Post lockdown sees a 37% jump in asthma- and COPD-related ED visits

Asthma and COPD emergency department (ED) visits jumped 37% after the relaxing of COVID-19 mitigation efforts. But the impact varied depending on the age of patients, with asthmatic children being hit hardest with rebound. Viruses may have a greater impact on these conditions than previously appreciated, according to a study in the Journal of Allergy and Clinical Immunology Global. It investigated the effects of pre- and post-lockdowns on respiratory disease visits to the ED. “We were surprised that the benefits of lockdown precautions in terms of asthma exacerbations were concentrated so strongly in children—and similarly that the rebound in asthma activity was so much more in children once people stopped masking,” said study coauthor Dr. Jeffrey Haspel. He is an associate professor of medicine at the Washington University School of Medicine. The study was a retrospective analysis of data on ED visits for asthma and COPD exacerbations, as well as positivity rates for common respiratory viruses at several hospitals in St. Louis, Missouri. Researchers looked at all age groups and at weekly event rates occurring in the 52-week intervals before, during, and after institution of the COVID-19 lockdown. Read: Omalizumab in the treatment of asthma: a long-term study They defined the period from March 22, 2019 to March 19, 2020, as the pre-lockdown period; March 20, 202, to March 18, 2021 as the lockdown period; and March 19, 2021 to March 18, 2022 as the post-lockdown period. Analyses found that the pre-lockdown, lockdown and post-lockdown periods had notable differences in ED detection of common respiratory viruses: 21,019; 3,229 and 15,102 cases for the different periods respectively. The study noted traditional seasonal patterns in viral detection was seen in the pre-lockdown period, while the lockdown period showed significantly reduced instances of virus detection. Results showed there was an overall resurgence in instances of respiratory virus detection during the post-lockdown period, with a shift in the cumulative seasonal peak to the summer months. Indeed, there was a 400% increase in viral positivity in the post-lockdown period compared to the lockdown period. Along with this was a 37% jump in asthma- and COPD-related ED visits. Respiratory syncytial virus (RSV), influenza virus, parainfluenza virus, and human meta-pneumovirus, viral positivity numbers were damped during the lockdown but strongly reemerged post-lockdown. On the other hand, rhinovirus (RV) and adenoviruses were less affected by lockdowns, the paper said. At the same time, the rates of asthma- and COPD-related ED visits dropped by 45% and 35%, respectively during the lockdown period. Interestingly, the study stated that “the resurgence of asthma- and COPD-related ED visits during the post-lockdown period diverged according to patient age.” When it came to asthma, prior to lockdowns, children had higher rates of ED visits, but this flattened during lockdowns. Post-lockdown the childhood peak for asthma-related ED visits came back—but differently than what was seen in other age groups. “Asthma-related ED visits overcorrected in children younger than five years, rising 81% on an annualized basis compared with during the pre-lockdown period whereas median weekly rates rose by 167%,” the study said. And this “overcorrection” was associated with viral infection, mostly from RV, RSV, and parainfluenza. “Respiratory viruses are ubiquitous, so you might have thought the effect of masking would accrue equally across ages. It would seem though that asthmatic children have a different relationship with viral exposures than adult asthmatics do, that their responses to viral infection is more likely to translate into an asthma exacerbation,” Dr. Haspel told the Medical Post. Another surprise was that in patients over the age of 20 years, asthma-related visits did not rise much in the post-lockdown period even though cases of ED virus detection rose in adults. In contrast to the asthma population in the study, COPD-related ED visits declined symmetrically during the lockdown across adult ages and then rebounded symmetrically in the post-lockdown period. COPD-related ED visits rebounded post-lockdown period while asthma ED visits did not. “Apparently, COPD and asthma in older patients are not the same disease even though both are chronic airway diseases with similar symptoms and similar treatments. To be sure, both disorders coexist in many patients, a condition termed asthma-COPD overlap syndrome. With respect to their relationship to viral triggers though, our data indicate a difference, at least for the winter 2021 to 2022 season,” Dr. Haspel said. Doctors should consider that viruses may play bigger roles in asthma and COPD than thought. “Going forward we have to think (about) how to use this information effectively to improve our patient’s disease control without doing harm to children’s future health in the long run. The natural experiment that is COVID lockdown is not over but will have ramifications for children for years to come,” he said. There are two take-home messages, according to Dr. Alan Kaplan. He is a clinical lecturer of medicine at the University of Toronto and was not part of the study. One is that COVID-19 precautions had “the unexpected effect of magnifying early-childhood asthma activity once common respiratory viruses recurred.” This is of especial concern with the current outbreak of multiple viruses. “On the other hand, viral mitigation measures such as masking and social distancing to avoid getting infected, do seem to have been effective for COVID, but also reduced the incidence of COPD exacerbations and asthma exacerbations in adults during the lockdowns,” he said. He noted: “The authors speculated that we should be cautious in applying viral mitigation strategies to young children as it may have had a hand in causing the overcorrection in viral positivity and thus asthma exacerbations.” But use caution when considering this. Dr. Kaplan added: “My fear is that this data would drive the group that believes that hygiene, masking and social distancing is unnecessary and now with this article, even potentially dangerous. We should remember that these precautions were there to protect us before we had vaccinations. While children overall do not get severe COVID with the frequency of adults, especially older and with comorbidities, they are not exempt from bad outcomes.”

Post lockdown sees a 37% jump in asthma- and COPD-related ED visits

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