Asthma Admissions Research Articles

THE IMPACT OF COVID-19 PANDEMIC ISOLATION MEASURES ON PEDIATRIC ASTHMA ADMISSIONS

<h3>Introduction</h3> Asthma is the most common chronic disease in children, with about 1 in 20 asthmatic children annually hospitalized for an exacerbation. Since respiratory viruses are common exacerbation triggers, there were concerns that SARS-CoV2 would lead to increased asthma admissions. We hypothesized that the CDC-implemented pandemic isolation measures would instead lead to a decrease in asthma admissions by limiting the spread of other respiratory viruses. <h3>Methods</h3> A retrospective chart review at a pediatric tertiary care center was conducted. Monthly asthma-related hospitalizations of patients 2-18 years of age were counted. Patients with tracheostomy or ventilator dependence were excluded. Admissions from the start of the pandemic in March 2020 until present were compared to baseline data from the 2 years preceding the pandemic. A Chi-square test was used to compare the uniformity of annual admissions and month-by-month admissions over 5 years. <h3>Results</h3> There were 4703 asthma admissions over the 5-year period. There was a statistically significant (p<0.001) decrease in the number of monthly asthma admissions during March 2020-June 2020, when the strictest isolation measures were in place. This decrease, compared to baseline data, persisted for approximately 12 months until again returning to baseline data in Spring 2021, as isolation measures eased. A lower magnitude and shorter duration decrease from baseline admissions was also seen during the Omicron spike. <h3>Conclusion</h3> Asthma admissions sharply declined during the strictest isolation measures and then returned to baseline levels as the measures eased. This data suggests that isolation measures may reduce respiratory virus transmission and contribute toward reduced pediatric asthma admissions.

IMPACT OF ALLERGEN SENSITIZATION ON AIRFLOW LIMITATION IN CHILDREN WITH SEVERE ASTHMA

<h3>Introduction</h3> Airflow limitation (AFL) has been shown to predict poor asthma outcomes across maturation. The objective of our study is to identify significant predictors of AFL in children with severe asthma from school-age to adolescence. <h3>Methods</h3> Children ages 5-18 years with treatment-refractory asthma underwent spirometry and diagnostic bronchoscopy. AFL was defined as pre-bronchodilator FEV₁/FVC <0.85 or <90% predicted. Demographics, treatments, and blood and lung markers of inflammation were analyzed with between group non-parametric tests and logistic regression models. <h3>Results</h3> 226 children were included in this analysis. Nearly one-half (n=105, 46%) had AFL. There was no difference in age, gender, BMI, or age of symptom onset between groups. Compared to children without AFL, those with AFL were more likely to have previous ICU admission for asthma, treatment with higher-dose inhaled corticosteroids (ICS), and reported black race. Children with AFL had significantly higher total blood and bronchoalveolar lavage (BAL) eosinophil count, total IgE, and greater number of positive allergen specific serum IgE. In younger children, those with sensitization to ≥4 allergens had greater airflow limitation but the opposite relationship was seen in adolescent children. Similarly, the effects of higher total IgE (>130 IU/mL) on airflow limitation were most prominent in younger children. <h3>Conclusion</h3> Significant predictors of airflow limitation in children with severe asthma include black race, previous ICU admission for asthma, higher-dose ICS treatment, and increased absolute blood and BAL eosinophil count. AFL is driven in part by allergic sensitization in the younger children whereas in older children this associated more with the absence of allergic sensitization.

Grass pollen exposure is associated with higher readmission rates for pediatric asthma.

