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Trends in asthma exacerbations in children before, during, and after the COVID-19 pandemic

Liesa Stadhouders1, Eline Hoogteijling1, Liesbeth Duijts2,3

  • 1Department of Pediatrics, Albert Schweitzer hospital, Dordrecht, The Netherlands.

Epidemiology and Infection
|December 5, 2025
PubMed

Insights

During COVID-19 lockdowns, children experienced fewer asthma exacerbations presenting to emergency departments. However, those who did required more hospital and intensive care admissions, indicating more severe asthma attacks.

Area of Science:

  • Pediatrics
  • Respiratory Medicine
  • Epidemiology

Background:

  • Asthma exacerbations are frequently triggered by respiratory infections.
  • Children, while less affected by COVID-19, experienced significant impacts from pandemic-related lockdowns.
  • Previous research indicated reduced asthma exacerbations during lockdowns, but data from secondary care settings are limited.

Purpose of the Study:

  • To analyze trends in the frequency and characteristics of childhood asthma exacerbations.
  • To compare emergency department visits, hospital admissions, and pediatric intensive care unit (PICU) admissions before, during, and after the COVID-19 pandemic.
  • To investigate potential changes in asthma exacerbation severity in children within a secondary care setting.

Main Methods:

  • Retrospective analysis of emergency department (ED) visits for asthma exacerbations in children.
  • Data collected from January 2018 to November 2022.
  • Comparison of ED visit incidence, hospital admissions, PICU admissions, medication use, and demographics.

Main Results:

  • A total of 1121 exacerbations were recorded in 670 children.
  • 42% of children were hospitalized, and 3.9% required PICU admission.
  • A decrease in ED visits for asthma exacerbations was observed during the pandemic, alongside an increased risk of hospital and PICU admissions.

Conclusions:

  • The COVID-19 pandemic was associated with a decrease in emergency department visits for childhood asthma exacerbations.
  • There was a concurrent increase in the severity of asthma exacerbations requiring hospitalization and PICU admission.
  • Potential contributing factors include healthcare access barriers and reduced viral exposure during the pandemic.

Keywords:
COVID-19PICUallergyasthmabronchial hyperreactivitypaediatric asthmasalbutamolviral wheezingwheezing

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