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Gaffney A, Himmelstein DU, Woolhandler S. Population-level trends in asthma and chronic obstructive pulmonary disease emergency department visits and hospitalizations before and during the coronavirus disease 2019 pandemic in the United States. Ann Allergy Asthma Immunol 2023; 131:737-744.e8. [PMID: 37619778 DOI: 10.1016/j.anai.2023.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 08/09/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Previous studies have identified reductions in exacerbations of chronic lung disease in many locales after onset of the coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVE To evaluate the population-level impacts of COVID-19 on asthma and chronic obstructive pulmonary disease (COPD) exacerbations-with a focus on disadvantaged communities-in the United States. METHODS We analyzed 2016 to 2020 county-level data on asthma and COPD acute care use, with myocardial infarction hospitalizations as a comparator condition. We linked this with county-level lower respiratory disease mortality data. We calculated rates of emergency department (ED) visits, hospitalizations, and deaths and evaluated changes using linear regressions adjusted for year and county-fixed effects. For a supplementary analysis, we calculated ED visit rates nationwide for asthma, COPD, or any diagnosis using the 2016 to 2020 National Hospital Ambulatory Medical Care Survey. RESULTS Our county-level data included 685 counties in 13 states. Rates of each outcome fell in 2020. In adjusted analyses, we found large reductions in asthma and COPD ED visit rates (eg, a 21.5 per 10,000-person reduction in COPD ED visits; 95% confidence interval, -23.8 to -19.1), with smaller reductions in hospitalizations and chronic lower respiratory mortality. Disadvantaged communities had mostly higher baseline rates of respiratory morbidity and larger absolute reductions in some outcomes. Among 90,808 ED visits in the National Hospital Ambulatory Medical Care Survey, asthma ED visits/y fell 33% during the pandemic and COPD visits by 51%; overall ED visits fell by only 7%. CONCLUSION Onset of the COVID-19 pandemic coincided with reductions in acute care utilization for asthma and COPD. Understanding the mechanism of this reduction might inform future efforts to prevent exacerbations.
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Affiliation(s)
- Adam Gaffney
- Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - David U Himmelstein
- Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts; Harvard Medical School, Boston, Massachusetts; Hunter College, City University of New York, New York, New York; Public Citizen Health Research Group, Washington, District of Columbia
| | - Steffie Woolhandler
- Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts; Harvard Medical School, Boston, Massachusetts; Hunter College, City University of New York, New York, New York; Public Citizen Health Research Group, Washington, District of Columbia
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Kouis P, Lemonaris M, Xenophontos E, Panayiotou A, Yiallouros PK. The impact of COVID-19 lockdown measures on symptoms control in children with asthma: A systematic review and meta-analysis of observational cohort studies. Pediatr Pulmonol 2023; 58:3213-3226. [PMID: 37606188 DOI: 10.1002/ppul.26646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVES Reported reductions in emergency department visits and hospitalizations for asthma in previous studies have suggested a beneficial effect of the coronavirus disease of 2019 (COVID-19) lockdown measures on asthma morbidity. Nevertheless, studies relying on administrative data may overestimate the true impact of lockdowns due to changes in health-seeking behavior and reduced availability of pediatric asthma services during the pandemic. In this study, we systematically reviewed the literature and identified observational cohort studies that focused on nonadministrative data to assess the true impact of COVID-19 lockdowns on symptom control in children with asthma. METHODS A systematic literature search was conducted between January 2020 and August 2022 (International Prospective Register of Systematic Reviews ID: CRD42022354369). The impact of COVID-19 lockdowns across studies was expressed as a standardized mean difference (SMD) for continuous outcomes and as a summary relative risk (RR) for binary outcomes. RESULTS During the lockdown periods, the pooled asthma symptoms control test score (SMD: 1.99, 95% confidence interval [CI]: 0.75, 3.24, I2 : 98.4%) and the proportion of children with well-controlled asthma (RR: 1.35, 95% CI: 1.06, 1.71, I2 : 77.6%) were significantly increased. On the other hand, the pooled proportion of children with poorly controlled asthma (RR: 0.47, 95% CI: 0.38, 0.57, I2 : 0.0%) was significantly decreased. CONCLUSIONS During COVID-19 lockdowns, asthma symptoms and breakthrough disease exacerbations were significantly reduced in children with asthma. Further research is warranted on potential interventions aiming to enhance asthma control after the pandemic while taking into consideration their acceptability and potential tradeoffs.
