COVID-19 and COPD: how it impacted primary healthcare indicators and what can we learn from it

Introduction: The COVID-19 pandemic brought challenges and difficulties that impacted the healthcare system, namely the routine management and diagnosis of chronic obstructive pulmonary disease (COPD) at primary healthcare (PHC) units. Objectives: To reflect on the impact of the COVID-19 pandemic on COPD management at PHC. Methods: We analyzed the publicly available COPD indicators, considering monthly data between Dec/2018 and Feb/2020 (pre-pandemic), Mar/2020, and Jun/2021 (pandemic), and Jul/2021 and Sep/2022 (post-general population vaccination against COVID-19). Results: Before the pandemic, there was a growing number of COPD patients in PHC, which reversed after the beginning of the pandemic and remained until the end of 2020. A fast increase was observed during 2021, with a significant decrease in early 2022, coincident with the new pandemic peak. This indicator was stabilizing to values slightly lower than before the COVID-19 pandemic. The eligibility of COPD patients for priority COVID-19 vaccination could have led to an increased COPD codification in PHC. However, the proportion of patients with COPD and FEV1 in the previous three years decreased. The COPD and FEV1 indicators were rising after the last most significant peak of cases in Jan-Feb/2022 but in Sep/2022 were not yet reaching pre-pandemic values. In Sep/2021, 47.1% of PHC patients had a registry of at least one surveillance consultation. Only half of PHC patients (51.3%) had a registry one year later. Conclusions: The analysis of the COPD indicators confirmed the significant impact of COVID-19 on COPD management at PHC. The restrictions of patients’ visits and difficulty in conducting spirometry limited diagnostic opportunities; on the other hand, the pandemic increased population awareness of vaccination and respiratory diseases. Beyond this analysis’s primary objective, these results led us to become aware of the need to better identify, follow, and manage COPD patients.