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Severe outcomes of COVID-19 among patients with COPD and asthma
Erik Soeren Halvard Hansen1, Amalie Lykkemark Moeller2, Vibeke Backer1
1Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Insights
Patients with chronic obstructive pulmonary disease (COPD) face a slightly higher risk of severe coronavirus disease 2019 (COVID-19) outcomes. However, this increased risk for COPD patients disappears when standardized for age.
Area of Science:
- Pulmonology
- Infectious Diseases
- Epidemiology
Background:
- Obstructive lung diseases, such as asthma and COPD, may increase the risk of severe COVID-19.
- Understanding this risk is crucial for patient management and public health strategies.
Purpose of the Study:
- To investigate the risk of severe outcomes in COVID-19 patients with asthma and COPD.
- To compare the severity of COVID-19 in patients with and without these obstructive lung diseases.
Main Methods:
- A nationwide cohort study included 5104 COVID-19 patients in Denmark (February–July 2020).
- Patients were categorized into asthma, COPD, or no obstructive lung disease groups using ICD codes and medication history.
- The primary outcome was a composite of severe COVID-19, intensive care unit admission, or death.
Main Results:
- COPD patients showed a slightly increased risk (4.0% difference) of severe outcomes compared to those without obstructive lung diseases (21.2% vs. 17.2%).
- Asthma patients had a similar risk profile to the control group (18.5% vs. 17.2%).
- Age-standardized analysis revealed no significant differences in severe outcomes across the groups. Low blood eosinophil counts were linked to increased severity in COPD patients.
Conclusions:
- Patients with COPD have a marginally elevated risk of severe COVID-19 outcomes.
- This increased risk is not significant when adjusted for age, suggesting age is a major confounding factor.
- Further research into factors like blood eosinophil counts may refine risk assessment for COPD patients.
Introduction:
Patients with obstructive lung diseases are possibly at risk of developing severe outcomes of coronavirus disease 2019 (COVID-19). Therefore, the aim of this study was to determine the risk of severe outcomes of COVID-19 among patients with asthma and COPD.
Methods:
We performed a nationwide cohort study of patients with COVID-19 from 1 February to 10 July 2020. All patients with COVID-19 registered in the Danish registers were included. Using International Classification of Diseases (ICD) codes and medication history, patients were divided into asthma, COPD or no asthma or COPD. Primary outcome was a combined outcome of severe COVID-19, intensive care or death.
Results:
Out of 5104 patients with COVID-19 (median age 54.8 years (25-75th percentile 40.5 to 72.3); women, 53.0%), 354 had asthma and 432 COPD. The standardised absolute risk of the combined end-point was 21.2% (95% CI 18.8-23.6) in patients with COPD, 18.5% (95% CI 14.3-22.7) in patients with asthma and 17.2% (95% CI 16.1-18.3) in patients with no asthma or COPD. Patients with COPD had a slightly increased risk of the combined end-point compared with patients without asthma or COPD (risk difference 4.0%; 95% CI 1.3-6.6; p=0.003). In age standardised analyses, there were no differences between the disease groups. Low blood eosinophil counts (<0.3×109 cells·L-1) were associated with increased risk of severe outcomes among patients with COPD.
Conclusion:
Patients with COPD have a slightly increased risk of developing severe outcomes of COVID-19 compared with patients without obstructive lung diseases. However, in age-standardised analysis, the risk difference disappears.
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