Aerosol Medication Use in COVID-19 Pandemic

Administration of aerolized drugs to patients diagnosed with COVID-19 leads to the risk of transmission of patient-generated infectious aerosols to healthcare providers.While the COVID-19 pandemic is ongoing, in order to provide the best treatment for patients and at the same time to protect healthcare providers at the highest level, it is necessary to increase access to information and pay maximum attention to preventive measures.Copyright © 2020 Bilimsel Tip Yayinevi. All rights reserved.

Treatable trait guided asthma management: A feasibility study

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.

TSANZSRS 2023 Australia and New Zealand Society of Respiratory Science and The Thoracic Society of Australia and New Zealand (ANZSRS/TSANZ) Annual Scientific Meeting for Leaders in Lung Health and Respiratory Science

The proceedings contain 360 papers. The topics discussed include: comparison of three methods assessing spirometry bronchodilator responsiveness in children;the quality of spirometry testing: a systematic review;airflow severity in asthma minimally affects within-session oscillometry variability;corrected normative multiple breath washout data in pre-school aged children;prevalence and predictors of tidal expiratory-flow-limitation in healthy adolescents/young adults;impact of change of significant bronchodilator response definition;volume-dependence of reactance as a measure of ventilation inhomogeneity;mechanisms of impaired gas exchange following hospitalization for severe COVID-19;increased shunt and dead space in recovered COVID-19 pneumonitis patients;airway hyperresponsiveness detection in atopic asthma using exhaled nitric oxide;increased conductive ventilation heterogeneity following exposure to coal-mine fire smoke;accuracy of transcutaneous carbon dioxide monitoring during sleep studies;and effect of hematopoietic stem cell transplant on small airways function.

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.

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.

The impact of passive smoking in infancy on respiratory morbidity during covid-19 pandemic: a birth-cohort study

Objective: To evaluate the role of passive smoking (PS) on the incidence of wheezing and overall respiratory morbidity in infants born during the first peak of the coronavirus (COVID-19) pandemic, compared to infants born during the preceding year. Method(s): We used data collected in our recently published retrospective birth cohort study of 588 infants, 294 in each group, born in February-March 2020 (COVID-19 group) compared to a control group born in February-March 2019 (pre-COVID-19 group), at one year of age, using parental, telephone questionnaires. The primary outcome of wheezing/bronchodilator were similarly decreased, in PS and in non-PS (NPS)1. We further, conducted a post-hoc subgroup analysis of the respiratory outcomes: recurrent wheezing, emergency-room (ER) visits, pneumonia and admissions due to lower-respiratory-tract-infections (LRTI), to account for PS exposure. Atopy, daycare attendance, breastmilk, cesarean-section, siblings and gestational age were included in logistic regression models. Result(s): Demographic, perinatal, and atopic characteristics were similar between the groups. In NPS, secondary outcomes, including wheezing (OR 0.43, 95%CI 0.24-0.76), LRTI admissions (OR 0.1, 95%CI 0.01-0.89), recurrent wheezing (OR 0.28, 95%CI 0.11-0.7), ER admissions (OR 0.32, 95%CI 0.13-0.8) and pneumonia (OR 0.16, 95%CI 0.04-0.57) showed significant decreases during the COVID-19 first year pandemic. However, in PS, we did not observe these decreases in the respiratory morbidities. Conclusion(s): This study uncovers the overwhelming hazard of PS in abolishing the effect of the first year of COVID19 pandemic lock-downs, on infant's major respiratory morbidities.

E-cigarette use and lung function: preliminary results from the VapeScan Study

Aims: VapeScan aims to study associations between e-cigarette (e-cig) use and lung structure and function in diverse young adults from New York City. Since the Study started during the pandemic, we performed preliminary analyses to test if recent COVID infection is a confounder of associations between e-cig use and lung function. Method(s): We are enrolling adults ages 18-50 years using e-cigs only, e-cigs and cigarettes, and dual non-users. Pre-bronchodilator spirometry and questionnaires are done at baseline. Lung function was regressed on e-cig use adjusted for age, sex, race, BMI, height, asthma, and COVID history. Result(s): 57 participants completed spirometry between October 2021 and May 2022, including 14 (25%) e-cig users, 13 (23%) dual e-cig/cigarette users, and 30 (53%) dual non-users. Average age was 26 years (range:18-49), 38 (67%) were women, 25 (44%) were non-Hispanic White, 6 (11%) were Black, 16 (28%) were Asian, 19 (33%) were Hispanic, 10 (18%) had asthma, 15 (26%) had prior COVID. After adjustment, e-cig use was associated with 8% lower FEV1-predicted (95%CI:17%,-2%,p=.1) and 0.05 lower FEV1/FVC (95%CI:0.11,-0.001,p=.06). COVID history was not associated with outcomes (p>.27) and effect estimates did not change after adjustment (Figure). Conclusion(s): In data collected during the Omicron Wave of the COVID-19 pandemic, e-cig use showed a trend towards association with lower FEV1% and FEV1/FVC independent of COVID history.

