COPD and Concomitant COVID-19 Linked to Increased Hospital Admission Rate

Amy Attaway, MD

A new cohort study found that patients with chronic obstructive pulmonary disease (COPD) and coronavirus disease 2019 (COVID-19) face a higher risk for healthcare utilization.

However, their adjusted in-hospital mortality risk was similar compared with COVID-19 patients without COPD.

Amy Attaway, MD, and colleagues at the Cleveland Clinic conducted a cohort assessment of the center’s patient registry, using covariate adjustment via multivariate logistic regression. Their goal was to determine whether COPD led to a higher hospitalization rate and worse clinical outcomes due to COVID-19.

The team included 15,536 individuals tested for COVID-19, of which 1319 had COPD. All subjects were >35 years old. Those with concurrent diagnosis of asthma, as well as other lung diseases, and <10 pack year smoking history were excluded from the study.

A total of 12.4% of COPD patients tested positive for COVID-19, versus 16.6% in the non-COPD population.

The results of the analysis showed that 48.2% COVID-10 positive COPD patients required hospitalization—compared with 26.5% of COVID-19 positive non-COPD cohort (P <.0001).

Of the total COVID-19 positive COPD population, 45.6% required ICU admission; whereas the rate for non-COPD positive patients was 34.2% (P = .003).

The investigators noted that rates of COVID-19 infection were similar across both patient groups (OR, 0.97; 95% CI, 0.89-1.05). Yet, when adjusting for covariates, COPD patients had greater risk for hospitalization (OR, 1.36; 95% CI, 1.15-1.60), ICU admission (OR, 1.20; 95% CI, 1.02-1.40), and need for invasive mechanical ventilation (OR, 1.49; 95% CI, 1.28-1.73).

Additionally, they found that the risk for in-hospital mortality was not significantly different between the COPD and non-COPD positive patients. (OR, 1.08; 95% CI, 0.81-1.42).

African Americans in the COPD group were more likely to require hospitalization (30.6% of total hospitalized) and ICU admission (39.5% admitted to the ICU) than outpatient treatment (13.6%, P <.001).

Conversely, Caucasians represented 75.3% of outpatients, 66.7% of those treated in hospital, and 55.8% of ICU admits. 

Additional results showed that 25.6% of the COPD positive patients admitted to the ICU were on immunosuppressive therapy.

Attaway and colleagues acknowledged that the assessed COPD population was on average 10 years older than the non-COPD population and had a greater number of comorbidities, including diabetes mellitus, hypertension, and cancer.

The study did not distinguish the severities of COPD, which the investigators noted as a limitation. Therefore, they were unable to determine if a specific cohort within the COPD population had increased risk for hospital utilization.

Nonetheless, the team highlighted the overall importance of their study, which was the largest observational study to have assessed COVID-19 and concomitant COPD.

“In addition to increased healthcare utilization, our study demonstrated that COPD patients had higher risk for mortality, which after adjustment with multivariate regression for age, race, BMI, and comorbidities (see Methods) was no longer statistically significant,” they wrote.

“This is an important finding of our study, which suggests that COPD does not confer mortality risk beyond its associated comorbidities,” Attaway and colleagues concluded. “Greater outreach to the COPD community and coordinated care with other sectors of public health such as the Veterans Administration may be needed, given these facilities care for a significant number of COPD patients.”

The study, “SARS-CoV-2 infection in the COPD population is associated with increased healthcare utilization: An analysis of Cleveland clinic's COVID-19 registry,” was published online in The Lancet: EClinicalMedicine.