1) The study aimed to determine the risk of persistent cough and asthma-like symptoms in children hospitalized for COVID-19. It found that 41.5% of children developed asthma-like symptoms post-hospitalization. 2) Those with asthma-like symptoms were more likely to have a family history of asthma or personal history of asthma/allergic rhinitis. 3) Symptom occurrence was higher in children with both COVID-19 and asthma-like symptoms, particularly fever. Laboratory findings did not differ between groups.

1. JOURNAL CLUB
PRESENTATION
PRESENTOR – DR DHEERAJ NAGPAL

2. TITLE OF THE STUDY
Persistent cough and asthma-like symptoms
with post COVID-19 hospitalization in children
• Published online in 12 MARCH 2022
• Impact factor : 3.667
• Source : BMC infectious diseases

3. AUTHOR
Hossein Esmaeilzadeh,
 Anahita Sanaei Dashti
 Negar Mortazavi
 Hossein Fatemian
 Mohebat Vali

4. GOALS OF STUDY
• This study aimed to determine the risk of developing
Persistent cough and asthma-like symptoms in
hospitalized children due to COVID-19.
• This study also aimed to describe the association of
asthma-like symptoms in hospitalized children
affected by COVID-19.

5. REASON TO CHOOSE THE TOPIC
• Respiratory viruses are the main triggers of asthma.
• Coronavirus contributes to the respiratory tract
infections that can lead to prolonged cough and
asthma.

6. OUTLINE OF PRESENTATION
• Introduction
• Objectives
• Material And Method
• Results
• Limitations
• Conclusions
• Clinical Appraisal

7. INTRODUCTION
• Coronavirus disease 2019 (COVID-19) rapidly spread
worldwide, characterized by severe pneumonia and
other complications, such as death in highly severe
cases.
• The diseases spread rapidly in the community due to
the easy transmission of the virus, even from
asymptomatic patients.

8. • The causing agent survives in respiratory droplets.
• Three months following the first emergence, about 2.6
million cases were reported globally due to high
community transmission.
• Some comorbidities related to COVID-19 outcomes:
Hypertension, chronic obstructive pulmonary disease,
diabetes mellitus, cardiovascular disease, obesity and
asthma.

9. OBJECTIVES
• To determine the risk of developing persistent cough
and asthma-like symptoms in hospitalized children
due to COVID-19.

10. STUDY DESIGN
• Demographic characteristics and clinical data were
evaluated for all the patients and compared by the
chi-square test.
• The laboratory test results were compared utilizing
the Mann–Whitney test.
• The correlation between asthma-like and COVID-19
hospitalization was examined in these patients.

11. MATERIAL AND METHOD
• This prospective study was carried out in tertiary
referral Hospital.
• Patients were identified based on a specialist
physician visit.
• Patient information is extracted by reviewing the file
data, an electronic repository of the health records
of hospitalized patients in the health system.

12. METHOD
• From February 2020 to January 2021, 69 pediatric
patients hospitalized with COVID-19 were tracked
during the epidemic. After discharge, patients were
monitored and seen for a cough and asthma
evaluation one, two, and six months later.
• Clinical and laboratory data were also documented
throughout this time.

13. METHOD
• Patients who received diagnoses of asthma-like
conditions during follow-up were grouped into
asthma-like groups, while those who showed no
symptoms of asthma were placed in the non-asthma
group.
• Risk variables and co-morbidities similar to asthma
were assessed and compared between the two
group

14. INCLUSION CRITERIA
• The inclusion criteria include the age of children
<18 years old, being evaluated from February 2020
to January 2021, and having received the diagnosis
of COVID-19

15. EXCLUSION CRITERIA
• Those COVID-19 patients whom RT-PCR did not confirm
were excluded.
• Death, the lack of response to call or avoid participating
in this cohort study,

16. EXCLUSION CRITERIA
• Patients were affected by other infectious diseases,
such as pneumonia, post-infectious cough in
2 months after infection.
• Patients considered COVID-19 outpatients were the
other exclusion criteria.

17. ALGORITHIM OF STUDY

18. SYMPTOMS
• Fever
• Cough
• Dyspnea
• Myalgia
• Headache
• Diarrhea
• Vomiting
• Abdominal Pain
• Cardiac Complication

19. STATISTICAL ANALYSIS
• Demographic characteristics and clinical data were
evaluated for all the patients and compared by the
chi-square test.
• To laboratory test results were compared utilizing the
Mann–Whitney test.

20. DEMOGRAPHIC CHARACTERSTICS
• The diverse demographic characteristics and clinical
data between COVID19 patients with and without
post-hospitalization.
• Most (37.3%) COVID-19 patients were <6 years,
regardless of asthma-like status.

