Rebound in asthma exacerbations following relaxation of COVID-19 restrictions: a longitudinal population-based study (COVIDENCE UK)

Background The imposition of restrictions on social mixing early in the COVID- 19 pandemic was followed by a reduction in asthma exacerbations in multiple settings internationally. Temporal trends in social mixing, incident acute respiratory infections (ARI) and asthma exacerbations following relaxation of COVID- 19 restrictions have not yet been described.Methods We conducted a population -based longitudinal study in 2312 UK adults with asthma between November 2020 and April 2022. Details of face covering use, social mixing, incident ARI and severe asthma exacerbations were collected via monthly online questionnaires. Temporal changes in these parameters were visualised using Poisson generalised additive models. Multilevel logistic regression was used to test for associations between incident ARI and risk of asthma exacerbations, adjusting for potential confounders.Results Relaxation of COVID- 19 restrictions from April 2021 coincided with reduced face covering use (p < 0.001), increased frequency of indoor visits to public places and other households (p < 0.001) and rising incidence of COVID- 19 (p < 0.001), non-COVID- 19 ARI (p < 0.001) and severe asthma exacerbations (p=0.007). Incident non-COVID- 19 ARI associated independently with increased risk of asthma exacerbation (adjusted OR 5.75, 95% CI 4.75 to 6.97) as did incident COVID- 19, both prior to emergence of the omicron variant of SARSCoV- 2 (5.89, 3.45 to 10.04) and subsequently (5.69, 3.89 to 8.31).Conclusions Relaxation of COVID- 19 restrictions coincided with decreased face covering use, increased social mixing and a rebound in ARI and asthma exacerbations. Associations between incident ARI and risk of severe asthma exacerbation were similar for non-COVID- 19 ARI and COVID- 19, both before and after emergence of the SARS- CoV- 2 omicron variant.