Impact of COPD on COVID-19 prognosis: A nationwide population-based study in South Korea

Abstract

Underlying chronic respiratory disease may be associated with the severity of coronavirus disease 2019 (COVID-19). This study investigated the impact of chronic obstructive pulmonary disease (COPD) on the risk for respiratory failure and mortality in COVID-19 patients. A nationwide retrospective cohort study was conducted in 4610 patients (≥ 40 years old) infected with COVID-19 between January 20 and May 27, 2020, using data from the Ministry of Health and Welfare and Health Insurance Review and Assessment Service in Korea. The clinical course and various clinical features were compared between COPD and non-COPD patients, and the risks of respiratory failure and all-cause mortality in COPD patients were analyzed using a multivariate logistic regression model. Among 4610 COVID-19 patients, 4469 (96.9%) and 141 (3.1%) were categorized into the non-COPD and COPD groups, respectively. The COPD group had greater proportions of older (≥ 60 years old) (78.0% vs. 45.2%, P < 0.001) and male (52.5% vs. 36.6%, P < 0.001) patients than the non-COPD group. Relatively greater proportions of patients with COPD received intensive critical care (7.1% vs. 3.7%, P = 0.041) and mechanical ventilation (5.7% vs. 2.4%, P = 0.015). Multivariate analyses showed that COPD was not a risk factor for respiratory failure but was a significant independent risk factor for all-cause mortality (OR = 1.80, 95% CI 1.11–2.93) after adjustment for age, sex, and Charlson Comorbidity Index score. Among COVID-19 patients, relatively greater proportions of patients with COPD received mechanical ventilation and intensive critical care. COPD is an independent risk factor for all-cause mortality in COVID-19 patients in Korea.

Diseased lungs may hinder COVID-19 development: A possible reason for the low prevalence of COPD in COVID-19 patients

“…In a South Korea population-based retrospective cohort study of 122,040 COVID-19 cases, only 3.6% had COPD, whereas the prevailing comorbidities were asthma, hypertension, and malignancy at 27%, 26%, and 18%, respectively [22] . This result is consistent with another South Korea cohort study of 4,610 COVID-19 patients, which reported a 3.1% prevalence of COPD [23] . In another retrospective study in Mexico involving 38,342 COVID-19 patients, 29% had hypertension, 28% had obesity, 25% had diabetes, but only 3.1% had COPD [24] .…”

“…In a prospective cohort study of 3995 COVID-19 patients in Kuwait, 19% had hypertension, 18% had diabetes, and only 0.4% had COPD [27] . These cohort studies, however, did find that COPD patients had a worse prognosis for severe and fatal COVID-19 [22] , [23] , [24] , [25] , [26] , [27] . For reference, the COPD prevalence in the adult general population is 13-15% in South Korea [28] , [29] , 8% in Mexico [30] , 10% in Spain [31] , 5% in Iran [32] , and 7% in Kuwait [33] .…”

Causas de fallecimiento en pacientes con COVID-19 en la Ciudad de México

“…A meta-analysis by Cai et al (2021) agrees with the finding that death risk is higher for COVID-19 patients with chronic kidney failure. Likewise, a study in South Korea (Lee et al , 2021) agrees with the finding that chronic obstructive pulmonary disease is an independent cause of death among COVID-19 patients. However, a press release by the Johns Hopkins School of Public Health (2021) regarding American immunosuppressed patients, is opposite to this study´s finding that immunosuppressed COVID-19 patients have a higher death risk.…”

Pulmonary function impairment of asymptomatic and persistently symptomatic patients 4 months after COVID-19 according to disease severity

“…As expected, COPD was associated with impaired pulmonary function in this cohort. While these patients have preexisting reduced pulmonary function due to COPD, it is also a known risk factor for all-cause mortality and progression to severe disease in COVID-19 patients [ 39 ].…”