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Childhood asthma outcomes during the COVID-19 pandemic: findings from the PeARL multinational cohort

Childhood asthma outcomes during the COVID-19 pandemic: findings from the PeARL multinational cohort
Childhood asthma outcomes during the COVID-19 pandemic: findings from the PeARL multinational cohort

Background: The interplay between COVID-19 pandemic and asthma in children is still unclear. We evaluated the impact of COVID-19 pandemic on childhood asthma outcomes. Methods: The PeARL multinational cohort included 1,054 children with asthma and 505 non-asthmatic children aged between 4 and 18 years from 25 pediatric departments, from 15 countries globally. We compared the frequency of acute respiratory and febrile presentations during the first wave of the COVID-19 pandemic between groups and with data available from the previous year. In children with asthma, we also compared current and historical disease control. Results: During the pandemic, children with asthma experienced fewer upper respiratory tract infections, episodes of pyrexia, emergency visits, hospital admissions, asthma attacks, and hospitalizations due to asthma, in comparison with the preceding year. Sixty-six percent of asthmatic children had improved asthma control while in 33% the improvement exceeded the minimal clinically important difference. Pre-bronchodilatation FEV1 and peak expiratory flow rate were improved during the pandemic. When compared to non-asthmatic controls, children with asthma were not at increased risk of LRTIs, episodes of pyrexia, emergency visits, or hospitalizations during the pandemic. However, an increased risk of URTIs emerged. Conclusion: Childhood asthma outcomes, including control, were improved during the first wave of the COVID-19 pandemic, probably because of reduced exposure to asthma triggers and increased treatment adherence. The decreased frequency of acute episodes does not support the notion that childhood asthma may be a risk factor for COVID-19. Furthermore, the potential for improving childhood asthma outcomes through environmental control becomes apparent.

childhood asthma, coronavirus, COVID-19
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1765-1775
Papadopoulos, Nikolaos G.
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Mathioudakis, Alexander G.
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Custovic, Adnan
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Deschildre, Antoine
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Cros, Pierrick
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Tulkki, Marleena
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Wasilczuk, Katarzyna
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Papadopoulos, Nikolaos G.
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Mathioudakis, Alexander G.
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Custovic, Adnan
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Deschildre, Antoine
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Phipatanakul, Wanda
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Wong, Gary
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Abou-Taam, Rola
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Agache, Ioana
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El-Sayed, Zeinab Awad
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Ramos, Ángel Mazón
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Schweitzer, Cyril E.
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Roberts, Graham C.
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PeARL collaborators, on behalf of the PeARL Think Tank (2021) Childhood asthma outcomes during the COVID-19 pandemic: findings from the PeARL multinational cohort. Allergy: European Journal of Allergy and Clinical Immunology, 76 (6), 1765-1775. (doi:10.1111/all.14787).

Record type: Article

Abstract

Background: The interplay between COVID-19 pandemic and asthma in children is still unclear. We evaluated the impact of COVID-19 pandemic on childhood asthma outcomes. Methods: The PeARL multinational cohort included 1,054 children with asthma and 505 non-asthmatic children aged between 4 and 18 years from 25 pediatric departments, from 15 countries globally. We compared the frequency of acute respiratory and febrile presentations during the first wave of the COVID-19 pandemic between groups and with data available from the previous year. In children with asthma, we also compared current and historical disease control. Results: During the pandemic, children with asthma experienced fewer upper respiratory tract infections, episodes of pyrexia, emergency visits, hospital admissions, asthma attacks, and hospitalizations due to asthma, in comparison with the preceding year. Sixty-six percent of asthmatic children had improved asthma control while in 33% the improvement exceeded the minimal clinically important difference. Pre-bronchodilatation FEV1 and peak expiratory flow rate were improved during the pandemic. When compared to non-asthmatic controls, children with asthma were not at increased risk of LRTIs, episodes of pyrexia, emergency visits, or hospitalizations during the pandemic. However, an increased risk of URTIs emerged. Conclusion: Childhood asthma outcomes, including control, were improved during the first wave of the COVID-19 pandemic, probably because of reduced exposure to asthma triggers and increased treatment adherence. The decreased frequency of acute episodes does not support the notion that childhood asthma may be a risk factor for COVID-19. Furthermore, the potential for improving childhood asthma outcomes through environmental control becomes apparent.

