The impact of asthma on COVID-19 disease severity in children and adolescents.

BACKGROUND: Atopy and allergic asthma have been found to be protective against coronavirus disease (COVID-19) in adults but have not been studied in children. OBJECTIVE: To identify whether children and adolescents with asthma had less severe disease and lower morbidity from COVID-19 than their counterparts without asthma. METHODS: This was a retrospective chart review from March 1, 2020, through January 31, 2021. Charts were eligible for inclusion if patients were over 6 years of age and below 20 years of age and tested positive for COVID-19 by PCR or antigen testing or were COVID-19 antibody positive when they presented to the emergency department (ED). Patients were grouped according to disease severity and divided into two groups, those with asthma and those without. A total of 1,585 patients were included-1,492 without asthma and 93 with asthma. RESULTS: Children and adolescents with asthma are less likely to be seen in the ED for COVID-19-related disease (p value< 0.0001, but if they presented to the ED, they were significantly more likely to be hospitalized, require oxygen, and have more severe forms of COVID-19 than children and adolescents without asthma (p value< 0.0001). CONCLUSIONS: Children and adolescents with asthma, though less likely to be seen in ED with COVID-19, were more likely to have severe disease than patients without asthma, once they presented to the ED.

Is There Benefit in Identifying Asthma Triggers During an Exacerbation?

Introduction. Allergen-specific IgE (sIgE) testing provides an objective assessment of sensitization to an allergen. Goal. To identify the time when serum measurements of sIgE would be most sensitive. Methods. This was a prospective study conducted between September 1, 2015, and February 25, 2019. Subjects ≥5 and ≤18 years of age, seen in the ED or admitted with an asthma exacerbation, were tested for total IgE and 8 perennial sIgE levels. Subjects with elevated sIgE were tested again after symptom resolution. Results. A total of 104 subjects were enrolled; 50 subjects were eligible for inclusion in the analysis. There were statistically significant differences between the visits for all sIgE, except Alternaria alternatum. Conclusions. In pediatric patients, serum sIgE levels measured during an asthma exacerbation were elevated compared with when their asthma was in better control. sIgE testing during an asthma exacerbation may help identify asthma triggers, mitigate exposure, and hence improve asthma control.

Nebulized Normal Saline Solution for Treatment of Bronchial Asthma Exacerbations and Bronchiolitis: Not Standard of Care.

Nebulized normal saline is frequently prescribed for the treatment of bronchiolitis or bronchial asthma exacerbations. We aimed to reinforce guidelines care by educating providers on the futility of saline administration. Frequency and indications for nebulized normal saline prescription were documented from November 1, 2014, to April 1, 2015, and then again, after dissemination of educational material to providers, from November 1, 2016, to April 1, 2017. A total of 263 patients had bronchiolitis and 470 had asthma. Nebulized normal saline for bronchiolitis decreased significantly in the emergency department (ED) and inpatient settings ( P < .001 and P = .027, respectively). For asthma exacerbations, the use of nebulized normal saline decreased significantly in the inpatient setting ( P = .025), while in the ED, numbers were low at baseline and remained unchanged. Nebulized normal saline administration in the hospital setting results in continued use in the community, where this leads to unnecessary ED visits, where first-line therapy should have been administered.