Effect of the SARS-CoV-2 pandemic on the control and severity of pediatric asthma

Background: The novel disease caused by the new coronavirus SARS-CoV-2 has caused an unprecedented global pandemic. Care providers of asthmatic children are increasingly con-cerned; as viral infections are one of the primary triggers of asthma flare-up. However, the effect of SARS-CoV-2 as well as the generated worldwide lockdown on asthmatic children is unknown.Objective: The aim of this study was to analyze the effects of pandemic SARS-CoV-2 in pediat-ric asthma control.Material and Methods: A retrospective, open, transversal study was performed at five tertiary hospitals. Recruited patients were aged <18 years and had physician-diagnosed asthma. Information regarding the 2019 and 2020 seasons were provided.Results: Data were collected from 107 children (age range: 3–18 years, mean age: 12 years). Well-controlled asthma was observed in 58 (54.2%) patients in 2020 versus 30 (28%) in 2019, and 15 (14%) patients had poorly controlled asthma in 2020 versus 28 (26.2%) in 2019. In 2020, a decrease in exacerbations caused by allergies to pollen, dust mites, molds, and through other causes not related to SARS-CoV-2 infection was observed. An increase in exacerbations was observed due to animal dander, stress, physical exercise, and SARS-CoV-2 infection. Children had a reduced need for asthma-controlling medication, made fewer visits to healthcare pro-viders and had lesser need of treatment with oral corticosteroids if compared with the same season of 2019.Conclusion: Pediatric asthma control improved, the need for controller medication declined, and fewer visits to healthcare providers were made during the pandemic if compared with the 2019 season.

Current Recommendations on the Management of Pediatric Asthma and Allergic Rhinitis during the COVID-19 Pandemic versus Real-Life Practice

<b><i>Introduction:</i></b> Several statements and position papers on the management of childhood asthma and allergies during the COVID-19 pandemic have been published of late. The aim of this study was to evaluate the knowledge and awareness of pediatricians and family physicians regarding the management of asthma and allergic rhinitis during the pandemic according to recently published updated guidelines. <b><i>Method:</i></b> We conducted an online survey among pediatricians and family physicians in Turkey, using a questionnaire designed to evaluate 4 items: (1) the relationship between COVID-19 infection risk and pediatric asthma/allergic rhinitis and medications used in treatment; (2) the follow-up and management of asthma/allergic rhinitis according to published updated recommendations; (3) pediatricians’ and family physicians’ observations and perceptions of treatment compliance and the attitudes of their pediatric asthma patients; and (4) pediatricians and family physicians’ attitudes to using telehealth in the follow-up and management of pediatric asthma patients during the pandemic. <b><i>Results:</i></b> A total of 346 participants responded to the survey. The relationship between the risk of COVID-19 and asthma was known by less than 25% of the participants. More than 33% of family physicians and 20% of pediatricians were unaware that asthma medication does not lead to a susceptibility to COVID-19 infection; 55% of family physicians and 48% of pediatricians thought that patients showed better compliance with asthma controller medication; over 33% of pediatricians and approximately 50% of family physicians stated that they could not distinguish between an asthma attack and lung involvement in COVID-19 infection; of the respondents, over 75% stated that they prefer face-to-face visits with patients, even in situations that do not require a physical examination. <b><i>Conclusion:</i></b> The overall knowledge and awareness of pediatricians and, especially, family physicians regarding the management of pediatric asthma/allergic rhinitis during the pandemic is not at a satisfactory level. There is an urgent need to inform them about updated recommendations appearing in recent guidelines published by allergy organizations.

Lung Ultrasound in Pediatric Asthma - Characterizing Baseline Findings Outside of Acute Exacerbations

Background: Lung ultrasound (LUS) has been shown to be an effective tool to rapidly diagnose certain causes of pediatric respiratory distress in the emergency department. However, very little is known about LUS findings in pediatric asthma outside of acute exacerbations. Objectives: The primary objective of this study was to characterize LUS findings in a cohort of pediatric patients with a definitive diagnosis of asthma, outside of an asthma exacerbation. Methods: Eligible patients, aged 6 to 17 years old and diagnosed with asthma, underwent LUS during an outpatient visit. LUS was conducted using a six-zone scanning protocol. A positive LUS was defined by one or more of the following: ≥3 B-lines per intercostal space, pulmonary consolidation and/or pleural anomaly. Images were interpreted by an expert sonographer blinded to patient clinical characteristics. Results: 52 patients were included. 10/52 patients had a positive LUS (19.2%, 95CI 8.3-30.1%). Of those with positive LUS findings, 8 had B lines, 7 had consolidations <1cm, 1 had a pleural line abnormality and 1 had a consolidation >1cm. Positive findings were seen in the right anterior and lateral zones in 60% of participants and were limited to 1-2 intercostal spaces within one lung zone in 100% of participants. Conclusion: To our knowledge, this is the first report of LUS findings in outpatient pediatric asthma. Positive LUS findings in asthmatic children can be seen outside of acute exacerbations. Such findings need to be taken into consideration when using LUS for the acute evaluation of a pediatric patient with asthma.