A multicentre survey of asthma-related quality-of-life and treatment in Egypt during the COVID-19 pandemic.

Background: Asthma is a common chronic noncommunicable disease which can impair the health-related quality-of-life (HRQOL) of patients. Aims: To investigate treatment-related experiences and HRQOL of asthma patients in Egypt during the COVID-19 pandemic. Methods: A multicentre cross-sectional study was conducted from 21 July to 17 December 2020 in 3 teaching hospitals in Egypt among a convenience sample of asthma patients. We used socioeconomic and clinical variables, perceived threat level of COVID-19, experiences before and during COVID-19, the Asthma Control Questionnaire (ACQ), and the mini Asthma Quality of Life Questionnaire (mini-AQLQ) to collect data. Results: Among the 200 respondents (66.0% male; mean age 40.2 years), 80.0% had uncontrolled asthma. The greatest impairment to HRQOL was due to limitation of activity. Females reported a higher level of perceived threat from COVID-19 (Chi squared = -2.33, P = 0.02). Before the pandemic, more patients visited the clinician when they had symptoms but did so more regularly during the pandemic. Over 75% could not differentiate between asthma and COVID-19 symptoms. Perceived uncontrolled asthma and poor compliance with treatment were significantly associated with impairment of HRQOL (P < 0.05) before COVID-19. Conclusion: The COVID-19 pandemic improved some asthma-related health behaviours, but limitations in HRQOL were still evident. Uncontrolled asthma is a key factor for HRQOL and should remain a focus for all patients.

Multiple manifestations of uncontrolled asthma increase the risk of severe COVID-19.

OBJECTIVE: Asthma control is of importance when assessing the risk of severe outcomes of COVID-19. The aim of this study was to explore associations of clinical characteristics and the effect of multiple manifestations of uncontrolled asthma with severe COVID-19. METHODS: In 2014-2020, adult patients with uncontrolled asthma, defined as Asthma Control Test (ACT) ≤19 were identified in the Swedish National Airway Register (SNAR) (n = 24533). The SNAR database, including clinical data, was linked with national registers to identify patients with severe COVID-19 (n = 221). The effect of multiple manifestations of uncontrolled asthma was based on: 1) ACT ≤15, 2) frequent exacerbations and 3) previous asthma inpatient/secondary care and evaluated stepwise. Poisson regression analyses were conducted with severe COVID-19 as the dependent variable. RESULTS: In this cohort with uncontrolled asthma, obesity was the strongest independent risk factor for severe COVID-19 in both sexes, but even greater in men. Multiple manifestations of uncontrolled asthma were more common among those with severe COVID-19 vs. without: one, 45.7 vs. 42.3%, two, 18.1 vs. 9.1% and three, 5.0 vs. 2.1%. The risk ratio (RR) of severe COVID-19 increased with an increasing number of manifestations of uncontrolled asthma: one, RR 1.49 (95% CI 1.09-2.02), two, RR 2.42 (95% CI 1.64-3.57) and three, RR 2.96 (95% CI 1.57-5.60), when adjusted for sex, age, and BMI. CONCLUSIONS: It is important to consider the effect of multiple manifestations of uncontrolled asthma and obesity when assessing patients with COVID-19, as this increases the risk of severe outcomes substantially.

