[Clinic and functional features of chronic obstructive pulmonary disease after virus-induced acute exacerbations.]

AIM: To establish symptoms, lung function and to evaluate subsequent exacerbations of chronic obstructive pulmonary disease (COPD) during a year after virus-induced COPD exacerbations. MATERIALS AND METHODS: Patients hospitalized with viral (n=60), bacterial (n=60) and viral-bacterial (n=60) COPD exacerbations were enrolled to single-center prospective observational study. COPD was diagnosed according spirography criteria. Viral infection was established in bronchoalveolar lavage fluid or sputum by real-time reverse transcription-polymerase chain reaction for RNA of influenza A and B virus, rhinovirus, respiratory syncytial virus and SARS-CoV-2. Symptoms, lung function, COPD exacerbations were assessed. Patients were investigated at the hospitalization onset and then 4 and 52 weeks following the discharge from the hospital. RESULTS: After 52 weeks in viral and viral-bacterial COPD exacerbations groups the rate of forced expiratory volume in one second (FEV1) decline were maximal - 71 (68; 73) ml/year and 69 (67; 72) ml/year versus 59 (55; 62) ml/year after bacterial exacerbations. Low levels of diffusion lung capacity for carbon monoxide (DLco/Va) - 52.5% (45.1%; 55.8%), 50.2% (44.9%; 56.0%) and 75.3% (72.2%; 80.1%) respectively, of 6-minute walk distance; p<0.001 in relation to bacterial exacerbations. In Cox proportional hazards regression analyses viral and viral-bacterial exacerbations were associated with increased risk of subsequent COPD exacerbations by 2.4 times independent of exacerbations rate before index event and FEV1. In linear regression models the relationships between airflow limitation and respiratory syncytial virus, rhinovirus and influenza virus infection, between low DLco/Va and rhinovirus, influenza virus and SARS-CoV-2 infection. CONCLUSION: COPD after virus-induced exacerbations were characterized by progression of airflow limitation, low DLco/Va, low 6-minute walking test distance, subsequent COPD exacerbations risk.

Clinical Approaches to Minimize Readmissions of Patients with COPD: A Narrative Review

Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease and also a lead-ing cause of morbidity and mortality worldwide. The frequent readmissions of patients with COPD may reduce lung function, mental health, and quality of life;it also increases the cost of treatment and mortality rate. Some common factors that may increase the readmission frequency of COPD patients include delay of diagnosis, advanced lung function decline, lack of adherence for COPD treatment, ineffective management of comorbidities, acute exacerbation or stable COPD, and infec-tions. However, these factors might be well controlled with appropriate approaches to minimize the readmission of patients with COPD. In this review, we propose a strategy with a seven-step approach to reduce the readmission in COPD patients, including early diagnosis of COPD, optimal treatment for stable COPD, targeted management of comorbidities, adequate therapy for acute ex-acerbations, individualized action plans for COPD patients, effective prevention of bacterial and viral infections, and adaptive program of pulmonary rehabilitation. Thus, implementing this approach may reduce the risk of readmission in patients with COPD.Copyright © 2023 Bentham Science Publishers.

Acute exacerbation of rheumatoid arthritis-associated interstitial lung disease triggered by COVID-19: What is the best practice for treatment?

We present a case of 79-year-old female with rheumatoid arthritis-associated interstitial lung disease (RA-ILD) developed an acute exacerbation (AE) triggered by coronavirus disease 2019 (COVID-19). The patient was unresponsive to a combination therapy of remdesivir, dexamethasone, and tocilizumab. Given that a recent multicenter cohort study reported ILD as a poor prognostic contributor in patients with RA and COVID-19, there may be potentially a certain number of patients with AE of RA-ILD triggered by COVID-19. This case highlights the need for a discussion how to treat these patients in a daily clinical practice.

Hospital-level care at home for patients with acute respiratory disease: A descriptive analysis.

