Characteristics of included studies

First author [ref.]CountryStringency index#AimDesignInclusion criteriaMethod of recruitmentPercentage of sample with COPDMethod of data collectionSummary of findings
Zhang [13]China26.39To investigate medication adherence and the associated influencing factors in patients with COPD during the COVID-19 pandemicCross-sectional observationCOPD patients discharged from the investigators’ department between January 2012 and April 2020Telephone100%Telephone surveyMedication adherence during the pandemic in patients with COPD was similar to pre-COVID-19 adherence
Adherence was correlated with drug combination, doctor's supervision and accompanying mood disorders
Pedrozo-Pupo [14]Colombia12.04To compare the prevalence of depression, perceived stress related to COVID-19, post-traumatic stress and insomnia in asthma and COPD patientsCross-sectional observationAsthma and COPD adult outpatients at a pulmonary clinic in Santa Marta, ColumbiaTelephone63%Online surveyAsthma and COPD patients present similar frequencies of depression risk, COVID-19 perceived stress, post-traumatic stress risk and insomnia risk during the Colombian lockdown
McAuley [15]UK5.56To evaluate the change in AECOPD treatment frequency during the first 6 weeks of lockdown compared with 2019 and to assess changes in self-reported behaviour/wellbeingCross-sectional observationConfirmed diagnosis of COPD and managed by a specialist COPD clinic (Complex COPD clinic, Leicester), and able to provide verbal consent via English language telephone consultationTelephone100%Electronic records or databases
Telephone survey
Treatment for AECOPD events increased during the first 6 weeks of the COVID-19 pandemic in the UK compared with 2019 This was associated with increased symptoms of anxiety and significant behavioural change
Hu [16]China26.39To identify the prevalence of COVID-19, acute exacerbations and outcomes in patients with COPD during the COVID-19 epidemicCross-sectional observationCOPD patients included in an ongoing study and COVID-19 patients from designated hospital for severe or critical patients with COVID-19Recruited from an established cohort100%Telephone or SMS survey
Electronic records or databases
Acute exacerbations and hospitalisations of COPD patients were infrequent during the COVID-19 pandemic
COVID-19 patients with pre-existing COPD had a higher risk of all-cause mortality
González [17]Spain11.11To assess the impact of COVID-19 lockdown on COPD exacerbations, symptoms and healthcare costs in a cohort of Spanish COPD patientsCross-sectional observationCOPD patients visiting the specialised pulmonary clinicRecruited from an established cohort100%Electronic records or databases
Telephone survey
Results suggest that the lockdown was associated with a reduction in COPD exacerbations and an improvement in symptoms
Faria [18]Portugal5.56To evaluate variations in sAECOPD rates after the pandemic outbreakCross-sectional observationCOPD patients aged >18 years followed-up by COPD specialistsNA, used anonymised/pseudonymised or internal clinical datasets100%Electronic records or databasesResults suggest that there was a significant reduction in the number of sAECOPD in March–July 2020, compared to the same months in 2016–2019
Pleguezuelos [19]Spain11.11To evaluate the impact of lockdown due to COVID-19 on quality of life and exacerbations in patients with severe COPDCross-sectional observationCOPD patients aged ≥40 years with a history of smoking and an FEV1 <70% predicted registered on an outpatient clinic listTelephone100%Telephone surveyResults suggested that lockdown had a low impact on COPD patients
Although many medical visits and tests were cancelled, patients were very satisfied with the medical telephone visits
Imeri [20]USA0.00To examine potential differences in physical activity and HLOC between those with and without COVID-19-related fear and worryCross-sectional observationAged ≥18 years, a resident of USA and having one or more chronic conditionsOnline via MTurk Amazon27.9%Online surveyPatients with worry or fear about how the COVID-19 pandemic would affect their ability to manage their chronic conditions had lower activation and lower external HLOC
Alsallakh [21]Wales and Scotland5.56To investigate the impact of the UK-wide COVID-19 lockdown on numbers of recorded sAECOPD leading to admission/death across primary and secondary careCross-sectional observationNone statedNA, used anonymised/pseudonymised or internal clinical datasets100%Electronic records or databasesLockdown was associated with 48% pooled reduction in emergency admissions for COPD in both countries relative to the 5-year averages
There was no statistically significant change in deaths due to COPD
Boyce [22]USA0.00To investigate telemedicine adoption, emergency department avoidance and related characteristics of patients with COPD during COVID-19Mixed-methodsNone statedOnline via the COPD Foundation website100%Online surveyIn response to social distancing and other COVID-19 precautions, people with COPD are avoiding traditional, in-person healthcare environments and turning to telemedicine to prevent and manage exacerbations
Mousing [23]Denmark0.00To explore the existential significance of living with the risk of being infected with coronavirus in patients with COPDPhenomenologyNone statedOnline via a Facebook group92%Interview (face-to-face or virtual)Patients with COPD felt compelled to self-isolate, as they feared dying from COVID-19
Proactive contact with health professionals appeared to reduce patients' feelings of deprivation, loneliness, hopelessness and anxiety
Tan [24]Singapore25.00To assess whether public health measures were associated with a reduction in AECOPDCross-sectional observationNone statedNA, used anonymised/pseudonymised or internal clinical datasets100%Electronic records or databasesThere was a significant and sustained decrease in hospital admissions for all AECOPD as well as respiratory viral infection associated AECOPD, which coincided with the introduction of public health measures during the pandemic
Ekdahl [25]SwedenTo describe women's experiences of everyday life with COPD stage III or IVQualitative descriptionAdults aged >18 years, diagnosed with COPD stage III or IV, who were able to speak and understand SwedishTelephone100%Interview (telephone)Being afraid of contracting infections and the consequences of suffocation had increased since the pandemic COVID-19, which led to self-isolation and an inactive everyday life To get help, support and socialise, women used digital media
