الفهرس 
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Abstract
The COVID-19 pandemic has led to many difficulties with the diagnosis and routine management of chronic pulmonary diseases such as COPD, Bronchial asthma, ILD and Bronchiectasis as well as raising concerns about the management and outcomes for patients with these diseases who develop COVID-19. Although there is conflicting evidence on whether patients with chronic respiratory diseases are more susceptible to COVID-19, these patients exhibit a more severe presentation and higher mortality compared with those without chronic respiratory diseases.
GOLD recommends that patients with COPD should follow basic infection control measures and whenever possible should wear masks. In most cases, a loose face covering, or even a face shield is tolerable and effective, but wearing a surgical mask does not appear to affect ventilation even in patients with severe airflow limitation.
COPD is associated with increased risk of morbidity and mortality in community-acquired pneumonia (CAP). Alterations in local/systemic inflammatory response, impaired host immunity, microbiome imbalance, persistent mucus production, structural damage, and use of inhaled corticosteroids have been hypothesized to contribute to such risk.
Asthma has not yet been identified as a risk factor for severe outcomes in COVID-19 in any of the large case series reported to date but chronic respiratory disease had the third highest case fatality ratio, after cardiovascular disease and diabetes.
Patients with preexisting interstitial lung disease (ILD) may be at high risk for severe coronavirus disease (COVID-19) because of impaired lung function, propensity to develop acute exacerbation of pulmonary fibrosis, or immunomodulatory medications that may interact with viral clearance or pathogenesis.
On the other hand, recent studies revealed that the rate of COVID-19 was relatively higher in patients with bronchiectasis than those without bronchiectasis. Considering that age-, sex-, and residence-matching was done before comparison, COVID-19 patients with bronchiectasis suffered from more severe infection than those without bronchiectasis.
So, we should clarify the prevalence of chronic pulmonary diseases and COVID-19 as well as shine light on the outcome of COVID-19 in patients with chronic chest diseases. So, the authors of this research aim to assess the clinical presentation, radiological patterns and outcome of COVID-19 infection in patients with COPD. Also, to investigate the inter-relationship between the severity of COVID-19 infection and chronic pulmonary diseases.
This observational case control study was conducted on 301participants including 150 patients with chronic pulmonary disease infected with SARS-COV-2 and 151 infected with SARS-COV-2 as control. All patients were subjected to thorough medical history, thorough clinical examination and investigations including (radiological and laboratory investigations).
Summary of results
● The prevalence of chronic pulmonary disease represented about 150 (50%) of the total population and SARS-COV-2 only without pulmonary disease represent 151(50%). chronic pulmonary disease was distributed as bronchial asthma in 28(9.3%), bronchiectasis in 40 (13.2%), COPD in 51(17%) and ILD in 31(10.2%).
● Age and sex were insignificantly different between both groups.
● BMI and smoking were significantly different between both groups (P value <0.001). BMI was significantly higher in Case group than in Control group (P value <0.001). Age, sex and BMI were insignificantly different among the four groups. Smoking was significantly different among the four groups (P value =0.001).
● Symptoms (fever, sore throat, chest pain and fatigue) were significantly different among the studied groups (P value <0.05) while other symptoms (cough, dyspnea, arthralgia, myalgia, malaise and headache) were insignificantly different among the studied groups. Duration of symptoms was significantly higher in case group than in control group (P value <0.001).
● All symptoms were insignificantly different among the studied groups. Duration of symptoms was significantly longer in Bronchiectasis group, COPD group and ILD group than Bronchial asthma group (P value <0.05) and was insignificantly different between Bronchiectasis group and (COPD group and ILD group) and between COPD group and ILD group.
● Chest CT on admission was significantly different between both groups. Chest CT on admission (Co-RADS 1 and Co-RADS 3) were significantly lower in Case group than Control group (P value <0.001) and Co-RADS 5 was significantly higher in Case group than Control group (P value<0.001) while Co-RADS 2 and Co-RADS 4 were insignificantly different between both groups. Regarding Chest CT on admission, Co-RADS 4 was insignificantly different among the four groups. Co-RADS 5 was significantly different among the four groups (P value <0.001). CO-RADS 1, CO-RADS 2 and CO-RADS 3 didn’t occur in any patients in all four groups.
