Characteristics of included studies
| First author [ref.] | Country | Stringency index# | Aim | Design | Inclusion criteria | Method of recruitment | Percentage of sample with COPD | Method of data collection | Summary of findings |
| Zhang [13] | China | 26.39 | To investigate medication adherence and the associated influencing factors in patients with COPD during the COVID-19 pandemic | Cross-sectional observation | COPD patients discharged from the investigators’ department between January 2012 and April 2020 | Telephone | 100% | Telephone survey | Medication 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] | Colombia | 12.04 | To compare the prevalence of depression, perceived stress related to COVID-19, post-traumatic stress and insomnia in asthma and COPD patients | Cross-sectional observation | Asthma and COPD adult outpatients at a pulmonary clinic in Santa Marta, Columbia | Telephone | 63% | Online survey | Asthma 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] | UK | 5.56 | To 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/wellbeing | Cross-sectional observation | Confirmed diagnosis of COPD and managed by a specialist COPD clinic (Complex COPD clinic, Leicester), and able to provide verbal consent via English language telephone consultation | Telephone | 100% | 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] | China | 26.39 | To identify the prevalence of COVID-19, acute exacerbations and outcomes in patients with COPD during the COVID-19 epidemic | Cross-sectional observation | COPD patients included in an ongoing study and COVID-19 patients from designated hospital for severe or critical patients with COVID-19 | Recruited from an established cohort | 100% | 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] | Spain | 11.11 | To assess the impact of COVID-19 lockdown on COPD exacerbations, symptoms and healthcare costs in a cohort of Spanish COPD patients | Cross-sectional observation | COPD patients visiting the specialised pulmonary clinic | Recruited from an established cohort | 100% | 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] | Portugal | 5.56 | To evaluate variations in sAECOPD rates after the pandemic outbreak | Cross-sectional observation | COPD patients aged >18 years followed-up by COPD specialists | NA, used anonymised/pseudonymised or internal clinical datasets | 100% | Electronic records or databases | Results 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] | Spain | 11.11 | To evaluate the impact of lockdown due to COVID-19 on quality of life and exacerbations in patients with severe COPD | Cross-sectional observation | COPD patients aged ≥40 years with a history of smoking and an FEV1 <70% predicted registered on an outpatient clinic list | Telephone | 100% | Telephone survey | Results 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] | USA | 0.00 | To examine potential differences in physical activity and HLOC between those with and without COVID-19-related fear and worry | Cross-sectional observation | Aged ≥18 years, a resident of USA and having one or more chronic conditions | Online via MTurk Amazon | 27.9% | Online survey | Patients 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 Scotland | 5.56 | To investigate the impact of the UK-wide COVID-19 lockdown on numbers of recorded sAECOPD leading to admission/death across primary and secondary care | Cross-sectional observation | None stated | NA, used anonymised/pseudonymised or internal clinical datasets | 100% | Electronic records or databases | Lockdown 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] | USA | 0.00 | To investigate telemedicine adoption, emergency department avoidance and related characteristics of patients with COPD during COVID-19 | Mixed-methods | None stated | Online via the COPD Foundation website | 100% | Online survey | In 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] | Denmark | 0.00 | To explore the existential significance of living with the risk of being infected with coronavirus in patients with COPD | Phenomenology | None stated | Online via a Facebook group | 92% | 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] | Singapore | 25.00 | To assess whether public health measures were associated with a reduction in AECOPD | Cross-sectional observation | None stated | NA, used anonymised/pseudonymised or internal clinical datasets | 100% | Electronic records or databases | There 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] | Sweden | To describe women's experiences of everyday life with COPD stage III or IV | Qualitative description | Adults aged >18 years, diagnosed with COPD stage III or IV, who were able to speak and understand Swedish | Telephone | 100% | 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] | England | To better understand the extent to which care has moved to using telehealth approaches for COPD under specialist community and secondary care services in the UK | Mixed-methods | Adults aged ≥18 years with COPD who had accessed specialty COPD care in the past 3 months | Online via the Thiscovery platform | 100% | Online survey | Adoption of remote care delivery appears high, with many care activities partially or completely delivered remotely | |
| Philip [26] | England | 5.56 | To identify and explore the concerns and impact of people with long-term respiratory conditions during the COVID-19 pandemic | Thematic analysis | None stated | Online via mailing lists, websites and social media platforms | 9% | Online survey | The 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] | Poland | 11.11 | To assess psychological health and insomnia in people with chronic diseases in the time of elevated stress associated with the pandemic | Cross-sectional observation | Adults aged ≥18 years with chronic diseases who attended the inpatient units and outpatient clinics of the West Pomerania region | Face-to-face recruitment at clinic | Incalculable | Face-to-face survey | Among chronic diseases including COPD, patients with Hashimoto's disease showed a strong correlation with increased scores on anxiety, depression and insomnia scales |
| Liang [28] | China | 26.39 | To investigate the change of respiratory symptoms, pharmacological treatment and healthcare utilisation of COPD patients during the epidemic in Beijing, China | Cross-sectional observation | Aged ≥40 years, a history of ≥3 months of being diagnosed with COPD according to GOLD report | Telephone | 100% | Telephone survey | Most 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] | UK | 0.00 | To ascertain what has happened to general practice contacts for acute physical and mental health outcomes during the pandemic | Cross-sectional observation | Aged ≥11 years; ≥1 year of registration with a GP practice contributing data to a central database | NA Used anonymised/pseudonymised or internal clinical datasets | NA | Electronic records or databases | There 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-Kong | 13.89 | To assess the number of admissions for AECOPD during the period of COVID-19 | Cross-sectional observation | Aged >45 years; known diagnosis of COPD; AECOPD | NA Used anonymised/pseudonymised or internal clinical datasets | NA | Electronic records or databases | The 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] | Greece | 0.00 | To assess if there were any changes in the number of patients hospitalised for respiratory diseases in Greece during the first COVID-19 wave | Cross-sectional observation | Hospitalisation caused by a respiratory disease (multiple) during the study period | NA Used anonymised/pseudonymised or internal clinical datasets | NA | Electronic records or databases | Observed 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 Korea | NK | To assess the effect of nonpharmaceutical interventions to mitigate COVID-19 on hospitalisations for respiratory conditions | Cross-sectional observation | Admission to hospital for an acute respiratory infection and/or chronic respiratory disease | NA Used anonymised/pseudonymised or internal clinical datasets | NA | Electronic records or databases | Hospitalisations 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] | Norway | 11.11 | To describe the changes in the use of hospital inpatient services in Norway during the initial response to the COVID-19 pandemic | Cross-sectional observation | Hospital use data recorded in the electronic records systems of Norwegian hospitals every day from 1 January 2020 up to and including November 2020 | NA Used anonymised/pseudonymised or internal clinical datasets | NA | Electronic records or databases | Pre-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] | Germany | 5.56 | To evaluate the deployment of emergency services and consecutive hospital admissions following the initial lockdown period in Germany | Cross-sectional observation | All 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 included | NA Used anonymised/pseudonymised or internal clinical datasets | 11.5% | Electronic records or databases | A 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).