Role of SARS-CoV-2 in asthma exacerbations

Asthma is one of the most common chronic respiratory diseases in the world and there is great concern about the effect of COVID-19 infection on asthma severity and control. Although the link between asthma and COVID-19 infection remains to be determined, available data indicate that asthma does not seem to be a risk factor for severe COVID-19. This review aims to summarize the updated data about the association between viral infections and asthma exacerbations including COVID infection and management of asthma flare-ups during the COVID pandemic, based on the recommended asthma guidelines.Copyright © 2020 Bilimsel Tip Yayinevi. All rights reserved.

Singing for people with advance chronic respiratory diseases: Qualitative meta-synthesis

Introduction/Aim: Although there remains insufficient evidence regarding singing programs as effective strategies for achieving clinically significant health outcomes, this non-pharmacological intervention appears to be subjectively low-risk and well-tolerated by people with advanced chronic respiratory diseases (CRD). Method(s): A meta-synthesis was undertaken to examine the current qualitative evidence regarding the experiences of singing for lung health programs in adults with advanced CRD and their careers. Electronic databases (Medline, CINAHL, PsycINFO, and EMBASE) were searched for qualitative studies published in English. Qualitative data was extracted and analysed, which generated descriptive and analytical themes. Result(s): Themes identified from seven included studies consisted of anticipation and reluctance to participate;physical and psychological benefits;new sense of purpose and enjoyment;social connection and achievement;and broad views regarding program structure and content. The themes were categorised into three time points to explore participants' perspectives before, during and after engaging in the singing program. Over time participants transitioned from anxiety to mastery of their chronic condition as the singing program progressed. Participants, however, raised concerns regarding several singing technicalities, the lack of ongoing support after the singing programs' conclusion and the social impacts of transitioning the sessions online during the COVID-19 pandemic. Conclusion(s): The increasing body of qualitative literature suggests that participants enjoyed the singing program and derived psychological, social and health benefits, not necessarily captured in quantitative studies. Future work should explore participants' experiences through qualitative, longitudinal methods to gain further insight into the acceptability and feasibility of singing programs and inform broader implementation of the intervention.

Comparison between in-person and remote assessment of four field tests for people with chronic lung diseases

Introduction: COVID-19 pandemic has driven an abrupt shift from centre-based pulmonary rehabilitation to home-based or telerehabilitation models in order to safely deliver this important treatment. However, functional capacity assessment is still carried out with in-person supervision. Aim(s): To compare remote and in-person assessment of four field tests for patients with chronic lung diseases. Method(s): People with chronic respiratory diseases underwent timed up and go test (TUG), 5-repetitions sit-to-stand test (5-repStS), 1-minute STS (1-minStS), and modified incremental step test (MIST). Tests were carried out at participants' home with in-person or remote (Skype or WhatsApp) assessment, in random order. During the remote assessment, the physiotherapist was at the pulmonary rehabilitation centre. The order of the tests was also randomized and was the same for in-person and remote supervision. Each test was performed twice and the test with best performance was used for comparison between remote and in-person supervision. A kit containing a finger pulse oximeter, tape measure, and a step was provided. Pair t -test expressed as mean difference (95% CI), intraclass correlation coefficient (ICC 2:1), and Bland-Altman method were used for analysis. Result(s): Forty-four participants (23 COPD, 18 bronchiectasis, three cystic fibrosis, FEV 1 47 +/- 19%, 56 +/- 15 years old) were assessed. There was no difference between in-person and remote supervision for all tests (TUG 0.04(-0.2-0.2) s, 5-repStS: 0.3(-0.1-0.7) s, 1-minStS: -0.9 (-1.9-0.1) repetitions, and MIST: -3.1 (-9.9-3.7) steps). High reproducibility was observed by ICC (95% CI) (TUG: 0.94 (0.89-0.97), 5-repStS: 0.96 (0.92-0.98), 1-minStS: 0.87 (0.77-0.93), and MIST: 0.94 (0.88-0.96). Limits of agreement were narrow for TUG (-0.8-1.7), 5-repStS (-2.3-2.9), and 1-minStS (-7.4-5.5), but wide for MIST (-46-40). Conclusion(s): Remote assessment provides similar results to in-person assessment for four field tests commonly used in people with chronic lung diseases.

