Worse Outcomes for Patients With COPD and COVID-19

Neil Osterweil

May 18, 2021

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

A study of COVID-19 outcomes across the United States bolsters reports from China and Europe that indicate that patients with chronic obstructive pulmonary disease (COPD) and SARS-CoV-2 infection have worse outcomes than patients with COVID-19 who do not have COPD.

Investigators at the University of Texas Medical Branch at Galveston, Galveston, Texas, combed through electronic health records from four geographic regions of the United States and identified a cohort of 6056 patients with COPD among 150,775 patients whose records indicate either a diagnostic code or a positive laboratory test result for COVID-19.

Their findings indicate that patients with both COPD and COVID-19 "have worse outcomes compared to non-COPD COVID-19 patients, including 14-day hospitalization, length of stay, ICU [intensive care unit] admission, 30-day mortality, and use of mechanical ventilation," reported Daniel Puebla Neira, MD, and colleagues from the University of Texas Medical Branch in a thematic poster presented during the virtual American Thoracic Society (ATS) 2021 International Conference.

A critical care specialist who was not involved in the study said that the results are concerning but not surprising.

"If you already have a lung disease and you develop an additional lung disease on top of that, you don't have as much reserve and you're not going to tolerate the acute COVID infection," said ATS expert Marc Moss, MD, Roger S. Mitchell Professor of Medicine in the Division of Pulmonary Sciences and Critical Care Medicine at the University of Colorado School of Medicine, Aurora, Colorado.

The evidence shows that "patients with COPD should be even more cautious, because if they get sick and develop, they could do worse," he said in an interview.

Retrospective Analysis

Neira and colleagues assessed the characteristics and outcomes of patients with COPD who were treated for COVID-19 in the United States from March through August 2020.

Baseline demographics of the patients with and those without COPD were similar except that the mean age was higher among patients with COPD (68.62 vs 47.08 years).

In addition, a significantly higher proportion of patients with COPD had comorbidities than did those without COPD. Comorbidities included diabetes, hypertension, asthma, chronic kidney disease, end-stage renal disease, stroke, congestive heart failure, cancer, coronary artery disease, and liver disease (P < .0001 for all comparisons).

Among patients with COPD, percentages were higher with respect to the following parameters: 14-day hospitalization for any cause (28.7% vs 10.4%); COVID-19-related 14-day hospitalization (28.1% vs. 9.9%); ICU use (26.3% vs 17.9%); mechanical ventilation use (26.3% vs 16.1%); and 30-day mortality (13.6% vs 7.2%; P < .0001 for all comparisons).

"Mechanisms Unclear"

"It is unclear what mechanisms drive the association between COPD and mortality in hospitalized patients with COVID-19," the investigators write. "Several biological factors have been proposed including chronic lung inflammation, oxidative stress, protease-antiprotease imbalance and increased airway mediators."

They recommend use of multivariable logistic regression to tease out the effects of covariates among patients with COPD and COVID-19 and call for research into long-term outcomes for these patients, "as survivors of critical illness are increasingly recognized to have cognitive, psychological, and physical consequences."

Moss said that in general, the management of patients with COPD and COVID-19 is similar to that for patients with COVID-19 who do not have COPD, although there may be "subtle" differences, such as ventilator settings for patients with COPD.

No source of funding for the study has been disclosed. The investigators and Moss have disclosed no relevant financial relationships.

American Thoracic Society (ATS) 2021 International Conference: Abstract A3779.

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