Introduction
Pediatric asthma is the most common chronic lung disease in children
worldwide and may cause serious morbidity and
mortality1. The main focus of optimal asthma
management is symptom control and prevention of exacerbations of the
disease. However, 5% of children suffer from uncontrolled asthma
despite maximal therapy, substantially contributing to asthma burden in
this patient group2,3. Asthma exacerbations, defined
as an acute deterioration requiring a prompt change in treatment, can be
so severe that they require an emergency department (ED) visit, a
hospital admission or even a pediatric intensive care unit (PICU)
admission4,5. Severe acute asthma (SAA) is
characterized by unresponsiveness to conventional therapy and requires
PICU admission for intravenous therapy and sometimes even
intubation6.
Usually, an asthma exacerbation is triggered by a viral infection,
mediated through increased T2 inflammation7. However,
external/environmental features such as pollen or air pollution are also
common triggers4,8, influencing not only the
occurrence of exacerbations but also, potentially, its
pathobiology9,10. The Coronavirus Disease 2019
(COVID-19) pandemic is another example of an external factor influencing
the risk for asthma exacerbations, especially during periods of major
daily disruptions, such as lockdowns11. It has been
suggested that the societal changes during the COVID-19 pandemic, in
terms of the environment, medical practice and medication usage, have
significantly influenced asthma management and
outcomes12. While the incidence of asthma
exacerbations in children during the COVID-19 pandemic has been
evaluated11,13-15, the incidence of SAA requiring PICU
admission and treatment during the pandemic is, to our knowledge, not
known. Therefore, the aim of this study was to examine the trend of
admissions for SAA at the PICU before and during the COVID-19 pandemic
and to evaluate whether this could be linked to the COVID-19
restrictions or other external factors including environmental triggers.