Abstract
Introduction
It is anticipated that Chronic Obstructive Pulmonary Disease (COPD) has greater risk in acquiring COVID-19 infection and poorer outcome. However, current worldwide data are conflicting.
Objectives
This study primarily aims to compare the outcomes of COVID-19 patients with COPD and those without COPD in terms of length of hospital stay (LOS), recovery or mortality, treatment received, and predictors of mortality.
Methods
This is a retrospective cohort chart review of 1,017 admitted adult COVID-19 patients from July to December 2020. Age, gender, smoking status, current control and medications for COPD, COVID-19 severity, symptoms, treatment, and outcomes of the two study groups were compared.
Results
Prevalence rate of COPD was 3.8%. COVID-19 patients with COPD were older (median age of 69 vs 54, p<0.001), male (87% vs 50%, p<0.001), hypertensive (72% vs 48%, p=0.004), and with tuberculosis (31% vs 11%, p=0.002). COVID-19 patients with COPD more commonly needed oxygen therapy, High Flow Nasal Cannula, Mechanical Ventilation, Tocilizumab, Convalescent Plasma Therapy and Dexamethasone, and had longer LOS. Significant risk factors for mortality are malignancy, investigational therapies, smoking, and older age. There was no difference in survival rates between the two groups.
Conclusion
COPD increases the risk for severe COVID-19 and lengthens LOS.
Keywords: COVID 19, COPD, Chronic Obstructive Pulmonary Disease, mortality, predictors
BACKGROUND
The coronavirus disease 2019 (COVID-19) was first noted on December 2019 due to an outbreak in Wuhan, China and it has spread worldwide causing a pandemic virtually affecting almost all countries. It is an acute respiratory disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).1 Presenting manifestations as well as signs and symptoms of the disease are heterogenous and severity varies greatly in each individual.
Several studies have tackled various risk factors that could possibly affect the severity of COVID-19 infection in patients. Risk factors include age, high LDL level, and high D-dimer levels as well as presence of comorbidity.2 According to a study by Guan et al., 20-51% of patients admitted with COVID 19 infection have at least one of the following co-morbidity namely: diabetes (10-20%), hypertension (10-15%), and cardiovascular and cerebrovascular disease (7-40%).3 Co-morbidities were also seen more frequently in severe cases of COVID-19. Additionally, poorer prognosis is seen in patients with diabetes, hypertension, respiratory disease, cardiac disease, pregnancy, renal disease, and malignancy. They are more predisposed to adverse clinical outcomes especially if with COVID-19.3
It is anticipated that patients with pre-existing lung diseases such as asthma and chronic obstructive pulmonary disease (COPD) would be at greater risk in acquiring COVID-19 infection. Respiratory diseases are highly prevalent worldwide and reports indicate that about 65 million people suffer from COPD and 334 million people suffer from asthma.4 However, the incidence of COVID-19 in the said population is frequently lower than the prevalence of these conditions in the general population.1 It has been reported that the percentage of patients with COVID-19 infection with COPD is at 1.5-5% and those with asthma at 0-12.5%.1
The Philippines has 3,667,542 COVID-19 cases as of March 2022 and is 26th in the highest census worldwide. The Philippine General Hospital has been designated as a COVID-19 referral center since March 24, 2020 and has catered to at least 9,264 patients with COVID-19. To date, there is no local data or published studies regarding clinical profiles and outcomes of COVID-19 positive patients with COPD. The results of this study will help in further understanding the relationship of COVID-19 and Chronic Obstructive Pulmonary Disease (COPD).
OBJECTIVES
General Objectives
To compare outcomes between patients with pre-existing Chronic Obstructive Pulmonary Disease (COPD) infected with COVID-19 versus non-COPD patients infected with COVID 19
Specific Objectives
To determine the epidemiology of COPD patients infected with COVID-19 based on age, sex, current COPD control, COVID-19 disease severity, COVID-19 symptoms, treatment, and outcomes.
To determine the differences in outcomes in terms of length of hospital stay and mortality between COPD patients infected with COVID-19 versus non-COPD patents infected with COVID-19.
METHODS
Setting and Study Design
This retrospective cohort study was conducted in a COVID-19 national referral center and tertiary government hospital from July to December 2020. The study commenced after being approved by the local ethics committee.
Study Population
The study reviewed the charts of patients aged 19 years and above admitted for COVID-19 infection diagnosed with COVID-19 Real Time Reverse Transcription Polymerase Chain Reaction (RT-PCR) from July 2020 to December 2020. Patients were excluded in the study if: (1) Patients are clinically suspected with COVID-19 with no positive RT-PCR results; (2) Patients with incomplete or unavailable medical records (Figure 1).