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Affiliation(s)
- Panayiotis Kouis
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Marios Lemonaris
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
- Medical School, University of Nicosia, Nicosia, Cyprus
| | - Eleana Xenophontos
- Cyprus International Institute for Environmental and Public Health, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Andrie Panayiotou
- Cyprus International Institute for Environmental and Public Health, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
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3
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Sinisterra M, Sweenie R, Ezmigna D, Fedele DA. Youth and caregiver asthma functioning and quality of life throughout the COVID-19 pandemic. Front Allergy 2023; 4:1268112. [PMID: 37731770 PMCID: PMC10507404 DOI: 10.3389/falgy.2023.1268112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/22/2023] [Indexed: 09/22/2023] Open
Abstract
Objectives The COVID-19 pandemic resulted in daily functioning changes for many families. Adjustments in daily functioning may have impacted asthma management and subsequent morbidity. The current study seeks to build upon extant literature by exploring differences in youth asthma exacerbations and control, as well as youth and caregiver asthma-related quality of life (ArQOL) throughout COVID-19 transitional points. Methods Ninety-three youth (9-17 years old) with asthma and their caregivers completed measures of demographic/medical information, asthma control, and ArQOL. Participants were recruited between January 2020 and October 2021 via their medical appointments and a hospital registry. We conducted Kruskal-Wallis H-tests to examine differences in youth asthma exacerbations (measured by short-acting beta agonist use), asthma control, and ArQOL, as well as caregiver ArQOL, across phases of the COVID-19 pandemic. Results Asthma exacerbations were higher prior to the onset of the pandemic compared to "during lockdown" and "post-lockdown," H(2) = 7.31, p < .05. Youth's asthma control was lower prior to the onset of the pandemic compared to youth enrolled "post-lockdown," H(2) = 7.04, p < .05. There were no differences in youth ArQOL across the duration of the pandemic. Caregiver ArQOL was significantly higher in the "post-lockdown," period, compared to caregivers enrolled prior to the pandemic onset, H(2) = 9.86, p < .01. Conclusion Youth and caregiver asthma functioning improved following the onset of the pandemic. These findings build upon existing literature to highlight higher ArQOL in caregivers following the pandemic onset, likely related to improvements in youth asthma control and morbidity. Future research should explore trajectories of asthma and psychosocial functioning throughout the pandemic for families.
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Affiliation(s)
- Manuela Sinisterra
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Rachel Sweenie
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Dima Ezmigna
- Department of Pediatrics, University of Florida, Gainesville, FL, United States
| | - David A. Fedele
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
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Raudenska J, Gumančík J, Raudenský M, Pasqualucci A, Moka E, Varrassi G, Paladini A, Javurkova A. Cognitive-Behavioral Play Therapy and COVID-19 Pandemic Trauma in Preschool Children. Cureus 2023; 15:e44249. [PMID: 37772203 PMCID: PMC10524805 DOI: 10.7759/cureus.44249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/28/2023] [Indexed: 09/30/2023] Open
Abstract
Traumatic life events, such as the ongoing COVID-19 pandemic, can be a challenging health emergency, among others. The pandemic can also affect young preschoolers. They can experience negative emotions and behavioral and social difficulties. It can be hard for children to understand on their own what is going on, as well as for their families. This narrative review summarizes the role of psychotherapeutic approaches in working with trauma and aims to manage trauma, such as COVID-19, in preschool children. It focuses on the possibilities of applying cognitive-behavioral play therapy (CBPT) in preschool children who suffer from trauma during the COVID-19 pandemic period. The therapeutic approaches are tailored to specific development in preschoolers. Furthermore, the article provides insights into the relationship between negative emotions, thinking, and behavior, and COVID-19 as a threat, by describing a cognitive model in preschool-aged children. Finally, the article offers possible ways of applying play-based cognitive-behavioral therapy programs in preschool children who are victims of trauma.
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Affiliation(s)
- Jaroslava Raudenska
- Department of Nursing, Second Medical Faculty of Charles University, Prague, CZE
| | - Jiří Gumančík
- Department of Psychology, Faculty of Health and Life Sciences, University of Northumbria in Newcastle, Newcastle upon Tyne, GBR
| | | | - Alberto Pasqualucci
- Department of Anesthesia and Critical Care, University of Perugia, Perugia, ITA
| | - Eleni Moka
- Department of Anesthesiology, Creta InterClinic, Heraklion, GRC
| | | | - Antonella Paladini
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, ITA
| | - Alena Javurkova
- Department of Clinical Psychology, University Hospital Královské Vinohrady, Prague, CZE
- Department of Nursing, Second Medical Faculty of Charles University and Motol University Hospital, Prague, CZE
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Cahal M, Amirav I, Rochman M, Be'er M, Besor O, Lavie M. Lockdown Fatigue in Pediatric Respiratory Patients: Lessons from the First COVID-19 Year. Children (Basel) 2022; 9. [PMID: 36553306 DOI: 10.3390/children9121862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/25/2022] [Accepted: 11/27/2022] [Indexed: 12/02/2022]
Abstract
Lockdown policies have been implemented worldwide to limit the spread of COVID-19. “Lockdown fatigue” is a state of exhaustion related to the accumulating effects of repeated lockdowns. The aim of the current study was to examine the effects of repeated lockdowns on children with respiratory disorders. Data on children aged 0−18 years old with respiratory disorders were collected by an electronic survey during the third lockdown in Israel. The retrieved information included demographics and baseline medical status, respiratory clinical status during the third lockdown compared to pre-lockdown periods, lockdown adherence, lifestyle modifications and caregiver emotional status. The results were compared to those of a similar questionnaire distributed during the first lockdown. A total of 234 patients (62% males, 37% females, mean age 6.8 years (confidence interval 6.1−7.5)) were enrolled. Respiratory symptoms and exacerbation frequency were reduced in 76 (35.5%) and 58 (27.4%) patients, respectively, compared to the pre-lockdown period and similar to the first lockdown (p = 0.840 and p = 0.063, respectively). However, compared to the first lockdown, the third lockdown was associated with greater use of reliever medications (p = 0.006), less use of inhaled corticosteroids as routine treatment (p = 0.027), and more pediatric emergency room visits and hospitalizations (p = 0.001 and p < 0.001, respectively). The results also showed an increase in sedentary lifestyle (e.g., reduced physical activity (p = 0.025), less healthy eating habits (p = 0.001)) and reduced adherence to lockdown policies (p < 0.001). These data show that the continuing stability of clinical improvement during lockdown was accompanied by deleterious sequelae that potentially indicate “lockdown fatigue” among children with respiratory disorders.
