What can lockdowns tell us about reducing COPD exacerbations?


By Dave Levitan

28 Jan 2021

COVID-19 lockdowns resulted in substantial reductions in COPD exacerbations, according to a Spanish study. The reductions suggest that in the future, relatively simple efforts could help patients with COPD in the absence of the disruption of a pandemic.

Researchers compared exacerbations among 310 COPD patients before and during the pandemic; the cohort had moderate to severe COPD, and most patients were classified as GOLD II (38%) or III (37%).

Importantly, the patients adhered relatively strictly to lockdown measures, with 56% of patients reporting that they did not leave home at all during the lockdown period from 1 March to 31 May 2020. Another 26% left home three times or fewer per week during that period.

The cohort saw a 62% decrease in the number of COPD exacerbations, from 102 in the same period in 2019 down to 39 in 2020 (P < .001). The average exacerbations per patient dropped from 0.37 to 0.14 (P < .001); most of the reduction was in moderate and severe exacerbations.

Patients reported a significantly better overall COPD Assessment Test (CAT) score during the lockdowns, with improvements seen across every symptom. There was also a 74% reduction in COPD-related healthcare costs accumulated over the lockdown period compared to the previous year.

Severity of dyspnoea worsened during lockdowns, though the authors noted the absolute change had little clinical relevance. The study was published in the journal Chest.

“Measures to reduce COVID-19 will also have reduced transmission of other viruses so a reduction in exacerbations makes sense – there has been less flu and less norovirus this winter,” Dr Nick Hopkinson, a reader in respiratory medicine at Imperial College London’s National Heart and Lung Institute who was not involved with the study, told the limbic.

“The lesson for healthcare and society more broadly is that it is possible to reduce viral transmission with simple steps, especially if people are supported to do so,” he said. In the future, he added, more care will be needed to avoid transmission – and thus the associated potential for COPD exacerbations – in particular in healthcare environments.

“Neither staff nor patients should be coming to outpatient clinics if they have upper respiratory tract symptoms suggesting viral infection,” Dr Hopkinson said. Mask wearing, he added, is likely to continue in many settings even after the pandemic, which could also help patients with COPD.

Aside from reduced viral transmission, another possibility that could explain the reductions in COPD exacerbations is the lockdown-associated reduction in vehicle traffic. Dr Hopkinson said many of his patients have reported that they believe the reduced traffic has improved their breathing.

“We’d hope that it would encourage people to focus on self-management issues too, such as online inhaler technique videos and also prompt quit attempts,” Dr Hopkinson said.

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