Chronic respiratory diseases and the outcomes of COVID-19: A nationwide retrospective cohort study of 39,420 cases

Guan, Wei-jie; Liang, Wen-hua; Shi, Ying; Gan, Lan-xia; Wang, Hai-bo; He, Jian-xing; Zhong, Nan-shan

Background Chronic respiratory diseases (CRD) are common among patients with coronavirus disease 2019 (COVID-19). Objectives We sought to determine the association between CRD (including disease overlap) and the clinical outcomes of COVID-19. Methods Data of diagnoses, comorbidities, medications, laboratory results and clinical outcomes were extracted from the national COVID-19 reporting system. CRD was diagnosed based on ICD-10 codes. The primary endpoint was the composite outcome of needing invasive ventilation, admission to intensive care unit, or death within 30 days after hospitalization. The secondary endpoint was death within 30 days after hospitalization. Results We included 39,420 laboratory-confirmed patients from the electronic medical records as of May 6th, 2020. Any CRD and CRD overlap was present in 2.8% and 0.2% of patients, respectively. COPD was most common (56.6%), followed by bronchiectasis (27.9%) and asthma (21.7%). COPD-bronchiectasis overlap was the most common combination (50.7%), followed by COPD-asthma (36.2%) and asthma-bronchiectasis overlap (15.9%). After adjustment for age, sex and other systemic comorbidities, patients with COPD (OR: 1.71, 95% CI: 1.44-2.03) and asthma (OR: 1.45, 95%CI: 1.05-1.98), but not bronchiectasis, were more likely to reach to the composite endpoint compared with those without at day 30 after hospitalization. Patients with CRD were not associated with a greater likelihood of dying from COVID-19 compared to those without. Patients with CRD overlap did not have a greater risk of reaching the composite endpoint compared to those without. Conclusion CRD was associated with the risk of reaching the composite endpoint, but not death, of COVID-19.