COVID-19 Not Associated With Asthma Development in Children

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COVID-19 likely does not increase the risk of asthma development in pediatric patients, research suggests.

Although respiratory viral infections early in life are known to be a risk factor for asthma, new research suggests that COVID-19 is not linked to asthma development in children.

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This retrospective cohort study was published in American Academy of Pediatrics.¹

“During the early days of the pandemic, we could isolate the effects of COVID-19 from other viruses and follow these patients long enough to observe the onset of asthma,” said first study author James P. Senter, MD, MPH, an attending physician in the Department of Pediatrics at Children’s Hospital of Philadelphia (CHOP), in a statement.² “We were also testing so frequently that we had a built-in control group to compare asthma symptoms and whether COVID-19 was a critical factor.”

In the wake of the COVID-19 pandemic, many families worried about the long-term effects of COVID and whether it might trigger an asthma diagnosis in their children. Therefore, this study aimed to address these concerns by determining whether COVID infection modified pediatric incident asthma risk.

The study included children aged 1 to 16 years who received polymerase chain reaction (PCR) testing for COVID-19 between March 1, 2020, and February 28, 2021. All patients were considered unvaccinated during this exposure window.

Additionally, all patients were required to have at least 1 ambulatory child visit in the year preceding the PCR test and at least 1 CHOP Care Network (CCN) visit at any time during an 18-month follow-up period after their first positive or last negative PCR test. The 18-month follow-up began 30 days after the PCR test to provide a reasonable separation between the exposure and outcome.

Sex, age, race, and insurance status was included in the analysis for all patients.

A total of 27,423 patients were included in the study, with 3147 (11.5%) individuals in the COVID-19–positive group and 24,276 (88.5%) individuals in the COVID-19–negative group. Patients in the COVID-19–positive group tended to be older (aged ≥ 12 years, 31.5% vs 22.7%), Black (24.9% vs 20.8%), Medicaid insured (31% vs 25.6%), among lower childhood opportunity index quintiles (very low, 23.4% vs 18.2%), and have a higher body mass index (19.3 vs 18.4) than patients who were COVID-19–negative.

COVID-19 positivity was not associated with new asthma diagnosis in the 18-month follow-up period (HR, 0.96; 95% CI, 0.73-1.27). However, Black race (HR, 1.49: 95% CI, 1.13-1.95), comorbid food allergy (HR, 1.26; 95% CI, 1.03-1.55), and allergic rhinitis (HR, 2.30; 95% CI, 1.93-2.74) were associated with a significantly higher hazard or new asthma diagnosis. On the other hand, children aged 5 to 11 years and 12 years and older were found less likely to have a new asthma diagnosis.

However, the researchers noted some limitations to the study. Since the study focused solely on pediatric patients, more research is needed to confirm there is no relationship between COVID-19 and the development of asthma. Additionally, because the study’s exposure window preceded the evolution of several COVID-19 variants, it is possible these later COVID-19 strains may influence asthma risk differently.

Despite these limitations, the researchers believe that COVID-19 positivity does not confirm an additional risk of asthma diagnosis within the first 18 months after PCR testing.

“This well-powered study reaffirms risk factors we know contribute to asthma development and provides clinically useful information to pediatricians and providers on the absence of risk of developing asthma as a result of COVID-19,” said senior study author David A. Hill, MD, PhD, an attending physician with the Division of Allergy and Immunology at CHOP, in a statement.² “We are hopeful that this study will put to rest an outstanding question on the minds of many their families.”

References

1. Senter JP, Aisenberg LK, Dudley JW, et al. Covid-19 and asthma onset in children. Pediatrics. Published online April 12, 2024. doi:10.1542/peds.2023-064615

2. Researchers find no link between COVID-19 virus and development of asthma in children. EurekAlert! News Release. April 12, 2024. Accessed April 17, 2024. https://www.eurekalert.org/news-releases/1040818.