Impact of an online breathing and wellbeing programme (ENO Breathe)in people with persistent symptoms following COVID-19: a randomised controlled trial

Aims: ENO Breathe is an online breathing and wellbeing programme for people with Long COVID focusing on breathing re-training using singing techniques. Aim(s): to assess whether ENO Breathe improves health related quality-of-life (HRQoL) in people with persistent breathlessness following COVID-19. Method(s): A parallel-group, single-blind, RCT, comparing ENO Breathe(6 weeks) with usual care in adults, with persisting breathlessness +/- anxiety, following assessment at an NHS Long COVID clinic. Primary Outcome: change in HRQoL using the RAND SF-36 Mental(MHC) and Physical(PHC) Health Composite Scores. Secondary Outcomes: CAT, VAS for breathlessness (rest, walking, stairs, and running), Dysp-12, GAD-7. Participant experience was assessed using focus groups and free-text responses. Result(s): 150 participants (mean(SD) 49(12)years, 81% female, 320(127) days symptomatic;ENO Breathe(n=74), Control(n=76). ENO Breathe was associated with improvement in MHC of 2.42 points (95%CI 0.03 to 4.80, p=0.045), but not PHC 0.6 (-1.33 to 2.52, p=0.541). VAS breathlessness (running) favoured ENO Breathe -10.48(-17.23 to -3.73, p=0.003). Three participant experience themes were identified 1) improvements in symptoms;2) feeling that the programme was complementary to standard care;3) the particular suitability of singing and music to address their needs. Conclusion(s): An online breathing and wellbeing programme can improve the mental component of HRQoL and elements of breathlessness in people with persisting symptoms after COVID-19. Mind-body and music-based approaches, including practical, enjoyable symptom-management techniques may have a role supporting recovery.

Effectiveness and safety of pulse oximetry in remote patient monitoring of patients with COVID-19 : Ahmed Alboksmaty

Context A surge of COVID cases globally is often portrayed as “very likely”, which overwhelms health systems and challenges their capacities. A mitigation strategy is seen by remotely monitoring COVID patients in out-of-hospital settings to determine the risk of deterioration. Description of the problem We need an indicator to enable remote monitoring of COVID patients at home that can be measured by a handy tool;pulse oximetry which measures peripheral blood oxygen saturation (SpO2). Evidence shows that SpO2 is a reliable indicator of deterioration among COVID patients. The UK initiated a national programme (COVID Oximetry @ Home (CO@H)) to assess the theory. The concept can be potentially applied in other countries in various settings. As part of CO@H, we conducted a systematic review of the evidence on the safety and effectiveness of pulse oximetry in remote monitoring of COVID patients. Results Our review confirms the safety and potential effectiveness of pulse oximetry in remote home monitoring among COVID patients. We identified 13 research projects involving 2,908 participants that assessed the proposed strategy. Evidence shows the need to monitor at-rest and post-exertional SpO2. At-rest SpO2 of ≤ 92% or a decrease of 5% or more in post-exertional SpO2 should indicate care escalation. The recommended method for measuring at-rest SpO2 is after 5-10 min of rest, and assessing post-exertional SpO2 is after conducting a 1-min sit-to-stand test. We could not find explicit evidence on the impact on health service use compared with other models of care. Lessons Remote monitoring of COVID patients could alleviate the pressure on health systems and save hospital resources. Monitoring SpO2 by pulse oximetry can be widely applied, including in resource-limited settings, as the tool is affordable, reliable, and easy to use. Key messages • Adopting relevant health technologies in remote patient monitoring is critical to combat the pandemic. • Pulse oximetry is an affordable, easy to use and widely available tool to monitor patients with COVID-19 at home.

