you do not go out (isolation periods vary from 10-14 days across Europe) and you should get a test if this is available in your region. The others in your household will also have to isolate until they have completed an isolation period which is often 14 days.
Take paracetamol for any fever and keep up with the usual treatments for your lung condition. Drink plenty of fluids as the fever can dehydrate you.
If the symptoms worsen or are not improving, you can get advice from your healthcare professional. This works differently in different countries.
If you think you have COVID-19 infection, ask yourself if you can manage the symptoms at home. Fever can be managed with paracetamol and drinking lots of fluids. If the symptoms are severe or you need additional advice, please contact your primary healthcare provider.
A useful question to ask yourself is “would I go to hospital the way I feel now if the coronavirus was not around?”. If the answer is yes, you should seek medical attention and may need treatment in hospital. The reasons for being admitted to hospital with COVID-19 are the same as for any lung infection. If you are too breathless to manage at home, or the symptoms are worsening or not improving then you should get medical advice.
It is important that you obtain medical help. If your condition has been going on for weeks and not improving, you should seek medical advice.
In many countries, alternative services such as community pharmacies and telephone services have been set up. If you can use these services, it may be best to do so first; this will limit your risks and mean that hospitals are less stressed.
Hospitals are there to help if you are ill enough to need hospital treatment and they will be practicing very strict hygiene measures to avoid people catching COVID-19 from visits to hospital.
It is important you get the treatment you need. Many health services have reopened their outpatient/ambulatory services, including lung function assessments, and they are available for those who need them. Some medical appointments have been rescheduled or they may take place in a different way, for example, over the phone or on a video call.
You should still go to any regular appointments you have, unless you are told not to attend.
Your health needs are as important as they were before COVID-19 and you should seek the care and treatment that you need. Health services have systems in place to make sure that care is available for anyone who needs it and measures are in place to reduce the risk of the virus spreading.
There are now a large number of studies which have examined whether people with asthma are at increased risk of complications and need for ventilation. Some studies show a small increase in risk, while many studies show no increased risk at all. The expert opinion is that asthma in general probably does not increase risk but there may be a slight increase in risk of complications with more severe asthma.
The ERS published two studies on this topic in 2020:
https://pubmed.ncbi.nlm.nih.gov/32732333/
https://pubmed.ncbi.nlm.nih.gov/33154029/
Yes. Research shows that cases of COVID-19 in people with asthma are generally mild and most patients are fully recovering.
What you have been told is wrong. Patients with asthma should never stop taking their preventer inhaler unless asked to do so by a medical professional. Stopping your steroid inhaler could put you at higher risk of complications of COVID-19 due to making your asthma worse. There is currently no reason to think that steroids make COVID-19 worse and in fact steroid tablets are used in hospitals as a treatment for severe COVID-19 because they are beneficial.
Do not stop or modify any of your asthma medications because of concern about COVID-19. There is a risk that doing so could make your asthma control worse, causing you to need medical treatment or hospital admission.
Anti-IL-5 should have no effect on the risk of getting COVID-19, and keeping taking it could theoretically reduce the risk of an asthma attack if you were to contract the virus. Research has shown very few cases of COVID-19 in people taking these type of medicines and no increase in the risk of severe cases.
There is no specific evidence that masks make asthma worse, but triggers for asthma symptoms are not always obvious and not always identified. If you think that something at work is making your asthma worse it may be appropriate to talk to your doctor or to the occupational health department for advice.
People with bronchiectasis might be at higher risk of complications if they get COVID-19, so here are a few suggestions to reduce your risk of getting the infection and the risk of complications if you do:
Bronchiectasis is a very diverse condition and ranges from severe to mild, and so it is not possible to give one recommendation that covers everyone. In general, if you have severe bronchiectasis, meaning that you have frequent chest infections or take preventative antibiotics, you should follow the advice in your country for people at high risk. This may include measures such as working from home where you can and avoiding unnecessary contact with people outside your household.
Patients with mild bronchiectasis, where you have only a mild cough and do not suffer frequent chest infections, may not need to take extra precautions but should still follow all hygiene and public health advice.
We do not know if bronchiectasis patients are more likely to have complications, but it is better to be careful.
Yes, most people with bronchiectasis who have had COVID-19 have had mild symptoms and have fully recovered. There is a slight increased risk of severe disease with COVID-19 in bronchiectasis.
