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Kattih M, Lee H, Jo H, Jeong J, Kim H, Park J, Yang H, Nguyen A, Kim HJ, Lee H, Kim M, Lee M, Kwon R, Kim S, Koyanagi A, Kim MS, Rahmati M, López Sánchez GF, Dragioti E, Kim JH, Woo S, Cho SH, Smith L, Yon DK. National prevalence of atopic dermatitis in Korean adolescents from 2009 to 2022. Sci Rep 2024; 14:12391. [PMID: 38811655 DOI: 10.1038/s41598-024-62475-4] [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: 11/15/2023] [Accepted: 05/17/2024] [Indexed: 05/31/2024] Open
Abstract
Previous studies have examined the prevalence of allergic diseases in adolescents 1-2 years after the emergence of the COVID-19 pandemic. However, more data is needed to understand the long-term impact of COVID-19 on allergic diseases. Thus, we aimed to examine the trend of the atopic dermatitis prevalence in Korean adolescents before and during the COVID-19 pandemic across 14 years. Additionally, we analyze the risk factors of atopic dermatitis (AD) based on the results. The Korean Disease Control and Prevention Agency conducted the Korea Youth Risk Behavior Web-based Survey from 2009 to 2022, from which the data for this study were obtained. Prevalence trends were compared across subgroups, and the β difference (βdiff) was calculated. We computed odds ratios to examine changes in the disease prevalence before and during the pandemic. This study included a total of 917,461 participants from 2009 to 2022. The prevalence of atopic dermatitis increased from 6.79% (95% CI 6.66-6.91) in 2009-2011 to 6.89% (95% CI 6.72-7.05) in 2018-2019, then decreased slightly to 5.82% (95% CI 5.60-6.04) in 2022. Across the 14 years, middle school student status, low parent's highest education level, low household income, non-alcohol consumption, non-smoker smoking status, no suicidal thoughts, and no suicide attempts were associated with increased risk of atopic dermatitis, while female sex, rural residence, high BMI, low school performance, low household income, and no feelings of sadness and despair was associated with a small increase. This study examined the prevalence of atopic dermatitis across an 18-year, and found that the prevalence increased in the pre-pandemic then decreased during the start of the pandemic and remained constant throughout the pandemic. This trend could be explained mainly by the large scale social and political changes that occurred during the COVID-19 pandemic.
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Affiliation(s)
- Mafaz Kattih
- Department of Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Hojae Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Hyesu Jo
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Jinyoung Jeong
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Hyejun Kim
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Applied Information Engineering, Yonsei University, Seoul, South Korea
| | - Jaeyu Park
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Hwi Yang
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Ann Nguyen
- Department of Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Hyeon Jin Kim
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Hyeri Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Minji Kim
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Myeongcheol Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Rosie Kwon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Sunyoung Kim
- Department of Family Medicine, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, Barcelona, Spain
| | - Min Seo Kim
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Masoud Rahmati
- Health Service Research and Quality of Life Center (CEReSS), Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran
- Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran
| | - Guillermo F López Sánchez
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, School of Medicine, University of Murcia, Murcia, Spain
| | - Elena Dragioti
- Department of Medical and Health Sciences, Pain and Rehabilitation Centre, Linköping University, Linköping, Sweden
- Research Laboratory Psychology of Patients, Families, and Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Ju Hee Kim
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, South Korea
| | - Selin Woo
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Seong H Cho
- Department of Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
- Division of Allergy and Immunology, Department of Internal Medicine, USF Morsani College of Medicine, Tampa, FL, USA.
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, CB1 1PT, UK.
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea.
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea.
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea.
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, South Korea.
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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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Rudsenske NE, Perkins JB. Assessing severity of COVID-19 and the development of multi system inflammatory syndrome in children (MIS-C) in pediatric patients with atopic disease. Allergy Asthma Proc 2024; 45:92-96. [PMID: 38449015 PMCID: PMC10926182 DOI: 10.2500/aap.2024.45.230087] [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] [Indexed: 03/08/2024]
Abstract
Background: Research surrounding the coronavirus disease 2019 (COVID-19) pandemic and its impact on patients who are atopic has mainly focused on adults. After the delta variant showed increased rates of COVID-19 in children, the pediatric population needs to be assessed as well. Objective: The objective was to assess and report outcomes in patients with COVID-19 and with and without certain atopic diseases in our patient cohort at the University of Mississippi Medical Center. Methods: We conducted a retrospective review of patients by using a de-identified data base that allows querying via medical claims codes from the University of Mississippi Medical Center's Research Data Warehouse. We searched for patients who were COVID-19 positive and ages 0-21 years from January 1, 2020, to December 31, 2021. We then divided this population into two cohorts: an atopic population and a non-atopic population. The incidence of hospitalizations, intensive care unit (ICU) admissions, death, length of stay, inhaled corticosteroid prescription history, and the incidence of multi-system inflammatory syndrome in children (MIS-C) outcomes in the two populations were collected. Results: There were 5261 patients ages 0-21 years and with confirmed COVID-19. After exclusion criteria were applied, there were 1420 patients in the atopic cohort and 2525 patients in the non-atopic cohort. There were more hospitalizations and a longer length of stay in the atopic population. Mortality was equivalent in the atopic and non-atopic populations. There were more ICU admissions in the atopic population. There were 101 patients total with the diagnosis of MIS-C, and the incidence of MIS-C was similar in the atopic and non-atopic populations. There were more patients who were atopic on inhaled corticosteroid than were the patients who were non-atopic. Conclusion: This study sought to further elucidate whether asthma, atopic dermatitis, and allergic rhinitis in pediatric patients was associated with severe COVID-19. Our study showed increased hospitalizations, length of stay, and intensive care in the atopic population but similar outcomes in mortality and the development of MIS-C. Future longitudinal prospective studies are needed to assess the long-term effects on patient's atopic disease after COVID-19 infection.
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Bazdar S, van den Berg S, Rutjes NW, Bloemsma LD, Downward GS, De Weger LA, Terheggen-Lagro SWJ, van Wijck Y, Maitland van der Zee AH, Kapitein B. The effects of the COVID-19 pandemic on PICU admissions for severe asthma exacerbations: A single-center experience. Pediatr Pulmonol 2024; 59:263-273. [PMID: 37937901 DOI: 10.1002/ppul.26741] [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: 05/26/2023] [Revised: 09/20/2023] [Accepted: 10/23/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND The incidence of severe asthma exacerbations (SAE) requiring a pediatric intensive care unit (PICU) admission during the coronavirus disease 2019 (COVID-19) pandemic (and its association with public restrictions) is largely unknown. We examined the trend of SAE requiring PICU admission before, during, and after COVID-19 restrictions in Amsterdam, the Netherlands, and its relationship with features such as environmental triggers and changes in COVID-19 restriction measures. METHODS In this single-center, retrospective cohort study, all PICU admissions of children aged ≥2 years for severe asthma at the Amsterdam UMC between 2018 and 2022 were included. The concentrations of ambient fine particulate matter (PM2.5 ) and pollen were obtained from official monitoring stations. RESULTS Between January 2018 and December 2022, 228 children were admitted to the PICU of the Amsterdam UMC for SAE. While we observed a decrease in admissions during periods of more stringent restriction, there was an increase in the PICU admission rate for SAE in some periods following the lifting of restrictions. In particular, following the COVID-19 restrictions in 2021, we observed a peak incidence of admissions from August to November, which was higher than any other peak during the indicated years. No association with air pollution or pollen was observed. CONCLUSION We hypothesize that an increase in clinically diagnosed viral infections after lockdown periods was the reason for the altered incidence of SAE at the PICU in late 2021, rather than air pollution and pollen concentrations.
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Affiliation(s)
- Somayeh Bazdar
- Department of Pulmonary Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sarah van den Berg
- Department of Pediatric Pulmonology and Allergy, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Niels W Rutjes
- Department of Pediatric Pulmonology and Allergy, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lizan D Bloemsma
- Department of Pulmonary Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam UMC, Amsterdam, The Netherlands
| | - George S Downward
- Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
- Department of Global Public Health & Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Letty A De Weger
- Department of Pulmonology and Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Suzanne W J Terheggen-Lagro
- Department of Pediatric Pulmonology and Allergy, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Yolanda van Wijck
- Department of Pulmonary Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam UMC, Amsterdam, The Netherlands
| | - Anke H Maitland van der Zee
- Department of Pulmonary Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Pediatric Pulmonology and Allergy, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Berber Kapitein
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Gleeson PK, Morales KH, Buckey TM, Fadugba OO, Apter AJ, Christie JD, Himes BE. Benefits of Aeroallergen Testing on Oral Corticosteroid Bursts in Adults with Asthma. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.29.24301962. [PMID: 38352545 PMCID: PMC10863005 DOI: 10.1101/2024.01.29.24301962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND Aeroallergen testing can improve precision care for persistent asthma and is recommended by the U.S. clinical guidelines. How testing benefits diverse populations of adults with asthma, and the importance of the testing modality used, are not fully understood. OBJECTIVE We sought to evaluate whether receipt of aeroallergen testing was associated with a reduction in oral corticosteroid (OCS) bursts. METHODS We used electronic health record data to conduct a retrospective, observational cohort study of adults with asthma who were prescribed an inhaled corticosteroid and had an Allergy/Immunology visit in a large health system between 1/1/2017-6/30/2022. Negative binomial regression models were used to evaluate whether OCS bursts in the 12-month period after an initial visit were reduced for patients who received aeroallergen testing. We also measured differences in benefit after excluding patients with chronic obstructive pulmonary disease (COPD) and smoking histories, and whether testing receipt was via skin prick or serum. RESULTS 668/1,383 (48.3%) patients received testing. Receipt of testing was not associated with fewer bursts in all patients (incidence rate ratio (IRR)=0.83 versus no testing, p=0.059), but it was among never smokers without COPD (417/844 tested, IRR=0.68, p=0.004). The receipt of skin testing was associated with fewer bursts in all patients (418/1,383 tested, IRR=0.77, p=0.02) and among never smokers without COPD (283/844 tested, IRR=0.59 versus no testing, p=0.001). CONCLUSION Guideline-concordant aeroallergen testing in the context of Allergy/Immunology care was associated with clinical benefit in a real-life, diverse cohort of adults with asthma. This benefit varied according to patient comorbidities and the testing modality.
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Singh A, Morley GL, Coignet C, Leach F, Pope FD, Neil Thomas G, Stacey B, Bush T, Cole S, Economides G, Anderson R, Abreu P, Bartington SE. Impacts of ambient air quality on acute asthma hospital admissions during the COVID-19 pandemic in Oxford City, UK: a time-series study. BMJ Open 2024; 14:e070704. [PMID: 38262660 PMCID: PMC10806833 DOI: 10.1136/bmjopen-2022-070704] [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: 12/09/2022] [Accepted: 12/14/2023] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVES The study aims to investigate the short-term associations between exposure to ambient air pollution (nitrogen dioxide (NO2), particulate matter pollution-particles with diameter<2.5 µm (PM2.5) and PM10) and incidence of asthma hospital admissions among adults, in Oxford, UK. DESIGN Retrospective time-series study. SETTING Oxford City (postcode areas OX1-OX4), UK. PARTICIPANTS Adult population living within the postcode areas OX1-OX4 in Oxford, UK from 1 January 2015 to 31 December 2021. PRIMARY AND SECONDARY OUTCOME MEASURES Hourly NO2, PM2.5 and PM10 concentrations and meteorological data for the period 1 January 2015 to 31 December 2020 were analysed and used as exposures. We used Poisson linear regression analysis to identify independent associations between air pollutant concentrations and asthma admissions rate among the adult study population, using both single (NO2, PM2.5, PM10) and multipollutant (NO2 and PM2.5, NO2 and PM10) models, where they adjustment for temperature and relative humidity. RESULTS The overall 5-year average asthma admissions rate was 78 per 100 000 population during the study period. The annual average rate decreased to 46 per 100 000 population during 2020 (incidence rate ratio 0.58, 95% CI 0.42 to 0.81, p<0.001) compared to the prepandemic years (2015-2019). In single-pollutant analysis, we observed a significantly increased risk of asthma admission associated with each 1 μg/m3 increase in monthly concentrations of NO2 4% (95% CI 1.009% to 1.072%), PM2.5 3% (95% CI 1.006% to 1.052%) and PM10 1.8% (95% CI 0.999% to 1.038%). However, in the multipollutant regression model, the effect of each individual pollutant was attenuated. CONCLUSIONS Ambient NO2 and PM2.5 air pollution exposure increased the risk of asthma admissions in this urban setting. Improvements in air quality during COVID-19 lockdown periods may have contributed to a substantially reduced acute asthma disease burden. Large-scale measures to improve air quality have potential to protect vulnerable people living with chronic asthma in urban areas.
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Affiliation(s)
- Ajit Singh
- School of Geography Earth and Environmental Sciences, University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Gabriella L Morley
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
| | - Cécile Coignet
- NHS Oxfordshire Clinical Commissioning Group, Oxford, UK
| | - Felix Leach
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - Francis D Pope
- School of Geography Earth and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Graham Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Tony Bush
- Department of Engineering Science, University of Oxford, Oxford, UK
- Apertum, Oxfordshire, UK
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Sarikloglou E, Fouzas S, Paraskakis E. Prediction of Asthma Exacerbations in Children. J Pers Med 2023; 14:20. [PMID: 38248721 PMCID: PMC10820562 DOI: 10.3390/jpm14010020] [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: 11/26/2023] [Revised: 12/17/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Asthma exacerbations are common in asthmatic children, even among those with good disease control. Asthma attacks result in the children and their parents missing school and work days; limit the patient's social and physical activities; and lead to emergency department visits, hospital admissions, or even fatal events. Thus, the prompt identification of asthmatic children at risk for exacerbation is crucial, as it may allow for proactive measures that could prevent these episodes. Children prone to asthma exacerbation are a heterogeneous group; various demographic factors such as younger age, ethnic group, low family income, clinical parameters (history of an exacerbation in the past 12 months, poor asthma control, poor adherence to treatment, comorbidities), Th2 inflammation, and environmental exposures (pollutants, stress, viral and bacterial pathogens) determine the risk of a future exacerbation and should be carefully considered. This paper aims to review the existing evidence regarding the predictors of asthma exacerbations in children and offer practical monitoring guidance for promptly recognizing patients at risk.
