Reduced asthma morbidity during COVID-19 in minority children: is medication adherence a reason?

Abstract

Objectives

Asthma control improved during the COVID-19 pandemic. This study examined objectively measured medication adherence, asthma morbidity and quality of life (QoL) outcomes in Black and Latinx children by month for January-June 2019 (pre-COVID) compared to January-June 2020 (including first peak of COVID).

Methods

Secondary analyses of 94 children with asthma (ages 10–17 years, 64% Latinx, 36% Black) and their caregivers assigned to the comparison group of a longitudinal RCT intervention trial. Outcomes included mean aggregate electronic adherence for controller medications, oral steroid bursts, acute healthcare utilization, caregiver asthma QoL, and the Asthma Control Test. Repeated measures analyses were conducted due to multiple observations.

Results

Adherence to controller medications declined 48% from 2019 to 2020 (LS Mean = 33.9% vs. 17.6%, p=.0004, f=.92) with levels reaching a low in May 2020. A reduction in steroid bursts was observed over the same timeframe, 1.29 vs. 0.61, p = 0.006, f=.63. Caregiver QoL increased from 2019 to 2020 on total score (5.18 vs. 5.85, p = 0.002, f=.72), activity limitations (5.04 vs. 5.95), and emotional functioning (5.26 vs. 5.80). Although not statistically significant, a clinically meaningful 62% reduction in acute healthcare visits (p = 0.15) was reported in 2020. Children reported better asthma control (OR = 1.47, 95% CI 1.24, 1.73, p < 0.0001) in 2020 versus 2019 driven by improvements from May to June 2020.

Conclusions

Decreased asthma morbidity in minority children during COVID was coupled with decreased adherence to controller medications. This observed decrease in morbidity is not explained by improvements in adherence.

Keywords:

• Compliance
• quality of life
• healthcare utilization
• asthma control
• disparities

Disclosure of interest

The authors report no conflict of interest.

Additional information

Funding

This work was funded by the Clinical and Translational Science Award.

This work was supported by the National Institutes of Health (R01HL128260 to JMF) and (CTSA 5UL1TR002556). The National Institutes of Health (study sponsor) had no role in the design, conduct of the study, writing of the report, or decision to submit this article.