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Understanding the environmental factors related to the decrease in Pediatric Emergency Department referrals for acute asthma during the SARS-CoV-2 pandemic
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  • Arianna Dondi,
  • Ludovica Betti,
  • Claudio Carbone,
  • Ada Dormi,
  • Marco Paglione,
  • Matteo Rinaldi,
  • Maurizio Gualtieri,
  • Fabiana Scotto,
  • Vanes Poluzzi,
  • Marianna Fabi,
  • Marcello Lanari
Arianna Dondi
Sant’Orsola University Hospital
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Ludovica Betti
Alma Mater Studiorum University of Bologna
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Claudio Carbone
Italian National Agency for New Technologies, Energy and Sustainable Economic Development (ENEA)
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Ada Dormi
Alma Mater Studiorum University of Bologna
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Marco Paglione
Italian National Research Council
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Matteo Rinaldi
Italian National Research Council
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Maurizio Gualtieri
Italian National Agency for New Technologies, Energy and Sustainable Economic Development (ENEA)
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Fabiana Scotto
Agency for Prevention, Environmental and Energy of Emilia-Romagna (Arpae)
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Vanes Poluzzi
Agency for Prevention, Environmental and Energy of Emilia-Romagna (Arpae)
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Marianna Fabi
Sant’Orsola University Hospital
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Marcello Lanari
Sant’Orsola University Hospital
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Abstract

Background: Asthma exacerbations, a common reason for Pediatric Emergency Department (PED) referral, can be triggered by multiple factors, including infections, air pollution and allergens. Lockdown measures and other public health interventions during the SARS-CoV-2 pandemic determined radical changes to behavioral and social habits, that were reflected by a reduction in the transmission of all respiratory pathogens and in the emissions of relevant air pollution anthropogenic sources. Objective: This study aims to describe how restrictions during SARS-CoV-2 pandemic impacted the PED referral for asthma exacerbations and their potentially associated environmental triggers in densely populated urban areas. Methods: PED referrals for acute asthma from 2015 to 2020 were compared to air pollution and pollen data. To this purpose, historical daily concentration records of PM2.5, PM10 (including specific chemical tracers), as well as NO2, C6H6, tree, grass and weed pollen were analyzed. Results: In 2020, asthma-related PED referrals decreased up to 85%, compared to the average referral rate of the previous 5 years (P<0.01). The drastic drop in PED referrals was associated with a reduction of high-priority cases by 50-60%, unlike PED referrals for overall diagnoses, showing a larger contribution for severe outcomes. A concomitant diminished contribution of traffic-related air pollution was shown. Conclusions: The lower rate of asthma exacerbations in childhood can be related to synergic interactions of the multiple effects of lockdown measures which induced lower viral infection rates and decreased exposure to outdoor allergens. The reduction of traffic-related air pollution determined a weakening of inflammatory properties of urban PM.

Peer review status:ACCEPTED

17 Apr 2021Submitted to Pediatric Pulmonology
19 Apr 2021Submission Checks Completed
19 Apr 2021Assigned to Editor
20 Apr 2021Reviewer(s) Assigned
15 May 2021Review(s) Completed, Editorial Evaluation Pending
19 May 2021Editorial Decision: Revise Major
25 Jun 20211st Revision Received
25 Jun 2021Assigned to Editor
25 Jun 2021Reviewer(s) Assigned
25 Jun 2021Submission Checks Completed
17 Jul 2021Review(s) Completed, Editorial Evaluation Pending
19 Jul 2021Editorial Decision: Revise Minor
05 Sep 20212nd Revision Received
06 Sep 2021Submission Checks Completed
06 Sep 2021Assigned to Editor
06 Sep 2021Reviewer(s) Assigned
19 Sep 2021Review(s) Completed, Editorial Evaluation Pending
19 Sep 2021Editorial Decision: Revise Minor
20 Sep 20213rd Revision Received
21 Sep 2021Submission Checks Completed
21 Sep 2021Assigned to Editor
21 Sep 2021Review(s) Completed, Editorial Evaluation Pending
21 Sep 2021Editorial Decision: Accept