Transition to virtual asthma care early in the COVID-19 pandemic
Published: March 6, 2022
In addition to its direct effects on health, the COVID-19 pandemic necessitated a rapid change in healthcare delivery from in-person to virtual care. Early in the pandemic, there was concern about how the clinical outcomes of patients with asthma in particular would be affected by both COVID-19 and the dramatic changes in care.
In an observational research study recently published in The Journal of Allergy and Clinical Immunology: In Practice, Cvietusa and colleagues from Kaiser Permanente Colorado (KPCO) report on the outcomes for patients with persistent asthma as they went from getting essentially all of their care in-person to getting much of their care virtually, during the first 8 months of the COVID-19 pandemic. Adults ages 18-99 with persistent asthma were evaluated during 2 time periods (March through October of 2019 and March through October of 2020). The study compared asthma exacerbations (hospitalizations, emergency department visits and courses of oral corticosteroids) as well as asthma medication metrics between the two time periods. Analyzing care during the first 8 months of the COVID pandemic (March through October of 2020), the study categorized the patient population by type of care received (in-person, virtual, a mix of virtual and in-person, or no care). Population characteristics as well as exacerbation rates and asthma metrics were then compared for these subgroups.
The study found that 85% of all care for this asthma patient population was provided in person during the 8-month pre-COVID period, with just 15% virtually and < 1% by video. However, by April 2020, 77% of care was delivered virtually, though it had decreased to 43% by October 2020. As noted in other studies looking at asthma populations during the pandemic, this study found a decrease in asthma exacerbations during the pandemic compared to the previous year. There was also a small but statistically significant increase in both asthma controller medication adherence and the Asthma Medication Ratio (a quality metric looking at the quantity of controller medications filled as a proportion of all asthma medications filled) during the first 8 months of the pandemic compared with the same time period in the prior year.
Looking at the transition to virtual care during the 8-month period in 2020, the study found those who used more virtual care or sought no care during the pandemic tended to be younger and had fewer co-morbidities, mental health diagnoses, or financial barriers to care. Those receiving a mix of in-person and virtual care had the highest exacerbation rates, while those receiving no care had the lowest exacerbation rates and the highest AMR.
While it is likely the reduced rate of asthma exacerbations was in large part due to social distancing and other mitigating factors imposed by the pandemic itself, this study suggests that the sudden and dramatic change to virtual care did not lead to worse clinical outcomes. This study should give clinicians some confidence that asthma care can be delivered virtually without compromising clinical outcomes.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.