3.2 Changes in Morbidity
The implementation of containment strategies for the spread of the pandemic appears to have caused an improvement in paediatric asthma control. A hospital study in the US reported a significant decrease in asthma-related emergency department (ED) visits and hospitalisations, which were below the seasonal variation seen in previous years. This observation was seen days after the implementation of a ‘stay-at-home’ and ‘home-schooling’ strategies.12 Interestingly, this change was observed during the spring season where cases of allergy-induced attacks and respiratory viral infections normally peak in incidence. Other studies from the USA, Slovenia and Italy reported decreased asthma-related emergency visits and hospitalisations in children, while data from Philadelphia also reported less use of systemic steroids and a reduction in rhinovirus infections during lockdowns.13-15 Similar trends were observed in nationwide studies. A large-scale study in Japan conducted a nationwide observation of asthma-related ED visits and hospitalisations during 2020 and compared it to previous years in 272 hospitals across the country, yielding similar trends.16 In South America, a study conducted in three Ecuadorian cities found an 89% decrease of ED visits in asthmatic children during lockdowns, but interestingly observed an unchanged use of inhaled corticosteroids and number of exacerbations, and an increased use of b-agonists.38 On the other hand, a study involving three tertiary care hospitals in Madrid observed a rise in the number of well-controlled asthmatic children, a decrease in the use of control medications and overall exacerbations, but an increase in exacerbations related to animal dander, exercise, stress and COVID-19.39 Finally, following the implementation of lockdowns in Greece and Cyprus, a community-based study documented in both countries a significant improvement in asthma control test (c-ACT) score, a decrease in asthma-related hospital ED visits, decrease in the use of systemic treatment such as oral corticosteroids and a lower infection incidence compared to previous years.11 In this study, greater improvements in c-ACT scores were observed in asthmatics with more severe disease. In line with the above, another study also found significant improvements of c-ACT scores in severe asthmatics taking biological agents after the lockdown, compared to before.40 Interestingly, some of these studies also confirmed a positive correlation between lockdown stringency and improvement in asthma control and exacerbations.11,25