Are patients with bronchiectasis more likely to catch COVID-19 infection?
In general, patients with bronchiectasis are not much more likely to catch COVID-19 than people without bronchiectasis.
However, if someone has bronchiectasis because of an underlying problem with the immune system (for example, due to low antibody levels), then they are more susceptible to COVID-19 as the weakness in the immune system means they cannot kill the virus as well as people with a normal immune system.
If someone with bronchiectasis catches COVID-19, are they more likely to get seriously ill?
Even if they catch COVID-19, most patients with bronchiectasis are not more likely to get severe pneumonia that people of the same age do without bronchiectasis – it is really age which is the biggest driver for developing severe infection, much more so that other causes of pneumonia. However, if because of bronchiectasis someone has very weak lungs, with lung function that is significantly reduced, then that will make any pneumonia more dangerous as there is less lung reserve to cope with infection. In addition, again if someone has bronchiectasis because of a poor immune system, if they catch COVID-19 it is much harder for their immune system to control the infection and they are much more likely to develop pneumonia and severe infection.
How to avoid COVID-19 infection
The best ways to avoid COVID-19 infection are:
- Get vaccinated, including having the booster dose when offered. Vaccination reduces the chance of severe disease by about 95%, although this wanes after around 6 months to about 90% (which is why the booster vaccine is important). The vaccine also reduces the chance of mild infections, but by not as much. Essentially, once you have been vaccinated, although you can still catch COVID-19, it is not likely to cause severe disease unless you have a markedly weakened immune system.
- Social distancing; we are all aware of these measures now, the general aim being to reduce contacts with other people so you are less likely to come across someone with infection. This means avoiding crowds, especially indoors, and using a face mask when indoors in a public place (although masks protect someone with COVID-19 from spreading the infection better than they protect the person wearing one from catching infection).
- Using the COVID-19 tests to ensure when you have a social occasion you and the others attending do not have COVID-19 infection without knowing it. For example, if you are holding a party, ask everyone to take a lateral flow test before attending.
- For those who have a very poor immune system due to chemotherapy, blood cancer, low antibody levels, or drugs such as oral prednisolone (inhaled steroids are fine) and other strong immunosuppressants, then additional measures will be needed as the vaccines work less well. The above measures become very important and in addition immunosuppressed people should have a 3rd dose of the COVID-19 vaccine. If someone who is immunosuppressed catches COVID-19, then they can be given the new antibody and antiviral medications that are very effective at preventing the infection becoming serious; this will need to be arranged through the consultant who looks after your condition.
Ongoing research
PHOSP-COVID study: UCL Respiratory has been closely involved in studies investigating the long term consequences of COVID-19 infection, contributing to the nationwide PHOSP-COVID study which has led to an important publication describing the effects of being hospitalised with COVID-19 infection several months later. The results show many people continue to have significant problems with their health several months after leaving hospital; future studies will see whether these symptoms improve with time and who in particular is likely to have prolonged problems. UCLH have also published papers which provides more in depth assessment of persisting symptoms and damage to the heart in patients admitted to UCLH with acute COVID as well as people who had COVID-19 infection but were not admitted to hospital.
You can find more information at: https://phosp.org/
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Publications
1. Physical, cognitive, and mental health impacts of COVID-19 after hospitalisation (PHOSP-COVID): a UK multicentre, prospective cohort study. Evans RA, McAuley H, Harrison EM, Shikotra A, Singapuri A, Sereno M, Elneima O, Docherty AB, Lone NI, Leavy OC, Daines L, Baillie JK, Brown JS, Chalder T, De Soyza A, Diar Bakerly N, Easom N, Geddes JR, Greening NJ, Hart N, Heaney LG, Heller S, Howard L, Hurst JR, Jacob J, Jenkins RG, Jolley C, Kerr S, Kon OM, Lewis K, Lord JM, McCann GP, Neubauer S, Openshaw PJM, Parekh D, Pfeffer P, Rahman NM, Raman B, Richardson M, Rowland M, Semple MG, Shah AM, Singh SJ, Sheikh A, Thomas D, Toshner M, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Wain LV, Brightling CE; PHOSP-COVID Collaborative Group. Lancet Respir Med. 2021 Oct 7:S2213-2600(21)00383-0. doi: 10.1016/S2213-2600(21)00383-0. Online ahead of print. PMID: 34627560 Free PMC article. https://pubmed.ncbi.nlm.nih.gov/34627560/
2. Patterns of myocardial injury in recovered troponin-positive COVID-19 patients assessed by cardiovascular magnetic resonance. Kotecha T, Knight DS, Razvi Y, Kumar K, Vimalesvaran K, Thornton G, Patel R, Chacko L, Brown JT, Coyle C, Leith D, Shetye A, Ariff B, Bell R, Captur G, Coleman M, Goldring J, Gopalan D, Heightman M, Hillman T, Howard L, Jacobs M, Jeetley PS, Kanagaratnam P, Kon OM, Lamb LE, Manisty CH, Mathurdas P, Mayet J, Negus R, Patel N, Pierce I, Russell G, Wolff A, Xue H, Kellman P, Moon JC, Treibel TA, Cole GD, Fontana M.Eur Heart J. 2021 May 14;42(19):1866-1878. doi: 10.1093/eurheartj/ehab075. https://pubmed.ncbi.nlm.nih.gov/33596594/
3. Post-COVID assessment in a specialist clinical service: a 12-month, single-centre analysis of symptoms and healthcare needs in 1325 individuals. Heightman et al. accepted BMJ Open October, 2021
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