Health Status and Inconveniences of Asthmatic Children During the First Year of the COVID-19 Pandemic
Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic has been the most significant health concern in recent years, with respiratory symptoms being the most prominent. In children, asthma is the most prevalent chronic disease. Due to the similarities between the symptoms of these two conditions, we sought to assess the general health status of pediatric patients with asthma and their COVID-19-related difficulties during the first year of the pandemic in Iran.
We collected data for this study by administering a questionnaire to the parents of 200 children with asthma who were registered in the database of the Asthma Clinic at a tertiary medical center in Tehran, Iran.
Forty-five (22.5%) of 200 patients were suspected of having COVID-19, 11 (24.4%) underwent polymerase chain reaction (PCR) testing, and 10 (90.9%) assays were positive. During the first year of the pandemic, 41 patients (20.5%) were referred to a medical center at least once, with 31.7% due to an asthma attack. One hundred eighty-nine patients (94.5%) reported an improved disease status than the previous year, and only 31 patients (15.5%) were using asthma-related medications such as Salbutamol. The estimated mean Asthma Control Test (ACT) scores for two age categories, 4-11 years and 12-18 years, were 25.55±2.27 and 23.28±3.31, respectively, indicating satisfactory disease control.
In the majority of our study population, asthma control was acceptable. However, the pandemic caused a significant increase in the anxiety levels of patients and their parents.
1. Masoli M, Fabian D, Holt S, Beasley R, Program GIfA. The global burden of asthma: executive summary of the GINA Dissemination Committee report. Allergy. 2004;59(5):469-78.
2. Fazlollahi MR, Najmi M, Fallahnezhad M, Sabetkish N, Kazemnejad A, Bidad K, et al. Paediatric asthma prevalence: The first national population‐based survey in Iran. Clin Respir J. 2019;13(1):14-22.
3. Johnston SL. Overview of virus-induced airway disease. Proc Am Thorac Soc. 2005;2(2):150-6.
4. Corne JM, Marshall C, Smith S, Schreiber J, Sanderson G, Holgate ST, et al. Frequency, severity, and duration of rhinovirus infections in asthmatic and non-asthmatic individuals: a longitudinal cohort study. Lancet. 2002;359(9309):831-4.
5. Cascella M, Rajnik M, Aleem A, Dulebohn SC, Di Napoli R. Features, evaluation, and treatment of coronavirus (COVID-19). Statpearls [internet]. 2022.
6. Perikleous E, Tsalkidis A, Bush A, Paraskakis E. Coronavirus global pandemic: An overview of current findings among pediatric patients. Pediatr Pulmonol. 2020;55(12):3252-67.
7. CDC COVID-19 Response Team. Coronavirus Disease 2019 in Children - United States, February 12-April 2, 2020. MMWR Morb Mortal Wkly Rep. 2020 Apr 10;69(14):422-426.
8. Swann OV, Holden KA, Turtle L, Pollock L, Fairfield CJ, Drake TM, et al. Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study. BMJ. 2020;370.
9. Rabha AC, Fernandes FR, Solé D, Bacharier LB, Wandalsen GF. Asthma is associated with lower respiratory tract involvement and worse clinical score in children with COVID‐19. Pediatr Allergy Immunol. 2021;32(7):1577-80.
10. Beken B, Ozturk GK, Aygun FD, Aydogmus C, Akar HH. Asthma and allergic diseases are not risk factors for hospitalization in children with coronavirus disease 2019. Ann Allergy Asthma Immunol. 2021;126(5):569-75.
11. Ruano FJ, Álvarez MLS, Haroun-Díaz E, de la Torre MV, González PL, Prieto-Moreno A, et al. Impact of the COVID-19 pandemic in children with allergic asthma. J Allergy Clin Immunol Pract. 2020;8(9):3172-4. e1.
12. Roland D, Teo KW, Bandi S, Lo D, Gaillard EA. COVID-19 is not a driver of clinically significant viral wheeze and asthma. Arch Dis Child. 2021;106(4):e22-e.
13. Wang JY, Pawankar R, Tsai HJ, Wu LSH, Kuo WS. COVID‐19 and asthma, the good or the bad? Allergy. 2021;76(2):565.
14. Jackson DJ, Busse WW, Bacharier LB, Kattan M, O’Connor GT, Wood RA, et al. Association of respiratory allergy, asthma, and expression of the SARS-CoV-2 receptor ACE2. J Allergy Clin Immunol. 2020;146(1):203-6. e3.
