COPD and COVID-19

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If you’re living with chronic obstructive pulmonary disease (COPD), you likely have questions about how your condition affects your risk for contracting or becoming seriously ill with COVID-19, what complications might occur, and whether your medications could either increase or decrease your risk. Fortunately, a year into this pandemic we are getting some answers that may reduce some of your fears.

While the Centers for Disease Control and Prevention (CDC) states that people with COPD are at an increased risk from COVID-19, some studies suggest that the risk is not as high as previously thought when looking at COPD alone (without the factors of age and other medical conditions).

We will look at what the studies show to date, what you should know about your medications, the current GOLD guidelines, and discuss a positive effect that COVID-19 precautions have had on COPD exacerbations.

COPD and COVID-19 Susceptibility Outcomes

Verywell / Jessica Olah

COPD and COVID-19 Risk

When talking about COPD and COVID-19 risk, it’s important to separate the question into two topics:

  • Susceptibility: Is someone who has COPD more likely to contract COVID-19 when exposed to the virus?
  • Outcomes: Is someone who has COPD and develops COVID-19 more likely to have bad outcomes, such as hospitalization, intensive care admission, the need to be intubated, or death?

Susceptibility

Whether having COPD increases the risk of becoming infected with COVID-19 when exposed is still unclear. People who have COPD have an increased susceptibility to infections in general, and some medications (inhaled corticosteroids) can increase the risk of pneumonia.

A number of factors could impact susceptibility to COVID-19, including:

  • Compromised immune systems: People with COPD tend to have blunted immune responses as well as reduced clearance of viruses by cilia in the airways.
  • Increased angiotensin 2 receptor levels in lungs: The ACE receptor is what COVID-19 binds to in order to enter cells.
  • Side effects from medications: Corticosteroids—either inhaled or oral—can affect immune responses.

Lower Risk Than Originally Thought

At the current time, it’s thought that if people with COPD are indeed more susceptible to infection, the risk is lower than expected.

Severity/Outcomes

Whether people with COPD are more likely to have more serious outcomes—like hospital admission, ICU care, the need for a mechanical ventilator, or death—when they develop COVID-19 is still uncertain. As with susceptibility, having COPD—and the medications for treatment—affects the immune system and airways.

It’s well known that people with COPD are at risk for severe outcomes with common cold virus infections, and these viruses—especially rhinoviruses—are a common cause of COPD exacerbations.

Because of this, having COPD has been considered a pre-existing condition likely to result in poorer outcomes with COVID-19 since the onset of the pandemic. But what do organizations such as the CDC and recent studies tell us?

According to the CDC, COPD is known to increase the risk of severe illness with COVID-19.

It is important to note, though, that some of the early studies did not control for age and gender, and in retrospect, people with COPD were more likely to be older and male. More recently, studies that separate COPD from other risk factors—such as age and coexisting medical conditions—suggest that COPD alone may not significantly raise the risk of poor outcomes, or at least death.

A number of studies in different regions look at slightly different parameters and with different controlled variables; we will share a few of the larger ones.

Belgian Study

A 2021 study in Belgium looked at people with COPD who were hospitalized with COVID-19. Researchers set out to answer the question of whether COPD alone raised the chance of a severe outcome with COVID-19 or if there may be other factors at play.

The study found that COPD (and being treated for COPD with inhaled or oral corticosteroids) was not a risk factor for either admission to the intensive care unit or death. Instead, other factors put participants at greater risk, including being:

  • Overweight
  • Male
  • Older
  • Diagnosed with cardiomyopathy
  • Diagnosed with an immunosuppressive disease

The highest risk was among those with both COPD and an immunosuppressive disease.

While a diagnosis of COPD alone did not appear to affect ICU admission or mortality, it was associated with prolonged intubations (longer duration of time on a ventilator until a person could be weaned off) relative to those who did not have COPD.

South Korean Study

A 2021 study in South Korea tells a somewhat different story.

Although people with COPD were more likely to require intensive care admission and mechanical ventilation, COPD was not a risk factor for respiratory failure. It was, however, a significant independent risk factor for all-cause mortality (patients were 80% more likely to die).

Danish Study

In a Danish study of 5,000 patients, people who had COPD had a slightly elevated risk of severe outcomes as compared with people who did not have chronic lung diseases.

When the study was controlled for age, however, the differences disappeared.

Chinese Study

In a very large study published in March of 2021, over 39,000 patients with chronic respiratory diseases were identified from a national reporting system and compared to people without chronic respiratory conditions.

In the study, people with COPD (but not bronchiectasis) were 71% more likely to be admitted to experience the primary endpoint (admission to ICU, mechanical ventilation, or death within 30 days of hospitalization). Having chronic respiratory disease, however, was not associated with a greater likelihood of the secondary endpoint (dying from COVID-19 within 30 days of hospital admission).

