Amid COVID-19 pandemic: Challenges with access to care for COPD patients

Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammation in the lungs that causes obstruction in the airway, poor airflow, and irreversible loss of lung function. In clinical practice, comprehensive care for COPD patients includes the diagnosis using spirometry, clinical examination and comprehensive pharmacological and non-pharmacological management. The diagnosis is based on symptoms, dyspnea and lung function impairment and can be mild to very severe. Symptoms are examined using the COPD assessment test (CAT) score, and dyspnea grade are examined using a modified MRC from GOLD guidelines. When mild, the care includes self-management education, smoking cessation, lifestyle modifications, vaccination, and short-acting bronchodilators. Self-management education involves inhaler device training, breathing technique, early recognition of acute exacerbations and writing action plans. As the disease progresses, other care measures are added. These measures include the addition of long-acting inhaler therapies, pulmonary rehabilitation, oral therapies, oxygen and lung transplantation. During the final stages of COPD, patients receive end-of-life care (Bourbeau et al., 2019).(1) The novel coronavirus disease (COVID-19) is a viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that is spread through respiratory droplets. This infectious disease has led to a pandemic and is affecting the lives of many around the world, including Canadians. During this pandemic, the non-essential health services, including caring for patients with COPD, have been put on hold to reduce the risk of spread. Other implications of this pandemic for COPD patients include the health risk in case of infection. A meta-analysis including studies from January to March 2020 in Wuhan showed that pre-existing COPD worsens the risk of COVID-19 progression and leads to poorer prognostics. The sub-group analysis showed a significantly higher risk of ICU requirements and death in COPD patients who are infected with the SARS-CoV-2 virus. Studies suggest strong efforts to mitigate the risk of infection in this population (Zhao et al., May 2020).(2) This makes caring for this population even more critical during the pandemic.