BACKGROUND: Home hospital (HH) is hospital-level substitutive care delivered at home for acutely ill patients who would traditionally be cared for in the hospital. Despite HH programs operating successfully for years, and scientific evidence of similar or better outcomes compared to bricks and mortar care, HH outcomes in the US for respiratory disease have not been evaluated. RESEARCH QUESTION: Do outcomes differ between patients admitted to HH with acute respiratory illness vs other acute general medical conditions? STUDY DESIGN AND METHODS: Retrospective evaluation of prospectively collected data of patients admitted to HH (2017-21). We compared patients requiring admission with respiratory disease (asthma exacerbation (26%), acute exacerbation for COPD [AECOPD] (33%), and non-COVID-19 pneumonia [PNA] (41%)) to all other HH patients. During HH, patients received 2 nurse and 1 physician visit daily, intravenous medications, advanced respiratory therapies, and continuous heart and respiratory rate monitoring. MAIN OUTCOMES: acute and post-acute utilization and safety. RESULTS: We analyzed 1,031 patients; 24% were admitted for respiratory disease. Patients with and without respiratory disease were similar: mean age 68 (SD, 17), 62% female, and 48% White. Respiratory patients were more often active smokers (21% vs 9%; p<0.001). FEV1/FVC ≤70 in 80% of cases; 28% had severe or very severe obstructive pattern (n=118). During HH, respiratory patients had less utilization: length of stay (mean days, 3.4 vs 4.6), laboratory orders (median, 0 vs 2), intravenous medication (43% vs 73%) and specialist consultation (2% vs 7%) (p all <0.001). 96% of patients completed the full admission at home with no mortality in the respiratory group. Within 30-days of discharge, both groups had similar readmission, ED presentation and mortality rates. INTERPRETATION: HH is as safe and effective for patients with acute respiratory disease as for those with other acute general medical conditions. If scaled, it can generate significant high-value capacity for health systems and communities, with opportunities to advance the complexity of care delivered.

Updated Key Points Interpretation of Global Strategy for the Diagnosis，Management，and Prevention of Chronic Obstructive Pulmonary Disease （2023 Report）

Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2023 Report) (GOLD 2023) maintains the basic framework of GOLD 2022, but with major revisions in the definition, assessment, initial therapy and follow-up management of chronic obstructive lung disease (COPD) as follow: (1) Chapter 1: The definition and overview section was rewritten to propose a new definition of COPD, incorporating new background information, therapeutic strategies and classifications for COPD, with the addition of content on chronic bronchitis;(2) Chapter 2: Content on screening and case-finding of COPD has been included, the ABCD assessment tool has been revised to the ABE assessment tool (no further grouping of high-risk population of acute exacerbation of COPD based on symptom levels), information on imaging and computed tomography scans (CT) has been included in the diagnosis and assessment section;(3) Chapter 3: Recommendations for Streptococcus pneumoniae vaccination have been updated, information on therapeutic interventions to reduce COPD mortality has been included, issues related to inhalation delivery have been updated, content on inhaled medications adherence and remote rehabilitation has been included, information on interventional and surgical therapies of COPD has been expanded in the prevention and maintenance treatment section;(4) Chapter 4: Information on the selection of inhalation devices has been included, information on initial drug therapy and follow-up drug therapy has been updated in the management of stable COPD section;(5) Chapter 5: A new definition of and set of acute exacerbation of COPD assessment parameters have been proposed, information on differential diagnoses of acute exacerbation of COPD has been expanded in the acute exacerbation of COPD section management;(6) Chapter 6 and 7: Updating content on COPD and complications (Chapter 6), COPD (Chapter 7) and COVID-19 based on the latest evidence. The above updates will be an important guide to the clinical management of COPD. © 2023 Chinese General Practice. All rights reserved.

Multiple complications of advanced IPF in an individual patient presentation.

We report a patient with advanced idiopathic pulmonary fibrosis (IPF), who in a single presentation experienced three complications of the disease: an acute exacerbation, spontaneous pneumomediastinum, and platypnoea-orthodeoxia syndrome. Despite there being no definitive evidence-based treatment for an acute exacerbation, we report a marked improvement with high-dose steroids. This case also highlights the importance in IPF patients of considering pneumomediastinum as a cause of non-cardiac chest pain, as well as platypnoea-orthodeoxia in those with positional dyspnoea.