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Manti S, Giallongo A, Parisi GF, Papale M, Presti S, Lo Bianco M, Spicuzza L, Leonardi S. Impact of COVID-19 Pandemic and Lockdown on the Epidemiology of RSV-Mediated Bronchiolitis: Experience from Our Centre. Children (Basel) 2022; 9. [PMID: 36360451 DOI: 10.3390/children9111723] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 10/26/2022] [Accepted: 11/08/2022] [Indexed: 11/12/2022]
Abstract
Background: The COVID-19 pandemic has dramatically affected the global epidemiology of other infectious respiratory diseases, leading to a significant decrease in their incidence. Hence, we aimed to characterize the epidemiology of RSV-bronchiolitis in children. Methods: children aged ≤2 years diagnosed with RSV-mediated bronchiolitis admitted to our Unit from October 2018 to December 2021, were retrospectively enrolled. Results: We included 95 patients (M/F = 46/49; mean age 7.56 ± 6.6 months). Specifically, 17 infants in 2018, 34 in 2019, 0 during 2020 lockdown, 1 during 2020 post-lockdown, and 43 in 2021. Incidence was significantly lower in 2020 compared with 2018, 2019 and 2021 (p < 0.05). No differences were found concerning need for respiratory support. Discussion: Several factors related to SARS-CoV-2 pandemic, especially restrictive measures, may have contributed to a significant reduction in hospitalizations due to RSV. The new outbreak in RSV infection-related hospitalizations reported between October and December 2021 has been suggested it may be due to an increased number of susceptible individuals to RSV infection. Conclusion: The experience of the SARS-CoV-2 outbreak has led to a marked decrease in other viral respiratory infections, such as RSV. This may pave the way for new approaches in preventing respiratory infections, highlighting the role of preventive measures.
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Hazan G, Fox C, Mok H, Haspel J. Age-dependent rebound in asthma exacerbations after COVID-19 lockdown. J Allergy Clin Immunol Glob 2022; 1:314-318. [PMID: 36377231 PMCID: PMC9364738 DOI: 10.1016/j.jacig.2022.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/23/2022] [Accepted: 06/07/2022] [Indexed: 06/16/2023]
Abstract
Background Virus mitigation measures enacted early in the coronavirus infectious disease 2019 (COVID-19) pandemic suppressed common respiratory viruses and reduced the number of obstructive lung disease exacerbations. However, many localities began to ease these precautions in the year 2021, leading to a resurgence of non-COVID viruses. How asthma and chronic obstructive pulmonary disease (COPD) activity responded to this upswing in viral abundance is unclear. Objective Our aim was to examine how viral resurgence during the relaxation of COVID-19 restrictions affected asthma and COPD exacerbations. Methods We analyzed electronic medical records for emergency department (ED) respiratory virus positivity, asthma visits, and COPD visits. We compared the 52-week interval before the COVID-19 restrictions (the pre-lockdown period [March 22, 2019-March 19, 2020]), the 52-week period immediately following enactment of the restrictions (the lockdown period [March 20, 2020-March 18, 2021]), and the 52-week period thereafter (the post-lockdown period [March 19, 2021-March 18, 2022]). We used MetaCYCLE to analyze seasonal trends in our data. Results The post-lockdown period was marked by a 400% increase in viral positivity compared with during the lockdown period. Asthma- and COPD-related ED visits each rose 37% compared with during the lockdown, with the rebound in asthma ED visits concentrated in individuals younger than 20 years. Interestingly, after the lockdown period, asthma ED visits overcorrected in children younger than 5 years, rising 81% compared with before the lockdown. Seasonal rhythms in asthma and COPD exacerbations were suppressed during the lockdown and recovered after the lockdown. Conclusions COVID-19 precautions had the unexpected effect of magnifying early-childhood asthma activity once common respiratory viruses recurred. These results may have implications for the future use of virus mitigation strategies in young children.
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Affiliation(s)
- Guy Hazan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Washington University School of Medicine, St Louis, Mo
- Division of Pediatric Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, Mo
| | - Carolyn Fox
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Washington University School of Medicine, St Louis, Mo
| | - Huram Mok
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Washington University School of Medicine, St Louis, Mo
| | - Jeffrey Haspel
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Washington University School of Medicine, St Louis, Mo
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10
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Teo KW, Patel D, Sisodia S, Roland D, Gaillard EA, Tang JW. Rhinovirus persistence during the COVID-19 pandemic-Impact on pediatric acute wheezing presentations. J Med Virol 2022; 94:5547-5552. [PMID: 35811371 PMCID: PMC9350342 DOI: 10.1002/jmv.27986] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 06/16/2022] [Accepted: 07/06/2022] [Indexed: 12/15/2022]
Abstract
Rhinoviruses have persisted throughout the COVID-19 pandemic, despite other seasonal respiratory viruses (influenza, parainfluenza, respiratory syncytial virus, adenoviruses, human metapneumovirus) being mostly suppressed by pandemic restrictions, such as masking and other forms of social distancing, especially during the national lockdown periods. Rhinoviruses, as nonenveloped viruses, are known to transmit effectively via the airborne and fomite route, which has allowed infection among children and adults to continue despite pandemic restrictions. Rhinoviruses are also known to cause and exacerbate acute wheezing episodes in children predisposed to this condition. Noninfectious causes such as air pollutants (PM2.5 , PM10 ) can also play a role. In this retrospective ecological study, we demonstrate the correlation between UK national sentinel rhinovirus surveillance, the level of airborne particulates, and the changing patterns of pediatric emergency department presentations for acute wheezing, before and during the COVID-19 pandemic (2018-2021) in a large UK teaching hospital.