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Affiliation(s)
| | - Sotirios Fouzas
- Department of Pediatrics, University of Patras Medical School, 26504 Patras, Greece;
| | - Emmanouil Paraskakis
- Paediatric Respiratory Unit, Paediatric Department, University of Crete, 71500 Heraklion, Greece
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Sasada T, Hayashi K, Okafuji I, Miyakoshi C, Tsuruta S. Incidence and causative agent distribution of viral-induced paediatric asthma exacerbations under strict infection control measures: a single-centre retrospective study in Japan. BMC Pulm Med 2023; 23:480. [PMID: 38031001 PMCID: PMC10685531 DOI: 10.1186/s12890-023-02779-9] [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: 08/22/2023] [Accepted: 11/22/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND The prevalence of respiratory viruses in children changed under strict infection control measures during the coronavirus disease 2019 (COVID-19) outbreak. In this study, we investigated the frequency of viral detection in the nasopharynx of paediatric patients with asthma exacerbations requiring hospitalization during the COVID-19 pandemic, as well as the distribution of causative viruses. METHODS We included paediatric patients admitted for asthma exacerbations between November 2020 and December 2022 at a single centre in Kobe, Japan. Demographic, clinical, and laboratory data were collected from their medical records and using additional questionnaires. All patients enrolled in this study met the diagnostic criteria for asthma exacerbations outlined in the Japanese Pediatric Guideline for the Treatment and Management of Bronchial Asthma 2020. Statistical differences were calculated using univariate analyses (chi-square or Mann‒Whitney U test). RESULTS We enrolled 203 children hospitalized for asthma attacks and collected nasopharyngeal samples from 189 patients. The median patient age was 3.0 years. Asthma severity was classified as mild (4.0%), moderate (82.3%), or severe (13.8%). The proportion of viral respiratory infections was 95.2% (180/189). The rate of patients with multiple viral infections was 20.6% (39/189). The most frequently detected pathogens were rhinovirus and enterovirus (RV/EV) at 69.3% (131/189), allowing for duplicate detection, followed by respiratory syncytial virus (RSV) at 28.6% (54/189). We also detected RV/EV almost every month compared to RSV and other viruses. In addition, RV/EV-positive patients were significantly older (p = 0.033), exhibited higher WBC counts (p < 0.001) and higher Eos counts (p < 0.001), had elevated total IgE levels (p < 0.001) and house dust mite-specific IgE levels (p = 0.019), had a shorter duration of hospitalization (p < 0.001), and had a shorter duration of oxygen therapy (p < 0.001). In patients positive for RV/EV, the use of ICSs significantly reduced the severity of the condition (p < 0.001). CONCLUSION Even under strict infection control measures, respiratory viruses were detected in the nasopharynx of almost all paediatric patients who had asthma exacerbations requiring hospitalization.
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Affiliation(s)
- Tsuyoshi Sasada
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 1-1, Minatojima-Minamimachi 2-Chome, Chuo-Ku, Kobe, 650-0047, Japan.
| | - Ken Hayashi
- Department of Pediatrics, Kobe City Medical Center General Hospital, 1-1, Minatojima-Minamimachi 2-Chome, Chuo-Ku, Kobe, 650-0047, Japan
| | - Ikuo Okafuji
- Department of Pediatrics, Kobe City Medical Center General Hospital, 1-1, Minatojima-Minamimachi 2-Chome, Chuo-Ku, Kobe, 650-0047, Japan
| | - Chisato Miyakoshi
- Department of Pediatrics, Kobe City Medical Center General Hospital, 1-1, Minatojima-Minamimachi 2-Chome, Chuo-Ku, Kobe, 650-0047, Japan
| | - Satoru Tsuruta
- Department of Pediatrics, Kobe City Medical Center General Hospital, 1-1, Minatojima-Minamimachi 2-Chome, Chuo-Ku, Kobe, 650-0047, Japan
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Alimani GS, Ananth S, Boccabella C, Khaleva E, Roberts G, Papadopoulos NG, Kosmidis C, Vestbo J, Papageorgiou E, Beloukas A, Mathioudakis AG. Prevalence and clinical implications of respiratory viruses in asthma during stable disease state and acute attacks: Protocol for a meta-analysis. PLoS One 2023; 18:e0294416. [PMID: 37967134 PMCID: PMC10651012 DOI: 10.1371/journal.pone.0294416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 10/31/2023] [Indexed: 11/17/2023] Open
Abstract
INTRODUCTION Viruses are detected in over 50% of acute asthma attacks and in a notable proportion of patients with asthma during stable disease state They are associated with worse outcomes. We will conduct a series of systematic reviews and meta-analyses to quantify the prevalence and clinical burden of various respiratory viruses in stable asthma and acute asthma attacks. In addition, we will assess the viral loads of respiratory viruses during stable and acute asthma, to explore whether viral load could differentiate attacks triggered by viruses versus those where viruses are present as "innocent bystanders". MATERIALS AND METHODS Based on a prospectively registered protocol (PROSPERO, ID: CRD42023375108) and following standard methodology recommended by Cochrane, we will systematically search Medline/PubMed, EMBASE, the Cochrane Library and relevant conference proceedings for studies assessing the prevalence or clinical burden of respiratory viruses in asthma. Methodological rigour of the included studies will be appraised using a tool specific for prevalence studies and the Newcastle-Ottawa Scale respectively. In anticipation of significant clinical and methodological heterogeneity, we will conduct random effect meta-analyses. For evaluating the prevalence of viruses, we will perform meta-analyses of proportions using the inverse variance method, and the Freeman-Tukey transformation. We will conduct meta-regression analyses for exploring heterogeneity. CONCLUSION We envisage that these systematic reviews and meta-analyses will quantify the prevalence and burden of respiratory viruses in stable and acute asthma and will drive future research and clinical practice.
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Affiliation(s)
| | - Sachin Ananth
- London North West University Healthcare Trust, London, United Kingdom
| | - Cristina Boccabella
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario "A Gemelli"—IRCCS, University of the Sacred Heart, Rome, Italy
| | - Ekaterina Khaleva
- Faculty of Medicine, Clinical and Experimental Sciences and Human Development in Health, University of Southampton, Southampton, United Kingdom
| | - Graham Roberts
- Faculty of Medicine, Clinical and Experimental Sciences and Human Development in Health, University of Southampton, Southampton, United Kingdom
- Paediatric Allergy and Respiratory Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Nikolaos G. Papadopoulos
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Chris Kosmidis
- Division of Evolution, Infection and Genomics, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Jørgen Vestbo
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- The North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Effie Papageorgiou
- Department of Biomedical Sciences, University of West Attica, Athens, Greece
| | - Apostolos Beloukas
- Department of Biomedical Sciences, University of West Attica, Athens, Greece
- National AIDS Reference Centre of Southern Greece, University of West Attica, Athens, Greece
| | - Alexander G. Mathioudakis
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- The North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
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10
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Xing Y, Leung ASY, Wong GWK. From preschool wheezing to asthma: Environmental determinants. Pediatr Allergy Immunol 2023; 34:e14049. [PMID: 38010001 DOI: 10.1111/pai.14049] [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: 10/19/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023]
Abstract
Wheezing is common among preschool children, representing a group of highly heterogeneous conditions with varying natural history. Several phenotypes of wheezing have been proposed to facilitate the identification of young children who are at risk of subsequent development of asthma. Epidemiological and immunological studies across different populations have revealed the key role of environmental factors in influencing the progression from preschool wheezing to childhood asthma. Significant risk factors include severe respiratory infections, allergic sensitization, and exposure to tobacco smoke. In contrast, a farming/rural environment has been linked to asthma protection in both human and animal studies. Early and intense exposures to microorganisms and microbial metabolites have been demonstrated to alter host immune responses to allergens and viruses, thereby driving the trajectory away from wheezing illness and asthma. Ongoing clinical trials of candidate microbes and microbial products have shown promise in shaping the immune function to reduce episodes of viral-induced wheezing. Moreover, restoring immune training may be especially important for young children who had reduced microbial exposure due to pandemic restrictions. A comprehensive understanding of the role of modifiable environmental factors will pave the way for developing targeted prevention strategies for preschool wheezing and asthma.
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Affiliation(s)
- Yuhan Xing
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Agnes Sze-Yin Leung
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Gary Wing-Kin Wong
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
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11
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Hamadneh M, Alquran A, Manna R. Impact of the COVID-19 on asthma control among children: A systematic review. J Public Health Res 2023; 12:22799036231197186. [PMID: 37693736 PMCID: PMC10492482 DOI: 10.1177/22799036231197186] [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: 11/18/2022] [Accepted: 07/16/2023] [Indexed: 09/12/2023] Open
Abstract
In December 2019, the current outbreak of coronavirus disease 2019 (COVID-19) was reported in Wuhan, China. Asthmatic patients are thought to be more vulnerable to the more severe form of SARS-CoV-2 infection due to their weakened immune systems and increased risk of respiratory exacerbation when infected with respiratory viruses; however, there is little evidence to support this theory. The objective of this systematic review is to assess the impact of the COVID-19 lockdown during the pandemic on asthma management outcome measures among children and adolescents. To conduct the search, we used five bibliographic databases. The results were limited to those articles published between December 2019 and February 2022, selecting only articles published in English that included the study population (children aged 0-18 years). All study designs were considered. Independent assessments of the included studies' quality were made and reported. Among the 945 results of the bibliographic search, only 21 articles were found to fit our eligibility criteria We organized the results from the studies according to the effect of the lockdown at the start of the COVID-19 pandemic on common outcomes, including the Pediatric Emergency Department Visits, hospitalization rates of pediatric asthmatic patients during the pandemic, asthma control, asthma exacerbations, psychological effects on patients, and caregivers' concerns. The management of pediatric asthma improved more during the 2020 COVID-19 pandemic lockdown than in previous years.
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Affiliation(s)
- Mai Hamadneh
- Department of Medical Science, Irbid Faculty, Al-Balqa Applied University (BAU), Irbid, Jordan
| | - Alaa Alquran
- Department of Public Health, Faculty of Medicine, Al-Balqa Applied University (BAU), Assalt, Jordan
| | - Rami Manna
- Jordan Ministry of Health, Ramtha Comprehensive Health Center, Ramtha, Jordan
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12
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Chand K, Butt MI, Tahir HM. Parental Attitude, Knowledge, and Practices Regarding the Usage of Antibiotics for Upper Respiratory Tract Infections in Children During the COVID-19 Pandemic. Cureus 2023; 15:e39932. [PMID: 37415993 PMCID: PMC10319945 DOI: 10.7759/cureus.39932] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/03/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has raised knowledge of the proper antibiotic dosage for treating childhood upper respiratory tract infections (URTIs). In order to ensure proper antibiotic usage and prevent the establishment of illnesses that is antibiotic-resistant during the COVID-19 pandemic, parental attitudes, knowledge, and behaviour surrounding antibiotic use for URTIs in children are essential. The goal of this study was to find out the parental attitude, knowledge, and practices regarding the usage of antibiotics for URTIs in children during the COVID-19 epidemic. METHODOLOGY This cross-sectional was conducted in the Department of Paediatric Medicine, Central Hospital, Ganesh Nagar, New Delhi, India from September 2022 to February 2023. The study analysed a total of 500. All the children had URTIs. A structured questionnaire was randomly distributed among parents. Socio-demographic information like gender, age, occupation, monthly family income, and age of the children were noted at the time of enrollment. Outcomes were recorded in terms of responses to questions regarding attitude, knowledge, and practices regarding the use of antibiotics for URTIs in children during the COVID-19 epidemic. Results: Of a total of 500 parents, 380 (76.0%) were male. The mean age was 39.9±8.3 years while 280 (56.0%) participants were aged between 31 to 45 years. Relatively older age (p<0.0001) and occupational status as unemployed (p<0.0001) were found to have a significant association with response to "virus being the cause of COVID-19". Females (p=0.0004) and increasing age (p<0.0001) were found to have significant associations with incorrect responses to "antibiotics are essential for managing the symptoms in children with COVID-19". Incorrect responses to "without the use of antibiotics, children usually suffer from greater periods of sickness" were associated with females and increasing age (p<0.0001). Incorrect responses to "not using antibiotics will prove beneficial for the children suffering from COVID-19" were significantly associated with female gender (p=0.0016) and increasing age (p<0.0001). The incorrect responses to "how often are antibiotics being prescribed to the COVID-19 children" was significantly linked with females and relatively older age (p<0.0001). CONCLUSIONS Parental attitude, knowledge, and practices regarding the usage of antibiotics for URTIs in children during the COVID-19 epidemic showed variations. Parental attitude, knowledge, and practices were associated with gender, age, and socio-economic status.
