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Chan KPF, Ting-Fung M, Sridhar S, Lui MMS, Ho JCM, Lam DCL, Ip MSM, Ho PL. Changes in the incidence, clinical features and outcomes of tuberculosis during COVID-19 pandemic. J Infect Public Health 2024; 17:102511. [PMID: 39068731 DOI: 10.1016/j.jiph.2024.102511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/23/2024] [Accepted: 07/24/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND COVID-19 pandemic has disrupted tuberculosis (TB) services in many countries, but the impacts on sites of involvement, drug susceptibility, smear positivity and clinical outcomes, and clinical outcomes of co-infection with influenza and COVID-19 remain unclear. METHODS Descriptive epidemiological study using episode-based and patient unique data of tuberculosis from Hospital Authority's territory-wide electronic medical record database, comparing baseline (January 2015-December 2019) and COVID-19 period (January 2020-December 2022), followed by univariate and multivariate analyses. Effects of co-infection with influenza and COVID-19 were investigated. RESULTS The study included 10,473 episodes of laboratory-confirmed TB, with 6818 in baseline period and 3655 during COVID-19 period. During COVID-19 period, TB patients had a lower proportion of smear positivity (49.2 % vs 54.7 %, P < 0.001), and fewer cases of extrapulmonary TB (7.0 % vs 8.0 %, P = 0.078) and multidrug resistant TB (1.0 % vs 1.6 %, P = 0.020). Mortality was higher in TB patients with COVID-19 coinfection (OR 1.7, P = 0.003) and influenza coinfection (OR 2.6, P = 0.004). During COVID-19 period, there were higher rates of treatment delay (20.5 % vs 15.5 %, P < 0.001) and episodic death (15.1 % vs 13.3 %, P = 0.006). Factors associated with higher mortality included age ≥ 70 years (OR 7.24), treatment delay (OR 2.16), extrapulmonary TB (OR 2.13). smear positivity (OR 1.71) and Charlson comorbidity index score ≥ 3 (OR 1.37). Higher mortality was observed with co-infection by influenza (OR 1.18) and COVID-19 (OR 1.7). CONCLUSIONS The epidemiology and outcomes of TB were changed during COVID-19 period. Mortality was higher during COVID-19 period and with co-infection by influenza and COVID-19.
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Affiliation(s)
- King-Pui Florence Chan
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region
| | - Ma Ting-Fung
- Department of Statistics, University of South Carolina, USA
| | - Siddharth Sridhar
- Department of Microbiology, Queen Mary Hospital, University of Hong Kong, Hong Kong Special Administrative Region
| | - Macy Mei-Sze Lui
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region
| | - James Chung-Man Ho
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region
| | - David Chi-Leung Lam
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region
| | - Mary Sau-Man Ip
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region
| | - Pak-Leung Ho
- Department of Microbiology, Queen Mary Hospital, University of Hong Kong, Hong Kong Special Administrative Region; Carol Yu Centre for Infection, University of Hong Kong, Hong Kong Special Administrative Region.
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Martinez FJ, Papi A, Welte T, Singh D, Galkin DV, Guasconi A, Pirondi S, Georges G, Imperato J, Hermans R. COPD Exacerbations Before and During COVID-19 in France, Germany, Italy, the UK and the US. Int J Chron Obstruct Pulmon Dis 2024; 19:1433-1445. [PMID: 38948907 PMCID: PMC11214557 DOI: 10.2147/copd.s451009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 06/10/2024] [Indexed: 07/02/2024] Open
Abstract
Background Exacerbations of chronic obstructive pulmonary disease (COPD) were reported less frequently during the COVID-19 pandemic. We report real-world data on COPD exacerbation rates before and during this pandemic. Methods Exacerbation patterns were analysed using electronic medical records or claims data of patients with COPD before (2017-2019) and during the COVID-19 pandemic (2020 through early 2022) in France, Germany, Italy, the United Kingdom and the United States. Data from each country were analysed separately. The proportions of patients with COPD receiving maintenance treatment were also estimated. Results The proportion of patients with exacerbations fell 45-78% across five countries in 2020 versus 2019. Exacerbation rates in most countries were reduced by >50% in 2020 compared with 2019. The proportions of patients with an exacerbation increased in most countries in 2021. Across each country, seasonal exacerbation increases seen during autumn and winter in pre-pandemic years were absent during the first year of the pandemic. The percentage of patients filling COPD prescriptions across each country increased by 4.53-22.13% in 2019 to 9.94-34.17% in 2021. Conclusion Early, steep declines in exacerbation rates occurred in 2020 versus 2019 across all five countries and were accompanied by a loss of the seasonal pattern of exacerbation.
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Affiliation(s)
| | - Alberto Papi
- Research Center on Asthma and COPD, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Tobias Welte
- Pneumonology and Infectiology, Member of the German Center of Lung Research, Hannover Medical School, Hannover, Germany
- Biomedical Research in End Stage and Obstructive Lung Disease, German Center for Lung Research, Hannover Medical School, Hannover, Germany
| | - Dave Singh
- Medicines Evaluations Unit, University of Manchester, Manchester University Foundation Hospitals Trust, Manchester, UK
| | | | | | - Stefania Pirondi
- Global Clinical Development, Chiesi Farmaceutici, S.p.A, Parma, Italy
| | - George Georges
- Global Clinical Development, Chiesi Farmaceutici, S.p.A, Parma, Italy
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Abdulfattah O, Kohli A, White P, Michael C, Alnafoosi Z. Impact of the COVID-19 Pandemic on Hospital Admission Rate, Length of Stay, and Mortality Rate for Patients with Chronic Obstructive Pulmonary Disease Exacerbation: A Retrospective Study. J Community Hosp Intern Med Perspect 2024; 14:1-8. [PMID: 38966505 PMCID: PMC11221434 DOI: 10.55729/2000-9666.1311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 11/07/2023] [Accepted: 01/02/2024] [Indexed: 07/06/2024] Open
Abstract
Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common cause of hospital admissions. Coronavirus disease 2019 (COVID-19) has large impact on patients with pulmonary diseases. The purpose of the study is to evaluate the impact of COVID-19 on patients with AECOPD. Method Retrospective study with two cohorts, the first period included patients with AECOPD before COVID-19 pandemic; the second period included patients with AECOPD since the beginning of COVID-19 pandemic. The length of stay (LOS), number of patients requiring mechanical ventilation, and allcause mortality were calculated. Results There was a total of 55 (44.72%) patients in the pre-COVID period compared to 68 (55.28%) patients in the COVID period. In the pre-COVID period: 14 (19.44%) had hypertension, 26(36.11%) had diabetes, 27(37.50%) had ischemic heart disease, 3(4.17%) had myocardial infarction; in the COVID period: 20 (29.41%) had hypertension, 24(35.29%) had diabetes, 27(39.71%) had ischemic heart disease, 1(1.47) had myocardial infarction. The LOS was shorter in pre-COVID period compared to COVID period, 6.51(SD 5.02) days vs 8.91(SD7.88) days with P-value of 0.042 respectively. The total number of patients needing mechanical ventilation in pre-COVID period was similar to the COVID period with P-value of 0.555. All-cause mortality number was 2 (3.64%) in the pre-COVID period compared to 6 (8.82%) in COVID period with P-value of 0.217. Conclusion Study results revealed significant difference in length of stay for patients with AECOPD, patient in COVID period had increased LOS compared to pre-COVID period. There was no significant difference in the other parameters.
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Affiliation(s)
- Omar Abdulfattah
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Southern Illinois University,
USA
| | - Akshay Kohli
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Southern Illinois University,
USA
| | - Peter White
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Southern Illinois University,
USA
| | - Cynthia Michael
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Southern Illinois University,
USA
| | - Zainab Alnafoosi
- Division of Infectious Disease, Department of Internal Medicine, Southern Illinois University,
USA
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4
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Poucineau J, Khlat M, Lapidus N, Espagnacq M, Chouaïd C, Delory T, Le Coeur S. Impact of the COVID-19 Pandemic on COPD Patient Mortality: A Nationwide Study in France. Int J Public Health 2024; 69:1606617. [PMID: 38362309 PMCID: PMC10868525 DOI: 10.3389/ijph.2024.1606617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/12/2024] [Indexed: 02/17/2024] Open
Abstract
Objectives: We investigated the mortality patterns of chronic obstructive pulmonary disease (COPD) patients in France relative to a control population, comparing year 2020 to pre-pandemic years 2017-2019. Methods: COPD patient and sex, age and residence matched control cohorts were created from the French National Health Data System. Survival was analyzed using Cox regressions and standardized rates. Results: All-cause mortality increased in 2020 compared to 2019 in the COPD population (+4%), but to a lesser extent than in the control population (+10%). Non-COVID-19 mortality decreased to a greater extent in COPD patients (-5%) than in the controls (-2%). Death rate from COVID-19 was twice as high in the COPD population relative to the control population (547 vs. 279 per 100,000 person-years). Conclusion: The direct impact of the pandemic in terms of deaths from COVID-19 was much greater in the COPD population than in the control population. However, the larger decline in non-COVID-19 mortality in COPD patients could reflect a specific protective effect of the containment measures on this population, counterbalancing the direct impact they had been experiencing.
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Affiliation(s)
- Jonas Poucineau
- Institut National d’Études Démographiques (INED), Paris, France
- Institut de Recherche et Documentation en Économie de la Santé (IRDES), Paris, France
| | - Myriam Khlat
- Institut National d’Études Démographiques (INED), Paris, France
| | - Nathanaël Lapidus
- Faculté de Santé, Sorbonne Université, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1136 Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
- Hôpital Saint-Antoine, Paris, France
| | - Maude Espagnacq
- Institut de Recherche et Documentation en Économie de la Santé (IRDES), Paris, France
| | - Christos Chouaïd
- Institut National de la Santé et de la Recherche Médicale (INSERM) U955 Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- Hospital Center Intercommunal De Créteil, Créteil, France
| | - Tristan Delory
- Institut National d’Études Démographiques (INED), Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1136 Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
- Centre Hospitalier Annecy Genevois (CH Annecy), Metz-Tessy, France
| | - Sophie Le Coeur
- Institut National d’Études Démographiques (INED), Paris, France
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Chen X, Jiang X, Zhang X, Ren D, Wei C, Xu A, Yang H, Bai R, Li C, Yue F, Bao S, Shi J, Fan J. Assessing the impact of diverse mask types on COPD patients: a randomised controlled trial study protocol. BMJ Open 2024; 14:e080721. [PMID: 38199633 PMCID: PMC10806656 DOI: 10.1136/bmjopen-2023-080721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Wearing masks has proven beneficial in preventing respiratory pathogen infections in individuals with chronic obstructive pulmonary disease (COPD). However, the impact of different mask types on physiological indicators and daily physical activity in COPD patients remains uncertain. This study aims to assess the immediate effects of various mask types on cardiopulmonary function indicators, subjective perceptions and the 6-minute walking distance (6MWD) in individuals with COPD. METHODS AND ANALYSIS This randomised controlled trial will enrol 129 stable COPD patients. Participants will be randomly divided into three groups: control, N95 mask and surgical mask groups. Each group will undergo both a 6-minute seated test and a 6-minute walk test (6MWT), without or with their respective masks. A 10-minute interval will be provided between the two phases. The primary indicators of the study include the 6MWD and blood oxygen saturation. Secondary outcomes encompass blood pressure, pulse rate, Borg score, Rate of Perceived Exertion (RPE) score and subjective perception score. Oxygen saturation, pulse rate and blood pressure will be recorded four times during the trial, while Borg and RPE scores will be compared before and after the 6MWT. Additionally, subjective perception scores will be collected after each mask-wearing stage. ETHICS AND DISSEMINATION This study has received approval from the Ethics Committee of the Affiliated Hospital of Gansu University of Chinese Medicine (approval number: 202335). We plan to disseminate research results through publication in a peer-reviewed journal or presentation at a conference. TRIAL REGISTRATION NUMBER ChiCTR2300074554.
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Affiliation(s)
- Xuwen Chen
- Center for Laboratory and Simulation Training, School of Public Health, Center for Evidence-Based Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Xiaomei Jiang
- Department of Psychosomatic and Sleep Medicine, Gansu Gem Flower Hospital, Lanzhou, Gansu, China
| | - Xuhui Zhang
- Department of Pulmonary Diseases, Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Dong Ren
- Department of Psychosomatic and Sleep Medicine, Gansu Gem Flower Hospital, Lanzhou, Gansu, China
| | - Caihong Wei
- Pulmonary and Critical Care Medicine, Gansu Gem Flower Hospital, Lanzhou, Gansu, China
| | - Aihong Xu
- Pulmonary and Critical Care Medicine, Gansu Gem Flower Hospital, Lanzhou, Gansu, China
| | - Hong Yang
- Department of Rehabilitation Medicine, Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Ruijia Bai
- Department of Pulmonary Diseases, Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Caiyun Li
- Center for Laboratory and Simulation Training, School of Public Health, Center for Evidence-Based Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Feiyan Yue
- Center for Laboratory and Simulation Training, School of Public Health, Center for Evidence-Based Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Shisan Bao
- Center for Laboratory and Simulation Training, School of Public Health, Center for Evidence-Based Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Jungang Shi
- Pulmonary and Critical Care Medicine, Gansu Gem Flower Hospital, Lanzhou, Gansu, China
| | - Jingchun Fan
- Center for Laboratory and Simulation Training, School of Public Health, Center for Evidence-Based Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
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Ho CCY, Chan CWH, Li C, Xiao J, Ng MSN. Literature review and development of pictorial action plan to promote self-management of chronic obstructive pulmonary disease. PATIENT EDUCATION AND COUNSELING 2023; 115:107923. [PMID: 37494782 DOI: 10.1016/j.pec.2023.107923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/03/2023] [Accepted: 07/21/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE This study aimed to review relevant literature and develop a pictorial action plan (PAP) to enhance self-management among older patients with chronic obstructive pulmonary disease (COPD). METHODS In Stage 1, an integrative review was conducted to identify key elements of respiratory self-management action plans. In Stage 2, cartoon pictograms with plain descriptions were designed. In Stage 3, the PAP was validated by 40 older patients with COPD and an expert panel. RESULTS While the eight included studies demonstrated positive effects on knowledge and quality of life, key elements identified included: traffic light motif, plain and explicit language, and several action plan topics. The final PAP comprises three traffic light-coloured zones and 24 pictograms that introduce self-management strategies for normal, decreasing, and severely decreased airflow. After revising the cartoon characters, all of the pictograms received guessability ratings above 70% and acceptable mean translucency ratings. DISCUSSION The integrative review provides evidence about the effectiveness and key elements of PAPs. The PAP developed was found to be valid and feasible for use among older patients with chronic respiratory conditions. PRACTICE IMPLICATIONS This study offered an example of translating evidence into patient education practice to enhance self-management in older patients with COPD.
