Pediatric Asthma Health Care Utilization, Viral Testing, and Air Pollution Changes During the COVID-19 Pandemic

Taquechel, Kiara; Diwadkar, Avantika R.; Sayed, Samir; Dudley, Jesse; Grundmeier, Robert W.; Kenyon, Chén C.; Henrickson, Sarah E.; Himes, Blanca E.; Hill, David A.

doi:10.1016/j.jaip.2020.07.057

Cited by 116 publications

(175 citation statements)

References 41 publications

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“…The reduction of respiratory pathology admission such as asthma is related to changes in respiratory virus infections (ie reduction of the contribution of person-to-person transmission of respiratory viruses) and also to less exposure to inhalant allergens related to facial mask and lockdown [ 26 , 27 ]. In addition to potentially changing levels of outdoor air pollutants, COVID-19 related public health interventions likely influenced pollution exposure profiles of children in other ways, including via decreased commuting and outdoor activity [ 27 ]. Another mechanism to reduce allergic responses include include the physical filtration of face masks and the potentially modified physiological response to allergens by breathing humid and hot air [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on the Emergency Department of a tertiary children’s hospital

et al. 2021

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Background Italy was the first country in Europe affected by COVID-19: the emergency started on February 20, 2020, culminating with national lockdown on March 11, which terminated on May 4, 2020. We describe how the pandemic affected Emergency Department (ED) accesses in a tertiary children’s hospital, composed by two different pediatric centers, one located in Rome’s city center and the second, Palidoro (regional COVID-19 center), in its surrounding metropolitan area, both in the Lazio region, analyzing the profile of admitted patients during the pandemic period in terms of their general characteristics (at presentation in the ED’s) and urgent hospitalizations compared to prepandemic period. Methods The study compare the period between the 21st of February and the 30th of April 2020, covering the three phases of the national responses (this period will be referred to as the pandemic period) with the same period of 2019 (prepandemic period). The study analyzes the number of ED visits and urgent hospitalizations and their distribution according to selected characteristics. Results The reduction of ED visits was 56 and 62%, respectively in Rome and Palidoro centers. The higher relative decline was encountered for Diseases of Respiratory System, and for Diseases of the Nervous System and Sense Organs. A doubling of the relative frequency of hospitalizations was observed, going from 14.2 to 24.4% in Rome and from 6.4 to 10.3% in Palidoro. In terms of absolute daily numbers the decrease of urgent hospitalizations was less sharp than ED visits. For pathologies such as peritonitis, tumors or other possible life-treathening conditions we did not observe a significative increase due to delayed access. Conclusions In the pandemic period there was a general reduction in the number of children referred to ED, such reduction was greater in low-acuity levels. The reduction for respiratory tract infections and other communicable diseases during school closure and the national lockdown must make us reflect on the possible impact that these conditions may have on the health system, in particular the ED, at the reopening of schools. The major problem remains the fear for possible diagnostic delays in life-threatening or crippling diseases; our study doesn’t demonstrate an increase in number or significant delay in some serious conditions such as tumors, peritonitis, diabetic ketoacidosis, ileo-colic intussusception and testis/ovary torsion. A continuous, deep re-organizational process step by step of the ED is nececessary in the present and upcoming pandemic situation.

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Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on the Emergency Department of a tertiary children’s hospital

et al. 2021

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“…Besides, the Japanese government convinced businessmen to stay and work at home during the ‘voluntary lockdown’ starting in April 8 . Previous reports have shown that adherence improved during lockdown for the COVID-19 pandemic 9 . Besides, PM2.5 was one of the environmental risk factors that decreased in several areas, including India, China, England, and The United States during lockdown.…”

Section: Discussionmentioning

confidence: 86%

Impact of the COVID-19 pandemic on infant and pediatric asthma: a multi-center survey using an administrative database in Japan

