Asthma and the Risk of SARS-CoV-2 Infection Among Children and Adolescents

Abstract

Importance: More than 4 million SARS-COV-2 infections have occurred among children and adolescents in the United States. Risk factors for SARS-CoV-2 infection among children remain poorly defined. Objective: To evaluate the association between asthma and the risk of SARS-CoV-2 infection among children. Design: Retrospective cohort study Setting: A large, integrated health system in central North Carolina. Participants: Children 5 to 17 years of age with a Durham County address and at least one health care encounter in the Duke University Health System between March 1, 2017, and February 28, 2020. Exposure: Diagnosis of asthma Main Outcomes and Measures: The primary outcome was SARS-CoV-2 infection identified by PCR testing of a respiratory sample collected between March 1, 2020, and October 31, 2020. We matched children with asthma 1:1 to children without asthma using propensity scores and used Poisson regression to evaluate the association between asthma and the risk of SARS-CoV-2 infection. We assessed for effect modification of this association by inhaled corticosteroid prescription and comorbid atopic diseases. Results: Of 49,455 children, 6,515 (13%) met criteria for a diagnosis of asthma; all children with asthma were matched to a control child without asthma for a final cohort of 13,030 children. Median (interquartile range) age was 11.0 (8.0, 14.0) years, 56% were male, and 78% were non-White. A diagnosis of asthma was associated with a decreased risk of SARS-CoV-2 infection [risk ratio (RR): 0.67, 95% confidence interval (CI): 0.49-0.92]. This association tended to be stronger in children with asthma who were prescribed inhaled corticosteroids (RR: 0.60, 95% CI: 0.38-0.94) or who had comorbid atopic diseases (RR: 0.59, 95% CI: 0.39-0.88). Of the 66 children with asthma who developed SARS-CoV-2 infection, none required hospitalization for COVID-19. Conclusions and Relevance: Children with asthma had a lower risk of SARS-CoV-2 infection, particularly children prescribed an inhaled corticosteroid or with comorbid atopic diseases. Further studies are needed to explore the complex relationship between asthma, inhaled corticosteroids, and SARS-CoV-2.

The association between pre‐existing asthma and reduced risk of death among children and adolescents hospitalized with COVID‐19 in Brazil

“…Although asthma is the most common chronic disease in children, there is a paucity of data on whether childhood asthma has increased the risk of SARS-CoV-2 infection or the severity of COVID-19. 4,17 Interestingly, in a recent retrospective cohort study, Rao et al 16 showed that children with asthma have a similar risk of SARS-CoV-2 infection compared to children without asthma. However, Shi et al 15 reported that school-age children with asthma with recent hospitalization or two or more courses of oral corticosteroids are at a significantly increased risk of hospitalization related to COVID-19.…”

“…Therefore, the relationship between COVID‐19 and asthma is still unclear 13,14 . Moreover, in the pediatric setting, most studies are from high‐income countries, often with a small sample size, which may limit the generalizability of findings 15–17 …”

“…13,14 Moreover, in the pediatric setting, most studies are from high-income countries, often with a small sample size, which may limit the generalizability of findings. [15][16][17] We previously reported the clinical outcomes and risk factors for death in pediatric patients hospitalized during the first and second waves of COVID-19 in Brazil using a national registry of hospitalized cases of COVID-19. 18,19 In both cohorts, we found a relevant and additive effect related to the presence of chronic medical conditions.…”