Clinical Consequences of COVID-19 Lockdown in Patients With COPD

González, Jessica; Moncusí‐Moix, Anna; Santisteve, Sally; Monge, Aida; Fontiveros, Maria Angeles; Carmona, Paola; Torres, Gerard; Barbé, Ferrán; Batlle, Jordi de

doi:10.1016/j.chest.2020.12.057

Cited by 41 publications

(102 citation statements)

References 8 publications

(11 reference statements)

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“…Moreover, they reported 80% (392) of their patients remained in a stable condition. In Spain, there was a 55% reduction in non-hospitalised COPD exacerbations (32 events vs 72 events) compared to the pre-pandemic period [ 20 ].…”

Section: Resultsmentioning

confidence: 99%

Reduction in hospitalised COPD exacerbations during COVID-19: A systematic review and meta-analysis

Oyelade²,

et al. 2021

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Background Reports have suggested a reduction in exacerbations of chronic obstructive pulmonary disease (COPD) during the coronavirus disease 2019 (COVID-19) pandemic, particularly hospital admissions for severe exacerbations. However, the magnitude of this reduction varies between studies. Method Electronic databases were searched from January 2020 to May 2021. Two independent reviewers screened titles and abstracts and, when necessary, full text to determine if studies met inclusion criteria. A modified version of the Newcastle-Ottawa Scale was used to assess study quality. A narrative summary of eligible studies was synthesised, and meta-analysis was conducted using a random effect model to pool the rate ratio and 95% confidence intervals (95% CI) for hospital admissions. Exacerbation reduction was compared against the COVID-19 Containment and Health Index. Results A total of 13 of 745 studies met the inclusion criteria and were included in this review, with data from nine countries. Nine studies could be included in the meta-analysis. The pooled rate ratio of hospital admissions for COPD exacerbations during the pandemic period was 0.50 (95% CI 0.44–0.57). Findings on the rate of community-treated exacerbations were inconclusive. Three studies reported a significant decrease in the incidence of respiratory viral infections compared with the pre-pandemic period. There was not a significant relationship between exacerbation reduction and the COVID-19 Containment and Health Index (rho = 0.20, p = 0.53). Conclusion There was a 50% reduction in admissions for COPD exacerbations during the COVID-19 pandemic period compared to pre-pandemic times, likely associated with a reduction in respiratory viral infections that trigger exacerbations. Future guidelines should consider including recommendations on respiratory virus infection control measures to reduce the burden of COPD exacerbations beyond the pandemic period.

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Section: Resultsmentioning

confidence: 99%

Reduction in hospitalised COPD exacerbations during COVID-19: A systematic review and meta-analysis

Oyelade²,

et al. 2021

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“… 47 Positively, physical and social isolation may reduce hospitalisation due to reduction in exacerbations in COPD patients. 12 However, patients with cancer may have suffered delays in treatment and less access to support due to restrictions on visitors, which may accelerate decline. 48 …”

Section: Discussionmentioning

confidence: 99%

“…11 On the other hand, there has been a significant reduction in exacerbations and improvement in symptoms in COPD patients, possibly relating to less exposure to respiratory viruses, and/or a strict adherence to physical and social isolation. 12 However, there was also a reluctance to seek medical attention during the pandemic by individuals considering themselves clinically vulnerable. 13 …”

Section: Introductionmentioning

confidence: 99%

Relationships between prolonged physical and social isolation during the COVID-19 pandemic, reduced physical activity and disability in activities of daily living among people with advanced respiratory disease

