Pediatric Patients With Uncontrolled Asthma at Risk of Severe COVID-19 Outcomes

Ting Shi, PhD

New research suggest children with uncontrolled asthma could be at a higher risk for hospitalizations and mortality from COVID-19.

A team, led by Ting Shi, PhD, Usher Institute, Edinburgh Medical School, University of Edinburgh, investigated the risk of COVID-19 hospitalization in children with markers for uncontrolled asthma.

In the national incident cohort study, the investigators examined all children in Scotland aged 5-17 years in the linked dataset of the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II).

Uncontrolled asthma was defined by either a previous asthma hospital admission or oral corticosteroid prescription in the previous 2 years.

The investigators also used a Cox proportional hazard model to develop hazard ratios and confidence intervals for the association of asthma and COVID-19 hospital admission, which was stratified by markers of asthma control, including previous asthma hospital admission and number of previous prescriptions for oral corticosteroids within 2 years of the study start date. The investigators adjusted for age, sex, socioeconomic status, comorbidity, and previous hospital admission.

Patients in risk groups that were either not relevant to the pediatric population, such as chronic obstructive pulmonary disease, coronary heart disease, dementia, and Parkinson disease or patients that had substantial missing data were excluded from the study.

Data on Hospitalizations

Overall there were 752,867 children included in the dataset between March 1, 2020 and July 27, 2021, 8.4% (n = 63,463) of which had clinically-diagnosed and recorded asthma. Looking at this group, 6.8% (n = 4339) had RT-PCR confirmed SARS-CoV-2 infections, 1.5% (n = 67) of which were hospitalized with COVID-19.

For the 689,404 children without asthma, 5.8% (n = 40,231) had confirmed SARS-CoV-2 infections, 0.9% (n = 382) of which were admitted to the hospital with COVID-19.

“The rate of COVID-19 hospital admission was higher in children with poorly controlled asthma than in those with well controlled asthma or without asthma,” the authors wrote.

Adjusting for Uncontrolled Asthma

After using previous hospital data for admissions for asthma as the marker for uncontrolled asthma, the adjusted HR was 6.40 (95% CI, 3.27-12.53) for patients with poorly controlled asthma. This reduced to 1.36 (95% CI, 1.84-6.21) for individuals with 3 or more prescribed courses of corticosteroids, 3.53 (95% CI, 1.87-6.67) for patients with 2 prescribed courses of corticosteroids, 1.52 (95% CI, 0.90-2.57) for individuals with 1 prescribed course of corticosteroids, and 1.34 (95% CI, 0.98-1.82) for patients with no prescribed course compared to individuals without asthma.

“We found that children aged 5–17 years with poorly controlled asthma are at markedly increased (3–6 times higher) risk of COVID-19 hospital admission compared with those without asthma,” the authors wrote. “In summary, we provide national evidence that in children and young people aged 5–17 years, markers of uncontrolled asthma were associated with an increased risk of COVID-19 hospital admission in Scotland.”

The investigators said the study results should drive policy decisions for vaccinations as the 9124 school-aged children in Scotland and 109,488 children in the UK have poorly controlled asthma and should be a priority for vaccination.

The study, “Risk of COVID-19 hospital admission among children aged 5–17 years with asthma in Scotland: a national incident cohort study,” was published in The Lancet Respiratory Medicine.