Chronic Lung Disease and COVID-19
Disclaimer: Not medical or professional advice. Always seek the advice of your physician.
The spread of COVID-19 is a matter of global concern. No wonder people with chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD), bronchial asthma, bronchiectasis, and others do not feel safe.
What Happens when You Get COVID-19
Studies show that airborne transmission was the main transmission route of the virus. Saliva droplets are particles of the virus generated when coughing, sneezing, or talking at a close distance (less than 2 m). This makes patients with respiratory diseases and disorders of local immunity mechanisms even more vulnerable to infection (for example, people with nicotine dependence).
Smokers and patients with COPD have increased airway expression of the angiotensin-converting enzyme II (ACE-2). ACE-2 has been identified as an entry receptor of coronavirus into bronchial and alveolar epithelial cells.
Pulmonary Complications in COVID-19
It’s been reported that the most common clinical manifestation of infection is bilateral pneumonia. Over 80% of infected remain asymptomatic or show symptoms of a common cold. It should be remembered that serious consequences in the form of pulmonary fibrosis can occur even in the case of a favorable outcome of viral pneumonia. Especially if there was the development of acute respiratory distress syndrome (ARDS).
- Respiratory distress syndrome (RDS) is a type of severe respiratory failure. It is accompanied by pulmonary edema, external breathing disorder, and oxygen deprivation. RDS is associated with damage of lung structures and impaired oxygen transport to the lungs. A sharp reduction of oxygen in the body causes oxygen deficiency in the heart and brain as well as the development of life-threatening conditions. With RDS, the lethality reaches 60–70% due to delay in treatment.
- Pulmonary fibrosis refers to the replacement of lung tissue with connective tissue, resulting in respiratory failure. This is a distant consequence of the pulmonary inflammatory process. As a result of inflammation, the lung tissue is replaced by a connective tissue scar, and a segment of the lung or lung lobe is excluded from gas exchange.
Who is at Risk?
- Patients who received mechanical ventilation or patients with severe clinical infection courses can get lung fibrosis. This does not imply that all of the patients will necessarily have irreversible fibrosis.
- In the majority of cases, pulmonary fibrosis does not occur after pneumonia. Lung function returns to its normal pattern.
- It usually takes two to three months to form resistance to pulmonary fibrosis.
Risk factors for the development of ARDS and, as a consequence, lung fibrosis include the elderly over 65 years old, people with weakened immune systems due to chronic diseases. These are patients with COPD, bronchial asthma, chronic heart failure, diabetes mellitus, etc.
Chronic Obstructive Pulmonary Disease (COPD) and COVID-19
Chronic obstructive pulmonary disease (COPD) is a progressive bronchopulmonary disease that makes it hard to breathe. It is characterized by airflow limitation in the respiratory tract. It is one of the most common chronic respiratory diseases.
According to the World Health Organization (WHO), COPD is now the 3rd leading cause of death in the world. It is estimated that about 2.8 million deaths are caused by COPD every year, accounting for 4.8% of all deaths globally. Given that both COPD and COVID-19 can cause severe lung damage, it is important to study the effects of SARS-CoV-2 infection on the clinical course, complications and outcomes of COPD. The challenge of combining COVID-19 and chronic obstructive pulmonary disease (COPD) lies in the similarity of clinical manifestations, the complexity of diagnosis, and the potential severe course of these diseases. COPD patients infected with SARS-CoV-2 represent a vulnerable group with a severe clinical course and often poor outcome of the disease. The characteristics of virus transmission complicate the provision of medical care to patients of this category during a pandemic at all stages.
Risk Factors Associated with COVID-19 for COPD Patients
It is still unclear whether COPD increases the risk of contracting COVID-19. However, as stated above, patients with COPD show increased production of angiotensin-converting enzyme II (ACE 2), which is a protein that helps the virus to enter cells.
Patients with COPD also have changes in the local (inflammation in a limited area) and systemic (general inflammatory response of the body, which is independent of the infection site) inflammatory response, weakened immune system, imbalanced microbiota of the respiratory tract, impaired mucociliary clearance (defense mechanism of the lung mucous membrane from the external exposure) and the structure of the bronchi.