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Affiliation(s)
- Kanwal Chand
- Department of Paediatric Medicine, Central Hospital, Delhi, IND
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13
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Akelma Z, Çetin S, Başkaya N, Bostancı İ, Özmen S. Preschool children with asthma during the Covid-19 pandemic: fewer infections, less wheezing. J Asthma 2023; 60:691-697. [PMID: 35696321 DOI: 10.1080/02770903.2022.2089994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION A few studies have already investigated preschool children with asthma during the pandemic. The purpose of this research was to investigate how preschool children with asthma were affected by the precautionary measures adopted during the pandemic. METHODS Preschool children with asthma aged 18-60 months evaluated in our clinic in March-May 2019, before the Covid-19 pandemic, were included in the study. The lockdown continued during March, April, and May 2020. The questionnaires and asthma symptom control tests for preschool children with asthma in 2019 and 2020 were then evaluated. RESULTS Sixty-three preschool children with asthma, 37 boys and 26 girls, aged 18-60 months (median 47) were included in the study. The median number of upper respiratory tract infections (URTIs) and lower respiratory tract infections (LRTIs), and the use of antibiotics were significantly lower in 2020 than 2019 (p<.01). The median numbers of the pediatric emergency department (PED) visits and hospitalizations were also lower in 2020 than in 2019 (p<.05). In 2019, 31 children with asthma were well controlled, 28 were partly controlled, and 4 were uncontrolled, compared to 58 well controlled, four partly controlled, and one uncontrolled in 2020 (p<.01). CONCLUSIONS Preschool children with asthma have been positively affected in terms of PED admission, hospitalization, and asthma symptom control in association with the Covid-19 pandemic and the resulting lockdown measures. This study revealed that wheezing decreased significantly in the absence of respiratory infection in preschool children with asthma. Namely, fewer infections meant less wheezing.
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Affiliation(s)
- Zülfikar Akelma
- Pediatric Allergy and Immunology Clinic, Dr. Sami Ulus Maternity and Children's Research and Training Hospital, Ankara, Türkiye
- Division of Pediatric Allergy and Immunology, Ankara Yıldırım Beyazıt University, Ankara, Türkiye
| | - Sema Çetin
- Pediatric Allergy and Immunology Clinic, Dr. Sami Ulus Maternity and Children's Research and Training Hospital, Ankara, Türkiye
| | - Nevzat Başkaya
- Pediatric Allergy and Immunology Clinic, Dr. Sami Ulus Maternity and Children's Research and Training Hospital, Ankara, Türkiye
| | - İlknur Bostancı
- Pediatric Allergy and Immunology Clinic, Dr. Sami Ulus Maternity and Children's Research and Training Hospital, Ankara, Türkiye
- Division of Pediatric Allergy and Immunology, University of Health Sciences, Ankara, Türkiye
| | - Serap Özmen
- Pediatric Allergy and Immunology Clinic, Dr. Sami Ulus Maternity and Children's Research and Training Hospital, Ankara, Türkiye
- Division of Pediatric Allergy and Immunology, University of Health Sciences, Ankara, Türkiye
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14
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Feldman JM, Serebrisky D, Starr S, Castaño K, Greenfield N, Silverstein G, Fruchter N, Mammen J, McGovern C, Arcoleo K. Reduced asthma morbidity during COVID-19 in minority children: is medication adherence a reason? J Asthma 2023; 60:468-478. [PMID: 35341432 PMCID: PMC9532462 DOI: 10.1080/02770903.2022.2059510] [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: 11/02/2021] [Revised: 03/18/2022] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Asthma control improved during the COVID-19 pandemic. This study examined objectively measured medication adherence, asthma morbidity and quality of life (QoL) outcomes in Black and Latinx children by month for January-June 2019 (pre-COVID) compared to January-June 2020 (including first peak of COVID). METHODS Secondary analyses of 94 children with asthma (ages 10-17 years, 64% Latinx, 36% Black) and their caregivers assigned to the comparison group of a longitudinal RCT intervention trial. Outcomes included mean aggregate electronic adherence for controller medications, oral steroid bursts, acute healthcare utilization, caregiver asthma QoL, and the Asthma Control Test. Repeated measures analyses were conducted due to multiple observations. RESULTS Adherence to controller medications declined 48% from 2019 to 2020 (LS Mean = 33.9% vs. 17.6%, p=.0004, f=.92) with levels reaching a low in May 2020. A reduction in steroid bursts was observed over the same timeframe, 1.29 vs. 0.61, p = 0.006, f=.63. Caregiver QoL increased from 2019 to 2020 on total score (5.18 vs. 5.85, p = 0.002, f=.72), activity limitations (5.04 vs. 5.95), and emotional functioning (5.26 vs. 5.80). Although not statistically significant, a clinically meaningful 62% reduction in acute healthcare visits (p = 0.15) was reported in 2020. Children reported better asthma control (OR = 1.47, 95% CI 1.24, 1.73, p < 0.0001) in 2020 versus 2019 driven by improvements from May to June 2020. CONCLUSIONS Decreased asthma morbidity in minority children during COVID was coupled with decreased adherence to controller medications. This observed decrease in morbidity is not explained by improvements in adherence.
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Affiliation(s)
- Jonathan M. Feldman
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
- Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Department of Pediatrics, Division of Academic General Pediatrics, Bronx, NY
| | | | - Sheena Starr
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
| | - Katerina Castaño
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
| | - Naomi Greenfield
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
| | | | - Natalie Fruchter
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
| | | | - Colleen McGovern
- University Of North Carolina at Greensboro School of Nursing, Greensboro, NC
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15
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Lovinsky-Desir S, Volerman A. Applying Lessons from the COVID-19 Pandemic to Improve Pediatric Asthma Care. Pulm Ther 2023; 9:15-24. [PMID: 36443534 PMCID: PMC9707220 DOI: 10.1007/s41030-022-00207-7] [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: 10/13/2022] [Accepted: 11/07/2022] [Indexed: 12/02/2022] Open
Abstract
Asthma is the most common chronic childhood condition and is a risk factor for severe respiratory viral infections. Thus, early during the coronavirus disease 2019 (COVID-19) pandemic there was concern that children with asthma would be at risk for severe COVID-19 illness and that asthma control could worsen as a result of the pandemic. This article seeks to summarize what was learned in the early stages of the pandemic about the impact of COVID-19 on children with asthma. We review evidence from several studies that demonstrated a significant decline in asthma morbidity in the first year of the pandemic. Additionally, we describe several potential mechanisms that may explain the reduced frequency in childhood asthma exacerbations as well as review lessons learned for future management of childhood asthma. While the COVID-19 pandemic initially brought uncertainty, it soon became clear that the pandemic had several positive effects for children with asthma. Now we can apply the lessons that were learned during the pandemic to re-examine asthma care practices as well as advocate for best approaches for asthma management.
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Affiliation(s)
- Stephanie Lovinsky-Desir
- Department of Pediatrics and Environmental Health Sciences, Columbia University Irving Medical Center, New York, NY, USA.
| | - Anna Volerman
- Departments of Medicine and Pediatrics, University of Chicago, Chicago, IL, USA
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16
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Ye D, Gates A, Radhakrishnan L, Mirabelli MC, Flanders WD, Sircar K. Changes in asthma emergency department visits in the United States during the COVID-19 pandemic. J Asthma 2023:1-7. [PMID: 36608267 DOI: 10.1080/02770903.2023.2165445] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE A better understanding of the impacts of the Coronavirus disease 2019 (COVID-19) pandemic on emergency department (ED) visits for asthma is needed to improve asthma control. METHODS Using data from the National Syndromic Surveillance Program (NSSP), we assessed changes in average weekly asthma ED visits in the United States in 3 surveillance periods: 1) March 15, 2020-January 2, 2021; 2) January 3, 2021-January 1, 2022; and 3) January 2-March 5, 2022, relative to pre-pandemic comparison periods between December 30, 2018 and December 28, 2019. For each surveillance period, we assessed changes in asthma ED visits by age group and sex. RESULTS For the surveillance period beginning March 15, 2020, average weekly asthma ED visits declined 31% relative to what was observed during the comparison period - that is, from 45,276 visits/week in 2019 to 31,374 visits/week in 2020. Declines of over 19% and 26% were observed for 2021 and 2022, respectively, relative to the comparison periods. In all surveillance periods, the largest declines occurred among children, especially those ages 0-4 (74%) and 5-11 (66%) years. CONCLUSIONS The COVID-19 pandemic impacted asthma ED visits in the United States. The impact was greater among children than adults, as ED visits among children were notably lower during all three pandemic surveillance periods than during the corresponding pre-pandemic periods. Additional information about the roles of behaviors of patients with asthma and changes in asthma care might improve our understanding of the reasons underlying these observed changes.
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Affiliation(s)
- Dongni Ye
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Abigail Gates
- Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lakshmi Radhakrishnan
- Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maria C Mirabelli
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - W Dana Flanders
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kanta Sircar
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.,U.S. Public Health Service Commissioned Corps, Rockville, MD, USA
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17
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Silva TM, Pinto BS, Cunha I, Roque F, Figueiras A, Fonseca J, Herdeiro MT, Gomes ER. Impact of the COVID-19 Pandemic on the Prescribing of Antiasthmatic Treatments in Portugal: A Nationwide Study. Clin Ther 2023; 45:e89-e99.e2. [PMID: 36775690 PMCID: PMC9841074 DOI: 10.1016/j.clinthera.2023.01.003] [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: 11/03/2022] [Revised: 12/22/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023]
Abstract
PURPOSE The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on everyday life, the environment, and health care services. A shift from in-person medical appointments to telemedicine was a main adjustment. Such changes can have repercussions on the control and management of chronic respiratory diseases, such as asthma. The available data suggest that there was an overall decrease in asthma-related morbidities during the first year of the pandemic. Therefore, the goal of this study was to quantify the effects of the pandemic on the prescribing of antiasthmatic treatments in outpatient care (public and private health care). METHODS This before-after study used a time series approach based on data from monthly prescriptions of antiasthmatic drugs (anti-inflammatory drugs and bronchodilators) dated between April 2018 and March 2021. An interrupted time series (ITS) design was used for assessing changes in antiasthmatic prescribing patterns in the short and long terms after COVID-19 was recognized as a pandemic. The results are complemented with seasonal autoregressive integrated moving average (sARIMA) models. FINDINGS The ITS analysis showed a non-significant increase in antiasthmatic prescribing in the short term. In the long term, after the pandemic was declared, a statistically significant decrease was observed in the prescribing of antiasthmatics (in anti-inflammatory drugs and, more pronounced, in bronchodilators). In the sARIMA model, the mean monthly volume of antiasthmatic prescriptions was 18.1% lower than predicted. The numbers of months outside of the 95% CIs were different between anti-inflammatory drugs (1 month) and bronchodilators (7 months). IMPLICATIONS The prescribing of antiasthmatic drugs in the long term was significantly decreased with the COVID-19 pandemic, with a greater effect in the case of bronchodilators.
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Affiliation(s)
- Tânia Magalhães Silva
- Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal.
| | - Bernardo Sousa Pinto
- Faculty of Medicine, Center for Health Technology and Services Research, and the Department of Community Medicine, Information and Health Decision Sciences, University of Porto, Porto, Portugal
| | - Inês Cunha
- Allergy and Clinical Immunology Service, University Hospital Center of Porto, Porto, Portugal
| | - Fátima Roque
- Research Unit for Inland Development, Guarda Polytechnic Institute, Guarda, Portugal; Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - Adolfo Figueiras
- Department of Preventive Medicine and Public Health, and the Health Research Institute of Santiago de Compostela, University of Santiago de Compostela, Santiago de Compostela, Spain; Consortium for Biomedical Research in Epidemiology and Public Health, Santiago de Compostela, Spain
| | - João Fonseca
- Faculty of Medicine, Center for Health Technology and Services Research, and the Department of Community Medicine, Information and Health Decision Sciences, University of Porto, Porto, Portugal
| | - Maria Teresa Herdeiro
- Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Eva Rebelo Gomes
- Allergy and Clinical Immunology Service, University Hospital Center of Porto, Porto, Portugal.
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Xepapadaki P, Adachi Y, Pozo Beltrán CF, El-Sayed ZA, Gómez RM, Hossny E, Filipovic I, Le Souef P, Morais-Almeida M, Miligkos M, Nieto A, Phipatanakul W, Pitrez PM, Wang JY, Wong GW, Papadopoulos NG. Utility of biomarkers in the diagnosis and monitoring of asthmatic children. World Allergy Organ J 2022; 16:100727. [PMID: 36601259 PMCID: PMC9791923 DOI: 10.1016/j.waojou.2022.100727] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 11/17/2022] [Accepted: 11/17/2022] [Indexed: 12/23/2022] Open
Abstract
Asthma imposes a heavy morbidity burden during childhood; it affects over 10% of children in Europe and North America and it is estimated to exceed 400 million people worldwide by the year 2025. In clinical practice, diagnosis of asthma in children is mostly based on clinical criteria; nevertheless, assessment of both physiological and pathological processes through biomarkers, support asthma diagnosis, aid monitoring, and further lead to better treatment outcomes and reduced morbidity. Recently, identification and validation of biomarkers in pediatric asthma has emerged as a top priority across leading experts, researchers, and clinicians. Moreover, the implementation of non-invasive biomarkers for the assessment and monitoring of paediatric patients with asthma, has been prioritized; however, only a proportion of them are currently included in the clinical practise. Although, the use of non-invasive biomarkers is highly supported in recent asthma guidelines for documenting diagnosis and supporting monitoring of asthmatic patients, data on the Pediatric population are limited. In the present report, the Pediatric Asthma Committee of the World Allergy Organization (WAO), aims to summarize and discuss available data for the implementation of non-invasive biomarkers in the diagnosis and monitoring in children with asthma. Information on the most studied biomarkers, including spirometry, oscillometry, markers of allergic sensitization, fractional exhaled nitric oxide, and the most recent exhaled breath markers and "omic" approaches, will be reviewed. Practical limitations and considerations based on both experts' opinion and critical review of the literature, on the utility of all "well-known" and newly introduced non-invasive biomarkers will be presented. A critical commentary on biomarkers' use in diagnosing and monitoring asthma during the COVID-19 pandemic, cost and availability of biomarkers in different settings and in developing countries, the differences on the biomarkers use between Primary Practitioners, Pediatricians, and Specialists and their role on the longitudinal aspect of asthma is provided.