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Affiliation(s)
- Cherry C Y Ho
- Division of Nursing Education, School of Continuing Education, The Hong Kong Baptist University, Hong Kong, China
| | - Carmen W H Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Caixia Li
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Jinnan Xiao
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Marques S N Ng
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China.
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Swain R, Forsyth F, Bowers B, Early F, Kuhn I, Shrivastva S, Tufnell R, Fuld J. A critical interpretive synthesis of the lived experiences and health and patient-reported outcomes of people living with COPD who isolated during the COVID-19 pandemic. Eur Respir Rev 2023; 32:230031. [PMID: 37495249 PMCID: PMC10369166 DOI: 10.1183/16000617.0031-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/23/2023] [Indexed: 07/28/2023] Open
Abstract
AIMS To determine the lived experiences of people with COPD who isolated at home during the coronavirus disease 2019 (COVID-19) pandemic, and explore how these experiences affected health and patient-reported outcomes. METHODS Keyword searches were performed in five bibliographic databases. Critical interpretative synthesis (CIS) methods were used to interrogate and understand patterns across studies. RESULTS 23 studies were identified; three employed qualitative methods and 20 quantitative methods. Application of CIS methods highlighted a core synthetic concept that appeared to underpin experiences and outcomes, that of a heightened perception of risk. Using the Risk Perception Model as a framework, we found that cognitive factors such as knowledge of underlying health status and the transmissibility of COVID-19; experiential factors including previous episodes of breathlessness and hospitalisation; and sociocultural factors such as access to trusted sources of information, influenced perceptions of risk. In turn, this influenced behaviour, which translated to outcomes such as reduced hospitalisations, deconditioning and social isolation as people avoided "high-risk" situations and settings. CONCLUSIONS Patients with COPD who isolated at home during the COVID-19 pandemic had a heightened perception of risk which was influenced by cognitive, experiential and sociocultural factors. The consequences of this were varied and included both positive (reduced exacerbations and hospitalisations) and negative (social isolation, deconditioning, diminished capacity for self-care) outcomes. Understanding risk and the impacts it can have could help clinicians to support people with COPD return to their pre-pandemic way of living and enable better communication of ongoing risk from respiratory viral illness.
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Affiliation(s)
- Rose Swain
- Department of Infection and Inflammation Research, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- These authors contributed equally to this work
| | - Faye Forsyth
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- These authors contributed equally to this work
| | - Ben Bowers
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Queen's Nursing Institute, London, UK
| | - Frances Early
- Department of Respiratory Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Isla Kuhn
- Medical Library, University of Cambridge, Cambridge, UK
| | - Sagar Shrivastva
- Department of Respiratory Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Rachel Tufnell
- Cambridge Breathlessness Intervention Service, Cambridge University Hospitals NHS Foundation, Cambridge, UK
| | - Jonathan Fuld
- Department of Respiratory Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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8
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Andreen N, Westin J, Vanfleteren LEGW. Hospital Admission Rates in Patients with COPD Throughout the COVID-19 Pandemic. Int J Chron Obstruct Pulmon Dis 2023; 18:1763-1772. [PMID: 37608833 PMCID: PMC10441640 DOI: 10.2147/copd.s409452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/14/2023] [Indexed: 08/24/2023] Open
Abstract
Purpose Several studies report decreased hospital admissions for acute exacerbations of COPD (AECOPD) during the COVID-19 pandemic. However, there are no studies that compare AECOPD admissions with admissions for respiratory infections, including COVID-19. This study aimed to examine hospital admission rates for AECOPD, pneumonia, influenza, and COVID-19 among COPD patients, before and during the COVID-19 pandemic. Patients and Methods We obtained anonymized data on hospital admissions of patients with COPD and a primary diagnosis code for AECOPD, pneumonia, influenza, or COVID-19, from the hospital patient admission register at a large Swedish hospital. The study compared the pandemic period (February 2020-March 2022) to a period before the pandemic (June 2017-January 2020). Sequential phases of the pandemic were evaluated separately. Monthly admission rates were compared using Poisson regression, controlling for admission month. Results Comparing monthly admission rates during the pandemic with the prepandemic period, incidence rate ratios were 0.72 for AECOPD (95% CI 0.67-0.77; p<0.001), 0.56 for pneumonia (95% CI 0.49-0.62; p<0.001), 0.18 for influenza during the winter period (95% CI 0.10-0.30; p<0.001) and 0.79 for total COPD admissions, including COVID-19 (95% CI 0.75-0.84; p<0.001). The study showed significantly lower rate ratios for AECOPD, pneumonia, and total COPD admissions during the first, second, third, and fifth (Omicron) waves. No significant effect on admissions was seen after the withdrawal of restriction measures. Conclusion There was a significant reduction in the overall rate of hospital admissions among COPD patients for AECOPD, pneumonia, and respiratory viral infections during the pandemic despite the rise in COVID-19 admissions. However, prepandemic admission levels returned in the post-restriction period.
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Affiliation(s)
- Niklas Andreen
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | - Johan Westin
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | - Lowie E G W Vanfleteren
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Respiratory Medicine and Allergology, COPD Center, Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Pappe E, Hammerich R, Saccomanno J, Sgarbossa T, Pohrt A, Schmidt B, Grah C, Eisenmann S, Holland A, Eggeling S, Stanzel F, Witzenrath M, Hübner RH. Impact of Coronavirus Disease 2019 on Hospital Admissions, Health Status, and Behavioral Changes of Patients with COPD. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2023; 10:211-223. [PMID: 37140947 PMCID: PMC10484494 DOI: 10.15326/jcopdf.2022.0383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 05/05/2023]
Abstract
Introduction Patients with chronic obstructive pulmonary disease (COPD) have an increased risk of acquiring severe coronavirus disease 2019 (COVID-19), which is why self-isolation was recommended. However, long periods of social isolation, accompanied by limited access to health care systems, might influence the outcome of patients with severe COPD negatively. Methods Data from COPD and pneumonia patients at Charité-Universitätsmedizin Berlin and the volume of endoscopic lung volume reduction (ELVR) surgeries from the German Lung Emphysema Registry (Lungenemphysem Register e.V.) were analyzed from pre-pandemic (2012 to 2019) to the pandemic period (2020 and 2021). In addition, 52 patients with COPD Global initiative for chronic Obstructive Lung Disease (GOLD) stage 4 status included in the lung emphysema registry received questionnaires during lockdowns from June 2020 to April 2021. Results Admissions and ventilation therapies administered to COPD patients significantly decreased during the COVID-19 pandemic. Likewise, there was a reduction in ELVR treatments and follow-ups registered in German emphysema centers. Mortality was slightly higher among patients hospitalized with COPD during the pandemic. Increasing proportions of COPD patients with GOLD stage 3 and GOLD stage 4 status reported behavioral changes and subjective feelings of increasing COPD symptoms the longer the lockdown lasted. However, COPD symptom questionnaires revealed stable COPD symptoms over the pandemic time period. Summary This study reveals reduced COPD admissions and elective treatment procedures of COPD patients during the pandemic, but a slight increase in mortality among patients hospitalized with COPD, irrespective of COVID-19. Correspondingly, patients with severe COPD reported subjective deterioration of their health status, probably caused by their very strict compliance with lockdown measures.
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Affiliation(s)
- Eva Pappe
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ralf Hammerich
- Administrative Office for Clinical Quality and Risk Management, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jacopo Saccomanno
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Sgarbossa
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Anne Pohrt
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Schmidt
- Department of Respiratory Medicine, DRK Kliniken Berlin Mitte, Berlin, Germany
| | - Christian Grah
- Department of Internal Medicine and Respiratory Medicine, Clinic Havelhöhe Berlin, Berlin, Germany
| | - Stephan Eisenmann
- Department of Internal Medicine I, Pulmonary Medicine, University Hospital Halle (Saale), Germany
| | - Angelique Holland
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Marburg, Germany
| | - Stephan Eggeling
- Department of Thoracic Surgery, Vivantes Netzwerk für Gesundheit, Klinikum Neukölln, Berlin, Germany
| | | | - Martin Witzenrath
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ralf-Harto Hübner
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Abstract
COPD is a heterogeneous condition, the onset and trajectory of which is influenced not only by tobacco exposure but also an individual's genetics and the exposures they accumulate over their life course. In such a complex chronic disease, phenotyping individuals based on similar clinical or molecular characteristics can aid in guiding appropriate therapeutic management. Treatable traits, characteristics for which evidence exists for a specific favorable treatment response, are increasingly incorporated into COPD clinical guidelines. But the COPD phenotyping literature is evolving. Innovations in lung imaging and physiologic metrics, as well as omics technologies and biomarker science, are contributing to a better understanding of COPD heterogeneity. This review summarizes the evolution of COPD phenotyping, the current use of phenotyping to direct clinical care, and how innovations in clinical and molecular approaches to unraveling disease heterogeneity are refining our understanding of COPD phenotypes.
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Affiliation(s)
- Stephanie A Christenson
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California, San Francisco, San Francisco, California.
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Galán-Negrillo M, García-Pachón E. Reduction in Hospital Admissions for Asthma and COPD During the First Year of COVID-19 Pandemic in Spain. Arch Bronconeumol 2023:S0300-2896(23)00125-4. [PMID: 37149468 PMCID: PMC10118055 DOI: 10.1016/j.arbres.2023.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 05/08/2023]
Affiliation(s)
- Marta Galán-Negrillo
- Section of Respiratory Medicine, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - Eduardo García-Pachón
- Section of Respiratory Medicine, Hospital General Universitario de Elche, Elche, Alicante, Spain.
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12
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Intensive critical care and management of asthmatic and smoker patients in COVID-19 infection. ACTA PHARMACEUTICA (ZAGREB, CROATIA) 2023; 73:29-42. [PMID: 36692461 DOI: 10.2478/acph-2023-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 01/25/2023]
Abstract
This century's most serious catastrophe, COVID-19, has been dubbed "the most life-threatening disaster ever". Asthmatic persons are even more prone to COVID-19's complex interplay with the underlying inflammatory condition. In order to protect themselves against COVID-19, asthmatic patients must be very vigilant in their usage of therapeutic techniques and drugs (e.g., bronchodilators, 5-lipoxygenase inhibitors), which may be accessed to deal with mild, moderate, and severe COVID-19 indications. People with asthma may have more severe COVID-19 symptoms, which may lead to a worsening of their condition. Several cytokines were found to be elevated in the bronchial tracts of patients with acute instances of COVID-19, suggesting that this ailment may aggravate asthma episodes by increasing inflammation. The intensity of COVID-19 symptoms is lessened in patients with asthma who have superior levels of T-cells. Several antibiotics, antivirals, antipyretics, and anti-inflammatory drugs have been suggested to suppress COVID-19 symptoms in asthmatic persons. Furthermore, smokers are more likely to have aggravated repercussions in COVID-19 infection. Being hospitalized to critical care due to COVID-19, needing mechanical breathing, and suffering from serious health repercussions, are all possible outcomes for someone who has previously smoked. Smoking damages airways and alveoli, which significantly raises the risk of COVID-19-related health complications. Patients with a previous record of smoking are predisposed to severe COVID-19 disease symptoms that essentially require a combination of bronchodilators, mucolytics, antivirals, and antimuscarinic drugs, to cope with the situation. The present review discusses the care and management of asthmatic and smoker patients in COVID-19 infection.
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de Albuquerque DDAR, de Melo MDT, de Sousa TLF, Normando PG, Fagundes JGM, Araujo-Filho JDAB. Hospital admission and mortality rates for non-COVID-19 respiratory diseases in Brazil's public health system during the covid-19 pandemic: a nationwide observational study. J Bras Pneumol 2023; 49:e20220093. [PMID: 36790283 PMCID: PMC9970380 DOI: 10.36416/1806-3756/e20220093] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/27/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To assess the influence of the COVID-19 pandemic on hospital admissions (HA), intra-hospital deaths (HD), and intra-hospital lethality rates (HL) related to respiratory diseases (RD) other than COVID-19 in Brazil. METHODS This observational time-series study was conducted through comparative analyses of the HA, HD, and HL related to non-COVID-19 RD registered between March and December 2020 by the Brazilian Unified Public Health System on the DataSUS Tabnet platform, using as reference the values recorded in the same period of 2019 and those projected by linear regression methods for 2020, considering the period from 2015 to 2019. The adopted statistical significance level was 5% (p < 0.05). RESULTS Compared to 2019, in 2020, there was a 42% decrease in HA and a 7.4% decrease in total HD related to non-COVID-19 RD, followed by a 60% increase in HL associated with this group of diseases. The HA and HL registered in 2020 differed significantly from the projected trend for that year by linear regression (p < 0.05). Of note, a significant reduction in hospitalizations due to asthma (-46%), chronic obstructive pulmonary disease (-45%), bronchiectasis (-54%), pneumonia (-46%), and acute bronchitis (-73%) was observed. CONCLUSIONS During the first 8 months of the pandemic, there was a decline in HA and an increase in HL related to non-COVID-19 RD in Brazil, which can hypothetically reflect logistical challenges and delays in the management of this group of diseases.
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Impact of the first wave of the COVID-19 pandemic on non-COVID inpatient care in southern Spain. Sci Rep 2023; 13:1634. [PMID: 36717651 PMCID: PMC9885064 DOI: 10.1038/s41598-023-28831-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
We assessed the impact of the first wave of COVID-19 pandemic on non-COVID hospital admissions, non-COVID mortality, factors associated with non-COVID mortality, and changes in the profile of non-COVID patients admitted to hospital. We used the Spanish Minimum Basic Data Set with diagnosis grouped according to the Diagnostic Related Groups. A total of 10,594 patients (3% COVID-19; 97% non-COVID) hospitalised during the first wave in 2020 (27-February/07-June) were compared with those hospitalised within the same dates of 2017-2019 (average annual admissions: 14,037). We found a decrease in non-COVID medical (22%) and surgical (33%) hospitalisations and a 25.7% increase in hospital mortality among non-COVID patients during the first pandemic wave compared to pre-pandemic years. During the officially declared sub-period of excess mortality in the area (17-March/20-April, in-hospital non-COVID mortality was even higher (58.7% higher than the pre-pandemic years). Non-COVID patients hospitalised during the first pandemic wave (compared to pre-pandemic years) were older, more frequently men, with longer hospital stay and increased disease severity. Hospitalisation during the first pandemic wave in 2020, compared to hospitalisation during the pre-pandemic years, was an independent risk factor for non-COVID mortality (HR 1.30, 95% CI 1.07-1.57, p = 0.008), reflecting the negative impact of the pandemic on hospitalised patients.
