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Lara ST, Rein LE, Simanek AM, Totoraitis MF, Rausch DJ, Weston BW, Ahn KW, Meurer JR, Beyer KMM. Asthma as a Risk Factor for Hospitalization in Children and Youth With COVID-19: A Retrospective Cohort Study. Pediatr Infect Dis J 2024; 43:437-443. [PMID: 38241639 DOI: 10.1097/inf.0000000000004248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
BACKGROUND Studies examining the association between asthma and hospitalization among children and youth with coronavirus disease 2019 (COVID-19) have yielded mixed results. Both asthma and COVID-19 hospitalization are characterized by racial, ethnic and socioeconomic disparities which also pattern geographically, yet no studies to date have adjusted for neighborhood context in the assessment of this association. METHODS Mixed effects logistic regression was used to estimate the association between asthma and hospitalization due to COVID-19 in a sample of 28,997 children and youth diagnosed with COVID-19 in Milwaukee County, Wisconsin, from March 1, 2020, to May 31, 2022. Models adjusted for individual-level sociodemographic factors (age, gender, race, ethnicity and city/suburb residence) and season of diagnosis were examined as moderators. Random intercepts by census tract accounted for geographic variation in neighborhood factors and census tract-level measures of education, health and environment, and social and economic factors were assessed via childhood opportunity indices. RESULTS Asthma history was statistically significantly associated with hospitalization due to COVID-19 among children and youth. Hospitalization rates varied statistically significantly by census tract, and results were unchanged after accounting for childhood opportunity indices and census tract. Season of diagnosis was not found to moderate the effect of asthma history on COVID-19 hospitalization. CONCLUSION Our study suggests that asthma history is a risk factor for hospitalization in the context of COVID-19 infection among children and youth, warranting observation and follow-up of children with asthma as well as continued measures to prevent COVID-19 in this population.
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Affiliation(s)
- Shana T Lara
- From the Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI
- Milwaukee County COVID-19 Epidemiology Intel Team, Milwaukee, WI
| | - Lisa E Rein
- From the Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI
- Milwaukee County COVID-19 Epidemiology Intel Team, Milwaukee, WI
| | - Amanda M Simanek
- Milwaukee County COVID-19 Epidemiology Intel Team, Milwaukee, WI
- Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI
- Michael Reese Foundation Center for Health Equity Research, Rosalind Franklin University, Chicago, IL
| | - Michael F Totoraitis
- Milwaukee County COVID-19 Epidemiology Intel Team, Milwaukee, WI
- City of Milwaukee Health Department, Milwaukee, WI
| | - Darren J Rausch
- Milwaukee County COVID-19 Epidemiology Intel Team, Milwaukee, WI
- Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI
- Greenfield Health Department, Milwaukee, WI
| | - Benjamin W Weston
- From the Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Kwang Woo Ahn
- From the Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI
- Milwaukee County COVID-19 Epidemiology Intel Team, Milwaukee, WI
| | - John R Meurer
- From the Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI
| | - Kirsten M M Beyer
- From the Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI
- Milwaukee County COVID-19 Epidemiology Intel Team, Milwaukee, WI
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Zhang T, Xu L, Zhang Y, Zhen L. The diagnostic value of bronchial provocation testing combined with fractional exhaled nitric oxide (FeNO) in children with chest tightness-variant asthma (CTVA). Respir Med 2024; 223:107543. [PMID: 38286340 DOI: 10.1016/j.rmed.2024.107543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/12/2024] [Accepted: 01/27/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND Chest tightness-variant asthma (CTVA) is a novel atypical asthma characterized by chest tightness as the sole or primary symptom. OBJECTIVES To investigate the value of bronchial provocation testing combined with fractional exhaled nitric oxide (FeNO) in the diagnosis of CTVA in children. METHODS This study included 95 children aged 6-14 years with chest tightness as the sole symptom, with a duration of symptoms exceeding 4 weeks. All subjects underwent FeNO measurement, pulmonary function testing, and bronchial provocation testing using the Astograph method. Subjects with positive bronchial provocation testing were classified as the CTVA group, while those with negative results served as the non-CTVA control group. RESULTS The lung function of children in both groups was normal. The FeNO level in the CTVA group was (22.35 ± 9.91) ppb, significantly higher than the control group (14.85 ± 5.63) ppb, with a statistically significant difference (P < 0.05). The value of FeNO in diagnosing CTVA was analyzed using an ROC curve, with an area under the curve of 0.073 (P < 0.05). The optimal cutoff point for diagnosing CTVA using FeNO was determined to be 18.5 ppb, with a sensitivity of 60.3 % and specificity of 77.8 %. There was a negative correlation between FeNO and Dmin as well as PD15 (P = 0.006). CONCLUSION FeNO can serve as an adjunctive diagnostic tool for CTVA, with the optimal cutoff point for diagnosing CTVA being 18.5 ppb. However, FeNO is not a specific diagnostic marker for CTVA and should be used in conjunction with bronchial provocation testing to enhance its diagnostic value.
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Affiliation(s)
- Tengteng Zhang
- Department of Respiration, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Lijuan Xu
- Department of Endocrinology, Genetics and Metabolism, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Yingqian Zhang
- Department of Respiration, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Lina Zhen
- Department of Respiration, Children's Hospital of Hebei Province, Shijiazhuang, China.
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Indolfi C, Klain A, Dinardo G, D’Addio E, Ferrara S, Decimo F, Ciprandi G, Tosca MA, Miraglia del Giudice M. COVID-19 Pediatric Follow-Up: Respiratory Long COVID-Associated Comorbidities and Lung Ultrasound Alterations in a Cohort of Italian Children. CHILDREN (BASEL, SWITZERLAND) 2024; 11:166. [PMID: 38397278 PMCID: PMC10887372 DOI: 10.3390/children11020166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/21/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024]
Abstract
In children, the factors that influence COVID-19 disease and its medium- and long-term effects are little known. Our investigation sought to evaluate the presence of comorbidity factors associated with respiratory long COVID manifestations in children and to study ultrasound abnormalities following SARS-CoV-2 infection. Children, who arrived at the 'Respiratory Diseases of Pediatric Interest Unit' at the Department of Woman, Child, and General and Specialized Surgery of the University of Campania 'Luigi Vanvitelli', were selected during the timeframe from September 2021 to October 2022. The children were diagnosed with a SARS-CoV-2 infection that occurred at least one month before the visit. All patients followed a COVID-19 follow-up protocol, developed by the Italian Society of Pediatric Respiratory Diseases (SIMRI), which included: collection of data regarding SARS-CoV-2 illness and history of known respiratory and allergic diseases; physical examination; BMI assessment; baseline spirometry and after bronchodilation test; six-minute walking test; and lung ultrasound (LUS). In a cohort of 104 participants with respiratory long COVID symptoms (64.7% male, average age 8.92 years), 46.1% had fever with other symptoms, and 1% required hospitalization. BMI analysis showed 58.4% of the cohort was overweight. The LUS was positive in 27.0% of cases. A significant BMI association was observed with COVID-19 symptoms and LUS score (p-value < 0.05). No associations were found with asthma or atopy.
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Affiliation(s)
- Cristiana Indolfi
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (C.I.); (G.D.); (E.D.); (S.F.); (F.D.); (M.M.d.G.)
| | - Angela Klain
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (C.I.); (G.D.); (E.D.); (S.F.); (F.D.); (M.M.d.G.)
| | - Giulio Dinardo
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (C.I.); (G.D.); (E.D.); (S.F.); (F.D.); (M.M.d.G.)
| | - Elisabetta D’Addio
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (C.I.); (G.D.); (E.D.); (S.F.); (F.D.); (M.M.d.G.)
| | - Serena Ferrara
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (C.I.); (G.D.); (E.D.); (S.F.); (F.D.); (M.M.d.G.)
| | - Fabio Decimo
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (C.I.); (G.D.); (E.D.); (S.F.); (F.D.); (M.M.d.G.)
| | - Giorgio Ciprandi
- Department of Medicine, Allergy Clinic, Casa di Cura Villa Montallegro, 16145 Genoa, Italy;
| | - Maria Angela Tosca
- Pediatric Allergy Center, Istituto Giannina Gaslini, 16147 Genoa, Italy;
| | - Michele Miraglia del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (C.I.); (G.D.); (E.D.); (S.F.); (F.D.); (M.M.d.G.)
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Wypych-Ślusarska A, Krupa-Kotara K, Oleksiuk K, Głogowska-Ligus J, Słowiński J, Niewiadomska E. Socioeconomic and Health Determinants of the Prevalence of COVID-19 in a Population of Children with Respiratory Diseases and Symptoms. CHILDREN (BASEL, SWITZERLAND) 2024; 11:88. [PMID: 38255401 PMCID: PMC10814875 DOI: 10.3390/children11010088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Most epidemiological studies indicate that bronchial asthma is not a risk factor for COVID-19, but previous analyses have not additionally focused on the socioeconomic determinants of SARS-CoV-2 infection in children with asthma, bronchitis, and respiratory symptoms. AIMS This research aimed to investigate the correlation between the socioeconomic status of families and the prevalence of respiratory conditions such as asthma, bronchitis, and respiratory symptoms in children, in addition to exploring their association with the prevalence of COVID-19. The study involved a cross-sectional epidemiological investigation conducted in 2022, encompassing 2454 students from elementary schools in Poland. The parents of the students completed a questionnaire modeled after the International Study on Asthma and Allergies in Childhood (ISAAC). Socioeconomic status (SES) indicators were determined based on parental education, self-reported economic status, and housing conditions. To assess the impact of social factors and health on the occurrence of COVID-19, odds ratios (ORs) were calculated. The findings revealed several COVID-19 risk factors, including higher maternal (OR 2.2; 95%CI: 1.3-3.0) and paternal education (OR 1.9; 95%CI: 1.3-2.4), urban residence (OR 1.7; 95%CI: 1.3-2.1), the presence of mold in residences (OR 1.7; 95%CI: 1.0-2.3), bronchitis (OR 1.5; 95%CI: 1.2-2.0), and chronic cough (OR 1.8; 95%CI: 1.3-2.4). Further analysis, stratifying children based on their baseline health status (i.e., presence or absence of asthma, bronchitis, and chronic cough), indicated that higher parental education increased the risk of COVID-19 solely for children without pre-existing conditions. The occurrence of SARS-CoV-2 infections was found to be notably associated with mold exposure in children who did not have bronchial asthma. Rigorous multivariate analyses substantiated the collective impact of factors such as residential environment, the existence of mold and moisture, and a history of bronchitis. This study's conclusions highlight a higher frequency of SARS-CoV-2 infections in cases where bronchitis had been diagnosed previously and chronic cough was prevalent. Interestingly, the initially hypothesized higher prevalence of COVID-19 among children with bronchial asthma did not receive confirmation in our findings. This study highlights the importance of urban residence, exposure to mold or dampness, and higher parental education in the incidence of COVID-19. Higher parental education was a significant factor in increasing the risk of COVID-19 among children without bronchitis, chronic cough, and asthma.
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Affiliation(s)
- Agata Wypych-Ślusarska
- Department of Epidemiology, Faculty of Public Health in Bytom, Medical University of Silesia in Katowice, 41-902 Katowice, Poland; (A.W.-Ś.); (K.O.); (J.G.-L.); (J.S.)
| | - Karolina Krupa-Kotara
- Department of Biostatistics, Faculty of Public Health in Bytom, Medical University of Silesia in Katowice, 41-902 Katowice, Poland;
| | - Klaudia Oleksiuk
- Department of Epidemiology, Faculty of Public Health in Bytom, Medical University of Silesia in Katowice, 41-902 Katowice, Poland; (A.W.-Ś.); (K.O.); (J.G.-L.); (J.S.)
| | - Joanna Głogowska-Ligus
- Department of Epidemiology, Faculty of Public Health in Bytom, Medical University of Silesia in Katowice, 41-902 Katowice, Poland; (A.W.-Ś.); (K.O.); (J.G.-L.); (J.S.)
| | - Jerzy Słowiński
- Department of Epidemiology, Faculty of Public Health in Bytom, Medical University of Silesia in Katowice, 41-902 Katowice, Poland; (A.W.-Ś.); (K.O.); (J.G.-L.); (J.S.)
| | - Ewa Niewiadomska
- Department of Biostatistics, Faculty of Public Health in Bytom, Medical University of Silesia in Katowice, 41-902 Katowice, Poland;
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Korematsu S, Fujisawa T, Saito N, Tezuka J, Miura K, Kobayashi I, Miyata I, Kosugi Y, Gohda Y, Koike Y, Suda A, Matsuo A, Sasaki M, Handa Y, Fujiwara M, Ono A, Koizumi S, Oishi T, Tanaka T, Ando Y, Taba N, Tsurinaga Y, Sato T, Kanai R, Yashiro M, Takagi T, Hida S, Harazaki M, Hoshina T, Okada S, Yasutomi M, Nakata S, Muto A, Tanabe S, Ueda Y, Hasegawa S, Kameda M, Tanaka‐Taya K, Fujimoto T, Okada K. Suppressed pediatric asthma hospitalizations during the COVID-19 pandemic in Japan, from a national survey. Clin Transl Allergy 2024; 14:e12330. [PMID: 38282201 PMCID: PMC10795717 DOI: 10.1002/clt2.12330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/06/2023] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Acute asthma exacerbation in children is often caused by respiratory infections. In this study, a coordinated national surveillance system for acute asthma hospitalizations and causative respiratory infections was established. We herein report recent trends in pediatric acute asthma hospitalizations since the COVID-19 pandemic in Japan. METHODS Thirty-three sentinel hospitals in Japan registered all of their hospitalized pediatric asthma patients and their causal pathogens. The changes in acute asthma hospitalization in children before and after the onset of the COVID-19 pandemic and whether or not COVID-19 caused acute asthma exacerbation were investigated. RESULTS From fiscal years 2010-2019, the median number of acute asthma hospitalizations per year was 3524 (2462-4570), but in fiscal years 2020, 2021, and 2022, the numbers were 820, 1,001, and 1,026, respectively (the fiscal year in Japan is April to March). This decrease was observed in all age groups with the exception of the 3- to 6-year group. SARS-CoV-2 was evaluated in 2094 patients from fiscal years 2020-2022, but the first positive case was not detected until February 2022. Since then, only 36 of them have been identified with SARS-CoV-2, none of which required mechanical ventilation. Influenza, RS virus, and human metapneumovirus infections also decreased in FY 2020. In contrast, 24% of patients had not been receiving long-term control medications before admission despite the severity of bronchial asthma. CONCLUSION SARS-CoV-2 was hardly detected in children with acute asthma hospitalization during the COVID-19 pandemic. This result indicated that SARS-CoV-2 did not induce acute asthma exacerbation in children. Rather, infection control measures implemented against the pandemic may have consequently reduced other respiratory virus infections and thus acute asthma hospitalizations during this period. However, the fact that many hospitalized patients have not been receiving appropriate long-term control medications is a major problem that should be addressed.
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Benito-Ruiz E, Pérez-Corral M, Blázquez-Ornat I, Ramón-Arbúes E, Antón-Solanas I, Navas-Ferrer C. [Educational interventions in childhood asthma: A systematic review]. Aten Primaria 2024; 56:102721. [PMID: 37741186 PMCID: PMC10541460 DOI: 10.1016/j.aprim.2023.102721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 09/25/2023] Open
Abstract
OBJECTIVE To analyze educational interventions in pediatric asthmatic patients to achieve an adequate inhalation technique and improve their self-management. DESIGN Systematic review based on the PRISMA recommendations. DATA SOURCES Pubmed, Scopus, Cuiden, Web of Science and Google Scholar databases were reviewed. STUDY SELECTION Sixteen articles published between 2014 and 2021 were included, with access to full text, languages: English, French and Spanish and pediatric population: 0-18 years. DATA EXTRACTION Two thousand three hundred and thirteen children were participated. The variables analyzed were: level of care, type of intervention, correct performance of the inhalation technique, follow-up of the technique, delivery of written recommendations, professional-educator category, variables related to respiratory pathology, school absenteeism, quality of life and economic costs. RESULTS The health care level was primary, hospital and community care, where specialist doctors, nurses and pharmacists stood out as educators. The most prevalent educational interventions are on-site demonstration and delivery of recommendations or multimedia interventions. Several articles report that asthma education is not carried out correctly, others state that their technique improves after the intervention, but most of them highlight the importance of periodic review of the technique. CONCLUSIONS The authors report improvement in the inhalation technique in all of them, as well as greater self-management of the disease and adherence to treatment. It is necessary to intensify the education of patients in the correct handling of the devices, and the follow-up and subsequent review to optimize the control of the disease.