Bun

Kishimoto

Shin

et al. 2020

Preprint

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BackgroundLimited data are available on the relationship between infant and pediatric asthma and severe acute respiratory syndrome coronavirus 2 (COVID-19). Political limitations such as school closure may affect the treatment behavior of pediatric asthma. To investigate the trends of treatment behavior in the field of pediatrics during the COVID-19 pandemic.MethodsThis is a retrospective observational study using Diagnosis Procedure Combination (DPC) data from the Quality Indicator/Improvement Project (QIP) database. We identified children with asthma aged 15 years or younger who were patients from July 1, 2018, to June 30, 2020. The main outcome was a comparison between asthma patients’ treatment behavior before the COVID-19 pandemic and during the COVID-19 pandemic.We statistically tested the admission volume changes based on the discharge date after adjusting for seasonality through a Fourier term using an interrupted time-series analysis (ITS).ResultsWe identified 10,481 inpatients cases in 67 hospitals and 258,911 out-patients cases in 180 hospitals who were diagnosed with asthma. We performed ITS analysis for inpatients. The reduction in the number of patients during this period was estimated to be 232 (P=0.001). In addition, ITS analysis was performed for patients aged <3 years. The reduced number of patients during this period was estimated to be 155 (P<0.001).ConclusionsWe found that the number of pediatric asthma patients dramatically decreased during the COVID-19 pandemic. We need to continue research into the trends of pediatric asthma patients after the COVID-19 pandemic in Japan.

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“…During the pandemic, children with asthma experienced improved disease control (two thirds of the patients), as evidenced by improved scores in validated asthma control measures (>MCID in one third), fewer asthma attacks, fewer hospitalizations, and improved pulmonary function. The multifaceted etiology of this observation may include the avoidance of major asthma triggers including outdoor allergens, viral infections, physical exercise and air pollution, due to social distancing, home sheltering and reduced school days 10,12,22,23,24,25 . Increased treatment adherence during the pandemic 26 , could have also contributed and is consistent with the high adherence levels observed during the pandemic in our cohort.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, it is also possible that allergic sensitization can have some protective effect against COVID-19 11 . However, this needs to be further explored 12,13 .…”

Section: Introductionmentioning

confidence: 99%

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

Papadopoulos

Mathioudakis

Čustović

et al. 2020

Preprint

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Objective: We evaluated the impact of COVID-19 pandemic on childhood asthma outcomes. Design: The PeARL multinational cohort included children with asthma and non-asthmatic controls recruited during the COVID-19 pandemic and compared current disease activity with data available from the previous year. Setting: Pediatric outpatient clinics. Participants: The study included 1,054 children with asthma and 505 non-asthmatic controls, aged between 4-18 years, from 25 pediatric departments, from 15 countries globally. Exposures: COVID-19 pandemic first wave, starting from the date of the first fatality in the respective country. Main outcomes and measures: We assessed the pandemic's impact on the frequency of respiratory infections, emergency presentations and hospital admissions in asthmatic versus non-asthmatic participants, controlling for confounding factors including the pandemic's duration and the frequency of such acute events during 2019. Using paired analyses, we evaluated the impact of the pandemic on the annualized frequency of asthma attacks and the previously mentioned acute events, asthma control, and pulmonary function in children with asthma, compared to their baseline disease activity, during the preceding year. 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 to the preceding year. Sixty-six percent of asthmatic children had improved asthma control while in 33% the improvement exceeded the minimally clinically important difference. Pre-bronchodilatation FEV1 and peak expiratory flow rate were also improved during the pandemic. When compared to non-asthmatic controls, children with asthma were not found to be at increased risk of LRTIs, episodes of pyrexia, emergency visits or hospitalizations during the pandemic. However, an increased risk of URTIs emerged. Conclusions and relevance: 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.

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Pediatric Asthma Health Care Utilization, Viral Testing, and Air Pollution Changes During the COVID-19 Pandemic

Cited by 116 publications

References 41 publications

Impact of the COVID-19 pandemic on the Emergency Department of a tertiary children’s hospital

Impact of the COVID-19 pandemic on the Emergency Department of a tertiary children’s hospital

Impact of the COVID-19 pandemic on infant and pediatric asthma: a multi-center survey using an administrative database in Japan

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

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