Impact of COVID-19 lockdown on emergency asthma admissions and deaths: national interrupted time series analyses for Scotland and Wales

Gwyneth A Davies; Mohammad A Alsallakh; Shanya Sivakumaran; Eleftheria Vasileiou; Ronan A Lyons; Chris Robertson; Aziz Sheikh; EAVE II Collaborators

doi:10.1136/thoraxjnl-2020-216380

Impact of COVID-19 lockdown on emergency asthma admissions and deaths: national interrupted time series analyses for Scotland and Wales

Gwyneth A Davies, Mohammad A Alsallakh, Shanya Sivakumaran, Eleftheria Vasileiou, Ronan A Lyons, Chris Robertson, Aziz Sheikh, EAVE II Collaborators

Research output: Contribution to journal › Article › peer-review

55 Citations (Scopus)

Abstract

BACKGROUND: The COVID-19 pandemic's impact on people with asthma is poorly understood. We hypothesised that lockdown restrictions were associated with reductions in severe asthma exacerbations requiring emergency asthma admissions and/or leading to death.

METHODS: Using data from Public Health Scotland and the Secure Anonymised Information Linkage Databank in Wales, we compared weekly counts of emergency admissions and deaths due to asthma over the first 18 weeks in 2020 with the national averages over 2015-2019. We modelled the impact of instigating lockdown on these outcomes using interrupted time-series analysis. Using fixed-effect meta-analysis, we derived pooled estimates of the overall changes in trends across the two nations. We also investigated trends in asthma-related primary care prescribing and emergency department (ED) attendances in Wales.

RESULTS: Lockdown was associated with a 36% pooled reduction in emergency admissions for asthma (incidence rate ratio, IRR: 0.64, 95% CI: 0.49 to 0.83, p value 0.001) across both countries. There was no significant change in asthma deaths (pooled IRR: 0.57, 95% CI: 0.17 to 1.94, p value 0.37). ED asthma attendances in Wales declined during lockdown (IRR: 0.85, 95% CI: 0.73 to 0.99, p value 0.03). A large spike of 121% more inhaled corticosteroids and 133% more oral corticosteroid prescriptions was seen in Wales in the week before lockdown.

CONCLUSIONS: National lockdowns were associated with substantial reductions in severe asthma exacerbations leading to hospital admission across both Scotland and Wales, with no corresponding increase in asthma deaths.

Original language	English
Pages (from-to)	867-873
Number of pages	7
Journal	Thorax
Volume	76
Issue number	9
Early online date	29 Mar 2021
DOIs	https://doi.org/10.1136/thoraxjnl-2020-216380
Publication status	Published - Sept 2021

Bibliographical note

Data availability statement
The anonymised person-level data used in this study are held by Public Health Scotland (PHS) and the Secure Anonymised Information Linkage (SAIL) Databank and are restricted and not publicly available but can be accessed upon reasonable requests from PHS and SAIL. All proposals to use SAIL are carefully reviewed by an independent Information Governance Review Panel to ensure proper and appropriate use of data (https://www.saildatabank.com/application-process). When approved, access is then provided through the SAIL Gateway, a privacy-protecting safe haven and a secure remote access system.

Keywords

Administration, Inhalation
Adrenal Cortex Hormones/therapeutic use
Asthma/drug therapy
COVID-19/prevention & control
Emergency Service, Hospital/statistics & numerical data
Humans
Interrupted Time Series Analysis
Patient Admission/statistics & numerical data
Primary Health Care/statistics & numerical data
SARS-CoV-2
Scotland/epidemiology
Wales/epidemiology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cite this

