Wheezing occurs less in children born during COVID-19 lockdown vs. pre-pandemic

Key takeaways:

• More children born in 2016 and 2017 vs. 2020 had a minimum of one wheezing episode at 30 months.
• Nebulized beta-2 agonist and glucocorticosteroid use was higher in the 2016 and 2017 birth group.

Wheezing at 30 months was less frequent in children born during vs. before the COVID-19 lockdown, according to a research letter published in JAMA Network Open.

“In this study, children born during the COVID-19 lockdown had fewer wheezing episodes and less use of respiratory medicines compared with the pre-pandemic cohort,” Elisa Barbieri, PharmD, PhD, postdoctoral researcher in the pediatric infectious diseases division in the department of women’s and children’s health at the University of Padua in Italy, and colleagues wrote.

Using the Pedianet database, Barbieri and colleagues evaluated 2,192 children born between February and April 2020 to see how wheezing rates and respiratory medication use differ from 3,889 children born between February and April in 2016 and 2017.

Both sets of children were similar in sex, area deprivation index, gestational age and family atopic disease presence, according to researchers.

A significantly greater proportion of children born in 2016 and 2017 vs. 2020 had a minimum of one wheezing episode at 30 months (15% vs. 9.4%).

Similarly, children born in 2016 and 2017 had a higher wheezing episode rate than those born in 2020 (110 vs. 67.6 per 10,000 person-months), as well as a higher bronchiolitis episode rate (82.4 vs. 6.6 per 10,000 person-months) and more use of nebulized beta-2 agonists (7.9 vs. 5.1 per 1,000 person-months) and nebulized glucocorticosteroids (23.5 vs. 19.5 per 1,000 person-months).

Researchers further found a significant elevated cumulative wheezing risk among those born in 2016 and 2017 vs. 2020 at month 45 (16% vs. 13%).

Mediation analysis revealed a 44% (HR = 0.56; 95% CI, 0.48-0.66) reduced risk for wheezing in the 2020 birth group vs. the 2016 and 2017 birth group. Based on a situation in which bronchiolitis was eliminated, researchers observed that lockdown preventive measures removed 30% of wheezing.

“In line with a large birth cohort study [by Christian Rosas-Salazar, MD, and colleagues] demonstrating that not being infected with RSV during the first year of life is associated with a 26% lower risk of 5-year current asthma, this study underscores the potential role of a universal RSV immunoprophylaxis in preventing postbronchiolitis wheezing,” Barbieri and colleagues wrote.

Reference:

• Rosas-Salazar C, et al. Lancet. 2023;doi:10.1016/S0140-6736(23)00811-5.