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Chan KPF, Ma TF, Sridhar S, Lam DCL, Ip MSM, Ho PL. Changes in Etiology and Clinical Outcomes of Pleural empyema during the COVID-19 Pandemic. Microorganisms 2023; 11:microorganisms11020303. [PMID: 36838268 PMCID: PMC9967836 DOI: 10.3390/microorganisms11020303] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/21/2023] [Accepted: 01/22/2023] [Indexed: 01/26/2023] Open
Abstract
Healthcare-seeking behavior changed during the COVID-19 pandemic and might alter the epidemiology of pleural empyema. In this study, the incidence, etiology and outcomes of patients admitted for pleural empyema in Hong Kong in the pre-COVID-19 (January 2015-December 2019) and post-COVID-19 (January 2020-June 2022) periods were compared. Overall, Streptococcus pneumoniae was the predominant organism in <18-year-old patients, while Streptococcus anginosus, anaerobes and polymicrobial infections were more frequent in adults. In the post-COVID-19 period, a marked decline in the incidence of pleural empyema in children was observed (pre-COVID-19, 18.4 ± 4.8 vs. post-COVID-19, 2.0 ± 2.9 cases per year, p = 0.036), while the incidence in adults remained similar (pre-COVID-19, 189.0 ± 17.2 vs. post-COVID-19, 198.4 ± 5.0 cases per year; p = 0.23). In the post-COVID-19 period, polymicrobial etiology increased (OR 11.37, p < 0.0001), while S. pneumoniae etiology decreased (OR 0.073, p < 0.001). In multivariate analysis, clinical outcomes (length of stay, ICU admission, use of intrapleural fibrinolytic therapy, surgical intervention, death) were not significantly different in pre- and post-COVID-19 periods. In conclusion, an increase in polymicrobial pleural empyema was observed during the pandemic. We postulate that this is related to the delayed presentation of pneumonia to hospitals.
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Affiliation(s)
- King-Pui Florence Chan
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - Ting-Fung Ma
- Department of Statistics, University of South Carolina, Columbia, SC 29208, USA
| | - Siddharth Sridhar
- Department of Microbiology, Carol Yu Centre for Infection, University of Hong Kong, Hong Kong SAR, China
| | - David Chi-Leung Lam
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - Mary Sau-Man Ip
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - Pak-Leung Ho
- Department of Microbiology, Carol Yu Centre for Infection, University of Hong Kong, Hong Kong SAR, China
- Correspondence:
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Wu TT, Jiang YQ, Zhao BF, Si FL, Wu P, Wang HY, Sheng CF, Xu X, Li F, Zhang J. Real-World COPD Management Over 3 Years at the Community Health Service Center of Shanghai During the COVID-19 Pandemic in China. Int J Chron Obstruct Pulmon Dis 2023; 18:349-364. [PMID: 36960355 PMCID: PMC10029936 DOI: 10.2147/copd.s391908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 03/06/2023] [Indexed: 03/19/2023] Open
Abstract
Objective To evaluate the real-world situation for the management of chronic obstructive pulmonary disease (COPD) and poorly controlled disease risk factors in the Chinese community. Methods This retrospective multicentre study analysed data from COPDMICand MICHC in Shanghai Songjiang District, Shanghai, China. The differences in COPD Assessment Test (CAT), the modified Medical Research Council (mMRC) dyspnea scale, and the number of emergency cases, emergency visits, inpatient cases, and hospitalisations from January 2018 to December 2020 were analysed. The impact of coronavirus disease 2019 (COVID-19) on COPD management was also assessed. Results For 2020 versus 2018, analysis of 468 COPD cases from COPDMIC matched with MICHC data showed significantly more patients with improved mMRC grades, significantly fewer emergency cases and emergency visits, and significantly fewer hospitalisation cases and hospitalisations. Differences in the number of emergency visits and hospitalisations per capita were statistically significant. Compared to GOLD 3-4, GOLD 1-2 patients showed significant improvements in CAT score, mMRC grade, the number of emergency visits and hospitalisations per capita. Treatment adherence from 2018 to 2020 was 25%, 29.1%, and 6.8%, and the proportion of medication regimens consistent with guidelines was 43.44%, 50.98%, and 71.87%, respectively. Higher treatment adherence resulted in significantly improved CAT scores and mMRC grades and fewer emergency department visits and hospitalisations per capita. Conclusion Combined with remote management tools, patients with COPD achieved continuous improvement in symptoms and exacerbations over 3 years. In the context of COVID-19 prevention/control measures, improvements were significant for patients with GOLD 1-2 COPD but limited with GOLD 3-4. Pharmacologic treatment significantly improved clinical symptoms and reduced emergency visits and hospitalisations. Severe airflow limitation and poor adherence to pharmacologic treatment were important risk factors for lack of disease remission.
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Affiliation(s)
- Ting-Ting Wu
- Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (Preparatory Stage), Shanghai, People’s Republic of China
| | - Yi Qun Jiang
- General Practice/International Medical Care Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Bang-Feng Zhao
- Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (Preparatory Stage), Shanghai, People’s Republic of China
| | - Feng-Li Si
- Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (Preparatory Stage), Shanghai, People’s Republic of China
| | - Peng Wu
- Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (Preparatory Stage), Shanghai, People’s Republic of China
| | - Huan-Ying Wang
- Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (Preparatory Stage), Shanghai, People’s Republic of China
| | - Chun-Feng Sheng
- Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (Preparatory Stage), Shanghai, People’s Republic of China
| | - Xun Xu
- Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (Preparatory Stage), Shanghai, People’s Republic of China
| | - Fan Li
- Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (Preparatory Stage), Shanghai, People’s Republic of China
- Correspondence: Fan Li; Jing Zhang, Email ;
| | - Jing Zhang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
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Cheng W, Li M, Yu S, Peng X, Zhang L, Zhou C, Wu Y, Zhang W. Epidemiological characteristics of community-acquired pneumonia and effects from the COVID-19 pandemic in Shenzhen of China. J Trop Pediatr 2022; 69:6917080. [PMID: 36525383 DOI: 10.1093/tropej/fmac111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This study aimed to observe the impact of the coronavirus disease 2019 (COVID-19) pandemic on the incidence of non-COVID-19 community-acquired pneumonia (CAP) in Shenzhen of China, offering new ideas for evaluating the effects of non-pharmaceutical interventions. METHODS A retrospective analysis was conducted of inpatients with pneumonia from 2017 to 2021. Epidemiological characteristics of CAP and effects from the COVID-19 pandemic were analyzed by the basic characteristics, time distribution, etiology and disease burden. RESULTS There were a total of 5746 CAP inpatient cases included from 2017 to 2021. The number of CAP hospitalizations decreased during the pandemic from 2020 to 2021, with seasonal variations of being higher in spring and winter and lower in summer and autumn, whereas it was prevalent throughout the year prior to the pandemic. The children group decreased significantly during the pandemic, with a 15% decrease in the share of CAP inpatients. The detection rates of bacteria and mycoplasma decreased in CAP patients, while the detection rate of the virus increased, and the number of moderate and severe cases reduced more than that of the mild. CONCLUSION Non-pharmaceutical interventions from COVID-19 have led to a decrease in the number of CAP inpatients, especially for children, with a specific seasonal prevalence in spring and winter, when the prevention interventions should be strengthened further for adults during the pandemic.
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Affiliation(s)
- Wenli Cheng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong 510632, China
| | - Min Li
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong 510632, China
| | - Susu Yu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong 510632, China
| | - Xinyue Peng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong 510632, China
| | - Luyun Zhang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong 510632, China
| | - Cheng Zhou
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong 510632, China
| | - Yanjie Wu
- Departments of Preventive Health Care and Hospital Infection Management, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, China
| | - Wenjuan Zhang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong 510632, China
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Chen X, Zhang C, Ibrahim S, Tao S, Xia X, Li Y, Li C, Yue F, Wang X, Bao S, Fan J. The impact of facemask on patients with COPD: A systematic review and meta-analysis. Front Public Health 2022; 10:1027521. [PMID: 36466486 PMCID: PMC9709116 DOI: 10.3389/fpubh.2022.1027521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background Since the emergence of COVID-19, mandatory facemask wearing has been implemented around the world to prevent viral transmission, however, the impact of wearing facemasks on patients with COPD was unclear. Methods The current study undertakes a systematic review and meta-analysis of a comprehensive literature retrieval from six databases, based on the pre-determined eligibility criteria, irrespective of language. The risk of bias was assessed using an established instrument. We primarily focused on analyzing ETCO2, SpO2, and heart and respiratory rates, and also considered the impacts on physiological and exercise performance. A descriptive summary of the data and possible meta-analysis was performed. Forest plots were generated to pool estimates based on each of the study outcomes. Results Of the 3,751 publications considered, six publications were selected for a systematic review and two publications were included for meta-analysis, however, the quality of these six studies was relatively low overall. In the case of inactivity, the facemask wearing COPD cohort had higher respiratory rates than that of the non-facemask wearing cohort (MD = 1.00 and 95% CI 0.47-1.53, P < 0.05). There was no significant difference in ETCO2 (MD = 0.10 and 95% CI -1.57-1.78, P > 0.05) and heart rate (MD = 0.40 and 95% CI -3.59-4.39, P > 0.05) nor SpO2 (MD = -0.40 and 95% CI -0.84-0.04, P > 0.05) between the COPD patients with and without facemasks. Furthermore, it was observed that the only significant differences between the COPD patients with and without facemasks undertaking different activities were FEV1 (%) (MD = 3.84 and 95% CI 0.14-7.54, P < 0.05), FEV1/FVC (%) (MD = 3.25 and 95% CI 0.71-5.79, P < 0.05), and blood lactate (MD = -0.90 and 95% CI -1.73 to -0.07, P < 0.05). Conclusion Wearing facemasks decreased the exercise performance of patients with COPD, however, it had minimal impact on physiological indexes. Further investigations will be performed on the high-quality data from randomized control studies. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=326265, identifier: CRD42022326265.
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Affiliation(s)
- Xuwen Chen
- School of Public Health, Center for Laboratory and Simulation Training, Centre for Evidence-Based Medicine, Gansu University of Chinese Medicine, Lanzhou, China
| | - Changqing Zhang
- Department of Radiology, Gansu Provincial People's Hospital, Lanzhou, China
| | - Sani Ibrahim
- School of Public Health, Center for Laboratory and Simulation Training, Centre for Evidence-Based Medicine, Gansu University of Chinese Medicine, Lanzhou, China
| | - Shunyu Tao
- School of Public Health, The University of Sydney, Camperdown, NSW, Australia
| | - Xiaoli Xia
- Department of Geriatrics, Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, China
| | - Yi Li
- Department of Respiratory Cadres, Gansu Provincial People's Hospital, Lanzhou, China
| | - Caiyun Li
- School of Public Health, Center for Laboratory and Simulation Training, Centre for Evidence-Based Medicine, Gansu University of Chinese Medicine, Lanzhou, China
| | - Feiyan Yue
- School of Public Health, Center for Laboratory and Simulation Training, Centre for Evidence-Based Medicine, Gansu University of Chinese Medicine, Lanzhou, China
| | - Xinhua Wang
- School of Public Health, Center for Laboratory and Simulation Training, Centre for Evidence-Based Medicine, Gansu University of Chinese Medicine, Lanzhou, China,Xinhua Wang
| | - Shisan Bao
- School of Public Health, Center for Laboratory and Simulation Training, Centre for Evidence-Based Medicine, Gansu University of Chinese Medicine, Lanzhou, China,Shisan Bao
| | - Jingchun Fan
- School of Public Health, Center for Laboratory and Simulation Training, Centre for Evidence-Based Medicine, Gansu University of Chinese Medicine, Lanzhou, China,*Correspondence: Jingchun Fan
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19
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Kouanfack C, Fomekong Fouakeng S, Nguekam MF, Whegang SY, Djam Chefor A, Dzudie A, Sobngwi E, Ateudjieu J, Fouda PJ. Effect of the COVID-19 pandemic on the financial revenues of public hospitals with a care centre: case of the Yaoundé Central Hospital. J Public Health Afr 2022; 13:2195. [PMID: 36337674 PMCID: PMC9627760 DOI: 10.4081/jphia.2022.2195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 04/25/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In 2020, the world was confronted with COVID-19, which caused a socio-economic panic in several sectors. The use of hospitals has been affected, with an impact on their financial performance. The objective of this study was to assess the effect of the pandemic on the financial performance of a hospital with a care center. METHODOLOGY This was a cross-sectional study targeting the Yaoundé Central Hospital over two periods : before the pandemic (March to August 2019) and during the pandemic (March to August 2020). Based on the administrative accounts, revenues from the main sources of financial inflows were recorded and compared before and during the pandemic. RESULTS From March to August 2019, overall revenue was 1,131,525,099 FCFA and from March to August 2020, it was 762,770,714 FCFA, representing a drop of 32.6%. Medical imaging showed a drop of 14% corresponding to a loss of 96,500,052 FCFA. The laboratory showed a 21% decrease corresponding to a loss of 80,691,347 FCFA. Hospital admissions fell by 21%, corresponding to a loss of 62,124,675 FCFA. Consultations fell by 10%, corresponding to a loss of 49,265,835 FCFA. CONCLUSION The COVID-19 pandemic had a negative effect on the financial revenues of the Yaoundé Central Hospital.
