COVID-19 hospitalization risk elevated in children with poorly controlled asthma

In a new study, school-aged children in Scotland with uncontrolled asthma had a 3 to 6 times higher risk for COVID-19 hospitalization compared with those without asthma, researchers reported in The Lancet Respiratory Medicine.

“The findings from this linkage of multiple data sources have helped inform the prioritization of school-aged children with poorly controlled asthma for vaccines,” Ting Shi, PhD, chancellor’s fellow at the Usher Institute, University of Edinburgh, U.K., and colleagues wrote.

The study included all children in Scotland aged 5 to 17 years in the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II) linked dataset from March 2020 to July 2021. The researchers evaluated the risk for COVID-19 hospitalization among children with markers of uncontrolled asthma, which was defined as a previous asthma hospitalization or prescriptions for oral corticosteroids within the previous 2 years.

Among 752,867 children, 8.4% had clinician-diagnosed and recorded asthma; of those, 6.8% had confirmed SARS-CoV-2 infection.

Of those with a confirmed infection, 1.5% were hospitalized with COVID-19.

When the researchers evaluated children without asthma (n = 689,404), 5.8% had confirmed SARS-CoV-2 infection and, of those, 0.9% were hospitalized with COVID-19.

The researchers reported a higher rate of COVID-19 hospitalization among children with poorly controlled asthma than those with well controlled or no asthma. Compared with patients without asthma, the adjusted HR for COVID-19 hospitalization in those with a previous admission for asthma was 6.4 (95% CI, 3.27-12.53) for those with poorly controlled asthma and 1.36 (95% CI, 1.02-1.8) for those with well-controlled asthma, according to the results. Compared with patients without asthma, the adjusted HR for COVID-19 hospitalization in those with a history of oral corticosteroids, the adjusted HR was 3.38 (95% CI, 1.84-6.21) for those with three or more prescribed courses, 1.52 (95% CI, 0.9-2.57) for those with one course and 1.34 (95% CI, 0.98-1.82) for those not prescribed oral corticosteroids, according to the results.

“Although the HR was elevated, the overall risk of admission to hospital with SARS-CoV-2 in children with asthma was low (1 in 380 children with poorly controlled asthma were admitted to hospital with COVID-19,” the researchers wrote.

“... This analysis also underscores the importance of maintaining good asthma control and careful monitoring of children with poorly controlled asthma if they develop SARS-CoV-2 infection. Good asthma control could help to protect children from developing more severe manifestations of COVID-19,” Shi and colleagues wrote.