Reduction in hospitalised COPD exacerbations during COVID-19: A systematic review and meta-analysis

  1. Jaber S. Alqahtani
  2. Tope Oyelade
  3. Abdulelah M. Aldhahir
  4. Renata Gonçalves Mendes
  5. Saeed M. Alghamdi
  6. Marc Miravitlles
  7. Swapna Mandal
  8. John R. Hurst

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Abstract

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.

Method

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.

Results

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).

Conclusion

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.

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  1. Version published to 10.1371/journal.pone.0255659
  2. ScreenIT

    SciScore for 10.1101/2021.05.17.21257335: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    MEDLINE and Embase via Ovid, and CINAHL were searched from 1st January 2020 to 17th May 2021 (see Supplementary Table S1).
    MEDLINE
    suggested: (MEDLINE, RRID:SCR_002185)
    The resulting search was sent to EndNote to remove duplicates, and citations were then exported to Rayyan software for screening of title, abstract and full text by two independent reviewers.
    EndNote
    suggested: (EndNote, RRID:SCR_014001)
    This was completed by computing the reported rate ratio in the selected studies with 95% CI using the Metan procedure in STATA software.
    STATA
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    These analyses have strengths and limitations. This is the first systematic analysis of the impact of COVID-19 pandemic restrictions on COPD exacerbations, especially the most severe COPD exacerbations requiring hospital admission. The results from nine countries were consistent, and we were able to pool data to estimate the weighted rate ratio, considering variation between studies. There was heterogeneity between studies in location and follow-up time while some studies did not report the rate ratio with 95% CI and could not be included in the meta-analysis. Restrictions within individual countries changed with time and we were not able to confirm that jurisdictions with the greatest restrictions saw the greatest reduction in exacerbations. Our DAG permits identification of confounders in the relationship between the coronavirus pandemic and reduced admissions to hospital for COPD exacerbations. Key confounders are age, sex, prior exacerbation frequency and prior disease severity. These confounders have not been accounted for in studies published to date. In conclusion, this systematic analysis and meta-analysis reports a 50% reduction in hospital admissions for COPD exacerbations during the COVID-19 pandemic, most likely primarily through reduction in transmission of respiratory viruses. Data for community treated exacerbations were inconclusive and this requires further examination. This work has important implications for future decision-making regarding the prevention o...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  3. Version published to 10.1101/2021.05.17.21257335v1 on medRxiv