Impact of COVID-19 Pandemic on the Frequency of Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Background Respiratory virus infection is an important trigger of acute exacerbation of chronic obstructive pulmonary disease（AECOPD）. China has adopted a series of containment measures assisting to curb COVID-19 transmission since the outbreak of the pandemic. Several studies showed a decrease in hospitalizations for AECOPD during the COVID-19 pandemic. However，there has been a relative lack of studies investigating the effects of preventive measures on the frequency and severity of exacerbations. Objective To explore the impact of the COVID-19 pandemic on the frequency of AECOPD with or without medical attention. Methods The subjects were from a prospective COPD cohort study conducted in the First Affiliated Hospital of Guangzhou Medical University，which began recruiting patients in early 2016，with visits every 3 months to collect demographic and clinical data，including those who were followed up during June to August 2017（group 1），June to August 2018（group 2），June to August 2019 （group 3），and June to August 2020（group 4）. Basic clinical data （including the frequency of AECOPD，sex，age，symptom score and so on） were collected from group 1 from October 2016 to May 2017，group 2 from October 2017 to May 2018，group 3 from October 2018 to May 2019，and group 4 from October 2019 to May 2020（during which the periods from October 2019 to January 2020，and from February to May 2020 were defined as preCOVID-19 period，and post-COVID-19 period，respectively）. The frequency of AECOPD during October to May next year in group 4 was compared with that of the other three groups. The changes in the frequency of AECOPD between pre- and postCOVID-19 periods were analyzed. Results There were 162 patients in group 1，157 in group 2，167 in group 3，and 159 in group 4. Group 1 had a higher frequency of AECOPD in February to May than in October to January next year（P=0.013），so did group 2（P=0.016）. In contrast，group 4 had a higher frequency of AECOPD in October to January next year than in February to May（P=0.001）. The frequency of AECOPD during October to December in group 4 was similar to that of the other three groups（P>0.05）. But the frequency of AECOPD from February to April in group 4 was lower than that in groups 1-3 （P<0.05）. There was no significant difference in the monthly frequency of AECOPD without medical attention in group 4 compared with that of groups 1-3（P>0.05）. The frequency of AECOPD with medical attention from October to December in group 4 was similar to that of groups 1-3（P>0.05）. but it from February to April in group 4 was lower than that in groups 1-3（P<0.05）. Conclusion Prevention and control measures targeting COVID-19 may be contributive to reducing the frequency of AECOPD. It is suggested that COPD patients should reduce gathering activities，maintain social distance，wear masks when going out，and wash hands frequently even after the COVID-19. © 2023 Chinese General Practice. All rights reserved.

Incidence of acute exacerbation in patients with interstitial lung disease after COVID-19 vaccination

Acute exacerbations due to COVID-19 vaccination in patients with interstitial lung disease (ILD) have been reported, but their incidence is unknown. We investigated the incidence of exacerbations of ILD and respiratory symptoms due to the mRNA COVID-19 vaccines. A questionnaire survey was conducted on adverse reactions to the mRNA COVID-19 vaccination in 545 patients with ILD attending our hospital and retrospectively examined whether the eligible patients actually developed acute exacerbations of ILD induced by the vaccine. Of the 545 patients, 17 (3.1%) patients were aware of the exacerbation of respiratory symptoms, and four (0.7%) patients developed an acute ILD exacerbation after vaccination. Of the four patients who experienced exacerbations, two had collagen vascular disease-associated ILD, one had nonspecific interstitial pneumonia, another had unclassifiable idiopathic pneumonia, and none had idiopathic pulmonary fibrosis. Four patients were treated using steroid pulse therapy with a steroid taper, and two of the four also received intravenous cyclophosphamide pulse therapy. Tacrolimus was started in one patient with myositis-associated interstitial lung disease. Eventually, all patients exhibited improvement with immunosuppressive treatment and were discharged. COVID-19 vaccination for patients with ILD should be noted for developing acute exacerbations of ILD with low incidence, although manageable with early diagnosis and treatment. © 2022 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases

Impact of COVID-19 Pandemic on the Frequency of Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Background Respiratory virus infection is an important trigger of acute exacerbation of chronic obstructive pulmonary disease（AECOPD）. China has adopted a series of containment measures assisting to curb COVID-19 transmission since the outbreak of the pandemic. Several studies showed a decrease in hospitalizations for AECOPD during the COVID-19 pandemic. However，there has been a relative lack of studies investigating the effects of preventive measures on the frequency and severity of exacerbations. Objective To explore the impact of the COVID-19 pandemic on the frequency of AECOPD with or without medical attention. Methods The subjects were from a prospective COPD cohort study conducted in the First Affiliated Hospital of Guangzhou Medical University，which began recruiting patients in early 2016，with visits every 3 months to collect demographic and clinical data，including those who were followed up during June to August 2017（group 1），June to August 2018（group 2），June to August 2019 （group 3），and June to August 2020（group 4）. Basic clinical data （including the frequency of AECOPD，sex，age，symptom score and so on） were collected from group 1 from October 2016 to May 2017，group 2 from October 2017 to May 2018，group 3 from October 2018 to May 2019，and group 4 from October 2019 to May 2020（during which the periods from October 2019 to January 2020，and from February to May 2020 were defined as preCOVID-19 period，and post-COVID-19 period，respectively）. The frequency of AECOPD during October to May next year in group 4 was compared with that of the other three groups. The changes in the frequency of AECOPD between pre- and postCOVID-19 periods were analyzed. Results There were 162 patients in group 1，157 in group 2，167 in group 3，and 159 in group 4. Group 1 had a higher frequency of AECOPD in February to May than in October to January next year（P=0.013），so did group 2（P=0.016）. In contrast，group 4 had a higher frequency of AECOPD in October to January next year than in February to May（P=0.001）. The frequency of AECOPD during October to December in group 4 was similar to that of the other three groups（P>0.05）. But the frequency of AECOPD from February to April in group 4 was lower than that in groups 1-3 （P<0.05）. There was no significant difference in the monthly frequency of AECOPD without medical attention in group 4 compared with that of groups 1-3（P>0.05）. The frequency of AECOPD with medical attention from October to December in group 4 was similar to that of groups 1-3（P>0.05）. but it from February to April in group 4 was lower than that in groups 1-3（P<0.05）. Conclusion Prevention and control measures targeting COVID-19 may be contributive to reducing the frequency of AECOPD. It is suggested that COPD patients should reduce gathering activities，maintain social distance，wear masks when going out，and wash hands frequently even after the COVID-19. © 2023 Chinese General Practice. All rights reserved.

Characteristics of 12-Month Readmission for Hospitalized Patients with COPD: A Propensity Score Matched Analysis of Prospective Multicenter Study.

Purpose: Hospitalization for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is considered as severe exacerbations. Readmission for severe exacerbations is a crucial event for COPD patients. However, factors associated with readmission for severe exacerbations are incomplete. The study aimed to investigate different characteristics between the severe and non-severe exacerbation groups. Patients and Methods: Patients hospitalized for severe AECOPD were included in multi-centers, and their exacerbations in next 12 months after discharge were recorded. According to exacerbations, patients were separated into the severe-exacerbation group and the non-severe exacerbation group. Propensity-score matching (PSM) and multivariable analyses were performed to compare the baseline characteristics of two groups. The Hosmer-Lemeshow test and receiver operating characteristic curve were applied to evaluate how well the model could identify clusters. Results: The cohort included 550 patients with severe AECOPD across 27 study centers in China, and 465 patients were finally analyzed. A total of 41.5% of patients underwent readmission for AECOPD within 1 year. There were no significant differences in baseline characteristics between groups after PSM. Severe exacerbations in the 12 months were related to some factors, eg, the duration of COPD (13 vs 8 years, P<0.001), the COPD Assessment Test (CAT) score (20 vs 17, P<0.001), the blood eosinophil percentage (1.5 vs 2.0, P<0.05), and their inhaler therapies. Patients readmitted with AECOPD had a longer time of diagnosis (≥9 years), more symptoms (CAT ≥10), and lower blood eosinophils (Eos <2%). A clinical model was derived to help identify patients at risk of readmission with severe exacerbations. Conclusion: These analyses confirmed the relevance of COPD at admission with future severe exacerbations. A lower blood eosinophils percentage appears to be related to readmission when combined with clinical history. Further studies are needed to evaluate whether this study can predict the risk of exacerbations.

