Asthma control important to protect children from severe COVID-19 disease: study

Children with poorly controlled asthma are at higher risk of COVID-19 hospitalisation and should be prioritised for vaccination, according to a Scottish study.

The population-level study of over 750,000 school-aged children 5-17 years old found those with poorly controlled asthma were 3-6 times more likely to be hospitalised with COVID-19 compared to other children.

Among 63,463 children (8.4%) with a diagnosis of asthma, 4,339 (6.8%) had a confirmed SARS-CoV-2 infection, and 67 (1.5%) of these were admitted to hospital with COVID-19.

The study, published in The Lancet Respiratory Medicine, said there were nine intensive care admissions including five deaths in children with asthma.

Children and teenagers with poorly controlled asthma (defined as being hospitalised with asthma within the past two years) were more likely to be admitted to hospital with COVID-19 (548 COVID-19 hospitalisations per 100,000 children), compared to children with well-controlled asthma (94 hospitalisations per 100,000 children), or without asthma (55 hospitalisations per 100,000 children).

The Hazard Ratio (HR) for a COVID-19 hospital admission in children with poorly controlled asthma was 3.78 in 5-11 year olds, 10.04 in 12-17 years old and 6.40 across 5-17 years olds.

Using two courses of oral corticosteroid prescriptions in the preceding 24 months as the marker of uncontrolled asthma, the HR for a COVID-19 hospital admission was 3.21 in 5-11 year olds, 3.96 in 12-17 year old and 3.53 across 5-17 year olds.

The study noted that although the HR was elevated, the overall risk of hospital admission with SARS-CoV-2 was a low 1 in 380 children with poorly controlled asthma.

The investigators said their findings underscore the importance of maintaining good asthma control and careful monitoring of children with poorly controlled asthma if they develop SARS-CoV-2 infection.

“Good asthma control could help to protect children from developing more severe manifestations of COVID-19,” they said.

“With vaccines in children and young people being given and planned internationally and nationally, together with other public health surveillance data, policy makers will be able to use data from our study to inform decisions on vaccination priorities among school-aged children with asthma,” they concluded.

“This is particularly important considering the potential limited vaccine supplies and the lower absolute risk of serious COVID-19 in children.”

An accompanying Comment in the journal said careful decision making around the delivery of the vaccine to children younger than 12 years was essential.

“Although children with asthma have been identified as having an increased risk of being admitted to hospital compared with peers without asthma, the overall risk remains very low. A balance between the risk of hospitalisation from SARS-CoV-2 and the low risk of vaccination side-effects needs to be carefully considered before vaccination is contemplated.”

The UK authors said a focus on excellent asthma control, including the delivery of the influenza vaccine, and improving air quality and hygiene in schools was essential for all children with asthma to reduce their susceptibility to exacerbations over their coming winter.

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