Impact of the COVID-19 Pandemic on Pediatric Emergency Department Use for Asthma

Simoneau, Tregony; Greco, Kimberly F.; Hammond, Adam; Nelson, Kyle A.; Gaffin, Jonathan M.

doi:10.1513/annalsats.202007-765rl

Cited by 51 publications

(65 citation statements)

References 5 publications

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“…Contrary to initial expectations, and in accord with our hypothesis, children affected by preschool wheeze had better outcomes during the lockdown. This is consistent with findings of reduction in emergency visits and admissions for asthma attacks in school‐age children 7,11 . Both cACT and CQ showed similar results.…”

Section: Discussionsupporting

confidence: 89%

Effects of the COVID‐19 pandemic and lockdown on symptom control in preschool children with recurrent wheezing

Ullmann

Allegorico

Bush

et al. 2021

Pediatric Pulmonology

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Introduction Preschool wheezers are at high risk of recurrent attacks triggered by respiratory viruses, sometimes exacerbated by exposure to allergens and pollution. Because of the COVID‐19 infection, the lockdown was introduced, but the effects on preschool wheezers are unknown. We hypothesized that there would be an improvement in outcomes during the lockdown, and these would be lost when the lockdown was eased. Materials and Methods Patients underwent medical visits before and after the COVID‐19 lockdown. We recorded the childhood Asthma Control Test (cACT) and a clinical questionnaire. Data on symptoms, the need for medications and the use of healthcare resources were recorded. We compared these data with retrospective reports from the preceding year and prospectively acquired questionnaires after lockdown. Results We studied 85 preschool wheezers, mean age 4.9 years. During the lockdown, cACT score was significantly higher (median 25 vs. 23); families reported a dramatic drop in wheezing episodes (51 vs. none), significant reductions in the day and nighttime symptoms, including episodes of shortness of breath (p < .0001); the use of salbutamol and oral corticosteroids (OCS) dropped significantly (p < .0001) and 79 (95%) patients needed no OCS bursts during the lockdown. Finally, patients had significantly fewer extra medical examinations, as well as fewer Emergency Room visits (p < .0001). All were improved compared with the same time period from the previous year, but outcomes worsened significantly again after lockdown (cACT median: 22). Conclusions During the national lockdown, children with persistent preschool wheeze showed a significant clinical improvement with reduction of respiratory symptoms, medication use for exacerbations, and use of healthcare resources. This trend reversed when lockdown restrictions were eased.

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Section: Discussionsupporting

confidence: 89%

Effects of the COVID‐19 pandemic and lockdown on symptom control in preschool children with recurrent wheezing

Ullmann

Allegorico

Bush

et al. 2021

Pediatric Pulmonology

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“… 35 , 51 This is supported by a decline in hospitalizations and ED visits for chronic obstructive pulmonary disease (COPD)/asthma and pneumonia during the COVID-19 pandemic, which shares many of these risk factors. 37 , 52 , 53 Another possible explanation is that the effective shift into telemedicine, coupled with the absence of prior distractions (eg, work, travel, etc. ), has led to increased treatment adherence and improved management of chronic conditions.…”

Section: Healthcare Characteristics and Utilization By Individuals Wimentioning

confidence: 99%

The Effects of the Health System Response to the COVID-19 Pandemic on Chronic Disease Management: A Narrative Review

