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. 2021 Jan 18;7(1):00718-2020.
doi: 10.1183/23120541.00718-2020. eCollection 2021 Jan.

COPD in the time of COVID-19: an analysis of acute exacerbations and reported behavioural changes in patients with COPD

Hamish McAuley  1   2 , Kate Hadley  2 , Omer Elneima  1   2 , Christopher E Brightling  1   2 , Rachael A Evans  1   2 , Michael C Steiner  1   2 , Neil J Greening  1   2
Affiliations

COPD in the time of COVID-19: an analysis of acute exacerbations and reported behavioural changes in patients with COPD

Hamish McAuley et al. ERJ Open Res. .

Abstract

Introduction: The impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and associated "lockdown" measures on acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is unknown. We aimed to evaluate the change in AECOPD treatment frequency during the first 6 weeks of lockdown in the UK compared with 2019 and assess changes in self-reported behaviour and wellbeing.

Methods: In this observational study in Leicestershire, UK, patients with COPD under a secondary care clinic were recruited. Exacerbation frequency in the first 6 weeks of COVID-19 lockdown was compared with the same period in 2019 using electronic health records. A telephone survey was used to assess changes in anxiety, inhaler adherence, physical activity and behaviour during the pre-lockdown and lockdown periods compared with normal.

Results: 160 participants were recruited (mean±sd age 67.3±8.1 years, 88 (55%) males, mean±sd forced expiratory volume in 1 s 34±13% pred). 140 (88%) reported at least one AECOPD in the previous year. Significantly more community managed exacerbations were observed in 2020 compared with 2019 (126 versus 99; p=0.026). The increase was a result of multiple courses of treatment, with a similar proportion of patients receiving at least one course (34.4% versus 33.8%).

Discussion: During lockdown participants reported significantly increased anxiety, adherence to their preventative inhalers and good adherence to shielding advice (all p<0.001). A significant reduction in self-reported physical activity and visitors was reported (both p<0.001).

Conclusions: Treatment for AECOPD events increased during the first 6 weeks of the SARS-CoV-2 pandemic in the UK compared with 2019. This was associated with increased symptoms of anxiety and significant behavioural change.

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Conflict of interest statement

Conflict of interest: H. McAuley has nothing to disclose. Conflict of interest: K. Hadley has nothing to disclose. Conflict of interest: O. Elneima has nothing to disclose. Conflict of interest: C.E. Brightling has nothing to disclose. Conflict of interest: R.A. Evans reports Clinical Scientist Fellowship CS-2016-16-020 from the NIHR during the conduct of the study. Conflict of interest: M.C. Steiner has nothing to disclose. Conflict of interest: N.J. Greening reports Post-Doctoral Fellowship PDF-2017-10-052 from the NIHR during the conduct of the study.

Figures

FIGURE 1
FIGURE 1
Number of exacerbations per patient between March 15 and April 30 in 2019 and 2020: a) all community and hospitalised managed exacerbations, b) community managed exacerbations only, and c) hospitalised managed exacerbations only. Data are presented as mean with 95% confidence interval.
FIGURE 2
FIGURE 2
Changes in self-reported behaviour in the 2 weeks pre-lockdown and during the first 6 weeks of lockdown compared with normal baseline for a) regular inhaler use, b) anxiety and c) physical activity. Change between pre-lockdown and lockdown for all groups p<0.001.
See this image and copyright information in PMC

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