Jahrestagung der Gesellschaft fur Padiatrische Pneumologie.

The proceedings contain 54 papers. The topics discussed include: cytokines in severe childhood asthma;transcriptional gene regulation of interleukin-6 in epithelial cells in viral-induced asthma exacerbation;assessment of the long-term safety and efficacy of dupilumab in children with asthma: LIBERTY ASTHMA EXCURSION;impulse oscillometry bronchodilator response in preschool children;pulmonary function in non-hospitalized adults and children after mild Covid-19;exhaled aerosols in PCR-confirmed SARS-CoV-2-infected children;early respiratory infectious diseases have an influence on the gut microbiome;comparison of three eradication treatment protocols for pseudomonas aeruginosa in children and adolescents with cystic fibrosis;neutrophilic airway inflammation in children with repaired esophageal atresia-tracheoesophageal fistula (EA/TEF);and multiplex immunofluorescence and multispectral imaging as a tool to evaluate host directed therapy.

Small airway function after Covid-19 infection

Introduction: Remaining respiratory symptoms is common after covid-19. The pathophysiology behind this is unclear, with spirometry often within the normal range. We hypothesised that impairment in the small airways can be an explanation. Aim(s): To investigate if the function of the small airways is impaired after covid-19. Method(s): 28 (18 females) post covid-19 subjects aged 27-63 yrs performed spirometry, DLCO, nitrogen (N ) multiple breath washout (MBW) and impulse oscillometry (IOS). Three out of 28 were hospitalized due to covid-19. Median (IQR) days between first symptom and participation was 216 (108;372). Results were compared to findings in 10 (7 females) non-covid-19 subjects, aged 29-63 yrs, and reported in z-score (z) related to GLI reference equations for spirometry and DLCO, while two healthy cohorts (n=400 and n=158) provided local reference values for N MBW and IOS, respectively. Result(s): IOS derived frequency dependence of resistance (FDR) and MBW derived Sacin were the only outcomes significantly different in post covid-19 subjects, median (IQR), 0.01 kPa/L/s (0.00;0.02) vs 0.04 kPa/L/s (0.01;0.06), p=0.028 for FDR and 0.070 (0.046;0.076) vs 0.009 (0.075;0.121), p=0.017 for Sacin. FDR was >1.96 z in 2/28 whileS >1.96 z was found in 14/28. In post covid-19 subjects with S >1.96 z, dyspnea were more common than in those with normal Sacin, (8/14 vs 2/14, p=0.049). FEV1 and DLCO were > -1.96 z in all but one subject. Conclusion(s): Ventilation heterogeneity at the entrance to the acinar airways were common in this small sample of post covid-19 subjects, as assessed by Sacin, and may explain the experience of dyspnea in these subjects, despite normal spirometry and DLCO. A larger study is ongoing.

COVID-19 CHRONIC IMPAIRMENT WITH PULMONARY SYMPTOMS

SESSION TITLE: Long COVID: It Can Take Your Breath Away SESSION TYPE: Original Investigations PRESENTED ON: 10/16/2022 10:30 am - 11:30 am PURPOSE: As the novel coronavirus SARS-CoV-2 swept the globe causing COVID-19 infection, a syndrome now known as “long COVID” has been well described in 10-30% of those who have experienced COVID-19. This study hoped to characterize changes in anatomical structure and physiology that may explain the ongoing dyspnea experienced by some individuals affected by the COVID-19 pandemic. METHODS: Patients with a history of symptomatic COVID-19 confirmed by positive PCR or antibody testing, between the age of 18-65, without pre-existing significant cardiopulmonary disease, and currently experiencing ongoing exertional or respiratory symptoms at least 3 months after onset of initial COVID symptoms were enrolled into this study. Each participant underwent standardized testing for underlying cardiopulmonary pathology by performance of a high-resolution chest CT, transthoracic echocardiography, electrocardiogram, full pulmonary function testing with lung volumes and diffusing capacity, impulse oscillometry, and a six minute walk test. RESULTS: To date, 63 patients have enrolled in the study with ongoing completion of study procedures. Of the current patients enrolled, 29 have had a high resolution chest CT completed;16 or 55% had radiographic evidence of pulmonary pathology. Most common were a nodular pattern (38%), mosaic attenuation (34%), residual ground glass opacities (28%), septal thickening (14%). Thirty-six participants performed the six minute walk test with an average walk distance of 1338.9 feet ± 520.4 feet with no participants desaturating below 90%. Pulmonary function testing has been completed in 36 participants with normal mean values. Impulse oscillometry testing performed on 30 individuals revealed mixed results with resistance at 5 Hz (R5) showing no substantive change to bronchodilator with a -14% ± 5%, however the area of reactance showed a potentially significant bronchodilator response with bronchodilator change of -43% ± 41%. CONCLUSIONS: In this interim analysis, we evaluated the radiographic and physiologic changes seen in a group of patients at least three months after symptomatic infection with COVID-19. There were radiographic changes in 50% of patients with a reticulonodular pattern as the most often reported finding. However, this finding did not correlate with PFT or exercise findings in the cohort;few showed significant PFT changes and the 6MWT did not show desaturations or limitation in walking distance. Pulmonary function testing and impulse oscillometry showed no statistically substantive physiologic derangements that might explain the ongoing symptoms of the group evaluated. CLINICAL IMPLICATIONS: Other than radiographic findings, there were no unified findings that could shed further light on the effects of COVID-19 that would predispose an individual to ongoing symptoms. DISCLOSURES: No relevant relationships by Brian Agan no disclosure on file for Timothy Burgess;no disclosure on file for Anuradha Ganesan;No relevant relationships by Stephen Goertzen No relevant relationships by Travis Harrell no disclosure on file for Nikhil Huprikar;No relevant relationships by David Lindholm No relevant relationships by Katrin Mende Speaker/Speaker's Bureau relationship with Janssen Please note: $1001 - $5000 by Michael Morris, value=Honoraria Speaker/Speaker's Bureau relationship with GSK Please note: $1001 - $5000 by Michael Morris, value=Honoraria Removed 03/29/2022 by Michael Morris no disclosure on file for Simon Pollett;no disclosure on file for Julia Rozman;No relevant relationships by Mark Simons No relevant relationships by David Tribble No relevant relationships by Robert Walter