Coronavirus disease 2019 vaccination-induced acute exacerbation in idiopathic pulmonary fibrosis.

We report a rare case of acute exacerbation (AE) of idiopathic pulmonary fibrosis (IPF) after coronavirus disease 2019 (COVID-19) vaccination. Clinicians should be aware of this COVID-19 vaccination-induced AE in IPF.

Pathological Roles of Pulmonary Cells in Acute Lung Injury: Lessons from Clinical Practice.

Interstitial lung diseases (ILD) are relatively rare and sometimes become life threatening. In particular, rapidly progressive ILD, which frequently presents as acute lung injury (ALI) on lung histopathology, shows poor prognosis if proper and immediate treatments are not initiated. These devastating conditions include acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF), clinically amyopathic dermatomyositis (CADM), epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI)-induced lung injury, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection named coronavirus disease 2019 (COVID-19). In this review, clinical information, physical findings, laboratory examinations, and findings on lung high-resolution computed tomography and lung histopathology are presented, focusing on majorly damaged cells in each disease. Furthermore, treatments that should be immediately initiated in clinical practice for each disease are illustrated to save patients with these diseases.

Influences of Two FEV1 Reference Equations (GLI-2012 and GIRH-2017) on Airflow Limitation Classification Among COPD Patients.

Objective: To explore the clinical effects of different forced expiratory volume in 1s (FEV1) reference equations on chronic obstructive pulmonary disease (COPD) airflow limitation (AFL) classification. Methods: We conducted a COPD screening program for residents over 40 years old from 2019 to 2021. All residents received the COPD screening questionnaire (COPD-SQ) and spirometry. Postbronchodilator FEV1/FVC (forced vital capacity) <0.7 was used as the diagnostic criterion of COPD and two reference equations of FEV1 predicted values were used for AFL severity classification: the European Respiratory Society Global Lung Function Initiative reference equation in 2012 (GLI-2012) and the Guangzhou Institute of Respiratory Health reference equation in 2017 (GIRH-2017). Clinical characteristics of patients in GOLD (Global Initiative for Chronic Obstructive Pulmonary Disease) 1-4 grades classified by the two reference equations were compared. Results: Among 3524 participants, 659 subjects obtained a COPD-SQ score of 16 or more and 743 participants were found to have AFL. The COPD-SQ showed high sensitivity (59%) and specificity (91%) in primary COPD screening. Great differences in COPD severity classification were found when applying the two equations (p < 0.001). Compared with GIRH-2017, patients with AFL classified by GLI-2012 equations were significantly severer. The relationship between symptom scores, acute exacerbation (AE) history distributions and COPD severities classified by the two equations showed a consistent trend of positive but weak correlation. Group A, B, C and D existed in all GOLD 1 to 3 COPD patients, but in GOLD 4, only Groups B and D existed. However, no clear significant differences were found in symptoms, AE risk assessments, risk factors exposure and even the combined ABCD grouping under the two equations. Conclusion: There were significant differences in COPD AFL severity classification with GLI-2012 and GIRH-2017 FEV1 reference equations. But these severity estimation differences did not affect symptoms, AE risk assessments and ABCD grouping of patients at all GOLD grades.

