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From lockdown to recovery: changing patterns of viral infection severity in a pediatric cohort with asthma

Cassidy Jones1, Matthew Laws2, Shahwar Yousuf3

  • 1Arkansas Children's Research Institute, Little Rock, AR, United States.

Frontiers in Allergy
|October 10, 2025
PubMed

Insights

Non-pharmaceutical interventions (NPIs) during COVID-19 significantly reduced pediatric asthma exacerbation severity. Viral infections rebounded post-pandemic, but illness severity remained lower, highlighting the lasting impact of public health measures.

Area of Science:

  • Pediatric Pulmonology
  • Infectious Diseases
  • Public Health

Background:

  • Respiratory viruses like rhinovirus and RSV commonly trigger childhood asthma flares.
  • The impact of COVID-19 non-pharmaceutical interventions (NPIs) on pediatric asthma outcomes is not fully understood.

Purpose of the Study:

  • To assess changes in the epidemiology and severity of respiratory viral infections in children with asthma before, during, and after COVID-19 NPIs.

Main Methods:

  • A cross-sectional analysis of 9,391 pediatric asthma patients (ages 4-18) with confirmed viral infections (2018-2024).
  • Viral detection via BioFire® Respiratory Panel; clinical severity assessed using modified WHO Ordinal Scale for Clinical Improvement (mWHO OSI).
  • Patients categorized by NPI period, virus type, rurality, and Childhood Opportunity Index (COI).

Main Results:

  • Rhinovirus/Enterovirus (RV/EV) was the most frequent virus. Viral incidence decreased during NPIs but increased post-NPI with altered seasonality.
  • Clinical severity (mWHO OSI scores) decreased significantly over time (pre-NPI: 2.98; NPI: 2.49; post-NPI: 2.28).
  • Hospitalizations, PICU admissions, and oxygen use were significantly reduced (p < 0.0001); disparities in severity for rural/low-COI patients narrowed post-NPI.

Conclusions:

  • NPIs led to sustained reductions in pediatric asthma exacerbation severity, despite increased viral detection post-pandemic.
  • Findings underscore the long-term public health impact of NPIs on pediatric asthma.
  • Ongoing surveillance of respiratory viruses and health disparities is crucial.
Abstract

Keywords:
asthmachildrendisease severitypediatric asthmaviral infections

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