Introduction: It is anticipated that Chronic Obstructive Pulmonary Disease (COPD) has greater risk in acquiring COVID-19 infection and poorer outcome. However, current worldwide data are conflicting. Objectives: This study primarily aims to compare the outcomes of COVID-19 patients with COPD and those without COPD in terms of length of hospital stay (LOS), recovery or mortality, treatment received, and predictors of mortality. Methods: This is a retrospective cohort chart review of 1,017 admitted adult COVID-19 patients from July to December 2020. Age, gender, smoking status, current control and medications for COPD, COVID-19 severity, symptoms, treatment, and outcomes of the two study groups were compared. Results: Prevalence rate of COPD was 3.8%. COVID-19 patients with COPD were older (median age of 69 vs 54, p<0.001), male (87% vs 50%, p<0.001), hypertensive (72% vs 48%, p=0.004), and with tuberculosis (31% vs 11%, p=0.002). COVID-19 patients with COPD more commonly needed oxygen therapy, High Flow Nasal Cannula, Mechanical Ventilation, Tocilizumab, Convalescent Plasma Therapy and Dexamethasone, and had longer LOS. Significant risk factors for mortality are malignancy, investigational therapies, smoking, and older age. There was no difference in survival rates between the two groups. Conclusion COPD increases the risk for severe COVID-19 and lengthens LOS.
COVID-19 ; Pulmonary Disease, Chronic Obstructive ; Mortality

China ; Humans ; Life Expectancy ; Pulmonary Disease, Chronic Obstructive ; mortality

Chronic obstructive pulmonary disease (COPD) is an ambulatory care-sensitive condition, and effective treatment of outpatients can prevent worsening of the illness and hospitalization. Current COPD guidelines provide appropriate guidance for the diagnosis and treatment of patients with COPD. In fact, it has been shown that when appropriate guidance and treatment are performed, the morbidity and mortality rates of COPD patients are reduced. However, there is a gap between the clinical guidelines and the actual clinical treatment. Therefore, the Health Insurance Review and Assessment Service (HIRA) conducted an evaluation of the adequacy of COPD diagnosis and treatment using the Claims Database of HIRA. This review provides a summary of the COPD adequacy assessment results reported by the HIRA and some brief comments on the results.
Diagnosis ; Hospitalization ; Humans ; Insurance, Health* ; Korea* ; Mortality ; Outpatients ; Pulmonary Disease, Chronic Obstructive*

Chronic obstructive pulmonary disease (COPD) is a common airway disease that has considerable impact on disease burdens and mortality rates. A large number of articles on COPD are published within the last few years. Many aspects on COPD ranging from risk factors to management have continued to be fertile fields of investigation. This review summarizes 6 clinical articles with regards to the risk factors, phenotype, assessment, exacerbation, management and prognosis of patients with COPD which were being published last year in major medical journals.
Airway Obstruction ; Humans ; Mortality ; Phenotype ; Prognosis ; Pulmonary Disease, Chronic Obstructive* ; Risk Factors

Chronic obstructive pulmonary disease(COPD) is a crucial public health problem and a major cause of disability and death throughout the world. To decrease morbidity and mortality from COPD, a number of new clinical guidelines have been published over the years. Recently, the Global Initiative for Chronic Obstructive Lung Disease(GOLD) Expert Panel's global strategy of the diagnosis, management, and prevention of COPD was published and updated in 2004. In addition, the full version of the new National Institute for Clinical Excellence(NICE) guidelines on the management of COPD was published. Based on these guidelines, this article covers the key points of clinical history and diagnosis in patients with COPD. The diagnosis of COPD can be made on the basis of a typical history of persistent progressive symptoms, appropriate risk factors such as cigarette smoking, and a confirmatory spirometric test of the presence of the airflow limitation that does not return to normal after bronchodilator administration. Spirometry is the current gold standard in the diagnosis and assessment of COPD, because it is the most reproducible, standardized, and objective way of measuring airflow limitation. FEV(1)/FVC <70% and a postbronchodilator FEV(1)<80% of predicted confirms the presence of airflow limitation.
Diagnosis* ; Humans ; Lung ; Mortality ; Public Health ; Pulmonary Disease, Chronic Obstructive* ; Risk Factors ; Smoking ; Spirometry

