Prevalence of asthma in hospitalized and non-hospitalized children with COVID-19

Floyd, G. Chandler; Dudley, Jesse; Xiao, Rui; Feudtner, Chris; Taquechel, Kiara; Miller, Kelly R.; Henrickson, Sarah E.; Hill, David A.; Kenyon, Chén C.

doi:10.1016/j.jaip.2021.02.038

Cited by 26 publications

(24 citation statements)

References 9 publications

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“…Thus, asthma does not appear to be over-represented among pediatric cases of COVID-19 compared to population asthma prevalence at the national (7.0%) (18) or local (8.0%) (19) levels. Consistent with our results, a retrospective study in Philadelphia revealed an asthma prevalence among pediatric COVID-19 cases there comparable to the local pediatric asthma prevalence estimates (20) . A recent retrospective study from Turkey reported that, among children with COVID-19 at their institution, only 54 (<1%) had asthma (21) .…”

Section: Discussionsupporting

confidence: 91%

“…Consistent with our results, a previous study in Colorado reported asthma as a risk of hospitalization in children with COVID-19, along with other chronic conditions (27) . However, others have reported conflicting results (20,23) . Given the paucity of individual-level studies evaluating the risk of asthma in COVID-19 among children, certain providers or systems may have had differing thresholds to admit a child with asthma compared to one without pre-existing conditions.…”

Section: Discussionmentioning

confidence: 99%

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Childhood Asthma and COVID-19: A Nested Case-Control Study

Gaietto

Freeman

DiCicco

et al. 2021

Preprint

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BACKGROUND: Most pediatric studies of asthma and COVID-19 to date have been ecological, which offer limited insight. We evaluated the association between asthma and COVID-19 at an individual level. METHODS: Using data from prospective clinical registries, we conducted a nested case-control study comparing three groups: children with COVID-19 and underlying asthma ("A+C" cases); children with COVID-19 without underlying disease ("C+" controls); and children with asthma without COVID-19 ("A+" controls). RESULTS: The cohort included 142 A+C cases, 1110 C+ controls, and 140 A+ controls. A+C cases were more likely than C+ controls to present with dyspnea and wheezing, to receive pharmacologic treatment including systemic steroids (all p<0.01), and to be hospitalized (4.9% vs 1.7%, p=0.01). In the adjusted analysis, A+C cases were nearly 4 times more likely to be hospitalized than C+ controls (adjusted OR=3.95 [95%CI=1.4-10.9]); however, length of stay and respiratory support level did not differ between groups. Among A+C cases, 8.5% presented with an asthma exacerbation and another 6.3% developed acute exacerbation symptoms shortly after testing positive for SARS-CoV-2. Compared to historic A+ controls, A+C cases had less severe asthma, were less likely to be on controller medications, and had better asthma symptom control (all p<0.01). CONCLUSIONS: In our cohort, asthma was a risk factor for hospitalization in children with COVID-19, but not for worse COVID-19 outcomes. SARS-CoV-2 does not seem to be a strong trigger for pediatric asthma exacerbations. Asthma severity was not associated with higher risk of COVID-19.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Childhood Asthma and COVID-19: A Nested Case-Control Study

Gaietto

Freeman

DiCicco

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Consistent with our results, some studies have reported asthma as a risk factor for hospitalization in children with COVID‐19, 26 , 27 while others have reported conflicting results. 20 , 22 Although our sample size was small and thus results need to be interpreted with caution, hospital LOS and the need for respiratory support or PICU admission did not seem to differ by asthma status. Taken together, these results suggest that the increased hospitalization rate may have been due to a different threshold to admit children with asthma, rather than truly because of a more severe presentation.…”

Section: Discussionmentioning

confidence: 79%

Asthma as a risk factor for hospitalization in children with COVID‐19: A nested case‐control study

