To evaluate the association between asthma and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection risk among children.

Children 5 to 17 years of age receiving care through the Duke University Health System with a Durham County, North Carolina residential address.

This was a retrospective cohort study of all children who met population criteria who had a positive SARS-CoV-2 polymerase chain reaction test between March 1, 2020 and September 30, 2021. Children were identified as having asthma based upon the electronic health record and compared 1:1 with children who did not have asthma through a propensity score matched system.

During the study period, 46 900 children were included, of which 13.5% had asthma and were matched to an equal size cohort without asthma (N = 6324 in each). There were 10 566 children who had 1 or more tests for SARS-CoV-2 (4% overall were positive). Children with asthma were more likely to be tested for SARS-CoV-2 infection (33% vs 21%), but were not more likely to have a positive test result when matched with the equal size cohort; 2.8% positive rate was seen in both cohorts (risk ratio: 0.98, 95% confidence interval: 0.85–1.13). No differences were identified based upon prior inhaled corticosteroid prescription, history of severe exacerbation, or comorbid atopic conditions. There were 34 total hospitalizations within 30 days of a positive test, 3 of whom had asthma.

This retrospective analysis did not identify any differences in either infection rate or hospitalizations between children with or without asthma who tested positive for SARS-CoV-2.

Because of the respiratory transmission of the SARS-CoV-2 virus, it was presumed in the early stages of the pandemic that it would cause increased risk for severe infection among people with asthma. Fortunately, dozens of studies have demonstrated similar findings throughout the pandemic: this virus did not behave similar to other respiratory viruses for people with asthma, regardless of age or severity. Despite evidence to the contrary, some organizations still list asthma as a risk factor for severe SARS-CoV-2 infection. This study evaluated children in one geographic location early in the pandemic before vaccination was widely available to children and during times of various circulating mutations. As such, these findings are even more reassuring regarding current risk assessment for children with asthma.