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Affiliation(s)
- Charles Kouanfack
- Faculty of Medicine and Pharmaceutical Sciences, Uninersity of Dschang, Cameroon,Faculty of Medicine and Pharmaceutical Sciences, Uninersity of Dschang, Cameroon.
| | | | - Michel Foalem Nguekam
- ANRS-Cameroon site, Yaoundé Central Hospital, Cameroon,Yaoundé Central Hospital, Yaoundé, Cameroon
| | | | - Alain Djam Chefor
- Faculty of Medicine and Pharmaceutical Sciences, Uninersity of Dschang, Cameroon
| | - Anastase Dzudie
- Clinical Research Education, Networking and Consultancy (CRENC), Cameroon
| | | | - Jérôme Ateudjieu
- Faculty of Medicine and Pharmaceutical Sciences, Uninersity of Dschang, Cameroon,Meilleur Accès aux Soins de Santé (M.A SANTE), Cameroon
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20
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Yakutcan U, Hurst JR, Lebcir R, Demir E. Assessing the impact of COVID-19 measures on COPD management and patients: a simulation-based decision support tool for COPD services in the UK. BMJ Open 2022; 12:e062305. [PMID: 36207043 PMCID: PMC9556746 DOI: 10.1136/bmjopen-2022-062305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To develop a computer-based decision support tool (DST) for key decision makers to safely explore the impact on chronic obstructive pulmonary disease (COPD) care of service changes driven by restrictions to prevent the spread of COVID-19. DESIGN The DST is powered by discrete event simulation which captures the entire patient pathway. To estimate the number of COPD admissions under different scenario settings, a regression model was developed and embedded into the tool. The tool can generate a wide range of patient-related and service-related outputs. Thus, the likely impact of possible changes (eg, COVID-19 restrictions and pandemic scenarios) on patients with COPD and care can be estimated. SETTING COPD services (including outpatient and inpatient departments) at a major provider in central London. RESULTS Four different scenarios (reflecting the UK government's Plan A, Plan B and Plan C in addition to a benchmark scenario) were run for 1 year. 856, 616 and 484 face-to-face appointments (among 1226 clinic visits) are expected in Plans A, B and C, respectively. Clinic visit quality in Plan A is found to be marginally better than in Plans B and C. Under coronavirus restrictions, lung function tests decreased more than 80% in Plan C as compared with Plan A. Fewer COPD exacerbation-related admissions were seen (284.1 Plan C vs 395.1 in the benchmark) associated with stricter restrictions. Although the results indicate that fewer quality-adjusted life years (in terms of COPD management) would be lost during more severe restrictions, the wider impact on physical and mental health must also be established. CONCLUSIONS This DST will enable COPD services to examine how the latest developments in care delivery and management might impact their service during and beyond the COVID-19 pandemic, and in the event of future pandemics.
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Affiliation(s)
- Usame Yakutcan
- Hertfordshire Business School, University of Hertfordshire, Hatfield, UK
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | - Reda Lebcir
- Hertfordshire Business School, University of Hertfordshire, Hatfield, UK
| | - Eren Demir
- Hertfordshire Business School, University of Hertfordshire, Hatfield, UK
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Poucineau J, Delory T, Lapidus N, Hejblum G, Chouaïd C, Le Cœur S, Khlat M. Hospital admissions and mortality for acute exacerbations of COPD during the COVID-19 pandemic: A nationwide study in France. Front Med (Lausanne) 2022; 9:995016. [PMID: 36186789 PMCID: PMC9522972 DOI: 10.3389/fmed.2022.995016] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/17/2022] [Indexed: 12/03/2022] Open
Abstract
Background A global reduction in hospital admissions for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) was observed during the first months of the COVID-19 pandemic. Large-scale studies covering the entire pandemic period are lacking. We investigated hospitalizations for AECOPD and the associated in-hospital mortality at the national level in France during the first 2 years of the pandemic. Methods We used the French National Hospital Database to analyse the time trends in (1) monthly incidences of hospitalizations for AECOPD, considering intensive care unit (ICU) admission and COVID-19 diagnoses, and (2) the related in-hospital mortality, from January 2016 to November 2021. Pandemic years were compared with the pre-pandemic years using Poisson regressions. Results The database included 565,890 hospitalizations for AECOPD during the study period. The median age at admission was 74 years (interquartile range 65–83), and 37% of the stays concerned women. We found: (1) a dramatic and sustainable decline in hospitalizations for AECOPD over the pandemic period (from 8,899 to 6,032 monthly admissions, relative risk (RR) 0.65, 95% confidence interval (CI) 0.65–0.66), and (2) a concomitant increase in in-hospital mortality for AECOPD stays (from 6.2 to 7.6% per month, RR 1.24, 95% CI 1.21–1.27). The proportion of stays yielding ICU admission was similar in the pre-pandemic and pandemic years, 21.5 and 21.3%, respectively. In-hospital mortality increased to a greater extent for stays without ICU admission (RR 1.39, 95% CI 1.35–1.43) than for those with ICU admission (RR 1.09, 95% CI 1.05–1.13). Since January 2020, only 1.5% of stays were associated with a diagnosis of COVID-19, and their mortality rate was nearly three-times higher than those without COVID-19 (RR 2.66, 95% CI 2.41–2.93). Conclusion The decline in admissions for AECOPD during the pandemic could be attributed to a decrease in the incidence of exacerbations for COPD patients and/or to a possible shift from hospital to community care. The rise in in-hospital mortality is partially explained by COVID-19, and could be related to restricted access to ICUs for some patients and/or to greater proportions of severe cases among the patients hospitalized during the pandemic.
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Affiliation(s)
- Jonas Poucineau
- French Institute for Demographic Studies (INED), Mortality, Health and Epidemiology Unit, Aubervilliers, France
- Institute for Research and Information in Health Economics (IRDES), Paris, France
- *Correspondence: Jonas Poucineau
| | - Tristan Delory
- French Institute for Demographic Studies (INED), Mortality, Health and Epidemiology Unit, Aubervilliers, France
- Annecy-Genevois Hospital Center, Annecy, France
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| | - Nathanaël Lapidus
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, Unité de Santé Publique, Paris, France
| | - Gilles Hejblum
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| | - Christos Chouaïd
- INSERM, IMRB (Clinical Epidemiology and Aging Unit), Paris Est Créteil University, Créteil, France
- Pneumology Department, Intercommunal Hospital Center of Créteil, Créteil, France
| | - Sophie Le Cœur
- French Institute for Demographic Studies (INED), Mortality, Health and Epidemiology Unit, Aubervilliers, France
| | - Myriam Khlat
- French Institute for Demographic Studies (INED), Mortality, Health and Epidemiology Unit, Aubervilliers, France
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22
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Lau VI, Dhanoa S, Cheema H, Lewis K, Geeraert P, Lu D, Merrick B, Vander Leek A, Sebastianski M, Kula B, Chaudhuri D, Agarwal A, Niven DJ, Fiest KM, Stelfox HT, Zuege DJ, Rewa OG, Bagshaw SM. Non-COVID outcomes associated with the coronavirus disease-2019 (COVID-19) pandemic effects study (COPES): A systematic review and meta-analysis. PLoS One 2022; 17:e0269871. [PMID: 35749400 PMCID: PMC9231780 DOI: 10.1371/journal.pone.0269871] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 05/29/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND As the Coronavirus Disease-2019 (COVID-19) pandemic continues, healthcare providers struggle to manage both COVID-19 and non-COVID patients while still providing high-quality care. We conducted a systematic review/meta-analysis to describe the effects of the COVID-19 pandemic on patients with non-COVID illness and on healthcare systems compared to non-pandemic epochs. METHODS We searched Ovid MEDLINE/EMBASE/Cochrane Database of Systematic Reviews/CENTRAL/CINAHL (inception to December 31, 2020). All study types with COVID-pandemic time period (after December 31, 2019) with comparative non-pandemic time periods (prior to December 31, 2019). Data regarding study characteristics/case-mix/interventions/comparators/ outcomes (primary: mortality; secondary: morbidity/hospitalizations/disruptions-to-care. Paired reviewers conducted screening and abstraction, with conflicts resolved by discussion. Effect sizes for specific therapies were pooled using random-effects models. Risk of bias was assessed by Newcastle-Ottawa Scale, with evidence rating using GRADE methodology. RESULTS Of 11,581 citations, 167 studies met eligibility. Our meta-analysis showed an increased mortality of 16% during the COVID pandemic for non-COVID illness compared with 11% mortality during the pre-pandemic period (RR 1.38, 95% CI: 1.28-1.50; absolute risk difference: 5% [95% CI: 4-6%], p<0.00001, very low certainty evidence). Twenty-eight studies (17%) reported significant changes in morbidity (where 93% reported increases), while 30 studies (18%) reported no significant change (very low certainty). Thirty-nine studies (23%) reported significant changes in hospitalizations (97% reporting decreases), while 111 studies (66%) reported no significant change (very low certainty). Sixty-two studies (37%) reported significant disruptions in standards-to-care (73% reporting increases), while 62 studies (37%) reported no significant change (very low certainty). CONCLUSIONS There was a significant increase in mortality during the COVID pandemic compared to pre-pandemic times for non-COVID illnesses. When significant changes were reported, there was increased morbidity, decreased hospitalizations and increased disruptions in standards-of-care. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020201256 (Sept 2, 2020).
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Affiliation(s)
- Vincent Issac Lau
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
| | - Sumeet Dhanoa
- Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
| | - Harleen Cheema
- Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
| | - Kimberley Lewis
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
- Division of Critical Care Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Patrick Geeraert
- Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
| | - David Lu
- Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
| | - Benjamin Merrick
- Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
| | - Aaron Vander Leek
- Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
| | - Meghan Sebastianski
- Alberta Strategy for Patient-Orientated Research Knowledge Translation Platform, University of Alberta, Edmonton, Alberta, Canada
| | - Brittany Kula
- Division of Infectious Disease, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
| | - Dipayan Chaudhuri
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
- Division of Critical Care Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Arnav Agarwal
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, General Internal Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Daniel J Niven
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, and Alberta Health Services, Calgary, Alberta, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, and Alberta Health Services, Calgary, Alberta, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, and Alberta Health Services, Calgary, Alberta, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Danny J Zuege
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, and Alberta Health Services, Calgary, Alberta, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Oleksa G Rewa
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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23
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Christenson SA, Smith BM, Bafadhel M, Putcha N. Chronic obstructive pulmonary disease. Lancet 2022; 399:2227-2242. [PMID: 35533707 DOI: 10.1016/s0140-6736(22)00470-6] [Citation(s) in RCA: 283] [Impact Index Per Article: 141.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 02/16/2022] [Accepted: 02/25/2022] [Indexed: 12/14/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity, mortality, and health-care use worldwide. COPD is caused by exposure to inhaled noxious particles, notably tobacco smoke and pollutants. However, the broad range of factors that increase the risk of development and progression of COPD throughout the life course are increasingly being recognised. Innovations in omics and imaging techniques have provided greater insight into disease pathobiology, which might result in advances in COPD prevention, diagnosis, and treatment. Although few novel treatments have been approved for COPD in the past 5 years, advances have been made in targeting existing therapies to specific subpopulations using new biomarker-based strategies. Additionally, COVID-19 has undeniably affected individuals with COPD, who are not only at higher risk for severe disease manifestations than healthy individuals but also negatively affected by interruptions in health-care delivery and social isolation. This Seminar reviews COPD with an emphasis on recent advances in epidemiology, pathophysiology, imaging, diagnosis, and treatment.
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Affiliation(s)
- Stephanie A Christenson
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Benjamin M Smith
- Department of Medicine, Columbia University Medical Center, New York, NY, USA; Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Mona Bafadhel
- School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK; Department of Respiratory Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Nirupama Putcha
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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24
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Cookson W, Moffatt M, Rapeport G, Quint J. A Pandemic Lesson for Global Lung Diseases: Exacerbations Are Preventable. Am J Respir Crit Care Med 2022; 205:1271-1280. [PMID: 35192447 PMCID: PMC9873111 DOI: 10.1164/rccm.202110-2389ci] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
A dramatic global reduction in the incidence of common seasonal respiratory viral infections has resulted from measures to limit the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the pandemic. This has been accompanied by falls reaching 50% internationally in the incidence of acute exacerbations of preexisting chronic respiratory diseases that include asthma, chronic obstructive pulmonary disease, and cystic fibrosis. At the same time, the incidence of acute bacterial pneumonia and sepsis has fallen steeply worldwide. Such findings demonstrate the profound impact of common respiratory viruses on the course of these global illnesses. Reduced transmission of common respiratory bacterial pathogens and their interactions with viruses appear also as central factors. This review summarizes pandemic changes in exacerbation rates of asthma, chronic obstructive pulmonary disease, cystic fibrosis, and pneumonia. We draw attention to the substantial body of knowledge about respiratory virus infections in these conditions, and that it has not yet translated into clinical practice. Now that the large scale of benefits that could be gained by managing these pathogens is unmistakable, we suggest that the field merits substantial academic and industrial investment. We consider how pandemic-inspired measures for prevention and treatment of common infections should become a cornerstone for managing respiratory diseases.
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Affiliation(s)
- William Cookson
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Miriam Moffatt
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Garth Rapeport
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Jennifer Quint
- National Heart and Lung Institute, Imperial College, London, United Kingdom
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25
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Akyıl FT, Önür ST, Sökücü S, Abalı H, Boyracı N, Çayır E, Altın S, Altin S. Lifestyle Changes and Exacerbation Frequency of COPD in Times of the Pandemic. Turk Thorac J 2022; 23:210-217. [PMID: 35579227 PMCID: PMC9450222 DOI: 10.5152/turkthoracj.2022.21165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this study is to analyze chronic obstructive pulmonary disease exacerbation rates and the effect of patients' behavioral changes on the exacerbations during the pandemic. MATERIAL AND METHODS This study was conducted in a reference hospital for chest diseases and patients who were hospitalized with an exacerbation of chronic obstructive pulmonary disease between March 11, 2019, and March 11, 2020, were designated. Patients' chronic obstructive pulmonary disease exacerbations requiring emergency department visits and/or hospitalization were com- pared between the pre-pandemic and pandemic periods. Each patient was surveyed with 25 questions using telemedicine. RESULTS Of all the 256 patients, 203 (79%) were male and the mean age was 66 ± 10 years. Compared to the previous year, emer- gency department visits and hospitalizations in our hospital were significantly lower and less frequent (P < .0001, for both). Smoking habits decreased in 9% of patients, and 60% had hardly spent time outdoors. Only 3 patients reported to spend time indoors. The household mask-use rate while contacting the patient was 50%. As a chronic obstructive pulmonary disease patient, 33% expressed themselves as "feeling better." Overall, 92(36%) patients were recorded not to have any exacerbation, and 34 (13%) to have no attacks of worsening were managed at home. Novel exacerbation risk was found to independently correlate with younger age (odds ratio: 0.944, CI: 0.904-0.986, P = .010) and having more frequent episodes of exacerbation in the pre-pandemic period (odds ratio: 1.2, CI: 1.025-1.405, P = .023). CONCLUSION Chronic obstructive pulmonary disease patients specifically benefited from confinements, restrictions, and lifestyle changes. Further studies are needed to better identify the most critical factors leading to these positive outcomes. A permanent patient management guideline for chronic obstructive pulmonary disease patients could be formulated where the weight of lifestyle factors is elevated.
