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Effect of chronic obstructive pulmonary disease and smoking on the outcome of COVID-19
R Pranata1, A Y Soeroto2, I Huang3
1Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia.
Insights
Chronic obstructive pulmonary disease (COPD) and smoking significantly increase the risk of poor outcomes in patients with COVID-19. This includes higher rates of mortality, severe disease, and intensive care unit admission.
Area of Science:
- Pulmonary Medicine
- Infectious Diseases
- Epidemiology
Background:
- Chronic obstructive pulmonary disease (COPD) is a significant global health concern.
- Smoking is a primary risk factor for COPD and numerous other respiratory and systemic diseases.
- The impact of pre-existing respiratory conditions and smoking on COVID-19 outcomes requires thorough investigation.
Purpose of the Study:
- To systematically review and meta-analyze the association between COPD and smoking with various adverse outcomes in patients diagnosed with COVID-19.
- To quantify the increased risk of poor outcomes, including mortality and disease severity, for COVID-19 patients with COPD or a history of smoking.
Main Methods:
- A comprehensive systematic literature search was conducted across major databases: PubMed, EuropePMC, SCOPUS, and the Cochrane Central Database.
- Studies reporting on COVID-19 patient outcomes, including composite poor outcomes, mortality, severe COVID-19, intensive care unit (ICU) admission, and disease progression, were included.
- Data from 21 studies, encompassing 4603 patients, were pooled for meta-analysis.
Main Results:
- COPD was significantly associated with an increased risk for composite poor outcome (OR 5.01), mortality (OR 4.36), severe COVID-19 (OR 4.62), ICU care (OR 8.33), and disease progression (OR 8.42).
- Smoking also increased the risk of composite poor outcome (OR 1.52) and severe COVID-19 (OR 1.65).
- Current smokers exhibited a higher risk of composite poor outcomes (OR 1.58) compared to former or non-smokers.
Conclusions:
- Both COPD and smoking are independently associated with significantly poorer outcomes in patients with COVID-19.
- These findings highlight the vulnerability of individuals with COPD and smokers to severe COVID-19 illness and adverse clinical trajectories.
- The results underscore the importance of considering these comorbidities in the management and risk stratification of COVID-19 patients.
Abstract:
OBJECTIVE: To investigate the association between chronic obstructive pulmonary disease (COPD) and smoking with outcome in patients with COVID-19.METHODS: A systematic literature search was performed using PubMed, EuropePMC, SCOPUS and the Cochrane Central Database. A composite of poor outcome, mortality, severe COVID-19, the need for treatment in an intensive care unit (ICU) and disease progression were the outcomes of interest.RESULTS: Data on 4603 patients were pooled from 21 studies. COPD was associated with an increased risk for composite poor outcome (OR 5.01, 95%CI 3.06-8.22; P < 0.001; I² 0%), mortality (OR 4.36, 95%CI 1.45-13.10; P = 0.009; I² 0%), severe COVID-19 (OR 4.62, 95%CI 2.49-8.56; P < 0.001; I² 0%), ICU care (OR 8.33, 95%CI 1.27-54.56; P = 0.03; I² 0%), and disease progression (OR 8.42, 95%CI 1.60-44.27; P = 0.01; I² 0%). Smoking was found to increase the risk of composite poor outcome (OR 1.52, 95%CI 1.16-2.00; P = 0.005; I² 12%), and subgroup analysis showed that smoking was significant for increased risk of severe COVID-19 (OR 1.65, 95%CI 1.17-2.34; P = 0.004; I² 11%). Current smokers were at higher risk of composite poor outcomes (OR 1.58, 95%CI 1.10-2.27; P = 0.01; I² 0%) than former/non-smokers.CONCLUSION: Our systematic review and meta-analysis revealed that COPD and smoking were associated with poor outcomes in patients with COVID-19.
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