COPD and COVID

For those who are living with or caring for someone with chronic obstructive pulmonary disease (COPD), it’s important to be aware of the risks that COVID-19 could pose. This article explains how COPD sufferers can stay as healthy as possible to minimize the risk of catching COVID-19. 

What are COPD and COVID-19?

Coronavirus, known as COVID or COVID-19 for short, is an infectious disease that’s been spreading throughout the world, causing a global pandemic. For many people, the symptoms are mild, but for older age groups, those with weakened immune systems, or those with existing long-term underlying health conditions, it can be more severe.

That’s certainly the case for those living with the long-term condition COPD, the name given to a group of lung conditions that cause breathing problems, such as chronic bronchitis and emphysema. Research has shown that the risk of suffering from severe breathing problems, complications, and a need for hospitalization with COVID-19 is higher with COPD. 

The main symptoms of COVID-19 include:

  • A new continuous cough
  • High temperature
  • Shortness of breath
  • Loss of taste or smell.

Most people who have Coronavirus will have at least one of these symptoms. 

If you have any of the symptoms of Coronavirus, get a test as soon as possible. In the meantime, you and anyone else living in your household should self-isolate by staying at home until you receive the test result. You should not attend work if you have any potential symptoms of coronavirus. 

How could Coronavirus affect you if you have COPD?

For those living with COPD, the respiratory and lung symptoms of COVID-19 run the risk of having a much bigger impact than for those who don’t have COPD. It’s already well recognized that influenza (flu) can cause serious problems if you have COPD, such as increasing the risk of pneumonia, and the case is similar for COVID-19. 

Chronic bronchitis and emphysema, which are breathing problems caused by COPD, both cause damage to the lungs. Chronic bronchitis causes long term inflammation of the airways, whilst emphysema damages the air sacs in the lungs. The immune system can also be affected, so an infection such as COVID-19 will leave COPD patients finding it much harder to fight it off. 

In addition to the symptoms of COVID-19, your usual symptoms of COPD could worsen, causing severe shortness of breath and difficulty breathing. The decreased lung function makes complications such as pneumonia more likely and if breathing becomes very badly affected, you may need to go to a hospital. 

Why might Coronavirus affect you more if you have COPD? 

Research into the exact reasons why COPD increases the risk of severe COVID-19 is ongoing, but early studies indicate several factors. These factors include:

  • Levels of the protein ACE-2 (angiotensin converting enzyme-2) – people with COPD tend to have increased levels of ACE-2 in their lower respiratory tract and the COVID-19 virus uses this protein to bind onto
  • Susceptibility to viruses – if you have COPD, you’re known to be susceptible to viral respiratory infections, of which COVID-19 is one example 
  • Immune dysfunction – COPD causes immune dysfunction, making it harder for your body to fight infections
  • Age – COVID-19 tends to be worse for patients who are older and COPD is more common in older people 
  • Underlying conditions – you’re more likely to get COVID-19 if you are already suffering from an existing or underlying health condition, such as COPD, which compromises pulmonary function. 

What risks does it pose? 

COPD is a severe lung disease and COVID-19 also affects breathing. Studies show that catching COVID-19 when you have COPD increases the risk of requiring hospitalization and intensive care unit (ICU) treatment. It also increases the risk of death from COVID-19, especially if you also smoke

However, having COPD doesn’t automatically mean you’ll catch COVID-19. One study found that only about 2% of people admitted to hospital with COVID-19 in China had underlying COPD (the overall incidence of COPD in China ranges from 5-13%). 

Another recent study showed a lower number of patients in hospitals with COPD and COVID-19 than those with just COVID. Some people suggest that perhaps COPD patients are successfully implementing measures, such as social distancing and wearing face-covering, to avoid catching COVID-19. 

How to reduce the risks?

If you are living with COPD it’s important to be extra careful to minimize your risk of catching COVID-19. Here are some practical steps you can take to reduce your risk of getting coronavirus:  

