PATHOPHYSIOLOGICAL ASSOCIATION OF COVID-19 WITH TYPE I DIABETES MELLITUS AND ASTHMA IN THE PEDIATRIC POPULATION AND ITS MANAGEMENT STRATEGYAbstract
Background and Aim: Coronavirus 2019 (COVID-19) is a pervasive emergency affecting 1-5% of children, among whom the majority are with preexisting comorbidities. This commentary aim is to highlight two such prominent childhood comorbidities, i.e., asthma and type 1 diabetes mellitus (T1-DM), with their pathophysiological link to COVID-19. Method: We searched the Google Scholar and PubMed databases till August 15, 2020, and retrieved the data connected to our aim for reviewing. Results: Asthma and T1-DM in children affect the COVID-19 progression due to their interlinked disease mechanisms with infection. Th-2 (T-helper) low endotype asthma and TI-DM connect by decreased ACE (angiotensin-converting enzyme) receptor expression, whereas Th-2 high endotype intensifies the COVID-19 via declining the IFNs (interferons) related anti-viral effect. Addressing these comorbidities therapeutically in this pandemic includes continuity in respective disease control treatment plans with the use of pressurized metered-dose inhaler (pMDI) with a spacer rather than nebulizers or keeping the low incidence of exacerbations by inhaled/oral corticosteroid and/or Montelukast in children with asthma is recommended. In the case of T1-DM, blood glucose of 70-144mg/dL and <0.6 mmol/L of blood ketone levels to be maintained without stopping Insulin dosing should be followed. Conclusion: Elevating the immunity with regular telemedicine and proper adherence to a prescribed action plan can address the present state of infection in children with asthma or T1-DM, or both.
T. Spurthi, M. M. Koushik and M. G. Rajanandh *
Department of Pharmacy Practice, Sri Ramachandra Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research, Deemed University, Porur, Chennai, Tamil Nadu, India.
08 October 2020
22 May 2021
10 June 2021
01 July 2021