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Affiliation(s)
- Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
- Corresponding author.
| | - Yuichi Adachi
- Department of Pediatrics, Faculty of Medicine, University of Toyam, Japan
| | | | - Zeinab A. El-Sayed
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | | | - Elham Hossny
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Ivana Filipovic
- University Hospital Center Dr Dragiša Mišović Hospital Pediatric Department, Serbia
| | - Peter Le Souef
- Faculty of Health and Medical Sciences, Dept of Respiratory Medicine, Child and Adolescent Health Service, University of Western Australia, Perth, Australia
| | | | - Michael Miligkos
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Antonio Nieto
- Pediatric Pulmonology & Allergy Unit Children's. Health Research Institute. Hospital La Fe, 46026, Valencia, Spain
| | - Wanda Phipatanakul
- Pediatric Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA
| | - Paulo M. Pitrez
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Jiu-Yao Wang
- Center for Allergy and Clinical Immunology Research, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Gary W.K. Wong
- Department of Paediatrics, The Chinese University of Hong Kong, China
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19
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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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20
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Nazif J, Silver E, Okada C, Gross E. Comparison of Children Hospitalized for Asthma Before and During the COVID-19 Pandemic. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2022; 35:174-178. [PMID: 36537703 DOI: 10.1089/ped.2022.0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: Studies suggest that children with asthma experienced improved symptom control and less frequent inpatient admission during the COVID-19 (coronavirus disease 2019) pandemic. The characteristics of hospitalized children remain less well defined. Methods: This retrospective cohort study compared patients admitted for asthma during the pandemic with patients hospitalized the year prior at a children's hospital in the Bronx, New York. Results: In the year before the pandemic, 667 children were hospitalized for asthma, compared with 177 children the following year. Children admitted during the pandemic were older (7.8 versus 7.0 years, P = 0.04), more likely underweight (P < 0.01), and more likely to have public insurance (P = 0.02). Additionally, children hospitalized during the pandemic required intensive care (P = 0.03) and magnesium sulfate (P = 0.05) more frequently. Despite this, length of stay remained similar. Conclusion: While inpatient utilization for asthma decreased during the pandemic, children hospitalized were sicker on presentation. The cause of this is likely multifactorial and requires further study.
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Affiliation(s)
- Joanne Nazif
- Albert Einstein College of Medicine, Bronx, New York, USA.,Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York, USA
| | - Ellen Silver
- Albert Einstein College of Medicine, Bronx, New York, USA.,Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York, USA
| | - Chihiro Okada
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Elissa Gross
- Albert Einstein College of Medicine, Bronx, New York, USA.,Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York, USA
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21
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Effects of COVID-19 and Social Distancing on Rhinovirus Infections and Asthma Exacerbations. Viruses 2022; 14:v14112340. [PMID: 36366439 PMCID: PMC9698629 DOI: 10.3390/v14112340] [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: 10/07/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 02/01/2023] Open
Abstract
Since their discovery in the 1950s, rhinoviruses (RVs) have been recognized as a major causative agent of the "common cold" and cold-like illnesses, accounting for more than 50% of upper respiratory tract infections. However, more than that, respiratory viral infections are responsible for approximately 50% of asthma exacerbations in adults and 80% in children. In addition to causing exacerbations of asthma, COPD and other chronic lung diseases, RVs have also been implicated in the pathogenesis of lower respiratory tract infections including bronchiolitis and community acquired pneumonia. Finally, early life respiratory viral infections with RV have been associated with asthma development in children. Due to the vast genetic diversity of RVs (approximately 160 known serotypes), recurrent infection is common. RV infections are generally acquired in the community with transmission occurring via inhalation of aerosols, respiratory droplets or fomites. Following the outbreak of coronavirus disease 2019 (COVID-19), exposure to RV and other respiratory viruses was significantly reduced due to social-distancing, restrictions on social gatherings, and increased hygiene protocols. In the present review, we summarize the impact of COVID-19 preventative measures on the incidence of RV infection and its sequelae.
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22
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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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23
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Doumit M, Chuang S, Middleton P, Selvadurai H, Sivam S, Ruseckaite R, Ahern S, Mallitt KA, Pacey V, Gray K, Jaffe A. Clinical outcomes of adults and children with cystic fibrosis during the COVID-19 pandemic. J Cyst Fibros 2022:S1569-1993(22)00685-3. [PMID: 36163166 PMCID: PMC9477965 DOI: 10.1016/j.jcf.2022.09.006] [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: 04/19/2022] [Revised: 09/06/2022] [Accepted: 09/14/2022] [Indexed: 11/30/2022]
Abstract
Background The onset of the COVID-19 pandemic was associated with restricted community movement and limited access to healthcare facilities, resulting in changed clinical service delivery to people with cystic fibrosis (CF). This study aimed to determine clinical outcomes of Australian adults and children with CF in the 12-months following the onset of the COVID-19 pandemic. Methods This longitudinal cohort study used national registry data. Primary outcomes were 12-month change in percent predicted forced expiratory volume in one second (FEV1 %pred), body mass index (BMI) in adults and BMI z-scores in children. A piecewise linear mixed-effects model was used to determine trends in outcomes before and after pandemic onset. Results Data were available for 3662 individuals (median age 19.6 years, range 0-82). When trends in outcomes before and after pandemic onset were compared; FEV1 %pred went from a mean annual decline of -0.13% (95%CI -0.36 to 0.11) to a mean improvement of 1.76% (95%CI 1.46-2.05). Annual trend in BMI improved from 0.03 kg/m2 (95%CI -0.02-0.08) to 0.30 kg/m2 (95%CI 0.25-0.45) and BMI z-scores improved from 0.05 (95%CI 0.03-0.07) to 0.12 (95%CI 0.09-0.14). Number of hospitalisations decreased from a total of 2656 to 1957 (p < 0.01). Virtual consultations increased from 8% to 47% and average number of consultations per patient increased from median (IQR) of 4(2-5) to 5(3-6) (p < 0.01). Conclusion In the 12-months following the onset of the COVID-19 pandemic, there was an improvement in the clinical outcomes of people with CF when compared to the pre-pandemic period.
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Affiliation(s)
- Michael Doumit
- Department of Health Sciences, Macquarie University, Department of Health Sciences, 75 Talavera Rd, Macquarie University, Macquarie Park, NSW 2109, Australia; School of Women's and Children's Health, University of New South Wales, Address Level 8, Bright Alliance Building, High St, Randwick, NSW, Australia.
| | - Sandra Chuang
- School of Women's and Children's Health, University of New South Wales, Address Level 8, Bright Alliance Building, High St, Randwick, NSW, Australia; Respiratory Medicine Department, Sydney Children's Hospital, Level 0, South West Wing, Sydney Children's Hospital, High St, Randwick, NSW, Australia
| | - Peter Middleton
- Respiratory Medicine Department, Westmead Hospital, Level 2, Clinical Sciences Building, PO Box 533, Westmead Hospital, Westmead, Australia
| | - Hiran Selvadurai
- Respiratory Medicine Department, The Children's Hospital at Westmead, Corner or Hawkesbury Rd and Hainsworth St, Locked Bag 4001, Westmead, Australia
| | - Sheila Sivam
- The Department of Respiratory Medicine, Royal Prince Alfred Hospital, Level 11, Building 75, RPA Hospital Missenden Rd, Camperdown, Australia
| | - Rasa Ruseckaite
- Department of Public Health and Preventive Medicine, Monash University, Level 3, 553 St Kilda Rd, Melbourne, Australia
| | - Susannah Ahern
- Department of Epidemiology and Preventive Medicine, Monash University, Level 3, 553 St Kilda Rd, Melbourne, Australia
| | - Kylie Ann Mallitt
- Sydney School of Public Health, University of Sydney, Edward Ford Building A27, The University of Sydney, NSW, Australia. Department of Health Sciences, Macquarie University, Macquarie Park, Australia
| | - Verity Pacey
- Department of Health Sciences, Macquarie University, Department of Health Sciences, 75 Talavera Rd, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Kelly Gray
- Department of Health Sciences, Macquarie University, Department of Health Sciences, 75 Talavera Rd, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Adam Jaffe
- School of Women's and Children's Health, University of New South Wales, Address Level 8, Bright Alliance Building, High St, Randwick, NSW, Australia; Respiratory Medicine Department, Sydney Children's Hospital, Level 0, South West Wing, Sydney Children's Hospital, High St, Randwick, NSW, Australia
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24
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Ferraro VA, Zanconato S, Carraro S. Impact of COVID-19 in Children with Chronic Lung Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11483. [PMID: 36141755 PMCID: PMC9517525 DOI: 10.3390/ijerph191811483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/08/2022] [Accepted: 09/10/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND since December 2019, the world has become victim of the coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The aim of our narrative review is to analyze the impact of COVID-19 in children suffering from chronic lung disease (CLD). METHODS we searched the MEDLINE/Pubmed database using the terms "SARS-CoV-2" or "COVID-19" or "Coronavirus Diseases 2019"; AND "chronic lung diseases" or "chronic respiratory diseases" or "asthma" or "cystic fibrosis" or "primary ciliary dyskinesia" or "bronchopulmonary dysplasia"; and limiting the search to the age range 0-18 years. RESULTS AND CONCLUSIONS although COVID-19 rarely presents with a severe course in children, CLD may represent a risk factor; especially when already severe or poorly controlled before SARS-CoV-2 infection. On the other hand, typical features of children with CLD (e.g., the accurate adoption of prevention measures, and, in asthmatic patients, the regular use of inhaled corticosteroids and T2 inflammation) might have a role in preventing SARS-CoV-2 infection. Moreover, from a psychological standpoint, the restrictions associated with the pandemic had a profound impact on children and adolescents with CLD.
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25
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Shah SA, Quint JK, Sheikh A. Impact of COVID-19 pandemic on asthma exacerbations: Retrospective cohort study of over 500,000 patients in a national English primary care database. THE LANCET REGIONAL HEALTH. EUROPE 2022; 19:100428. [PMID: 35756853 PMCID: PMC9213032 DOI: 10.1016/j.lanepe.2022.100428] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Several countries reported a substantial reduction in asthma exacerbations associated with COVID-19 pandemic-related restrictions. However, it is not known if these early reported declines were short-term and if these have rebounded to pre-pandemic levels following easing of lockdown restrictions. Methods We undertook a retrospective, cohort study of all asthma patients in a national primary care database of almost 10 million patients, Optimum Patient Care Database (OPCRD), identified from January 1, 2010, to December 31, 2015, using a previously validated algorithm. We subsequently followed the identified cohort of asthma patients from January 1, 2016, to October 3, 2021, and identified every asthma exacerbation episode with a validated algorithm. To quantify any pandemic-related change in exacerbations, we created a control time-series (mean of 2016-2019) and then compared the change in exacerbation rate in 2020-2021 over quarterly periods when compared with the control period (the pre-pandemic period). We undertook overall and stratified analyses by age group, sex, and English region. Findings We identified 100,362 asthma patients (502,669 patient-years) from across England who experienced at least one exacerbation episode (298,390 exacerbation episodes during the entire follow-up). Except for the first quarter of 2020, the exacerbation rates were substantially lower (>25%) during all quarters in 2020-2021 when compared with the rates during 2016-2019 (39.7% (95% Confidence Interval (CI): 34.6, 44.9) in quarter-2, 2020; 46.5% (95%CI: 36.7, 56.4) in quarter-3, 2020; 56.3% (95%CI: 48.7, 63.9) in quarter-4, 2020; 63.2% (95%CI: 53.9, 72.5) in quarter-1, 2021; 57.7% (95%CI: 52.9, 62.4) in quarter-2, 2021; 53.3% (95%CI: 43.8, 62.8) in quarter-3, 2021). Interpretation There was a substantial and persistent reduction in asthma exacerbations across England over the first 18 months after the first lockdown. This is unlikely to be adequately explained by changes in health-seeking behaviour, pandemic-related healthcare service disruption, or any air-quality improvements. Funding Asthma UK, Health Data Research UK (HDR UK), Medical Research Council (MRC), National Institute for Health Research (NIHR).
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Affiliation(s)
- Syed Ahmar Shah
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, UK
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26
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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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27
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Daoud Pérez Z, Rázquin Arias M, López‐Escobar A, Díaz‐Conradi A, Arce A, Ruggeri N, Romero Blanco I, Díaz‐Delgado B, Ventura Wichner PS. The impact of COVID-19 lockdown on children with recurrent wheezing and asthma in Spain. J Paediatr Child Health 2022; 58:1635-1641. [PMID: 35748401 PMCID: PMC9350390 DOI: 10.1111/jpc.16068] [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: 12/02/2021] [Revised: 04/29/2022] [Accepted: 05/29/2022] [Indexed: 12/13/2022]
Abstract
AIM The rapid spread of a novel human coronavirus SARS-CoV-2 led to drastic measures world-wide. Most countries were forced to declare a national lockdown. We studied the effect of lockdown measures on the level of asthma control and maintenance treatment in children with recurrent wheezing and asthma during the first wave of COVID-19 in Spain. METHODS We analysed children with recurrent wheezing or asthma before and after the implementation of the lockdown, by using a questionnaire aimed to examine pre-existing respiratory disorders, step treatment and level of asthma control before/after lockdown, COVID history and laboratory testing including IgG SARS-CoV-2. RESULTS We enrolled 475 asthmatic and pre-school wheezers (60.6% males), mean age 5.6 years. There were no differences in asthma treatment comparing both periods: 81.7% maintained the same treatment (P = 0.103). According to child asthma-control questionnaire, 87.7% remained well controlled during confinement. Nearly, a third of children (34.9%) needed reliever treatment, mainly in older children. Determination of IgG SARS-CoV-2 was performed in 233 children (49.1%) of whom 17 (7.3%) tested positive. Seven patients positive to IgG SARS-CoV-2 were assisted in the emergency department and two required hospital admission. CONCLUSIONS During COVID-19 lockdown in Spain, most children with recurrent wheezing and asthma remained well controlled from their underlying disease and did not modify greatly their maintenance treatments. Unexpectedly, we also observed that those children who tested positive to SARS-CoV-2 IgG showed a significant increase in paediatric hospital admissions and attendances to urgent care settings.
