How does the corona pandemic affect disease management in COPD?

The basic tenor of the expert statements is that COPD patients should continue their therapy to prevent exacerbations and thus also avoid the need for a visit to the doctor or hospitalization. As a risk group for severe courses, COPD sufferers should continue to adhere to protective measures.

Patients with COPD, like those affected by certain other lung diseases (e.g., bronchiectasis, cystic fibrosis, or lung cancer), are at increased risk for severe COVID-19 courses [1,2]. This is shown by recent empirical data [3–5]. A significantly increased risk can be assumed in COPD patients with cardiovascular comorbidity [6–8]. Patients with severe COPD and emphysema are also at higher risk of complications from COVID-19 disease [9].

According to a statement of the German Society of Pneumology and Respiratory Medicine (DGP) of May 27, 2020, guideline-based inhaled therapy should generally be continued in COPD [2]. So far, there is no evidence that therapy with inhaled steroids has a prognostically unfavorable effect in COPD, according to the expert panel’s interim conclusion in this regard. Antihypertensive therapy, including treatment with ACE inhibitors or sartans, should also be continued. According to current data, there is no evidence that this increases the risk of severe courses [10,11]. A publication in the New England Journal of Medicine even reported evidence that ACE inhibitor therapy may reduce the risk of severe courses [12]. COPD patients who smoke are strongly advised to stop smoking. Pneumococcal vaccination is also strongly recommended if this has not already been done. Quarantine in the home environment is not considered mandatory unless there is evidence of COVID-19 disease. The recommendations of local health authorities, which continually adapt their assessments to changing circumstances, should be followed consistently. Professor James Chalmers, infectious disease expert at the European Respiratory Society (ERS), advises continued use of steroids in COPD patients who experience acute exacerbations as a result of COVID-19 in an interview published in European Lung [9]. This is also in line with the recommendation of the World Health Organization (WHO). To date, there is no evidence that steroids can exacerbate disease progression in COVID-19, he said [9]. If symptoms worsen, patients should consult their treating physician.

New explanation for increased risk of severe COVID-19 courses.

According to findings published in the European Respiratory Journal 2020, smokers and patients with chronic obstructive pulmonary disease (COPD) express more of the ACE2 receptor in their airways, through which SARS coronaviruses enter cells [13]. Consequently, the susceptibility to severe courses is not only due to the pre-damaged lungs, as was previously assumed. Pulmonologists at the University of British Columbia and St. Paul’s Hospital examined angiotensin-converting enzyme 2 (ACE2) expression on cells taken by bronchoscopy from the airways of patients with COPD. Thus, they demonstrated that the airway cells of COPD patients expressed increased levels of ACE2 compared to healthy controls. In smokers among COPD sufferers, this expression was particularly high. According to the research team, these individuals are doubly vulnerable and should consistently adhere to protective measures such as “social distancing” [13].

Summary

COPD patients are at increased risk for severe COVID19 events and should avoid situations with increased risk of infection whenever possible and adhere to appropriate protective measures [2].
To prevent hospitalization and physician visits, good symptom control is particularly important during corona periods [2].
Experts recommend continuation of guideline-adherent inhaled therapy. According to current data, there is no evidence of a prognostically unfavorable effect [2].
COPD patients suffering from COVID-19 with acute exacerbations can take steroids. To date, there is no evidence that steroids exacerbate disease progression in COVID-19, he said [9].

Literature:

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German Society of Pneumology (DGP): Statement: Risk assessment in patients with chronic respiratory and pulmonary diseases in the context of the SARS-CoV-2 pandemic. https://pneumologie.de, last accessed 18.06.2020
Zhao Q, et al. The impact of COPD and smoking history on the severity of Covid-19: A systemic review and meta-analysis. J Med Virol 2020, In press.
Alqahtani JS, et al: Prevalence, Severity and Mortality associated with COPD and Smoking in patients with COVID-19: A Rapid Systematic Review and Meta-Analysis. PLoS One 2020; 15(5):e0233147.
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European Lung Foundation: interview with Professor James Chalmers, infectious disease expert at the European Respiratory Society (ERS), www.europeanlung.org/de/qa-covid-19, last accessed 18.06.2020
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Leung JM, et al: ACE-2 Expression in the Small Airway Epithelia of Smokers and COPD Patients: Implications for COVID-19. European Respiratory Journal 2020; DOI: 10.1183/13993003.00688-2020.