Kids With Uncontrolled Asthma at Higher Odds for Severe COVID-19

By Denise Mann HealthDay Reporter

Asthma is a tough disease for kids and their parents to manage well, but not keeping it under control may make these children up to six times more likely to wind up in the hospital with severe COVID-19, new research shows.

With the cold and flu season about to kick in and COVID-19 rates climbing again in some areas, kids with asthma should make sure their disease is under tight control, said study author Aziz Sheikh. He is the director of the University of Edinburgh’s Usher Institute, in Scotland.

“It is also important that they are offered an additional layer of protection through being vaccinated against COVID-19,” he added.

For the study, the researchers analyzed data on about 750,000 kids aged 5 to 17, including 63,463 with asthma, from March 2020 to July 2021.

Poorly controlled asthma was defined as a previous hospitalization for asthma or being prescribed at least two courses of oral steroids to treat an asthma flare during the past two years.

After controlling for other factors known to increase the risk of serious COVID-19, including certain underlying illnesses, children who had recently been hospitalized with asthma were six times more likely to be admitted to hospital with COVID-19, while those who had recently been prescribed oral steroids were three times more likely to be hospitalized with severe COVID-19 than kids without asthma. Kids with poorly controlled asthma were also more likely to be hospitalized for COVID-19 than those with well-controlled asthma, the study found.

Still, serious complications from COVID-19 are rare in kids, including those with asthma. Just one in 380 children with poorly controlled asthma in the study was hospitalized with COVID-19, the findings showed.

Exactly why kids with poorly controlled asthma are harder hit by COVID-19 than other kids is not fully understood yet.

“It may be because these children have inflamed airways from their sub-optimally controlled asthma and are more liable to adverse effects if exposed to the SARS-CoV-2 virus,” Sheikh suggested.

The findings were published online Nov. 30 in The Lancet Respiratory Medicine journal.

The implications of this study are clear, said Rachel Harwood, a pediatric surgical registrar at Alder Hey Children’s Hospital in Liverpool.

“We advise that all children who are eligible to receive the flu vaccine do so and that children [and their families] ensure that they continue to take their asthma medication and use a spacer to take any inhalers,” said Harwood, who wrote an editorial accompanying the new research. (A spacer is a device that can help get more asthma medicine into the lungs.)

What’s more, children who are due to have an asthma review or whose asthma seems to be getting worse should make an appointment to see their doctor to ensure that they are receiving the correct treatment.

It’s not that children with asthma are at higher risk for severe COVID-19, it’s kids who have poorly controlled asthma who are at risk, said Dr. William Sheehan, an allergist and immunologist at Children’s National Hospital in Washington, D.C.

This suggests there is a window of opportunity to prevent complications from COVID-19 for these kids, Sheehan said.

Schedule a check-in with your child’s doctor to get a head start on virus season, he suggested. “Use this visit to make sure that your child has all the proper asthma medications and refills and is using them correctly,” he said. “If they are not working, your doctor can adjust the doses or switch medications for better asthma control.”

Children with poorly controlled asthma should also be prioritized when it comes to receiving COVID vaccines, he said. In the United States, COVID-19 vaccines are authorized for kids aged 5 and up.

More information

The American Academy of Pediatrics offers tips on creating an asthma action plan for your child.

SOURCES: Aziz Sheikh, director, University of Edinburgh’s Usher Institute, Scotland; William Sheehan, MD, allergist, immunologist, Children’s National Hospital, Washington, D.C.; Rachel Harwood, pediatric surgical registrar, Alder Hey Children’s Hospital, Liverpool, U.K.; The Lancet Respiratory Medicine, Nov. 30, 2021, online

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