The Lancet

Date: 04 August, 2020

Heidi Makrinioti, Mando Watson, Andrew Bush, Dougal Hargreaves
Published:August 04, 2020

The pattern of increasing visits to the emergency department by children younger than 5 years with preschool wheeze and other respiratory conditions has been disrupted by the COVID-19 pandemic. Since March, 2020, presentations to the emergency department have decreased among children of all age groups, especially infants and preschool children who are the most frequent attenders. This notable change in asthma exacerbations in children has raised research interest into how the COVID-19 pandemic has contributed to this change, and what lessons can be learned. Risks of harm due to delayed medical assessment or treatment were flagged early in the pandemic but are still unclear; empirical UK data to date have been conflicting, with one prospective multicentre study suggesting that the number of “inappropriately delayed hospital presentations” was low, but another survey of paediatricians reported more widespread evidence of delay. The sudden changes to health-care seeking behaviour and health-care delivery offers a rare opportunity to redesign and improve health care for children with preschool wheeze to allow for better outcomes in the future.

We have previously argued the need for a joined-up strategy to improve outcomes of children with preschool wheeze and this need is reinforced by lessons from the COVID-19. Three important areas to consider include measures to reduce the incidence of wheeze attacks (viral triggers, environmental pollution, direct and second-hand smoke); improved accessibility of health-care pathways; and the provision of the right advice at the right time, enhancing parental knowledge and confidence to manage the condition successfully.