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Affiliation(s)
- Eva Benito-Ruiz
- Urgencias pediátricas. Hospital Universitario Materno-Infantil Miguel Servet, Zaragoza, España; Departamento Fisiatría y Enfermería. Facultad Ciencias de la Salud. Universidad de Zaragoza, Zaragoza, España.
| | - María Pérez-Corral
- Urgencias pediátricas. Hospital Universitario Materno-Infantil Miguel Servet, Zaragoza, España
| | - Isabel Blázquez-Ornat
- Departamento Fisiatría y Enfermería. Facultad Ciencias de la Salud. Universidad de Zaragoza, Zaragoza, España
| | - Enrique Ramón-Arbúes
- Facultad Ciencias de la Salud. Universidad San Jorge. Campus Universitario, Zaragoza, España
| | - Isabel Antón-Solanas
- Departamento Fisiatría y Enfermería. Facultad Ciencias de la Salud. Universidad de Zaragoza, Zaragoza, España
| | - Carlos Navas-Ferrer
- Departamento Fisiatría y Enfermería. Facultad Ciencias de la Salud. Universidad de Zaragoza, Zaragoza, España
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Özata MC, Dikici Ü, Özdemir Ö. COVID-19 frequency and clinical course in children with asthma. World J Virol 2023; 12:272-285. [PMID: 38187499 PMCID: PMC10768388 DOI: 10.5501/wjv.v12.i5.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/13/2023] [Accepted: 11/30/2023] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND The epidemic of severe acute respiratory syndrome coronavirus 2 infection, known as the coronavirus disease 2019 (COVID-19), has caused a global health concern. Since its emergence, numerous studies have focused on various clinical manifestations and outcomes in different populations. However, studies are ongoing as the consequences and impact of COVID-19 in children with chronic diseases such as asthma are controversial. AIM To fill this research gap by retrospectively evaluating the course, laboratory, and clinical findings of COVID-19 among 414 asthmatic children followed up from the pediatric allergy outpatient clinic and known to have had COVID-19. METHODS The data of 5510 patients over the age of 5 diagnosed with asthma in our hospital's data were retrospectively scanned with specific parameters using protocol numbers from the hospital filing system. The data included retrospective evaluation of pulmonary function test results before and after COVID-19, routine hematological and biochemical parameters, sensitization states (total IgE, specific IgE, and skin prick test results), and radiological (computed tomography) findings. To inquire about the course and symptoms of COVID-19, asthma patients or their parents were then called and evaluated with a questionnaire. RESULTS As a result of retrospectively scanning the data of 5510 asthma patients over the age of 5, it was determined that 414 (7.5%) patients had COVID-19. The mean age of 414 patients was 17.18 ± 4.08 (min: 6; max: 28) years. Two hundred and three of our 414 patients are male, and 211 are female. When their vaccination status was questioned, 21.5% were vaccinated. When the symptoms of our 290 patients were questioned, it was stated that 59.0% had fever symptoms. The rate of using regular prophylactic asthma medications was 19%. The rate of using salbutamol in asthma was found to be 22%. The rate of patients using methylprednisolone was 1%. Emergency service admission was 17.2%, and hospitalization was found to be 4.8%. Leukopenia (< 4000) was found in 14.1% of patients, and 8.08% of our patients had neutropenia (< 1500). Lymphopenia (< 1500) was detected in 44.4% of patients, and lymphocytosis (> 4000) was found in 5.05% of patients. In 65% of our patients, the C-reactive protein value was elevated. A high aspartate aminotransferase and alanine aminotransferase value was detected in 3.2% and 5.4% of patients were found, respectively. 31% of patients had an elevated lactate dehydrogenase value. Typical radiological findings for COVID-19 were detected in 3/309 of patients. CONCLUSION According to our study, there is a correlation between the severity of COVID-19 and asthma symptoms and the course of the disease. However, it is worth noting that the retrospective nature of the study and the differences in sample size, age, and demographic characteristics between the two groups do not allow for an optimal comparison. Therefore, further investigation is needed to explore the relationship between COVID-19 and asthma, and it can be suggested that COVID-19 may trigger asthma attacks and asthma may impact the course of COVID-19.
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Affiliation(s)
| | - Ümmügülsüm Dikici
- Department of Pediatric Allergy and Immunology, Sakarya University, Adapazarı 54100, Sakarya, Türkiye
| | - Öner Özdemir
- Department of Pediatric Allergy and Immunology, Sakarya University, Adapazarı 54100, Sakarya, Türkiye
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Gaietto K, Bergum N, Rosser F, Snyder O, Acevedo-Torres N, DiCicco LA, Butler G, Rauenswinter S, Iagnemma J, Wolfson D, Han YY, Kazmerski TM, Forno E. Odds of COVID-19-associated asthma exacerbations in children higher during Omicron wave. Pediatr Pulmonol 2023; 58:3179-3187. [PMID: 37594160 PMCID: PMC10592137 DOI: 10.1002/ppul.26642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND We aimed to determine the association of COVID-19 variant wave with asthma exacerbations in children with asthma. METHODS We conducted a retrospective cross-sectional study of children in the Western Pennsylvania COVID-19 Registry (WPACR). We extracted data for all children in the WPACR with asthma and compared their acute clinical presentation and outcomes during the Pre-Delta (7/1/20-6/30/21), Delta (8/1/21-12/14/21), and Omicron (12/15/21-8/30/22) waves. We conducted multivariable logistic regression analyses of SARS-CoV-2-associated asthma exacerbations, adjusting for characteristics that have been associated with COVID-19 outcomes in prior studies. RESULTS Among 573 children with asthma in the WPACR during the study period, the proportion of children with COVID-19 who had an asthma exacerbation was higher during the Omicron wave than during the prior two variant waves (40.2% vs. 22.6% vs. 26.2%, p = 0.002; unadjusted OR = 2.12 [95% confidence interval (CI) = 1.39-3.22], p < 0.001). In our multivariable regression models, the odds of an asthma exacerbation were 2.8 times higher during the Omicron wave than during prior waves (adjusted OR = 2.80 [95% CI = 1.70-4.61]). Results were similar after additionally adjusting for asthma severity but were no longer significant after additionally adjusting for poor asthma control. CONCLUSION The proportion of children with asthma experiencing an asthma exacerbation during SARS-CoV-2 infection was higher during Omicron than prior variant waves, adding to the body of evidence that COVID-19-associated respiratory symptoms vary by variant. These findings provide additional support for vaccination and prevention.
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Affiliation(s)
- Kristina Gaietto
- Division of Pulmonary Medicine, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nicholas Bergum
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Franziska Rosser
- Division of Pulmonary Medicine, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Oliver Snyder
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Leigh Anne DiCicco
- Division of Hospital Medicine, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gabriella Butler
- UPMC Children’s Hospital of Pittsburgh Clinical Analytics, Pittsburgh, PA, USA
| | | | | | - David Wolfson
- UPMC Children’s Community Pediatrics, Pittsburgh, PA, USA
| | - Yueh-Ying Han
- Division of Pulmonary Medicine, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Traci M Kazmerski
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Erick Forno
- Division of Pulmonary Medicine, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
- Now at the Division of Pulmonary, Allergy, and Sleep Medicine, Riley Children’s Hospital, Department of Pediatrics, Indiana University, Indianapolis, IN
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9
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Gaietto K, Bergum N, Acevedo-Torres N, Snyder O, DiCicco LA, Butler G, Rauenswinter S, Iagnemma J, Wolfson D, Kazmerski TM, Forno E. The Impact of SARS-CoV-2 Infection on Symptom Control and Lung Function in Children with Asthma. Ann Am Thorac Soc 2023; 20:1605-1613. [PMID: 37495209 PMCID: PMC10632927 DOI: 10.1513/annalsats.202302-117oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 07/26/2023] [Indexed: 07/28/2023] Open
Abstract
Rationale: Little is known about the long-term impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on children with asthma. Objectives: To determine whether SARS-CoV-2 infection affects symptom control and lung function in children with asthma. Methods: Using data from clinical registries and the electronic health record, we conducted a prospective case-control study of children with asthma aged 6-21 years who had (cases) or did not have (control subjects) SARS-CoV-2 infection, comparing baseline and follow-up asthma symptom control and spirometry within an ∼18-month time frame and, for cases, within 18 months of acute coronavirus disease (COVID-19). Results: A total of 171 cases had baseline and follow-up asthma symptom data, and 114 cases had baseline and follow-up spirometry measurements. There were no significant differences in asthma symptom control (P = 0.50), forced expiratory volume in 1 second (P = 0.47), forced vital capacity (P = 0.43), forced expiratory volume in 1 second/forced vital capacity (P = 0.43), or forced expiratory flow, midexpiratory phase (P = 0.62), after SARS-CoV-2 infection. Compared with control subjects (113 with symptom data and 237 with spirometry data), there were no significant differences in follow-up asthma symptom control or lung function. A similar proportion of cases and control subjects had poorer asthma symptom control (17.5% vs. 9.7%; P = 0.07) or worse lung function (29.0% vs. 32.5%; P = 0.50) at follow-up. Patients whose asthma control worsened after COVID-19 had a shorter time to follow-up (3.5 [1.5-7.5] vs. 6.1 [3.1-9.8] mo; P = 0.007) and were more likely to have presented with an asthma exacerbation during COVID-19 (46% vs. 26%; P = 0.04) than those without worse control. Conclusions: We found no significant differences in asthma symptom control or lung function in youth with asthma up to 18 months after acute COVID-19, suggesting that COVID-19 does not affect long-term asthma severity or control in the pediatric population.
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Affiliation(s)
- Kristina Gaietto
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Division of Pulmonary Medicine
| | - Nicholas Bergum
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Division of Pulmonary Medicine
| | | | | | - Leigh Anne DiCicco
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Division of Hospital Medicine
| | | | - Sherry Rauenswinter
- University of Pittsburgh Medical Center Children’s Community Pediatrics, Pittsburgh, Pennsylvania
| | - Jennifer Iagnemma
- University of Pittsburgh Medical Center Children’s Community Pediatrics, Pittsburgh, Pennsylvania
| | - David Wolfson
- University of Pittsburgh Medical Center Children’s Community Pediatrics, Pittsburgh, Pennsylvania
| | - Traci M. Kazmerski
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Erick Forno
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Division of Pulmonary Medicine
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10
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Kannoth S, Chung SE, Tamakloe KD, Albrecht SS, Azan A, Chambers EC, Sheffield PE, Thompson A, Woo Baidal JA, Lovinsky-Desir S, Stingone JA. Neighborhood environmental vulnerability and pediatric asthma morbidity in US metropolitan areas. J Allergy Clin Immunol 2023; 152:378-385.e2. [PMID: 36990323 PMCID: PMC10524145 DOI: 10.1016/j.jaci.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/13/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Research suggests demographic, economic, residential, and health-related factors influence vulnerability to environmental exposures. Greater environmental vulnerability may exacerbate environmentally related health outcomes. We developed a neighborhood environmental vulnerability index (NEVI) to operationalize environmental vulnerability on a neighborhood level. OBJECTIVE We explored the relationship between NEVI and pediatric asthma emergency department (ED) visits (2014-19) in 3 US metropolitan areas: Los Angeles County, Calif; Fulton County, Ga; and New York City, NY. METHODS We performed separate linear regression analyses examining the association between overall NEVI score and domain-specific NEVI scores (demographic, economic, residential, health status) with pediatric asthma ED visits (per 10,000) across each area. RESULTS Linear regression analyses suggest that higher overall and domain-specific NEVI scores were associated with higher annual pediatric asthma ED visits. Adjusted R2 values suggest that overall NEVI scores explained at least 40% of the variance in pediatric asthma ED visits. Overall NEVI scores explained more of the variance in pediatric asthma ED visits in Fulton County. NEVI scores for the demographic, economic, and health status domains explained more of the variance in pediatric asthma ED visits in each area compared to the NEVI score for the residential domain. CONCLUSION Greater neighborhood environmental vulnerability was associated with greater pediatric asthma ED visits in each area. The relationship differed in effect size and variance explained across the areas. Future studies can use NEVI to identify populations in need of greater resources to mitigate the severity of environmentally related outcomes, such as pediatric asthma.
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Affiliation(s)
- Sneha Kannoth
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY.
| | - Sarah E Chung
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY
| | - Kelvin D Tamakloe
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY
| | - Sandra S Albrecht
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY
| | - Alexander Azan
- Department of Population Health, New York University Langone Health, New York City, NY
| | - Earle C Chambers
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Perry E Sheffield
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Azure Thompson
- Department of Community Health Sciences, School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Jennifer A Woo Baidal
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY
| | - Stephanie Lovinsky-Desir
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY
| | - Jeanette A Stingone
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY
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11
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Grandinetti R, Palazzolo E, Rizzo L, Carbone R, Pisi G, Fainardi V, Esposito S. Impact of SARS-CoV-2 Infection in Children with Asthma and Impact of COVID-19 Vaccination: Current Evidence and Review of the Literature. Microorganisms 2023; 11:1745. [PMID: 37512917 PMCID: PMC10383403 DOI: 10.3390/microorganisms11071745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/30/2023] Open
Abstract
The clinical aspects of SARS-CoV-2 infection, as well as the COVID-19 vaccines' safety, efficacy and effectiveness in pediatric patients with asthma, are crucial to adapting clinical management in this fragile population and for prevention strategies. The aim of this narrative review was to evaluate the impact of SARS-CoV-2 infection in children with asthma and the impact of COVID-19 vaccination. Systematic research using the principal medical databases was conducted using specific search query strings from the early spreading of COVID-19 globally until March 2023; further relevant data were drawn from the main national and supranational institutions. No significant differences in SARS-CoV-2 incidence and morbidity were found in asthmatic pediatric patients compared to non-asthmatic ones; however, subjects with uncontrolled asthma were found to be at increased risk of developing a serious disease during SARS-CoV-2 infection. Regarding COVID-19 vaccines, accumulating data support their safety, efficacy and effectiveness on asthmatic children regardless of asthma severity. Further cohort-based studies are needed as the evidence of new epidemic waves caused by new viral variants makes the current knowledge outdated.
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Affiliation(s)
| | | | | | | | | | | | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy (E.P.); (G.P.); (V.F.)
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12
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Majellano EC, Bell RL, Flynn AW, Mckenzie A, Sivamalai S, Goldman M, Vaughan L, Gibson PG. Identifying the asthma research priorities of people with asthma, their carers and other stakeholders. Respirology 2023; 28:636-648. [PMID: 36921924 DOI: 10.1111/resp.14492] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 03/01/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND AND OBJECTIVE People living with asthma, their carers, clinicians and policymakers are the end-users of research and need research that address their individual healthcare needs. We aimed to understand the research priorities of end-users of asthma research. METHODS A national cross-sectional mixed-methods study was conducted. The study included an online survey that engaged patients, carers, healthcare professionals and policymakers to provide statements to free-text questions about what they would like to see answered by research to improve living with asthma on a day-to-day basis. Responses where thematically analysed followed by three online priority setting consensus workshops. RESULTS There were 593 respondents who provided 1446 text comments. Participants prioritized 10 asthma research themes which were: (1) asthma in children, (2) COVID 19 and asthma, (3) asthma care and self-management, (4) diagnosis and medication, (5) managing asthma attacks, (6) causes, prevention and features of asthma, (7) mental health, (8) asthma and ageing, (9) severe asthma, (10) asthma and other health conditions. Each theme comprises specific research questions. CONCLUSION This project successfully established 10 priority research themes for asthma, reflecting the collective voice of the end-users of this research. These novel data can be used to address the documented mismatch in research prioritization between the research community and the end-users of research.
