Impact of COVID-19 national lockdown on asthma exacerbations: interrupted time-series analysis of English primary care data.

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  • Additional Information
    • Source:
      Publisher: British Medical Assn Country of Publication: England NLM ID: 0417353 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1468-3296 (Electronic) Linking ISSN: 00406376 NLM ISO Abbreviation: Thorax Subsets: MEDLINE
    • Publication Information:
      Original Publication: London : British Medical Assn.
    • Subject Terms:
      Disease Progression* ; Symptom Flare Up*; Asthma/*epidemiology ; COVID-19/*prevention & control ; Primary Health Care/*statistics & numerical data; Administration, Oral ; Adolescent ; Adrenal Cortex Hormones/therapeutic use ; Adult ; Asthma/drug therapy ; Emergency Service, Hospital/statistics & numerical data ; England/epidemiology ; Female ; Humans ; Interrupted Time Series Analysis ; Male ; Middle Aged ; Patient Admission/statistics & numerical data ; SARS-CoV-2 ; Young Adult
    • Abstract:
      Background: The impact of COVID-19 and ensuing national lockdown on asthma exacerbations is unclear.
      Methods: We conducted an interrupted time-series (lockdown on 23 March 2020 as point of interruption) analysis in asthma cohort identified using a validated algorithm from a national-level primary care database, the Optimum Patient Care Database. We derived asthma exacerbation rates for every week and compared exacerbation rates in the period: January to August 2020 with a pre-COVID-19 period and January to August 2016-2019. Exacerbations were defined as asthma-related hospital attendance/admission (including accident and emergency visit), or an acute course of oral corticosteroids with evidence of respiratory review, as recorded in primary care. We used a generalised least squares modelling approach and stratified the analyses by age, sex, English region and healthcare setting.
      Results: From a database of 9 949 387 patients, there were 100 165 patients with asthma who experienced at least one exacerbation during 2016-2020. Of 278 996 exacerbation episodes, 49 938 (17.9%) required hospital visit. Comparing pre-lockdown to post-lockdown period, we observed a statistically significant reduction in the level (-0.196 episodes per person-year; p<0.001; almost 20 episodes for every 100 patients with asthma per year) of exacerbation rates across all patients. The reductions in level in stratified analyses were: 0.005-0.244 (healthcare setting, only those without hospital attendance/admission were significant), 0.210-0.277 (sex), 0.159-0.367 (age), 0.068-0.590 (region).
      Conclusions: There has been a significant reduction in attendance to primary care for asthma exacerbations during the pandemic. This reduction was observed in all age groups, both sexes and across most regions in England.
      Competing Interests: Competing interests: None declared.
      (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)
    • Comments:
      Erratum in: Thorax. 2023 Sep;78(9):e3. (PMID: 37586734)
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    • Grant Information:
      MC_PC_19004 United Kingdom MRC_ Medical Research Council; MC_PC_19075 United Kingdom MRC_ Medical Research Council; MR/S019669/1 United Kingdom MRC_ Medical Research Council
    • Contributed Indexing:
      Keywords: COVID-19; asthma; asthma epidemiology
    • Accession Number:
      0 (Adrenal Cortex Hormones)
    • Publication Date:
      Date Created: 20210330 Date Completed: 20210830 Latest Revision: 20240403
    • Publication Date:
      20240403
    • Accession Number:
      PMC8011425
    • Accession Number:
      10.1136/thoraxjnl-2020-216512
    • Accession Number:
      33782080