Study Links Pre-COVID Lung Health to Severe COVID-19 Risk

Medscape

14-05-2025

In a large US cohort study, pre-pandemic severe obstructive lung function, as measured by spirometry, was linked to more than a twofold increased risk for severe COVID-19.
METHODOLOGY:
Researchers analyzed the association of pre-pandemic measures of lung function and structure with the risk for severe COVID-19 using data from 11 prospective US population-based cohorts.
Overall, 29,323 participants (mean age, 67.1 years) with valid pre-pandemic lung function and incident COVID-19 data were followed up for a median of 17.3 months from March 1, 2020.
Pre-pandemic spirometry data were used to classify lung function: Normal physiology (forced expiratory volume in 1 second [FEV1]/forced vital capacity [FVC] ratio ≥ 0.70 and FVC ≥ 80% of the predicted value). Obstructive physiology (FEV1/FVC ratio < 0.70) and severe obstruction (FEV1 < 50% of the predicted value). Restrictive physiology (FEV1/FVC ratio ≥ 0.70 and FVC < 80% of the predicted value).
Structural abnormalities, including emphysema and interstitial lung abnormalities such as lung distortion, honeycombing, traction bronchiectasis, nonemphysematous cysts, and ground-glass or reticular opacities, were assessed on CT scans.
The primary outcome was severe COVID-19 (COVID-19 leading to hospitalization or death), and the secondary outcome was nonsevere COVID-19 (SARS-CoV-2 infection not requiring hospitalization).
TAKEAWAY:
Severe obstructive physiology and restrictive physiology were associated with an increased risk for severe COVID-19 compared with normal spirometry, with adjusted hazard ratios (aHRs) of 2.11 (95% CI, 1.36-3.27) and 1.40 (95% CI, 1.12-1.76), respectively.
The risk for severe COVID-19 was 1.64-fold higher risk among those in the highest quartile than among those in the lowest quartile of percent emphysema (95% CI, 1.03-2.61).
Higher pre-pandemic FEV1 and FVC levels and being in the highest quartile of percent high attenuation areas (indicative of interstitial lung disease) were associated with an increased risk for nonsevere COVID-19.
COVID-19 vaccination was associated with a reduced risk for severe disease across all lung function and structure categories (aHR, 0.19-0.50; P for interaction > .30).
IN PRACTICE:
'These findings support enhanced COVID-19 risk mitigation, including COVID-19 vaccination, for individuals with impaired lung health,' the authors wrote.
SOURCE:
This study was led by Pallavi P. Balte, MBBS, PhD, Division of General Medicine, Columbia University Irving Medical Center, New York City. It was published online on April 16, 2025, in American Journal of Respiratory and Critical Care Medicine .
LIMITATIONS:
This study primarily collected data during the pre-Omicron period, limiting the generalizability of the findings to current variants. Additionally, some cohort studies recruited participants who were healthier than average, while others oversampled individuals with disease, affecting population representativeness.
DISCLOSURES:
This study was supported by a grant from the National Heart, Lung, and Blood Institute; reported receiving co-funding from the National Institute of Neurological Disorders and Stroke and the National Institute on Aging; and reported receiving additional funding from the American Lung Association. Six authors reported having financial ties with various pharmaceutical companies and research organizations.