Asthma as a risk factor for hospitalization in children with COVID‐19: A nested case‐control study

Gaietto, Kristina; Freeman, Megan Culler; DiCicco, Leigh Anne; Rauenswinter, Sherry; Squire, Joseph R; Aldewereld, Zachary; Iagnemma, Jennifer; Campfield, Brian T; Wolfson, David; Kazmerski, Traci M.; Forno, Erick

doi:10.1111/pai.13696

Cited by 34 publications

(49 citation statements)

References 45 publications

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“…27 In contrast, a recent nested case-control study of 1,392 children in Western Pennsylvania found that children with asthma who became infected with SARS-CoV-2 were four times more likely to be hospitalized than SARS-CoV-2-infected children without asthma, though length of stay and respiratory support did not differ between these groups. 28 It is also possible that asthma severity could influence SARS-CoV-2 outcomes among children. A study of over 700,000 children in Scotland found that SARS-CoV-2-infected children with poorly controlled asthma were at higher risk of hospitalization for COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Asthma and the Risk of SARS-CoV-2 Infection Among Children and Adolescents

Rao¹,

Hurst

Zhao³

et al. 2022

Pediatrics

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OBJECTIVE Over 6 million pediatric SARS-CoV-2 infections have occurred in the United States, but risk factors for infection remain poorly defined. We sought to evaluate the association between asthma and SARS-CoV-2 infection risk among children. METHODS We conducted a retrospective cohort study of children 5 to 17 years of age receiving care through the Duke University Health System and who had a Durham County, NC residential address. Children were classified as having asthma using previously validated electronic health record-based definitions. SARS-CoV-2 infections were identified based on positive PCR testing of respiratory samples collected between March 1, 2020, and September 30, 2021. We matched children with asthma 1:1 to children without asthma using propensity scores and used Poisson regression to evaluate the association between asthma and SARS-CoV-2 infection risk. RESULTS Of 46,900 children, 6,324 (13.5%) met criteria for asthma. Children with asthma were more likely to be tested for SARS-CoV-2 infection than children without asthma (33.0% vs. 20.9%, p<0.0001). In a propensity score-matched cohort of 12,648 children, 706 (5.6%) children tested positive for SARS-CoV-2 infection, including 350 (2.8%) children with asthma and 356 (2.8%) children without asthma [risk ratio: 0.98, 95% confidence interval: 0.85-1.13]. There was no evidence of effect modification of this association by inhaled corticosteroid prescription, history of severe exacerbation, or comorbid atopic diseases. Only one child with asthma required hospitalization for SARS-CoV-2 infection. CONCLUSIONS After controlling for factors associated with SARS-CoV-2 testing, we found that children with asthma have a similar SARS-CoV-2 infection risk as children without asthma.

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Section: Discussionmentioning

confidence: 99%

Asthma and the Risk of SARS-CoV-2 Infection Among Children and Adolescents

Rao¹,

Hurst

Zhao³

et al. 2022

Pediatrics

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“…Asthma was identified here as a risk factor for CCU admission for both age groups (<> 2 years old). Recent studies have also shown the involvement of asthma in the risk of hospital admission but not of CCU admission ( 7 , 28 ). This increased risk of hospitalization, primarily for children with poorly controlled asthma ( 29 ), was not related to asthma severity, and SARS-CoV-2 infection did not appear to be a trigger exacerbation of asthma ( 28 ).…”

Section: Discussionmentioning

confidence: 99%

Risk factors for admission to the pediatric critical care unit among children hospitalized with COVID-19 in France