Spotting the Needle Amongst the Haystack - When Asthma Isn't Asthma

Introduction/Background: Eosinophilic granulomatosis with polyangiitis (EGPA), previously known as Churg-Strauss Syndrome, is a rare, small to medium vessel ANCA associated vasculitis. Hallmarks of EGPA include asthma, chronic rhinosinusitis, and peripheral neuropathy. EGPA is characterized by a prodrome of asthma and allergic rhinitis, followed by peripheral blood hyper-eosinophilia and accumulation of extravascular eosinophils, and finally systemic vasculitis. Extrapulmonary involvement is common, sometimes with fatal outcomes. The onset of EPGA is typically between 25-50 years;however, EGPA also occurs during childhood and has a significant morbidity and mortality. Description/Method: Our patient presented to the emergency department with a 2-week history of lethargy, wheeze and left sided neck swelling. After testing COVID-19 positive eight months prior to this, she developed wheezy episodes and was subsequently diagnosed with asthma which was managed with bronchodilators as required. She was reviewed by an allergist who confirmed a dust mite allergy and prescribed Montelukast. She remained well during the summer months however during winter she had 3 distinctive episodes of wheeze and cough which were managed by antibiotics and prednisolone. In the emergency department, an echocardiogram was performed which showed a cardiac tamponade. She was transferred to CICU where she had a pericardial drain inserted. The fluid was abundant with inflammatory cells. Multiple investigations were performed as follows: Hb: 135g/L, wbc: 20.30 x 10 9/L, Eosinophils: 12.77 x 10 9/L, CRP: 51 mg/L, ESR: 75 mm/hr, LDH: 1188 IU/L, IgE: 8000 UI/ml, ANA, ANCA: negative. CT chest showed mediastinal lymphadenopathy and patchy bilateral infiltrate and cardiac MRI showed myopericarditis and LV fibrosis. BMA showed no malignant cells and sinusitis was confirmed by CT. On examination, she was underweight. Her nasal mucosa looked inflamed. Otherwise systemic examination was unremarkable. In the context of poor ejection fraction (20%) with LV fibrosis, urgent MDT was arranged and concluded that our working diagnosis was EGPA. The decision was made to start IV methylprednisolone 10mg/kg/day for 3 days and Ivermectin. That night our patient had a VF arrest which required a single shock conversion 4J/kg. There was 7-minute downtime. Treatment was escalated to include cyclophosphamide, rituximab and plasmapheresis. The patient made a remarkable recovery, extubated and transferred to a normal ward. Her eosinophils count and inflammatory markers improved dramatically following treatment. However, she developed severe neuropathic left leg pain and NCS confirmed peripheral neuropathy Discussion/Results: EGPA is a very rare disease and diagnosis can be challenging especially with the absence of histopathology diagnosis. Early empirical treatment especially in a very ill child in intensive care unit can save lives and divert the progress of the disease. This patient has fulfilled the American College of Rheumatology criteria to diagnose EGPA including asthma, eosinophil count > 10% of upper normal, peripheral neuropathy, pulmonary infiltrates on CT thorax and paranasal sinuses abnormalities. Cardiac biopsy of the fibrotic mass may be a useful tool for diagnosis;however, this invasive procedure may expose this patient with high risk of fatal arrhythmias. Since other causes of eosinophilia were ruled out including parasitic infections, lymphoproliferative disorders, and rare primary immunodeficiency syndromes (hyper-IgE syndrome due to STAT3 or DOCK8 deficiency and Omenn syndrome) and the patient responded well to treatment, the diagnosis of EGPA was supported. Key learning points/Conclusion: Asthma not responding to bronchodilator could be another diagnosis Eosinophilia should be interpreted with caution. Defer the need for histopathology diagnosis in critically ill children Cardiac involvement is a life-threatening marker Early diagnosis prevents life threatening complications.

Pulmonary palytoxin poisoning on CT imaging

Background: Palytoxin poisoning is an uncommon exposure in the US, and is most frequently encountered amongst hobbiests and professionals in the aquarium industry. The toxin is produced by the microalgae Ostreopsis as well as the coral Palythoa toxica. Discovered in Hawaii, the name limu-make-o-Hana translates to "seaweed of death from Hana." Palytoxin interrupts Na+/ K+ ATPase pump, resulting in widespread cellular dysfunction. Persons are at highest risk when cleaning a fish tank housing the coral that produces palytoxin, resulting in cutaneous or inhalational exposure. We present a case of palytoxin inhalational exposure with computed tomography (CT) imaging. Case report: A 41-year-old male presented to the emergency department (ED) with dyspnea, cough, and wheezing after cleaning his saltwater fish tank. He reported that he maintains Zoanthid corals in his home saltwater fish tank and typically wears personal protective equipment when cleaning the tank. He had taken off his mask directly after using hot water to clean the tank, and quickly developed shortness of breath. He contacted Poison Control and was instructed to take loratadine with initial improvement in his symptoms. He then developed decreased appetite, nausea, and chills. The following day, in addition to these symptoms, he developed a fever of 102.5 degreeF and an oxygen saturation of 88% measured with an at-home pulse oximeter. He then proceeded to the ED where he was found to be hypoxic to 91% on room air, tachycardic to 120 bpm, hypotensive to 93/ 70mmHg, febrile to 100.9 degreeF and tachypneic at a respiratory rate of 30. Physical exam revealed clear lung sounds. Application of supplemental oxygen at 2 L resulted in improvement in his oxygen saturation and his hypotension and tachycardia responded to intravenous fluids. Significant laboratory results included WBC count of 20.4 with bands of 14%, elevated lactate of 2.4mmol/L, elevated D-dimer of 0.48 mug/mL and a negative COVID PCR test. CTA thorax revealed patchy ground-glass opacities in the bilateral upper and lower lobes with mosaicism. The patient received doxycycline in addition to broad spectrum antibiotics due to concern for inhalational marine toxicity. He was also started on 60mg prednisone, inhaled steroids, and bronchodilators for symptomatic treatment, with improvement in his symptoms. During his hospitalization, a respiratory viral panel was negative for common viruses associated with atypical pneumonia including influenza, coronavirus, metapneumovirus, rhinovirus, enterovirus, adenovirus, parainfluenza, bocavirus, Chlamydophila pneumoniae, and Mycoplasma pneumonia. His dyspnea gradually improved and he was weaned off supplemental oxygen prior to discharge home on hospital day 2. Discussion(s): It is unclear what changes are expected on thoracic imaging in patients with inhalational palytoxin exposure. Chest radiographs in two previous cases displayed scattered infiltrates, and a chest CT in another case showed pleural based consolidations. The ground-glass mosaicism suggests that a more diffuse reactive airway process after an inhalational palytoxin insult. Conclusion(s): Patients with inhalational palytoxin exposure may be found to have reactive airway symptoms along with ground glass opacities with mosaicism on CT imaging.

POST-COVID PULMONARY COMPLICATIONS IN THE OUTPATIENT SETTING: ARE WE PREPARED FOR THE AVALANCHE?