Treatable trait guided asthma management: A feasibility study

Introduction/Aim: Treatable traits based personalised medicine has been shown to improve outcomes in severe asthma clinic. We assessed the feasibility of a randomised controlled trial of protocolised 'focused' and 'extended' treatable trait guided asthma management in patients not under a severe asthma clinic. Method(s): Ten week single-group cohort study. Participants had a doctor's diagnosis of asthma, asthma control questionnaire (ACQ) score >1, and a history of exacerbation in the last year. Patients already under the care of a severe asthma clinic or receiving high-dose inhaled corticosteroids, biological therapy or maintenance oral corticosteroids were excluded. Intervention(s): asthma medication according to application of a 'focused' treatable trait algorithm, targeting type-2 inflammation and airflow obstruction. Feasibility outcomes: recruitment rates, acceptability of intervention, willingness to enrol in a full RCT, need for 'extended' trait assessment after 10 weeks, and estimation of trait prevalence. Result(s): Recruitment ceased after 14 months with 30/50 participants due to difficulties associated with COVID-19. 92% found the intervention acceptable and were willing to be randomised in a future study. 65% remained not well-controlled with an ACQ >1 after 10 weeks and would have required the 'extended' algorithm. Participants had a mean (SD) 4.8(2.3) of 13 traits assessed. Participation in the study was associated with clinically important improvements in ACQ, -1.0 (1.5) units;St George Respiratory Questionnaire, -15.1 (14.7) units;Asthma Quality of Life Questionnaire, +1.0 (1.1) units;and FEV1, +0.4 (0.4) L. Post-bronchodilator airflow obstruction reduced from 60% of participants at study commencement to 35%. 53% of participants were allocated continuous oral corticosteroids at some point during the study. Conclusion(s): Protocolised treatable trait management was acceptable, associated with significant clinical benefit and a full trial appears feasible. Targeting two traits was insufficient to control asthma in the majority of patients over the timeframe of this study, despite significant corticosteroid exposure.

Pediatric asthma control during the COVID-19 pandemic.

BACKGROUND: The lockdown imposed by the COVID-19 pandemic resulted in a completely different style of life with possible effects on the attitude toward their disease in patients with chronic lung disease, such as asthma. The aim of our study was to investigate in asthmatic children the level of asthma control and the maintenance therapy used during the lockdown. METHODS: Among asthmatic children attending our clinic, we identified those who had been prescribed the same therapy in March-April 2019 and March-April 2020. The level of asthma control (GINA-score) and the maintenance therapy used during the lockdown (March-April 2020) were compared with those of March-April 2019. We separately analyzed a small group of children with severe asthma treated with Omalizumab during the lockdown. RESULTS: We enrolled 92 asthmatic children (67 males). Compared to 2019, in 2020 a higher proportion of children modified their maintenance therapy (38% vs. 15.2%, p < .001), with a significant increase in both the proportion of children who increased (p = .033) and in that of children who decreased their therapy (p = .026). The level of control resulted as significantly higher in 2020 (March p = .023; April p = .007). Also, the 13 children treated with Omalizumab showed a good level of control in 2020. CONCLUSIONS: In asthmatic children, the COVID-19 pandemic lockdown had a significant impact on their asthma control and on their attitude toward maintenance therapy.

How asthmatic children dealt with the coronavirus pandemia? Adherence to Controller Medications and Level of Control among Children with Asthma Registered in Mashhad University of Medical Sciences

Background: Coronavirus disease 2019 pandemic had a great effect on the lives of asthmatic children. In this study we assessed changes in medication adherence and asthma control rate among our registered children with pediatric asthma.Methods: This cross-sectional study was conducted on 113 patients registered in our asthma and allergy clinic in Mashhad, Iran. We called them via phone and completed a questionnaire on the level of asthma medication adherence and the asthma control test (ACT) before and in the 6 months after COVID-19 emergence. We investigated the changes in medication adherence and asthma control due to COVID-19 pandemic.Results: A total of 113 asthmatic children in the age range of 1 to 15 (mean, 7.02 +/- 3.24 years) were included in the study. There were zero confirmed positive cases among them since COVID-19 introduction. The minority of patients (8.8%) had weak adherence, most of the children (35.4%) completed one course of prescribed medications, 33% had longer adherence, and only 25 patients (22.1%) had full adherence during the pandemic. Overall, our patients experienced better asthma control with a 1.51 rise in ACT score to arrive in 23.64 points out of 25. They had no asthma exacerbation and emergency visit. Over half of the families compiled the national preventive measures;as 85% of children had followed the stay-at-home order during the first peak of the pandemic.Conclusion: Our patients managed to come to a higher asthma control level despite their generally decreased adherence to medications during the pandemic. COVID-19 not only could not worsen asthma status in our children but surprisingly improved it. This shows that the preventive measures should be strongly applied for the asthmatic population.

