. 2021 Jun;76(6):1765-1775.

doi: 10.1111/all.14787. Epub 2021 Mar 24.

Childhood asthma outcomes during the COVID-19 pandemic: Findings from the PeARL multi-national cohort

Nikolaos G Papadopoulos^{1

2}, Alexander G Mathioudakis^{1

3}, Adnan Custovic⁴, Antoine Deschildre⁵, Wanda Phipatanakul⁶, Gary Wong⁷, Paraskevi Xepapadaki², Rola Abou-Taam⁸, Ioana Agache⁹, Jose A Castro-Rodriguez¹⁰, Zhimin Chen¹¹, Pierrick Cros¹², Jean-Christophe Dubus¹³, Zeinab Awad El-Sayed¹⁴, Rasha El-Owaidy¹⁴, Wojciech Feleszko¹⁵, Vincenzo Fierro¹⁶, Alessandro Fiocchi¹⁶, Luis Garcia-Marcos^{17

18}, Anne Goh¹⁹, Elham M Hossny¹⁴, Yunuen R Huerta Villalobos²⁰, Tuomas Jartti²¹, Pascal Le Roux²², Julia Levina²³, Aida Inés López García²⁴, Ángel Mazón Ramos²⁵, Mário Morais-Almeida²⁶, Clare Murray¹, Karthik Nagaraju²⁷, Major K Nagaraju²⁸, Elsy Maureen Navarrete Rodriguez²⁹, Leyla Namazova-Baranova^{23

30}, Antonio Nieto Garcia²⁵, Cesar Fireth Pozo Beltrán^{31

32}, Thanaporn Ratchataswan⁶, Daniela Rivero Yeverino³³, Eréndira Rodríguez Zagal²⁰, Cyril E Schweitzer³⁴, Marleena Tulkki³⁵, Katarzyna Wasilczuk¹⁵, Dan Xu¹¹; PeARL collaborators, on behalf of the PeARL Think Tank

Collaborators, Affiliations

Collaborators

PeARL collaborators, on behalf of the PeARL Think Tank:
Anna Alekseeva, Bethan Almeida, Maud Andre, Polina Arimova, Aurore Blonde, Amparito Cunningham, Sofia Da Mota, Kamilla Efendieva, Vera Kalugina, Sébastien Kiefer, Anais Klein, Chrystopherson Gengyny Caballero López, Juan Jesús Ríos López, Caroline Moratellti, Miguel Fuentes Pérez, Meryl Simermann, José Sergio Papaqui Tapia, Aurelie Tatopoulos, Elena Vishneva, Κonstantin Volkov, Leonard Bacharier, Matteo Bonini, Timothy Craig, Zuzana Diamant, Francine M Ducharme, James E Gern, Jonathan Grigg, Eckard H Hamelmann, Gunilla Hedlin, Tuomas Jartti, Omer Kalayci, Alan Kaplan, Jon Konradsen, Piotr Kuna, Susanne Lau, Peter Le Souef, Robert F Lemanske, Mika J Makela, Paolo M Matricardi, René-Maximiliano Gómez, Michael Miligkos, Paulo Mc Pitrez, David Price, Petr Pohunek, Graham C Roberts, Aziz Sheikh, Ioanna Tsiligianni, Steve Turner, Arunas Valiulis, Tonya Winders, Osman M Yusuf, Heather Zar

