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Impact of COVID-19 Lockdown on the Incidence and Mortality of Acute Exacerbations of Chronic Obstructive Pulmonary Disease: National Interrupted Time Series Analyses for Scotland and Wales

First national level analysis shows hospital admissions for COPD (Chronic Obstructive Pulmonary Disease) across Scotland and Wales fell during the first COVID-19 lockdown.

Nearly half the number of hospital visits – and no increase in deaths 

The study found a 39% reduction in GP consultations and a 48% reduction in hospital admissions for COPD following the introduction of the first national lockdown. This was compared with data from the last 5 years.  

Additionally, no evidence was found that COPD deaths increased. This is important because a reduction in health care activity on this scale for other conditions has corresponded with higher mortality. 

COPD affects at least 1.2 million people in the UK 

COPD is an incurable condition that can severely limit the sufferer’s activity levels and quality of life. It is a common condition that primarily, but not exclusively, affects smokers and ex-smokers as they get older, leading to breathlessness and other respiratory problems. 1.2 million people are estimated to be living with diagnosed COPD; around 2% of the UK population. 

Scotland-wide monitoring of COVID-19 

The EAVE II study, led by The University of Edinburgh and funded by the Medical Research Council, tracks the COVID-19 pandemic as it happens across Scotland. It does so by analysing health data for 5.4 million people living in Scotland, in partnership with Public Health Scotland.  

For this study, the EAVE II team worked with researchers at Swansea University Medical School – using EAVE II’s population-based data with near complete geographical coverage across Scotland and Wales’s SAIL Databank. The work was supported by BREATHE – The Health Data Research Hub for Respiratory Health. 

Amidst all the havoc that COVID-19 has heaped on our lives and the NHS, it is encouraging to see that lockdown measures have been associated with important improvements in some health outcomes. Our study, drawing on data from across Scotland and Wales, found that lockdown was associated with an almost 50% reduction in hospital admissions for acute exacerbations of chronic obstructive pulmonary disease (COPD). These are the most substantial reductions in COPD ever seen across the UK, and are likely to be the result of improved hygiene measures and curtailed social mixing leading to a reduction in the circulating viruses that trigger many COPD exacerbations.

These findings build on our work earlier this year, also showing substantial reductions in serious asthma exacerbations. Our focus is now on identifying the transferable lessons from this body of work, which can hopefully be taken forward into the post-COVID era to improve outcomes for the millions of people living with chronic respiratory disorders in the UK and globally.

Professor Aziz SheikhDirector of Usher Institute and BREATHE

Learning for the future 

It is hoped that these findings will help harness learnings from COVID-19 lockdowns to support an improved public health message beyond the pandemic. For example, to facilitate effective self-management and reduce the transmission of respiratory infections through better hygiene and other precautionary measures.  

The implications of this work stretch beyond those with COPD. A reduction in COPD-related attendances also increases health care capacity and resources to treat people with COVID-19 and other illnesses. 

The authors advise future investigation to fully understand the underlying reasons behind these results. However, along with other similar recent studies of serious exacerbations of asthma, these findings could also support the drive to reduce pollution levels. 

Lockdown measures to reduce COVID-19 seem also to have led to a dramatic drop in COPD attacks and we need to understand the reasons behind this better. These findings have important implications in preventing COPD attacks. Public health strategies need to capture the positive elements here that could reduce COPD attacks in the future. These are likely to include hygiene measures, effective self-management and improved air quality.

Professor Gwyneth DaviesProfessor of Respiratory Medicine at Swansea University 

Read the full paper  

Available from BMC Medicine

Cite as

Alsallakh, M.A., Sivakumaran, S., Kennedy, S. et al. 

Impact of COVID-19 Lockdown on the Incidence and Mortality of Acute Exacerbations of Chronic Obstructive Pulmonary Disease: National Interrupted Time Series Analyses for Scotland and Wales. BMC Med 19, 124 (2021).

https://doi.org/10.1186/s12916-021-02000-w