Figure 1.
Flow diagram of patients included and excluded from the study.
Data Collection Procedure
All admitted adult COVID-19 patients in the Philippine General Hospital were included in the study. Gender, age, smoking status, COVID-19 symptoms, status, treatment and final management outcome, improved vs deceased, were obtained and recorded. For those who have concomitant COPD, information about the current control, medications used, and compliance were also extracted from patient medical records.
The diagnosis of COPD was based on either the physician’s assessment, prior COPD (clinically diagnosed and/or laboratory confirmed to have Chronic Obstructive Pulmonary Disease with or without treatment for at least six months), history of progressive and persistent dyspnea, and no diagnostics such as spirometry were used.
A data collection form via Microsoft Excel for ease of documentation was used to collect the necessary variables and outcomes needed in the study. The said data collection form was transcribed into the primary investigator’s laptop which is password protected. Only the investigator and research assistant were involved in reviewing the charts. All data was kept anonymous and no identifying codes that could link the data to the subject was made. In cases of incomplete or missing data, these were not included in the analysis.
All data transcribed were secured from the primary investigators’ laptop to a password-protected hard drive for safekeeping and was only accessible to the study team. This was kept in a secure location within the study site and it will be kept for a maximum of ten years after which it will be destroyed. The files will be deleted from the system and the hard drive used to store the data will be reformatted. All data transcribed were only shared with the statistician through secure means. Collection of data commenced last May 28, 2021 with approval from the Ethics Board.
Statistical Analysis
Descriptive statistics was used to summarize the general and clinical characteristics of the patients. Categorical variables were presented as frequency and proportion. Shapiro-Wilk was used to determine the normality distribution while Levene’s was used to test the homogeneity of variance of continuous variables. Skewed continuous quantitative data was reported as median and interquartile range (IQR). Statistical significance of differences between groups (with and without COPD) was evaluated by using the Mann-Whitney U test for skewed continuous data. Categorical variables were compared using Chi-square test. If the expected percentages in the cells are less than 5%, Fisher’s Exact test was used. Two-sided p-value at P <0.05 were considered significant. Data were encoded using Microsoft Excel version 16.58 (Microsoft, USA) and STATA version 15.0 (StataCorp SE, College Station, TX, USA) was used for data analysis.
RESULTS
A total of 1,503 charts were initially included in the study as these were those who were admitted from July to December 2020. Four hundred seventy-eight (478) were excluded due to incomplete data. One thousand twenty-five (1,025) charts were reviewed however there were seven patients who were re-admitted – six patients readmitted twice and one patient readmitted three times. Only the first admission was analyzed.
The 1,017 patients confirmed with COVID-19 were analyzed (Table 1). A total of 39 (3.8%) patients were diagnosed with COPD which is comparable to the prevalence of COPD in other studies which revealed a prevalence rate of 1.4-7.7%.1,5–9 However, the study by Gasmi et al. described the prevalence of COPD in COVID-19 patients to be only 0.95%10 while Bloom et al.’s analysis of data from the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) WHO Clinical Characterization Protocol UK (CCP-UK) study described a prevalence as high as 15.6%.11
Table 1.
