Amid COVID-19 pandemic: Challenges with access to care for COPD patients

Abstract

Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammation in the lungs that causes obstruction in the airway, poor airflow, and irreversible loss of lung function. In clinical practice, comprehensive care for COPD patients includes the diagnosis using spirometry, clinical examination and comprehensive pharmacological and non-pharmacological management. The diagnosis is based on symptoms, dyspnea and lung function impairment and can be mild to very severe. Symptoms are examined using the COPD assessment test (CAT) score, and dyspnea grade are examined using a modified MRC from GOLD guidelines. When mild, the care includes selfmanagement education, smoking cessation, lifestyle modifications, vaccination, and short-acting bronchodilators. Self-management education involves inhaler device training, breathing technique, early recognition of acute exacerbations and writing action plans. As the disease progresses, other care measures are added. These measures include the addition of long-acting inhaler therapies, pulmonary rehabilitation, oral therapies, oxygen and lung transplantation. During the final stages of COPD, patients receive end-of-life care (Bourbeau et al., 2019). 1 The novel coronavirus disease (COVID-19) is a viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that is spread through respiratory droplets. This infectious disease has led to a pandemic and is affecting the lives of many around the world, including Canadians. During this pandemic, the non-essential health services, including caring for patients with COPD, have been put on hold to reduce the risk of spread. Other implications of this pandemic for COPD patients include the health risk in case of infection. A meta-analysis including studies from January to March 2020 in Wuhan showed that pre-existing COPD worsens the risk of COVID-19 progression and leads to poorer prognostics. The sub-group analysis showed a significantly higher risk of ICU requirements and death in COPD patients who are infected with the SARS-CoV-2 virus. Studies suggest strong efforts to mitigate the risk of infection in this population (Zhao et al., May 2020). 2 This makes caring for this population even more critical during the pandemic.

The Effects of the Health System Response to the COVID-19 Pandemic on Chronic Disease Management: A Narrative Review

“…), leading to improved health outcomes. 52 , 64 For people with epilepsy, virtual services like electronic seizure journals, mobile apps, messaging, and video conferencing have led to high patient satisfaction rates, lower no show rates, and better health outcomes. 65 …”

“…Despite these advantages, telemedicine is associated with many barriers to implementation, including (1) limited ability to perform physical exams or ancillary testing, (2) reduced ability to pick up verbal and nonverbal cues, which could result in more diagnostic errors, and (3) a lack of access to technology and limitations inherent to variations in digital literacy, especially in elderly patients for whom chronic conditions are common. 64–66 Digital illiteracy is more common among socioeconomically disadvantaged, racialized, older, and rural-residing individuals, which may contribute to lower telemedicine access by these populations. Consistent with this, rates of telemedicine visits for chronic disease patients have been found to be reduced among those who have lower-income or older age (>60 years), are racialized (Hispanic, Black, Asian/Pacific Islander), living in rural areas, and non-English speaking.…”

Relação entre a Epidemia de Tabagismo e a Epidemia recente de Covid-19: um Panorama Atual das Evidências Científicas

“…E, no dia 1/5/2020, foi publicado um estudo revisado por pares e que envolveu dados de pacientes de 169 hospitais espalhados pela China, Japão, Coréia do Sul, Itália, Turquia, Espanha, Alemanha, França, Reino Unido, Canadá e Estados Unidos, totalizando 8.910 indivíduos 11 . Mais uma vez, os resultados apontaram que o fumante atual hospitalizado tem uma chance de morrer maior do que não fumante ou ex-fumante (OR 1,79; IC95%:1, 47). Esse achado foi independentemente da idade, do sexo, de comorbidades selecionadas preexistentes (e.g., doenças cardiovasculares, DPOC etc.)…”

“…Vale ressaltar que o Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA) publicou nota 46 criticando duramente o estudo francês e a hipótese de que a nicotina teria papel protetor na epidemia de Covid-19. A nota alertou sobre os riscos da nicotina para a saúde da população e a necessidade ainda maior nesse período de pandemia de se atingir, com políticas públicas eficazes voltadas ao combate da epidemia do tabagismo, a população mais vulnerável de fumantes 3,40,[47][48][49][50] . Com atitudes como essa, busca-se, de certa forma, minimizar também a interferência da indústria do tabaco na perpetuação dos danos causados por essas duas epidemias 51 .…”

Telerehabilitation Using Fitness Application in Patients with Severe Cystic Fibrosis Awaiting Lung Transplant: A Pilot Study

“…Participation in a hospital-based pulmonary rehabilitation (PR) program is problematic for patients with CF due to the group setting leading to increased risk of infection, commute to the center, work/family time conflicts, and its traditional design for a largely elderly population [ 7 ]. The recent pandemic has accelerated the need for a hybrid or entirely home-based PR program option for many individuals [ 8 ]. Home-based exercise programs have been found to be safe and effective in pediatric and more mild to moderately ill adult CF populations [ 9 , 10 ] but have not been evaluated for the severely ill adult CF population.…”