ABSTRACT
Introduction/Aim: Treatable traits based personalised medicine has been shown to improve outcomes in severe asthma clinic. We assessed the feasibility of a randomised controlled trial of protocolised 'focused' and 'extended' treatable trait guided asthma management in patients not under a severe asthma clinic. Method(s): Ten week single-group cohort study. Participants had a doctor's diagnosis of asthma, asthma control questionnaire (ACQ) score >1, and a history of exacerbation in the last year. Patients already under the care of a severe asthma clinic or receiving high-dose inhaled corticosteroids, biological therapy or maintenance oral corticosteroids were excluded. Intervention(s): asthma medication according to application of a 'focused' treatable trait algorithm, targeting type-2 inflammation and airflow obstruction. Feasibility outcomes: recruitment rates, acceptability of intervention, willingness to enrol in a full RCT, need for 'extended' trait assessment after 10 weeks, and estimation of trait prevalence. Result(s): Recruitment ceased after 14 months with 30/50 participants due to difficulties associated with COVID-19. 92% found the intervention acceptable and were willing to be randomised in a future study. 65% remained not well-controlled with an ACQ >1 after 10 weeks and would have required the 'extended' algorithm. Participants had a mean (SD) 4.8(2.3) of 13 traits assessed. Participation in the study was associated with clinically important improvements in ACQ, -1.0 (1.5) units;St George Respiratory Questionnaire, -15.1 (14.7) units;Asthma Quality of Life Questionnaire, +1.0 (1.1) units;and FEV1, +0.4 (0.4) L. Post-bronchodilator airflow obstruction reduced from 60% of participants at study commencement to 35%. 53% of participants were allocated continuous oral corticosteroids at some point during the study. Conclusion(s): Protocolised treatable trait management was acceptable, associated with significant clinical benefit and a full trial appears feasible. Targeting two traits was insufficient to control asthma in the majority of patients over the timeframe of this study, despite significant corticosteroid exposure.
ABSTRACT
Background: Some patients present persistent ground glass opacities (GGO) and/or consolidations after an acute episode of SARS-CoV-2 pneumonia (COVID19). Risk factors for persistent pneumonitis (PPN) and potential response to corticosteroids remain unclear. Objective(s): To evaluate the clinical characteristics of patients with PPN, as well as to detect possible risk factors and the role of corticosteroids. Method(s): We conducted a prospective, controlled, multicenter analysis of patients hospitalized because of COVID19 with (n=152) or without (n=140) PPN. PPN was defined by the persistence of pulmonary opacities in a chest CT scan >14 days after admission. Characteristics of participants were obtained from their medical records. A CT score was used to quantify parenchymal abnormalities when PPN was suspected. Result(s): Compared to controls, patients with PPN were older and suffered more comorbidities, also D-dimer and Creactive protein levels were higher. The most frequent features observed in CT scans were GGO (97%), consolidation (95%), bronchial dilatation (93%) and reticular pattern (92%) with a CT score of 16.12+/-4.26. Multivariate logistic regression identified age and C-reactive protein levels on admission as independent risk factors for PPN. No significant differences were observed in thoracic CT scan one-month after discharge in patients treated with higher corticosteroids doses (>50 mg/day after discharge) compared to lower doses. Conclusion(s): Age and raised C-reactive protein levels on admission are significant risk factors of PPN after COVID19. Treatment with high doses of corticosteroids does not seem to add benefit.