Characteristics of COVID-19 Patients, by COPD Status (n=1017)
| All (n=1017) | No COPD (n=978) | With COPD (n=39) | p-value | |
|---|---|---|---|---|
|
| ||||
| Median (IQR); Frequency (%) | ||||
| Age, years | 55 (40-65) | 54 (40-64) | 69 (62-77) | <.001 * |
| <60 | 630 (61.95) | 624 (63.8) | 6 (15.38) | |
| ≥60 | 387 (38.05) | 354 (36.2) | 33 (84.62) | |
|
| ||||
| Sex | <.001† | |||
| Male | 522 (51.33) | 488 (49.9) | 34 (87.18) | |
| Female | 495 (48.67) | 490 (50.1) | 5 (12.82) | |
|
| ||||
| Comorbidities | ||||
| Hypertension | 500 (49.16) | 472 (48.26) | 28 (71.79) | .004 † |
| Diabetes mellitus | 283 (27.83) | 271 (27.71) | 12 (30.77) | .676† |
| Cardiovascular disease | 104 (10.23) | 97 (9.92) | 7 (17.95) | .108‡ |
| Chronic kidney disease | 81 (7.96) | 80 (8.18) | 1 (2.56) | .359‡ |
| Chronic liver disease | 11 (1.08) | 10 (1.02) | 1 (2.56) | .351‡ |
| Malignancy | 80 (7.87) | 77 (7.87) | 3 (7.69) | .999‡ |
| Asthma | 95 (9.34) | 93 (9.51) | 2 (5.13) | .572‡ |
| Past or present TB disease | 128 (12.59) | 116 (11.86) | 12 (30.77) | .002 ‡ |
|
| ||||
| Smoking history | <.001‡ | |||
| Never | 741 (72.86) | 741 (75.77) | 0 (0) | |
| Previous | 229 (22.52) | 197 (20.14) | 32 (82.05) | |
| Current | 47 (4.62) | 40 (4.09) | 7 (17.95) | |
|
| ||||
| Pack-years | 10 (4.75-30) | 10 (3-20) | 30 (20-50) | <.001* |
|
| ||||
| COVID-19 severity | <.001 † | |||
| Mild | 150 (14.75) | 150 (15.34) | 0 (0) | |
| Moderate | 224 (22.03) | 220 (22.49) | 4 (10.26) | |
| Severe | 310 (30.48) | 297 (30.37) | 13 (33.33) | |
| Critical | 333 (32.74) | 311 (31.8) | 22 (56.41) | |
|
| ||||
| Signs and symptoms | ||||
| Cough | 543 (53.39) | 515 (52.66) | 28 (71.79) | .019 † |
| Fever | 520 (51.13) | 503 (51.43) | 17 (43.59) | .337† |
| Shortness of breath | 105 (10.32) | 103 (10.53) | 2 (5.13) | .420‡ |
| Dyspnea | 335 (32.94) | 314 (32.11) | 21 (53.85) | .005† |
| Fatigue | 67 (6.59) | 65 (6.65) | 2 (5.13) | .999‡ |
| Anorexia | 48 (4.72) | 46 (4.7) | 2 (5.13) | .706‡ |
| Diarrhea | 109 (10.72) | 106 (10.84) | 3 (7.69) | .791‡ |
|
| ||||
| Diagnosis | - | |||
| Physician assessment | 39 (3.83) | - | 39 (100) | |
| Laboratory findings | 0 (0) | - | 0 (0) | |
|
| ||||
| Duration of COPD diagnosis | - | |||
| ≥6 months | 25 (2.46) | - | 25 (64.10) | |
| <6 months | 4 (0.39) | - | 14 (35.90) | |
|
| ||||
| GOLD Classification | - | |||
| GOLD A | 12 (1.18) | - | 12 (30.77) | |
| GOLD B | 2 (0.20) | - | 2 (5.13) | |
| GOLD C | 14 (1.38) | - | 14 (35.9) | |
| GOLD D | 11 (1.08) | - | 11 (28.21) | |
Statistical tests used:
– Mann-Whiney U test;
– Chi-square test;
– Fisher–s exact test.
The COVID 19 patients with COPD were older (median age of 69 vs 54, p<0.001), male (87% vs 50%, p<0.001), with history of hypertension (72% vs 48%, p=0.004) and tuberculosis (31% vs 11%, p=0.002). All COPD patients were smokers – both previous and current (100% vs 24%, p<0.001) with a median pack year of 30 pack years. These are similar to the findings in a study done in Wuhan, China wherein clinical characteristics of COVID-19 patients with COPD were older (median age 71 years old) and male.1 Similarly, findings by Calmes et al. also revealed that COVID-19 patients with COPD were more likely hypertensive.8 All COPD patients were smokers with a median pack year of 30 which is an expected finding. It is a well-established fact that smoking is one of the risk factors for development of COPD. It is said that 15-50% of smokers develop COPD and 80-90% of COPD patients are smokers or former smokers.5
COPD patients with COVID 19 tend to have moderate to severe COVID as compared to those without COPD. Most of COVID-19 with COPD presented with cough (72% vs 53%, p=0.019). This finding is similar to several studies which state that COPD is a significant risk for severe COVID-19 infection to as high as a fivefold increase risk or 88% higher risk for severe disease.1,4-6,10,12-15 Cough was also noted to be a frequent manifestation of COPD patients with COVID-19 which is not surprising since COPD patients suffer from chronic cough and sputum production. Fever, headache, cough, and myalgia were the most common presenting symptoms in patients with asthma and COPD with COVID-198 however, shortness of breath was the frequent symptom of COVID-19 patients with COPD1.
