Explained: Why Pediatric Asthma Cases Dramatically Decreased During the Covid-19 Pandemic

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According to some studies, the Covid-19 lockdown measures have led to a dramatic drop in hard-to-control cases of asthma attacks, not only around the world but also in India. It took a pandemic to understand the importance of school-related respiratory viral infections as a major factor in exacerbating asthma in children, and how wearing a mask can be a measure of protection against this disease, experts said.

Asthma cases drop during the Covid-19 pandemic

Dr Sundeep Salvi, chairman of the Chronic Respiratory Disease Section, Global Burden of Disease-India, said asthma cases fell during the pandemic. “Before the start of the pandemic, more than 60% of children who saw a pediatrician in India did so for respiratory symptoms and a large proportion of them were for asthma. With the start of the Covid-19 pandemic, the number of childhood asthmatics consulting a pediatrician has dropped by more than 50 to 60%. This came as a surprise to doctors, as there were concerns that the SARS COV-2 virus, being a predominant respiratory virus, could cause asthma to worsen. The shocking reduction in the number of pediatric asthma cases visiting a healthcare facility has actually been a godsend… ”said Dr Salvi.

“There has been a remarkable change in the world and a similar trend has been seen in India,” Dr Salvi said.

Schools are closed, lockdown restrictions are a big factor

Lockdown restrictions, school closures for in-person classes and social distancing have had significant implications for movement and play behaviors, limiting children’s physical activity and reducing exposure to environmental triggers, say the researchers. experts in their study “Impact of the Covid-19 pandemic on asthma control among children from a caregiver’s perspective, published in the British Medical Journal (BMJ-Open).

The European Respiratory Journal also published findings from studies in Singapore, where researchers observed a sustained reduction in admissions for asthma with PCR-proven respiratory viral infections (RTIs) that coincided with widespread adoption of measures. public health during the pandemic. The reduction in the number of motor vehicles on the roads and the closure of industries, which were major sources of air pollution in towns and villages, must also have helped to reduce personal exposure to air pollution. air, said Dr Salvi.

Asthma, a growing problem in India

Asthma is the most common chronic disease in children and, according to the WHO, it affected around 262 million people in 2019 and caused 4.61 lakh of deaths. Inflammation and narrowing of the small airways in the lungs cause asthma symptoms which can be a combination of coughing, wheezing, shortness of breath, and chest tightness. Asthma symptoms are intermittent and often get worse at night or during exercise.

According to the latest Global Burden of Disease (GBD) report, there are around 3.4 crores of asthma sufferers in India, of which around 25% are children. Although India accounts for 11% of asthma cases in the world, the country accounts for a shocking 42% of all asthma deaths worldwide.

Respiratory viral infections recognized as triggers of attacks

Until recently, based on research conducted in the Western world, it was believed that asthma was primarily caused and triggered by a multitude of environmental factors, including plant allergens (pollen), animal origin ( cats, dogs, horses), mites, house dust, deodorants and perfumes. Respiratory viral infections were also a recognized trigger for asthma exacerbations in children, but were not given much prominence, Dr Salvi said.

A potential explanation for the fall in asthma in children during the Covid-19 pandemic, according to the expert, is that children were not going to school and were staying at home due to the pandemic and the lockdown . As a result, there were no respiratory viral infections among the children, which would otherwise have happened if the children had gone to school.

On average, a child develops between two and five respiratory viral infections over the course of a year and this becomes the cause of exacerbations in children with asthma. The fact that asthma exacerbations have dropped in children suggests that school-related respiratory viral infections were a major cause of asthma exacerbations in children. Similar observations have been made in other parts of the world.

The pandemic taught the importance of hand hygiene, masks

Asthma is a huge and growing problem in India that demands the attention of policy makers and healthcare providers. Wearing a mask can be a very useful protective measure against asthma. As schools eventually reopen, experts like Dr Salvi and others have said this pandemic has underscored the importance of avoiding respiratory viral infections in schools. Children wearing masks when they go to school, even after the pandemic is over, will likely be the most effective solution to reducing the suffering and exacerbations of asthma.

Wearing a mask not only protects against the Covid-19 virus, but also protects against the capture of other respiratory viruses. Protection against ambient air pollution will be an additional advantage when wearing masks. “We also need to continue with this hand hygiene behavior even after the pandemic is over,” Dr Salvi said.

Meanwhile, with easing of containment-type restrictions, pediatricians have noted a slight increase in the number of wheezing cases. Dr Umesh Vaidya, senior pediatrician and expert member of the Pune Covid task force, said this was true last year, but with the opening after the lockdown there are more cases of wheezing.

“The increase in the number of cases is usually a combination of weather conditions and viral infections. Last year there was a total lockdown and therefore there have been very few cases. With the restrictions easing. lockdown, there has been some social interaction, especially as children play with each other and mild viral infections can trigger episodes of wheezing. This month we started to see a increase in cases and in our hospital there are no spare nebulizers as all have been given to patients, ”said Dr Vaidya.

Dr Gaurav Sethi, a consultant pediatrician with a particular interest in pediatric asthma, said the new cases had definitely decreased and the episodes of asthma attacks were mild. The extended lockdowns have also helped improve air quality, Dr Sethi said.


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