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IntroductionOur hospital redeployed healthcare professionals to implement a telephone-based Virtual Covid Ward (VCW) during the COVID-19 pandemic. Standardised clinical assessment included numeric (0 – 10) rating scales (NRS) for breathlessness and cough, and pulse oximetry.Aims and objectivesTo assess staff experience of routine breathlessness documentation by surveying feedback on the clinical effectiveness of assessment tools used in the VCW.MethodsData were obtained from an anonymous online survey distributed to VCW staff, summarised in themes and analysed with descriptive statistics.Results9/19 VCW staff completed the survey;9 female;5 nurses, 3 physiotherapists, 1 Operating Department Practitioner;8 were senior, 1 junior. 100% had acute or respiratory medicine experience, 66% had experience in remote assessments. 100% reported absence of breathlessness at rest the most reassuring sign when discharging patients. 100% confidence when assessing breathlessness over the phone. 100% felt breathlessness was a ‘red flag’. 66% found the breathlessness NRS useful and 67% found the cough NRS useful. 89% believed patients’ responses were meaningful at least half the time. 78% believed patients overestimated the breathlessness score at least half of the time and 55% believed patients underestimated respiratory distress.ConclusionVCW staff were confident in assessing patients remotely and using the NRS. Staff found assessment of breathlessness useful in predicting adverse patient outcomes, but were less confident using the NRS (0–10) rating scale to quantify breathlessness was clinically valuable.
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Introduction: Per the CDC, it is estimated that 69,710 opioid overdose deaths occurred in the United States (US) from September 2019 to September 2020. However, it is unclear whether naloxone prescribing also increased or otherwise fluctuated in this time. We sought to assess and compare the naloxone prescribing rate at a tertiary medical center in 2019 and 2020, as it pertained specifically to patients diagnosed with opioid use disorder (OUD). Method(s): A cross-sectional, retrospective medical record review was performed on patients with OUD from January 2019 through December 2020 at the University of Alabama at Birmingham Hospital, inclusive of outpatient, inpatient and emergency department settings. Naloxone prescribing, defined as either a written prescription or a provided take home kit in the current study, was assessed for all patients who presented to the hospital from January 2019 through December 2020. Patient demographic characteristics, marital and insurance status, were also obtained. Analyses were performed using descriptive statistics and Chi-square analysis. Result(s): In 2019, 11,959 visits were made by 2,962 unique patients with OUD, compared to 11,661 visits from 2,641 unique patients in 2020. Six hundred nine naloxone prescriptions in 2019 (5.1%) and 619 in 2020 (5.3%) were provided to these patients. In both years, most OUD-related visits were from whites (n = 4,253, 75.9%), unmarried individuals (n = 4,102, 73.2%), and males (n = 2,870, 51.2%). Similarly, in both years most naloxone prescriptions were given to whites (n = 934, 76.1%), unmarried individuals (n = 920, 74.9%), and males (n = 651, 53.0%), with no significant differences between 2019 and 2020. Compared with 2019, more naloxone prescriptions were given to uninsured patients in 2020 (202 vs 274, 33.2% vs 44.3%, P < 0.05). Compared with 2019, more patients were admitted to inpatient settings due to OUD (770 vs 824, 26.0% vs 31.2%, P < 0.05) and received more naloxone prescriptions in the inpatient setting (282 vs 384, 46.3% vs 62.0%, P < 0.05) in 2020. In addition, compared to 2019, the percentage of multiple presentations to the ED (P < 0.001) and inpatients ( P = 0.02) settings increased in 2020. Conclusion(s): In general, naloxone prescribing rates are extremely low as compared to the number of visits from patients with OUD. Although prescription numbers were similar in both years, more uninsured patients received naloxone prescriptions in 2020, especially in the inpatient setting. These findings may indicate the need for improving naloxone awareness in providers and prescribing for patients at risk for opioid overdose, particularly in emergency department and outpatient settings.