More Research Is Needed

Because of inconsistent findings, further research into the risk of severe outcomes posed by underlying COPD is needed.

Unknown Risks

At the current time, it’s unknown whether people with COPD (and possibly those using inhaled steroids) are any more or less likely to develop long COVID.

It’s also unknown whether experiencing a serious COVID-19 infection will affect the progression or prognosis of COPD in the future. Fortunately, these questions are being asked by scientists, and information is being gathered.

Complications of COPD and COVID-19

There are special considerations for people with COPD who may have symptoms of COVID-19 or have been diagnosed with COVID-19.

Challenge of Diagnosis

The first challenge and potential complication of living with COPD during this pandemic is the challenge of distinguishing COVID-19 from a COPD exacerbation. Symptoms of the two can be very similar, with a cough and shortness of breath common to both. With COVID-19, symptoms such as a fever, fatigue, muscle aches, loss of taste, headaches, and nausea/vomiting are more common but may not be present.

Even when examined by a healthcare provider, discriminating between the two can be difficult. Chest X-rays are relatively insensitive early on and with mild disease.

What is most important at this time is that people with COPD who develop new or worsening respiratory symptoms, a fever, or any other suspicious symptoms (such as loss of taste/smell) be tested to see if they have an infection with COVID-19.

If identified early, this would provide the greatest ability for people to work with their healthcare providers to reduce risk, if possible, and to ensure adequate management.

Prolonged Intubation

People who live with the more advanced stages of COPD are familiar with the concern about ventilatory support. If intubation is required, would there be difficulty removing the tube eventually? According to the Belgian study above, prolonged intubation was more common in people with COPD.

For people without COPD, it was discovered that delaying intubation (if possible) led to better outcomes, and this appears to be the case with COPD as well.

In addition, with COPD it was found that high flow nasal therapy (HFTN) is preferable to noninvasive ventilation (NIV) when oxygen therapy alone cannot maintain oxygen levels in the blood.

Blood Clots

Unlike influenza, which is primarily a disease that affects the lungs, the ability of COVID-19 to affect blood vessels and clotting was noted fairly early. Instead of being a disease that led to respiratory failure alone, other symptoms were seen, including:

Social Isolation and Depression

Few people have been spared the feeling of isolation imposed by needed COVID-19 restrictions, and those living with COPD are no different.

Social isolation, decreased physical activity, and increased anxiety have all been noted in people living with COPD. A 2021 study found that almost half (48%) of patients with COPD reported the pandemic had a negative effect on their mental health.

COPD Treatments and COVID-19

If you’re living with COPD, you may wonder whether your medications (especially corticosteroids) could affect your risk of COVID-19. And if you should develop COVID-19, would your treatment differ from someone who does not have COPD?

COPD Treatments During the COVID-19 Pandemic

At the current time, the CDC recommends that people with COPD continue their usual medications, including inhaled corticosteroids if used.

In addition, current GOLD recommendations hold that antibiotics and oral corticosteroids should be used according to indications whether or not a person also has COVID-19.

Since inhaled corticosteroids (ICI) may increase the risk of pneumonia, there was some concern at the beginning of the pandemic that these medications could either predispose to infection or worsen COVID-19 severity if contracted.

In one study early on, it appeared that severity was worse among those treated with ICIs. When looked at more closely, however, this increased severity was likely related to the severity of the underlying COPD.

According to current recommendations, ICIs are only recommended for people who have had a COPD exacerbation in the past year. The severity of a person’s lung disease, rather than the medications they use, appeared to have the most impact on outcomes.

A different study looking specifically at inflammation and factors that may affect COVID-19 severity found that people with COPD who were treated with either inhaled or oral corticosteroids did not have a higher risk of severe COVID-19 infections. (They suspect that ICIs have effects on inflammation and ACE2 receptors that may both increase and reduce susceptibility to severe COVID-19.)

Don't Stop Taking Your Medication

People with COPD should continue to take their oral and inhaled COPD medications during the pandemic.

Hospital-based pulmonary rehabilitation has been helpful for some people with COPD, but restrictions related to COVID-19 have led to the temporary closure of some of these practices. Even when available, many people wanted to face the risk of infection posed by leaving home. While home-based programs are less effective, it’s thought that they are “better than nothing” with regard to maintaining disease control when COVID-19 is prevalent in the community.

COVID-19 Treatments in People With COPD

For people with COPD who become infected with COVID-19, currently available treatments such as dexamethasone, blood thinners, and antibodies should be used as they would for people without COPD.

For asymptomatic or mild disease, current protocols should be followed. For moderate symptoms of COVID-19 (or worse), people with COPD should be monitored more often than people without COPD, especially with regard to the need for oxygen therapy.

