Adult Asthma and COPD Healthcare Utilization During the COVID-19 Pandemic

Rationale: The Coronavirus Disease 2019 (COVID-19) pandemic has greatly impacted health care delivery patterns, including for patients with asthma and chronic obstructive pulmonary disease (COPD). Patients who experience both asthma and COPD symptoms, referred to as asthma-COPD overlap (ACO), have increased morbidity and healthcare utilization than patients with either disease alone. Methods: We obtained de-identified encounter-level electronic health record (EHR) data for adult asthma and COPD encounters within Penn Medicine occurring between January 1, 2015 and October 31, 2020. Variables extracted included codified demographic information, ICD-10 encounter codes and encounter type (i.e., office visit, hospital encounter, telemedicine or other). Patients were included if they were aged at least 18 years at first encounter and had at least two encounters over a period of at least a year. We classified patients as having asthma, COPD or ACO based on ICD-10 diagnoses (J45∗ for asthma and J41-44∗ for COPD) and medication prescriptions (short-acting β2-agonist for asthma and either shortacting β2-agonist or short-acting muscarinic antagonist for COPD), where ACO patients were defined as those meeting asthma and COPD criteria. We compared asthma and COPD healthcare encounters before (pre-pandemic) and after (pandemic) March 17, 2020 in terms of encounter volume and type. We also tested for differences in the demographic distributions of telemedicine vs. in-person visits using t- and χ2-tests. Results: A total 66,191 patients met our inclusion criteria, of which 46,257 (70%) had asthma, 12,580 (19%) had COPD, and 7,354 (11%) had ACO. Average monthly volume of office visits and hospital encounters for asthma/COPD decreased considerably during the pandemic (>50% decrease in office visits and >25% decrease in hospital encounters across all patient groups), while the volume of telemedicine visits increased dramatically (from 0-1 to 481-1,343 average monthly telemedicine visits across all patient groups) [Figure 1]. During the pandemic, non-Hispanic Black patients were more likely to be encountered via telemedicine than in-person encounters across all patient groups (39% vs. 34% of asthma patients encountered via telemedicine and in-person visits, respectively, were non-Hispanic Black;33% vs. 26% of COPD patients, and 50% vs. 44% among ACO patients;p<0.01 for all comparisons). Telemedicine and in-person visits for asthma/COPD during the pandemic did not differ significantly by mean age or sex among any of the patient groups. Conclusions: Telemedicine visits for asthma and COPD increased dramatically during the COVID-19 pandemic, while office visits and hospital encounters decreased. Further study.