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Autoimmune pulmonary alveolar proteinosis (PAP) is a rare disease, especially in pediatrics, but important to consider, as it may avoid unnecessary and/or invasive investigations and delayed diagnosis. This case report highlights an adolescent girl with rapid onset dyspnea but an unremarkable physical exam and initial testing. However, due to a high index of suspicion, a chest computed tomography (CT) scan was done, revealing a "crazy paving" pattern, which then prompted expedited assessment. This finding, however, is not as specific as often discussed and has a broad differential diagnosis, which will be reviewed in detail as part of this case. Furthermore, this report demonstrates a diagnostic approach for PAP that avoids lung biopsy, previously considered to be required for diagnosis of PAP, but is increasingly becoming unnecessary with more advanced blood tests and understanding of their sensitivity and specificity. Additionally, management strategies for PAP will be briefly discussed.Copyright © 2022 Canadian Thoracic Society.
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Introduction: In acute respiratory distress syndrome (ARDS) inhomogeneities in lung aeration can act as local multipliers of pressure during inspiration (stress risers), increasing the risk of lung damage even in presence of airway pressures considered safe [1]. In this study we aimed to describe lung inhomogeneities in COVID-19 related ARDS (C-ARDS) and to relate these to disease severity and lung morphology. Method(s): We enrolled patients with C-ARDS within 3 days from mechanical ventilation start, deeply sedated and paralyzed. Lung CT scan was obtained at PEEP of 5 cmH2O to measure lung weight compartments (non-, poorly-, well- and over-aerated). Lung inhomogeneities were computed as the gas/tissue ratio of each voxel compared to the neighboring voxels. We considered values > 1.61 as pathologic lung inhomogeneities, as previously described [1]. The fraction of total lung volume with pathologic inhomogeneities (extent) and the average severity of inhomogeneities contained in that fraction (intensity) was calculated. Respiratory system compliance and blood gas analysis were obtained at the same PEEP level of the CT scan. Some results have been presented in another publication [2]. Result(s): Forty patients were studied in the supine position 1 (0-1) days after ICU admission. The extent of pathologic lung inhomogeneities represented 18 +/- 4% of total lung volume. The intensity of pathologic lung inhomogeneities was on average 2.53 +/- 0.12. Extent was positively correlated with the amount of poorly aerated lung weight ( r2 = 0.51, p < 0.001) (Fig. 1) and negatively correlated with the amount of non-aerated lung weight ( r2 = 0.22, p = 0.002). No correlation was found between extent and intensity and PaO2/ FiO2, dead space fraction or respiratory system compliance. Conclusion(s): In C-ARDS lung inhomogeneities represent roughly 20% of total lung volume. In these regions local stress is increased with risk of secondary lung damage.
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Purpose of Study: The post-acute sequelae of COVID-19, as a multisystemic disease have been described in adults. Although some studies have described the pulmonary complications up to 3 months post-COVID infection, longitudinal data on pulmonary sequalae are sparse. The objective of this review was to summarize the findings of studies that included a longitudinal follow-up of patients with moderate to severe pulmonary COVID-19 infection. Methods Used: We performed a literature search using Pubmed, Google Scholar and Medline using key words: "pulmonary function test", PFT?, "long-COVID", longitudinal? and sequalae?. We included studies of adult patients (>18 years of age) who had been hospitalized with acute COVID-19 infection and had at least two follow-ups with PFT measurements, including one follow-up at least 6 months post-infection. Studies that did not account for co-morbidities and other lung diseases or those which only included one-time follow-up were excluded. Summary of Results: Five studies satisfied our inclusion criteria (See Table). The studies showed persistent lung injury for at least 3 months after discharge, with decreased forced expiratory volume (FEV1), total lung capacity (TLC), forced vital capacity (FVC), diffusion vital capacity of the lungs for carbon monoxide (DCLO) and carbon monoxide transfer coefficient (KCO). Although these values improved at 6 and 12 months of follow-up, those with more severe disease continued to have decreased DLCO suggestive of restrictive lung damage. Studies that included symptomatic assessment revealed that a minority of patients continued with fatigue and dyspnea uf to 12 months after the infection. The limitations of the studies include availability of data from a single center, small sample size and the variability in controlling for different co-morbidities. In addition, baseline PFT measurement before COVID-19 infection was not available for most patients. Most of the studies were done at the time that the Delta variant was dominant, therefore the data may not be applicable to other variants. Conclusion(s): Our literature review shows that some adult patients hospitalized with acute covid pulmonary infection continue to have abnormal PFTs for up to 12 months after infection. Although PFTs improve overtime, a minority of patients with more severe disease on admission continue with abnormal functional abnormalities, specifically restrictive ventilatory pattern with impaired DLCO at 12 months of follow-up. It is important that patients hospitalized with moderate to severe pulmonary COVID-19 infection be followed up and managed for at least 12 months after the initial infection. Larger prospective studies including different variants of COVID-19 that take into account various co-morbidities and different management strategies are warranted.
