Impact of COVID-19 national lockdown on asthma exacerbations: interrupted time-series analysis of English primary care data

Abstract

Background The impact of COVID-19 and ensuing national lockdown on asthma exacerbations is unclear. Methods We conducted an interrupted time-series (lockdown on 23rd March as point of interruption) analysis in asthma cohort identified using a validated algorithm from a national-level primary care database, the Optimum Patient Care Database. We derived asthma exacerbation rates for every week and compared exacerbation rates in the period: January–August 2020 with a pre-COVID-19 period, January–August 2016–2019. Exacerbations were defined as asthma related hospital attendance/admission (including accident and emergency visit), or an acute course of oral corticosteroids with evidence of respiratory review, as recorded in primary care. We used a generalised least squares modelling approach and stratified the analyses by age, sex, English region and healthcare setting. Results From a database of 9 949 387 patients, there were 100 165 patients with asthma who experienced at least one exacerbation during 2016–2020. Of 278 996 exacerbation episodes, 49 938 (17.9%) required hospital visit. Comparing pre-lockdown to post-lockdown period, we observed a statistically significant reduction in the level (−0.196 episodes per person-year; p<0.001; almost 20 episodes for every 100 patients with asthma per year) of exacerbation rates across all patients. The reductions in level in stratified analyses were: 0.005– 0.244 (healthcare setting, only those without hospital attendance/admission were significant), 0.210–0.277 (sex), 0.159–0.367 (age), 0.068–0.590 (region). Conclusions There has been a significant reduction in attendance to primary care for asthma exacerbations during the pandemic. This reduction was observed in all age groups, both sexes and across most regions in England.

Rights

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/'>https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/'>https://creativecommons.org/licenses/by/4.0/.

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DOI

http://dx.doi.org/10.1136/thoraxjnl-2020-216512

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https://www.research.ed.ac.uk/portal/en/publications/impact-of-covid19-national-lockdown-on-asthma-exacerbations(c3c5be50-0cca-4429-b96d-3bc5391c0a25).html