Uncontrolled Asthma Raises COVID-19 Hospitalization Risk in Children

Children with uncontrolled asthma had a 3- to 6-times the risk of hospitalization for COVID-19, the investigators found.

Children with uncontrolled asthma should be prioritized for vaccination against SARS-CoV-2, the virus that causes COVID-19, due to an increased risk of hospitalization, according to a new study.

The report comes from Scotland, where investigators used a national COVID-19 surveillance database to track cases and hospitalizations. They found children with asthma were more likely to have severe cases of COVID-19 if their asthma was uncontrolled. The findings were published in The Lancet Respiratory Medicine.

Corresponding author Aziz Sheikh, MD, of the University of Edinburgh, and colleagues wrote that the pandemic created an “urgent need” to understand how the SARS-CoV-2 virus affects children with asthma. The authors noted that while it is rare for children to be hospitalized with COVID-19, some children require critical care. Moreover, vaccine supplies are limited in some parts of the world, meaning it is important to understand which children are most likely to benefit from vaccination.

Sheikh and colleagues consulted Scotland’s Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II) database, looking for all cases among children aged 5 to 17. Children with asthma were considered to have uncontrolled asthma if they had a hospital admission or oral corticosteroid prescription in the prior 2 years. Investigators used a Cox proportional hazard model to identify links between COVID-19 hospital admission and asthma control markers.

Overall, more than 750,000 children between ages 5 and 17 were added to the database between March 2020 and July 2021. Of those, 63,463 (8.4%) had a history of asthma. Among those with asthma, 4339 (6.8%) received a positive SARS-CoV-2 test, compared with 40,231 (5.8%) of children without asthma.

Among children with asthma and COVID-19, 67 (1.5%) ended up requiring hospital admission for COVID-19. In the non-asthma group, 382 patients (0.9%) were admitted to the hospital following a COVID-19 diagnosis.

Yet, the investigators found the risk is highest among children with uncontrolled asthma.

“When using previous hospital admission for asthma as the marker of uncontrolled asthma, the adjusted hazard ratio [HR] was 6.40 (95% CI, 3.27–12.53) for those with poorly controlled asthma and 1.36 (1.02–1.80) for those with well controlled asthma, compared with those with no asthma,” the authors found.

When the investigators used oral corticosteroid prescriptions as a proxy for uncontrolled asthma, the authors found HRs as high as 3.53 (1.87–6.67), with some variance based on the number of courses prescribed, compared with patients with no asthma.

“We found that children aged 5–17 years with poorly controlled asthma are at markedly increased (3-6 times higher) risk of COVID-19 hospital admission compared with those without asthma,” the authors said, adding that the risk to children with well-controlled asthma was relatively low.

The authors said they believe their study is the first national, population-level study of COVID-19 risk in children with uncontrolled asthma. They said the breadth of the study population is a strength, although they noted that it may not capture all relevant data. For instance, they said the reasons for emergency department visits were not reliably recorded, so it is possible some patients received emergency treatment for COVID-19, but their cases were not accurately reported as such.

Still, they said their findings align with earlier research suggesting patients with asthma do not face an increased risk of COVID-19-related hospitalization if their asthma is controlled.

Sheikh and colleagues said their data make a strong case for children with uncontrolled asthma to be prioritized for vaccination when possible.

“School-aged children with asthma with previous recent hospital admission or 2 or more courses of oral corticosteroids are at markedly increased risk of COVID-19 hospital admission and should be considered a priority for vaccinations,” they said.


Shi T, Pan J, Katikireddi SV, et al. Risk of COVID-19 hospital admission among children aged 5-17 years with asthma in Scotland: a national incident cohort study. Lancet Respir Med. Published online November 30, 2021. doi:10.1016/S2213-2600(21)00491-4