The effect of the COVID-19 pandemic on severe asthma care in Europe: will care change for good?

Background: The coronavirus disease 2019 (COVID-19) pandemic has put pressure on healthcare services, forcing the reorganisation of traditional care pathways. We investigated how physicians taking care of severe asthma patients in Europe reorganised care, and how these changes affected patient satisfaction, asthma control and future care. Methods: In this European-wide cross-sectional study, patient surveys were sent to patients with a physician-diagnosis of severe asthma, and physician surveys to severe asthma specialists between November 2020 and May 2021. Results: 1101 patients and 268 physicians from 16 European countries contributed to the study. Common physician-reported changes in severe asthma care included use of video/phone consultations (46%), reduced availability of physicians (43%) and change to home-administered biologics (38%). Change to phone/video consultations was reported in 45% of patients, of whom 79% were satisfied or very satisfied with this change. Of 709 patients on biologics, 24% experienced changes in biologic care, of whom 92% were changed to home-administered biologics and of these 62% were satisfied or very satisfied with this change. Only 2% reported worsening asthma symptoms associated with changes in biologic care. Many physicians expect continued implementation of video/phone consultations (41%) and home administration of biologics (52%). Conclusions: Change to video/phone consultations and home administration of biologics was common in severe asthma care during the COVID-19 pandemic and was associated with high satisfaction levels in most but not all cases. Many physicians expect these changes to continue in future severe asthma care, though satisfaction levels may change after the pandemic.

The effect of the COVID-19 pandemic on severe asthma care in Europe - will care change for good?

Background The COVID-19 pandemic has put pressure on health-care services forcing the reorganisation of traditional care pathways. We investigated how physicians taking care of severe asthma patients in Europe reorganised care, and how these changes affected patient satisfaction, asthma control and future care. Methods In this European-wide cross-sectional study, patient surveys were sent to patients with a physician-diagnosis of severe asthma, and physician surveys to severe asthma specialists between November 2020 and May 2021. Results 1101 patients and 268 physicians from 16 European countries contributed to the study. Common physician-reported changes in severe asthma care included use of video/phone consultations (46%), reduced availability of physicians (43%) and change to home-administered biologics (38%). Change to phone/video consultations was reported in 45% of patients, of whom 79% were satisfied or very satisfied with this change. Of 709 patients on biologics, 24% experienced changes in biologic care, of whom 92% were changed to home-administered biologics and of these 62% were satisfied or very satisfied with this change. Only 2% reported worsening asthma symptoms associated with changes in biologic care. Many physicians expect continued implementation of video/phone consultations (41%) and home administration of biologics (52%). Conclusions Change to video/phone consultations and home administration of biologics was common in severe asthma care during the COVID-19 pandemic, and was associated with high satisfaction levels in most but not all cases. Many physicians expect these changes to continue in future severe asthma care, though satisfaction levels may change after the pandemic.

Impact of Smoking on Women During the Covid-19 Pandemic.

The coronavirus disease 2019 (COVID-19) brought in 2020 an important challenge for health-care systems and authorities. Smoking and its influence on this disease remain, after months of the pandemic, one of the debatable risk factors. From the literature point of view, the focus of most articles is on smoking as a possible general risk factor for all analyzed populations. Women tend to represent a more significant population in exposed occupations. In our mini-review, we try to dig deeper, looking for gender-related health effects of smoking in this pandemic context, its effects on the infection with this novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), on illness severity, and on the rate of hospitalization and mortality. Despite the fact that the male gender is reported in many articles as a predictor of a poor outcome, we suggest that further research is needed to confirm or deny these relationships. Moreover, studies focusing specifically on women in these study populations are required.