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Affiliation(s)
- Eleanor C Majellano
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma and Centre for Research Excellence in Treatable Traits, The University of Newcastle, Newcastle, New South Wales, Australia
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute Asthma and Breathing Research Program, Newcastle, New South Wales, Australia
| | - Rose L Bell
- Research, Information and Evaluation, Asthma Australia, Melbourne, Victoria, Australia
| | - Anthony W Flynn
- Research, Information and Evaluation, Asthma Australia, Melbourne, Victoria, Australia
| | - Anne Mckenzie
- Telethon Kids Institute, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Sundram Sivamalai
- Ethnic Communities' Council of Victoria, Ballarat, Victoria, Australia
| | | | - Lauren Vaughan
- Australia Marketing and Communication, Asthma Australia, Fortitude Valley, Queensland, Australia
| | - Peter G Gibson
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma and Centre for Research Excellence in Treatable Traits, The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute Asthma and Breathing Research Program, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
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13
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Oliveira MCL, Colosimo EA, Vasconcelos MA, Martelli-Júnior H, Mak RH, Silva LR, Pinhati CC, Simões E Silva AC, Oliveira EA. The association between pre-existing asthma and reduced risk of death among children and adolescents hospitalized with COVID-19 in Brazil. Pediatr Pulmonol 2023; 58:727-737. [PMID: 36382503 DOI: 10.1002/ppul.26245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/28/2022] [Accepted: 11/13/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE There have been conflicting reports on the relationship between asthma and COVID-19 severity. This study aimed to compare the risk of death among children with asthma and healthy peers hospitalized due to COVID-19. METHODS We carried out an analysis of all pediatric patients 2-19 years of age with asthma and COVID-19 registered in Influenza Epidemiological Surveillance Information System-Gripe, a Brazilian nationwide surveillance database, between February 2020 and March 2022. The primary outcome was time to death, which was evaluated considering discharge as a competitive risk using the cumulative incidence function. RESULTS Among 30,405 hospitalized children with COVID-19, 21,340 (70.2%) had no comorbidities, 6444 (21.2%) had comorbidities other than asthma, 2165 (7.1%) had asthma, and 465 (1.5%) had asthma with other comorbidities. The estimated probability of a fatal outcome for each group was 4.1%, 14.9%, 2.1%, and 10.7%, respectively. After adjustment, children with asthma had a 60% reduction in the hazard of death than healthy peers (hazard ratio [HR] = 0.39, 95% confidence interval [CI], 0.29-0.53, p < 0.0001). Among children with asthma and no other comorbidities, two covariates were independently associated with in-hospital mortality, age ≥12 years, HR = 4.0, 95% CI, 2.5-6.4), and low oxygen saturation at admission (HR = 2.3, 95% CI, 1.4-3.2). CONCLUSION Children with asthma and no comorbidities had a lower risk of death compared with healthy peers after controlling for clinical and demographic confounding factors.
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Affiliation(s)
- Maria C L Oliveira
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Enrico A Colosimo
- Department of Statistics, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Mariana A Vasconcelos
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Hercílio Martelli-Júnior
- Health Science/Primary Care Postgraduate Program, State University of Montes Claros (Unimontes), Montes Claros, Minas Gerais, Brazil
| | - Robert H Mak
- Department of Pediatrics, Rady Children's Hospital, University of California, San Diego, La Jolla, California, USA
| | - Ludmila R Silva
- Health Science/Postgraduate Program in Nursing, School of Nursing, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Clara C Pinhati
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Ana C Simões E Silva
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Eduardo A Oliveira
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
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14
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Kwok WC, Tam TCC, Lam DCL, Leung JKC, Chan KPF, Chan SKS, Chiang KY, Ip MSM, Ho JCM. Worsening of asthma control after recovery from mild to moderate COVID-19 in patients from Hong Kong. Respir Res 2023; 24:53. [PMID: 36788605 PMCID: PMC9927038 DOI: 10.1186/s12931-023-02363-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND While there are postulations that asthma is potentially associated with severe coronavirus disease 2019 (COVID-19), there has been conflicting results from studies on the impact mild-to-moderate COVID-19 on asthma control after recovery. METHODS A case control study on the association between mild-to-moderate COVID-19 and asthma control post infection was conducted. The primary outcome was a reduction in Asthma Control Test (ACT) score by ≥ 3 points post-COVID infection. The secondary outcomes included the change in ACT score, the proportion of patient with ACT score who dropped to ≤ 15 on enrolment visit and the need for escalation of asthma maintenance therapy. RESULTS Out of the total of 221 adult patients with asthma recruited, 111 had mild-to-moderate COVID-19 within 30 to 270 days prior to study enrolment. The adjusted odds ratio (aOR) for a reduction in ACT score by ≥ 3 points after COVID-19 was 3.105 (95% CI = 1.385-6.959, p = 0.006). The odds of escalation of asthma maintenance therapy by at least 1 Global Initiative for Asthma (GINA) step was 4.733 (95% CI = 1.151-19.467, p = 0.031) and asthma patient are more likely to become uncontrolled after COVID-19 [aOR = 5.509 (95% CI = 1.061-28.600, p = 0.042)]. CONCLUSION Mild-to-moderate COVID-19 among asthma patients, upon recovery, was associated with worsening of asthma symptom, lower ACT score, a higher need for escalation of asthma maintenance therapy and more uncontrolled asthma.
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Affiliation(s)
- Wang Chun Kwok
- grid.194645.b0000000121742757Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 4/F, Professorial Block, 102 Pokfulam Road, Pokfulam, Hong Kong, Special Administrative Region China
| | - Terence Chi Chun Tam
- grid.194645.b0000000121742757Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 4/F, Professorial Block, 102 Pokfulam Road, Pokfulam, Hong Kong, Special Administrative Region China
| | - David Chi Leung Lam
- grid.194645.b0000000121742757Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 4/F, Professorial Block, 102 Pokfulam Road, Pokfulam, Hong Kong, Special Administrative Region China
| | - Jackson Ka Chun Leung
- grid.194645.b0000000121742757Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 4/F, Professorial Block, 102 Pokfulam Road, Pokfulam, Hong Kong, Special Administrative Region China
| | - King Pui Florence Chan
- grid.194645.b0000000121742757Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 4/F, Professorial Block, 102 Pokfulam Road, Pokfulam, Hong Kong, Special Administrative Region China
| | - Shung Kay Samuel Chan
- grid.194645.b0000000121742757Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 4/F, Professorial Block, 102 Pokfulam Road, Pokfulam, Hong Kong, Special Administrative Region China
| | - Ka Yan Chiang
- grid.194645.b0000000121742757Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 4/F, Professorial Block, 102 Pokfulam Road, Pokfulam, Hong Kong, Special Administrative Region China
| | - Mary Sau Man Ip
- grid.194645.b0000000121742757Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 4/F, Professorial Block, 102 Pokfulam Road, Pokfulam, Hong Kong, Special Administrative Region China
| | - James Chung Man Ho
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 4/F, Professorial Block, 102 Pokfulam Road, Pokfulam, Hong Kong, Special Administrative Region, China.
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15
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Chelabi K, Osmanlliu E, Gravel J, Drouin O, Tse SM. The effect of the COVID-19 pandemic on pediatric asthma-related emergency department visits and hospital admissions in Montréal, Quebec: a retrospective cohort study. CMAJ Open 2023; 11:E152-E159. [PMID: 36787991 PMCID: PMC9933991 DOI: 10.9778/cmajo.20220072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Asthma is a chronic respiratory condition that affects 10% of Canadian children and is often exacerbated by viral respiratory infections, prompting concerns about the severity of SARS-CoV-2 disease in children with asthma. We compared sociodemographic and clinical characteristics of children presenting to the emergency department and the incidence of these visits, before and during the pandemic. METHODS We included children aged 0 to 17 years presenting with asthma to 2 tertiary pediatric emergency departments in Montréal, Quebec, between the prepandemic (Jan. 1, 2017, to Mar. 31, 2020) and pandemic (Apr. 1, 2020, to June 30, 2021) periods. We compared the number of emergency department visits and hospital admissions with an interrupted time series analysis and compared the sociodemographic characteristics based on the Canadian Index of Multiple Deprivation (CIMD) and clinical characteristics (including triage level, intensive care admissions, etc.) with Mann-Whitney and χ2 tests. RESULTS We examined 22 746 asthma-related emergency department visits. During the pandemic, a greater proportion of patients presented a triage level 1 or 2 (19.3% v. 14.7%) and were admitted to the intensive care unit (2.5% v. 1.3%). The patients' CIMD quintile distributions did not differ between the 2 periods. We found a 47% decrease (relative risk [RR] 0.53, 95% confidence interval [CI] 0.37 to 0.76) in emergency department visits and a 49% decrease (RR 0.51, 95% CI 0.34 to 0.76) in hospital admissions during the pandemic. INTERPRETATION The decrease in asthma-related emergency department visits was observed through the third wave of the pandemic, but children presented with a higher acuity and with no identified sociodemographic changes. Future studies are required to understand individual behaviours that may have led to the increased acuity at presentation observed in this study.
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Affiliation(s)
- Khadidja Chelabi
- Department of Pediatrics (Chelabi), McGill University; Department of Pediatrics (Osmanlliu), Division of Pediatric Emergency Medicine, Montreal Children's Hospital; Faculty of Medicine (Osmanlliu), McGill University; Department of Pediatric Emergency Medicine (Gravel), Centre hospitalier universitaire Sainte-Justine; Division of Respiratory Medicine (Drouin, Tse), Department of Pediatrics, Centre hospitalier universitaire Sainte-Justine; Department of Social and Preventive Medicine (Drouin), School of Public Health, Université de Montréal; Faculty of Medicine (Tse), Université de Montréal, Montréal, Que
| | - Esli Osmanlliu
- Department of Pediatrics (Chelabi), McGill University; Department of Pediatrics (Osmanlliu), Division of Pediatric Emergency Medicine, Montreal Children's Hospital; Faculty of Medicine (Osmanlliu), McGill University; Department of Pediatric Emergency Medicine (Gravel), Centre hospitalier universitaire Sainte-Justine; Division of Respiratory Medicine (Drouin, Tse), Department of Pediatrics, Centre hospitalier universitaire Sainte-Justine; Department of Social and Preventive Medicine (Drouin), School of Public Health, Université de Montréal; Faculty of Medicine (Tse), Université de Montréal, Montréal, Que
| | - Jocelyn Gravel
- Department of Pediatrics (Chelabi), McGill University; Department of Pediatrics (Osmanlliu), Division of Pediatric Emergency Medicine, Montreal Children's Hospital; Faculty of Medicine (Osmanlliu), McGill University; Department of Pediatric Emergency Medicine (Gravel), Centre hospitalier universitaire Sainte-Justine; Division of Respiratory Medicine (Drouin, Tse), Department of Pediatrics, Centre hospitalier universitaire Sainte-Justine; Department of Social and Preventive Medicine (Drouin), School of Public Health, Université de Montréal; Faculty of Medicine (Tse), Université de Montréal, Montréal, Que
| | - Olivier Drouin
- Department of Pediatrics (Chelabi), McGill University; Department of Pediatrics (Osmanlliu), Division of Pediatric Emergency Medicine, Montreal Children's Hospital; Faculty of Medicine (Osmanlliu), McGill University; Department of Pediatric Emergency Medicine (Gravel), Centre hospitalier universitaire Sainte-Justine; Division of Respiratory Medicine (Drouin, Tse), Department of Pediatrics, Centre hospitalier universitaire Sainte-Justine; Department of Social and Preventive Medicine (Drouin), School of Public Health, Université de Montréal; Faculty of Medicine (Tse), Université de Montréal, Montréal, Que
| | - Sze Man Tse
- Department of Pediatrics (Chelabi), McGill University; Department of Pediatrics (Osmanlliu), Division of Pediatric Emergency Medicine, Montreal Children's Hospital; Faculty of Medicine (Osmanlliu), McGill University; Department of Pediatric Emergency Medicine (Gravel), Centre hospitalier universitaire Sainte-Justine; Division of Respiratory Medicine (Drouin, Tse), Department of Pediatrics, Centre hospitalier universitaire Sainte-Justine; Department of Social and Preventive Medicine (Drouin), School of Public Health, Université de Montréal; Faculty of Medicine (Tse), Université de Montréal, Montréal, Que
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16
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Skevaki C, Chinthrajah RS, Fomina D, Rohde G, Cao S, He Z, Serdotetskova S, Seidemann C, Grünewaldt A, Vengadeswaran A, Xie M, Karsonova A, Karaulov A, Nadeau KC, Chung HR, Renz H. Comorbidity defines asthmatic patients' risk of COVID-19 hospitalization: A global perspective. J Allergy Clin Immunol 2023; 151:110-117. [PMID: 36336123 PMCID: PMC9632231 DOI: 10.1016/j.jaci.2022.09.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/13/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The global epidemiology of asthma among patients with coronavirus disease 2019 (COVID-19) presents striking geographic differences, defining prevalence zones of high and low co-occurrence of asthma and COVID-19. OBJECTIVE We aimed to compare asthma prevalence among hospitalized patients with COVID-19 in major global hubs across the world by applying common inclusion criteria and definitions. METHODS We built a network of 6 academic hospitals in Stanford (Stanford University)/the United States; Frankfurt (Goethe University), Giessen (Justus Liebig University), and Marburg (Philipps University)/Germany; and Moscow (Clinical Hospital 52 in collaboration with Sechenov University)/Russia. We collected clinical and laboratory data for patients hospitalized due to COVID-19. RESULTS Asthmatic individuals were overrepresented among hospitalized patients with COVID-19 in Stanford and underrepresented in Moscow and Germany as compared with their prevalence among adults in the local community. Asthma prevalence was similar among patients hospitalized in an intensive care unit and patients hospitalized in other than an intensive care unit, which implied that the risk for development of severe COVID-19 was not higher among asthmatic patients. The numbers of males and comorbidities were higher among patients with COVID-19 in the Stanford cohort, and the most frequent comorbidities among these patients with asthma were other chronic inflammatory airway disorders such as chronic obstructive pulmonary disease. CONCLUSION The observed disparity in COVID-19-associated risk among asthmatic patients across countries and continents is connected to the varying prevalence of underlying comorbidities, particularly chronic obstructive pulmonary disease.
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Affiliation(s)
- Chrysanthi Skevaki
- Institute of Laboratory Medicine and Pathobiochemistry, Philipps University Marburg, Marburg, Germany; Universities of Giessen and Marburg Lung Center (UGMLC), Philipps University Marburg, Marburg, Germany.
| | - R Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif
| | - Daria Fomina
- Department of Clinical Immunology and Allergology, Laboratory of Immunopathology, Sechenov University, Moscow, Russia; Moscow City Research and Practical Center of Allergy and Immunology, Clinical State Hospital 52, Moscow Ministry of Healthcare, Moscow, Russia
| | - Gernot Rohde
- Department of Respiratory Medicine, University Hospital Frankfurt, Frankfurt, Germany; CAPNETZ Foundation, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), the German Center for Lung Research, Hannover, Germany
| | - Shu Cao
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif
| | - Ziyuan He
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif
| | - Sofia Serdotetskova
- Moscow City Research and Practical Center of Allergy and Immunology, Clinical State Hospital 52, Moscow Ministry of Healthcare, Moscow, Russia
| | - Christian Seidemann
- Department of Data Integration Center, MIRACUM, Philipps University Marburg, Marburg, Germany
| | - Achim Grünewaldt
- Department of Respiratory Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | - Abisha Vengadeswaran
- Institute for Medical Informatics, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt, Germany
| | - Min Xie
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Antonina Karsonova
- Department of Clinical Immunology and Allergology, Laboratory of Immunopathology, Sechenov University, Moscow, Russia
| | - Alexander Karaulov
- Department of Clinical Immunology and Allergology, Laboratory of Immunopathology, Sechenov University, Moscow, Russia
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif
| | - Ho-Ryun Chung
- Institute for Medical Bioinformatics and Biostatistics, Philipps University Marburg, Marburg, Germany
| | - Harald Renz
- Institute of Laboratory Medicine and Pathobiochemistry, Philipps University Marburg, Marburg, Germany; Universities of Giessen and Marburg Lung Center (UGMLC), Philipps University Marburg, Marburg, Germany; Department of Clinical Immunology and Allergology, Laboratory of Immunopathology, Sechenov University, Moscow, Russia
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17
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Ramadan S, Nguyen TTD, Laberge S, Marcotte J, Zisman‐Colman Z, Tse SM. Pre and post-COVID 19 infection pulmonary functions in children with chronic respiratory disease: A case series. Respirol Case Rep 2022; 11:e01077. [PMID: 36578269 PMCID: PMC9780698 DOI: 10.1002/rcr2.1077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/10/2022] [Indexed: 12/25/2022] Open
Abstract
As functional respiratory impairment following COVID-19 infection (COVID-19) is increasingly reported in adult, data regarding children especially with pre-existing chronic respiratory disease (PCRD) remain scarce. We retrospectively assessed clinical presentation, duration of symptoms related to COVID-19 from paediatric patients with PCRD and compared their pre/post COVID-19-I spirometry values. Data from 12 patients were analysed. Timing between COVID-19 diagnosis and subsequent functional evaluation ranged from 26 to 209 days (mean 77). The PCRD in these patients included asthma, cystic fibrosis, bronchiolitis obliterans and bronchomalacia. During COVID-19, all clinical presentations were mild. One patient displayed persistent post-COVID-19 symptoms for 8 weeks after infection. Two patients presented significant deterioration of post-COVID-19 spirometric values with a return to pre-COVID-19 values in subsequent measures. We concluded that children with PCRD are not at increased risk for severe COVID disease and that most of them have no or only transient pulmonary functional impairment 1 to 7 months after COVID-19.