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26
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Mak IL, Wan EYF, Wong TKT, Lee WWJ, Chan EWY, Choi EPH, Chui CSL, Ip MSM, Lau WCS, Lau KK, Lee SF, Wong ICK, Yu EYT, Lam CLK. The Spill-Over Impact of the Novel Coronavirus-19 Pandemic on Medical Care and Disease Outcomes in Non-communicable Diseases: A Narrative Review. Public Health Rev 2022; 43:1604121. [PMID: 35574567 PMCID: PMC9091177 DOI: 10.3389/phrs.2022.1604121] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 03/07/2022] [Indexed: 12/15/2022] Open
Abstract
Objectives: The coronavirus-19 (COVID-19) pandemic has claimed more than 5 million lives worldwide by November 2021. Implementation of lockdown measures, reallocation of medical resources, compounded by the reluctance to seek help, makes it exceptionally challenging for people with non-communicable diseases (NCD) to manage their diseases. This review evaluates the spill-over impact of the COVID-19 pandemic on people with NCDs including cardiovascular diseases, cancer, diabetes mellitus, chronic respiratory disease, chronic kidney disease, dementia, mental health disorders, and musculoskeletal disorders.Methods: Literature published in English was identified from PubMed and medRxiv from January 1, 2019 to November 30, 2020. A total of 119 articles were selected from 6,546 publications found.Results: The reduction of in-person care, screening procedures, delays in diagnosis, treatment, and social distancing policies have unanimously led to undesirable impacts on both physical and psychological health of NCD patients. This is projected to contribute to more excess deaths in the future.Conclusion: The spill-over impact of COVID-19 on patients with NCD is just beginning to unravel, extra efforts must be taken for planning the resumption of NCD healthcare services post-pandemic.
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Affiliation(s)
- Ivy Lynn Mak
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong, Hong Kong SAR, China
- *Correspondence: Eric Yuk Fai Wan,
| | - Teenie Kwan Tung Wong
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Wendy Woo Jung Lee
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Esther Wai Yin Chan
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong, Hong Kong SAR, China
| | - Edmond Pui Hang Choi
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Celine Sze Ling Chui
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong, Hong Kong SAR, China
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Mary Sau Man Ip
- Division of Respiratory Medicine, Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Wallace Chak Sing Lau
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Kui Kai Lau
- Division of Neurology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Shing Fung Lee
- Department of Clinical Oncology, Queen Mary Hospital, Hospital Authority, Hong Kong, Hong Kong SAR, China
- Department of Clinical Oncology, Tuen Mun Hospital, Hospital Authority, Hong Kong, Hong Kong SAR, China
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - Ian Chi Kei Wong
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong, Hong Kong SAR, China
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
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27
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Khanolkar RA, Trajkovski A, Agarwal A, Pauls MA, Lang ES. Emerging evidence for non-pharmacologic interventions in reducing the burden of respiratory illnesses. Intern Emerg Med 2022; 17:639-644. [PMID: 35119570 PMCID: PMC8814568 DOI: 10.1007/s11739-022-02932-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/15/2022] [Indexed: 12/30/2022]
Abstract
The global pandemic caused by SARS-CoV-2 (COVID-19) has led to significant morbidity and mortality, and unprecedented economic and health system disruption. Non-pharmacologic interventions (NPIs) such as masking and physical distancing have formed the underpinnings of COVID-19 infection control strategies. Concomitantly, numerous jurisdictions have seen a decrease in hospitalizations for non-COVID-19 respiratory illnesses (NCRIs) such as asthma, community-acquired pneumonia, influenza, and chronic obstructive pulmonary disease relative to pre-pandemic levels. These associations give rise to a number of testable hypotheses regarding the efficacy of NPIs in reducing the substantial burden of NCRIs. Here, we review emerging perspectives on the role of NPIs in NCRI prevention with the ultimate goal of informing future research and public policy development as we move into what may be the endemic phase of the COVID-19 pandemic.
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Affiliation(s)
- Rutvij A Khanolkar
- Cumming School of Medicine, University of Calgary, #305, 2011 University Dr NW, Calgary, AB, T2N 4T4, Canada.
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada.
| | | | - Arnav Agarwal
- Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Merril A Pauls
- Health Sciences Centre, Max Rady College of Medicine, Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Eddy S Lang
- Cumming School of Medicine, University of Calgary, #305, 2011 University Dr NW, Calgary, AB, T2N 4T4, Canada
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
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28
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Guimarães RA, Policena GM, de Paula HDSC, Pedroso CF, Pinheiro RS, Itria A, Braga Neto ODO, Teixeira AM, Silva IA, de Oliveira GA, Batista KDA. Analysis of the impact of coronavirus disease 19 on hospitalization rates for chronic non-communicable diseases in Brazil. PLoS One 2022; 17:e0265458. [PMID: 35324951 PMCID: PMC8947087 DOI: 10.1371/journal.pone.0265458] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/01/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The coronavirus disease (COVID-19) pandemic has impacted health services and healthcare systems worldwide. Studies have shown that hospital admissions for causes related to chronic non-communicable diseases (NCDs) have decreased significantly during peak pandemic periods. An analysis of the impact of the COVID-19 pandemic on hospital admissions for NCDs is essential to implement disability and mortality mitigation strategies for these groups. Therefore, this study aimed to analyze the impact of the COVID-19 pandemic on hospital admissions for NCDs in Brazil according to the type of NCD, sex, age group, and region of Brazil. METHODS This is an ecological study conducted in Brazil. Data on hospital admissions from January 1, 2017 to May 31, 2021 were extracted from the Unified Health System's Hospital Admissions Information System. The hospital admission rates per 100,000 thousand inhabitants were calculated monthly according to the type of NCD, sex, age group, and region of Brazil. Poisson regression models were used to analyze the impact of the COVID-19 pandemic on the number of hospital admissions. In this study, the pre-pandemic period was set from January 1, 2017 to February 29, 2020 and the during-pandemic from March 1, 2020 to May 31, 2021. RESULTS There was a 27.0% (95.0%CI: -29.0; -25.0%) decrease in hospital admissions for NCDs after the onset of the pandemic compared to that during the pre-pandemic period. Decreases were found for all types of NCDs-cancer (-23.0%; 95.0%CI: -26.0; -21.0%), diabetes mellitus (-24.0%; 95.0%CI: -25.0%; -22.0%), cardiovascular diseases (-30.0%; 95.0%CI: -31.0%; -28.0%), and chronic respiratory diseases (-29.0%; 95.0%CI: -30.0%; -27.0%). In addition, there was a decrease in the number of admissions, regardless of the age group, sex, and region of Brazil. The Northern and Southern regions demonstrated the largest decrease in the percentage of hospital admissions during the pandemic period. CONCLUSIONS There was a decrease in the hospitalization rate for NCDs in Brazil during the COVID-19 pandemic in a scenario of social distancing measures and overload of health services.
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Affiliation(s)
- Rafael Alves Guimarães
- Faculty of Nursing, Federal University of Goiás, Goiânia, Goiás, Brazil
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Gabriela Moreira Policena
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil
| | | | - Charlise Fortunato Pedroso
- Federal Institute of Education, Science and Technology of Goiás, Goiânia Oeste Campus, Goiânia, Goiás, Brazil
| | - Raquel Silva Pinheiro
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Alexander Itria
- Federal University of São Carlos, Sorocaba Campus, Sorocaba, São Paulo, Brazil
| | | | - Adriana Melo Teixeira
- Department of Hospital and Emergency Care of the Ministry of Health, Distrito Federal, Brasília, Brazil
| | - Irisleia Aires Silva
- Department of Hospital and Emergency Care of the Ministry of Health, Distrito Federal, Brasília, Brazil
| | - Geraldo Andrade de Oliveira
- Federal Institute of Education, Science and Technology of Goiás, Valparaíso Campus, Valparaíso, Goiás, Brazil
| | - Karla de Aleluia Batista
- Federal Institute of Education, Science and Technology of Goiás, Goiânia Oeste Campus, Goiânia, Goiás, Brazil
- Institute of Biological Sciences 2, Federal University of Goiás, Goiânia, Goiás, Brazil
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29
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Sarc I, Lotric Dolinar A, Morgan T, Sambt J, Ziherl K, Gavric D, Selb J, Rozman A, Dosenovic Bonca P. Mortality, seasonal variation, and susceptibility to acute exacerbation of COPD in the pandemic year: a nationwide population study. Ther Adv Respir Dis 2022; 16:17534666221081047. [PMID: 35253548 PMCID: PMC8905064 DOI: 10.1177/17534666221081047] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background: Previous studies have suggested that the coronavirus disease 2019 (COVID-19) pandemic was associated with a decreased rate of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Data on how the COVID-19 pandemic has influenced mortality, seasonality of, and susceptibility to AECOPD in the chronic obstructive pulmonary disease (COPD) population is scarce. Methods: We conducted a national population-based retrospective study using data from the Health Insurance Institute of Slovenia from 2015 to February 2021, with 2015–2019 as the reference. We extracted patient and healthcare data for AECOPD, dividing AECOPD into severe, resulting in hospitalisation, and moderate, requiring outpatient care. The national COPD population was generated based on dispensed prescriptions of inhalation therapies, and moderate AECOPD events were analysed based on dispensed AECOPD medications. We extracted data on all-cause and non-COVID mortality. Results: The numbers of severe and moderate AECOPD were reduced by 48% and 34%, respectively, in 2020. In the pandemic year, the seasonality of AECOPD was reversed, with a 1.5-fold higher number of severe AECOPD in summer compared to winter. The proportion of frequent exacerbators (⩾2 AECOPD hospitalisations per year) was reduced by 9% in 2020, with a 30% reduction in repeated severe AECOPD in frequent exacerbators and a 34% reduction in persistent frequent exacerbators (⩾2 AECOPD hospitalisations per year for 2 consecutive years) from 2019. The risk of two or more moderate AECOPD decreased by 43% in 2020. In the multivariate model, pandemic year follow-up was the only independent factor associated with a decreased risk for severe AECOPD (hazard ratio [HR]: 0.71; 95% confidence interval [CI]: 0.61–0.84; p < 0.0001). In 2020, non-COVID mortality decreased (−15%) and no excessive mortality was observed in the COPD population. Conclusion: In the pandemic year, we found decreased susceptibility to AECOPD across severity spectrum of COPD, reversed seasonal distribution of severe AECOPD and decreased non-COVID mortality in the COPD population.
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Affiliation(s)
- Irena Sarc
- Noninvasive Ventilation Department, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik 36, 4204 Golnik, Slovenia Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Alesa Lotric Dolinar
- Academic Unit for Mathematics, Statistics and Operations Research, School of Economics and Business, University of Ljubljana, Ljubljana, Slovenia
| | - Tina Morgan
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Joze Sambt
- Academic Unit for Mathematics, Statistics and Operations Research, School of Economics and Business, University of Ljubljana, Ljubljana, Slovenia
| | - Kristina Ziherl
- Noninvasive Ventilation Department, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Dalibor Gavric
- The Health Insurance Institute of Slovenia, Ljubljana, Slovenia
| | - Julij Selb
- Faculty of Medicine, University of Ljubljana, Ljubljana, SloveniaUniversity Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Ales Rozman
- Faculty of Medicine, University of Ljubljana, Ljubljana, SloveniaUniversity Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Petra Dosenovic Bonca
- Academic Unit for Economics, School of Economics and Business, University of Ljubljana, Ljubljana, Slovenia
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30
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Lawless M, Burgess M, Bourke S. Impact of COVID-19 on Hospital Admissions for COPD Exacerbation: Lessons for Future Care. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58010066. [PMID: 35056374 PMCID: PMC8778793 DOI: 10.3390/medicina58010066] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/21/2021] [Accepted: 12/30/2021] [Indexed: 12/24/2022]
Abstract
Background and Objectives: Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide. Acute exacerbations (AECOPD) are common and often triggered by viral infection. During the COVID-19 pandemic social restrictions, including ‘shielding’ and ‘lockdowns’, were mandated. Multiple, worldwide studies report a reduction in AECOPD admissions during this period. This study aims to assess the effect of the pandemic and Lockdown on the rates of admission with AECOPD and severity of hospitalised exacerbations in the North-East of England. Materials and Methods: Data were extracted for patients presenting with a diagnosis of AECOPD or respiratory failure secondary to AECOPD during the ‘COVID-19 period’ (26/3/20–31/12/20) and a date-matched control period from the year previous. We present descriptive statistics and regression analysis of the effects of the COVID-19 period on the rates of hospital admission. Results: Compared to the matched control period, the COVID-19 period was associated with fewer AECOPD admissions (COVID-19 = 719, control = 1257; rate ratio 0.57, p < 0.001) and shorter length of stay (COVID-19 = 3.9 ± 0.2, control = 4.78 ± 0.2 days; p = 0.002), with similar in-hospital plus 30-day post-discharge mortality. Demographics were similar between periods. Only six patients had a positive COVID-19 PCR test. Conclusion: During the COVID-19 period there was a substantial reduction in AECOPD admissions, but no increase in overall severity of exacerbations or mortality. Rather than fear driving delayed hospital presentation, physical and behavioural measures taken during this period to limit transmission of COVID-19 are likely to have reduced transmission of other respiratory viruses. This has important implications for control of future AECOPD.