SESSION TITLE: What Lessons Will We Take From the Pandemic? SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Post COVID pulmonary complications can be attributed to severe inflammatory response that can result in pulmonary fibrosis. It is somewhat predictable in patients with severe illness, advanced age and comorbidities. However, a little is known about pulmonary complications in younger patients with mild illness followed up at outpatient clinics. We aim to shed light on post COVID pulmonary complications in patients who did not require hospitalization but had significant outpatient visits. METHODS: This study is based upon a retrospective chart review of patients who presented to Pulmonology Clinic at Cayuga Medical Associates with respiratory symptoms associated with COVID-19 disease. Mild illness was defined as symptoms of dyspnea on exertion or fatigue or shortness of breath that have not required oxygen and lasted for less than or equal to two months. Moderate illness was defined as symptoms of mild illness lasting for more than two months without oxygen supplementation. Severe illness was defined as hypoxia requiring home oxygen. We have excluded the patients who were hospitalized for COVID pneumonia. RESULTS: Of 23 patients (56.52% female) with COVID illness seen at Pulmonology Clinic in one-year duration, 13.04% had COPD, 26.09% had asthma and 21.74% had OSA. Median age was 33 with mean BMI 27.61.13.04% were current smokers. 39.13% required a PFT among which 77.78% had normal results. 21.74% of the total patients who never had OSA as an underlying diagnosis, required sleep study, among which 60% had mild OSA and 20% had severe OSA. 13.04% were already on oral steroids for other diseases. Majority of the patients had normal chest x-ray findings. 39.13% had CT chest, majority of which showed normal findings and few with diffuse ground glass opacities. 8.70% developed palpitations along with respiratory symptoms. At six months follow up, 43.48% had mild illness who were managed with conservative management such as incentive spirometry, deep breathing techniques, prone positioning and as needed short acting bronchodilator treatments. 43.48% had moderate illness who were treated with short course of oral steroids in addition to conservative management. 13.04% had severe illness who required home oxygen up to 2 L for two months maximum. Most common pulmonary complaint was dyspnea on exertion, seen in 43.48%. 17.39% had fatigue. 21.74% had sleep apnea symptoms. Median duration of symptoms was two months. CONCLUSIONS: Our study outlines the incidence of post COVID pulmonary complications in patient group where these complications are least expected. CLINICAL IMPLICATIONS: Post COVID pulmonary complications appear to be of significant concern in patients visiting outpatient clinics. The heterogeneity in management of those complications needs a serious attention. The feasibility and implementation strategy of post COVID-19-care-clinic with proper management guidelines should be brought to streamline practice. DISCLOSURES: No relevant relationships by Sameer Acharya No relevant relationships by Ali AKRAM No relevant relationships by Samjhauta Bhattarai No relevant relationships by Lavanya Kodali

DYSPNEIC AFTER EVERY COVID-19 SHOT: SUSPECTED BNT162B2 MRNA VACCINE-RELATED, DRUG-INDUCED PULMONARY EOSINOPHILIA

SESSION TITLE: Issues After COVID-19 Vaccination Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Eosinophilia is the most commonly reported adverse event following administration of the Pfizer/BioNTech vaccine, accounting for 237 of 372 events (63.7%). Eosinophilic pneumonia has been described noted in 3 of all reported cases. CASE PRESENTATION: We present the case of a 73 year-old male presented to his PCP with a 3 week history of nonproductive cough and wheezing. He completed a 2-shot series of BNT162b2 mRNA (Pfizer/BioNTech) COVID vaccine 1 week prior to symptom onset. He had no history of respiratory symptoms, smoking, sick contacts, recent travel, chemical or biological exposures. On presentation, he was afebrile, tachycardic and required 3LPM supplemental oxygen to maintain peripheral oxygen saturation (SpO2) above 94%. Laboratory findings noted leukocytosis (13,200/mL) and eosinophilia at 5% (Absolute Eosinophil Count (AEC): 580 cells/L). Respiratory viral panel, procalcitonin, ESR and D-dimer were negative. Chest CT scan was unremarkable. He was treated with azithromycin, prednisone and inhaled bronchodilators with improvement in hypoxia. 2 weeks later, he reported intermittent dyspnea during a pulmonary clinic visit. Pulmonary function testing was normal (FEV1/FVC: 76%;FVC: 3.67L (90% predicted);FEV1: 2.80L (88% predicted). IgE level was normal and eosinophilia had resolved. 6 months after initial symptom onset, the patient received his third BNT162b2 mRNA vaccine dose. 2 weeks after vaccination, he presented to the ED with severe dyspnea, wheezing and cough with yellow sputum. He also noted a new itchy, erythematous bilateral forearm rash and painless oral ulcers. On exam, he was afebrile, tachypneic with SpO2 of 93% on 4LPM supplemental oxygen and audibly wheezing with a prolonged expiratory phase. Laboratory studies noted elevated creatinine and leukocytosis (23,100/mL) with marked eosinophilia (29.5 %, AEC: 6814 cells/L). Chest CT scan revealed a 2 cm rounded ground-glass opacity in the right upper lobe. (Figure 1.) Further workup revealed a weakly positive antihistone antibody (1:4 titer). IgE, ANA, ANCA, SS-A/B, anti-CCP, and complement levels were normal. Intravenous methylprednisolone treatment was initiated with rapid improvement in dyspnea, eosinophilia and renal function. A transbronchial biopsy (Figure 2.) of the RUL lung lesion revealed organizing pneumonia with mixed inflammatory infiltrate. Bronchoalveolar lavage analysis revealed elevated WBC (432 cells/L) with neutrophilic predominance (85%). Patient was discharged home on a prednisone taper with resolution of symptoms. DISCUSSION: Subsequent allergy work up did not indicate any apparent etiology of hypereosinophilia. Testing for strongyloides, coccidiosis and aspergillosis were also negative. A final diagnosis of BNT162b2 mRNA vaccine related pulmonary eosinophilia was made. CONCLUSIONS: Additional study is warranted into eosinophilic disease associated with the BNT162b2 mRNA vaccine. Reference #1: 1. United States Department of Health and Human Services (DHHS), Public Health Service (PHS), Centers for Disease Control (CDC) / Food and Drug Administration (FDA), Vaccine Adverse Event Reporting System (VAERS) 1990 - 03/11/2022, CDC WONDER On-line Database. Accessed at http://wonder.cdc.gov/vaers.html on Mar 11, 2022 1:18:37 PM DISCLOSURES: No relevant relationships by Matthew Haltom No relevant relationships by Nikky Keer No relevant relationships by Thekrayat Khader No relevant relationships by Muthiah Muthiah

GRANULOMATOUS-LYMPHOCYTIC INTERSTITIAL LUNG DISEASE AS THE NONINFECTIOUS COMPLICATION OF COMMON VARIABLE IMMUNODEFICIENCY