Affiliations

¹ Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK.
² Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece.
³ North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
⁴ Imperial College London, London, UK.
⁵ INSERM Unit 1019, CNRS UMR 8204, Center for infection and immunity of Lille, Institut Pasteur de Lille, Univ. Lille, Lille cedex, France.
⁶ Department of Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA.
⁷ Department of Pediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong.
⁸ Pediatric Pulmonology and Allergy DepartmentHôpital Necker-Enfants Malades, Paris, France.
⁹ Allergy & Clinical Immunology, Transylvania University, Brasov, Romania.
¹⁰ Department of Pediatric Pulmonology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.
¹¹ Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
¹² Department of Pediatrics, University Hospital Morvan, Brest, France.
¹³ Centre de Ressources et de Compétences pour la Mucoviscidose Pneumo-Allergologie, Ventilation, Maladies RespiratoiresRares de l'Enfant CHU Timone-Enfants, Marseille, France.
¹⁴ Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt.
¹⁵ Department of Pediatric Pneumonology and Allergy, The Medical University of Warsaw, Warsaw, Poland.
¹⁶ Allergy Department, Bambino Gesù Children's Hospital IRCCS, Roma, Italy.
¹⁷ Pediatric Respiratory and Allergy Units, "Virgen de la Arrixaca" Children's University Clinical Hospital, University of Murcia, Murcia, Spain.
¹⁸ Institute for Biomedical Research of Murcia, IMIB-Arrixaca; & Network of Asthma and Adverse and Allergic Reactions ARADyAL, Murcia, Spain.
¹⁹ Department of Internal Medicine, Rush Medical College, Chicago.
²⁰ Hospital General Regional 1 "Dr. Carlos Mac Gregor Sánchez Navarro" IMSS, Mexico, Mexico.
²¹ Department of Pediatrics and Adolescent Medicine, Oulu University Hospital and University of Oulu, Oulu, Finland.
²² Department of Pediatrics, Groupe Hospitalier Le Havre, Le Havre, France.
²³ Pediatric and Child Health Research Institute of the Central Clinical Hospital of the Russian Academy of Sciences, Moskva, Russia.
²⁴ Allergy and Clinical Immunology Service of the University Hospital of Puebla, Puebla, Mexico.
²⁵ Pediatric Pulmonology & Allergy Unit Children's Hospital la Fe, Valencia, Spain.
²⁶ Allergy Center, CUF Descobertas Hospital, Lisbon, Portugal.
²⁷ VN Allergy & Asthma Research Centre, Chennai, India.
²⁸ Department of Allergy & Clinical Immunology, Saveetha Medical College, Chennai, India.
²⁹ Pediatric Allergy and Clinical Immunology Service, Hospital Infantil, til de Mexico Federico Gómez, Mexico City, Mexico.
³⁰ Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia.
³¹ Teaching and Research Department and Paediatric Allergy Department, Hospital with Specialties Juan María de Salvatierra, La Paz, Mexico.
³² Allergy & immunology Department Hospital Infantil de Medico Federico Gomez, Mexico City, Mexico.
³³ Allergy and Clinical Immunology Department, Hospital Universitario de Puebla, Puebla, Mexico.
³⁴ CHRU de Nancy, Hôpitald'Enfants, Vandoeuvre, France.
³⁵ Department of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland.

PMID: 33608919
PMCID: PMC8013557
DOI: 10.1111/all.14787

Childhood asthma outcomes during the COVID-19 pandemic: Findings from the PeARL multi-national cohort

Nikolaos G Papadopoulos et al. Allergy. 2021 Jun.

. 2021 Jun;76(6):1765-1775.

doi: 10.1111/all.14787. Epub 2021 Mar 24.

Authors

Collaborators

PeARL collaborators, on behalf of the PeARL Think Tank:
Anna Alekseeva, Bethan Almeida, Maud Andre, Polina Arimova, Aurore Blonde, Amparito Cunningham, Sofia Da Mota, Kamilla Efendieva, Vera Kalugina, Sébastien Kiefer, Anais Klein, Chrystopherson Gengyny Caballero López, Juan Jesús Ríos López, Caroline Moratellti, Miguel Fuentes Pérez, Meryl Simermann, José Sergio Papaqui Tapia, Aurelie Tatopoulos, Elena Vishneva, Κonstantin Volkov, Leonard Bacharier, Matteo Bonini, Timothy Craig, Zuzana Diamant, Francine M Ducharme, James E Gern, Jonathan Grigg, Eckard H Hamelmann, Gunilla Hedlin, Tuomas Jartti, Omer Kalayci, Alan Kaplan, Jon Konradsen, Piotr Kuna, Susanne Lau, Peter Le Souef, Robert F Lemanske, Mika J Makela, Paolo M Matricardi, René-Maximiliano Gómez, Michael Miligkos, Paulo Mc Pitrez, David Price, Petr Pohunek, Graham C Roberts, Aziz Sheikh, Ioanna Tsiligianni, Steve Turner, Arunas Valiulis, Tonya Winders, Osman M Yusuf, Heather Zar