Pediatric asthma hospital readmission is a burden on the individual and costly for Australian hospitals. Grass pollen's role, a known trigger for asthma admissions, is unexamined in readmissions. We examined the association between grass pollen and pediatric asthma readmission. The Victorian Admitted Episodes Dataset was used to identify all primary admissions with a principal diagnosis of asthma in children aged 2-18 years between 1997 and 2009. Readmissions were defined as subsequent admissions within 28 days of index admission discharge. Generalized additive models were used to assess associations between readmission, grass pollen season, and daily grass pollen counts, lagged and cumulative. Models were further stratified by sex and age group. Mean daily readmission was higher during grass pollen season than other times of the year, incidence rate ratio (IRR) 1.44 (95% CI, 1.03, 2.02) and for children aged 2-5 years, IRR 1.99 (1.26, 3.14). Same day grass pollen was nonlinearly associated with daily readmission for the 13-18 age group between 110 and 256 grains/m3 , p < .01. Lag 2 grass pollen was nonlinearly associated with daily readmissions overall (p=.03), boys (p=.01), and younger age groups 2-5 (p=.02) and 6-12 (p < .001). Grass pollen exposure was associated with higher readmission rates for pediatric asthma. Treatment plans prior to discharge could be implemented to reduce the likelihood of readmission by younger children during the pollen season.

The impact on ambient air pollution and asthma-related admissions of COVID-19 transport restrictions

Abstract Exposure to air pollution is a known risk factor for asthma exacerbations, emergency attendances and hospitalisations. In Europe, the main source of air pollution is the transport industry, and so the COVID-19 transport restrictions provided an opportunity to examine if reduction in traffic had a demonstrable impact on ambient air quality and asthma-related admissions. Routinely collected data was used to conduct a retrospective population cohort study. The Environmental Protection Agency provided daily nitrogen dioxide (NO2) and particulate matter (PM) concentrations for Dublin, and all asthma-related admissions were collected from the Hospital In-Patient Enquiry system. The two years prior to the pandemic were compared with the period of transport restrictions (from March 2020). During the period of restrictions, there was a significant reduction in the mean number of daily asthma admissions (2.8 v 4.5 admissions p &amp;lt; 0.001). There was also a significant decrease in mean daily concentrations in two pollutants: NO2 (16.7 v 24.0µg/m3 p &amp;lt; 0.001) and PM2.5 (7.8 v 8.9µg/m3 p = 0.002). Only NO2 had a statistically significant correlation with asthma admissions (r = 0.132 p &amp;lt; 0.001). Transport restrictions introduced to mitigate against COVID-19 led to improvements in air quality, as seen by the reductions in pollutant concentrations. Previously described associations between pollutants and asthma, would suggest that these improvements in air quality contributed to the reduction in asthma admissions. Whereas the primary source of NO2 is transport emissions, PM is made up of particles from multiple sources, which likely explains the lack of correlation between asthma admissions and PM. Public Health need to advocate for transport policies which can improve air quality, and as a result, public health. Key messages

91 The impact of non-pharmaceutical public health interventions on hospital admissions and mortality from common causes of pediatric respiratory distress: a single center perspective

Abstract Background In response to the COVID-19 pandemic, jurisdictions around the world implemented policies to reduce COVID-19 transmission through public masking, travel restrictions, and closure of non-essential businesses. Collectively known as non-pharmaceutical interventions (NPI), these strategies reliably reduce the spread of COVID-19. International data suggests NPI also reduce hospitalizations for pediatric respiratory infections and their consequences, particularly asthma exacerbation. However, few Canadian studies have examined the impact of NPI on hospitalizations for common causes of pediatric respiratory distress. Objectives This study describes the impact of NPI on admissions for bronchiolitis, pneumonia, and asthma at a Canadian pediatric tertiary care centre. Design/Methods A retrospective chart review was conducted including all pediatric patients &amp;lt;18 years admitted to the general pediatric and pediatric intensive care units with bronchiolitis, pneumonia, or asthma. Data regarding diagnosis, length of hospitalization, and mortality were collected before (September 2016-March 2020) and in the 6 months after provincial NPI implementation (March 2020-September 2020). NPI were present throughout this period, however, specific measures varied due to evolving public health orders. Chi-squared testing was conducted to describe the impact of NPI on number of admissions, length of hospitalization, and mortality. Results Participants (n=1631) included 111 (6.8%) patients &amp;lt;1 month, 878 (53.8%) patients 1-23 months, 331 (20.3%) patients 24 months-4 years, and 311 (19.1%) patients ≥5 years. A mean of 205 patients were admitted every 6 months with respiratory distress (bronchiolitis, pneumonia, and/or asthma) prior to NPI implementation. During this timeframe, the 6-month mean admissions due to asthma, pneumonia, and bronchiolitis were 48, 56, and 101, respectively. In the 6 months following NPI implementation, there were 56 admissions for respiratory distress, including 15 for asthma, 19 for pneumonia, and 22 for bronchiolitis. Mean length of stay increased following the implementation of NPI from 8.49 to 11.68 days, whereas 6-month mean mortality decreased from two to zero deaths. Results did not attain statistical significance (p&amp;gt;0.05). Conclusion Results suggest NPI reduce hospitalizations and mortality from bronchiolitis, pneumonia, and asthma. Given the similar seasonality of these conditions, periodic use of NPI beyond the COVID-19 pandemic may reduce pediatric morbidity and mortality from common causes of respiratory distress. However, additional research is needed to describe the relationship between NPI and length of hospitalization. Future studies should also examine the impact of NPI on other pediatric infectious diseases to better characterize their utility.