COVID-19 Infection Prevention
Patients with COPD should follow basic infection prevention measures.
- Compliance with social distancing.
- Frequent hand washing.
- Wearing a mask in public.
- Switch to remote work from home, if possible.
- Physical activity, doing exercises at home as much as possible.
- Conduct remote consultations with a doctor over the phone or internet, if possible.
Difficulties in Diagnosing COVID-19 in Patients with COPD
There is an obvious similarity between the symptoms of COPD exacerbation and COVID-19 as the most common signs of infection are cough, fever, intoxication, and shortness of breath. These same symptoms are often associated with COPD exacerbation.
Due to the similarity of symptoms, coronavirus infection can be clinically asymptomatic and masked by manifestations of chronic lung pathology. In case of doubt, patients with COPD and exacerbations should be tested for SARS-CoV-2 infection.
COVID-19 and Asthma
Bronchial asthma is a chronic disease characterized by recurrent attacks of breathlessness and wheezing. The attack frequency can range from several times a day to several times a week. The WHO estimates that 235 million people worldwide suffer from asthma.
During an asthma attack, the mucous membrane of the bronchi swells, the muscles around the airways tighten and spasm, resulting in limiting the amount of air supply to the lungs. Breathing out usually becomes more difficult than breathing in. Asthma attacks are accompanied by coughing, wheezing, increased shortness of breath.
Respiratory tract infections and allergies can trigger asthma attacks. In this case, the immune system has to fight not only asthma but also other diseases. Current COVID-19 studies suggest that asthma does not appear to increase the risk of getting the SARS-CoV-2 virus (the virus that causes Covid-19). Research data shows that patients with respiratory diseases are more likely to experience serious complications due to COVID-19 infection. Prevention of coronavirus infection in asthmatics is the same as in patients with COPD.
Interstitial Lung Disease and COVID-19
Interstitial lung disease is a type of lung disorder characterized by widespread inflammation of pulmonary stromal cells, as well as the alveoli and bronchi. The interstitium refers to the tissue that surrounds and separates the alveoli in the lungs. Inflammation of this tissue occurs in interstitial lung disease. The outcome of this pathological process is fibrosis - the development of fibrous connective tissue with scar tissue formation, resulting in impaired respiratory function. The group of interstitial lung diseases includes many pathologies. The diseases are more prevalent in men aged 40-70 years. In most cases, they are smokers. Some diseases of this group have a reversible course and a relatively favorable prognosis, while others lead to early disability and even death.
A considerable proportion of patients with interstitial lung disease (IDL) are at a high risk of contracting COVID-19 due to a number of factors, such as old age and the side effects of treatment. This requires strict adherence to social isolation. Patients with ILD can be monitored over the phone or by e-mail.
Routine pulmonary tests, as well as control bronchoscopic and tomographic examinations, should be postponed. Patients with fever should be screened for possible COVID-19 infection. Acute respiratory distress syndrome (ARDS) may be associated with fibrosis in patients with a genetic predisposition. Research shows that some patients may develop ARDS when infected with COVID-19. Therefore, it may require long-term medical supervision for possible fibrotic changes after a pandemic.
COVID-19 Vaccine: What People With Lung Conditions Need to Know
The vaccine is safe for people with lung conditions. The vaccine has been tested on people with chronic conditions and on people from different age groups, including older people. It was decided that it was safe for people with long-term conditions and that people at high risk should get the vaccine first. There is no reason to believe that the vaccine interacts with any medications.
It would help if you kept up with your regular treatment for a lung condition as normal. If you have asthma and are treated with biologics (known as monoclonal antibodies), talk to your clinician about the timing of your vaccine and your asthma biologic.
What Conclusions Can Be Drawn?
- The presence of COPD as comorbidity increases the risk of a severe course of COVID-19 by more than five times.
- Patients with COPD should strictly observe isolation measures to avoid contact with the virus. They should be monitored carefully if infected.
- Chronic obstructive pulmonary disease can largely determine the unfavorable outcome of the coronavirus infection. This once again emphasizes the vulnerability of chronic pulmonary patients to COVID-19.