CLINICAL OUTCOMES FROM COVID-19 INFECTION IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE: 5 YEARS LATER

Authors

  • Jordan Minov Institute for Occupational Health of R. North Macedonia - Skopje, Faculty of Medicine, Ss Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Sasho Stoleski Institute for Occupational Health of R. North Macedonia - Skopje, Faculty of Medicine, Ss Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Daniela Buklioska-Ilievska 2PHI City General Hospital “8th September” - Skopje, R. North Macedonia Faculty of Medical Sciences – University “Goce Delchev” – Shtip, R. North Macedonia
  • Aneta Atanasovska Institute for Occupational Health of R. North Macedonia - Skopje, Faculty of Medicine, Ss Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Maja Panajotovic-Radevska Institute for Occupational Health of R. North Macedonia - Skopje, Faculty of Medicine, Ss Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Dragana Bislimovska Institute for Occupational Health of R. North Macedonia - Skopje, Faculty of Medicine, Ss Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Dragan Mijakoski Institute for Occupational Health of R. North Macedonia - Skopje, Faculty of Medicine, Ss Cyril and Methodius University in Skopje, Republic of North Macedonia

Keywords:

chronic obstructive pulmonary disease, COVID-19 infection, exacerbation rate, lung function, symptoms

Abstract

Introduction: Evidence of impact of COVID-19 infection on course of chronic obstructive pulmonary disease (COPD) is still limited.

Aim: To assess clinical outcomes of moderate COVID-19 infection in patients with moderate COPD by comparison of disease control, i.e., the frequency and severity of symptoms, level of health status impairment, values of spirometrc parameters and exacerbation risk, registered at two points in time: 2020 and 2025.

Material and methods: We performed a cross-sectional study including 74 patients with moderate COPD divided in two groups. The first group (COVID-19 group) included 37 COPD patients who had COVID-19 infection of moderate severity in 2020. The second group (non-COVID-19 group) included patients with COPD who did not have coronavirus disease in the period 2020-2025. The frequency and severity of symptoms and level of health impairment were assessed by COPD Assessment Test (CAT): lung function was assessed by spirometric measurements, and exacerbation risk was predicted by exacerbation rate registered in the previous year.   

Conclusion: Our findings indicated significant impact of the COVID-19 infection on symptoms, patient’s health and daily life, as well as on the lung function and exacerbation risk emphasizing a need of careful monitoring of these patients upon recovery from COVID-19 infection in order to minimize the impact of infection on COPD progression.

References

Coronaviridae Study Group of the International Committee on Taxonomy of V. The species severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2 Nat Microbiol 2020; 5(4): 536–544. doi: 10.1038/s41564-020-0695-z.

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395(10223): 497-506. doi: 10.1016/S0140-6736(20)30183-5.

Koc HC, Xiao J, Liu W, Li Y, Chen G. Long COVID and its Management. Int J Biol Sci 2022; 18(12): 4768-4780. doi: 10.7150/ijbs.75056.

Poucineau J, Khlat M, Lapidus N, Espagnacq M, Chouaïd C, Delory T, et al. Impact of the COVID-19 pandemic on COPD patient mortality: a nationwide study in France. Int J Public Health 2024; 69: 1606617. doi: 10.3389/ijph.2024.1606617.

Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. 2025 Report. Available at: htpps://goldcopd.org/ (Accessed 28.08.2025).

Minov J, Stoleski S. Chronic obstructive airways diseases: Where are we now? Open Respir Med J; 2015; 9 (1): 37-38. doi: 10.2174/1874306401509010037.

Chen S, Kuhn M, Prettner K, Yu F, Yang T, Bärnighausen T, et al. The global economic burden of chronic obstructive pulmonary disease for 204 countries and territories in 2020-50: a health-augmented macroeconomic modeling study. Lancet Glob Health 2023; 11(8): e1183-e1193. doi: 10.1016/S2214-109X(23)00217-6.

Singh D, Long G, Cancado JED, Higham A. Small airway disease in chronic obstructive pulmonary disease: insights and implications for the clinician. Curr Opin Pulm Med 2020; 26(2): 162-168. doi: 10.1097/MCP.0000000000000637.

Stridsman C, Vanfleteren LEGW, Konradsen JR, Axelsson Fisk S, Pedroletti C, Sjöö Y, et al. Predictors of severe COVID-19 in a registry-based Swedish cohort of patients with chronic obstructive pulmonary disease (COPD). Eur Respir J 2021; 58(5): 2101920. doi: 10.1183/13993003.01920-2021.

Lang M, Som A, Mendoza DP, Flores EJ, Reid N, Carey D, et al. Hypoxaemia related to COVID-19: vascular and perfusion abnormalities on dual-energy CT. Lancet Infect Dis 2020; 20(12): 1365-1366. doi: 10.1016/S1473-3099(20)30367-4.

