Global Initiative for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease. The 2020 GOLD Science Committee Report on COVID-19 and Chronic Obstructive Pulmonary Disease

Abstract

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has raised many questions about the management of patients with chronic obstructive pulmonary disease (COPD) and whether modifications of their therapy are required. It has raised questions about recognizing and differentiating coronavirus disease (COVID-19) from COPD given the similarity of the symptoms. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) Science Committee used established methods for literature review to present an overview of the management of patients with COPD during the COVID-19 pandemic. It is unclear whether patients with COPD are at increased risk of becoming infected with SARS-CoV-2. During periods of high community prevalence of COVID-19, spirometry should only be used when it is essential for COPD diagnosis and/or to assess lung function status for interventional procedures or surgery. Patients with COPD should follow basic infection control measures, including social distancing, hand washing, and wearing a mask or face covering. Patients should remain up to date with appropriate vaccinations, particularly annual influenza vaccination. Although data are limited, inhaled corticosteroids, long-acting bronchodilators, roflumilast, or chronic macrolides should continue to be used as indicated for stable COPD management. Systemic steroids and antibiotics should be used in COPD exacerbations according to the usual indications. Differentiating symptoms of COVID-19 infection from chronic underlying symptoms or those of an acute COPD exacerbation may be challenging. If there is suspicion for COVID-19, testing for SARS-CoV-2 should be considered. Patients who developed moderate-to-severe COVID-19, including hospitalization and pneumonia, should be treated with evolving pharmacotherapeutic approaches as appropriate, including remdesivir, dexamethasone, and anticoagulation. Managing acute respiratory failure should include appropriate oxygen supplementation, prone positioning, noninvasive ventilation, and protective lung strategy in patients with COPD and severe acute respiratory distress syndrome. Patients who developed asymptomatic or mild COVID-19 should be followed with the usual COPD protocols. Patients who developed moderate or worse COVID-19 should be monitored more frequently and accurately than the usual patients with COPD, with particular attention to the need for oxygen therapy.

Keywords: COVID-19; chronic obstructive pulmonary disease; diagnosis; treatment.

Figure 1.

Chronic obstructive pulmonary disease and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection: clinical features, abnormal investigations, and possible interventions at different stages of the disease. ARDS = acute respiratory distress syndrome; BNP = brain natriuretic peptide; COPD = chronic obstructive pulmonary disease; COVID-19 = coronavirus disease; CRP = C-reactive protein; CT = computed tomography; CXR = chest radiograph; HFNT = high-flow nasal therapy; IMV = invasive mechanical ventilation; LDH = lactate dehydrogenase; NIV = noninvasive ventilation; PCT = procalcitonin; PFT = pulmonary function tests; PR = pulmonary rehabilitation; SIRS = systemic inflammatory response syndrome; SOB = shortness of breath; Sp_O2 = peripheral oxygen saturation; VTE = venous thromboembolism.