Pediatric Asthma Health Care Utilization Following Onset of COVID-19 Pandemic

As in-person health care encounters decreased following the onset of the coronavirus disease 2019 (COVID-19) pandemic, changes in pediatric asthma health care delivery patterns resulted in reduced hospital admissions and systemic steroid prescriptions in Philadelphia.

New research published in The Journal of Allergy and Clinical Immunology: In Practice found that public health interventions aimed at limiting the spread of SARS-CoV-2, the virus that causes COVID-19, also led to a reduction in rhinovirus (RV) infections, a key cause of asthma exacerbations. In addition to respiratory virus exposure, pollution can worsen asthma symptoms.

“The public health interventions adopted to slow down the transmission of SARS-CoV-2 have altered environmental exposure profiles, which also influence the risk of asthma exacerbations,” the authors explained. “Infection prevention measures, including wearing face masks, washing hands frequently, and social distancing as a result of stay-at-home orders and school closures, reduce person-to-person transmission of all respiratory viruses.”

The Children’s Hospital of Philadelphia (CHOP) recorded its first positive COVID-19 test for a patient on March 17, 2020, and after the city enacted a stay-at-home order, patients and their parents deferred many in-person care visits to prevent exposure to the virus, and CHOP adopted video telemedicine (VTM), according to the researchers.

They used asthma patient encounter data from January 17 to May 17 for the years 2015 to 2020 from sites of care in the CHOP Care Network. They found that asthma health care visits and encounter types prior to March 17 in 2020 were similar to the historical averages, but in the 60 days after March 17, there was a 60% decrease in total daily asthma health care visits. The average number of daily outpatient encounters decreased by 87% and hospital encounters decreased by 84%. While outpatient and hospital encounters were on the decline, asthma telephone encounters increased by 19%, and VTM was adopted after March 17, 2020, and accounted for 61% of all encounters.

Compared with the 60 days prior, after March 17, Black patients represented a higher proportion of outpatient (54% vs 35%), hospital (78% vs 65%), and telephone (49% vs 24%) care. Black children represented only 26% of VTM encounters.

“We were unable to determine whether this observed difference by race in VTM care was due to patient preference, differences in access to VTM, or some other factor,” the authors wrote.

Patients with Medicaid also represented a higher proportion of outpatient (55% vs 41%) and hospital (73% vs 63%) care in the days after March 17 compared with the 60 days before.

While most asthma prescriptions were similar before and after March 17, there was an 83% decrease in systemic steroid prescriptions for patients who had at least 1 systemic steroid prescription from any primary asthma encounter between January 17 and May 17, 2020.

The researchers also analyzed 4 key viruses that cause asthma exacerbations: influenza A virus (IFV-A), influenza B virus (IFV-B), respiratory syncytial virus (RSV), and RV. While the IFV-A, IFV-B, and RSV seasons were waning by March 17, 2020, the 2020 RV season was nearing its peak. According to the researchers, RV was the only virus with significantly decreased levels after March 17, 2020, compared with the same time period in previous years.

They did not observe statistically significant decreases in air pollutants after COVID-19 public health interventions. The January 17 to May 17 time frame has known seasonal trends in air pollutants, they explained.

“We found that public health interventions designed to limit SARS-CoV-2 transmission in the Philadelphia region were associated with increased VTM and decreased overall asthma encounters, systemic steroid prescriptions, and RV positivity in our [emergency department],” the authors concluded.

Reference

Taquechel K, Diwadkar AR, Sayed S, et al. Pediatric asthma health care utilization, viral testing, and air pollution changes during the COVID-19 pandemic. J Allergy Clin Immunol Pract. Published August 20, 2020. doi:10.1016/j.jaip.2020.07.057