COVID-19 Infections and Asthma.

The severe acute respiratory syndrome coronavirus 2, which causes coronavirus disease 2019 (COVID-19), has infected more than 200 million and led to the deaths of more than 4.3 million people. Although there are known risk factors for severe disease, asthma was initially hypothesized to be a risk factor for severe disease given the association between asthma exacerbations and respiratory viral illnesses in general. Fortunately, clinical outcomes for patients with asthma overall are similar to those for patients without asthma, without convincing evidence that asthma is a risk factor for severe disease. This may be explained in part by the decreasing gradient of angiotensin-converting enzyme-2 receptor from the upper to lower respiratory epithelium and that aeroallergen-sensitized patients with asthma can have up to 50% reduction in angiotensin-converting enzyme-2 receptor expression. Vaccination for patients with asthma is recommended for all without clear contraindications. COVID-19-specific treatment options are available depending on the severity of disease. We caution the use of systemic corticosteroids in patients with asthma not requiring supplemental oxygen given an association with worse outcomes. Postacute COVID-19 syndrome or long-haul COVID does not appear to be more prevalent in the population with asthma, and a multidisciplinary approach to care is a reasonable option.

Postprandial Hypotension in the Intensive Care Unit Due To Portal Hypertension and Coronavirus Disease 2019: A Case Report.

A 49-year-old man with cirrhosis and portal hypertension was admitted for acute respiratory distress syndrome secondary to coronavirus disease 2019 (COVID-19) pneumonia. His course was complicated by postprandial hypotension (PPH)-episodic hemodynamic collapse that occurred minutes after enteral administration of medications or fluids. Octreotide, which reduces splanchnic pooling and can treat PPH, successfully prevented ongoing events. PPH is associated with mortality in the outpatient setting, and at-risk patients include the elderly and those with autonomic dysfunction, including those with COVID-19. Portal hypertension is a likely additional risk factor that has not been previously described. Octreotide is the mainstay of PPH prophylaxis.