SESSION TITLE: Difficult Diffuse Lung Disease SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 10:15 am - 11:10 am INTRODUCTION: Common Variable Immunodeficiency (CVID) is one of the most common humoral immunodeficiency disorders and usually manifests as infectious complications. However, noninfectious complications such Granulomatous-Lymphocytic Interstitial Lung Disease (GLILD) can convey a much poorer prognosis in patients with CVID. In this case report, we present a patient with GLILD who presented with cough and shortness of breath. CASE PRESENTATION: A 66 year old female with past medical history of provoked DVT (off anticoagulation), cervical cancer (s/p resection) presented to pulmonology clinic with complaints of chronic cough and shortness of breath on exertion. She had a negative smoking history and no occupational exposures. She was up to date on vaccinations and COVID was negative. Vitals were stable and physical exam was normal including clear breath sounds. CXR revealed emphysema and hazy opacities in the lung bases. PFTs demonstrated moderate obstructive pattern with no response to bronchodilator, normal lung volumes, and DLCO of 76%. Due to lack of improvement in her cough, CT Chest was done which revealed diffuse pulmonary nodules, bronchiectasis with possible atelectasis or scarring in the RML and lingula, and a prominent subcarinal lymph node. EBUS TBNA of station 7 returned negative for malignancy. Culture showed polymicrobial growth with negative AFB and fungi. Patient was treated without antibiotics, but due to family history of immunodeficiency, immunoglobulin panel was sent which returned low IgG subclasses. She then received IVIG. However, given the centrilobular nodules and lack of response to IVIG, repeat bronchoscopy with TBBx and BAL was performed. BAL revealed lymphocytic predominance and tissue biopsy showed non-caseating granulomas and negative cultures. Eventually patient was diagnosed with GLILD and started on 6 weeks of prednisone 40 mg daily along with PJP prophylaxis. However, her symptoms remained same and rituximab was prescribed with improvement in the symptoms. DISCUSSION: Although recurrent sinopulmonary infections are common in CVID patients, if clinical response to IVIG is minimal to none, GLILD should be considered on the differential. Centrilobular nodules and ground glass opacities should raise suspicion of GLILD and tissue sample should be obtained in these patients to confirm the diagnosis. Appropriate treatment with prednisone or rituximab along with IVIG improves GLILD patient symptoms and yields better outcomes in terms of morbidity and quality of life. CONCLUSIONS: Appropriate treatment with prednisone or rituximab along with IVIG improves GLILD patient symptoms and yields better outcomes in terms of morbidity and quality of life. Reference #1: Hurst JR, Verma N, Lowe D, Baxendale HE, Jolles S, Kelleher P, et al. British lung foundation/United Kingdom primary immunodeficiency network consensus statement on the definition, diagnosis, and management of granulomatous-lymphocytic interstitial lung disease in common variable immunodeficiency disorders. J Allergy Clin Immunol Pract. (2017) 5:938– 45. doi: 10.1016/j.jaip.2017.01.021 DISCLOSURES: No relevant relationships by Benjamin Butler No relevant relationships by Abdulmetin Dursun No relevant relationships by Badri Giri No relevant relationships by Emily Smallwood

INTRIGUING STUDY OF PULMONARY FUNCTION TESTS POST-COVID-19 PNEUMONIA IN A HISPANIC-DOMINANT POPULATION

SESSION TITLE: Unique Uses of Pulmonary Function Tests SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Coronavirus disease 2019 (COVID-19) is a highly transmissible respiratory disease that causes global pandemic. It is known to cause impairment of lung function leading to morbidity and mortality. Long term data for lung function tests in these populations is still limited. METHODS: A retrospective chart review of patients with COVID-19 pneumonia who had initial and follow up spirometry tests from August 2020 to December 2021 in a pulmonary clinic in Corpus Christi, Texas was performed. Baseline characteristic and spirometry parameters including age, gender, race, body mass index, comorbidities, pre/post bronchodilator FEV1, FVC, lung volume, DLCO and 6-minute walk test were collected. T test analysis was performed to compare the data between initial and follow up pulmonary function tests. RESULTS: A total of 29 patients were enrolled.The mean COVID diagnosis to PFT interval was 126 days. Mean follow up duration was 309 days. Mean (SD) age was 58 (10) years. Forty-eight percent of the participants were male gender. Majority of our participants were hispanic (72%) followed by caucasian (21%) and others (7%). Average BMI (SD) was 34.6 (7.5) kg/m². Restrictive lung defect pattern was found in 55.2% on initial pulmonary function test in the clinic which dropped to 41.4% in the follow up test with supportive management. Initial and follow up prebronchodilator percent predicted mean(SD) of FVC were 65 (20) and 72 (20) respectively with a mean difference of 6.3 (p=0.002, 95% CI 2.54-10.10). Initial and follow up prebronchodilator percent predicted mean(SD) of FEV1 were 71 (23) and 78 (21) respectively with a mean difference of 6.7 (p=0.003, 95% CI 2.46-10.90). Moreover, mean(SD) of DLCO and TLC showed significant improvement during follow-up visit [DLCO-69 (24) and 77 (20), mean difference of 7.6 (p=0.016, 95% CI 1.58-13.59), TLC-64 (17) and 71 (14) respectively, mean difference of 7(p=0.005, 95%CI 2.32-11.76)]. CONCLUSIONS: We found improvement of many parameters of pulmonary function test in post COVID-19 patients during follow-up with supportive care. CLINICAL IMPLICATIONS: Regular follow up can be a useful tool to understand the prognosis of post COVID-19 pneumonia sequelae. DISCLOSURES: No relevant relationships by Asad Chohan No relevant relationships by Saiara Choudhury No relevant relationships by Pahnwat Taweesedt No relevant relationships by Abhay Vakil