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title = "Impact of COVID-19 lockdown on emergency asthma admissions and deaths: national interrupted time series analyses for Scotland and Wales",

abstract = "BACKGROUND: The COVID-19 pandemic's impact on people with asthma is poorly understood. We hypothesised that lockdown restrictions were associated with reductions in severe asthma exacerbations requiring emergency asthma admissions and/or leading to death.METHODS: Using data from Public Health Scotland and the Secure Anonymised Information Linkage Databank in Wales, we compared weekly counts of emergency admissions and deaths due to asthma over the first 18 weeks in 2020 with the national averages over 2015-2019. We modelled the impact of instigating lockdown on these outcomes using interrupted time-series analysis. Using fixed-effect meta-analysis, we derived pooled estimates of the overall changes in trends across the two nations. We also investigated trends in asthma-related primary care prescribing and emergency department (ED) attendances in Wales.RESULTS: Lockdown was associated with a 36% pooled reduction in emergency admissions for asthma (incidence rate ratio, IRR: 0.64, 95% CI: 0.49 to 0.83, p value 0.001) across both countries. There was no significant change in asthma deaths (pooled IRR: 0.57, 95% CI: 0.17 to 1.94, p value 0.37). ED asthma attendances in Wales declined during lockdown (IRR: 0.85, 95% CI: 0.73 to 0.99, p value 0.03). A large spike of 121% more inhaled corticosteroids and 133% more oral corticosteroid prescriptions was seen in Wales in the week before lockdown.CONCLUSIONS: National lockdowns were associated with substantial reductions in severe asthma exacerbations leading to hospital admission across both Scotland and Wales, with no corresponding increase in asthma deaths.",

keywords = "Administration, Inhalation, Adrenal Cortex Hormones/therapeutic use, Asthma/drug therapy, COVID-19/prevention & control, Emergency Service, Hospital/statistics & numerical data, Humans, Interrupted Time Series Analysis, Patient Admission/statistics & numerical data, Primary Health Care/statistics & numerical data, SARS-CoV-2, Scotland/epidemiology, Wales/epidemiology",

author = "Davies, {Gwyneth A} and Alsallakh, {Mohammad A} and Shanya Sivakumaran and Eleftheria Vasileiou and Lyons, {Ronan A} and Chris Robertson and Aziz Sheikh and {EAVE II Collaborators} and Lewis Ritchie",

note = "Data availability statement The anonymised person-level data used in this study are held by Public Health Scotland (PHS) and the Secure Anonymised Information Linkage (SAIL) Databank and are restricted and not publicly available but can be accessed upon reasonable requests from PHS and SAIL. All proposals to use SAIL are carefully reviewed by an independent Information Governance Review Panel to ensure proper and appropriate use of data (https://www.saildatabank.com/application-process). When approved, access is then provided through the SAIL Gateway, a privacy-protecting safe haven and a secure remote access system.",

year = "2021",

month = sep,

doi = "10.1136/thoraxjnl-2020-216380",

language = "English",

volume = "76",

pages = "867--873",

journal = "Thorax",

issn = "0040-6376",

publisher = "BMJ Publishing Group Ltd",

number = "9",

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TY - JOUR

T1 - Impact of COVID-19 lockdown on emergency asthma admissions and deaths

T2 - national interrupted time series analyses for Scotland and Wales

AU - Davies, Gwyneth A

AU - Alsallakh, Mohammad A

AU - Sivakumaran, Shanya

AU - Vasileiou, Eleftheria

AU - Lyons, Ronan A

AU - Robertson, Chris

AU - Sheikh, Aziz

AU - EAVE II Collaborators

A2 - Ritchie, Lewis

N1 - Data availability statement The anonymised person-level data used in this study are held by Public Health Scotland (PHS) and the Secure Anonymised Information Linkage (SAIL) Databank and are restricted and not publicly available but can be accessed upon reasonable requests from PHS and SAIL. All proposals to use SAIL are carefully reviewed by an independent Information Governance Review Panel to ensure proper and appropriate use of data (https://www.saildatabank.com/application-process). When approved, access is then provided through the SAIL Gateway, a privacy-protecting safe haven and a secure remote access system.