It is difficult to comment on a specific case. Most people who get COVID-19 will have a mild illness similar to a cold or the flu, even if they have underlying conditions. Severe heart disease and lung disease have been associated with worse outcomes, particularly in patients who are over the age of 80 years. Cancer, when successfully treated, is not usually a risk factor for worse outcomes in respiratory infections like COVID-19.
Find more information about cancer and COVID-19 at www.womenagainstlungcancer.eu/emergenza-covid-19/#more
About 50% of people who contract COVID-19 will experience no symptoms at all. Some people will experience a mild cold with running nose, sore muscles, fever and a cough. Others develop a more “flu-like” illness with worse fever, sore muscles and tiredness. In the most severe cases it causes a pneumonia with breathlessness and coughing in addition to the symptoms above.
Because COPD patients have lung problems to begin with, they may be more likely to experience breathlessness with COVID-19, and more likely therefore to need hospital treatment. Nevertheless, most people with COPD would experience no symptoms or just mild symptoms and make a full recovery.
Patients with severe COPD and emphysema are among those considered to be at higher risk of complications from COVID-19. This is because the lungs are affected by COVID-19, and if the lungs are already slightly damaged, they have less ability to fight the virus. A large UK research study found that people with chronic respiratory conditions, the majority of which were COPD, had a 17% increase in the risk of death from COVID-19.
Please follow guidance from your healthcare professionals and the local response to COVID-19.
Avoid places where there is likely to be an increased risk of exposure such as crowds – especially in poorly ventilated areas.
Currently there are no blanket recommendations about school attendance. This will depend on your local circumstances and individual advice from your local CF centre.
If you are employed, we recommend contacting your employer to consider what reasonable adjustments can be made to your working conditions to help protect you. Your local CF centre may be able to provide advice and support for this.
The information above was summarised from the Cystic Fibrosis Trust. You can find out more here https://www.cysticfibrosis.org.uk/news/COVID-19-qa
Your transplant team or specialist may already have a plan in place and if so you should follow their advice.
In general, if you develop symptoms that would be consistent with a viral infection it would be advisable to self-isolate at home and contact your local transplant team for advice. If you are unwell with problems such as difficult breathing you should seek medical attention urgently, as would be the case at any other time.
No, previous infections do not increase the risk of more severe infections in future unless the previous infections were due to other diseases (such as severe heart or lung conditions, diabetes or conditions or drugs that suppress the immune system).
You should follow the national guidelines in your country. In the UK this would mean social distancing, which is not the same as self-isolating. You should stay at home as much as possible, but you can go out once a day for shopping and/or exercise. You should stay away from anyone else who is not in your family (maintain a distance of at least 2 metres while you are out).
It is important to continue with your TB treatment even if you start to feel unwell. Keep taking your medications unless advised by a healthcare professional. TB should not have any effect on the severity of COVID-19 infection. Treatment of COVID-19 infection might be more complicated due to interaction between TB medications and other medications, so it is important you speak to a pharmacist or doctor before taking medication.
Possibly. Post-TB lung damage often puts you at a higher risk of picking up chest infections and so you might be at slightly higher risk of having a chest infection if you were infected with COVID-19. It is important to emphasise, however, that most people experience either a mild illness or no symptoms at all, even if they have underlying lung disease.
Not necessarily. Patients with underlying lung conditions are at higher risk of complications if they have low lung function or severe breathlessness. If your alpha-1 antitrypsin deficiency has not caused COPD or significant emphysema there is probably no need to worry. Even if you have moderate or severe COPD, although you would be at higher risk of complications most patients are recovering well from COVID-19.
You would have to discuss this with your doctor who will know whether your treatment is essential or could be delayed until infection rates start to decline where you are.
Not unless you also have other underlying health conditions. Pneumothorax can occur in a completely healthy person and in that case, you are not at any greater risk from coronavirus than anyone else. If your pneumothorax was a complication of COPD, cystic fibrosis or another lung condition, then it is the underlying lung condition that would put you at risk.
There is no evidence that this is the case. Pneumothorax is a rare complication of viral infections and there is no evidence that previous pneumothorax would put you more at risk unless you have another underlying lung condition.
