Impact of COVID-19 related alterations in circulating respiratory viruses on children and adult patients with recurrent wheeze and asthma

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Introduction During COVID-19 pandemic, the epidemiology of respiratory infections changed fundamentally. During lockdown periods rates of respiratory infection were low. An increase of respiratory syncytial virus and rhinovirus infections was reported after easing of hygiene measures compared to lockdown and pre-pandemic periods. We investigated the impact of this observation on children and adults with wheeze and asthma. Methods Within the ALL Age Asthma Cohort (ALLIANCE), we conducted questionnaires at three time points, during (Pilot: Feb-Aug 2020: n= 279, Phase 1: Oct–Apr 2020/21: n= 412) and after lockdown periods (Phase 2 Jun-Oct 2021: n= 327). Data on disease control (based on personal assessment and adapted GINA control status), use of medication and etiology of exacerbations were analyzed. Results Preschool children (age 0-5.9 years) showed a noticeable high improvement of 35% (Pilot) and 32% (Phase 1) in disease burden measured by specific symptoms and general personal assessment during lockdown periods. In contrast, after easing of hygiene measures none of the preschoolers reported improvement compared to the beginning of the pandemic and lockdown phases (Pilot/ Phase 2; p= 0,0003; Phase 1/Phase 2; p = 0.004), but 29% showed worsening of their condition (Pilot/Phase 2, p = 0.02), associated with viral infections and higher need for medication. Children aged 6-18 years had a stable asthma course over all phases. Adults reported higher proportion of worsening of their asthma in Phase 1 (30%) in comparison to the Pilot (19%), (p = 0.02), but not in Phase 2 (22%) compared to the Pilot (p= 0.39) or Phase 1 (p= 0.14). Conclusion COVID-19 related measures caused a reduction and re-emergence of respiratory virus infections, which influenced the course of disease in preschool children with recurrent wheeze, but not in older children and adults with asthma. Publication History Article published online: 21 September 2022 © 2022. Thieme. All rights reserved. Georg Thieme Verlag Rüdigerstraße 14, 70469 Stuttgart, Germany

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