COVID-19 Pandemic–Related Reductions in Pediatric Asthma Exacerbations Corresponded with an Overall Decrease in Respiratory Viral Infections

Abstract

What is already known about this topic? Although respiratory viruses, air pollutants, and aeroallergens are implicated in worsening pediatric asthma symptoms, the interplay between these factors and asthma exacerbations is not well understood. Asthma exacerbations decreased significantly during the coronavirus disease 2019 pandemic, allowing for the investigation of these asthma triggers relative to asthma activity.What does this article add to our knowledge? The sustained reductions in viral infections and acute asthma activity we observed during the coronavirus disease 2019 pandemic support a strong link between respiratory virus infections and pediatric asthma exacerbations.How does this study impact current management guidelines? Our findings suggest that viral respiratory infections are a primary driver of pediatric asthma exacerbations and that preventive measures taken to control exposure to these viruses may help limit exacerbating asthma symptoms BACKGROUND: Respiratory viruses, air pollutants, and aeroallergens are all implicated in worsening pediatric asthma symptoms, but their relative contributions to asthma exacerbations are poorly understood. A significant decrease in asthma exacerbations has been observed during the coronavirus disease 2019 pandemic, providing a unique opportunity to study how major asthma triggers correlate with asthma activity. OBJECTIVE: To determine whether changes in respiratory viruses, air pollutants, and/or aeroallergens during the coronavirus disease 2019 pandemic were concomitant with decreased asthma exacerbations. METHODS: Health care utilization and respiratory viral testing data between January 1, 2015, and December 31, 2020, were extracted from the Children's Hospital of Philadelphia Care Network's electronic health record. Air pollution and allergen data were extracted from US Environmental Protection Agency public databases and a National Allergy Bureauecertified station, respectively. Pandemic data (2020) were compared with historical data. RESULTS: Recovery of in-person asthma encounters during phased reopening (June 6 to November 15, 2020) was uneven: primary care well and specialty encounters reached 94% and

The effects of COVID‐19 outbreak on pediatric emergency department admissions for acute wheezing

“…In support of this hypothesis, Gujon et al 15 in California confirmed a correlation between the reduction in ED visits for asthma exacerbation and the reduction in particulate matter as well as in viral infections 15 . Differently, Sayed et al 24 in Philadelphia did not observe changes in the rate of air pollution and in the environmental aeroallergens during the pandemic compared with previous seasonal data, while they highlighted a significant reduction of viral infections including RSV, Rhinovirus, Influenza A and B.…”

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.…”

Impacts of COVID-19 Prevention and Control Measures on Asthma-Related Hospital and Outpatient Visits in Yichang, China

“…After stratification, during the regular prevention period, only the weekly visits of adults increased significantly compared with lockdown period. Previous studies have focused on the impact of the COVID-19 lockdown on health care utilization for asthma, and mostly focus on children [ 17 , 18 , 19 , 20 , 21 , 22 ]. For example, a cross-sectional study from Guangzhou (China) reported that the number of hospitalized children with severe asthma exacerbation decreased under the implementation of strict countermeasures for COVID-19 [ 17 ].…”

“…For example, a cross-sectional study from Guangzhou (China) reported that the number of hospitalized children with severe asthma exacerbation decreased under the implementation of strict countermeasures for COVID-19 [ 17 ]. Two related studies in Philadelphia, USA, also focused only on childhood asthma [ 18 , 19 ]. Although a study in the UK covered people of all ages, it only analyzed the impact of lockdown on asthma-related health care utilization, without further stratification by adults and children [ 20 ].…”