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Affiliation(s)
- Kah Wee Teo
- Department of Paediatric Respiratory MedicineUniversity Hospitals of Leicester NHS TrustLeicesterUK
| | - Deepa Patel
- Department of Paediatric Respiratory MedicineUniversity Hospitals of Leicester NHS TrustLeicesterUK
| | | | - Damian Roland
- Children's Emergency Department, Paediatric Emergency Medicine Leicester Academic (PEMLA) groupUniversity Hospitals of Leicester NHS TrustLeicesterUK,SAPPHIRE Group, Health SciencesUniversity of LeicesterLeicesterUK
| | - Erol A. Gaillard
- Department of Paediatric Respiratory MedicineUniversity Hospitals of Leicester NHS TrustLeicesterUK,Department of Respiratory SciencesUniversity of LeicesterLeicesterUK
| | - Julian W. Tang
- Department of Respiratory SciencesUniversity of LeicesterLeicesterUK,Department of Clinical Microbiology, University Hospitals of Leicester NHS TrustLeicester Royal infirmaryLeicesterUK
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Akelma Z, Başkaya N, Çetin S, Bostancı İ, Özmen S. Improvement in school-aged children with asthma during the Covid-19 pandemic. Pediatr Pulmonol 2022; 57:2518-2523. [PMID: 35794002 PMCID: PMC9350178 DOI: 10.1002/ppul.26068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 06/10/2022] [Accepted: 07/01/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The coronavirus 2019 disease (Covid-19) pandemic led to a number of measures being introduced in many countries worldwide. Lockdowns were imposed on individuals aged <18 years, education was delivered online, and mask-wearing was made compulsory in public places, resulting in an unprecedented period for children. Real-life data showing how children with asthma are affected by major changes are limited. This study investigated how asthmatic children are affected by pandemic conditions based on real-life data. METHODS Patients with asthma aged 6-18 years followed up from March to May 2019-before the Covid-19 pandemic-were included in the study. Data from March to May 2020 and 2019 were then compared to reveal the effects of pandemic-related lifestyle changes on symptoms, frequency of exacerbations, and drug use in asthmatic children. RESULTS Eighty-six children with asthma aged 6-18 years were included in this study. Time spent inside the home was significantly higher in 2020 than in 2019. Rescue medication requirements and emergency department visits were significantly lower in 2020 compared to 2019 (p < 0.001). The number of well-controlled patients with asthma was higher in 2020 than in 2019 (p < 0.0001). The number of patients using prophylactic drugs within the previous 3 months was lower in 2020 compared to 2019 (p = 0.007). CONCLUSION The present study yielded valuable insights, based on real-life data, into the condition of children over the age of 6 years during the Covid-19 pandemic. Numbers of asthmatic exacerbations, rescue drug use, and asthma control were positively affected in school-aged children with asthma during the pandemic.
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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, Turkey.,Division of Pediatric Allergy and Immunology, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Nevzat Başkaya
- Pediatric Allergy and Immunology Clinic, Dr. Sami Ulus Maternity and Children's Research and Training Hospital, Ankara, Turkey
| | - Sema Çetin
- Pediatric Allergy and Immunology Clinic, Dr. Sami Ulus Maternity and Children's Research and Training Hospital, Ankara, Turkey
| | - İlknur Bostancı
- Pediatric Allergy and Immunology Clinic, Dr. Sami Ulus Maternity and Children's Research and Training Hospital, Ankara, Turkey.,Division of Pediatric Allergy and Immunology, University of Health Sciences, Ankara, Turkey
| | - Serap Özmen
- Pediatric Allergy and Immunology Clinic, Dr. Sami Ulus Maternity and Children's Research and Training Hospital, Ankara, Turkey.,Division of Pediatric Allergy and Immunology, University of Health Sciences, Ankara, Turkey
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12
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Urrutia-Pereira M, Chong-Neto HJ, Annesi Maesano I, Ansotegui IJ, Caraballo L, Cecchi L, Galán C, López JF, Aguttes MM, Peden D, Pomés A, Zakzuk J, Rosário Filho NA, D'Amato G. Environmental contributions to the interactions of COVID-19 and asthma: A secondary publication and update. World Allergy Organ J 2022; 15:100686. [PMID: 35966894 PMCID: PMC9359502 DOI: 10.1016/j.waojou.2022.100686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/22/2022] [Accepted: 07/29/2022] [Indexed: 11/01/2022] Open
Abstract
An outbreak of coronavirus disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) started in Wuhan, Hubei Province, China and quickly spread around the world. Current evidence is contradictory on the association of asthma with COVID-19 and associated severe outcomes. Type 2 inflammation may reduce the risk for severe COVID-19. Whether asthma diagnosis may be a risk factor for severe COVID-19, especially for those with severe disease or non-allergic phenotypes, deserves further attention and clarification. In addition, COVID-19 does not appear to provoke asthma exacerbations, and asthma therapeutics should be continued for patients with exposure to COVID-19. Changes in the intensity of pollinization, an earlier start and extension of the pollinating season, and the increase in production and allergenicity of pollen are known direct effects that air pollution has on physical, chemical, and biological properties of the pollen grains. They are influenced and triggered by meteorological variables that could partially explain the effect on COVID-19. SARS-CoV-2 is capable of persisting in the environment and can be transported by bioaerosols which can further influence its transmission rate and seasonality. The COVID-19 pandemic has changed the behavior of adults and children globally. A general trend during the pandemic has been human isolation indoors due to school lockdowns and loss of job or implementation of virtual work at home. A consequence of this behavior change would presumably be changes in indoor allergen exposures and reduction of inhaled outdoor allergens. Therefore, lockdowns during the pandemic might have improved some specific allergies, while worsening others, depending on the housing conditions.