Wu [9]EnglandTo better understand the extent to which care has moved to using telehealth approaches for COPD under specialist community and secondary care services in the UKMixed-methodsAdults aged ≥18 years with COPD who had accessed specialty COPD care in the past 3 monthsOnline via the Thiscovery platform100%Online surveyAdoption of remote care delivery appears high, with many care activities partially or completely delivered remotely
Philip [26]England5.56To identify and explore the concerns and impact of people with long-term respiratory conditions during the COVID-19 pandemicThematic analysisNone statedOnline via mailing lists, websites and social media platforms9%Online surveyThe COVID-19 pandemic is having profound psychological impacts The concerns we identified largely reflect contextual factors, as well as their subjective experience of the current situation
Wańkowicz [27]Poland11.11To assess psychological health and insomnia in people with chronic diseases in the time of elevated stress associated with the pandemicCross-sectional observationAdults aged ≥18 years with chronic diseases who attended the inpatient units and outpatient clinics of the West Pomerania regionFace-to-face recruitment at clinicIncalculableFace-to-face surveyAmong chronic diseases including COPD, patients with Hashimoto's disease showed a strong correlation with increased scores on anxiety, depression and insomnia scales
Liang [28]China26.39To investigate the change of respiratory symptoms, pharmacological treatment and healthcare utilisation of COPD patients during the epidemic in Beijing, ChinaCross-sectional observationAged ≥40 years, a history of ≥3 months of being diagnosed with COPD according to GOLD reportTelephone100%Telephone surveyMost COPD patients contacted maintained their long-term medications and had mild-to-moderate symptoms
∼30% of patients experienced worsening respiratory symptoms, but did not seek medical care in the hospital due to concerns about cross-infection
Mansfield [29]UK0.00To ascertain what has happened to general practice contacts for acute physical and mental health outcomes during the pandemicCross-sectional observationAged ≥11 years; ≥1 year of registration with a GP practice contributing data to a central databaseNA
Used anonymised/pseudonymised or internal clinical datasets
NAElectronic records or databasesThere were substantial reductions in primary care contacts for acute physical and mental conditions following the introduction of restrictions, with limited recovery by July 2020 To July 2020, in people with COPD there were ∼43 900 per million fewer contacts for COPD exacerbations than expected
Chan [30]Hong-Kong13.89To assess the number of admissions for AECOPD during the period of COVID-19Cross-sectional observationAged >45 years; known diagnosis of COPD; AECOPDNA
Used anonymised/pseudonymised or internal clinical datasets
NAElectronic records or databasesThe number of admissions for AECOPD decreased in first 3 months of 2020, compared with previous years
This was observed with increased masking percentage and social distancing
Kyriakopoulos [31]Greece0.00To assess if there were any changes in the number of patients hospitalised for respiratory diseases in Greece during the first COVID-19 waveCross-sectional observationHospitalisation caused by a respiratory disease (multiple) during the study periodNA
Used anonymised/pseudonymised or internal clinical datasets
NAElectronic records or databasesObserved a significant reduction in respiratory admissions in 2020 that suggests patients may have avoided seeking medical attention during the COVID-19 pandemic
Huh [32]Republic of KoreaNKTo assess the effect of nonpharmaceutical interventions to mitigate COVID-19 on hospitalisations for respiratory conditionsCross-sectional observationAdmission to hospital for an acute respiratory infection and/or chronic respiratory diseaseNA
Used anonymised/pseudonymised or internal clinical datasets
NAElectronic records or databasesHospitalisations for four respiratory conditions decreased substantially during the analysis period
The cumulative incidence of admissions for COPD was 58% of the mean incidence during the 4 preceding years
Helgeland [33]Norway11.11To describe the changes in the use of hospital inpatient services in Norway during the initial response to the COVID-19 pandemicCross-sectional observationHospital use data recorded in the electronic records systems of Norwegian hospitals every day from 1 January 2020 up to and including November 2020NA
Used anonymised/pseudonymised or internal clinical datasets
NAElectronic records or databasesPre-pandemic, there was an average of 2400 inpatient admissions per day, which decreased to ∼1500 in the first few days post-lockdown Admission rates gradually increased to pre-pandemic levels in June
The reductions in admissions for COPD seemed to persist
Stöhr [34]Germany5.56To evaluate the deployment of emergency services and consecutive hospital admissions following the initial lockdown period in GermanyCross-sectional observationAll emergency physicians' records containing the pre-clinical diagnosis of unstable angina pectoris, ST-elevation myocardial infarction, heart failure, uncontrolled hypertension, arrhythmic event, cardiopulmonary resuscitation, syncope/dizziness and stroke were includedNA
Used anonymised/pseudonymised or internal clinical datasets
11.5%Electronic records or databasesA significant decline in hospitalisation for cardiovascular events was observed during the government-enforced shutdown
Reductions in admissions was mainly driven by “discretionary” cardiovascular events (unstable angina, heart failure, exacerbated COPD)
Reductions in unavoidable events (e.g. cardiopulmonary resuscitation) were not observed

COVID-19: coronavirus disease 2019; (s)AECOPD: (severe) acute exacerbation of COPD; SMS: short message service; NA: not applicable; FEV1: forced expiratory volume in 1 s; HLOC: health locus of control; GOLD: Global Initiative for Chronic Obstructive Lung Disease; GP: general practitioner; NK: not known. #: stringency indexes for the period January 2020 (or closest date to this) were obtained from the Oxford Coronavirus Government Response Tracker (OxCGRT) project [40]. The stringency index is a composite measure of nine of the response metrics; a higher score indicates a stricter response (i.e. 100=strictest response).