Childhood asthma outcomes during the COVID‐19 pandemic: Findings from the PeARL multi‐national cohort
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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 FEV 1 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.
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SciScore for 10.1101/2020.10.27.20219436: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis We did not perform power calculations, as this was an exploratory analysis. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Limitations and strengths: Evaluation of the frequency of acute events during the pandemic is challenging, but we believe our methodology was rigorous. Firstly, the …
SciScore for 10.1101/2020.10.27.20219436: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis We did not perform power calculations, as this was an exploratory analysis. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Limitations and strengths: Evaluation of the frequency of acute events during the pandemic is challenging, but we believe our methodology was rigorous. Firstly, the accuracy of parent-reported frequency of acute events has been previously validated41. We assumed a potential under-reporting of acute events during 2019, due to recall bias, however we do not anticipate between group differences in this bias. In addition, potential under-reporting of acute events prior to the pandemic would have led to an overestimation of the relative risk during the pandemic. Since we did not find an increased risk, we suggest the impact of recall bias was minimal. For estimating the duration of the pandemic, we considered the onset of the pandemic to coincide with the first fatality in each respective country. This usually followed a few days to weeks after the identification of the first case. We chose this time-point as an objective marker that could better identify the onset of the impact of the pandemic in each community. Since we were inquiring for acute episodes during the epidemic, we wanted to avoid a potential underestimation of the frequency of the events that could have been caused by accounting for a wider time-period of the epidemic. Extrapolating an annualized asthma attack rate based on the events that were observed during the pandemic is complicated by the seasonal variability of asthma attacks42,43. However, numerous high-quality studies demonstrate a peak in childhood asthma ...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- No funding statement was detected.
- No protocol registration statement was detected.
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