Asthma Hospital Admission and Readmission Spikes, Advancing Accurate Classification to Advance Understanding of Causes.

Background: An important component of asthma care is understanding potential causes of high asthma admissions (HAADs) or readmissions (HARDs) with potential of risk mitigation. Crucial to this research is accurately distinguishing these events from background seasonal changes and time trends. To date, classification methods have been based on ad hoc and untested definitions which may hamper understanding causes of HAADs and HARDs due to misclassification. The aim of this article is to introduce an easily applied robust statistical approach, with high classification accuracy in other settings—the Seasonal Hybrid Extreme Studentized Deviate (S-H-ESD) method. Methods: We demonstrate S-H-ESD on a time series between 1996 and 2009 of all daily paediatric asthma hospital admissions in Victoria, Australia. Results: S-H-ESD clearly identified HAADs and HARDs without applying ad hoc classification definitions, while appropriately accounting for seasonality and time trend. Importantly, it was done with statistical testing, providing evidence in support of their identification. Conclusion: S-H-ESD is useful and statistically appropriate for accurate classification of HAADs and HARDS. It obviates ad hoc approaches and presents as a means of systemizing their accurate classification and detection. This will strengthen synthesis and efficacy of research toward understanding causes of HAADs and HARDs for their risk mitigation.

347 The Association of Environmental Factors on Emergency Pediatric Asthma-Related Health Care Utilization

Asthma is a multifactorial disease in which complex environmental exposures contribute to asthma exacerbations, often requiring acute medical attention. Although asthma exacerbations follow a seasonal pattern, our ability to precisely predict the timing and magnitude of increased asthma admissions remains limited. Pediatric asthma-related emergency department (ED) visits historically follow a bimodal distribution with peak admissions occurring in the spring and fall, while being lowest during the summer.

: Short-term effects of exposure to particulate matter on hospital admissions for asthma and chronic obstructive pulmonary disease.

We investigated the effects of particulate matter (PM) factors on hospitalization rates for asthma and chronic obstructive pulmonary disease (COPD).We obtained data on pollutants—PM10, PM2.5—in Seoul, South Korea. We also investigated data for asthma and COPD exacerbation that required hospitalization from 2006 to 2016. We used a time-stratified case-crossover design and generalized additive models with log transformation to assess adjusted risk, and conditional logistic regression was performed to analyze these data.Our study showed that PM10 and PM2.5, on different best lag days, were associated with increased risks of COPD or asthma hospitalization. The odds ratios (ORs) for each per-unit increase in PM10 and PM2.5 were higher in patients with male asthma (PM10: OR, 1.012; 95% confidence interval [CI], 1.008–1.016 and PM2.5: OR, 1.015; 95% CI, 1008–1.023), preschool asthma (PM10: OR, 1.015; 95% CI, 1.006–1.015 and PM2.5: OR, 1.015; 95% CI, 1.009–1.024), male COPD (PM10: OR, 1.012; 95% CI, 1.005–1.019 and PM2.5: OR, 1.013; 95% CI, 1.000–1.026), and senior COPD (PM10: OR, 1.016; 95% CI, 1.008–1.024 and PM2.5: OR, 1.022; 95% CI, 1.007–1.036).Increasing PM levels increased hospitalizations for asthma and COPD. Additionally, the consequences may be different according to age and sex, and PM2.5 may have a more significant effect on airway disease patients than PM10.

