The impact of chronic obstructive pulmonary disease on the dynamics of clinical manifestations in severe COVID-19

Introduction. The prevalence of chronic obstructive pulmonary disease (COPD) in confirmed COVID-19 cases is relatively low, but severe COVID-19 is a significant burden for patients with COPD.

Aim. To study the effect of COPD on the dynamics of clinical manifestations of severe COVID-19.

Materials and methods. A retrospective single-center longitudinal study included 154 patients hospitalized for COVID-19 (103 patients with COPD and 51 patients without COPD and a smoking history). The presence of COVID-19 was confirmed by laboratory tests and/or clinical and radiological examination. Patients with COPD had a documented diagnosis of chronic obstructive pulmonary disease. The dynamics of clinical and laboratory-instrumental parameters were assessed in the first seven days of observation.

Results. In the studied patients, COPD in most cases was represented by the bronchitis phenotype, proceeded with frequent exacerbations and had pronounced clinical manifestations before COVID-19. Analysis of the dynamics of clinical manifestations of COVID-19 demonstrated that blood oxygen saturation, the volume of lung damage according to chest CT and the level of CRP statistically significantly differed depending on the presence/absence of COPD. The intensity of positive changes in clinical laboratory parameters and CT images was statistically significantly higher in the COVID group without COPD. Analysis of the dynamics of the severity of COVID-associated lung damage showed that in the COVID + COPD group of patients there were no statistically significant changes, and in the group of patients with COVID without COPD, there was a statistically significant positive dynamics of a decrease in the severity of lung damage. After 7 days of observation, in the COVID + COPD group of patients, there were more patients with severity grade III and fewer with severity grade II compared to COVID patients without COPD. Conclusions. Analysis of the dynamics of clinical manifestations of COVID-19 showed that patients with COPD have longer-term persistence of hypoxemia, inflammatory activity and lung damage.

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