The effects of the covid-19 lockdown on severe asthma in patients taking biologic therapy and air pollution

Background: The curfews and lockdowns imposed during the COVID 19 pandemic may decreased volume of traffic and reduced air pollution. In addition, social distancing measures may contribute to reduce infection and asthma exacerbation. Objective: To assess asthma control and asthma medication use among sever asthmatics on biologics before and after COVID-19 pandemic Method: This is a cross-sectional survey study of patients with severe asthma receiving biologic therapy at King Abdulaziz Medical City-Riyadh (KAMC-R), Saudi Arabia. We looked at the effects of the COVID19 lockdown on this cohort of sever asthmatics on biologic therapy from March till June 2020 over a period of 12 weeks. We investigated changes in patients symptoms and asthma control using the asthma control test (ACT) score and other parameters including, emergency department (ED) visits, hospitalizations, use of oral prednisolone, changes in inhaler therapy, frequency of bronchodilators use and patient perception of their symptoms before and after the lockdown period. Results: A total of 56, Female 39;(69%0;mean age ± SD 47.4 ± 13.8 years. The duration of bronchial asthma since diagnosis range from 4-30 years. Most patients had been treated with Omalizumab (47;84%);the rest received Mepolizumab (7;12.5%) and Dupilumab (2;3.6%). All these patients had been on biologic therapy for 5 months, range from 5 to 120 months. Most of the patients (45;80.4%) agreed that their symptoms of asthma had improved with biologic therapy. Most of the patients felt overall asthma symptoms is better after curfew and lockdown 28 (50%). Less use of bronchodilators post curfew reported in 38% of the patients. Asthma control (≥20) using ACT score was significantly higher among patients in post curfew and lockdown period compared to pre curfew period 34(61.7%) and 23 (41%), (p.0.001) respectively. Conclusion: Asthma control was better post curfew and lockdown. Decrease in air pollution and social distances may be contribute factor.