Asthma-related outcomes during the SARS-CoV2 pandemic: A single-center observational study.
Asthma-related outcomes during the SARS-CoV2 pandemic: A single-center observational study.
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DOI：
10.1016/j.jaip.2021.05.034
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发表时间：
2021-09
期刊：
影响因子：
--
通讯作者：
McGowan EC
中科院分区：
文献类型：
--
作者：
Al-Hazaymeh A;Patrie J;Adams JC;Borish L;McGowan EC
哮喘是一种常见的慢性疾病，影响美国约7.5%的儿童和成人。1呼吸道病毒感染是哮喘急性发作的常见原因，在儿童哮喘急性发作中高达85%，其中鼻病毒（RV）始终占约60%至70%。鼻病毒感染全年都很常见;大多数不会导致病情加重。4然而，对急诊科（艾德）就诊的研究一致表明，春季和秋季哮喘急性发作的高峰，这与研究进行的北方的过敏季节相对应。5随后的研究表明，RV引起的哮喘急性发作与空气过敏原暴露之间存在明确的联系，导致春季哮喘“流行病”。2019年，一种新型病毒--严重急性呼吸道综合征冠状病毒2型（SARS-CoV-2）出现，导致了2019年冠状病毒病（COVID-19）大流行。2020年3月7日，弗吉尼亚州首次发现COVID-19，导致社交距离和居家令的呼吁于2020年3月30日至6月8日实施。我们假设，实施这些社交距离措施将导致RV感染减少，从而减少哮喘加重，特别是在春季和秋季。在这项研究中，我们检查了2020年3月至12月期间弗吉尼亚大学（UVA）儿童和成人的哮喘急性发作指标（包括艾德就诊、门诊类固醇处方和记录的RV感染）是否减少。从2016年1月1日至2020年12月31日在UVA卫生系统接受护理的0至40岁患者中提取数据。UVA医疗中心企业数据仓库系统包含来自UVA电子病历系统的数据，用于使用国际疾病分类第10版（ICD-10）代码J 45识别诊断为哮喘急性加重的患者。21，J45。31，J45。41，J45。51和J 45。901.门诊患者口服类固醇使用定义为与任何ICD-10哮喘代码相关的全身性类固醇制剂（泼尼松龙、泼尼松、甲泼尼龙或地塞米松）处方（J 45. 2-J45 5，J45。9)作为门诊患者，包括门诊或远程医疗就诊、电话呼叫以及在艾德或住院患者就诊结束时下达的用于门诊患者的订单。哮喘急性发作的艾德访视定义为在ED中观察到的哮喘急性发作的ICD-10代码。鼻病毒感染定义为门诊或住院呼吸道病原体检测结果为阳性聚合酶链反应（PCR），这与UVA的SARS-CoV 2检测结果不同。基于患者自我报告，从病历中提取人种和种族数据。收集每个结局的每月病例数。每月RV感染定义为RV阳性检测在所有RV PCR检测中的百分比。对于每个结果，进行了分段自相关时间序列回归，以确定2016年1月至2020年3月每个结果的每月数字趋势在2020年4月至12月是否不同。这些车型的过渡点被确定为2020年4月1日，因为弗吉尼亚州的居家令于3月30日生效。对于门诊类固醇处方、艾德访视和RV阳性试验的百分比，时间序列模型先验地按年龄（0-5岁、6-18岁和19-40岁）分层，因为RV相关哮喘急性发作的患病率在年龄组较低。
Asthma is a common chronic disease affecting approximately 7.5% of children and adults in the United States. 1 Respiratory viral infections are a frequent cause of asthma exacerbations, triggering up to 85% of exacerbations in children, of which rhinovirus (RV) consistently accounts for approximately 60% to 70%. 2, 3 Rhinovirus infections are common throughout the year; most do not produce exacerbations. 4 However, studies examining emergency department (ED) visits consistently demonstrate spikes in asthma exacerbations in the spring and fall, which correspond to allergy seasons in the northern hemisphere where the studies were conducted. 5 Subsequent studies demonstrated a clear link between RV-induced asthma exacerbations and aeroallergen exposure, resulting in a spring asthma “epidemic.” In 2019, a novel virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), appeared, leading to the coronavirus disease 2019 (COVID-19) pandemic. COVID-19 was first detected in Virginia on March 7, 2020, resulting in a call for social distancing and a stay-at-home order that was implemented from March 30 to June 8, 2020. We hypothesized that the implementation of these social distancing measures would lead to a decrease in RV infections and thus asthma exacerbations, particularly in the spring and fall. In this study, we examined whether measures of asthma exacerbation, including ED visits, outpatient steroid prescriptions, and documented RV infections, decreased among children and adults at the University of Virginia (UVA) from March to December 2020. Data were abstracted for patients aged 0 to 40 years, who were receiving care at the UVA Health System from January 1, 2016 until December 31, 2020. The UVA Medical Center Enterprise Data Warehouse system, which contains data sourced from UVA’s Electronic Medical Record System, was used to identify patients with a diagnosis of asthma with acute exacerbation using International Classification of Diseases, 10th Revision (ICD-10) codes J45. 21, J45. 31, J45. 41, J45. 51, and J45. 901. Outpatient oral steroid use was defined as a prescription for systemic steroid preparations (prednisolone, prednisone, methylprednisolone, or dexamethasone) associated with any ICD-10 code for asthma (J45. 2-J45. 5 and J45. 9) as an outpatient, which includes outpatient or telemedicine visits, telephone calls, and orders placed at the end of ED or inpatient visits for outpatient use. An ED visit for an asthma exacerbation was defined as an ICD-10 code for asthma with acute exacerbation seen in the ED. Rhinovirus infections were defined as a positive polymerase chain reaction (PCR) detected on the outpatient or inpatient respiratory pathogens panel, which is distinct from the SARS-CoV2 assay at UVA. Data on race and ethnicity were extracted from the medical record based on patient self-report. The number of cases per month were collected for each outcome. Monthly RV infections were defined as the percentage of RV-positive tests among all RV PCR tests performed. For each outcome, segmented autocorrelation time series regression was conducted to determine whether the trend in monthly numbers for each outcome from January 2016 to March 2020 was different in April to December 2020. The transition point for these models was identified as April 1, 2020, because the Virginia stay-at-home order went into effect on March 30. For the outpatient steroid prescription, ED visits, and the percentage of RV-positive tests, the time series models were stratified a priori by age (0-5, 6-18, and 19-40 years), because the prevalence of RV-associated asthma exacerbations is lower in …
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影响因子：
14.2
作者：
Zambrano, JC;Carper, HT;Heymann, PW
通讯作者：
Heymann, PW
DOI：
10.1016/j.jaci.2006.08.041
发表时间：
2007-03
期刊：
The Journal of allergy and clinical immunology
影响因子：
--
作者：
Khetsuriani N;Kazerouni NN;Erdman DD;Lu X;Redd SC;Anderson LJ;Teague WG
通讯作者：
Teague WG
DOI：
10.1016/j.jaip.2020.09.060
发表时间：
2021-01
期刊：
The journal of allergy and clinical immunology. In practice
影响因子：
--
作者：
Abe K;Miyawaki A;Nakamura M;Ninomiya H;Kobayashi Y
通讯作者：
Kobayashi Y
影响因子：
14.2
作者：
Johnston, NW;Johnston, SL;Sears, MR
通讯作者：
Sears, MR
影响因子：
--
作者：
JOHNSTON, SL;PATTEMORE, PK;HOLGATE, ST
通讯作者：
HOLGATE, ST