What is the relationship between underlying chronic lung disease and coronavirus disease 2019 (COVID-19)?

Updated: Jan 12, 2021
  • Author: Setu K Patolia, MD, MPH; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Patients with chronic lung disease are at an increased risk of severe respiratory illness owing to alterations in the local/systemic immune response, host microbiome, excessive mucous production, and poor pulmonary reserve. [69]

The CDC states that patients with moderate-to-severe asthma are at a higher risk for severe respiratory illness when infected with SARS-CoV-2. [70]

Patients with chronic obstructive pulmonary disease (COPD) are known to have increased levels of ACE2, the host receptor for SARS-CoV-2, thereby theoretically increasing the risk of severe lung disease. A meta-analysis of seven studies that included approximately 1,592 patients showed up to five times increased risk of severe disease in patients with COPD. [69]

The prevalence of chronic respiratory diseases and diabetes was studied in COVID-19 patients in China and was compared with data available for SARS from China, Canada, and Hong Kong. [71] Chronic respiratory diseases are surprisingly underrepresented. However, it is possible that there might be a higher number of patients with undiagnosed respiratory disease.

A meta-analysis of eight studies that included approximately 46,000 infected patients showed the most prevalent comorbidities in severe COVID-19 disease were hypertension and diabetes, followed by cardiovascular disease and chronic respiratory disease. [72] Further studies are needed to investigate the actual risk of disease acquisition, severity, and management in these vulnerable populations.

Currently, there is no evidence to suggest that the use of inhaled corticosteroids increases the risk of COVID-19 acquisition. Hence, the recommendation is to continue the use of long-term inhaler therapy for patients with asthma or COPD.

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