The Association of Food Insecurity With Asthma Control in Adults During COVID-19.

BACKGROUND: Food insecurity has been associated with poorer asthma control in children, but research lacks in adults. OBJECTIVE: To assess the frequency of food insecurity and its association with asthma control in adults during the coronavirus disease 2019 pandemic. METHODS: An online cross-sectional survey study was conducted in US adults with asthma. Survey questions included how worried or concerned participants were about food security since the pandemic. Asthma control was assessed using the Asthma Control Test, with uncontrolled asthma defined as Asthma Control Test score less than or equal to 19. Self-report of food insecurity since the pandemic was assessed. Food insecurity variables were dichotomized into high insecurity (≥3) or low insecurity (<3). Descriptive statistics and bivariate analyses were performed. RESULTS: Of the total participants (N = 866), 82.79% were female; mean age of participants was 44 ± 15.05 years, their mean Asthma Control Test score was 19.25 ± 4.54, and 18.48% had high food insecurity. Participants with high food insecurity were more likely to have uncontrolled asthma (74.38%) compared with those with lower food insecurity (34.99%; P < .01). The relationship between asthma control and food insecurity remained significant after adjusting for age, education, sex, race, anxiety, and living stability concerns due to the pandemic. CONCLUSIONS: Food insecurity exists in adults with asthma and is associated with uncontrolled asthma. Providers should consider screening their patients for food insecurity when treating individuals with uncontrolled asthma.

Onasm@: Helping severe asthma patients to prepare the telematic visit with their specialist

Background: In March 2020, the state of alarm was declared in Spain due to the health crisis caused by SARS-COV-2. The rapid spread of the virus generated uncertainty and concern about the impact it could have on patients with severe asthma (SA) and boosted for the first time the use of teleconsultation for the management of these patients. For this reason, it was necessary to facilitate the transition to a hybrid model that combines face-to-face and digital consultations. Objective(s): Development of the first document designed for SA patients, aimed to support the preparation of the telematic follow-up consultations with their specialist. Method(s): Nine experts in SA from different specialties: 4 allergists, 3 pulmonologists and 2 asthma unit nurses contributed to the conceptualization and development of the document. In a first phase of conceptualization, the profile of patients to which the material is addressed was defined and the minimum content needed to be useful to both patients and healthcare professionals (HCPs) was established. A first draft was prepared and refined after evaluation by adult patients and parents of pediatric patients through cognitive interviews. Result(s): Onasm@ is the first document intended for SA patients to prepare the telematic follow-up consultation with their specialist. It consists of three blocks: A first one with general considerations to be applied on the telematic consultation, a second one to collect all the information that might be requested by the healthcare professional (HCP) during the off-site visit (asthma medications, dosage, adherence, asthma crisis events, emergency visits and oral corticosteroid use) and the third block with tips for achieving and maintaining asthma control. The asthma control test (ACTTM) for adults and the children's version (cACTTM) is also incorporated. Conclusion(s): The transition to a hybrid healthcare model due to the pandemic situation makes it essential to support SA patients to face the telematic follow-up consultation with their specialist. Onasm@ is the first document designed to help patients to appreciate the information needed to face this type of visit, with the aim to promote a fluid communication with their HCP and more efficient visits. This type of document could be applied to the management of other conditions and as such have broader impact on the future of healthcare, which is currently immersed in far-reaching change and transformation.

A descriptive evaluation of COVID-19 disease in adult asthma patients at La Paz University Hospital

