Perspective from Kristina Gaietto, MD
Disclosures: Alabdulkarim reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

April 22, 2022
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Fewer children hospitalized with asthma exacerbations during early days of COVID-19

Perspective from Kristina Gaietto, MD
Disclosures: Alabdulkarim reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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Fewer children with asthma were hospitalized for exacerbations during the first few months of the COVID-19 pandemic compared with the previous year, although they presented with more severe symptoms, according to a recent study.

Nada Alabdulkarim, MBBS, a pediatric resident at Children’s National Hospital in Washington, D.C., and colleagues examined 50 cases between April 1 and Sept. 30, 2020, as well as 243 controls from the same period in 2019, in the study published in Annals of Allergy, Asthma & Immunology.

63% of patients received intravenous magnesium sulfie between April 1 and Sept. 30, 2019, compared to 84% between April 1 and Sept. 30, 2020.
Data were derived from Alabdulkarim N, et al. Ann Allergy Asthma Immunol. 2022;doi:10.1016.j.janai.2022.03.033.

The children in the pandemic cases were significantly older compared with those in the control cases (9.8 ± 4.3 years vs. 6.7 ± 3.8 years; P < .0001). There also was a trend toward fewer Hispanic children among the pandemic cases compared with the controls.

The control cases had a greater proportion of children with eczema (32.1% vs. 16%; P = .02) and food allergies (18.5% vs. 6%; P = .03), although the researchers did not find any significant differences in the prevalence of other comorbidities.

Considering its use an objective measure of increased severity of asthma exacerbations at presentation, the researchers said that intravenous magnesium sulfate was more frequently administered during the pandemic compared with the control period (84% vs. 63%; P = .001).

In fact, there was a 16% higher likelihood of patients receiving magnesium sulfate with each year increase in age. African American and Hispanic patients had higher odds of receiving magnesium sulfate in the ED as well.

However, use was independent of sex or comorbidities such as obstructive sleep apnea, eczema, food allergies, obesity, baseline asthma management regimens and reported compliance with preventive regimens.

More of the pandemic cases did not comply with controller medications compared with the control cases (46% vs. 24.7%; P = .0023), and a smaller proportion of them received inhaled corticosteroids during their hospital stay (30% vs. 58.8%; P = .0002).

Yet the researchers also noted that non-compliance was not an independent predictor of whether magnesium would be needed. Plus, fewer children began or restarted controller therapy during the pandemic compared with the control period.

This lower compliance may have contributed to the visit, the researchers continued, but it did not influence the need for magnesium, indicating that other clinical differences such as a lower prevalence of atopy between cases and controls may influence asthma severity during presentation.

These lower rates of atopy among children who were hospitalized line up with previous studies finding a protective effect of atopy among patients who had been infected with SARS-CoV-2, the researchers said, possibly due to the use of inhaled corticosteroids.

The researchers further speculated that parents and caregivers may have been afraid to visit the ED for mild asthma symptoms during the pandemic and treated them at home instead, leading to the greater proportion of more severe cases.

The financial and transportation difficulties experienced by many families may have prevented them from refilling controller medications or attending routine asthma care visits, also leading to the greater severities in asthma exacerbations, the researchers said.