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P136 Table 1Results of correlation analysis Correlation analysis 4MGS 1STSreps SpO2% desaturation Results r p-value r p-value r p-value Pre-COVID mMRC dyspnoea score 0(0–1) -0.267** <0.001 -0.285** <0.001 -0.108 0.094 Post-COVID mMRC dyspnoea score 1(0–2) -0.442** <0.001 -0.457** <0.001 -0.143* 0.025 NRS breathlessness 3(0–5) -0.287** <0.001 -0.406** <0.001 -0.490 0.445 NRS fatigue 3(0–5) -0.315** <0.001 -0.379** <0.001 -0.190* 0.003 NRS cough 0(0–2) -0.660 0.292 -0.153* 0.017 0.083 0.194 NRS pain 1(0–4) -0.278** <0.001 -0.346** <0.001 -0.188* 0.003 NRS sleep difficulty 2(0–5) -0.246** <0.001 -0.386** <0.001 -0.122 0.057 Data are presented as median (interquartile range) or frequency (proportion%;95% confidence interval). SpO2% desaturation = SpO2% desaturation from baseline during 1 minute sit to stand test;1STSreps = repetitions per minute during 1 minute sit to stand test;4MGS = 4 metre gait speed;mMRC = modified Medical Research Council;NRS = 0 – 10 numerical rating scale;r = Spearman correlation coefficient. *indicates statistical significance at 0.05 level. **indicates statistical significance at 0.001 level.ConclusionRespiratory symptoms were not strong predictors of 4-metre gait speed and 1-minute sit-to-stand test performance. These data highlight the importance of face-to-face testing to objectively assess functional limitation in patients recovering from severe COVID pneumonia.
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P22 Table 1Clinical characteristics of patients in DO-IRT pathwayResults24(22%) of 109 referred inpatients were accepted onto DO-IRT;22/24(92%) for oxygen weaning and 2/24(8%) for LTOT. Clinical characteristics are shown in table 1. Majority of declined referrals (55%) were patients who were above target saturations on oxygen and were supported to wean to air by IRT as inpatients. Duration on DO-IRT pathway was mean (SD) 16.3(7.2) days;median (IQR) length of stay saved for the oxygen weaning cohort were 9 (7–13) days. All-cause 30-day mortality and readmission rates on DO-IRT were 0% and 21% respectively. 14(58%) patients completed the satisfaction survey;14(100%) reported confidence in their care and were ‘extremely likely’ to recommend DO-IRT.DiscussionEarly supported discharge with home oxygen weaning for SARS-CoV2 pneumonia patients is feasible, safe and well-received by patients. Integrated respiratory teams with specialist oxygen expertise can make a valuable contribution to supporting acute medical flow. Future studies should investigate the feasibility of supported early discharge pathways with domiciliary oxygen in other conditions.
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P135 Table 1Patient demographics, self-reported scores and functional test results by wave 1st wave 2nd wave p-value Demographics n=167 n=141 Age 59±13 58±12 0.564 Female 60 (35.93;28.94–43.40) 62 (43.97;35.97–52.22) 0.15 BMI (kg/m2) 30.5 (26.6–35.2) 32.1 (28.5–37.9) 0.009 ** BAME 115 (69.7;62.39–76.32) 72 (59.5;50.62–67.94) 0.073 Number of comorbidities 2 (1–3) 2 (1–3) 0.144 Patients Receiving Drugs Dexamethasone 11 (6.63;3.57–11.17) 138 (97.87;94.43–99.40) <0.001 *** Remdesivir 18 (10.84;6.79–16.24) 81 (57.45;49.20–65.39) <0.001 *** Other Immunomodulator 2 (1.20;0.25–3.81) 31 (21.99;15.76–29.35) <0.001 *** Questionnaire Scores n=164 n=132 NRS Breathlessness 2 (0–5) 3 (0–5) 0.153 ≥4 56 (34.78;27.75–42.36) 52 (37.14;29.47–45.34) 0.67 NRS Cough 0 (0–2) 0 (0–3) 0.439 ≥4 17 (10.56;6.52–16.00) 18 (13.64;8.59–20.26) 0.419 NRS Fatigue 3 (0–5) 3 (0–5) 0.867 ≥4 65 (40.63;33.24–48.35) 48 (36.92;28.99–45.43) 0.52 NRS Pain 0 (0–5) 1 (0–3) 0.682 ≥4 44 (27.50;21.03–34.78) 30 (23.08;16.48–30.86) 0.39 NRS Sleep disturbance 2 (0–5) 2 (0–5) 0.558 ≥4 52 (32.50;25.61–40.02) 49 (37.40;29.47–45.89) 0.382 Pre-COVID-19 mMRC 1 (0–2) 1 (1–2) 0.478 Post-COVID-19 mMRC 0 (0–1) 0 (0–1) 0.329 Post-COVID-19 mMRC ≥2 66 (40.99;33.61–48.70) 49 (38.58;30.45–47.23) 0.678 PCFS 2 (0–3) 1 (0–2) 0.055 PCFS ≥2 80 (50.00;42.31–57.69) 51 (42.15;33.62–51.05) 0.191 PHQ-9 ≥10 32 (20.38;14.66–27.19) 29 (23.02;16.33–30.92) 0.592 GAD-7 ≥10 34 (21.38;15.56–28.24) 16 (12.80;7.81- 19.49) 0.059 TSQ ≥6 43 (27.56;21.01–34.94) 27 (22.31;15.60–30.33) 0.319 Functional Tests n=160 n=139 4MGS <0.8 (ms-1) 67 (42.41;34.89–50.19) 47 (35.07;27.38–43.40) 0.201 1STS repetitions 18 (12–23) 17 (12–21) 0.460 <2.5 percentile 96 (60.00;52.29–67.36) 108 (77.70;70.25–84.00) 0.011 * Desaturation ≥4% 52 (34.67;27.40–4 .52) 42 (32.31;24.73–40.67) 0.677 Parametric data are presented as mean ± standard deviation, non-parametric data are presented as median (interquartile range) or frequency (proportion;95% confidence interval). Statistical significance indicated by * (p<0.05), ** (p<0.01), *** (p<0.001). BMI = Body mass index, BAME = Black, Asian or minority ethnic, NRS = Numerical rating scale (0–10), mMRC = modified Medical Research Council for dyspnoea (0–4), PCFS = Post-COVID-19 functional status scale (0–4), PHQ-9 = Patient health questionnaire 9 (0–27), GAD-7 = General Anxiety Disorder-7 scale (0–21), TSQ = Trauma screening questionnaire (0–10), 4MGS = 4-metre gait speed, 1STS = 1-minute sit-to-stand.ConclusionDespite shorter admission duration, and less frequent IMV, the burden of symptoms and functional limitation experienced post-hospitalisation for severe COVID-19 pneumonia was at least as severe during Wave 2 as in Wave 1. Identification of contributing factors and impact on post-COVID rehabilitation outcomes requires further study.
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Introduction:Inhalers are the mainstay of treatment for Chronic obstructive pulmonary disease and asthma. Studies have shown that less than one-third of users operate their inhalers properly;this comes with the risk of therapeutic failure and economic impact. Inhaler use literacy is associated with the patient's cognitive ability, age, and level of education. Repeated one to one education with demonstration has shown to improve inhaler technique and disease control, but this is often impractical in busy clinics. With the emergence of Coronavirus disease 2019 (COVID-19), more practitioners are shifting towards telehealth visits, creating new challenges for inhaler education. Here, we analyzed the inhaler use education practices across different specialties from a single center.Methods:A survey exempted by East Tennessee State University (ETSU) institutional review board has been distributed among ETSU affiliated staff and resident physicians from family medicine, internal medicine, pediatrics, and pulmonary medicine. The survey was open for one week at the beginning of December 2020.Results: The survey was sent to a total of 340 physicians. Sixty-three responses were received over one week (18% response rate). The maximum number of responses received were from internal medicine (43%), followed by family medicine (32%), pediatrics (18%), and Pulmonary medicine (7%). About 84% of the responders reported they prescribe inhalers often or very often. 60% reported they educate the patient only during the initial encounter for inhaler prescription. In comparison, 12% reported educating at every visit, 14% only at the patient's request, and another 14% reported that they never educate. More pediatricians tend to educate their patients at every visit (36%). Internal medicine had the greatest number of responders who never educate the patient (15%). One to one demonstration is the most popular teaching method reported (Image 1). Only 8% of responders said COVID-19 affected their inhaler education practices. Since the pandemic, 6% of the responders started advising YouTube videos on inhaler use, while 30% were doing that even before COVID-19. Only 10% of those who recommend YouTube videos provide the patient with a specific video-link.Conclusion: The survey hints that repeated Inhaler education is not happening in real-life practice. COVID-19 is gradually influencing the inhaler use education practices, with more physicians recommending methods like YouTube videos. Validation and identification of quality videos need to be done for proper patient education by this method. The authors realize that a single academic center survey may not represent the majority of prescribers.