Background: COVID-19 is an infectious entity caused by the SARS-CoV-2 virus. There have been reported risk factors like chronic airway entities such as chronic obstructive pulmonary disease. Since asthma is a respiratory disease, it could be found as a risk factor to develop severe COVID-19 disease. However, most of the evidence reveals that asthma isn't associated with higher severity or worse prognosis. Madrid has been one of the most affected regions in the world during the pandemic. La Paz University Hospital has developed one of the largest cohorts in Europe. We used this data and described several characteristics around COVID-19 disease in asthma patients. Method(s): We collected data by individual review of the patients' electronic clinical records (DXC-HCIS, Healthcare Information System). Then we describe the general characteristics of the patients, their asthma, and COVID-19 evolution. The analyzed data includes general demographics, asthma classification (T2 or no T2), basal treatment, and pre-COVID-19 asthma control (by ACT and exacerbations). We studied acute COVID-19 disease symptoms and treatment, the presence of pneumonia, thromboembolism, the need for hospitalization, admission to the intensive care unit (ICU), and mortality. Result(s): The total number of patients studied was 173, the majority were women (67%) with an average age of 55 and type 2 asthma (67%) which was controlled before COVID-19 disease (ACT median was 25, the median of exacerbations was 0). The majority used the combination of long-acting beta 2 agonists and inhaled corticosteroids (ICS+LABA) for asthma treatment (67%). Only 2 patients were treated with omalizumab, which was discontinued during COVID-19 disease. The most frequent symptoms were cough and dyspnea (80% and 75% respectively). 4% of patients presented thromboembolism. 60% had pneumonia. 60% required hospitalization, 11% of whom died due to COVID-19 complications. The most common treatment was hydroxychloroquine and azithromycin (75% and 45% respectively), followed by oral corticosteroids (15%), lopinavir/ritonavir (8%), tocilizumab (5%), and remdesivir (2%). Conclusion(s): This cohort represents asthmatic patients in La Paz University Hospital. We observed that the proportion of hospitalizations, ICU admissions, and mortality due to COVID-19 was similar as described in previous studies and therefore no different from non-asthmatic patients. The characteristics presented in this study help us better understand the complications of asthmatic patients thanks to one of the largest COVID-19 cohorts in Europe.

Quality of life and the psychological status of the adolescents with asthma and their parents during the COVID-19 pandemic

Background: People's concerns about both health and emerging social life significantly affected not only their physical but also mental health during the COVID-19 pandemic. Patients those with chronic diseases such as asthma are more vulnerable about the outcomes of the pandemic. We aim to evaluate the anxiety and quality of life(QoL) of adolescents and their parents who were followed up with the diagnosis of asthma during the pandemic comparing with age-matched control group. Method(s): This study was conducted after the first lockdown of the coronavirus pandemic, namely new normalization period. Demographic features were noted, all adolescents completed the State-Trait Anxiety Inventories for Children(STAI-C) state and trait scales, and Pediatric QoL inventories(PedsQL). Parents also fulfilled PedsQL parent version, STAI state and trait scales. Asthma control test(ACT) was completed by only asthma group. Result(s): Totally 121 adolescents(61 asthma group[59% female];60 control group[73.8% female]) were included into the study. The mean age of the patients was 15.4(+1.69) and their parents was 41.52(+6.04) years. The comparative demographic and general characteristics of the patients are shown in Table 1. There were no significant difference in terms of PedsQL both child's and parent's perspective, STAI-C and STAI scores between study groups. In the asthma group 65.6% of the patients used asthma medications regularly and 73.8% of them continued asthma follow-up during the pandemic. The asthma group was divided into three subgroups according to asthma symptom control in Global Initiative for Asthma report (well-controlled, partly controlled, uncontrolled). The QoL was associated with asthma severity;PedsQL PH, PSH and TH scores were also significantly different according to the asthma control status, p value is < 0.001, 0.023 and 0.008, respectively. The uncontrolled asthma group had the lowest PedQL scores and also reached the highest STAI-C trait scores. Girls with asthma had significantly lower PedQL and ACT scores than boys. Conclusion(s): Although the quality of life and anxiety scores of children with asthma do not differ from control group, good asthma control in adolescents with asthma may improve QoL. Optimizing asthma treatment adherence and being aware of the difficulties that adolescents may experience during the pandemic is important. Clinicians should routinely enquire about mental health as well as physical health of patients with chronic diseases. (Table Presented).

