COVID-19 in patients with airways disease: COPD, asthma and bronchiectasis

COPD, asthma and bronchiectasis patients are an increased risk of respiratory infections, and in 2020 they were assumed to be more vulnerable to COVID-19 morbidity and mortality. However, evidence suggests that these patients were not over-represented among those hospitalised during the pandemic, although considerable variability in prevalence has been observed. COPD is associated with increased mortality and more severe outcomes from COVID-19, potentially related to increased expression of ACE2, the primary receptor for SARS-CoV-2 entry into host cells. Whether asthma increases the risk of severe COVID-19 is less clear, and evidence suggests that a type 2 high endotype may offer some protection against SARS-CoV-2 infection. Currently, guidance suggests that the continuation of usual maintenance therapies, including inhaled corticosteroids and biologics, is safe in SARS-CoV-2 infection. Public health measures taken during the COVID-19 pandemic reduced the circulation of other respiratory viruses and, as a consequence, reduced the frequency of exacerbations, including hospitalisations, for people with airways diseases.