Real world evidence in asthma and chronic obstructive pulmonary disease to understand the burden of COVID-19 infection in United Kingdom

Date of ISAC Approval: 
Lay Summary: 
Coronavirus has had a major impact on all of our lives, in particular people with long-term conditions. We will investigate the effect of the coronavirus pandemic on individuals with the two common lung diseases, chronic obstructive pulmonary disease and asthma, using electronic health records in three ways. First, we will use epidemiologic approaches to look at “direct” effects, caused directly when people become infected. Second, we will study “indirect” effects, which are not due to infection, but due to changes in the health system or peoples’ behaviours during the pandemic, such as not attending hospitals due to fear of infection. Third, we will investigate the cost of both the direct and indirect effects of the pandemic for people with chronic obstructive pulmonary disease and asthma at the individual and the population level. Together, these results will help to understand the actual impact of coronavirus on individuals with long-term conditions, and may inform health service and public planning.
Technical Summary: 
The coronavirus pandemic has had unprecedented effects on all aspects of society. As health system responses grapple with second waves and roll-out of vaccination, it is important to understand the actual impact on individuals with long-term conditions. In this project, we intend to use CPRD linked database to better understand the impact of the coronavirus pandemic on individuals with chronic obstructive pulmonary disease (COPD) and asthma. Using a cohort of these patients, we will describe the epidemiology of COVID-19 in this population in terms of incidence and prevalence across different severity levels of COVID-19 and severity classes of asthma and COPD. In addition, we will determine COVID-19-related and all-cause clinical and healthcare resource use outcomes among these patients, including the demographic, disease-related, comorbidity-related, and treatment-related factors associated with mortality, COVID-19-related complications and the incurring of healthcare resource use. This study will utilise both CPRD Aurum and CPRD GOLD database and the study period will begin on 1 January 2010 until the last GP’s collection day. Each of the clinical outcomes of interest will be described separately. Event rates and 95% CIs will be reported as both incidence risks and incidence rates. Relative risks and risk factors associated with outcomes will be estimated using Cox regression models. In addition, we aim to further evaluate the care pathways of the patients to understand the health resource use and the financial cost of the direct and indirect burden of disease, including hospital admission, ITU admission and GP visits. Such evidence will be used to highlight any unmet treatment needs and inform modelling of the impact of the pandemic in other patient subpopulations, and will aid planning for future pandemics.
Health Outcomes to be Measured: 
• Death (all cause, COVID-19, non-COVID-19, respiratory, cardiovascular) • COVID-19 infection (hospitalised versus non-hospitalised) • Intubation/mechanical ventilation • Pneumonia • Asthma-related healthcare utilisation • COPD-related healthcare utilisation • Sepsis • Stroke/TIA • Intensive care unit admission (all cause, asthma-related, COPD-related) • Hospital admissions and re-admissions (all cause, asthma-related, COPD-related) • Hospital admission length (all cause, asthma-related, COPD-related) • Outpatient attendances (all cause, asthma-related, COPD-related) • Days alive out of hospital

Jil Billy Mamza - Chief Investigator - Astra Zeneca Ltd
Laura Pasea - Corresponding Applicant - University College London ( UCL )
Amitava Banerjee - Collaborator - University College London ( UCL )
Spiros Denaxas - Collaborator - University College London ( UCL )
Mehrdad Mizani - Collaborator - University College London ( UCL )
Alvina Lai - Collaborator - University College London ( UCL )
Michail Katsoulis - Collaborator - University College London ( UCL )
Adrian Rabe - Collaborator - Imperial College London
Tasmin Luff - Collaborator - Astra Zeneca Ltd

HES A&E;HES Admitted;HES APC;ONS;Practice IMD;Patient IMD