RETROSPECTIVE ANALYSIS OF PULMONARY FUNCTION DURING THE POSTACUTE SEQUELAE OF SARS-COV-2 INFECTION

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: The World Health Organization has defined post-acute sequelae of SARS-CoV-2 infection, or Long-COVID, as prolonged symptomatology after initial recovery lasting more than 2 months. Changes in respiratory function associated with this syndrome are not fully understood. Therefore, we performed a retrospective analysis of patients with pulmonary function tests (PFT) after COVID-19. METHODS: We retrospectively reviewed records of 2,234 patients with a history of COVID-19 diagnosed by RT-PCR who followed up in pulmonary clinics in Hartford, Connecticut from March 2020 to December 2021. Data included the patients’ age, sex, comorbidities, PFT results, and the maximum oxygen requirement during acute illness: room air (RA), low-flow oxygen (LF), high-flow nasal cannula (HFNC), non-invasive ventilation (NIV) or mechanical ventilation (MV). We performed an adjusted logistic regression analysis to evaluate if the disease severity (defined by oxygen requirement) was associated with the presence of obstructive and restrictive disease during follow-up. SPSS 26.0 was used with an alpha level of 0.05. RESULTS: Of the 2,234 records, 471 (21.1%) had available PFTs. Only PFTs done between 2 and 12 months post COVID-19 were included. The mean age (± SD) of the sample was 56 ± 15 years;62.6% were female. Twenty three (4.9%) patients required MV, 17 (3.6%) NIV, 45 (9.5%) HFNC, 111 (23.6%) LF and 275 (58.4%) remained on RA. Obstructive disease was seen in 106 (22.5%), and bronchodilator response was seen in 34 (9.1%). Restrictive disease was seen in 129 (27.4%) and was associated with use of HFNC, NIV and MV (OR: 2.44, 3.67, 3.26;p<0.01). The presence of obstruction did not correlate with disease severity, however use of HFNC did correlate with the absence of obstruction (OR: 0.24;p=0.019). CONCLUSIONS: Our results show a significant association between disease severity and restrictive disease during follow up. This is compatible with smaller studies and is likely related to the fibrotic stage of Acute Respiratory Distress Syndrome. There was an association of HFNC use with the absence of obstruction. Perhaps, patients with the pre-existing obstruction and severe COVID were less likely to tolerate HFNC and required higher support for recovery. Bronchodilator responsiveness was only present in a small portion of patients. Severe disease did not appear to predispose patients to the development of obstructive disease during the follow up period. Studies including pre- and post-COVID PFTs would further strengthen this assertion. CLINICAL IMPLICATIONS: We did find an association between severity of COVID-19 and restrictive disease during follow up. Conversely, disease severity did not correlate with obstruction. These data will help to define the typical course of progression in patients suffering from Long-COVID and may imply that management should mirror strategies employed in other pulmonary conditions that cause restriction. DISCLOSURES: No relevant relationships by Brian Bustos No relevant relationships by Christopher Dipollina No relevant relationships by David O'Sullivan No relevant relationships by Eduardo Padrao No relevant relationships by Ravneet Randhawa No relevant relationships by Tejal Shah No relevant relationships by Pooja Shekar

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

INTERSTITIAL LUNG DISEASE EXACERBATED BY NON-NOVEL SARS-COV-2

SESSION TITLE: Variety in Chest Infections Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Viruses are thought to trigger acute exacerbation of interstitial lung disease (AE-ILD) [1]. AE-ILD results in significant morbidity and mortality [1]. We report a case of AE-ILD due to non-SARS CoV2 viral infection in the era of the COVID-19 pandemic. CASE PRESENTATION: A 61 year-old African-American male with a history of hypertension, diabetes mellitus, and smoking crack cocaine presented with acute onset of dyspnea, fever, and worsening of his chronic cough. He was diagnosed with ILD suspected to be idiopathic pulmonary fibrosis (IPF) 9 months prior to hospitalization and needed 3 L supplemental oxygen at baseline. He had received 3 doses of COVID-19 vaccination. He was tachycardic, tachypneic, hypoxemic and arrived on a non-rebreather mask to the ED. Physical examination revealed bilateral coarse inspiratory crackles. Laboratory workup revealed leukocytosis, neutrophilia, and lymphopenia. Procalcitonin, lactic acid, BNP, and troponin were normal. CXR showed significantly increased bilateral interstitial markings compared to prior imaging. The patient was not stable for a chest CT. Respiratory pathogen panel was negative for SARS-CoV2, but positive for Coronavirus OC43. Sputum culture grew normal respiratory flora. He continued to have increased work of breathing and was placed on NIV support. He received methylprednisolone, bronchodilators, and ceftriaxone with azithromycin. Antibiotics were discontinued after negative sputum cultures. The patient continued to worsen despite supportive care, he wished to transition the goals of care to comfort only. He was transitioned to hospice care and died within 24 hours. DISCUSSION: Viruses are identified in 10-20% of cases of AE-ILD, in which the virus may be acting as an extrinsic trigger [2]. Efficacious antiviral agents are lacking. Currently, there are no strong evidence based guidelines for the treatment of AE-ILD. Corticosteroids are empirically used to manage exacerbation, however response is variable and particularly worse in the IPF variant of ILD [3]. An effort should be made to identify a treatable infectious etiology in all cases of AE-ILD with any worsening symptoms. Our case highlights that the "common cold” may have fatal consequences for at-risk patients. Care for patients with AE-ILD often goes beyond medications and should encompass emotional and family support. CONCLUSIONS: Hand hygiene and mask wearing are beneficial for ILD patients, in addition to pneumococcal, COVID-19, and influenza vaccinations. In patients with IPF, antifibrotics may help prevent exacerbations [2]. There remains a need for clinical trials to aid in establishing efficacious treatment in AE-ILD. Reference #1: Charokopos A, Moua T, Ryu JH, Smischney NJ. Acute exacerbation of interstitial lung disease in the intensive care unit. World J Crit Care Med 2022;11(1): 22-32 [DOI: 10.5492/wjccm.v11.i1.22] Reference #2: Kreuter M, Polke M, Walsh SLF, et al. Acute exacerbation of idiopathic pulmonary fibrosis: international survey and call for harmonisation. Eur Respir J 2020;55: 1901760 [https://doi.org/ 10.1183/13993003.01760-2019 Reference #3: Jang HJ, Yong SH, Leem AY, et al. Corticosteroid responsiveness in patients with acute exacerbation of interstitial lung disease admitted to the emergency department. Sci Rep. 2021;11(1):5762. Published 2021 Mar 11. doi:10.1038/s41598-021-85539-1 DISCLOSURES: No relevant relationships by Ibukun Fakunle No relevant relationships by Prajwal Shanker No relevant relationships by Aashish Valvani

EFFECTS OF BENRALIZUMAB ON AIRWAY DYNAMICS IN SEVERE EOSINOPHILIC ASTHMA USING FUNCTIONAL RESPIRATORY IMAGING PARAMETERS: THE BURAN STUDY DESIGN

