How Contracting COVID-19 May Affect COPD
Because the coronavirus that causes COVID-19 can severely impact respiratory function, doctors are concerned about its effect on people who already have inflammation of the lungs, such as those with chronic obstructive pulmonary disorder (COPD).
One thing is clear: Healthcare experts agree that people with COPD should take every precaution to avoid getting the virus.
Does Having COPD Put You at Higher Risk of Contracting COVID-19?
The answer to this question is likely to be yes, says David Au, MD, a professor in the division of pulmonary, critical care, and sleep medicine at the University of Washington Medical School in Seattle. “I say ‘likely’ and not ‘definitively’ yes because even though all the epidemiological evidence suggests that patients with COPD are at increased risk of testing positive for COVID-19, it can be tricky —?patients with COPD have symptoms that can mimic symptoms of COVID-19, such as cough, shortness of breath, and fatigue,” says Dr. Au.
Because of the overlapping symptoms, COPD patients as a group are more likely to be tested for COVID-19 than other people, says Au, adding “if you’re more likely to be tested, you’re probably more likely to be found to have the disease.”
Men and women with COPD who become infected with the coronavirus may be more likely to have a severe case and complications, says Au. Existing data from other viral respiratory infections suggest that the coronavirus may cause flare-ups for individuals with COPD that could lead to more severe cases of COVID-19, according to the Centers for Disease Control and Prevention (CDC).
A study of COVID-19 patients published in the European Respiratory Journal on March 13, 2020,?found that COPD was associated with a greater risk of admission to an intensive care unit, being put on a ventilator, or dying.
Are There Extra Safety Precautions People With COPD Should Take to Avoid Exposure?
Everyone, including people with COPD, should follow the guidelines put forth by the CDC — hand-washing, wearing a face covering, and social distancing. “Because people with COPD are at increased risk of complications, they should really be taking these recommendations to heart,” says Au, noting, “they should be very vigilant about social distancing and sheltering in place.” Stay at home, stay safe, he urges.
“As society begins to venture away from [CDC] recommendations,” Au adds, “it’s really important for people with COPD to continue to be cautious. They should be among the last groups to come out from social distancing and sheltering at home.”
One particular challenge for people with COPD is that wearing a face covering can make breathing even more difficult. The American Lung Association offers tips to help you get used to wearing a face covering, such as keeping a positive outlook, trying out different types of masks and face coverings, and wearing one around the house for short periods of time as a sort of dress rehearsal before going out in public.
How Will Your COPD Be Affected if You Test Positive for COVID-19?
It’s hard to know all the ways that COVID-19 will interact with COPD because the coronavirus is incredibly variable in its impact on different people. “It was identified as a respiratory virus and it’s transmitted as a respiratory virus. But although it clearly affects the lungs, it also affects a lot of organ systems on top of that,” says Au.
He adds, “I think a big issue is that patients with COPD are going to have less resilience to the virus because those patients tend to be older and have multiple comorbidities [additional health problems].”
If someone with COPD tests positive for COVID-19, they would likely experience certain typical symptoms, such as cough, shortness of breath, and fatigue with more severity. “Because COPD and COVID-19 have many of the same symptoms, the virus could easily be seen as sort of a worsening of COPD, at least initially,” says Au.
Your COPD Treatment Checklist During This Pandemic: How to Be Prepared
It’s important to continue to manage your COPD and stay as healthy as possible during the COVID-19 pandemic, which includes continuing to take your medications unless your doctor instructs you otherwise and, if you’re a smoker, quitting.
The American Lung Association recommends considering using a mail-order pharmacy option for your controller medications and securing a 90-day supply of your prescription medication if your insurance allows.
Are There Changes to Formal COPD Treatment Guidelines to Follow?
There haven’t been changes to COPD treatment recommendations. The guidelines put forth by medical organizations have been focused on prevention measures, such as staying home, says Au.
The Global Initiative for Chronic Obstructive Lung Disease issued the following statements:
- There isn’t scientific evidence at this time to suggest that inhaled or oral corticosteroids should be avoided during the COVID-19 epidemic.
- COPD patients should continue to take their regular therapy.
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Are There Any Prescribed Medications for COPD That May Now Be Unsafe to Take Due to COVID-19?
Although there are no recommendations to stop inhaled corticosteroids (ICS), medical experts have some concerns about these medications overall, says Au.
