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