Effectiveness and safety of pulse oximetry in remote patient monitoring of patients with COVID-19: a systematic review

The COVID-19 pandemic has led health systems to increase the use of tools for monitoring and triaging patients remotely. In this systematic review, we aim to assess the effectiveness and safety of pulse oximetry in remote patient monitoring (RPM) of patients at home with COVID-19. We searched five databases (MEDLINE, Embase, Global Health, medRxiv, and bioRxiv) from database inception to April 15, 2021, and included feasibility studies, clinical trials, and observational studies, including preprints. We found 561 studies, of which 13 were included in our narrative synthesis. These 13 studies were all observational cohorts and involved a total of 2908 participants. A meta-analysis was not feasible owing to the heterogeneity of the outcomes reported in the included studies. Our systematic review substantiates the safety and potential of pulse oximetry for monitoring patients at home with COVID-19, identifying the risk of deterioration and the need for advanced care. The use of pulse oximetry can potentially save hospital resources for patients who might benefit the most from care escalation;however, we could not identify explicit evidence for the effect of RPM with pulse oximetry on health outcomes compared with other monitoring models such as virtual wards, regular monitoring consultations, and online or paper diaries to monitor changes in symptoms and vital signs. Based on our findings, we make 11 recommendations across the three Donabedian model domains and highlight three specific measurements for setting up an RPM system with pulse oximetry.

Trends and associated factors for Covid-19 hospitalisation and fatality risk in 2.3 million adults in England.

The Covid-19 mortality rate varies between countries and over time but the extent to which this is explained by the underlying risk in those infected is unclear. Using data on all adults in England with a positive Covid-19 test between 1st October 2020 and 30th April 2021 linked to clinical records, we examined trends and risk factors for hospital admission and mortality. Of 2,311,282 people included in the study, 164,046 (7.1%) were admitted and 53,156 (2.3%) died within 28 days of a positive Covid-19 test. We found significant variation in the case hospitalisation and mortality risk over time, which remained after accounting for the underlying risk of those infected. Older age groups, males, those resident in areas of greater socioeconomic deprivation, and those with obesity had higher odds of admission and death. People with severe mental illness and learning disability had the highest odds of admission and death. Our findings highlight both the role of external factors in Covid-19 admission and mortality risk and the need for more proactive care in the most vulnerable groups.

Influence of the first wave of COVID-19 on asthma inhaler prescriptions.

In the beginning of the COVID-19 pandemic, there were major concerns regarding the huge demand for asthma inhalers. Using the primary-care medical records for 614,700 asthma patients between January and June 2020, we found that there was a substantial increase in inhalers solely in March 2020. Patients significantly associated with receiving higher inhaled corticosteroid prescriptions were younger, of higher socioeconomic status, and had milder asthma.

Incidence and severity of covidd-19 in patients with spondyloarthritis in Argentina

Objectives: To describe the incidence and severity of COVID-19 disease in Spondyloarthritis patients in Argentina. Methods: Patients with axial spondyloarthritis (AxSpA) radiological (AS) and non-radiological (AxSpA-nr) and peripheral spondyloarthritis (according to ASAS criteria, SpAp) and Psoriatic arthritis (PsA) (according to CASPAR criteria) were included. The patients were followed up by phone or in person on a monthly basis. Data were collected from 1/4/2020 to 20 / 9/2020. Descriptive statistics were performed with mean and standard deviation (SD) and median and 25-75 percentile according to distribution, and the cumulative incidence (CI) of the disease was calculated. Results: 320 patients were included, of which 55%were male, with a mean age of 50 (SD 13), 21.6% had a diagnosis of AS, 6.9% AxSpA-nr, 6.9% SpAp and 64.7% PsA. The duration of the disease was 11 (5-16), BASDAI 3.65 (3), BASFI 3 (1.5-9), PASI 0.3 (0-7), BSA 0.2 (0-6). Fourteen patients with a diagnosis of COVID-19 (4.4%) were reported, of which 10 diagnoses were by positive PCR and 4 by symptoms associated with positive close contact. Thirteen (93%) cases were patients from the Province of Buenos and Ciudad Autónoma de Buenos Aires (CABA) and 1 patient from Santiago del Estero. The total CI of the country was 0.04, the CI of the Province of Buenos Aires + CABA 0.04, and the CI of the rest of the provinces 0.01. Of the 14 patients with COVID-19: 50% were men;4 have a diagnosis of AS, 1 of SpAax-nr, 9 (64.3%) PsA. All of them in urban areas, 79% have social work, 2 (14%) have hypertension, 1 (7%) diabetes mellitus, 4 (28.6%), hypothyroidism, 1 (7%) Chronic Obstructive Pulmonary Disease, 2 (14%) Depression o Anxiety. Regarding the treatments: 4 (28.6%) were in treatment with anti TNF (3 with Adalimumab, 1 with certolizumab pegol), 4 (28.6%) with Anti IL17 (3 with Secukinumab and 1 with Ixekizumab), 8 (57%) methotrexate and 2 (14%) Leflunomide, 1 (7%) were under treatment with Enalapril, 1 (7%) with Losartan. 10 (71.4%) stayed at home, 3 (21.4%) hospitalized in the common room and 1 (7) in the intensive care unit. No patients died due to COVID-19. Conclusion: An incidence of 4.4% of COVID-19 was found in this SpA population, most of the cases occurred in the Province of Buenos Aires and CABA, most of them suffered mild symptoms and no deaths were reported.