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Accepted/In Press date: 2021
e-pub ahead of print date: 20 February 2021
Additional Information: Funding Information: This study was supported by the Respiratory Effectiveness Group (REG). REG has received support from AstraZeneca, Novartis, and Sanofi for continued work on PeARL. AGM was supported by the National Institute of Health Research Manchester Biomedical Research Centre (NIHR Manchester BRC). We thank Mrs Maria Kritikou for excellent administrative support of the study. Funding Information: This study was supported by the Respiratory Effectiveness Group (REG). REG has received support from AstraZeneca, Novartis, and Sanofi for continued work on PeARL. TJ reports grants from The Paulo Foundation, Helsinki, Finland. MT reports grants from The Sigrid Juselius Foundation, Helsinki, Finland, during the conduct of the study. None of the other authors had any conflicts of interest directly related to this work. AND, AF, KN,EH, LN‐B, WP, ZC, WF, GW, LG‐M, ZAW‐S, YRHV, CFPB, DRY, CS, PLR, PS, RA‐T, J‐CD, JL, TR, DY, AMR, KW, RE‐O, JAC‐R, AG, CM, AILG, MM‐A, EMNR, MKN, VF, and ER‐Z do not declare any conflicts of interest outside the submitted work either. NGP reports personal fees from ALK, Novartis, Nutricia, HAL, Menarini/FAES Farma, Sanofi, Mylan/MEDA, Biomay, AstraZeneca, GSK, MSD, ASIT BIOTECH, and Boehringer Ingelheim; grants from Gerolymatos International SA and Capricare outside the submitted work. AGM reports grants from Boehringer Ingelheim outside the submitted work. AC reports personal fees from Novartis, Thermo Fisher Scientific, Philips, Sanofi, Stallergenes Greer, AstraZeneca, outside the submitted work. AD reports personal fees and other from Novartis, ALK, MYLAN, GSK,CHIESI, Astra Zeneca, DBV technologies, grants and personal fees from Stallergenes Greer, personal fees from AImmune, Zambon, Boehringer Ingelheim, Nestlé HealthScience, other from Nutricia, outside the submitted work. IA reports and Associate Editor Allergy journal. PXreports personal fees from Nutricia, Nestle, Menarini, Uriach, Novartis PharmaAG, and GlaxoSmithkline outside the submitted work. CM reports personal fees from Novartis, GSK, ThermoFisher, Boehringer Ingelheim, outside the submitted work. Publisher Copyright: © 2021 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
Keywords: childhood asthma, coronavirus, COVID-19

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Local EPrints ID: 448495
URI: http://eprints.soton.ac.uk/id/eprint/448495
ISSN: 0105-4538
PURE UUID: 7361e7ac-0282-4442-b96e-43541e7ed686
ORCID for Graham C. Roberts: ORCID iD orcid.org/0000-0003-2252-1248

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Date deposited: 23 Apr 2021 16:31
Last modified: 26 Nov 2021 02:49

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Contributors

Author: Nikolaos G. Papadopoulos
Author: Alexander G. Mathioudakis
Author: Adnan Custovic
Author: Antoine Deschildre
Author: Wanda Phipatanakul
Author: Gary Wong
Author: Paraskevi Xepapadaki
Author: Rola Abou-Taam
Author: Ioana Agache
Author: Jose A. Castro-Rodriguez
Author: Zhimin Chen
Author: Pierrick Cros
Author: Jean Christophe Dubus
Author: Zeinab Awad El-Sayed
Author: Rasha El-Owaidy
Author: Wojciech Feleszko
Author: Vincenzo Fierro
Author: Alessandro Fiocchi
Author: Luis Garcia-Marcos
Author: Anne Goh
Author: Elham M. Hossny
Author: Yunuen R. Huerta Villalobos
Author: Tuomas Jartti
Author: Pascal Le Roux
Author: Julia Levina
Author: Aida Inés López García
Author: Ángel Mazón Ramos
Author: Mário Morais-Almeida
Author: Clare Murray
Author: Karthik Nagaraju
Author: Major K. Nagaraju
Author: Elsy Maureen Navarrete Rodriguez
Author: Leyla Namazova-Baranova
Author: Antonio Nieto Garcia
Author: Cesar Fireth Pozo Beltrán
Author: Thanaporn Ratchataswan
Author: Daniela Rivero Yeverino
Author: Eréndira Rodríguez Zagal
Author: Cyril E. Schweitzer
Author: Marleena Tulkki
Author: Katarzyna Wasilczuk
Author: Dan Xu
Author: Anna Alekseeva
Author: Bethan Almeida
Author: Maud Andre
Author: Polina Arimova
Author: Aurore Blonde
Author: Amparito Cunningham
Author: David Price
Corporate Author: PeARL collaborators, on behalf of the PeARL Think Tank

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