While patients with chronic obstructive pulmonary disease (COPD) don’t appear to have a higher risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the novel coronavirus responsible for coronavirus 2019 (COVID-19), patients with COPD who do contract SARS-CoV-2 typically have worse prognosis than patients without COPD, according to a study in the International Journal of Chronic Obstructive Pulmonary Disease.
The study was based on data from the ongoing, retrospective SEMI-COVID registry, which includes consecutive patients with COVID-19 hospitalized in Spain since March 2020. A total of 10,420 patients who were included in the registry as of May 21, 2020, were included in this analysis.
In this study, researchers collected and evaluated data on patient demographics, clinical characteristics, comorbidities, laboratory tests, radiology, treatment, and progression. The investigators identified 746 patients in the registry who had a comorbid diagnosis of COPD and compared the outcomes of this group with patients without COPD.
Patients with COPD were older than patients without COPD (77 vs 68 years) and were more often men (82.2% vs 54.7%; P <.001). Overall, patients with COPD had a significantly higher Charlson Comorbidity Index (3 vs 6; P <.001). Comorbidities more frequently reported in the COPD group included hypertension (69.1% vs 48.9%; P <.001), hyperlipidemia (53.4% vs 38.1%; P <.001), diabetes mellitus (25.8% vs 18.1%; P <.001), atrial fibrillation (23.6% vs 10.4%; P <.001), heart failure (17.8% vs 6.7%; P <.001), ischemic heart disease (12.2% vs 6.8%; P <.001), peripheral vascular disease (12.0% vs 4.3%; P <.001), and kidney failure (11% vs 5.7%; P <.001).
The mortality rate was also significantly higher in patients with COPD and COVID-19 vs patients with COVID-19 but without COPD (38.3% vs 19.2%, respectively; P <.001). Survival was higher in patients with COPD and COVID-19 who received hydroxychloroquine (87.1% vs 74.9%; P <.001) and macrolides (57.9% vs 50%; P <.037). Prognosis was not improved with either prone positioning or non-invasive mechanical ventilation, high-flow nasal cannula, or invasive mechanical ventilation.
A limitation of this study was the lack of spirometry data for some patients, which could have resulted in the inclusion of patients without a formal or proper diagnosis of COPD.
The investigators concluded that patients with COPD who receive a COVID-19 diagnosis “must be identified early in order to establish preventive measures that reduce risk and provide adequate management.”
Gómez Antúnez M, Muiño Míguez A, Bendala Estrada AD, et al. Clinical characteristics and prognosis of COPD patients hospitalized with SARS-CoV-2. Int J Chron Obstruct Pulmon Dis. Published online January 5, 2021. doi:10.2147/COPD.S276692