Alarming findings show need to prioritise COPD patients for COVID-19 vax

COPD is a significant risk factor for adverse outcomes from COVID-19 – justifying its inclusion as criteria for the phase 1b priority list for COVID-19 vaccination, an Australian respiratory physician says.

A recent systematic review of the evidence has shown that COPD patients who contract COVID-19 are four times more likely to be hospitalised, 1.3 times more likely to require ICU admission, and almost three times more likely to die than COVID-19 patients who do not have COPD.

The review identified 39 clinical studies of COVID-19 patients in which COPD status and at least one pre-specified clinical outcomes – hospitalisation, ICU admission as a surrogate for severe disease, and mortality – was reported.

In the studies, comprising almost 700,000 patients from 16 countries, 2.1% of patients had COPD.

The study found the COPD patients had an increased risk of hospital admission (OR 3.12), ICU admission (OR 1.35) and death (OR 2.47).

“The heterogeneity in the effects of COPD on these outcomes was not fully explained by differences in the average age or sex distribution of the study participants,” the study said.

The study, coauthored by Australian respiratory physician Dr Stephen Milne, said COPD patients were possibly underrepresented among COVID-19 cases due to increased social distancing during the pandemic.

“However, our results confirm that, after contracting SARS-CoV-2, COPD patients are at a high risk of progression to a poor clinical outcome.”

“These data highlight the importance of public and personal health measures to protect patients with COPD from becoming infected with SARS-CoV-2 (e.g. with the use of well-fitting masks, social distancing and hand hygiene measures) and managing these patients (should they develop COVID-19) with aggressive systemic corticosteroids and other strategies to mitigate their excess risk for morbidity and mortality.”

“These data also demonstrate COPD patients should be prioritised for immunisation with COVID-19 vaccine(s),” they concluded.

Alarming findings

Dr Milne, currently a postdoctoral fellow at the University of British Columbia, Canada, told the limbic the findings were quite alarming.

“In the drama of the pandemic, patients with COPD have been a little bit forgotten about. One of the most fascinating observations has been that we are not seeing this massive wave of COPD patients having COVID-19 in the first place.”

“It probably turns out that they are very good at social distancing. They recognised themselves as a vulnerable group of the population and they are doing their best to wash their hands, wear a mask, keep away from people and stay inside the house, and that is probably protecting them as a population as a whole.”

“We have shown unequivocally that they are at risk of adverse events,” he said.

Dr Milne said it was pleasing to see COPD patients included in the list of Australians considered vulnerable because of their underlying medical conditions.

“I guess the concern is that if these are a particularly vulnerable group, just saying it [the vaccine] is available might not be enough.

“If you look at the estimated numbers for the phase 1b roll out in Australia, COPD is included in a group of two million people expected to have underlying medical conditions as well as three million people over the age of 70 years.”

“My concern would be they get lost in this mass of people calling up and wanting to get vaccinated because it’s their time whereas within that group we still need to prioritise the vulnerable.”

He said health professionals might need to be proactive in making sure their patients with COPD were vaccinated.

For example, doctors might be able to flag these patients as a priority in their practice management software.

“I’d like to think that if I still had my practice in Sydney, that I would actively reach out to my patients and say ‘I might not be able to give it to you but please make sure you manage to get to see your GP and let me know so I can make a note’,” he said.

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