Is asthma gone?

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cowbydoc

cowbydoc

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Greetings everyone! I’m a pedi anesthesiologist in New England. Over the past three months or so I’ve noticed a significant drop off in kids coming in with asthma symptoms during my preop exam. We have a large asthma population here for various reasons and it is not uncommon for kids to be a little wheezy at baseline. Even more eye opening is that the vast majority say they haven’t used their inhalers in about a year, basically when everyone started staying home from the pandemic. I’ve talked with a local pediatric pulmonologist and he says his clinic is running on fumes. Even in my own life, my child has needed Flovent in the winter for the past two years but not this year.
Have we completely underestimated the role recurrent infections have on our lungs? What if asthma is not the intrinsic inflammatory process that we thought it was. What if we somehow were able to somehow control URI’s, would the vast majority of asthma just go away?
I would love to hear your thoughts on this subject. I only see a small sample of kids but other clinicians I have talked with are seeing the same thing. Look forward to the discussion.
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Well my emergency department is still seeing good numbers of asthma exacerbations. They do seem a little less severe recently but seeing them a good amount none-the-less.
 
cowbydoc said:
Greetings everyone! I’m a pedi anesthesiologist in New England. Over the past three months or so I’ve noticed a significant drop off in kids coming in with asthma symptoms during my preop exam. We have a large asthma population here for various reasons and it is not uncommon for kids to be a little wheezy at baseline. Even more eye opening is that the vast majority say they haven’t used their inhalers in about a year, basically when everyone started staying home from the pandemic. I’ve talked with a local pediatric pulmonologist and he says his clinic is running on fumes. Even in my own life, my child has needed Flovent in the winter for the past two years but not this year.
Have we completely underestimated the role recurrent infections have on our lungs? What if asthma is not the intrinsic inflammatory process that we thought it was. What if we somehow were able to somehow control URI’s, would the vast majority of asthma just go away?
I would love to hear your thoughts on this subject. I only see a small sample of kids but other clinicians I have talked with are seeing the same thing. Look forward to the discussion.
Click to expand...

Sure I think this is a valid point. I'm not sure if this is underestimating the role of URIs in asthma though, URI season usually corresponds with status asthmaticus season. Also think about how many kids stayed inside this past year and weren't exposed as heavily to all the allergens in the past spring/fall that they would usually be exposed to. Breathing through masks constantly that filtered some of the irritants that would cause an asthma exacerbation. Less asthma but more obesity and depression....
 
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Was gone in the fall, we're picking up speed in my PICU though.

Is the morbidity associated with viral URI's higher than we thought? Probably. I also think a lot of people misconstrue asthma as a bronchoconstrictive disease, and don't focus as much on the chronic inflammation (probably not the pulmonologists, but most everyone else most likely). Or people will focus on allergic symptoms and not think "inflammation". Removing a major inciting pathway and it's not surprising most were healthier.
 
I think most people appreciate the seasonality of asthma and the fact that the winter cold/flu season directly correlates with exacerbations. I mean, I will often tell families that even Flovent usage is seasonal and sometimes only needed during the winter months.

Is the current decrease directly related to the fact schools aren't open and outdoor activities are cancelled and everyone wears a mask and not touch each other? Absolutely. If you were somehow able to control viruses without impeding people's ability to interact with one another, would asthma rates decrease? Yes (though there would be confounders unrelated to viruses but related to other exposures... ie pollution/toxins). But are you gonna be able to do so? No... so there it is.

Edit: for those interested in the relationship between asthma and school attendance (ie playing in the Petri dish)

Seasonality of Asthma: A Retrospective Population Study

OBJECTIVES:. Seasonal variations in asthma are widely recognized, with the highest incidence during September. This retrospective population study aimed to investigate whether this holds true in a large group of asthmatic children in primary care and to assess the impact of age, gender...
pediatrics.aappublications.org pediatrics.aappublications.org
 
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Agree with Beta. We are definitely seeing an uptick in the PICU lately. It didn't completely disappear but did go down this past season. Given that we've seen no flu and almost no RSV, you're probably right in pointing to the role of infection or exposure as a trigger.
 
Definitely less this year. I'm curious to see if we get the summer RSV season that Australia saw. If all the cold viruses pick up this summer maybe we will see a summer asthma exacerbation uptick this year. That would be even more confirmation that the 'mild' illnesses are playing a big role.
 
rhinovirus is still running rampant, all the severe asthma exacerbations I have seen have been rhino. Couple ecmo cases
 
It's May 25th, it was 90 degrees out yesterday, and my PICU is at capacity and a full 1/3 of the patients had RSV...unbelievable.
 
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BigRedBeta said:
It's May 25th, it was 90 degrees out yesterday, and my PICU is at capacity and a full 1/3 of the patients had RSV...unbelievable.
Click to expand...

I was in the picu and ED the last 2 months and definitely saw a bunch of URI’s/RSV and asthma. For some of the interns it was their first time seeing RSV or managing asthma... in like April/May.. so crazy
 
SurfingDoctor said:
We’ve certainly seen a lot of late season RSV this year. We’ve seen actually a lot of kids with comorbidities get really sick with Parainfluenza this year.
Click to expand...
And unrelated to you folks, but us adult doctors are seeing a lot of lobar pneumonia. It's getting weird out here.
 
SurfingDoctor said:
We’ve certainly seen a lot of late season RSV this year. We’ve seen actually a lot of kids with comorbidities get really sick with Parainfluenza this year.
Click to expand...
Is it all paraflu 3 where you are? It feels like half the hospital had paraflu 3 this week including several kids with bad pARDS.
 
PTPoeny said:
Is it all paraflu 3 where you are? It feels like half the hospital had paraflu 3 this week including several kids with bad pARDS.
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I’m not sure the viral panels we send do subtypes. But I bet if you’re seeing that subtype, we’re seeing the same.

Edit: No you're right, Paraflu 3.
 
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PTPoeny said:
Is it all paraflu 3 where you are? It feels like half the hospital had paraflu 3 this week including several kids with bad pARDS.
Click to expand...
Yes

Lots of RSV/Paraflu 3 combos
some Corona OC43
Rhino/entero is at typical for summer levels it feels like
Have not seen any adeno
 
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