TWO PANDEMICS COALITION: COVID-19 AND OBESITY

COVID-19 epidemic caused by an influenza-like virus strain (SARS-CoV-2) invaded the world. The World Health Organization (WHO) announced this infection outbreak as a global pandemic on 11 March 2020. From one day to another the number of new cases is growing and also the number of deaths. This infection emerged earlier in Wuhan City and rapidly spread throughout China and around the world since December 2019. Another silent pandemic disease spreading mainly in industrialized countries is obesity. The best example is US were about 34% of the Americans are obese. In actual context, it can be said there is a coalition of 2 pandemics. In Romania, obesity and overweight prevalence assessed by Predatorr study is at a high level: 34,7% overweight and 31,9% obesity. Systemic inflammation in obesity is the central mechanism leading to lung function decline. There are two main questions a) is obese more sensible to viral infection or b) potentially more contagiousș The answer is positive to both. Recent WOF official position stated that obesity is a risk factor for developing severe forms of COVID-19. Donna Ryan's message, as president of World Obesity Federation WOF,US emphasized at the beginning of April the risk for severe complications for persons with obesity who contracted the infection with SARS-CoV-2. Nutritional support in COVID-19 should prefer oral feeding, whenever is possible. A special attention should be dedicated to a healthy microbiome and intestinal immunity. Energy intake should be 25-30 kcal/body weight, with 1.2-2g/kg proteins. Enteral nutrition will be recommended in severe cases. Evidence is supporting the recommendation that for people at risk of developing COVID-19 to consider for few weeks a dosage of 10000UI/day of vitD3, than a maintainance dose of 5000 UI/day. The target must be to stabilize a level of 40-60 ng/ml for 25(OH) D concentration. Pulmonary rehabilitation, smoking cessation, included in a healthy lifestyle will be further steps after patients recovery from this infection. Facing this pandemic coalition, our messages should be stronger in stimulating prevention of obesity. Since more than a half of Romanian population is already overweight or obese, healthy lifestyle should become a daily prescription, not just a luxury recommendation. Daily, right messages from doctors acting like role models, in a partnership between general practitioner and other specialties like diabetologists, pneumologists, cardiologists, nutritionists will be efficient weapons against this cruel coalition: Obesity and COVID 19. (English) [ABSTRACT FROM AUTHOR] Epidemia COVID-19 cauzată de o tulpină virală influenza-like (SARS-CoV-2) a invadat lumea. Organizația Mondială a Sănătății (OMS) a anunțat infecția ca o pandemie globală pe data de 11 martie 2020. De la o zi la alta, numărul de cazuri noi crește, precum și numărul de decese. Această infecție a apărut în orașul Wuhan și s-a răspândit rapid în toată China și în întreaga lume din decembrie 2019. O altă boală pandemică tăcută, răspândită în principal în țările industrializate, este obezitatea. Cel mai bun exemplu este că SUA, aproximativ 34% dintre americani fiind obezi. În contextul actual, se poate spune că există o coaliție a două pandemii. În România, prevalența obezității și supraponderalilății evaluată prin studiul Predatorr este ridicată: 34,7% pentru supraponderalitate și 31,9% pentru obezitate. Inflamația sistemică este mecanismul central care duce la declinul funcției pulmonare în obezitate. Există două întrebări principale a) este obezul mai sensibil la infecția virală sau b) potențial mai contagios? Răspunsul este pozitiv pentru ambele. Poziția oficială recentă a WOF a afirmat că obezitatea este un factor de risc pentru dezvoltarea unor forme severe de COVID-19. Mesajul președintelui Federației Mondiale a Obezității (WOF), Donna Ryan, a subliniat, la începutul lunii aprilie, riscul de complicații severe pentru persoanele cu obezitate care au contactat infecția cu SARS-CoV-2. Sprijinul nutrițional în COVID-19 ar trebui să implice hrănirea orală, ori de câte ori este posibil. O atenție specială ar trebui acordată menținerii unui microbiom sănătos și imunității intestinale. Aportul de energie trebuie să fie de 25-30 kcal/kg greutate corporală, cu 1,2-2 g/kg proteine. Nutriția enterală va fi recomandată în cazurile severe. Dovezile susțin recomandarea ca persoanele cu risc de a dezvolta COVID-19 să primească timp de câteva săptămâni o doză de 10000 UI/zi de vit D3, mai degrabă decât o doză de întreținere de 5000 UI/zi. Ținta trebuie să fie atingerea unui nivel stabil de 40-60 ng/ml al concentrației de 25 (OH) D. Reabilitarea pulmonară, renunțarea la fumat, incluse într-un stil de viață sănătos, vor fi etape ulterioare în recuperarea pacienților după această infecție. În fața acestei coaliții pandemice, mesajele prin care stimulăm prevenirea obezității ar trebui să fie mai puternice. Deoarece mai mult de jumătate din populația României este deja supraponderală sau obeză, stilul de viață sănătos ar trebui să devină o rețetă zilnică, nu doar o recomandare de lux. Mesajele zilnice și corecte ale medicilor care acționează ca modele de urmat, într-un parteneriat între medicul generalist și alte specialități precum diabetologi, pneumologi, cardiologi, nutriționiști vor fi arme eficiente împotriva acestei crude coaliții: obezitatea și COVID 19. (Romanian) [ABSTRACT FROM AUTHOR] Copyright of Internal Medicine / Medicina Interna is the property of Romanian Society of Internal Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

