ORIGINAL RESEARCH article
Front. Allergy
Sec. Asthma
Volume 6 - 2025 | doi: 10.3389/falgy.2025.1645968
This article is part of the Research TopicImpact of Viral Infections on Childhood Asthma: Susceptibility and PathomechanismsView all articles
From Lockdown to Recovery: Changing Patterns of Viral Infection Severity in a Pediatric Cohort with Asthma
Provisionally accepted
Cassidy Jones1Matthew Laws2Shahwar Yousuf2
Andrew Delo2Susanna Hartzell1Emma Kinder1Ashton Ingold1,2
Bobby Boyanton2,3Dana Frederick2Rachel A Frenner3
Erin Hathorn3Peter M Mourani1,2
Joshua L Kennedy1,2*- 1Arkansas Children's Research Institute, Little Rock, United States
- 2University of Arkansas for Medical Sciences, Little Rock, United States
- 3Arkansas Children's Hospital, Little Rock, United States
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Respiratory viruses such as rhinovirus and respiratory syncytial virus (RSV) are common triggers of asthma exacerbations in children. The COVID-19 pandemic introduced nonpharmaceutical interventions (NPIs) that altered viral circulation; however, their long-term effects on pediatric asthma outcomes remain unclear.To evaluate how the epidemiology and severity of respiratory viral infections in children with asthma changed before, during, and after COVID-19-related NPIs.We conducted a cross-sectional analysis of pediatric asthma patients (ages 4-18) with laboratory-confirmed respiratory viral infections from 2018 to 2024 at Arkansas Children's (AC) and AC Northwest (ACNW). Viral detection was performed using the BioFire® Respiratory Panel. Clinical severity was evaluated using a modified World Health Organization Ordinal Scale for Clinical Improvement (mWHO OSI). Patients were categorized by period (pre-NPI, NPI, post-NPI), viral type, rurality, and Childhood Opportunity Index (COI).This study included 9,391 pediatric asthma patients with laboratory-confirmed viral infections.RV/EV was the most common virus during all periods. Viral incidence decreased during NPIs but rebounded post-NPI with unusual seasonality. mWHO OSI scores declined over time (pre-NPI: 2.98; NPI: 2.49; post-NPI: 2.28), with significant reductions in hospitalizations, PICU admissions, and oxygen use (p<0.0001). Severe disease (mWHO OSI 6-8) was infrequent.Rural and low-COI patients exhibited higher severity, although disparities narrowed post-NPI.NPIs were associated with sustained reductions in asthma-related illness severity, even with increased viral detection post-pandemic. These findings highlight the long-term impact of public health measures on pediatric asthma outcomes and emphasize the need for ongoing surveillance of respiratory viruses and health disparities.
Keywords: Asthma, viral infections, Disease Severity, pediatric asthma, Children
Received: 12 Jun 2025; Accepted: 02 Sep 2025.
Copyright: © 2025 Jones, Laws, Yousuf, Delo, Hartzell, Kinder, Ingold, Boyanton, Frederick, Frenner, Hathorn, Mourani and Kennedy. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Joshua L Kennedy, University of Arkansas for Medical Sciences, Little Rock, United States
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