Impact of COVID-19 on Pediatric Asthma: Practice Adjustments and Disease Burden

Nikolaos G Papadopoulos¹, Adnan Custovic², Antoine Deschildre³, Alexander G Mathioudakis⁴, Wanda Phipatanakul⁵, Gary Wong⁶, Paraskevi Xepapadaki⁷, Ioana Agache⁸, Leonard Bacharier⁹, Matteo Bonini¹⁰, Jose A Castro-Rodriguez¹¹, Zhimin Chen¹², Timothy Craig¹³, Francine M Ducharme¹⁴, Zeinab Awad El-Sayed¹⁵, Wojciech Feleszko¹⁶, Alessandro Fiocchi¹⁷, Luis Garcia-Marcos¹⁸, James E Gern¹⁹, Anne Goh²⁰, René Maximiliano Gómez²¹, Eckard H Hamelmann²², Gunilla Hedlin²³, Elham M Hossny¹⁵, Tuomas Jartti²⁴, Omer Kalayci²⁵, Alan Kaplan²⁶, Jon Konradsen²⁷, Piotr Kuna²⁸, Susanne Lau²⁹, Peter Le Souef³⁰, Robert F Lemanske³¹, Mika J Mäkelä³², Mário Morais-Almeida³³, Clare Murray³⁴, Karthik Nagaraju³⁵, Leyla Namazova-Baranova³⁶, Antonio Nieto Garcia³⁷, Osman M Yusuf³⁸, Paulo M C Pitrez³⁹, Petr Pohunek⁴⁰, Cesar Fireth Pozo Beltrán⁴¹, Graham C Roberts⁴², Arunas Valiulis⁴³, Heather J Zar⁴⁴; Pediatric Asthma in Real Life Collaborators

Collaborators, Affiliations

Collaborators

Affiliations

¹ Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, United Kingdom; Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece. Electronic address: ngpallergy@gmail.com.
² Department of Paediatrics, Imperial College London, London, United Kingdom.
³ Pediatric Pulmonology and Allergy Department, Hôpital Jeanne de Flandre, Lille, France.
⁴ Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, United Kingdom; North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom.
⁵ Children's Hospital Boston, Pediatric Allergy and Immunology, Boston, Mass.
⁶ Department of Pediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong.
⁷ Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece.
⁸ Allergy & Clinical Immunology, Transylvania University, Brasov, Romania.
⁹ Division of Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Washington University, St Louis, Mo.
¹⁰ Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy; National Heart and Lung Institute (NHLI), Imperial College London, London, United Kingdom.
¹¹ Division of Pediatrics, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.
¹² Pulmonology Department, Children's Hospital Zhejiang University School of Medicine, Zhejiang, China.
¹³ Department of Allergy and Immunology, Penn State University, State College, Pa.
¹⁴ Department of Pediatrics, University of Montréal, Department of Social and Preventive Medicine, University of Montréal, Montréal, QC, Canada.
¹⁵ Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt.
¹⁶ Department of Pediatric Respiratory Diseases and Allergy, The Medical University of Warsaw, Warsaw, Poland.
¹⁷ Allergy Department, Bambino Gesù Children's Hospital, Rome, Italy.
¹⁸ Pediatric Respiratory and Allergy Units, "Virgen de la Arrixaca" Children's University Clinical Hospital, University of Murcia, Murcia, Spain; Institute for Biomedical Research of Murcia, IMIB-Arrixaca, & Network of Asthma and Adverse and Allergic Reactions (ARADyAL), Murcia, Spain.
¹⁹ Department of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
²⁰ Department of Internal Medicine, Rush Medical College, Chicago, Ill.
²¹ Research & Education, Ayre Foundation, Salta, Argentina; Allergy & Asthma Department, Alas Medical Institute, Salta, Argentina.
²² Children's Center Bethel, EvKB, University Bielefeld, Bielefeld, Germany.
²³ Paediatric Allergy, Centre for Allergy Research, Karolinska Institutet, Solna, Sweden.
²⁴ Department of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland.
²⁵ Pediatric Allergy and Asthma Unit, Hacettepe University School of Medicine, Ankara, Turkey.
²⁶ Family Physician Airways Group of Canada, Edmonton, AB, Canada.
²⁷ Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
²⁸ Department of Internal Medicine, Asthma and Allergy, Medical University of Lodz, Lodz, Poland.
²⁹ Charité Universitätsmedizin Berlin, Pediatric Pulmonology, Immunology and Intensive Care Medicine, Berlin, Germany.
³⁰ School of Paediatrics & Child Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Crawley, WA, Australia.
³¹ Departments of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
³² Department of Allergy, Helsinki University Central Hospital, Helsinki, Finland.
³³ Allergy Center, CUF Descobertas Hospital, Lisbon, Portugal.
³⁴ Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, United Kingdom.
³⁵ VN Allergy & Asthma Research Centre, Chennai, Tamilnadu, India.
³⁶ Pediatric Department, Pirogov Russian National Research Medical University, the Ministry of Health, Moscow, Russia.
³⁷ Pediatric Pulmonology & Allergy Unit, Children's Hospital la Fe, Valencia, Spain.
³⁸ Allergy and Respiratory Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom.
³⁹ Pediatric Pulmonology Division, Hospital Moinhos de Vento, Porto Alegre, Brazil.
⁴⁰ Pediatric Pulmonology, Pediatric Department, 2nd Faculty of Medicine, Charles University, Prague, University Hospital Motol, Prague, Czech Republic.
⁴¹ Teaching and Research Department and Paediatric Allergy Department, Hospital with Specialties Juan María de Salvatierra, La Paz, Baja California Sur México, La Paz, Mexico; Allergy & Immunology Department, Hospital Infantil de Medico Federico Gomez, Mexico City, Mexico.
⁴² Paediatric Allergy and Respiratory Medicine within Medicine at the University of Southampton, Southampton, United Kingdom.
⁴³ Clinic of Children's Diseases, Institute of Clinical Medicine, Medical Faculty of Vilnius University, Vilnius, Lithuania.
⁴⁴ Department of Pediatrics & Child Health, MRC Unit on Child & Adolescent Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.

