The coronavirus pandemic has been a particularly scary time for children with asthma and their parents, but there is growing evidence that as a group kids with asthma are not only doing OK during COVID-19, but may actually be doing better.
A study in Annals of the American Thoracic Society documented a steep drop in emergency department (ED) visits for asthma exacerbations at Boston Children’s Hospital during the early months of the pandemic when citywide lockdowns were in place.
While ED avoidance may have played a part in the roughly 80% decline in pediatric asthma visits in the spring and early summer, Tregony Simoneau, MD, of Boston Children’s Hospital, and colleagues said the drop may have more to do with actual declines in asthma exacerbations among kids during the period.
In addition, in a separate, international investigation of asthma outcomes among kids during COVID-19, a team reported that two-thirds of the children in the study showed evidence of improved asthma control during the first wave of the pandemic, with an overall decrease in asthma exacerbations and hospitalizations.
In late October, results from the Pediatric Asthma in Real Life (PeARL) study were reported without peer review on the preprint server medRxiv. “This is the first study to show a positive impact of the COVID-19 pandemic on childhood asthma activity,” wrote Nikolaos Papadopoulos, MD, PhD, of the University of Manchester in England, and colleagues.
The team concluded that the improvements were “probably the result of reduced exposure to asthma triggers and increased treatment adherence.”
Simoneau told MedPage Today that viral triggers are common causes of asthma exacerbations, and increased isolation may mean fewer viral exposures.
She said similar studies have documented a drop in bronchiolitis and other pediatric diseases caused by viral triggers during the COVID-19 pandemic. Pediatric asthma exacerbations also tend to decline during the summer months when children are not in school, Simoneau noted.
“Exacerbations tend to drop in the summer, and they always peak again in September within about 2 weeks of school starting,” she explained. “Another factor here is that kids may be using their asthma medications more appropriately because there is a lot of anxiety and fear related to COVID-19.”
The team compared ED visits for asthma exacerbations between January 5 and May 23 in 2018, 2019, and 2020. Schools and day care facilities were ordered closed in Massachusetts in mid-March of this year, and a statewide “stay at home” order was declared on March 24. The Boston Children’s ED, ambulatory clinics, and hospital remained open during the lockdown for urgent care, and all other medical visits were conducted via telehealth.
The researchers documented a total of 2,543 total ED asthma visits across the 3-year periods of January 5 to May 23. After adjusting for year, weeks, and time period (pre- or post- shutdown), a significant decline in ED visits was found to occur in 2020, compared with the two previous years (IRR 0.21, 95% CI 0.11-0.37, P<0.0001), and 2019 (IRR 0.18, 95% CI 0.10-0.32, P<0.0001), but not between 2018 and 2019 (P=0.6250).
For the pre-shutdown week of March 15-21, the rate of ED visits was similar across the three years, while in the following week the rate of ED visits decreased 80% (IRR 0.20, 95% CI 0.14-0.28) and 82% (IRR 0.18, 95% CI 0.13-0.25) in 2020 relative to 2018 and 2019, respectively (P<0.0001).
This trend continued through May 23, with an 82% and 87% reduction compared with 2018 and 2019, respectively. While ED visits dropped in spring 2020, the rate of hospital admissions for asthma exacerbations did not increase, the researchers found.
“We originally thought that with the drop in ED visits, children who presented to EDs would be sicker due to delays in seeking care,” Simoneau said. “We expected to see a higher proportion requiring hospital admission, but that was not the case.”
She said the findings from the study and others should reassure parents, patients, and clinicians who treat children with asthma: “So many of my patients are terrified right now. Our study and others suggest patients with asthma are doing well overall with all of the precautions in place.”
Simoneau and co-authors noted no funding source, and stated that they had no relevant conflicts of interest related to the study.
The PeARL study was funded by the Respiratory Effectiveness group, which received funding from AstraZeneca, Novartis, and Sanofi; Papadopoulos reported financial relationships with ALK, Novartis, Nutricia, HAL, GlaxoSmithKline, Boehringer Ingelheim, and others unrelated to the research; co-authors also reported multiple ties to industry.