Impact of COVID-19 pandemic on asthmasymptoms and management: a prospectiveanalysis of asthmatic children in Ecuador

Abstract

ackground:Asthma affects up to 33% of children in Latin American settings. The ongoingCOVID-19 pandemic has had a significant impact on access to and use of health services. Weaimed to evaluate the impact of the COVID-19 lockdown on asthma exacerbations, medical facilityvisits, and use of asthma medications in children.Methods:We used data from a prospective cohort of 213 children aged 5–17 years in 3 Ecua-dorian cities and analysed the impact of the COVID-19 lockdown on asthma. Outcomes (asthmaexacerbations, emergency room [ER] visits, planned and unplanned outpatient visits, and use ofinhaled corticosteroids and Beta-2 agonists) were analysed using repeated Poisson counts (ie,number of events per participant before and during the COVID-19 lockdown).Results:During compared to before lockdown: a) the number of asthma exacerbations remainedconstant (IRR, 0.87; 95% CI: 0.72–1.05; p¼0.152); b) outpatient visits (IRR 0.26, 95% CI 0.14–0.47,p<0.001) declined 74% while ER visits declined 89% (IRR 0.11, 95% CI 0.04–0.32, p<0.001); andc) there was no change in inhaled corticosteroids use (IRR 1.03, 95% CI 0.90–1.16, P¼0.699) whileBeta-2 agonist use increased (IRR 1.32, 95% CI 1.10–1.58, P¼0.003).Conclusions:In a cohort of Ecuadorian children with asthma, health services attendancedecreased dramatically after COVID-19 lockdown, but asthma exacerbations and use of inhaledcorticosteroids were unchanged. Future analyses will address the question of the effect of SARS-CoV-2 infection on asthma exacerbations and control in this paediatric population.