Obesity is a Risk Factor for Decrease in Lung Function after COVID-19 Infection in Children with Asthma

PURPOSE OF THE STUDY: To investigate the clinical severity of severe acute respiratory syndrome coronavirus 2 infection among children with asthma and determine the risk factors for the decline in lung function tests (LFTs). STUDY POPULATION: Study included asthma patients with coronavirus disease 2019 (COVID-19) infection (n = 187) and without COVID-19 infection (n = 792) who were followed between March 2020 and March 2021 by the Hacettepe University Department of Pediatric Allergy in Ankara, Turkey. METHODS: Demographic and clinical features of patients were obtained from medical records. COVID-19 infection severity was classified from mild to severe. LFTs, chest x-ray, and computed tomography images (if performed), treatments and outcomes were obtained from electronic medical records. Patients with COVID-19 infection were either confirmed by testing or probable by clinical history and symptoms. Prepandemic LFTs were evaluated in the control and study groups, and LFTs were also performed in children >5 years of age in the study group at a median of 72 weeks after the COVID-19 infection. All the children and their parents completed the Turkish Childhood Asthma Control Test (4–11 years old) or Asthma Control Test (≥12 years old). Asthma severity was assessed according to the Global Initiative for Asthma 2019 guidelines. Obesity was defined as having a BMI ≥95th percentile for age and sex. RESULTS: Asthmatic children with COVID-19 were mainly male (57.2%), and the median age was 8.6 years. Atopic sensitization was more common in the COVID-19 group (P = .027). Prematurity (21%) and obesity (21.8%) were the most common comorbid conditions. Of patients, 163 (87.6%) had a mild clinical COVID-19 course and 13 (7%) had moderate disease. There was no significant difference in forced expiratory volume1 (FEV1) %, forced vital capacity (FVC) %, and forced expiratory flow (FEF) 25% to 75% between the control and study patients before COVID-19 infection. In comparing LFTs before and after COVID-19 infection in study patients, no significant differences were found in FEV1%, FVC%, and FEV1/FVC. However, the frequency of patients with moderate asthma increased after COVID-19 infection (34% vs 45%, P < .001). Obesity (odds ratio: 3.785, 95% confidence interval: 1.152–12.429, P = .028) and having a family history of atopy (odds ratio: 3.359, 95% confidence interval: 1.168–9.657, P = .025) were found to be the independent risk factors for ≥25% decrease in FEF25-75 because of