Italian studies show that pulmonary emphysema sufferers are no longer at risk of coronavirus infection. But care must always be taken
The Sars-CoV-2 virus, responsible for Covid 19, can be more serious in people suffering from pulmonary emphysema, one of the types of presentation of Chronic Obstructive Pulmonary Disease (COPD), a framework that affects 6 to 8 percent of the population and is closely linked to the habit of smoking. For this reason it is essential to carefully follow the therapies, in addition to respecting the rules of distancing, to limit the risks.
What the studies say
Italian data say that those suffering from COPD did not have a greater risk of getting coronavirus infection and that this pathology was not one of the main conditions associated with mortality in patients. This situation contrasts with the results of a research conducted in China on the comorbidities of 1590 patients with new coronavirus disease shows that severe cases were more likely to have COPD than less severe ones (62.5 percent vs 15.6 percent) and that a significantly greater number of patients with COPD went to ICU hospitalization, invasive ventilation or death compared to patients without COPD.
"The respiratory system represents a fundamental target when it comes to Covid-19 and people with COPD – reports Francesco Blasi, Ordinary of Diseases of the Respiratory System at the University of Milan. From the experience we have experienced, however, it seems that patients would not have a greater risk of becoming seriously ill: perhaps the fact of following the therapies, given that it is a chronic disease, could be protective against more severe forms of the infection. This feeling was also confirmed by the data on about 3000 deceased patients disclosed by the Istituto Superiore di Sanità ".
The important thing, therefore, as happens for blood pressure, is to follow the treatments and, from the doctor's point of view, to personalize the treatment. However, it must be remembered that first of all we must stop smoking, both in prevention and in terms of the treatment of this condition.
A disease to be known
But what is COPD? It is a complex and heterogeneous disease: complex because it has several components with nonlinear dynamic interactions, heterogeneous because not all of these components are present in all patients or in the same patient in all stages of the disease.
This complexity explains and justifies the need for a focused approach to improve evaluation, treatment and outcomes. Individual patients may need different treatment approaches at different stages of the disease. The important thing, therefore, and not only for the risks related to the virus, is to study the most effective treatment for each patient.
If in less severe forms, characterized by a limited risk of exacerbations, i.e. acute aggravations of chronicity, the combination of two anti-inflammatory and bronchodilator drugs may be sufficient, in patients with multiple exacerbations the initial treatment with three appears fundamental associated drugs.
Thanks to this approach, as confirmed by the IMPACT study, the risk of death from all causes can be reduced: the body in fact needs oxygen and if this is not available, as in the case of the more serious forms, the heart, the circulatory tree and other districts.
What to do?
"These results say that triple therapy is the one that most reduces cardiovascular, respiratory and COPD-related mortality – explains Girolamo Pelaia, director of the University Pneumological Clinic and the School of Specialization in Respiratory Diseases of the University of Studies from Catanzaro. In the IMPACT study, the risk of exacerbations leading to hospitalization is reduced by 34 percent compared to two bronchodilator therapy ".
The important thing, in any case, is to aim for the most correct treatment for each person, based on the type of disease and the appearance of aggravations that require hospitalization.
“The chronicity of COPD – adds Blasi – undermines the quality of life of patients over time, gradually compromised by the persistence of typical symptoms and, in its progression, by the appearance of exacerbations, phenomena that affect about 30 percent of patients. The lack of resolution of symptoms, combined with low adherence and the appearance of exacerbations, leads patients to adopt an increase in therapy over time. This study clearly shows that thanks to the triple therapy already in the front line, a reduction in the risk of death in these patients can be obtained ".