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Affiliation(s)
- Salim Ramadan
- Division of Respiratory Medicine, Department of PediatricsSainte‐Justine University Hospital CenterMontrealQuébecCanada,Faculty of MedicineUniversity of MontrealMontrealQuébecCanada,Pediatric Pulmonology Unit, Department of Pediatrics, Gynecology and ObstetricsUniversity Hospitals of GenevaGenevaSwitzerland
| | - The Thanh Diem Nguyen
- Division of Respiratory Medicine, Department of PediatricsSainte‐Justine University Hospital CenterMontrealQuébecCanada,Faculty of MedicineUniversity of MontrealMontrealQuébecCanada
| | - Sophie Laberge
- Division of Respiratory Medicine, Department of PediatricsSainte‐Justine University Hospital CenterMontrealQuébecCanada,Faculty of MedicineUniversity of MontrealMontrealQuébecCanada
| | - Jacques‐Edouard Marcotte
- Division of Respiratory Medicine, Department of PediatricsSainte‐Justine University Hospital CenterMontrealQuébecCanada,Faculty of MedicineUniversity of MontrealMontrealQuébecCanada
| | - Zofia Zisman‐Colman
- Division of Respiratory Medicine, Department of PediatricsSainte‐Justine University Hospital CenterMontrealQuébecCanada,Faculty of MedicineUniversity of MontrealMontrealQuébecCanada
| | - Sze Man Tse
- Division of Respiratory Medicine, Department of PediatricsSainte‐Justine University Hospital CenterMontrealQuébecCanada,Faculty of MedicineUniversity of MontrealMontrealQuébecCanada
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18
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Sitthikarnkha P, Uppala R, Mairiang D, Suebsarakam P, Sirikarn P, Techasatian L. Pediatric asthma control in tertiary care setting using telemedicine during COVID-19 era. Transl Pediatr 2022; 11:1892-1898. [PMID: 36643676 PMCID: PMC9834956 DOI: 10.21037/tp-22-287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 11/10/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND During the coronavirus disease 2019 (COVID-19) pandemic, national measures have affected health care services. Children with asthma were a vulnerable population who were advised to avoid needless hospital visits. Telemedicine was utilized in this circumstance. However, data in Thailand is limited. This study aimed to evaluate asthma control in patients who were followed up by telemedicine compared with in-person visits at an outpatient clinic in Thailand's tertiary academic medical center. METHODS This was a retrospective study among pediatric patients with asthma who were followed up in the pediatric pulmonary and allergy clinic of Srinagarind Hospital from 1 January to 31 May 2021. We offered telemedicine (telephone visit) and in-person visits at the hospital by their willingness during this period. All patients were asked about asthma clinical control symptoms, medication compliance, exacerbation events, and hospital admissions by pediatric pulmonologists and allergists. Then, we decided to prescribe in controller medications. In the telemedicine groups, we used the postal service to deliver controller medicine to patients. RESULTS Among 195 asthmatic children, 83 (42.56%) were followed up by telemedicine. Children who were followed up by telemedicine had more controlled symptoms than the in-person visit group [adjusted relative risk (aRR): 1.219; 95% confidence interval (CI): 1.062-1.400; P value =0.005]. In the in-person visit group, children had more asthma exacerbation events than telemedicine (5 vs. 0, respectively, P value =0.073). CONCLUSIONS During the COVID-19 pandemic, telemedicine follow-up in asthmatic children resulted in well-controlled symptoms and few asthma exacerbation events.
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Affiliation(s)
| | - Rattapon Uppala
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Dara Mairiang
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Porntipa Suebsarakam
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Prapassara Sirikarn
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Leelawadee Techasatian
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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19
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Otunla A, Rees K, Dennison P, Hobbs R, Suklan J, Schofield E, Gunnell J, Mighiu A, Hartmann-Boyce J. Risks of infection, hospital and ICU admission, and death from COVID-19 in people with asthma: systematic review and meta-analyses. BMJ Evid Based Med 2022; 27:263-273. [PMID: 34933924 DOI: 10.1136/bmjebm-2021-111788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To determine if and to what degree asthma may predispose to worse COVID-19 outcomes in order to inform treatment and prevention decisions, including shielding and vaccine prioritisation. DESIGN Systematic review and meta-analysis. SETTING Electronic databases were searched (October 2020) for clinical studies reporting at least one of the following stratified by asthma status: risk of infection with SARS-CoV-2; hospitalisation, intensive care unit (ICU) admission or mortality with COVID-19. PARTICIPANTS Adults and children who tested positive for or were suspected to have COVID-19. MAIN OUTCOME MEASURES Main outcome measures were the following stratified by asthma status: risk of infection with SARS-CoV-2; hospitalisation, ICU admission or mortality with COVID-19. We pooled odds ratios (ORs) and presented these with 95% confidence intervals (CI). Certainty was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluations). RESULTS 30 (n=112 420) studies were included (12 judged high quality, 15 medium, 3 low). Few provided indication of asthma severity. Point estimates indicated reduced risks in people with asthma for all outcomes, but in all cases the evidence was judged to be of very low certainty and 95% CIs all included no difference and the possibility of increased risk (death: OR 0.90, 95% CI 0.72 to 1.13, I2=58%; hospitalisation: OR 0.95, 95% CI 0.71 to 1.26; ICU admission: OR 0.96, 95% CI 0.75 to 1.24). Findings on hospitalisation are also limited by substantial unexplained statistical heterogeneity. Within people with asthma, allergic asthma was associated with less COVID-19 risk and concurrent chronic obstructive pulmonary disease was associated with increased risk. In some studies, corticosteroids were associated with increased risk, but this may reflect increased risk in people with more severe asthma. CONCLUSIONS Though absence of evidence of a clear association between asthma and worse outcomes from COVID-19 should not be interpreted as evidence of absence, the data reviewed indicate that risks from COVID-19 in people with asthma, as a whole, may be less than originally anticipated.
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Affiliation(s)
| | - Karen Rees
- Freelance systematic reviewer, Warwickshire, UK
| | - Paddy Dennison
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jana Suklan
- NIHR Newcastle In Vitro Diagnostics, Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Ella Schofield
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - James Gunnell
- Medical Sciences Division, University of Oxford, Oxford, UK
| | | | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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20
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Munblit D, Greenhawt M, Brough HA, Pushkareva A, Karimova D, Demidova A, Warner JO, Kalayci O, Sediva A, Untersmayr E, Rodriguez Del Rio P, Vazquez-Ortiz M, Arasi S, Alvaro-Lozano M, Tsabouri S, Galli E, Beken B, Eigenmann PA. Allergic diseases and immunodeficiencies in children, lessons learnt from COVID-19 pandemic by 2022: A statement from the EAACI-section on pediatrics. Pediatr Allergy Immunol 2022; 33:e13851. [PMID: 36282136 PMCID: PMC9538373 DOI: 10.1111/pai.13851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/23/2022] [Accepted: 08/31/2022] [Indexed: 11/28/2022]
Abstract
By the April 12, 2022, the COVID-19 pandemic had resulted in over half a billion people being infected worldwide. There have been 6.1 million deaths directly due to the infection, but the pandemic has had many more short- and long-term pervasive effects on the physical and mental health of the population. Allergic diseases are among the most prevalent noncommunicable chronic diseases in the pediatric population, and health-care professionals and researchers were seeking answers since the beginning of pandemic. Children are at lower risk of developing severe COVID-19 or dying from infection. Allergic diseases are not associated with a higher COVID-19 severity and mortality, apart from severe/poorly controlled asthma. The pandemic disrupted routine health care, but many mitigation strategies, including but not limited to telemedicine, were successfully implemented to continue delivery of high-standard care. Although children faced a multitude of pandemic-related issues, allergic conditions were effectively treated remotely while reduction in air pollution and lack of contact with outdoor allergens resulted in improvement, particularly respiratory allergies. There is no evidence to recommend substantial changes to usual management modalities of allergic conditions in children, including allergen immunotherapy and use of biologicals. Allergic children are not at greater risk of multisystem inflammatory syndrome development, but some associations with Long COVID were reported, although the data are limited, and further research is needed. This statement of the EAACI Section on Pediatrics provides recommendations based on the lessons learnt from the pandemic, as available evidence.
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Affiliation(s)
- Daniel Munblit
- Inflammation, Repair and Development Section, Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Matthew Greenhawt
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Helen A Brough
- Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas' Hospital, London, UK.,Paediatric Allergy Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Anna Pushkareva
- European Academy of Allergy and Clinical Immunology (EAACI), Zurich, Switzerland
| | - Diana Karimova
- European Academy of Allergy and Clinical Immunology (EAACI), Zurich, Switzerland
| | - Anastasia Demidova
- European Academy of Allergy and Clinical Immunology (EAACI), Zurich, Switzerland
| | - John O Warner
- Inflammation, Repair and Development Section, Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Omer Kalayci
- Pediatric Allergy and Asthma, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Anna Sediva
- Department of Immunology, 2nd Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Eva Untersmayr
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | | | - Marta Vazquez-Ortiz
- Inflammation, Repair and Development Section, Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Stefania Arasi
- Translational Research in Pediatric Specialities Area, Division of Allergy, IRCCS, Bambino Gesù Children's Hospital, Rome, Italy
| | - Montserrat Alvaro-Lozano
- Allergology and Clinical Immunology Department, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Sophia Tsabouri
- Child Health Department, University of Ioannina School of Medicine, Ioannina, Greece
| | - Elena Galli
- Pediatric Allergology Unit, Department of Pediatric Medicine, S.Pietro Hospital Fatebenefratelli, Rome, Italy
| | - Burcin Beken
- Department of Pediatric Allergy and Immunology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Philippe A Eigenmann
- Pediatric Allergy Unit, Department of Woman, Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
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21
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Filip R, Gheorghita Puscaselu R, Anchidin-Norocel L, Dimian M, Savage WK. Global Challenges to Public Health Care Systems during the COVID-19 Pandemic: A Review of Pandemic Measures and Problems. J Pers Med 2022; 12:1295. [PMID: 36013244 PMCID: PMC9409667 DOI: 10.3390/jpm12081295] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/21/2022] [Accepted: 08/05/2022] [Indexed: 12/15/2022] Open
Abstract
Beginning in December 2019, the world faced a critical new public health stressor with the emergence of SARS-CoV-2. Its spread was extraordinarily rapid, and in a matter of weeks countries across the world were affected, notably in their ability to manage health care needs. While many sectors of public structures were impacted by the pandemic, it particularly highlighted shortcomings in medical care infrastructures around the world that underscored the need to reorganize medical systems, as they were vastly unprepared and ill-equipped to manage a pandemic and simultaneously provide general and specialized medical care. This paper presents modalities in approaches to the pandemic by various countries, and the triaged reorganization of medical sections not considered first-line in the pandemic that was in many cases transformed into wards for treating COVID-19 cases. As new viruses and structural variants emerge, it is important to find solutions to streamline medical care in hospitals, which includes the expansion of digital network medicine (i.e., telemedicine and mobile health apps) for patients to continue to receive appropriate care without risking exposure to contagions. Mobile health app development continues to evolve with specialized diagnostics capabilities via external attachments that can provide rapid information sharing between patients and care providers while eliminating the need for office visits. Telemedicine, still in the early stages of adoption, especially in the developing world, can ensure access to medical information and contact with care providers, with the potential to release emergency rooms from excessive cases, and offer multidisciplinary access for patients and care providers that can also be a means to avoid contact during a pandemic. As this pandemic illustrated, an overhaul to streamline health care is essential, and a move towards greater use of mobile health and telemedicine will greatly benefit public health to control the spread of new variants and future outbreaks.
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Affiliation(s)
- Roxana Filip
- Faculty of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
- BK Laboratory, SuceavaCounty Emergency Hospital, 720224 Suceava, Romania
| | - Roxana Gheorghita Puscaselu
- Faculty of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
- Integrated Center for Research, Development and Innovation in Advanced Materials, Nanotechnologies, and Distributed Systems for Fabrication and Control, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
| | - Liliana Anchidin-Norocel
- Faculty of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
| | - Mihai Dimian
- Integrated Center for Research, Development and Innovation in Advanced Materials, Nanotechnologies, and Distributed Systems for Fabrication and Control, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
- Department of Computers, Electronics and Automation, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
| | - Wesley K. Savage
- Faculty of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
- Integrated Center for Research, Development and Innovation in Advanced Materials, Nanotechnologies, and Distributed Systems for Fabrication and Control, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
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22
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Soyak Aytekin E, Sahiner UM, Tuten Dal S, Unsal H, Hakverdi O, Oguz B, Ozsurekci Y, Sekerel BE, Soyer O. Obesity is a risk factor for decrease in lung function after COVID-19 infection in children with asthma. Pediatr Pulmonol 2022; 57:1668-1676. [PMID: 35502514 PMCID: PMC9347415 DOI: 10.1002/ppul.25949] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 04/18/2022] [Accepted: 04/23/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION It is not clear whether asthma, the most frequent chronic disease in childhood, is a risk for severe SARS-CoV-2 infection in the pediatric population and how SARS-CoV-2 infection affects the lung functions in these patients. PURPOSE We aimed to investigate the course and the consequences of SARS-CoV-2 infection among children with asthma and determine the risk factors for the decline in lung function tests (LFTs). METHODS In this retrospective study, asthmatic children with coronavirus disease 2019 (COVID-19) were compared with a random control group of asthmatic patients without COVID-19. In addition, the clinical course and the effect on LFTs of COVID-19 among children with asthma were also evaluated. RESULTS One hundred eighty-nine patients who had COVID-19, and 792 who did not were included in the study. Fever, fatigue, and cough were the most frequent symptoms during COVID-19. Regarding the severity of COVID-19, 163 patients (87.6%) had a mild clinical condition, 13 (7%) had moderate disease, 1 (0.5%) had severe disease, and 2 had (1.1%) critically ill disease. Two patients were diagnosed with multisystem inflammatory syndrome in children (MIS-C), one patient suffered from pneumothorax. LFTs of the patients before and after COVID-19 infection were analyzed; no significant differences were found in FEV1 % (91.7% vs. 90.9%, p = 0.513), FVC% (89.8% vs. 90.8%, p = 0.502) and FEV1 /FVC (103.1% vs. 100.6%, p = 0.056), while FEF25%-75% values (107.6% vs. 98.4%, p < 0.001) were significantly lower after the COVID-19 infection. Obesity (odds ratio [OR]: 3.785, 95% confidence interval [CI]: 1.152-12.429, p = 0.028] and having a family history of atopy (OR: 3.359, 95% CI: 1.168-9.657, p = 0.025] were found to be the independent risk factors for ≥25% decrease in FEF25-75 after COVID-19 infection. CONCLUSION COVID-19 infection leads to dysfunction of the small airways in asthmatic children and obesity is an independent risk factor for a ≥25% decrease in FEF25-75. The long-term effects of COVID-19 infection especially on small airways require close monitoring in children with asthma.