SESSION TITLE: Imaging Across the Care Spectrum SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Eosinophilic airway inflammation and mucus plugs are common in asthma patients. Eosinophil depletion may reduce mucus plugging and improve airway patency and airflow distribution. This study will investigate the short-term benefits of sustained depletion of airway eosinophils by benralizumab, an anti-IL-5Rα monoclonal antibody, on airway structure and dynamics using functional respiratory imaging (FRI) in adults with severe eosinophilic asthma (SEA). METHODS: A multicenter, single-arm, open-label, phase 4 study enrolling approximately 138 patients. Screening will be followed by a run-in period of up to 21 days, before administration of subcutaneous benralizumab 30 mg at Weeks 0, 4 and 8, final assessment at Week 13, and a 2-week follow-up period. RESULTS: Key inclusion criteria: age 18-70 years with diagnosed SEA inadequately controlled by high-dose inhaled corticosteroid and long-acting β2-agonist (ICS-LABA) treatment +- oral corticosteroids (OCS) or other asthma controllers;documented post-bronchodilator (BD) reversibility;≥2 exacerbations in prior 12 months;baseline peripheral blood eosinophil count ≥300/μL (≥150 cells/μL if OCS-dependent);pre-BD forced vital capacity (FVC) <65% predicted, pre-BD FEV1 <80% predicted and Asthma Control Questionnaire (ACQ-6) ≥1.5. Key exclusion criteria: exacerbation/pulmonary infection 6 weeks pre-screening;smokers or ex-smokers who stopped smoking ≤12 months pre-screening and/or history of >10 pack-years;positive for COVID-19 at or ≤6 weeks before screening, or severe COVID-19 at any time.The primary endpoint is mean change from baseline in specific airway volume measured at total lung capacity. Secondary objectives include change from baseline in airway dynamics (lung, airway and blood vessel volumes, airflow distribution, airway resistance, air trapping, ventilation/perfusion mapping) and mucus plug scores, and correlations with conventional lung function measurements (FVC, FEV1) at baseline and Week 13. FRI will be via computed tomography scans assessed using computer modelling. Exploratory objectives include: relationships between airway dynamics and patient-reported outcomes (PROs) such as the Asthma Impairment and Risk Questionnaire (AIRQ), ACQ-6, and St George's Respiratory Questionnaire (SGRQ) at baseline, from baseline to Week 13, and change from baseline in Central/Peripheral (C/P) lung deposition ratio of inhaled drugs. Safety and tolerability will also be assessed. CONCLUSIONS: This study will advance understanding of the eosinophil-depletion effects of benralizumab on airway structure, dynamics, and mucus plugs and could provide additional useful insights into the relationship of PROs with changes in airway dynamics and structure. CLINICAL IMPLICATIONS: Our results may help further characterize physiologic changes resulting from eosinophil depletion with benralizumab and better delineate the impact of changes in lung function and structure on PROs. DISCLOSURES: stockholder relationship with AstraZeneca Please note: 2 years Added 03/31/2022 by Donna Carstens, value=Salary No relevant relationships by Wilfried De Backer Employee relationship with AstraZeneca LP Please note: Since 2014 by Eduardo Genofre, value=Salary Shareholder relationship with AstraZeneca LP Please note: Since 2014 by Eduardo Genofre, value=LTIs Employee relationship with FLUIDDA Inc Please note: Aug 2021 - Present Added 04/12/2022 by Patrick Muchmore, value=Salary Advisory Committee Member relationship with AstraZeneca Please note: 24 months Added 03/29/2022 by Reynold Panettieri, value=Grant/Research Support Removed 03/29/2022 by Reynold Panettieri Consultant relationship with AstraZeneca Please note: 24 months Added 03/29/2022 by Reynold Panettieri, value=Honoraria Removed 03/29/2022 by Reynold Panettieri Speaker/Speaker's Bureau relationship with AstraZeneca Please note: 24 months by Reynold Panettieri, value=Honoraria Removed 03/29/20 2 by Reynold Panettieri Advisory Committee Member relationship with RIFM Please note: 24 months by Reynold Panettieri, value=Grant/Research Support Removed 03/29/2022 by Reynold Panettieri Consultant relationship with RIFM Please note: 24 months by Reynold Panettieri, value=Honoraria Removed 03/29/2022 by Reynold Panettieri Advisory Committee Member relationship with Equillium Please note: 24 months Added 03/29/2022 by Reynold Panettieri, value=Grant/Research Support Removed 03/29/2022 by Reynold Panettieri Advisory Committee Member relationship with Equillium Please note: 24 months by Reynold Panettieri, value=Honoraria Removed 03/29/2022 by Reynold Panettieri Advisory Committee Member relationship with Genetech Please note: 24 months Added 03/29/2022 by Reynold Panettieri, value=Grant/Research Support Removed 03/29/2022 by Reynold Panettieri Speaker/Speaker's Bureau relationship with Genetech Please note: 24 months by Reynold Panettieri, value=Honoraria Removed 03/29/2022 by Reynold Panettieri Speaker/Speaker's Bureau relationship with Sanofi/Regeneron Please note: 24 months by Reynold Panettieri, value=Honoraria Removed 03/29/2022 by Reynold Panettieri Consultant relationship with Bayer Please note: 24 months by Reynold Panettieri, value=Honoraria Advisory Committee Member relationship with Theravance Please note: 24 months by Reynold Panettieri, value=Grant/Research Support Advisory Committee Member relationship with Novartis Please note: 24 months Added 03/29/2022 by Reynold Panettieri, value=Grant/Research Support Removed 03/29/2022 by Reynold Panettieri Contracted Research relationship with Optikira Please note: 24 months by Reynold Panettieri, value=Grant/Research Support Removed 03/29/2022 by Reynold Panettieri Advisory Committee Member relationship with Medimmune Please note: 24 months Added 03/29/2022 by Reynold Panettieri, value=Grant/Research Support Removed 03/29/2022 by Reynold Panettieri Contracted Research relationship with Maven Please note: 24 months by Reynold Panettieri, value=Grant/Research Support Removed 03/29/2022 by Reynold Panettieri Contracted Research relationship with Evelobio Please note: 24 months by Reynold Panettieri, value=Grant/Research Support Contracted Research relationship with Johnson & Johnson Please note: 24 months by Reynold Panettieri, value=Grant/Research Support Advisory Committee Member relationship with AstraZeneca;RIFM;Equillium;Genentech;Thervance Please note: 24 months by Reynold Panettieri, value=Honoraria Removed 03/29/2022 by Reynold Panettieri