Impact of COVID-19 pandemic on asthma exacerbations: Retrospective cohort study of over 500,000 patients in a national English primary care database

Shah, Syed Ahmar; Quint, Jennifer; Sheikh, Aziz

doi:10.1016/j.lanepe.2022.100428

Cited by 26 publications

(30 citation statements)

References 35 publications

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“…Our findings support those of others who have investigated temporal trends in COVID-19 and asthma exacerbations over the course of the pandemic 5-7,19 and extend them substantively by the addition of granular repeated-measures data capturing month-to-month changes in behaviours and non-COVID-19 ARI over an 18-month period spanning the lockdown of Winter 2020-21, the subsequent relaxation of restrictions and the emergence of the omicron variant of SARS-CoV-2. With regard to behaviours, our findings are broadly consistent with national data from the UK reporting good compliance with recommendations on use of coverings and reduced social mixing during early-2021, with increases in visiting and travel starting from April 2021.…”

Section: Discussionsupporting

confidence: 92%

“…Our findings support those of others who have investigated temporal trends in COVID-19 and asthma exacerbations over the course of the pandemic [5][6][7]19 and extend them substantively by the addition of granular repeated-measures data capturing month-to-month changes in behaviours and non-COVID-19 ARI over an 18-month period spanning the lockdown of Winter 2020-21, the subsequent relaxation of restrictions and the emergence of the omicron variant of SARS-CoV-2.…”

Section: Discussionsupporting

confidence: 91%

“…22 Similarly, national surveillance data show increases in cases of influenza, influenzalike illnesses and other respiratory viruses in 2021/2022 compared to 2020/2021, although incidence continued to remain lower than before the pandemic. 23 Our findings also complement those of a retrospective cohort study conducted using data from an English national primary care database, 7 which reported a trend towards an increase in mean asthma exacerbation rate over the course of 2021. Our demonstration that COVID-19 associates strongly with risk of moderate/severe exacerbation is in keeping with findings of a mixed-methods analysis reporting an association between COVID-19 and increased inhaler use in a cohort of adults with asthma.…”

Section: Discussionsupporting

confidence: 75%

“…A retrospective cohort study using data from an English national primary care database from January 2016 to October 2021 reported that asthma exacerbation rates were substantially lower between the second quarter of 2020 and the third quarter of 2021 than before the pandemic (2016-2019). 7 Although this study did not formally demonstrate an increase in incidence of exacerbations over the course of 2021, a trend towards an increase in mean exacerbation rate from the first to the third quarter of 2021 was observed -a period which coincided with relaxation of COVID-19 restrictions in the UK. However, since the study was conducted using routinely collected data, it was not possible to establish whether changes in risk of asthma exacerbation over time were temporally associated with changes in behaviours affecting viral transmission.…”

Section: Introductioncontrasting

confidence: 58%

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Rebound in asthma exacerbations following relaxation of COVID-19 restrictions: a longitudinal population-based study (COVIDENCE UK)

Tydeman

Pfeffer

Vivaldi

et al. 2022

Preprint

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Background: The imposition of restrictions on social mixing early in the COVID-19 pandemic was followed by a reduction in asthma exacerbations in multiple settings internationally. Temporal trends in social mixing, incident acute respiratory infections (ARI) and asthma exacerbations following relaxation of COVID-19 restrictions have not yet been described. Methods: We conducted a population-based longitudinal study in 2,312 UK adults with asthma between November 2020 and April 2022. Details of face covering use, social mixing, incident ARI and moderate/severe asthma exacerbations were collected via monthly on-line questionnaires. Temporal changes in these parameters were visualised using Poisson generalised additive models. Multilevel logistic regression was used to test for associations between incident ARI and risk of asthma exacerbations, adjusting for potential confounders. Results: Relaxation of COVID-19 restrictions from April 2021 coincided with reduced face covering use (p<0.001), increased frequency of indoor visits to public places and other households (p<0.001) and rising incidence of COVID-19 (p<0.001), non-COVID-19 ARI (p<0.001) and moderate/severe asthma exacerbations (p=0.007). Incident non-COVID-19 ARI associated independently with increased risk of asthma exacerbation (adjusted odds ratio 5.75, 95% CI 4.75 to 6.97) as did incident COVID-19, both prior to emergence of the omicron variant of SARS-CoV-2 (5.89, 3.45 to 10.04) and subsequently (5.69, 3.89 to 8.31). Conclusions: Relaxation of COVID-19 restrictions coincided with decreased face covering use, increased social mixing and a rebound in ARI and asthma exacerbations. Associations between incident ARI and risk of moderate/severe asthma exacerbation were similar for non-COVID-19 ARI and COVID-19, both before and after emergence of the SARS-CoV-2 omicron variant.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 75%

