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COVID-19 and asthma: what are the risks for children?

Fortunately, COVID-19 causes much milder disease in children compared to adults. In fact, there have been very few children with serious or life-threatening COVID-19 illness around the world. The reasons why children are more mildly affected than adults is not clear and we are trying to solve this mystery through an extensive program of research at MCRI. This research will likely reveal important clues as to how the virus infects our cells and what drives severe COVID-19 disease. We will also seek to further understand whether chronic health conditions in children, such as lung disease, increases the risk of severe infection.
 
As COVID-19 affects the lungs it is important to understand how children with common lung conditions, such as asthma, might be affected if they contract the virus. 

My child has asthma, are they at higher risk of COVID-19?

Fortunately, we have had very few cases of COVID-19 in children in Australia and to date, no child has needed intensive care admission or mechanical ventilation. Reassuringly, studies from overseas have reported similar findings. Epidemiological studies (of large populations of people) investigating factors associated with severe COVID-19 show that chronic lung diseases such as asthma do not appear to increase risk. Some authors have even suggested that having asthma, or being on asthma medication, may actually lower the risk of severe COVID-19, however this is yet to be proven. 

As COVID-19 infection causes cough and shortness of breath, it is possible that milder cases of COVID-19 in asthmatics have been mistaken as asthma flare-ups. In any case, the bottom line is that, as viruses are a major trigger for asthma flare-ups in children, we are treating COVID-19 like any other respiratory virus in children.

What do I need to do to keep my child with asthma safe?

As we are entering the cooler months it is important that children with asthma are taking their preventer medication regularly, if prescribed, and are always carrying their Ventolin. They should use their inhalers via a spacer (and mask in children aged 4 years or under). Daily use of a preventer is the single most effective method of reducing the chance of a bad asthma flare-up. Now is the time to arrange a visit to your local GP to ensure that you have an up-to-date asthma action plan and to make any adjustments to your asthma medication. 

The annual influenza vaccine is also very important to reduce the chance of becoming very unwell with the flu. It is a good idea for all household members to have the vaccine also to reduce the chances of your child being exposed. And of course, prevention is always better than cure, so, minimise the chance of becoming infected and follow social distancing recommendations closely and ensure your child washes their hands regularly. 

Do inhaled steroids increase the risk of COVID-19?

Whilst there was some earlier evidence to suggest that steroid medication could worsen COVID-19, this is unclear. In the setting of a moderate to severe flare-up of asthma oral steroids are still recommended. In fact, it is possible, but not proven, that inhaled steroid medications may be protective against severe COVID-19 infection but further research is needed in this area. 

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Author: Dr Danielle Wurzel is a Respiratory Physician and post-doctoral researcher at Melbourne Children’s Campus (The Royal Childrens Hospital, The University of Melbourne and Murdoch Children's Research Institute). She is leading research into hospitalisations for COVID-19 and developing a platform to collect data across Australia and New Zealand. She is also investigating how COVID-19 affects children with chronic respiratory diseases, such as asthma and bronchiectasis, to help inform future management and prevention strategies.