Asthma control, self-management
and healthcare access during the COVID-19 pandemic in Beijing
Chun Chang a* M.D., Linlin Zhanga*B.S., Fawu Dong a* B.S., Ying
Liang a M.D., Yahong Chen a M.D.,
Ying Shang a B.S., Mairipaiti Abulikemua B.S.,
Yongchang Suna# M.D.
aDepartment of Respiratory and Critical Care Medicine,
Peking University Third Hospital, Beijing, China.
#, Corresponding to Yongchang Sun:
Department of Respiratory and Critical Care Medicine, Peking University
Third Hospital, Beijing, China.
North Garden Rd. 49.
Haidian District, Beijing, 100191, China
Tel: +86 010 139 1097 9132
Fax +86 108 226 6989
E-mail: suny@bjmu.edu.cn
* Chun Chang, Linlin Zhang and Fawu Dong contribute equally to this
work;
Abstract
Background Social distancing and restriction measures during
the Coronavirus Disease-19 (COVID-19) pandemic may have impacts on
asthma control and management in terms of medication availability and
healthcare access. We aimed to understand the status of asthma control,
exacerbations, self-management and healthcare utilization during the
COVID-19 pandemic in Beijing, China.
Methods Patients with asthma, selected randomly from our
hospital database, were interviewed by phone call. During the interview,
sociodemographic information and clinical data, including status of
asthma control, asthma exacerbation, self-management and medication
before and during the COVID-19 pandemic (From January 25, 2020 to April
25, 2020), were collected.
Results We contacted 286 patients, of whom 178 (62.2%)
responded with valid results. Before the COVID-19 pandemic, 4.5%
(8/178) and 6.7% (12/178) of the patients, respectively, had been
hospitalized and visited emergency departments due to asthma
exacerbations. 20.3% (36/177) of the patients had regularly visited the
hospital for follow-up and prescription, and 66.7% (118/177) had
received maintenance medication. During the COVID-19 pandemic, the
majority (92.1%, 164/178) of the patients felt that their symptoms were
similar or improved compared with usual times. The mean asthma control
test (ACT) score of the patients was 22.76 ± 3.06 (ranging from 8 to
25). 24.7% (44/178) of patients sought medical care for asthma. 25.6%
(45/176) of the patients ever experienced aggravation of asthma
symptoms, but mostly managed by themselves. It was also notable that
13.5% (24/178) of the patients had worried about potential shortage of
medications and some reduced dosing.
Conclusion During the COVID-19 pandemic, most of the patients
interviewed reported controlled asthma and compliance with usual care.
Although a quarter of the patients experienced asthma exacerbations,
only a few needed emergency visit or hospitalization. It is important
for patients to continue taking their prescribed asthma medications as
usual and maintain good asthma control during the ongoing pandemic.
Keywords: COVID-19 pandemic; asthma control; asthma medication,
self-management, healthcare access
Introduction
The pandemic of COVID-19, caused
by the pathogen respiratory syndrome coronavirus (SARS-CoV-2), has now
spread around the globe with over 4.0 million individuals affected and
over 270,000 deaths internationally. As of May 10, 2020, 84431 cases
have been diagnosed and 4643 died in China1, 2.
Chronic health conditions such as diabetes, hypertension and heart
diseases are major risk factors for developing more severe symptoms of
COVID-193.
Asthma is a common chronic airway disease worldwide, affecting 1–18%
of the populations of different countries1. A large
comprehensive asthma survey in a nationally representative sample of
Chinese adults indicated that asthma is a major public health challenge
in China that affects 45.7 million adults aged 20 years or
older4. Published data from China noted that asthma
was not a strong risk factor for severe COVID-19
disease5-8. However, recently, a report from the CDC
in the US indicated that adults hospitalized with COVID-19 had a higher
rate of a history of asthma (12.9%) than the general population
(10%)9.
International societies responded quickly by releasing
guidelines/guidance on the management of asthma during the COVID-19
pandemic1, 10, 11, and the recommendation that
patients with asthma should remain on their current asthma medications
is supported by multiple international organizations, including the
Centers for Disease Control and Prevention11, the
Global Initiative for Asthma1, and the North American
consensus guideline on allergy care during the COVID-19
pandemic12. However, these temporary guidelines were
based largely on previous asthma guidelines and expert consensus,
because evidence from related studies was lacking.