TWO PANDEMICS COALITION: COVID-19 AND OBESITY

COVID-19 epidemic caused by an influenza-like virus strain (SARS-CoV-2) invaded the world. The World Health Organization (WHO) announced this infection outbreak as a global pandemic on 11 March 2020. From one day to another the number of new cases is growing and also the number of deaths. This infection emerged earlier in Wuhan City and rapidly spread throughout China and around the world since December 2019. Another silent pandemic disease spreading mainly in industrialized countries is obesity. The best example is US were about 34% of the Americans are obese. In actual context, it can be said there is a coalition of 2 pandemics. In Romania, obesity and overweight prevalence assessed by Predatorr study is at a high level: 34,7% overweight and 31,9% obesity. Systemic inflammation in obesity is the central mechanism leading to lung function decline. There are two main questions a) is obese more sensible to viral infection or b) potentially more contagious? The answer is positive to both. Recent WOF official position stated that obesity is a risk factor for developing severe forms of COVID-19. Donna Ryan's message, as president of World Obesity Federation WOF, US emphasized at the beginning of April the risk for severe complications for persons with obesity who contracted the infection with SARS-CoV-2. Nutritional support in COVID-19 should prefer oral feeding, whenever is possible. A special attention should be dedicated to a healthy microbiome and intestinal immunity. Energy intake should be 25-30 kcal/body weight, with 1.2-2 g/kg proteins. Enteral nutrition will be recommended in severe cases. Evidence is supporting the recommendation that for people at risk of developing COVID-19 to consider for few weeks a dosage of 10000 UI/day of vitD3, than a maintainance dose of 5000 UI/day. The target must be to stabilize a level of 40-60 ng/ml for 25(OH) D concentration. Pulmonary rehabilitation, smoking cessation, included in a healthy lifestyle will be further steps after patients recovery from this infection. Facing this pandemic coalition, our messages should be stronger in stimulating prevention of obesity. Since more than a half of Romanian population is already overweight or obese, healthy lifestyle should become a daily prescription, not just a luxury recommendation. Daily, right messages from doctors acting like role models, in a partnership between general practitioner and other specialties like diabetologists, pneumologists, cardiologists, nutritionists will be efficient weapons against this cruel coalition: Obesity and COVID 19. (English) [ABSTRACT FROM AUTHOR] Epidemia de COVID-19, cauzată de o tulpină virală asemănătoare gripei (SARS-CoV-2), a invadat lumea. Pe data de 11 martie 2020, Organizația Mondială a Sănătății (OMS) a anunțat pandemia globală. De la o zi la alta, numărul de cazuri noi este în creștere și, de asemenea, numărul de decese. Această infecție a apărut inițial în orașul Wuhan și s-a răspândit rapid în China și în întreaga lume, începând cu luna decembrie 2019. O altă pandemie silențioasă care se răspândește în principal în țările industrializate este obezitatea. Cel mai bun exemplu este SUA, aproximativ 34% dintre americani fiind obezi. În contextul actual, se poate spune că există o coaliție de două pandemii. În România, prevalența obezității și supraponderalității, evaluate de studiul Predatorr, sunt ridicate: 34,7% persoane supraponderale și 31,9% persoane obeze. Inflamația sistemică din obezitate este mecanismul central care determină scăderea funcției pulmonare. Există două întrebări principale a) este persoana obeză mai sensibilă la infecția virală sau b) potențial mai contagioasă? Răspunsul este pozitiv pentru ambele. Poziția oficială recentă a WOF a stabilit că obezitatea este un factor de risc pentru dezvoltarea formelor severe de COVID-19. Prin mesajul său, Donna Ryan, în calitate de președinte al World Obesity Federation WOF, SUA, a subliniat la începutul lunii aprilie riscul de complicații severe pentru persoanele obeze care au contactat infecția cu SARS-CoV-2. Suportul nutrițional în COVID-19 ar trebui să se administreze, ori de câte ori este posibil, pe cale orală. O atenție specială ar trebui să fie dedicată unui microbiom sănătos și imunității intestinale. Aportul de energie trebuie să fie de 25-30 kcal/kg greutate corporală, cu 1,2-2 g/kg proteine. Nutriția enterală se va recomanda în cazurile severe. Dovezile științifce susțin recomandarea ca, persoanelor cu risc de a contacta COVID-19, să li se administreze o doză de 10000 UI/zi de VitD3 pentru câteva săptămâni, apoi o doză de întreținere de 5000 Ul/zi. Ținta trebuie să fie stabilizarea concentrației serice de 25 (OH) D la 40-60 ng/ml. Reabilitarea pulmonară, renunțarea la fumat, ca parte a unui stil de viață sănătos, vor fi pași suplimentari pentru recuperarea pacienților după această infecție.În fața acestei coaliții pandemice, mesajele noastre ar trebui să fie mai puternice în sensul prevenirii obezității. Întrucât mai mult de jumătate din populația română este deja supraponderală sau obeză, stilul de viață sănătos ar trebui să devină o rețetă zilnică, nu doar o recomandare de lux. Mesajele corecte de la medici care acționează ca modele, într-un parteneriat între medicul generalist și alte specialități precum diabetologi, pneumologi, cardiologi, nutriționiști vor fi arme eficiente împotriva acestei coaliții crude: obezitatea și COVID19. (Romanian) [ABSTRACT FROM AUTHOR] Copyright of Internal Medicine / Medicina Interna is the property of Romanian Society of Internal Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Possible Nutritional Interventions in COVID 19.

