Introduction
We report 3 challenging cases of asthmatics, with COVID19, that elucidate the heterogeneity of presentation and disease progression.
Case Description
Our first case is a 66-year-old African American female managed on omalizumab, fluticasone furoate-vilanterol, montelukast, and tiotropium for moderate persistent asthma and allergic rhinitis. She developed a fever of 102°°F, nonproductive cough, dyspnea, headache, and diarrhea. Azithromycin initially improved her symptoms, but her cough and dyspnea relapsed, requiring hospital admission. While inpatient, she was found to be COVID positive. Management included IV hydration, hypokalemia management, and oxygenation via nasal cannula. She was discharged after 9 days with all symptoms resolved save for mild to moderate dyspnea.
Second, we have a 47-year-old Hispanic female with allergic rhinitis and moderate persistent asthma managed on omalizumab, budesonide-formoterol, tiotropium, fluticasone, and montelukast. She experienced a persistent cough, dyspnea, anosmia, ageusia, and an ongoing temperature > 100.4° °F. She tested positive for COVID 19 and was started on prednisone 60 mg along with azithromycin. Her dyspnea persisted so hydroxychloroquine was added to her regimen and her dyspnea resolved within 6 weeks.
Our final case is a 69-year Caucasian COVID19 positive female with mild persistent asthma and allergic rhinitis managed with montelukast. She developed diarrhea, ear pain, anosmia, ageusia, weight loss, productive cough, and an average temperature of 101.9° °F. She started azithromycin with symptom resolution by 14 days.
Discussion
In our experience, COVID19 infected asthmatics, with comorbid allergic rhinitis, all recovered between 14-42 days without developing pneumonia or acute respiratory distress syndrome.