● Regarding radiological patterns, Ground glass opacity, Interstitial thickening and Bilateral patchy shadowing were significantly higher in Case group than Control group (P value <0.05) while Local patchy shadowing was insignificantly different between both groups. Radiological patterns were insignificantly different among the four studied groups.
● Hb, platelets, NLR, ALT, AST and D-dimer were significantly higher in Case group than in Control group (P value <0.001). Lymphocytes, neutrophils, INR, prothrombin time, prothrombin concentration and O2 saturation were significantly lower in Case group than in Control group (P value <0.05). WBCs, serum ferritin, CRP, LDH, Na, K and Ca were insignificantly different between both groups.
● Hb, WBCs, PLT, lymphocytes, serum ferritin, ALT, AST, CRP, LDH, Na, K, INR, prothrombin time, prothrombin concentration and d-dimer were insignificantly different among the studied groups.
● Neutrophils and NLR were significantly higher in Bronchiectasis group, COPD group and ILD group than Bronchial asthma group (P value<0.05) and insignificantly different between Bronchiectasis group and (COPD group and ILD group) and between COPD group and ILD group.
● Ca was insignificantly different between Bronchial asthma group and (Bronchiectasis group, COPD group and ILD group) and between COPD group (Bronchiectasis group and ILD group) and was significantly higher in Bronchiectasis group than in ILD group.
● PaO2 and PCO2 were significantly higher in Case group than in Control group (P value <0.001). HCO3 was insignificantly different between both groups. PCO2, PaO2 and HCO3 were insignificantly different among the four groups. O2 saturation was significantly lower in Bronchiectasis group, COPD group and ILD group than Bronchial asthma group (P value<0.001) and was insignificantly different between Bronchiectasis group and (COPD group and ILD group) and between COPD group and ILD group.
● RR, Heart rate and Temperature significantly higher in Case group than in Control group (P value <0.05). Systolic blood pressure and Diastolic blood pressure were significantly lower in case group than Control group (P value<0.001). Regarding vital signs, RR, heart rate, systolic blood pressure, diastolic blood pressure and temperature were insignificantly different among the four groups.
● Disease severity was significantly lower in Case group than Control group (P value=0.047). Disease severity was significantly lower in Bronchial asthma group than (Bronchiectasis group and COPD group) while insignificantly different between Bronchial asthma group and ILD group. Disease severity was insignificantly different between Bronchiectasis group and (COPD group and ILD group) and significantly higher in COPD group than ILD group (P value =0.033).
● O2 mask was insignificantly different between both groups. O2 mask with reservoir, NIV and MV were significantly different between both groups (P value <0.001). O2 mask, NIV and MV were insignificantly different among the four groups.
● Hospital stay was significantly higher in Case group than in Control group (P value <0.001).
● Regarding prognosis, improved was significantly lower in Case group than in Control group while died was significantly higher in Case group than in Control group (P value <0.001).
● Hospital stay was insignificantly different among the four groups.
● Regarding prognosis, Die was significantly lower in Bronchial asthma group than (Bronchiectasis group, COPD group and ILD group) (P value <0.05) and insignificantly different between Bronchiectasis group and (COPD group and ILD group) and between COPD group and ILD group.
Conclusions
The prevalence of chronic pulmonary disease represented about 150 (50%) of the total population and SARS-COV-2 only without pulmonary disease represent 151(50%). chronic pulmonary disease was distributed as bronchial asthma in 28(9.3%), bronchiectasis in 40 (13.2%), COPD in 51(17%) and ILD in 31(10.2%).
Coexistences of chronic pulmonary diseases in COVID-19 patients were significantly associated with higher rate of NIV, MV, longer hospital stays and higher mortality rate. NIV was the greatest in BE patients while MV and mortality rate were the most in COPD.
Limitations
● It was a single center study that may result in different findings than elsewhere.
● Relatively small sample size that may produce imprecise conclusion.
Recommendations
● Further studies in other centers to compare findings.
● Further studies with large sample size produce significant results.
● A plethora of intervention studies are needed to exhibit the effect of therapeutic management on different types of chronic pulmonary diseases with and without COVID-19.