Affiliations

¹ Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK.
² Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece.
³ North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
⁴ Imperial College London, London, UK.
⁵ INSERM Unit 1019, CNRS UMR 8204, Center for infection and immunity of Lille, Institut Pasteur de Lille, Univ. Lille, Lille cedex, France.
⁶ Department of Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA.
⁷ Department of Pediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong.
⁸ Pediatric Pulmonology and Allergy DepartmentHôpital Necker-Enfants Malades, Paris, France.
⁹ Allergy & Clinical Immunology, Transylvania University, Brasov, Romania.
¹⁰ Department of Pediatric Pulmonology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.
¹¹ Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
¹² Department of Pediatrics, University Hospital Morvan, Brest, France.
¹³ Centre de Ressources et de Compétences pour la Mucoviscidose Pneumo-Allergologie, Ventilation, Maladies RespiratoiresRares de l'Enfant CHU Timone-Enfants, Marseille, France.
¹⁴ Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt.
¹⁵ Department of Pediatric Pneumonology and Allergy, The Medical University of Warsaw, Warsaw, Poland.
¹⁶ Allergy Department, Bambino Gesù Children's Hospital IRCCS, Roma, Italy.
¹⁷ Pediatric Respiratory and Allergy Units, "Virgen de la Arrixaca" Children's University Clinical Hospital, University of Murcia, Murcia, Spain.
¹⁸ Institute for Biomedical Research of Murcia, IMIB-Arrixaca; & Network of Asthma and Adverse and Allergic Reactions ARADyAL, Murcia, Spain.
¹⁹ Department of Internal Medicine, Rush Medical College, Chicago.
²⁰ Hospital General Regional 1 "Dr. Carlos Mac Gregor Sánchez Navarro" IMSS, Mexico, Mexico.
²¹ Department of Pediatrics and Adolescent Medicine, Oulu University Hospital and University of Oulu, Oulu, Finland.
²² Department of Pediatrics, Groupe Hospitalier Le Havre, Le Havre, France.
²³ Pediatric and Child Health Research Institute of the Central Clinical Hospital of the Russian Academy of Sciences, Moskva, Russia.
²⁴ Allergy and Clinical Immunology Service of the University Hospital of Puebla, Puebla, Mexico.
²⁵ Pediatric Pulmonology & Allergy Unit Children's Hospital la Fe, Valencia, Spain.
²⁶ Allergy Center, CUF Descobertas Hospital, Lisbon, Portugal.
²⁷ VN Allergy & Asthma Research Centre, Chennai, India.
²⁸ Department of Allergy & Clinical Immunology, Saveetha Medical College, Chennai, India.
²⁹ Pediatric Allergy and Clinical Immunology Service, Hospital Infantil, til de Mexico Federico Gómez, Mexico City, Mexico.
³⁰ Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia.
³¹ Teaching and Research Department and Paediatric Allergy Department, Hospital with Specialties Juan María de Salvatierra, La Paz, Mexico.
³² Allergy & immunology Department Hospital Infantil de Medico Federico Gomez, Mexico City, Mexico.
³³ Allergy and Clinical Immunology Department, Hospital Universitario de Puebla, Puebla, Mexico.
³⁴ CHRU de Nancy, Hôpitald'Enfants, Vandoeuvre, France.
³⁵ Department of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland.

PMID: 33608919
PMCID: PMC8013557
DOI: 10.1111/all.14787

Abstract

Background: The interplay between COVID-19 pandemic and asthma in children is still unclear. We evaluated the impact of COVID-19 pandemic on childhood asthma outcomes.

Methods: The PeARL multinational cohort included 1,054 children with asthma and 505 non-asthmatic children aged between 4 and 18 years from 25 pediatric departments, from 15 countries globally. We compared the frequency of acute respiratory and febrile presentations during the first wave of the COVID-19 pandemic between groups and with data available from the previous year. In children with asthma, we also compared current and historical disease control.