21. DEMOGRAPHIC CHARACTERSTICS
• Slightly over half (60.9%) of the COVID-19 patients
were male.
• The asthma-like group cases had a very high familial
history of asthma (63.0%), past medical history of
asthma (33.3%), and Allergic rhinitis (85.2%).

22. DEMOGRAPHIC CHARACTERSTICS

23. CLINICAL COMORBIDITIES
• The prevalence of various comorbidities and
symptoms was then specifically determined in
COVID-19 patients based on their post-
hospitalization status for asthma-like symptoms .
• Comparing COVID-19 patients with and without
asthma to those with COVID-19, those with both
COVID-19 and asthma-like symptoms experienced
significantly higher rates of symptom occurrence.

24. CLINICAL COMORBIDITIES
• Fever was found to be higher in the asthma-like
group, but vomiting was not significantly different
between patients with and without post-
hospitalization asthma-like .
• There was no difference in the frequency of
symptoms between those who had asthma before
and those who developed asthma after Covid 19.

25. SYMPTOMS ASTHMA PATIENT ASTHMA AFTER
COVID 19
P VALUE
FEVER 25.9 22.1 0.822
SORE THROAT 88.9 85.6 0.794
DYSPNEA 23.0 20.5 0.877
SPUTUM 21.0 20.6 0.979
MYALGIA 23.0 21.5 0.926
COUGH 21.0 19.8 0.939
HEADACHE 24.0 19.9 0.937
DIARRHEA 22.0 19.9 0.895
VOMITTING 18 17.8 0.989

27. LABORATORY DATA ANALYSIS
• A total of 69 patients were investigated with COVID-19 .
• Complete blood cell count indicated that White Blood
Cell (WBC), Hemoglobin (Hb), Platelet (plt), C-reactive
Protein (CRP), Alanine Aminotransferase(ALT), Alkaline
phosphatase (ALP), and eosinophil count were not
significantly different between patients with and without
post-hospitalization asthma.

28. LABORATORY RESULTS

29. RESULTS
• Most COVID-19 hospitalized patients (N=42; 58.5%)
were not affected by symptoms resembling asthma
at the time of follow-up. 60.9% of COVID-19 patients
were male.
• The asthma-like group cases had a significant familial
history of asthma (63.0%), a prior medical history of
asthma (33.3%), and allergic rhinitis (85.2%).
• Patients with COVID-19 and a history of asthma were
significantly more likely to experience signs and
symptoms while being treated in the hospital.

30. LIMITATIONS
• The data was collected retrospectively after the
patient’s discharge, causing limitations for causal
inferences.
• The data for the current study were gathered between
February 2020 and January 2021, and new data may
be collected after the study period, which could
change the results

31. LIMITATIONS
• It was considered that the probability of testing
asthmatic patients was higher due to the chronic
nature of this lung condition.
• Another drawback is that this study focus on COVID-
19 hospitalized patients who have more severe
infection than outpatients, which does not include all
COVID-19 patients.
• Another restriction that makes globalization difficult
is a small sample size.

32. STRENGTH
• Good study designs.
• Follow up for examination.

33. ADVERSE EVENTS
• No adverse events were encountered during the
study procedure.

34. CONCLUSIONS
• The post-hospitalization persistent cough and asthma
like prevalence of 41.5% in the cohort of COVID-19
hospitalized patients.
• This study indicates that post hospitalization asthma-
like risk factors may have a family history of asthma and
previous history of asthma and Allergic rhinitis.

35. CONCLUSIONS
• The incidence of COVID-19 signs and symptoms is
higher in the asthma-like group, especially fever.
• No difference was observed between the two groups
in terms of laboratory information.

36. OTHER RELATED STUDIES

39. CLINICAL APPRAISAL
DID THE STUDY ADDRESS A CLEAR FOCUS QUESTION? YES
WERE THE PEOPLE ASSESSING/ANALYSING OUTCOME
BLIND?
NO
WERE THE SUBJECT RECRUITED IN THE ACCEPTABLE
WAY?
YES

40. WERE THE STUDY GROUP SIMILAR AT THE START OF
TRIAL?
YES
WERE THE EFFECT OF STUDY REPORTED
COMPREHENSIVELY?
YES
DID EACH STUDY GROUP RECEIVE SAME LEVEL OF CARE? NO

41. WERE THE MEASURE ACCURATELY MEASURE TO
REDUCE THE BIAS?
YES
WERE ALL PARTICIPANTS WHO ENTERED THE STUDY
ACCOUNTED FOR ITS CONCLUSION?
YES
WERE THE RESULTS APPLICAPLE IN CLINICAL PRACTICE? YES