Asthma control, self-management and healthcare access during the COVID-19 Epidemic in BeijingChun Chang a* M.D., Linlin Zhanga*B.S., Fawu Dong a* B.S., Ying Liang a M.D., Yahong Chen a M.D., Ying Shang a B.S., Mairipaiti Abulikemua B.S., Yongchang Suna# M.D.aDepartment of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China.#, Corresponding to Yongchang Sun:Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China.North Garden Rd. 49.Haidian District, Beijing, 100191, ChinaTel: +86 010 139 1097 9132Fax +86 108 226 6989E-mail: [email protected]* Chun Chang, Linlin Zhang and Fawu Dong contributed equally to this work;To the Editor:The pandemic of COVID-19, caused by the pathogen SARS-CoV-2, has now spread around the globe. Social distancing and restriction measures during COVID-19 pandemic may have impacts on asthma control and management in terms of medication availability and healthcare access. International societies responded quickly by releasing guidance on the management of asthma during the COVID-19 pandemic1-4. However, these temporary guidelines were based largely on previous asthma guidelines and expert consensus, because evidence from related studies was lacking. Therefore, we investigated the status of asthma control, self-management, medications and healthcare utilization of asthma patients during the COVID-19 epidemic in Beijing, aiming to provide data for guideline recommendations on asthma managements during the emergency.Patients with asthma, selected randomly from our hospital database, were interviewed by phone call. Detailed description of items in the questionnaire is available in this article’s online supplementary material.We contacted 286 patients, of whom 178 (62.2%) responded with valid results. Sociodemographic data and clinical characteristics of the patients before the COVID-19 pandemic are provided as online supplements. During the COVID-19 epidemic in Beijing (January 25, 2020 to April 25, 2020), the majority (74.2%, 132/178) of the patients felt that their symptoms had not changed as compared with usual times, while 18.0% (32/178) felt better, and 7.9% (14/178) felt worse. The mean ACT score of the 178 patients was 22.76 ± 3.06 (ranging from 8 to 25) in the last 4 weeks before the survey. According to the criteria of ACT scoring from GINA, asthma was classified as well-controlled in 89.3%, not well-controlled in 6.2%, and very poorly controlled in 4.5% of the patients. During this period, only 24.7% (44/178) of the patients had ever visited a hospital or clinic for asthma, of whom 11 patients had 2 visits, and 6 had ≥3 visits, totaling 74 visits. 14.9% (11/74) of all medical visits were due to exacerbation of asthma, while the remaining visits (63/74, 85.1%) were for regular prescription of asthma medications. Only 6 patients (3.4%) sought consultation online. (Table 1)Notably, 25.6% (45/176) of the patients experienced aggravation of asthma symptoms during the COVID-19 epidemic, but 75.6% (34/45) of them did not see a doctor, because 67.6% (23/34) of the patients thought that they did not need to go to the hospital and took more medications by themselves, and the remaining 32.4% (11/34) worried about cross-infection of COVID-19 in the hospital. No patient said that they did not see a doctor because they could not arrange an appointment. Eleven patients went to the hospital due to aggravation, 81.8% (9/11) to the outpatient, while only 18.2% (2/11) to the Emergency Department (ED).Table 1 Asthma control and management during the COVID-19 epidemic in Beijing

Background Social distancing and restriction measures during the COVID-19 pandemic may have impacts on asthma control and management in terms of medication availability and healthcare access. We aimed to understand the status of asthma control, exacerbations, self-management and healthcare utilization during the COVID-19 pandemic in Beijing, China. Methods Patients with asthma, selected randomly from our hospital database, were interviewed by phone call. During the interview, sociodemographic information and clinical data, including status of asthma control, asthma exacerbation, self-management and medication before and during the COVID-19 pandemic (From January 25, 2020 to April 25, 2020), were collected. Results We contacted 286 patients, of whom 178 (62.2%) responded with valid results. Before the COVID-19 pandemic, 4.5% (8/178) and 6.7% (12/178) of the patients, respectively, had been hospitalized and visited emergency departments due to asthma exacerbations. 66.7% (118/177) had received maintenance medication. During the COVID-19 pandemic, the majority (92.1%, 164/178) of the patients felt that their symptoms were similar or improved compared with usual times. The mean ACT score of the patients was 22.76 ± 3.06. 24.7% (44/178) of patients sought medical care for asthma. 25.6% (45/176) of the patients ever experienced aggravation of asthma symptoms, but mostly managed by themselves. 13.5% (24/178) of the patients had worried about potential shortage of medications and some reduced dosing. Conclusion It is important for patients to continue taking their prescribed asthma medications as usual and maintain good asthma control during the ongoing pandemic.