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Smart home security and safety systems have gained more importance in recent years. This is attributable to their significant impact in reducing and preventing loss of assets and human life. The COVID-19 pandemic adds a new dimension to home security as potentially infected people or those not taking necessary precautions such as sanitization or wearing masks may enter homes and cause further transmission. The traditional security systems are effective in conventional scenarios but require human intervention and contact which can lead to the spread of the virus. This necessitates the development of smart security systems that are autonomous and contactless. This paper presents a novel IoT enabled home security system that restricts unauthorized access and at the same time ensures that permitted users are normothermic and are following proper COVID hygiene. The proposed system is a smart edge device that does not require a cloud platform for its computational needs. Facial recognition is used to authenticate and allow approved users to get access. If an unfamiliar person tries to enter the premises, the system takes a photo, computes mask detection on the image, measures temperature and sends these three data points as a WhatsApp notification to the administrative user. The door lock can then be controlled automatically or remotely using a WhatsApp bot. © 2021 IEEE.
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Introduction Conventional lung function testing involves forced expiratory manoeuvres which risk aerosolisation of respiratory droplets and nosocomial transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2/COVID-19). Between-patient decontamination procedures render routine testing impractical. Parasternal electromyography (EMGpara) is an effort-independent method of assessing inspiratory muscle activity that tracks clinical trajectory in COPD, cystic fibrosis and pulmonary fibrosis. We evaluated EMGpara as a method of monitoring respiratory muscle function during recovery from COVID-19 pneumonia in Post-COVID clinic. Methods Prospective single-centre observational cohort study (05/Q0703/82). All patients hospitalised with severe COVID-19 pneumonia (oxygen requirement-40% or critical care admission) were invited to clinic 6-8 weeks post-discharge. EMGpara was recorded in consecutive patients attending 12 clinic sessions using transcutaneous second intercostal space electromyography. Measurements were made over 2 minutes of tidal breathing followed by maximal inspiratory manoeuvres (inspiration to total lung capacity and maximal sniff manoeuvres) and the values for root mean square (RMS) EMGpara per breath, EMGpara%max (RMS EMGpara as a proportion of volitional maximum), Neural Respiratory Drive Index (NRDI) and sex-specific standardised residuals (z-scores) recorded. After each measurement, equipment was decontaminated using alcohol-based wipes and surface electrodes were disposed of. Symptom questionnaires and radiographic assessment of lung oedema (RALE) scores were recorded. Results Between 4th June and 2nd July 2020, EMGpara was measured in 25 patients. All approached patients consented to participate, no adverse events occurred. Mean±SD age 57.1 ±15.6 years, 64% male, BMI 29.4±5.6 kg/m2, 29% current/ex-smokers. mMRC was at pre-COVID baseline in 56%, 32% reported persistent burdensome breathlessness. Respiratory rate 15±3 breaths/minute, oxygen saturation 98±2.0%, heart rate 87±12 bpm. EMGpara measures are presented in table 1. Zscores of all EMGpara indices were raised. NRDI was associated with admission, worst inpatient and follow-up RALE scores (R=0.41 (p=0.04), R=0.40 (p=0.046) and R=0.49 (p=0.01), respectively), not mMRC (R=0.24, p=0.24 Conclusions Inspiratory muscle activation was high, which may reflect underlying interstitial pathology, critical illness myopathy, deconditioning or anxiety relating to clinic attendance. Parasternal electromyography is a well-tolerated technique that avoids aerosolisation of respiratory droplets and utilises equipment that is easily decontaminated between patients. This makes it a practical and informative measure of lung function during the COVID-19 pandemic.
