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. 2025 Mar 27;26(1):116.
doi: 10.1186/s12931-025-03123-x.

Risk of acute exacerbation of chronic obstructive pulmonary disease after COVID-19 recovery: a nationwide population-based cohort study

Sang Hyuk Kim #  1   2 , Hyun Lee #  3 , Min Ji Kim #  4   5 , Youlim Kim  6 , Kyung Hoon Min  2 , Kwang Ha Yoo  6 , Jong Seung Kim  7   8   9 , Ji-Yong Moon  10   11
Affiliations

Risk of acute exacerbation of chronic obstructive pulmonary disease after COVID-19 recovery: a nationwide population-based cohort study

Sang Hyuk Kim et al. Respir Res. .

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is associated with severe Coronavirus disease 2019 (COVID-19) outcomes. However, it is uncertain whether the risk of acute exacerbation of COPD (AECOPD) increases after recovering from COVID-19.

Methods: This study included 2,118 individuals with COPD from the Korea National Health Insurance Service database who were also diagnosed with COVID-19. Matched controls were chosen using 1:1 propensity score (PS) matching. We compared the risk of AECOPD after COVID-19 recovery between the COVID-19 cohort and matched controls between October 8, 2020, and December 31, 2021, using PS-matched Cox proportional hazard regression models.

Results: During a median follow-up of 62 days (interquartile range, 29-179 days), including a median of 14 days of recovery time after COVID-19, 68 people (5.6%) in the COVID-19 cohort and 50 (3.9%) in the matched control group experienced AECOPD. Compared to the matched controls, the COVID-19 cohort had a significantly higher risk of overall AECOPD (hazard ratio [HR] = 1.45, 95% confidence interval [CI] = 1.09-1.92). This increased risk was particularly evident for severe AECOPD among individuals who had severe COVID-19 within the first 30days post-recovery (aHR = 8.14, 95% CI = 3.32-19.97). When classified by COVID-19 severity, while severe COVID-19 significantly increased this risk (aHR = 2.97, 95% CI = 2.15-4.11), non-severe COVID did not significantly influence the risk of AECOPD, regardless of time duration or exacerbation severity.

Conclusion: Individuals with COPD who had severe COVID-19 have increased risk of AECOPD after COVID-19 recovery, especially within the first 30 days after COVID-19 recovery.

Keywords: Coronavirus; Exacerbation; Lung Disease, Obstructive; Pulmonary Disease, Chronic Obstructive.

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Conflict of interest statement

Declarations. Ethics approval: The study protocol was approved by the Institutional Review Board of Hanyang University Hospital (No. 2023-03-008). The requirement for informed consent was waived because all patient records were anonymized before use. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of the study population Abbreviations: COPD = chronic obstructive pulmonary disease, COVID-19 = Coronavirus disease 2019, PS = propensity score
Fig. 2
Fig. 2
Cumulative incidence of AECOPD after COVID-19 recovery. The dashed lines represent a 3% cumulative incidence. The p-value was calculated using a log-rank test. (A) Overall exacerbation, (B) non-severe AECOPD, and (C) severe AECOPD
See this image and copyright information in PMC

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