COVID-19 infection doesn’t trigger asthma in children: CHOP research

PHILADELPHIA — As the COVID-19 pandemic swept across the globe, parents everywhere worried about the potential long-term effects the virus could have on their children’s health. One particular concern was whether contracting COVID-19 could increase a child’s risk of developing asthma, a chronic lung disease that causes wheezing, chest tightness, shortness of breath, and coughing. Thankfully, new research shows there’s no link between the two conditions.

Asthma affects millions of children worldwide, and previous research has shown that certain respiratory viral infections, such as rhinovirus (the common cold) and respiratory syncytial virus (RSV), can trigger asthma development in some kids. So it’s natural to wonder if the virus behind COVID-19, known as SARS-CoV-2, could have a similar effect.

But the new study, published in the journal Pediatrics, brings some reassuring news for parents. The research, led by doctors at Children’s Hospital of Philadelphia, found that children who tested positive for COVID-19 were at no greater risk of being diagnosed with asthma over the next 18 months compared to children who tested negative.

How the study was conducted

To reach this conclusion, the researchers analyzed the electronic health records of over 27,000 children between the ages of 1 and 16 who received a PCR test for COVID-19 between March 2020 and February 2021. PCR tests are considered the gold standard for diagnosing COVID-19 infection by detecting the genetic material of the SARS-CoV-2 virus.

The researchers divided the children into two groups – those who tested positive for COVID-19 and those who tested negative. They then tracked which children in each group were newly diagnosed with asthma over the following year and a half. To ensure they were capturing true asthma cases, the researchers looked for kids who not only had a new asthma diagnosis code in their medical record, but were also prescribed an asthma medication like an inhaler.

What they found was that 1.81% of kids who had COVID-19 were later diagnosed with asthma, compared to 2.13% of kids who never had COVID-19 – a difference that was not statistically significant. In other words, contracting COVID-19 did not appear to meaningfully increase a child’s chances of developing asthma.

Importantly, the researchers made sure to account for a range of other factors that could influence a child’s asthma risk, such as age, race, insurance status, neighborhood socioeconomic conditions, premature birth, obesity, and pre-existing allergic conditions like eczema and food allergies. Even after adjusting for all these variables, there was still no link between COVID-19 infection and asthma onset.

Why doesn’t COVID lead to asthma?

So what might explain why COVID-19 doesn’t seem to trigger asthma the way other viruses sometimes do? The researchers point to differences in how the immune system responds to SARS-CoV-2 compared to viruses like rhinovirus and RSV. While those viruses tend to provoke allergic-type immune responses that can promote asthma, COVID-19 elicits more of an antiviral immune response aimed at eliminating infected cells. This suggests the inflammation caused by SARS-CoV-2, while potentially severe, may be less likely to cause lasting changes in the lungs’ airways that lead to asthma.

The new findings should provide some peace of mind to parents, as they suggest that even if a child is unlucky enough to catch COVID-19, it likely won’t raise their risk of a chronic disease like asthma. Of course, COVID-19 can still cause significant illness in some kids, which is why pediatricians continue to recommend vaccination as the best way for eligible children to stay protected.

At the same time, the study is an important reminder that there are many factors beyond viral infections that shape a child’s chances of developing asthma. The research confirmed that kids who are Black, obese, born prematurely, or have allergies remain at higher risk and may need closer monitoring and care to keep their lungs healthy. By better understanding all the complex influences on asthma development, doctors can work to ensure as few children as possible have to face the burdens of this challenging disease, during the pandemic and beyond.