Ultrasonic personal spirometer appears accurate and feasible for remote monitoring

Introduction/Aim: Home spirometry may improve respiratory disease monitoring and management and mitigate the decline in testing exacerbated by COVID-19. Smartphone-connected spirometers could allow patients to conduct spirometry independently without the need to travel to lung function clinics. This study assessed the accuracy of a personal spirometer and the feasibility of unsupervised home spirometry. Method(s): Subjects (19-88 years) with (n = 44) and without (n = 20) respiratory disease, were recruited and supervised to perform spirometry on a standard desktop spirometer (MGC Diagnostics) and a personal ultrasonic spirometer (SpiroHome) in the clinical laboratory. Unsupervised testing was subsequently conducted using the SpiroHome at the subjects' home (2 tests/week for 3 weeks). Subjects returned to the clinic to conduct an exit survey which assessed their willingness to adopt a personal spirometer into their long-term care plan. Comparisons between desktop and personal spirometry, as well as supervised and unsupervised spirometry, were compared by Bland-Altman analysis (%Bias +/- CI) and Pearson's correlation. Result(s): The proportion of tests meeting American Thoracic Society/European Respiratory Society criteria (80%) remained constant across clinic and home spirometry sessions for subjects who completed 3 weeks of home testing (p = 0.73, Fisher's exact test, n = 61). Supervised spirometry on the SpiroHome (n = 56) reliably measured FEV 1 (-3.12+/-27.01%;r=0.98, p < 0.0001) and FVC (-0.38+/-22.91%;r=0.99, p < 0.0001) producing a small underestimation compared to desktop spirometry. Unsupervised home spirometry (when performed <24 hrs from the clinic appointment) on the SpiroHome (n = 51) produced a small underestimation of FEV 1 (-2.41+/-35.57%;r=0.96, p < 0.0001) and a slight overestimation of FVC (0.08+/-24.70%;r=0.98, p < 0.0001) compared with supervised manoeuvres in the clinical laboratory. Conclusion(s): Findings indicate that lung function assessed by SpiroHome compares well with in-clinic standard desktop spirometry across a range of diseases and severities in both the clinic and home settings. A larger cohort of subjects are being recruited to confirm the accuracy and the overall utility of personal spirometry.

Asthma as a comorbid disease in COVID-19

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a novel coronavirus that causes coronavirus disease 2019 (COVID-19). In terms of asthma and COVID-19, there is also a risk of experiencing an asthma exacerbation triggered by coronavirus infection beyond the direct risk of the infection itself. As a comorbid disease, the prevalence of COVID-19 infection in asthma patients is not clear. In addition, the influence of asthma on the severity of COVID-19 has not been reported. The aim of this review was to summarize the reported worldwide data about the prevalence and the clinical characteristics of patients with asthma during COVID-19 infection.Copyright © 2020 Bilimsel Tip Yayinevi. All rights reserved.

Interleukin-6 in SARS-CoV2 risk stratification

Introduction: Since the emergence of COVID19, a broad spectrum of presentation has been described, from the absence of symptoms to critical illness. Some studies show that increased levels of interleukin-6 (IL-6) are correlated with increased mortality and disease severity. Objective(s): To establish the value of IL-6 as an early predictor of severity in SARS-CoV2 infection. Method(s): Prospective study with IL-6 assay as part of the initial study of patients with SARS-CoV2 infection, between 20/10/2021 and 31/01/2022. Two groups were created (I: without hospitalization;II: with hospitalization). Exclusion criteria: chronic respiratory disease, rheumatologic disease and/or inflammatory bowel disease;time between dosing and hospitalization >=72h. Statistics (SPSS v28): Mann Whitney test, AUROC, Spearman correlation. Result(s): Sample of 117 patients (after excluding 10). Group I: 80 patients, 38 (47.5%) were male;mean age of 46.40 +/- 18.85 years old (18-88). Group II: 37 patients, 24 (64.9%) were male;mean age of 72.35 +/- 15.39 years old (29-96). Mean hospital stay of 19.49 +/- 17.02 days;9 (24.3%) were admitted to the ICU. Significantly higher IL-6 values in group II (p<0.001), showing good discriminating power regarding the probability of hospitalization (AUC=0.888;p<0.001) and a statistically significant (p=0.02) positive correlation (0.380) with the length of stay. The optimal cut-off value of IL-6 to establish the need for hospitalization, in our sample, was 12.4 pg/mL (Sensitivity: 97%;Specificity: 69%;Youden index: 0.66). Conclusion(s): IL-6 levels were significantly higher in patients requiring hospitalization and correlated with length of hospital stay. Larger studies are needed to validate its use in risk stratification.

