Updated: July 17, 2021 8:41:25 am
Worldwide, Covid-19 lockdown measures have seen a huge drop in difficult-to-control cases of asthma attacks, including in school-going children. It has taken a pandemic to understand the importance of school-related respiratory viral infections as one of the major factors of asthma exacerbation in children, and how masks can be a protective measure against this disease, experts have said.
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“Before the pandemic started, over 60% of children who visited a paediatrician in India did so for respiratory symptoms, and a large proportion of these were for asthma. With the onset of the pandemic, the number of childhood asthmatics visiting a paediatrician plummeted by over 50–60%,” said Dr Sundeep Salvi, chair of the Chronic Respiratory Diseases Section, Global Burden of Diseases–India.
“This came as a surprise for doctors, as it was feared that the SARS-CoV-2 virus, being a respiratory predominant virus, would cause worsening of asthma. The reduction in the number of paediatric asthma cases visiting a healthcare facility actually came as a boon…,” Dr Salvi said.
Dr Gaurav Sethi, consultant paediatrician with a special interest in paediatric asthma, said new cases have gone down and episodes of asthma attacks been low. Extended lockdowns have also led to improved air quality.
Lockdown restrictions, schools being shut for in-person classes and social distancing have limited children’s physical activity and reduced exposure to environmental triggers, experts say in a study published in BMJ Open.
The European Respiratory Journal has published observations from studies in Singapore, where researchers noted a sustained reduction in asthma admissions with PCR-proven respiratory viral infections that coincided with public health measures during the pandemic. A reduced number of motor vehicles on the road and shutting down of industries, which were major sources of air pollution, must have also contributed, Dr Salvi said.
No physical school: According to Dr Salvi, a potential explanation for why asthma in children plummeted during the pandemic is that children did not attend school and stayed at home due to the pandemic. On an average, a child develops between two and five respiratory viral infections during a year and this becomes the reason for exacerbations among children suffering with asthma. The fact that asthma exacerbations plummeted among children suggests that school-related respiratory viral infections were a major cause of asthma exacerbations. Similar observations have been made in other countries.
Hand hygiene, masks: Wearing a mask can be a very useful protective measure against asthma. While schools will eventually reopen, Dr Salvi and other experts have said children wearing masks when they attend school even after the pandemic is over will likely be the most effective solution to reduce asthma suffering and exacerbations.
Wearing a mask not only protects against SARS-Cov-2, but also against other respiratory viruses. Protection from ambient air pollution will be an added advantage. “We also need to continue with the behaviour of hand hygiene even after the pandemic is over,” Dr Salvi said.
Burden of asthma
Asthma is the most common chronic disease among children. According to the World Health Organization (WHO), it affected an estimated 262 million people in 2019 and caused 4.61 lakh deaths.
According to the latest Global Burden of Disease (GBD) report, there are an estimated 3.4 crore asthmatics in India, of whom around 25% are children. Although India has 11% of global asthma cases, it accounts for 42% of global asthma deaths.
After the relaxation
With relaxations in lockdown-like restrictions, paediatricians have noted a slight rise in the number of cases of wheezing. Dr Umesh Vaidya, senior paediatrician and expert member in Pune’s Covid task force, said: “Rise in cases is usually a combination of weather and viral infections. Last year, there was a total lockdown and hence there were very few cases. With easing of lockdown restrictions, there has been some social interaction, especially as children play with each other and mild viral infections can trigger wheezing episodes. This month, we have started seeing a rise in cases.”
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