Patients with existing illnesses that cause breathlessness, wheezing or lung problems run a higher risk of developing severe cases of COVID-19 infection due to the new coronavirus, according to a pooled analysis study published in March. COVID-19 is a respiratory infection that in severe cases causes shortness of breath and lung failure. In milder cases, the most common symptoms are a fever and cough.
Vageesh Jain of University College London’s Institute for Global Health, who co-led the work, explained that the findings should help guide public health officials and doctors in prioritising people at highest risk of severe illness with COVID-19. The study was published by MedRxiv and has not yet been peer reviewed but has been shared in order to assist health workers.
The study found that that shortness of breath – also known as dyspnoea – is the only symptom of COVID-19 that is significantly associated with severe cases and with patients requiring admission to intensive care units.
The research work found that Chronic obstructive pulmonary disease, or COPD, – a chronic progressive lung disease that causes long-term breathing problems – is the greatest risk factor for severe COVID-19 among hospitalized patients. According to earlier research, smoking is a major cause of COPD but 15 percent of COPD cases are work-related, due to exposure to dusts and fumes. There are concerns that such dusts can originate from the insulation material Manmade Vitreous Fibres (MMVF), which is widely used and commonly known as mineral wool.
The new study, conducted by researchers at Britain’s University College London, pooled and analysed the results of seven smaller studies from China and included a total of 1,813 patients, all of whom were hospitalized with laboratory-confirmed COVID-19. Patients with shortness of breath were 3.7 times more likely to have severe COVID-19 disease and 6.6 times more likely to need intensive care than those without, it found. Patients with COPD were 6.4 times more likely to develop severe disease, and 17.8 times more likely to be admitted to intensive care.
“Whilst dyspnoea was not a particularly common symptom in COVID-19 patients, its significant association with both severe disease and ICU admission may help clinicians discriminate between severe and non-severe COVID-19 cases,” Jain said in a statement about the findings.
Similar concerns have been raised in France, where groups such as France’s national association for COPD sufferers have spoken out about the increased risk which COVID-19 poses to COPD patients. Approximately 700,000 French citizens are severely impacted by the illness, while 150,000 rely on supplemental oxygen to survive. As the French COPD association raises, COPD patients are already “permanently suffocating”, making them uniquely vulnerable to respiratory diseases like the flu or COVID-19. Philippe Poncet, the organisation’s head, deplored the fact that governments have yet to take any specific measures to protect COPD sufferers from COVID-19. “Since coronavirus destroys the lungs, it’s us, those suffering from COPD, who will die first”, Poncet underlined, calling on the French health ministry to make hospital services more aware of the unique challenges COPD sufferers face and to provide them with FFP2 masks and disinfectant gel.
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has stated that people with COPD are amongst the worst affected by COVID-19 and that they are working with WHO to try to minimise the impact of the infection. The organisation strongly encourages people with COPD to follow the advice of the public health teams in their own countries to try to minimise the chance of becoming infected and on when and how to seek help if they show symptoms of the infection. They added that they are not aware of any scientific evidence to support that inhaled (or oral) corticosteroids should be avoided in patients with COPD during the COVID-19 epidemic, adding that COPD patients should maintain their regular therapy. The organisation also said that oxygen therapy should be provided if needed following standard recommendations.