COPD is not associated with a poor prognosis in COVID-19

Abstract Background: Coronavirus disease 2019 (COVID-19) is a worldwide pandemic. The effect of underlying chronic obstructive pulmonary disease (COPD) on COVID-19 is controversial. We set this study to examine the clinical outcomes of COVID-19 according to the underlying COPD.Methods: COVID-19 patients were assessed using nationwide health insurance data. COPD patients were operationally defined. Comorbidities were evaluated by using the modified Charlson Comorbidity Index (mCCI) which excluded the factors of COPD from conventional CCI scores. Baseline characteristics and clinical outcomes of COVID-19, such as mortality, hospital length of stay (LOS), and intensive care unit (ICU) admission, were assessed. Subgroup analysis about the effect of inhaled corticosteroid of COPD patients on COVID-19 was performed.Results: COPD group were older (71.3±11.6 vs. 47.7±19.1, p < 0.001) and have higher CCI scores (2.6±1.9 vs. 0.8±1.3, p < 0.001) than non-COPD group. Mortality was higher in COPD groups than in non-COPD group (22.9% vs. 3.2%, p < 0.001). The ICU admission rate and hospital LOS were not significantly different between the two groups. In univariate analysis, ages, male sex, mCCI, socioeconomic status, and underlying COPD were associated with mortality. In multivariate analysis, underlying COPD was not associated with mortality after adjusted. On the other hand, other variables are still associated with mortality. Older ages (odds ratio [OR] 1.12; 95% confidence interval [CI] 1.11–1.14; p < 0.001), male sex (OR 2.29; 95% CI 1.67–3.12; p < 0.001), higher mCCI (OR 1.30; 95% CI 1.20–1.41; p < 0.001), and medical aid insurance (OR 1.55; 95% CI 1.03–2.32; p = 0.035) were associated with mortality of COVID-19. Underlying COPD was also not associated with hospital LOS and ICU admission rates in the adjusted analyses. In the subgroup analysis, there was no significant difference between the ICS user and nonuser including mortality and hospital LOS. In the adjusted analyses, the use of ICS in COPD patients was not associated with mortality and hospital LOS in COVID-19.Conclusions: Mortality, hospital LOS, and ICU admission rate were not associated with underlying COPD in COVID-19.