Childhood asthma outcomes during the COVID-19 pandemic: Findings from the PeARL multi-national cohort

Abstract

Objective: We evaluated the impact of COVID-19 pandemic on childhood asthma outcomes. Design: The PeARL multinational cohort included children with asthma and non-asthmatic controls recruited during the COVID-19 pandemic and compared current disease activity with data available from the previous year. Setting: Pediatric outpatient clinics. Participants: The study included 1,054 children with asthma and 505 non-asthmatic controls, aged between 4-18 years, from 25 pediatric departments, from 15 countries globally. Exposures: COVID-19 pandemic first wave, starting from the date of the first fatality in the respective country. Main outcomes and measures: We assessed the pandemic's impact on the frequency of respiratory infections, emergency presentations and hospital admissions in asthmatic versus non-asthmatic participants, controlling for confounding factors including the pandemic's duration and the frequency of such acute events during 2019. Using paired analyses, we evaluated the impact of the pandemic on the annualized frequency of asthma attacks and the previously mentioned acute events, asthma control, and pulmonary function in children with asthma, compared to their baseline disease activity, during the preceding year. Results: During the pandemic, children with asthma experienced fewer upper respiratory tract infections, episodes of pyrexia, emergency visits, hospital admissions, asthma attacks and hospitalizations due to asthma, in comparison to the preceding year. Sixty-six percent of asthmatic children had improved asthma control while in 33% the improvement exceeded the minimally clinically important difference. Pre-bronchodilatation FEV1 and peak expiratory flow rate were also improved during the pandemic. When compared to non-asthmatic controls, children with asthma were not found to be at increased risk of LRTIs, episodes of pyrexia, emergency visits or hospitalizations during the pandemic. However, an increased risk of URTIs emerged. Conclusions and relevance: Childhood asthma outcomes, including control, were improved during the first wave of the COVID-19 pandemic, probably because of reduced exposure to asthma triggers and increased treatment adherence. The decreased frequency of acute episodes does not support the notion that childhood asthma may be a risk factor for COVID-19. Furthermore, the potential for improving childhood asthma outcomes through environmental control becomes apparent.

COVID-19 in Children with Asthma

“…Recent large studies focusing on the course of asthmatic children during the pandemic revealed that they are not disproportionately affected by the virus, and surprisingly, they appear to have improved outcomes [15]. This was attributed to reduced exposure to asthma triggers, increased steroid prescriptions, and better treatment adherence during the pandemic.…”

Asthma Patients Benefit More Than Chronic Obstructive Pulmonary Disease Patients in the Coronavirus Disease 2019 Pandemic

“…As such, the improved air quality may have helped stabilize the condition of asthma patients and reduce the frequency of AE. This is also affirmed by one multinational cohort study involving 1,054 children with asthma, showing that the outcomes of childhood asthma improved during the pandemic (18). Furthermore, research in the US and UK has shown a marked reduction in emergency visits by asthma patients during the pandemic (19,35).…”

“…As asthma and COPD exacerbations can both be triggered by respiratory infections and air pollution, among others (12,17), COVID-19 and its resulting social isolation measures may have had effects on chronic airway disease patients in several ways. Since previous studies have indicated that patients with asthma or COPD experienced improved disease control during the pandemic due to behavioral changes (18)(19)(20)(21), we hypothesized that the COVID-19 pandemic would confer an impact on the conditions of chronic respiratory diseases patients. Therefore, the present study aimed to compare the differences in clinical characteristics before and during the pandemic between asthma and COPD patients to analyze their risk factors for acute exacerbations (AEs) during the pandemic, and further to develop management strategies for chronic airway disease patients.…”

COVID-19 Pandemic and Reduced Physical Activity: Is There an Impact on Healthy and Asthmatic Children?

“…In particular, improved or unchanged asthma control during pandemic was reported by 90.2% of the participants to a multi-national cohort study including 1,054 children with asthma and 505 non-asthmatic children aged 4-18 years from 15 countries. These findings might be due to reduced exposure to outdoor asthma triggers, such as seasonal allergens and air pollutants, and increased treatment adherence (38). Noteworthy, social distancing and facemasks have been proposed to reduce respiratory viral infection, leading to less hospital admission for asthma exacerbation in adults.…”