Background:

Reported reductions in emergency department visits and hospitalisations for asthma in previous studies have suggested a beneficial effect of COVID-19 lockdown measures on asthma morbidity. Nevertheless, studies relying on administrative data may overestimate the true impact of lockdowns due to changes in health seeking behaviour and reduced availability of pediatric asthma services during the pandemic. We systematically reviewed the literature and identified observational cohort studies that focused on non-administrative data to assess the true impact of COVID-19 lockdowns on symptoms control in children with asthma.

Methods:

A systematic literature search was conducted between January 2020 and August 2022 (PROSPERO ID: CRD42022354369).

Results:

During the lockdown periods, the pooled asthma symptoms control test (cACT) score (standardized mean difference: 1.99, 95%CI: 1.02, 2.97, I2: 97.6%) and the proportion of children with well controlled asthma (Relative Risk (RR): 1.31, 95%CI: 1.05, 1.63, I2: 71.8%) were significantly increased. On the other hand, the pooled proportion of children with poorly controlled asthma (RR: 0.54, 95%CI:0.38. 0.76, I2: 59.7%) and the pooled proportion of children experiencing asthma exacerbations (RR: 0.31, 95%CI: 0.25, 0.38, I2:10.6%) were significantly decreased.

Conclusions:

During COVID-19 lockdowns, asthma symptoms and breakthrough disease exacerbations were significantly reduced in children with asthma. Further research is warranted on potential interventions aiming to enhance asthma control after the pandemic, while taking into consideration their acceptability and potential trade-offs.