FRIDAY, Dec. 4, 2020 — For kids with asthma, more time spent at home and donning masks due to the COVID-19 pandemic may be providing a reprieve from emergency symptoms, new research shows.
Boston Children’s Hospital’s emergency department (ED) observed a steep decline in asthma-related emergency visits last spring. That coincided with a surge of coronavirus cases amid a lockdown ordered by Massachusetts Gov. Charlie Baker on March 24.
“Our most significant finding was the drastic, sudden drop in ED visits shortly after schools closed and the stay-at-home order went into effect,” said study author Dr. Tregony Simoneau, assistant professor of pediatrics at Boston Children’s Hospital. “How this drop was sustained over several months is quite notable.”
Why the big drop? One expert unconnected to the study offered some possible reasons.
“Viral illnesses are likely the most significant trigger of asthma exacerbations,” noted Dr. David Fagan, vice chair of Pediatric Administration-Ambulatory General Pediatrics at Cohen Children’s Medical Center in New Hyde Park, N.Y.
“Given the lockdown, with schools closing and families staying home, we witnessed a sudden steep decline in cases of [non-COVID] viral illnesses such as influenza,” Fagan said. “So with decreased transmission of viruses one might expect a decrease in exacerbations.”
Allergens in the air are another potential trigger for asthma attacks, he added. “Again, because of mask wearing, social distancing, we had a very mild to nonexistent spring allergy season,” Fagan noted, and that might also have helped kept asthma flare-ups at bay.
In the new study, published online Dec. 4 in the Annals of the American Thoracic Society, the Boston team tracked the medical records of children and young adults age 2 to 22 who visited the hospital’s emergency department for asthma treatments from Jan. 5 to May 23 in three separate years: 2018, 2019 and 2020.
In the Boston area, the stay-at-home order this year closed schools, day care centers and afterschool programs. For the study, researchers separated Jan. 5 to March 21 and March 22 to May 23 into “pre-shutdown and “post-shutdown” categories.
They found that the percent of total emergency visits due to asthma was lower in 2020 than in 2018 and 2019. Specifically, in the week of March 15 to March 21, pre-shutdown, the rates were similar to those weeks in the previous two years.
But in the first post-shutdown week, emergency visits dropped 80% and 82% compared to those weeks in 2018 and 2019. That reduction continued through May 23, with 82% fewer compared to the 2018 rate and 87% fewer compared to 2019.
The percentage of total asthma-related emergency department was lower in 2020 compared with both previous years. The authors noted that this suggests the effect was not just due to an overall avoidance of the emergency department during the shutdown.
The number of hospital admissions for asthma also declined, while the proportion of asthma-related emergency visits that required hospitalization remained similar to previous years.
“We think that our findings suggest a similar severity [of asthma attacks] when comparing the 2020 ED visits with previous years,” Simoneau said in a journal news release. So, the findings are “more reflective of an overall decrease in exacerbations rather than just patients with milder exacerbations being managed at home.”
But Fagan believes some milder attacks might be being managed at home — with electronic assistance.
“With the rapid expansion of telehealth once the lockdown started, there is the possibility that patients having exacerbations were able to be managed at home through frequent telehealth check-ins,” he said.
Dr. Teresa Murray Amato is chair of emergency medicine at Long Island Jewish Forest Hills in New York City. Reading over the findings, she agreed that “some of the measures put in place to decrease the spread of COVID could be impacting severity and frequency of asthma exacerbation as in children.”
But Amato stressed that “we are still recommending any parent to not hesitate to call their doctor or visit the emergency department with their child if they have any concerns about their child having an asthma exacerbation.”
Simoneau said her team’s findings give “reassurance from a pediatric perspective that COVID is not necessarily resulting in an increase in asthma exacerbations. In fact, the social distancing measures in place seem to have resulted in a significant decrease in exacerbations.”
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