@article {McAuley00718-2020, author = {Hamish McAuley and Kate Hadley and Omer Elneima and Christopher E. Brightling and Rachael A. Evans and Michael C. Steiner and Neil J. Greening}, title = {COPD in the time of COVID-19: an analysis of acute exacerbations and reported behavioural changes in patients with COPD}, volume = {7}, number = {1}, elocation-id = {00718-2020}, year = {2021}, doi = {10.1183/23120541.00718-2020}, publisher = {European Respiratory Society}, abstract = {Introduction The impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and associated {\textquotedblleft}lockdown{\textquotedblright} measures on acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is unknown. We aimed to evaluate the change in AECOPD treatment frequency during the first 6 weeks of lockdown in the UK compared with 2019 and assess changes in self-reported behaviour and wellbeing.Methods In this observational study in Leicestershire, UK, patients with COPD under a secondary care clinic were recruited. Exacerbation frequency in the first 6 weeks of COVID-19 lockdown was compared with the same period in 2019 using electronic health records. A telephone survey was used to assess changes in anxiety, inhaler adherence, physical activity and behaviour during the pre-lockdown and lockdown periods compared with normal.Results 160 participants were recruited (mean{\textpm}sd age 67.3{\textpm}8.1 years, 88 (55\%) males, mean{\textpm}sd forced expiratory volume in 1 s 34{\textpm}13\% pred). 140 (88\%) reported at least one AECOPD in the previous year. Significantly more community managed exacerbations were observed in 2020 compared with 2019 (126 versus 99; p=0.026). The increase was a result of multiple courses of treatment, with a similar proportion of patients receiving at least one course (34.4\% versus 33.8\%).Discussion During lockdown participants reported significantly increased anxiety, adherence to their preventative inhalers and good adherence to shielding advice (all p\<0.001). A significant reduction in self-reported physical activity and visitors was reported (both p\<0.001).Conclusions Treatment for AECOPD events increased during the first 6 weeks of the SARS-CoV-2 pandemic in the UK compared with 2019. This was associated with increased symptoms of anxiety and significant behavioural change.The $\#$COVID19 pandemic has changed healthcare provision and access. This study shows a 38\% increase in the number of community treated $\#$AECOPD in 2020 compared with 2019, alongside increased anxiety and inhaler adherence with reduced physical activity. https://bit.ly/3lV17Q6}, URL = {https://openres.ersjournals.com/content/7/1/00718-2020}, eprint = {https://openres.ersjournals.com/content/7/1/00718-2020.full.pdf}, journal = {ERJ Open Research} }