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Background: Comorbid disease is a risk factor for severe coronavirus disease 2019 (COVID-19) infection. However, initial rates of chronic obstructive pulmonary disease (COPD) in case series were low and severity of COVID-19 in COPD patients was variable. Methods: We performed a retrospective study of patients admitted with COVID-19 and evaluated outcomes in those with and without COPD and/or emphysema. Patients were identified as having COPD if they had a diagnosis in the medical record and a history of airflow-obstruction on spirometry, or a history of tobacco use and prescribed long-acting bronchodilator(s). Computed tomography scans were evaluated by radiologists. Propensity matching was performed for age, body mass index (BMI), and serologic data correlated with severity of COVID-19 disease (D-dimer, C-reactive protein, ferritin, fibrinogen, absolute lymphocyte count, lymphocyte percentage, and lactate dehydrogenase). Results: Of 577 patients admitted with COVID-19, 103 had a diagnosis of COPD and/or emphysema. The COPD/emphysema cohort was older (67 versus 58, p

COPD is a complex disease and telemedicine is a promising intervention that could assist with the management of this chronic condition. Patients with severe disease, frequent exacerbations, and limited social or community support may particularly benefit from telemedicine interventions. The use of remote telemonitoring systems that include decision-making support led by a physician and enabling therapeutic interventions 24/7 has shown improved patient outcomes. However, the current existing evidence with regard to the use of telehealth for the management of COPD is inconsistent due in part to the heterogeneous interventions and outcomes measured.

Background: Determine the impact of tobacco smoking status on patients hospitalized with COVID-19 pneumonia in the need for ICU care, mechanical ventilation and mortality. Methods: We performed a retrospective cohort study, that involved chart review. All adults 18 years or older with a diagnosis of COVID-19 pneumonia hospitalized from March 15th, 2020 to May 06th, 2020 with a positive reverse transcription polymerase chain reaction (RT-PCR) nasopharyngeal swab for COVID-19. We used chi-squared test for categorical variables and student t-tests or Wilcoxon rank sum tests for continuous variables. We further used adjusted and unadjusted logistic regression to assess risk factors for mortality and intubation.Results: Among 577 patients hospitalized with COVID-19 pneumonia, 268 (46.4%) had a history of smoking including 187 former and 81 active smokers. The former smokers when compared with non-smokers were predominantly older with more comorbidities. Also, when compared with never smokers D Dimer levels were elevated in active (p=0.05) and former smokers (pConclusions: In our cohort of hospitalized patients with COVID-19 pneumonia, former smokers had higher need for non-invasive respiratory support on admission, ICU care, and mortality compared to non-smokers. Also, active smokers versus non-smokers needed more mechanical ventilation.

Worldwide chronic obstructive pulmonary disease (COPD) is the third most common cause of non-communicable deaths. The pathobiology of the disease is predominantly neutrophilic but there is a subset of patients with elevated peripheral eosinophil count that respond better to inhaled and systemic corticosteroids currently being classified as eosinophilic phenotype. This review focuses on the role of mepolizumab, a fully humanized monoclonal antibody against IL-5 molecule that regulates the eosinophil life cycle, in the management of patients with this phenotype of COPD. Areas covered: A comprehensive appraisal of the existing literature about the pharmacokinetics/pharmacodynamics as well as the clinical efficacy, safety and side effects of mepolizumab in the management of COPD patients with high peripheral eosinophil count. Expert commentary: The use of monoclonal antibodies against IL-5 to decrease the eosinophil proliferation and subsequent airway inflammation is a promising therapeutic target for this phenotype of COPD patients. The current phase three trials showed a moderate effect on the decrease of annual rate of exacerbations significant in only one study. Further research is needed to specifically define the eosinophilic phenotype in the patients with COPD and the clinical efficacy of treatments designed as targeted therapy in patients with that characteristic profile.

Clinical trials evaluating the management of acute exacerbations of COPD assess heterogeneous outcomes, often omitting those that are clinically relevant or more important to patients. We have developed a core outcome set, a consensus-based minimum set of important outcomes that we recommend are evaluated in all future clinical trials on exacerbations management, to improve their quality and comparability. COPD exacerbations outcomes were identified through methodological systematic reviews and qualitative interviews with 86 patients from 11 countries globally. The most critical outcomes were prioritised for inclusion in the core outcome set through a two-round Delphi survey completed by 1063 participants (256 patients, 488 health professionals and 319 clinical academics) from 88 countries in five continents. Two global, multi-stakeholder, virtual consensus meetings were conducted to 1) finalise the core outcome set and 2) prioritise a single measurement instrument to be used for evaluating each of the prioritised outcomes. Consensus was informed by rigorous methodological systematic reviews. The views of patients with COPD were accounted for at all stages of the project. Survival, treatment success, breathlessness, quality of life, activities of daily living, the need for a higher level of care, arterial blood gases, disease progression, future exacerbations and hospital admissions, treatment safety and adherence were all included in the core outcome set. Focused methodological research was recommended to further validate and optimise some of the selected measurement instruments. The panel did not consider the prioritised set of outcomes and associated measurement instruments to be burdensome for patients and health professionals to use.