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Affiliation(s)
| | - Herberto Jose Chong-Neto
- Division of Allergy and Immunology, Department of Pediatrics, Federal University of Paraná, Curitiba, PR, Brazil
| | - Isabella Annesi Maesano
- French NIH (INSERM), and EPAR Department, IPLESP, INSERM and Sorbonne University, Paris, France
| | | | - Luis Caraballo
- Institute for Immunological Research, University of Cartagena, Cartagena, Colombia
| | - Lorenzo Cecchi
- Centre of Bioclimatology, University of Florence, Florence, Italy.,SOS Allergy and Clinical Immunology, USL Toscana Centro, Prato, Italy
| | - Carmen Galán
- Department of Botany, Ecology and Plant Physiology, International Campus of Excellence on Agrifood (ceiA3), University of Córdoba, Córdoba, Spain
| | - Juan Felipe López
- Institute for Immunological Research, University of Cartagena, Cartagena, Colombia
| | | | - David Peden
- UNC School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Anna Pomés
- Basic Research, Indoor Biotechnologies, Inc, Charlottesville, VA, United States
| | - Josefina Zakzuk
- Institute for Immunological Research, University of Cartagena, Cartagena, Colombia
| | | | - Gennaro D'Amato
- Division of Respiratory and Allergic Diseases, High Specialty Hospital A. Cardarelli, School of Specialization in Respiratory Diseases, Federico II University, Naples, Italy
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13
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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14
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Rad D, Magulod GC, Balas E, Roman A, Egerau A, Maier R, Ignat S, Dughi T, Balas V, Demeter E, Rad G, Chis R. A Radial Basis Function Neural Network Approach to Predict Preschool Teachers' Technology Acceptance Behavior. Front Psychol 2022; 13:880753. [PMID: 35756273 PMCID: PMC9218334 DOI: 10.3389/fpsyg.2022.880753] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/05/2022] [Indexed: 12/13/2022] Open
Abstract
With the continual development of artificial intelligence and smart computing in recent years, quantitative approaches have become increasingly popular as an efficient modeling tool as they do not necessitate complicated mathematical models. Many nations have taken steps, such as transitioning to online schooling, to decrease the harm caused by coronaviruses. Inspired by the demand for technology in early education, the present research uses a radial basis function (RBF) neural network (NN) modeling technique to predict preschool instructors' technology usage in classes based on recognized determinant characteristics of technology acceptance. In this regard, this study utilized the RBFNN approach to predict preschool teachers' technology acceptance behavior, based on the theory of planned behavior, which states that behavioral achievement, in our case the actual technology use in class, depends on motivation, intention and ability, and behavioral control. Thus, this research design is based on an adapted version of the technology acceptance model (TAM) with eight dimensions: D1. Perceived usefulness, D2. Perceived ease of use, D3. Perceived enjoyment, D4. Intention to use, D5. Actual use, D6. Compatibility, D7. Attitude, and D8. Self-efficacy. According to the TAM, actual usage is significantly predicted by the other seven dimensions used in this research. Instead of using the classical multiple linear regression statistical processing of data, we opted for a NN based on the RBF approach to predict the actual usage behavior. This study included 182 preschool teachers who were randomly chosen from a project-based national preschool teacher training program and who responded to our online questionnaire. After designing the RBF function with the actual usage as an output variable and the other seven dimensions as input variables, in the model summary, we obtained in the training sample a sum of squares error of 37.5 and a percent of incorrect predictions of 43.3%. In the testing sample, we obtained a sum of squares error of 14.88 and a percent of incorrect predictions of 37%. Thus, we can conclude that 63% of the classified data are correctly assigned to the models' dependent variable, i.e., actual technology use, which is a significant rate of correct predictions in the testing sample. This high significant percentage of correct classification represents an important result, mainly because this is the first study to apply RBFNN's prediction on psychological data, opening up a new interdisciplinary field of research.
