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Published on: November 7, 2020
COVID-19 Pandemic-Related Reductions in Pediatric Asthma Exacerbations Corresponded with an Overall Decrease in
Samir Sayed1, Avantika R Diwadkar2, Jesse W Dudley3
1Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa.
Insights
Viral respiratory infections significantly drive pediatric asthma exacerbations. The coronavirus disease 2019 pandemic provided insights into asthma triggers, highlighting viruses as key factors in worsening symptoms.
Area of Science:
- Pediatric Asthma Research
- Epidemiology of Respiratory Illnesses
- Environmental Health and Asthma
Background:
- Pediatric asthma exacerbations are influenced by respiratory viruses, air pollutants, and aeroallergens, but their relative impact is unclear.
- The coronavirus disease 2019 (COVID-19) pandemic saw a notable reduction in asthma exacerbations, offering a unique opportunity to study trigger associations.
- Understanding these triggers is crucial for managing childhood asthma effectively.
Purpose of the Study:
- To investigate the association between changes in respiratory viruses, air pollutants, and aeroallergens during the COVID-19 pandemic and the decrease in pediatric asthma exacerbations.
- To differentiate the contributions of various environmental and infectious triggers to asthma activity.
Main Methods:
- Extracted health care utilization and viral testing data (2015-2020) from an electronic health record system.
- Collected air pollution data from EPA databases and aeroallergen data from a National Allergy Bureau station.
- Compared pandemic-era data (2020) with historical data to assess changes in triggers and asthma activity.
Main Results:
- Asthma exacerbations decreased during the pandemic, with uneven recovery of in-person encounters.
- Influenza A and B viral infections became negligible, while respiratory syncytial virus and rhinovirus decreased but remained present.
- No significant changes were observed in air pollution or aeroallergen levels compared to historical data.
Conclusions:
- Viral respiratory infections appear to be the primary driver of pediatric asthma exacerbations.
- These findings underscore the importance of viral infections in asthma management and public health policy.
- Targeting viral triggers could significantly reduce childhood asthma morbidity.
Background:
Respiratory viruses, air pollutants, and aeroallergens are all implicated in worsening pediatric asthma symptoms, but their relative contributions to asthma exacerbations are poorly understood. A significant decrease in asthma exacerbations has been observed during the coronavirus disease 2019 pandemic, providing a unique opportunity to study how major asthma triggers correlate with asthma activity.
Objective:
To determine whether changes in respiratory viruses, air pollutants, and/or aeroallergens during the coronavirus disease 2019 pandemic were concomitant with decreased asthma exacerbations.
Methods:
Health care utilization and respiratory viral testing data between January 1, 2015, and December 31, 2020, were extracted from the Children's Hospital of Philadelphia Care Network's electronic health record. Air pollution and allergen data were extracted from US Environmental Protection Agency public databases and a National Allergy Bureau-certified station, respectively. Pandemic data (2020) were compared with historical data.
Results:
Recovery of in-person asthma encounters during phased reopening (June 6 to November 15, 2020) was uneven: primary care well and specialty encounters reached 94% and 74% of prepandemic levels, respectively, whereas primary care sick and hospital encounters reached 21% and 40% of prepandemic levels, respectively. During the pandemic, influenza A and influenza B decreased to negligible frequency when compared with prepandemic cases, whereas respiratory syncytial virus and rhinovirus infections decreased to low (though nonnegligible) prepandemic levels, as well. No changes in air pollution or aeroallergen levels relative to historical observations were noted.
Conclusions:
Our results suggest that viral respiratory infections are a primary driver of pediatric asthma exacerbations. These findings have broad relevance to both clinical practice and the development of health policies aimed at reducing asthma morbidity.
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