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Introduction The 'Long COVID' syndrome, where symptoms persist beyond the acute illness with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2/COVID-19), is anecdotally described. However, a comprehensive report of clinical, radiological, functional and psychological recovery from COVID-19 is currently lacking. We present a detailed radiological, patient-reported and physiological characterisation of patients attending face-to-face assessment following hospitalisation with COVID-19 pneumonia. Methods Prospective single-centre observational cohort study at an inner-city South London teaching hospital. All patients admitted with severe COVID-19 pneumonia (admission duration-48 hours, oxygen requirement-40% or critical care admission) were invited to attend Post-COVID Clinic 6-8 weeks following hospital discharge. Primary outcome: Radiological resolution of COVID-19 pneumonitis. Secondary outcomes: Demographics and anthropometrics, inpatient clinical course, patient-reported and physiological outcomes at follow-up (symptoms, functional disability, mental health screening, 4-metre gait speed (4MGS), 1-minute sit-to-stand (STS) test). Results 119 consecutive patients attended clinic between 3rd June and 2nd July 2020, at median (IQR) 61 (51-67) days post discharge. Baseline characteristics are presented in table 1. Despite apparent radiographic resolution of lung infiltrates in the majority (RALE score <5 in 87% of patients), patients commonly reported persistent fatigue (78/115 (67.8%;95%CI 60.0-76.5)), sleep disturbance (65/115 (56.5;47.3-66.1)) and breathlessness (37/115 (32.2;25.2-40.0)). mMRC breathlessness score was above pre-COVID baseline in 55/115 (46.2;37.8-54.6). Burdensome cough was less common (8/115 (7.0;3.5-10.4)). 56 thoracic computed tomography scans were performed, of which 75% demonstrated COVID-related interstitial lung disease and/or airways disease. Significant depression (PHQ-9-9) or anxiety (GAD-7-9) were present in 20/111 (18.0;11.7-23.4) and 25/113 (22.1;15.0-29.8), respectively. The Trauma Screening Questionnaire was positive (-6) in 28/113 (24.8;18.1-31.9). Post-COVID functional scale was-2 in 47/115 (40.9;33.0-47.8). 4MGS was <0.8 m/s in 44/115 (38.3;29.6-46.1), 39/109 (34.5;26.5-41.6) desaturated by-4% during STS, 25/32 (78.1;62.5-93.1) who desaturated also had abnormal CT findings. Conclusions Persistent symptoms, functional limitation and adverse mental health outcomes are common 8 weeks after severe COVID-19 pneumonia. Follow-up chest radiograph is a poor marker of recovery. Physiological testing to identify oxygen desaturation is useful for triaging patients for further investigation. Face-to-face or virtual clinical assessments are recommended to facilitate early recognition and management of post-COVID sequelae in this vulnerable cohort.
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Aims & Objectives: In this study we analysed the predictability of Neutrophil/Lymphocyteratio in patient with severe SARS-CoV-2 Acute Respiratory Distress Syndrome and role of steroid (Dexamethasone and Methylprednisolone) in controlling transition of inflammatory phase of pneumonia to hyper inflammatory phase ofARDS. Patients/Materials & Methods: This retrospective observational study includes>250 patients admitted in BKCCOVID Centre Mumbaifrom 1st September onwards (ongoing) who are RT-PCR positive for SARSCoV2 and presented with pneumonicpatchin Xray and breathlessness. All these patients were treated with standard of care treatment special with steroids (Dexamethasone 6 mg/day or Methylprednisolone 80 mg BD) and LMWH. Patients with high N/L Ratio>5 with GGOs in Xray were put on steroidsplus LMWH and amoxicillineplusclavulanic acid.While those who on admission with N/L>7 with distress were considered for MPSpulse therapy. Results: Patient who were having N/L ratio>7 without any coverofsteroids and LMWH had poor disease outcome as compared to patients who are on steroids and LMWH. While those who were N/L>5 but were on Steroids and LMWH had better outcome even after increase in N/L ratio. Discussion &Conclusion: Patients with N/L>5 should be started with steroids with LMWH with broad spectrum antibiotics, while those with N/L>7 with respiratory distress should be considered for MPS pulsetherapy.
