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Background: Persisting breathlessness after COVID-19 infection is common and debilitating. We aimed to characterise and identify risk factors for patients with persistent breathlessness following COVID-19 hospitalisation. Method(s): PHOSP-COVID is a multi-centre prospective cohort study of UK adults hospitalised for COVID-19. Clinical data were collected during hospitalisation and at a research visit. Breathlessness was measured by a numeric rating scale of 0-10. We defined post-COVID breathlessness as an increase in score of 1 or more compared to the preCOVID-19 level. Multivariable logistic regression was used to identify risk factors. Result(s): We included 1,226 participants (37% female, median age 59 years, 22% mechanically ventilated). At a median five months after discharge, 50% reported post-COVID breathlessness. Risk factors for post-COVID breathlessness were socio-economic deprivation (adjusted odds ratio, 1.67;95% confidence interval, 1.14-2.44), pre-existing depression/anxiety (1.58;1.06-2.35), female sex (1.56;1.21-2.00) and admission duration (1.01;1.00- 1.02). Black ethnicity (0.56;0.35-0.89) and older age groups (0.31;0.14-0.66) were less likely to report post-COVID breathlessness. Post-COVID breathlessness was associated with worse performance on the shuttle walk test and forced vital capacity, but not with obstructive airflow limitation. Conclusion(s): Half of this national cohort of patients hospitalised for COVID-19 experienced persistent breathlessness at follow up. The risk factors identified for post-COVID breathlessness should inform mechanistic work to understand causal processes and develop future interventions to improve outcomes in this growing population.
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P80 Figure 1Generalised additive models showing trends in behaviours and acute respiratory infections (ARI) from November 2020 to April 2022 in UK adults with asthma. A, visits to indoor public places. B, visits to other households. C, use of face coverings. D, RT-PCR or antigen test-confirmed COVID-19. E, ARI testing negative for SARS-CoV-2 by RT-PCR or antigen test. F, asthma exacerbations requiring treatment with systemic corticosteroids and/or hospitalisation. Dotted lines show 95% confidence intervals[Figure omitted. See PDF]ConclusionsRelaxation of COVID-19 restrictions coincided with decreased use of face coverings, increased social mixing and a rebound in ARI and asthma exacerbations. Associations between incident ARI and risk of exacerbation were similar for non-COVID ARI and COVID-19, both before and after emergence of the omicron variant of SARS-CoV-2.ReferenceThorax, 2021. 76(9): p. 867–873.Please refer to page A214 for declarations of interest related to this .
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BACKGROUND: Barts Health National Health Service Trust (BHNHST) serves a diverse population of 2.5 million people in London, UK. We undertook a health services assessment of factors used to evaluate the risk of severe acute respiratory coronavirus 2 (SARS-CoV-2) infection.METHODS: Patients with confirmed polymerase chain reaction (PCR) test results admitted between 1 March and 1 August 2020 were included, alongwith clinician-diagnosed suspected cases. Prognostic factors from the 4C Mortality score and 4C Deterioration scores were extracted from electronic health records and logistic regression was used to quantify the strength of association with 28-day mortality and clinical deterioration using national death registry linkage.RESULTS: Of 2783 patients, 1621 had a confirmed diagnosis, of whom 61% were male and 54% were from Black and Minority Ethnic groups; 26% died within 28 days of admission. Mortality was strongly associated with older age. The 4C mortality score had good stratification of risk with a calibration slope of 1.14 (95% CI 1.01-1.27). It may have under-estimated mortality risk in those with a high respiratory rate or requiring oxygen.CONCLUSION: Patients in this diverse patient cohort had similar mortality associated with prognostic factors to the 4C score derivation sample, but survival might be poorer in those with respiratory failure.
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COVID-19 , State Medicine , Aged , Female , Hospitalization , Humans , London/epidemiology , Male , Risk Factors , SARS-CoV-2ABSTRACT
Introduction A Virtual Covid-19 Follow-up Clinic was designed in response to the need to review a large number of in-patients, at a large hospital trust, recovering from Covid-19 but without any significant increase in resources. Methods Patients complete a structured online/telephone symptom and psychological health questionnaire and have a chest x-ray 12 weeks after their illness. These results, and their medical records, are reviewed asynchronously by the medical team in a virtual clinic. Patients are then triaged to further virtual review, telephone review, face to face review, or are discharged. All patients receive comprehensive written information to aid their recovery. Results During the first 8 weeks of the service, 388 patients have completed the questionnaire (63% online) and been reviewed. Current symptoms are shown in figure 1. The questionnaire has identified the holistic needs of patients and allowed triaged follow-up with 122 discharged and 53 urgent face-to-face review appointments completed. 25 CT pulmonary angiogram scans were arranged for patients with typical symptoms of pulmonary emboli;no thromboembolic disease was identified. Conclusion This early experience of a new service has highlighted 5 learning points:.