Kendzerska¹,

Zhu²,

Gershon³

et al. 2021

RMHP

182

143

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Background Individuals with chronic conditions require ongoing disease management to reduce risks of adverse health outcomes. During the COVID-19 pandemic, health care for non-COVID-19 cases was affected due to the reallocation of resources towards urgent care for COVID-19 patients, resulting in inadequate ongoing care for chronic conditions. Methods A keyword search was conducted in PubMed, Google Scholar, Science Direct, and Scopus for English language articles published between January 2020 and January 2021. Findings During the COVID-19 pandemic, in-person care for individuals with chronic conditions have decreased due to government restriction of elective and non-urgent healthcare visits, greater instilled fear over potential COVID-19 exposure during in-person visits, and higher utilization rates of telemedicine compared to the pre-COVID-19 period. Potential benefits of a virtual-care framework during the pandemic include more effective routine disease monitoring, improved patient satisfaction, and increased treatment compliance and follow-up rates. However, more needs to be done to ensure timely and effective access to telemedicine, particularly for individuals with lower digital literacy. Capitation primary care models have been proposed as a more financially-robust approach during the COVID-19 pandemic than fee-for-service primary care models; however, the interplay between different primary models and the health outcomes is still poorly understood and warrants further investigation. Shortages of medication used to manage chronic conditions were also observed at the beginning of the COVID-19 pandemic due to global supply chain disruptions. Finally, patients with chronic conditions faced lifestyle disruptions due to the COVID-19 pandemic, specifically in physical activity, sleep, stress, and mental health, which need to be better addressed. Interpretation Overall, this review elucidates the disproportionately greater barriers to primary and specialty care that patients with chronic diseases face during the COVID-19 pandemic and emphasizes the urgent need for better chronic disease management strategies moving forward.

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“…Behavioral factors may also have contributed to the lower prevalence of pediatric asthmatics among COVID cohorts. Several studies reporting a significant decrease in pediatric asthma‐related visits to emergency departments and an increased utilization of telehealth raise the possibility that parents with vulnerable children are being proactive in protecting them against unnecessary exposure to COVID‐19 84,85 …”

Section: Comorbidities and Severitymentioning

confidence: 99%

COVID‐19 in childhood: Transmission, clinical presentation, complications and risk factors

Siebach

Piedimonte

Ley

2021

Pediatric Pulmonology

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Children less than 18 years of age account for an estimated 2%-5% of reported severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases globally. Lower prevalence of coronavirus disease 2019 (COVID-19) among children, in addition to higher numbers of mild and asymptomatic cases, continues to provide challenges in determining appropriate prevention and treatment courses. Here, we summarize the current evidence on the transmission, clinical presentation, complications and risk factors in regard to SARS-CoV-2 in children, and highlight crucial gaps in knowledge going forward. Based on current evidence, children are rarely the primary source of secondary transmission in the household or in child care and school settings and are more likely to contract the virus from an adult household member. Higher transmission rates are observed in older children (10-19 years old) compared with younger children ( <10 years old). While increasing incidence of COVID-19 in neonates raises the suspicion of vertical transmission, it is unlikely that breast milk is a vehicle for transmission from mother to infant. The vast majority of clinical cases of COVID-19 in children are mild, but there are rare cases that have developed complications such as multisystem inflammatory syndrome in children, which often presents with severe cardiac symptoms requiring intensive care. Childhood obesity is associated with a higher risk of infection and a more severe clinical presentation. Although immediate mortality rates among children are low, long-term respiratory, and developmental implications of the disease remain unknown in this young and vulnerable population.epidemiology, pulmonology (general), social dimensions of pulmonary medicine | INTRODUCTIONChildren less than 18 years of age account for an estimated 1.7% of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) clinical infections in the United States, 1 with global estimates ranging from 2.0 2 to 4.8%. 3 The low prevalence of pediatric cases has made it difficult to draw conclusive statements about many aspects of the virus in this population, but the reported case numbers are likely an underestimation of the true pediatric case load, as many cases in children are mild or asymptomatic. 4 Initial observations report that

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Impact of the COVID-19 Pandemic on Pediatric Emergency Department Use for Asthma

Cited by 51 publications

References 5 publications

Effects of the COVID‐19 pandemic and lockdown on symptom control in preschool children with recurrent wheezing

Effects of the COVID‐19 pandemic and lockdown on symptom control in preschool children with recurrent wheezing

The Effects of the Health System Response to the COVID-19 Pandemic on Chronic Disease Management: A Narrative Review

COVID‐19 in childhood: Transmission, clinical presentation, complications and risk factors

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