Results: During the pandemic, children with asthma experienced fewer upper respiratory tract infections, episodes of pyrexia, emergency visits, hospital admissions, asthma attacks, and hospitalizations due to asthma, in comparison with the preceding year. Sixty-six percent of asthmatic children had improved asthma control while in 33% the improvement exceeded the minimal clinically important difference. Pre-bronchodilatation FEV₁ and peak expiratory flow rate were improved during the pandemic. When compared to non-asthmatic controls, children with asthma were not at increased risk of LRTIs, episodes of pyrexia, emergency visits, or hospitalizations during the pandemic. However, an increased risk of URTIs emerged.

Conclusion: Childhood asthma outcomes, including control, were improved during the first wave of the COVID-19 pandemic, probably because of reduced exposure to asthma triggers and increased treatment adherence. The decreased frequency of acute episodes does not support the notion that childhood asthma may be a risk factor for COVID-19. Furthermore, the potential for improving childhood asthma outcomes through environmental control becomes apparent.

Keywords: COVID-19; childhood asthma; coronavirus.

PubMed Disclaimer

Conflict of interest statement

This study was supported by the Respiratory Effectiveness Group (REG). REG has received support from AstraZeneca, Novartis, and Sanofi for continued work on PeARL. TJ reports grants from The Paulo Foundation, Helsinki, Finland. MT reports grants from The Sigrid Juselius Foundation, Helsinki, Finland, during the conduct of the study. None of the other authors had any conflicts of interest directly related to this work. AND, AF, KN,EH, LN‐B, WP, ZC, WF, GW, LG‐M, ZAW‐S, YRHV, CFPB, DRY, CS, PLR, PS, RA‐T, J‐CD, JL, TR, DY, AMR, KW, RE‐O, JAC‐R, AG, CM, AILG, MM‐A, EMNR, MKN, VF, and ER‐Z do not declare any conflicts of interest outside the submitted work either. NGP reports personal fees from ALK, Novartis, Nutricia, HAL, Menarini/FAES Farma, Sanofi, Mylan/MEDA, Biomay, AstraZeneca, GSK, MSD, ASIT BIOTECH, and Boehringer Ingelheim; grants from Gerolymatos International SA and Capricare outside the submitted work. AGM reports grants from Boehringer Ingelheim outside the submitted work. AC reports personal fees from Novartis, Thermo Fisher Scientific, Philips, Sanofi, Stallergenes Greer, AstraZeneca, outside the submitted work. AD reports personal fees and other from Novartis, ALK, MYLAN, GSK,CHIESI, Astra Zeneca, DBV technologies, grants and personal fees from Stallergenes Greer, personal fees from AImmune, Zambon, Boehringer Ingelheim, Nestlé HealthScience, other from Nutricia, outside the submitted work. IA reports and Associate Editor Allergy journal. PXreports personal fees from Nutricia, Nestle, Menarini, Uriach, Novartis PharmaAG, and GlaxoSmithkline outside the submitted work. CM reports personal fees from Novartis, GSK, ThermoFisher, Boehringer Ingelheim, outside the submitted work.