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Affiliation(s)
- Elif Soyak Aytekin
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey
| | - Umit M Sahiner
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey
| | - Sevda Tuten Dal
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey
| | - Hilal Unsal
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ozan Hakverdi
- Department of Pediatrics, Hacettepe University School of Medicine, Ankara, Turkey
| | - Berna Oguz
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Yasemin Ozsurekci
- Department of Pediatric Infectious Disease, Hacettepe University School of Medicine, Ankara, Turkey
| | - Bulent E Sekerel
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ozge Soyer
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey
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23
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Abstract
PURPOSE OF REVIEW The interplay of asthma and coronavirus disease 2019 (COVID-19) in children is yet unknown. The purpose of this review is to determine the interplay of asthma and asthma therapeutics and COVID-19. RECENT FINDINGS There is no evidence to date that asthma is a risk factor for more severe COVID-19 outcomes, especially in children. There is actually some basis to suggest that children with atopic asthma may be at reduced risk of asthma exacerbations during COVID-19. The impact of asthma therapeutics on COVID-19 outcomes is unclear, but guidance is relatively uniform in recommending that those with asthma remain on current asthma medications. A focus on social determinants of health may be increasingly important during the pandemic and beyond. SUMMARY Asthma in children appears to be more friend, than foe, during COVID-19.
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Affiliation(s)
- Elissa M Abrams
- Section of Allergy and Clinical Immunology, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
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24
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Sancakli O, Tuncel T, Eren Akarcan S, Kanık A, Özyurt G, Ozdogru EE. Anxiety Levels and Changes in Health and Hygiene Behaviors in Mothers of Children with Asthma in Early COVID-19 Lockdown in Turkey. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2022; 35:27-35. [PMID: 35290751 DOI: 10.1089/ped.2021.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Objective: The restrictions imposed by the coronavirus disease 2019 (COVID-19) pandemic have caused significant changes in people's lives. This study aimed to investigate anxiety levels and changes in health and hygiene behaviors in mothers of children with asthma in early COVID-19 lockdown in Turkey. Materials and Methods: This study was a cross-sectional survey conducted on children with asthma, 6 to 11 years of age, between June 1 and 30, 2020, in Turkey. A sociodemographic data form, health and hygiene behavior form, childhood asthma control test, and state-trait anxiety inventory were administered to the mothers of the children. Results: The asthma group included 123 children (Female: 39.0%) and median age, interquartile range (IQR) [minimum-maximum]: 8.0 (6) [6-12] years; the control group included 88 children (Female: 47.7%) median age, IQR [minimum-maximum]: 8.0 (7) [5-12] years. Increased hygiene behaviors and high compliance with social isolation measures were recorded in the early lockdown, with no difference between the groups. Before the pandemic, the most frequently used cleaning products were general-purpose cleaners. During the early lockdown, however, the most frequently used product was disinfectants and was similar in both groups. In both groups, the rate of using nutritional supplements increased during the pandemic period, but the rate was higher in children with asthma both before and during the early lockdown (P < 0.001). The anxiety levels of the mothers in asthma and control groups were similar. Conclusion: This study is the first in Turkey demonstrating that, in mothers of children with asthma, lifestyle changes related to health and hygiene and anxiety levels are similar to those of other children and their mothers during the early lockdown period of COVID-19 pandemic.
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Affiliation(s)
- Ozlem Sancakli
- Department of Pediatric Allergy Immunology, Başkent University, Izmir, Turkey
| | - Tuba Tuncel
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Izmir University of Health Sciences Izmir Tepecik Training and Research Hospital, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - Sanem Eren Akarcan
- Department of Pediatric Allergy and Immunology, Izmir University of Health Sciences Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ali Kanık
- Department of Pediatrics, Izmir University of Health Sciences Izmir Tepecik Training and Research Hospital, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - Gonca Özyurt
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - Emine Ece Ozdogru
- Department of Pediatric Allergy and Immunology, Izmir University of Health Sciences Izmir Tepecik Training and Research Hospital, Izmir, Turkey
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25
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Bartha I, Bernaola M, Escudero C, Rodríguez Del Río P, Bazire R, Ibáñez Sandín MD. COVID-19 and childhood asthma: Analysis of a pediatric referral hospital. Pediatr Allergy Immunol 2022; 33:e13757. [PMID: 35338727 PMCID: PMC9115475 DOI: 10.1111/pai.13757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Irene Bartha
- Allergy Derpartment, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - Marta Bernaola
- Allergy Derpartment, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - Carmelo Escudero
- Allergy Derpartment, Hospital Infantil Universitario Niño Jesús, Madrid, España.,FibHNJ, ARADyAL-RETICs RD16/RD16/0006/0026 Instituto de Salud Carlos III, Madrid, España.,IIS La Princesa, Madrid, España
| | - Pablo Rodríguez Del Río
- Allergy Derpartment, Hospital Infantil Universitario Niño Jesús, Madrid, España.,FibHNJ, ARADyAL-RETICs RD16/RD16/0006/0026 Instituto de Salud Carlos III, Madrid, España.,IIS La Princesa, Madrid, España
| | - Raphaëlle Bazire
- Allergy Derpartment, Hospital Infantil Universitario Niño Jesús, Madrid, España.,FibHNJ, ARADyAL-RETICs RD16/RD16/0006/0026 Instituto de Salud Carlos III, Madrid, España.,IIS La Princesa, Madrid, España.,Contrato Río Hortega CM20/00253, Instituto de Salud Carlos III, Fondo Social Europeo, Madrid, Spain
| | - Maria Dolores Ibáñez Sandín
- Allergy Derpartment, Hospital Infantil Universitario Niño Jesús, Madrid, España.,FibHNJ, ARADyAL-RETICs RD16/RD16/0006/0026 Instituto de Salud Carlos III, Madrid, España.,IIS La Princesa, Madrid, España
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26
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Choi JH, Choi SH, Yun KW. Risk Factors for Severe COVID-19 in Children: A Systematic Review and Meta-Analysis. J Korean Med Sci 2022; 37:e35. [PMID: 35132841 PMCID: PMC8822112 DOI: 10.3346/jkms.2022.37.e35] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/28/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has been the most important global issue since December 2019. Although the clinical course of COVID-19 is known to be milder in children than in adults, associated hospitalizations among children have increased since the emergence of contagious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants and the achievement of a high vaccination rate in adults. Considering these global and domestic situations, we believe that risk stratification in children with COVID-19 is urgently needed for decision making regarding hospitalization priority in children infected with SARS-CoV-2 and vaccination priority against COVID-19. METHODS This systematic review and meta-analysis was performed by comprehensively searching the PubMed, EMBASE, Scopus and KoreaMed databases through August 25, 2021. The criteria for enrollment were "severe COVID-19" as poor outcomes (intensive care unit admission, invasive mechanical ventilation, and/or death) and underlying comorbidities before SARS-CoV-2 infection. RESULTS Among 872 screened studies, 17 articles were included in the systematic review, and 10 articles were included in the meta-analysis. Neonate (risk ratio [RR], 2.69; 95% confidence interval [CI], 1.83-3.97), prematurity in young infants (RR, 2.00; 95% CI, 1.63-2.46), obesity (RR, 1.43; 95% CI, 1.24-1.64), diabetes (RR, 2.26; 95% CI, 1.95-2.62), chronic lung disease (RR, 2.62; 95% CI, 1.71-4.00), heart disease (RR, 1.82; 95% CI, 1.58-2.09), neurologic disease (RR, 1.18; 95% CI, 1.05-1.33), and immunocompromised status (RR, 1.44; 95% CI, 1.01-2.04) were significant risk factors for severe COVID-19 in children. In the subgroup analysis, age younger than 3 months (RR, 0.26; 95% CI, 0.11-0.66), asthma (RR, 1.08; 95% CI, 0.98-1.20), and neurodevelopmental disorders (RR, 0.88; 95% CI, 0.75-1.04) were not risk factors for severe COVID-19. CONCLUSION Children with comorbidities such as obesity, diabetes, heart disease, chronic lung diseases other than asthma, seizure disorders, and an immunocompromised status had a high prevalence of severe COVID-19. Neonate and premature infants had a high risk of severe COVID-19. Defining the high-risk group for severe COVID-19 could help to guide hospital admission and priority for vaccination against SARS-CoV-2.
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Affiliation(s)
- Jae Hong Choi
- Department of Pediatrics, Jeju National University School of Medicine, Jeju, Korea
| | - Soo-Han Choi
- Department of Pediatrics, Pusan National University Hospital, Busan, Korea
| | - Ki Wook Yun
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
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27
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Shi T, Pan J, Katikireddi SV, McCowan C, Kerr S, Agrawal U, Shah SA, Simpson CR, Ritchie LD, Robertson C, Sheikh A. Risk of COVID-19 hospital admission among children aged 5-17 years with asthma in Scotland: a national incident cohort study. THE LANCET. RESPIRATORY MEDICINE 2022; 10:191-198. [PMID: 34861180 PMCID: PMC8631918 DOI: 10.1016/s2213-2600(21)00491-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 02/09/2023]
Abstract
BACKGROUND There is an urgent need to inform policy deliberations about whether children with asthma should be vaccinated against SARS-CoV-2 and, if so, which subset of children with asthma should be prioritised. We were asked by the UK's Joint Commission on Vaccination and Immunisation to undertake an urgent analysis to identify which children with asthma were at increased risk of serious COVID-19 outcomes. METHODS This national incident cohort study was done in all children in Scotland aged 5-17 years who were included in the linked dataset of Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II). We used data from EAVE II to investigate the risk of COVID-19 hospitalisation among children with markers of uncontrolled asthma defined by either previous asthma hospital admission or oral corticosteroid prescription in the previous 2 years. A Cox proportional hazard model was used to derive hazard ratios (HRs) and 95% CIs for the association between asthma and COVID-19 hospital admission, stratified by markers of asthma control (previous asthma hospital admission and number of previous prescriptions for oral corticosteroids within 2 years of the study start date). Analyses were adjusted for age, sex, socioeconomic status, comorbidity, and previous hospital admission. FINDINGS Between March 1, 2020, and July 27, 2021, 752 867 children were included in the EAVE II dataset, 63 463 (8·4%) of whom had clinician-diagnosed-and-recorded asthma. Of these, 4339 (6·8%) had RT-PCR confirmed SARS-CoV-2 infection. In those with confirmed infection, 67 (1·5%) were admitted to hospital with COVID-19. Among the 689 404 children without asthma, 40 231 (5·8%) had confirmed SARS-CoV-2 infections, of whom 382 (0·9%) were admitted to hospital with COVID-19. The rate of COVID-19 hospital admission was higher in children with poorly controlled asthma than in those with well controlled asthma or without asthma. When using previous hospital admission for asthma as the marker of uncontrolled asthma, the adjusted HR was 6·40 (95% CI 3·27-12·53) for those with poorly controlled asthma and 1·36 (1·02-1·80) for those with well controlled asthma, compared with those with no asthma. When using oral corticosteroid prescriptions as the marker of uncontrolled asthma, the adjusted HR was 3·38 (1·84-6·21) for those with three or more prescribed courses of corticosteroids, 3·53 (1·87-6·67) for those with two prescribed courses of corticosteroids, 1·52 (0·90-2·57) for those with one prescribed course of corticosteroids, and 1·34 (0·98-1·82) for those with no prescribed course, compared with those with no asthma. INTERPRETATION School-aged children with asthma with previous recent hospital admission or two or more courses of oral corticosteroids are at markedly increased risk of COVID-19 hospital admission and should be considered a priority for vaccinations. This would translate into 9124 children across Scotland and an estimated 109 448 children across the UK. FUNDING UK Research and Innovation (Medical Research Council), Research and Innovation Industrial Strategy Challenge Fund, Health Data Research UK, and Scottish Government.
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Affiliation(s)
- Ting Shi
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Jiafeng Pan
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | | | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Steven Kerr
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Utkarsh Agrawal
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Syed Ahmar Shah
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Colin R Simpson
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK; School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | | | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK; Public Health Scotland, Glasgow, UK
| | - Aziz Sheikh
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK; Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK.
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28
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Harwood R, Yan H, Talawila Da Camara N, Smith C, Ward J, Tudur-Smith C, Linney M, Clark M, Whittaker E, Saatci D, Davis PJ, Luyt K, Draper ES, Kenny SE, Fraser LK, Viner RM. Which children and young people are at higher risk of severe disease and death after hospitalisation with SARS-CoV-2 infection in children and young people: A systematic review and individual patient meta-analysis. EClinicalMedicine 2022; 44:101287. [PMID: 35169689 PMCID: PMC8832134 DOI: 10.1016/j.eclinm.2022.101287] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/06/2022] [Accepted: 01/17/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND We aimed to describe pre-existing factors associated with severe disease, primarily admission to critical care, and death secondary to SARS-CoV-2 infection in hospitalised children and young people (CYP), within a systematic review and individual patient meta-analysis. METHODS We searched Pubmed, European PMC, Medline and Embase for case series and cohort studies published between 1st January 2020 and 21st May 2021 which included all CYP admitted to hospital with ≥ 30 CYP with SARS-CoV-2 or ≥ 5 CYP with PIMS-TS or MIS-C. Eligible studies contained (1) details of age, sex, ethnicity or co-morbidities, and (2) an outcome which included admission to critical care, mechanical invasive ventilation, cardiovascular support, or death. Studies reporting outcomes in more restricted groupings of co-morbidities were eligible for narrative review. We used random effects meta-analyses for aggregate study-level data and multilevel mixed effect models for IPD data to examine risk factors (age, sex, comorbidities) associated with admission to critical care and death. Data shown are odds ratios and 95% confidence intervals (CI).PROSPERO: CRD42021235338. FINDINGS 83 studies were included, 57 (21,549 patients) in the meta-analysis (of which 22 provided IPD) and 26 in the narrative synthesis. Most studies had an element of bias in their design or reporting. Sex was not associated with critical care or death. Compared with CYP aged 1-4 years (reference group), infants (aged <1 year) had increased odds of admission to critical care (OR 1.63 (95% CI 1.40-1.90)) and death (OR 2.08 (1.57-2.86)). Odds of death were increased amongst CYP over 10 years (10-14 years OR 2.15 (1.54-2.98); >14 years OR 2.15 (1.61-2.88)).The number of comorbid conditions was associated with increased odds of admission to critical care and death for COVID-19 in a step-wise fashion. Compared with CYP without comorbidity, odds ratios for critical care admission were: 1.49 (1.45-1.53) for 1 comorbidity; 2.58 (2.41-2.75) for 2 comorbidities; 2.97 (2.04-4.32) for ≥3 comorbidities. Corresponding odds ratios for death were: 2.15 (1.98-2.34) for 1 comorbidity; 4.63 (4.54-4.74) for 2 comorbidities and 4.98 (3.78-6.65) for ≥3 comorbidities. Odds of admission to critical care were increased for all co-morbidities apart from asthma (0.92 (0.91-0.94)) and malignancy (0.85 (0.17-4.21)) with an increased odds of death in all co-morbidities considered apart from asthma. Neurological and cardiac comorbidities were associated with the greatest increase in odds of severe disease or death. Obesity increased the odds of severe disease and death independently of other comorbidities. IPD analysis demonstrated that, compared to children without co-morbidity, the risk difference of admission to critical care was increased in those with 1 comorbidity by 3.61% (1.87-5.36); 2 comorbidities by 9.26% (4.87-13.65); ≥3 comorbidities 10.83% (4.39-17.28), and for death: 1 comorbidity 1.50% (0.00-3.10); 2 comorbidities 4.40% (-0.10-8.80) and ≥3 co-morbidities 4.70 (0.50-8.90). INTERPRETATION Hospitalised CYP at greatest vulnerability of severe disease or death with SARS-CoV-2 infection are infants, teenagers, those with cardiac or neurological conditions, or 2 or more comorbid conditions, and those who are obese. These groups should be considered higher priority for vaccination and for protective shielding when appropriate. Whilst odds ratios were high, the absolute increase in risk for most comorbidities was small compared to children without underlying conditions. FUNDING RH is in receipt of a fellowship from Kidney Research UK (grant no. TF_010_20171124). JW is in receipt of a Medical Research Council Fellowship (Grant No. MR/R00160X/1). LF is in receipt of funding from Martin House Children's Hospice (there is no specific grant number for this). RV is in receipt of a grant from the National Institute of Health Research to support this work (grant no NIHR202322). Funders had no role in study design, data collection, analysis, decision to publish or preparation of the manuscript.