Alqahtani JS, Oyelade T, Aldhahir AM, Alghamdi SM, Almehmadi M, Alqahtani AS, et al. Prevalence, severity and mortality associated with COPD and smoking in patients with COVID-19: a rapid systematic review and meta-analysis. PLoS One 2020; 15(5): e0233147. doi: 10.1371/journal.pone.0233147.

Gerayeli FV, Milne S, Cheung C, Li X, Yang CWT, Tam A, et al. COPD and the risk of poor outcomes in COVID-19: a systematic review and meta- analysis. EClinicalMedicine 2021; 33:100789. doi: 10.1016/j.eclinm.2021.100789.

Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. 2020 Report. Available at: htpps://goldcopd.org/ (Accessed 27.08.2025).

Coronavirus disease 2019 (COVID-19) treatment guidelines. National Institutes of Health. Available at: ncbi.nlm.nih.gov/ (Accessed 26.08.2025).

Coronavirus disease 2019 (COVID-19). Available at: https://www.mayoclinic.org/ (Accessed 26.08.2025).

WHO Report on the Global Tobacco Epidemic, 2019, Geneva: World Health Organization, 2019.

The COPD Assessment Test (CAT). Available at: https://www.catestonline.org/ (Accessed 27.08.2025).

Pellegrino R, Viegi G, Brusasco V. Interpretative strategies for lung function tests. Eur Respir J 2005; 26(5): 948-968. doi: https://doi.org/10.1183/09031936. 05.00035205

Culver BH, Graham BL, Coates AL, Wanger J, Berry CE, Clarke PK, et al. Recommendations for Standardized Pulmonary Function Report. An Official American Thoracic Society Technical Statement. Am J Respir Crit Care Med 2017; 196(11): 1463-1472. doi: 10.1164/rccm.201710-1981ST.

Awatade NT, Wark PAB, Chan ASL, Mamun SMAA, Mohd Esa NY, Matsunaga K, et al. The complex association between COPD and COVID-19. J Clin Med 2023; 12(11): 3791. doi: 10.3390/jcm12113791.

Higham A, Mathioudakis A, Vestbo J, Singh D. COVID-19 and COPD: a narrative review of the basic science and clinical outcomes. Eur Respir Rev 2020; 29 (158): 200199. doi: 10.1183/16000617.0199-2020.

Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395(10223): 507-513. doi: 10.1016/S0140-6736(20)30211-7.

Argenziano MG, Bruce SL, Slater CL, Tiao JR, Baldwin MR, Barr RG, et al. Characterization and clinical course of 1000 patients with coronavirus disease 2019 in New York: retrospective case series. BMJ 2020; 369: m1996. doi: 10.1136/bmj.m1996.

Halpin DMG, Singh D, Hadfield RM. Inhaled corticosteroids and COVID-19: a systematic review and clinical perspective. Eur Respir J 2020; 55(5): 2001009. doi: 10.1183/13993003.01009-2020.

Lu C, Mao X. Risk of adverse reactions associated with inhaled corticosteroids for chronic obstructive pulmonary disease: A meta-analysis. Medicine (Baltimore) 2024; 103(3): e36609. doi: 10.1097/MD.0000000000036609.

Minov J, Karadžinska-Bislimovska J, Vasilevska K, Nelovska Z, Risteska-Kuc S, Stoleski S, et al. Smoking among Macedonian workers five years after the anti-smoking campaign. Arh Hig Rada Toksikol 2012; 63(2): 207-213. doi: 10.2478/10004-1254-63-2012-2150.

Minov J, Stoleski S, Stikova E, Mijakoski M, Atanasovska A, Karadzinska Bislimovska J. COPD in a sample of general adult population from the Skopje region. Acad Med J 2022; 2(1): 47-58. doi:10.53582/AMJ2221047.

Buklioska-Ilievska D, Minov J, Kocovska-Kamcevska N, et al. Cardiovascular comorbidity in patients with chronic obstructive pulmonary disease: Echocardiography changes and their relation to the level of airflow limitation. Open Access Maced J Med Sci 2019; 7(21): 3568-3573.

Buklioska-Ilievska D, Minov J, Kochovska-Kamchevska N, Prgova-Veljanova B, Petkovikj N, Ristovski V, et al. Metabolic syndrome (mets) as one of the major comorbidities of chronic obstructive pulmonary disease (copd). Respiratio 2023; 13(1-2): 45-56. doi: 10.3889/oamjms.2019.848.

Kwok WC, Chau CH, Tam TCC, Lam FM, Ho JCM, et al. Outcomes among patients with chronic obstructive pulmonary disease after recovery from COVID-19 infection of different severity. Scientific reports 2024; 14(1): 13881. doi: 10.1038/s41598-024-64670-9.

Choi JY, Kim KJ, Rhee CK. Change in exacerbation rate of COPD patients before and after COVID-19 infection. Scientific Reports 2025; 15: 2427. DOI:10.1038/s41598-025-86426-9.

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Published

2025-12-16

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Original Articles