15. Abrams EM, W‘t Jong G, Yang CL. Asthma and COVID-19. CMAJ. 2020;192(20):E551-E.
16. Shaker MS, Oppenheimer J, Grayson M, Stukus D, Hartog N, Hsieh EW, et al. COVID-19: pandemic contingency planning for the allergy and immunology clinic. T J Allergy Clin Immunol Pract. 2020;8(5):1477-88. e5.
17. Chhiba KD, Patel GB, Vu THT, Chen MM, Guo A, Kudlaty E, et al. Prevalence and characterization of asthma in hospitalized and nonhospitalized patients with COVID-19. J Allergy Clin Immunol. 2020;146(2):307-14. e4.
18. Izquierdo JL, Almonacid C, González Y, Del Rio-Bermudez C, Ancochea J, Cárdenas R, et al. The impact of COVID-19 on patients with asthma. Eur Respir J. 2021;57(3).
19. Baptist AP, Lowe D, Sarsour N, Jaffee H, Eftekhari S, Carpenter LM, et al. Asthma disparities during the COVID-19 pandemic: a survey of patients and physicians. J Allergy Clin Immunol Pract. 2020;8(10):3371-7. e1.
20. Papadopoulos NG, Custovic A, Deschildre A, Mathioudakis AG, Phipatanakul W, Wong G, et al. Impact of COVID-19 on pediatric asthma: practice adjustments and disease burden. J Allergy Clin Immunol Pract. 2020;8(8):2592-9. e3.
21. Chavasse R, Almario A, Christopher A, Kappos A, Shankar A. The indirect impact of COVID-19 on children with asthma. Arch Bronconeumol. 2020;56(11):768.
22. Levene R, Fein DM, Silver EJ, Joels JR, Khine H. The ongoing impact of COVID-19 on asthma and pediatric emergency health-seeking behavior in the Bronx, an epicenter. Am J Emerg Med. 2021;43:109-14.
23. Smith SJ, Busby J, Heaney LG, Pfeffer PE, Jackson DJ, Yang F, et al. The impact of the first COVID-19 surge on severe asthma patients in the UK. Which is worse: the virus or the lockdown? ERJ open research. 2021;7(1).
24. Hepkaya E, Kilinc AA, Cebi MN, Koyuncu Z, Cokugras H. General health status of children with asthma during the COVID‐19 pandemic. Pediatr Int. 2021;63(3):331-7.
25. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
26. Guan W-j, Liang W-h, Zhao Y, Liang H-r, Chen Z-s, Li Y-m, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J. 2020;55(5).
27. De Marco R, Locatelli F, Sunyer J, Burney P, Group ECRHSS. Differences in incidence of reported asthma related to age in men and women: a retrospective analysis of the data of the European Respiratory Health Survey. Am J Respir Crit Care Med. 2000;162(1):68-74.
28. Zare-Zardini H, Soltaninejad H, Ferdosian F, Hamidieh AA, Memarpoor-Yazdi M. Coronavirus disease 2019 (COVID-19) in children: prevalence, diagnosis, clinical symptoms, and treatment. Int J Gen Med. 2020:477-82.
29. Rosenthal JA, Awan SF, Fintzi J, Keswani A, Ein D. Asthma is associated with increased risk of intubation but not hospitalization or death in coronavirus disease 2019. Ann Allergy Asthma Immunol. 2021;126(1):93-5.
30. Vinuya RZ. Upper airway disorders and asthma: a syndrome of airway inflammation. Ann Allergy Asthma Immunol. 2002;88(4):8-15.
31. Kenyon CC, Hill DA, Henrickson SE, Bryant-Stephens TC, Zorc JJ. Initial effects of the COVID-19 pandemic on pediatric asthma emergency department utilization. J Allergy Clin Immunol Pract. 2020;8(8):2774-6. e1.
32. Ochoa-Avilés AM, Ochoa-Avilés C, Morillo-Argudo DA, Molina-Cando MJ, Rodas-Espinoza CR, Ster IC, et al. Impact of COVID-19 pandemic on asthma symptoms and management: A prospective analysis of asthmatic children in Ecuador. World Allergy Organ J. 2021;14(6):100551.
33. Cardinale F, Ciprandi G, Barberi S, Bernardini R, Caffarelli C, Calvani M, et al. Consensus statement of the Italian society of pediatric allergy and immunology for the pragmatic management of children and adolescents with allergic or immunological diseases during the COVID-19 pandemic. Ital J Pediatr. 2020;46(1):1-14.