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The lung is the most common organ affected by sarcoidosis. Multiple tools are available to assist clinicians in assessing lung disease activity and in excluding alternative causes of respiratory symptoms. Improving outcomes in pulmonary sarcoidosis should focus on preventing disease progression and disability, and preserving quality of life, in addition to timely identification and management of complications like fibrotic pulmonary sarcoidosis. While steroids continue to be first-line therapy, other therapies with fewer long-term side-effects are available and should be considered in certain circumstances. Knowledge of common clinical features of pulmonary sarcoidosis and specific pulmonary sarcoidosis phenotypes is important for identifying patients who are more likely to benefit from treatment.Copyright © ERS 2022.
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In patients who have recovered from COVID-19, the functional impairment and prolonged symptoms of dyspnea, cough, weakness and fatigue can persist for a long period. The aim of this study was to evaluate functional capacity, respiratory muscle and hangrip strenght, pulmonary function tests and pulmonary rehabilitation outcome in patients recovering from COVID-19 disease. Study included patients recovering from COVID-19 diasese who attended standard in-person pulmonary rehabilitation program (PRP) five days a week, for three weeks. Patients were recruited during six months period, mainly treated on an outpatient basis for acute COVID-19 disease without previously recorded lung disease, and the reason for referral to PRP was dyspnea and exercise intolerance. Pulmonary function testing (spirometry, diffusing lung capacity for carbon monoxide, body pletysmography), maximum static inspiratory pressure (Pi max), maximum static expiratory pressure (Pe max), 6-minute walking test (6MWT) and handgrip musle strength were performed. There where 87 patients (40 male and 47 female), with mean age of 52,3 years. Average results of pulmonary function tests and Pe max prior to PRP showed no limitations, with reduced Pi max (73 cmH2O, 68%) and 6MWT distance (435m, 77%). There were statistically significant difference in 6MWT distance, Pi max and Pe max, hand grip muscle strength prior and after PRP (p<0.05). Patients in our study had exercise intolerance and decreased inspiratory muscle strength prior PRP with significant improvement after PRP. Our study shows that pulmonary rehabilitation is effective and important in patients recovering from COVID-19 disease.
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Background: Despite recovery from COVID-19,concern remains that some organs, including the lungs, might have long-term impairment following infection. Aim(s): Assess symptoms,pulmonary function,exercise capacity and chest HRCT changes in non-intubated patients hospitalised with severe COVID19 pneumonia at 3months. Method(s): In this prospective,longitudinal study,patients admitted to hospital for severe COVID19 who did not require mechanical ventilation were prospectively followed up at 3months after discharge from respiratory department Rabta Hospital of Tunis. During the follow-up,patients were interviewed and underwent pulmonary function tests(PFT),chest high-resolution CT(HRCT)and 6-min walk distance test(6MWT). PFT included:diffusing capacity of the lungs for carbon monoxide (DLCO);forced vital capacity(FVC);forced expiratory volume in 1 second (FEV1) and total lung capacity (TLC). Result(s): Between June 1st, and august 31, 2021;47 patients (mean age 56 +/- 12 years;sex ratio 0.74)were included. At 3 months, the most common persistent symptoms were dyspnea(78.7%),cough(46.8%),fatigue(36.2%) and anxiety(17%). Abnormal HRCT findings were pulmonary fibrosis (4%),ground glass opacities(42.5%) and consolidation(32%). Median FVC, FEV1 and TLC were respectively 97% (53-119%), 87.5% (30-120%) and 87% (72- 127%). DLCO was below the lower limit of normal in 12.7% of patients. During 6MWT, the average walked distance was 480 meters [120-680];22 patients (46.8%) showed reduced physical capacity. Conclusion(s): At 3 months after severe COVID pneumonia,a substantial number of patients still have respiratory symptoms with radiological and functional impairment. A long-term monitoring is mandatory.
