Unexpected decline in pediatric asthma morbidity during the coronavirus pandemic

Abstract

The Coronavirus disease 2019 (COVID‐19) pandemic profoundly impacted health care utilization. We evaluated asthma‐related emergency department (ED) and inpatient health care utilization by a county‐specific Medicaid population, ages 2–18, during the COVID‐19 pandemic and compared it to utilization from a 3‐year average including 2017–2019. All‐cause ED utilization and asthma medication fill rates were evaluated during the same timeframes. Relative to the 2017–2019 3‐year average, cumulative asthma‐related ED visits from January through June decreased by 45.8% (p = .03) and inpatient admission rates decreased by 50.5% (p = .03). The decline in asthma‐related ED utilization was greater than the reduction of overall ED use during the same time period, suggesting that the decline involved factors specific to asthma and was not due solely to avoidance of health care facilities. Fill rates for asthma controller medications decreased during this time (p = .03) and quick relief medication fill rates had no significant change (p = .31). Multiple factors may have contributed to the decrease in acute asthma health care visits. Locally, decreased air pollution and viral exposures coincided with the “Stay‐at‐home” order in Ohio, and increased utilization of telehealth for assessment during exacerbations may have impacted outcomes. Identification of the cause of the decline in visit rates could spur new interventions to limit the need for ED and inpatient visits for asthma patients, leading to both economic and health‐associated benefits.

Unforeseen changes in seasonality of pediatric respiratory illnesses during the first COVID‐19 pandemic year

“…First, there was an actual decrease in pediatric respiratory illnesses secondary to changes in behavior, including social distancing, adherence to hand hygiene practices, and the use of facemasks—to decrease person‐to‐person transmission of respiratory viruses 22 , 23 ; decrease in air pollution mostly during lockdowns when traffic was most restricted, 23 , 24 and limited exposure to outdoor pollution and aeroallergens. 23 There was also greater adherence to preventive treatment of respiratory illnesses 25 , 26 as the result of parents spending more time with their children during lockdowns and providing better supervision and a higher level of vigilance. 27 Second, except for the actual decrease in pediatric respiratory illnesses, fear of contracting COVID‐19 during hospitalization was a major factor in the reduced healthcare utilization during lockdown.…”

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

“…A recent paper by Ulrich et al 27 reported that the drastic decline in PED visits and admissions rates for asthma exacerbation was in excess of the decline observed in PED utilization for all diagnoses. Accordingly, in our study, the reduction in acute asthma referrals presents a similar pattern to that of all PED visits, but the fall in high‐priority asthma cases was strikingly higher during the most severe lockdown (Figure 1) and hardly explained solely by the reluctance to seek hospital care or by pandemic policies.…”

“…1,2 This was attributed to the introduction of new guidance for primary care (e.g., phone selection triage procedure, more telehealth) and fear of exposure to SARS-CoV-2 infection, leading to a higher risk of severe illness from delayed diagnosis. 1,26 A recent paper by Ulrich et al 27 reported that the drastic decline in PED visits and admissions rates for asthma exacerbation was in excess of the decline observed in PED utilization for all diagnoses.…”

A response to COVID‐19 school closures: The feasibility of a school‐linked text message intervention as an adaptation to school‐supervised asthma therapy

“…as other studies have shown decreases in pediatric asthma healthcare utilization during the pandemic. 36,37 However, our baseline and follow-up assessment of asthma health outcomes were both conducted after the onset of the pandemic, mitigating the impact of pre-to postpandemic changes in asthma morbidity.…”