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Respirology ; 28(Supplement 2):115, 2023.
Article in English | EMBASE | ID: covidwho-2314523


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.

European Respiratory Journal Conference: European Respiratory Society International Congress, ERS ; 60(Supplement 66), 2022.
Article in English | EMBASE | ID: covidwho-2255874


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.