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Respiratory symptoms and functional disorders are registered in patients who suffered from COVID-19 (COronaVIrus Disease 2019). Aim. Clinical and functional evaluation of the respiratory system during 6-month follow-up in patients who had moderate and severe COVID-19. Methods. 80 patients were included in the cohort observational prospective study. Patients were examined in 46 (36 - 60) days from the onset of symptoms of COVID-19 and in 93 (89 - 103) and 180 (135 - 196) days at the 2nd and 3rd stages respectively. At all stages, symptoms, dyspnea level, and quality of life were analyzed using validated questionnaires, and a 6-minute step test was performed. At the 2nd and 3rd stages, we assessed spirometric parameters, total lung capacity, carbon monoxide diffusing capacity (DLCO), and high resolution computed tomography scans of chest organs. Results. At the 1st stage of the study, 62% of patients complained of fatigue, muscle weakness, 61% of patients had dyspnea of variable severity. At the 3rd stage of the study, 43% and 42% of patients had the same complaints respectively. The prevalence of moderate COVID-19 form in patients with 35 (25 - 45)% lung damage and severe COVID-19 form with 75 (62 - 75)% of lung damage was established. At the 2nd stage, a DLCO < 80% level was recorded in 46% of patients with 35 (25 - 45)% lung damage and in 54% of patients with 75 (62 - 75)%. At the 3rd stage, DLCO < 80% was diagnosed in 51.9% and 48.1% of patients with of 35 (25 - 45)% and 75 (62 - 75)% lung damage respectively. The level of DLCO < 60% was found in 38,5% and 35,5% of patients with moderate and severe lung damage at the 2nd and 3rd stages of the study respectively. Conclusion. The symptoms were reported less frequently during the 6-month follow-up after COVID-19. 77% and 87% of patients had DLCO < 80% in 93 (89 - 103) and 180 (135 - 196) days after the disease onset, respectively. 38.5% and 35.5% of those patients, predominantly having suffered COVID-19 in severe form, had DLCO < 60% at 93 (89 - 103) and 180 (135 - 196) days, respectively. This calls for a continuous observation and regular examinations after COVID-19.Copyright © 2022 Leshchenko I.V., Glushkova T.V.
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Besides parenchymal changes that have been described extensively in COVID-19, bronchiectasis is also reported but detailed characterization of airway changes is lacking. Hence, we aimed to quantify the number of visible airways and their diameters in end-stage COVID-19 lungs. Explanted right lungs, obtained after lung transplantation (n=2) or autopsy (n=1) (65.3+/-26.7 days after symptom onset), were inflated to total lung capacity, frozen and scanned with whole lung microCT (155 mum). Airways were segmented using Mimics Innovation Suite (Materialise, Belgium) and airway count and diameter were assessed using Neuronstudio. Three discarded donor lungs were used as controls. Number of visible airways increased in COVID-19 lungs compared to controls (fig.1a) potentially caused by airway remodeling and bronchiectasis (fig.1b, red arrows) due to fibrotic rearrangement (fig. 1b). Small airway count (diameter 0-2 mm) in generation (G) 1-11 was lower in COVID-19 patients compared to controls, with a shift of small airways from lower generations (G1-11) to higher generations (G12-27) in COVID-19 patients. Simultaneously, airways with a diameter > 2 mm were increased in all generations in COVID-19 (present until G21 compared to G13 in controls). This study shows that COVID-19 causes a remodeling of the (small) airways, leading to an increase of visible airways and diameter of large and small airways, similar to that seen in idiopathic pulmonary fibrosis due to traction bronchiectasis. (Figure Presented).
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Background: The evolution of SARS-CoV-2 pneumonia is unpredictable and patient-dependent. The aim of our study was to assess the clinical, radiological, and respiratory functional outcomes three months after the diagnosis of hypoxemic pneumonia due to SARS-CoV-2. Method(s): Retrospective study conducted on the records of adult patients hospitalized in COVID-19 medical units in Mongi Slim La Marsa Hospital, for hypoxemic pneumonia due to SARS-Cov2 during the period from October 2020 to August 2021. Three months after le diagnosis of the pneumonia, all patients have had an appointment for examination, control thoracic CT scan and respiratory function assessment. Result(s): A total of 455 patients was hospitalized for hypoxemic pneumonia due to SARS-Cov2 during the period of study but only 57 (gender ratio M/F= 1,19 ;mean age= 62+/-10 years) had respiratory functional and radiological evaluation at three months. At least one symptom persisted in 58% of patients: dyspnoea (33%), asthenia (12%), dry cough (14%), and diffuse chest pain (9%). Chest CT showed persistent abnormalities in 3/4 of patients: ground-glass opacities (68%), consolidations (14%), pulmonary fibrosis (15%) and reticulations (10%). The mean value of the forced vital capacity (FVC) in percentage relative to predicted values was 81,5+/-15% and that of total lung capacity in percentage relative to predicted values was 87+/-19%. Persistent consolidation lesions were associated with lower FVC in percentage (p=0.009) and persistent dyspnea (p=0.013). Conclusion(s): Persistent thoracic CT scan abnormalities in post SARS-CoV-2 hypoxemic pneumonia are frequent with an impact on respiratory function.
