UCL Respiratory, University College London, London, United Kingdom.
Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia.
PLoS One. 2021 Aug 3;16(8):e0255659. doi: 10.1371/journal.pone.0255659. eCollection 2021.
Reports have suggested a reduction in exacerbations of chronic obstructive pulmonary disease (COPD) during the coronavirus disease 2019 (COVID-19) pandemic, particularly hospital admissions for severe exacerbations. However, the magnitude of this reduction varies between studies.
Electronic databases were searched from January 2020 to May 2021. Two independent reviewers screened titles and abstracts and, when necessary, full text to determine if studies met inclusion criteria. A modified version of the Newcastle-Ottawa Scale was used to assess study quality. A narrative summary of eligible studies was synthesised, and meta-analysis was conducted using a random effect model to pool the rate ratio and 95% confidence intervals (95% CI) for hospital admissions. Exacerbation reduction was compared against the COVID-19 Containment and Health Index.
A total of 13 of 745 studies met the inclusion criteria and were included in this review, with data from nine countries. Nine studies could be included in the meta-analysis. The pooled rate ratio of hospital admissions for COPD exacerbations during the pandemic period was 0.50 (95% CI 0.44-0.57). Findings on the rate of community-treated exacerbations were inconclusive. Three studies reported a significant decrease in the incidence of respiratory viral infections compared with the pre-pandemic period. There was not a significant relationship between exacerbation reduction and the COVID-19 Containment and Health Index (rho = 0.20, p = 0.53).
There was a 50% reduction in admissions for COPD exacerbations during the COVID-19 pandemic period compared to pre-pandemic times, likely associated with a reduction in respiratory viral infections that trigger exacerbations. Future guidelines should consider including recommendations on respiratory virus infection control measures to reduce the burden of COPD exacerbations beyond the pandemic period.
有报道称，在 2019 年冠状病毒病（COVID-19）大流行期间，慢性阻塞性肺疾病（COPD）的恶化次数有所减少，尤其是严重恶化的住院治疗次数有所减少。然而，这种减少的幅度在不同的研究中有所不同。
从 2020 年 1 月至 2021 年 5 月，检索电子数据库。两名独立的审查员筛选标题和摘要，如果有必要，还筛选全文，以确定研究是否符合纳入标准。使用改良的纽卡斯尔-渥太华量表评估研究质量。对符合条件的研究进行叙述性总结，并使用随机效应模型进行荟萃分析，以汇总住院率的比值比和 95%置信区间（95%CI）。将恶化减少情况与 COVID-19 控制和健康指数进行比较。
共有 745 项研究中的 13 项符合纳入标准，并纳入本综述，数据来自 9 个国家。有 9 项研究可以纳入荟萃分析。大流行期间 COPD 恶化住院率的汇总比值比为 0.50（95%CI 0.44-0.57）。关于社区治疗恶化的发生率的结果尚无定论。有 3 项研究报告称，与大流行前相比，呼吸道病毒感染的发生率显著下降。恶化减少与 COVID-19 控制和健康指数之间没有显著关系（rho=0.20，p=0.53）。
与大流行前相比，COVID-19 大流行期间 COPD 恶化的住院率降低了 50%，这可能与触发恶化的呼吸道病毒感染减少有关。未来的指南应考虑纳入关于呼吸道病毒感染控制措施的建议，以降低 COVID-19 大流行后 COPD 恶化的负担。
