Bronchial asthma is a common medical problem among children. Typically, asthma bouts occur during the middle of winter, while some smaller peaks happen in spring.
During the coronavirus disease (COVID-19) pandemic, an international team of researchers has found that children with asthma experienced fewer upper respiratory tract infections, emergency visits, fever episodes, asthma attacks, and hospital admissions compared with the previous year.
The team also revealed that 66 percent of children with asthma showed improved asthma control, while in 33 percent, the improvement exceeded the minimally clinically important difference.
Fewer asthma attacks
In the study, published as preprint on the bioRxiv* server, the researchers aimed to assess the impact of COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), on childhood asthma outcomes.
To arrive at the study's findings, the team used the PeARL multi-national cohort, which included children with asthma and non-asthmatic controls recruited during the pandemic. The results were compared with available data from the previous year.
The study participants ranged between 4 and 18 years old and who were diagnosed with asthma. The participants were also being monitored in one of the participating asthma clinics. Meanwhile, the non-asthmatic controls were children of the same age, who were being monitored for a non-respiratory condition.
The researchers collected data that include the frequency of acute events, like asthma attacks, fever, emergency visits, upper respiratory tract infections (URTIs), lower respiratory tract infections (LRTIs), and hospital admissions, during and before the pandemic.
What the study found
The study included more than 1,054 children with asthma and 505 control participants across 25 pediatric departments from 15 countries.
In terms of outcomes of acute events, children with asthma were not at increased risk of LRTS, fever episodes, hospitalizations, and emergency room visits during the pandemic. However, these children were found to be at risk of URTI compared to the control group during the pandemic.
The team also compared the frequency of each acute event during the pandemic compared to the previous year. They found that asthmatic children had fewer URTIs, fever episodes, emergency visits, asthma attacks, hospitalization due to asthma, and hospital admissions during the pandemic, compared with the preceding year. Further, the team said no differences were observed in the frequency or LRTIs before and during the pandemic.
However, the coronavirus pandemic seems not to affect the frequency of emergency visits to hospital admissions in the control group. Also, there was a decrease in URTIs and fever episodes frequency, and an increased risk of LRTIs during the pandemic.
In terms of asthma control during the pandemic, the team revealed that 90.2 participants reported improved or unchanged asthma control during the pandemic, while 65.9 percent experienced an improvement.
COVID-19 pandemic and asthma
There are many reasons why children with asthma had improved disease control, fewer asthma attacks, fewer hospitalizations, and improved pulmonary function during the pandemic. During the pandemic, children were not allowed to attend school, and they resorted to online learning. As a result, they did not leave their houses and, therefore, were not exposed to outdoor allergens, air pollution, and viral infections.
The team also revealed the improved and increased treatment compliance during the pandemic. However, even with the protective effect of the pandemic on asthmatic children, they may also be exposed to indoor allergens and pollutants, which may precipitate worse asthma control in some children.
In a nutshell, the researchers found improved health and asthma activity during the pandemic, which has been tied to the decreased exposure to asthma triggers and enhanced treatment adherence.
The study also showed that during the pandemic, children with mild to moderate atopic asthma did not experience an increase in the frequency of cute episodes that could represent COVID-19 infection.
"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," the authors wrote in the paper.
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.