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Childhood asthma outcomes during the COVID-19 pandemic: Findings from the PeARL multi-national cohort
Nikolaos G Papadopoulos1,2, Alexander G Mathioudakis1,3, Adnan Custovic4
1Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK.
Insights
The COVID-19 pandemic improved childhood asthma outcomes, with fewer infections and asthma attacks observed. This suggests environmental control can enhance pediatric asthma management and does not indicate asthma is a COVID-19 risk factor.
Area of Science:
- Pediatric Pulmonology
- Infectious Disease Epidemiology
- Public Health
Background:
- The impact of the COVID-19 pandemic on pediatric asthma remains incompletely understood.
- Previous research has not clarified the relationship between pandemic conditions and asthma exacerbations in children.
Purpose of the Study:
- To evaluate the effect of the COVID-19 pandemic on asthma control and acute outcomes in children.
- To compare respiratory illness frequency in asthmatic children during the pandemic versus the prior year.
Main Methods:
- Utilized the multinational PeARL cohort of 1,054 children with asthma and 505 controls (ages 4-18).
- Compared acute respiratory and febrile presentations during the pandemic's first wave against the previous year.
- Assessed current and historical asthma control metrics in asthmatic participants.
Main Results:
- Children with asthma showed reduced upper respiratory tract infections, pyrexia, emergency visits, hospitalizations, and asthma attacks during the pandemic.
- Asthma control improved in 66% of asthmatic children, with 33% showing clinically significant improvement.
- Lung function (FEV1, PEFR) improved; asthmatic children faced no increased risk for LRTIs or hospitalizations but had higher URTI risk compared to controls.
Conclusions:
- Childhood asthma outcomes, including control, improved during the pandemic, likely due to reduced trigger exposure and better adherence.
- The findings do not support childhood asthma as a COVID-19 risk factor.
- Environmental control strategies show potential for improving pediatric asthma management.
Background:
The interplay between COVID-19 pandemic and asthma in children is still unclear. We evaluated the impact of COVID-19 pandemic on childhood asthma outcomes.
Methods:
The PeARL multinational cohort included 1,054 children with asthma and 505 non-asthmatic children aged between 4 and 18 years from 25 pediatric departments, from 15 countries globally. We compared the frequency of acute respiratory and febrile presentations during the first wave of the COVID-19 pandemic between groups and with data available from the previous year. In children with asthma, we also compared current and historical disease control.
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 with the preceding year. Sixty-six percent of asthmatic children had improved asthma control while in 33% the improvement exceeded the minimal clinically important difference. Pre-bronchodilatation FEV1 and peak expiratory flow rate were improved during the pandemic. When compared to non-asthmatic controls, children with asthma were not at increased risk of LRTIs, episodes of pyrexia, emergency visits, or hospitalizations during the pandemic. However, an increased risk of URTIs emerged.
Conclusion:
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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