Increased Treatment of Acute COPD Exacerbations During the COVID-19 Pandemic

An elderly patient wearing an oxygen mask
An elderly patient wearing an oxygen mask
This study evaluated the change in AECOPD treatment frequency during the first 6 weeks of lockdown in the UK compared with 2019 and assess changes in self-reported behavior and wellbeing.

An increase in the treatment of acute exacerbations of chronic obstructive pulmonary disease (COPD) has been reported during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and associated lockdown measures. Results of the analysis were published in the journal ERJ Open Research.

An observational, prospective study on the subject was conducted among patients with COPD managed in the community and hospital setting in a single center—Glenfield Hospital in Leicestershire, United Kingdom— between the initial 6-week period of the SARS-CoV-2 lockdown in England (from March 15, 2020, to April 30, 2020).

The investigators sought to compare the rates of treatment for acute exacerbations of COPD in the first 6-week coronavirus disease 2019 (COVID-19) lockdown in England with the same 6-week period in the prior year—March 15, 2019, to April 30, 2019. All of the participants were recruited prospectively between June 2, 2020, and July 8, 2020, with all recruitment and interview calls made by either experienced respiratory research nurses or clinicians. Community COPD exacerbation rates were chronicled with the use of electronic community prescription records, and hospital COPD exacerbations rates were recorded with the use of electronic hospital records.

A scripted telephone survey was conducted to examine potential reasons for any differences in COPD exacerbation risk. The participants were asked to compare behavioral and emotional changes (ie, changes in anxiety, inhaler adherence, and physical activity) with their baseline “normal” state as a reference, using the following 2 discrete periods: (1) prelockdown, which was defined as 2 weeks prior to the actual lockdown (ie, March 1, 2020, to March 14, 2020) and (2) the lockdown period itself (ie, March 15, 2020, to April 20, 2020).

A total of 160 participants were recruited for the study. The mean patient age was 67.3 ± 8.1 years; 55% of the participants were male. Mean forced expiratory volume in 1 second was 34 ± 13% predicted. Overall, 88% (140 of 160) of the participants reported ≥1 acute exacerbation of COPD in the previous year.

Results of the study showed that significantly more community-managed COPD exacerbations were observed in 2020 compared with 2019 (126 events vs 99 events, respectively; P =.026). This increase in COPD exacerbations was attributed to multiple courses of treatment, with similar percentages of patients receiving ≥1 course of treatment (34.4% vs 33.8%, respectively). During the lockdown, study participants reported significantly increased preventive inhaler compliance, indicative of greater health concerns; enhanced levels of anxiety; and widespread adherence to shielding advice, likely reflecting a shared concern among the patients over the risks associated with COVID-19 (P <.001 for all),. Further, a significant reduction in self-reported physical activity and visitors was reported (P <.001 for both).

The investigators concluded that the results of this study underscore the need for potential psychological support in a vulnerable patient population with COPD during the COVID-19 pandemic, in which anxiety and depression are both common.


McAuley H, Hadley K, Elneima O, et al. COPD in the time of COVID-19: an analysis of acute exacerbations and reported behavioural changes in patients with COPD. ERJ Open Res. Published online January 18, 2021. doi:10.1183/23120541.00718-2020