Incidence of acute exacerbation in patients with interstitial lung disease after COVID-19 vaccination

Acute exacerbations due to COVID-19 vaccination in patients with interstitial lung disease (ILD) have been reported, but their incidence is unknown. We investigated the incidence of exacerbations of ILD and respiratory symptoms due to the mRNA COVID-19 vaccines. A questionnaire survey was conducted on adverse reactions to the mRNA COVID-19 vaccination in 545 patients with ILD attending our hospital and retrospectively examined whether the eligible patients actually developed acute exacerbations of ILD induced by the vaccine. Of the 545 patients, 17 (3.1%) patients were aware of the exacerbation of respiratory symptoms, and four (0.7%) patients developed an acute ILD exacerbation after vaccination. Of the four patients who experienced exacerbations, two had collagen vascular disease-associated ILD, one had nonspecific interstitial pneumonia, another had unclassifiable idiopathic pneumonia, and none had idiopathic pulmonary fibrosis. Four patients were treated using steroid pulse therapy with a steroid taper, and two of the four also received intravenous cyclophosphamide pulse therapy. Tacrolimus was started in one patient with myositis-associated interstitial lung disease. Eventually, all patients exhibited improvement with immunosuppressive treatment and were discharged. COVID-19 vaccination for patients with ILD should be noted for developing acute exacerbations of ILD with low incidence, although manageable with early diagnosis and treatment.

Viral Infection and Airway Epithelial Immunity in Asthma.

Viral respiratory tract infections are associated with asthma development and exacerbation in children and adults. In the course of immune responses to viruses, airway epithelial cells are the initial platform of innate immunity against viral invasion. Patients with severe asthma are more vulnerable than those with mild to moderate asthma to viral infections. Furthermore, in most cases, asthmatic patients tend to produce lower levels of antiviral cytokines than healthy subjects, such as interferons produced from immune effector cells and airway epithelial cells. The epithelial inflammasome appears to contribute to asthma exacerbation through overactivation, leading to self-damage, despite its naturally protective role against infectious pathogens. Given the mixed and complex immune responses in viral-infection-induced asthma exacerbation, this review examines the diverse roles of airway epithelial immunity and related potential therapeutic targets and discusses the mechanisms underlying the heterogeneous manifestations of asthma exacerbations.

Two cases of acute respiratory failure following SARS-CoV-2 vaccination in post-COVID-19 pneumonia.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination is a very effective method of preventing infection and is recommended for people having recovered from coronavirus disease 2019 (COVID-19). In this novel case report, we describe two patients with post-COVID-19 pneumonia who experienced acute respiratory failure and new bilateral ground-glass opacities several days after receiving SARS-CoV-2 vaccination. Both patients were treated with methylprednisolone pulse therapy and recovered from the disease successfully. Indeed, post-COVID-19 patients can gain benefits from the vaccine, but vaccination at the early stage of recovery from COVID-19 might be a risk for certain populations. These cases highlight a potential association between vaccination, interstitial lung disease and worsening of post-COVID-19 pneumonia. Further investigation and research examining the relationship between the timing of SARS-CoV-2 vaccination and potential risks in post-COVID-19 patients is recommended.

Combination of acute exacerbation of idiopathic nonspecific interstitial pneumonia and pulmonary embolism after booster anti-COVID-19 vaccination.

Coronavirus disease-2019 (COVID-19) is a systemic disorder with the lung and the vasculature being the preferred targets. Patients with interstitial lung diseases represent a category at high risk of progression in the case of Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV)-2 infection, and as such deserve special attention. We first describe the combination of acute exacerbation and pulmonary embolism in an elderly ILD patient after booster anti-COVID-19 mRNA vaccination. Vaccines availability had significantly and safety impacted COVID-19 morbidity and mortality worldwide. Immunization against COVID-19 is indisputable but must not be separated from the awareness of potential adverse effects in fragile patients.

Case report: Acute exacerbation of interstitial pneumonia related to messenger RNA COVID-19 vaccination.

