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Caring for patients with COPD and COVID-19: a viewpoint to spark discussion
  1. Sami O Simons1,
  2. John R Hurst2,
  3. Marc Miravitlles3,
  4. Frits M E Franssen1,4,
  5. Daisy J A Janssen4,5,
  6. Alberto Papi6,
  7. Marieke L Duiverman7,8,
  8. Huib A M Kerstjens8,9
  1. 1 Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
  2. 2 Academic Unit of Respiratory Medicine, UCL Medical School, London, UK
  3. 3 Department of Pneumology, Hospital Universitari Vall d"Hebron, Ciber de Enfermedades Respiratorias (CIBER), Barcelona, Spain
  4. 4 Department of Research and Development, CIRO, Center of Expertise for Chronic Organ Failure, Horn, the Netherlands
  5. 5 Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
  6. 6 Department of Respiratory Medicine, University of Ferrara, Ferrara, Italy
  7. 7 Department of Pulmonary Diseases, Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
  8. 8 Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, the Netherlands
  9. 9 Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
  1. Correspondence to Dr Sami O Simons, Department of Respiratory Medicine, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands; sami.simons{at}

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Coronavirus SARS-CoV-2 is currently causing a pandemic of COVID-19, with more than 3 million confirmed cases around the globe identified as of June 2020. During these extraordinary times, caring for patients with COVID-19 and underlying COPD poses particular challenges. Certain treatments relevant to treating patients with COPD, such as nebulised bronchodilators and non-invasive ventilation (NIV), are thought to carry an increased risk of viral spread via aerosols. Uncertainties on whether to use systemic steroids have entered the minds of intensive care and respiratory communities. Moreover, questions regarding which life-sustaining treatments to start, when to start them and even whether to start them are faced by clinicians on a daily basis. Treating COPD effectively in the context of COVID-19 is important since patients with COPD are at an increased risk of poor outcomes. Here, we summarise current viewpoints from four European countries on how to care for patients with COPD and COVID-19.

We will address the following specific questions:

  1. Are patients with COPD at an increased risk of COVID-19?

  2. Should COVID-19 be considered a COPD exacerbation?

  3. What is the optimal medical treatment for a patient with COPD and COVID-19?

  4. Which ventilatory support should be provided to patients with COPD and COVID-19?

  5. What other supportive treatments should be offered to patients with COPD and COVID-19?

  6. How should end-of-life care be delivered in patients with COPD during the COVID-19 pandemic?

Are patients with COPD at an increased risk for COVID-19?

Since patients with COPD are vulnerable to viral respiratory tract infections, and COPD is generally a disease of the elderly, many had expected that patients with COPD would have a considerably increased risk of acquiring COVID-19. Studies so far, however, indicated only around 2% of patients admitted to hospital with COVID-19 infection in China had underlying COPD,1 2 while the prevalence of COPD in China ranges from 5% to 13%.3 Indeed, …

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