Morbidity and mortality associated with COVID-19 patients from Luanda, Angola

Background: The impact of SARS-CoV-2 infection in Africa is still unclear. Objective(s): Study the diseases associated with COVID-19 morbidity and mortality in Luanda, Angola. Method(s): A cross-sectional study was conducted with 1,683 patients >=18 years old, treated at the Military Hospital in Luanda, from March 2020 to March 2021. The survey includes sociodemographic and clinical data. The chi-square test, Fisher's exact test or logistic regression were performed and considered significant when p<0.05. Result(s): Patients who tested positive for SARS-CoV-2 (39%) were mostly men (64%), mean age 51.2+/-14.7 years. RT PCR positivity was associated with age >=46 years, arterial hypertension and other cardiovascular diseases (aOR:1.75;p<0.001) and Diabetes Mellitus (aOR:1.96;p<0.001) however, HIV infection (aOR:0.26;p<0.001), pulmonary tuberculosis (aOR:0.33;p=0.037) and its sequelae (aOR:0.34;p=0.025) were associated with a protective effect. There were no significant association between SARS-CoV-2 infection and asthma, allergic rhinitis, chronic obstructive pulmonary disease (COPD) or smoking. Of the 663 positive patients, 14% died. The main comorbidities significantly related to mortality were only malignant diseases (aOR:12.00;p=0.023). There were no significant association between COVID-19 mortality and HIV infection, pulmonary tuberculosis and its sequelae, asthma, allergic rhinitis, COPD, or smoking. Conclusion(s): Infectious diseases were associated with a protective effect for SARS-CoV-2 infection and were not associated with mortality, while chronic respiratory diseases were not associated with infection or mortality by COVID-19. Future studies should be carried out to better understand these aspects.

Pulmonary telerehabilitation in patients with chronic respiratory diseases during the pandemic by COVID-19 in Argentina. A multicenter observational study

Introduction: To our knowledge, there are no published studies on the implementation and results of Pulmonary telerehabilitation (PTR) in Argentina. Our objective was to describe PTR strategies used during the COVID-19 pandemic, the results of the different PTR modalities and the patient satisfaction. Method(s): A prospective study was carried out between April and August 2020. Patients who switched to different PTR modalities participated: synchronous (SPTR) or asynchronous (APTR). The level of satisfaction, quality of life with the St. George's Respiratory Questionnaire (SGRQ) and anxiety and depression with the Hospital Anxiety and Depression Scale (HADS) at baseline, 6 and 12 weeks were evaluated. Result(s): 20 centers participated. 299 patients were included (55.9% female), with a median (P25-75) age of 68 (62- 72) years, 184/249 (73.9%) diagnosed with COPD, 37 (14.9%) interstitial lung diseases, 12 (4.8%) asthma and 16 (6.4%) other CRD. 110 (36.8%) patients underwent SPTR and 189 (63.2%) with APTR. No differences were observed in the SGRQ and HADS except in the activities subscale of the SGRQ that increased significantly (p<0.05) in both groups, the impact subscale and the total that increased significantly in the SPTR group at 12 weeks (p<0.01). Both groups reported being satisfied with the PTR, 5.9 (5.4-6.3) in SPTR and 5 (4.6-5.4) in APTR, being significantly higher in SPTR (p=0.004) Conclusion(s): We observed significant satisfaction with PRT during the pandemic. No improvements were seen in quality of life, anxiety, or depression.

