Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jun 25:19:1433-1445.
doi: 10.2147/COPD.S451009. eCollection 2024.

COPD Exacerbations Before and During COVID-19 in France, Germany, Italy, the UK and the US

Fernando J Martinez  1 , Alberto Papi  2 , Tobias Welte  3   4 , Dave Singh  5 , Dmitry V Galkin  6 , Alessandro Guasconi  7 , Stefania Pirondi  7 , George Georges  7 , Joseph Imperato  8 , Ruben Hermans  9
Affiliations

COPD Exacerbations Before and During COVID-19 in France, Germany, Italy, the UK and the US

Fernando J Martinez et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Background: Exacerbations of chronic obstructive pulmonary disease (COPD) were reported less frequently during the COVID-19 pandemic. We report real-world data on COPD exacerbation rates before and during this pandemic.

Methods: Exacerbation patterns were analysed using electronic medical records or claims data of patients with COPD before (2017-2019) and during the COVID-19 pandemic (2020 through early 2022) in France, Germany, Italy, the United Kingdom and the United States. Data from each country were analysed separately. The proportions of patients with COPD receiving maintenance treatment were also estimated.

Results: The proportion of patients with exacerbations fell 45-78% across five countries in 2020 versus 2019. Exacerbation rates in most countries were reduced by >50% in 2020 compared with 2019. The proportions of patients with an exacerbation increased in most countries in 2021. Across each country, seasonal exacerbation increases seen during autumn and winter in pre-pandemic years were absent during the first year of the pandemic. The percentage of patients filling COPD prescriptions across each country increased by 4.53-22.13% in 2019 to 9.94-34.17% in 2021.

Conclusion: Early, steep declines in exacerbation rates occurred in 2020 versus 2019 across all five countries and were accompanied by a loss of the seasonal pattern of exacerbation.

Keywords: COPD exacerbation; COVID-19; chronic obstructive pulmonary disease; electronic health records; real-world study.

