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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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Rømer V, Fosgaard MB, Sivapalan P, Eklöf J, Saeed MI, Toennesen LL, Svorre Jordan A, Gissel T, Johansson SL, Jensen JUS. Incidence of community-acquired pneumonia hospitalisation in persons with bronchiectasis during the COVID-19 lockdown in Denmark: a retrospective cohort study. BMJ Open Respir Res 2023; 10:e001517. [PMID: 38016706 PMCID: PMC10685970 DOI: 10.1136/bmjresp-2022-001517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 11/03/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Persons with bronchiectasis have a high risk of community-acquired pneumonia. Social distancing measures, implemented to prevent the spreading of SARS-CoV-2, could potentially reduce the incidence of other infectious diseases. RESEARCH QUESTION Was the COVID-19 lockdown period, along with accompanying social distancing measures, associated with reduced hospital admissions for community-acquired pneumonia and decreased overall mortality rates among individuals with bronchiectasis? METHODS Social distancing measures were introduced in Denmark by 12 March 2020 and were preserved until 20 May 2020 (social distancing period), after which the measures were gradually dismissed. The study included all adults (≥18 years) with bronchiectasis residing in Denmark. Confirmed cases of SARS-CoV-2 infection were excluded. We retrospectively investigated the incidence of community-acquired pneumonia hospital admission, death of all causes and respiratory antibiotic treatment in the 10-week social distancing period in 2020, compared with the same dates in 2019. 9344 persons were included in the study. RESULTS In the social distancing period, the incidence rate of pneumonia-hospitalisation per 10 000 person-weeks was 9.2 compared with 13.8 in the reference period. This reduction corresponds to an incidence rate ratio (IRR) of 0.67 (95% CI 0.51 to 0.88, p<0.01). Mortality was unchanged (IRR 0.90, 95% CI 0.61 to 1.32, p=0.58). Fewer persons received respiratory antibiotics (IRR 0.85, 95% CI 0.78 to 0.94, p<0.001). CONCLUSION The social distancing period was associated with a lower incidence of community-acquired pneumonia hospitalisations and respiratory antibiotic treatments in persons with bronchiectasis while all-cause mortality remained unchanged.
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Affiliation(s)
- Valdemar Rømer
- Department of Medicine, Section of Respiratory Medicine, Gentofte University Hospital, Hellerup, Denmark
| | - Martina Bjørka Fosgaard
- Department of Medicine, Section of Respiratory Medicine, Gentofte University Hospital, Hellerup, Denmark
| | - Pradeesh Sivapalan
- Department of Medicine, Section of Respiratory Medicine, Gentofte University Hospital, Hellerup, Denmark
| | - Josefin Eklöf
- Department of Medicine, Section of Respiratory Medicine, Gentofte University Hospital, Hellerup, Denmark
| | - Mohamad Isam Saeed
- Department of Medicine, Section of Respiratory Medicine, Gentofte University Hospital, Hellerup, Denmark
| | - Louise Lindhardt Toennesen
- Department of Medicine, Section of Respiratory Medicine, Gentofte University Hospital, Hellerup, Denmark
| | - Alexander Svorre Jordan
- Department of Medicine, Section of Respiratory Medicine, Gentofte University Hospital, Hellerup, Denmark
| | - Tina Gissel
- Department of Internal Medicine, Viborg Regional Hospital, Viborg, Denmark
| | | | - Jens-Ulrik Stæhr Jensen
- Department of Medicine, Section of Respiratory Medicine, Gentofte University Hospital, Hellerup, Denmark
- PERSIMUNE & CHIP: Department of Infectious Diseases, University of Copenhagen, Kobenhavn, Denmark
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Fernández Villar A, Golpe Gómez R, González Montaos A, Fernández García S, Pazos Area L, Priegue Carrera A, Ruano Raviña A, Represas Represas C. The impact of the SARS-CoV-2 pandemic on the demographic, clinical and social profiles of patients admitted to the Pneumology Department for a COPD exacerbation. PLoS One 2023; 18:e0290156. [PMID: 37708160 PMCID: PMC10501653 DOI: 10.1371/journal.pone.0290156] [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: 12/21/2022] [Accepted: 08/02/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Although a reduction in admissions for pathologies other than SARS-CoV-2 has been reported during the pandemic, there are hardly any specific studies in relation to COPD. The objective of this study was to analyse differences in the profile of those admitted for AEPOC and their prognosis during this period. METHODS Prospective study (SocioEPOC validation cohort) conducted in two hospitals. Demographic, clinical and social characteristics were compared