The impact of COVID‐19 lockdown on children with recurrent wheezing and asthma in Spain

Abstract

Aim The rapid spread of a novel human coronavirus SARS‐CoV‐2 led to drastic measures world‐wide. Most countries were forced to declare a national lockdown. We studied the effect of lockdown measures on the level of asthma control and maintenance treatment in children with recurrent wheezing and asthma during the first wave of COVID‐19 in Spain. Methods We analysed children with recurrent wheezing or asthma before and after the implementation of the lockdown, by using a questionnaire aimed to examine pre‐existing respiratory disorders, step treatment and level of asthma control before/after lockdown, COVID history and laboratory testing including IgG SARS‐CoV‐2. Results We enrolled 475 asthmatic and pre‐school wheezers (60.6% males), mean age 5.6 years. There were no differences in asthma treatment comparing both periods: 81.7% maintained the same treatment ( P = 0.103). According to child asthma‐control questionnaire, 87.7% remained well controlled during confinement. Nearly, a third of children (34.9%) needed reliever treatment, mainly in older children. Determination of IgG SARS‐CoV‐2 was performed in 233 children (49.1%) of whom 17 (7.3%) tested positive. Seven patients positive to IgG SARS‐CoV‐2 were assisted in the emergency department and two required hospital admission. Conclusions During COVID‐19 lockdown in Spain, most children with recurrent wheezing and asthma remained well controlled from their underlying disease and did not modify greatly their maintenance treatments. Unexpectedly, we also observed that those children who tested positive to SARS‐CoV‐2 IgG showed a significant increase in paediatric hospital admissions and attendances to urgent care settings.

The outcome of COVID‐19 in children with chronic lung disease: Systematic review and meta‐analyses

“…Many looked at all children affected with COVID‐19 who were admitted, and CLD was a risk factor 8,21,22 . We found articles that described the prevalence, risk, and complications of COVID‐19 among children with asthma and CF 11,19,20,23–26 . In this review, out of the 14 studies included, 10 studies reported on features and outcomes of COVID‐19 in asthma patients, 11,19,20,24–30 and 4 studies reported features of COVID‐19 in patients with CF 6,23,31,32 …”

“…Both Shi et al and Gaietto et al extracted data from children with asthma from asthma registries (Children's Hospital of Pittsburgh Asthma registry and Early Assessment of Covid‐19 epidemiology and Vaccine/Antiviral Effectiveness II, respectively) 11,28 . Daoud et al, Soyak Aytekin et al, and Rao et al diagnosed asthma based on a doctor's clinical diagnosis with specifics mentioned 24–26 …”

“…Nursoy et al diagnosed children based on either the RT‐PCR or clinical criteria and epidemiological evidence without any confirmatory test 29 . Daoud et al used immunoglobulin G antibodies, whereas Soyak Aytekin et al used both antibodies and RT‐PCR 24,26 . Rao et al identified COVID‐19 infection based on a positive test from the electronic health record, but the test was not specified 25 .…”

“…8,21,22 We found articles that described the prevalence, risk, and complications of COVID-19 among children with asthma and CF. 11,19,20,[23][24][25][26] In this review, out of the 14 studies included, 10 studies reported on features and outcomes of COVID-19 in asthma patients, 11,19,20,[24][25][26][27][28][29][30] and 4 studies reported features of COVID-19 in patients with CF. 6,23,31,32 The characteristics of the included studies and the corresponding study objectives and outcomes are shown in Supporting Information: E-Tables 1(a) and 1(b).…”

“…The prevalence of COVID-19 in children with asthma was determined by dividing the total number of asthmatic children with asthma control test/asthma control test or validated asthma questionnaire. 24,26 Asseri et al did not have a conventional classification for asthma control, so we used ≥1 hospitalization for asthma exacerbation (last year) was taken as uncontrolled. 19 Asthma severity was grouped into severe and nonsevere.…”