Study highlights reduction in asthma exacerbations during COVID-19 pandemic

Researchers reported a significant decline in asthma exacerbations during the COVID-19 pandemic across all age groups, sexes and most regions in England.

“To our knowledge, this is the first national-level study that assessed the impact of the COVID-19 pandemic on attendance to primary or secondary care for asthma exacerbations,” Syed A. Shah, MD, chancellor’s fellow at the Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute at the University of Edinburgh, U.K., and colleagues wrote in Thorax.

The researchers performed an interrupted time-series analysis of 9,949,387 patients with asthma (60.1% women) identified using the Optimum Patient Care Database. Researchers obtained asthma exacerbation rates for every week and compared rates in January to August 2020 with a pre-COVID-19 period and January to August 2016 to 2019. The single intervention period for the analysis was the week of March 23, 2020, which started the lockdown period in England.

Asthma exacerbations were defined as asthma-related hospital attendance/admission or an acute course of oral corticosteroids with respiratory review evidence recorded by a primary care physician.

In the cohort, 100,165 patients experienced at least one asthma exacerbation from 2016 to 2020. Of the 278,996 asthma exacerbation episodes recorded, 17.9% required a visit to the hospital.

The researchers reported a reduction in asthma exacerbation episodes in the post-lockdown period compared with the pre-lockdown period (–0.196 episodes per person-year; P < .001), according to the results.

Most asthma exacerbations did not require hospital attendance/admission and were resolved in a primary care setting.

Compared with men, women were slightly more likely to experience asthma exacerbations (0.976 vs. 1.09). Among age groups, those aged at least 55 years had the highest rate of asthma exacerbations (1.305), followed by those aged 18 to 54 years (0.919), those aged 0 to 5 years (0.839) and those aged 5 to 17 years (0.618). Across regions within England, people living in the West Midlands had the highest rate of asthma exacerbations (1.383), followed by the North East (1.205); those living in London had the lowest exacerbation rate (0.639), according to the results.

“This reduction in exacerbation rate was mainly seen in relation to exacerbations resolved within primary care without a need for a hospital visit,” the researchers wrote. “There is a need for further work to investigate the factors responsible for this decrease.”