Does COPD plus COVID-19 equal higher mortality?

The evaluation of chronic obstructive pulmonary disease (COPD) patients with COVID-19 did not find increased mortality, nor a negative impact of exacerbation status. Similar results were found for asthma and COVID-19.

“We sought to assess whether COPD or asthma are risk factors for intubation in COVID-19, as well as mortality in COVID-19,” Dr Jacob Schwartz (Lenox Hill Hospital, NY, USA) said [1]. For this analysis, data of 21,865 patients was included after extraction from electronic health records during the pandemic from March to July 2020. Findings from COVID-19 patients who had COPD or asthma were evaluated versus those without obstructive lung disease. Mechanical ventilation served as an indicator of severe COVID-19. The study cohort consisted of 1,370 patients with asthma plus COVID-19, 847 with COPD plus COVID-19, and 19,347 with COVID-19 but no obstructive lung disease.

The results for the COPD patients revealed a greater likelihood for intubation (aOR 1.35 vs controls; P=0.0095), but there was no link between COPD and COVID-19 mortality. On the other hand, patients with asthma and COVID-19 were neither at greater odds for mechanical ventilation nor increased mortality. “Our findings with regard to intubation may be explained by a more aggressive approach to intubate instead of using non-invasive ventilation early in the pandemic,” Dr Schwartz explained, “We especially intubated these patients early as they are likely perceived as high risk due to underlying lung disease.”

When comparing patients with the combination of COPD plus COVID-19 to those with asthma and COVID-19, the latter were less likely to die from COVID-19 than those with COPD (aOR 0.72; P=0.0329). The authors hypothesised that this disparity could be due to the different underlying pathophysiology of the diseases, as well as the possibility of a small protective impact derived from inhaled steroids. Whether asthma or COPD were exacerbated or stable while having COVID-19 did not augment the risk to die from COVID-19. “It is our hope that this data contributes to the further understanding of the complex relationship of COVID-19 and obstructive lung disease,” Dr Schwartz concluded.

1. Schwartz J, et al. COVID-19 and Obstructive Lung Disease: Are COPD and asthma risk factors for severe COVID-19? Evaluating the data from the largest health system in New York State. Session TP3: COVID-19 infections, mechanisms, and clinical implications. ATS 2021 International Conference, 14-19 May.

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Posted on 5 July 2021