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Affiliation(s)
- Rachel Harwood
- Molecular and Integrative Biology, Centre for Pre-Clinical Imaging, Institute of Systems, University of Liverpool, Crown Street, Liverpool L69 3BX, United Kingdom
- Department of Paediatric Surgery, Alder Hey in the Park, Liverpool, United Kingdom
- Corresponding author at: Molecular and Integrative Biology, Centre for Pre-Clinical Imaging, Institute of Systems, University of Liverpool, Crown Street, University of Liverpool, Liverpool L69 3BX, United Kingdom.
| | - Helen Yan
- Medical School, UCL, London, United Kingdom
| | | | - Clare Smith
- NHS England and NHS Improvement, London, United Kingdom
- Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Joseph Ward
- UCL Great Ormond St. Institute of Child Health, London, United Kingdom
| | - Catrin Tudur-Smith
- Department of Statistics, University of Liverpool, Liverpool, United Kingdom
| | - Michael Linney
- Royal College of Paediatrics and Child Health, London, United Kingdom
- University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - Matthew Clark
- NHS England and NHS Improvement, London, United Kingdom
| | - Elizabeth Whittaker
- Department of Paediatric Infectious Diseases, St Mary's Hospital, London, United Kingdom
- Imperial College London, London, United Kingdom
| | | | - Peter J. Davis
- NHS England and NHS Improvement, London, United Kingdom
- Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Karen Luyt
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Elizabeth S. Draper
- PICANet, Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Simon E Kenny
- Molecular and Integrative Biology, Centre for Pre-Clinical Imaging, Institute of Systems, University of Liverpool, Crown Street, Liverpool L69 3BX, United Kingdom
- Department of Paediatric Surgery, Alder Hey in the Park, Liverpool, United Kingdom
- NHS England and NHS Improvement, London, United Kingdom
| | - Lorna K. Fraser
- Martin House Research Centre, Department of Health Sciences, University of York, United Kingdom
| | - Russell M. Viner
- UCL Great Ormond St. Institute of Child Health, London, United Kingdom
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29
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Abstract
Asthma is common in children and exacerbations are usually triggered by respiratory viruses. There was considerable concern about the impact of COVID-19 on children with asthma. It was expected that children with asthma would fare poorly during the pandemic. However, the reported effect of the COVID-19 pandemic on pediatric asthma including acute asthma admissions, does not appear to be significant, but this needs careful follow-up. The socioeconomic effects of the pandemic and reduced healthcare access could potentially impact on ongoing delivery of health care in chronic respiratory conditions including asthma, especially in resource-poor settings. Children with chronic asthma need to be treated as per internationally published guidelines with innovative models of disease monitoring and ongoing care during the pandemic. During the pandemic, children with acute asthma need to be managed carefully based on local guidelines and using strict infection control policies. The use of technology such as telehealth and various tools of asthma management including questionnaires and digital monitoring will play an important role in asthma management during the pandemic. Medical professionals, healthcare administrators, and governments should be sensitive to the evolving needs of the community and work closely to continue to provide services in a challenging yet unresolved pandemic.
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30
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Abrams EM, Jordan K, Szefler SJ. School Asthma Care During COVID-19: What We Have Learned and What We Are Learning. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY: IN PRACTICE 2022; 10:453-459. [PMID: 34848382 PMCID: PMC8626345 DOI: 10.1016/j.jaip.2021.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/15/2021] [Accepted: 11/19/2021] [Indexed: 02/07/2023]
Abstract
The focus of this article is to review school asthma care during coronavirus disease 2019 (COVID-19). Asthma is listed as a risk factor in some guidelines, although children with asthma appear to not be at increased risk of severe respiratory outcomes compared with children without asthma during the pandemic. Differentiating COVID-19 from allergic disease is very difficult in the school-aged children. For school management, there is firm evidence that masks do not exacerbate underlying lung conditions including asthma, and evidence to date supports that children with asthma can learn in-person at school because they do not appear to be at increased risk of COVID-19 morbidity or mortality. For children and adolescents, the COVID-19 vaccine has been demonstrated to be safe and well tolerated. School asthma management includes remaining on prescribed asthma medications. Asthma management, as with management of all pediatric conditions, must also factor in the impact of adverse social determinants and health disparities. Broadly, the pandemic has also served as a call to resource stewardship and innovation and allowed practitioners to consider how this may impact asthma care moving forward.
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Affiliation(s)
- Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Man, Canada.
| | - Kamyron Jordan
- Department of Pediatrics, Section of Pediatric Pulmonary and Sleep Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colo
| | - Stanley J Szefler
- Department of Pediatrics, Section of Pediatric Pulmonary and Sleep Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colo
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31
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Devrim İ, Böncüoğlu E, Kıymet E, Şahinkaya Ş, Çelebi MY, Cem E, Düzgöl M, Arıkan KÖ, Kara AA, Devrim F, Ağın H, Bayram N. Comparison of the pediatric hospitalizations due to COVID-19 and H1N1pdm09 virus infections during the pandemic period. J Med Virol 2022; 94:2055-2059. [PMID: 35023188 PMCID: PMC9015540 DOI: 10.1002/jmv.27589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/18/2021] [Accepted: 01/10/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND There are two major pandemics in the new millennium, including the pandemic of swine influenza, and the COVID-19 pandemic. These two pandemics affected children as well as the adult population. In this case-control study, we compared children with COVID-19 infection and those with H1N1pdm09 virus infection. METHODS In this case-control study, we compared the demographic factors, underlying disease, and the requirement for intensive care admission between the hospitalized children with COVID-19 infection and children with H1N1pdm09 virus infection who were hospitalized during the 2009 H1N1 pandemic. RESULTS In this study, we evaluated 103 patients with H1N1pdm09 virus infection and 392 patients with COVID-19 infection. The age was significantly higher in the COVID-19 patients' group compared to the pandemic influenza group (p<0.001). The ratio of the children ≥ 12 years was 10.7% (n = 11) in the H1N1pdm09 virus infection and 36.2% (n = 142) in the COVID-19 group. The rate of underlying disease was significantly higher in the patients with H1N1pdm09 virus infections (p = 0.02). The prevalence of underlying disease in patients requiring PICU hospitalization was 69.2% (n = 9/13) compared to 25.7% (n = 124/482) in patients who did not require PICU hospitalization. The rate of underlying disease was significantly higher in the PICU group regardless of COVID-19 or H1N1pdm09 virus (p = 0.002). CONCLUSION Our results suggest that older children were more hospitalized for COVID-19 infections compared to pandemic influenza. In addition, regardless of the type of pandemic infection, the underlying disease is an important factor for pediatric intensive care unit admission. This finding is important for developing strategies for the protection of children with the underlying disease in the upcoming pandemics. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- İlker Devrim
- Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Department of Pediatric Infectious Diseases, Izmir, Turkey
| | - Elif Böncüoğlu
- Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Department of Pediatric Infectious Diseases, Izmir, Turkey
| | - Elif Kıymet
- Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Department of Pediatric Infectious Diseases, Izmir, Turkey
| | - Şahika Şahinkaya
- Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Department of Pediatric Infectious Diseases, Izmir, Turkey
| | - Miray Yılmaz Çelebi
- Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Department of Pediatric Infectious Diseases, Izmir, Turkey
| | - Ela Cem
- Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Department of Pediatric Infectious Diseases, Izmir, Turkey.,Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Department of Pediatrics, Izmir, Turkey.,Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Department of Pediatric Intensive Care, Izmir, Turkey
| | - Mine Düzgöl
- Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Department of Pediatric Infectious Diseases, Izmir, Turkey
| | - Kamile Ötiken Arıkan
- Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Department of Pediatric Infectious Diseases, Izmir, Turkey
| | - Aybüke Akaslan Kara
- Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Department of Pediatric Infectious Diseases, Izmir, Turkey
| | - Fatma Devrim
- Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Department of Pediatrics, Izmir, Turkey
| | - Hasan Ağın
- Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Department of Pediatric Intensive Care, Izmir, Turkey
| | - Nuri Bayram
- Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Department of Pediatric Infectious Diseases, Izmir, Turkey
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32
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Gatti E, Piotto M, Lelii M, Pensabene M, Madini B, Cerrato L, Hassan V, Aliberti S, Bosis S, Marchisio P, Patria MF. Therapeutic Strategies for COVID-19 Lung Disease in Children. Front Pediatr 2022; 10:829521. [PMID: 35321012 PMCID: PMC8936419 DOI: 10.3389/fped.2022.829521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 01/20/2022] [Indexed: 12/15/2022] Open
Abstract
The novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection has milder presentation in children than in adults, mostly requiring only supportive therapy. The immunopathogenic course of COVID-19 can be divided in two distinct but overlapping phases: the first triggered by the virus itself and the second one by the host immune response (cytokine storm). Respiratory failure or systemic involvement as Multisystem Inflammatory Syndrome in Children (MIS-C) requiring intensive care are described only in a small portion of infected children. Less severe lung injury in children could be explained by qualitative and quantitative differences in age-related immune response. Evidence on the best therapeutic approach for COVID-19 lung disease in children is lacking. Currently, the approach is mainly conservative and based on supportive therapy. However, in hospitalized children with critical illness and worsening lung function, antiviral therapy with remdesivir and immunomodulant treatment could be considered the "therapeutic pillars."
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Affiliation(s)
| | | | - Mara Lelii
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | | | | | - Stefano Aliberti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, Italy.,Respiratory Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Milan, Italy
| | - Samantha Bosis
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Marchisio
- Università Degli Studi di Milano, Milan, Italy.,Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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33
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Chiang CY, Ellwood P, Ellwood E, García-Marcos L, Masekela R, Asher I, Badellino H, Sanz AB, Douros K, El Sony A, Diaz CG, Rodríguez MA, Moreno-Salvador A, Pérez-Martini LF, Filho NR, Shpakou A, Sulaimanov S, Tavakol M, Valverde-Molina J, Yousef AA, Pearce N. Infection with SARS-CoV-2 among children with asthma: evidence from Global Asthma Network. Pediatr Allergy Immunol 2022; 33:e13709. [PMID: 34856034 DOI: 10.1111/pai.13709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/12/2021] [Accepted: 11/30/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Clinical presentations of coronavirus disease 2019 (COVID-19) among children with asthma have rarely been investigated. This study aimed to assess clinical manifestations and outcome of COVID-19 among children with asthma, and whether the use of asthma medications was associated with outcomes of interest. METHODS The Global Asthma Network (GAN) conducted a global survey among GAN centers. Data collection was between November 2020 and April 2021. RESULTS Fourteen GAN centers from 10 countries provided data on 169 children with asthma infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 was asymptomatic in 58 (34.3%), mild in 93 (55.0%), moderate in 14 (8.3%), and severe/critical in 4 (2.4%). Thirty-eight (22.5%) patients had exacerbation of asthma and 21 (12.4%) were hospitalized for a median of 7 days (interquartile range 3-16). Those who had moderate or more severe COVID-19 were significantly more likely to have exacerbation of asthma as compared to those who were asymptomatic or had mild COVID-19 (adjusted odds ratio (adjOR) 3.97, 95% CI 1.23-12.84). Those who used inhaled bronchodilators were significantly more likely to have a change of asthma medications (adjOR 2.39, 95% CI 1.02-5.63) compared to those who did not. Children who used inhaled corticosteroids (ICS) did not differ from those who did not use ICS with regard to being symptomatic, severity of COVID-19, asthma exacerbation, and hospitalization. CONCLUSIONS Over dependence on inhaled bronchodilator may be inappropriate. Use of ICS may be safe and should be continued in children with asthma during the pandemic of COVID-19.
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Affiliation(s)
- Chen-Yuan Chiang
- International Union Against Tuberculosis and Lung Disease, Paris, France.,Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Philippa Ellwood
- Department of Paediatrics, Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Eamon Ellwood
- Department of Paediatrics, Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Luis García-Marcos
- Pediatric Allergy and Pulmonology Units, Virgen de la Arrixaca University Children's Hospital, University of Murcia and IMIB Bioresearch Institute, Murcia, Spain.,ARADyAL Allergy Network, Edificio Departamental-Laib, El Palmar, Murcia, Spain
| | - Refiloe Masekela
- Department of Paediatrics and Child Health, Nelson R Mandela School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Innes Asher
- Department of Paediatrics, Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Héctor Badellino
- Pediatric Respiratory Medicine Department, UCES University and Clínica Regional del Este, Corrientes, San Francisco, Argentina
| | - Alberto Bercedo Sanz
- Cantabrian Health Service, Valdecilla Research Institute (IDIVAL), Dobra Health Center, Torrelavega, Cantabria, Spain
| | - Konstantinos Douros
- School of Medicine, 3rd Department of Pediatrics, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Asma El Sony
- Epidemiological Laboratory (Epi-Lab) for Public Health, Research and Development, Khartoum, Sudan
| | - Carlos González Diaz
- Department of Pediatrics, University of the Basque Country, Bilbao, Vizcaya, Spain.,UPV/EHU, Basurto University Hospital, Bilbao, Vizcaya, Spain
| | - Ms Albi Rodríguez
- Pediatric Pneumology and Allergy Unit, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - Ana Moreno-Salvador
- Pediatric Allergy Unit, Virgen de la Arrixaca University Children's Hospital, University of Murcia, Spain
| | - Luis F Pérez-Martini
- Asociación Guatemalteca de Neumología y Cirugía de Tórax, Guatemala, Ciudad, Guatemala
| | | | - Andrei Shpakou
- Department of Theory of Physical Culture and Sport Medicine, Yanka Kupala State University of Grodno, Grodno, Belarus
| | | | - Marzieh Tavakol
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - José Valverde-Molina
- Department of Pediatrics, Hospital General Universitario Santa Lucia, Cartagena, Murcia, Spain
| | - Abdullah A Yousef
- College of Medicine, Imam Abdulrahman bin Faisal University, Al Khobar, Saudi Arabia.,Department of Pediatrics, King Fahd Hospital of the University Alkhobar, Al Khobar, Saudi Arabia
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
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Yeh HR, Lim MS, Seo HJ, Lee EJ, Kim JG, Yum HY. Severe asthma exacerbation associated with COVID-19 in children: A case report. ALLERGY ASTHMA & RESPIRATORY DISEASE 2022. [DOI: 10.4168/aard.2022.10.4.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hye Ryun Yeh
- Department of Pediatrics, Seoul Medical Center, Seoul, Korea
| | - Mi Sun Lim
- Department of Pediatrics, Seoul Medical Center, Seoul, Korea
| | - Hyun-Joo Seo
- Department of Pediatrics, Seoul Medical Center, Seoul, Korea
| | - Eun Jung Lee
- Department of Pediatrics, Seoul Medical Center, Seoul, Korea
| | - Joong Gon Kim
- Department of Pediatrics, Seoul Medical Center, Seoul, Korea
| | - Hye Yung Yum
- Department of Pediatrics, Seoul Medical Center, Seoul, Korea
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Yang Z, Wang X, Wan XG, Wang ML, Qiu ZH, Chen JL, Shi MH, Zhang SY, Xia YL. Pediatric asthma control during the COVID-19 pandemic: A systematic review and meta-analysis. Pediatr Pulmonol 2022; 57:20-25. [PMID: 34672436 PMCID: PMC8662014 DOI: 10.1002/ppul.25736] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/08/2021] [Accepted: 10/13/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND With the onset of the coronavirus disease 2019 (COVID-19) pandemic, many experts expected that asthma-associated morbidity because of severe acute respiratory syndrome coronavirus 2 infection would dramatically increase. However, some studies suggested that there was no apparent increasing in asthma-related morbidity in children with asthma, it is even possible children may have improved outcomes. To understand the relationship between the COVID-19 pandemic and asthma outcomes, we performed this article. METHODS We searched PubMed, Embase, and Cochrane Library to find literature from December 2019 to June 2021 related to COVID-19 and children's asthma control, among which results such as abstracts, comments, letters, reviews, and case reports were excluded. The level of asthma control during the COVID-19 pandemic was synthesized and discussed by outcomes of asthma exacerbation, emergency room visit, asthma admission, and childhood asthma control test (c-ACT). RESULTS A total of 22,159 subjects were included in 10 studies. Random effect model was used to account for the data. Compared with the same period before the COVID-19 pandemic, asthma exacerbation reduced (odds ratio [OR] = 0.26, 95% confidence interval [CI] = [0.14-0.48], Z = 4.32, p < 0.0001), the odds of emergency room visit decreased as well (OR = 0.11, 95% CI = [0.04-0.26], Z = 4.98, p < 0.00001). The outcome of asthma admission showed no significant difference (OR = 0.84, 95% CI = [0.32-2.20], Z = 0.36, p = 0.72). The outcome of c-ACT scores were not analyzed because of the different manifestations used. Overall, c-ACT scores reduced during the pandemic. CONCLUSION Compared to the same period before the COVID-19 pandemic, the level of asthma control has been significantly improved. We need to understand the exact factors leading to these improvements and find methods to sustain it.