With severe disease, oxygen, prone positioning, and ventilatory options (high flow oxygen, noninvasive ventilation, and mechanical ventilation) should be used per protocol.

COVID-19 Treatments in People With COPD

It’s recommended for people with COPD who develop moderate or severe COVID-19, that pulmonary rehabilitation should be offered after discharge from the hospital.

Frequently Asked Questions

The CDC covers many frequently asked questions about COVID-19. The most common among people with COPD are:

Should I get the vaccine?

With any medical treatment, it’s important to weigh the potential benefits against the potential risks. For most people with COPD, the answer to whether you should get the vaccine is an overwhelming “yes.” As far as which vaccine, most experts say it’s best to get the first vaccine that’s offered to you.

At the current time, while there have been some people who have had adverse reactions, there have been millions who received the vaccination without problems.

When considering the vaccine, it’s important to look further than the death statistics commonly quoted. For each person who dies from the disease, there are several who face grueling (and often expensive) hospitalizations. And for those who recover, the risk of long Covid symptoms or damage isn’t negligible and may occur even when symptoms are mild.

How does smoking affect the combination of COPD and COVID-19?

If you smoke, you’ve probably heard that smoking is a risk factor for COVID-19 and is actually an indication for getting the vaccine sooner rather than later.

Despite these recommendations and early findings that suggest greater susceptibility, it’s still not clear whether people who smoke (whether or not they have COPD) have a higher risk of developing COVID-19. For those who are infected, however, symptoms may be more severe due to underlying inflammation and changes in lung structure due to tobacco smoke.

Certainly, smoking can accelerate the progression of COPD, and quitting at any time can be helpful.

Is staying isolated beneficial for people with COPD?

So far we’ve talked about concerns related to the COVID-19 pandemic on top of a diagnosis of COPD, but we’re learning there has actually been a silver lining—an unexpected “benefit.”

A significant contributor to illness and hospitalizations, cost, and deaths from COPD has been COPD exacerbations. In turn, a leading cause of these exacerbations is viral infections. Frequent exacerbations not only lead to more deaths from COPD but speed up the progression of lung damage and reduce the quality of life. Many of these infections (unlike COVID-19) are not preventable with vaccines.

A study in Singapore comparing hospitalizations for COPD exacerbations in a pre-pandemic period (January of 2018 through January of 2020) to that during the pandemic (February to July of 2020) found that there was a 50% reduction in COPD exacerbation admissions each month. In addition, a test done to look for a number of respiratory viruses went from being positive 49% of the time to only 11% of the time.

Not only is this a silver lining amidst the pandemic we are still experiencing, but it has important implications for the future. Could simple hygiene measures (such as masks, distancing, hand washing) reduce COPD exacerbations to this degree? In addition, this finding pointed out the role that common viral infections (especially rhinovirus) play in COPD care and could lead to further treatments for these in the future.

How to Stay Safe

Staying safe and healthy with COPD amidst the pandemic requires thought and balance.

CDC recommendations for prevention should be followed, including:

  • Masking (preferably two masks for now) or a face shield if mask wearing is not possible (studies have found that masks do not reduce the ability to breathe even for people who have severe airflow obstruction due to COPD)
  • Careful handwashing
  • Distancing (and shielding via plexiglass in some circumstances)

That said, the current GOLD standards for COPD note that these measures should not lead to social isolation and inactivity, which can be detrimental for those with COPD. People with COPD require contact with family and friends (in safe ways) and continued physical activity.

Tips that can make living with COPD during the pandemic easier include:

  • Make sure you have at least a 30-day supply of medications
  • Make sure you have an adequate supply of oxygen if you use it
  • Avoid triggers that you know can make your symptoms worse
  • Keep regular appointments with your healthcare provider (via telehealth if possible) to make sure you have the best control possible of your disease
  • Stay up-to-date on immunizations such as those for influenza and pneumonia
  • Consult reputable sources for up-to-date information concerning COVID-19 and how it is managed

Taking Care of Your Mental Health

It’s also important to care for yourself emotionally. In addition to the worries of those without COPD, those with COPD have faced worries about:

  • A more severe illness should they become ill
  • Being infected by loved ones

It’s important to check in with yourself and make sure your mental health is stable. If you need help, do not hesitate to reach out.

A Word From Verywell

If you’re living with COPD, you’ve likely been concerned about the current COVID-19 pandemic. While risks related to COPD remain, they may not be quite as concerning as first thought.

In addition to the hope of feeling in control of this pandemic in the near future, researchers have gained insight into causes of COPD exacerbations that may reduce the physical and emotional costs of such exacerbations in the future. The pandemic has been hard on many people with COPD due to social isolation and anxiety, but this may be one silver lining after a dark winter.

The information in this article is current as of the date listed. As new research becomes available, we’ll update this article. For the latest on COVID-19, visit our coronavirus news page.

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