Primary care of children and young people with asthma during the COVID-19 era.

Around 1.1 million children and young people (CYP) currently receive treatment for asthma in the UK.1 The UK performs poorly compared with other European countries in children’s outcomes of asthma management and has had among the highest number of reported asthma deaths in Europe since 1998.2 Here we evaluate evidence of the impact of COVID-19 on CYP with asthma and consider what actions GPs can take to protect these children from serious harm. There is no strong evidence that CYP with asthma are more susceptible to COVID-19 infection than the general population, although children with long-term conditions are under-represented in epidemiological studies.3 In fact, there is even some evidence that, as CYP with atopic asthma tend to have lower angiotensin-converting enzyme 2 (ACE2) expression, they are potentially less susceptible to COVID-19 infection.4 Across Europe, the overall incidence of COVID-19 cases for CYP is 1.8%: 1.1% for children aged <10 years and 2.5% for young people aged 10–19 years.5 However, incidence is variable and highly dependent on exposure. Fortunately, most CYP with COVID-19 usually experience an asymptomatic infection or mild self-limiting illness, with only very few experiencing the hyperinflammatory response, Paediatric Inflammatory Multisystem Syndrome (PIMS).6 Hence, CYP with asthma are more likely to experience poor health because of their underlying long-term condition rather than COVID-19 infection itself. Viral infections worsen asthma symptoms. Viruses are detected in up to 80% of asthma exacerbations and annual seasonal strains of coronavirus are associated with 8.4% of asthma exacerbations in CYP.6 An asthma exacerbation would require a child to attend, and potentially be admitted to, a healthcare setting that may carry a small additional risk of exposure to COVID-19. Children are less than half as likely to transmit COVID-19 compared with adults,7 but transmission will inevitably increase …