Reduction in Hospital Admissions for Acute Exacerbations of COPD during COVID-19 pandemic

Title: Reduction in Hospital Admissions for Acute Exacerbations of COPD during COVID-19 pandemic
Author(s): A Straszewicz, E Jordan, A Nolan, H Mulryan, N Byrne, D Langan, A O’Regan, M McDonnell, M Harrison, R Rutherford, M Brennan.
Institution: Galway University Hospital
Poster: Click to view poster
Category: COVID-19
Abstract: Background:
Ireland has the highest acute exacerbation of COPD (AECOPD) of all OECD countries. Patients with COPD are at risk of severe COVID-19 infection with 2.68 times increased risk of ICU admission, mechanical ventilation or death.
The COVID-19 pandemic led to the rapid introduction of community infection control measures to mitigate viral transmission of SARS-CoV-2. We sought to examine the impact of these measures on hospital admission rates for AECOPD.

A retrospective cohort study of patients hospitalised with a primary diagnosis of AECOPD was conducted over a two-month period 01/03/2020-30/04/2020 and compared with the same time period in 2019. Electronic Healthcare Records were reviewed to collect data on baseline demographics and functional status, clinical presentation and outcomes for all patients.

The primary outcome was the number of patients admitted with AECOPD
The secondary outcomes were:
A) Severity of AECOPD measured using DECAF score
B) Length of stay in hospital
C) In-hospital mortality
D) Number of patients who tested positive for SARS-CoV-2

There was a 31.8% reduction in the number of patients admitted with AECOPD during the COVID-19 period compared with the previous year.
No patient tested positive for SARS-CoV-2 in the 2020 group.
There was no difference in baseline characteristics, clinical severity scores, predicted mortality at presentation, length of stay or actual mortality between the patient groups.

This study found a reduction in severe AECOPD by almost one-third compared to the previous year. This is most likely due to reduction in community viral transmission as a result of infection control measures introduced to combat the spread of COVID-19. Hospital avoidance was unlikely given the similarity in baseline function, clinical severity and outcomes. Future COPD management could incorporate some of these approaches in selected patients who continue to exacerbate despite optimised current treatment.