Respiratory admissions before and during the COVID-19 pandemic with mediation analysis of air pollutants, mask-wearing and influenza rates.

Background and objectiveDecline in hospitalizations for various respiratory diseases has been reported during the COVID‐19 pandemic, but what led to such an observation is uncertain.MethodsThis was a territory‐wide, retrospective cohort study involving all public hospital admissions in Hong Kong from 1 January 2017 to 31 December 2020. Hospital admissions for respiratory diseases, including asthma, COPD and non‐COVID pneumonia, were assessed. COVID‐related admissions were excluded from this study. The time of commencement of the pandemic was taken from the fourth week of January 2020. The associations between air pollutant levels, influenza and mask‐wearing rates with hospital admissions were assessed by mediation analyses.ResultsThere were altogether 19,485, 78,693 and 238,781 admissions for asthma, COPD and non‐COVID pneumonia from January 2017 to December 2020. There was a marked reduction in hospital admissions of asthma, COPD and non‐COVID pneumonia (37%, 36% and 12% decrease in average daily admissions, respectively) during the COVID‐19 pandemic compared to before. Air pollutant levels and influenza rate were decreased while mask‐wearing rate was increased. Collinearity of mask‐wearing rates and pandemic year was observed. For COPD, NO2, SO2, PM10 and influenza rates (4%, 11%, 4% and 4% of the total effect, respectively), while for non‐COVID pneumonia, PM10 and influenza rates (11% and 52%, respectively) had significant mediation effect on changes in hospital admissions before and during the COVID‐19 pandemic.ConclusionDuring the COVID‐19 pandemic, a decrease in air pollutant levels and influenza rate had mediation effect on the reduction in hospitalizations of COPD and non‐COVID pneumonia.

Increased Risk of Hospital Admission for Asthma from Short-Term Exposure to Low Air Pressure

PurposeAsthma has a major impact on patients’ quality of life, mortality, and healthcare burden. Some evidence suggests that environmental factors may trigger asthma. However, there has been limited research on the relationship between air pressure and asthma hospital admissions, especially in China. Thus, we aimed to study the influence of air pressure and identify potentially susceptible populations.MethodsThe study data were gathered from hospitalization records with a primary diagnosis of asthma from all secondary and tertiary hospitals in Beijing from January 1, 2013, to December 31, 2016. The study examined the association between the risk of asthma and air pressure using a distributed lag non-linear model (DLNM). We also performed a stratified analysis to identify the susceptible populations.ResultsA total of 23,697 asthma hospital admissions were included in the study. We found that the relative risk (RR) and the 7-day cumulative relative risk (CRR) of asthma had an approximate negative correlation with air pressure. At the same time, we found that the association was most apparent on the day of exposure (lag = 0).ConclusionAmbient air pressure had an approximately negative correlation with daily asthma hospital admissions in Beijing, China. That means the risk of hospital admission for asthma would be increased by low air pressure. Furthermore, air pressure has a significant effect on asthma only on the day of exposure. It is possibly significant to protect the vulnerable on days with low air pressure, especially those younger than 65 years.

