Covid-19: reduced asthma presentations in children

The impact of covid-19 on children will continue for years, affecting them educationally, emotionally, and financially, with indirect effects on their health.1 Children must not be sidelined as we rebuild and redesign systems for the future.

One “benefit” of the pandemic has been the reduced number of paediatric hospital admissions. Reports from other countries indicated that acute covid-19 in children was milder than adults, rarely resulting in admission.23 We found unexpected reductions in other typical causes for admission, such as acute asthma, which fell from 3 to 5 children a day to 1 to 2 a week after lockdown and was 90% lower overall for the period in our hospital. Initial fears of delayed presentations have diminished over time, and regular telephone reviews find children in good health.

Why has this change occurred? Patients, driven by fear, have potentially become more adherent to controller therapy. Improvement in air quality, secondary to reduced travel, might be beneficial, although local measurements (daily PM₁₀ and NO₂ levels) do not support this.4 Risk factors for asthma mentioned in the editorial (toxic stress and poor quality and overcrowded housing) have not led to acute attacks.1

The greatest change for most children has been school closure combined with distancing from peers. Reduced transmission of respiratory viruses, halted by the unique isolation of lockdown, seems the most plausible factor in reducing asthma presentations.

The importance of school education is undeniable, but we should reflect on the school environment and the effects (positive and negative) it has on children’s health. The state of school infrastructure, overcrowded classrooms, and inattention to hand hygiene all affect the spread of viruses. One action for educationists would be to minimise these potential harms. As paediatricians we need to ensure that children benefit from lessons learnt in this unusual time. It will be interesting to monitor how rapidly asthma presentations recur as schools reopen.