Ongoing asthma management in children during the COVID-19 pandemic: to step down or not to step down?

Optimizing asthma care in low-to-middle income countries through multisectoral collaboration: recommendation report of the first Philippine Asthma Assembly

INTRODUCTION

Asthma is one of the most common noncommunicable diseases, raising serious concerns about asthma-related deaths globally. Studies have reported safety concerns with short-acting beta-agonists (SABAs) monotherapy. SABA overuse contributes significantly to the healthcare burden in the Philippines. Despite Global Asthma Network's years-long advocacy for equal access to essential medicines at affordable cost, the uptake of international healthcare policies is limited in most low- and middle-income countries, including the Philippines.

AREAS COVERED

We reviewed synthesis of targeted nonsystematic literature searches on prevalence of asthma and asthma-related mortality, SABA overreliance and its adverse events, alternatives to SABA, patient referral, and multidisciplinary team (MDT) approach for asthma management. We describe regional challenges and recommendations for improving asthma care through continued multisectoral collaboration.

EXPERT OPINION

Use of medications like inhaled corticosteroid-formoterol combinations may aid in reducing adverse events including severe exacerbations, hospitalizations, complications from oral corticosteroid use, and long-term treatment costs. Raising patient awareness about preventive measures, proper inhaler techniques, and medication adherence can mitigate burden of uncontrolled asthma. Improving access to asthma medications alongside developing treatment algorithms and referral pathways (including MDT) for primary care physicians will pave the way for optimal asthma care in LMICs, including the Philippines.

Environmental Health Knowledge Does Not Necessarily Translate to Action in Youth

Environmental challenges pose serious health problems, especially for children, and lay public action is lacking. This study sought to characterize the relationship between environmental health knowledge and behavior in youth. A cross-sectional, descriptive survey with quantitative and qualitative questions was conducted. Open-ended questions were coded to generate themes/subthemes. Subscales' scores were presented as mean ± SD or median and interquartile range (IQR). T- and Mann-Whitney tests were used to compare groups, and correlations were used to evaluate covariation. A total of 452 children were surveyed. Youth verbalized concerns about their environments and their impact on health. Air pollution was the most concerning issue. Participants had moderate knowledge scores. Few described the three health domains; even fewer included environment. Behavior scores were low and weakly correlated with knowledge, but were moderately correlated with attitude and self-efficacy. Participation in environmental classes, activities, and clubs was associated with higher scores. We found variable environmental health knowledge, limited understanding of the local environment's impact on health, and a weak association between youth's knowledge and behavior. Focused formal and non-formal educational experiences were associated with improved scores, indicating the value of targeted youth educational programming to increase environmental health knowledge and action.

Shifts in Asthma Evaluation and Management During COVID-19

Purpose of Review

The comprehensive management of asthma has historically relied on in-person visits to obtain a detailed history, thorough physical exam, and diagnostic and monitoring tools such as pulmonary function testing. The COVID-19 pandemic has posed numerous challenges to adequately utilizing these strategies. Despite these limitations, telemedicine has provided an important means to deliver asthma care. In this review, we discuss how these challenges have created paradigm shifts in not only the clinical aspects of asthma management, but also in patient attitudes and physician-patient relationships.

Recent Findings

Different strategies have been suggested to address asthma during COVID-19. Telemedicine has taken on an important role during the pandemic. The emphasis on asthma questionnaire use, education regarding lapsed asthma control, and as-needed oral corticosteroid courses have proven to be important instruments in the remote management of asthma. Overall, asthma exacerbations have decreased during this time. This is thought to be due to a variety of factors such as decreased exposure to common triggers.

Summary

Although the COVID-19 pandemic significantly limited an allergist's ability to provide conventional comprehensive asthma management, we also found that patient outcomes have actually improved. In addition to the decreased exposure to asthma triggers, this may also be an effect of increased patient ownership of their asthma, and subsequent improved therapeutic alliance.

Coronavirus disease 2019 and pediatric asthma: friend or foe?

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.

School Asthma Care During COVID-19: What We Have Learned and What We Are Learning

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.