Impact of COVID-19 pandemic waves on pediatric emergency department patients presenting with asthma attacks in Taiwan
1Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 204 Keelung, Taiwan
2Division of Pediatric Gastroenterology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, 333 Taoyuan, Taiwan
3Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and Chang Gung University College of Medicine, 333 Taoyuan, Taiwan
Submitted: 09 February 2022 Accepted: 14 April 2022
Online publish date: 16 June 2022
The number of pediatric emergency department (PED) visits fell significantly during the coronavirus disease 2019 (COVID-19) pandemic. However, the impact of the ongoing pandemic on PED patients suffering from asthma attacks in Taiwan has not been studied. We thus analyzed patients with asthma attacks visiting a PED during the early stage of the COVID-19 pandemic and the following (resurgent) waves. We retrospectively studied pediatric patients with asthma attacks who visited the PED from 01 January 2019 to 30 September 2021. We retrieved patient numbers, demographic characteristics, triage acuities, medications, and PED dispositions during the various waves of the COVID-19 pandemic. A total of 1842 patients with asthmatic attacks presented to the PED during the study period. PED visits caused by asthmatic attacks declined by 55% after the first COVID-19 outbreak in early 2020 (p = 0.009) and fell even more remarkably (by 85%) in mid-2021 (p = 0.038), during the time when the numbers of confirmed COVID-19 cases skyrocketed (the second wave). However, neither the high-triage acuity rate nor the rate of admission differed between the two periods (p = 0.08 and 0.406, respectively). However, the proportion of systemic corticosteroid (SCS) prescriptions increased during the pandemic (81.90 vs. 77.77%, p = 0.029). The COVID-19 pandemic notably impacted the number of asthmatic PED visits not only during the first peak period but also during the following waves, but asthma severity did not vary over time. Physicians tended to prescribe more SCSs during the pandemic to control respiratory symptoms. We suggest that SCSs should be used cautiously even during the pandemic to minimize their adverse effects.
Pediatric emergency department; Asthma; Pediatric; Hospital volume; COVID-19; Corticosteroid
Hsin-Kuan Wu,En-Shuo Chang,Chien-Wei Cheng,Wei-Che Chien,Hsin-Hui Chou. Impact of COVID-19 pandemic waves on pediatric emergency department patients presenting with asthma attacks in Taiwan. Signa Vitae. 2022.doi:10.22514/sv.2022.045.
 Lucero AD, Lee A, Hyun J, Lee C, Kahwaji C, Miller G, et al. Underutilization of the emergency department during the COVID-19 pandemic. Western Journal of Emergency Medicine. 2020; 21: 15–23.
 Even L, Lipshaw MJ, Wilson PM, Dean P, Kerrey BT, Vukovic AA. Pediatric emergency department volumes and throughput during the COVID-19 pandemic. The American Journal of Emergency Medicine. 2021; 46: 739–741.
 Imlach F, McKinlay E, Middleton L, Kennedy J, Pledger M, Russell L, et al. Telehealth consultations in general practice during a pandemic lockdown: survey and interviews on patient experiences and preferences. BMC Family Practice. 2020; 21: 269.
 Erdevir M, Uyaroğlu OA, Özdede M, Tanrıöver MD. “COVID-19: The final nail in the coffin for physical examination” evaluation of the effects of COVID-19 pandemic on physical examination habits of residents in a university hospital: a cross-sectional survey. International Journal of Clinical Practice. 2021; e14988.
 Krivec U, Kofol Seliger A, Tursic J. COVID-19 lockdown dropped the rate of paediatric asthma admissions. Archives of Disease in Childhood. 2020; 105: 809–810.
 Yeoh DK, Foley DA, Minney-Smith CA, Martin AC, Mace AO, Sikazwe CT, et al. Impact of coronavirus disease 2019 public health measures on detections of influenza and respiratory syncytial virus in children during the 2020 Australian winter. Clinical Infectious Diseases. 2021; 72: 2199–2202.
 Kenyon CC, Hill DA, Henrickson SE, Bryant-Stephens TC, Zorc JJ. Initial effects of the COVID-19 pandemic on pediatric asthma emergency department utilization. The Journal of Allergy and Clinical Immunology: In Practice. 2020; 8: 2774–2776.e1.
 Simoneau T, Greco KF, Hammond A, Nelson K, Gaffin JM. Impact of the COVID-19 pandemic on pediatric emergency department use for asthma. Annals of the American Thoracic Society. 2021; 18: 717–719.
 Gupta N, Dhar R, Swarnakar R, Bedi R, Chawla R. Impact of COVID-19 on (Non-COVID) chronic respiratory disease outcome survey in India (CCROS study). Lung India. 2021; 38: 454.
 Alsallakh MA, Sivakumaran S, Kennedy S, Vasileiou E, Lyons RA, Robertson C, et al. Impact of COVID-19 lockdown on the incidence and mortality of acute exacerbations of chronic obstructive pulmonary disease: national interrupted time series analyses for Scotland and Wales. BMC Medicine. 2021; 19: 124.
 Anderson RM, Heesterbeek H, Klinkenberg D, Hollingsworth TD. How will country-based mitigation measures influence the course of the COVID-19 epidemic? The Lancet. 2020; 395: 931–934.
 Lin CF, Huang YH, Cheng CY, Wu KH, Tang KS, Chiu IM. Public Health Interventions for the COVID-19 pandemic reduce respiratory tract infection-related visits at pediatric emergency departments in Taiwan. Frontiers in Public Health. 2020; 8: 604089.
 Powell CV. Acute severe asthma. Journal of Paediatrics and Child Health. 2016; 52: 187–191.