Yes, European research shows that patients with interstitial lung disease have a 60% increase in risk of complications compared to people without interstitial lung disease. Therefore, patients with idiopathic pulmonary fibrosis should make every effort to avoid infection. Even though the risk is increased in patients with IPF, most IPF patients that develop COVID-19 will still have a mild infection and recover fully.
No, pleural thickening would not affect the risk of catching COVID-19 and would not increase the risk of complications unless it is combined with other heart or lung conditions.
No, unless the pleurisy is due to another underlying lung condition. The lung conditions that place you at greater risk are those that affect the airways or cause reduced lung function, such as COPD, severe asthma, bronchiectasis, cystic fibrosis, pulmonary fibrosis or lung cancer.
If you are otherwise healthy, there is no reason to think that this would make COVID-19 infection more severe or more likely.
This information also applies to healthy people with smaller lungs caused for example by scoliosis or kyphosis. It might cause some restriction of your lung volume and your risk would depend on how severe the restriction was, but in general you would not be at significantly increased risk of complications.
Pulmonary embolism, if it has been treated with blood thinning medication and your oxygen levels are normal, would not be expected to have any effect on your risk of complications with COVID-19.
The recommendations are different in different countries, but in the UK at the moment (for example) you would not be asked to remain indoors for 12 weeks. You would be asked to socially distance, meaning:
Only those with severe underlying conditions such as immune problems, cancer or severe COPD, asthma and other lung conditions are being asked to stay indoors for 12 weeks. Chronic thromboembolic disease in not one of these conditions.
No, if you have a chronic cough that is not due to a severe lung condition such as COPD or cystic fibrosis, you would not be considered to be at higher risk.
No, VATS and pleurodesis treat the pleura – the lining of the lung. There is no evidence that COVID-19 affects the lining of the lung and so there is no reason to think this would make you more likely to get severe illness.
Low levels of IgM, if they are not associated with low levels of IgG or IgA or another medical condition, would not be expected to greatly increase your risk of severe COVID-19 infection.
It is hard to comment on individual cases, but this does not sound like a risk factor, in and of itself, for complications of COVID-19.
No, not if the punctured lung has repaired itself, or has been repaired through treatment with a chest drain. You would not be at any higher risk of complications than the general population if your lungs are otherwise healthy.
Yes, we think that because primary ciliary dyskinesia makes it harder to clear the lungs, it could make COVID-19 more severe. For that reason, in many countries patients with PCD have been advised to stay at home as much as possible and pay extra special attention to hand hygiene, social distancing and avoiding visitors to the house.
It is very difficult to comment on individual cases. You may be more at risk if this causes you to have frequent chest infections or to have lower lung function than normal. It is important to remember that even if you have a slightly higher risk, most people who catch COVID-19 recover fully.
No, not unless you have been left with permanent lung damage such as bronchiectasis as a result.
Probably not, unless the cysts in the lungs have caused a lower lung function or lower oxygen level than normal.
This is quite a rare condition and so there will not be specific information about this condition and COVID-19. In general, we think that people are more at risk if they have very low lung function, get breathless easily (such as having to stop after walking 100 metres or less) or have frequent chest infections. If your condition is not causing these kinds of symptoms and signs, you are not likely to be at greatly increased risk.
It depends on whether your aspergillosis is still active or not. If it has been successfully treated and you are feeling well you should be at no further risk. If you are very breathless, such as not being able to walk 100 metres without stopping, or have low lung function due to your aspergillosis, you would be at higher risk of complications. If this is the case, you should pay special attention to social distancing measures and may be advised to stay at home as much as possible.
It is difficult to comment without more information but it is quite likely. People with severe lung conditions are at higher risk, for example people who have low lung function and those who get breathless walking short distances such as 100 metres. You should discuss with your doctor whether you should be taking extra measures to protect yourself such as staying at home as much as possible.
No, a high IgE level by itself would not increase your risk of COVID-19 or complications if you get COVID-19. There is no evidence that IgE is involved in COVID-19.
It is hard to say without further information but usually this would be a risk factor for breathing problems and therefore COVID-19 could be more complicated. In general, it is important to remember that most people who catch COVID-19, even if they have underlying conditions, experience just a mild flu like illness and recover fully.
