Fundamental facts of interest for COPD management:
- The upregulation of ACE-2 is seen in smoker and COPD patients2.
- Gene expression levels of ACE-2 are also inversely related to individual’s forced expiratory volume in 1 second (FEV1)2.
- ACE-2 could protect animals from severe lung injury. This has been shown in a study using mice in a context of aspiration and sepsis2.
- In COVID-19 infection, ACE-2 is the entry utilized by the virus and this may explain why COPD patients have an increased symptoms severity1,2.
Management of COPD patients not infected :
- Patients in stable phase must maintain their treatment3.
- Treatments used by COPD and asthma patients could reduce the risk of infection4.
- Drug delivery services should be used if accessible3.
- Follow-up visits should be postponed if they have a stable condition3.
- If patients have fever, cough, increased breathlessness or difficulty breathing, they should seek medical attention as soon as possible3.
This data comes from 4 different publications. Ji HL., et al present a review to summarize the existence of elevated plasminogen in patients with comorbidities infected by COVID-19. Leung JM., et al present a Research letter to determine if patients with COPD have increased expression of ACE-2 which is the cellular entry receptor for SARS-CoV-2. Jie Z., et al present a medical instruction for management and prevention of COPD during the COVID-19 epidemic period. Halpin D., et al present a commentary where they studied the risk of SARS-CoV-2 infection with patient with COPD and asthma and suggested some hypothesis to explain the results.
- Ji HL., Zhao R., Matalon S., et al. (March 27, 2020). Elevated Plasmin(ogen) as a Common Risk Factor for Covid-19 Susceptibility. Physiological Reviews, American Physiological Society. https://doi.org/10.1152/physrev.00013.2020
- Leung JM., Yang CX., Tam A., et al. (April 8, 2020). ACE-2 Expression in the Small Airway Epithelia of Smokers and COPD Patients: Implications for COVID-19. European Respiratory journal. DOI:1183/13993003.00688-2020
- Jie Z., Hu HH., Zhi Z., et al. (March 10, 2020). Medical management and prevention instruction of chronic obstructive pulmonary disease during the coronavirus disease 2019 epidemic. https://doi.org/10.3760/cma.j.cn112147-20200227-00201
- Halpin D., Faner, R., Sibila, O., Badia, J. R. & Agusti, A. (April 03, 2020).Do chronic respiratory diseases or their treatment affect the risk of SARS-CoV-2 infection? The Lancet Respiratory Medicine.Doi: https://doi.org/10.1016/S2213-2600(20)30167-3