OBJECTIVES: To evaluate the indirect impact of Coronavirus Disease 2019 (COVID-19) pandemic on patients with chronic obstructive pulmonary disease (COPD) in the US by describing changes in the rate of exacerbations over time.

METHODS: This retrospective, longitudinal cohort study described patients by calendar year aged ≥40 years with COPD and treated with maintenance therapy identified in the US Optum Research Database. Patients were followed from January 2018–May 2022 or until disenrollment. Baseline characteristics and rates of exacerbations defined as moderate (emergency, outpatient or telemedicine visit with a COPD code plus an oral corticosteroid and/or antibiotic prescription) or severe (hospitalization with a COPD code) were described monthly over the study period.

RESULTS: In 2018, 139,128 patients with COPD were identified and followed until 2022. The mean age (standard deviation) was 71.8 (9.8) years, and 58.2% were female. Common comorbidities were hypertension (82.7%), other lower respiratory tract disease (77.5%), disorders of lipid metabolism (72.9%), and disease of the heart (69.8). From Jan 2018 to March 2020, the monthly proportion of patients with at least one exacerbation ranged between 5.5% and 9.6%, with peaks observed in December to February of each year. At the start of the pandemic, in April 2020, the monthly proportion dropped to its lowest point (4.2%) and remained low compared to pre-pandemic levels (ranged 4.2% to 5.8%) until the end of study period.

In the 2020 cohort, the proportion of patients with COVID-19 that had exacerbations was high (24%) during the month of first diagnosis but then dropped substantially and remained low (<5%) in subsequent months.

CONCLUSIONS: Rates of COPD exacerbations decreased during the COVID-19 pandemic and appeared to remain lower than pre-pandemic levels, though it is unclear whether observed decreases are attributable to decreases in respiratory triggers, changes in healthcare-seeking behaviors, and/or other factors.

FUNDING: GSK (214628)