Messenger RNA (mRNA) vaccines that protect against COVID-19 are widely used in many countries owing to their high efficacy and safety profiles. Recently, few severe adverse events, such as anaphylaxis and myocarditis, were reported in healthy individuals. The safety of mRNA COVID-19 vaccines has not been adequately studied in patients with interstitial lung disease. We report 2 cases of acute exacerbation of preexisting interstitial pneumonia associated with mRNA COVID-19 vaccination. In both cases, lung disease was stable before the vaccination. Initial responses to steroid therapy were unfavorable, and intravenous cyclophosphamide was administered in both cases. Both patients were diagnosed with vaccine-related exacerbation of interstitial pneumonia based on laboratory results, radiologic features, and the observed clinical course, which lacked other causative events. We suggest that clinicians should note the possibility of acute exacerbation of pneumonia after mRNA COVID-19 vaccination and carefully monitor patients with interstitial lung disease.

Mortality, seasonal variation, and susceptibility to acute exacerbation of COPD in the pandemic year: a nationwide population study.

BACKGROUND: Previous studies have suggested that the coronavirus disease 2019 (COVID-19) pandemic was associated with a decreased rate of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Data on how the COVID-19 pandemic has influenced mortality, seasonality of, and susceptibility to AECOPD in the chronic obstructive pulmonary disease (COPD) population is scarce. METHODS: We conducted a national population-based retrospective study using data from the Health Insurance Institute of Slovenia from 2015 to February 2021, with 2015-2019 as the reference. We extracted patient and healthcare data for AECOPD, dividing AECOPD into severe, resulting in hospitalisation, and moderate, requiring outpatient care. The national COPD population was generated based on dispensed prescriptions of inhalation therapies, and moderate AECOPD events were analysed based on dispensed AECOPD medications. We extracted data on all-cause and non-COVID mortality. RESULTS: The numbers of severe and moderate AECOPD were reduced by 48% and 34%, respectively, in 2020. In the pandemic year, the seasonality of AECOPD was reversed, with a 1.5-fold higher number of severe AECOPD in summer compared to winter. The proportion of frequent exacerbators (⩾2 AECOPD hospitalisations per year) was reduced by 9% in 2020, with a 30% reduction in repeated severe AECOPD in frequent exacerbators and a 34% reduction in persistent frequent exacerbators (⩾2 AECOPD hospitalisations per year for 2 consecutive years) from 2019. The risk of two or more moderate AECOPD decreased by 43% in 2020. In the multivariate model, pandemic year follow-up was the only independent factor associated with a decreased risk for severe AECOPD (hazard ratio [HR]: 0.71; 95% confidence interval [CI]: 0.61-0.84; p < 0.0001). In 2020, non-COVID mortality decreased (-15%) and no excessive mortality was observed in the COPD population. CONCLUSION: In the pandemic year, we found decreased susceptibility to AECOPD across severity spectrum of COPD, reversed seasonal distribution of severe AECOPD and decreased non-COVID mortality in the COPD population.

COVID-19-Triggered Acute Exacerbation of IPF, an Underdiagnosed Clinical Entity With Two-Peaked Respiratory Failure: A Case Report and Literature Review.

Because severe coronavirus disease 2019 (COVID-19) affects the respiratory system and develops into respiratory failure, patients with pre-existing chronic lung disorders, such as idiopathic pulmonary fibrosis (IPF), are thought to be at high risk of death. Patients with IPF often suffer from a lethal complication, acute exacerbation (AE), a significant part of which is assumed to be triggered by respiratory viral infection. However, whether mild to moderate COVID-19 can trigger AE in patients with IPF remains unknown. This is the case report of a 60-year-old man with a 4-year history of IPF who successfully recovered from moderate COVID-19 but subsequently developed more severe respiratory failure, which was considered to be a COVID-19-triggered acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF). It is important to be aware of the risk of AE-IPF after COVID-19 and to properly manage this deadly complication of IPF. Recent literature reporting cases with chronic interstitial lung diseases which developed respiratory failure by complications with COVID-19 is also reviewed and discussed.