Asthma as a risk factor for hospitalization in children with COVID‐19: A nested case‐control study

  1. Kristina Gaietto
  2. Megan Culler Freeman
  3. Leigh Anne DiCicco
  4. Sherry Rauenswinter
  5. Joseph R. Squire
  6. Zachary Aldewereld
  7. Jennifer Iagnemma
  8. Brian T. Campfield
  9. David Wolfson
  10. Traci M. Kazmerski
  11. Erick Forno

Reviewed by

Read the full article

Listed in

Log in to save this article

Abstract

Background

Most pediatric studies of asthma and COVID‐19 to date have been ecological, which offer limited insight. We evaluated the association between asthma and COVID‐19 at an individual level.

Methods

Using data from prospective clinical registries, we conducted a nested case‐control study comparing three groups: children with COVID‐19 and underlying asthma (“A+C” cases); children with COVID‐19 without underlying disease (“C+” controls); and children with asthma without COVID‐19 (“A+” controls).

Results

The cohort included 142 A+C cases, 1110 C+ controls, and 140 A+ controls. A+C cases were more likely than C+ controls to present with dyspnea and wheezing, to receive pharmacologic treatment including systemic steroids (all p  < .01), and to be hospitalized (4.9% vs. 1.7%, p  = .01). In the adjusted analysis, A+C cases were nearly 4 times more likely to be hospitalized than C+ controls (adjusted OR = 3.95 [95%CI = 1.4–10.9]); however, length of stay and respiratory support level did not differ between groups. Among A+C cases, 8.5% presented with an asthma exacerbation and another 6.3% developed acute exacerbation symptoms shortly after testing positive for SARS‐CoV‐2. Compared to historic A+ controls, A+C cases had less severe asthma, were less likely to be on controller medications, and had better asthma symptom control (all p  < .01).

Conclusions

In our cohort, asthma was a risk factor for hospitalization in children with COVID‐19, but not for worse COVID‐19 outcomes. SARS‐CoV‐2 does not seem to be a strong trigger for pediatric asthma exacerbations. Asthma severity was not associated with higher risk of COVID‐19.

Article activity feed

  1. Version published to 10.1111/pai.13696
  2. ScreenIT

    SciScore for 10.1101/2021.09.20.21263838: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: The WPACR and the CHP Asthma Registry are both approved by the Institutional Review Board at the University of Pittsburgh (protocols STUDY20110072 and STUDY19020359, respectively).
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    We performed all analyses using STATA v16.1 (StataCorp, College Station, TX) or SAS v9.4 (SAS Institute, Cary, NC).
    STATA
    suggested: (Stata, RRID:SCR_012763)
    StataCorp
    suggested: (Stata, RRID:SCR_012763)
    SAS Institute
    suggested: (Statistical Analysis System, RRID:SCR_008567)

    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:
    Our study also has several limitations. Given the nature of the pandemic, follow-up duration has been short, precluding the ability to track long-term outcomes. However, it seems unlikely that asthma would have a lasting impact on COVID-19 outcomes, given the generally mild courses of the children in this study. Yet, future studies should also focus on long-term consequences such as changes in lung function or asthma severity and control in children who recovered from acute COVID-19. Another limitation is the small number of hospitalized patients in this study; it is unclear if this is secondary to regional variation in severity or management, possibly due to local variants, or if the low proportion of hospitalized children is secondary to our ability to include even mild and asymptomatic cases (e.g. asymptomatic children who tested positive for SARS-CoV-2) in the registry. It will be crucial to analyze multi-center data to evaluate whether findings vary across different settings. More importantly, the current study period preceded the emergence of the Delta variant of the virus; our registry is ongoing and we plan to analyze any potential differences as we see the already surging wave of pediatric cases across the country. In summary, we found that asthma severity does not seem to be associated with increased risk of SARS-CoV-2 infection in children. Pre-existing asthma did increase the risk of hospitalization for COVID-19 in our population, but hospital length of stay, need...

    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.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.09.20.21263838v1 on medRxiv