Ambient air pollutant concentrations and asthma-related hospital admissions during COVID-19 transport restrictions

ObjectivesExposure to air pollution is a known risk factor for asthma exacerbations and hospitalisations. This study aimed to identify if COVID-19 transport restrictions led to improvements in air quality in Dublin and if this had an impact on asthma-related hospital admissions. Study designThis was a population-based retrospective cohort study. MethodsDaily concentration levels of particulate matter (PM2.5 and PM10) and nitrogen dioxide (NO2) were obtained from the Environmental Protection Agency (EPA). The Hospital In-Patient Enquiry (HIPE) system provided the daily number of asthma-related hospital admissions in Dublin. The figures for 2018–2019 were compared with the period of transport restrictions (from March 2020). ResultsDuring the period of transport restrictions, there was a significant decrease in mean daily concentrations in both PM2.5 (8.9 vs 7.8 μg/m3, P = 0.002) and NO2 (24.0 vs 16.7 μg/m3, P < 0.001). There was also a significant reduction in the mean number of daily asthma admissions (4.5 vs 2.8 admissions, P < 0.001). Only NO2 showed a statistically significant correlation with asthma admissions (r = 0.132, P < 0.001). ConclusionTransport restrictions introduced to mitigate against COVID-19 led to lower pollutant levels and improved air quality. Previously described associations between pollutants and asthma would indicate that these improvements in air quality contributed to the reduction in asthma-related admissions. The complex nature of PM is the likely explanation for the lack of correlation between its concentration and asthma admissions, unlike NO2 whose primary source is vehicular emissions. Public Health needs to advocate for transport policies, which can improve air quality and hence improve human health.

Impact of anti-tobacco legislation on hospitalization of patients with respiratory diseases in three regions of the Russian Federation

AIM: Tо assess the impact of anti-tobacco measures under federal anti-tobacco law on the hospital admissions for pneumonia of various diagnoses, and other acute respiratory infections of the lower respiratory tract, bronchial asthma, and asthmatic status in the Samara, Arkhangelsk regions, and the Chuvash Republic.&#x0D; MATERIAL AND METHODS: A retrospective analysis of monthly hospital admissions for pneumonia (ICD-10 J12J18), and other acute respiratory infections of the lower respiratory airways (ICD-10 J20J22), asthma (ICD-10 J45), and status asthmaticus (ICD-10 J46) was carried out in the three selected regions of the Russian Federation from the 1st of January, 2012, till the 31st of December, 2017, and in subgroups (014, 1559, 60 years, and older). The analytical approach used was the interrupted time series method, which was performed using the STATA 15.0 software package.&#x0D; RESULTS: From this study, it was revealed that there was a decrease in the hospital incidence of respiratory airways infections after each stage of enacting the anti-tobacco policy in all the three selected regions of the Russian Federation. In the Arkhangelsk region, this decrease amounted to 19% in 2013, and 22% in 2014. In the Samara region, 20% and 23% respectively, and the Chuvash Republic, 31% and 39% respectively. A significant decrease in hospital admissions for asthma and status asthmaticus was observed only in the Chuvash Republic (the decrease occurred by 11% in 2013, and by 12% in 2014). In other regions, the observed decrease was not significant.&#x0D; CONCLUSION: From this study, the results obtained have shown that the anti-tobacco measures introduced in Russia in 2013 and 2014 were responsible for the decrease in the number of hospitalizations for lower respiratory airways infections within the same period.

16-year trends in asthma hospital admissions in Canada

BackgroundAsthma hospitalizations declined rapidly in many parts of the world, including Canada, in the 1990s and early 2000s. ObjectiveTo examine whether the declining trend of asthma hospitalizations persisted in recent years in Canada. MethodsUsing the Canadian comprehensive nationwide hospitalization data (2002-2017), we identified hospital admissions with the main International Classification of Diseases codes for asthma. We analyzed sex-specific age-standardized trends in annual hospitalization rates among pediatric (< 19 years) and adult (19+ years) patients. We used change-point analysis to evaluate any substantial changes in the trends in the sex-age groups. ResultsThere were 254,672 asthma-related hospital admissions (59% pediatric, 50% female) during the study period. Among children, age-adjusted annual rates per 100,000 decreased by 55% in females (152-69) and by 60% in males (270-108) from 2002 to 2017. Among adults, the rates decreased by 59% in both sexes (females: 61-25; males: 27-11). Change-point analysis indicated a substantial plateauing of the annual rate in both pediatric (from −15.3 [females] and −25.8 [males] before 2010 to −0.6 [females] and −0.8 [males] after 2010) and adult (from −5.4 [females] and −2.6 [males] before 2008 to −0.6 [females] and −0.2 [males] after 2008) groups. ConclusionAfter a substantial decline in hospital admissions for acute asthma, there has been minimal further decline since 2010 for children and 2008 for adults. In addition to adhering to the contemporary standards of asthma care, novel, disruptive strategies are likely needed to further reduce the burden of asthma.

