McConnery Jason R, Bone Jeffrey N, Goldman Ran D, Hicks Anne, Seaton Claire, Subbarao Padmaja, Moraes Theo J
Division of Respiratory Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario.
Department of Obstetrics and Gynecology, BC Children's Hospital, Vancouver.
Paediatr Child Health. 2023 Jun 26;29(2):98-103. doi: 10.1093/pch/pxad037. eCollection 2024 May.
Asthma is a chronic lung condition that can be exacerbated when triggered by viruses. Pandemic public health restrictions aimed to reduce COVID-19 transmission indirectly effected other circulating viruses. This study assessed the impact of the pandemic and associated public health measures on acute paediatric asthma across four tertiary sites in three Canadian provinces. We queried whether pandemic-related changes would impair preventive care and delay presentation to care, increasing asthma exacerbation severity.
This retrospective study compared the frequency of acute care access and severity of presentation to emergency departments (ED) for acute asthma to four tertiary care children's hospitals during the COVID-19 pandemic (from March 17, 2020 to June 30, 2021) to a pre-lockdown control period (July 1, 2018 to March 16, 2020). Data was subjected to interrupted time series and Chi-square analysis.
Our study included 26,316 acute asthma visits to ED. Sites experienced a 63% to 89% reduction in acute asthma visits during the pandemic, compared with pre-lockdown controls, and a 17% to 85% reduction in asthma, that is out of proportion as a fraction of all-cause ED visits. For asthma, there was no difference in severity measured by rate of ward admission or rate of Paediatric Intensive Care Unit (PICU) admission.
Public health measures appear to have resulted in a specific protective association on acute asthma with reduced acute care utilization over and above the reduction in all-cause presentations, without an increase in severity upon presentation. Our study indicates an importance to antiviral public health and engineering strategies to reduce viral transmission and thereby asthma morbidity.
哮喘是一种慢性肺部疾病，在受到病毒触发时可能会加重。旨在减少新冠病毒传播的大流行公共卫生限制措施间接影响了其他传播的病毒。本研究评估了大流行及相关公共卫生措施对加拿大三个省份四个三级医疗机构中儿童急性哮喘的影响。我们探究了与大流行相关的变化是否会损害预防保健并延迟就医，从而增加哮喘加重的严重程度。
这项回顾性研究将新冠大流行期间（2020年3月17日至2021年6月30日）四家三级护理儿童医院急性哮喘患者到急诊科就诊的频率和就诊严重程度，与封锁前的对照期（2018年7月1日至2020年3月16日）进行了比较。数据采用中断时间序列分析和卡方分析。
我们的研究纳入了26316例急性哮喘患者到急诊科就诊的病例。与封锁前的对照期相比，各医疗机构在大流行期间急性哮喘就诊病例减少了63%至89%，哮喘病例减少了17%至85%，这一减少比例相对于所有病因的急诊科就诊病例而言不成比例。对于哮喘，通过病房收治率或儿科重症监护病房（PICU）收治率衡量的严重程度没有差异。
公共卫生措施似乎对急性哮喘产生了特定的保护作用，在全病因就诊病例减少之外，还降低了急性护理的利用率，且就诊时严重程度并未增加。我们的研究表明抗病毒公共卫生和工程策略对于减少病毒传播从而降低哮喘发病率具有重要意义。