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Affiliation(s)
- Zarife Daoud Pérez
- Pediatrics Pulmonology DepartmentHM HospitalsMadridSpain,Pediatrics DepartmentEmirates Speciality Hospital DubaiDubaiUnited Arab Emirates
| | | | - Alejandro López‐Escobar
- Pediatrics DepartmentHospital Vithas Madrid La MilagrosaMadridSpain,Clinical Research UnitFundación Vithas, Grupo VithasMadridSpain
| | | | - Amalia Arce
- Pediatrics DepartmentHM Nens, HM HospitalsBarcelonaSpain
| | - Nora Ruggeri
- Pediatrics Pulmonology DepartmentHM Nens, HM HospitalsBarcelonaSpain
| | | | | | - Paula S Ventura Wichner
- Pediatrics DepartmentHM Nens, HM HospitalsBarcelonaSpain,Pediatrics DepartmentFundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP)BadalonaSpain
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28
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Morillo D, Mena-Bucheli S, Ochoa A, Chico ME, Rodas C, Maldonado A, Arteaga K, Alchundia J, Solorzano K, Rodriguez A, Figueiredo C, Ardura-Garcia C, Bachmann M, Perkin MR, Chis Ster I, Cruz A, Romero NC, Cooper P. Prospective study of factors associated with asthma attack recurrence (ATTACK) in children from three Ecuadorian cities during COVID-19: a study protocol. BMJ Open 2022; 12:e056295. [PMID: 35710244 PMCID: PMC9207574 DOI: 10.1136/bmjopen-2021-056295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Asthma is a growing health problem in children in marginalised urban settings in low-income and middle-income countries. Asthma attacks are an important cause of emergency care attendance and long-term morbidity. We designed a prospective study, the Asthma Attacks study, to identify factors associated with recurrence of asthma attacks (or exacerbations) among children and adolescents attending emergency care in three Ecuadorian cities. METHODS AND ANALYSIS Prospective cohort study designed to identify risk factors associated with recurrence of asthma attacks in 450 children and adolescents aged 5-17 years attending emergency care in public hospitals in three Ecuadorian cities (Quito, Cuenca and Portoviejo). The primary outcome will be rate of asthma attack recurrence during up to 12 months of follow-up. Data are being collected at baseline and during follow-up by questionnaire: sociodemographic data, asthma history and management (baseline only); recurrence of asthma symptoms and attacks (monthly); economic costs of asthma to family; Asthma Control Test; Pediatric Asthma Quality of life Questionnaire; and Newcastle Asthma Knowledge Questionnaire (baseline only). In addition, the following are being measured at baseline and during follow-up: lung function and reversibility by spirometry before and after salbutamol; fractional exhaled nitric oxide (FeNO); and presence of IgG antibodies to SARS-CoV-2 in blood. Recruitment started in 2019 but because of severe disruption to emergency services caused by the COVID-19 pandemic, eligibility criteria were modified to include asthmatic children with uncontrolled symptoms and registered with collaborating hospitals. Data will be analysed using logistic regression and survival analyses. ETHICS AND DISSEMINATION Ethical approval was obtained from the Hospital General Docente de Calderon (CEISH-HGDC 2019-001) and Ecuadorian Ministry of Public Health (MSP-CGDES-2021-0041-O N° 096-2021). The study results will be disseminated through presentations at conferences and to key stakeholder groups including policy-makers, postgraduate theses, peer-review publications and a study website. Participants gave informed consent to participate in the study before taking part.
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Affiliation(s)
- Diana Morillo
- Escuela de Medicina, Universidad Internacional del Ecuador, Quito, Ecuador
| | | | - Angélica Ochoa
- Department of Biosciences, Universidad de Cuenca, Cuenca, Ecuador
| | - Martha E Chico
- Escuela de Medicina, Universidad Internacional del Ecuador, Quito, Ecuador
| | - Claudia Rodas
- Facultad de Medicina, Universidad de Azuay, Cuenca, Ecuador
| | - Augusto Maldonado
- School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador
- Emergency Department, Hospital General Docente Calderón, Quito, Ecuador
| | - Karen Arteaga
- Emergency Department, Hospital Verdi Cevallos Balda, Portoviejo, Ecuador
| | - Jessica Alchundia
- Pediatric Pneumology, Hospital de Especialidades Portoviejo, Portoviejo, Ecuador
| | - Karla Solorzano
- Pediatric Pneumology, Hospital de Especialidades Portoviejo, Portoviejo, Ecuador
| | | | - Camila Figueiredo
- Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | | | - Max Bachmann
- Norwich Medical School, University of East Anglia, University of East Anglia, Norwich, UK
| | | | - Irina Chis Ster
- Institute of Infection and Immunity, St. George's University of London, London, UK
- Institute of Infection and Immunity, St. George's University of London, London, UK
| | - Alvaro Cruz
- Núcleo de Excelência em Asma, Universidade Federal da Bahia, Salvador, Brazil
| | - Natalia Cristina Romero
- School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador
- GRAAL, Grups de Recerca d'America i Africa Llatines, Cerdanyola del Valles, Barcelona, Spain
| | - Philip Cooper
- Escuela de Medicina, Universidad Internacional del Ecuador, Quito, Ecuador
- Institute of Infection and Immunity, St. George's University of London, London, UK
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29
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A pediatric asthma camp experience during the coronavirus disease 2019 pandemic. Ann Allergy Asthma Immunol 2022; 128:597-598. [PMID: 35131411 PMCID: PMC8813763 DOI: 10.1016/j.anai.2022.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 11/24/2022]
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30
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Goldfeld S, O'Connor E, Sung V, Roberts G, Wake M, West S, Hiscock H. Potential indirect impacts of the COVID-19 pandemic on children: a narrative review using a community child health lens. Med J Aust 2022; 216:364-372. [PMID: 35066868 DOI: 10.5694/mja2.51368] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 12/12/2022]
Abstract
▪In this narrative review, we summarise the vast and burgeoning research on the potential and established indirect impacts on children of the COVID-19 pandemic. We used a community child health lens to organise our findings and to consider how Australia might best respond to the needs of children (aged 0-12 years). ▪We synthesised the literature on previous pandemics, epidemics and natural disasters, and the current COVID-19 pandemic. We found clear evidence of adverse impacts of the COVID-19 pandemic on children that either repeated or extended the findings from previous pandemics. ▪We identified 11 impact areas, under three broad categories: child-level factors (poorer mental health, poorer child health and development, poorer academic achievement); family-level factors that affect children (poorer parent mental health, reduced family income and job losses, increased household stress, increased abuse and neglect, poorer maternal and newborn health); and service-level factors that affect children (school closures, reduced access to health care, increased use of technology for learning, connection and health care). ▪There is increasing global concern about the likely disproportionate impact of the current pandemic on children experiencing adversity, widening existing disparities in child health and developmental outcomes. ▪We suggest five potential strategy areas that could begin to address these inequities: addressing financial instability through parent financial supplements; expanding the role of schools to address learning gaps and wellbeing; rethinking health care delivery to address reduced access; focusing on prevention and early intervention for mental health; and using digital solutions to address inequitable service delivery.
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Affiliation(s)
- Sharon Goldfeld
- Centre for Community Child Health, Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | - Elodie O'Connor
- Centre for Community Child Health, Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Melbourne, VIC
| | - Valerie Sung
- Centre for Community Child Health, Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | - Gehan Roberts
- Centre for Community Child Health, Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | - Melissa Wake
- Centre for Community Child Health, Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | - Sue West
- Centre for Community Child Health, Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Melbourne, VIC
| | - Harriet Hiscock
- Centre for Community Child Health, Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
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31
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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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32
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Molińska K, Latek M, Rychlik B, Lach J, Strapagiel D, Majak J, Błażowski Ł, Jerzyńska J, Kuna P, Majak P. House dust mite sensitization and frequent antibiotic courses may suppress remission of rhinosinusitis and asthma symptoms in young children. Allergy 2022; 77:301-304. [PMID: 34510485 DOI: 10.1111/all.15085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/28/2021] [Accepted: 09/02/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Katarzyna Molińska
- Department of Internal Medicine, Asthma and Allergy Medical University of Lodz Lodz Poland
| | - Marta Latek
- Department of Internal Medicine, Asthma and Allergy Medical University of Lodz Lodz Poland
| | - Błażej Rychlik
- Department of Molecular Biophysics University of Lodz Lodz Poland
| | - Jakub Lach
- Biobank Lab Department of Molecular Biophysics University of Lodz Lodz Poland
| | - Dominik Strapagiel
- Biobank Lab Department of Molecular Biophysics University of Lodz Lodz Poland
| | - Joanna Majak
- Audiology and Phoniatrics Clinic Nofer Institute of Occupational Medicine Lodz Poland
| | - Łukasz Błażowski
- Department of Allergology and Pulmonology National Research Institute of Tuberculosis and Lung Diseases Rabka‐Zdroj Branch Poland
- Department of Pathophysiology Institute of Medical Sciences Medical College of Rzeszow University Rzeszow Poland
| | - Joanna Jerzyńska
- Department of Pediatrics and Allergy Medical University of Lodz Lodz Poland
| | - Piotr Kuna
- Department of Internal Medicine, Asthma and Allergy Medical University of Lodz Lodz Poland
| | - Pawel Majak
- Department of Pediatric Pulmonology Medical University of Lodz Lodz Poland
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33
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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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34
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Alvaro‐Lozano M, Sandoval‐Ruballos M, Giovannini M, Jensen‐Jarolim E, Sahiner U, Tomic Spiric V, Quecchia C, Chaker A, Heffler E, Klimek L, Brough H, Sturm G, Untersmayr E, Bonini M, Pfaar O. Allergic patients during the COVID-19 pandemic-Clinical practical considerations: An European Academy of Allergy and Clinical Immunology survey. Clin Transl Allergy 2022; 12:e12097. [PMID: 35070270 PMCID: PMC8762981 DOI: 10.1002/clt2.12097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 12/18/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has affected health care systems unexpectedly. However, data focusing on practical considerations experienced by health care professionals (HCPs) providing care to allergic patients is scarce. METHODS Under the framework of the European Academy of Allergy and Clinical Immunology (EAACI), a panel of experts in the field of immunotherapy developed a 42-question online survey, to evaluate real-life consequences of the COVID-19 pandemic in allergy practice. RESULTS The respondents in the survey were 618. About 80% of HCPs indicated being significantly affected in their allergy practice. A face-to-face visit reduction was reported by 93% of HCPs and about a quarter completely interrupted diagnostic challenges. Patients with severe uncontrolled asthma (59%) and anaphylaxis (47%) were prioritized for in-person care. About 81% maintained an unaltered prescription of inhaled corticosteroids (ICS) in asthmatics. About 90% did not modify intranasal corticosteroids (INCS) in patients with allergic rhinitis. Nearly half of respondents kept biological prescriptions unmodified for asthma. About 50% of respondents kept their allergen immunotherapy (AIT) prescription patterns unchanged for respiratory allergies; 60% for insect venom allergies. Oral immunotherapy (OIT) for food allergies was initiated by 27%. About 20% kept carrying out up-dosing without modifications and 14% changed to more prolonged intervals. Telemedicine practice was increased. CONCLUSIONS HCPs providing care to allergic patients were affected during the pandemic in diagnostic, management, and therapeutic approaches, including AIT for respiratory, insect-venom, and food allergies. Most HCPs maintained controller treatments for both asthma, and allergic rhinitis consistent with international recommendations, as well as biological agents in asthma. Remote tools are valuable in delivering allergy care.