Chronic obstructive pulmonary disease (COPD) is a chronic and progressive inflammatory disease of the airways and lungs that results in limitations of continuous airflow and is caused by exposure to noxious gasses and particles. A major cause of morbidity and mortality in adults, COPD is a complex disease pathologically mediated by many inflammatory pathways. Macrophages, neutrophils, dendritic cells, and CD8+ T-lymphocytes are the key inflammatory cells involved in COPD. Recently, the non-coding small RNA, micro-RNA, have also been intensively investigated and evidence suggest that it plays a role in the pathogenesis of COPD. Here, we discuss the accumulated evidence that has since revealed the role of each inflammatory cell and their involvement in the immunopathogenesis of COPD. Mechanisms of steroid resistance in COPD will also be briefly discussed.
Adult ; Dendritic Cells ; Humans ; Lung ; Lymphocytes ; Macrophages ; Mortality ; Neutrophils ; Pulmonary Disease, Chronic Obstructive* ; RNA ; T-Lymphocytes

BACKGROUND: Although intensively studied in patients with cardiovascular diseases (CVDs), the prognostic value of diastolic blood pressure (DBP) has little been elucidated in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This study aimed to reveal the prognostic value of DBP in AECOPD patients. METHODS: Inpatients with AECOPD were prospectively enrolled from 10 medical centers in China between September 2017 and July 2021. DBP was measured on admission. The primary outcome was all-cause in-hospital mortality; invasive mechanical ventilation and intensive care unit (ICU) admission were secondary outcomes. Least absolute shrinkage and selection operator (LASSO) and multivariable Cox regressions were used to identify independent prognostic factors and calculate the hazard ratio (HR) and 95% confidence interval (CI) for adverse outcomes. RESULTS: Among 13,633 included patients with AECOPD, 197 (1.45%) died during their hospital stay. Multivariable Cox regression analysis showed that low DBP on admission (<70 mmHg) was associated with increased risk of in-hospital mortality (HR = 2.16, 95% CI: 1.53-3.05, Z = 4.37, P <0.01), invasive mechanical ventilation (HR = 1.65, 95% CI: 1.32-2.05, Z = 19.67, P <0.01), and ICU admission (HR = 1.45, 95% CI: 1.24-1.69, Z = 22.08, P <0.01) in the overall cohort. Similar findings were observed in subgroups with or without CVDs, except for invasive mechanical ventilation in the subgroup with CVDs. When DBP was further categorized in 5-mmHg increments from <50 mmHg to ≥100 mmHg, and 75 to <80 mmHg was taken as reference, HRs for in-hospital mortality increased almost linearly with decreased DBP in the overall cohort and subgroups of patients with CVDs; higher DBP was not associated with the risk of in-hospital mortality. CONCLUSION: Low on-admission DBP, particularly <70 mmHg, was associated with an increased risk of adverse outcomes among inpatients with AECOPD, with or without CVDs, which may serve as a convenient predictor of poor prognosis in these patients. CLINICAL TRIAL REGISTRATION Chinese Clinical Trail Registry, No. ChiCTR2100044625.
Humans ; Blood Pressure ; Pulmonary Disease, Chronic Obstructive/therapy* ; Cohort Studies ; Respiration, Artificial ; Inpatients ; Hospital Mortality

OBJECTIVETo study the death burden of chronic obstructive pulmonary diseases (COPD) in west rural areas of China in 2004 - 2005.

