Impact of COVID-19 restrictions on asthma control in children with social determinants of heath

Rationale: School-centered asthma programs demonstrate a significant impact on asthma. The Colorado Comprehensive School-Centered Asthma Program (AsthmaCOMP) has demonstrated reduced asthma hospitalizations, ED visits and asthma attacks. The COVID-19 pandemic has disproportionally impacted minority communities including school disruptions since March 2020. We, therefore, evaluated the impact of COVID-19 restrictions on asthma control in children with families who identified social determinants of health (SDOH). We hypothesized that COVID-19 restrictions, specifically the abrupt school closures, would result in loss of asthma control, especially for children with previously identified SDOH, due to limited access to health care. Methods: AsthmaCOMP is implemented in 40 elementary schools, enrolling students ages 5 to 11, in a patient education and care coordination program. Most students come from low-income families with limited resources. There are 2 cohorts (Cohort 1/2018-2019: 45 students-Cohort 2/2019-2020: 83 students) meeting with asthma counselors every 3 months. We compared asthma clinical outcomes (ACT scores and ED visits) before and during the pandemic assessing the impact of COVID-19 restrictions on asthma in children with and without SDOH. We evaluated similar data from students who were lost to follow-up for impact on program engagement. Results: Outcomes were evaluated at 3 intervals: beginning of the school year, mid-year, and end of year (See Figure 1 below). Results showed no change in asthma control for both cohorts, as indicated by ACT scores, for students with or without identified SDOH. In cohort 1, an increase in ED visits for students without identified SDOH was noted during the pandemic. Students lost to follow-up had worse asthma clinical outcomes at baseline, particularly those students with identified SDOH. Conclusions: Students participating in AsthmaCOMP maintained asthma control despite COVID-19 restrictions. Students with poorly controlled asthma at baseline, particularly those with identified SDOH were more likely to be lost to follow-up. This study reinforces the importance and effectiveness of school-based asthma programs in improving asthma control, even for high-risk populations with SDOH. Students without identified SDOH were more likely to be seen in the ED during the pandemic;perhaps this is related to disruption of social structure which may evoke SDOH not previously identified. Future studies are needed to explore the mechanisms by which the pandemic and restrictions affect children with asthma and SDOH.