Management of COPD patients during COVID: difficulties and experiences

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.

KEYWORDS:

• COVID-19
• copd
• pharmacological management
• non-pharmacological interventions
• open questions

Article highlights

• The role of COPD in COVID-19 is not yet well-understood although there is increasing evidence that patients with COPD, mainly if they are current smokers, have worse outcomes after COVID-19 infection.

• When a smoker is exposed to SARS-CoV-2, upregulation of ACE2 expression may facilitate increased viral entry and replication.

• Differentiating the symptoms of COVID-19 infection from the chronic underlying symptoms of COPD or those of an AECOPD may be challenging.

• Patients with COPD must maintain their regular therapy because optimal pharmacological treatment is the best way to prevent exacerbations and/or reduce the severity of exacerbations secondary to SARS-CoV-2.

• Furthermore, systemic corticosteroids should be used according to the usual indications, as there is no evidence that they alter the susceptibility to a SARS-CoV-2 infection or worsen outcomes.

• If hypoxemia is inadequately controlled with maximum oxygen supplementation in patients with hypoxemic COPD and COVID-19, HFNC therapy or CPAP with high oxygen flow should be considered. NIV should be instituted in patients with acute (on chronic) hypercapnic respiratory failure, and IMV should be used in patients with severe hypoxemic respiratory failure or when NIV has proved insufficient.

• COPD patients who have tested positive for SARS-CoV-2 must be closely followed over time because any delay in diagnosis and initiation of appropriate therapy could negatively affect their prognosis.

• There are several open questions concerning COVID-19 and COPD that need to be considered. Future studies are absolutely necessary to answer these questions.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or material discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers in this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.