A?meta-analysis published in?International Immunopharmacology?in December 2019?found an association between fluticasone-containing inhaled steroids (but not budesonide-containing inhaled steroids) and increased pneumonia risk.
Pneumonia?can be a complication of COVID-19 in people with or without COPD, according to the?CDC.
Inhaled corticosteroids are overused in the population with COPD. “Over the last several years the guidelines have been narrowing the use of these medications to people who are frequent exacerbators,” says Au, meaning those who have two or more exacerbations (symptom flare-ups) a year.
What Resources Are Available if You Can No Longer Afford Your Medications?
If paying for your COPD medications is an issue, you should definitely discuss it with your healthcare provider right away. “They would want to know if you’re having trouble,” says Au.
There are a few things that can help you cover the costs of your COPD therapy, says Au.
- If you’re on a branded medication, go to the company website to see if there is a patient assistance program to help with costs.
- Ask your doctor if there’s an opportunity to make a transition from a “name brand” drug to a?generic. According to Au, “In COPD treatment specifically, generic drugs have been coming out more frequently, so there may be an opportunity now to reduce your cost.”
- Shop around for the right pharmacy. “There are many places that offer very inexpensive generic medications,” Au says.
What Can Someone With COPD Take to Safely Boost Their Immune System?
There really isn’t anything that can help boost the immune system of someone with COPD as a way to stave off the coronavirus. “It’s about prevention; an ounce of prevention in COVID-19 is worth a pound of cure,” says Au.
“You want to do the things that make sense to do. Smoking for patients with COPD is clearly bad. Stopping smoking is one of the few interventions that we refer to as the trifecta in healthcare: It reduces mortality, improves quality of life, and saves money over time for our health system and our patients,” he says.
Eating well, sleeping enough, and minding your weight are all behaviors that help your immune system function as it should, says Au.
There has been some evidence of a connection between vitamin D levels and COVID-19. An analysis published in the Irish Medical Journal?on May 12 suggested that vitamin D deficiency may lead to increased risk of contracting COVID-19 or having a more severe case. The researchers believe that having a healthy level of vitamin D is “likely to reduce serious COVID-19 complications.” Larger, more rigorous studies are needed.
Managing COPD, Mental Health, COVID-19 Concerns, and You
These are very stressful times. Finding ways to relax and decrease anxiety are important to maintaining mental health. It’s established that depression and anxiety are more common in people with COPD; research suggests that people with COPD are more than 70 percent more likely to develop depression and 85 percent more likely to develop anxiety disorders than people without the condition.
Can Anxiety Around Coronavirus Make COPD Worse?
“Stress can make people with COPD more symptomatic. We know that anxiety and stress increase people’s sense of shortness of breath and are clearly related to exacerbation frequency,” says Au.
“I encourage people to engage in activities that reduce stress and make them feel happy,” he says, adding that it’s also very important to make sure you’re sleeping well.
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If your depression or anxiety worsens during the pandemic, you should tell your healthcare provider, says Au. Depending on your symptoms, they may suggest stress reduction strategies, talk therapy, or medication.
How Can You Stay Emotionally Healthy During the Pandemic?
One of the challenges of the COVID-19 pandemic is that every day under lockdown can start to feel the same. “We wake up in our house, we spend the entire day in our house, we go to sleep in our house, and we never leave. Every day can seem a lot like the one before,” says Au.
“Although a routine is important, try to have some variation within that routine that helps you deal with the monotony,” he suggests.
The COPD Foundation offers recommendations for how to stay emotionally healthy during the pandemic.
- Stay up-to-date. It’s okay to watch the news, but take periodic breaks and limit your consumption.
- Keep it light. Try to find something to laugh or smile about, whether it’s old family photos or a comedy on television.
- Research has shown that meditation and mindfulness can help ease stress and anxiety. Try downloading a meditation app on your phone or visit YouTube and look through the many free guided meditations or online relaxation exercises.
Managing COPD-Related Doctor’s Appointments
Figuring out how to best manage your healthcare appointments is largely determined by where you live. “There are certain parts of the United States where [coronavirus] prevalence is very low. I would advise following state guidance on going out,” says Au. Many doctors are now offering telemedicine as a way to support social distancing while providing care.
Should You Continue to Go to Regularly Scheduled Doctor’s Appointments?
It’s important to seek in-person care when necessary (call your doctor if you’re not sure whether you need to go in), but if you can substitute a virtual visit, do so, especially if you live in an area that has a lot of active COVID-19 cases. “Although doctor’s offices are taking precautions to prevent spread of the virus, an in-person visit still carries more risk than a virtual appointment,” says Au.
