Impact of COVID-19 lockdown on emergency asthma admissions and deaths: national interrupted time series analyses for Scotland and Wales
March 2021: Study finds 36% fewer people were admitted to hospital in Scotland and Wales in the first lockdown due to asthma.
Researchers from EAVE II, in partnership with AUKCAR (Asthma UK Centre for Applied Research) and BREATHE (the Health Data Research Hub for Respiratory Health) have found that the first lockdown was associated with a 36% drop in emergency admissions for asthma in Scotland and Wales.
This large, population-based study across two UK nations shows the most substantial reduction in severe asthma exacerbations in the UK ever recorded.
Asthma an expected risk factor
Early in the pandemic, asthma was identified as a potential risk factor for hospital admission and death from COVID-19, and since the majority of asthma exacerbations are associated with respiratory viral illnesses, it was expected that asthma exacerbations might increase.
Stay at home messages from governments, and fear of the virus could have dissuaded patients experiencing asthma exacerbations from seeking help from health services.
On the other hand, restrictions on travel and social contact, resulted in reduced air pollution and transmission of other respiratory viruses, which could have led to a true reduction in asthma exacerbations during lockdown. In the UK the first nationwide lockdown began on 23 March, 2020.
Professor Gwyneth Davies, Postgraduate Training Lead at AUKCAR, and colleagues used official data on emergency admissions and deaths due to asthma from Public Health Scotland and Wales’ SAIL Databank. They compared weekly rates in the first 18 weeks of 2020 with the national averages over 2015-2019. They looked at how trends changed between the first 13 weeks of 2020 compared with the five weeks post-lockdown.
Across both countries, the number of asthma exacerbations resulting in emergency hospital admission fell by more than a third (36%) post-lockdown, and there was no significant change in asthma deaths.
Davies and colleagues say, “We do not yet know to what degree the reduced numbers of emergency presentations of asthma in our study are due to improvements in asthma control or reductions in exposures to triggers during the pandemic versus avoidance of healthcare settings.”
The researchers note that in Wales there was a large spike in GP prescriptions for asthma medication the week before lockdown - 121% more inhaled corticosteroids and 133% more oral corticosteroid prescriptions compared with the five-year average.
This is an observational study, and as such, can’t establish cause. The authors of the article also point out several limitations including that case definitions were not validated and that the small number of asthma deaths in both nations restrict the power to detect small changes in deaths during lockdown.
Read the article
Davies GA, Alsallakh MA, Sivakumaran S, et al. Impact of COVID-19 lockdown on emergency asthma admissions and deaths: national interrupted time series analyses for Scotland and Wales. Thorax Published Online First: 29 March 2021. doi: 10.1136/thoraxjnl-2020-216380