LAUSR

The emergence of a novel coronavirus in Wuhan, China in late 2019 has transformed the world and our medical practice. In a remarkable testament to the effectiveness of modern medicine, clinical and basic scientists have developed effective treatment approaches and vaccines within 12 months of the pandemic beginning [1,2]. The management of infectious disease relies heavily on non-pharmacological measures and good public health advice must be based on an accurate appreciation of who is at risk of contracting the disease. As SARS-CoV-2 infections swept beyond the borders of China clinicians and epidemiologists published numerous papers reporting the principal risk factors for illness age, male gender, ethnicity and pre-existing illness [3]. Before the pandemic began chronic obstructive pulmonary disease (COPD) was seen as one of the major causes of global morbidity and mortality [4]. The reduction in ventilatory reserve that characterizes this illness and the propensity to exacerbate when contracting common respiratory viral infections pointed to COPD patients as a major risk group for SARS-CoV-2 infection. Initial data from China tended to support this view but the findings were not clear cut, reflecting the variety of study designs and sample sizes reported. A more international overview of this topic was needed and in a recent publication in EClinicalMedicine Firoozeh Gerayeli and colleagues from a research group in Vancouver with a longstanding interest in COPD have met this need [5]. These workers identified 59 published studies reporting data about patients with COPD and COVID-19 outcomes. These papers were quite heterogeneous as might be expected given the short timescale for data collection and most were case series where the diagnosis of COPD was extracted from the medical records rather than being confirmed by spirometry. Data came from 16 different countries with the USA and China contributing most reports. Study size varied from 32 patients to over 300.000 recorded in the Mexico national registry. A diagnosis of COPD was associated with a more than fourfold greater