Are There Any Extra Precautions to Take for In-Person Appointments?
If you need to go to a doctor’s appointment, take the precautions that the CDC recommends, including wearing a face covering, washing your hands, using hand sanitizer if there’s no soap and water available, and maintaining at least six feet between yourself and other people whenever possible.
Call your doctor and ask about the safety measures they are instituting, Au suggests. Many clinics, such as Duke Health in Durham, North Carolina, are using floor decals to enforce social distancing and allowing patients to wait in the car until the doctor is ready to see them.
Are Virtual Doctor’s Visits as Effective as In-Person?
“I would definitely recommend the use of telehealth services during this time,” says Au. “There are many issues that can be managed in COPD remotely, particularly if you use video conferencing. I do think you learn a lot by seeing a patient in addition to talking with them; you can infer a lot about the physical exam through seeing someone on a video.”
If a video appointment isn’t available, a phone appointment can be beneficial as well, Au adds.
What Types of Appointments Should You Do Virtually vs. In-Office?
“Immunizations have to be done in person, although we may see patients immunizing themselves at some point in the future because it isn’t that difficult to do,” says Au.
The CDC recommends that people with COPD get the following vaccines:
- Influenza vaccine, which protects against the seasonal flu. This should be done every year.
- Tdap vaccine, which protects against tetanus, diphtheria, and whooping cough. A tetanus vaccine is required every 10 years, while a Tdap is only required once as an adult.
- Pneumococcal vaccine, which protects against pneumococcal diseases. These are any infections caused by bacteria called Streptococcus pneumoniae or pneumococcus and can range from ear and sinus infections to pneumonia and bloodstream infections.
- Zoster vaccine, which protects against shingles.
If you are due for a vaccine you should discuss it with your doctor remotely to see if it’s necessary for you to plan an in-person visit in the future.
Repeat pulmonary functioning tests for COPD require an office visit, but those are probably not very valuable or worth the risk during the pandemic, according to Au.
What to Expect at a Telehealth COPD Appointment and How to Get Prepared
There are a few things you can do to prepare for your telehealth appointment in order to make sure you get the most out of it, says Au.
- Be ready at your phone or computer at the time of your appointment.
- Test the conferencing call platform that you’re going to use to make sure that it works.
- Have your phone ready in case the video conference doesn’t work.
- Prepare as you would for an in-person appointment by writing down all your questions.
- If you feel it’s going to be a complex conversation or one filled with detailed instructions, have someone else listen in to help you.
- Write down what your doctor says if you think you’ll have trouble remembering later.
- Take the appointment in a quiet place without distractions so you can give your healthcare provider your full attention.
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5 Expert Tips for Living With COPD During the Coronavirus Pandemic
Preventing deconditioning with?regular exercise is a key component of successfully managing COPD during the pandemic. “COPD is largely a disorder of shortness of breath, and most people don’t like to exercise or exert themselves when they’re short of breath. When you get short of breath you have a tendency to want to stop —?then that makes you a little more deconditioned, which then makes you more short of breath and you get into this spiral,” says Au.
Au and the Respiratory Health Association offer a few tips on how to keep exercising.
- Exercise at least three times a week for 30 minutes a day.
- Set up an exercise course in your house or in an area of your neighborhood that’s free of exposure risk.
- March in place, or do arm circles or leg lifts. Use small weights or canned goods while moving.
- Go up and down the stairs.
- Listen to soft music and practice deep breathing exercises.
Make sure that you use your medications when you’re supposed to, as well, Au adds.
Trusted Resources We Love to Help Those With COPD in COVID-19 Times
American Lung Association is a nonprofit working to save lives and improve lung health through research, education, and advocacy. The organization offers a Lung Helpline to answer questions about COVID-19, as well as educational webinars and online support groups.
Respiratory Health Association is a nonprofit dedicated to preventing lung disease, promoting clean air, and helping people with respiratory illnesses live better through education, research, and policy efforts. The website posts important news and updates regarding COVID-19.
COPD Foundation is a nonprofit that supports research, education, and advocacy. They provide valuable information for people with COPD during the pandemic, including tips on exercise, strategies for coping with challenges in daily life, and pointers on telehealth.
Living With COPD is a support community sponsored by the American Lung Association. People with COPD share advice and concerns around a variety of issues, including COVID-19.