ABSTRACT
A significant reduction in hospitalizations for acute exacerbations of COPD (AECOPD) is seen during the COVID-19 pandemic. It remains unclear whether this reduction is the result of avoidance of medical care by patients, or of infection prevention and control (IPC) measures. This study used a real-life inpatient pulmonary rehabilitation (PR) setting to explore the impact of COVID-19-related IPC measures on the incidence of AECOPD, thereby mitigating the potential effect of care avoidance. Patients with COPD admitted for eight weeks of inpatient PR at Ciro (Horn, the Netherlands) were included in this retrospective study. Patients admitted between October 1st 2020 and March 1st 2021, the first winter season with COVID-19-related IPC measures in place, were compared to patients admitted during the same periods in previous years (2017-2018, 2018-2019 and 2019-2020). Electronic medical records were retrospectively screened for the incidence of moderate to severe AECOPD, drop-out and mortality during the PR period. A total of 501 patients with COPD (median age 66.6 [IQR 60.3-71.9] years, 43.1% male, FEV1 35.9 [26.8-50.6] % predicted) were analyzed. During 2020-2021, 22 patients (31.0%) experienced >=1 AECOPD compared to 43 patients (33.6%) in 2019-2020, 55 patients (36.9%) in 2018-2019 and 83 patients (54.2%) in 2017-2018, p=0.077. No differences in the mean AECOPD rate, AECOPD severity, drop-out nor mortality rates were observed. This study is the first to demonstrate that COVID-19-related IPC measures do not affect the incidence of AECOPD during inpatient PR. These findings may therefore suggest that the reduction of AECOPD observed in hospital settings may be related to care avoidance.