P119\u2005The effects of the COVID-19 lockdown on severe asthma in patients taking biologic therapy and air pollution

Abstract

Introduction Whilst Coronavirus Disease 2019 (COVID-19) wreaked havoc, an expected increase in exacerbations of asthma did not materialize. There was significant improvement in quality of air during lockdown period due to reduced traffic and industrial activity as per local metrological data. The aim of this study was to determine the impact of enforced social distancing (i.e. lockdown) and air pollution on patients with severe asthma taking biologic therapy over 12 weeks’ period. Methods A cross-sectional survey of 60 patients with severe asthma receiving biologic therapy was performed with ethical approval. Results Fifty six (56) patients participated (F39; mean age 47.4 years; response rate 93.3%). Mean time since diagnosis was 19.6 years (SD 11.5 years). All had been on biologic therapy Omalizumab (45), Mepolizumab (7), or Dupilumab (2) for at least three months (mean 38.4 months ± SD 26.5 months). subjectively thirty, 30 (53.6%) patients reported improvement in their asthma symptoms and attributed it to reduced traffic activity. Objective Stratified asthma control test (ACT) scores are detailed in table 1. There was an increase in the proportion of patients who were controlled before and after 12 weeks of the lockdown [23 (41%) vs 34 (60.7%)] When all participants whose ACT scores increased were compared with those whose did not, no statistically significant differences in age, gender, employment status, level of education, marital status, access to medications, oral steroid use, ED visits, or failure to receive scheduled biologic therapy were found. None were admitted to hospital and 38 patients did not escalate their treatment during the 12 weeks’ period. Eighteen (32.1%) patients’ ACT scores improved ≥3 points. The absolute difference in the proportion of patients with controlled asthma was 19.6% (95%CI 1.5%–37.8%). Conclusions During the COVID-19 lockdown period there were significant subjective and objective improvement in asthma symptoms based on ACT Scores over 12 weeks’ period. We believe that the major reason for this improvement is a reduction in air pollution due to reduced traffic and industrial activity, though other factors (psychological, behavioral) were beyond the scope of this study.