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Introduction: We don't known whether pharmacological treatments and adaptation of ventilatory support has changed the outcomes of intensive care unit (ICU) COVID-19 survivors during the consecutive waves (W) of the pandemics. Aims and objectives: To assess pulmonary functional outcomes, radiologic pattern and quality of life (QoL) in ICU COVID-19 survivors at 3 months, according to W of pandemics. Method(s): Patients admitted to ICU for COVID-19 acute respiratory distress syndrome (ARDS) in 2 university hospitals were prospectively included, and assessed 3 months post discharge by a chest CT Scan, pulmonary function test (PFT), 6-minute walking distance test (6MWDT), respiratory muscle strength (RMS), and Short Form 36 (SF-36) questionnaire. Result(s): 84 ARDS COVID -19 survivors were included. Hospital length of stay was shorter during W3 vs W1 (23.4 +/- 14.2 vs 34.7 +/- 20.8, p= 0.03). Less patients required mechanical ventilation (MV) during W2 vs W1 (33.3 % vs 63.9%, p=0.0038). Three months after discharge, PFT, 6MWDT and RMS were similar, regardless the W (p>0.05). QoL (SF-36) was worse for patients of W1 vs W3 (64.7+/- 16.3 vs 49.2 +/- 23.2, p= 0.0169). On multivariate analysis, MV was associated with decreased total lung capacity (TLC), forced expiratory volume in 1 sec (FEV1), diffusing capacity of CO (DLCO) and RMS (w1,2,3, p<0.05). Low SF-36 score was correlated with low 6MWDT (w3, p= 0.01). Glucocorticoids use was associated with better PFT and chest CT recovery (p=0.00001), and tocilizumab with higher TLC (w1, p=0.03). Remdesevir improved MV duration in w2 (p=0.008). Conclusions At 3 months, PFT remains similar in ICU survivors, regardless pandemic w.
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Background: Knowledge on the long-term impact of COVID-19 pneumonia on pulmonary function is still limited. Aim(s): To describe pulmonary function findings up to 1 year for a cohort of patients admitted with moderate to critical COVID-19 pneumonia and assess the time-course of recovery. Method(s): 162 patients admitted with COVID-19 pneumonia were followed. Initial disease severity was classified as moderate (WHO ordinal scale 3), severe (WHO scale 4) or critical (WHO scale 5-7). Pulmonary function testing, including spirometry, total lung capacity (TLC) and CO diffusion capacity (DLCO), was performed at 6 weeks, 3 months and 1 year after discharge. Groups were compared by Chi-square test. Recovery over time was assessed by paired-samples t-test. Result(s): Pulmonary function tests were obtained after 1 year for 109 patients (37 moderate, 49 severe and 23 critical). DLCO < 80% was found in 51%, FVC<80% in 21% and TLC< 80% in 13%. DCLO <80% was significantly more often found after critical (74%) than severe (50%) or moderate (38%) pneumonia (p=0.03). Mean DLCO improved significantly between 6 weeks and 3 months with further recovery after 1 year (Figure 1). Conclusion(s): Diffusion impairment is the main pulmonary function abnormality after moderate tot severe COVID-19 pneumonia. Recovery occurs over time, but after 1 year DLCO is still below 80% for 51% of cases. (Figure Presented).