Clinical outcomes in asthmatic patients following COVID 19 infection

Background: COVID-19 disease caused by SARS-CoV-2, has changed life as we know it, causing millions of deaths worldwide. Reported risk factors for mortality include advanced age, obesity, hypertension, diabetes mellitus, and chronic obstructive pulmonary disease. Although asthma is a chronic obstructive disease, most evidence reveals a protective effect between asthma, eosinophilia and COVID-19. La Paz University Hospital, in Madrid, has developed one of the largest cohorts in Europe, with more than 3500 patients with COVID-19. Our aim was to evaluate post-COVID-19 evolution at 6 and 12 months in asthmatic patients. Method(s): We selected the asthmatic patients in this cohort. We obtained information from their clinical history, including sex, age and comorbidities. We classified patients by T2 or non-T2 asthma and collected pre-COVID19 information: treatment, control (measured by asthma control test (ACT) and number of exacerbations), pulmonary lung function, eosinophils in blood and immunoglobulin E levels. Post-COVID-19 data after 6 and 12 months were recorded: symptoms (chest pain, cough, expectoration and dyspnea), ACT, number of exacerbations, the need to intensify the asthma treatment, and the pulmonary lung function. Result(s): Significant association was found between COVID-19 pneumonia in asthmatic patients and the risk of having chest pain after 6 months (p = 0.009). Fewer eosinophilic count was associated with dyspnea 6 months post-covid (p = 0.043). Asthmatic smokers had an increased risk of thromboembolism 12 months after COVID-19 (p = 0.025). Although significant association standards were not met nor demonstrated, thoracic pain was more frequent 6 months post-COVID-19 in non-T2 asthmatic patients (44.4%) than T2 patients (20.3%) (p = 0.064). Eosinophilic asthma (eosinophil counts higher than 250/ mcl), presented lower prevalence of chest pain 12 months post-COVID-19 (p = 0.081). Conclusion(s): This is the first study that demonstrates the association between risk of chest pain and dyspnea after 6 months in asthmatic patients with COVID-19 pneumonia. It was also found that if these patients smoked, there was an increased risk of thromboembolism at 12 months. Further studies, with a higher number of patients are needed to explore deeply the impact of COVID-19 in asthma outcomes.

Evaluation of Asthma Control Status and Anxiety Level During the COVID-19 Pandemic in Children with Asthma.

Objective: We aimed to evaluate asthma control status, drug compliance and anxiety levels of children and their parents who were followed up with the diagnosis of asthma during the COVID-19 pandemic. Material(s) and Method(s): Sixty-seven children aged between 8-12 years diagnosed with asthma and their parents were prospectively recruited to the study. A questionnaire including demographic features such as age, gender, asthma medications and questions about COVID-19 prepared according to a 5-point Likert scale was conducted to the parents. Children completed the State-Trait Anxiety Inventories for Children (STAI-C) scales, and childhood asthma control test(c-ACT). Parents also fulfilled STAI scales. Result(s): The mean age of the patients was 9.5+/-1.2 years, the median follow-up period for asthma (C-ACT) was 36 (21-66) months, and 45 (67.2%) were male. Most of the children were using their asthma medication regularly. Children's STAI-C state and trait anxiety scores showed a statistically significant positive correlation with parents' STAI state and trait anxiety scores. The anxiety levels of parents who thought that they would get the disease and that there would be no effective treatment and vaccine against COVID-19 were found to be higher. Conclusion(s): During the pandemic period, regular asthma follow-up and drug compliance are very important controlling asthma symptoms in children. Considering the effects of the pandemic in children with asthma, psychosocial evaluations during outpatient controls may have positive effects on children's mental health and disease control.Copyright © 2021 Ankara Pediatric Hematology Oncology Training and Research Hospital. All rights reserved.

