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Children with asthma exposed to COVID-19 implies decrease in severity from its baseline: Systematic Review from March 2020- September 2022

Juel Chowdhury*, Rejoice P. Ravi

Introduction: During the COVID-19 pandemic, children have been severely affected by SARSCoV-2 infection which primarily affects the respiratory system. Children with chronic respiratory diseases such as asthma, emphysema, and chronic bronchitis can experience an exacerbation of the preexisting conditions. This systematic review aims to identify the severity of asthma in COVID-19-exposed children aged 4-12 years. Methods: A systematic review of the literature was performed to gain an understanding of children with asthma exposed to COVID-19. Data were extracted from the PubMed database between March 2020 and September 2022. During the COVID-19 pandemic, 169 PubMedpublished articles involving children aged 4-12 years were identified. Children underwent testing for SARS-CoV-2 and positive test results were included in the study. We screened 28 articles out of 169 PubMed articles. Finally, 7 articles out of 28 articles were included in the study. Results: The number of children with asthma hospitalized owing to COVID-19 across the world was 1% to 2.7%. Incidence was 12.8 times less frequent in children than in adults. Increased expression of the angiotensin-converting enzyme-2 gene in the bronchial epithelium of patients with type 2-low or T1-high asthma tended to have higher known risk factors for COVID-19 including hypertension, and lymphopenia. Among school-age children (N=277,285), 1.2% were hospitalized, 0.1% had intensive care unit admissions, and <0.1% died. Of those patients (hospitalized, ICU admissions, and those who died from COVID-19), each had at least one underlying medical condition and 55% of the underlying conditions were accounted for by chronic lung disease including asthma. Conclusion: Childhood asthma outcomes were improved during the COVID-19 pandemic. This could be due to reduced exposure to asthma triggers. Parents, caregivers, and children are advised to continue proper asthma management.