Observational Study: Lung Function and Symptom Control in Youth With Asthma up to 34 Months After COVID-19

Prior studies of pediatric asthma control and lung function after COVID-19 have been limited by short follow-up intervals. We aimed to evaluate symptom control and lung function in children with asthma up to 34 months post-COVID-19.

We conducted a prospective observational chart review study. We reviewed electronic health records of children with asthma in the Western Pennsylvania COVID-19 Registry, abstracting pre- and all post-infection spirometry results and Childhood Asthma Control Test (C-ACT) or Asthma Control Test (ACT) scores (to measure symptom control) through August 2023. We conducted adjusted mixed models with linear spline to compare C-ACT/ACT or FEV₁ before and after COVID-19. For individuals with worse outcomes at initial follow-up, we evaluated characteristics associated with lack of eventual recovery.

We found no significant differences between baseline and post-infection symptom control (n = 267) or lung function (n = 196). Of the 28% of children who had worse lung function at initial follow-up, 34% fully recovered at final follow-up. Of the 19% with worse C-ACT/ACT score at initial follow-up, 38% fully recovered at final follow-up. Final follow-up median C-ACT/ACT scores and mean FEV₁ were in the normal range even for the group without eventual recovery. Obesity (p = 0.04) was associated with hindered symptom control recovery.

There were no significant differences between baseline and follow-up symptom control or lung function in children with asthma up to 34 months post-COVID-19. Only a small proportion of children worsened and did not recover, and decrements were generally small. Obesity was associated with impaired symptom control recovery.