Impact statement
Severe acute asthma (SAA) is a severe asthma exacerbation usually
requiring admission to a pediatric intensive care unit (PICU) and causes
serious morbidity and mortality; moreover, over the past few decades the
number of PICU admissions for SAA has shown a significant increase. The
Coronavirus Disease 19 (COVID-19) pandemic has influenced the medical
health care system as a whole including asthma and its exacerbation
pattern. Over the past few years, changes to the number of asthma
exacerbations and lockdown regulations or environmental triggers during
the COVID-19 pandemic have been evaluated; however, SAA requiring PICU
admission have not. In this study, the relationship between number of
PICU admissions for SAA and the COVID-19 pandemic lockdown regulations.
Additionally, changes to possible environmental factors triggering
severe exacerbations, including air pollution and pollen index, are
explored. This study took place in a tertiary hospital in Amsterdam, The
Netherlands, and included all children over two years of age admitted
for SAA to the PICU between 2018 and 2021. It was found that when
COVID-19 restrictions were strict and lockdown was in place, number of
SAA admissions at the PICU drastically decreased. After most
restrictions had lifted, especially from August to November of 2021, a
large peak in admissions was observed. It is hypothesized that outbreak
of viral infections other than COVID-19 might have been the cause for
this association, as spread of viruses was decreased during regulations.
Finally, no association between air pollution and pollen index and SAA
admissions was observed. In the future, it must be known that large
societal changes may have an impact on SAA patterns and physicians must
be aware of an increase in number of children coming to the ED with
symptoms.