Impact of COVID-19 on pediatric asthma: practice adjustments and disease burden.

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Abstract

Background

It is unclear whether asthma may affect susceptibility or severity of the Coronavirus Disease 2019 (COVID-19) in children and how pediatric asthma services worldwide have responded to the pandemic.

Objective

To describe the impact of the COVID-19 pandemic on pediatric asthma services and on disease burden in their patients.

Methods

An online survey was sent to members of the Pediatric Asthma in Real Life (PeARL) think-tank and the World Allergy Organization Pediatric Asthma Committee. It included questions on service provision, disease burden and on the clinical course of confirmed cases of COVID-19 infection among children with asthma.

Results

Ninety-one respondents, caring for an estimated population of >133,000 children with asthma, completed the survey. COVID-19 significantly impacted pediatric asthma services: 39% ceased physical appointments, 47% stopped accepting new patients, 75% limited patients visits. Consultations were almost halved to a median of 20 (IQR: 10-25) patients per week. Virtual clinics and helplines were launched in most centers. Better than expected disease control was reported in 20% (10-40%) of patients, while control was negatively affected in only 10% (7.5-12.5%). Adherence also appeared to increase. Only 15 confirmed cases of COVID-19 were reported among the population; the estimated incidence is not apparently different from the reports of general pediatric cohorts.

Conclusion

Children with asthma do not appear to be disproportionately affected by COVID-19. Outcomes may even have improved, possibly through increased adherence and/or reduced exposures. Clinical services have rapidly responded to the pandemic by limiting and replacing physical appointments with virtual encounters.

Highlights box

What is already known about this topic?
COVID-19 has a mild disease course in children and adolescents. Chronic respiratory conditions, including asthma, have been suggested as risk factors, however, asthma in children is highly variable in both triggers and severity.
What does this article add to our knowledge?
During the pandemic, pediatric asthma services limited consultations and established virtual clinics. However, respondents perceived their patients’ asthma control to be retained or even improved, while treatment adherence was considered increased. Children with asthma were not disproportionately affected by COVID-19.
How does this study impact current management guidelines?
Trigger avoidance and treatment adherence can rapidly improve asthma control in children, even under lockdown pressure. Children/adolescents with asthma do not appear to need additional prophylactic measures from COVID-19 when asthmais well-treated.

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Author and article information

Contributors

Nikolaos G. Papadopoulos

Journal

Journal ID (nlm-ta): J Allergy Clin Immunol Pract

Journal ID (iso-abbrev): J Allergy Clin Immunol Pract

Title: The Journal of Allergy and Clinical Immunology. in Practice

Publisher: Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology

ISSN (Print): 2213-2198

ISSN (Electronic): 2213-2201

Publication date PMC-release: 17 June 2020

Publication date (Electronic): 17 June 2020

Affiliations

[1 ]Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK

[2 ]Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece

[3 ]Department of Paediatrics, Imperial College London, London, UK

[4 ]Pediatric Pulmonology and Allergy Department, Hôpital Jeanne de Flandre, CHU Lille, France

[5 ]North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK

[6 ]Children's Hospital Boston, Pediatric Allergy and Immunology, Boston, Massachusetts, USA

[7 ]Department of Pediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong

[8 ]Allergy & Clinical Immunology, Transylvania University, Brasov, Romania

[9 ]Division of Allergy, Immunology and Pulmonary Medicine Washington

[10 ]Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Rome, Italy

[11 ]National Heart and Lung Institute (NHLI), Imperial College London, UK

[12 ]Division of Pediatrics, School of Medicine, Pontificia Universidad Catolica de Chile

[13 ]Pulmonology Department, Children’s Hospital Zhejiang University School of Medicine

[14 ]Department of Allergy and Immunology, Penn State University, State College, PA, USA

[15 ]Department of Pediatrics, University of Montreal, Department of Social and Preventive Medicine, University of Montreal

