Asthma, COPD, and Long COVID: Who's Most Likely to Keep Feeling Sick?

Most people recover from COVID-19 within a few weeks, but a meaningful share of patients continue to experience symptoms long after the initial infection clears. For people already living with a chronic lung condition like asthma or COPD, new research suggests this lingering illness may be especially common — and certain personal and clinical factors seem to raise the odds further.

A study published in npj Primary Care Respiratory Medicine looked at Swedish adults with diagnosed asthma or COPD who had confirmed COVID-19 infections, using survey data collected in 2022 as part of the long-running PRAXIS study. Researchers wanted to understand how often these patients went on to report post-COVID-19 symptoms, and which characteristics were linked to a higher chance of this happening.

A Striking Share Reported Lingering Symptoms

Among the 494 patients included in the analysis, 59% said they experienced symptoms consistent with post-COVID-19 condition — generally defined as symptoms that persist for 12 weeks or more and aren't better explained by another illness. That figure is notably higher than estimates from general population studies, where post-COVID prevalence has typically been reported in the range of roughly 2% to 42%, depending on the study population and methods used. The authors note that this pattern fits with other research indicating that people with pre-existing asthma or COPD may face a greater likelihood of developing lasting post-COVID symptoms compared to those without chronic respiratory disease.

What Set Higher-Risk Patients Apart

Using statistical models adjusted for age and type of lung disease, the researchers identified several factors associated with a greater likelihood of reporting post-COVID-19 symptoms:

- Severity of the original infection stood out as the strongest factor, with those who had a severe acute case showing dramatically higher odds of lingering symptoms compared with milder cases. - Older age was linked to somewhat increased odds, as was female sex. - Obesity, defined as a BMI of 30 or above, was associated with more than double the odds compared to patients without obesity. - Patients who reported chronic pain before or alongside their COVID illness had notably higher odds of persistent symptoms. - Those with a history of anxiety or depression also showed a raised likelihood.

None of these associations prove that a given factor directly causes long-lasting symptoms. Because the study was cross-sectional — capturing a snapshot of self-reported experiences at one point in time — it can identify patterns and statistical links, but it cannot establish a cause-and-effect relationship or rule out other contributing influences.

Why Lung Disease Patients Might Be More Vulnerable

The researchers point to several biological mechanisms that could plausibly help explain why chronic respiratory disease and post-COVID symptoms often travel together. Persistent inflammation, lingering immune system activation, damage to small blood vessels, and disruptions to cellular energy production have all been proposed as contributors to long COVID in general. In people whose lungs are already affected by asthma or COPD, these processes could overlap with existing disease activity, potentially intensifying or prolonging symptoms like breathlessness, fatigue, and reduced exercise tolerance.

It's also possible that some of what gets labeled as "post-COVID symptoms" in this population reflects flare-ups or worsening of the underlying asthma or COPD itself, since the symptoms can look similar. The study's design doesn't allow for cleanly separating new post-viral symptoms from an exacerbation of pre-existing disease, which the authors acknowledge as a limitation.

Putting the Findings to Use

For clinicians managing patients with asthma or COPD, the findings offer a potential way to flag who might benefit from closer follow-up after a COVID-19 infection — particularly those who had severe acute illness, are older, live with obesity, or have coexisting chronic pain or mental health conditions. The researchers describe these traits as warning signs worth monitoring, not guarantees of a particular outcome.

If you have asthma or COPD and are still dealing with symptoms weeks or months after a COVID-19 infection, this research doesn't replace a conversation with your own healthcare provider, who can evaluate your specific situation and rule out other causes. Everyone's recovery path looks different, and persistent symptoms can stem from a range of overlapping conditions that deserve individual assessment.

Source: npj Primary Care Respiratory Medicine, DOI: 10.1038/s41533-026-00570-x, based on a cross-sectional study by Andreason et al. using data from the Swedish PRAXIS cohort.