PubMed Disclaimer

Conflict of interest statement

F.J. Martinez reports support for the present manuscript from Chiesi Farmaceutici S.p.A.; reports grants or contracts from AstraZeneca, Chiesi Farmaceutici S.p.A., GSK and Sanofi/Regeneron; reports consulting fees from AstraZeneca, Boehringer Ingelheim, Chiesi Farmaceutici S.p.A., CSL Behring, GSK, Novartis, Polarean, Pulmatrix, Pulmonx, Sanofi/Regeneron, Sunovion, Teva, Theravance/Viatris and UpToDate®; reports payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from AstraZeneca and GSK; and reports participation on a Data Safety Monitoring Board or advisory board for GSK and Medtronic. A. Papi reports study support from Chiesi Farmaceutici S.p.A.; reports grants or contracts from Agenzia Italiana del Farmaco (AIFA), AstraZeneca, Chiesi Farmaceutici S.p.A., GSK and Sanofi; reports consulting fees from AstraZeneca, Avillion, Chiesi Farmaceutici S.p.A., Elpen Pharmaceuticals, GSK, Novartis, Roche and Sanofi; reports payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from AstraZeneca, Avillion, Chiesi Farmaceutici S.p.A., Edmond Pharma, Elpen Pharmaceuticals, GSK, IQVIA, Menarini, Mundipharma, Novartis, Sanofi and Zambon; and reports advisory board membership for AstraZeneca, Avillion, Chiesi Farmaceutici S.p.A., Elpen Pharmaceuticals, GSK, IQVIA, MSD, Novartis, Regeneron and Sanofi. T. Welte reports all support for the present manuscript from Chiesi Farmaceutici S.p.A.; reports consulting fees from AstraZeneca, Berlin-Chemie, Boehringer Ingelheim, Chiesi Farmaceutici S.p.A. and GSK; and reports payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from AstraZeneca, Berlin-Chemie, Boehringer Ingelheim, Chiesi Farmaceutici S.p.A. and GSK. He also reports a grant paid to his institution from the German Ministry of Research and Education. D. Singh reports consulting fees from Aerogen, AstraZeneca, Boehringer Ingelheim, Chiesi Farmaceutici S.p.A., Cipla, CSL Behring, EpiEndo, Genentech, GSK, Glenmark, Gossamer Bio, Kinaset Therapeutics, Menarini, Novartis, Orion, Pulmatrix, Sanofi, Synairgen, Teva, Theravance Biopharma and Verona Pharma. D. Singh is also supported by the National Institute for Health Research Manchester Biomedical Research Centre. D.V. Galkin is an employee of Chiesi Farmaceutici S.p.A.; reports support for this manuscript from Chiesi Farmaceutici S.p.A.; and holds stock or stock options with GSK. A. Guasconi is an employee of Chiesi Farmaceutici S.p.A. S. Pirondi is an employee of Chiesi Farmaceutici S.p.A. and is on SiMEF Società Italiana di Medicina Farmaceutica Working Group on Observational Studies. G. Georges is an employee of Chiesi Farmaceutici S.p.A. J. Imperato and R. Hermans are employees of IQVIA and were on the consulting team that led the analysis of the real-world data for this manuscript. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Annual exacerbationa ratesb for the exacerbation cohort (a) and the continuous follow-up cohort (b) in France, Germany, Italy, the UK and the US. aAn exacerbation was indicated by any of the following: a COPD exacerbation diagnostic code; prescriptions for a COPD-specific antibiotic and an oral corticosteroid (OCS) within 7 days; or two or more respiratory symptoms of exacerbation (eg cough, sputum production, breathlessness) with COPD-specific antibiotics or OCS within the next 7 days. bThe exacerbation rate was the number of exacerbations per attributable person-time for the period of interest. cThe exacerbation cohort consisted of patients with at least one exacerbation during the observed time. dThe continuous follow-up cohort consisted of patients with a diagnosis of COPD in 2016 and who were continuously enrolled in the database from 2017 to 2021.
Figure 2
Figure 2
Seasonal exacerbation trends for the (a) COPD population and (b) exacerbation population in France, Germany, Italy, the UK and the US. The pink circles indicate the nadir in the number of exacerbations during spring 2020. The black arrows indicate the autumn/winter trends and the blue arrows indicate an upward trend in exacerbation later in 2020 and 2021. Winter = January to March, spring = April to June; summer = July to September; autumn = October to December. An exacerbation was indicated by any of the following: a COPD exacerbation diagnostic code; prescriptions for a COPD-specific antibiotic and an oral corticosteroid (OCS) within 7 days; or two or more respiratory symptoms of exacerbation (eg cough, sputum production, breathlessness) with COPD-specific antibiotics or OCS within the next 7 days.
See this image and copyright information in PMC

References

    1. The Global Strategy for Diagnosis, Management and Prevention of COPD (updated 2023), the Pocket Guide. Available from: https://goldcopd.org/2023-gold-report-2/. Accessed September 14, 2023.
    1. Safiri S, Carson-Chahhoud K, Noori M, et al. Burden of chronic obstructive pulmonary disease and its attributable risk factors in 204 countries and territories, 1990–2019: results from the Global Burden of Disease Study 2019. BMJ. 2022;378:e069679. doi:10.1136/bmj-2021-069679 - DOI - PMC - PubMed
    1. Wedzicha JA, Miravitlles M, Hurst JR, et al. Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline. Eur Respir J. 2017;49(3):1600791. doi:10.1183/13993003.00791-2016 - DOI - PubMed
    1. Sadatsafavi M, Sin DD, Zafari Z, et al. The association between rate and severity of exacerbations in chronic obstructive pulmonary disease: an application of a joint frailty-logistic model. Am J Epidemiol. 2016;184(9):681–689. doi:10.1093/aje/kww085 - DOI - PMC - PubMed
    1. Hurst JR, Vestbo J, Anzueto A, et al. Susceptibility to exacerbation in chronic obstructive pulmonary disease. N Engl J Med. 2010;363(12):1128–1138. doi:10.1056/NEJMoa0909883 - DOI - PubMed

LinkOut - more resources