Probably not – we have not seen this come out as a risk factor in any of the analyses that have been conducted so far and there is not a strong reason to believe that this would be a risk factor either for catching COVID-19 or having a severe condition.
This condition is too rare for there to be any reports of the risk in this condition. In general, children are at low risk of severe infection and, even if they have underlying conditions, children seem to do very well with a low risk of severe disease.
In general, patients with interstitial lung diseases such as hypersensitivity pneumonitis are thought to be at higher risk of complications from COVID-19. A European study found people with these types of lung conditions had a 60% increase in risk of complications compared to people without interstitial lung diseases. It is not possible to comment on a specific case but hypersensitivity pneumonitis can vary from mild to very severe and the risk is likely to be highest in those with severe lung disease.
Yes, there have been people who have had a confirmed case of COVID-19 and have been re-infected. It is not common and research has shown that having the virus once gives approximately 85% protection over at least 6 months. This is similar to the level of protection provided by vaccines. The fact that reinfection can happen does highlight that it is important to continue to practice safety measures such as hand washing, wearing a face covering and social distancing even if you have had COVID-19.
Most people who get COVID-19 recover fully with no lasting effects. A small proportion of people have developed long lasting effects such as lung scarring. This is more likely with very severe infections or people that require ventilation in the intensive care unit. Rehabilitation and support can help patients to get back to a normal life. This will only affect a small percentage of patients who get the infection.
Symptoms of COVID-19 can persist for a significant period of time and a majority of people who have been hospitalized will still have some symptoms up to 4 weeks after recovering from the infection. The most common ongoing symptoms are fatigue and breathlessness but there are a wide range of symptoms that have been reported. Recovery is expected between 4 and 12 weeks after COVID-19.
Some people are getting longer term problems and complications with COVID-19 and this is referred to as post-COVID-19 syndrome or “long COVID-19”. This is diagnosed if the symptoms continue beyond 12 weeks and are not explained by another condition. Estimates of developing this vary between 1 in 20 and 1 in 10 cases of COVID-19 depending on how it is defined.
Chest pains after 2 months are unusual and should be discussed with your doctor to ensure they are not caused by something else.
A lot of patients are reporting pain or discomfort in the chest during COVID-19 and it is quite a common symptom; in a recent UK report more than 1 in 10 patients with COVID-19 had chest pain. It is most likely caused by inflammation of the lining of the lung (sometimes called pleurisy) although pains in the muscles of the chest due to coughing are also common.
It is important you discuss the pain with your doctor because although it is a common symptom of COVID-19 there are other important things that can cause chest pain.
This is possible as severe infections are known to be a cause of bronchiectasis. So far, some studies using CT lung scanning have found around 10% of people with COVID-19 infection have bronchiectasis. This might mean that COVID-19 can cause bronchiectasis, but it is too early to know if the bronchiectasis being found in these studies will be permanent, or if some people had bronchiectasis before they got COVID-19.
Most people will have mild infections and be able to treat themselves at home using similar treatments to those used for the flu, such as paracetamol to bring down a fever. For people who need to go to hospital several treatments have been trialed and the ERS has released guidelines on this which are under constant review. If you go to hospital your doctors will know the best way to look after you under the current guidelines. Two treatments have been shown to cut the risk of death from COVID-19, both of which are anti-inflammatory treatments. There is ongoing research to find the best treatments for COVID-19 and many patients admitted to hospital with COVID-19 will be asked if they would like to participate in research trials.
We now have vaccines that have been approved and are in use across the world.
What most people mean when they say airborne is that it can spread through the air. COVID-19 is mostly spread by droplets, meaning small droplets of water containing the virus which are released when infected people cough or sneeze. COVID-19 can therefore be spread through the air when infected people cough or sneeze, and aerosols can be formed by vigorous coughing or certain procedures. The fact it can be spread from person to person through droplets in the airway is why we strongly recommend you stay at least 2 metres away from others at the moment, because this protects you from being affected by droplets. Face coverings also catch any droplets or aerosols that you generate during coughing and helps to protect others, and you, from infection.
Yes, the vast majority of people who catch COVID-19 will experience no symptoms at all, or just mild symptoms.
It can be as little as a fever, cough or a runny nose and a headache for a few days. COVID-19 seems to be quite different for different people, but for the majority of people who have had it, it is mild and passes in a few days.