Gaietto

Freeman

DiCicco

et al. 2021

Pediatric Allergy Immunology

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Background Most pediatric studies of asthma and COVID‐19 to date have been ecological, which offer limited insight. We evaluated the association between asthma and COVID‐19 at an individual level. Methods Using data from prospective clinical registries, we conducted a nested case‐control study comparing three groups: children with COVID‐19 and underlying asthma (“A+C” cases); children with COVID‐19 without underlying disease (“C+” controls); and children with asthma without COVID‐19 (“A+” controls). Results The cohort included 142 A+C cases, 1110 C+ controls, and 140 A+ controls. A+C cases were more likely than C+ controls to present with dyspnea and wheezing, to receive pharmacologic treatment including systemic steroids (all p < .01), and to be hospitalized (4.9% vs. 1.7%, p = .01). In the adjusted analysis, A+C cases were nearly 4 times more likely to be hospitalized than C+ controls (adjusted OR = 3.95 [95%CI = 1.4–10.9]); however, length of stay and respiratory support level did not differ between groups. Among A+C cases, 8.5% presented with an asthma exacerbation and another 6.3% developed acute exacerbation symptoms shortly after testing positive for SARS‐CoV‐2. Compared to historic A+ controls, A+C cases had less severe asthma, were less likely to be on controller medications, and had better asthma symptom control (all p < .01). Conclusions In our cohort, asthma was a risk factor for hospitalization in children with COVID‐19, but not for worse COVID‐19 outcomes. SARS‐CoV‐2 does not seem to be a strong trigger for pediatric asthma exacerbations. Asthma severity was not associated with higher risk of COVID‐19.

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“…Children with asthma had a slightly lower risk of infection and a somewhat increased risk of hospital admission compared to children without asthma. Current asthma has been suggested to be negatively associated with the risk of hospitalisation for Covid-19 in children 24,25 and was not associated with hospitalisation in a study including both children and adults. 26 Similar to our study, other chronic cardiopulmonary conditions have been reported as risk factors for hospital admission and/or ICU transfer.…”

Section: Discussionmentioning

confidence: 87%

Risk factors for SARS-CoV-2 infection and hospitalisation in children and adolescents in Norway: A nationwide population-based study

Størdal

Ruiz

Greve-Isdahl

et al. 2021

Preprint

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Objective: To determine risk factors for SARS-CoV-2 infection and hospitalisation among children and adolescents. Design: Nationwide, population-based cohort study. Setting: Norway from 1 March 2020 to 31 April 2021. Participants: All Norwegian residents <18 years of age. Main outcome measures: Population-based health care and population registries were used to study risk factors for SARS-CoV-2 infection, including socioeconomic factors, country of origin, and pre-existing chronic comorbidities. All residents were followed until age 18, emigration, death, or end of follow-up. Hazard ratios (HR) estimated by Cox regression models were adjusted for testing frequency. Further, risk factors for admission to the hospital among the infected were investigated. Results: Of 1 182 796 residents, 22608 (1.9%) tested positive by polymerase chain reaction or lateral flow tests, of whom 107 (0.5%) were admitted to a hospital. Low family income (aHR 1.40, 95% confidence interval 1.36 to 1.46), crowded housing (1.35, 1.30 to 1.39), household size, age, and area of living were independent risk factors for infection. A non-Nordic country of origin was the strongest risk factor (aHR 2.37, 95% CI 2.30 to 2.49), whereas chronic comorbidity was not associated with the risk of infection. Chronic comorbidity was associated with hospitalisation (aHR 4.15, 2.63 to 6.56), in addition to age, whereas socioeconomic status and country of origin did not predict hospitalisation among those infected. Conclusions: Socioeconomic factors, country of origin, and area of living were associated with the risk of SARS-CoV-2 infection. However, these factors did not predict hospitalisation among those infected. Chronic comorbidity was associated with the risk of admission but not with the overall risk of acquiring SARS-CoV-2.

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Prevalence of asthma in hospitalized and non-hospitalized children with COVID-19

Cited by 26 publications

References 9 publications

Childhood Asthma and COVID-19: A Nested Case-Control Study

Childhood Asthma and COVID-19: A Nested Case-Control Study

Asthma as a risk factor for hospitalization in children with COVID‐19: A nested case‐control study

Risk factors for SARS-CoV-2 infection and hospitalisation in children and adolescents in Norway: A nationwide population-based study

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