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S55 Table 1Baseline characteristicsAge (years) 58.7 ± 14.4 Sex Female 45 (37.8;29.4–46.2) Male 74 (62.2;53.8–70.6) Ethnicity BAME (Yes/No) 83 (69.7;61.3–78.2) White 36 (30.3;22.6–37.8) Black 52 (43.7;36.1–51.3) Asian 18 (15.1;10.1–20.2) Mixed race 5 (4.2;1.7–6.7) Other 8 (6.7;3.4–10.9) Index of multiple deprivation score (n=115) 26.6 ± 9.7 Body Mass Index (kg/m2) (n=118) 30.0 (25.9–35.2) Charlson comorbidity index 2 (1–4) Admission PaO2:FiO2 168.8 (105.9–272.3) Critical care admission 41 (34.5;26.9–42.9) COVID-19 complications None during admission 49 (41.2;33.6–48.7) Venous thromboembolism 27 (22.7;16.8–29.4) Pulmonary embolism 23 (19.3;12.6–26.1) Deep vein thrombosis 6 (5.0;2.5–7.6) Acute kidney injury 41 (34.5;25.2–43.7) Deranged liver function 17 (14.3;9.2–20.2) Delirium 18 (15.1;10.1–20.2) Data presented as mean ± SD, median (IQR) or frequency (%;95% confidence interval). Abbreviations: BAME = Black, Asian or Minority Ethnic, PaO2:FiO2 = ratio of arterial partial pressure of oxygen to fraction of inspired oxygen.Results119 consecutive patients attended clinic between 3rd June and 2nd July 2020, at median (IQR) 61 (51–67) days post discharge. Baseline characteristics are presented in table 1. Despite apparent radiographic resolution of lung infiltrates in the majority (RALE score <5 in 87% of patients), patients commonly reported persistent fatigue (78/115 (67.8%;95%CI 60.0–76.5)), sleep disturbance (65/115 (56.5;47.3–66.1)) and breathlessness (37/115 (32.2;25.2–40.0)). mMRC breathlessness score was above pre-COVID baseline in 55/115 (46.2;37.8–54.6). Burdensome cough was less common (8/115 (7.0;3.5–10.4)). 56 thoracic computed tomography scans were performed, of which 75% demonstrated COVID-related interstitial lung disease and/or airways disease. Significant depression (PHQ-9 ≥9) or anxiety (GAD-7 ≥9) were present in 20/111 (18.0;11.7–23.4) and 25/113 (22.1;15.0–29.8), respectively. The Trauma Screening Questionnaire was positive (≥6) in 28/113 (24.8;18.1–31.9). Post-COVID functional scale was ≥2 in 47/115 (40.9;33.0–47.8). 4MGS was <0.8 m/s in 44/115 (38.3;29.6–46.1), 39/109 (34.5;26.5–41.6) desaturated by ≥4% during STS, 25/32 (78.1;62.5–93.1) who desaturated also had abnormal CT findings.ConclusionsPersistent symptoms, functional limitation and adverse mental health outcomes are common 8 weeks after severe COVID-19 pneumonia. Follow-up chest radiograph is a poor marker of recovery. Physiological testing to identify oxygen desaturation is useful for triaging patients for further investigation. Face-to-face or virtual clinical assessments are recommended to facilitate early recognition and management of post-COVID sequelae in this vulnerable cohort.
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P240 Table 1Measures of parasternal electromyography Measured value Z-score EMGpara (µV) 5.80 (3.91–12.26) 1.27 (0.73–2.10) EMGpara%max (%) 15.45 (11.41–23.27) 2.93 (1.91–4.34) NRDI (%.bpm) 224 (164–306) 2.68 (1.79–3.90) Data are presented as median (interquartile range). Abbreviations: z-score = standardised residual, EMGpara = mean root mean square parasternal electromyography per breath, µV = microvolts, EMGpara%max = EMGpara as a proportion of volitional maximum, NRDI = Neural Respiratory Drive Index.ConclusionsInspiratory muscle activation was high, which may reflect underlying interstitial pathology, critical illness myopathy, deconditioning or anxiety relating to clinic attendance. Parasternal electromyography is a well-tolerated technique that avoids aerosolisation of respiratory droplets and utilises equipment that is easily decontaminated between patients. This makes it a practical and informative measure of lung function during the COVID-19 pandemic.