Abstract
BACKGROUND: The COVID-19 pandemic and related public health restrictions have substantially altered healthcare access and delivery, particularly for patients with chronic conditions such as chronic obstructive pulmonary disease (COPD). This study aimed to evaluate the impact of the COVID-19 pandemic and lockdown measures on COPD-related symptoms and hospital admissions, and to compare these outcomes with the pre-pandemic period. METHODS: This multicenter cross-sectional study was conducted between July 2021 and February 2022 across ten tertiary pulmonary outpatient clinics in Turkey. A total of 347 COPD patients were included. Data on demographics, spirometry, symptom progression, medication access, COVID-19 history, and hospital admissions were collected via structured questionnaire and medical records. Pandemic-related outcomes were compared with data from the pre-pandemic year (March 2019-March 2020). Additional multivariable regression analyses were performed to identify predictors of hospital admission and COVID-19-related hospitalization. RESULTS: The mean number of hospital admissions significantly decreased during the pandemic compared to the pre-pandemic period (p < 0.001), while patient-reported respiratory symptoms increased over time. Hospital admissions were lowest during the first pandemic period, when restrictions were most intense. Regression analyses showed that lower FEV₁, advanced GOLD stage, and inhaled corticosteroid (ICS) use were independently associated with increased hospital admissions. COVID-19 was diagnosed in 21.1% of patients. Lower FEV₁, GOLD stage, and smoking were significantly associated with COVID-19-related hospitalization. CONCLUSION: Although COPD-related hospital admissions decreased during the pandemic, respiratory symptoms progressively worsened. These findings reflect the complex interplay between public health measures, healthcare accessibility, and chronic disease management. Disease severity and airflow limitation were key determinants of adverse outcomes. Maintaining access to routine care and adopting personalized approaches in COPD management are essential during public health emergencies.