COVID-19 and Chronic Obstructive Pulmonary Disease. (The CO-COPD Study)
UHB, UoB, The Turing, UCL, UCLH, Leeds, Edinburgh
In March 2020 the World Health Organisation (WHO) declared the disease, COVID-19, caused by virus SARS-CoV-2, a pandemic. Patients with long term medical conditions tend to have worse outcomes (including needing intensive care treatment and death) from COVID-19, and one of the most common long-term health conditions is Chronic Obstructive Pulmonary Disease (or COPD).
COPD is a chronic lung condition associated with breathlessness, coughs, and progressive lung damage which can lead to lung failure and death. People with COPD are very susceptible to lung infections by bacteria and viruses, and these infections can be very serious.
Discussion groups with patients have identified considerable fear among patients with COPD over COVID-19.
Published studies have described poorer outcomes for patients with COVID-19 and COPD, but these are often crude assessments, which do not consider the impact of other diseases people have, the severity of the COPD or other factors such as whether patients currently smoke.
Our patients have tasked us with understanding this risk, so we can provide disease specific advice. In addition to investigating the additional risk of a COVID-19 related death due to COPD, we also intend to determine if the health of COVID-19 patients with COPD deteriorates quicker than COVID-19 patients without COPD.
Furthermore, it can sometimes be difficult to determine if a COPD patient is experiencing COPD exacerbations or experiencing COVID-19 complications. Whilst clinicians in the UK can use COVID-19 tests to differentiate between the two, being able to determine this without tests would assist with COVID-19 care in locales where effective COVID-19 tests are
As a serious lung disease, COPD influences the treatments that are used for patients with COVID-19. In particular ventilation strategies may have to be adapted or changed. There is a need first of all to understand if and how COPD patients are treated differently from other COVID-19 patients and what treatment decisions are associated with the best patient outcomes.
Finally, infections in COPD are often treated with a combination of steroids and antibiotics. Steroids have been found to be a useful treatment in COVID-19. It is unclear whether the steroids patients may be put on for COPD could help their recovery from COVID-19.
This study will seek to answer some of these important questions.
We will continue to work with patient and public representatives to ensure that the research is relevant, and benefits patients. Patients have asked us to share these results with the British Lung Foundation groups, so we can share our findings widely with patients and their carers. Our research will also be published in scientific journals to inform the scientific community. All analytical code (the computer code we use to analyse the data) will also be made available any researchers, to ensure that our research follows “FAIR” principles (Findable, Accessible, Interoperable and Reusable).
Chronic obstructive pulmonary disease is estimated to affect 5.38% of English adults aged 35 or over, and has no disease modifying treatments. COPD is associated with social deprivation, smoking and several comorbidities such as cardiovascular disease (CVD).
Current studies have suggested that COPD is associated with poorer outcomes from COVID-19, but these have often not corrected for important confounding factors such as age, CVD or social deprivation. It is unclear what risk COPD poses to COVID-19 patients. Currently there is no clear evidence to provide disease specific advice on social distancing.
Clinically, we were expecting a wave of COVID-19 related COPD admissions, but this has not occurred. The present study aims at providing essential and timely results on the relationship between COVID-19 and COPD that will impact at multiple levels: from triaging in small communities to nationwide treatment decisions for COPD individuals.
Specifically, the challenges that will be tackled concern:
• Q1: The relationship between COVID-19 severity and COPD status/severity which has
not yet been properly clarified in the literature. There is preliminary evidence of different
severity levels between COPD and the other COVID-19 patients (Lippi, 2020, Zhao et al,
2020) that is still to be confirmed by properly designed studies.
• Q2: The identification of important symptoms and signs which discriminate COPD patients
with COVID-19 from COPDs with exacerbations which can greatly improve triaging,
particularly in countries where COVID-19 tests are not yet available.
• Q3&4: The evaluation of hospital strategies for COPD patients and their treatments during
the COVID-19 pandemic. Ventilation strategies for COPD patients (Brochard et al, 1995,
Rodríguez-Roisin, 2006) may need to be modified from those routinely used. The suitability
of relevant COPD medication (e.g. inhaled corticosteroids) on admission to hospital needs to
be revised in light of the possible impact on COVID-19 risk/outcome.
In this regard, the DECOVID database provides a unique opportunity to address all these
fundamental questions and return essential information to practitioners to effectively shape
intervention strategies and treatments for COPD patients in the COVID-19 era.