Modifiable factors associated with pediatric asthma readmissions: a multi-center linked cohort study

Objectives To (a) identify rates of hospital readmission and emergency department (ED) re-presentation for asthma within a 12-month period, (b) estimate the effects of modifiable hospital, general practitioner (GP) and home environmental factors on hospital readmission, ED re-presentations and rescue oral corticosteroid use. Methods We recruited 767 children aged 3–18 years who were admitted to 3 hospitals in Victoria, Australia between 2017 and 2018 with a validated diagnosis of asthma on chart review. Primary outcome was hospital readmission with asthma within 12 months of index admission. Secondary outcomes were ED re-presentation for asthma and rescue oral corticosteroid use. All outcomes were identified through linked administrative datasets. Their caregivers and 277 nominated GPs completed study surveys regarding the home environment and their usual asthma management practices respectively. Results Within 12 months of an index admission for asthma 263 (34.3%) participants were readmitted to a hospital for asthma, with participants between the ages of 3–5 years accounting for 69.2% of those readmitted. The estimated effect of GP reported guideline discordant care on the odds of readmission was OR 1.57, 95% CI 1.00–2.47, p = 0.05. None of the hospital or home environmental factors appeared to be associated with hospital readmissions. Conclusions Hospital readmissions among Australian children with asthma are increasing, and linked datasets are important for objectively identifying the health services burden of asthma. They also confirm the important role of the GP in the management of pediatric asthma.

Reducing short-acting beta-agonist overprescribing in asthma: lessons from a quality-improvement prescribing project in East London.

BackgroundExcess prescription and use of short-acting beta-agonist (SABA) inhalers is associated with poor asthma control and increased risk of hospital admission.AimTo quantify the prevalence and identify the predictors of SABA overprescribing.Design and settingA cross-sectional study using anonymised clinical and prescribing data from the primary care records in three contiguous East London boroughs.MethodPrimary care medical record data for patients aged 5–80 years, with ‘active’ asthma were extracted in February 2020. Explanatory variables included demography, asthma management, comorbidities, and prescriptions for asthma medications.ResultsIn the study population of 30 694 people with asthma, >25% (1995/7980), were prescribed ≥6 SABA inhalers in the previous year. A 10-fold variation between practices (<6% to 60%) was observed in the proportion of patients on ≥6 SABA inhalers/year. By converting both SABAs and inhaled corticosteroids (ICSs) to standard units the accuracy of comparisons was improved across different preparations. In total, >25% of those taking ≥6 SABAs/year were underusing ICSs, this rose to >80% (18 170/22 713), for those prescribed <6 SABAs/year. Prescription modality was a strong predictor of SABA overprescribing, with repeat dispensing strongly linked to SABA overprescribing (odds ratio 6.52, 95% confidence interval = 4.64 to 9.41). Increasing severity of asthma and multimorbidity were also independent predictors of SABA overprescribing.ConclusionIn this multi-ethnic population a fifth of practices demonstrate an overprescribing rate of <20% a year. Based on previous data, supporting practices to enable the SABA ≥12 group to reduce to 4–12 a year could potentially save up to 70% of asthma admissions a year within that group.

A nurse-led Asthma Care Team transitioning patients from hospital to home improves asthma control: A pilot study exploring an alternative model of care.

