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Controversies and challenges in respiratory medicine
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. 1Department 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. 2Academic Unit of Respiratory Medicine, UCL Medical School, London, UK
  3. 3Department of Pneumology, Hospital Universitari Vall d"Hebron, Ciber de Enfermedades Respiratorias (CIBER), Barcelona, Spain
  4. 4Department of Research and Development, CIRO, Center of Expertise for Chronic Organ Failure, Horn, the Netherlands
  5. 5Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
  6. 6Department of Respiratory Medicine, University of Ferrara, Ferrara, Italy
  7. 7Department of Pulmonary Diseases, Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
  8. 8Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, the Netherlands
  9. 9Department 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}mumc.nl

http://dx.doi.org/10.1136/thoraxjnl-2020-215095

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    Introduction

    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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    Footnotes

    • Twitter @mlduiverman

    • Contributors SOS and HAMK were responsible for the design of the manuscript. All authors (SOS, JRH, MM, DJAJ, FF, AP, MLD, HAMK) were responsible for writing and revising the manuscript. All authors (SOS, JRH, MM, DJAJ, FF, AP, MLD, HAMK) approved the final version and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests SOS has received speaker fees from AstraZeneca and research grants from GlaxoSmithKline, all outside the submitted work. JRH has received support to attend meetings, and payment for advisory work and educational activity, personally or to his employer (UCL), from pharmaceutical companies that make medicines to treat COPD. These include AstraZeneca, Boehringer Ingelheim, Chiesi and GlaxoSmithKline, all outside the submitted work. MM has received speaker fees from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, Menarini, Rovi, Bial, Sandoz, Zambon, CSL Behring, Grifols and Novartis, consulting fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Bial, Gebro Pharma, Kamada, CSL Behring, Laboratorios Esteve, Ferrer, Mereo Biopharma, Verona Pharma, TEVA, Spin Therapeutics, pH Pharma, Novartis, Sanofi and Grifols, and research grants from GlaxoSmithKline and Grifols, outside the submitted work. FF has received support to attend meetings, speakers and consultancy fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis and TEVA; also he obtained research grants from AstraZeneca and Novartis. DJAJ has received speaker fees from AstraZeneca, Boehringer Ingelheim and Novartis in the previous 3 years. AP reports grants, personal fees, non-financial support and other from GlaxoSmithKline; grants, personal fees and non-financial support from AstraZeneca; grants, personal fees, non-financial support and other from Boehringer Ingelheim; grants, personal fees, non-financial support and other from Chiesi Farmaceutici; grants, personal fees, non-financial support and other from TEVA; personal fees, non-financial support and other from Mundipharma; personal fees, non-financial support and other from Zambon; personal fees, non-financial support and other from Novartis; grants, personal fees and non-financial support from Menarini; personal fees, non-financial support and other from Sanofi/Regeneron; personal fees from Roche, grants from Fondazione Maugeri, grants from Fondazione Chiesi, personal fees from Edmond Pharma, outside the submitted work. MLD reports grants, speaking fees and consultancy/advisory board participation from/for Philips, ResMed, Vivisol, Fisher and Paykel, and Novartis, and all outside the submitted work and paid to her institution. HAMK reports grants and consultancy/advisory board participation from/for Novartis, GlaxoSmithKline and Boehringer Ingelheim, and a grant from Chiesi, all outside the submitted work and paid to his institution.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.