among patients admitted for an AECOPD before and after the declaration of the COVID-19 healthcare emergency. Mortality and the need for hospital care in the following 3 months were analysed. RESULTS 340 patients (76.6% male, 72 years, FEV1 43.5%) were included, 174 in the post-pandemic phase. During pandemic, especially before population-level vaccination, admissions for AECOPD were in patients with more severe disease and with a higher level of eosinophils. No differences were found in social profile, except they had more informal caregivers. The mortality rate at 90 days was the same (9%), although those admitted during the pandemic came for more hospital visits in the following 3 months (53.8% vs. 42%; p = 0.003), with the pandemic phase being an independent predictor of this possibility (OR = 1.6.; 95% IC = 1.1-2.6). CONCLUSIONS In the first few months of the pandemic, the clinical profile of patients hospitalised for an AECOPD differed from that both prior to this period and during the latter months of the pandemic, with minimal changes at the social level. Although the mortality rate were similar, unscheduled hospital visits increased during the COVID-19 pandemic.
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Affiliation(s)
- Alberto Fernández Villar
- Pulmonology Department, Álvaro Cunqueiro University Hospital, Vigo, Spain
- Institute of Health Research Galicia Sur (IISGS), Neumo I + i. Research Group, Pontevedra, Spain
| | | | - Almudena González Montaos
- Pulmonology Department, Álvaro Cunqueiro University Hospital, Vigo, Spain
- Institute of Health Research Galicia Sur (IISGS), Neumo I + i. Research Group, Pontevedra, Spain
| | - Sara Fernández García
- Institute of Health Research Galicia Sur (IISGS), Neumo I + i. Research Group, Pontevedra, Spain
| | - Luis Pazos Area
- Pulmonology Department, Álvaro Cunqueiro University Hospital, Vigo, Spain
- Institute of Health Research Galicia Sur (IISGS), Neumo I + i. Research Group, Pontevedra, Spain
| | - Ana Priegue Carrera
- Institute of Health Research Galicia Sur (IISGS), Neumo I + i. Research Group, Pontevedra, Spain
| | - Alberto Ruano Raviña
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública—CIBERESP), Barcelona, Spain
| | - Cristina Represas Represas
- Pulmonology Department, Álvaro Cunqueiro University Hospital, Vigo, Spain
- Institute of Health Research Galicia Sur (IISGS), Neumo I + i. Research Group, Pontevedra, Spain
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Fedeli U, Casotto V, Barbiellini Amidei C, Vianello A, Guarnieri G. COPD-Related Mortality before and after Mass COVID-19 Vaccination in Northern Italy. Vaccines (Basel) 2023; 11:1392. [PMID: 37631960 PMCID: PMC10459975 DOI: 10.3390/vaccines11081392] [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: 07/12/2023] [Revised: 08/08/2023] [Accepted: 08/18/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND/OBJECTIVE Little is known about the impact of the COVID-19 pandemic on mortality from COPD at the population level. The objective was to investigate COPD-related mortality throughout different epidemic waves in Italy before and after the vaccination campaign, which started in late December 2020 and initially targeted the population aged ≥80 years. METHODS Death certificates of residents in Veneto (Northeastern Italy) aged ≥40 years between 2008 and 2021 were analyzed. Age-standardized morality rates were computed for death certificates with any mention of COPD. Generalized estimating equation (GEE) models were fitted to estimate the expected mortality during the pandemic. The results were stratified by age groups of 40-79 and ≥80 years, main comorbidities, and place of death. RESULTS COPD was mentioned in 3478 death certificates in 2020 (+14% compared to the 2018-2019 average) and in 3133 in 2021 (+3%). Age-standardized mortality rates increased in all age and sex groups in 2020; in 2021, mortality returned to pre-pandemic levels among the elderly but not in the population aged 40-79 years (+6%). GEE models confirmed this differential trend by age. COPD-related mortality peaks were observed, especially in the first pandemic waves, with COVID-19 identified as the underlying cause of death in a relevant proportion (up to 35% in November 2020-January 2021). Mortality with comorbid diabetes and hypertensive diseases slightly increased during the pandemic. CONCLUSION COPD-related mortality increased at the beginning of the pandemic, due to deaths from COVID-19. The start of the vaccination campaign was associated with an important decline in COPD-related mortality, especially among the elderly, who first benefited from COVID-19 vaccines. The study findings show the role of mass vaccination in reducing COPD-related deaths during the later phases of the pandemic.
