What do we know about the effect of long COVID and its impact on asthma or COPD patients?
What the research says:
Estimated prevalence of long-COVID (symptoms 12+ weeks following acute COVID-19 illness) vary considerably, ranging from <5% to >80% of patients following acute COVID-19 illness (Cabrera Martimbianco et al 2021). In a UK-based longitudinal study of 6899 adults who self-reported acute COVID-19 illness, long-COVID (symptoms beyond 12 weeks) increased with age from ~7.8% (mean age 28 years) to ~17% (mean age 58 years) (Thompson et al 2021). Among those hospitalised with COVID-19, between 50% and 89% have been reported to have at least one enduring symptom after 2 months after discharge (NIHR 2021). These estimates are based on the situation when the predominant SARS-CoV-2 variant was Delta and the picture may change once data for periods when the Omicron variant data was dominant.
Symptoms associated with long-COVID may impair an individual’s ability to function in their daily lives including performing activities of daily living and work. The most common symptoms include: fatigue, dyspnoea, cardiac abnormalities, cognitive impairment, sleep disturbances, symptoms of post-traumatic stress disorder, concentration problems, muscle pain and headache (Crook et al 2021).
A higher risk for long-COVID has been reported for those with asthma (as much as 32% increased risk reported in one study; Thompson et al 2021). In a UK-based survey of 4500 individuals with asthma 10.5% reported COVID-19 illness. Of these, 56% reported having long-COVID and were more likely than those without long-COVID to describe their breathing as worse/much worse, reported increased inhaler use and worse or much worse asthma management (Philip et al 2022).
In a UK-based primary care population, COPD, bronchitis and emphysema was not associated with an increased risk for long-COVID (defined as symptoms ≥4 weeks) (OR 1.53; 95% CI [0.84–2.72]; Jones et al 2021). In a prospective single-center study COPD was associated with symptom persistence at 12 months following discharge from hospital for acute COVID-19 illness (Fumagalli et al 2021). No systematic data on the risk factors and symptom profile of long-COVID among patients with COPD are yet available.
What this means for your clinical practice:
• Continue to follow-up with patients once they recover from acute COVID-19 illness of any severity, with particular vigilance for symptoms persisting beyond 12 weeks from onset of the acute illness
• For patients with asthma or COPD, review regularly
With grateful thanks to Karin Lispers, Associate Professor (Family Medicine and Preventive Medicine, Uppsala University, Sweden) for and on behalf of the IPCRG practice driven answers review group.
Useful links and supporting references:
Cabrera Martimbiano AL, et al. Frequency, signs and symptoms, and criteria adopted for long-COVID-19: A systematic review. Int J Clin Pract 2021;75:e14357.
Crook H, et al. Long covid – mechanisms, risk factors, and management. BMJ 2021;374:n1648.
Fumagalli C, et al. Factors associated with persistence of symptoms 1 year after COVID019: A longitudinal, prospective phone-based interview follow-up cohort study. Eur J Intern Med 2021; S0953-6205(21)00405-2.
Jones R, et al. Risk predictors and symptom features of long COVID within a broad primary care patient population including both tested and untested patients. Prag Obs Res 2021;12:93–104.
NIHR. Living with COVID19 – Second review. March 2021. Available at: https://evidence.nihr.ac.uk/themedreview/living-with-covid19-second-review/#How. Accessed February 2022.
Perez Gonzalez A, et al. Long COVID in hospitalized and non-hospitalized patients in a large cohort in Northwest Spain, a prospective cohort study. 2021. Preprint not yet peer reviewed. Available at: https://www.medrxiv.org/content/10.1101/2021.08.05.21261634v1. Accessed January 2022.
Philip KEJ, et al. Impact of COVID-19 on people with asthma : A mixed methods analysis from a UK wide survey. BMJ Open Respir Res 2022;9:e001056. Available at: https://bmjopenrespres.bmj.com/content/9/1/e001056/. Accessed January 2022
Thompson EJ, et al. Risk factors for long COVID: analyses of 10 longitudinal studies and electronic health records in the UK. 2021. Pre-print (not yet per-reviewed). Available at: https://www.medrxiv.org/content/10.1101/2021.06.24.21259277v2. Accessed January 2022