OBJECTIVES: We aimed to characterize the epidemiology of asthma in children using the automated analytical platform Livingstone.

METHODS: The study was conducted in the combined Clinical Practice Research Datalink Aurum and GOLD datasets (01/01/2004—31/12/2021). Cases were selected with ≥1 medical codes indicative of asthma recorded within the datasets. Two age cohorts were analyzed; 0–4 and 5–14 years. Annual incidence per 1,000 person years (pkpy) and point prevalence (%) were calculated. All analysis was performed by Livingstone.

RESULTS: 156,928 asthma cases were identified in the 0–4 cohort, and 251,868 in the 5–14 cohort. Mean and median age for the 0–4 cohort was 3 years, and 60.7% were male. Mean and median age for the 5–14 cohort was 9 and 8 years, and 56.1% were male. The prevalence of asthma showed a gradual decrease from 2004 to 2021 (4.4% to 0.7% for 0–4; 16.4% to 8.2% for 5–14). Incidence peaked in 2004 (20.2 pkpy for 0–4 and 10.6 in 5–14), and gradually decreased to 2019 (7.3 for 0–4 and 7.8 for 5–14). There was a 43% and 37% decrease between 2019 and 2020 for the 0–4 (7.3 to 4.2) and 5–14 (7.8 to 5.0) cohort, respectively, followed by an increase in 2021 (5.8 for 0–4 and 5.2 for 5–14), but not to pre-COVID-19 pandemic levels.

CONCLUSIONS: Over the study period, the prevalence of asthma decreased. Higher incidence rates early in the study period may be artifact of increased reporting following Quality Outcomes Framework in 2003. The decline in incidence in 2020 may reflect environmental changes following COVID-19 lockdown, but may be due to decreased presentation during the pandemic resulting in underdiagnosis and undertreatment. If so, it is important that any undiagnosed cases are identified.