Asthma and the Risk of SARS-CoV-2 Infection among Children and Adolescents
American Academy of Pediatric Journal:
TAKE-HOME MESSAGE
This retrospective cohort study looked at the association between asthma and SARS-CoV-2 infection risk in children aged 5 to 17 years. Children who had asthma were more likely to be tested for SARS-CoV-2 infection than those without asthma.
However, the infection rates among children with and without asthma were nearly identical (2.8% for both). The use of inhaled corticosteroids, history of severe exacerbation, and presence of comorbid atopic disease had no effect modification on infection risk.
What’s Known on This Subject:
Risk factors for SARS-CoV-2 infection among children remain poorly defined. Current guidelines recommend that individuals with asthma take additional precautions to prevent SARS-CoV-2 infection, but the relationship between asthma and SARS-CoV-2 infection risk and severity in children is unclear.
However, several prior studies suggested that asthma may be associated with a lower susceptibility to SARS-CoV-2 infection and a low risk of severe COVID-19.
What This Study Adds:
This study suggests that children with asthma were not at increased risk of SARS-CoV-2 infection compared with children without asthma and generally had mild SARS-CoV-2-associated illnesses.
In summary, despite the continued general precaution regarding asthma and COVID-19, authors found no evidence that asthma predisposes children to SARS-CoV-2 infection or severe illness from COVID-19.
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OBJECTIVES
Over 6 million pediatric severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections have occurred in the United States, but risk factors for infection remain poorly defined. We sought to evaluate the association between asthma and SARS-CoV-2 infection risk among children.
METHODS
We conducted a retrospective cohort study of children 5 to 17 years of age receiving care through the Duke University Health System and who had a Durham County, North Carolina residential address. Children were classified as having asthma using previously validated electronic health record-based definitions. SARS-CoV-2 infections were identified based on positive polymerase chain reaction testing of respiratory samples collected between March 1, 2020, and September 30, 2021. We matched children with asthma 1:1 to children without asthma, using propensity scores and used Poisson regression to evaluate the association between asthma and SARS-CoV-2 infection risk.
RESULTS
Of 46 900 children, 6324 (13.5%) met criteria for asthma. Children with asthma were more likely to be tested for SARS-CoV-2 infection than children without asthma (33.0% vs 20.9%). In a propensity score-matched cohort of 12 648 children, 706 (5.6%) children tested positive for SARS-CoV-2 infection, including 350 (2.8%) children with asthma and 356 (2.8%) children without asthma. There was no evidence of effect modification of this association by inhaled corticosteroid prescription, history of severe exacerbation, or comorbid atopic diseases. Only 1 child with asthma required hospitalization for SARS-CoV-2 infection.
CONCLUSIONS
After controlling for factors associated with SARS-CoV-2 testing, we found that children with asthma have a similar SARS-CoV-2 infection risk as children without asthma.
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