PMID: 32561497
PMCID: PMC7297686
DOI: 10.1016/j.jaip.2020.06.001

Impact of COVID-19 on Pediatric Asthma: Practice Adjustments and Disease Burden

Nikolaos G Papadopoulos et al. J Allergy Clin Immunol Pract. 2020 Sep.

. 2020 Sep;8(8):2592-2599.e3.

doi: 10.1016/j.jaip.2020.06.001. Epub 2020 Jun 17.

Authors

Collaborators

Affiliations

¹ Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, United Kingdom; Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece. Electronic address: ngpallergy@gmail.com.
² Department of Paediatrics, Imperial College London, London, United Kingdom.
³ Pediatric Pulmonology and Allergy Department, Hôpital Jeanne de Flandre, Lille, France.
⁴ Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, United Kingdom; North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom.
⁵ Children's Hospital Boston, Pediatric Allergy and Immunology, Boston, Mass.
⁶ Department of Pediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong.
⁷ Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece.
⁸ Allergy & Clinical Immunology, Transylvania University, Brasov, Romania.
⁹ Division of Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Washington University, St Louis, Mo.
¹⁰ Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy; National Heart and Lung Institute (NHLI), Imperial College London, London, United Kingdom.
¹¹ Division of Pediatrics, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.
¹² Pulmonology Department, Children's Hospital Zhejiang University School of Medicine, Zhejiang, China.
¹³ Department of Allergy and Immunology, Penn State University, State College, Pa.
¹⁴ Department of Pediatrics, University of Montréal, Department of Social and Preventive Medicine, University of Montréal, Montréal, QC, Canada.
¹⁵ Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt.
¹⁶ Department of Pediatric Respiratory Diseases and Allergy, The Medical University of Warsaw, Warsaw, Poland.
¹⁷ Allergy Department, Bambino Gesù Children's Hospital, Rome, Italy.
¹⁸ Pediatric Respiratory and Allergy Units, "Virgen de la Arrixaca" Children's University Clinical Hospital, University of Murcia, Murcia, Spain; Institute for Biomedical Research of Murcia, IMIB-Arrixaca, & Network of Asthma and Adverse and Allergic Reactions (ARADyAL), Murcia, Spain.
¹⁹ Department of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
²⁰ Department of Internal Medicine, Rush Medical College, Chicago, Ill.
²¹ Research & Education, Ayre Foundation, Salta, Argentina; Allergy & Asthma Department, Alas Medical Institute, Salta, Argentina.
²² Children's Center Bethel, EvKB, University Bielefeld, Bielefeld, Germany.
²³ Paediatric Allergy, Centre for Allergy Research, Karolinska Institutet, Solna, Sweden.
²⁴ Department of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland.
²⁵ Pediatric Allergy and Asthma Unit, Hacettepe University School of Medicine, Ankara, Turkey.
²⁶ Family Physician Airways Group of Canada, Edmonton, AB, Canada.
²⁷ Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
²⁸ Department of Internal Medicine, Asthma and Allergy, Medical University of Lodz, Lodz, Poland.
²⁹ Charité Universitätsmedizin Berlin, Pediatric Pulmonology, Immunology and Intensive Care Medicine, Berlin, Germany.
³⁰ School of Paediatrics & Child Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Crawley, WA, Australia.
³¹ Departments of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
³² Department of Allergy, Helsinki University Central Hospital, Helsinki, Finland.
³³ Allergy Center, CUF Descobertas Hospital, Lisbon, Portugal.
