| Summary: | William Toppen,1,* Peter Yan,2,* Daniela Markovic,3 Carolyn M Shover,4,5 Russell G Buhr,4,6 Jennifer A Fulcher,6,7 Donald P Tashkin,4 Igor Barjaktarevic4 1Section of Hospital Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA; 2David Geffen School of Medicine, University of California, Los Angeles, CA, USA; 3Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, CA, USA; 4Division of Pulmonary, Critical Care and Sleep Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA; 5Offsite Care, Santa Rosa, CA, USA; 6Department of Medicine, Greater Los Angeles Veterans Affairs Health Care System, Los Angeles, CA, USA; 7Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, USA*These authors contributed equally to this workCorrespondence: Igor Barjaktarevic, 10833 Le Conte Avenue, 43118 CHS, Los Angeles, CA, 90095, Email ibarjaktarevic@mednet.ucla.eduBackground: Chronic obstructive pulmonary disease (COPD) is associated with worsened outcomes in COVID-19 (coronavirus disease 2019). However, data remain fraught with heterogeneity and bias from comorbid conditions. Additionally, data on the impact of COPD-specific factors, such as pre-hospital medications and pulmonologist involvement, remain sparse.Objective: We report a single-center analysis of COPD patients hospitalized with COVID-19 compared to those without COPD. Primary outcomes include ICU admission, mechanical ventilation, and in-hospital mortality.Methods: We evaluated all patients ≥ 40 years admitted with PCR-confirmed COVID-19 between February 2020 and February 2021. COPD was defined by documented ICD-10 diagnosis of COPD, confirmed smoking history, and active bronchodilator use. We compared outcomes between COPD patients and the remainder of the COVID-19 cohort. Multivariable analyses were adjusted for age, sex, smoking status, and comorbid conditions.Results: Of 1537 hospitalized COVID-19 patients, 122 (7.9%) carried a diagnosis of COPD. The COPD cohort was older (74 ± 13 vs 66 ± 15 years, P < 0.001) and more often former smokers (P < 0.001). Comorbid conditions including diabetes, cardiovascular disease, and kidney disease were more prevalent in the COPD group (P < 0.001). After adjusting for comorbid conditions, the COPD cohort had higher severity scores and trended towards fewer hospital-free days. Among patients with COPD, pre-hospital use of aspirin was associated with decreased ICU admissions (aHR 0.56, P = 0.049) and mechanical ventilation (aHR 0.25, P = 0.008), while LAMAs (long-acting muscarinic antagonists) were associated with decreased in-hospital mortality (aHR 0.34, P = 0.047). Involvement of pulmonology in pre-hospital management of COPD was not found to significantly affect outcomes.Conclusion: When corrected for comorbid illnesses, COPD was associated with more severe disease but not with increased ICU admission, mechanical ventilation, or in-hospital mortality rates. Among COPD patients, prehospital treatment with aspirin and COPD-directed therapies were associated with improved outcomes.Keywords: COVID-19, COPD, survival, critical illness, ARDS
|
|---|