Consultant relationship with AstraZeneca;RIFM;Equillium;Bayer Please note: 24 months by Reynold Panettieri, value=Honoraria Removed 03/29/2022 by Reynold Panettieri Speaker/Speaker's Bureau relationship with AstraZeneca;Sanofi/Regeneron;Genentech Please note: 24 months by Reynold Panettieri, value=Honoraria Removed 03/29/2022 by Reynold Panettieri Research grant recipient relationship with Novartis;Optikira;Medimmune;Maven;Evelobio Please note: 24 months by Reynold Panettieri, value=Grant/Research Support Removed 03/29/2022 by Reynold Panettieri Research grant recipient relationship with Johnson & Johnson;AstraZeneca;RIFM;Equillium;Genentech Please note: 24 months by Reynold Panettieri, value=Grant/Research Support Removed 03/29/2022 by Reynold Panettieri Research grant recipient relationship with Theravance Please note: 24 months by Reynold Panettieri, value=Grant/Research Support Advisory Committee Member relationship with AstraZeneca Please note: $1001 - $5000 by Reynold Panettieri, value=Consulting fee Removed 03/29/2022 by Reynold Panettieri Principal Investigator relationship with AstraZeneca Please note: $20001 - $100000 by Reynold Panettieri, value=Grant/Research Support Removed 03/29/2022 by Reynold Panettieri Speaker/Speaker's Bureau relationship with AstraZeneca Please note: $1001 - $5000 by Reynold Panettieri, value=Honoraria Removed 03/29/2022 by Reynold Panettieri Advisory Committee Member relationship with MedImmune Please note: $1001 - $5000 by Reynold Panettieri, value=Consulting fee Removed 0 /29/2022 by Reynold Panettieri Principal Investigator relationship with MedImmune Please note: $20001 - $100000 by Reynold Panettieri, value=Grant/Research Support Removed 03/29/2022 by Reynold Panettieri Advisory Committee Member relationship with Reseaerch Institute for Fragrance Materials Please note: $1001 - $5000 by Reynold Panettieri, value=Consulting fee Removed 03/29/2022 by Reynold Panettieri Principal Investigator relationship with Reseaerch Institute for Fragrance Materials Please note: $20001 - $100000 by Reynold Panettieri, value=Grant/Research Support Removed 03/29/2022 by Reynold Panettieri Advisory Committee Member relationship with Equillium Please note: $1001 - $5000 by Reynold Panettieri, value=Consulting fee Removed 03/29/2022 by Reynold Panettieri Principal Investigator relationship with Equillium Please note: $20001 - $100000 by Reynold Panettieri, value=Grant/Research Support Removed 03/29/2022 by Reynold Panettieri Advisory Committee Member relationship with Theravance Please note: $1001 - $5000 by Reynold Panettieri, value=Consulting fee Removed 03/29/2022 by Reynold Panettieri Advisory Committee Member relationship with Avillion Please note: $1001 - $5000 by Reynold Panettieri, value=Consulting fee Speaker/Speaker's Bureau relationship with Sanofi/Regeneron Please note: $1001 - $5000 by Reynold Panettieri, value=Honoraria Removed 03/29/2022 by Reynold Panettieri Speaker/Speaker's Bureau relationship with Genentech Please note: $1001 - $5000 by Reynold Panettieri, value=Honoraria Removed 03/29/2022 by Reynold Panettieri Principal Investigator relationship with Genentech Please note: $20001 - $100000 by Reynold Panettieri, value=Grant/Research Support Removed 03/29/2022 by Reynold Panettieri Principal Investigator relationshipwith OncoArendi Please note: $20001 - $100000 by Reynold Panettieri, value=Grant/Research Support Principal Investigator relationship with Metera Please note: $20001 - $100000 by Reynold Panettieri, value=Grant/Research Support Removed 03/29/2022 by Reynold Panettieri Consultant relationship with TEVA Please note: 24 months Added 03/29/2022 by Reynold Panettieri, value=Honoraria Removed 03/29/2022 by Reynold Panettieri Consultant relationship with AstraZeneca Please note: 24 months Added 03/29/2022 by Reynold Panettieri, value=Honoraria Advisory Committee Member relationship with AstraZeneca Please note: 24 months Added 03/29/2022 by Reynold Panettieri, value=Honoraria Speaker/Speaker's Bureau relationship with AstraZeneca Please note: 24 months Added 03/29/2022 by Reynold Panettieri, value=Honoraria Principal Investigator relationship with AstraZeneca Please note: 24 months Added 03/29/2022 by Reynold Panettieri, value=Grant/Research Support Consultant relationship with RIFM Please note: 24 months Added 03/29/2022 by Reynold Panettieri, value=Honoraria Advisory Committee Member relationship with RIFM Please note: 24 months Added 03/29/2022 by Reynold Panettieri, value=Honoraria Principal Investigator relationship with RIFM Please note: 24 months Added 03/29/2022 by Reynold Panettieri, value=Grant/Research Support Advisory Committee Member relationship with Genentech Please note: 24 months Added 03/29/2022 by Reynold Panettieri, value=Honoraria Principal Investigator relationship with Genentech Please note: 24 months Added 03/29/2022 by Reynold Panettieri, value=Grant/Research Support Consultant relationship with TEVA Please note: 24 months Added 03/29/2022 by Reynold Panettieri, value=Honoraria Principal Investigator relationship with TEVA Please note: 24 months Added 03/29/2022 by Reynold Panettieri, value=Grant/Research Support Principal Investigator relationship with Equillium Please note: 24 months Added 03/29/2022 by Reynold Panettieri, value=Grant/Research Support Principal Investigator relationship with Novartis Please note: 24 months Added 03/29/2022 by Reynold Panettieri, value=Grant/Research Support Principal Investigator relationship with Medimmune Please note: 24 months Added 03/29/2022 by Reynold Panettieri, value=Grant/Research Support Principal Investigator r lationship with Origo Please note: 24 months Added 03/29/2022 by Reynold Panettieri, value=Grant/Research Support Principal Investigator relationship with ACTIV-1 Please note: 24 months Added 03/29/2022 by Reynold Panettieri, value=Grant/Research Support Principal Investigator relationship with Janssen Please note: 24 months Added 03/29/2022 by Reynold Panettieri, value=Grant/Research Support Principal Investigator relationship with Vault Health Please note: 24 months Added 03/29/2022 by Reynold Panettieri, value=Grant/Research Support Speaker/Speaker's Bureau relationship with Sanofi Please note: 24 months Added 03/29/2022 by Reynold Panettieri, value=Honoraria Speaker/Speaker's Bureau relationship with Merck & Co Please note: 24 months Added 03/29/2022 by Reynold Panettieri, value=Honoraria Employee No relevant relationships by Vivian Shih Shareholder relationship with AstraZeneca Please note: >5 years by Frank Trudo, value=Shares

