Background: The COVID-19 pandemic has led to widespread implementation of public health measures, such as stay-at-home orders, social distancing, and masking mandates. In addition to decreasing spread of SARS-CoV2, these measures also impact the transmission of seasonal viral pathogens, which are common triggers of COPD exacerbations. Whether reduced viral prevalence mediates reduction in COPD exacerbation rates is unknown. Methods: We performed retrospective analysis of data from a large, multicenter healthcare system to assess admission trends associated with community viral prevalence and with initiation of COVID-19 pandemic control measures. We applied difference-in-differences (DiD) analysis to compare season-matched weekly frequency of hospital admissions for COPD before and after implementation of public health measures for COVID-19. Community viral prevalence was estimated using regional Center for Disease Control and Prevention test positivity data and correlated to COPD admissions. Results: Data involving 4,422 COPD admissions demonstrated a season-matched 53% decline in COPD admissions during COVID-19 pandemic, which correlated to community viral burden (r=0.73; 95% CI: 0.67 to 0.78) and represented a 36% greater decline over admission frequencies observed in other medical conditions less affected by respiratory viral infections (IRR, 0.64; 95% CI, 0.57 to 0.71, p<0.001). The post-COVID-19 decline in COPD admissions was most pronounced in patients with fewer comorbidities and without recurrent admissions. Conclusion: The implementation of public health measures during the COVID-19 pandemic was associated with decreased COPD admissions. These changes are plausibly explained by reduced prevalence of seasonal respiratory viruses.

Rationale: Chronic obstructive pulmonary disease, (COPD) is a major cause of morbidity and mortality in the United States. Peak expiratory flow rate (PEFR) monitoring could provide a daily objective measurement of lung function in COPD patients at home. We hypothesized that individuals with greater variability in daily PEFR would signal an unstable patient population with worse outcomes. Methods: This was a retrospective analysis of prospectively collected data using an electronic diary to record daily PEFR and symptoms in severe and very severe COPD patients. Rates of PEFR change were used to characterize patients into stable and unstable groups determined by the distribution of slopes. Exacerbation-free days, time to first hospitalization, hospitalization rate, length of hospitalization, and all-cause mortality were assessed. Results: A total of 104 severe and very severe COPD patients met entry criteria, and were observed for 37,702 patient-days. There were no significant differences in baseline symptoms, demographics, forced expiratory volume in 1 second (FEV1) or comorbidities between stable versus unstable groups. The unstable group had 34.7 less exacerbation-free days and significantly shorter 6 minute walk distances (6MWD) (227.1 versus 270.7 meters, p=0.031), shorter time to first hospitalization (163 versus 286 days, p=0.017), more frequent hospitalizations (2.6 versus 1.7 per year, p=0.032) and higher all-cause mortality (10.8 versus 5.1%, p=0.04). Conclusion: Patients with severe to very severe COPD with greater changes in PEFR have shorter 6MWD, reduced time to first hospitalization, more frequent hospitalizations, and higher all-cause mortality despite similar demographic, spirometric and comorbid parameters at baseline. Daily peak flow monitoring can be a useful tool in identifying COPD patients predisposed to worse outcomes. AbstractAbbreviations: chronic obstructive pulmonary disease, COPD; peak expiratory flow rate, PEFR; forced expiratory volume in 1 second, FEV 1 ; 6 minute walk distance, 6MWD; Pennsylvania Study of COPD Exacerbations , PA-

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We investigate how support for President Donald Trump, beyond partisanship, guided Americans’ attitudes toward COVID-19. This speaks to not just how “Trumpism” and the Trump administration’s handling of the pandemic influenced public attitudes but to the larger issue of how Trump’s hold on voters within and beyond the Republican Party provides further evidence that leaders surpass the role of parties in influencing public opinion. Using longitudinal data with individual fixed-effects, we find that from the start of the pandemic, support for Trump above and beyond partisanship drove public attitudes capturing skepticism toward COVID-19, fears of personal vulnerability, compliance with public-safety measures, and viewing the pandemic in racist terms. Between March and August 2020, this gulf in attitudes between Trump voters and non-supporters, and between Republicans and Democrats, widened; the widening was more pronounced between Trump voters and non-supporters. Trump’s influence on Independents and non-voters also grew over the same period. While the use of terms like “China virus” was related to partisanship and support for Trump, we find an increase in awareness across groups that these terms were racist.

Asthma is an obstructive lung disease affecting >230 million people worldwide and a significant cause of morbidity in patients of all ages. It is a heterogeneous disease with a complex pathophysiology and phenotype. Diagnosis is made with thorough history-taking and physical examination, and the condition is characterised by variable airflow obstruction and airway hyper-responsiveness. Understanding the severity of the disease is important, and treatment is aimed at symptom control and the prevention of future exacerbations. Pharmacologic treatment with beta-agonists for intermittent asthma and inhaled corticosteroids and a combination of inhaled corticosteroids and long-acting beta-2 agonists for persistent asthma are recommended. Additional and alternative treatments with leukotriene modifiers, anticholinergics, biologics, and bronchial thermoplasty are also available. However, understanding an individual’s disease phenotype, endotype, and comorbidities is necessary for asthma treatment, with appropriate consultation with asthma specialists required for those with severe asthma.

Significant seasonal and regional variability exist in the rate and severity of exacerbations and overall mortality in adults with COPD without cardiovascular disease.

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