 Chang Y, Hwang C, Chen Y, Lin M, Chen T, Chu S, et al. Prevalence of atopic dermatitis, allergic rhinitis and asthma in Taiwan: a national study 2000 to 2007. Acta Dermato Venereologica. 2010; 90: 589–594.
 Lin H, Kao S, Wen H, Wu C, Chung C. Length of stay and costs for asthma patients by hospital characteristics—a five-year population-based analysis. Journal of Asthma. 2005; 42: 537–542.
 Levene R, Fein DM, Silver EJ, Joels JR, Khine H. The ongoing impact of COVID-19 on asthma and pediatric emergency health-seeking behavior in the Bronx, an epicenter. The American Journal of Emergency Medicine. 2021; 43: 109–114.
 Lo H, Chaou C, Chang Y, Ng C, Chen S. Prediction of emergency department volume and severity during a novel virus pandemic: experience from the COVID-19 pandemic. The American Journal of Emergency Medicine. 2021; 46: 303–309.
 Cheng CW. The impact of coronavirus disease 19 on emergency volume in northern Taiwan. Signa Vitae. 2022; 18: 41–47.
 Morais-Almeida M, Aguiar R, Martin B, Ansotegui IJ, Ebisawa M, Arruda LK, et al. COVID-19, asthma, and biological therapies: what we need to know. World Allergy Organization Journal. 2020; 13: 100126.
 Navalpakam A, Secord E, Pansare M. The impact of coronavirus disease 2019 on pediatric asthma in the United States. Pediatric Clinics of North America. 2021; 68: 1119–1131.
 Hatoun J, Correa ET, Donahue SMA, Vernacchio L. Social distancing for COVID-19 and diagnoses of other infectious diseases in children. Pediatrics. 2020; 146: e2020006460.
 Scaramuzza A, Tagliaferri F, Bonetti L, Soliani M, Morotti F, Bellone S, et al. Changing admission patterns in paediatric emergency departments during the COVID-19 pandemic. Archives of Disease in Childhood. 2020; 105: 704–706.
 Eguiluz‐Gracia I, Mathioudakis AG, Bartel S, Vijverberg SJH, Fuertes E, Comberiati P, et al. The need for clean air: the way air pollution and climate change affect allergic rhinitis and asthma. Allergy. 2020; 75: 2170–2184.
 Riccio MP, Borrelli M, Fioretti MT, Del Bene M, Bravaccio C, Poeta M, et al. Is quarantine for COVID-19 pandemic associated with psychological burden in primary ciliary dyskinesia? International Journal of Environmental Research and Public Health. 2020; 17: 8099.
 Jartti T, Liimatainen U, Xepapadaki P, Vahlberg T, Bachert C, Finotto S, et al. Clinical correlates of rhinovirus infection in preschool asthma. Allergy. 2021; 76: 247–254.
 Lazzerini M, Barbi E, Apicella A, Marchetti F, Cardinale F, Trobia G. Delayed access or provision of care in Italy resulting from fear of COVID-19. The Lancet Child & Adolescent Health. 2020; 4: e10–e11.
 Camargo CA, Rachelefsky G, Schatz M. Managing asthma exacerbations in the emergency department: summary of the national asthma education and prevention program expert panel report 3 guidelines for the management of asthma exacerbations. The Journal of Emergency Medicine. 2009; 37: S6–S17.
 Ferraro VA, Zamunaro A, Spaggiari S, Di Riso D, Zanconato S, Carraro S. Pediatric asthma control during the COVID-19 pandemic. Immunity, Inflammation and Disease. 2021; 9: 561–568.
 Gray DM, Davies MA, Githinji L, Levin M, Mapani M, Nowalaza Z, et al. COVID-19 and pediatric lung disease: a South African tertiary center experience. Frontiers in Pediatrics. 2020; 8: 614076.
 Fan H, He C, Yin G, Qin Y, Jiang N, Lu G, et al. Frequency of asthma exacerbation in children during the coronavirus disease pandemic with strict mitigative countermeasures. Pediatric Pulmonology. 2021; 56: 1455–1463.
 Golan‐Tripto I, Arwas N, Maimon MS, Bari R, Aviram M, Gatt D, et al. The effect of the COVID-19 lockdown on children with asthma-related symptoms: a tertiary care center experience. Pediatric Pulmonology. 2021; 56: 2825–2832.
 Chao JY, Derespina KR, Herold BC, Goldman DL, Aldrich M, Weingarten J, et al. Clinical characteristics and outcomes of hospitalized and critically ill children and adolescents with coronavirus disease 2019 at a tertiary care medical center in New York city. The Journal of Pediatrics. 2020; 223: 14–19.e2.
 National Asthma Education and Prevention Program. Expert panel report 3 (EPR-3): guidelines for the diagnosis and management of asthma-summary report 2007. Journal of Allergy and Clinical Immunology. 2007; 120: S94–138.
 Amirav I, Newhouse MT. Asthma and COVID-19: in defense of evidence-based SABA. Journal of Asthma and Allergy. 2020; 13: 505–508.
 Adir Y, Saliba W, Beurnier A, Humbert M. Asthma and COVID-19: an update. European Respiratory Review. 2021; 30: 210152.
 Kitazawa H, Hizawa N, Nishimura Y, Fujisawa T, Iwanaga T, Sano A, et al. The impact of the COVID-19 pandemic on asthma treatment in Japan: perspectives based on doctors’ views. Respiratory Investigation. 2021; 59: 670–674.
Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.
IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.
Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.
Scopus: CiteScore 0.5(2021) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.
Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.