COPD Patients Face Much Higher Risk of Severe COVID-19

By Reuters Staff

April 24, 2020

NEW YORK (Reuters Health) - Patients with chronic obstructive pulmonary disease (COPD) have more than four times higher odds of developing severe COVID-19 infection, while current smokers may also be more prone to severe disease, according to a new review and meta-analysis.

"The results of this study indicate that pre-existing COPD is likely to worsen the progression and prognosis of Covid-19," Dr. Qianwen Zhao of West China Hospital, Sichuan University, in Chengdu, and colleagues write in the Journal of Medical Virology. "Strong efforts should be directed to avoid infection in patients with underlying COPD."

Early case series suggested that COPD and smoking were more prevalent among patients with severe COVID-19, the authors note, although a recent meta-analysis found no link between smoking and severe disease.

Dr. Zhao and colleagues reviewed 11 articles, one in Chinese and 10 in English, that included 2,002 patients, 334 of whom had severe COVID-19.

Ten studies reported preexisting COPD in participants. Pooled odds ratio (OR) for severe COVID-19 was 4.38 for COPD patients (95% confidence interval, 2.34 to 8.20), with moderate heterogeneity among the studies.

Pooled analysis of the seven studies that included information on smoking and COVID-19 severity found active smokers had an OR of 1.98 (95% CI, 1.29 to 3.05) for severe disease. When the authors excluded a study that was a "major source of heterogeneity," the increase was no longer significant (OR, 1.55; 95% CI, 0.83 to 2.87), however.

The relationship between smoking and severe COVID-19 is "controversial," the authors note, and the excluded study was the only one to distinguish between current and ex-smokers. Also, not all studies reported smoking duration, they add.

"It is well known that cessation of smoking improves pulmonary function, however, this benefit is less among older smokers due to the cumulative injury to lung over a prolonged period of time," the authors write. "These results indicate a complicated relationship between smoking history and the severity of Covid-19."

SOURCE: Journal of Medical Virology, online April 15, 2020.