PY - 2021/9

Y1 - 2021/9

N2 - BACKGROUND: The COVID-19 pandemic's impact on people with asthma is poorly understood. We hypothesised that lockdown restrictions were associated with reductions in severe asthma exacerbations requiring emergency asthma admissions and/or leading to death.METHODS: Using data from Public Health Scotland and the Secure Anonymised Information Linkage Databank in Wales, we compared weekly counts of emergency admissions and deaths due to asthma over the first 18 weeks in 2020 with the national averages over 2015-2019. We modelled the impact of instigating lockdown on these outcomes using interrupted time-series analysis. Using fixed-effect meta-analysis, we derived pooled estimates of the overall changes in trends across the two nations. We also investigated trends in asthma-related primary care prescribing and emergency department (ED) attendances in Wales.RESULTS: Lockdown was associated with a 36% pooled reduction in emergency admissions for asthma (incidence rate ratio, IRR: 0.64, 95% CI: 0.49 to 0.83, p value 0.001) across both countries. There was no significant change in asthma deaths (pooled IRR: 0.57, 95% CI: 0.17 to 1.94, p value 0.37). ED asthma attendances in Wales declined during lockdown (IRR: 0.85, 95% CI: 0.73 to 0.99, p value 0.03). A large spike of 121% more inhaled corticosteroids and 133% more oral corticosteroid prescriptions was seen in Wales in the week before lockdown.CONCLUSIONS: National lockdowns were associated with substantial reductions in severe asthma exacerbations leading to hospital admission across both Scotland and Wales, with no corresponding increase in asthma deaths.

AB - BACKGROUND: The COVID-19 pandemic's impact on people with asthma is poorly understood. We hypothesised that lockdown restrictions were associated with reductions in severe asthma exacerbations requiring emergency asthma admissions and/or leading to death.METHODS: Using data from Public Health Scotland and the Secure Anonymised Information Linkage Databank in Wales, we compared weekly counts of emergency admissions and deaths due to asthma over the first 18 weeks in 2020 with the national averages over 2015-2019. We modelled the impact of instigating lockdown on these outcomes using interrupted time-series analysis. Using fixed-effect meta-analysis, we derived pooled estimates of the overall changes in trends across the two nations. We also investigated trends in asthma-related primary care prescribing and emergency department (ED) attendances in Wales.RESULTS: Lockdown was associated with a 36% pooled reduction in emergency admissions for asthma (incidence rate ratio, IRR: 0.64, 95% CI: 0.49 to 0.83, p value 0.001) across both countries. There was no significant change in asthma deaths (pooled IRR: 0.57, 95% CI: 0.17 to 1.94, p value 0.37). ED asthma attendances in Wales declined during lockdown (IRR: 0.85, 95% CI: 0.73 to 0.99, p value 0.03). A large spike of 121% more inhaled corticosteroids and 133% more oral corticosteroid prescriptions was seen in Wales in the week before lockdown.CONCLUSIONS: National lockdowns were associated with substantial reductions in severe asthma exacerbations leading to hospital admission across both Scotland and Wales, with no corresponding increase in asthma deaths.

KW - Administration, Inhalation

KW - Adrenal Cortex Hormones/therapeutic use

KW - Asthma/drug therapy

KW - COVID-19/prevention & control

KW - Emergency Service, Hospital/statistics & numerical data

KW - Humans

KW - Interrupted Time Series Analysis

KW - Patient Admission/statistics & numerical data

KW - Primary Health Care/statistics & numerical data

KW - SARS-CoV-2

KW - Scotland/epidemiology

KW - Wales/epidemiology

U2 - 10.1136/thoraxjnl-2020-216380

DO - 10.1136/thoraxjnl-2020-216380

M3 - Article

C2 - 33782079

SN - 0040-6376

VL - 76

SP - 867

EP - 873

JO - Thorax

JF - Thorax

IS - 9

ER -

Impact of COVID-19 lockdown on emergency asthma admissions and deaths: national interrupted time series analyses for Scotland and Wales

Abstract

Bibliographical note

Keywords

UN SDGs

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