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Affiliation(s)
- Ze Yang
- The First Clinical Medical College of Zhejiang Traditional Chinese Medical University, Hangzhou, China
| | - Xiang Wang
- The First Clinical Medical College of Zhejiang Traditional Chinese Medical University, Hangzhou, China
| | - Xi-Gang Wan
- The First Clinical Medical College of Zhejiang Traditional Chinese Medical University, Hangzhou, China
| | - Meng-Lei Wang
- The Third Clinical Medical College of Zhejiang Traditional Chinese Medical University, Hangzhou, China
| | - Zong-Hua Qiu
- The First Clinical Medical College of Zhejiang Traditional Chinese Medical University, Hangzhou, China
| | - Jia-Li Chen
- The First Clinical Medical College of Zhejiang Traditional Chinese Medical University, Hangzhou, China
| | - Man-Hao Shi
- The First Clinical Medical College of Zhejiang Traditional Chinese Medical University, Hangzhou, China
| | - Shi-Yi Zhang
- The First Clinical Medical College of Zhejiang Traditional Chinese Medical University, Hangzhou, China
| | - Yong-Liang Xia
- Department of Internal Traditional Chinese Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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O’Neill L, Chumbler NR. Risk Factors for COVID-19 Hospitalization in School-Age Children. Health Serv Res Manag Epidemiol 2022; 9:23333928221104677. [PMID: 35706910 PMCID: PMC9189522 DOI: 10.1177/23333928221104677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction With the recent emergence of the Omicron variant, there has been a rapid and alarming increase in the number of COVID-19 cases among pediatric populations. Yet few US pediatric cohort studies have characterized the clinical features of children with severe COVID-19. The objective of this study was to identify those chronic comorbidities that increase the risk of hospitalization for pediatric populations with severe COVID-19. Methods A retrospective cohort study that utilized the Texas Inpatient Public Use Data file was conducted. The study included 1187 patients (ages 5 to 19) from 164 acute-care Texas hospitals with the primary or secondary ICD-10CM diagnosis code U07.1 (COVID-19, virus identified). The baseline comparison group included 38 838 pediatric patients who were hospitalized in 2020. Multivariable binary logistic regression, controlling for patient characteristics, sociodemographic factors, and health insurance, was used to estimate the adjusted risk of hospitalization for COVID-19. Results Obesity and type 1 diabetes increased the risk of hospitalization with COVID-19 among both children (5-12 years) and adolescents (13-19 years). Adolescents with morbid obesity were 10 times more likely to have severe COVID-19 (p < 0.001). Regardless of age, single-parent households (%) for the patient's zip code was associated with an increased risk of hospitalization with COVID-19 (AOR = 1.02, CI: 1.01-1.03, p < 0.01). Other risk factors included chronic kidney disease (p < 0.05), male gender (p < 0.001), Medicaid (p < 0.001), and charity care (p < 0.001). Conclusion Pediatric providers and public health officials should consider the need to tailor clinical management and mitigation efforts for pediatric populations with identifiable risk factors for severe COVID-19. These findings can be used to improve risk communication with families of children with underlying medical conditions and to prioritize prevention measures, including vaccinations.
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Affiliation(s)
- Liam O’Neill
- Department of Rehabilitation and Health Services, University of North Texas, Denton, TX, USA
| | - Neale R. Chumbler
- Department of Diagnostic and Health Sciences, College of Health Professions, University of Tennessee Health Science Center, Memphis, TN, USA
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Gaietto K, Freeman MC, DiCicco LA, Rauenswinter S, Squire JR, Aldewereld Z, Iagnemma J, Campfield BT, Wolfson D, Kazmerski TM, Forno E. Asthma as a risk factor for hospitalization in children with COVID-19: A nested case-control study. Pediatr Allergy Immunol 2022; 33:e13696. [PMID: 34775650 PMCID: PMC8646549 DOI: 10.1111/pai.13696] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/25/2021] [Accepted: 11/10/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Most pediatric studies of asthma and COVID-19 to date have been ecological, which offer limited insight. We evaluated the association between asthma and COVID-19 at an individual level. METHODS Using data from prospective clinical registries, we conducted a nested case-control study comparing three groups: children with COVID-19 and underlying asthma ("A+C" cases); children with COVID-19 without underlying disease ("C+" controls); and children with asthma without COVID-19 ("A+" controls). RESULTS The cohort included 142 A+C cases, 1110 C+ controls, and 140 A+ controls. A+C cases were more likely than C+ controls to present with dyspnea and wheezing, to receive pharmacologic treatment including systemic steroids (all p < .01), and to be hospitalized (4.9% vs. 1.7%, p = .01). In the adjusted analysis, A+C cases were nearly 4 times more likely to be hospitalized than C+ controls (adjusted OR = 3.95 [95%CI = 1.4-10.9]); however, length of stay and respiratory support level did not differ between groups. Among A+C cases, 8.5% presented with an asthma exacerbation and another 6.3% developed acute exacerbation symptoms shortly after testing positive for SARS-CoV-2. Compared to historic A+ controls, A+C cases had less severe asthma, were less likely to be on controller medications, and had better asthma symptom control (all p < .01). CONCLUSIONS In our cohort, asthma was a risk factor for hospitalization in children with COVID-19, but not for worse COVID-19 outcomes. SARS-CoV-2 does not seem to be a strong trigger for pediatric asthma exacerbations. Asthma severity was not associated with higher risk of COVID-19.
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Affiliation(s)
- Kristina Gaietto
- Division of Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Megan Culler Freeman
- Division of Infectious Diseases, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Leigh Anne DiCicco
- Division of Hospital Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Joseph R Squire
- Children's Community Pediatrics, Pittsburgh, Pennsylvania, USA
| | - Zachary Aldewereld
- Division of Infectious Diseases, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Division of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Brian T Campfield
- Division of Infectious Diseases, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David Wolfson
- Children's Community Pediatrics, Pittsburgh, Pennsylvania, USA
| | - Traci M Kazmerski
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Erick Forno
- Division of Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Pediatric Asthma Center, UPMC Children's Hospital of Pittsburgh and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Uka A, Buettcher M, Bernhard-Stirnemann S, Fougère Y, Moussaoui D, Kottanattu L, Wagner N, Zimmermann P, Ritz N. Factors associated with hospital and intensive care admission in paediatric SARS-CoV-2 infection: a prospective nationwide observational cohort study. Eur J Pediatr 2022; 181:1245-1255. [PMID: 34845526 PMCID: PMC8628837 DOI: 10.1007/s00431-021-04276-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/27/2021] [Accepted: 09/26/2021] [Indexed: 11/30/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is usually less severe in children compared to adults. This study describes detailed clinical characteristics, treatment and outcomes of children with COVID-19 in a non-hospitalised and hospitalised setting and quantifies factors associated with admission to hospital and intensive care unit in children with SARS-CoV-2 infection on a nationwide level. Data were collected through the Swiss Paediatric Surveillance Unit from children < 18 years with confirmed SARS-CoV-2 infection. All 33 paediatric hospitals in Switzerland reported non-hospitalised and hospitalised cases from March 1 to October 31, 2020 during both pandemic peaks. In total, 678 children were included. The median age was 12.2 years (IQR 5.0-14.6), 316 (46.6%) were female and 106 (15.6%) had comorbidities. Overall, 126 (18.6%) children were hospitalised of whom 16 (12.7%) required ICU admission. Comorbidities were the only factor associated with hospital admission in a multivariable regression analysis (odds ratio 3.23, 95%CI 1.89 to 5.50; p-value < 0.01). Children with preexisting comorbidities did not require ICU admission more often. Hospitalised children more often presented with fever (96 [76.2%] vs 209 [38.1%], p-value < 0.01) and rash (16 [12.8%] vs 6 [1.1%], p-value < 0.01). Anosmia/dysgeusia was more prevalent in non-hospitalised children (73 [13.3%] vs 3 [2.4%], p-value < 0.01). In hospitalised children, oxygen treatment was required in 34 (27.0%), inotropes in nine (7.3%) and mechanical ventilation in eight (6.3%) cases. Complications were reported in 28 (4.1%) children with cardiovascular complications being most frequent (12 [1.8%]). Three deaths were recorded.Conclusion: This study confirms that COVID-19 is mostly a mild disease in children. Fever, rash and comorbidities are associated with higher admission rates. Continuous observation is necessary to further understand paediatric COVID-19, guide therapy and evaluate the necessity for vaccination in children. What is Known: • Clinical manifestations of SARS-CoV-2 infection in children vary from asymptomatic to critical disease requiring intensive care unit admission. • Most studies are based on hospitalised children only; currently, there is limited data on non-hospitalised children. What is New: • The clinical spectrum and severity of COVID-19 is influenced by age: in children less than 2 years, fever, cough and rhinorrhoea are the most common symptoms and in adolescents, fever, cough and headache are more common. • Hospitalised children more often presented with fever and rash, while anosmia/dysgeusia is more prevalent in non-hospitalised children. • Children with pre-existing comorbidities are more frequently hospitalised but do not require ICU admission more often.
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Affiliation(s)
- Anita Uka
- Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
- Department of Paediatrics, Fribourg Hospital HFR, Fribourg, Switzerland
| | - Michael Buettcher
- Paediatric Infectious Diseases, Children’s Hospital Lucerne, Luzern, Switzerland
| | | | - Yves Fougère
- Pediatric Infectious Diseases and Vaccinology Unit, Department Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Dehlia Moussaoui
- Department of Paediatrics, Gynaecology and Obstetrics, General Paediatrics Division, Geneva University Hospitals, Geneva, Switzerland
| | - Lisa Kottanattu
- Ente Ospedaliero Cantonale, Istituto Pediatrico Della Svizzera Italiana, Bellinzona, Switzerland
| | - Noémie Wagner
- Department of Paediatrics, Gynaecology and Obstetrics, General Paediatrics Division, Geneva University Hospitals, Geneva, Switzerland
| | - Petra Zimmermann
- Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
- Department of Paediatrics, Fribourg Hospital HFR, Fribourg, Switzerland
- Infectious Diseases Research Group, Murdoch Children’s Research Institute, Parkville, Australia
| | - Nicole Ritz
- Paediatric Infectious Diseases and Vaccinology, University of Basel Children’s Hospital, Basel, Switzerland
- Department of Paediatrics, The Royal Children’s Hospital Melbourne, The University of Melbourne, Melbourne, Australia
- University Children’s Hospital Basel UKBB, Spitalstrasse 33, CH-4031 Basel, Switzerland
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Okur DS. Clinical impact of COVID-19 on Turkish children with neurological and neuromuscular diseases: One center experience. Medicine (Baltimore) 2021; 100:e28401. [PMID: 34941179 PMCID: PMC8702014 DOI: 10.1097/md.0000000000028401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/01/2021] [Indexed: 01/05/2023] Open
Abstract
This study aims to explore the effects of new type of coronavirus disease (COVID-19) in children with neurological and/or neuromuscular diseasesA retrospective study was conducted at State Hospital of Denizli. Pediatric patients diagnosed with COVID-19 who were hospitalized between March 18, 2020 and January 18, 2021 were included in the study. Children were divided into two groups: those with (group I) and without neurological and /or neuromuscular disorders (group II).Male cases were more than female cases in group I. The difference between group I and group II was significant in terms of seizure (47.3%; 1.7%), dyspnea (36.8%, 6.2%) and number of days with fever (2.6 ± 1.9; 1.58 ± 1.42) (P < .01, P < .01, P = .02). Hypoxemia (7, 11; 36.8%, 4.5%) and abnormal auscultation findings (8, 44; 42.1%, 18.1%) were more common in children in group I, hypertension was more common in group II (0, 8; 0%, 3.3%). Lung involvement of COVID-19 was found to be more severe in group I (P = .04). The frequency of hospitalization in the intensive care unit (P < .01) and application of noninvasive mechanical ventilation (NIMV) (P < .01); the number of days followed-up in the intensive care (P < .01) and in the hospital (P = .02) of the patients in group I were higher than those in group II.It is recognized that children with underlying neurological and/or neuromuscular diseases are severely affected by COVID-19.
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Cekic S, Karali Z, Cicek F, Canitez Y, Sapan N. The Impact of the COVID-19 Pandemic in Adolescents with Asthma. J Korean Med Sci 2021; 36:e339. [PMID: 34931499 PMCID: PMC8688346 DOI: 10.3346/jkms.2021.36.e339] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/17/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic is affecting people at any age and there is limited information about the effect of the COVID-19 pandemic on quality of life (QoL) in adolescents with asthma. In the present study, it was aimed to assess the attitudes of adolescents with asthma toward the COVID-19 pandemic and determine the effects of the pandemic on their QoL. METHODS In total, 125 adolescents with asthma and 98 healthy adolescents participated in the present study. The questionnaire form consisted of three parts. In the first part, all the participants were asked whether they complied with the protective measures against COVID-19. The second part included questions for measuring the participants' level of concern about COVID-19, while the third part consisted of EUROHIS-QOL 8. RESULTS The patient and control groups were similar in terms of the female/male ratio (55/70 and 48/50, respectively) and mean participant age (14.6 ± 2 and 15.1 ± 1.65 years, respectively) (P = 0.459 and P = 0.062, respectively). The prevalence of COVID-19 in the patients (n = 2, 1.6%) was lower than that in the controls (n = 6, 6.1%); however, the difference was not statistically significant (P = 0.142). The total EUROHIS-QOL score was significantly lower in the patients (31.2 ± 6.7) than in the controls (33.7 ± 4.4) (P < 0.001). The total QoL scores of asthmatic adolescents without other allergic disease (31.4 ± 6.7) was also lower than those of the controls (33.7 ± 4.4) (P = 0.009). Treatment disruption was significantly more common in patients who received subcutaneous immunotherapy (n = 20, 48.8%) than in those who did not (n = 8, 9.5%) (P < 0.001). Moreover, the patients had lower EUROHIS-QOL scores in the overall QoL, general health, finance, and home domains. CONCLUSION Our results indicate that the mean QoL score of asthmatic adolescents during COVID-19 pandemic is lower than in the healthy population. Disruption in their treatment was most common in patients with asthma who were receiving subcutaneous immunotherapy.
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Affiliation(s)
- Sukru Cekic
- Division of Pediatric Allergy, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Zuhal Karali
- Division of Pediatric Allergy, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Fatih Cicek
- Division of Pediatric Allergy, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Yakup Canitez
- Division of Pediatric Allergy, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Nihat Sapan
- Division of Pediatric Allergy, Uludag University Faculty of Medicine, Bursa, Turkey.