34. Diseases CoI. Reduction of the influenza burden in children. Pediatrics. 2002;110(6):1246-52.
35. Du H, Dong X, Zhang Jj, Cao Yy, Akdis M, Huang Pq, et al. Clinical characteristics of 182 pediatric COVID‐19 patients with different severities and allergic status. Allergy. 2021;76(2):510-32.
36. Chang C, Zhang L, Dong F, Liang Y, Chen Y, Shang Y, et al. Asthma control, self‐management, and healthcare access during the COVID‐19 epidemic in Beijing. Allergy. 2021;76(2):586.
37. Gautier C, Charpin D. Environmental triggers and avoidance in the management of asthma. J Asthma Allergy. 2017:47-56.
38. Abrams EM, Szefler SJ. Managing asthma during coronavirus disease-2019: an example for other chronic conditions in children and adolescents. J Pediatr. 2020;222:221-6.
39. Denaro M, Smeriglio A, Barreca D, De Francesco C, Occhiuto C, Milano G, et al. Antiviral activity of plants and their isolated bioactive compounds: An update. Phytother Res. 2020;34(4):742-68.
40. Oyero OG, Toyama M, Mitsuhiro N, Onifade AA, Hidaka A, Okamoto M, et al. Selective inhibition of hepatitis c virus replication by Alpha-zam, a Nigella sativa seed formulation. Afr J Tradit Complement Altern Med. 2016;13(6):144-8.
41. Peters U, Dixon AE, Forno E. Obesity and asthma. J Allergy Clin Immunol. 2018;141(4):1169-79.
42. Society CT. Inhaled Salbutamol Shortage - Mitigation Strategy for Asthma [Internet] [Available from: https://cts-sct.ca/wp-content/uploads/2020/04/FINAL-April-13_CTS-re-Asthma-Salbutamol-Shortage.pdf.
43. Searing DA, Dutmer CM, Fleischer DM, Shaker MS, Oppenheimer J, Grayson MH, et al. A phased approach to resuming suspended allergy/immunology clinical services. J Allergy Clin Immunol Pract. 2020;8(7):2125-34.
44. Eldeirawi K, Huntington-Moskos L, Nyenhuis SM, Polivka B. Increased disinfectant use among adults with asthma in the era of COVID-19. J Allergy Clin Immunol Pract. 2021;9(3):1378-80. e2.
45. Le Moual N, Varraso R, Siroux V, Dumas O, Nadif R, Pin I, et al. Domestic use of cleaning sprays and asthma activity in females. Eur Respir J. 2012;40(6):1381-9.
46. Lawson M, Piel MH, Simon M. Child maltreatment during the COVID-19 pandemic: Consequences of parental job loss on psychological and physical abuse towards children. Child Abuse Negl. 2020;110:104709.
2. Fazlollahi MR, Najmi M, Fallahnezhad M, Sabetkish N, Kazemnejad A, Bidad K, et al. Paediatric asthma prevalence: The first national population‐based survey in Iran. Clin Respir J. 2019;13(1):14-22.
3. Johnston SL. Overview of virus-induced airway disease. Proc Am Thorac Soc. 2005;2(2):150-6.
4. Corne JM, Marshall C, Smith S, Schreiber J, Sanderson G, Holgate ST, et al. Frequency, severity, and duration of rhinovirus infections in asthmatic and non-asthmatic individuals: a longitudinal cohort study. Lancet. 2002;359(9309):831-4.
5. Cascella M, Rajnik M, Aleem A, Dulebohn SC, Di Napoli R. Features, evaluation, and treatment of coronavirus (COVID-19). Statpearls [internet]. 2022.
6. Perikleous E, Tsalkidis A, Bush A, Paraskakis E. Coronavirus global pandemic: An overview of current findings among pediatric patients. Pediatr Pulmonol. 2020;55(12):3252-67.
7. CDC COVID-19 Response Team. Coronavirus Disease 2019 in Children - United States, February 12-April 2, 2020. MMWR Morb Mortal Wkly Rep. 2020 Apr 10;69(14):422-426.
8. Swann OV, Holden KA, Turtle L, Pollock L, Fairfield CJ, Drake TM, et al. Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study. BMJ. 2020;370.
9. Rabha AC, Fernandes FR, Solé D, Bacharier LB, Wandalsen GF. Asthma is associated with lower respiratory tract involvement and worse clinical score in children with COVID‐19. Pediatr Allergy Immunol. 2021;32(7):1577-80.
