Prevalence of COPD lower than expected in one study

The prevalence of chronic obstructive pulmonary disease (COPD) was lower than expected in a pooled analysis involving more than 11,000 patients hospitalized for Covid-19; however, having COPD was associated with a higher risk for death, researchers found.

Meanwhile, in a separate analysis, researchers from Memorial Sloan Kettering Cancer Center in New York City reported a high rate of mechanical ventilation and death among critically ill cancer patients with respiratory failure due to Covid-19.

These studies were two of several examining the impact of co-morbid conditions on Covid-19 morbidity and mortality presented at CHEST 2020 — the virtual annual meeting of the American College of Chest Physicians, held Oct. 18-21.

In the COPD analysis, hypertension was the most common comorbidity among the cohort — occurring in 42% of the hospitalized patients — followed by diabetes mellitus, which was present in 23% of patients.

While the global prevalence of COPD is estimated to be slightly greater than 9% among adults who are 40 years of age or older, just 5% of the Covid-19 patients in the pooled cohort were also COPD patients. And, notably, among the patients with cancer or a recent history of cancer admitted to ICUs for Covid-19 pneumonia, 68% required prolonged mechanical ventilation and 39% died.

In the cancer study, “Nearly 40% of cancer patients with Covid-19 in our study did not survive after developing acute respiratory failure requiring mechanical ventilation in the ICU,” said lead researcher Michael Dang, MD, of Memorial Sloan Kettering, in a press release.

Although the research is limited, earlier studies examining Covid-19 outcomes have shown worse outcomes and greater mortality in patients with COPD and cancer compared to patients without the conditions.

The Covid-19 and COPD study presented at CHEST 2020 included pooled data from 22 studies conducted in 8 countries, involving more than 11,000 patients hospitalized for Covid-19.

Researchers Vikramaditya Samala Venkata and Gerard Kiernan conducted a systematic electronic search to identify retrospective studies involving patients hospitalized with Covid-19.

COPD was present in 5% of the patients and was associated with higher rates of death (OR 3.23, 95% CI, 1.59-6.57; P<0.05). The researchers added that, while 37% of patients were smokers, smoking was not associated with worsening disease severity (OR 1.52, 95% CI, 0.81-2.87; P=0.20).

“While one would expect patients with prior lung disease to have greater mortality with Covid-19, it is curious to see that the prevalence of COPD was lower than the general population (global prevalence is patients >40 years is estimated to be around >9%) and may reflect greater measures taken by COPD patients to avoid coronavirus exposure,” the researchers wrote.

They further noted that the reason for the observed lack of association between smoking and more severe Covid-19 is unclear and deserves further study.

The study of Covid-19 outcomes among cancer patients included adult patients with active or recent history of cancer and confirmed Covid-19 who developed acute hypoxemic respiratory insufficiency or respiratory failure who were admitted to two ICUs at Memorial Sloan Kettering between March 16 and May 27.

The hospital adopted an early-intubation strategy during the first 4 weeks and a waiting period of 4 weeks before considering a tracheostomy, and pressure control ventilation and targeted tidal volume of 6 ml/kg predicted body weight and moderate to high PEEP was standard practice.

During the study period, a total of 290 patients were admitted to the two ICUs with Covid-19 pneumonia, including 90 (31%) patients with active (n=87) or recent (n=3) history of cancer.

The mean patient age was 65 years; 60% were male, 67% were White; 49% had hypertension, 29% had diabetes mellitus; and 50% had a smoking history. Fifty-two (63%) had solid tumors and 38 (37%) had hematologic malignancies. Advanced stage non-small cell lung carcinoma and breast carcinomas were the most frequent solid tumors and leukemia and lymphoma were the most common hematologic cancers. Vasopressors were required in 38 (42%) patients and continuous renal replacement therapy (CRRT) in 8 (9%).

In-hospital treatments for Covid-19 included remdesivir in 20%, convalescent plasma in 12%, hydroxychloroquine in 37%, azithromycin in 35%, corticosteroids in 56%, IL-6 inhibitors in 6%, and IL-1 receptor antagonists in 1%.

Acute respiratory failure (ARF) leading to invasive mechanical ventilation (MV) developed in 61 patients (68%) with a mean of 25 days on MV. Prone positioning (self or during MV) was implemented in 44 patients (49%). Eighteen patients (30%) were extubated after a mean of 11.5 days and 16 (26%) underwent a tracheostomy, 10 of whom (63%) were successfully removed from mechanical ventilation. Thirty-six patients (40%) had a Do-Not-Resuscitate Order during their ICU stay.

As of May 27, 24 (39%) of the 61 patients who required MV had died compared to 5 (17%) of the 29 non-ventilated patients. 40 patients (44%) were discharged and 25 (28%) remain hospitalized.

“More than a third of cancer patients who developed acute respiratory failure due to Covid-19 requiring mechanical ventilation in the ICU did not survive,” Dang and colleagues wrote, adding that more research is needed to better understand how to best care for hospitalized Covid-19 patients with cancer.

  1. The prevalence of chronic obstructive pulmonary disease (COPD) was smaller than expected but having the chronic lung disesae was associated with a higher risk for death in a pooled analysis of patients hospitalized for Covid-19.
  2. In a study of patients with cancer or a recent history of cancer admitted to ICUs for Covid-19 pneumonia, 68% required prolonged mechanical ventilation and 39% died.

Salynn Boyles, Contributing Writer, BreakingMED™

The researchers rdid not report any disclosures related to this study.

 

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