Progression to a severe form of COVID-19 among patients with chronic respiratory diseases

Abstract

Rationale Viral respiratory infections, including SARS-CoV-2 infection, can trigger respiratory symptoms among patients suffering from chronic respiratory diseases, leading to exacerbations and hospitalizations. Despite the tropism of SARS-CoV-2 into the respiratory tract, chronic respiratory diseases do not seem to be risk factors for severe forms of COVID-19. Objectives To assess whether hospitalized patients for COVID-19 with chronic respiratory diseases were at lower risk of developing a severe form than other patients. Methods This French study included patients admitted to hospital in COVID-19 ward, suffering from a SARS-CoV-2 infection, diagnosed on RT-PCR or chest computed tomography associated with clinical symptoms, from March 15 to June 30, 2020. Ambulatory patients who were tested in the emergency department and patients with severe hypoxaemia requiring intensive care were not included. All data were collected from electronic medical records up to discharge of the patient. Main Results 617 patients were included: 125 with a chronic respiratory disease, mainly chronic obstructive pulmonary disease (45%) and asthma (30%). The percentage of patients scoring 6 or higher on the WHO Clinical Progression Scale during hospital stay was lower in patients with chronic respiratory disease compared to those without chronic respiratory disease (21.6% versus 31.3%, respectively, p = 0.03). Among patients with chronic respiratory disease, temperature above 38 °C on admission (OR 16.88 (95% CI 4.01–71.00)), lymphopenia (OR 5.08 (1.25–20.72)), CPAP therapy (OR 4.46 (1.04–19.17)) and age (OR 1.09 (1.02–1.16)) were associated with an increased risk to reach a score of 6 or above. Conclusions Hospital admissions in COVID-19 ward of patients suffering from chronic respiratory diseases are at lower risk of developing a severe form of COVID- 19, especially in patients with chronic obstructive pulmonary disease or asthma. Prospective studies would confirm our results and allow to better organize the follow-up of these patients in a pandemic period.

Impact of COPD on clinical and CT characteristics of COVID-19-associated pneumonia: single tertiary center experience

“…“Reversed halo” sign was not present in the patients with COPD. In regards to the severity score, our results are concordant with those by Basin S. et al [ 41 ]. In detail, the referenced study reported CT1 category of 63.1% vs. 42.4%; CT2 category, 26.2% vs. 40.2%; CT3 category, 9.2% vs. 15.0%; CT4 category (more than 75%), 1.5% vs. 3.3% in COPD vs. non-COPD group, respectively.…”

“…Similar results are demonstrated by Gemicioglu B. et al, lower ALC (1.42 ± 0.77 × 109/L), higher WBC (10.6 ± 5.2 × 109/L) and ANC (7.94 ± 4.18 × 109/L), with the median level of NLR 8.09 ± 7.25 [ 32 ]. In contrast, Basin S. et al observed no significant differences in the level of leukocytes and lymphocytes in patients with COPD vs. control group (6.4 × 109/L vs. 6.5 × 109/L and 1.0 vs. 0.9 × 109/L, respectively) [ 41 ]. Such heterogeneities in the results might be due to differences in the severity of the disease among included patients in different studies.…”

Anti-Viral Surfaces in the Fight against the Spread of Coronaviruses

“…Coronavirus disease might also influence other organs. Thus, the associated comorbidities of COVID-19 include many more chronic diseases, such as lung [ 40 ] and kidney [ 41 ] disorders. It should be noted that the long-term consequences of the infection are still not yet known; consequently, the other undesirable effects might be revealed with time.…”

Letter to Sarah Basin et al.

“…We read with interest the work of Sarah Basin et al [1] . who are to be congratulated for their counter intuitive insight into the assessment of risk in patients with chronic respiratory diseases and we fully agree with them when they conclude that this category of patients is under-represented among those who will present the most severe forms of Covid 19.…”