The feasibility and acceptability of delivering Virtual pulmonary rehabilitation during the Covid-19 pandemic

Introduction Pulmonary Rehabilitation (PR) services have been unable to provide face-to-face PR due to covid-19. Our service developed a virtual PR (VPR) programme and sought to understand its feasibility and acceptability. Methods Our PR programme was adapted to an online format in conjunction with patients. Multiple video conferencing platforms were trialled with both clinicians and patients preferring Zoom. Exercise intensity was pragmatically prescribed using the BORG scale. One clinician demonstrated exercises and another provided feedback. Education consisted of facilitated group discussions. We recruited patients from PR classes and waitlists. One-toone assessments took place over a video platform (AccuRx). Exercise capacity was assessed using the 1-minute sit to stand (1STS). Health status was measured using the Chronic Respiratory Disease Questionnaire (CRQ) and COPD Assessment Test (CAT). Other measures included the Hospital Anxiety and Depression scale (HADS) and Lung Information Needs Questionnaire (LINQ). We collected patient and clinician feedback. Results We screened 58 patients for VPR-18 (31%) accepted, 21 (36%) were unsuitable (20-unwell, 1-language barrier), 19 (33%) had no internet access or declined. The participants (10 male) had an average age of 69 years (37-84). Respiratory pathology included COPD (11), Asthma (3), Bronchiectasis (2) and Interstitial lung disease (2). Average MRC was 3 (2-4) and FEV166% (29%-114%). We undertook VPR in 3 cohorts (2x/week for 6 weeks). 18 (100%) patients completed. No adverse events occurred. Over 50% of patient's achieved the MCID for exercise capacity, health status (CRQ) and learning needs (see figure 1). 10 patients responded to our post-VPR survey. 100% found VPR beneficial with 80% stating Zoom was 'very easy' or 'easy to use'. Benefits included reduced social isolation, not having to travel and confidence in home-based exercise. Clinician feedback was positive, but challenges were noted. VPR increased staff time for IT support and individualised exercise prescription proved difficult. The cohort model used may increase wait times but could allow for pathology specific groups. Conclusion VPR was feasible and acceptable during the closure of face-to-face PR. The future role of VPR warrants further investigation-particularly around remote assessment, who can access VPR and exercise prescription.