Covid19 infection in patients suffering from chronic respiratory diseases

Introduction: The relationship between the severity of SARS COV 2 infections and chronic respiratory diseases remains controversial Aim: To identify the characteristics of SARS COV 2 infection in patients suffering from chronic respiratory diseases Method: a retrospective, and descriptive study including 1190 patients that were hospitalized for COVID19, from March 2020 to March 2021. Result(s): Among 1190 patients, one hundred and nineteen (10%) had chronic respiratory disease. Male gender was dominant. Asthma and COPD were the most identified conditions (N=64) and (N=47) respectively. Other comorbidities were identified like hypertension (37,8%) and diabetes (12,6%). The most described symptoms were dyspnea (69.8%), cough (52.9%), and digestive symptoms (20.16%). The most common chest CT findings were ground-glass opacities (68.65%) with moderate (31%) to severe (28,5%) scores. More severe CT scores were identified among asthmatics (P = 0.009). Death occurred in 19.6% of cases and 17% of patients needed intensive care transfer, non-invasive ventilation and they suffered from COPD in 70% of cases. However, we notice that asthma was related to severe radiological scores compared to COPD, probably due to bacterial infection because of inhaled corticosteroid use but with a better prognosis. Hypercapnia in COPD and OHS may worsen the scene. Conclusion(s): Many studies proved that asthmatics are less prone to have severe clinical forms of COVID19. It is probably thanks to corticosteroid use. More studies are needed to explain the lack of these protective effect in other inhaled corticosteroid users.

Validation of the one minute sit to stand test(1MSTS)for identification of exertional oxygen desaturation in chronic respiratory disease

Background: Despite limited validation data (Kalin et al Systematic Reviews 2021 Mar 16;10(1):77), the 1MSTS was widely used as a rapid exercise test to assess exertional oxygen desaturation during the COVID-19 pandemic. Aim(s): To assess the diagnostic accuracy of the 1MSTS to detect significant exertional oxygen desaturation in people with chronic respiratory disease. Method(s): 99 patients referred for pulmonary rehabilitation assessment were assessed for ambulatory oxygen requirements using a shuttle walk test according to British Thoracic Society Guidelines for Home Oxygen Use. Exertional oxygen desaturation was defined as a drop in oxygen saturations (SpO ) of >=4% with nadir <90%. 1MSTS was conducted in each participant by an assessor blinded to ambulatory oxygen assessment results. Result(s): Mean(SD) age 68.9(11.4) years, 59%COPD, 13%ILD. 21% demonstrated significant exertional oxygen desaturation. Using a drop of SpO >=4% to nadir <90% threshold, the 1MSTS only identified 6 out of 21 patients with exertional oxygen desaturation (sensitivity 29%). Simplifying the threshold to a drop in SpO of >=4% alone during 1MSTS improved sensitivity to 81% with specificity of 87%. Conclusion(s): Using a threshold of drop in SpO of >=4%, the 1MSTS test had reasonable sensitivity and specificity identifying significant exertional oxygen desaturation in patients with chronic respiratory disease.

Analysis of COVID-19's Effects on the Incidence of Chronic Respiratory Symptoms in KPK

Introduction: Pakistan has a high prevalence of chronic respiratory disorders, including bronchial asthma and chronic obstructive pulmonary disease (COPD). Objective(s): Finding the effect of COVID-19 on chronic respiratory disease in Pakistan is the study's key goal. Material(s) and Method(s): From February 2021 to December 2021, this cross-sectional research was carried department of pulmonology at HMC hospital Peshawar A specified To differentiate between the COVID-19 era and the period preceding it, a set of criteria in the form of a questionnaire was applied. Result(s): A total of 157 participants contributed to the data set. Patients who tested positive for COVID 19 were additionally asked about their experiences with respiratory co morbidities. More than a third of respondents mentioned COPD as a co morbidity;many also mentioned bronchial asthma, ILD, and tuberculosis (TB). Conclusion(s): COVID-19 would certainly increase chronic respiratory disorders in Khyber Pakhtunkhwa. The pandemic might increase respiratory disorders, strain health systems, and cost people impacted. Increase public health awareness and ensure chronic respiratory illness patients get proper treatment and resources to address these issues. To decrease the pandemic's effect on Khyber Pakhtunkhwa's population, early respiratory disease identification and treatment techniques are needed.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.

