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Impact of COVID-19 national lockdown on asthma exacerbations: interrupted time-series analysis of English primary care data.
Shah, Syed A; Quint, Jennifer K; Nwaru, Bright I; Sheikh, Aziz.
  • Shah SA; Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute, The University of Edinburgh, Edinburgh, UK Ahmar.Shah@ed.ac.uk.
  • Quint JK; National Heart & Lung Institute, Imperial College London, London, UK.
  • Nwaru BI; Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute, The University of Edinburgh, Edinburgh, UK.
  • Sheikh A; Krefting Research Centre, The University of Edinburgh, Gothenburg, Sweden.
Thorax ; 76(9): 860-866, 2021 09.
Article in English | MEDLINE | ID: covidwho-1158123
ABSTRACT

BACKGROUND:

The impact of COVID-19 and ensuing national lockdown on asthma exacerbations is unclear.

METHODS:

We conducted an interrupted time-series (lockdown on 23 March 2020 as point of interruption) analysis in asthma cohort identified using a validated algorithm from a national-level primary care database, the Optimum Patient Care Database. We derived asthma exacerbation rates for every week and compared exacerbation rates in the period January to August 2020 with a pre-COVID-19 period and January to August 2016-2019. Exacerbations were defined as asthma-related hospital attendance/admission (including accident and emergency visit), or an acute course of oral corticosteroids with evidence of respiratory review, as recorded in primary care. We used a generalised least squares modelling approach and stratified the analyses by age, sex, English region and healthcare setting.

RESULTS:

From a database of 9 949 387 patients, there were 100 165 patients with asthma who experienced at least one exacerbation during 2016-2020. Of 278 996 exacerbation episodes, 49 938 (17.9%) required hospital visit. Comparing pre-lockdown to post-lockdown period, we observed a statistically significant reduction in the level (-0.196 episodes per person-year; p<0.001; almost 20 episodes for every 100 patients with asthma per year) of exacerbation rates across all patients. The reductions in level in stratified analyses were 0.005-0.244 (healthcare setting, only those without hospital attendance/admission were significant), 0.210-0.277 (sex), 0.159-0.367 (age), 0.068-0.590 (region).

CONCLUSIONS:

There has been a significant reduction in attendance to primary care for asthma exacerbations during the pandemic. This reduction was observed in all age groups, both sexes and across most regions in England.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Primary Health Care / Asthma / Disease Progression / Symptom Flare Up / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Adolescent / Adult / Female / Humans / Male / Middle aged / Young adult Country/Region as subject: Europa Language: English Journal: Thorax Year: 2021 Document Type: Article Affiliation country: Thoraxjnl-2020-216512

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Primary Health Care / Asthma / Disease Progression / Symptom Flare Up / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Adolescent / Adult / Female / Humans / Male / Middle aged / Young adult Country/Region as subject: Europa Language: English Journal: Thorax Year: 2021 Document Type: Article Affiliation country: Thoraxjnl-2020-216512