Outcomes from treating rhinitis in patients with refractory breathlessness

Background: In our multi-disciplinary airways service, we assess refractory breathlessness due to suspected inducible laryngeal obstruction (ILO) and/or breathing pattern disorder (BPD). A significant proportion of patients have evidence of uncontrolled co-morbidity, including rhinitis and asthma, which aggravate airway symptoms. Aim(s): To identify the impact of rhinitis management on i) nasal symptoms ii) asthma control and iii) cough control, for individuals referred with suspected ILO +/- BPD and evidence of rhinitis. Method(s): Patient demographics/clinical data were collected between January 2021 and January 2022. Symptoms were recorded using the Total Nasal Symptom Score (TNSS), Asthma Control Questionnaire (ACQ) in those with asthma and a 10-point self-rating scale in chronic refractory cough (CRC). Result(s): Data were available for 43 patients [72% female, 18% atopic, median (IQR) age 54 (41-64) years] with symptoms of rhinitis, confirmed by nasendoscopy in 41% (not all patients had nasendoscopy due to COVID-19 pandemic). Co-morbidities included asthma 54% (39%, of whom were on biologic treatment), CRC (21%), ILO (35%) and BPD (35%). Rhinitis management comprised education (100%), nasal corticosteroids (91%), saline nasal douche (49%) and antihistamines (10%). TNSS scores improved [from 5 (4-6) to 3 (2-4), p<0.001] following intervention. In those with asthma, there was improvement in ACQ [2.98 (2.15-3.70) to 2.00 (0.95-3.05), p<0.001], and in those with chronic refractory cough in self-rating score [8 (4-9) to 2 (2-6), p=0.11]. Conclusion(s): Optimisation of medical treatment for individuals with rhinitis is important and can improve outcomes in patients with asthma, CRC, ILO and BPD.

Impact of the COVID-19 pandemic on Swedish asthma and COPD care

Background: Since the start of the pandemic, healthcare resources have been prioritized for covid-19 care. Aim(s): To describe the impact of the COVID-19 pandemic on the care of patients with asthma and COPD in Sweden. Method(s): Within the Swedish National Airway Register (SNAR), healthcare data on patients with asthma and COPD has been registered since 2013 in primary and secondary care. The variables included in SNAR are harmonized with guidelines which gives the opportunity to identify inequalities and sub-optimal care of patients with obstructive lung diseases. Result(s): The cumulative number of unique patients with asthma and COPD in SNAR were in 2019 n=277467, 2020 n=310436 and 2021 n=334639. Since the initiation of SNAR, annual registrations of visits, spirometries and other follow-up test have increased until the start of the covid-19 pandemic. Compared with 2019, total number of registrations decreased with 21% in 2020, and 41% in 2021 (Fig 1), while registrations of new patients decreased with 31% in 2020, and 50% in 2021, similarly in both asthma and COPD. The numbers of spirometries, available data on Asthma Control Test, and COPD Assessment Test decreased with 53%, 40% and 46% respectively, in 2021 compared with in 2019. Conclusion(s): The reduced number of patient registrations, spirometries, and the use of symptom questionnaires shows that diagnosis and the care of patients with asthma and COPD have been highly affected by the pandemic.

Predictors of severe COVID-19 among patients with uncontrolled asthma: a register- based study

Background: Uncontrolled asthma is a risk factor for severe COVID-19. However, research on predictors of severe COVID-19 in patients with a history of uncontrolled asthma is still limited. Aim(s): To identify factors associated with severe COVID-19 in patients with uncontrolled asthma. Method(s): Based on the Swedish National Airway Register, a cohort of 24533 adult patients with uncontrolled asthma were identified in primary and secondary care. Most recent clinical data were obtained before the COVID-19 pandemic. Uncontrolled asthma was defined as Asthma Control Test (ACT) score <=19. By linkage to other Swedish registers, n=221 (0.9%) individuals with severe COVID-19 were identified (defined as hospitalization or death due to COVID-19). Result(s): Patients with severe COVID-19 (n=221) were older (mean 63.3 vs 50.4 years, p<0.001), had a higher BMI (mean 32.9 vs 28.6, p<0.001), lower FEV1 % predicted (mean 76.8 vs. 83.1, p<0.001) and lower ACT scores (mean 14.2 vs 15.2, p<0.001) than those without severe COVID-19 (n=24312). A higher proportion of patients with severe COVID-19 had antihistamine treatment, oral corticosteroids medication, and higher doses of inhaled corticosteroids, compared to patients without severe COVID-19. In both groups, about 50% had received patient education on asthma. Conclusion(s): Among patients with uncontrolled asthma, severe COVID-19 was associated with a history of increased need for asthma medication and lower FEV1 % predicted. Despite all patients having uncontrolled asthma, only about half had received patient education on asthma before the pandemic.