Feasibility study of home-based pulmonary rehabilitation (PR)in Bangladesh

Aim: PR is an integral part of chronic respiratory disease (CRD) management. Evidence on the effectiveness, applicable components, and deliverable models have generated from high-income countries a different clinical context from low- and middle-income countries. Informed by global PR guidelines, a systematic review and stakeholder engagement, we adapted a PR programme to home-based (because of COVID) in a low-resource setting. This feasibility study tested the PR programme in Bangladesh. Method(s): Intervention was, assessment at the PR centre, twice-weekly tele-supervised sessions for 8 weeks at home. Primary outcomes were Endurance Shuttle Walk Test (ESWT) and COPD Assessment Test (CAT). Nonparametric tests were used to compare pre-and post- outcomes using SPSS version 26. Result(s): 51 participants (33 male;mean age 55yrs (SD 12)) were recruited with a range of CRDs. 40 completed the final assessment (COVID deterred eight follow-ups). Both ESWT and CAT improved by more than the minimum clinically important difference (MCID). Conclusion(s): Home-based PR is feasible in the Bangladesh context and associated with significant improvements in functional exercise capacity and health-related quality of life.

Risk factors for mortality in COPD patients with COVID19 admitted to Intensive Care Unit

Background and aim: Patients with Chronic obstructive pulmonary disease (COPD) and COVID-19 have increased risk of hospitalization and Instensive Care Unit (ICU) admission (1). Aims and objectives: To indentify risk factors for intrahospital mortality in COPD patients with COVID-19 admitted to Spanish ICUs. Method(s): Demographic and clinical data during ICU admission were recorded using REDCap on all patients hospitalized for COVID-19 in 70 Spanish ICUs (2). We described the baseline clinical characteristics of COPD compared to other chronic respiratory disease (CRD) and to the overall population. We identified the risk factors for intrahospital mortality of COPD patients receiving invasive mechanical ventilation (IMV) and for those COPD receiving noninvasive respiratory support (NIRS). Result(s): Two hundred and sixty-eight ICU patients (5%) had COPD out of 5196 included. No differences were found between COPD, CRD or the overall population in the rates of IMV (76-78%) vs NIRS (22-24%). COPD intrahospital mortality was much higher in the IMV subgroup (58%). Independent risk factors for intrahospital mortality in the COPD+IMV or COPD+NIRS were: age and chronic Kidney disease or hypertension, respectively. Previous NIRS in COPD+IMV group was protective for intrahospital mortality (Figure). Conclusion(s): New strategies are needed to reduce the high intrahospital and 90-days mortality of COPD COVID-19 patients admitted to ICU.

The Importance of CMV Reactivation in COVID-19-Related ARDS Patients

Objectives: Cytomegalovirus (CMV) reactivation is a significant cause of morbidity and mortality in critically ill patients. Existing or newly developed immunosuppression appears to be the main factor for reactivation. COVID-19 patients with acute respiratory distress syndrome can be affected by a variety of conditions that cause immunosuppression. Clarifying CMV reactivation and notably its predictive features became important during the epidemic. Method(s): This is a retrospective, observational, and cohort study. All COVID-19 patients admitted to the ICU between March 11, 2020 and March 11, 2021 were analyzed. All of the information was gathered from the hospital's electronic records. CMV reactivation was defined as CMV DNA >=1000 copies/ml in tracheal samples. The patient population was analyzed in two groups, namely, patients with CMV reactivation and patients without reactivation. Result(s): During the study period, 99 of all COVID-19 ARDS patients fulfilled the inclusion criteria, and CMV reactivation was detected in 55 (55.6%) of them. Age, BMI, APACHE-II score, hypertension, chronic respiratory disease, the usage of interleukin blockers, the duration of steroid usage, procalcitonin (PCT), and CD-8 T-cell levels differed significantly from the patients without CMV reactivation. Furthermore, the reactivation group had longer ICU stays, longer durations of mechanical ventilation, and higher mortality. Conclusion(s): CMV can be reactivated in critically ill COVID-19 ARDS patients, which appears to correlate with worse outcomes. Obesity, the usage of IL-blockers and steroids >12 days, high PCT, and low CD-8 T-cell levels appear to be risk factors. Critically ill COVID-19 patients should be closely monitored with regard to immunosuppression and CMV status.Copyright © 2022 by The Cardiovascular Thoracic Anaesthesia and Intensive Care.

