The Presence of COPD Worsens the Course of COVID-19 – Results of Epidemiological Studies

Introduction

The highest mortality from COVID-19 is observed in individuals aged over 80, with a significant rise already seen in those over 70. Another high-risk group consists of patients with severe comorbidities. Epidemiological data show that in the older patient group, severe disease progression with a risk of death is associated with the presence of chronic comorbidities, including COPD, diabetes mellitus, and cardiovascular diseases such as arterial hypertension. In the presence of these comorbidities, a severe to critical course of the disease can also occur in younger individuals.

COPD affects men more frequently, with chronic tobacco use being the most common pathogenetic factor. Smokers have shown increased expression of the angiotensin-converting enzyme 2 receptor in lung tissue, which is a key molecule for the entry of viral particles into host cells. The largest study to date examining the relationship between smoking and COVID-19 infection was published by Guan et al. (n = 1099). This study demonstrated a higher risk of severe infection and death from the disease in smokers compared to non-smokers. Other studies have directly assessed the risks for patients with chronic obstructive pulmonary disease during the current pandemic.

Study Results

Wang et al. investigated prognostic factors in 339 patients with COVID-19. The criterion for study inclusion was an age above 60; the average age of patients in the sample was 71 ± 8 years. The most common comorbidity was arterial hypertension (40.8%), followed by diabetes (16.0%) and cardiovascular diseases (15.7%). COPD affected 21 patients (6.2%), with 11 of them succumbing to the disease. Along with cardiovascular and cerebrovascular diseases, COPD became a significant predictor of death (hazard ratio [HR] 2.24; p < 0.001).

Guan et al. analyzed the impact of comorbidities on the course of COVID-19 in 1590 patients. The primary objective was to achieve a composite endpoint characterized by admission to the intensive care unit, invasive mechanical ventilation, or death. After adjusting the analysis for age and smoking, the presence of COPD was among the risk factors for achieving the composite endpoint (HR 2.681; 95% confidence interval [CI] 1.424–5.048) alongside diabetes (HR 1.59; 95% CI 1.03–2.45), arterial hypertension (HR 1.58; 95% CI 1.07–2.32), and malignancies (HR 2.681; 95% CI 1.60–7.64).

Conclusion

Published epidemiological studies indicate that chronic obstructive pulmonary disease, along with other chronic comorbidities, constitutes a significant risk factor for severe course and mortality from COVID-19.

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