Poorly-Controlled Asthma Tied to Worse COVID Outcomes in Kids

Children with poorly-controlled asthma were at much greater risk for COVID-19 hospitalization, a retrospective study from Scotland found.

Among roughly 750,000 children ages 5 to 17, those with an asthma-related hospitalization in the 2 years before the pandemic — a marker for uncontrolled asthma — had a more than sixfold higher risk of being hospitalized for COVID-19 (adjusted hazard ratio [aHR] 6.40, 95% CI 3.27-12.53) compared to kids without asthma, reported Aziz Sheikh, MD, MBBS, of the University of Edinburgh in Scotland, and colleagues.

In contrast, well-controlled asthma — marked by no asthma-related hospitalization before the pandemic — was associated with only a modest risk increase (aHR 1.36, 95% CI 1.02-1.80), driven mostly by children ages 5 to 11 (aHR 2.05, 95% CI 1.35-3.12), according to their findings in Lancet Respiratory Medicine.

When using prescriptions to define uncontrolled asthma, a significantly higher risk for COVID-19 hospitalization was seen among kids with asthma who were prescribed two or more courses of oral corticosteroids in the past 2 years, as compared to kids without asthma:

• Two courses: aHR 3.53 (95% CI 1.87-6.67)
• Three or more courses: aHR 3.38 (95% CI 1.84-6.21)

“The key takeaway from this study is that keeping children’s asthma under control is critical as this greatly reduces the risk of COVID-19 hospitalization,” Sheikh said in a press release. “Understanding which children with asthma are at increased risk of serious COVID-19 outcomes is critical to ongoing policy deliberations on vaccine prioritization.”

“As we enter the holiday season, this study reminds us the importance of influenza and COVID-19 vaccinations to protect all school-aged children, including those with underlying medical conditions like asthma, from vaccine-preventable hospitalizations,” said Katherine Poehling, MD, of the Wake Forest School of Medicine in Winston-Salem, North Carolina, who was not involved in the study.

In an accompanying editorial, Rachel Harwood, PhD, and Ian Sinha, PhD, both of the University of Liverpool in England, called the increased COVID-19 hospitalization risk among the 5 to 11-year-olds with well-controlled asthma, as defined by the study, “particularly interesting.”

“The study design results in the youngest of children not receiving corticosteroids or being admitted to hospital with asthma before entering the study due to the diagnostic criteria for asthma,” they noted. “However, this might not reflect their subsequent asthma control during the study period and the data for this youngest group of children should be treated with caution.”

For their study, Sheikh and colleagues evaluated data from the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II), which included 752,867 children ages 5-17, including 63,463 (8.4%) with asthma.

Among those with asthma, 6.8% tested positive for COVID-19 during the study period (March 1, 2020 to July 27, 2021), as compared to 5.8% of those without asthma. Rates of hospitalization for COVID-19 among those testing positive were 1.54% and 0.95%, respectively. Overall, nine children in the study were admitted to intensive care or died, too few to make comparisons between groups, the authors noted.

The main purpose of the study was to identify children with asthma at increased risk of serious COVID-19 outcomes. Follow-up occurred until patients were hospitalized with COVID-19, died, or by study completion. Analyses adjusted for demographics, comorbidities, and prior hospitalizations.

The study had several limitations, the researchers noted, including that the overall risk of COVID-19-related hospitalization was low in kids with poorly controlled asthma (one of every 380 kids).