April 22 2022
2 minutes to read
Source / Disclosures
Al-Abdulkarim states that there are no relevant financial disclosures. Please see the study for all relevant financial disclosures by other authors.
Fewer children with asthma were hospitalized with exacerbations during the first few months of the COVID-19 pandemic than in the previous year, despite developing more severe symptoms, according to a recent study.
Nada Al-Abd Al-Karim MBBS A pediatrician resident at Children’s National Hospital in Washington, D.C., and colleagues examined 50 cases between April 1 and September 30, 2020, as well as 243 control cases from the same period in 2019, in the study published in Annals of Allergy, Asthma and Immunology.
Children in the pandemic cases were significantly older than those in the control cases (9.8 ± 4.3 years vs. 6.7 ± 3.8 years; s <.0001). There was also a trend towards fewer Hispanic children among epidemic cases compared to controls.
Control cases had a greater proportion of children with eczema (32.1% versus 16%; s = .02) and food allergies (18.5% vs. 6%; s = .03), although the researchers found no significant differences in the prevalence of other comorbidities.
Taking into account its use as an objective measure of increased severity of asthma exacerbations at presentation, the researchers said that intravenous magnesium sulfate was administered more frequently during the epidemic than in the control period (84% vs 63%; s = .001).
In fact, there was a 16% higher probability of patients receiving magnesium sulfate with increasing age each year. African American and Hispanic patients had higher odds of receiving magnesium sulfate in ED as well.
However, use was independent of gender or comorbidities such as obstructive sleep apnea, eczema, food allergies, obesity, basic asthma management regimens and reporting of compliance with preventive regimens.
More pandemic cases did not comply with control medication than control (46% vs. 24.7%; s = .0023), and a lower proportion of them received inhaled corticosteroids during their hospital stay (30% vs 58.8%; s = .0002).
However, the researchers also noted that non-compliance was not an independent predictor of whether magnesium was needed. In addition, fewer children started or restarted control therapy during the pandemic than during the control period.
The researchers continued that this lower compliance may have contributed to the visit, but did not affect the need for magnesium, suggesting that other clinical differences such as lower prevalence of atopy between cases and controls may influence asthma severity during presentation.
These lower rates of atopy among hospitalized children are in line with previous studies that have found a protective effect of atopy among patients who have been infected with SARS-CoV-2, possibly due to use of inhaled corticosteroids, the researchers said.
The researchers further speculated that parents and caregivers may have been afraid to visit the emergency department due to mild asthma symptoms during the pandemic and instead treat them at home, which has led to a greater proportion of more severe cases.
The financial difficulties and transportation difficulties many families experienced may have prevented them from refilling control medications or attending routine asthma care visits, which also worsens asthma severity, the researchers said.