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Lai AYK, Sit SMM, Wu SYD, Wang MP, Wong BYM, Ho SY, Lam TH. Associations of Delay in Doctor Consultation With COVID-19 Related Fear, Attention to Information, and Fact-Checking. Front Public Health 2021; 9:797814. [PMID: 34966717 PMCID: PMC8710678 DOI: 10.3389/fpubh.2021.797814] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Delaying doctor consultation is harmful. Fear of COVID-19 leads to delays in seeking medical care at a time when pandemic information overflows. However, little is known about the role of COVID-19 related fear, attention to information, and fact-checking in such delay. Objective: Under the Hong Kong Jockey Club SMART Family-Link Project, we examined the associations of delay in doctor consultation amidst the pandemic with sociodemographic characteristics, COVID-19 related fear, attention to information, and fact-checking. Methods: We conducted a population-based online cross-sectional survey in May 2020 on Hong Kong Chinese adults. Respondents reported whether the pandemic caused any delay in doctor consultation (yes/no), level of COVID-19 related fear, attention to information and fact-checking (all on a scale of 0 to 10 and recoded into tertiles of low, moderate, high). Regression analyses were used to examine the associations of delay and fear with sociodemographic characteristics, attention and fact-checking, adjusting for covariates. Data were weighted by sex, age and education level of the population. Results: Of 4,551 respondents (46.5% male, 59.7% aged over 45 years), 10.1% reported delay in doctor consultation. The mean score was 6.4 for fear, 8.0 for attention and 7.4 for fact-checking. Delay was more common in males and increased with age and fear. High vs. low level of fear was associated with delay [adjusted odd ratios (AOR) 2.68, 95% confidence interval (CI) 2.08, 3.47]. Moderate level of fact-checking was negatively associated with delay (AOR 0.72, 95% CI 0.56, 0.92). Females reported greater fear and fear decreased with age. Fear increased with attention to information and decreased with fact-checking. Fear substantially mediated the association of delay with attention (96%) and fact-checking (30%). Conclusions: We have first shown that delay in doctor consultation increased with fear of COVID-19 and decreased with fact-checking amidst the pandemic. Fear also increased with attention to COVID-19 related information and decreased with fact-checking. Understanding these associations can help policymakers develop targeted communication and support to the public to reduce delayed doctor consultations and the associated COVID-19-related or unrelated morbidity and mortality in the community.
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Affiliation(s)
- Agnes Yuen-Kwan Lai
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Shirley Man-Man Sit
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong SAR, China.,School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Socrates Yong-Da Wu
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Man-Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Bonny Yee-Man Wong
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Sai-Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Tai-Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Tan LF, Soh RYH, Seetharaman SK. Impact of the COVID-19 pandemic on hospital admissions of nursing home residents. Australas J Ageing 2021; 41:330-334. [PMID: 34913228 DOI: 10.1111/ajag.13032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/03/2021] [Accepted: 11/18/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic has impacted nursing home care and activities in profound ways. We sought to understand whether the COVID-19 pandemic had any impact on hospital admissions of nursing home residents. METHODS A retrospective analysis of hospital admissions of nursing home residents to a tertiary general hospital in Singapore during the COVID-19 pandemic in 2020 was conducted and compared to admissions in the preceding year. Patients' demographics, length of stay, primary diagnosis on admission, death and causes of death were recorded. RESULTS Our study found reduced number of hospital admissions of nursing home residents to a tertiary hospital in Singapore. There was a significant decrease in pneumonia (p < 0.001) and fall (p = 0.001) as a primary diagnosis on admission and a decrease in pneumonia as the cause of death (p < 0.001) for nursing home residents admitted to hospital during the COVID-19 pandemic. CONCLUSIONS This suggests that measures implemented during the pandemic may have impacted outcomes of nursing home residents. Further study is warranted to lead to practise changing outcomes for nursing home settings.
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Affiliation(s)
- Li Feng Tan
- Healthy Ageing Programme, Alexandra Hospital, Singapore City, Singapore
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Halpin DMG, Vogelmeier CF, Agusti A. COVID-19 and COPD: lessons beyond the pandemic. Am J Physiol Lung Cell Mol Physiol 2021; 321:L978-L982. [PMID: 34585618 PMCID: PMC8598249 DOI: 10.1152/ajplung.00386.2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Early in the COVID pandemic there were concerns about the outcomes for patients with COPD who developed COVID-19. Although the pandemic has made the diagnosis and routine management of COPD more difficult, the risk of patients developing COVID or of having poor outcomes is less than anticipated and there have been some unexpected findings that may lead to significant improvements in the management of COPD in future.
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Affiliation(s)
- David M G Halpin
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Member of the German Center for Lung Research (DZL), Philipps-University Marburg, Marburg, Germany
| | - Alvar Agusti
- Cátedra Salut Respiratoria (University of Barcelona), Respiratory Institute (Hospital Clinic), IDIBAPS, CIBERES, Barcelona, Spain
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Trujillo C, Garnet B, Zadeh AV, Urdaneta G, Campos M. Decrease in Exacerbations During the Coronavirus Disease 2019 Pandemic in a Cohort of Veterans with COPD. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2021; 8:572-579. [PMID: 34592084 PMCID: PMC8686846 DOI: 10.15326/jcopdf.2021.0234] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Studies have shown a decline in hospitalizations due to acute exacerbations of COPD (AECOPD) during the coronavirus disease 2019 (COVID-19) pandemic. However, the impact of the pandemic in AECOPD of all severities in longitudinal cohorts of patients is lacking. METHODS We conducted analysis of 123 individuals with COPD who have been followed since 2017. AECOPDs of mild (treatment at home), moderate (emergency department or urgent visit evaluation), and severe (hospitalization) type were assessed by chart review and patient interview. Compliance with preventive measures to avoid COVID-19 infection was assessed in 2020. Differences between the rate of AECOPD by year was analyzed as well as differences in preventive measures by COPD disease severity. RESULTS During the COVID-19 pandemic in 2020, there was a significant reduction in AECOPDs in our cohort with 26 participants (21%) having an exacerbation compared to 46 (37%) in 2019, 52 (42%) in 2018, and 44 (36%) in 2017. Mean exacerbation rates decreased 54% overall and 74% in frequent exacerbators compared with the prior 3-year average. The decrease was noted in AECOPDs of all severities. Overall, there was a high rate of reported compliance with social distancing and face mask use that was significantly higher in the group with more severe COPD based on symptoms and forced expiratory volume in 1 second. CONCLUSIONS Individuals with COPD, including frequent exacerbators, showed a marked decrease in AECOPD during the COVID-19 pandemic and high adherence to recommended preventive measures. Evaluation of the impact of preventive strategies on AECOPD in a non-pandemic setting may be of value and requires further study.
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Affiliation(s)
| | - Brian Garnet
- Miami Veterans Administration Medical Center, Miami, Florida, United States
- Miller School of Medicine, University of Miami, Miami, Florida, United States
| | - Ali Vaeli Zadeh
- Miami Veterans Administration Medical Center, Miami, Florida, United States
| | - Gisel Urdaneta
- Miami Veterans Administration Medical Center, Miami, Florida, United States
| | - Michael Campos
- Miami Veterans Administration Medical Center, Miami, Florida, United States
- Miller School of Medicine, University of Miami, Miami, Florida, United States
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Steuder R, Pott H, Maxheim M, Schmeck B. Pneumonie und COVID-19 bei COPD-Patienten. PNEUMO NEWS 2021; 13:30-35. [PMID: 34691274 PMCID: PMC8526095 DOI: 10.1007/s15033-021-2749-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Regina Steuder
- Klinik für Innere Medizin mit Schwerpunkt Pneumologie, Universitätsklinikum Marburg, Hans-Meerwein-Str. 2, 35043 Marburg, Germany
| | - Hendrik Pott
- Klinik für Innere Medizin mit Schwerpunkt Pneumologie, Universitätsklinikum Marburg, Hans-Meerwein-Str. 2, 35043 Marburg, Germany
| | - Michael Maxheim
- Klinik für Innere Medizin mit Schwerpunkt Pneumologie, Universitätsklinikum Marburg, Hans-Meerwein-Str. 2, 35043 Marburg, Germany
| | - Bernd Schmeck
- Klinik für Innere Medizin mit Schwerpunkt Pneumologie, Universitätsklinikum Marburg, Hans-Meerwein-Str. 2, 35043 Marburg, Germany
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Chan KPF, Ma TF, Ip MSM, Ho PL. Invasive pneumococcal disease, pneumococcal pneumonia and all-cause pneumonia in Hong Kong during the COVID-19 pandemic compared with the preceding 5 years: a retrospective observational study. BMJ Open 2021; 11:e055575. [PMID: 34635536 PMCID: PMC8506049 DOI: 10.1136/bmjopen-2021-055575] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To compare the incidence and severity of invasive pneumococcal diseases (IPDs), pneumococcal pneumonia and all-cause pneumonia during the COVID-19 pandemic period with universal masking and social distancing with that of previous 5 years. DESIGN Retrospective observational study on incidence of IPDs, pneumococcal pneumonia and all-cause pneumonia between January 2015-December 2019 and March 2020-March 2021. January-February 2020 was excluded from analysis as it was treated as a transitional period between normal time and pandemic. SETTING Episode-based data by retrieval of hospitalisation records from the Hospital Authority's territory-wide electronic medical record database in Hong Kong. PARTICIPANTS Hospitalised patients with IPD (n=742), pneumococcal pneumonia (n=2163) and all-cause pneumonia (including COVID-19 pneumonia, n=453 999) aged 18 years or above. Control diagnoses were included to assess confounding from health-seeking behaviours. PRIMARY AND SECONDARY OUTCOMES Primary outcome is the incidence of diseases between two periods. Secondary outcomes include disease severity surrogated by length of stay and mortality. RESULTS Monthly average number of IPD, pneumococcal pneumonia and all-cause pneumonia hospitalisation significantly decreased by 88.9% (95% CI 79.8% to 98.0%, p<0.0005), 72.5% (95% CI 65.9% to 79.1%, p<0.0005) and 17.5% (95% CI 16.8% to 18.2%, p<0.0005), respectively. Changes in trend from January 2015-December 2019 to March 2020-March 2021 were -70% (95% CI -87% to -35%, p=0.0025), -43% (95% CI -59% to -19%, p=0.0014) and -11% (95% CI -13% to -10%, p<0.0005), respectively. Length of stay for IPD and pneumococcal pneumonia episodes were insignificantly different in the two periods. No reductions in hospitalisations for control diagnoses were observed. CONCLUSIONS Incidence of IPD, pneumococcal pneumonia and all-cause pneumonia decreased during the COVID-19 pandemic. This was observed with universal masking and social distancing. We postulated this is related to reduced transmission of respiratory viruses and bacteria.
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Affiliation(s)
| | - Ting-Fung Ma
- Department of Statistics, University of Wisconsin, Madison, Wisconsin, USA
| | - Mary Sau-Man Ip
- Department of Medicine, University of Hong Kong, Hong Kong, People's Republic of China
| | - Pak-Leung Ho
- Department of Microbiology, Queen Mary Hospital, University of Hong Kong, Hong Kong, People's Republic of China
- Carol Yu Centre for Infection, University of Hong Kong, Hong Kong, People's Republic of China
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Jenkins CR. Towards precision in defining COPD exacerbations. Breathe (Sheff) 2021; 17:210081. [PMID: 35035551 PMCID: PMC8753624 DOI: 10.1183/20734735.0081-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 06/28/2021] [Indexed: 11/25/2022] Open
Abstract
COPD is the most prevalent chronic respiratory disease worldwide and a major cause of disability and death. Acute exacerbations of COPD remain a key feature of the disease in many patients and research assessing interventions to prevent and treat them requires a robust definition with high sensitivity and specificity. To date, no such definition exists, and multiple different definitions are used in clinical studies depending on the research question. The strengths and weaknesses of current definitions are discussed in the context of evolving knowledge and different settings in which studies are undertaken. Whether identification and recording of exacerbations remains essentially clinical, or can be identified with a dependable biomarker, it should be sensitive and adaptable to context while retaining clarity and facilitating data collection. This is essential to progress a better understanding of the pathophysiology and phenotypic expression of exacerbations to reduce their impact and personal burden for patients.
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Affiliation(s)
- Christine R. Jenkins
- Respiratory Group, The George Institute for Global Health, Sydney, Australia
- UNSW Sydney, Sydney, Australia
- Concord Clinical School, University of Sydney, Sydney, Australia
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Sigala I, Giannakas T, Giannakoulis VG, Zervas E, Brinia A, Gianiou N, Asimakos A, Dima E, Kalomenidis I, Katsaounou P. Effect of COVID-19-Related Lockdown οn Hospital Admissions for Asthma and COPD Exacerbations: Associations with Air Pollution and Patient Characteristics. J Pers Med 2021; 11:867. [PMID: 34575644 PMCID: PMC8465209 DOI: 10.3390/jpm11090867] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/24/2021] [Accepted: 08/27/2021] [Indexed: 11/16/2022] Open
Abstract
We conducted a retrospective observational study to assess the hospitalization rates for acute exacerbations of asthma and COPD (chronic obstructive pulmonary disease) during the first imposed lockdown in Athens, Greece. Patient characteristics and the concentration of eight air pollutants [namely, NO (nitrogen monoxide), NO2 (nitrogen dioxide), CO (carbon monoxide), PM2.5 (particulate matter 2.5), PM10 (particulate matter 10), O3 (ozone), SO2 (sulfur dioxide) and benzene] were considered. A total of 153 consecutive hospital admissions were studied. Reduced admissions occurred in the Lockdown period compared to the Pre-lockdown 2020 (p < 0.001) or the Control 2019 (p = 0.007) period. Furthermore, the concentration of 6/8 air pollutants positively correlated with weekly hospital admissions in 2020 and significantly decreased during the lockdown. Finally, admitted patients for asthma exacerbation during the lockdown were younger (p = 0.046) and less frequently presented respiratory failure (p = 0.038), whereas patients with COPD presented higher blood eosinophil percentage (p = 0.017) and count (p = 0.012). Overall, admissions for asthma and COPD exacerbations decreased during the lockdown. This might be partially explained by reduction of air pollution during this period while medical care avoidance behavior, especially among elderly patients cannot be excluded. Our findings aid in understanding the untold impact of the pandemic on diseases beyond COVID-19, focusing on patients with obstructive diseases.
