Pediatric Asthma Exacerbation in Children with Suspected and Confirmed Coronavirus Disease 2019 (COVID-19): An Observational Study from Saudi Arabia

Figures & data

Table 1 Characteristics of COVID-19 and Non-COVID-19 Asthmatic

Variables	Total n=60	Asthmatic with COVID-19 n=10 (16.7%)	Asthmatic Without COVID-19 n=50 (83.3%)	P value
Age, median (IQR), y	5 (3–8)	6.5 (4.25–8.75)	5 (3–7.75)	0.119
-Toddler (<3y)		0 (0.0%)	11 (22%)	0.183
-Preschool (3–<5y)		3 (30%)	12 (24%)	0.699
-School age (5–12y)		7 (70%)	26 (52%)	0.488
Sex, male, No. (%)	35 (58%)	5 (50%)	30 (60%)	0.727
History of contact with COVID-19, No. (%)	11 (18.3%)	9 (90%)	2 (4%)	<0.001*
Age at first symptoms (months)	12 (6–24)	9 (5.5–20)	12 (6–24)	0.800
Clinical features at presentation, No. (%)
-Fever	56 (93.3%)	9 (90%)	47 (94%)	0.427
-Cough	60 (100%)	10 (100%)	50 (100%)	–
-Shortness of breath (SOB)	57 (95%)	8 (80%)	49 (98%)	0.308
-Sore throat	52 (86.6%)	9 (90%)	43 (86%)	0.636
-Runny nose	52 (86.7%)	9 (90%)	43 (86%)	0.636
-URTI	51 (85%)	8 (80%)	43 (86%)	0.637
-Temperature, mean –/+SD	37±0.8	37.5 ±0.4	37±0.86	0.014*
-Respiratory Rate, median (IQR)	38 (30–45)	35 (27–38)	39 (30–45)	0.068
-Oxygen saturation, median (IQR)	85% (80–88)	88% (82.5–90)	85% (80–88)	0.149
Hemoglobin (Ref: 11.5–15.5 g/dL), median (IQR)	13(12–13.9)	14(12.9–14.9)	13(11.8–13.8)	0.153
ESR (Ref: 0.0–15 mm/hr), median (IQR)	24(12–41)	28(16–36)	24(11–42)	0.542

Note: *P < 0.05 (significant).

Table 2 Severity and Phenotypes of COVID-19 and Non-COVID-19 Asthmatic

Variables	Total n=60	Asthmatic (COVID-19 +) n=10 (16.7%)	Asthmatic (COVID-19 −) n=50 (83.3%)	P value
Asthma severity, No. (%)
-Intermittent	21(35%)	1(10%)	20(40%)	0.083
-Mild	11(18.3%)	3(30%)	8(16%)	0.371
-Moderate	12(20%)	0(0%)	12(24%)	0.188
-Severe	16(26.7%)	6(60%)	10(20%)	0.016*
Asthma duration ≥ 5 yrs	26(43.3%)	6(60%)	20(40%)	0.305
≥1 hospitalization for asthma exacerbation (last year)	41(68.3%)	5(50%)	36(72%)	0.263
ER visit last year	59 (98.3%)	9(90%)	49(98%)	0.308
OCS last year (No.)	57 (95%)	9(90%)	47(94%)	0.528
Previous intubation or PICU admission	21(35%)	5(50%)	16(32%)	0.298
Associated atopies for at least one	45(75%)	10 (100%)	36 (72%)	0.097
-Allergic rhinitis	35 (58.3)	8 (80%)	27 (54%)	0.171
-Eczema	40 (66.7%)	6 (60%)	33 (66%)	0.728
-Food allergies	10 (16.7%)	2 (20%)	8 (16%)	0.668
Preadmission eosinophilic counts (cells/µL), median (IQR)	420(275–625)	530(52.5–1100)	420(312.5–570)	0.921
Eosinophilic asthma (Blood Eos ≥ 300/µL)	33 (55%)	5 (50%)	28 (56%)	0.742
Serum IgE (IU/mL), median (IQR)	398(183–249)	864(534–6240)	240(93.5–1486)	0.081
Admission eosinophils counts (cells/µL), median (IQR)	25(10–112.5)	10(0–30)	30(10–130)	0.118
Neutrophils (Ref: 1500–8500 cells/µL), median (IQR)	8120(5287.5–10,957.5)	4810(1707.5–9500)	8465(5922.5–11,032.5)	0.075

Note: *P < 0.05 (significant).

Table 3 Therapies and Outcomes of the Enrolled Patients

Variables	Total n=60	Asthmatic (COVID-19 +) n=10 (16.7%)	Asthmatic (COVID-19 –) n=50 (83.3%)	P value
Management, No (%)
Systemic steroids	60 (100%)	10 (100%)	50(100%)	–
Bronchodilators (SABA)	60 (100%)	10 (100%)	50(100%)	–
Critical care admission and respiratory support, No (%)
PICU admission	14 (23.3%)	3 (30%)	12 (24%)	0.699
HFNC use	13 (21.7%)	3 (20%)	11 (22%)	0.685
O2 use days, median (IQR)	3 (3–4)	3(1–4)	3(3–4)	0.418
Outcome measures
-Total hospital stays, median (IQR)	4 (3–5)	4.5 (1.75–6.25)	4 (3–5)	0.738
-Total PICU stays, median (IQR)	2(2–3.25)	5	3(2–3)	0.144
-Discharged, No (%)	60 (100%)	10 (100%)	50 (100%)	–

Abbreviations: SABA, Short-Acting Beta-2 Agonist; PICU, Pediatric Intensive Care Unit; HFNC, High Flow Nasal Cannula; O2, Oxygen; IQR, Interquartile Range.