OBJECTIVES: Pulmonary infections, the main trigger of chronic obstructive pulmonary disease (COPD) exacerbations, were characterized by a seasonality well known by clinicians with an increased number of exacerbations during winters before the 2020 COVID-19 pandemic. However, the infection control protocols implemented during the pandemic have led to a decrease in theses pulmonary infections. In this study, we examined whether these preventive measures reduced the number of COPD exacerbations and analyzed their trend before and during the pandemic in France.

METHODS: A retrospective observational study was conducted using the French National Claims Database (SNDS). Adult patients (≥40 years) treated with triple therapy for COPD between January 1, 2015, and December 31, 2015, were included. Patients were further divided into controlled and uncontrolled according to the number and type of exacerbation under treatment. A 6-years follow-up period was used to identify exacerbations after inclusion. The trend of seasonal exacerbation was evaluated with a Seasonal-Trend Decomposition (STL) method using LOESS method.

RESULTS: In 2015, 186,963 COPD patients were included with 39,847 of them uncontrolled by triple therapy. Of these, 58.0% were men, and median age was 69 years old. Exacerbations showed a seasonal pattern, with peaks at the beginning of the calendar year and dips in the middle of the year. There was a significant reduction in the exacerbation rate between 2020 and 2021 (Covid period) in both groups with 3 times less exacerbation compared to the similar pre-pandemic period. Furthermore this overall reduction of exacerbations, no seasonality was observed 2020 and 2021.

CONCLUSIONS: This study offers insightful results of the trend of COPD exacerbations in France in both controlled and uncontrolled patients before and during the pandemic in France, showing a significant reduction in the exacerbation rate and seasonality. Further analysis with post pandemic data will be of interest to analyze post pandemic trends.