Evaluation of the Impact of Environmental Changes on Asthma Control in Children, Access to Health Care, and Treatment Adherence in Early COVID-19 Lockdown

Abstract

Objective : During the coronavirus disease 2019 pandemic, lockdown measures and difficulties in accessing healthcare have impacted asthma management in children. This study aimed to determine the evaluation of the impact of environmental changes on asthma control in children, access to health care, and treatment adherence in early coronavirus disease 2019 lockdown. Materials and Methods: The study included children with asthma aged 6-11 years. A survey form was administered to the patients who visited the pediatric allergy outpatient clinic between June 1 and 30, 2020. The survey acquired demographic information about the children and their families as well as information about their asthma symptoms, how they reached healthcare services, and adherence. The childhood asthma control test was administered. The P values <.05 were considered significant. Results: The study included a total of 123 children (female/male : 48/75) with a mean age of 8.4 ± 1.9 years. According to the mothers’ self-report, it was found that 78% of the patients were not able to follow-up routinely, 19.5% were non-adherence to treatment, and 16.2% were poorly controlled asthma. It was found that, based on childhood asthma control test scores, asthma control was better during the pandemic lockdown period ( P = .001). Asthma symptoms were better in 41.5% of the patients compared to the previous months and in 53.7% compared to the same period last year. Conclusion: Our study found that the children’s asthma was controlled although most of them did not have their follow-up visits, and poorly controlled asthma was higher in older children in early coronavirus disease 2019 lockdown.

The impact of COVID‐19 lockdown measures on symptoms control in children with asthma: A systematic review and meta‐analysis of observational cohort studies

“…A quantitative synthesis was not possible for these additional endpoints due to the low number of studies examining each outcome or the different definitions used across the included studies. However, the overall direction of the effects was the same for asthma symptoms and asthma‐related quality of life, as an overall improvement in asthma symptoms and asthma severity during lockdown was reported in all studies that addressed these endpoints 41,45,48 . A similar result was obtained by Feldman et al, who assessed asthma‐related quality of life using the Pediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ).…”

“…Asthma symptom control was more frequently quantified using the c‐ACT score, 31,38,40,42–48 while in the remaining studies, asthma symptom control was quantified using the Global Initiative for Asthma score 39,43,45 . Differences in asthma control before and during lockdown periods were also quantified through changes in exacerbation frequency 39,43–45 and in symptom severity 41,48 . Among the nine studies assessing asthma symptom control directly, three reported changes in the mean level of asthma symptom control 31,38,48 and were included in the SMD meta‐analysis.…”

“…Asthma symptom control was more frequently quantified using the c-ACT score, 31,38,40,[42][43][44][45][46][47][48] while in the remaining studies, asthma symptom control was quantified using the Global Initiative for Asthma score. 39,43,45 Differences in asthma control before and during lockdown periods were also quantified through changes in exacerbation frequency 39,[43][44][45] and in symptom severity.…”

“…39,43,45 Differences in asthma control before and during lockdown periods were also quantified through changes in exacerbation frequency 39,[43][44][45] and in symptom severity. 41,48 Among the nine studies assessing asthma symptom control directly, three reported changes in the mean level of asthma symptom control 31,38,48 and were included in the SMD metaanalysis. The results indicate a statistically significant pooled increase in mean c-ACT score during the lockdown period (SMD: 1.99, 95%…”

“…31 Due to the inhomogeneity of reported outcomes in studies assessing ED visits or in studies assessing hospitalizations, a meta-analysis for these two outcomes was not possible. Finally, among the included studies, some additional endpoints were reported, such as asthma symptoms severity, 41,45,48 asthma-related quality of life, 40 unscheduled or acute or general outpatient/clinician visits, 38,40,44 and asthma medication use or treatment adherence. [38][39][40][41][42]44,45,47,48 A quantitative synthesis was not possible for these additional endpoints due to the low number of studies examining each outcome or the different definitions used across the included studies.…”