  • Wear a face-covering – wearing a face-covering, such as a face mask or visor, will reduce the risk of breathing in droplets carrying the virus. A face covering also helps you reduce the spread of the infection by protecting anyone you come into contact with. Remember to wash your face covering regularly.
  • Practice social distancing – keeping a distance from other people when you’re out helps to reduce the spread of COVID-19. Check the government advice in your area for the current recommended social distance.
  • Avoid crowded places – avoid meeting up with groups of people either indoors or outside.
  • Wash your hands often – keep washing your hands often with soap and warm water and use alcohol hand gel if you’re out.
  • Manage your COPD well – if your COPD is well managed and controlled, then your risk of having complications with COVID-19 is reduced. Follow your self-management plan, continue taking all your oral medication and inhalers as guided by your doctor, and don’t change your health routine unless advised to.
  • Have enough medication – make sure you have enough medication at home in case you have a COPD flare-up and need to take steroids or antibiotics. Signs of a flare-up include an increase in breathlessness, coughing, and phlegm. 
  • Clean your equipment – don’t forget to regularly clean the equipment you use, such as spacers, peak flow meters, and nebulizers. Use washing-up liquid or follow the recommended instructions provided. 
  • Avoid triggers – do your best to avoid contact with any known triggers that can exacerbate your COPD, such as cigarette smoke, chemicals, or fumes. 
  • Avoid public transport – if you are employed and aren’t able to work at home, try to avoid using public transport where possible. 
  • Shielding – if you are advised to practice shielding, follow the guidance you’re given. 
  • Stop smoking – if you’re a smoker, try to quit. Not only will it help you manage your COPD, but it will also reduce your risk of COVID-19.

If you care for someone with COPD, be aware that airway clearance techniques to induce phlegm or sputum can introduce potentially infectious droplets into the environment. So, the person using the techniques should do so in a well-ventilated room away from other people to reduce the risk of unintentionally spreading infection.  

Recovering 

COVID-19 is still a new virus, so research and understanding into the effects and how people recover is still ongoing. 

Often COVID-19 involves pneumonia, and it’s already known that pneumonia on its own can take COPD patients weeks or months to recover from, which indicates how much COVID-19 can impact lives. Research suggests that recovery from COVID-19 is a gradual process and may involve ups and downs. It’s normal to experience some post-COVID-19 symptoms, such as fatigue, continued loss of smell and taste, and breathlessness. 

Every case is individual and it depends on factors such as the stage of your COPD, your age, and how severe your COVID-19 was. 

COVID-19 can affect both the body and mind and it’s not unusual to experience mental and emotional issues, such as fear, worry, or anxiety after you’ve had COVID-19. 

Be guided by your medical professionals as to how you can best recover from your COVID-19 experience, while also managing your usual COPD symptoms. Don’t put pressure on yourself to do too much and take each day as it comes. If you feel you could benefit from a listening ear or additional mental health support, ask your doctor about psychological or talking therapies.

 

SOURCES

Attaway AA, Zein J and Hatipoglu US. SARS-CoV-2 infection in the COPD population is associated with increased healthcare utilization: An analysis of Cleveland’s clinic’s COVID-19 registry. The Lancet; vol 26: 100515, September 1 2020. DOI:https://doi.org/10.1016/j.eclinm.2020.100515

British Lung Foundation. Coronavirus and COVID-19

British Lung Foundation. How will I recover if I’ve had coronavirus

Higham A, Mathioudakis A, Vestbo J, Singh D. COVID-19 and COPD: a narrative review of the basic science and clinical outcomes.  Eur Respir Rev. 2020 Nov 5;29(158):200199. doi: 10.1183/16000617.0199-2020. 

Leung JM, Niikura M, Yang CWT et al. COVID-19 and COPD. European Respiratory Journal 2020 56: 2002108; DOI: 10.1183/13993003.02108-2020

NICE. 2020. COVID-19 rapid guideline: community-based care of patients with chronic obstructive pulmonary disease (COPD). 

NICE. Chronic obstructive pulmonary disease in adults

 

Olloquequi J. COVID-19 Susceptibility in chronic obstructive pulmonary disease. Eur J Clin Invest. 2020 Oct;50(10):e13382. doi: 10.1111/eci.13382. Epub 2020 Sep 2. PMID: 32780415; PMCID: PMC7435530.

Simons SO, Hurst JR, Miravitlles M et al. Caring for patients with COPD and COVID-19: a viewpoint to spark discussion. Thorax. September 2 2020. 10.1136. http://dx.doi.org/10.1136/thoraxjnl-2020-215095 

Sin DD. COVID-19 in COPD: A growing concern. The Lancet. September 19 2020. https://doi.org/10.1016/j.eclinm.2020.100546 

Venkata VS, Kiernan G. COVID-19 and COPD: pooled analysis of observational studies. Presented at: the CHEST Virtual Annual Meeting; October 18-21, 2020. Abstract 2469.

Your Covid Recovery. NHS