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Affiliation(s)
- Ugo Fedeli
- Epidemiological Department, Azienda Zero-Veneto Region, 35131 Padua, Italy; (U.F.); (V.C.); (C.B.A.)
| | - Veronica Casotto
- Epidemiological Department, Azienda Zero-Veneto Region, 35131 Padua, Italy; (U.F.); (V.C.); (C.B.A.)
| | | | - Andrea Vianello
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, Respiratory Pathophysiology Division, University of Padova, 35126 Padua, Italy;
| | - Gabriella Guarnieri
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, Respiratory Pathophysiology Division, University of Padova, 35126 Padua, Italy;
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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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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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Maurici R. What happened to non-SARS-CoV-2 respiratory diseases during the pandemic? J Bras Pneumol 2023; 49:e20230042. [PMID: 36946821 PMCID: PMC10171263 DOI: 10.36416/1806-3756/e20230042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Affiliation(s)
- Rosemeri Maurici
- . Departamento de Clínica Médica, Universidade Federal de Santa Catarina - UFSC - Florianópolis (SC) Brasil
- . Programa de Pós-Graduação em Ciências Médicas - UFSC - Florianópolis (SC) Brasil
- . Hospital Universitário - UFSC - Florianópolis (SC) Brasil
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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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The Impact of Social Distancing in 2020 on Admission Rates for Exacerbations in Asthma: A Nationwide Cohort Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY: IN PRACTICE 2022; 10:2086-2092.e2. [PMID: 35500879 PMCID: PMC9352355 DOI: 10.1016/j.jaip.2022.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/08/2022] [Accepted: 04/13/2022] [Indexed: 11/30/2022]
Abstract
Background Social distancing measures introduced during the coronavirus disease 2019 pandemic have reduced admission rates for various infectious and noninfectious respiratory diseases. We hypothesized that rates of asthma exacerbations would decline following the national lockdown in Denmark. Objective To determine weekly rates of in- and out-of-hospital asthma exacerbations before and during the social distancing intervention implemented on March 12, 2020. Methods All individuals older than 18 years with at least 1 outpatient hospital contact with asthma as the main diagnosis from January 1, 2013, to December 31, 2017, were included. Weekly asthma exacerbation rates from January 1, 2018, to May 22, 2020, were calculated. An interrupted time-series model with the lockdown on March 12, 2020, as the point of interruption was used. Results A total of 38,225 patients with asthma were identified. The interrupted time-series model showed no immediate fall in exacerbation rates during the first week after March 12, 2020. However, there was a significant decline in weekly exacerbation rates in the following 10 weeks (change in trend for exacerbations requiring hospitalization: −0.75 [95% CI, −1.39 to −0.12]; P < .02 and in all asthma exacerbations: −12.2 [95% CI, −19.1 to −5.4; P < .001), amounting to a reduction of approximately 1 and 16.5 exacerbations per year per 100 patients in the cohort, respectively. Conclusions The introduction of the social distancing measures in Denmark did not lead to an immediate reduction in asthma exacerbation rates; however, a gradual decline in exacerbation rates during the following 10-week period was observed.
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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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