[16 ]Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt

[17 ]Department of Department of Pediatric Respiratory Diseases and Allergy, The Medical University of Warsaw, Poland

[18 ]Allergy Department, Bambino Gesù Children’s Hospital, Roma – Italy

[19 ]Pediatric Respiratory and Allergy Units, “Virgen de la Arrixaca” Children's University Clinical Hospital, University of Murcia

[20 ]Institute for Biomedical Research of Murcia, IMIB-Arrixaca; & Network of Asthma and Adverse and Allergic Reactions (ARADyAL)

[21 ]Department of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, USA

[22 ]Department of Internal Medicine, Rush Medical College

[23 ]Head, Research & Education, Ayre Foundation. Salta, Argentina

[24 ]Consultant, Allergy & Asthma Dept, Alas Medical Institute. Salta

[25 ]Children’s Center Bethel, EvKB, University Bielefeld, Germany

[26 ]Paediatric Allergy, Centre for Allergy Research, Karolinska Institutet, Sweden

[27 ]Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt

[28 ]Department of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Finland

[29 ]Pediatric Allergy and Asthma Unit, Hacettepe University School of Medicine, Ankara, Turkey

[30 ]Chair Family Physician Airways Group of Canada

[31 ]Astrid Lindgren Children´s Hospital, Karolinska University Hospital, Stockholm, Sweden

[32 ]Department of Women´s and Children´s Health, Karolinska Institutet, Stockholm, Sweden

[33 ]Department of Internal Medicine, Asthma and Allergy, Medical University of Lodz, Poland

[34 ]Charité Universitätsmedizin Berlin, Pediatric Pulmonology, Immunology and Intensive Care Medicine, Germany

[35 ]School of Paediatrics & Child Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia

[36 ]Departments of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis

[37 ]Department of Allergy, Helsinki University Central Hospital, Finland

[38 ]Allergy Center, CUF Descobertas Hospital, Lisbon, Portugal

[39 ]Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, UK

[40 ]VN Allergy & Asthma Research Centre, Chennai, Tamilnadu, India

[41 ]Head of the pediatric department in Pirogov Russian National Research Medical University of the Ministry of Health of the Russian

[42 ]Pediatric Pulmonology & Allergy Unit Children’s Hospital la Fe, Spain

[43 ]Allergy and Respiratory Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK

[44 ]Pediatric Pulmonology Division, Hospital Moinhos de Vento

[45 ]Pediatric Pulmonology, Pediatric Department, 2nd Faculty of Medicine, Charles University, Prague, University Hospital Motol, Prague, Czech Republic

[46 ]Teaching and Research Department and Paediatric Allergy department, Hospital with Specialties Juan María de Salvatierra, La Paz, Baja California Sur México

[47 ]Allergy & immunology Department Hospital Infantil de Medico Federico Gomez, Mexico city

[48 ]Paediatric Allergy and Respiratory Medicine within Medicine at the University of Southampton

[49 ]Clinic of Children's Diseases, Institute of Clinical Medicine, Medical Faculty of Vilnius University, Vilnius, Lithuania

[50 ]Department of Pediatrics & Child Health, Director MRC Unit on Child & Adolescent Health, Red Cross War Memorial Children’s Hospital, University of Cape Town

Author notes

[# ]Corresponding Author: Professor Nikolaos G. Papadopoulos, Division of Infection, Immunity & Respiratory Medicine, The University of Manchester, Manchester UK. and Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece. Phone: +30 210 7776964 ngpallergy@ 123456gmail.com

Article

Publisher ID: S2213-2198(20)30599-7

DOI: 10.1016/j.jaip.2020.06.001

PMC ID: 7297686

PubMed ID: 32561497

SO-VID: a5ffa5fc-31dd-4d62-98f4-26e8dce110ce

License:

Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

History

Date received : 8 May 2020

Date revision received : 25 May 2020

Date accepted : 1 June 2020

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