Study suggests that preventive measures against COPD are needed during seasonal virus circulation

New evidence suggests there is an overlap between preventive measures against infection transmission and the reduction of exacerbations of chronic obstructive pulmonary disease (COPD). In addition, there is a link between the resurgence of seasonal viruses and the return of COPD exacerbations.1

These conclusions come from new research on COPD admissions before, during and after the COVID-19 pandemic. The conclusions support the use of individual protective measures during winter by COPD patients as well as those of their relatives and guardians.

This new research was led by Arnaud Bourdin, MD, PhD, of the Department of Respiratory Diseases at the Centre Hospitalier Universitaire (CHU) Montpellier at the University of Montpellier in France. The researchers found that COPD conditions can be exacerbated by pollution, bacteria, and other causes, with bacterial and viral infections specifically associated with inflammation and exacerbations.2.3

Background and methods

Both COPD exacerbations and viral infections are known to have seasonal peaks. Some examples are flu or colds, and the correlation supports their associations with each other.

“Physicians and patients experienced this seasonality until 2020, when the COVID-19 pandemic began,” Bourdin and colleagues wrote. “Aware of the potential contribution of respiratory viruses to the occurrence of COPD exacerbations, we examined the number of COPD-related admissions before, during and after the COVID-19 pandemic.”

The researchers conducted their retrospective cross-sectional study by evaluating data from the French National Health Data System. The research team used an algorithm to identify COPD exacerbations using ICD-10 codes from all hospital admissions in France during the period between January 2013 and July 2023.

The team implemented an interrupted time series analysis (ITSA) along with the R package its.analysis to determine the association between the implementation of preventive measures and hospital admissions for COPD. They implemented a linear regression for graphical representation.

The anonymous retrospective observational research did not require the approval of an ethics committee or the consent of the participants, in accordance with French regulations. The research team used two-sided statistical tests and these were considered significant at P < .05.


A total of 800,730 people were studied and 1,393,825 patients were enrolled, with the average age of the patients being 74.4 years. The researchers found that 62.5% were male and 37.5% were female. The most common comorbidities were heart failure (43.2%), hypertension (63.5%), bladder cancer (2.4%) and lung cancer (6.9%).

Before the COVID-19 pandemic, both hospital and intensive care unit admissions for COPD exacerbations showed a seasonal trend, with peaks occurring once or twice in the fall and winter. However, in March 2020, the start of COVID-19 lockdowns coincided with a sharp decline in COPD exacerbations and remained low until the end of 2021.

This decline coincided with the start of measures to contain the spread of the virus, such as social distancing and wearing masks. The research team observed a gradual but still smaller increase in exacerbations in 2022 despite the easing of regulations, with particular declines in June, July and winter.

The end of the pandemic in 2023 announced by the World Health Organization led to the loss of these prevention measures and a return of the typical seasonal peak of exacerbations. The researchers' ITSA analysis complemented these findings, with the data showing large differences between periods for both severe (F = 5.081; P= .008) and mild (F = 3.850; P= .02) instances.

“Limitations of the study include the lack of individual clinical information in the national registry and no direct comparison with the number of diagnosed viral infections,” they wrote. “Relevant data on demographic characteristics and comorbidities confirm that patient profiles are consistent with what would be expected in a population with COPD.”


  1. Bourdin A, Ahmed E, Vachier I, et al. Hospitalizations for exacerbation of chronic obstructive pulmonary disease during COVID-19. JAMA Netw Open. 2024;7(5):e2412383. doi:10.1001/jamanetworkopen.2024.12383.
  2. Sethi S, Murphy TF. Infection in the pathogenesis and course of chronic obstructive pulmonary disease. N Engl J Med. 2008;359(22):2355-2365. doi:10.1056/NEJMra0800353PubMedGoogle ScholarCrossref.
  3. Mallia P, Message SD, Gielen V, et al. Experimental rhinovirus infection as a human model for exacerbation of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2011;183(6):734-742. doi:10.1164/rccm.201006-0833OC.