Asthma Exacerbations Declined Among Black and Hispanic Patients During COVID-19

Following the onset of the COVID-19 pandemic, asthma exacerbations among Black/African American and Hispanic/Latinx individuals with moderately severe asthma nearly halved, according to a study published in The Journal of Allergy and Clinical Immunology: In Practice.

In the PREPARE Study, investigators recruited 1178 Black/African America and Hispanic/Latinx adults. The study was a national randomized, open-label, pragmatic trial of a patient-guided, reliever-triggered inhaled corticosteroid strategy.

The patients completed monthly questionnaires online, by phone, or by mail for 15 months after an in-person appointment. Recruitment was initiated in November 2018 and enrollment was completed March 2020 just as COVID-19–related lockdowns and stay-at-home orders were being initiated.

More than half (55%) were not working outside the home and 72% had an asthma exacerbation in the year before they enrolled in the trial. Asthma exacerbation rates decreased from the first quarter of 2020 to the second quarter compared with the same time period in 2019 for a relative reduction of 41%.

"We found a substantial decrease in asthma exacerbation—on the order of what we see for biologic therapies for severe asthma," lead author Justin Salciccioli, MBBS, MA, a fellow in the Division of Pulmonary and Critical Care Medicine at Brigham and Women's Hospital, said in a statement. "Although we don't know for sure who in the cohort changed their behavior, it's likely that decreased exposure to environmental or viral triggers contributed to our findings."

Patients who worked outside of the home had a 65% reduction in asthma exacerbations compared with a 23% decrease for patients who worked at home. Decreases were largest for patients who did not have type 2 inflammation, which suggested that viral or occupational factors may contribute more to exacerbation for patients with type 2 inflammation.

“This effect may be related to social-distancing and occupational changes and unlikely to be related to reduced health-system avoidance during the COVID-19 pandemic,” the authors wrote.

The results may not be generalizable to the general public since it only included Black/African American and Hispanic/Latinx adults, they noted.

This study stands apart from other studies of asthma exacerbations during COVID-19 that reported reductions in hospital and emergency presentations for asthma because it assessed exacerbations before and after the pandemic. Other studies that reported reductions may have reflected a reluctance to initiate in-person contact, the authors explained.

"This is the first study to assess asthma exacerbation before and after the COVID-19 pandemic using data that are unlikely to be affected by patients avoiding the health care system," said Salciccioli. "Because this was part of a prospective trial that started before the pandemic and was planned to be remote, it gave us a unique window into how changes during the pandemic may have led to a dramatic decrease in asthma exacerbation."

Reference

Salciccioli JD, She L, Tulchinsky A, Rockhold F, Cardet JC, Israel E. Effect of Covid19 on asthma exacerbation. J Allergy Clin Immunol Pract. Published online April 30, 2021. doi:10.1016/j.jaip.2021.04.038