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Affiliation(s)
- Ioanna Sigala
- Pulmonary and Respiratory Failure Department, First ICU, Evangelismos Hospital, Ipsilandou 45-7, 10676 Athens, Greece; (I.S.); (N.G.); (A.A.); (E.D.); (I.K.)
| | - Timoleon Giannakas
- Medical School, National Kapodistrian University of Athens, 10679 Athens, Greece; (T.G.); (V.G.G.); (A.B.)
| | - Vassilis G. Giannakoulis
- Medical School, National Kapodistrian University of Athens, 10679 Athens, Greece; (T.G.); (V.G.G.); (A.B.)
| | - Efthimios Zervas
- Laboratory of Technology and Policy of Energy and Environment, School of Science and Technology, Hellenic Open University, Parodos Aristotelous 18, 26335 Patra, Greece;
| | - Aikaterini Brinia
- Medical School, National Kapodistrian University of Athens, 10679 Athens, Greece; (T.G.); (V.G.G.); (A.B.)
| | - Niki Gianiou
- Pulmonary and Respiratory Failure Department, First ICU, Evangelismos Hospital, Ipsilandou 45-7, 10676 Athens, Greece; (I.S.); (N.G.); (A.A.); (E.D.); (I.K.)
| | - Andreas Asimakos
- Pulmonary and Respiratory Failure Department, First ICU, Evangelismos Hospital, Ipsilandou 45-7, 10676 Athens, Greece; (I.S.); (N.G.); (A.A.); (E.D.); (I.K.)
| | - Efi Dima
- Pulmonary and Respiratory Failure Department, First ICU, Evangelismos Hospital, Ipsilandou 45-7, 10676 Athens, Greece; (I.S.); (N.G.); (A.A.); (E.D.); (I.K.)
| | - Ioannis Kalomenidis
- Pulmonary and Respiratory Failure Department, First ICU, Evangelismos Hospital, Ipsilandou 45-7, 10676 Athens, Greece; (I.S.); (N.G.); (A.A.); (E.D.); (I.K.)
- Medical School, National Kapodistrian University of Athens, 10679 Athens, Greece; (T.G.); (V.G.G.); (A.B.)
| | - Paraskevi Katsaounou
- Pulmonary and Respiratory Failure Department, First ICU, Evangelismos Hospital, Ipsilandou 45-7, 10676 Athens, Greece; (I.S.); (N.G.); (A.A.); (E.D.); (I.K.)
- Medical School, National Kapodistrian University of Athens, 10679 Athens, Greece; (T.G.); (V.G.G.); (A.B.)
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Alqahtani JS, Oyelade T, Aldhahir AM, Mendes RG, Alghamdi SM, Miravitlles M, Mandal S, Hurst JR. Reduction in hospitalised COPD exacerbations during COVID-19: A systematic review and meta-analysis. PLoS One 2021; 16:e0255659. [PMID: 34343205 PMCID: PMC8330941 DOI: 10.1371/journal.pone.0255659] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/21/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Reports have suggested a reduction in exacerbations of chronic obstructive pulmonary disease (COPD) during the coronavirus disease 2019 (COVID-19) pandemic, particularly hospital admissions for severe exacerbations. However, the magnitude of this reduction varies between studies. METHOD Electronic databases were searched from January 2020 to May 2021. Two independent reviewers screened titles and abstracts and, when necessary, full text to determine if studies met inclusion criteria. A modified version of the Newcastle-Ottawa Scale was used to assess study quality. A narrative summary of eligible studies was synthesised, and meta-analysis was conducted using a random effect model to pool the rate ratio and 95% confidence intervals (95% CI) for hospital admissions. Exacerbation reduction was compared against the COVID-19 Containment and Health Index. RESULTS A total of 13 of 745 studies met the inclusion criteria and were included in this review, with data from nine countries. Nine studies could be included in the meta-analysis. The pooled rate ratio of hospital admissions for COPD exacerbations during the pandemic period was 0.50 (95% CI 0.44-0.57). Findings on the rate of community-treated exacerbations were inconclusive. Three studies reported a significant decrease in the incidence of respiratory viral infections compared with the pre-pandemic period. There was not a significant relationship between exacerbation reduction and the COVID-19 Containment and Health Index (rho = 0.20, p = 0.53). CONCLUSION There was a 50% reduction in admissions for COPD exacerbations during the COVID-19 pandemic period compared to pre-pandemic times, likely associated with a reduction in respiratory viral infections that trigger exacerbations. Future guidelines should consider including recommendations on respiratory virus infection control measures to reduce the burden of COPD exacerbations beyond the pandemic period.
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Affiliation(s)
- Jaber S. Alqahtani
- UCL Respiratory, University College London, London, United Kingdom
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Tope Oyelade
- UCL Division of Medicine, London, United Kingdom
| | - Abdulelah M. Aldhahir
- Respiratory Care Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Renata Gonçalves Mendes
- Department of Physical Therapy, Cardiopulmonary Physiotherapy Laboratory, Federal University of São Carlos, São Paulo, Brazil
| | - Saeed M. Alghamdi
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d´Hebron/Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Campus; CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Swapna Mandal
- UCL Respiratory, University College London, London, United Kingdom
- Royal Free London NHS Foundation Trust, London, United Kingdom
| | - John R. Hurst
- UCL Respiratory, University College London, London, United Kingdom
- Royal Free London NHS Foundation Trust, London, United Kingdom
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The indirect impact of COVID-19 large-scale containment measures on the incidence of community-acquired pneumonia in older people: a region-wide population-based study in Tuscany, Italy. Int J Infect Dis 2021; 109:182-188. [PMID: 34216731 PMCID: PMC8245306 DOI: 10.1016/j.ijid.2021.06.058] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/12/2021] [Accepted: 06/24/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To evaluate the indirect effect of COVID-19 large-scale containment measures on the incidence of community-acquired pneumonia (CAP) in older people during the first epidemic wave of COVID-19 in Tuscany, Italy. METHODS A population-based study was carried out on data from the Tuscany healthcare system. The outcome measures were: hospitalization rate for CAP, severity of CAP hospitalizations, and outpatient consumption of antibacterials for CAP in people aged 65 and older. Outcomes were compared between corresponding periods in 2020 (week 1 to 27) and previous years. RESULTS Compared with the average of the corresponding periods in the previous 3 years, significant reductions in weekly hospitalization rates for CAP were observed from the week in which the national containment measures were imposed (week 10) until the end of the first COVID-19 wave in July (week 27). There was also a significant decrease in outpatient consumption in all antibacterial classes for CAP. CONCLUSIONS The implementation of large-scale COVID-19 containment measures likely reduced the incidence of CAP in older people during the first wave of the COVID-19 pandemic in Tuscany, Italy. Considering this indirect impact of pandemic containment measures on respiratory tract infections may improve the planning of health services during a pandemic in the future.
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Farrugia Y, Spiteri Meilak BP, Grech N, Asciak R, Camilleri L, Montefort S, Zammit C. The Impact of COVID-19 on Hospitalised COPD Exacerbations in Malta. Pulm Med 2021; 2021:5533123. [PMID: 34258061 PMCID: PMC8241528 DOI: 10.1155/2021/5533123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 06/03/2021] [Accepted: 06/12/2021] [Indexed: 11/26/2022] Open
Abstract
METHOD Data was collected retrospectively from electronic hospital records during the periods 1st March until 10th May in 2019 and 2020. RESULTS There was a marked decrease in AECOPD admissions in 2020, with a 54.2% drop in admissions (n = 119 in 2020 vs. n = 259 in 2019). There was no significant difference in patient demographics or medical comorbidities. In 2020, there was a significantly lower number of patients with AECOPD who received nebulised medications during admission (60.4% in 2020 vs. 84.9% in 2019; p ≤ 0.001). There were also significantly lower numbers of AECOPD patients admitted in 2020 who received controlled oxygen via venturi masks (69.0% in 2020 vs. 84.5% in 2019; p = 0.006). There was a significant increase in inpatient mortality in 2020 (19.3% [n = 23] and 8.4% [n = 22] for 2020 and 2019, respectively, p = 0.003). Year was found to be the best predictor of mortality outcome (p = 0.001). The lack of use of SABA pre-admission treatment (p = 0.002), active malignancy (p = 0.003), and increased length of hospital stay (p = 0.046) were also found to be predictors of mortality for AECOPD patients; however, these parameters were unchanged between 2019 and 2020 and therefore could not account for the increase in mortality. CONCLUSIONS There was a decrease in the number of admissions with AECOPD in 2020 during the COVID-19 pandemic, when compared to 2019. The year 2020 proved to be a significant predictor for inpatient mortality, with a significant increase in mortality in 2020. The decrease in nebuliser and controlled oxygen treatment noted in the study period did not prove to be a significant predictor of mortality when corrected for other variables. Therefore, the difference in mortality cannot be explained with certainty in this retrospective cohort study.
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Affiliation(s)
- Yvette Farrugia
- Mater Dei Hospital, Triq id-Donaturi tad-Demm, Msida MSD2090, Malta
| | | | - Neil Grech
- Mater Dei Hospital, Triq id-Donaturi tad-Demm, Msida MSD2090, Malta
| | - Rachelle Asciak
- Mater Dei Hospital, Triq id-Donaturi tad-Demm, Msida MSD2090, Malta
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Cazzola M, Ora J, Bianco A, Rogliani P, Matera MG. Management of COPD patients during COVID: difficulties and experiences. Expert Rev Respir Med 2021; 15:1025-1033. [PMID: 33975511 DOI: 10.1080/17476348.2021.1929176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: The role of COPD in COVID-19 is not yet well understood. However, there is increasing evidence showing that COPD patients with COVID-19 have a higher risk of presenting a serious infection, a greater likelihood of requiring ICU support, and a higher mortality than other groups.Areas covered: In this article, we address some critical questions on COVID-19 as they pertain to COPD. In particular, we discuss whether the usual algorithms of pharmacological and non-pharmacological management in COPD still apply.Expert opinion: Patients with COPD must continue their regular therapy, regardless of whether they are affected by COVID-19. Corticosteroids reduce mortality in COVID-19 patients in need of supportive oxygen therapy or invasive mechanical ventilation. It is essential that a COPD patient who has tested positive for SARS-CoV-2 is closely followed over time because any delay in diagnosis and initiation of appropriate therapy could negatively affect his/her prognosis. However, we still do not know if COVID-19 infection occurs and evolves differently in each of the recognized COPD phenotypes and, therefore, whether it needs a different management. There are other open questions concerning COVID-19 and COPD that need to be considered. Future studies are absolutely necessary to answer these questions.
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Affiliation(s)
- Mario Cazzola
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Josuel Ora
- Respiratory Diseases Unit, "Tor Vergata" University Hospital, Rome, Italy
| | - Andrea Bianco
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli"/Monaldi Hospital, Naples, Italy
| | - Paola Rogliani
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy.,Respiratory Diseases Unit, "Tor Vergata" University Hospital, Rome, Italy
| | - Maria Gabriella Matera
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
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Alsallakh MA, Sivakumaran S, Kennedy S, Vasileiou E, Lyons RA, Robertson C, Sheikh A, Davies GA. Impact of COVID-19 lockdown on the incidence and mortality of acute exacerbations of chronic obstructive pulmonary disease: national interrupted time series analyses for Scotland and Wales. BMC Med 2021; 19:124. [PMID: 33993870 PMCID: PMC8126470 DOI: 10.1186/s12916-021-02000-w] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/30/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic and ensuing national lockdowns have dramatically changed the healthcare landscape. The pandemic's impact on people with chronic obstructive pulmonary disease (COPD) remains poorly understood. We hypothesised that the UK-wide lockdown restrictions were associated with reductions in severe COPD exacerbations. We provide the first national level analyses of the impact of the COVID-19 pandemic and first lockdown on severe COPD exacerbations resulting in emergency hospital admissions and/or leading to death as well as those recorded in primary care or emergency departments. METHODS Using data from Public Health Scotland and the Secure Anonymised Information Linkage Databank in Wales, we accessed weekly counts of emergency hospital admissions and deaths due to COPD over the first 30 weeks of 2020 and compared these to the national averages over the preceding 5 years. For both Scotland and Wales, we undertook interrupted time-series analyses to model the impact of instigating lockdown on these outcomes. Using fixed-effect meta-analysis, we derived pooled estimates of the overall changes in trends across the two nations. RESULTS Lockdown was associated with 48% pooled reduction in emergency admissions for COPD in both countries (incidence rate ratio, IRR 0.52, 95% CI 0.46 to 0.58), relative to the 5-year averages. There was no statistically significant change in deaths due to COPD (pooled IRR 1.08, 95% CI 0.87 to 1.33). In Wales, lockdown was associated with 39% reduction in primary care consultations for acute exacerbation of COPD (IRR 0.61, 95% CI 0.52 to 0.71) and 46% reduction in COPD-related emergency department attendances (IRR 0.54, 95% CI 0.36 to 0.81). CONCLUSIONS The UK-wide lockdown was associated with the most substantial reductions in COPD exacerbations ever seen across Scotland and Wales, with no corresponding increase in COPD deaths. This may have resulted from reduced transmission of respiratory infections, reduced exposure to outdoor air pollution and/or improved COPD self-management.
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Affiliation(s)
- Mohammad A Alsallakh
- Population Data Science, Swansea University Medical School, Data Science Building, Singleton Park, Swansea University, Swansea, SA2 8PP, UK.
- Health Data Research UK BREATHE Hub for Respiratory Health, University of Edinburgh, Edinburgh, EH8 9AG, UK.
| | - Shanya Sivakumaran
- Population Data Science, Swansea University Medical School, Data Science Building, Singleton Park, Swansea University, Swansea, SA2 8PP, UK
| | - Sharon Kennedy
- Health Protection Scotland, Public Health Scotland, Glasgow, UK
| | - Eleftheria Vasileiou
- Health Data Research UK BREATHE Hub for Respiratory Health, University of Edinburgh, Edinburgh, EH8 9AG, UK
- Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Ronan A Lyons
- Population Data Science, Swansea University Medical School, Data Science Building, Singleton Park, Swansea University, Swansea, SA2 8PP, UK
| | - Chris Robertson
- Health Protection Scotland, Public Health Scotland, Glasgow, UK
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Aziz Sheikh
- Health Data Research UK BREATHE Hub for Respiratory Health, University of Edinburgh, Edinburgh, EH8 9AG, UK
- Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Gwyneth A Davies
- Population Data Science, Swansea University Medical School, Data Science Building, Singleton Park, Swansea University, Swansea, SA2 8PP, UK
- Health Data Research UK BREATHE Hub for Respiratory Health, University of Edinburgh, Edinburgh, EH8 9AG, UK
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Nagano H, Takada D, Shin JH, Morishita T, Kunisawa S, Imanaka Y. Hospitalization of mild cases of community-acquired pneumonia decreased more than severe cases during the COVID-19 pandemic. Int J Infect Dis 2021; 106:323-328. [PMID: 33794382 PMCID: PMC8006513 DOI: 10.1016/j.ijid.2021.03.074] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic has affected all healthcare systems. This study aimed to assess the impact of the COVID-19 pandemic on the number and severity of cases of community-acquired pneumonia (CAP) in Japan. METHODS Using claims data from the Quality Indicator/Improvement Project (QIP) database, urgent cases of inpatients for CAP from 01 August 2018 to 30 July 2020 were included. The monthly ratios of inpatient cases were compared from August 2018 to July 2019 and August 2019 to July 2020 as a year-over-year comparison. These ratios were also compared according to the "A-DROP" severity score, and an interrupted time series (ITS) analysis was performed to evaluate the impact of the COVID-19 pandemic on the monthly number of inpatient cases. RESULTS This study included a total of 67,900 inpatient cases for CAP in 262 hospitals. During the COVID-19 pandemic (defined as the period between March and July 2020) the number of inpatient cases for CAP drastically decreased compared with the same period in the previous year (-48.1%), despite a temporary reduction in the number of other urgent admissions. The number of inpatient cases decreased according to the severity of pneumonia. Milder cases showed a greater decrease in the year-over-year ratio than severe ones: mild -55.2%, moderate -45.8%, severe -39.4%, and extremely severe -33.2%. The ITS analysis showed that the COVID-19 pandemic significantly reduced the monthly number of inpatient cases for CAP (estimated decrease: -1233 cases; 95% CI -521 to -1955). CONCLUSIONS This study showed a significant reduction in the number of inpatient cases for CAP during the COVID-19 pandemic in Japan. The milder cases showed a greater decrease in the year-over-year ratio of the number of inpatient cases.
