Study Suggests COPD Preventative Measures Needed During Seasonal Virus Circulations

There is an overlap between preventive measures for infection transmission and decreases in chronic obstructive pulmonary disease (COPD) exacerbations, according to new findings, in addition to a correlation between the recirculation of seasonal viruses and COPD exacerbation returns.¹

These conclusions were the result of new research into COPD admissions before, during, and after the COVID-19 pandemic. The conclusions support the utilization of individual protective measures in the wintertime by individuals with COPD, in addition to measures by their relatives and guardians.

This new research was led by Arnaud Bourdin, MD, PhD, from the department of respiratory diseases at the University of Montpellier’s Centre Hospitalier Universitaire (CHU) Montpellier in France. The investigators noted that COPD conditions can be worsened through pollution, bacteria, and other causes, with bacterial and viral infections specifically linked to inflammation and exacerbations.^2,3

Background and Methods

COPD exacerbations as well as viral infections are known for their seasonal peaks. Some examples include influenza or colds, and the connection further supports their associations with one another.

“Clinicians and patients experienced this seasonality until 2020, when the COVID-19 pandemic began,” Bourdin and colleagues wrote. “Remembering the possible contribution of respiratory viruses to onset of COPD exacerbations, we investigated the number of COPD-related admissions before, during, and after the COVID-19 pandemic.”

The investigators conducted their retrospective cross-sectional trial by assessing data drawn from the French National Health Data System. The research team used an algorithm to identify COPD exacerbations through the use of ICD-10 codes from any admission to a hospital in France in the period between January 2013 - July 2023.

The team implemented an interrupted time series analysis (ITSA) alongside the R package its.analysis to determine the connection between taking preventive measures and admissions to hospitals for COPD. They implemented linear regression for the purposes of graphical depiction.

The anonymous retrospective observational research did not, in compliance with French regulations, necessitate ethics committee approval or informed participant consent. The research team used 2-sided statistical tests and they were considered significant at P < .05.

Findings

Overall, there were 800,730 individuals assessed and 1,393,825 noted admissions, with the average age of subjects being 74.4 years. The investigators noted that 62.5% had been male, 37.5% female, and the most common comorbidities percentages had been 43.2% with heart failure, 63.5% with hypertension, 2.4% with bladder cancer, and 6.9% with lung cancer.

Prior to the COVID-19 pandemic, both hospital and ICU admissions for exacerbations of COPD had shown a seasonal trend, with peaks occurring once or twice in the autumn and winter seasons. By March 2020, however, the onset of COVID-19 lockdowns coincided with a sharp decrease in COPD exacerbations, remaining low until 2021’s conclusion.

This decrease coincided with the beginning of measures designed to prevent the spread of viruses, some examples of which being social distancing and mask-wearing. A gradual but still reduced rise in exacerbations was observed by the research team in 2022, even as regulations diminished, with specific decreases in June, July, and wintertime.

The 2023 conclusion of the pandemic, announced by the World Health Organization, led to the loss of these measures for prevention and a return of the typical seasonal peak of exacerbations. The investigators’ ITSA analysis added to these findings, with the data indicating major differences between periods for both severe (F = 5.081; P = .008) and mild (F = 3.850; P = .02) instances.

“Study limitations include the lack of individual clinical information in the national registry and no direct comparison with the number of diagnosed viral infections,” they wrote. “Relevant data on demographic characteristics and comorbidities confirm that the patients’ profiles align with what is expected in a population with COPD.”

References

1. ^{Bourdin A, Ahmed E, Vachier I, et al. Hospitalizations for Chronic Obstructive Pulmonary Disease Exacerbation During COVID-19. JAMA Netw Open. 2024;7(5):e2412383. doi:10.1001/jamanetworkopen.2024.12383.}
2. ^{Sethi S, Murphy TF. Infection in the pathogenesis and course of chronic obstructive pulmonary disease. N Engl J Med. 2008;359(22):2355-2365. doi:10.1056/NEJMra0800353PubMedGoogle ScholarCrossref.}
3. ^{Mallia P, Message SD, Gielen V, et al. Experimental rhinovirus infection as a human model of chronic obstructive pulmonary disease exacerbation. Am J Respir Crit Care Med. 2011;183(6):734-742. doi:10.1164/rccm.201006-0833OC.}