Case study: Diagnosing underlying asthma after COVID-19 infection in child

Pediatric providers often are challenged with discerning whether persistent symptoms could be attributed as complications following a COVID-19 infection versus an underlying condition that was unmasked following an acute viral infection.

The patient

A 3-year-old twin girl with a history of prematurity (32 weeks gestational age), intubated for five days in the neonatal intensive care unit (NICU) and who developed pneumothorax as a neonate, was referred to the pediatric pulmonology clinic with dyspnea with activity following a symptomatic COVID-19 infection three months prior to presentation. She was symptomatic with a high fever (104 F), dry cough, fatigue and dyspnea during the COVID-19 infection but recovered without sequelae. Now, she only gets short of breath when she does physical activity or plays outside. Her mother denied any respiratory symptoms prior to the COVID-19 infection. However, she stated that when the patient and her twin sister get sick with viral infections, the patient takes a longer time to recover compared to her sister. She was prescribed albuterol by her pediatrician, and her mom reports this medication improved the child’s symptoms.

The challenge

Given the novelty of COVID-19, its often asymptomatic nature in children and the paucity of short- and long-term data, providers often are challenged with discerning whether persistent symptoms could be attributed as a sequela to the COVID-19 infection or an underlying condition that was unmasked following an acute viral infection.

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The physicians

Physicians with Norton Children’s Pulmonology, affiliated with the UofL School of Medicine, including Ronald L. Morton, M.D., pediatric pulmonologist treated the patient.

The solution

Further history revealed that the patient has a strong modified Asthma Predictive Index (mAPI)1 and has a high likelihood of having underlying asthma that was unmasked by an acute COVID-19 infection. She was born prematurely, which is a risk factor for childhood asthma. Furthermore, her mother and older sister have persistent asthma and take daily controller medications. She has a history of allergic rhinitis and has been noted by providers to have wheezed in the past, with or without infections. According to the mAPI used for children under 4 years old, her odds of having underlying asthma are higher than the general population (by up to ninefold).

Our patient’s modified Asthma Predictive Index

(to be used in patients 4 years old and under)

(Positive mAPI consists of reported episodic wheezing with one major or two minor criteria.)

The result

She was started on a daily inhaled corticosteroid for preventing airway inflammation as well as albuterol as needed for symptomatic relief and prior to physical activity.

Norton Children’s Pulmonology’s specialists have the experience and training to provide specialized care for all types of asthma in children and teens. At the Norton Children’s Severe Asthma Clinic, a place where children with the most difficult-to-treat and severe asthma receive care, specialists from Norton Children’s Pulmonology work in conjunction with colleagues from Norton Children’s Allergy & Immunology, affiliated with the UofL School of Medicine.


1 Chang TS, Lemanske RF, Guilbert TW, Gern JE, Coen MH, Evans MD, et al. Evaluation of the modified asthma predictive index in high-risk preschool children. J Allergy Clin Immunol: In Practice. 2013 March 1; 1:152-156.

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