All COPD patients were diagnosed via physician assessment and most of them were diagnosed within the last 6 months (64%). About 12% of the COPD population was under GOLD A Classification, 2% under GOLD B Classification, 14% under GOLD C Classification, and 11% under GOLD D Classification. COPD can be diagnosed based on history, symptomatology and spirometry to establish the presence of airflow limitation.16 Spirometeric testing has been limited in the midst of the pandemic due to issues with aerosolization and spread of infection16 hence diagnosis was based on physician assessment from history and physical examination.
Table 2 illustrates management and outcomes of patients based on COPD status. Patient with COPD more commonly needed oxygen therapy (80% vs 56%, p=0.004), High Flow Nasal Cannula (HFNC) use (44% vs 21%, p=0.001), Mechanical Ventilation (33% vs 20%, p=0.040), Tocilizumab (33% vs 19%, p=0.021), Convalescent Plasma Therapy (18% vs 6%, p=0.013), and Dexamethasone (82% vs 52%, p<0.001). The length of hospital stay of those with COPD was significantly longer with a median stay of 14 days as compared to those without COPD with median stay of 12 days. Median length of hospital stay for those with mild to moderate COVID is at 10 days while those with severe COVID-19 stayed for a median of 16 days and those with critical COVID at 13 days. However, there was insufficient evidence to distinguish a difference in the survival rates of those without COPD (79%) and those with COPD (69%). This finding is comparable to the study of Calmes et al. which showed that COPD was a predictor of death in the univariate analysis but not in the age and sex adjusted and multivariate analysis8 and in the systematic review and meta-analysis done by Gerayeli et al. in which there is no sufficient evidence that
Table 2.
Management and Outcomes of Patients, by COPD Status
| All (n=1017) | No COPD (n=978) | With COPD (n=39) | P | |
|---|---|---|---|---|
|
| ||||
| Frequency (%); Median (IQR) | ||||
| COVID-19 management | ||||
| Oxygen therapy | 583 (57.33) | 552 (56.44) | 31 (79.49) | .004 † |
| HFNC | 219 (21.53) | 202 (20.65) | 17 (43.59) | .001 † |
| Mechanical ventilation | 207 (20.35) | 194 (19.84) | 13 (33.33) | .040 † |
| Remdesivir | 162 (15.93) | 153 (15.64) | 9 (23.08) | .214† |
| Tocilizumab | 194 (19.08) | 181 (18.51) | 13 (33.33) | .021 † |
| Convalescent plasma therapy | 69 (6.78) | 62 (6.34) | 7 (17.95) | .013 ‡ |
| Hemoperfusion | 63 (6.19) | 62 (6.34) | 1 (2.56) | .507‡ |
| Dexamethasone | 545 (53.59) | 513 (52.45) | 32 (82.05) | <.001 † |
|
| ||||
| Hospital days | 12 (7-17) | 12 (7-17) | 14 (9-22) | .024 * |
| Mild COVID [n=150] | 10 (5-12) | 10 (5-12) | - | - |
| Moderate COVID [n=224] | 10 (7-14) | 10 (7-14) | 10 (8.5-13) | .867* |
| Severe COVID [n=310] | 16 (11-22) | 13 (9-18) | 16 (11-22) | .408* |
| Critical COVID [n=333] | 13 (6-20) | 13 (6-20) | 15.5 (10-22) | .174* |
|
| ||||
| Readmission | 7 (0.69) | 7 (0.72) | 0 (0) | .999‡ |
|
| ||||
| Mortality | 218 (21.44) | 206 (21.06) | 12 (30.77) | .148† |
| Mild COVID-19 [n=150] | 2 (1.33) | 2 (1.33) | - | .999‡ |
| Moderate COVID-19 [n=224] | 4 (1.79) | 4 (1.82) | 0 (0) | .999‡ |
| Severe COVID-19 [n=310] | 17 (5.48) | 17 (5.72) | 0 (0) | .693† |
| Critical COVID-19 [n=333] | 195 (58.56) | 183 (58.84) | 12 (54.55) | |
Statistical tests used:
– Mann-Whiney U test;
– Chi-square test
– Fisher’s exact test.
COPD is related to mortality after adjusting for age and sex17. However, this is a different finding from several studies wherein patients with COPD have an increased mortality rate (54-60%) as compared to patients without underlying respiratory conditions.7,9,11,13-14 Differences in results may be due to difference in the population of the studies as well as prevalence of COPD in the study population.
