Impact of the COVID-19 Pandemic on COPD

By: Farrukh Abbas, MBBS; Kadambari Vijaykumar, MD; Navitha Ramesh, MD, MBBS, FCCP; and Allen Blaivas, DO, FCCP (on behalf of the CHEST Airways Disorders NetWork)

November 23, 2020

In the first week of May, on a particularly busy night in the COVID ICU, a physician received a frantic call from Ms. R, a health-care worker in a nursing home. Ms. R was a long-term patient in the COPD outpatient clinic and wanted to know if she was going to contract coronavirus and die from it. Ms. R has moderate to severe COPD, had completed her last session of pulmonary rehabilitation in January following an exacerbation, and had been stable on her treatment regimen of inhalers and azithromycin. She was very concerned that working in a nursing home with a COVID outbreak put her at an increased risk of contracting the virus. She requested to be taken off work and unfortunately did what she knew best to allay her fears—increased the number of cigarettes she was smoking.

COPD is a common respiratory condition. It affects more than 5% of the population and is associated with higher morbidity and mortality. Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory distress syndrome coronavirus (SARS-CoV-2) has led to increased risks in patients with COPD and created challenges in caring for this patient population.

Increased Risk Due to COPD

Studies have shown that the presence of COPD is associated with a nearly three- to four-fold higher risk of developing severe COVID-19 and possibly a higher risk of death from COVID-19.1,2 The impact of active cigarette smoking on COVID-19 is controversial. Active smoking was associated with an increased risk of developing severe COVID-19 and death in some studies1,2, while in another study, active smoking was not associated with advanced risk of progressing toward severe disease.3 Systemic hypertension is the most common comorbidity in patients with COPD and may be associated with higher mortality in COVID-194.

Challenges in Patient Management

The COVID-19 pandemic poses many challenges to the care of patients with COPD. Currently, there are insufficient data to determine whether inhaled corticosteroids should be continued or withheld as a preventive measure for patients with COPD during the COVID-19 pandemic. Although historical evidence for systemic corticosteroids in viral pandemics has not been favorable, dexamethasone has become standard of care treatment for COVID-19 patients with hypoxemia.

COVID-19 has also impacted patients with COPD in many other ways, including the closure of onsite pulmonary rehabilitation and home visit programs. While online pulmonary rehabilitation programs may be as effective as onsite sessions,5 the need to navigate new technology, cost, and patient preferences may become barriers to joining online sessions. In addition, fear of contracting COVID-19 in the hospital may have led to delayed care and possibly uncontrolled disease. The long-term effects of COVID-19 on COPD remain to be seen.

Four months later in September, during a telehealth visit with her physician, a dejected Ms. R expressed that while she was able to work from home and is compliant with her medications, she was unable to stop smoking and keep up with the exercises she needs. Management of COPD requires a robust multidisciplinary approach inclusive of preventive care for smoking cessation, pulmonary rehabilitation, and attention to mood disorders in addition to medication optimization—measures that have proven to be beneficial, but have been especially challenging during this pandemic.

While more research is needed to better answer questions on the risk of COVID-19 susceptibility in patients with COPD, mortality, and the role of smoking, we continue to face increasing numbers of COVID-19 cases, highlighting the dire need for the establishment of effective virtual programs and inclusive care.

REFERENCES

  1. Zhao Q, Meng M, Kumar R, et al. The impact of COPD and smoking history on the severity of COVID-19: a systemic review and meta-analysis. J Med Virol. 2020. doi: 10.1002/jmv.25889
  2. Alqahtani JS, Oyelade T, Aldhahir AM, et al. Prevalence, severity and mortality associated with COPD and smoking in patients with COVID-19: a rapid systematic review and meta-analysis. PloS One. 2020;15(5):e0233147. doi: 10.1371/journal.pone.0233147
  3. Lippi G, Henry BM. Active smoking is not associated with severity of coronavirus disease 2019 (COVID-19). Eur J Intern Med. 2020. doi: 10.1016/j.ejim.2020.03.014
  4. Jordan RE, Adab P, Cheng K. Covid-19: risk factors for severe disease and death. BMJ. 2020. doi: 10.1136/bmj.m1198
  5. Bourne S, DeVos R, North M, et al. Online versus face-to-face pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: randomised controlled trial. BMJ Open. 2017;7(7):e014580. doi: 10.1136/bmjopen-2016-014580

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