Impact of the COVID-19 pandemic on infant and pediatric asthma: a multi-center survey using an administrative database in Japan

Bun, Seiko; Kishimoto, Kenji; Shin, Jung-ho; Takada, Daisuke; Morishita, Tetsuji; Kunisawa, Susumu; Imanaka, Yuichi

BackgroundLimited data are available on the relationship between infant and pediatric asthma and severe acute respiratory syndrome coronavirus 2 (COVID-19). Political limitations such as school closure may affect the treatment behavior of pediatric asthma. To investigate the trends of treatment behavior in the field of pediatrics during the COVID-19 pandemic. MethodsThis is a retrospective observational study using Diagnosis Procedure Combination (DPC) data from the Quality Indicator/Improvement Project (QIP) database. We identified children with asthma aged 15 years or younger who were patients from July 1, 2018, to June 30, 2020. The main outcome was a comparison between asthma patients treatment behavior before the COVID-19 pandemic and during the COVID-19 pandemic. We statistically tested the admission volume changes based on the discharge date after adjusting for seasonality through a Fourier term using an interrupted time-series analysis (ITS). ResultsWe identified 10,481 inpatients cases in 67 hospitals and 258,911 out-patients cases in 180 hospitals who were diagnosed with asthma. We performed ITS analysis for inpatients. The reduction in the number of patients during this period was estimated to be 232 (P=0.001). In addition, ITS analysis was performed for patients aged <3 years. The reduced number of patients during this period was estimated to be 155 (P<0.001). ConclusionsWe found that the number of pediatric asthma patients dramatically decreased during the COVID-19 pandemic. We need to continue research into the trends of pediatric asthma patients after the COVID-19 pandemic in Japan. Key MessagesThere are increasingly available data on the relationship between adults asthma and COVID-19. However, in the fields of pediatrics, limited data are available. Patients with moderate to severe asthma who needed hospitalization dramatically decreased during the COVID-19 pandemic. Besides, doctors prescribed nebulizers more than metered-dose inhalers by the clinical guideline recommendation. Our findings reinforce the value of political inventions, such as school closure reduced the number of asthma attacks in infants and school-age children.