Recurrent asthma admissions are frequent in our patients at a tertiary Australian hospital and are commonly related to poor health literacy and medication adherence. A need exists to improve these asthma self-management skills within our current model of care, especially during the vulnerable postdischarge period. To examine if the addition of a nurse-led Asthma Care Transition Team (ACTT) compared with usual care alone (UC) (1) improves asthma control at 12 weeks posthospital discharge; the number of patients using a Written Action Plan (WAP), compliance with inhaler therapy at 12 weeks, and readmission rates at 6months. Adults admitted with asthma were randomised to either: UC: involving review of asthma medication and self-management skills by the ward team prior to discharge; a standard 6-week post discharge clinic visit and a 12-week study visit where an independent assessor assessed outcomes; or ACTT: In addition to UC, involved ACTT nurse-led review at 1week and 6 weeks. Key aspects included a pre defined, structured review reinforcing education and self-management skills, and telephone support during working hours. Sixty participants (UC and ACTT) had similar baseline characteristics: Mean age: 41 vs 38 years, asthma duration: 20 vs 18 years, baseline Asthma Control Questionnaire 3.1 vs 3.4. At 12 weeks Asthma Control Questionnaire (ACQ) improved significantly in both groups but more so with ACTT; ACTT group had a higher uptake of WAP and a trend to reduced readmissions. A nurse-led ACTT improves asthma control and self-management skills following discharge and may lead to fewer readmissions.

20-YEAR TRENDS IN ASTHMA HOSPITAL ADMISSIONS IN CANADA

TYPE: Late Breaking Abstract TOPIC: Obstructive Lung Diseases PURPOSE: To investigate 20-year trends in asthma-related hospitalizations in Canada. METHODS: Using the Canadian comprehensive nationwide hospitalization data (1998–2017), we identified hospital admissions with the main diagnostic International Classification of Diseases codes for asthma. We analyzed sex-specific age-standardized trends in annual hospitalization rates among pediatric (<19 years) and adult (19+ years) patients. We used change-point analysis to examine any substantial change in the trends in each of the sex-age groups. RESULTS: There were 452,228 asthma-related hospital admissions (53% pediatric, 52% female) during the study period. Among pediatric patients, age-adjusted annual rates per 100,000 decreased by 74% in both sexes from 1998 to 2017 (females: 262 to 69; males: 407 to 108). Among adult patients, the rates decreased by 87% in females (197 to 25) and 88% in males (96 to 11). Change-point analysis (Figure 1) indicated a substantial plateauing of the annual rate of decline in both pediatric (26.9 [females] and 34.9 [males] before 2003 to 0.1 [females] and 0.9 [males] after 2012) and adult patients (from 36.9 [females] and 18.6 [males] before 2003 to 2.3 [females] and 1.1 [males] after 2003). CONCLUSIONS: Following a major decline in hospital admissions for acute asthma, there has been minimal further decline since 2012 for all sex and age groups. CLINICAL IMPLICATIONS: The current hospitalisation rates represent an avoidable source of burden. Our study calls for future research to identify specific factors contributing to these trends, thereby potentially identifying avenues where we can further improve asthma outcomes with existing preventive and therapeutic interventions and policies. DISCLOSURE: Nothing to declare. KEYWORD: Asthma

Impact of COVID-19 on Respiratory Admissions in a Tertiary Pediatric Intensive Care Unit.

BackgroundPediatric inpatient admissions for viral respiratory infections decreased worldwide during the early part of the coronavirus disease 2019 (COVID-19) pandemic. This was likely due to social distancing measures and mask mandates leading to a decreased spread of viruses. We question if there was an increase in respiratory admissions during the winter of 2020-2021 due to the overlap of seasonal respiratory viruses and COVID-19 and the severity of those admissions.MethodsWe performed a single-center retrospective chart review of all respiratory admissions to our pediatric intensive care unit (PICU) from October to April during the years 2018-2019, 2019-2020, and 2020-2021. We compared the total number of respiratory admissions from different viruses and respiratory admissions by diagnoses among those time periods. Second, we compared the PICU length of stay and duration of mechanical ventilation (both invasive and non-invasive) for these respiratory admissions during those years.ResultsWe saw a drastic decrease in the total respiratory admissions to the PICU in 2020-2021 compared to the same period of time in the last two years. The greatest contributor to this decrease was admissions secondary to bronchiolitis. We noticed a statistically significant decrease in both asthma (p<0.001) and chronic respiratory failure admissions (p=0.0029) during the pandemic winter compared to previous winters. Although, the total number of all respiratory viral admissions is not significant, admissions specific to the respiratory syncytial virus (RSV) (p<0.0001), rhino-enterovirus (p<0.0001), and multi-virus (p=0.0016), achieved statistical significance. There was no statistical difference between the PICU length of stay and duration of mechanical ventilation during the three years.ConclusionDespite a decrease in pediatric respiratory admissions during the COVID-19 pandemic, the severity of illness based on length of stay in the PICU and length of time on respiratory support remains unchanged compared to the previous two years.

