Pathophysiological association of covid-19 with type i diabetes mellitus and asthma in the pediatric population and its management strategy

Abstract

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.