Seroprevalence of COVID-19 among out patients with chronic respiratory disease in a tertiary care hospital in India

Background: Unexpectedly, COVID-19 was less prevalent in Chronic Respiratory Disease(CRD) than in the general population (Gupta N et al. Lung India. 2021;38(5):454-9). The vaccine and infection-related immune status of CRD patients is unknown. Aims and Objectives: Our primary objective was to study the cross sectional seroprevalence among chronic respiratory disease patients attending the Pulmonary medicine outpatients service and comparing it with the national seroprevalence data. Method(s): Consecutive subjects with CRD were recruited. History of past COVID 19 infection and other relevant information was obtained. Blood sample was taken for Roche Elecsys SARS-CoV-2 assay to detect anti-N and anti-S antibodies. Result(s): We recruited 364 patients(Asthma & COPD-100 each, Bronchiectasis, ILD & PTB-sequelae- 50 each and other restrictive diseases-14). The overall seroprevalence in CRD(Anti-S) was 85.16%, which was significantly higher than the 4th national serosurvey seroprevalence of 67.60%(p=0.001) (ICMR, Ministry of Health and Family Welfare;2021). Asthma had the highest seroprevalence, which was higher than COPD [93% vs 78%, p=0.027] and bronchiectasis [93% vs 80%, p=0.018]. Seroprevalence dropped with increasing age: <40 yrs: 93%, 41-60 yrs: 87% and >= 61 yrs: 77% (p=0.004). Patients on inhaled-steroids had higher seroprevalence than those without (89% vs 80%;p=0.026) and those on inhaled-anticholinergics (89% VS 79%;p=0.013). Conclusion(s): COVID-19 seroprevalence is higher in CRD than in the general population. Asthmatics had the highest prevalence and the seroprevalence dropped with increasing age.

Home-based pulmonary rehabilitation for patients with chronic respiratory diseases in Malaysia: A feasibility study

Introduction: Chronic respiratory diseases (CRDs) are growing problems worldwide. Pulmonary rehabilitation (PR) has proven benefits for patients with CRDs, but programmes need to be adapted to low resource settings, in the context of the recent COVID-19, to home-based delivery. Aim(s): To evaluate the feasibility of delivering home-based PR for patients with CRDs in Malaysia. Method(s): We recruited people with CRD from two hospitals in Klang Valley, Malaysia to home-based PR programme. Patients were provided education sessions, and assessments [functional exercise capacity {6-Minutes walking test (6MWT)}] and [Health-Related Quality of Life (HRQOL) {COPD Assessment Test (CAT)}] were made at centres prior to the start of programme. They performed exercise at least 5 sessions per week for 8 weeks at home and were supervised weekly via phone calls. Post PR, we assessed the attendance and retention rate and measured 6MWT and CAT at centre. Result(s): We recruited 30 patients. The retention rate was 93.3%;2 dropped out due to hospitalization. However, only 11(36.7%) attended post PR assessment at centres, of these 9 (81.8%) had performed all 40 sessions of home exercises. The attendance for post- PR assessment was limited due to COVD-19 restrictions that forbade travel in Malaysia at that time. Data from the 11 patients showed significant change in CAT scores, 5.09;pre: 22.45, post: 17.36(95% confidence interval (CI) 1.48, 8.70, p=0.01) but no significant change in 6MWT distance -24.36;pre: 276.36, post: 300.72(95% CI -80.52,-31.79, p=0.356). Conclusion(s): Home-based PR is feasible and can be a valuable method to deliver PR remotely.

Outcome of patients admitted in Covid ICU during first wave and second wave in Mumbai Tertiary Hospital

