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

Abstract

Background Reports have suggested a reduction in exacerbations of chronic obstructive pulmonary disease (COPD) during the coronavirus (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. Seven 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 0.42-0.58). 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. Conclusion There was a 50% reduction in admissions for COPD exacerbations during the COVID-19 pandemic period, associated with a reduction in respiratory viral infections that trigger exacerbations. We provide pooled evidence supporting the potential effectiveness of COVID-19 preventive interventions in reducing the risk of admissions for COPD exacerbations.

The impact of COVID‐19 on acute non‐invasive ventilation services: A case for change

“…We used the new BTS quality standard and measured the decision to mask time (Table 1). Despite 45.8% fewer patients receiving NIV, in concordance with recent reports of fewer COPD exacerbation presentations, 5 we saw an increased median (interquartile range) decision to mask time, from 61 min (43-77) to 132 min (65-179), in 2020 (p < 0.0001) (Table 1). Following this delay in NIV set up, we saw increased deaths (4 [4.8%] vs. 8 [17.8%], p = 0.014) associated with lower blood gas pH levels (7.34 [7.30-7.37] vs. 7.62 [6.53-9.17], p = 0.019) and higher partial pressure of carbon dioxide (pCO 2 ) levels (8.59 [7.79-10.37] vs. 7.62 [6.53-9.17], p < 0.001) in 2019 versus 2020 (Table 1).…”

Acceptability of hygiene, face covering and social distancing interventions to prevent exacerbations in people living with airways diseases

“…Multiple studies subsequently reported a substantial reduction in hospitalisations due to asthma and chronic obstructive pulmonary disease (COPD) exacerbations, temporally associated with introduction of COVID-19 infection control measures [5], likely because people avoiding SARS-CoV-2 were also avoiding viruses that cause exacerbations [6].…”

Viral kinetic modeling and clinical trial simulation predicts disruption of respiratory disease trials by non-pharmaceutical COVID-19 interventions

“…About 10% of all trials conducted in Europe in pre-COVID-19 times were on respiratory diseases 13,14 . Due to COVID-19 containment measures that intend to attenuate SARS-CoV-2 transmission, respiratory disease transmission is altered at the population scale, and/or there might be under-reporting of respiratory diseases to healthcare services (see a recent systematic review by Alqahtani et al (2021) 15 ).…”

“…Due to COVID-19 containment measures that intend to attenuate SARS-CoV-2 transmission, respiratory disease transmission is altered at the population scale, and/or there might be under-reporting of respiratory diseases to healthcare services (see a recent systematic review by Alqahtani et al . (2021) 15 ). Recent reports show that seasonal dynamics of common respiratory tract infections (RTIs) have almost vanished during the COVID-19 pandemic 16–19 .…”