The effect of the COVID-19 lockdown on children with asthma-related symptoms: A tertiary care center experience

Introduction Following the opening of lockdown and relaxation of public health restrictions, an unusual surge of respiratory illness occurred during the spring/summer (Q2) 2021 season. We aimed to characterize this surge compared to previous years. Methods Children discharged from a single tertiary hospital for respiratory illness or selected noncommunicable diseases (NCDs) between 2015 and 2021 were included, and hospitalization rates were compared. To evaluate whether the current respiratory surge resembles a typical winter, characteristics of the second quarter (Q2, April–June) of 2021 were compared to parallel seasons and to autumn/winter (Q4, October–December) of the previous years. Results Respiratory illness showed a seasonal peak, while the pattern of NCD was consistent throughout the study period. Respiratory illnesses showed a delayed surge in Q2 2021 (389 patients), with a missing seasonal peak in Q2 and Q4 2020 (135 and 119 patients, respectively). There were more cases of croup in Q2 2021 compared to Q2 and Q4 2015–2019 (26.2 vs. 12.5% and 15.8%, p < 0.001), fewer cases of pneumonia (5.9 vs. 15.9% and 11.7%, p < 0.001), lower admission rates (22.4 vs. 36.3% and 31.5%, p < 0.001), and fewer hypoxemia during hospitalization (6.3 vs. 11.7% and 10%, p < 0.001). Additionally, lower use of antibiotics (6.2 vs. 12.3% and 10.3%, p = 0.001 and 0.012, respectively) and higher use of steroids (33.7 vs. 24.8% and 28.3%, p < 0.001 and 0.034, respectively). Conclusions The postponed increase in respiratory morbidity after lockdown had unique characteristics, with upper respiratory illness predominating and fewer hospitalizations. Follow‐up is needed to assess the altered epidemiological patterns of respiratory diseases in the post‐COVID era.

Section: Discussionmentioning

confidence: 94%

Characterization of respiratory illness surge (April–June 2021) post‐COVID‐19 lockdown

Masarweh¹,

Gur²,

Bar‐Yoseph³

et al. 2021

“…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.…”

Section: Study Characteristicmentioning

confidence: 99%

“…Five studies 16,17,19,19,21,22 were included in this outcome. The metaanalysis showed that there was no significant difference between two groups in asthma admission (OR = 0.84, 95% CI = [0.32-2.20], Z = 0.36, p = 0.72) (Figure 3).…”

Section: Asthma Admissionmentioning

confidence: 99%

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

Yang

Wang

Wan

et al. 2021

Background: With the onset of the coronavirus disease 2019 (COVID-19) pandemic, many experts expected that asthma-associated morbidity because of severe acute respiratory syndrome coronavirus 2 infection would dramatically increase. However, some studies suggested that there was no apparent increasing in asthma-related morbidity in children with asthma, it is even possible children may have improved outcomes. To understand the relationship between the COVID-19 pandemic and asthma outcomes, we performed this article. Methods: We searched PubMed, Embase, and Cochrane Library to find literature from December 2019 to June 2021 related to COVID-19 and children's asthma control, among which results such as abstracts, comments, letters, reviews, and case reports were excluded. The level of asthma control during the COVID-19 pandemic was synthesized and discussed by outcomes of asthma exacerbation, emergency room visit, asthma admission, and childhood asthma control test (c-ACT). Results: A total of 22,159 subjects were included in 10 studies. Random effect model was used to account for the data. Compared with the same period before the COVID-19 pandemic, asthma exacerbation reduced (odds ratio [OR] = 0.26, 95% confidence interval [CI] = [0.14-0.48], Z = 4.32, p < 0.0001), the odds of emergency room visit decreased as well (OR = 0.11, 95% CI = [0.04-0.26], Z = 4.98, p < 0.00001). The outcome of asthma admission showed no significant difference (OR = 0.84, 95% CI = [0.32-2.20], Z = 0.36, p = 0.72). The outcome of c-ACT scores were not analyzed because of the different manifestations used. Overall, c-ACT scores reduced during the pandemic. Conclusion:Compared to the same period before the COVID-19 pandemic, the level of asthma control has been significantly improved. We need to understand the exact factors leading to these improvements and find methods to sustain it.

“…Several studies reported how social distancing and stepped‐up hygiene measures determined a concomitant reduction in the diffusion of respiratory pathogens, leading to decreased respiratory tract infections, 3,8,28–32 and identify it as the main factor. Moreover, increased adherence to controller medications among the asthmatic population during lockdowns was demonstrated 30,32,33 …”

Section: Discussionmentioning

confidence: 99%

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

Dondi¹,

Betti

Carbone

et al. 2021

Background: Lockdown measures during the SARS-CoV-2 pandemic determined radical changes to behavioral and social habits, that were reflected by a reduction in the transmission of respiratory pathogens and in anthropogenic atmospheric emissions.Objective: This ecological study aims to provide a descriptive evaluation on how restrictive measures during the SARS-CoV-2 pandemic impacted Pediatric Emergency Department (PED) referrals for asthma exacerbations, and their potentially associated environmental triggers in Bologna, a densely populated urban area in Northern Italy.Methods: Files of children evaluated for acute asthma during 2015 to 2020 at the PED of Sant'Orsola University Hospital of Bologna were retrospectively reviewed.Historical daily concentration records of particulate (PM 2.5 , PM 10 ) and gaseous (NO 2 , C 6 H 6 ) air pollutants, and pollen were concurrently evaluated, including specific PM chemical tracers for traffic-related air pollution (TRAP).Results: In 2020, asthma-related PED referrals decreased compared to referral rates of the previous 5 years (p < 0.01). This effect was particularly marked during the first lockdown period (March to May), when the drastic drop in PED referrals was associated with a reduction of high-priority cases up to 85% and by 54%, on average.