During the COVID-19 pandemic, governments have implemented restrictions,
even city lockdown, to contain transmission of the disease. In Beijing,
from late January 2020, the government advised citizens to stay home and
keep social distancing. These measures could compound asthma medication
or healthcare access, and even negatively impact asthma control and
management. However, there has been no study on the real impact of
COVID-19 on asthma. Therefore, we conducted a survey of asthma control,
medication, self-management and health resource use during the COVID-19
pandemic in Beijing.
Methods
Study design
This was a single-center, retrospective, cross-sectional survey by
telephone call performed in Peking University Third Hospital. Patients
were selected for interview by the following inclusion criteria: (1) 18
years of age or older; (2) a history of at least 3 months of diagnosed
asthma according to GINA guidelines [GINA, 2016]. During the phone
interview, sociodemographic information and clinical data, including the
status of asthma control, exacerbation, medication, self-management
plan, and the patients’ perceptions of overall asthma control before and
during the COVID-19 pandemic (From January 25, 2020 to April 25, 2020)
were collected.
The study protocol was approved by the Independent Ethics Committee of
the Peking University Third Hospital. (IRB00006761-M2020189)
Telephone interview and data
collection
The study was performed via a telephone interview that was communicated
in plain language and designed to assess the status of asthma control,
exacerbation, self-management, hospital visits, medication availability
and the patients’ perceptions of asthma control before and during the
COVID-19 pandemic. The interviewing physician would explain the aim and
significance of this investigation, the amount of time required, and the
confidentiality and user-permissions for the collection of data. Upon
getting approval from the patients, the interviewer carried on asking
the questions from a questionnaire, which covered the following items.
Demographics
Demographic variables assessed included time of the survey
(month/day/year), sex (male vs. female), age, ethnicity, permanent
residence, employment (currently working, retired, unemployed vs.
other), professions, education, medical insurances, and smoking status.
Asthma control, self-management and medication before the
COVID-19
pandemic
Questions concerning asthma control, self-management and medication
before the COVID-19 pandemic were asked, including, (1) history of
asthma, status of asthma control, hospitalization or emergency
department (ED) visits due to asthma exacerbation in the previous year
before the COVID-19 pandemic;(2) asthma management: written asthma
action plans, peak flow monitoring, attendance to asthma education
program, online consultation, regular follow-up; (3) asthma medications:
medications used and compliance.
Asthma control, self-management, medication and healthcare
utilization during the COVID-19
pandemic
For evaluation of asthma control, self-management, compliance and health
resource utilization in the previous 3 months during the COVID-19
pandemic, we asked the following questions: (1) Asthma Control Test
(ACT) scores, by which the control level of asthma was classified into
well-controlled (20-25), not well-controlled (16-19) and very poorly
controlled (5-15) (1). (2)Asthma exacerbations, hospital or ED visits
due to asthma exacerbation; (3) Self-management, disease monitoring,
rescue drug use; (4) Asthma medications: compliance in maintenance
therapy, maintenance medication, prescription refill, follow-up visits
to doctors.
Quality control
Prior to the investigation, the physicians involved were required to
attend a centralized training session. Any identifier to an individual
patient, such as identification number and full name, was not collected.
All data were inputted into a programmed database by two people
independently for statistical analysis.
Statistical analysis
Statistical analyses were performed using SPSS Statistics 24(The IBM,
Chicago, USA). The mean (SD) was used for continuous variables, and
frequency distribution, constituent ratios and percentages were used for
categorical variable/binary data. Our analyses used all participants for
whom the variables of interest were available. We did not impute missing
data.
Results
Demographic and clinical characteristics of study
participants
We made telephone calls to 286 patients, of whom 178 (62.2%) accepted
the interview and responded with valid results, while108 (37.8%)
refused. The mean age of the 178 patients was 49.74 ± 17.06 (ranging
from 20 to 92) years, with a median duration of disease of 4.00 (ranging
from 0.5 to 62) years. There were 100 women (56.2%) and 78 men
(43.8%). The majority of them (90.8%) lived in urban Beijing. 11.0%
(19/172) of the patients were current smokers and 7.6% (13/172) were
former smokers, with an amount of smoking of 21.03 ± 16.76 (ranging from
4 to 57) pack-years. 54.0% (88/163) were employed, and 88.8% (150/169)
had medical insurance coverage, including Free Medical Service, Urban
Resident Basic Medical Insurance (URBMI)/Urban Employee Basic Medical
Insurance (UEBMI), Medical Insurance in Different Places and New Rural
Cooperative Medical System (NCMS). The demographic and socioeconomic
data are summarized in Table 1.
Table 1. Demographic and socioeconomic data.