About 218 (21.44%) patients died and mortality rates in the COPD group and non-COPD group were at 30.77% and 21.06%, respectively as shown in Table 3. A study done in Leige, Belgium also had similar outcomes where 34.8% of COVID-19 patients with COPD died.8 Using the GOLD grade, in hospital mortality rate were as follows 8.33% for GOLD A, 50% for GOLD B, 28.57% for GOLD C and 54.55% for GOLD D patients.
Table 3.
Mortality among Patients, by COPD Status and Severity
| N | Fatality | Proportion (95% CI) | |
|---|---|---|---|
| No COPD | 978 | 206 | 21.06 (18.55–23.76) |
|
| |||
| With COPD | 39 | 12 | 30.77 (17.02–47.57) |
| GOLD A | 12 | 1 | 8.33 (0.21–38.48) |
| GOLD B | 2 | 1 | 50 (1.26–98.74) |
| GOLD C | 14 | 4 | 28.57 (8.39–58.10) |
| GOLD D | 11 | 6 | 54.55 (23.38–83.25) |
Table 4 shows a univariate analysis for risk factors of mortality. Age, presence of hypertension, diabetes mellitus, malignancy, history of tuberculosis, positive smoking history, and use on investigational therapies for COVID-19 such as Remdesivir, Tocilizumab, Dexamethasone or combination of all were significantly associated with mortality. There was no sufficient evidence to support that COPD is a significant predictor of in-hospital mortality.
Table 4.
Univariate Analysis for Risk Factors of Mortality
| Died (n=218) | Survived (n=799) | Crude OR (95% CI) | p | |
|---|---|---|---|---|
| COPD | 12 (5.5) | 27 (3.38) | 1.666 (0.83-3.34) | .151 |
|
| ||||
| Age, years | 60 (47-69) | 53 (38-64) | 1.024 (1.02-1.03) | <.001 |
|
| ||||
| Male | 121 (55.5) | 401 (50.19) | 1.238 (0.92-1.67) | .164 |
|
| ||||
| Any comorbidity | 176 (80.73) | 549 (68.71) | 1.908 (1.32-2.76) | .001 |
| Hypertension | 120 (55.05) | 380 (47.56) | 1.350 (0.99-1.82) | .050 |
| Diabetes mellitus | 68 (31.19) | 215 (26.91) | 1.231 (0.89-1.71) | .211 |
| Cardiovascular disease | 21 (9.63) | 83 (10.39) | 0.920 (0.56-1.52) | .744 |
| Chronic kidney disease | 21 (9.63) | 60 (7.51) | 1.313 (0.78 (2.21) | .306 |
| Chronic liver disease | 5 (2.29) | 6 (0.75) | 3.103 (0.94-10.26) | .064 |
| Malignancy | 39 (17.89) | 41 (5.13) | 4.028 (2.52-6.43) | <.001 |
| Asthma | 19 (8.72) | 76 (9.51) | 0.908 (0.54-1.54) | .720 |
| History of TB disease | 38 (17.43) | 90 (11.26) | 1.663 (1.10-2.51) | .016 |
|
| ||||
| Smoking history | 79 (36.24) | 197 (24.66) | 1.737 (1.26-2.39) | .001 |
|
| ||||
| COVID-19 management | ||||
| Remdesivir | 50 (22.94) | 112 (14.02) | 1.826 (1.26-2.65) | .002 |
| Tocilizumab | 77 (35.32) | 117 (14.64) | 3.183 (2.27-4.47) | <.001 |
| Convalescent plasma therapy | 16 (7.34) | 53 (6.63) | 1.115 (0.62-1.99) | .713 |
| Dexamethasone | 182 (83.49) | 363 (45.43) | 6.072 (4.14-8.91) | <.001 |
| Remdesivir/CPT/Dexamethasone/TCZ | 186 (85.32) | 381 (47.68) | 6.378 (4.27-9.51) | <.001 |
Logistic models are presented in Table 5, one with full predictors and another with only significant factors retained. In the former model, COPD status was not predictive of outcome of mortality (P = .267). In the latter, predicted odds of mortality inflated nearly five-fold (95% CI 2.79-7.93) in the presence of malignancy; six-fold (95% CI 3.94-9.14) if with management by remdesivir, tocilizumab, dexamethasone, or CPT; by 63.9% (95% CI 16%-132%) if with smoking history; and by 1.1% (95% CI 0.06%-2%) for every additional year of patient age. As with previous studies, presence of comorbidities conferred a higher risk for severe outcomes and mortality for the patient with COVID-19.1-2,4-6,10,17-20 Smoking as a risk factor for severe disease and mortality in patients with COVID-19 infection has been described in previous literature.5–6,10 In a systematic review and meta-analysis by Alqahtani, it was found that 22.3% of current smokers and 46% of ex-smokers had severe complications and mortality rate up to 38.5% in current smokers. Current smokers with 1.45 times more likely to have severe disease compared to former and never smokers.6 In a meta-analysis by Shi et al., current smokers with COVID-19 infection were 2.95 times more likely to die than non-smokers.19
Table 5.