10. Beken B, Ozturk GK, Aygun FD, Aydogmus C, Akar HH. Asthma and allergic diseases are not risk factors for hospitalization in children with coronavirus disease 2019. Ann Allergy Asthma Immunol. 2021;126(5):569-75.
11. Ruano FJ, Álvarez MLS, Haroun-Díaz E, de la Torre MV, González PL, Prieto-Moreno A, et al. Impact of the COVID-19 pandemic in children with allergic asthma. J Allergy Clin Immunol Pract. 2020;8(9):3172-4. e1.
12. Roland D, Teo KW, Bandi S, Lo D, Gaillard EA. COVID-19 is not a driver of clinically significant viral wheeze and asthma. Arch Dis Child. 2021;106(4):e22-e.
13. Wang JY, Pawankar R, Tsai HJ, Wu LSH, Kuo WS. COVID‐19 and asthma, the good or the bad? Allergy. 2021;76(2):565.
14. Jackson DJ, Busse WW, Bacharier LB, Kattan M, O’Connor GT, Wood RA, et al. Association of respiratory allergy, asthma, and expression of the SARS-CoV-2 receptor ACE2. J Allergy Clin Immunol. 2020;146(1):203-6. e3.
15. Abrams EM, W‘t Jong G, Yang CL. Asthma and COVID-19. CMAJ. 2020;192(20):E551-E.
16. Shaker MS, Oppenheimer J, Grayson M, Stukus D, Hartog N, Hsieh EW, et al. COVID-19: pandemic contingency planning for the allergy and immunology clinic. T J Allergy Clin Immunol Pract. 2020;8(5):1477-88. e5.
17. Chhiba KD, Patel GB, Vu THT, Chen MM, Guo A, Kudlaty E, et al. Prevalence and characterization of asthma in hospitalized and nonhospitalized patients with COVID-19. J Allergy Clin Immunol. 2020;146(2):307-14. e4.
18. Izquierdo JL, Almonacid C, González Y, Del Rio-Bermudez C, Ancochea J, Cárdenas R, et al. The impact of COVID-19 on patients with asthma. Eur Respir J. 2021;57(3).
19. Baptist AP, Lowe D, Sarsour N, Jaffee H, Eftekhari S, Carpenter LM, et al. Asthma disparities during the COVID-19 pandemic: a survey of patients and physicians. J Allergy Clin Immunol Pract. 2020;8(10):3371-7. e1.
20. Papadopoulos NG, Custovic A, Deschildre A, Mathioudakis AG, Phipatanakul W, Wong G, et al. Impact of COVID-19 on pediatric asthma: practice adjustments and disease burden. J Allergy Clin Immunol Pract. 2020;8(8):2592-9. e3.
21. Chavasse R, Almario A, Christopher A, Kappos A, Shankar A. The indirect impact of COVID-19 on children with asthma. Arch Bronconeumol. 2020;56(11):768.
22. Levene R, Fein DM, Silver EJ, Joels JR, Khine H. The ongoing impact of COVID-19 on asthma and pediatric emergency health-seeking behavior in the Bronx, an epicenter. Am J Emerg Med. 2021;43:109-14.
23. Smith SJ, Busby J, Heaney LG, Pfeffer PE, Jackson DJ, Yang F, et al. The impact of the first COVID-19 surge on severe asthma patients in the UK. Which is worse: the virus or the lockdown? ERJ open research. 2021;7(1).
24. Hepkaya E, Kilinc AA, Cebi MN, Koyuncu Z, Cokugras H. General health status of children with asthma during the COVID‐19 pandemic. Pediatr Int. 2021;63(3):331-7.
25. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
26. Guan W-j, Liang W-h, Zhao Y, Liang H-r, Chen Z-s, Li Y-m, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J. 2020;55(5).
27. De Marco R, Locatelli F, Sunyer J, Burney P, Group ECRHSS. Differences in incidence of reported asthma related to age in men and women: a retrospective analysis of the data of the European Respiratory Health Survey. Am J Respir Crit Care Med. 2000;162(1):68-74.
28. Zare-Zardini H, Soltaninejad H, Ferdosian F, Hamidieh AA, Memarpoor-Yazdi M. Coronavirus disease 2019 (COVID-19) in children: prevalence, diagnosis, clinical symptoms, and treatment. Int J Gen Med. 2020:477-82.
29. Rosenthal JA, Awan SF, Fintzi J, Keswani A, Ein D. Asthma is associated with increased risk of intubation but not hospitalization or death in coronavirus disease 2019. Ann Allergy Asthma Immunol. 2021;126(1):93-5.