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Affiliation(s)
- Dana Rad
- Faculty of Educational Sciences, Psychology and Social Sciences, Center of Research Development and Innovation in Psychology, Aurel Vlaicu University of Arad, Arad, Romania
| | - Gilbert C. Magulod
- College of Teacher Education, Cagayan State University, Tuguegarao, Philippines
| | - Evelina Balas
- Faculty of Educational Sciences, Psychology and Social Sciences, Center of Research Development and Innovation in Psychology, Aurel Vlaicu University of Arad, Arad, Romania
| | - Alina Roman
- Faculty of Educational Sciences, Psychology and Social Sciences, Center of Research Development and Innovation in Psychology, Aurel Vlaicu University of Arad, Arad, Romania
| | - Anca Egerau
- Faculty of Educational Sciences, Psychology and Social Sciences, Center of Research Development and Innovation in Psychology, Aurel Vlaicu University of Arad, Arad, Romania
| | - Roxana Maier
- Faculty of Educational Sciences, Psychology and Social Sciences, Center of Research Development and Innovation in Psychology, Aurel Vlaicu University of Arad, Arad, Romania
| | - Sonia Ignat
- Faculty of Educational Sciences, Psychology and Social Sciences, Center of Research Development and Innovation in Psychology, Aurel Vlaicu University of Arad, Arad, Romania
| | - Tiberiu Dughi
- Faculty of Educational Sciences, Psychology and Social Sciences, Center of Research Development and Innovation in Psychology, Aurel Vlaicu University of Arad, Arad, Romania
| | - Valentina Balas
- Faculty of Engineering, Aurel Vlaicu University of Arad, Arad, Romania
| | - Edgar Demeter
- Faculty of Educational Sciences, Psychology and Social Sciences, Center of Research Development and Innovation in Psychology, Aurel Vlaicu University of Arad, Arad, Romania
| | - Gavril Rad
- Faculty of Educational Sciences, Psychology and Social Sciences, Center of Research Development and Innovation in Psychology, Aurel Vlaicu University of Arad, Arad, Romania
| | - Roxana Chis
- Faculty of Educational Sciences, Psychology and Social Sciences, Center of Research Development and Innovation in Psychology, Aurel Vlaicu University of Arad, Arad, Romania
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15
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Rosenfeld N, Mandelberg A, Dalal I, Tasher D, Kamar A, Schnapper M, Armoni Domany K. The impact of the COVID-19 pandemic on respiratory morbidity during infancy: A birth-cohort study. Pediatr Pulmonol 2022; 57:848-856. [PMID: 35018744 DOI: 10.1002/ppul.25822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/04/2022] [Accepted: 01/08/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the incidence of wheezing and overall respiratory morbidity in healthy infants born during the first peak of the coronavirus disease-2019 (COVID-19) pandemic, compared with infants born during the preceding year. METHODS This was a single-center retrospective birth cohort study to compare a cohort of children born between February and March 2020 (COVID-19 group) to a control group of children born between February and March 2019 (pre-COVID-19 group). At 1 year of age, we collected respiratory data using parental and telephone questionnaires. PRIMARY OUTCOME wheezing incidence and/or bronchodilator use. SECONDARY OUTCOMES recurrent wheezing, emergency-room visits, hospital admissions, pneumonia diagnosis, and admissions due to lower-respiratory-tract-infections (LRTI). We included the following covariate risk factors in the logistic regression models; atopy, daycare attendance, breastmilk feeding, parental smoking, C-section, siblings, and gestational age. RESULTS We enrolled 588 infants, 294 in each group (48% males). Demographic, perinatal, and atopic characteristics were similar between the groups. Compared to the pre-COVID-19 group, infants born during the COVID-19 period were significantly less likely to report wheezing and/or bronchodilator use (adjusted-odds ratio [OR], 0.4; 95% confidence interval [CI] 0.28-0.59), systemic steroid use, (adjusted-OR, 0.47; 95% CI 0.24-0.91), emergency-room visits (adjusted-OR, 0.36; 95% CI 0.17-0.72), LRTI admissions (adjusted-OR, 0.2; 95% CI 0.05-0.74), or pneumonia diagnosis (adjusted-OR, 0.22; 95% CI 0.09-0.53). CONCLUSIONS This study investigated wheezing and respiratory morbidity over the first year of the COVID-19 pandemic in infants born during the first peak of COVID-19. The study demonstrated a significant decrease in most aspects of respiratory morbidity. A longitudinal follow-up study to explore the subsequent impact of these findings is warranted.
