Risk of Acute Exacerbation of Chronic Obstructive Pulmonary Disease after COVID-19 Recovery: A Nationwide Population-based Cohort Study

초록

Background: Chronic obstructive pulmonary disease (COPD) is associated with severe Coronavirus disease 2019 (COVID-19) outcomes. However, it is uncertain whether the risk of acute exacerbation of COPD (AECOPD) increases after recovering from COVID-19. Methods: This study included 2,118 individuals with COPD from the Korea National Health Insurance Service database who were also diagnosed with COVID-19. Matched controls were chosen using 1:1 propensity score (PS) matching. Using PS-matched Cox proportional hazard regression models, we compared the risk of AECOPD after COVID-19 recovery between the COVID-19 cohort and matched controls between October 8, 2020, and December 31, 2021. Results: During a median follow-up of 62 days (interquartile range, 29–179 days), including a median of 14 days of recovery time after COVID-19, 68 people (5.6%) in the COVID-19 cohort and 50 (3.9%) in the matched control group experienced AECOPD. Compared to the matched controls, the COVID-19 cohort had a significantly higher risk of overall AECOPD (hazard ratio [HR]=1.45, 95% confidence interval [CI]=1.09–1.92). This increased risk was particularly evident for severe AECOPD among individuals with severe COVID-19 within the first 30 days post-recovery (aHR = 8.14, 95% CI = 3.32–19.97). When classified by COVID-19 severity, while severe COVID-19 significantly increased this risk (aHR=2.97, 95% CI=2.15–4.11), non-severe COVID did not significantly influence the risk of AECOPD, regardless of time duration or exacerbation severity. Conclusion: Individuals with COPD who have severe COVID-19 have an increased risk of AECOPD after COVID-19 recovery.