COPD and smoking associated with higher COVID-19 mortality

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Current smokers and people with chronic obstructive pulmonary disease (COPD) have an increased risk of severe complications and higher mortality with COVID-19 infection, according to a study by Jaber Alqahtani of University College London, UK, and colleagues.

COPD is a common, persistent dysfunction of the lung associated with a limitation in airflow. An estimated 251m people worldwide are affected by COPD. Given the effects of the SARS-CoV-2 coronavirus on respiratory function, the authors of the present study sought to understand the prevalence and the effects of COPD in COVID-19 patients.

In the study, researchers systematically searched databases of scientific literature to find existing publications on the epidemiological, clinical characteristics and features of COVID-19 and the prevalence of COPD in COVID-19 patients. 123 potentially relevant papers were narrowed to 15 that met all quality and inclusion guidelines. The included studies had a total of 2473 confirmed COVID-19 patients. 58 (2.3%) of those patients also had COPD while 221 (9%) were smokers.

Critically ill COVID-19 patients with COPD had a 63% risk of severe disease and a 60% risk of mortality while critically ill patients without COPD had only a 33.4% risk of severe disease (RR 1.88, 95% CI 1.4-2.4) and 55% risk of mortality (RR 1.1, 95% CI 0.6-1.8). In addition, current smokers were 1.45 times more likely to have severe complications compared to former and never smokers (95% CI 1.03-2.04). The study was not able to examine whether there was an association between the frequency of COPD exacerbations, or severity of COPD, with COVID-19 outcomes or complications. The results are limited by the fact that few studies were available to review, as well as the diverse locations, settings, and designs of the included studies.

The authors add: “Despite the low prevalence of COPD and smoking in COVID-19 cases, COPD and current smokers were associated with greater COVID-19 severity and mortality.”

Abstract
Background: Coronavirus disease 2019 (COVID-19) is an evolving infectious disease that dramatically spread all over the world in the early part of 2020. No studies have yet summarized the potential severity and mortality risks caused by COVID-19 in patients with chronic obstructive pulmonary disease (COPD), and we update information in smokers.

Methods: We systematically searched electronic databases from inception to March 24, 2020. Data were extracted by two independent authors in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study quality was assessed using a modified version of the Newcastle-Ottawa Scale. We synthesized a narrative from eligible studies and conducted a meta-analysis using a random-effects model to calculate pooled prevalence rates and 95% confidence intervals (95%CI).
Results: In total, 123 abstracts were screened and 61 full-text manuscripts were reviewed. A total of 15 studies met the inclusion criteria, which included a total of 2473 confirmed COVID-19 patients. All studies were included in the meta-analysis. The crude case fatality rate of COVID-19 was 7.4%. The pooled prevalence rates of COPD patients and smokers in COVID-19 cases were 2% (95% CI, 1%–3%) and 9% (95% CI, 4%–14%) respectively. COPD patients were at a higher risk of more severe disease (risk of severity = 63%, (22/35) compared to patients without COPD 33.4% (409/1224) [calculated RR, 1.88 (95% CI, 1.4–2.4)]. This was associated with higher mortality (60%). Our results showed that 22% (31/139) of current smokers and 46% (13/28) of ex-smokers had severe complications. The calculated RR showed that current smokers were 1.45 times more likely [95% CI: 1.03–2.04] to have severe complications compared to former and never smokers. Current smokers also had a higher mortality rate of 38.5%.
Conclusion: Although COPD prevalence in COVID-19 cases was low in current reports, COVID-19 infection was associated with substantial severity and mortality rates in COPD. Compared to former and never smokers, current smokers were at greater risk of severe complications and higher mortality rate. Effective preventive measures are required to reduce COVID-19 risk in COPD patients and current smokers.

Authors
Alqahtani JS, Oyelade T, Aldhahir AM, Alghamdi SM, Almehmadi M, Alqahtani AS

PLOS One abstract

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