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41
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Sabetkish N, Rahmani A. The overall impact of COVID-19 on healthcare during the pandemic: A multidisciplinary point of view. Health Sci Rep 2021; 4:e386. [PMID: 34622020 PMCID: PMC8485600 DOI: 10.1002/hsr2.386] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/21/2021] [Accepted: 08/22/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND AIMS The Coronavirus disease 2019 (COVID-19) pandemic globally changed the priorities of medical and surgical procedures. It has caused many healthcare systems to stop performing their routine screenings. Altering medical clinics to COVID-19 referral centers, lockdowns, and the public fear to refer to medical centers caused a significant reduction in the referral rate; especially in the elderly. This short review article highlights the transform in clinical practice during the post-COVID era and the need for future medical revolutions. METHODS A comprehensive literature search was separately performed by both authors. The articles published between 2019 and August 2021 were included in this study and selected according to a quality appraisal method. RESULTS We have summarized the possible corresponding changes in the diagnosis and treatment of all fields of medical care including internal medicine, surgical, and minor subcategories after the COVID-19 pandemic. We have also discussed the potential impacts of the pandemic on all these different categories and subcategories of medicine, including the outpatient setting and clinical work. We do believe that the lack of routine check-ups has led to an increase in the stage of disease in patients with a previously diagnosed problem. On the other hand, the dramatic change in the lifestyle of the population including restricted mobility and increased consumption of unhealthy food has caused metabolic syndrome and other new diseases that have not been diagnosed and properly managed. CONCLUSION Our findings revealed the urgent need for public health awareness. It indicated the need to carry out both psychological and screening approaches in the post-COVID era to not miss patients with a chronic disease and new cases who were undiagnosed during the COVID pandemic.
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Affiliation(s)
- Nastaran Sabetkish
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical CenterTehran University of Medical SciencesTehranIran
- ImmunologyAsthma and Allergy Research Institute, Tehran University of Medical SciencesTehranIran
| | - Alireza Rahmani
- Research Center for Prevention of Cardiovascular DiseaseInstitute of Endocrinology & Metabolism, Iran University of Medical SciencesTehranIran
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Moreno-Sánchez E, Castillo-Viera E, Vélez-Moreno E, Gago-Valiente FJ. Facts and Challenges about Asthma and COVID-19 among the Paediatric Population: A Systematic Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57121306. [PMID: 34946251 PMCID: PMC8706787 DOI: 10.3390/medicina57121306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/26/2021] [Accepted: 11/28/2021] [Indexed: 01/02/2023]
Abstract
A systematic review of the literature was conducted to analyse the factors that affect the probability of the paediatric asthma population suffering from COVID-19 or SARS-CoV-2, such as asthma phenotypes, inhaled corticosteroids, and the effects of lockdown. This systematic review was based on PRISMA guidelines. A bibliographic search was conducted using BNE, BVS (LILAC), CSIC (IME, ISOC), IBECS, Scielo, Scopus, Medline, and PubMed, using the following search profile: (COVID-19 or 2019-NCOV or SARS-CoV-2 or COV-19) AND asthma AND (children or adolescents or youths or children or teenagers). The results were limited to those articles published between December 2019 and December 2020, selecting only articles published in Spanish, English and French that included the study population (children aged 0–18 years). Among the 1066 results of the bibliographic search and seven articles selected from a manual search, only 19 articles were found to fit our eligibility criteria. Most of the articles highlight the effects of lockdown on the paediatric asthma population, increased therapeutic compliance, and the role of inhaled corticosteroids and intrinsic factors such as ACE2 receptors as causes of the decreased prevalence of COVID-19 among the paediatric asthma population. This population has unique characteristics that serve as protective factors against COVID-19. The safety measures implemented during the lockdown period along with inhaled corticosteroid treatment also contributed to this protection.
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Affiliation(s)
- Emilia Moreno-Sánchez
- Department of Pedagogy, Faculty of Education, Psychology and Sports Sciences, University of Huelva, 21071 Huelva, Spain;
| | - Estefanía Castillo-Viera
- Faculty of Education, Psychology and Sports Sciences, University of Huelva, 21071 Huelva, Spain
- Correspondence: ; Tel.: +34-959219272
| | - Emilia Vélez-Moreno
- Medicine Department, Faculty of Medicine, University of Malaga, 29071 Malaga, Spain;
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Vezir E, Hizal M, Cura Yayla B, Aykac K, Yilmaz A, Kaya G, Oygar PD, Ozsurekci Y, Ceyhan M. Does aeroallergen sensitivity and allergic rhinitis in children cause milder COVID-19 infection? Allergy Asthma Proc 2021; 42:522-529. [PMID: 34871160 DOI: 10.2500/aap.2021.42.210087] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: There are conflicting data with regard to the impact of respiratory and allergic comorbidities on the course of novel coronavirus disease 2019 (COVID-19) in children. Objective: This study aimed to investigate the relationship between allergic diseases and COVID-19 severity in pediatric patients. Methods: Seventy-five pediatric patients with COVID-19 were classified according to clinical severity and evaluated in the allergy/immunology and pulmonology departments 1 to 3 months after the infection resolved. Blood was collected from the patients for a complete blood cell count and assessment of immunoglobulin and total immunoglobulin E (IgE) levels, and skin-prick tests and spirometry tests were performed. Results: A total of 75 patients ages 5-18 years were evaluated. COVID-19 was asymptomatic/mild in 44 patients and moderate/severe/critical in 31 patients. Based on allergy evaluation, allergic rhinitis was diagnosed in 19 patients (25.3%), asthma in 10 patients (13%), and atopic dermatitis in 3 patients (4%). Aeroallergen sensitivity was detected in 26 patients (34.7%). COVID-19 infection was asymptomatic/mild in 15 patients with allergic rhinitis (78.9%) and in 21 with aeroallergen sensitivity (80.8%) (p = 0.038 and p = 0.005, respectively). There was no difference in severity between the patients with and without asthma (p = 0.550). The median (interquartile range) total IgE level was significantly higher in the asymptomatic/mild group (71.8 [30.7-211.2]) (p = 0.015). There were no differences in terms of spirometry parameters. Conclusion: Aeroallergen sensitization and allergic rhinitis in children may be associated with a milder course of COVID-19. The knowledge that atopy is associated with less-severe COVID-19 outcomes in children may guide clinical risk classification.
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Affiliation(s)
- Emine Vezir
- From the Department of Pediatric Allergy and Clinical Immunology, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Mina Hizal
- Department of Pediatric Pulmonology, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Burcu Cura Yayla
- Department of Pediatric Infectious Disease, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Kubra Aykac
- Department of Pediatric Infectious Disease, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Arzu Yilmaz
- Department of Pediatrics, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey, and
| | - Gamze Kaya
- Department of Pediatrics, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey, and
| | - Pembe Derin Oygar
- Department of Pediatric Infectious Disease, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Yasemin Ozsurekci
- Department of Pediatric Infectious Disease, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Ceyhan
- Department of Pediatric Infectious Disease, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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COVID-19-Related Pneumonia in an Adolescent Patient with Allergic Asthma. Case Rep Med 2021; 2021:6706218. [PMID: 34642587 PMCID: PMC8502245 DOI: 10.1155/2021/6706218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/17/2021] [Indexed: 01/08/2023] Open
Abstract
Background The latest coronavirus infection due to SARS-CoV-2, which started in China in December 2019, was announced as a pandemic by the World Health Organization (WHO) in March 2020. All epidemiological data so far show us that SARS-CoV-2 infection is less serious in children than in adults. Allergic asthma, the most common chronic disease in children, is usually not to be related to greater risk or severity for COVID-19 in pediatric populations. Although reports/research on asthma and COVID-19 in children have thus far been comforting, when coming across an asthma patient with any lower airway infection, attention should be given to evaluate their asthma control level and the possibility of SARS-CoV-2 infection. Case Report. Here, we report a rare adolescent case of COVID-19-related pneumonia development with underlying asthma. A 16-year-old male patient has been followed up by the pediatric allergy outpatient clinic with the diagnosis of asthma for the last 5 years. He was thought to have typical clinical and laboratory findings for SARS-CoV-2 infection combined with underlying pediatric (allergic) asthma. Pulmonary CT showed findings consistent with COVID-19-related pneumonia. He was discharged after 1 week when all his complaints regressed, his examination became normal, and 5-day favipiravir treatment was completed. Conclusion When a physician comes across an asthma patient with any lower airway infection, attention should be given to evaluate their asthma control level and possibility of SARS-CoV-2 infection.
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Asseri AA. Pediatric Asthma Exacerbation in Children with Suspected and Confirmed Coronavirus Disease 2019 (COVID-19): An Observational Study from Saudi Arabia. J Asthma Allergy 2021; 14:1139-1146. [PMID: 34594113 PMCID: PMC8476942 DOI: 10.2147/jaa.s326860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/14/2021] [Indexed: 11/23/2022] Open
Abstract
Background Most asthma exacerbations are caused by viral respiratory infections such as rhinovirus, coronaviruses, influenza viruses, and many others. While there have been data about the impact of COVID-19 on adult asthma, much remains unknown about the impact of COVID-19 on childhood asthma. Methods This retrospective cohort study included all pediatric patients aged 2 to 12 years who were admitted to Abha Maternity and Children Hospital for acute asthma exacerbation between June 1, 2020, and May 31, 2021, and underwent testing for SARS-CoV-2 using nasopharyngeal real-time polymerase chain reaction. Results Sixty children hospitalized with the diagnosis of asthma were included in the study. Out of these patients, 10 (16.7%) were diagnosed with COVID-19. The enrolled patients were between 2 and 12 years, with a median age of five years (interquartile range, 3.8), and 58% were males (35/60). Cough, shortness of breath, and hypoxia were the most common presenting symptoms and signs. Severe asthma was more prevalent among positive COVID-19 compared with negative COVID-19 patients (60 vs 20%; P= 0.016). In addition, chronic asthma for more than five years was more prevalent among positive COVID-19 than negative COVID-19 patients (60 vs 40%, P= 0.305). Fifty-five percent of the enrolled patients had eosinophilic asthma using a 300cells/μL threshold. None of the children required invasive respiratory support (ventilation through an endotracheal tube or tracheostomy), but 12 patients (21.7%) required respiratory support via high-flow nasal cannula. The total days of hospitalization in either PICU or pediatric general ward did not differ between the two groups. All patients were discharged, and there were no reports of serious morbidity or mortality. Conclusion Eosinophilic asthma was the most prevalent asthma phenotype in the study group. Furthermore, there was no difference in the presenting symptoms of an asthma flare-up, laboratory indicators, and hospitalization outcomes (critical care admission and hospital stay) between asthmatics with and without a COVID-19 diagnosis.
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Affiliation(s)
- Ali Alsuheel Asseri
- Department of Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia
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Pirkle CM, Saiki KN, Yamauchi J, Irvin LH. Advancing Health Equity in Hawai'i: Critical Reflections on COVID-19, Chronic Conditions, and Health Disparities. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2021; 80:3-5. [PMID: 34704061 PMCID: PMC8538109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Catherine M Pirkle
- Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, HI
| | - Kara N Saiki
- Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, HI
| | | | - Lola H Irvin
- Hawai'i State Department of Health, Honolulu, HI
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Bun S, Kishimoto K, Shin JH, Maekawa T, Takada D, Morishita T, Kunisawa S, Imanaka Y. Impact of the COVID-19 pandemic on asthma exacerbations in children: A multi-center survey using an administrative database in Japan. Allergol Int 2021; 70:489-491. [PMID: 34281768 PMCID: PMC8282991 DOI: 10.1016/j.alit.2021.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 02/07/2023] Open
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48
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Navalpakam A, Secord E, Pansare M. The Impact of Coronavirus Disease 2019 on Pediatric Asthma in the United States. Pediatr Clin North Am 2021; 68:1119-1131. [PMID: 34538303 PMCID: PMC8139266 DOI: 10.1016/j.pcl.2021.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has caused severe economic and health impacts in the United States, and the impact is disproportionately more in socially disadvantages areas. The available data, albeit limited in children, suggest that the initial concerns of the potential of serious impact of COVID-19 illness in children with asthma are unproven so far. The reduction in asthma morbidities is due to improved adherence, COVID-19 control measures, school closures, and decreased exposure to allergens and viral infections in children. During the pandemic, asthma guidelines were updated to guide physicians in asthma care. In the face of unprecedented time, it is important to be vigilant, adhere to treatment guidelines, and implement preventive measures to eradicate the virus and improve outcomes in children with asthma.
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Affiliation(s)
- Aishwarya Navalpakam
- Division of Allergy and Immunology, Department of Pediatrics, Pediatric Specialty Center, Children’s Hospital of Michigan, 4th Floor, 3950 Beaubien Boulevard, Detroit, MI 48236, USA
| | - Elizabeth Secord
- Department of Pediatrics, Wayne State University, Detroit, MI, USA
| | - Milind Pansare
- Department of Pediatrics, Division of Allergy and Immunology, Pediatric Specialty Center, Children's Hospital of Michigan, Central Michigan University, Suite # 4018, 4th Floor, 3950 Beaubien Boulevard, Detroit, MI 48236, USA.
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Jenkins BN, Moskowitz J, Halterman JS, Kain ZN. Applying theoretical models of positive emotion to improve pediatric asthma: A positive psychology approach. Pediatr Pulmonol 2021; 56:3142-3147. [PMID: 34379892 DOI: 10.1002/ppul.25600] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 06/15/2021] [Accepted: 06/22/2021] [Indexed: 02/05/2023]
Abstract
Positive emotion, encompassing feelings such as joy and happiness, has been shown to predict a multitude of health outcomes. However, the role of positive emotion in pediatric asthma is not understood. No work to date has examined how positive emotion may offer benefits to children and adolescents with asthma. Based on theory and models of positive emotion and health, we hypothesize that positive emotion may improve asthma outcomes through mediators such as health behaviors and health-relevant physiological functioning. Moreover, boosting positive emotion during times of stress may be particularly relevant in mitigating asthma symptoms. In the present commentary, we elaborate on the hypothesized mechanisms behind such associations grounded within positive emotion theoretical frameworks. Additionally, we summarize the methodologically rigorous work of positive emotion interventions in other clinical settings to propose that positive emotion could be a useful tool in the management of pediatric asthma.
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Affiliation(s)
- Brooke N Jenkins
- Department of Psychology, Chapman University, Orange, California, USA.,Center on Stress & Health, University of California, Irvine, California, USA.,Department of Anesthesiology and Perioperative Care, University of California, Irvine, California, USA
| | - Judith Moskowitz
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jill S Halterman
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York, USA
| | - Zeev N Kain
- Center on Stress & Health, University of California, Irvine, California, USA.,Department of Anesthesiology and Perioperative Care, University of California, Irvine, California, USA
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50
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Rabha AC, Fernandes FR, Solé D, Bacharier LB, Wandalsen GF. Asthma is associated with lower respiratory tract involvement and worse clinical score in children with COVID-19. Pediatr Allergy Immunol 2021; 32:1577-1580. [PMID: 33966294 PMCID: PMC8236910 DOI: 10.1111/pai.13536] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/02/2021] [Accepted: 05/03/2021] [Indexed: 01/22/2023]
Affiliation(s)
- Anna Clara Rabha
- Division of Allergy, Clinical Immunology and Rheumatology, Federal University of São Paulo, São Paulo, Brazil.,Instituto Pensi, Sabará Hospital Infantil, Fundação José Luiz Egydio Setúbal, São Paulo, Brazil
| | | | - Dirceu Solé
- Division of Allergy, Clinical Immunology and Rheumatology, Federal University of São Paulo, São Paulo, Brazil
| | - Leonard Benjamin Bacharier
- Division of Pediatric Allergy, Immunology and Pulmonary Medicine, Monroe Carell Jr Children's Hospital at Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gustavo Falbo Wandalsen
- Division of Allergy, Clinical Immunology and Rheumatology, Federal University of São Paulo, São Paulo, Brazil.,Instituto Pensi, Sabará Hospital Infantil, Fundação José Luiz Egydio Setúbal, São Paulo, Brazil
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