The Covid-19 pandemic has significantly impacted COPD care in many ways. Although COPD does not appear to increase the likelihood of contracting the virus, people with COPD are more susceptible to becoming severely ill due to Covid-19 and have higher rates of hospitalisation, readmissions, and admissions to critical care units. They also have an increased risk of complications, including heart attacks [1]. In addition, people with chronic respiratory conditions, mostly COPD, had a 17% increase in the risk of death from Covid-19. Notably, COPD patients are more vulnerable to inflammageing, a chronic inflammation associated with ageing, which may account for the higher risk of severe Covid-19 disease. The pandemics also impacted the mental health of COPD patients. People isolated themselves out of fear of the virus, and they tended to develop more depression and anxiety. COPD patients reported feeling alone because they feared going out. They also reported a considerable decrease in physical activity owing to the pandemic [2]. Furthermore, it became difficult for patient associations to provide peer support to patients, so organisations had to postpone awareness initiatives.

The pandemic has also made it harder to access in-person care, with delays in both diagnosis and follow-up [1]. The main impact, according to six out of ten countries surveyed, was the delay in follow-up specialist visits due to the closure of many outpatient services for several weeks. Such delays continue to impact on patient care because of the long waiting lists for a specialist visit, thereby making follow-up visits less regular. In some countries (Iceland, Italy, Ireland, and the Netherlands), the adoption of digital solutions such as e-prescriptions and e-consultations mitigated the lack of in-person care during the pandemic.

Another relevant issue related to the care of patients during and after the pandemics is the increase in the demand for pulmonary rehabilitation due to access to rehabilitation post-Covid. As a result, the availability of pulmonary rehabilitation for patients with COPD has decreased, and no corrective measures have been adopted to meet the increased demand. Some countries have shortened rehabilitation programmes to less than eight weeks, a move that contradicts existing scientific evidence for COPD patients and results in suboptimal outcomes, including reduced symptom control, decreased exercise endurance, and a decline in overall health status [3]. Tele-rehabilitation has been proposed as an alternative to in-person activities during the pandemic. It is a viable alternative, particularly for patients with reduced mobility or who live far away from the centres. However, there are some barriers to the implementation of this approach, including limited access to and difficulty using technology, particularly among patients at advanced ages. Programmes, methods, and tools for evaluation are not yet standardised, and health professionals have inadequate training and resources for optimally delivering tele-rehabilitation to patients [4]. Furthermore, patients with COPD assert the advantages of social interaction; thus, patients’ organisations could complement the decrease in in-person programmes with community-based programmes.

Diagnoses have also slowed down because of Covid-19 due to an increased average waiting time for the first consultation and a delay in carrying out tests. According to the Swedish quality register (SNAR), the number of newly registered COPD patients decreased by 44%. To reduce the potential increased burden of undiagnosed COPD during the pandemic years, all stakeholders should place an effort to raise awareness among physicians, particularly GPs, to detect these cases and, among people to refer to GPs if they believe they may have COPD. Online questionnaires may be a useful tool for first level screening.
COPD is a chronic condition; therefore, early diagnosis, appropriate follow-up, pulmonary rehabilitation, and appropriate treatments are essential to keep it under control. It is conceivable that such delays will have a measurable negative impact on COPD patients in the near future.