METHODSThe data from 2004 - 2005 the Third National Mortality Retrospective Sampling Survey were used in the study. A total of 28 621 276 person years were investigated in west rural areas, which covered 12 provinces, and consisted of 42 surveillance districts. Based on the data of death cause and population, mortality of COPD, years of potential life lost(YPLL) rate, working YPLL (WYPLL) rate, YPLL rate due to COPD/YPLL rate due to all deaths in west rural areas were calculated and compared with other rural areas. Standardized death rate, standardized YPLL (SYPLL) rate, standardized working YPLL (SWYPLL) rate were calculated from census data in 2000 as standard population and 2004 - 2005 national life expectancy as standard life expectancy.

RESULTSThe elder has the higher crude death rate and YPLL rate of COPD in survey districts of west rural areas. And the crude death rate of COPD and YPLL rate were different in different genders. The YPLL rate was 15.47‰ in male and 15.73‰ in female. The crude death rate, YPLL rate, WYPLL rate, the ratio of YPLL rate due to COPD/YPLL rate due to all deaths in survey districts of west rural areas were: 109.53/100 000, 15.76‰, 2.82‰, 11.23%, which were high. While crude death rate, YPLL rate, WYPLL rate, the ratio of YPLL rate due to COPD/YPLL rate due to all deaths in the poorest survey districts of west rural areas were: 122.04/100 000, 27.47‰, 4.26‰, 13.44%, which were higher than other stratifications of west rural areas.

CONCLUSIONThe death burden of COPD in west rural areas in 2004 - 2005 was the heaviest one in China which experienced the feature that the poorer the rural regions, the heavier the death burden.

China ; epidemiology ; Cost of Illness ; Female ; Humans ; Male ; Pulmonary Disease, Chronic Obstructive ; economics ; epidemiology ; mortality ; Rural Population

Humans ; Patient Compliance ; Practice Guidelines as Topic ; Pulmonary Disease, Chronic Obstructive ; diagnosis ; etiology ; mortality ; therapy ; Survival Rate

OBJECTIVETo analyze the disease burden of chronic obstructive pulmonary disease (COPD) among people aged over 15 years in 1990 and 2010 in China.

METHODSThe estimation of China data for the Global Burden of Disease Study 2010 (GBD 2010) was used to analyze the mortality and prevalence as well as the years of life lost due to premature mortality (YLL), years lived with disability (YLD) and disability-adjusted life years (DALY) of COPD in China in 1990 and 2010 for Chinese people aged 15 years and above. The death rate and DALY rate of COPD in China in 1990 and 2010 were compared.

RESULTSIn 2010, 0.934 million people (0.534 million men and 0.400 million women) aged over 15 years died from COPD, decreased 34.5% (24.3% for men and 44.4% for women) compared with that in 1990 (1.425 million with 0.705 million men and 0.720 million women). There were 41.764 million COPD patients in 2010 (22.111 million men and 19.653 million women), increased 42.1% (41.7% for men and 42.6% for women) compared with 1990 (29.382 million patients with 15.599 million men and 13.783 million women). The mortality rate of COPD decreased for 61.5% from 2.352/100 000 in 1990 to 90.5/100 000 in 2010. The prevalence rate of COPD was 4.2% and 3.9% in 1990 and 2010, respectively. The DALY, YLL and YLD due to COPD was 16.598, 12.946, and 3.652 million person years, respectively in 2010. The YLD increased 42.3% compared with 1990 (2.567 million person years). From 1990 to 2010, the age-standardized DALY rate, YLL rate and YLD rate decreased from 4 120.1/100 000 to 1 575.9/100 000, from 3 756.9/100 000 to 1 235.6/100 000 and from 363.2/100 000 to 340.3/100 000, respectively.

CONCLUSIONAlthough there was significant decrease of DALY due to COPD in 2010, compared to 1990, the YLD burden is still increasing.

China ; Cost of Illness ; Female ; Humans ; Male ; Mortality ; Prevalence ; Pulmonary Disease, Chronic Obstructive ; Quality-Adjusted Life Years