Find more information about symptoms on our COVID-19 information page.
You can get COVID-19 if you have other infections and there are reports of “co-infections”, meaning two infections at the same time. Don’t catch a cold!
Pulmonary fibrosis after COVID-19 is uncommon but it does happen. Research is needed to find out how to prevent this as we currently do not know the answer to this question. The only definite way to prevent this from happening is to avoid infection in the first place. Several trials are happening across Europe to test treatments that might prevent this from happening.
Fever is a common symptom of COVID-19 but is not the only symptom. Other symptoms are a persistent cough, loss of taste and smell, sore throat, runny nose, tiredness and in severe cases, breathing difficulties. Other viruses and chest conditions can cause these symptoms as well and so you can never be 100% sure they are caused by COVID-19 without a test.
If you have these symptoms but they are not severe enough to need to go to hospital, you should assume that you have COVID-19 and self-isolate. If testing is available where you are, you should get tested.
In most cases the answer is no. There are cases, particularly when patients are admitted to the intensive care unit, where a loss of lung capacity and lung scarring have happened after COVID-19. If you have ongoing symptoms of breathlessness or difficulty exercising, your healthcare professionals may arrange a follow-up to test your lung function. Most people will not require this kind of follow-up.
In severe cases COVID-19 causes a condition called pneumonia and in the most severe cases it causes a condition called acute respiratory distress syndrome (ARDS). In both cases the blood vessels supplying the lungs become “leaky” due to too much inflammation and the lungs fill with fluid and cells that can damage the lung. There is also evidence that the blood becomes thicker during COVID-19 causing blood clots to form in the blood vessels supplying the lungs. This problem can be mild in some people, and they will get better with oxygen and time. In severe cases of ARDS a ventilator may be needed to support the lungs until the inflammation settles and the fluid goes away.
Unfortunately we don’t think that the temperature of the air is going to have much effect on your risk of catching COVID-19. The disease can spread in very warm countries and in very cold countries. Extreme air temperatures will not prevent you from catching COVID-19 but could cause breathing difficulties.
Pulmonary embolism has been reported in a high number of patients with COVID-19 including patients admitted to hospital and particularly in patients with severe COVID-19 in the intensive care unit. This is because of the inflammation caused by COVID-19 and because patients in hospital are not able to move around as much as normal. There is no evidence that people with a mild COVID-19 infection at home are at increased risk of a pulmonary embolism.
Yes, research shows a 60% increase in the risk of complications for people with pulmonary fibrosis. Patients with IPF are advised to pay special attention to social distancing rules and stay at home as much as possible.
No, the virus is mostly spread via droplets of water from coughs and sneezes. It can also be passed from person to person by touch when these droplets are transferred from one person to another.
This is not something I have seen or heard from patients. I would suggest you discuss this with your doctor.
The main test used to diagnose COVID-19 is a swab of the nose, throat or both to detect the virus. This test is very specific – so if your test is positive it means you have the virus or have recently had the virus (false-positives are uncommon). If the test is negative, there is a small chance that this is a false-negative test. UK scientists have estimated that 10% of people who truly have COVID-19 will have a negative test.
We do not know any factors that are associated with a negative test and there is no evidence that this is influenced by having a lung condition.
Not usually. The main effect of COVID-19 on the lungs is to cause them to fill with fluid (sometimes called pneumonia or ARDS). This does not cause bronchospasm or airway narrowing as we would see in asthma. Even patients with asthma who get COVID-19 are often not wheezy, suggesting no large element of bronchospasm.
This has been reported in studies that have looked at lung tissue under the microscope in COVID-19. This most likely occurs only in the most severe cases, such as those patients admitted to the intensive care unit. It is important to remember that most cases of COVID-19 are mild and either do not involve the lungs extensively or do not result in long term damage to the lungs.
It is completely safe to exercise with a mask and it will not affect your oxygen levels. Make sure you check the regulations where you live. It is not required in all European countries to wear a mask while exercising outdoors as the risk of transmission of the virus in outdoor settings is very low.
This needs to be completed by someone with knowledge of your medical history and so this would usually be your doctor or a doctor working in an occupational health department. You should discuss the situation with your employer.
If you have a confirmed influenza (flu) infection, then no, you do not need to be more worried. Getting one virus does not make you more likely to get another infection.
