The impact of COPD and smoking history on the severity of COVID‐19: A systemic review and meta‐analysis

Abstract

Comorbidities are associated with the severity of coronavirus disease 2019 . This meta-analysis aimed to explore the risk of severe COVID-19 in patients with pre-existing chronic obstructive pulmonary disease (COPD) and ongoing smoking history. A comprehensive systematic literature search was carried out to find studies published from December 2019 to 22 March 2020 from five databases. The languages of literature included English and Chinese. The point prevalence of severe COVID-19 in patients with pre-existing COPD and those with ongoing smoking was evaluated with this meta-analysis. Overall 11 case series, published either in Chinese or English language with a total of 2002 cases, were included in this study. The pooled OR of COPD and the development of severe COVID-19 was 4.38 (fixed-effects model; 95% CI: 2.34-8.20), while the OR of ongoing smoking was 1.98 (fixed-effects model; 95% CI: 1.29-3.05). There was no publication bias as examined by the funnel plot and Egger's test (P = not significant).The heterogeneity of included studies was moderate for both COPD and ongoing smoking history on the severity of COVID-19. COPD and ongoing smoking history attribute to the worse progression and outcome of COVID-19.COPD, COVID-2019, smoking 2.34-8.20), heterogeneity among the different studies being moderate (I 2 = 41%; P = .08). Sensitivity analysis showed that the results were not affected by any individual study. Publication bias, as accessed by funnel plot ( Figure 2B) and Egger's test, showed no publication bias in this analysis (P for Egger's test was 0.5492). | Pre-existing COPD and mortalityOnly two of the included studies reported the association between death and pre-existing COPD. 11,12 Death was reported in 6 of 10 (60%) of patients with COPD and 80 of 233 (34.3%) of non-COPD patients. The pooled OR of COPD for death was 1.93 (95%CI: 0.59-7.43); however, the heterogeneity in this analysis (I 2 = 61%; P = .11) was quite high. | Smoking history and the severity of COVID-19Seven studies reported the relationship between active smoking and the severity of 8,[11][12][13]16,17 The exact duration of smoking was not reported in most studies. The pooled OR is summarized in Figure 2C, which shows that smoking increases the risk of severe COVID-19 (fixed-effects model; OR = 1.98; 95% CI: 1.29-3.05) by around twofolds. The heterogeneity among the different studies was moderate (I 2 = 44%; P = .10). Sensitivity analysis by excluding each study one by one showed that the study from Guan 6 was a major source of heterogeneity. After excluding this F I G U R E 3 Subgroup analysis for the impact of COPD and smoking histology on the severity of COVID-19. CI, confidence interval; COPD, chronic obstructive pulmonary disease; COVID-19, coronavirus disease 2019; ICU, intesive care unit; OR, odds ratio ZHAO ET AL.| 5 overall sample size could be a possible explanation. When the study with the largest sample size was excluded from sensitivity analysis, the effect of smoking on the severity of COVID-19 was no longer significant. An...

What factors increase the risk of complications in SARS-CoV-2 positive patients? A cohort study in a nationwide Israeli health organization

“…Our analysis also points out to reduced importance of respiratory diseases and smoking. Both conditions appear as factors in most at-risk definitions [3,5]: Chronic obstructive pulmonary disease has been associated with severe COVID-19 in multiple (though not all [6]) studies [20], while the role of smoking has been somewhat controversial [20,21]. The discrepancies between our analysis and previous reports likely stem from the different cohorts analyzed: SARS-CoV-2 positive individuals, ranging from asymptomatic to severe COVID-19 versus hospitalized COVID-19 patients, respectively.…”

Smoking Is Associated With COVID-19 Progression: A Meta-analysis

“…[8][9][10][11][12][13][14][15][16][18][19][20][21][22][23][24][25][26] Only one 17 of the studies reported unadjusted and adjusted ORs using multivariate analysis; after adjusting for confounding by age, maximum temperature at admission, respiratory failure, severe illness, albumin, creatinine, procalcitonin, and C-reactive protein level, the effect of smoking on disease severity increased (unadjusted: OR 12.19, 95% CI 1.76-84.31, p = .011; adjusted: OR 14.29, 95% CI 1.58-25.0, p = .018). Three peer-reviewed meta-analysis papers 6,34,35 on association between smoking and COVID-19 were also based on unadjusted ORs, but with fewer studies included.…”

Risk Factors of the Severity of COVID-19: a Meta-Analysis

“…There is an ongoing debate on whether smoking is a risk factor for COVID-19 severity. Although some regard it as a risk factor 9,27 , others found no significant alliance between smoking and the . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.…”