Lung Function Tests, Quality of Life and Telemedicine: Three Windows on the Multifaceted World of Asthma in Adolescents.

Asthma is a heterogeneous disease usually characterized by chronic airway inflammation and recognized as the most prevalent chronic illness among children. Despite this, the knowledge as to how asthma affects adolescents is still scarce. One of the main management problems of asthmatic adolescents is the poor adherence to pharmacological and non-pharmacological treatments. The assessment of respiratory function and the impact on quality of life are still two crucial challenges in the management of asthmatic adolescents. Additionally, the COVID-19 pandemic has prompted physicians to explore complementary management strategies including telemedicine technologies. This review aims to provide an update on the contribution of respiratory functional tests, how asthma affects quality of life of adolescents and, finally, how telemedicine contributes to the management of adolescent asthmatics during the COVID-19 pandemic.

Impulse Oscillometry System for the Diagnosis of Wheezing Episode in Children in Office Practice.

Background and Objective: Objectively differentiating between wheezing episodes and other respiratory disorders will be helpful in treatment in office practice. The impulse oscillometry system has been useful in assessing airway resistance in children 3-6 years old. As the reference values are different in geographical regions the use of the impulse oscillometry is still limited. Comparison between the percent change in IOS parameters as compared to reference standards and changes in actual IOS parameters was done to diagnose wheezing episodes. Methodology: Three to six years old children with a history of fever, cough, cold, and/or breathlessness with noisy breathing and who were not on any regular medications, whose parents gave consent were recruited in the study. The children underwent an impulse oscillometry system examination as per the guidelines. The test was repeated after they were given nebulization by salbutamol (2.5 mg) (before COVID 19 pandemic). Final diagnosis was done by following patients for 7 days. Results: About 106 children were recruited in the study. Five children could not perform the IOS test. Eighteen children did not complete the follow-up. Hence, 83 children were analyzed. There were 47 males and 36 female patients. The change in actual values of AX, R5, and X20 showed statistically significant difference in wheezing episode group (p-value<0.001). The percentage change as compared to predicted values of R5 and X20 also showed a statistically significant difference in the wheezing episode group and the others group (p-value<0.001). Conclusion: The change in actual values of AX, R5, X20, and resonant frequency may help to differentiate wheezing episode from other respiratory diseases.

Follow-up pulmonary function of COVID-19 patients 4 months after hospital discharge

The end of the acute period of COVID-19 does not mean complete recovery. Observation of patients in the post-COVID-19 period showed that a significant number of people experience shortness of breath, fatigue, muscle weakness, sleep disorders, cough, palpitations, so the term postCOVID-19 syndrome was coined. The examination to identify the causes of complaints of COVID-19 convalescents should include lung function assessment. The aim of the study was to assess the dynamics of lung function 4 months after hospitalization for COVID-19. Methods. 31 patients (26 males, the median age was 49 years) underwent traditional pulmonary function tests (PFTs) (spirometry, body plethysmography, test of diffusing lung capacity) and impulse oscillometry (IOS). Results. During the 1st visit, the average PFTs and IOS parameters were within the normal range in the whole group, apart from the diffusing lung capacity (DLCO), which was reduced mildly (on the border with moderate) in 77% of patients. During the 2nd visit, which was conducted on average 102 days after the 1st one, 58% of patients demonstrated abnormal lung diffusion capacity. The second assessment revealed a statistically significant increase in the slow and forced vital capacity (VC and FVC), the forced exhalation volume in 1 second (FEV1), total lung capacity (TLC), DLCO, and a decrease in the ratio of FEV1/FVC and the residual lung volume to TLC ratio. Conclusion. PostCOVID-19 patients show a statistically significant improvement of their lung function 4 months after hospital discharge. A systematic follow-up is essential for such patients to detect lung function abnormalities and correct them. © 2021 Vestnik Tomskogo Gosudarstvennogo Universiteta, Matematika i Mekhanika. All rights reserved.

