Asthma as a risk factor for hospitalization in children with COVID‐19: A nested case‐control study. Issue 1 (24th November 2021)

• Record Type: Journal Article
• Authors: Gaietto, Kristina; Freeman, Megan Culler; DiCicco, Leigh Anne; Rauenswinter, Sherry; Squire, Joseph R.; Aldewereld, Zachary; Iagnemma, Jennifer; Campfield, Brian T.; Wolfson, David; Kazmerski, Traci M.; Forno, Erick
• Editors: Kalayci, Ömer
• Is Part Of: Pediatric allergy and immunology. Volume 33:Issue 1(2022)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2021-11-24
• Subjects: asthma -- COVID‐19 -- SARS‐CoV‐2; Allergy in children -- Periodicals; Immunologic diseases in children -- Periodicals; 617
• DOI: 10.1111/pai.13696
• Languages: English
• ISSNs: 0905-6157

Abstract

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.