#parent | #kids | COVID-19, asthma, and return to school | #covid19 | #kids | #childern

It is unclear where various countries will be with respect to ongoing community spread of COVID-19 in the autumn, but we anticipate constraints in ongoing health-care resource allocation in many parts of the world; for example, prioritisation of respiratory care in people with moderate to severe asthma, including limitation of exposure to aerosol generating procedures such as spirometry.

These constraints might reduce access and follow up for children and young people with milder asthma, who are at high risk of asthma exacerbations and emergency department visits. However, as stay at home orders have had a substantial impact on children and young people, including decreased vaccination rates, delayed management of health conditions, prolonged exposure to indoor home air pollutants, and impacts on mental health, it is possible that in some children and young people a return to school might improve overall asthma control.

Despite this, children and young people with asthma might be at high risk of missing out on education when schools reopen. Asthma can be confused with COVID-19 respiratory symptoms,

and children and young people with cough and wheeze at school are at greater risk of being sent home. To minimise this disruption, rapid testing services, which are likely to be stretched, should be prioritised for children and young people wherever possible. Primary, secondary, and tertiary care services can also mitigate this problem by adhering to evidence-based approaches to childhood asthma. In particular, a focus on asthma control, risk stratification, and medication adherence will be essential, including ongoing review of inhaler technique and a personalised written asthma action plan, whether in-person or virtually.

Prioritising less (or no) short-acting bronchodilator use, as recommended in the Global Initiative for Asthma (GINA) 2019 and 2020 strategy, and clear stepwise action plans might improve asthma control and management among people with mild asthma. An ongoing cycle of assess, adjust, and review, as recommended in the GINA guideline, is essential because a return to school this year might impact asthma in ways that are unpredictable at present. An appreciation of the effect of social determinants of health among families of children and young people with asthma, whether this be housing quality, adequately heated and ventilated homes, access to transportation, poverty, health literacy, access to medications, or access to health care,

will be important, since economic depression is anticipated to worsen.

Broad access to influenza vaccination will be an important public health strategy to further decrease risk, and particular effort must be made to educate families about the benefits of vaccinating children and young people with asthma.

ensuring that those with asthma return to school safely will require diligence and ongoing monitoring. In addition to the broader public health recommendations (screening, physical distancing, mask wearing, and hand hygiene), specific recommendations might be especially salient for families of children and young people with asthma. For example, regular environmental cleaning is recommended to reduce the presence of severe acute respiratory syndrome coronavirus 2 on surfaces in schools,

but various household cleaning products have been associated with an increased risk of asthma and wheeze across all age groups.

Consequently, cleaning products used in schools should be free of organic compounds, irritants, or fragrances.

Improving classroom ventilation will be important overall,

but there is a fine balance between opening windows and maintaining thermal comfort, and care must be taken to reduce exposure to outdoor seasonal aeroallergens, such as mould or pollens, in children and young people with atopic asthma.

Indoor air quality monitors that measure carbon dioxide and humidity might be useful adjuncts. Schools could use strategies to reduce traffic pollution, including anti-idling policies at drop-off and pick-up times for those driving cars, encourage as many students as possible to arrive on foot or by bicycle, and arranging deliveries outside school hours.