Childhood asthma outcomes during the COVID‐19 pandemic: Findings from the PeARL multi‐national cohort

Abstract

Background The interplay between COVID‐19 pandemic and asthma in children is still unclear. We evaluated the impact of COVID‐19 pandemic on childhood asthma outcomes. Methods The PeARL multinational cohort included 1,054 children with asthma and 505 non‐asthmatic children aged between 4 and 18 years from 25 pediatric departments, from 15 countries globally. We compared the frequency of acute respiratory and febrile presentations during the first wave of the COVID‐19 pandemic between groups and with data available from the previous year. In children with asthma, we also compared current and historical disease control. Results During the pandemic, children with asthma experienced fewer upper respiratory tract infections, episodes of pyrexia, emergency visits, hospital admissions, asthma attacks, and hospitalizations due to asthma, in comparison with the preceding year. Sixty‐six percent of asthmatic children had improved asthma control while in 33% the improvement exceeded the minimal clinically important difference. Pre‐bronchodilatation FEV 1 and peak expiratory flow rate were improved during the pandemic. When compared to non‐asthmatic controls, children with asthma were not at increased risk of LRTIs, episodes of pyrexia, emergency visits, or hospitalizations during the pandemic. However, an increased risk of URTIs emerged. Conclusion Childhood asthma outcomes, including control, were improved during the first wave of the COVID‐19 pandemic, probably because of reduced exposure to asthma triggers and increased treatment adherence. 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.

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

“…The PeARL study reported decreased incidence of upper and lower respiratory infections and febrile episodes among children with and without asthma, suggesting that decreased infectious triggers could play a role in improved asthma outcomes. 24 Supporting the potential role of decreased respiratory infections, a single center study of children with asthma reported the absence of the typical fall seasonal spike in asthma exacerbations that has been attributed to increased circulation of common respiratory viruses associated with schools reopening, as well as increased exposure to indoor allergens, changes in outdoor allergens, and colder weather. 25 While we did not have access to data on incidence of respiratory infections, we did find a decrease in prescriptions for antibiotics commonly prescribed for respiratory infections, suggesting decreased infections in our study population.…”

“… 23 Another retrospective analysis using data from 1054 children with asthma and 505 non‐asthmatic children in the multinational Pediatric Asthma in Real Life (PeARL) cohort identified decreased asthma‐related hospitalizations and emergency department visits and improved scores on validated asthma control measures, though there was an increase in the frequency of treatment escalation. 24 …”

Understanding the environmental factors related to the decrease in Pediatric Emergency Department referrals for acute asthma during the SARS-CoV-2 pandemic

“…As reported in other studies, social distancing and stepped-up hygiene measures determined a concomitant reduction in the diffusion of respiratory pathogens, leading to decreased respiratory tract infections 3,[25][26][27] . Moreover, the feeling of the emergency period might have enhanced adherence to controller medications among asthmatic population 27,28 .…”

Screening, Diagnostic and Prognostic Tests for COVID-19: A Comprehensive Review

“…On the other hand, other comorbidities, such as asthma [75][76][77], urticaria and erythema nodosum [78] have been associated with decreased risk of adverse COVID-19 outcome. However, these diseases often affect younger people, who are anyway less prone to COVID-19 adverse outcomes, and therefore, the observed protective effect might be the result of confounding [69].…”