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Pediatric asthma control during the COVID-19 pandemic: A systematic review and meta-analysis
Ze Yang1, Xiang Wang1, Xi-Gang Wan1
1The First Clinical Medical College of Zhejiang Traditional Chinese Medical University, Hangzhou, China.
Insights
The COVID-19 pandemic unexpectedly improved asthma control in children, reducing exacerbations and emergency visits. Further research is needed to understand and sustain these positive outcomes for pediatric asthma management.
Area of Science:
- Pediatric Pulmonology
- Infectious Disease Epidemiology
- Public Health
Background:
- Initial expectations suggested increased asthma morbidity due to COVID-19.
- However, emerging evidence indicated potential improvements in pediatric asthma outcomes during the pandemic.
Purpose of the Study:
- To investigate the relationship between the COVID-19 pandemic and asthma-related outcomes in children.
- To synthesize existing literature on pediatric asthma control during the pandemic.
Main Methods:
- Systematic literature search of PubMed, Embase, and Cochrane Library (December 2019–June 2021).
- Included studies focused on asthma exacerbation, emergency room visits, hospital admissions, and childhood asthma control test (c-ACT) scores.
- Excluded were abstracts, comments, letters, reviews, and case reports.
Main Results:
- Analysis of 10 studies involving 22,159 children revealed a significant reduction in asthma exacerbations (OR=0.26) and emergency room visits (OR=0.11).
- No significant difference was observed in asthma admissions (OR=0.84).
- Childhood asthma control test (c-ACT) scores generally decreased, though not analyzed quantitatively due to varied metrics.
Conclusions:
- Asthma control in children significantly improved during the COVID-19 pandemic compared to pre-pandemic periods.
- Identifying the factors contributing to these improvements is crucial for developing strategies to maintain better asthma management.
- Further investigation is warranted to understand the mechanisms behind improved pediatric asthma control during the pandemic.
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.
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