Comparison of Video-Coached Remote Spirometry with In-Person Spirometry in Patients with Severe Asthma Participating in the NHLBI PrecISE Network

Introduction: PrecISE is an ongoing Phase II clinical trial sponsored by the National Heart, Lung, and Blood Institute to investigate the efficacy of several treatments for severe asthma. The threat of COVID-19 has raised interest in obtaining reliable spirometry data for asthma research and clinical care in a remote, “no-touch” fashion. Prior studies of the accuracy of remote spirometry have not included real-time coaching. The PrecISE investigators hypothesized that remote spirometry with real-time video coaching could provide an accurate FEV1 for use as a study endpoint in a clinical trial setting. Methods: PrecISE network participants had remote spirometry post-bronchodilator (4 puffs of albuterol) measured with video coaching from trained research coordinators using the ZEPHYRx platform connected to MIR Spirobank Smart handheld spirometers. Remote spirometry measurements occurred within a +/- 3-day window from scheduled in-person PrecISE visits during which in-person spirometry with bronchodilator challenge was measured with standard equipment (Vyaire Medical). All measurements occurred during the screening/run-in period of the PrecISE protocol. Both remote and in-person spirometry was overread by the PrecISE Spirometry Core and only included in analysis if sessions met ATS acceptability and reproducibility criteria. Correlations between remote and in-person FEV1 and FVC were analyzed, and Bland-Altman plots generated. As a comparison, within subject biological variability was measured using data from separate in-person visits during the screening/run-in period. Results: A total of 128 pairs of remote/in-person spirometry data were obtained. The mean FEV1 for remote spirometry was 2.50 L (SD 0.81) and for inperson spirometry was 2.42 L (SD 0.80), with an estimated correlation of 0.95 (95% CI: 0.93, 0.97). The mean difference in FEV1 (in-person - remote) was -0.07 L (95% CI: -0.11, -0.03, SD 0.25). The mean FVC for remote spirometry was 3.72 L (SD 1.01) and for in-person spirometry was 3.53 L (SD 0.93), with an estimated correlation of 0.91 (95% CI: 0.87, 0.93). The mean difference in FVC (in-person - remote) was -0.19 L (95% CI: -0.27, -0.12, SD 0.42). A total of 142 pairs of repeated in-person spirometry measurements were performed (median time between measurements: 43 days), with mean difference in FEV1 of -0.01 L (95% CI: -0.06, 0.03) and FVC of -0.02 L (95% CI: -0.07, 0.03). Bland-Altman plots for FEV1 differences are shown in Figure 1. Conclusions: Remote spirometry with real-time video coaching provides a reliable FEV1 measurement which correlates closely with in-person spirometry and is suitable for use in clinical trials. (Figure Presented).

Implementation of Standardized Care Path for COPD Exacerbations

Introduction: Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) is a major cause of hospitalization and re-admissions. Lack of standardized management and non-adherence to guideline-directed treatment may lead to poor outcomes and increase cost. Interventions implemented by health systems to reduce readmissions have had varied success. Heterogeneity in the target patient population is a significant challenge. The Cleveland Clinic COPD Care Path consists of an admission order set that incorporates multi-disciplinary management, evidence-based medications, and postdischarge integrated care. In this study, we examined impact of this Care Path on quality metrics and 30-day readmissions of patients with proven COPD on spirometry. Methods: We studied patients with spirometry proven persistent airflow obstruction (postbronchodilator FEV1/FVC<70) admitted to the general nursing floor with AECOPD during the 3 years prior to the COVID pandemic (February 2, 2017 to January 31, 2020), excluding those who left against medical advice, hospice and transplant patients. Patient's Care Path status (On vs Off), age, gender, BMI, baseline lung function and comorbidities were recorded. We measured process metrics such as appropriate use of antibiotics and corticosteroids, and post-discharge integrated disease management (rates of prescribing long-acting bronchodilator, follow-up appointments). 30-day readmission rate, length of stay (LOS) observed to expected (O: E) ratio and cost per case were recorded. For continuous variables, we used means and standard deviations and the ANOVA test for statistical analysis. For categorical variables, percentages, and the t- test were used. The level of statistical significance was set at p < 0.05. Results: Of the total of 857 patients with airflow obstruction, the Care Path was utilized in 52.8% and 21.94% were readmitted within 30 days. Lower re-admissions were associated with lower comorbidity index and completed follow-up appointments. Lung function, long acting bronchodilator prescription and cost or length of index hospitalization did not affect readmission. The care path was utilized more among patients with lower FEV1/FVC ratio but less in patients with concomitant heart failure. Use of the care path was associated with more follow-up appointments (scheduled and completed), long-acting bronchodilator prescription on discharge, lower cost but not length of stay. On-Care-Path patients did not have a reduced risk of readmission on univariate analysis. Conclusions: The findings from this retrospective study of patients with spirometry proven COPD suggest that using standardized care path for AECOPD hospitalizations is associated with lower cost and facilitates transitions of care. However, length of stay and 30-day readmission rates are unaffected. (Figure Presented).

Rare Form of Congenital Cystic Bronchiectasis in a Filipino Adult

Background: Tuberculosis remains to be the most common lung infection in the Philippines. Compliance to medication leads to significant improvement. A portion of the population however remains untreated leading to complication such as bronchiectasis. In the approach to treatment, etiologies such as a possible genetic abnormality must be considered aside from a post inciting event. Case: This is a case of D.A. 20 year old, female who came in due to difficulty of breathing. She grew up having recurrent upper and lower respiratory tract infection. She was previously treated with pulmonary tuberculosis for 6 months last 2011. She was initially admitted at the COVID wards during the surge because any patient with pulmonary complains with bilateral infiltrates will be tagged as COVID suspect until a negative RT PCR result becomes available. She was admitted with complains of difficulty of breathing with desaturation. Her body mass index is 12.8 which is underweight. Pertinent physical examination shows bilateral coarse crackles with clubbing which suggest a chronic disease. Complete work up was done. Echocardiography which revealed an ejection fraction of 74%, severe pulmonary hypertension with dilated right atrium and right ventricle. Chest radiography revealed bronchiectatic changes with infiltrates while a confirmatory chest computed tomography scan revealed post infection pulmonary fibrosis with cystic bronchiectasis both lung fields. Spirometry revealed a severe obstructive ventilatory defect with no response to bronchodilator and a probable restrictive ventilatory defect which explains why the patient had higher frequency of admissions. Paranasal sinus xray to rule out Kartagener's syndrome was done which revealed normal results. Microbiologic studies such as sputum TB culture and sputum gene xpert was negative. The sputum culture revealed Stenotrophomonas maltophilia which was treated with intravenous antibiotics. To rule out other possible differentials for the cystic bronchiectasis, karyotyping was facilitated which revealed a normal female karyotype (46 XX). She was managed as a case of cor pulmonale, post tuberculous bronchiectasis, bacterial pneumonia, with considerations of mucociliary defects such as cystic fibrosis. It was unfortunate that a sweat chloride test was not done as it was not available in the country. Conclusion: In a country with endemic infectious pulmonary diseases such as tuberculosis, there is an anticipated sequelae of post infection bronchiectasis and fibrosis. Even if resources are scare and diagnostic tests are limited, repeated lung infection in a young patient warrants further investigation as congenital causes of structural lung diseases may initially present as an infectious process. (Figure Presented).