Better COVID-19 outcomes in children with good asthma control

Background: The role of pediatric asthma in susceptibility to COVID-19 is poorly defined. The aim of our study was to assess possible risk factors for severe COVID-19 in children with asthma. Method(s): In our observational study, we systematically assessed the occurrence of COVID-19 in children with asthma <18 years in a six-month period prior to their regular outpatient visit in our asthma clinic from December 1, 2020 to March 31, 2021, by using a predefined questionnaire. We compared characteristics of patients presenting with signs of SARS-CoV-2 upper (URTI) or lower respiratory tract infection (LRTI), focusing on factors that could be associated with severity of COVID-19, such as asthma phenotype, treatment with inhaled corticosteroids (ICS), asthma severity and the degree of asthma control assessed by the Asthma Control Test at the outpatient visit. Result(s): Out of 210 screened patients, 27% (57/210) reported exposure to COVID-19. Forty-two children were symptomatic after the exposure. In the symptomatic group, 64% (27/42) reported symptoms of URTI and 36% (15/42) of LRTI. We observed poorer asthma control in patients with LRTI compared to URTI (80% vs 7%, p <0.001). Moreover, patients with LRTI were older (14.6+/-3.2 years vs 12.0+/-4.1 years, p=.042), more frequently girls (60% vs 26%, p=.029), with a non-allergic asthma phenotype (43% vs 13%, p=.020). Regular ICS use and asthma severity were not associated with COVID-19 presentation in these children. However, patients on regular ICS had better asthma control (p=.026). Conclusion(s): The results of our study suggest that good asthma control, treatment adherence optimization and allergic asthma phenotype enable better COVID-19 outcomes in children with asthma.

Reduced asthma morbidity during COVID-19 in minority children: is medication adherence a reason?

OBJECTIVES: Asthma control improved during the COVID-19 pandemic. This study examined objectively measured medication adherence, asthma morbidity and quality of life (QoL) outcomes in Black and Latinx children by month for January-June 2019 (pre-COVID) compared to January-June 2020 (including first peak of COVID). METHODS: Secondary analyses of 94 children with asthma (ages 10-17 years, 64% Latinx, 36% Black) and their caregivers assigned to the comparison group of a longitudinal RCT intervention trial. Outcomes included mean aggregate electronic adherence for controller medications, oral steroid bursts, acute healthcare utilization, caregiver asthma QoL, and the Asthma Control Test. Repeated measures analyses were conducted due to multiple observations. RESULTS: Adherence to controller medications declined 48% from 2019 to 2020 (LS Mean = 33.9% vs. 17.6%, p=.0004, f=.92) with levels reaching a low in May 2020. A reduction in steroid bursts was observed over the same timeframe, 1.29 vs. 0.61, p = 0.006, f=.63. Caregiver QoL increased from 2019 to 2020 on total score (5.18 vs. 5.85, p = 0.002, f=.72), activity limitations (5.04 vs. 5.95), and emotional functioning (5.26 vs. 5.80). Although not statistically significant, a clinically meaningful 62% reduction in acute healthcare visits (p = 0.15) was reported in 2020. Children reported better asthma control (OR = 1.47, 95% CI 1.24, 1.73, p < 0.0001) in 2020 versus 2019 driven by improvements from May to June 2020. CONCLUSIONS: Decreased asthma morbidity in minority children during COVID was coupled with decreased adherence to controller medications. This observed decrease in morbidity is not explained by improvements in adherence.

