COPD in the time of COVID-19: An analysis of acute exacerbations and reported behavioural changes in patients with COPD

Introduction

The impact of the SARS-CoV-2 pandemic, and lockdown measures, on acute exacerbations of COPD (AECOPD) is unknown. We aimed to evaluate the change in AECOPD treatment frequency during the first six weeks of lockdown in the UK compared with 2019 and assess changes in self-reported behaviour and well-being.

Methods

In this observational study patients with established COPD were recruited. Exacerbation frequency was measured in the first six weeks of COVID lockdown and compared with the same period in 2019 using electronic health records. A telephone survey was used to assess changes in anxiety, inhaler adherence, physical activity, shopping and visitor behaviour during the pre-lockdown and lockdown periods compared to normal.

Results

160 participants were recruited (mean [SD] age 67.3 [8.1] years, 88 [55%] male, FEV1 34.3 [13] % predicted) and 140 [88%] reported at least one AECOPD in the previous year. Significantly more community treated exacerbations were observed in 2020 compared with 2019 (126 vs 99, p=0.026). The increase was as a result of multiple courses of treatment, with a similar proportion of patients receiving at least one course (34.4% vs 33.8%).

During “lockdown” participants reported significantly increased anxiety, adherence to their preventative inhalers, and good adherence to shielding advice (all p<0.001). A significant reduction in self-reported physical activity and visitors was reported (both p<0.001).

Discussion

Treatment for AECOPD events increased during the first six weeks of the SARS-CoV-2 pandemic in the UK compared to 2019. This was associated with increased symptoms of anxiety and significant behavioural change.

What is the key question?

How has the COVID-19 pandemic lockdown affected exacerbation patterns and behaviour in patients with COPD?

What is the bottom line?

A 38% increase in the number of community treated exacerbations was seen in 2020 compared with 2019. Increased symptoms of anxiety were seen in patients, alongside increased inhaler adherence and reduced physical activity.

Why read on?

The impact of the COVID-19 pandemic has led to significant changes in treatment for exacerbations of COPD in the community, as well as increased anxiety amongst patients.