Progression to a severe form of COVID-19 among patients with chronic respiratory diseases

Abstract

Rationale: Viral respiratory infections, including SARS-CoV-2 infection, can trigger respiratory symptoms among patients suffering from chronic respiratory diseases, leading to exacerbations and hospitalizations. Despite the tropism of SARS-CoV-2 into the respiratory tract, chronic respiratory diseases do not seem to be risk factors for severe forms of COVID-19.

Objectives: To assess whether hospitalized patients for COVID-19 with chronic respiratory diseases were at lower risk of developing a severe form than other patients.

Methods: This French study included patients admitted to hospital in COVID-19 ward, suffering from a SARS-CoV-2 infection, diagnosed on RT-PCR or chest computed tomography associated with clinical symptoms, from March 15 to June 30, 2020. Ambulatory patients who were tested in the emergency department and patients with severe hypoxaemia requiring intensive care were not included. All data were collected from electronic medical records up to discharge of the patient.

Main results: 617 patients were included: 125 with a chronic respiratory disease, mainly chronic obstructive pulmonary disease (45%) and asthma (30%). The percentage of patients scoring 6 or higher on the WHO Clinical Progression Scale during hospital stay was lower in patients with chronic respiratory disease compared to those without chronic respiratory disease (21.6% versus 31.3%, respectively, p = 0.03). Among patients with chronic respiratory disease, temperature above 38 °C on admission (OR 16.88 (95% CI 4.01-71.00)), lymphopenia (OR 5.08 (1.25-20.72)), CPAP therapy (OR 4.46 (1.04-19.17)) and age (OR 1.09 (1.02-1.16)) were associated with an increased risk to reach a score of 6 or above.

Conclusions: Hospital admissions in COVID-19 ward of patients suffering from chronic respiratory diseases are at lower risk of developing a severe form of COVID- 19, especially in patients with chronic obstructive pulmonary disease or asthma. Prospective studies would confirm our results and allow to better organize the follow-up of these patients in a pandemic period.

Keywords: Asthma; COVID-19; Chronic obstructive lung disease; Chronic respiratory failure; Respiratory intensive care; SARS-CoV-2; Viral infections of the respiratory tract.

Fig. 1

Flowchart of the study population. COPD: chronic obstructive pulmonary disease; CRD: chronic respiratory disease; ICU: intensive care unit; ILD: interstitial lung disease; OHS: obesity hypoventilation syndrome; PH: pulmonary hypertension; SARS- CoV-2: severe acute respiratory syndrome coronavirus 2.

Fig. 2

Comparison of survival rates between patients with chronic respiratory disease and patients without chronic respiratory disease.