Pediatric asthma exacerbations during the COVID-19 pandemic: Absence of the typical fall seasonal spike in Washington, DC

Sheehan, William J.; Patel, Shilpa J.; Margolis, Rachel; Fox, Erin R.; Shelef, Deborah Q.; Kachroo, Nikita; Pillai, Dinesh K.; Teach, Stephen J.

doi:10.1016/j.jaip.2021.02.008

Cited by 33 publications

(38 citation statements)

References 8 publications

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“…However, the significant reduction in the day and nighttime respiratory symptoms and in medication use (both salbutamol and OCS) shows there was a real improvement in outcomes. Our innovative results in children with preschool wheeze confirm the benefit found by Sheehan et al in DC asthmatic patients during fall 2020 12 . Unfortunately, we recorded a significant worsening again at the end of October with a new increase in respiratory symptoms, even if not as bad as that registered from the winter season 2020–2021.…”

Section: Discussionsupporting

confidence: 87%

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: 87%

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

View full text Add to dashboard Cite

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“… 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. Moreover, we observed a marked decrease in the percentage of ambulatory encounters associated with antibiotic prescriptions, though the total number of ambulatory encounters (both outpatient and telehealth) increased, suggesting that there may have been fewer encounters due to suspected respiratory infections during the pandemic.…”

Section: Discussionmentioning

confidence: 56%

“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Hurst

Zhao

Fitzpatrick

et al. 2021

Pediatric Pulmonology

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The COVID‐19 pandemic has had a profound impact on healthcare access and utilization, which could have important implications for children with chronic diseases, including asthma. We sought to evaluate changes in healthcare utilization and outcomes in children with asthma during the COVID‐19 pandemic. We used electronic health records data to evaluate healthcare use and asthma outcomes in 3959 children and adolescents, 5–17 years of age, with a prior diagnosis of asthma who had a history of well‐child visits and encounters within the healthcare system. We assessed all‐cause healthcare encounters and asthma exacerbations in the 12‐months preceding the start of the COVID‐19 pandemic (March 1, 2019–February 29, 2020) and the first 12 months of the pandemic (March 1, 2020–February 28, 2021). All‐cause healthcare encounters decreased significantly during the pandemic compared to the preceding year, including well‐child visits (48.1% during the pandemic vs. 66.6% in the prior year; p < .01), emergency department visits (9.7% vs. 21.0%; p < .01), and inpatient admissions (1.6% vs. 2.5%; p < .01), though there was over a 100‐fold increase in telehealth encounters. Asthma exacerbations that required treatment with systemic steroids also decreased (127 vs. 504 exacerbations; p < .01). Race/ethnicity was not associated with changes in healthcare utilization or asthma outcomes. The COVID‐19 pandemic corresponded to dramatic shifts in healthcare utilization, including increased telehealth use and improved outcomes among children with asthma. Social distancing measures may have also reduced asthma trigger exposure.

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“…Specifically, we selected 2 acute conditions with infectious etiology which we hypothesized would occur less frequently due to public health interventions in place to reduce coronavirus transmission (acute respiratory tract infection (ARTI); gastroenteritis) 10 , 11 and 2 acute conditions which we hypothesized would have stable and nondeferrable need for care (hyperbilirubinemia; urinary tract infections [UTIs]). Among chronic conditions, we selected one where we hypothesized that public health interventions may have reduced exacerbations (asthma), 23 one where school closures may have altered management plans (attention deficit-hyperactivity disorder), and one where it was less likely that pandemic-related factors would impact disease control (eczema). Finally, we selected one group of diagnoses where we anticipated an increase in acute and chronic needs (anxiety and depression) due to pandemic-related societal changes.…”

Section: Methodsmentioning

confidence: 99%

Trends in Pediatric Primary Care Visits During the Coronavirus Disease of 2019 Pandemic

Schweiberger

Patel

Mehrotra

et al. 2021

Academic Pediatrics

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Pediatric asthma exacerbations during the COVID-19 pandemic: Absence of the typical fall seasonal spike in Washington, DC

Cited by 33 publications

References 8 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

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

Trends in Pediatric Primary Care Visits During the Coronavirus Disease of 2019 Pandemic

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