Impact of COVID-19 mitigation strategies on asthma hospitalizations in Brazil.

BackgroundIn 2020, a unique social experience was provided by the pandemic of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2. Interventions to tackle the pandemic may affect the burden of other respiratory diseases.ObjectiveThis study aims to assess the impact of the COVID-19 mitigation strategies on hospitalizations for asthma in children aged between 1 and 14 years, adults aged between 20 and 59 years, and elderly older than 60 years.MethodsData from hospital admissions for asthma were obtained from the Department of Informatics of Brazilian Public Health System database in the period between January 2016 and December 2020 and analyzed by age groups. To evaluate the effect of containment measures on the incidence of asthma and respiratory system diseases (total), the absolute reduction and relative reduction were calculated by analyzing the subsets from 2016 to 2019 versus 2020.ResultsThere was a significant reduction in the average incidence of hospitalizations in 2020, with numbers ranging from −59% (incidence rate ratio, 0.41 [0.37-0.45]) for age 1 to 14 years (prepandemic 1,393.2/100,000 vs pandemic 574.9/100.000), −37% (incidence rate ratio, 0.63 [0.49-0.80]) for age 20 to 59 years (prepandemic 160.2/100,000 vs pandemic 101.1/100,000), and −60% (incidence rate ratio, 0.40 [0.33-0.47]) for older than 60 years (prepandemic 460.6/100,000 vs pandemic 185.3/100,000).ConclusionsAshtma hospitalizations decreased in 2020, especially in the pediatric group and the older group during the COVID-19 pandemic, which may be associated with the reduction in the incidence of many respiratory viral infections.

Corticosteroids and Other Treatments Administered to Children Tested for SARS-CoV-2 Infection in Emergency Departments.

ObjectiveWe sought to determine if corticosteroid administration is associated with a SARS-CoV-2 nucleic acid test-positive result and to describe therapies administered to SARS-CoV-2 infected children.MethodsWe collected cross-sectional data from participants recruited in 41 pediatric emergency departments (ED) in 10 countries between March 2020 and June 2021. Participants were <18 years old, had signs or symptoms of, or risk factors for acute SARS-CoV-2 infection, and had nucleic acid testing performed. To determine if SARS-CoV-2 test status was independently associated with corticosteroid administration, we used a multivariable conditional logistic regression model matched by study site to compare treatments administered based on SARS-CoV-2 test and disposition status. This analysis was repeated for the subgroup of study participants who were hospitalized.Results30.3% (3,121/10,315) of participants were SARS-CoV-2-positive. Although remdesivir was more commonly administered to SARS-CoV-2-positive children, use was infrequent (25/3120 [0.8%] vs 1/7188 [0.01%]; P = .001). Corticosteroid use was less common among SARS-CoV-2-positive children (219/3120 [7.0%] vs 759/7190 [10.6%]; P < .001). Among hospitalized children, there were no differences in provision of inotropes, respiratory support, chest drainage or extracorporeal membrane oxygenation between groups. Corticosteroid administration was associated with age, history of asthma, wheezing, study month, hospitalization and intensive care unit admission; it was not associated with a positive SARS-CoV-2 test result overall (aOR: 0.91; 95%CI: 0.74, 1.12) or among the subgroup of those hospitalized (aOR: 1.04; 95%CI: 0.75, 1.44).ConclusionsFew disease-specific treatments are provided to SARS-CoV-2-positive children; clinical trials evaluating therapies in children are urgently needed.