Multivariate Analysis for Risk Factors of Mortality
| Model 1 | Model 2 | |||
|---|---|---|---|---|
|
|
|
|||
| Adjusted OR (95% CI) | P | Adjusted OR (95% CI) | P | |
| COPD | 0.635 (0.28-1.42) | .267 | - | - |
|
| ||||
| Age, years | 1.014 (1.002-1.03) | .023 | 1.011 (1.0006-1.02) | .039 |
|
| ||||
| Male | 1.053 (0.73-1.51) | .780 | - | - |
|
| ||||
| Any comorbidity | ||||
| Hypertension | 0.881 (0.6-1.29) | .516 | - | - |
| Diabetes mellitus | 1.039 (0.71-1.52) | .845 | - | - |
| Cardiovascular disease | 0.675 (0.39-1.18) | .170 | - | - |
| Chronic kidney disease | 1.176 (0.64-2.15) | .597 | - | - |
| Chronic liver disease | 1.75 (0.44-6.98) | .428 | - | - |
| Malignancy | 4.421 (2.58-7.59) | <.001 | 4.702 (2.79-7.93) | <.001 |
| Asthma | 0.949 (0.53-1.7) | .861 | - | - |
| Past or present TB disease | 1.398 (0.87-2.24) | .163 | - | - |
|
| ||||
| Smoking history | 1.692 (1.14-2.52) | .010 | 1.639 (1.16-2.32) | .005 |
|
| ||||
| Remdesivir/CPT/Dexamethasone/TCZ | 6.153 (4.02-9.41) | <.001 | 5.997 (3.94-9.14) | <.001 |
|
| ||||
| Pseudo-R2 | 15.28%, P <.001 | 14.67%, P<.001 | ||
Model 1: All variables were included in the multivariable logistic regression.
Model 2: Backward logistic regression was employed.
DISCUSSION
The prevalence of COPD in the study is comparable to the prevalence of COPD in other studies as previously stated. Majority of the patients were diagnosed within the last six months mostly because COPD may be under recognized and underdiagnosed in the community especially in a developing country like the Philippines leading to its diagnosis only when the patient seeks consult in the hospital for another reason such as in this case for COVID-19 infection.
COVID patients with COPD were older, male, smokers, with history of hypertension. They more commonly required oxygen support, HFNC, mechanical ventilation, Tocilizumab, Convalescent plasma therapy, and Dexamethasone, and had a longer median length of hospital stay at 14 days. This may be due to the fact that COPD patients have moderate to severe COVID thus needing more intensive treatment as compared to those without COPD.
Mortality rates for patient with COPD and without COPD from this study was consistent to other studies done. Upon analysis of mortality in GOLD grades, those under GOLD B and GOLD D were higher and this may be due to the fact that patients under GOLD B and GOLD D are more symptomatic probably due to poor symptom control from medications or more severe disease.16 COPD was not a predictive outcome of mortality but smoking is a risk factor for severe disease.
This current study has several limitations. The time frame of admission of the patients included in the study spanned only six months. A longer time frame and subsequently a larger sample size would probably include more COPD patients and it would also show us the effect of the previous two surges of COVID-19 cases specifically from the Delta and Omicron variant on COPD. The diagnosis of COPD was based mostly on physician assessment and not on spirometry, and results from this study are not comparable to those derived from more objective definitions of COPD.
CONClUSION
COPD patients are at increased risk for severe disease and longer length of hospital stay but the presence of COPD as a comorbidity does not have a significant association with mortality. Significant predictors for mortality include older age, smoking, presence of malignancy, and use of investigational therapy (Remdesivir, Tocilizumab, CPT or Dexamethasone).
Statement of Authorship
Both authors certified fulfillment of ICMJE authorship criteria.
Author Disclosure
Both authors declared no conflicts of interest.
Funding Source
This study was self-funded by the author and did not receive any grant from any institution or pharmaceutical company.
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