Reduced pediatric urgent asthma utilization and exacerbations during the COVID‐19 pandemic

Abstract

The COVID‐19 pandemic has had a profound impact on healthcare access and utilization, which could have important implications for children with chronic diseases, including asthma. We sought to evaluate changes in healthcare utilization and outcomes in children with asthma during the COVID‐19 pandemic. We used electronic health records data to evaluate healthcare use and asthma outcomes in 3959 children and adolescents, 5–17 years of age, with a prior diagnosis of asthma who had a history of well‐child visits and encounters within the healthcare system. We assessed all‐cause healthcare encounters and asthma exacerbations in the 12‐months preceding the start of the COVID‐19 pandemic (March 1, 2019–February 29, 2020) and the first 12 months of the pandemic (March 1, 2020–February 28, 2021). All‐cause healthcare encounters decreased significantly during the pandemic compared to the preceding year, including well‐child visits (48.1% during the pandemic vs. 66.6% in the prior year; p < .01), emergency department visits (9.7% vs. 21.0%; p < .01), and inpatient admissions (1.6% vs. 2.5%; p < .01), though there was over a 100‐fold increase in telehealth encounters. Asthma exacerbations that required treatment with systemic steroids also decreased (127 vs. 504 exacerbations; p < .01). Race/ethnicity was not associated with changes in healthcare utilization or asthma outcomes. The COVID‐19 pandemic corresponded to dramatic shifts in healthcare utilization, including increased telehealth use and improved outcomes among children with asthma. Social distancing measures may have also reduced asthma trigger exposure.

Impact of the COVID-19 Pandemic on Incidence of Asthma Exacerbations and Hospitalizations in US Subspecialist-Treated Patients with Severe Asthma: Results from the CHRONICLE Study

“… 18 Similarly, several studies have observed decreases in pediatric exacerbations, hospitalizations, and ED visits among US children with asthma of any severity following the implementation of stay-at-home orders, compared with prior years. 20 , 21 , 23 , 24 Another US report observed 76% fewer ED visits for children with asthma following stay-at-home orders, and a drop in subsequent asthma-related hospital admissions from 31% to 22%. 17 Reduced exacerbation rates have also been reported in Japan, the United Kingdom, and the Netherlands following the implementation of COVID-19 stay-at-home orders in those countries compared with prior-year rates.…”

Impact of COVID-19 mitigation strategies on asthma hospitalizations in Brazil

“…21 Viral infections are the main triggers of asthma exacerbations in all age groups. 13,22 All over the world, there is a growing body of evidence regarding the reduction during the pandemic of health care utilization for asthma, [23][24][25][26][27][28][29][30][31][32][33] and reductions in hospital admissions for seasonal respiratory diseases (upper airway infections, bronchiolitis, and pneumonia) were widely recorded. 3,7,9,10,20,34,35 In addition, the decrease in recorded air pollutants must be considered, because exposure to air pollution is one of the external triggers for the onset of asthma, particularly in larger cities.…”

Effect of the coronavirus disease 2019 pandemic on morbidity among children hospitalized for an asthma exacerbation

“…[4][5][6][7] Although SARS-CoV-2 can exacerbate asthma, children admitted to the hospital with asthma and COVID-19 infection did not seem to be at a higher risk of more severe COVID-19 or asthma symptoms than the healthy population. 8,9 The decrease in disease burden was also observed in the outpatient setting where children with asthma consistently required fewer controller medications and oral steroids compared with the prepandemic period. 4,10 Although our center reported fewer ED visits and hospitalization in 2020, the ratio of hospitalization, including to the intensive care unit, to ED visits was higher suggesting that children were more acutely ill at the time of presentation.…”