Evaluating the impact of COVID-19 on asthma morbidity: a comprehensive analysis of potential influencing factors.

Guijon, Olga L; Morphew, Tricia; Consulting, Morphew; Ehwerhemuepha, Louis; Galant, Stanley P

BACKGROUND The COVID pandemic period is experiencing better asthma control, less exacerbations, and healthcare utilization, with little data on factors that could explain this phenomenon. OBJECTIVE To confirm these improved asthma outcomes during COVID -19 and examine potential contributing factors. METHODS In 18,912 pediatric asthma patients treated in the Children's Hospital of Orange County network from 2017-2020, monthly asthma-related encounters, and medication summaries were extracted from electronic health records, PM2.5 air pollution from California Air Resources Board, and influenza like illness from ILINet for the first six months of each year. Changes in outcomes from Jan-Mar to Apr-Jun (post COVID-19 shut-down in 2020) were compared to historical data using GEE analyses for patient outcomes and GLM for pollution exceedance, influenza positive, and telehealth visit rates. RESULTS During COVID-19 we found 78%, 90%, 68% reductions in hospitalization, ED visits, and exacerbations compared to pre COVID-19 2020, significantly greater changes than the same time period 2017 - 2019, and significant reductions in albuterol and ICS usage, p <.05. ED reduction was not seen for African Americans. PM2.5 and influenza rates were also significantly reduced during COVID-19 p<.05. Increased rates in telehealth visits were greater in the publicly insured group when compared to commercially insured. CONCLUSION Our data confirm reduced healthcare utilization and suggest better asthma control during COVID-19, except for African Americans. This was associated with a significant increase in telehealth visits and reductions in PM2.5 and influenza infections, but not better asthma controller adherence.