In patients with chronic obstructive pulmonary disease (COPD), lockdown for coronavirus disease 2019 (COVID-19) was associated with a reduction in exacerbations and an improvement in symptoms, according to results of an analysis published in CHEST.
Researchers sought to evaluate the impact of COVID-19 lockdown in Spain — defined as the limitation of free movement other than for acquiring food and medicines, seeking health care, and attending work in essential services — on exacerbations, symptoms, and health care costs in a cohort of well-characterized patients with COPD. Telephonically administered surveys with standardized scripting were used to evaluate pulmonary symptoms (eg, modified Medical Research Council [mMRC] dyspnea scale and COPD Assessment Test [CAT]); the social and labor situation; enforcement of lockdown (ie, the number of times leaving the home per week); and the number and type of COPD exacerbations occurring during the lockdown period from March 1 to May 31, 2020.
All COPD exacerbations were confirmed via comprehensive review of each patient’s electronic medical records (EMRs) to evaluate the exact date and type of exacerbation according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. No significant differences were observed in the characteristics between the included patients and the excluded patients. Prior to COVID-19 lockdown, spirometric measures showed that the cohort had moderate to severe COPD (ie, mean predicted percentage of forced expiratory volume in 1 second [FEV1] of 52%±19%; total lung capacity of 92%±23%; residual volume of 145%±65%; and adjusted diffusing capacity for carbon monoxide of 49%±19%). Overall, 38% of the participants were classified as GOLD II and 37% as GOLD III, with 37% in GOLD A and 21% in GOLD D.
Among 369 patients with COPD who had visited the pulmonary consultation center in 2019, 24 individuals had died since their last visit, 31 patients could not be reached after 3 calls, and 4 individuals did not consent to participate in the study. Thus, a total of 310 patients with COPD were included in the current analysis. The mean participant age was 67±8 years. Overall, 83% of the participants were men; 79% were former smokers. A total of 78% of the participants were retired and experienced strong lockdown enforcement, with 56% of the individuals not leaving home at all and 26% leaving home 3 or fewer times per week during lockdown.
A 62% decrease in the number of COPD exacerbations was reported during the COVID-19 lockdown period, with this difference focused on the number of participants with moderate and severe exacerbations. With respect to COPD symptoms, participants reported significantly better overall CAT scores and better scores in the various CAT dimensions (P <.001 for all). The severity of the participants’ dyspnea, however, worsened during the lockdown period, although this difference did not have much clinical relevance (+0.35 points, on average). Further, a 74% decrease in COPD-related health care costs was observed.
The investigators concluded that an in-depth analysis of factors to potentially explain these results, as well as the impact of the new post-lockdown scenario, warrants further study.
González J, Moncusí-Moix A, Benitez ID, et al. Clinical consequences of COVID-19 lockdown in patients with COPD: results of a pre-post study in Spain. CHEST. Published online January 11, 2021. doi:10.1016/j.chest.2020.12.057