et al. 2022

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BackgroundCOVID-19 infection is less severe among children than among adults; however, some patients require hospitalization and even critical care. Using data from the French national medico-administrative database, we estimated the risk factors for critical care unit (CCU) admissions among pediatric COVID-19 hospitalizations, the number and characteristics of the cases during the successive waves from January 2020 to August 2021 and described death cases.MethodsWe included all children (age < 18) hospitalized with COVID-19 between January 1st, 2020, and August 31st, 2021. Follow-up was until September 30th, 2021 (discharge or death). Contiguous hospital stays were gathered in “care sequences.” Four epidemic waves were considered (cut off dates: August 11th 2020, January 1st 2021, and July 4th 2021). We excluded asymptomatic COVID-19 cases, post-COVID-19 diseases, and 1-day-long sequences (except death cases). Risk factors for CCU admission were assessed with a univariable and a multivariable logistic regression model in the entire sample and stratified by age, whether younger than 2.ResultsWe included 7,485 patients, of whom 1988 (26.6%) were admitted to the CCU. Risk factors for admission to the CCU were being younger than 7 days [OR: 3.71 95% CI (2.56–5.39)], being between 2 and 9 years old [1.19 (1.00–1.41)], pediatric multisystem inflammatory syndrome (PIMS) [7.17 (5.97–8.6)] and respiratory forms [1.26 (1.12–1.41)], and having at least one underlying condition [2.66 (2.36–3.01)]. Among hospitalized children younger than 2 years old, prematurity was a risk factor for CCU admission [1.89 (1.47–2.43)]. The CCU admission rate gradually decreased over the waves (from 31.0 to 17.8%). There were 32 (0.4%) deaths, of which the median age was 6 years (IQR: 177 days–15.5 years).ConclusionSome children need to be more particularly protected from a severe evolution: newborns younger than 7 days old, children aged from 2 to 13 years who are more at risk of PIMS forms and patients with at least one underlying medical condition.

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“…However, the association between asthma and SARS-CoV-2 infection remains unclear in the pediatric population, as many large-scale ecological studies presented reduced pediatric asthma during the pandemic likely due to physical distancing, masks, and perhaps decreases in air pollution. On the other hand, other research focused on the individual level and presented asthma as a risk factor for hospitalization in children with COVID-19, but not for worse COVID-19 outcomes (24,25).…”

Section: Discussionmentioning

confidence: 99%

Post-COVID syndrome prevalence and risk factors in children and adolescents: A population-based serological study

Dumont

Richard

Lorthe

et al. 2022

Preprint

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Objectives Post-COVID syndrome remain poorly studied in children and adolescents. In this study, we aimed to investigate the prevalence and risk factors of pediatric post-COVID in a population-based sample, stratifying by serological status. Study design We used data from the SEROCoV-KIDS cohort study (State of Geneva, Switzerland), which included children (aged 6 months to 17 years) selected from random samples drawn from state registries or who had a household member participating in a COVID-19 seroprevalence study conducted by our group. Children were tested for anti-SARS-CoV-2 N antibodies. Parents filled in a questionnaire on persistent symptoms in their children (lasting over 12 weeks) compatible with post-COVID syndrome. Results From December 1st, 2021 to February 16th, 2022, 1034 children were included, among whom 570 (55.1%) were seropositive. The sex- and age-adjusted prevalence of persistent symptoms among seropositive children was 9.1% (95%CI: 6.7;11.8) and 5.0% (95%CI: 3.0;7.1) among seronegatives, with an adjusted prevalence difference (ΔaPrev) of 4.1% (95%CI: 1.1;7.3). After stratification by age group, the prevalence was higher among adolescents aged 12-17 years (ΔaPrev=8.3%, 95%CI: 3.5;13.5) than among younger children (0.0%, 95%CI: -5.2;5.2 among 6-11 years old and 4.2%; 95%CI: -4.4;13.3 among 0-5 years old). The most frequently declared persistent symptoms among seropositives were smell loss, trouble concentrating and abdominal pain. Older age, having a chronic condition and lower socioeconomic conditions were identified as risk factors. Conclusion A significant proportion of seropositive children, particularly adolescents, experienced persistent symptoms. While there is a need for further investigation, growing evidence of pediatric post-COVID syndrome urges early screening and primary care management.

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Asthma as a risk factor for hospitalization in children with COVID‐19: A nested case‐control study

Cited by 34 publications

References 45 publications

Asthma and the Risk of SARS-CoV-2 Infection Among Children and Adolescents

Asthma and the Risk of SARS-CoV-2 Infection Among Children and Adolescents

Risk factors for admission to the pediatric critical care unit among children hospitalized with COVID-19 in France

Post-COVID syndrome prevalence and risk factors in children and adolescents: A population-based serological study

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