April 22, 2022
2 min read
Fewer children with asthma were admitted for exacerbations during the first few months of the COVID-19 pandemic compared to the previous year, even though they had more severe symptoms, according to a recent study.
Nada Alabdulkarim, MBBS, a pediatric resident at Children’s National Hospital in Washington, DC, and colleagues examined 50 cases between April 1 and September 30, 2020, as well as 243 controls from the same period in 2019, in the study published in Annals of Allergy, Asthma & Immunology.
The children in the pandemic cases were significantly older compared to the children in the control cases (9.8 ± 4.3 years vs. 6.7 ± 3.8 years; P <0.0001). There was also a tendency for fewer Latin American children among the pandemic cases compared to the controls.
Control cases had a greater proportion of children with eczema (32.1% vs. 16%; P = 0.02) and food allergies (18.5% vs. 6%; P = .03), although the researchers did not find any significant differences in the incidence of other comorbidities.
Given its use as an objective measure of the increased severity of asthma exacerbations at presentation, the researchers said that intravenous magnesium sulfate was administered more frequently during the pandemic compared to the control period (84% vs. 63%; P = 0.001).
In fact, patients were given a 16% higher probability of receiving magnesium sulfate with increasing age each year. African American and Hispanic patients also had higher odds of receiving magnesium sulfate in ED.
However, use was independent of gender or comorbidities such as obstructive sleep apnea, eczema, food allergy, obesity, baseline asthma treatment regimens, and reported adherence to preventive regimens.
Several of the pandemic cases did not comply with controlling medication compared to the control cases (46% vs. 24.7%; P = .0023), and a small proportion of them received inhaled corticosteroids during their hospital stay (30% vs. 58.8%; P = 0.0002).
Nevertheless, the researchers also noted that non-compliance was not an independent prediction of whether magnesium would be necessary. Plus, fewer children started or restarted controller treatment during the pandemic compared to the control period.
This lower compliance may have contributed to the visit, the researchers continued, but it did not affect the need for magnesium, indicating that other clinical differences, such as a lower incidence of atopy between cases and controls, may affect the severity of asthma during presentation.
These lower rates of atopy among children who were hospitalized in line with previous studies that found a protective effect of atopy among patients who had been infected with SARS-CoV-2, the researchers said, possibly due to the use of inhaled corticosteroids.
The researchers further speculated that parents and caregivers may have been afraid to visit the ED for mild asthma symptoms during the pandemic and treated them at home instead, leading to a greater proportion of more serious cases.
The financial and transportation difficulties that many families experience may have prevented them from refilling control medications or participating in routine asthma treatment visits, which has also led to greater severity of asthma exacerbations, the researchers said.