³⁴ Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, United Kingdom.
³⁵ VN Allergy & Asthma Research Centre, Chennai, Tamilnadu, India.
³⁶ Pediatric Department, Pirogov Russian National Research Medical University, the Ministry of Health, Moscow, Russia.
³⁷ Pediatric Pulmonology & Allergy Unit, Children's Hospital la Fe, Valencia, Spain.
³⁸ Allergy and Respiratory Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom.
³⁹ Pediatric Pulmonology Division, Hospital Moinhos de Vento, Porto Alegre, Brazil.
⁴⁰ Pediatric Pulmonology, Pediatric Department, 2nd Faculty of Medicine, Charles University, Prague, University Hospital Motol, Prague, Czech Republic.
⁴¹ Teaching and Research Department and Paediatric Allergy Department, Hospital with Specialties Juan María de Salvatierra, La Paz, Baja California Sur México, La Paz, Mexico; Allergy & Immunology Department, Hospital Infantil de Medico Federico Gomez, Mexico City, Mexico.
⁴² Paediatric Allergy and Respiratory Medicine within Medicine at the University of Southampton, Southampton, United Kingdom.
⁴³ Clinic of Children's Diseases, Institute of Clinical Medicine, Medical Faculty of Vilnius University, Vilnius, Lithuania.
⁴⁴ Department of Pediatrics & Child Health, MRC Unit on Child & Adolescent Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.

PMID: 32561497
PMCID: PMC7297686
DOI: 10.1016/j.jaip.2020.06.001

Abstract

Background: It is unclear whether asthma may affect susceptibility or severity of coronavirus disease 2019 (COVID-19) in children and how pediatric asthma services worldwide have responded to the pandemic.

Objective: To describe the impact of the COVID-19 pandemic on pediatric asthma services and on disease burden in their patients.

Methods: An online survey was sent to members of the Pediatric Asthma in Real Life think tank and the World Allergy Organization Pediatric Asthma Committee. It included questions on service provision, disease burden, and the clinical course of confirmed cases of COVID-19 infection among children with asthma.

Results: Ninety-one respondents, caring for an estimated population of more than 133,000 children with asthma, completed the survey. COVID-19 significantly impacted pediatric asthma services: 39% ceased physical appointments, 47% stopped accepting new patients, and 75% limited patients' visits. Consultations were almost halved to a median of 20 (interquartile range, 10-25) patients per week. Virtual clinics and helplines were launched in most centers. Better than expected disease control was reported in 20% (10%-40%) of patients, whereas control was negatively affected in only 10% (7.5%-12.5%). Adherence also appeared to increase. Only 15 confirmed cases of COVID-19 were reported among the population; the estimated incidence is not apparently different from the reports of general pediatric cohorts.

Conclusions: Children with asthma do not appear to be disproportionately affected by COVID-19. Outcomes may even have improved, possibly through increased adherence and/or reduced exposures. Clinical services have rapidly responded to the pandemic by limiting and replacing physical appointments with virtual encounters.

Keywords: Adherence; Asthma; COVID-19; Children; Control; SARS-CoV2; Virus.

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Impact of COVID-19 on Pediatric Asthma: Practice Adjustments and Disease Burden

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Impact of COVID-19 on Pediatric Asthma: Practice Adjustments and Disease Burden

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