et al. 2021

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In people with advanced respiratory disease, we examined (i) the impact of COVID-19–related physical and social isolation on physical activity and (ii) relationships between time spent in isolation and disability in activities of daily living. Cross-sectional analysis was conducted in adults with advanced non-small cell lung cancer, chronic obstructive lung disease or interstitial lung disease. Measures included change in physical activity since physically and socially isolating (Likert scale) and disability (Barthel Index and Lawton–Brody IADL scale) or difficulty (World Health Organisation Disability Assessment Schedule-2.0) in daily activities. Multiple logistic regression was used to examine factors associated with disability in daily activities. 194/201 participants were isolating for a median [IQR] 5 [3–8]-month period, often leading to lower levels of physical activity at home ( n = 94, 47%), and outside home ( n = 129, 65%). 104 (52%) and 142 (71%) were not fully independent in basic and instrumental activities of daily living, respectively. 96% reported some degree of difficulty in undertaking daily activities. Prolonged physical and social isolation related to increased disability in basic (r = −0.28, p < 0.001) and instrumental (r = −0.24, p < 0.001) activities of daily living, and greater difficulty in daily activities (r = 0.22, p = 0.002). Each month spent in physical or social isolation was independently related to disability in basic activities of daily living (odds ratio [OR], 1.17 [95% CI: 1.03–1.33], p = 0.013). These findings suggest disability in daily activities is associated with prolonged physical or social isolation, which may present as difficulty in people who are fully independent. Post-isolation recovery and rehabilitation needs should be considered for all people deemed extremely clinically vulnerable.

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“…Despite the disruption to routine COPD care [5,6], the societal changes associated with lockdown-in particular, improvements in air quality and reductions in other viruses responsible for acute respiratory tract infections [7,8]-may have led to an overall improvement in COPD outcomes. The available body of evidence suggests that there may have been a reduction in acute exacerbations of COPD (AECOPD), but these data are difficult to interpret because of methodological limitations including studying selective populations and/or from a limited number of centres [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. Despite the changes in healthcare-seeking behaviour during the lockdown, people with severe AECOPD were still likely to seek medical attention as the symptoms are intense such that they are difficult to tolerate at home [12].…”

Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 lockdown on the incidence and mortality of acute exacerbations of chronic obstructive pulmonary disease: national interrupted time series analyses for Scotland and Wales

Alsallakh

Sivakumaran

Kennedy

et al. 2021

BMC Med

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Background The COVID-19 pandemic and ensuing national lockdowns have dramatically changed the healthcare landscape. The pandemic’s impact on people with chronic obstructive pulmonary disease (COPD) remains poorly understood. We hypothesised that the UK-wide lockdown restrictions were associated with reductions in severe COPD exacerbations. We provide the first national level analyses of the impact of the COVID-19 pandemic and first lockdown on severe COPD exacerbations resulting in emergency hospital admissions and/or leading to death as well as those recorded in primary care or emergency departments. Methods Using data from Public Health Scotland and the Secure Anonymised Information Linkage Databank in Wales, we accessed weekly counts of emergency hospital admissions and deaths due to COPD over the first 30 weeks of 2020 and compared these to the national averages over the preceding 5 years. For both Scotland and Wales, we undertook interrupted time-series analyses to model the impact of instigating lockdown on these outcomes. Using fixed-effect meta-analysis, we derived pooled estimates of the overall changes in trends across the two nations. Results Lockdown was associated with 48% pooled reduction in emergency admissions for COPD in both countries (incidence rate ratio, IRR 0.52, 95% CI 0.46 to 0.58), relative to the 5-year averages. There was no statistically significant change in deaths due to COPD (pooled IRR 1.08, 95% CI 0.87 to 1.33). In Wales, lockdown was associated with 39% reduction in primary care consultations for acute exacerbation of COPD (IRR 0.61, 95% CI 0.52 to 0.71) and 46% reduction in COPD-related emergency department attendances (IRR 0.54, 95% CI 0.36 to 0.81). Conclusions The UK-wide lockdown was associated with the most substantial reductions in COPD exacerbations ever seen across Scotland and Wales, with no corresponding increase in COPD deaths. This may have resulted from reduced transmission of respiratory infections, reduced exposure to outdoor air pollution and/or improved COPD self-management.

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Clinical Consequences of COVID-19 Lockdown in Patients With COPD

Cited by 41 publications

References 8 publications

Reduction in hospitalised COPD exacerbations during COVID-19: A systematic review and meta-analysis

Reduction in hospitalised COPD exacerbations during COVID-19: A systematic review and meta-analysis

Relationships between prolonged physical and social isolation during the COVID-19 pandemic, reduced physical activity and disability in activities of daily living among people with advanced respiratory disease

Impact of COVID-19 lockdown on the incidence and mortality of acute exacerbations of chronic obstructive pulmonary disease: national interrupted time series analyses for Scotland and Wales

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