Frequency of asthma exacerbation in children during the coronavirus disease pandemic with strict mitigative countermeasures

Abstract

Background: Strict countermeasures for coronavirus disease (COVID-19) were undertaken in China without knowing their influence on asthma.Objective: To investigate the associations between the frequencies of asthma exacerbations and respiratory infections and air pollutants before and during the COVID-19 pandemic, which were direct consequences of countermeasures undertaken for the pandemic.Methods: Asthma exacerbations and respiratory infections among hospitalized children in the permanent population of Guangzhou City, China, from February to June 2016-2019 (before the pandemic) to February to June 2020 (during the pandemic) were collected in this cross-sectional study in Guangzhou.Results: The number of asthma exacerbation cases per month documented in the Guangzhou Women and Children's Hospital before (median: 13.5; range: 0-48) and during (median: 20; range: 0-34) the mitigative response to the COVID-19 pandemic was similar. The frequency of severe asthma exacerbation cases per month decreased, whereas that of mild asthma exacerbation cases per year increased (p = .004). The number of patients hospitalized with infectious respiratory diseases decreased from 146 (range: 90-172) per month before the pandemic to 42 (range: 33-57) per month during the pandemic (p = .004). Most pathogens and air pollutants decreased during the COVID-19 pandemic. The frequency of severe asthma exacerbations positively correlated to that of respiratory infections in children, but did not correlate to air pollutants. Conclusion:Strict countermeasures undertaken for the pandemic were associated with a decreased the frequency of infectious respiratory diseases and severe asthma exacerbations among urban children.

Pediatric asthma control during the COVID‐19 pandemic: A systematic review and meta‐analysis

“…The main characteristics of the 10 articles were summarized in Table 1. AHRQ scores suggested that all studies scored at 8–9 as high quality 14 …”

“…Ten studies, [14][15][16][17][18][19][20][21][22][23] with 22,159 subjects were included for the final meta-analysis. The sample size of the studies ranged from 16 to 18,912.…”

“…Four studies 14,15,20,20,23 were included in this outcome, with 835 cases during COVID-19 pandemic, and 945 cases before COVID-19 pandemic. Heterogeneity test analysis suggested that there was heterogeneity (I 2 = 75%, p = 0.007) (Figure 2A).…”

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

“…Other authors recently discussed the potential factors involved in the decline in pediatric asthma exacerbations during lockdown, 37 including improved air quality levels; however, a relevant role of the fall in the concentration of air pollutants still has to be demonstrated. Recently, also Fan et al, 38 for example, failed to demonstrate such a direct correlation.…”

“…Other authors recently discussed the potential factors involved in the decline in pediatric asthma exacerbations during lockdown,37 including improved air quality levels; however, a relevant role of the fall in the concentration of air pollutants still has to be demonstrated. Recently, also Fan et al,38 for example, failed to demonstrate such a direct correlation. Pollen emissions, which are not impacted by changes in human behaviors and social restrictions, did not present substantial variations beyond their interannual variability during lockdown periods.…”