Impact of smoking, COPD and comorbidities on the mortality of COVID-19 patients

Donato Lacedonia,Onofrio Resta,Giovanni Larizza,Emanuela Resta,Carla Santomasi,Maria Pia Foschino Barbaro,Giovanna Elisiana Carpagnano,Giulia Scioscia,Paolo Fuso,Andrea Portacci,Emanuela Profilo,Franco Mastroianni,Eugenio Sabato

doi:10.1038/s41598-021-98749-4

Abstract

The prognosis of the coronavirus disease 2019 (COVID-19) patients is variable and depends on several factors. Current data about the impact of chronic obstructive pulmonary disease (COPD) and smoking on the clinical course of COVID-19 are still controversial. This study evaluated the prevalence and the prognosis of COPD patients and smokers in a cohort of 521 patients admitted to four intermediate Respiratory Intensive Care Units (Puglia, Italy) with respiratory failure due to COVID-19 pneumonia. The prevalence of COPD and current smokers was 14% and 13%, respectively. COPD patients had a higher 30-day all-cause mortality than non-COPD patients. Former smokers compared to never smokers and current smokers had higher 30-day all-cause mortality. COPD patients and former smokers had more comorbidities. This study described the prevalence and the outcomes of COPD patients and smokers in a homogenous cohort of COVID-19 patients. The study showed that the prevalence of COPD and current smokers was not high, suggesting that they were not at increased risk of getting the infection. However, when SARS-CoV-2 infection occurred, COPD patients and former smokers were those with the highest all-cause mortality, which seemed to be mainly related to the presence of comorbidities and not to COPD and smoking itself.

Highlights

The prognosis of the coronavirus disease 2019 (COVID-19) patients is variable and depends on several factors
The primary aim was to analyse the prevalence of chronic obstructive pulmonary disease (COPD) and the prognosis of COPD patients in a selected and homogenous cohort of patients with acute respiratory failure due to COVID-19-related pneumonia and admitted to intermediate Respiratory Intensive Care Units (RICUs), a model of care designed for monitoring and treating respiratory patients whose illness is at a level of severity that is intermediate between that which requires intensive care unit (ICU) facilities and that which can be managed on a conventional ward[20,21]
The anamnesis was aimed at identifying patients on Long-term oxygen therapy (LTOT) or Long-term Non Invasive Ventilation (LTNIV) in order to assess the presence of chronic respiratory failure at baseline

Summary

Introduction

The prognosis of the coronavirus disease 2019 (COVID-19) patients is variable and depends on several factors. When SARS-CoV-2 infection occurred, COPD patients and former smokers were those with the highest all-cause mortality, which seemed to be mainly related to the presence of comorbidities and not to COPD and smoking itself. We hypothesized that COPD and tobacco smoking may have a different impact on patients’ susceptibility to SARS-CoV-2 infection and on the severity and clinical course of the disease. The primary aim was to analyse the prevalence of COPD and the prognosis of COPD patients in a selected and homogenous cohort of patients with acute respiratory failure due to COVID-19-related pneumonia and admitted to intermediate Respiratory Intensive Care Units (RICUs), a model of care designed for monitoring and treating respiratory patients whose illness is at a level of severity that is intermediate between that which requires intensive care unit (ICU) facilities and that which can be managed on a conventional ward[20,21]. The secondary aim was to examine the prevalence of smokers and the association of tobacco smoking with sociodemographic and clinical features during the clinical course of these hospitalized patients

Methods

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Discussion

Conclusion