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Affiliation(s)
- Montserrat Alvaro‐Lozano
- Pediatric Allergology and Clinical ImmunologyHospital Sant Joan de DéuBarcelonaSpain
- Childhood and Adolescence Allergic Illness GroupInstitut de Recerca Sant Joan de DéuBarcelonaSpain
- Facultat de Medicina i Ciències de la SalutUniversitat de BarcelonaBarcelonaSpain
| | - Mónica Sandoval‐Ruballos
- Pediatric Allergology and Clinical ImmunologyHospital Sant Joan de DéuBarcelonaSpain
- Childhood and Adolescence Allergic Illness GroupInstitut de Recerca Sant Joan de DéuBarcelonaSpain
| | - Mattia Giovannini
- Allergy UnitDepartment of PediatricsMeyer Children's University HospitalFlorenceItaly
| | - Erika Jensen‐Jarolim
- Institute of Pathophysiology and Allergy ResearchCenter for Pathophysiology, Infectiology and ImmunologyMedical University ViennaViennaAustria
- The Interuniversity Messerli Research Institute, Medical University Vienna, Veterinary University Vienna, and University ViennaViennaAustria
| | - Umit Sahiner
- Department of Pediatric Allergy and AsthmaHacettepe University School of MedicineAnkaraTurkey
| | - Vesna Tomic Spiric
- Faculty of MedicineUniversity of BelgradeBelgradeSerbia
- Clinic of Allergology and ImmunologyClinical Centre of SerbiaBelgradeSerbia
| | - Cristina Quecchia
- “Io e l’Asma” CenterChildren's HospitalASST Spedali CiviliBresciaItaly
| | - Adam Chaker
- Department of Otolaryngology and Center of Allergy and EnvironmentTUM School of MedicineTechnical University of MunichMunichGermany
| | - Enrico Heffler
- Personalized Medicine, Asthma and AllergyHumanitas Clinical and Research Hospital IRCCSRozzanoItaly
- Department of Biomedical SciencesHumanitas UniversityMilanItaly
| | - Ludger Klimek
- Center for Rhinology and AllergologyWiesbadenGermany
| | - Helen Brough
- Children's Allergy ServiceEvelina Children's HospitalGuy's and St. Thomas' HospitalLondonUK
- Paediatric Allergy GroupDepartment of Women and Children's HealthSchool of Life Course SciencesKing's College LondonLondonUK
| | - Gunter Sturm
- Department of Dermatology and VenerologyMedical University of GrazGrazAustria
- Allergy Outpatient Clinic ReummanplatzViennaAustria
| | - Eva Untersmayr
- Institute of Pathophysiology and Allergy ResearchCenter for Pathophysiology, Infectiology and ImmunologyMedical University ViennaViennaAustria
| | - Mateo Bonini
- Department of Cardiovascular and Thoracic SciencesFondazione Policlinico Universitario A. Gemelli – IRCCSUniversità Cattolica del Sacro CuoreRomeItaly
- National Heart and Lung Institute (NHLI)Imperial College LondonLondonUK
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital MarburgPhilipps‐Universität MarburgMarburgGermany
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35
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Sayed S, Diwadkar AR, Dudley JW, O'Brien J, Dvorin D, Kenyon CC, Himes BE, Hill DA, Henrickson SE. COVID-19 Pandemic–Related Reductions in Pediatric Asthma Exacerbations Corresponded with an Overall Decrease in Respiratory Viral Infections. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY: IN PRACTICE 2022; 10:91-99.e12. [PMID: 34785388 PMCID: PMC8590625 DOI: 10.1016/j.jaip.2021.10.067] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 11/29/2022]
Abstract
Background Respiratory viruses, air pollutants, and aeroallergens are all implicated in worsening pediatric asthma symptoms, but their relative contributions to asthma exacerbations are poorly understood. A significant decrease in asthma exacerbations has been observed during the coronavirus disease 2019 pandemic, providing a unique opportunity to study how major asthma triggers correlate with asthma activity. Objective To determine whether changes in respiratory viruses, air pollutants, and/or aeroallergens during the coronavirus disease 2019 pandemic were concomitant with decreased asthma exacerbations. Methods Health care utilization and respiratory viral testing data between January 1, 2015, and December 31, 2020, were extracted from the Children’s Hospital of Philadelphia Care Network’s electronic health record. Air pollution and allergen data were extracted from US Environmental Protection Agency public databases and a National Allergy Bureau–certified station, respectively. Pandemic data (2020) were compared with historical data. Results Recovery of in-person asthma encounters during phased reopening (June 6 to November 15, 2020) was uneven: primary care well and specialty encounters reached 94% and 74% of prepandemic levels, respectively, whereas primary care sick and hospital encounters reached 21% and 40% of prepandemic levels, respectively. During the pandemic, influenza A and influenza B decreased to negligible frequency when compared with prepandemic cases, whereas respiratory syncytial virus and rhinovirus infections decreased to low (though nonnegligible) prepandemic levels, as well. No changes in air pollution or aeroallergen levels relative to historical observations were noted. Conclusions Our results suggest that viral respiratory infections are a primary driver of pediatric asthma exacerbations. These findings have broad relevance to both clinical practice and the development of health policies aimed at reducing asthma morbidity.
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Affiliation(s)
- Samir Sayed
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Avantika R Diwadkar
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Jesse W Dudley
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pa
| | | | | | - Chén C Kenyon
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Center for Pediatric Clinical Effectiveness and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Blanca E Himes
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
| | - David A Hill
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Institute for Immunology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
| | - Sarah E Henrickson
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Institute for Immunology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
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36
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Gao YD, Agache I, Akdis M, Nadeau K, Klimek L, Jutel M, Akdis CA. The effect of allergy and asthma as a comorbidity on the susceptibility and outcomes of COVID-19. Int Immunol 2021; 34:177-188. [PMID: 34788827 PMCID: PMC8689956 DOI: 10.1093/intimm/dxab107] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/10/2021] [Indexed: 12/12/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic causes an overwhelming number of hospitalization and deaths with a significant socioeconomic impact. The vast majority of studies indicate that asthma and allergic diseases do not represent a risk factor for COVID-19 susceptibility nor cause a more severe course of disease. This raises the opportunity to investigate the underlying mechanisms of the interaction between an allergic background and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The majority of patients with asthma, atopic dermatitis, allergic rhinitis, chronic rhinosinusitis, food allergies and drug allergies exhibit an over-expression of type 2 immune and inflammatory pathways with the contribution of epithelial cells, innate lymphoid cells, dendritic cells, T cells, eosinophils, mast cells, basophils, and the type 2 cytokines interleukin (IL)-4, IL-5, IL-9, IL-13, and IL-31. The potential impact of type 2 inflammation-related allergic diseases on susceptibility to COVID-19 and severity of its course have been reported. In this review, the prevalence of asthma and other common allergic diseases in COVID-19 patients is addressed. Moreover, the impact of allergic and non-allergic asthma with different severity and control status, currently available asthma treatments such as inhaled and oral corticosteroids, short- and long-acting β2 agonists, leukotriene receptor antagonists and biologicals on the outcome of COVID-19 patients is reviewed. In addition, possible protective mechanisms of asthma and type 2 inflammation on COVID-19 infection, such as the expression of SARS-CoV-2 entry receptors, antiviral activity of eosinophils and cross-reactive T-cell epitopes, are discussed. Potential interactions of other allergic diseases with COVID-19 are postulated, including recommendations for their management.
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Affiliation(s)
- Ya-Dong Gao
- Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.,Hubei Province Key Laboratory of Allergy and Immunology, Wuhan University, Wuhan, Hubei, China
| | - Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
| | - Mübeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Herman-Burchard Strasse, Davos, Switzerland
| | - Kari Nadeau
- Sean N. Parker Center for Allergy and Asthma Research, Department of Medicine, Stanford University, Palo Alto, California, USA
| | - Ludger Klimek
- Center for Rhinology and Allergology, An den Quellen, Wiesbaden, Germany
| | - Marek Jutel
- Department of Clinical Immunology, Wrocław Medical University.,All-MED Medical Research Institute, Wrocław, Poland
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Herman-Burchard Strasse, Davos, Switzerland
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37
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McIntire K, Weis B, Litwin Ye L, Krugman SD. Feasibility of video observed therapy to support controller inhaler use among children in West Baltimore. J Asthma 2021; 59:1961-1972. [PMID: 34550849 DOI: 10.1080/02770903.2021.1984525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess feasibility of a novel video directly observed therapy (DOT)-based digital asthma program intended to support correct inhaled corticosteroid (ICS) use among children. METHODS We conducted a 60-day pilot study among patients 2-18 years attending a primary care clinic with prescribed ICS and sub-optimally controlled asthma (recent hospitalization, ICS nonadherence, frequent rescue inhaler use, therapy escalation, or Asthma Control Test <20). Participants used a mobile application to receive reminders, submit videos of ICS doses (video DOT), and receive asynchronous feedback on adherence and inhaler technique. We assessed enrollment, engagement, program metrics, and user experience; adherence and inhaler errors were secondary outcomes. RESULTS Of 26 eligible patients, 21 (81%) enrolled and submitted ≥1 video; median age was 11 years (8-15), 71% were male, 90% had Medicaid, and 62% experienced ≥1 exacerbation in the previous 6 months. Retention was 57% and 52% at week 5 and 8, respectively. Participants submitted 810 videos. Missed doses, inhaler errors (n = 247) and adherence issues (n = 107) prompted 543 communications; inadequate inspiration or holding breath were most common. Among 16 patients with engagement >7 days and >4 videos, median inhaler error rate (proportion of videos with ≥1 error) decreased from week 1 to week 2 (73% vs 8%, p ≤ 0.05) with median adherence >80%. Participants experienced the program as long, but easy to use; benefits included building routines, skill, and independence. CONCLUSIONS This pilot study suggests high program acceptability among our cohort. High engagement with improved inhaler technique over the first 14 days suggests shorter implementation.
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Affiliation(s)
- K McIntire
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - B Weis
- Department of Pediatrics, Herman and Walter Samuelson Children's Hospital of Sinai, Baltimore, MD, USA
| | - L Litwin Ye
- emocha Mobile Health Inc, Baltimore, MD, USA
| | - S D Krugman
- Department of Pediatrics, Herman and Walter Samuelson Children's Hospital of Sinai, Baltimore, MD, USA
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38
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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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39
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Hurst JH, Zhao C, Fitzpatrick NS, Goldstein BA, Lang JE. Reduced pediatric urgent asthma utilization and exacerbations during the COVID-19 pandemic. Pediatr Pulmonol 2021; 56:3166-3173. [PMID: 34289526 PMCID: PMC8441648 DOI: 10.1002/ppul.25578] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/06/2021] [Accepted: 07/11/2021] [Indexed: 12/21/2022]
Abstract
The COVID-19 pandemic has had a profound impact on healthcare access and utilization, which could have important implications for children with chronic diseases, including asthma. We sought to evaluate changes in healthcare utilization and outcomes in children with asthma during the COVID-19 pandemic. We used electronic health records data to evaluate healthcare use and asthma outcomes in 3959 children and adolescents, 5-17 years of age, with a prior diagnosis of asthma who had a history of well-child visits and encounters within the healthcare system. We assessed all-cause healthcare encounters and asthma exacerbations in the 12-months preceding the start of the COVID-19 pandemic (March 1, 2019-February 29, 2020) and the first 12 months of the pandemic (March 1, 2020-February 28, 2021). All-cause healthcare encounters decreased significantly during the pandemic compared to the preceding year, including well-child visits (48.1% during the pandemic vs. 66.6% in the prior year; p < .01), emergency department visits (9.7% vs. 21.0%; p < .01), and inpatient admissions (1.6% vs. 2.5%; p < .01), though there was over a 100-fold increase in telehealth encounters. Asthma exacerbations that required treatment with systemic steroids also decreased (127 vs. 504 exacerbations; p < .01). Race/ethnicity was not associated with changes in healthcare utilization or asthma outcomes. The COVID-19 pandemic corresponded to dramatic shifts in healthcare utilization, including increased telehealth use and improved outcomes among children with asthma. Social distancing measures may have also reduced asthma trigger exposure.
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Affiliation(s)
- Jillian H Hurst
- Department of Pediatrics, Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Pediatrics, Children's Health & Discovery Initiative, Duke University School of Medicine, Durham, North Carolina, USA
| | - Congwen Zhao
- Department of Pediatrics, Children's Health & Discovery Initiative, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Nicholas S Fitzpatrick
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Benjamin A Goldstein
- Department of Pediatrics, Children's Health & Discovery Initiative, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA.,Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Jason E Lang
- Department of Pediatrics, Children's Health & Discovery Initiative, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
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40
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Ding M, Dong X, Sun YL, Sokolowska M, Akdis M, van de Veen W, Azkur AK, Azkur D, Akdis CA, Gao YD. Recent advances and developments in COVID-19 in the context of allergic diseases. Clin Transl Allergy 2021; 11:e12065. [PMID: 34582102 PMCID: PMC8646609 DOI: 10.1002/clt2.12065] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/09/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Since the first reports of coronavirus disease 2019 (COVID-19) in Wuhan, China, in December 2019, there have been 198 million confirmed cases worldwide as of August 2021. The scientific community has joined efforts to gain knowledge of the newly emerged virus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the immunopathological mechanisms leading to COVID-19, and its significance for patients with allergies and asthma. METHODS Based on the current literature, recent advances and developments in COVID-19 in the context of allergic diseases were reviewed. RESULTS AND CONCLUSIONS In this review, we discuss the prevalence of COVID-19 in subjects with asthma, attacks of hereditary angioedema, and other allergic diseases during COVID-19. Underlying mechanisms suggest a protective role of allergy in COVID-19, involving eosinophilia, SARS-CoV-2 receptors expression, interferon responses, and other immunological events, but further studies are needed to fully understand those associations. There has been significant progress in disease evaluation and management of COVID-19, and allergy care should continue during the COVID-19 pandemic. The European Academy of Allergy & Clinical Immunology (EAACI) launched a series of statements and position papers providing recommendations on the organization of the allergy clinic, handling of allergen immunotherapy, asthma, drug hypersensitivity, allergic rhinitis, and other allergic diseases. Treatment of allergies using biologics during the COVID-19 pandemic has also been discussed. Allergic reactions to the COVID-19 vaccines, including severe anaphylaxis, have been reported. Vaccination is a prophylactic strategy that can lead to a significant reduction in the mortality and morbidity associated with SARS-CoV-2 infection, and in this review, we discuss the proposed culprit components causing rare adverse reactions and recommendations to mitigate the risk of anaphylactic events during the administration of the vaccines.
