COVID-19 and Asthma: Understanding the Post-Pandemic Rise in Respiratory Diseases

As care shifts beyond the acute pandemic, clinicians are seeing more patients with post-COVID respiratory symptoms, and some cohorts report higher rates of new-onset asthma.

Post-infectious inflammatory and immune responses may exacerbate chronic airway disease, underscoring the need for careful monitoring. Observational studies report an association between prior COVID-19 and elevated rates of new-onset asthma and other airway diseases; causality has not been established, as noted in a cohort study reporting increased asthma incidence after COVID-19. Taken together, these data are prompting clinicians to reinforce controller therapy adherence and to standardize follow-up for patients with post-COVID respiratory symptoms.

Inhaled corticosteroids have long been first-line per international guidelines; pandemic-era data largely support continuing them rather than indicating a therapeutic shift, as outlined in an editorial discussing continuation of inhaled corticosteroids during COVID-19.

These therapies have remained foundational and are associated with fewer exacerbations, aligning with consensus to continue controller therapy during COVID-19. By continuing such regimens, patients may reduce the risk of virus-related exacerbations, including those triggered by SARS-CoV-2.

To illustrate, consider a middle-aged patient who recovered from COVID-19 and later reports persistent cough, wheeze, and exertional dyspnea. Spirometry reveals variable airflow limitation, and symptoms improve with a trial of low-dose inhaled corticosteroids and formoterol. For such patients, reinforcing daily controller adherence and arranging structured follow-up can clarify trajectory and reduce the likelihood of exacerbations.

Post-infectious immune, inflammatory, and endothelial changes may have respiratory and cardiovascular consequences. Observational data suggest that, among individuals with severe asthma after COVID-19, cardiovascular events such as ischemic heart disease may be more frequent; residual confounding cannot be excluded, as reported in a study associating severe asthma after COVID-19 with ischemic heart disease risk. Consider cardiovascular risk assessment for patients with post-COVID respiratory symptoms, prioritizing those with established risk factors or severe disease.

Risk stratification in practice often starts with identifying red flags (e.g., frequent reliever use, nocturnal symptoms, prior exacerbations), comorbidities, and social determinants that may affect adherence and access to care. Standardizing reassessment—such as scheduling a follow-up visit within 4–6 weeks, repeating spirometry when feasible, and using validated control tools—can help differentiate transient post-infectious changes from evolving asthma.

For patients experiencing new asthma symptoms after COVID-19, these findings can help contextualize symptoms and inform clinical assessments. Clear communication about the observational nature of current evidence helps set expectations while maintaining focus on modifiable risks and guideline-consistent care.

For clinicians, concrete steps include reinforcing daily controller adherence, keeping vaccinations up to date, and considering cardiovascular risk assessment for high-risk patients.

Key Takeaways:

• COVID-19 and respiratory diseases like asthma are deeply interconnected, demanding revised clinical approaches grounded in careful monitoring and follow-up.
• Inhaled corticosteroids remain foundational first-line therapy; pandemic-era evidence supports continuing controller regimens to reduce exacerbation risk.
• Consider cardiovascular risk assessment for patients with post-COVID respiratory symptoms—particularly those with severe disease or established risk factors.