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1.
Thorax ; 76(Suppl 2):A139-A140, 2021.
Article in English | ProQuest Central | ID: covidwho-1506040

ABSTRACT

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.

2.
Thorax ; 76(SUPPL 1):A144-A145, 2021.
Article in English | EMBASE | ID: covidwho-1146446

ABSTRACT

Introduction: Mepolizumab is a biologic agent targeting interleukin (IL)-5 which is currently licensed as add-on therapy for severe eosinophilic asthmatic (SEA). It is usually administered in a hospital setting but with the option of homecare being introduced in 2019, the 4-weekly subcutaneous injections can be self-administered at home. We investigated whether there was a change in asthma control following the transition to home administration and whether a differential response to treatment exists following transition to homecare before and after the onset of the COVID-19 pandemic. Methods: Patients receiving mepolizumab via home care were stratified according to those who had a planned transition to homecare prior to 1st Feb 2020 versus those who had an unplanned transition after this date necessitated by the COVID-19 pandemic. The last Asthma Control Questionnaire-6 (ACQ6) measured in clinic ('baseline') was compared with that collected by telephone consultation 6-8 weeks after transition ('homecare'). Patients were excluded if both values were not available. Results: Of 87 mepolizumab patients included in the analysis, 46 were planned transitions. There was no significant (Figure presented) difference in the pre-biologic ACQ6 (p=0.07) between groups. Immediately prior to transition to homecare (baseline), the planned group had a lower mean ACQ6 than those in the unplanned group (1.19 vs 1.90, P=0.004). The ACQ6 on homecare decreased significantly in both groups (-0.47 in the planned group vs -0.56 in the unplanned group, both P<0.001). The ACQ6 for the planned cohort during homecare was significantly lower than that for the unplanned group (0.72 vs 1.34, P=0.012) (figure 1). (Table presented) Conclusions: We found a significant improvement in ACQ6 for all SEA patients established on Mepolizumab who transitioned to home mepolizumab administration. This improvement occurred irrespective of whether the transition was 'planned' or 'unplanned'. Further research is required to understand the potential influence of shielding during lockdown and the method of ACQ assessment (telephone vs face-to-face ACQ reporting in clinic) on this improvement.

3.
Thorax ; 76(SUPPL 1):A144, 2021.
Article in English | EMBASE | ID: covidwho-1146445

ABSTRACT

Introduction: The COVID-19 pandemic necessitated the rapid transition of large numbers of patients onto homecare to facilitate on-going therapy in a cohort of patients who were 'shielding'. Alongside this, patients continued to need to be initiated on biologic therapy in spite of the pandemic. The impact of administering biologic therapy at home is largely unknown, yet crucial to optimise patient outcome and minimise steroid burden. We investigated whether there was a differential response following transition to homecare of established patients versus those newly started. Methods: Patients with severe eosinophilic asthma receiving home benralizumab were stratified according to those who had received ≥3 doses prior to COVID-19 lockdown on the 15th March 2020 ('established' patients) versus those who were initiated after this date ('new' patients). We compared the last Asthma Control Questionnaire-6 (ACQ6) measured in clinic with that collected by telephone consultation 8-12 weeks after transition to homecare. Patients were excluded if both values were not available. Results: 246 benralizumab patients were included in the analysis, of whom 49 (20%) were new. There was no significant difference in pre-biologic ACQ6, pre-homecare (baseline) (Figure presented) ACQ6 or post-homecare ACQ6 between the new and established patient groups. Both cohorts exhibited a similar magnitude of improvement in their ACQ6 following the transition to homecare (-0.73 in the established group vs -0.73 in the new group, both P<0.0001) (figure 1). Conclusions: We have demonstrated that early transition to homecare in patients treated with benralizumab is not associated with worse clinical outcomes as assessed by ACQ6. The improvements in ACQ6 were seen irrespective of whether they were 'established' on therapy at time of transition or 'new'. Further research is required to understand the potential influence of lockdown and/or telephone vs face-to-face ACQ reporting.

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