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Affiliation(s)
- Mei Ding
- Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, China.,Hubei Province Key Laboratory of Allergy and Immunology, Wuhan University, Wuhan, China
| | - Xiang Dong
- Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, China.,Hubei Province Key Laboratory of Allergy and Immunology, Wuhan University, Wuhan, China
| | - Yuan-Li Sun
- Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, China.,Hubei Province Key Laboratory of Allergy and Immunology, Wuhan University, Wuhan, China
| | - Milena Sokolowska
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland.,Christine Kühne - Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
| | - Mübeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Willem van de Veen
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Ahmet Kursat Azkur
- Department of Virology, Faculty of Veterinary Medicine, University of Kirikkale, Kirikkale, Turkey
| | - Dilek Azkur
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of Kirikkale, Kirikkale, Turkey
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland.,Christine Kühne - Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
| | - Ya-Dong Gao
- Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, China.,Hubei Province Key Laboratory of Allergy and Immunology, Wuhan University, Wuhan, China
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Kobayashi J, Takeuchi R, Shibuya F, Murata Y, Takahashi K. Recommendations for the urgent need to vaccinate school-aged and adolescent children against COVID-19 in the Asia-Pacific region. Trop Med Health 2021; 49:74. [PMID: 34530919 PMCID: PMC8443906 DOI: 10.1186/s41182-021-00365-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/07/2021] [Indexed: 11/28/2022] Open
Abstract
We recommend urgent expansion of a vaccination program for adolescents and school-age children against SARS-CoV-2 infection in the Western Pacific region. Since July 2021, SARS-CoV-2 infections in children have increased rapidly in this region. As infection rates rise due to the SARS-CoV-2 B.1.617.2 (Delta) variant, current preventive strategies such as mask wearing and social distancing have controlled its spread effectively. Prolonged school closure is currently being promoted to suppress virus spread among children. However, the negative impact of prolonged school closure is significant. Although vaccination of children under 12 is still controversial, preparations must be made now for their vaccination.
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Affiliation(s)
- Jun Kobayashi
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, 207 Uehara, Nakagami-gun, Nishihara, Okinawa, 903-0215, Japan.
- Japanese Consortium of Global School Health Research, Okinawa, Japan.
| | - Rie Takeuchi
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, 207 Uehara, Nakagami-gun, Nishihara, Okinawa, 903-0215, Japan
- Japanese Consortium of Global School Health Research, Okinawa, Japan
| | - Fumiko Shibuya
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, 207 Uehara, Nakagami-gun, Nishihara, Okinawa, 903-0215, Japan
- Japanese Consortium of Global School Health Research, Okinawa, Japan
| | - Yuki Murata
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Kenzo Takahashi
- Japanese Consortium of Global School Health Research, Okinawa, Japan
- Graduate School of Public Health, Teikyo University, Tokyo, Japan
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Xiong R, Zhao Z, Lu H, Ma Y, Zeng H, Chen Y. Asthma Patients Benefit More Than Chronic Obstructive Pulmonary Disease Patients in the Coronavirus Disease 2019 Pandemic. Front Med (Lausanne) 2021; 8:709006. [PMID: 34568369 PMCID: PMC8460914 DOI: 10.3389/fmed.2021.709006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/23/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Coronavirus disease 2019 (COVID-19) has raised many questions about the role of underlying chronic diseases on disease outcomes. However, there is limited information about the effects of COVID-19 on chronic airway diseases. Therefore, we conducted the present study to investigate the impact of COVID-19 on patients with asthma or chronic obstructive pulmonary disease (COPD) and ascertain risk factors for acute exacerbations (AEs). Methods: This single-center observational study was conducted at the Second Xiangya Hospital of Central South University, involving asthma or COPD patients who had been treated with inhaled combination corticosteroids (ICSs), such as budesonide, and one long-acting beta-2-agonist (LABA), such as formoterol, for at least a year before the COVID-19 pandemic. We conducted telephone interviews to collect demographic information and clinical data between January 1, 2019, and December 31, 2020, focusing on respiratory and systemic symptoms, as well as times of exacerbations. Data for asthma and COPD were then compared, and the risk factors for AEs were identified using logistic regression analysis. Results: A total of 251 patients were enrolled, comprising 162 (64.5%) who had asthma and 89 who had COPD, with none having COPD/asthma overlap. Frequency of AEs among asthma patients was significantly lower in 2020 than in 2019 (0.82 ± 3.33 vs. 1.00 ± 3.16; P < 0.05). Moreover, these patients visited the clinic less (0.37 ± 0.93 vs. 0.49 ± 0.94; P < 0.05) and used emergency drugs less (0.01 ± 0.11 vs. 007 ± 0.38; P < 0.05) during the COVID-19 pandemic. In contrast, among COPD patients, there were no significant differences in AE frequency, clinic visits, or emergency drug use. Furthermore, asthma patients visited clinics less frequently during the pandemic than those with COPD. Logistic regression analysis also showed that a history of at least one AE within the last 12 months was associated with increased AE odds for both asthma and COPD during the COVID-19 pandemic (odds ratio: 13.73, 95% CI: 7.04-26.77; P < 0.01). Conclusion: During the COVID-19 pandemic, patients with asthma showed better disease control than before, whereas patients with COPD may not have benefited from the pandemic. For both diseases, at least one AE within the previous 12 months was a risk factor for AEs during the pandemic. Particularly, among asthma patients, the risk factors for AE during the COVID-19 pandemic were urban environment, smoking, and lower asthma control test scores.
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Affiliation(s)
- Ruoyan Xiong
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
- Research Unit of Respiratory Diseases, Central South University, Changsha, China
- Hunan Centre for Evidence-Based Medicine, Changsha, China
| | - Zhiqi Zhao
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
- Research Unit of Respiratory Diseases, Central South University, Changsha, China
- Hunan Centre for Evidence-Based Medicine, Changsha, China
| | - Huanhuan Lu
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
- Research Unit of Respiratory Diseases, Central South University, Changsha, China
- Hunan Centre for Evidence-Based Medicine, Changsha, China
| | - Yiming Ma
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
- Research Unit of Respiratory Diseases, Central South University, Changsha, China
- Hunan Centre for Evidence-Based Medicine, Changsha, China
| | - Huihui Zeng
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
- Research Unit of Respiratory Diseases, Central South University, Changsha, China
- Hunan Centre for Evidence-Based Medicine, Changsha, China
| | - Yan Chen
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
- Research Unit of Respiratory Diseases, Central South University, Changsha, China
- Hunan Centre for Evidence-Based Medicine, Changsha, China
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Mathioudakis AG, Miligkos M, Boccabella C, Alimani GS, Custovic A, Deschildre A, Ducharme FM, Kalayci O, Murray C, Garcia AN, Phipatanakul W, Price D, Sheikh A, Agache IO, Bacharier L, Beloukas A, Bentley A, Bonini M, Castro-Rodriguez JA, De Carlo G, Craig T, Diamant Z, Feleszko W, Felton T, Gern JE, Grigg J, Hedlin G, Hossny EM, Ierodiakonou D, Jartti T, Kaplan A, Lemanske RF, Le Souëf PN, Mäkelä MJ, Mathioudakis GA, Matricardi P, Mitrogiorgou M, Morais-Almeida M, Nagaraju K, Papageorgiou E, Pité H, Pitrez PMC, Pohunek P, Roberts G, Tsiligianni I, Turner S, Vijverberg S, Winders TA, Wong GW, Xepapadaki P, Zar HJ, Papadopoulos NG. Management of asthma in childhood: study protocol of a systematic evidence update by the Paediatric Asthma in Real Life (PeARL) Think Tank. BMJ Open 2021; 11:e048338. [PMID: 34215609 PMCID: PMC8256789 DOI: 10.1136/bmjopen-2020-048338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Clinical recommendations for childhood asthma are often based on data extrapolated from studies conducted in adults, despite significant differences in mechanisms and response to treatments. The Paediatric Asthma in Real Life (PeARL) Think Tank aspires to develop recommendations based on the best available evidence from studies in children. An overview of systematic reviews (SRs) on paediatric asthma maintenance management and an SR of treatments for acute asthma attacks in children, requiring an emergency presentation with/without hospital admission will be conducted. METHODS AND ANALYSIS Standard methodology recommended by Cochrane will be followed. Maintenance pharmacotherapy of childhood asthma will be evaluated in an overview of SRs published after 2005 and including clinical trials or real-life studies. For evaluating pharmacotherapy of acute asthma attacks leading to an emergency presentation with/without hospital admission, we opted to conduct de novo synthesis in the absence of adequate up-to-date published SRs. For the SR of acute asthma pharmacotherapy, we will consider eligible SRs, clinical trials or real-life studies without time restrictions. Our evidence updates will be based on broad searches of Pubmed/Medline and the Cochrane Library. We will use A MeaSurement Tool to Assess systematic Reviews, V.2, Cochrane risk of bias 2 and REal Life EVidence AssessmeNt Tool to evaluate the methodological quality of SRs, controlled clinical trials and real-life studies, respectively.Next, we will further assess interventions for acute severe asthma attacks with positive clinical results in meta-analyses. We will include both controlled clinical trials and observational studies and will assess their quality using the previously mentioned tools. We will employ random effect models for conducting meta-analyses, and Grading of Recommendations Assessment, Development and Evaluation methodology to assess certainty in the body of evidence. ETHICS AND DISSEMINATION Ethics approval is not required for SRs. Our findings will be published in peer reviewed journals and will inform clinical recommendations being developed by the PeARL Think Tank. PROSPERO REGISTRATION NUMBERS CRD42020132990, CRD42020171624.
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Affiliation(s)
- Alexander G Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Athens Breath Centre, Athens, Greece
| | - Michael Miligkos
- First Department of Pediatrics, "Aghia Sofia" Children's Hospital, University of Athens, Athens, Attica, Greece
| | - Cristina Boccabella
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Milano, Lombardia, Italy
| | - Gioulinta S Alimani
- Athens Breath Centre, Athens, Greece
- Department of Biomedical Sciences, University of West Attica, Egaleo, Attica, Greece
| | - Adnan Custovic
- Department of Paediatrics, Imperial College London, London, UK
| | - A Deschildre
- Unité de Pneumologie et Allergologie Pédiatriques, Hôpital Jeanne de Flandre, CHU Lille, Lille, Hauts-de-France, France
| | | | - Omer Kalayci
- Pediatric Allergy and Asthma Unit, Hacettepe Universitesi, Ankara, Turkey
| | - Clare Murray
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Antonio Nieto Garcia
- Pulmonology and Allergy Unity, La Fe University and Polytechnic Hospital, Valencia, Comunidad Valenciana, Spain
| | - Wanda Phipatanakul
- Pediatric Allergy and Immunology, Children's Hospital Boston, Boston, Massachusetts, USA
| | - David Price
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
- Observational and Pragmatic Research Institute, Singapore
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | | | - Leonard Bacharier
- Department of Allergy, Immunology, and Pulmonary Medicine, University of Washington, Seattle, Washington, USA
| | - Apostolos Beloukas
- Department of Biomedical Sciences, University of West Attica, Egaleo, Attica, Greece
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Andrew Bentley
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Acute Intensive Care Unit, University Hospital of South Manchester NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Matteo Bonini
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Milano, Lombardia, Italy
- National Heart and Lung Institute (NHLI), Imperial College London, London, UK
| | | | - Giuseppe De Carlo
- Allergy and Airway Diseases Patient's Associations, European Federation of Pharmaceutical Industries and Associations, Brussels, Belgium
| | - Timothy Craig
- Allergy, Asthma and Immunology, Penn State University, Hershey, Pennsylvania, USA
| | - Zuzana Diamant
- Department of Respiratory Medicine and Allergology, Institute for Clinical Science, Skane University Hospital Lund Hematological Clinic, Lund, Skåne, Sweden
- Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
- Department of Clinical Pharmacy & Pharmacology, University of Groningen, University Medical Center of Groningen and QPS-NL, Groningen, Netherlands
| | - Wojciech Feleszko
- Department of Pediatric Pulmonology and Allergy, Medical University of Warsaw, Warszawa, Poland
| | - Tim Felton
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - James E Gern
- Department of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jonathan Grigg
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Gunilla Hedlin
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Stockholm, Sweden
| | - Elham M Hossny
- Pediatric Allergy and Immunology Unit, Ain Shams University, Cairo, Egypt
| | - Despo Ierodiakonou
- Department of Social Medicine, Faculty of Medicine, University of Crete, Rethimno, Greece
| | - Tuomas Jartti
- Department of Paediatrics, University of Turku, Turku, Finland
| | - Alan Kaplan
- Family Physician, Airways Group of Canada, University of Toronto, Toronto, Ontario, Canada
| | - Robert F Lemanske
- Department of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Peter N Le Souëf
- School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
| | - Mika J Mäkelä
- Department of Allergy, University of Helsinki, Helsinki, Uusimaa, Finland
| | | | - Paolo Matricardi
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité - University Medicine, Berlin, Germany
| | - Marina Mitrogiorgou
- Third Department of Paediatrics, National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece
| | | | | | - Effie Papageorgiou
- Department of Biomedical Sciences, University of West Attica, Egaleo, Attica, Greece
| | - Helena Pité
- Allergy Center, Hospital CUF Descobertas, Lisboa, Portugal
- Allergy Center, CUF Infante Santo Hospital, Lisbon, Portugal
- Chronic Diseases Research Center (CEDOC), NOVA Medical School / Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Paulo M C Pitrez
- Laboratory of Respiratory Physiology, Infant Center, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Petr Pohunek
- Paediatric Department, Motol University Hospital, Praha, Czech Republic
| | - Graham Roberts
- The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport Isle of Wight, UK
- Faculty of Medicine, Clinical and Experimental Sciences and Human Development in Health Academic Units, University of Southampton, Southampton, UK
- NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ioanna Tsiligianni
- Department of Social Medicine, Faculty of Medicine, University of Crete, Rethimno, Greece
| | - Stephen Turner
- Department of Child Health, University of Aberdeen, Aberdeen, Aberdeen, UK
| | - Susanne Vijverberg
- Department of Respiratory Medicine and Department of Pediatric Pulmonology, University of Amsterdam, Amsterdam, Netherlands
| | - Tonya A Winders
- Allergy & Asthma, Global Patient Platform, Virginia, Virginia, USA
| | - Gary Wk Wong
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Paraskevi Xepapadaki
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Attica, Greece
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Rondebosch, Western Cape, South Africa
- Unit on Child and Adolescent Health, Medical Reaserch Council, Cape Town, South Africa
| | - Nikolaos G Papadopoulos
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Attica, Greece
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Ulinici M, Covantev S, Wingfield-Digby J, Beloukas A, Mathioudakis AG, Corlateanu A. Screening, Diagnostic and Prognostic Tests for COVID-19: A Comprehensive Review. Life (Basel) 2021; 11:561. [PMID: 34198591 PMCID: PMC8231764 DOI: 10.3390/life11060561] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 05/31/2021] [Accepted: 06/10/2021] [Indexed: 02/05/2023] Open
Abstract
While molecular testing with real-time polymerase chain reaction (RT-PCR) remains the gold-standard test for COVID-19 diagnosis and screening, more rapid or affordable molecular and antigen testing options have been developed. More affordable, point-of-care antigen testing, despite being less sensitive compared to molecular assays, might be preferable for wider screening initiatives. Simple laboratory, imaging and clinical parameters could facilitate prognostication and triage. This comprehensive review summarises current evidence on the diagnostic, screening and prognostic tests for COVID-19.
