INTRODUCTION
Since the coronavirus disease 2019 (COVID-19) was first reported in Wuhan, China, in December 2019, the disease caused by SARS-CoV2 virus has rapidly spread worldwide resulting in declaration of a pandemic by the World Health Organization (WHO) on March 2020, becoming one of the most important challenges humans are facing nowadays. [1,2] Its clinical manifestations characteristically vary from asymptomatic cases, to mild and severe cases, mainly affecting the respiratory tract.
People with asthma are usually at greater risk of more severe outcomes due to virus infections. However, recent reports reveal that the prevalence of COVID-19 in asthma patients is lower than expected. [3]
It seems that COVID-19 has less direct impact on children and adolescents than on adults. Only about 1% of the entire COVID-19 population are children, being pediatric asthma patients underrepresented in this population. [4] Symptoms tend to be less severe, varying from asymptomatic, to mild-moderate cases. There is no gender difference, and all ages appear to be susceptible to the disease. [5]
Several hypotheses have been proposed to explain this fact: reduced angiotensin converting enzyme 2 (ACE2) gene expression, less often comorbidities associated, less potent PAMP activation, suboptimal and Th2-skewed cytokine production, resulting in a hypo-inflammatory immune response, and an extensive vaccination program, leading all to a beneficial immune response towards SARS-CoV-2 infection. [1,5]
Until now, no one has considered if both individual and social behavior of patients before the pandemic could have influenced this low prevalence.
The main purpose of this study is to analyze lifestyle before the pandemic in severe pediatric asthma patients in treatment with monoclonal antibody (MAB), belonging to Castellon’s University General Hospital Health’s Department (Castellon, Spain), and investigate the prevalence of COVID-19 in these patients in order to see if their lifestyle may have influenced the probability of being infected by COVID-19 or not. Secondly, we wanted to study the behavioral of these patients, and determine the level of asthma control during the pandemic.