Asthma and the Risk of SARS-CoV-2 Infection Among Children and Adolescents

• Published in: Pediatrics (Evanston) 2022-06, Vol.149 (6), p.1
• Main Authors: Rao, Saahithi, Hurst, Jillian H, Zhao, Congwen, Goldstein, Benjamin A, Thomas, Laine, Lang, Jason E, Kelly, Matthew S
• Format: Article
• Language: English
• Subjects: Adolescent; Asthma; Asthma - complications; Asthma - diagnosis; Asthma - epidemiology; Atopy; Child; Children; Coronaviruses; COVID-19 - epidemiology; COVID-19 Testing; Electronic medical records; Humans; Infections; Pediatrics; Retrospective Studies; Risk factors; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Teenagers; United States
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2021-056164

Over 6 million pediatric severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections have occurred in the United States, but risk factors for infection remain poorly defined. We sought to evaluate the association between asthma and SARS-CoV-2 infection risk among children. We conducted a retrospective cohort study of children 5 to 17 years of age receiving care through the Duke University Health System and who had a Durham County, North Carolina residential address. Children were classified as having asthma using previously validated electronic health record-based definitions. SARS-CoV-2 infections were identified based on positive polymerase chain reaction testing of respiratory samples collected between March 1, 2020, and September 30, 2021. We matched children with asthma 1:1 to children without asthma, using propensity scores and used Poisson regression to evaluate the association between asthma and SARS-CoV-2 infection risk. Of 46 900 children, 6324 (13.5%) met criteria for asthma. Children with asthma were more likely to be tested for SARS-CoV-2 infection than children without asthma (33.0% vs 20.9%, P < .0001). In a propensity score-matched cohort of 12 648 children, 706 (5.6%) children tested positive for SARS-CoV-2 infection, including 350 (2.8%) children with asthma and 356 (2.8%) children without asthma (risk ratio: 0.98, 95% confidence interval: 0.85-1.13. There was no evidence of effect modification of this association by inhaled corticosteroid prescription, history of severe exacerbation, or comorbid atopic diseases. Only 1 child with asthma required hospitalization for SARS-CoV-2 infection. After controlling for factors associated with SARS-CoV-2 testing, we found that children with asthma have a similar SARS-CoV-2 infection risk as children without asthma.