Abstract
BackgroundAsthma affects up to 33% of children in Latin American settings. The ongoing COVID-19 pandemic has had a significant impact on access to and use of health services. We aimed to evaluate the impact of the COVID-19 lockdown on asthma exacerbations, medical facility visits, and use of asthma medications in children. MethodsWe used data from a prospective cohort of 213 children aged 5–17 years in 3 Ecuadorian cities and analysed the impact of the COVID-19 lockdown on asthma. Outcomes (asthma exacerbations, emergency room [ER] visits, planned and unplanned outpatient visits, and use of inhaled corticosteroids and Beta-2 agonists) were analysed using repeated Poisson counts (ie, number of events per participant before and during the COVID-19 lockdown). ResultsDuring compared to before lockdown: a) the number of asthma exacerbations remained constant (IRR, 0.87; 95% CI: 0.72–1.05; p = 0.152); b) outpatient visits (IRR 0.26, 95% CI 0.14–0.47, p < 0.001) declined 74% while ER visits declined 89% (IRR 0.11, 95% CI 0.04–0.32, p < 0.001); and c) there was no change in inhaled corticosteroids use (IRR 1.03, 95% CI 0.90–1.16, P = 0.699) while Beta-2 agonist use increased (IRR 1.32, 95% CI 1.10–1.58, P = 0.003). ConclusionsIn a cohort of Ecuadorian children with asthma, health services attendance decreased dramatically after COVID-19 lockdown, but asthma exacerbations and use of inhaled corticosteroids were unchanged. Future analyses will address the question of the effect of SARS-CoV-2 infection on asthma exacerbations and control in this paediatric population.
Highlights
Asthma affects up to 33% of children in Latin American settings
During compared to before lockdown: a) the number of asthma exacerbations remained constant (IRR, 0.87; 95% CI: 0.72–1.05; p 1⁄4 0.152); b) outpatient visits (IRR 0.26, 95% CI 0.14–0.47, p < 0.001) declined 74% while emergency room (ER) visits declined 89% (IRR 0.11, 95% CI 0.04–0.32, p < 0.001); and c) there was no change in inhaled corticosteroids use (IRR 1.03, 95% CI 0.90–1.16, P 1⁄4 0.699) while Beta-2 agonist use increased (IRR 1.32, 95% CI 1.10–1.58, P 1⁄4 0.003)
We used data from an ongoing prospective study of asthma in children and adolescents in 3 large Ecuadorian cities to study the impact of the implementation of lockdown measures to control the COVID-19 pandemic in Ecuador on the risk of asthma exacerbations, planned and unplanned health facility visits, and use of asthma medications
Summary
Asthma is the most common children’s chronic disease and is estimated to affect between 9% and 33% of children in Latin American settings.[1,2,3,4] The ongoing COVID-19 pandemic has had a significant impact on access to and use of health services.[5,6] Data from US hospital records and online surveys of health-care providers have documented major reductions in emergency room (ER) visits,[7] uptakes of follow-up visits, prescriptions, treatment adherence,[6,8] and asthma control.[5,9] hospital records analysis in Japan revealed a decrease in asthma hospitalisations during the pandemic.[10] Such reductions likely reflect the combined effects of stay-at-home orders, reassignment of health services, fear of contagion or reduction of severe asthma attacks. We used data from an ongoing prospective study of asthma in children and adolescents in 3 large Ecuadorian cities to study the impact of the implementation of lockdown measures to control the COVID-19 pandemic in Ecuador on the risk of asthma exacerbations, planned and unplanned health facility visits, and use of asthma medications
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