Evaluation of Asthma Control Status and Anxiety Level During the COVID-19 Pandemic in Children with Asthma

Objective: We aimed to evaluate asthma control status, drug compliance and anxiety levels of children and their parents who were followed up with the diagnosis of asthma during the COVID-19 pandemic. Material and Methods: Sixty-seven children aged between 8-12 years diagnosed with asthma and their parents were prospectively recruited to the study. A questionnaire including demographic features such as age, gender, asthma medications and questions about COVID-19 prepared according to a 5-point Likert scale was conducted to the parents. Children completed the State-Trait Anxiety Inventories for Children (STAI-C) scales, and childhood asthma control test(c-ACT). Parents also fulfilled STAI scales. Results: The mean age of the patients was 9.5±1.2 years, the median follow-up period for asthma (C-ACT) was 36 (21-66) months, and 45 (67.2%) were male. Most of the children were using their asthma medication regularly. Children's STAI-C state and trait anxiety scores showed a statistically significant positive correlation with parents' STAI state and trait anxiety scores. The anxiety levels of parents who thought that they would get the disease and that there would be no effective treatment and vaccine against COVID-19 were found to be higher. Conclusion: During the pandemic period, regular asthma follow-up and drug compliance are very important controlling asthma symptoms in children. Considering the effects of the pandemic in children with asthma, psychosocial evaluations during outpatient controls may have positive effects on children's mental health and disease control.

Worsening of asthma control after recovery from mild to moderate COVID-19 in patients from Hong Kong.

BACKGROUND: While there are postulations that asthma is potentially associated with severe coronavirus disease 2019 (COVID-19), there has been conflicting results from studies on the impact mild-to-moderate COVID-19 on asthma control after recovery. METHODS: A case control study on the association between mild-to-moderate COVID-19 and asthma control post infection was conducted. The primary outcome was a reduction in Asthma Control Test (ACT) score by ≥ 3 points post-COVID infection. The secondary outcomes included the change in ACT score, the proportion of patient with ACT score who dropped to ≤ 15 on enrolment visit and the need for escalation of asthma maintenance therapy. RESULTS: Out of the total of 221 adult patients with asthma recruited, 111 had mild-to-moderate COVID-19 within 30 to 270 days prior to study enrolment. The adjusted odds ratio (aOR) for a reduction in ACT score by ≥ 3 points after COVID-19 was 3.105 (95% CI = 1.385-6.959, p = 0.006). The odds of escalation of asthma maintenance therapy by at least 1 Global Initiative for Asthma (GINA) step was 4.733 (95% CI = 1.151-19.467, p = 0.031) and asthma patient are more likely to become uncontrolled after COVID-19 [aOR = 5.509 (95% CI = 1.061-28.600, p = 0.042)]. CONCLUSION: Mild-to-moderate COVID-19 among asthma patients, upon recovery, was associated with worsening of asthma symptom, lower ACT score, a higher need for escalation of asthma maintenance therapy and more uncontrolled asthma.

Evaluation of Asthma Control Status and Anxiety Level During the COVID-19 Pandemic in Children with Asthma.

Objective: We aimed to evaluate asthma control status, drug compliance and anxiety levels of children and their parents who were followed up with the diagnosis of asthma during the COVID-19 pandemic. Material(s) and Method(s): Sixty-seven children aged between 8-12 years diagnosed with asthma and their parents were prospectively recruited to the study. A questionnaire including demographic features such as age, gender, asthma medications and questions about COVID-19 prepared according to a 5-point Likert scale was conducted to the parents. Children completed the State-Trait Anxiety Inventories for Children (STAI-C) scales, and childhood asthma control test(c-ACT). Parents also fulfilled STAI scales. Result(s): The mean age of the patients was 9.5+/-1.2 years, the median follow-up period for asthma (C-ACT) was 36 (21-66) months, and 45 (67.2%) were male. Most of the children were using their asthma medication regularly. Children's STAI-C state and trait anxiety scores showed a statistically significant positive correlation with parents' STAI state and trait anxiety scores. The anxiety levels of parents who thought that they would get the disease and that there would be no effective treatment and vaccine against COVID-19 were found to be higher. Conclusion(s): During the pandemic period, regular asthma follow-up and drug compliance are very important controlling asthma symptoms in children. Considering the effects of the pandemic in children with asthma, psychosocial evaluations during outpatient controls may have positive effects on children's mental health and disease control. Copyright © 2021 Ankara Pediatric Hematology Oncology Training and Research Hospital. All rights reserved.