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Introduction Severe asthma patients were assumed to be at greater risk of morbidity from infection with the novel severe acute respiratory syndrome coronavirus (COVID-19), hence, in the UK, were advised to shield. Community data on COVID-19 infection in severe asthmatics is lacking. We assessed the burden of shielding, the impact of COVID-19 and the effect of asthma medication on the UK severe asthma population. Methods Adults previously consented to inclusion in the UK Severe Asthma Registry (UKSAR) across 14 centres were contacted in June 2020 to collect data on potential COVID-19 infection, asthma control and shielding. Electronic records, where available, were reviewed for confirmation. Data was combined with clinical data from the UKSAR. Univariate and multivariate logistic regression analyses were performed to identify risk factors for COVID-19 infection. Results 1365 patients were included. 1268 (93%) were advised to shield, 1131 (89%) patients who received shielding advice followed it. Men (OR 0.4, p=0.045) and those in non-shielding households (OR 0.27, p=0.001) were less likely to follow shielding advice. 544 (47%) of patients advised to shield reported worsening of mental health;females (OR 1.59, p=0.001) and those with history of anxiety or depression (OR 2.12 p=0.001) were at greater risk. 97 (7.1%) patients had suspected/confirmed COVID-19 infection, 19 (1.39%) PCR/serology confirmed infection, 13(0.95%) were hospitalised and 2 patients (0.15%) died (table 1). 918 (67%) were on biologic therapy, 515 (37%) maintenance oral corticosteroid (mOCS). Multivariate analysis showed neither biologic therapy (OR 0.73, p=0.165) nor mOCS (OR 1.18, p=0.427) increased the risk of COVID-19 infection. Patients on biologics were less likely to require an acute course of corticosteroids for asthma symptoms (OR 0.6, p=0.002) while patients on mOCS were more likely (OR 1.96 p£0.001). Inhaled corticosteroids (ICS) were not associated with COVID-19 infection, including high dose (2000 mcg BDP equivalent) (OR 0.64, p=0.234). Hospitalised patients were on lower median doses of ICS vs non-hospitalised patients (1000 vs 2000 mcg BDP equivalent, p=0.002). Conclusion Hospitalisation and death occurred in small numbers in our severe asthma population. From this observational data, biologic agents for asthma were not associated with increased risk of COVID-19 infection or hospitalisation.
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Background: Many patients with SARS-CoV-2 infection are reporting long lasting symptoms, requiring holistic multi-disciplinary rehabilitation;however, there are severe capacity restraints in rehabilitation services. We report on the development and initial experience of a digitally-enabled remote, supported rehabilitation programme: 'Covid Recovery' from UCLP/Living With. Methods: Covid Recovery includes: (i) a clinical pathway;(ii) an app delivering physiotherapy, dietetic and psychology education and treatments for common symptoms (breathlessness, fatigue, anxiety) plus validated Patient-Reported Outcome Measures (PROMS);and (iii) a digital dashboard for clinicians to monitor patient activity and progress. A two-way messaging function allows personalisation of advice. (Figure presented) Results: In the first 3 months, 66 patients with diverse demographics have been registered on the App: mean (range) age 54 years (23-78 years);33 female;19 Black/Asian ethnicity, 38 White/Caucasian ethnicity, remainder not stated/other. Amongst patients registered on the App for at least one week, patients undertake a mean average 7.0 actions per week covering 'recording weight', 'completing a PROM - FACIT-F, Covid Recovery, GAD-7, MRC Breathlessness, D-12', 'tracking exercise', and finishing a 'fatigue diary'. Overall on average each patient has read 11 articles, and 1 in 2 patients are creating and tracking a goal. Weekly review takes 2-3 minutes per patient. Example Case: A 47-year-old male joined the App following primary care managed Covid-19 but with residual symptoms at 12 weeks. In 77 days of using the App, he logged 97 activities including 15 messages on the two-way platform. Clinician support focused on managing breathlessness and fatigue symptoms whilst returning to exercise. Significant improvement was identified across the outcome measures for both physical and mental health in conjunction with an increase in exercise activity and intensity (see figure 1). Discussion: Patients recovering from Covid-19 report multiple and variable symptoms. Covid Recovery provides specialist services in a personalised manner, supporting patients through their rehabilitation and recovery journey, enabling them to feel seen, heard and believed.
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S25 Table 1Characteristics of severe asthma patients with suspected or confirmed mild (ambulatory) or severe (hospitalised) COVID-19 infection Mild COVID-19 (n=84)Hospitalised with COVID-19 (n=13)p-valueAge (Years) (mean [SD])50.5 (13.8)55.6 (13.7)0.215Male Gender (n [%])39 (46.4%)4 (30.8%)0.290BMI (kg-m2) (mean [SD])31.3 (6.3)31.3 (4.9)0.967Non-Caucasian Ethnicity (n [%])15 (17.9%)3 (25.0%)0.553Atopic Disease (n [%])48 (62.3%)10 (76.9%)0.310FEV1% Predicted (mean [SD])67.9 (59.9,82.8)73.7 (60.1,84.8)0.555ICS Dose (BDP equivalent-ug) (median [IQR])2000 (1600,2000)1000 (800,1600)0.002On Maintenance OCS (n [%])35 (47.9%)3 (23.1%)0.872Evidence of Poor Adherence (n [%])18 (24.7%)7 (53.8%)0.033Maintenance Macrolides (n [%])7 (9.9%)2 (16.7%)0.428On Asthma Biologic (n [%])57 (67.9%)8 (61.5%)0.652Shielding against COVID-19Followed Shielding Advice (n [%])64 (84.2%)9 (90.0%)0.631Shielding affected mental health (n [%])33 (46.5%)5 (50.0%)0.835Contracted COVID-19 Before Shielding (n [%])40 (60.6%)4 (40.0%)0.219ConclusionHospitalisation and death occurred in small numbers in our severe asthma population. From this observational data, biologic agents for asthma were not associated with increased risk of COVID-19 infection or hospitalisation.