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Affiliation(s)
- Hiroyuki Nagano
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Japan
| | - Daisuke Takada
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Japan
| | - Jung-Ho Shin
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Japan
| | - Tetsuji Morishita
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Japan
| | - Susumu Kunisawa
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Japan
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Japan.
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45
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Helgeland J, Telle KE, Grøsland M, Huseby BM, Håberg S, Lindman ASE. Admissions to Norwegian Hospitals during the COVID-19 Pandemic. Scand J Public Health 2021; 49:681-688. [PMID: 33764202 DOI: 10.1177/14034948211000813] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND In mid-March 2020, the Norwegian government implemented measures to contain the coronavirus disease 2019 (COVID-19) pandemic, and hospitals prepared to handle an unpredictable inflow of patients with COVID-19. AIM The study was performed to describe the changes in hospital admissions during the first phase of the pandemic. METHODS The Norwegian Institute of Public Health established a national preparedness register with daily updates on COVID-19 cases and the use of health services. We used individual-level information on inpatients from the electronic journal systems for all hospitals in Norway to estimate daily hospital admissions. RESULTS Before the onset of the pandemic in March, there was an average of 2400 inpatient admissions per day in Norway, which decreased to approximately 1500 in the first few days after lockdown measures were implemented. The relative magnitudes of the decreases were similar in men and women and across all age groups. The decreases were substantial for both elective (54%) and emergency (29%) inpatient care. The admission rate gradually increased and reached pre-pandemic levels in June. However, the reductions in admissions for pneumonia and chronic obstructive pulmonary disease seemed to persist. CONCLUSIONS The elective and emergency inpatient admission rates were substantially reduced a few days after the pandemic response measures were implemented. The ways in which the lack or postponement of care may have affected the health and well-being of patients is an important issue to be addressed in future research.
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Affiliation(s)
- Jon Helgeland
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Kjetil E Telle
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Mari Grøsland
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Beate M Huseby
- Division of Health Intelligence and Policy, Norwegian Directorate of Health, Trondheim, Norway
| | - Siri Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Anja S E Lindman
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
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46
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Papiris SA, Bouros D, Markopoulou K, Kolilekas L, Papaioannou AI, Tzilas V, Tzouvelekis A, Fouka E, Papakosta D, Daniil Z, Steiropoulos P, Gogali A, Papanikolaou IC, Xyfteri A, Haritou A, Korbila I, Tomos IP, Loukides S, Bellelli R, Kounti G, Rampiadou C, Karampitsakos T, Dimeas I, Kirgou P, Bompoki A, Vasarmidi E, Loverdos K, Antonogiannaki EM, Blizou M, Bouros E, Kagouridis K, Maniati M, Karakatsani A, Antoniou KM, Manali ED. Early COVID-19 lockdown in Greece and idiopathic pulmonary fibrosis: a beneficial "impact" beyond any expectation. Eur Respir J 2021; 57:13993003.03111-2020. [PMID: 33334934 DOI: 10.1183/13993003.03111-2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/08/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Spyros A Papiris
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Demosthenes Bouros
- First Academic Dept of Pneumonology, Hospital for Diseases of the Chest "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Iatriko Medical Center, Athens, Greece
| | | | | | - Andriana I Papaioannou
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Argyrios Tzouvelekis
- Dept of Respiratory Medicine, General Hospital of Patras, University of Patras, Patra, Greece
| | - Eva Fouka
- A Dept of Pulmonary Medicine, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | - Despoina Papakosta
- A Dept of Pulmonary Medicine, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | - Zoe Daniil
- Dept of Respiratory Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Paschalis Steiropoulos
- Dept of Pneumonology, University Hospital of Alexandroupolis, Democritus University of Thrace, Komotini, Greece
| | - Athina Gogali
- Dept of Pneumonology, Medical School, University of Ioannina, Ioannina, Greece
| | | | | | | | - Ioanna Korbila
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis P Tomos
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stylianos Loukides
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Rita Bellelli
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Kounti
- Pulmonary Dept, "G Papanikolaou" General Hospital, Thessaloniki, Greece
| | | | - Theodoros Karampitsakos
- Dept of Respiratory Medicine, General Hospital of Patras, University of Patras, Patra, Greece
| | - Ilias Dimeas
- Dept of Respiratory Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Paraskevi Kirgou
- Dept of Respiratory Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Andromachi Bompoki
- Dept of Thoracic Medicine and Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Eirini Vasarmidi
- Dept of Thoracic Medicine and Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Crete, Greece
| | | | - Elvira-Markela Antonogiannaki
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Myrto Blizou
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Konstantinos Kagouridis
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Maniati
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Karakatsani
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina M Antoniou
- Dept of Thoracic Medicine and Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Crete, Greece.,These authors contributed equally to this work
| | - Effrosyni D Manali
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece.,These authors contributed equally to this work
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47
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Faria N, Costa MI, Gomes J, Sucena M. Reduction of Severe Exacerbations of COPD during COVID-19 Pandemic in Portugal: A Protective Role of Face Masks? COPD 2021; 18:226-230. [PMID: 33764237 DOI: 10.1080/15412555.2021.1904387] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Viral infections are known to be the main trigger for Chronic obstructive pulmonary disease (COPD) exacerbations. Face masks are acknowledged for effective viral aerosol shedding reduction. COVID-19 pandemic generated an opportunity to study the impact of face masks and confinement on droplet transmission diseases, usually implicated in acute exacerbations of COPD (AECOPD). We aimed to evaluate the variation on severe AECOPD (sAECOPD) rate in a Portuguese COPD cohort during the first COVID-19 lockdown and following months. This retrospective self-controlled study enrolled 322 adult patients followed at COPD-specialized consultation in a tertiary hospital from February 2016 to July 2020, of whom 286 met inclusion criteria. Severe AECOPD events were registered from March 2020 (beginning of state of emergency) until July 2020. From 2016 to 2019 there was a mean of 38 patients per year with sAECOPD. During 2020, 11 patients experienced sAECOPD. Over the course of 2020 there was a 73.4% (p < 0.001) decrease in sAECOPD events comparing with previous years' average. After the end of State of Emergency, the rate of sAECOPD events also declined by 74.6% (p < 0.001) comparing with the same timeline of previous years. Results were consistent and statistically significant when comparing 2020 with each of previous years for every period of analysis. Our findings suggest a sustained decrease in the rate of sAECOPD during confinement and in the following months. The widespread use of face mask and social distancing during COVID-19 pandemic may play an important role in preventing the transmission of respiratory infections and consequently reducing sAECOPD.
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Affiliation(s)
- Nuno Faria
- Department of Pulmonology, Centro Hospitalar e Universitário do Porto, Porto, Portugal.,Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Maria Inês Costa
- Department of Pulmonology, Centro Hospitalar e Universitário do Porto, Porto, Portugal.,Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Joana Gomes
- Department of Pulmonology, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Maria Sucena
- Department of Pulmonology, Centro Hospitalar e Universitário do Porto, Porto, Portugal
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48
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Contoli M, Papi A, Tomassetti L, Rizzo P, Vieceli Dalla Sega F, Fortini F, Torsani F, Morandi L, Ronzoni L, Zucchetti O, Pavasini R, Fogagnolo A, Volta CA, Bartlett NW, Johnston SL, Spadaro S, Campo G. Blood Interferon-α Levels and Severity, Outcomes, and Inflammatory Profiles in Hospitalized COVID-19 Patients. Front Immunol 2021; 12:648004. [PMID: 33767713 PMCID: PMC7985458 DOI: 10.3389/fimmu.2021.648004] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/10/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Deficient interferon responses have been proposed as one of the relevant mechanisms prompting severe manifestations of COVID-19. Objective: To evaluate the interferon (IFN)-α levels in a cohort of COVID-19 patients in relation to severity, evolution of the clinical manifestations and immune/inflammatory profile. Methods: This is prospective study recruiting consecutive hospitalized patients with respiratory failure associated with SARS-COV-2 infection and matched controls. After enrollment, patients were assessed every 7 ± 2 days for additional 2 consecutive visits, for a total of 21 days. The severity of the clinical condition was ranked based on the level of respiratory support required. At each time-point blood samples were obtained to assess immune cells and mediators by multiplex immunoassay. Results: Fifty-four COVD-19 and 11 control patients matched for severity were enrolled. At recruitment, lower levels of blood IFN-α were found in COVID-19 patients compared to controls (3.8-fold difference, p < 0.01). Improvements in COVID-19 severity were paralleled by a significant increase of blood IFN-α levels. A significant increase in blood IFN-α was found over the study period in survivors (70% of the study population). A similar trend was found for blood IFN-β with IFN-β levels below the threshold of detectability in a substantial proportion of subjects. Significantly higher values of blood lymphocytes and lower levels of IL-10 were found at each time point in patients who survived compared to patients who died. In patients who clinically improved and survived during the study, we found an inverse association between IL-10 and IFN-α levels. Conclusion: The study identifies a blood immune profile defined by deficient IFN-α levels associated with increased IL-10 expression in patients progressing to severe/life threatening COVID-19 conditions, suggesting the involvement of immunological pathways that could be target of pharmacological intervention. Clinical Trial Registration:ClinicalTrials.gov identifier NCT04343053.
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Affiliation(s)
- Marco Contoli
- Respiratory Section, Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,Azienda Ospedaliera Universitaria Ferrara, Ferrara, Italy
| | - Alberto Papi
- Respiratory Section, Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,Azienda Ospedaliera Universitaria Ferrara, Ferrara, Italy
| | - Luca Tomassetti
- Department of Physics and Earth Sciences University of Ferrara, Ferrara, Italy.,National Institute of Nuclear Physics, INFN Sezione di Ferrara, Ferrara, Italy
| | - Paola Rizzo
- Laboratory for Technologies of Advanced Therapies, University of Ferrara, Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | | | | | - Francesca Torsani
- Respiratory Section, Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,Azienda Ospedaliera Universitaria Ferrara, Ferrara, Italy
| | - Luca Morandi
- Respiratory Section, Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,Azienda Ospedaliera Universitaria Ferrara, Ferrara, Italy
| | - Luca Ronzoni
- Respiratory Section, Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,Azienda Ospedaliera Universitaria Ferrara, Ferrara, Italy
| | - Ottavio Zucchetti
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | - Rita Pavasini
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | - Alberto Fogagnolo
- Intensive Care Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Carlo Alberto Volta
- Intensive Care Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Nathan W Bartlett
- Priority Research Centre for Healthy Lungs, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Sebastian L Johnston
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Savino Spadaro
- Intensive Care Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Gianluca Campo
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.,Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
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49
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Territory-wide Study on Hospital Admissions for Asthma exacerbation in COVID-19 Pandemic. Ann Am Thorac Soc 2021; 18:1624-1633. [PMID: 33636091 PMCID: PMC8522301 DOI: 10.1513/annalsats.202010-1247oc] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Rationale: Patients with asthma were advised to avoid coronavirus disease (COVID-19) and comply with medication during the COVID-19 pandemic. Respiratory tract infection is a common cause of asthma exacerbations. There has not been evidence suggesting the link between COVID-19 and asthma exacerbation, especially in places with dramatic responses in infection control with universal masking and aggressive social distancing. Objectives: To assess the number for admissions of asthma exacerbations in January to April 2020 in Hong Kong with reference to admission in the past 5 years. Methods: Admission records of asthma exacerbations were retrieved from the Clinical Data Analysis and Reporting System. Patients aged 18 years or older with a known history of asthma admitted for asthma exacerbation were included. Log-linear was used to model count, with year and masking used as covariate and further analysis on ambient temperature and length of hospital stays. Fisher’s exact test was used to compare the mortality rate and mechanical ventilation between the periods. Admissions for myocardial infarction, ischemic stroke, and gastric ulcer were included as controls. Results: The number of admissions for asthma exacerbations significantly decreased by 53.2% (95% confidence interval [CI], 50.4–55.8%) in 2020 compared with monthly average admission in 2015–2019, with a higher magnitude of decrease compared with control diagnoses. Admissions for asthma exacerbations decreased by 2.0% (95% CI, 1.8–2.2%) with every 1°C (1.8°F) increase in temperature and by 0.8% with every 1% increase in masking (95% CI, 0.8–0.9%). Conclusions: Hospitalization number for asthma exacerbations significantly decreased in early 2020, with similar length of stay. This was observed with concomitant practice of universal masking and social distancing during the COVID-19 pandemic in Hong Kong. We proposed that universal masking and social distancing reduced respiratory viral infection, leading to fewer hospital admissions for asthma exacerbations.
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50
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Sykes DL, Faruqi S, Holdsworth L, Crooks MG. Impact of COVID-19 on COPD and asthma admissions, and the pandemic from a patient's perspective. ERJ Open Res 2021; 7:00822-2020. [PMID: 33575313 PMCID: PMC7734714 DOI: 10.1183/23120541.00822-2020] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 11/18/2020] [Indexed: 12/15/2022] Open
Abstract
There has been a significant reduction in all-cause and exacerbation-related #asthma and #COPD admissions during the #COVID19 pandemic. Patients also report a subjective decline in disease control and describe a negative impact on their mental health. https://bit.ly/2Kv0O0H.
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Affiliation(s)
- Dominic L. Sykes
- Respiratory Research Group, Hull University Teaching Hospitals, Hull, UK
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