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Affiliation(s)
- Mariana Ulinici
- Department of Preventive Medicine, Discipline Microbiology and Immunology, State University of Medicine and Pharmacy “Nicolae Testemitanu”, 2004 Chisinau, Moldova;
| | - Serghei Covantev
- Department of Respiratory Medicine, State University of Medicine and Pharmacy “Nicolae Testemitanu”, 2004 Chisinau, Moldova;
| | - James Wingfield-Digby
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester M23 9LT, UK; (J.W.-D.); (A.G.M.)
- The North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK
| | - Apostolos Beloukas
- Department of Biomedical Sciences, University of West Attica, 12243 Athens, Greece
- Institute of Infection & Global Health, University of Liverpool, Liverpool L69 7BE, UK
| | - Alexander G. Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester M23 9LT, UK; (J.W.-D.); (A.G.M.)
- The North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK
| | - Alexandru Corlateanu
- Department of Respiratory Medicine, State University of Medicine and Pharmacy “Nicolae Testemitanu”, 2004 Chisinau, Moldova;
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Ulinici M, Covantev S, Wingfield-Digby J, Beloukas A, Mathioudakis AG, Corlateanu A. Screening, Diagnostic and Prognostic Tests for COVID-19: A Comprehensive Review. Life (Basel) 2021. [DOI: doi.org/10.3390/life11060561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
While molecular testing with real-time polymerase chain reaction (RT-PCR) remains the gold-standard test for COVID-19 diagnosis and screening, more rapid or affordable molecular and antigen testing options have been developed. More affordable, point-of-care antigen testing, despite being less sensitive compared to molecular assays, might be preferable for wider screening initiatives. Simple laboratory, imaging and clinical parameters could facilitate prognostication and triage. This comprehensive review summarises current evidence on the diagnostic, screening and prognostic tests for COVID-19.
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Ochoa-Avilés AM, Ochoa-Avilés C, Morillo-Argudo DA, Molina-Cando MJ, Rodas-Espinoza CR, Chis Ster I, Maestre Calderón MP, Maldonado G A, Arteaga Vaca K, Rodriguez A, Cruz AA, Romero-Sandoval N, Cooper PJ. Impact of COVID-19 pandemic on asthma symptoms and management: A prospective analysis of asthmatic children in Ecuador. World Allergy Organ J 2021; 14:100551. [PMID: 34141051 PMCID: PMC8190468 DOI: 10.1016/j.waojou.2021.100551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/23/2021] [Accepted: 04/26/2021] [Indexed: 02/07/2023] Open
Abstract
Background Asthma affects up to 33% of children in Latin American settings. The ongoing COVID-19 pandemic has had a significant impact on access to and use of health services. We aimed to evaluate the impact of the COVID-19 lockdown on asthma exacerbations, medical facility visits, and use of asthma medications in children. Methods We used data from a prospective cohort of 213 children aged 5–17 years in 3 Ecuadorian cities and analysed the impact of the COVID-19 lockdown on asthma. Outcomes (asthma exacerbations, emergency room [ER] visits, planned and unplanned outpatient visits, and use of inhaled corticosteroids and Beta-2 agonists) were analysed using repeated Poisson counts (ie, number of events per participant before and during the COVID-19 lockdown). Results During compared to before lockdown: a) the number of asthma exacerbations remained constant (IRR, 0.87; 95% CI: 0.72–1.05; p = 0.152); b) outpatient visits (IRR 0.26, 95% CI 0.14–0.47, p < 0.001) declined 74% while ER visits declined 89% (IRR 0.11, 95% CI 0.04–0.32, p < 0.001); and c) there was no change in inhaled corticosteroids use (IRR 1.03, 95% CI 0.90–1.16, P = 0.699) while Beta-2 agonist use increased (IRR 1.32, 95% CI 1.10–1.58, P = 0.003). Conclusions In a cohort of Ecuadorian children with asthma, health services attendance decreased dramatically after COVID-19 lockdown, but asthma exacerbations and use of inhaled corticosteroids were unchanged. Future analyses will address the question of the effect of SARS-CoV-2 infection on asthma exacerbations and control in this paediatric population.
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Affiliation(s)
- Angélica M Ochoa-Avilés
- Department of Biosciences, Faculty of Chemistry, University of Cuenca, Cuenca, Azuay, Ecuador
| | - Cristina Ochoa-Avilés
- Department of Biosciences, Faculty of Chemistry, University of Cuenca, Cuenca, Azuay, Ecuador.,Instituto de Ciencias da Saude, Universidade Federal da Bahia, Salvador, Bahía, Brazil
| | | | - María José Molina-Cando
- Department of Biosciences, Faculty of Chemistry, University of Cuenca, Cuenca, Azuay, Ecuador.,School of Medicine, International University of Ecuador, Quito, Pichincha, Ecuador
| | | | - Irina Chis Ster
- Institute of Infection and Immunity, St George's University of London, London, UK
| | | | - Augusto Maldonado G
- Universidad San Francisco de Quito School of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hospital General Docente de Calderón, Quito, Pichincha, Ecuador
| | | | - Alejandro Rodriguez
- School of Medicine, International University of Ecuador, Quito, Pichincha, Ecuador
| | - Alvaro A Cruz
- Fundação ProAR and Universidade Federal da Bahia, Salvador, Brazil
| | | | - Philip J Cooper
- School of Medicine, International University of Ecuador, Quito, Pichincha, Ecuador.,Institute of Infection and Immunity, St George's University of London, London, UK
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Licari A, Marseglia GL. What are the considerations for treating pediatric asthma during the COVID-19 pandemic? Expert Opin Pharmacother 2021; 22:651-653. [PMID: 33586565 PMCID: PMC7885721 DOI: 10.1080/14656566.2021.1883586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/27/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Amelia Licari
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Chirurgical, Diagnostic and Pediatric Science, University of Pavia, Pavia, Italy
| | - Gian Luigi Marseglia
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Chirurgical, Diagnostic and Pediatric Science, University of Pavia, Pavia, Italy
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Attanasi M, Porreca A, Papa GFS, Di Donato G, Cauzzo C, Patacchiola R, Di Filippo P, Di Pillo S, Chiarelli F. Emergency Department Visits for allergy related-disorders among children: experience of a single Italian hospital during the first wave of the COVID-19 pandemic. Multidiscip Respir Med 2021; 16:786. [PMID: 34745607 PMCID: PMC8524361 DOI: 10.4081/mrm.2021.786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/05/2021] [Indexed: 12/26/2022] Open
Abstract
Introduction: The aim of this study was to compare the number of the Pediatric Emergency Department (PED) visits for young allergic patients with respiratory or cutaneous symptoms during the first wave of the coronavirus disease 19 (COVID-19) pandemic in 2020 with the same period in 2019, evaluating the percentage of positive cases to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). We carried out a retrospective analysis using data from young patients who visited the PED with cutaneous or respiratory symptoms in the period from 20th February to 12th May of the years 2020 and 2019. Data on allergy and COVID-19 nasal swab were also collected. We observed eleven (28.2%) PED visits for allergic patients with respiratory or cutaneous symptoms for the period from 20th February to 12th May of the year 2020 and ninety-three (31.8%) PED visits for the same time frame of the year 2019 (p=0.645). Only a two-month-old child out of 39 patients with non-allergic respiratory or cutaneous symptoms resulted positive for SARS-CoV-2. Specifically, we found for all the PED visits: 21 (7.2%) in 2019 vs 2 (5.1%) in 2020 for patients with urticaria/angioedema or atopic dermatitis (p=0.634); 3 (1.0%) in 2019 vs 3 (7.7%) in 2020 for patients with anaphylaxis (p=0.003); 19 (6.5%) in 2019 vs 2 (5.1%) in 2020 for those with asthma (p=0.740); 11(3.8%) in 2019 vs 1(2.6%) in 2020 for those with lower respiratory diseases, excluding asthma (p=0.706); 39(13.4%) in 2019 vs 3 (7.7%) in 2020 for those with upper respiratory diseases (URDs) (p=0.318). We also showed a substantial decrease (~80%) in all PED visits compared with the same time frame in 2019 (absolute number 263 vs 1,211, respectively). Among all the PED visits a significant reduction was mostly found for URDs [155 (12.8%) in 2019 vs 17 (6.5%) in 2020; p=0.045)]. The total number of PED visits for allergic patients with respiratory or cutaneous symptoms dropped precipitously in 2020. It is very tricky to estimate whether it was a protective action of allergy or the fear of contagion or the lockdown or a reduction in air pollution that kept children with allergy from visiting the PED. Further studies are needed to better understand the impact of underlying allergies on COVID-19 susceptibility and disease severity.
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Affiliation(s)
- Marina Attanasi
- Department of Pediatrics, University of Chieti-Pescara, Chieti
| | - Annamaria Porreca
- Department of Economic Studies, University of Chieti-Pescara, Chieti
| | | | - Gulia Di Donato
- Department of Pediatrics, University of Chieti-Pescara, Chieti
| | - Chiara Cauzzo
- Department of Pediatrics, University of Chieti-Pescara, Chieti
| | | | | | | | - Francesco Chiarelli
- Department of Pediatrics, University of Chieti-Pescara, Chieti.,Department of Economic Studies, University of Chieti-Pescara, Chieti
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Liuzzo Scorpo M, Ferrante G, La Grutta S. An Overview of Asthma and COVID-19: Protective Factors Against SARS-COV-2 in Pediatric Patients. Front Pediatr 2021; 9:661206. [PMID: 33996694 PMCID: PMC8116485 DOI: 10.3389/fped.2021.661206] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/31/2021] [Indexed: 12/14/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a pandemic infectious disease caused by severe acute respiratory syndrome coronavirus SARS-COV-2. Aberrant innate immunity response and cytokine storm are responsible for the syndrome. Apparently, in asthmatic patients, the inadequate antiviral immune response and the tendency for asthma exacerbation evoked by common respiratory viruses could explain increased susceptibility to SARS-COV-2 infection. However, asthma has not been suggested to be a risk factor in COVID-19 patients. Therefore, in asthmatic patients some potential protective mechanisms against SARS-COV-2 have been hypothesized, like type 2 immune response, number of eosinophils, overproduction of mucus, and asthma treatment, along with behavioral factors not strictly related to asthma, such as social distancing, hygiene measures and wearing facemasks, that contribute to reduce the individual susceptibility to SARS-COV-2 infection. In this mini-review, we will describe the current literature regarding potential protective factors against COVID-19 in children with asthma based on the evidence available so far.
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Affiliation(s)
- Maria Liuzzo Scorpo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Giuliana Ferrante
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Stefania La Grutta
- Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
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Ferrante G, Mollicone D, Cazzato S, Lombardi E, Pifferi M, Turchetta A, Tancredi G, La Grutta S. COVID-19 Pandemic and Reduced Physical Activity: Is There an Impact on Healthy and Asthmatic Children? Front Pediatr 2021; 9:695703. [PMID: 34568238 PMCID: PMC8456015 DOI: 10.3389/fped.2021.695703] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/20/2021] [Indexed: 12/18/2022] Open
Abstract
Physical activity (PA) has been seen to improve asthma symptoms, lung function, and quality of life, as well as to reduce airway inflammation and bronchial responsiveness. As a consequence of the COVID-19 pandemic, the minimal amount of PA recommended by the World Health Organization-i.e., about 60 min/day of moderate-to-high intensity-is difficult to achieve for many children, particularly those living in urban areas. Short-term changes in PA because of the COVID-19 pandemic may become habitual, increasing the risk of adverse asthma outcomes in children. Indeed, prolonged home confinement during the COVID-19 pandemic reduces PA levels and increases sedentary behaviors, possibly impairing immune system function and increasing susceptibility to inflammatory diseases. However, there is limited evidence regarding the effects of lockdown due to COVID-19 on PA and sedentary behaviors in asthmatic children. Given that children stay longer indoors, indoor air pollution represents a major issue to consider during home confinement. This narrative review aims to summarize the available evidence about the impact of decreased PA and increased sedentary behaviors on children with asthma during the COVID-19 pandemic. In addition, strategies for supporting PA in children with asthma during the COVID-19 pandemic are suggested, also looking at the issue of indoor air quality.
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Affiliation(s)
- Giuliana Ferrante
- Department of Health Promotion, Mother, and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Desiree Mollicone
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Salvatore Cazzato
- Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | - Enrico Lombardi
- Pediatric Pulmonary Unit, Meyer Pediatric University Hospital, Florence, Italy
| | - Massimo Pifferi
- Department of Paediatrics, University Hospital of Pisa, Pisa, Italy
| | | | | | - Stefania La Grutta
- National Research Council of Italy, Institute for Biomedical Research and Innovation (IRIB), Palermo, Italy
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