Section: Introductioncontrasting

confidence: 58%

See 2 more Smart Citations

Rebound in asthma exacerbations following relaxation of COVID-19 restrictions: a longitudinal population-based study (COVIDENCE UK)

Tydeman

Pfeffer

Vivaldi

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

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“…Several studies have reported a substantial reduction in asthma exacerbation during the COVID-19 pandemic. [4][5][6][7][8][9][10] However, whether SARS-CoV-2 infections cause or are associated with acute exacerbation in patients with asthma remains controversial. 11) Such associations might be independent of improved asthma control during the COVID-19 pandemic considering possible confounding factors such as social distancing, minimal social interactions, and lower susceptibility of younger individuals to SARS-CoV-2 infection.…”

Section: A C C E P T E D a R T I C L Ementioning

confidence: 99%

Management of patients with allergic diseases in the era of COVID-19

Lee¹

2022

Clin Exp Pediatr

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In the early days of the coronavirus disease 2019 (COVID-19) pandemic, allergic diseases, especially asthma, were considered to be risk factors for severe COVID-19 infection, hospitalization, and death. These concerns stemmed from the idea that individuals with allergic diseases are generally more susceptible to respiratory virus infections, which are major causes of exacerbation of allergic diseases.However, epidemiologic data with mechanistic studies showed that the associations between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and clinical outcomes of allergic diseases are complex and affected by diverse factors such as allergic disease severity, phenotypes, and control status with current medications. In addition, children generally have less severe clinical outcomes of COVID-19 than those of adults, which complicates the association between allergic diseases and COVID-19-related outcomes among them. The present review summarizes the potential association between allergic diseases and COVID-19-related outcomes and discusses the factors requiring consideration. The findings viewed herein will aid the management of allergic diseases in patients with SARS-CoV-2 infection and the establishment of medical polices for managing patients with allergic diseases.

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Suppressed pediatric asthma hospitalizations during the COVID‐19 pandemic in Japan, from a national survey

Korematsu,

Fujisawa,

Saito

et al. 2024

Clinical & Translational All

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BackgroundAcute asthma exacerbation in children is often caused by respiratory infections. In this study, a coordinated national surveillance system for acute asthma hospitalizations and causative respiratory infections was established. We herein report recent trends in pediatric acute asthma hospitalizations since the COVID‐19 pandemic in Japan.MethodsThirty‐three sentinel hospitals in Japan registered all of their hospitalized pediatric asthma patients and their causal pathogens. The changes in acute asthma hospitalization in children before and after the onset of the COVID‐19 pandemic and whether or not COVID‐19 caused acute asthma exacerbation were investigated.ResultsFrom fiscal years 2010–2019, the median number of acute asthma hospitalizations per year was 3524 (2462–4570), but in fiscal years 2020, 2021, and 2022, the numbers were 820, 1,001, and 1,026, respectively (the fiscal year in Japan is April to March). This decrease was observed in all age groups with the exception of the 3‐ to 6‐year group. SARS‐CoV‐2 was evaluated in 2094 patients from fiscal years 2020–2022, but the first positive case was not detected until February 2022. Since then, only 36 of them have been identified with SARS‐CoV‐2, none of which required mechanical ventilation. Influenza, RS virus, and human metapneumovirus infections also decreased in FY 2020. In contrast, 24% of patients had not been receiving long‐term control medications before admission despite the severity of bronchial asthma.ConclusionSARS‐CoV‐2 was hardly detected in children with acute asthma hospitalization during the COVID‐19 pandemic. This result indicated that SARS‐CoV‐2 did not induce acute asthma exacerbation in children. Rather, infection control measures implemented against the pandemic may have consequently reduced other respiratory virus infections and thus acute asthma hospitalizations during this period. However, the fact that many hospitalized patients have not been receiving appropriate long‐term control medications is a major problem that should be addressed.

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Impact of COVID-19 pandemic on asthma exacerbations: Retrospective cohort study of over 500,000 patients in a national English primary care database

Cited by 26 publications

References 35 publications

Rebound in asthma exacerbations following relaxation of COVID-19 restrictions: a longitudinal population-based study (COVIDENCE UK)

Rebound in asthma exacerbations following relaxation of COVID-19 restrictions: a longitudinal population-based study (COVIDENCE UK)

Management of patients with allergic diseases in the era of COVID-19

Suppressed pediatric asthma hospitalizations during the COVID‐19 pandemic in Japan, from a national survey

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