Cited by

Prediction of Asthma Exacerbations in Children.
Sarikloglou E, Fouzas S, Paraskakis E. Sarikloglou E, et al. J Pers Med. 2023 Dec 22;14(1):20. doi: 10.3390/jpm14010020. J Pers Med. 2023. PMID: 38248721 Free PMC article. Review.
COVID-19 Pandemic and Reduced Physical Activity: Is There an Impact on Healthy and Asthmatic Children?
Ferrante G, Mollicone D, Cazzato S, Lombardi E, Pifferi M, Turchetta A, Tancredi G, La Grutta S. Ferrante G, et al. Front Pediatr. 2021 Sep 8;9:695703. doi: 10.3389/fped.2021.695703. eCollection 2021. Front Pediatr. 2021. PMID: 34568238 Free PMC article. Review.
Pediatric asthma control during the COVID-19 pandemic: A systematic review and meta-analysis.
Yang Z, Wang X, Wan XG, Wang ML, Qiu ZH, Chen JL, Shi MH, Zhang SY, Xia YL. Yang Z, et al. Pediatr Pulmonol. 2022 Jan;57(1):20-25. doi: 10.1002/ppul.25736. Epub 2021 Nov 18. Pediatr Pulmonol. 2022. PMID: 34672436 Free PMC article.
Obesity is a risk factor for decrease in lung function after COVID-19 infection in children with asthma.
Soyak Aytekin E, Sahiner UM, Tuten Dal S, Unsal H, Hakverdi O, Oguz B, Ozsurekci Y, Sekerel BE, Soyer O. Soyak Aytekin E, et al. Pediatr Pulmonol. 2022 Jul;57(7):1668-1676. doi: 10.1002/ppul.25949. Epub 2022 May 14. Pediatr Pulmonol. 2022. PMID: 35502514 Free PMC article.
Management of asthma in childhood: study protocol of a systematic evidence update by the Paediatric Asthma in Real Life (PeARL) Think Tank.
Mathioudakis AG, Miligkos M, Boccabella C, Alimani GS, Custovic A, Deschildre A, Ducharme FM, Kalayci O, Murray C, Garcia AN, Phipatanakul W, Price D, Sheikh A, Agache IO, Bacharier L, Beloukas A, Bentley A, Bonini M, Castro-Rodriguez JA, De Carlo G, Craig T, Diamant Z, Feleszko W, Felton T, Gern JE, Grigg J, Hedlin G, Hossny EM, Ierodiakonou D, Jartti T, Kaplan A, Lemanske RF, Le Souëf PN, Mäkelä MJ, Mathioudakis GA, Matricardi P, Mitrogiorgou M, Morais-Almeida M, Nagaraju K, Papageorgiou E, Pité H, Pitrez PMC, Pohunek P, Roberts G, Tsiligianni I, Turner S, Vijverberg S, Winders TA, Wong GW, Xepapadaki P, Zar HJ, Papadopoulos NG. Mathioudakis AG, et al. BMJ Open. 2021 Jul 2;11(7):e048338. doi: 10.1136/bmjopen-2020-048338. BMJ Open. 2021. PMID: 34215609 Free PMC article.

See all "Cited by" articles

References

1. Wu H, Zhu H, Yuan C, et al. Clinical and immune features of hospitalized pediatric patients with coronavirus disease 2019 (COVID‐19) in Wuhan, China. JAMA Netw Open. 2020;3(6):e2010895. 10.1001/jamanetworkopen.2020.10895 - DOI - PMC - PubMed
1. Shekerdemian LS, Mahmood NR, Wolfe KK, et al. Characteristics and outcomes of children with coronavirus disease 2019 (COVID‐19) infection admitted to US and Canadian Pediatric Intensive Care Units. JAMA Pediatr. 2020;174:868‐873.In press. - PMC - PubMed
1. Viner RM, Mytton OT, Bonell C, et al. Susceptibility to SARS‐CoV‐2 infection among children and adolescents compared with adults: a systematic review and meta‐analysis. JAMA Pediatr. 2020;175:143‐156. 10.1001/jamapediatrics.2020.4573 - DOI - PMC - PubMed
1. Ioannou GN, Locke E, Green P, et al. Risk factors for hospitalization, mechanical ventilation, or death among 10 131 US veterans with SARS‐CoV‐2 infection. JAMA Netw Open. 2020;3(9):e2022310. 10.1001/jamanetworkopen.2020.22310 - DOI - PMC - PubMed
1. Grasselli G, Greco M, Zanella A, et al. Risk factors associated with mortality among patients with COVID‐19 in intensive care units in Lombardy, Italy. JAMA Intern Med. 2020;180:1345‐1355.In press. - PMC - PubMed

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Grants and funding

MR/S025340/1/MRC_/Medical Research Council/United Kingdom

LinkOut - more resources

Full Text Sources
Other Literature Sources
- scite Smart Citations
Medical
- MedlinePlus Consumer Health Information
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Childhood asthma outcomes during the COVID-19 pandemic: Findings from the PeARL multi-national cohort

Collaborators

Affiliations

Childhood asthma outcomes during the COVID-19 pandemic: Findings from the PeARL multi-national cohort

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Similar articles

Cited by

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Abstract

Conflict of interest statement

Similar articles

Cited by

References

Publication types

MeSH terms

Related information

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical