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Risk of Severe Asthma Attacks Increased After Relaxation of COVID-19 Restrictions


The end or relaxation of COVID-19 restrictions was associated with increased risk of severe asthma attacks.

The relaxation of COVID-19 restrictions and decreased use of face coverings coincided with a significant increase in asthma and acute respiratory illness (ARI) exacerbations, according to recent study findings.

This population-based study, whose findings were published in Thorax and presented at the British Thoracic Society meeting, observed the risk of asthma exacerbations in association with the relaxation of COVID-19 restrictions, and how it compared to the risks associated with COVID-19 and non–COVID-19 ARIs.

“We report findings of the first study to compare the influence of COVID-19 vs non-COVID-19 ARI on risk of asthma exacerbation and to investigate the strength of association between COVID-19 and asthma exacerbation before and after emergence of the Omicron variant of SARS-CoV-2,” the researchers wrote.

The researchers surveyed a total of 19,981 residents from the United Kingdom, aged 16 years and older, using the COVIDENCE UK baseline questionnaire from May 1, 2020, to October 6, 2021.

Of the total residents surveyed, 2312 UK adults self-reported having asthma from November 2020 to April 2022. Next, the researchers had participants answer a monthly questionnaire, collecting data for statistical analysis concerning face covering use, social mixing, incident ARI, and severe asthma exacerbations.

When testing for associations between ARI and risk asthma exacerbations, the researchers found that the relaxation of COVID-19 restriction in April 2021 coincided with decreased face covering use (P = .001), an increase in indoor visits to public places and other households (P < .001), and rising incidences of COVID-19 (P < .001), non–COVID-19 ARI (P < .001), and severe asthma exacerbations (P = .007).

Additionally, incident COVID-19 showed associations with increased risk of severe asthma attacks both prior to (aOR, 5.89; 95% CI, 3.45-10.04) and after (aOR, 5.69; 95% CI, 3.89-8.31) the emergence of the Omicron variant.

Furthermore, the results showed that increased risk of severe asthma attacks in association with COVID-19 was no greater than that observed with other ARIs.

“This research shows that relaxation of COVID-19 restrictions coincided with an increased risk of severe asthma attacks,” lead author Adrian R. Martineau, FRSB, professor of respiratory infection and immunity, Queen Mary University at London, said in a press release.

The researchers acknowledged that the study had limitations, including its observational nature. However, they also believed the study accurately captured the impact of lifting national restrictions on patients with asthma, giving insight on potential health reforms and policies that may be adopted globally.

The researchers suggested that health care policy may be able to address these associations by implementing face covering interventions to reduce the risk of severe asthma, while also educating the public that COVID-19 is no more likely to trigger asthma exacerbations than other forms of ARI.

“Our study was observational, so it can’t prove cause-and-effect,” continued Martineau. “But our findings do raise the possibility that certain elements of the public health measures introduced during the pandemic, such as wearing facemasks, could help in reducing respiratory illnesses moving forward.”


Tydeman F, Pfeffer PE, Vivaldi G, et al. Rebound in asthma exacerbations following relaxation of covid-19 restrictions: a longitudinal population-based study (COVIDENCE UK). Thorax. Published online November 24, 2022. Accessed December 7, 2022. doi:10.1136/thorax-2022-219591

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