Differences in COVID-19-triggered pediatric asthma exacerbations across variant waves

Background: SARS-CoV-2 variants have differed in severity, but whether they are more or less likely to trigger asthma symptoms in children is unknown. Aims: To assess the likelihood of pediatric asthma exacerbations in the setting of COVID-19 across variant waves. Methods: Using data from the UPMC Children’s Hospital of Pittsburgh Emergency Department (ED) and the Western Pennsylvania COVID-19 Registry (WPACR), we compared outcomes among children with asthma in the pre-delta (01Jul20-30Jun21), delta (01Aug21-14Dec21), and omicron (15Dec21-15Jan22) waves. Results: Among 372 patients with asthma presenting with COVID-19 (pre-delta=202, delta=125, omicron=45), acute asthma exacerbations increased during omicron (respectively 24%, 31%, 91%; p<.001), including in subgroup analyses of children presenting to the ED (n=66, 67%, 87%, 100%; p=.02) and those followed by an asthma specialist (n=74, 29%, 50%, 75%; p=.003). COVID+ children with asthma were more likely to receive systemic steroids during omicron (12%, 20%, 42%; p<.001), including in subgroup analyses of those with an exacerbation (52%, 65%, 95%; p=.004). Among hospitalized COVID-positive children with asthma (n=49), hypoxia was more common during omicron (26%, 17%, 43%; p=.04). In addition, among 2150 ED encounters for asthma (pre-delta=1038, delta=949, omicron=163), a COVID+ test was significantly more frequent during omicron (3%, 2%, 12%; p<.001). Patients during delta were younger, with no other differences in sex or age across waves. Conclusions: The omicron variant is more likely to trigger pediatric asthma exacerbations than prior variants, supporting the need for ongoing surveillance of children with asthma who develop COVID-19.