Asthma symptoms and breakthrough disease exacerbations declined among children with asthma aged 1 to 18 years during the COVID-19 lockdowns, according to study findings published in Pediatric Pulmonology.
Researchers conducted a systematic review and meta-analysis to assess the effects of COVID-19 pandemic lockdown measures on pediatric asthma morbidity. The review included prospective or retrospective observational cohort studies published between January 2020 and August 2022, avoiding studies based on administrative data.
The meta-analysis included 11 studies with 5490 participants (51% to 72.8% male; mean age range, 8.4 to 13.47 years).
Studies evaluating asthma symptom control showed a statistically significant increase in the mean childhood Asthma Control Test (c-ACT) score during the lockdown period (standardized mean difference [SMD], 1.99; 95% CI, 0.75-3.24). Additionally, 4 studies observed changes in the proportion of patients with well-controlled asthma, while 5 noted changes in the proportion of patients with poorly controlled asthma. The pooled proportion of patients with well-controlled asthma increased during the lockdown period (pooled relative risk [RR], 1.35; 95% CI, 1.06-1.71). Conversely, the pooled proportion of patients with poorly controlled asthma decreased (pooled RR, 0.47; 95% CI, 0.38-0.57).
A change in the proportion of patients who experienced asthma exacerbations was reported by 2 studies. In 1 study, asthma exacerbations decreased from 10.9% before the lockdowns to 4.9% during the lockdown period. Another study showed a nonstatistically significant incidence rate ratio (IRR) of 0.89 for exacerbations.
In 4 studies, consistent findings were reported regarding a decrease in emergency department (ED) visits during COVID-19 lockdowns. In 1 study, researchers found a 69% reduction in the number of visits; in another, ED visits decreased from 34.4% in 2019 to 11.0% in 2020. Fewer hospitalizations were also consistent across 3 studies, with 1 study reporting a 76% reduction in the number of hospitalizations.
Notably, quantitative synthesis was not possible for other endpoints such as asthma symptoms severity, asthma-related quality of life, unscheduled or acute or general outpatient or clinician visits, and asthma medication use or treatment due to a low number of studies; however, an overall improvement in asthma symptoms and severity during lockdown was observed in all studies that addressed these endpoints.
Study limitations include a reliance on aggregate estimates from included studies and heterogeneity observed across different outcomes.
“In this systematic review and metanalysis, we have shown that pediatric asthma symptoms control, asthma exacerbations, ED visits, hospitalizations, and other endpoints such as asthma medication use or treatment adherence were significantly improved during the COVID‐19 lockdowns compared to the period before them,” said the study authors. “After the pandemic, public health measures can be considered with the aim to produce a similar cumulative beneficial effect on asthma control,” the researchers added.
Kouis P, Lemonaris M, Xenophontos E, Panayiotou A, Yiallouros PK. The impact of COVID-19 lockdown measures on symptoms control in children with asthma: a systematic review and meta-analysis of observational cohort studies. Pediatr Pulmonol. Published online August 22, 2023. doi:10.1002/ppul.26646