At the end of 2019, a new viral pandemic evolution totaly surprised all services worldwide. This pandemic hit has a huge interference with three global crises: governance, economics, and migration (1). It is a new coronavirus infection, "COVID-19" (which is the acronym of "coronavirus disease 2019"), first reported to the WHO Country Office in China on the 31st of December 2019 and detected in Wuhan, the largest metropolitan area in China's Hubei province (2), COVID-19 outbreak situation on 6 April 2020 was with more than 1 175 000 confirmed cases, more than 65 000 deaths and already reported in 209 countries (3). This new coronavirus belongs to the Orthocoronavirinae subfamily of the Coronaviridae family (order Nidovirales) and it is a positive-stranded RNA virus with a crown-like appearance under an electron microscope, SARS-CoV-2 belonging to the beta CoVs human category. It is sensitive to ultraviolet rays and heat and is inactivated by lipid solvents including ether (75%), ethanol, chlorine-containing disinfectant, peroxyacetic acid and chloroform (except for chlorhexidine) (4) Genomic analyses suggest that SARS-CoV-2 probably evolved from a strain found in bats. The mammalian host between bats and humans is not well known; also, it is not certain whether this intermediary really exists (5). The pathogenic mechanism inducing pneumonia is complex. The virus is capable of producing an excessive immune reaction in the host; for some patients, the disaster starts from a 'cytokine storm' with tissue damage (one of the protagonists is IL6) (6).