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Affiliation(s)
- Nataly Rosenfeld
- Department of Pediatric, The Edith Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Avigdor Mandelberg
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Pediatric Pulmonology Unit, The Edith Wolfson Medical Center, Holon, Israel
| | - Ilan Dalal
- Department of Pediatric, The Edith Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Diana Tasher
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Infectious Diseases Unit, The Edith Wolfson Medical Center, Holon, Israel
| | - Alma Kamar
- Department of Pediatric, The Edith Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Michael Schnapper
- Department of Pediatric, The Edith Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Keren Armoni Domany
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Pediatric Pulmonology Unit, The Edith Wolfson Medical Center, Holon, Israel
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16
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Masarweh K, Gur M, Bar-Yoseph R, Bentur L, Dabaja-Younis H. Characterization of respiratory illness surge (April-June 2021) post-COVID-19 lockdown. Pediatr Pulmonol 2022; 57:667-673. [PMID: 34914208 DOI: 10.1002/ppul.25792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/21/2021] [Accepted: 12/14/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Following the opening of lockdown and relaxation of public health restrictions, an unusual surge of respiratory illness occurred during the spring/summer (Q2) 2021 season. We aimed to characterize this surge compared to previous years. METHODS Children discharged from a single tertiary hospital for respiratory illness or selected noncommunicable diseases (NCDs) between 2015 and 2021 were included, and hospitalization rates were compared. To evaluate whether the current respiratory surge resembles a typical winter, characteristics of the second quarter (Q2, April-June) of 2021 were compared to parallel seasons and to autumn/winter (Q4, October-December) of the previous years. RESULTS Respiratory illness showed a seasonal peak, while the pattern of NCD was consistent throughout the study period. Respiratory illnesses showed a delayed surge in Q2 2021 (389 patients), with a missing seasonal peak in Q2 and Q4 2020 (135 and 119 patients, respectively). There were more cases of croup in Q2 2021 compared to Q2 and Q4 2015-2019 (26.2 vs. 12.5% and 15.8%, p < 0.001), fewer cases of pneumonia (5.9 vs. 15.9% and 11.7%, p < 0.001), lower admission rates (22.4 vs. 36.3% and 31.5%, p < 0.001), and fewer hypoxemia during hospitalization (6.3 vs. 11.7% and 10%, p < 0.001). Additionally, lower use of antibiotics (6.2 vs. 12.3% and 10.3%, p = 0.001 and 0.012, respectively) and higher use of steroids (33.7 vs. 24.8% and 28.3%, p < 0.001 and 0.034, respectively). CONCLUSIONS The postponed increase in respiratory morbidity after lockdown had unique characteristics, with upper respiratory illness predominating and fewer hospitalizations. Follow-up is needed to assess the altered epidemiological patterns of respiratory diseases in the post-COVID era.
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Affiliation(s)
- Kamal Masarweh
- Pediatric Pulmonary Institute and CF Center, The Ruth Rappaport Children's Hospital, Haifa, Israel
| | - Michal Gur
- Pediatric Pulmonary Institute and CF Center, The Ruth Rappaport Children's Hospital, Haifa, Israel.,Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ronen Bar-Yoseph
- Pediatric Pulmonary Institute and CF Center, The Ruth Rappaport Children's Hospital, Haifa, Israel.,Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Lea Bentur
- Pediatric Pulmonary Institute and CF Center, The Ruth Rappaport Children's Hospital, Haifa, Israel.,Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Halima Dabaja-Younis
- Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.,Pediatric Infectious Diseases Unit, Rappaport Children's Hospital, Haifa, Israel
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17
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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18
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Zhang Z, Wang L, Wang J, Jia Y, Yi M, Chen O. Physical activity and childhood asthma control: Mediation and moderation role of body mass index. Pediatr Pulmonol 2021; 56:3720-3727. [PMID: 34516730 DOI: 10.1002/ppul.25662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Physical activity (PA) may be associated with asthma management. Whether PA is associated with childhood asthma control is not well studied, and the role of body mass index (BMI) in this association remains unclarified. This study aimed to evaluate the association between PA and childhood asthma control and investigate the potential mediating and modifying role of BMI in the association. METHODS This cross-sectional study involved 303 asthmatic children aged 5-14 years. Information on PA was collected from children. Asthma control was assessed using a valid questionnaire by children and their parents. Height and weight were objectively measured and BMI was calculated and classified. Multiple linear regression, mediation, and moderation analyses were performed. RESULTS There was a positive association between PA and childhood asthma control with adjustment for variates (B = 0.144, p = .012). Mediation analysis indicated that BMI status negatively mediated the association (estimate = -0.656, 95% credit interval: -1.645, -0.006), and such indirect effect is lower than the direct effect (indirect effect/direct effect = 58.3%). No evidence of effect modification by BMI was observed (Pinteraction = 0.516). Stratified analyses showed that the significant association was only observed in children with overweight/obesity (normal weight: B = 0.863, p = .189; overweight/obese: B = 1.494, p = .044). CONCLUSIONS Increased PA is associated with improved childhood asthma control, especially for children with higher BMI. BMI exhibited a negative effect but not effect modification in this association. PA should be encouraged to improve asthma control for asthmatic children. Besides, mechanisms other than weight loss may explain the association.
