COVID-19 and COPD: a narrative review of the basic science and clinical outcomes

Abstract

The 2019 coronavirus disease (COVID-19) pandemic is caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Clinical outcomes, including mortality, are worse in males, older individuals and patients with comorbidities. COPD patients are included in shielding strategies due to their susceptibility to virus-induced exacerbations, compromised pulmonary function and high prevalence of associated comorbidities. Using evidence from basic science and cohort studies, this review addresses key questions concerning COVID-19 and COPD. First, are there mechanisms by which COPD patients are more susceptible to SARS-CoV-2 infection? Secondly, do inhaled corticosteroids offer protection against COVID-19? And, thirdly, what is the evidence regarding clinical outcomes from COVID-19 in COPD patients? This up-to-date review tackles some of the key issues which have significant impact on the long-term outlook for COPD patients in the context of COVID-19.

COPD & COVID-19

“…Most studies of symptomatic people in the community tested for SARS-CoV-2 have not shown chronic respiratory disease as an independent risk factor for testing positive, 7 , 8 although at least one has. 9 Patients with COPD are at a slightly increased risk of hospitalization for COVID-19 but the evidence about the risk of developing severe disease and death are contradictory: COPD has been reported to independently increase the risk of severe disease or death in some series 12 , 13 , 14 , 15 but not all. 9 , 16 , 17 Overall the magnitude of these risks seems to be lower than might be expected.…”

“…ICS have an overall protective effect against exacerbations in COPD patients with a history of exacerbations; however, their use is also associated with an increased risk of pneumonia. There are theoretical reasons why they may be beneficial, 12 but a systematic review identified no clinical studies concerning the relationship between ICS use in COPD and clinical outcomes from coronavirus infections. 13 A more recent study suggested ICS use in COPD was not protective against coronavirus infection and raised the possibility that it increased the risk of developing COVID-19, 14 but the results are likely to be confounded by the indication for ICS.…”

Challenges and Opportunities from Targeting Inflammatory Responses to SARS-CoV-2 Infection: A Narrative Review

“…[ 124 ]. Unlike other viral respiratory pandemics (most recently the 2009 H1N1/Influenza A outbreak) or endemics (e.g., influenza), low prevalence of comorbid respiratory conditions (including asthma and chronic obstructive pulmonary disease (COPD)) has been repeatedly noted in patients with COVID-19 [ 125 , 126 , 127 ]. Among factors that may account for such epidemiological signal is that ICS, alone or in combination with bronchodilators, are widely used in the treatment of asthma and have a role in the management of some patients with COPD [ 124 , 125 , 126 , 127 ].…”

“…Unlike other viral respiratory pandemics (most recently the 2009 H1N1/Influenza A outbreak) or endemics (e.g., influenza), low prevalence of comorbid respiratory conditions (including asthma and chronic obstructive pulmonary disease (COPD)) has been repeatedly noted in patients with COVID-19 [ 125 , 126 , 127 ]. Among factors that may account for such epidemiological signal is that ICS, alone or in combination with bronchodilators, are widely used in the treatment of asthma and have a role in the management of some patients with COPD [ 124 , 125 , 126 , 127 ]. As such, ICS may exert protective effects against the respiratory symptoms associated with COVID-19 without necessarily limiting the systemic immune response to COVID-19 [ 124 , 125 , 126 , 127 , 128 ], but this hypothesis still needs to be verified in clinical trials [ 127 ].…”

“…Among factors that may account for such epidemiological signal is that ICS, alone or in combination with bronchodilators, are widely used in the treatment of asthma and have a role in the management of some patients with COPD [ 124 , 125 , 126 , 127 ]. As such, ICS may exert protective effects against the respiratory symptoms associated with COVID-19 without necessarily limiting the systemic immune response to COVID-19 [ 124 , 125 , 126 , 127 , 128 ], but this hypothesis still needs to be verified in clinical trials [ 127 ]. Until more information is available, there is currently no evidence to support the COVID-19-due discontinuation of ICS in patients treated with these drugs [ 124 , 129 ].…”