Digest author: Emer Kelly, incoming ERS E-Learning Director / 17 May, 2021
Accompanying commentary: ‘COVID-19 and ‘basal’ exacerbation frequency in COPD‘ by Daryl O Cheng and John R Hurst
This article appeared as a brief communication publication in the British Medical Journal (BMJ) and was the subject of a commentary discussing other articles that have investigated the effect of COVID-19 on the rate of exacerbation frequency and the impact of the current paper. Respiratory viruses are triggers for COPD exacerbations. Since the COVID-19 pandemic began, precautionary measures to reduce spread, such as social distancing, hygiene reinforcement and compulsory mask-wearing, have reduced spread of the virus. These measures should also have an impact on other viruses and reduce COPD exacerbations.
This study was done in a single centre in Singapore. Electronic records were used to identify patients admitted with acute exacerbations of COPD (AECOPD) who tested positive for respiratory viral infections (RVI) over a 6 month period (February 2020 to July 2020) and were compared with the 2 year pre-pandemic period (January 2018 to January 2020). In clinical practice in this institution, patients with presentations suggestive of viral triggered AECOPD (e.g. normal serum procalcitonin) were tested for RVIs with a 16-target respiratory virus multiplex PCT (RV-16) on respiratory specimens, at the primary physician’s request.
Pre-pandemic an average of 92 AECOPD admissions per month were seen compared to 36 admissions per month in the post-pandemic period; a reduction of 50%. Some patients may have managed AECOPD in the community to avoid hospitalisation. Testing for RVIs increased from 60% pre-pandemic to 98% post pandemic. Despite the increase of testing during the pandemic period which may have been triggered by an increase in vigilance, the incidence of PCR positive RVIs among COPD admissions dropped significantly; 106 cases per 1000 AECOPD admissions (23 cases, 216 admissions) during the pandemic compared with 304 per 1000 AECOPD admissions pre-pandemic (701 cases, 2300 admissions), a decline that was statistically significant. Pre-pandemic close to half of AECOPD admissions tested had a PCR positive RVI (48.8%) compared to 10.8% during the pandemic.
This is a small, single centre study but it demonstrates a very interesting finding. The accompanying editorial comments that current strategies focusing on reduction in exacerbation frequency do not approach the 50% impact seen in this study. There have certainly been negative impacts on COPD patients during the pandemic with COPD being associated with greater severity of COVID-19 infection and increased mortality as well as an increase in anxiety and decrease in physical exercise and pulmonary rehabilitation programmes but the findings of this study warrant consideration. It is also raised that given that most exacerbations are caused by RVIs, the absence of vaccines and drugs to prevent and treat such infections may be a glaring omission in our therapeutic approach. It also supports the idea that there is scope to reduce COPD exacerbations further.