Introduction: India has recorded over 4.23 Crores of COVID -19 cases and 5.04 lakh deaths till now. Available literature shows mortality in Covid ICU of 30-35%. Aim(s): To study mortality and comorbidities in Covid Pandemic First & Second wave. Methodology: In this retrospective study conducted at Covid ICU in Mumbai, all patients needing ICU admission were enrolled. We studied 214 Covid patients in first wave and 97 patients in second wave. Covid patients (pts) with breathlessness, fever, sore throat were included. Patients with underlying chronic respiratory lung diseases were also treated as per standard Covid protocol. Result(s): Of the 214 patients in first Covid wave, 210 patients needed high flow oxygen (92.51%);180 pts needed NIV (82.94%);30 pts needed Mechanical Ventilation (MV);28 pts expired (13.33%). Most patients belonged to sixth decade. The major co morbidities in dead pts were diabetes (33.33%) followed by hypertension (24.20%). Comorbidities of chronic respiratory diseases were COPD (12.1%), post TB sequelae (3%) and tuberculosis (3%) In 2nd covid wave(n=97), 95 needed oxygen. 67 needed NIV (69.07%) and 28 needed MV (28.86%). Of these, 25 pts expired (28.86%). The major comorbidities in dead pts were hypertension (38.3%), followed by diabetes(25.5%). In chronic respiratory diseases, COPD (4.3%) was the most common comorbidity. Conclusion(s): The COVID-ICU mortality was high at 13.33% (first wave) and 28.86%(second wave). Pt's mean age was 56.0 yrs and 63.5 yrs in first and second wave respectively. Respiratory failure with high oxygen requirement and ARDS were leading causes of deaths. Comorbidities like diabetes and COPD had high mortality.

Trajectories of respiratory recovery after severe SARSCoV-2 infection (RE2COVERI): a pragmatic, longitudinal cohort study

Background: Severe COVID-19 survivors may exhibit functional impairment, radiological sequelae and persistent symptoms at short to mid-term follow-up. Aim(s): To determine the trajectories of respiratory recovery after severe COVID-19, and factors that could influence it. Method(s): Prospective, multicentre, longitudinal cohort study of adult patients hospitalized for severe COVID-19 (LOS >= 7d, oxygen flow >= 3L), evaluated at 3 months from hospital discharge with conditional follow-up at 6 and 12 months. Result(s): 486 participants from 13 French hospitals were included (median age 61y;female sex 27%): 173 needed oxygen only, 96 required non invasive ventilatory support and 217 were intubated. 454 (93%) patients were evaluated at 3 months, whereas 294 (60%) and 163 (34%) were followed up at 6 and 12 months, respectively. At 3- months assessment, a restrictive lung defect, an altered diffusion capacity and significant radiological abnormalities were observed in 33%, 71% and 57% of the cases, respectively. In case of extended follow-up, FVC (% pred.) increased by 4 points at M6 and by 7 points at M12, in mean;DLCO (% pred.) by 5 and 7 points, respectively. Age, sex, obesity, immunodepression, chronic cardiac or respiratory disease, initial extension of pneumonia and mechanical ventilation over 14 days were associated with lung function at 3 months but not with respiratory trajectories from this time point. Conclusion(s): A systematic follow-up seems justified after a severe COVID-19, especially in patients with extensive radiological lesions during acute illness. Pulmonary function and residual radiological abnormalities may improve up to 1-year after hospital discharge. Covid-19 A.

Neutrophil-to-lymphocyte : a useful biomarker for predicting severity in coronavirus disease-2019 (COVID19)

Introduction: The worldwide novel coronavirus disease-2019 (COVID-19) pandemic has caused great loss of lives. Many studies are focusing on the identification of the risk factors associated with COVID-19 severity. Objective(s): This study aims to assess the association between the neutrophil-to-lymphocyte ratio (NLR) and the incidence of severe COVID-19 infection. Method(s): A retrospective study was conducted on 356 patients who were admitted to our pulmonology department from September 2020 to December 2021 for COVID-19 pneumonia confirmed by RT-PCR. Sociodemographic information, clinical and radiological features as well as blood test results were collected from medical records. Data were entered and analyzed using SPSS 18.0 software. Result(s): The mean age was 63,51 +/- 13,80 years, and 152 cases were females. Cough (64,7%) and dyspnea (75,1%) were the two most common symptoms. The cut-off value for elevated NLR was 6,8. Elevated NLR was found in 176 (51,9%) patients. This parameter was associated with obesity (p=0.025), a high rate of intensive care requirement (p=0.044), and an exacerbation of chronic respiratory diseases (p=0.037). A CRP rate higher than 100 mg/L and elevated LDH values were positively associated with elevated NLR (p=0.026 and p=0.016 respectively). Conclusion(s): This study showed that NLR could be identified as a powerful biomarker for early identification of patients with COVID-19 who are at high risk of poor clinical outcomes.