Impulse Oscillometry Findings and Their Associations With Lung Ultrasound Signs in COVID-19 Survivors.

BACKGROUND: Because impulse oscillometry (IOS) can detect changes in the small airways and is safer to perform during the COVID-19 pandemic than other pulmonary function tests, it may have value in investigating pulmonary sequelae in COVID-19 survivors. This study evaluated the performance of IOS in detecting lung abnormalities in COVID-19 survivors and investigated the associations of the findings with those of lung ultrasound (LUS) and spirometry. METHODS: In this cross-sectional study, 117 subjects underwent IOS at a frequency range of 4-20 Hz 2 months after COVID-19 diagnosis. They also underwent spirometry and LUS, and their aeration scores were calculated. RESULTS: On IOS, the resonance frequency was > 12 Hz, and the area under the reactance curve was > 3.60 cm H2O/L/s in 70 (59.8%) and 55 (47.0%) subjects, respectively. A heterogeneity of resistance between R4 and R20 (R4-R20) > 20% was observed in 60 (51.3%) participants. Based on their abnormalities in resistive and reactive parameters, 76 (65.0%) participants had abnormal IOS. Spirometry abnormalities were detected in 40 (34.2%) cases. LUS was abnormal in 51 (43.6%) participants, and the median aeration score was 0 (0-8) points. Abnormal IOS was associated with abnormal LUS (P < .001) and abnormal spirometry (P = .002). Abnormal spirometry had a significant but weaker association with abnormal LUS (P = .031). In participants who reported hospitalization, abnormal IOS was associated with both abnormal LUS (P = .001) and abnormal spirometry (P = .006). In participants who did not report hospitalization, abnormal IOS was associated with abnormal LUS (P < .001) but not abnormal spirometry (P = .063). CONCLUSIONS: In COVID-19 survivors, IOS detected changes even when spirometry was normal. In these individuals, IOS parameters were more strongly associated with abnormalities on LUS than with abnormalities on spirometry.

Small airway function in Finnish COVID-19 survivors.

Follow-up studies of COVID-19 patients have found lung function impairment up to six months after initial infection, but small airway function has not previously been studied. Patients (n = 20) hospitalised for a severe SARS-CoV-2 infection underwent spirometry, impulse oscillometry, and multiple measurements of alveolar nitric oxide three to six months after acute infection. None of the patients had small airway obstruction, nor increased nitric oxide concentration in the alveolar level. None of the patients had a reduced FEV1/FVC or significant bronchodilator responses in IOS or spirometry. In conclusion, we found no evidence of inflammation or dysfunction in the small airways.

Small-Airway Function Variables in Spirometry, Fractional Exhaled Nitric Oxide, and Circulating Eosinophils Predicted Airway Hyperresponsiveness in Patients with Mild Asthma.

PURPOSE: Patients with variable symptoms suggestive of asthma but with normal forced expiratory volume in 1 second (FEV1) often fail to be diagnosed without a bronchial provocation test, but the test is expensive, time-consuming, risky, and not readily available in all clinical settings. PATIENTS AND METHODS: A cross-sectional study was performed in 692 patients with FEV1≥80% predicted; normal neutrophils and chest high-resolution computed tomography; and recurrent dyspnea, cough, wheeze, and chest tightness. RESULTS: Compared with subjects negative for AHR (n=522), subjects positive for AHR (n=170) showed increased FENO values, peripheral eosinophils (EOS), and R5-R20; decreased FEV1, FEV1/Forced vital capacity (FVC), and forced expiratory flow (FEFs) (P≤.001 for all). Small-airway dysfunction was identified in 104 AHR+ patients (61.17%), and 132 AHR- patients (25.29%) (P<0.001). The areas under the curve (AUCs) of variables used singly for an AHR diagnosis were lower than 0.77. Using joint models of FEF50%, FEF75%, or FEF25%-75% with FENO increased the AUCs to 0.845, 0.824, and 0.844, respectively, significantly higher than univariate AUCs (P <0.001 for all). Patients who reported chest tightness (n=75) had lower FEFs than patients who did not (P<0.001 for all). In subjects with chest tightness, the combination of FEF50% or FEF25%-75% with EOS also increased the AUCs substantially, to 0.815 and 0.816, respectively (P <0.001 for all versus the univariate AUCs). CONCLUSION: FENO combined with FEF50% and FEF25%-75% predict AHR in patients with normal FEV1. FEF25%-75%, FEF50%, or FEF25%-75% together with EOS also can potentially suggest asthma in patients with chest tightness.