Mid-term impact of COVID-19 related non-pharmaceutical interventions on the incidence of hospitalizations for severe asthma exacerbation in children: a ten-year time-series analysis

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Background The aim of this study was to analyze the temporal association of the national incidence of severe asthma exacerbations (SAEs) in children with the implementation and lifting of NPIs.Methods We performed a time-series analysis of a national, hospital-based French surveillance system. An SAE was defined as asthma associated with acute respiratory failure. All children aged ≤18 years hospitalized for an SAE in metropolitan France between January 2013 and June 2023 were included. The main outcome was the monthly incidence of hospitalizations for SAEs per 100,000 children, analyzed by a quasi-Poisson regression model, adjusted for pollution exposure. The incidence of hospitalizations for acute pyelonephritis over the same period was analyzed as a control outcome.Results NPI implementation in March 2020 was associated with a significant decrease in the monthly incidence of SAEs (immediate change, −29.4%; 95%CI −49.4 to −1.5; p = 0.041), and a significant increase following the lifting of the NPIs in March 2021 (immediate change, 59.1%; 95%CI 12.8 to 124.6; p = 0.008), resulting in a non-significant excess compared to the pre-COVID-19 pandemic period trend (+12.3%; 95%CI −12.6 to 44.5; p = 0.36), independently of pollution exposure. No significant changes were observed for acute pyelonephritis hospitalizations over the study period.Conclusions NPIs were associated with significant changes in the incidence of pediatric SAEs. This unexpected benefit suggests that public health interventions targeting respiratory viruses may reduce the burden of SAEs in children. The mid- and long-term impact of lifting NPIs on SAEs and on the use of healthcare resources should be carefully monitored.

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