Feasibility and usage of one minute sit-tostand test, as a measure of recovery in postacute covid 19 patients, following hospital discharge

Background Patients discharged from hospital following treatment for COVID-19 infection, experience ongoing breathlessness during recovery.1 One minute sit-to-stand test (1MSTS) has been recommended to identify desaturation in these patients during acute and post-acute phase.2 We aimed to assess the feasibility of 1MSTS to monitor recovery in COVID-19 patients following hospital discharge. Methods All patients admitted to our hospital, with COVID-19 were offered clinic review approximately 6-8 weeks post discharge. This clinical assessment included 1MSTS, bloods and imaging. If ongoing clinical concern, a second review was offered at 3 months. We reviewed the 1MSTS in terms of (a) ability to complete test (b) oxygen desaturation >3%2 (c) longitudinal improvement in 1MSTS repetitions. Fisher's exact and Mann-Whitney tests were used to compare variables. Results 366/413(88%) COVID-19 patients reviewed at initial follow-up clinic completed a 1MSTS and 141 repeated 1MSTS at 3 months. Those who were unable to complete a 1MSTS at initial clinic were older, frailer and had longer hospital admissions with COVID-19 (table 1). 77/366 (21%) patients had desaturation of >3% on 1MSTS at initial follow-up, which was associated with severe disease during admission (p=0.051) and persisting radiographic abnormalities (p=0.0018). No association between desaturation and symptom burden was noted. Clinicians found 1MSTS with no desaturation to be helpful in the discharge process if other investigations were normal. Desaturation during initial clinic was not predictive of abnormal cardiac and respiratory investigations at 3 month followup (p=0.317). An improvement in number of repetitions/minute between clinic visits did not correlate with an improvement in VAS breathlessness (p=0.099), MRC score (p=0.267) or imaging (p=0.448). Conclusion The majority of patients recovering from COVID-19 can perform 1MSTS at follow-up clinic. Those unable were generally more frail, older and with co-morbidities. 1MSTS helped with discharge decisions at 6-8 weeks. However, the wider utility of the 1MSTS results is limited in COVID-19 follow-up. Serial measurements were not helpful in predicting symptomatic or radiological improvement.

S56 Feasibility and Usage of one minute sit-to-stand test, as a measure of recovery in post-acute COVID 19 Patients, following hospital discharge

S56 Table 1Demographics and clinical descriptors of patients completing and not completing 1MSTS at initial COVID-19 follow-up clinicConclusionThe majority of patients recovering from COVID-19 can perform 1MSTS at follow-up clinic. Those unable were generally more frail, older and with co-morbidities.1MSTS helped with discharge decisions at 6–8 weeks. However, the wider utility of the 1MSTS results is limited in COVID-19 follow-up. Serial measurements were not helpful in predicting symptomatic or radiological improvement.ReferencesCarfì A, et al. ( 2020) Persistent symptoms in patients after acute COVID 19. JAMA324(6):603–605.Greenhalgh T, et al. ( 2020) Management of post-acute covid-19 in primary care. BMJ370:m3026

P81 The feasibility and acceptability of delivering virtual pulmonary rehabilitation during the covid-19 pandemic

P81 Figure 1Virtual Pulmonary Rehabilitation OutcomesOutcome Measure Mean change (range) % meeting MCID (number) % meeting MCID in PR Clinical Audit 2019 1-minute Sit to Stand (1STS) 2 (-10 – 9) 56% (10) 59.8%1 CRQ- Dyspnoea 0.65 (-0.8 – 3) 56% (10) 58.6% CRQ- Emotional Function 0.75 (-1.29 -3.6) 56% (10) 53.7% CRQ- Fatigue 0.75 (-1.50–3.25) 61% (11) 59.0% CRQ- Mastery 0.51 (-2.25–3) 44% (8) 58.2% CAT 0 (-6 -8) 28% (5) 58% LINQ -3 (-8 -2) 83% (15) * HADS (Anxiety) 1 (-3 -7) 11% (2) * HADS (Depression) 0 (-4 – 8) 28% (5) * 1 as per the minimal clinically important difference (MCID) for incremental shuttle walk test (ISWT)/6-minute walk test (6MWT) *No audit data available. CRQ-Chronic Respiratory Disease Questionnaire, CAT- COPD Assessment Test, LINQ-Lung Information needs questionnaire, HADS-Hospital Anxiety and Depression scale.ConclusionVPR was feasible and acceptable during the closure of face-to-face PR. The future role of VPR warrants further investigation- particularly around remote assessment, who can access VPR and exercise prescription.