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Affiliation(s)
- Zeyi Zhang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Liwen Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China.,Intensive Care Unit, Qingdao Municipal Hospital, Qingdao, China
| | - Jingjing Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yuanmin Jia
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Mo Yi
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ou Chen
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
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19
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Rázquin Arias M, Ventura Wichner PS, López-Escobar A, Díaz-Conradi A, Daoud Pérez Z. Letter from Spain. Respirology 2021; 26:1190-1191. [PMID: 34725891 DOI: 10.1111/resp.14178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 09/23/2021] [Accepted: 10/09/2021] [Indexed: 11/30/2022]
Affiliation(s)
| | - Paula Sol Ventura Wichner
- Pediatrics Department, HM Nens, HM Hospitals, Barcelona, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Alejandro López-Escobar
- Pediatrics Department, Hospital Vithas Madrid La Milagrosa, Madrid, Spain.,Clinical Research Unit, Fundación Vithas, Grupo Vithas, Madrid, Spain
| | | | - Zarife Daoud Pérez
- Pediatrics Pulmonology Department, HM Hospitals, Madrid, Spain.,Pediatrics Department, Emirates Speciality Hospital Dubai, Dubai, United Arab Emirates
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20
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Ullmann N, Allegorico A, Bush A, Porcaro F, Negro V, Onofri A, Cherchi C, De Santis S, Rosito L, Cutrera R. Effects of the COVID-19 pandemic and lockdown on symptom control in preschool children with recurrent wheezing. Pediatr Pulmonol 2021; 56:1946-1950. [PMID: 33852779 PMCID: PMC8251173 DOI: 10.1002/ppul.25400] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Preschool wheezers are at high risk of recurrent attacks triggered by respiratory viruses, sometimes exacerbated by exposure to allergens and pollution. Because of the COVID-19 infection, the lockdown was introduced, but the effects on preschool wheezers are unknown. We hypothesized that there would be an improvement in outcomes during the lockdown, and these would be lost when the lockdown was eased. MATERIALS AND METHODS Patients underwent medical visits before and after the COVID-19 lockdown. We recorded the childhood Asthma Control Test (cACT) and a clinical questionnaire. Data on symptoms, the need for medications and the use of healthcare resources were recorded. We compared these data with retrospective reports from the preceding year and prospectively acquired questionnaires after lockdown. RESULTS We studied 85 preschool wheezers, mean age 4.9 years. During the lockdown, cACT score was significantly higher (median 25 vs. 23); families reported a dramatic drop in wheezing episodes (51 vs. none), significant reductions in the day and nighttime symptoms, including episodes of shortness of breath (p < .0001); the use of salbutamol and oral corticosteroids (OCS) dropped significantly (p < .0001) and 79 (95%) patients needed no OCS bursts during the lockdown. Finally, patients had significantly fewer extra medical examinations, as well as fewer Emergency Room visits (p < .0001). All were improved compared with the same time period from the previous year, but outcomes worsened significantly again after lockdown (cACT median: 22). CONCLUSIONS During the national lockdown, children with persistent preschool wheeze showed a significant clinical improvement with reduction of respiratory symptoms, medication use for exacerbations, and use of healthcare resources. This trend reversed when lockdown restrictions were eased.
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Affiliation(s)
- Nicola Ullmann
- Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Annalisa Allegorico
- Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrew Bush
- Department of Paediatric Respiratory Medicine, National Heart and Lung Institute, Imperial College and Royal Brompton Hospital, London, UK
| | - Federica Porcaro
- Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Valentina Negro
- Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandro Onofri
- Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Claudio Cherchi
- Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Simone De Santis
- Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Lorenza Rosito
- Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Renato Cutrera
- Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Taytard J, Coquelin F, Beydon N. Improvement in Asthma Symptoms and Pulmonary Function in Children After SARS-CoV-2 Outbreak. Front Pediatr 2021; 9:745611. [PMID: 34746060 PMCID: PMC8569423 DOI: 10.3389/fped.2021.745611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/28/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Little is known on the effect of SARS-CoV-2 circulation on asthma daily symptoms in children. We compared asthma exacerbations, asthma symptom control and lung function before and after SARS-CoV-2 outbreak in children. Methods: Retrospective study of children with persistent asthma referred for lung function testing. The second quarter of 2020 being a period with nearly no activity, we compared the activity between the first, third and fourth quarters of 2019 and 2020 (Q1-2019 vs. Q1-2020, Q3-2019 vs. Q3-2020 and Q4-2019 vs. Q4-2020). Results: We retrieved 1,871 files in 2019 and 1,548 in 2020. The whole population [2,165 (63.3%) boys] had a median [IQR] age of 9.7 [6.8;13.1] years. There was no difference in age, sex, and ethnicity between 2019 and 2020 populations. Asthma was better controlled during Q4-2020 compared to Q4-2019 (P = 0.042), and there was a lower proportion of children with at least one exacerbation in the previous 3 months after the reopening, compared to the same period in 2019 (P < 0.0001). Baseline FEV1 (Z-score) recorded after the reopening was significantly higher (with less reversibility) compared to the same period before the epidemic (P < 0.0001). Baseline FEV1/FVC (Z-score) was significantly higher during Q3-2020 compared to Q3-2019 (P = 0.026), with fewer children having a significant reversibility (P = 0.035). Discussion: We demonstrated a trend toward increased exacerbations just before the recognition of the epidemic, and fewer exacerbations, better asthma symptom control and improvement in the lung function of asthmatic children after the reopening.
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Affiliation(s)
- Jessica Taytard
- AP-HP, Centre de Référence des Maladies Respiratoires Rares, Service de pneumologie pédiatrique, Hôpital Armand-Trousseau, Paris, France.,Sorbonne Université, INSERM, UMRS1158, Paris, France
| | - Florence Coquelin
- APHP, Unité Fonctionnelle de Physiologie-Explorations Fonctionnelles Respiratoires, hôpital Armand-Trousseau, Paris, France
| | - Nicole Beydon
- APHP, Unité Fonctionnelle de Physiologie-Explorations Fonctionnelles Respiratoires, hôpital Armand-Trousseau, Paris, France.,INSERM U934, Centre de Recherche Saint Antoine, Paris, France
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