30. Vinuya RZ. Upper airway disorders and asthma: a syndrome of airway inflammation. Ann Allergy Asthma Immunol. 2002;88(4):8-15.
31. Kenyon CC, Hill DA, Henrickson SE, Bryant-Stephens TC, Zorc JJ. Initial effects of the COVID-19 pandemic on pediatric asthma emergency department utilization. J Allergy Clin Immunol Pract. 2020;8(8):2774-6. e1.
32. Ochoa-Avilés AM, Ochoa-Avilés C, Morillo-Argudo DA, Molina-Cando MJ, Rodas-Espinoza CR, Ster IC, et al. Impact of COVID-19 pandemic on asthma symptoms and management: A prospective analysis of asthmatic children in Ecuador. World Allergy Organ J. 2021;14(6):100551.
33. Cardinale F, Ciprandi G, Barberi S, Bernardini R, Caffarelli C, Calvani M, et al. Consensus statement of the Italian society of pediatric allergy and immunology for the pragmatic management of children and adolescents with allergic or immunological diseases during the COVID-19 pandemic. Ital J Pediatr. 2020;46(1):1-14.
34. Diseases CoI. Reduction of the influenza burden in children. Pediatrics. 2002;110(6):1246-52.
35. Du H, Dong X, Zhang Jj, Cao Yy, Akdis M, Huang Pq, et al. Clinical characteristics of 182 pediatric COVID‐19 patients with different severities and allergic status. Allergy. 2021;76(2):510-32.
36. Chang C, Zhang L, Dong F, Liang Y, Chen Y, Shang Y, et al. Asthma control, self‐management, and healthcare access during the COVID‐19 epidemic in Beijing. Allergy. 2021;76(2):586.
37. Gautier C, Charpin D. Environmental triggers and avoidance in the management of asthma. J Asthma Allergy. 2017:47-56.
38. Abrams EM, Szefler SJ. Managing asthma during coronavirus disease-2019: an example for other chronic conditions in children and adolescents. J Pediatr. 2020;222:221-6.
39. Denaro M, Smeriglio A, Barreca D, De Francesco C, Occhiuto C, Milano G, et al. Antiviral activity of plants and their isolated bioactive compounds: An update. Phytother Res. 2020;34(4):742-68.
40. Oyero OG, Toyama M, Mitsuhiro N, Onifade AA, Hidaka A, Okamoto M, et al. Selective inhibition of hepatitis c virus replication by Alpha-zam, a Nigella sativa seed formulation. Afr J Tradit Complement Altern Med. 2016;13(6):144-8.
41. Peters U, Dixon AE, Forno E. Obesity and asthma. J Allergy Clin Immunol. 2018;141(4):1169-79.
42. Society CT. Inhaled Salbutamol Shortage - Mitigation Strategy for Asthma [Internet] [Available from: https://cts-sct.ca/wp-content/uploads/2020/04/FINAL-April-13_CTS-re-Asthma-Salbutamol-Shortage.pdf.
43. Searing DA, Dutmer CM, Fleischer DM, Shaker MS, Oppenheimer J, Grayson MH, et al. A phased approach to resuming suspended allergy/immunology clinical services. J Allergy Clin Immunol Pract. 2020;8(7):2125-34.
44. Eldeirawi K, Huntington-Moskos L, Nyenhuis SM, Polivka B. Increased disinfectant use among adults with asthma in the era of COVID-19. J Allergy Clin Immunol Pract. 2021;9(3):1378-80. e2.
45. Le Moual N, Varraso R, Siroux V, Dumas O, Nadif R, Pin I, et al. Domestic use of cleaning sprays and asthma activity in females. Eur Respir J. 2012;40(6):1381-9.
46. Lawson M, Piel MH, Simon M. Child maltreatment during the COVID-19 pandemic: Consequences of parental job loss on psychological and physical abuse towards children. Child Abuse Negl. 2020;110:104709.
| Files | ||
| Issue | Vol 22 No 3 (2023) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijaai.v22i3.13052 | |
| Keywords | ||
| Asthma Child COVID-19 Pandemics SARS-CoV-2 | ||
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How to Cite
1.
Gharagozlou S, Rostamzadeh N, Gharagozlou M. Health Status and Inconveniences of Asthmatic Children During the First Year of the COVID-19 Pandemic. Iran J Allergy Asthma Immunol. 2023;22(3):245-253.
