COPD Linked to Three-Fold Greater Mortality Risk in Severe COVID-19 Patients

Vikramaditya Samala Venkata, MD

The prevalence of comorbid chronic obstructive pulmonary disease (COPD) among patients hospitalized with coronavirus 2019 (COVID-19) is actually lower than its presence in the general population, according to a new observational cohort analysis.

In new data presented online during the American College of Chest Physicians (CHEST) 2020 Annual Meeting this week, investigators reported just 1 in 20 observed patients hospitalized with COVID-19 suffered from COPD—versus significantly greater rates of cardiometabolic disease among the most severely ill patients.

Study authors Vikramaditya Samala Venkata, MD, and Gerard N. Kiernan, MD, both of Dartmouth-Hitchcock Medical Center, conducted a systematic electronic search-based assessment of COVID-19 clinical trials to define associations between baseline COPD and overall outcomes of hospitalized patients.

Current understanding of such associations is not yet comprehensive, but nonetheless troubling given the respiratory burden of the pandemic virus.

“Although clinical data is limited, studies published so far raise concerns about an association between COPD and worse clinical outcomes in COVID-19,” they wrote.

The systematic search included retrospective studies including original hospitalized COVID-19 patient data from any of 3 major databases. Venkata and Kiernan used pooled analysis with a random-effects model in order to interpret the associations between COPD and COVID-19.

Their analyses included 22 studies from 8 countries including 11,000-plus patients hospitalized with COVID-19. Mean patient age was 56 years old, with 58% reported as male.

Among all comorbidities, hypertension was the most prevalent in hospitalized patients, at 42%. Another 23% of patients had diabetes mellitus.

Investigators observed a COPD prevalence rate of just 5% (n = 437) in patients hospitalized with COVID-19. However, such patients faced a three-fold greater risk of mortality (odds ratio [OR], 3.23; 95% CI, 1.59 – 6.57; P <.05). They noted the global prevalence of COPD among patients >40 years old is approximately 9%.

One explanation may be precautions put in place by COPD patients and their friends, family, and neighbors to limit their risk of COVID-19 exposure, given fears of more severe disease risks for such patients.

“While one would expect patients with prior lung disease to have greater mortality with COVID-19, it is curious to see that the prevalence of COPD was lower than the general population may reflect greater measures taken by COPD patients to avoid coronavirus exposure,” investigators wrote.

Uniquely, Venkata and Kiernan also found that smoking was present in more than one-third (37%) of COVID-19 patients—yet patients who smoked faced only a 52% worsened risk of disease severity (OR, 1.52; 95% CI, 0.81 – 2.87; P = .20). Reasoning for a mixed association, they noted, is still unclear.

Investigators concluded that more randomized trials are necessary to understand relationships between COPD, smoking status, and hospitalized COVID-19 prognosis in patients.

“This will alert clinicians to the worse prognosis of COVID-19 infection in patients with history of COPD and it will raise a question for future studies to look at the association between baseline COPD and COVID-19,” they concluded.

The study, “COVID-19 and COPD: Pooled Analysis of Observational Studies,” was presented at CHEST 2020.