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Lung fibrosis quantification from CT scans is prone to large inter and intra observer variability and its correlation with PFT is essential in the definition of disease progression. There is the need for a reliable and reproducible tool for abnormalities quantification. For this reason, a deep learning abnormalities quantification model was used to explore the correlation with PFT in ILD patients. The abnormalities segmentation model is based on 2D U-Net combined with Res Next as encoder and deep supervision and was trained on axial unenhanced chest CT scans of 199 COVID-19 patients and externally validated on 50 COVID-19 patients. Whole lungs were segmented using RadiomiX toolbox. Validation of the quantification performance was explored in a cohort of 20 ILD patients. The model performed the automatic segmentation of all abnormalities and calculate the ratio on the total lung volume ((abnormalities volume/whole lungs volume) * 100). This value is then correlated with the Forced Vital Capacity (FVC) and Diffusion Lung Capacity for carbon monoxide (DLCO) for each patient with Pearson correlation coefficient (rho). The deep learning segmentation algorithm achieved good performances (mean DSC 0.6 +/- 0.1) on the external test set. The percentage volume of disease region correlated with FVC and DLCO were the rho = -0.70402, -0.58133, respectively (P <. 001 for all). The developed algorithm performed similarly to radiologists for disease-extent contouring, which correlated with pulmonary function to assess CT images from patients with ILD. This automatic quantification tool could help in the prognosis and diagnosis of ILDs, based on the lung abnormalities extent.
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Background: SARS-CoV-2 infection induces disturbed airway microbiota during the acute phase of infection that may contribute to persistence of long-term pulmonary sequelae. To date it is unclear if the presence of a disrupted microbiota following severe disease is linked to long-term pulmonary function impairment. This one-year follow-up study investigated the association between airway microbiota and lung function after severe COVID-19. Method(s): In the Swiss COVID Lung study (NCT04581135), we conducted 16S rRNA sequencing on upper respiratory tract specimen obtained by oropharyngeal swabs 3 to 12 months after hospitalisation from 72 subjects (total samples n = 169) with severe COVID-19. Subjects underwent 1 - 3 follow-up visits during which lung function testing was performed to investigate correlation with the richness and composition of airway microbiota. Result(s): Total lung capacity (TLC) was negatively correlated with bacterial richness (p = 0.0081). Recovered COVID-19 subjects with ongoing respiratory impairment (TLC < 80%) showed low phylum heterogeneity with a majority of the dominant taxa being Bacteroidetes (64% of the 50 most abundant taxa in the group). In contrast, the phylum with the largest number of dominant taxa in subjects with TLC >= 80% was Firmicutes (48% of the 50 most abundant taxa in the group). Conclusion(s): Patients with impaired total lung capacity between 3 and 12 months after severe COVID-19 have a distinct oropharyngeal microbiota from those with restored total lung capacity. Future studies need to assess the contribution of microbiota to lung function impairment after severe COVID-19, as airway microbiota analysis may assist monitoring of sequelae and recovery.
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BACKGROUND: The evaluation of COVID-19 systemic consequences is a wide research field in which respiratory function assessment has a pivotal role. However, the available data in the literature are still sparse and need further strengthening. AIM: To assess respiratory function 4-6 months after hospital discharge based on lung disease severity in patients who overcome COVID-19 pneumonia. METHODS: Patients hospitalised either in the Internal Medicine Department (IMD) for moderate to severe disease or in the Intensive Care Unit (ICU) for critical disease underwent spirometry with maximal flow-volume curve, lung volumes, lung diffusion capacity (DLCO ) and six-minute walking test (6-MWT). RESULTS: Eighty-eight patients were analysed: 40 from the IMD and 48 from the ICU. In both cohorts, there was a greater prevalence of male patients. In the IMD cohort, 38% of patients showed at least one altered respiratory parameter, while 62% in the ICU cohort did so (P < 0.05). Total lung capacity (TLC) and DLCO were the most frequently altered parameters: 15% and 33% from IMD versus 33% and 56% from ICU, respectively (P < 0.05). In IMD patients, 5% had only restrictive deficit, 22% had only lung diffusion impairment and 10% had both. In ICU patients, 6% had only restrictive deficit, 29% had only lung diffusion impairment and 27% had both (P < 0.05). ICU patients showed a higher frequency of abnormal 6-MWT (P < 0.05). CONCLUSION: Lung function tests and 6-MWT are highly informative tools for monitoring the negative consequences of COVID-19 pneumonia, which were more frequent and more complex in patients discharged from ICU.
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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: Breathlessness, fatigue, and exertional intolerance can persist for several months in up to 50% people after recovery from SARS-CoV-2 infection. The physiological underpinning(s) of the reduced exercise capacity associated with post-acute sequelae of SARS-CoV-2 infection (PASC) requires further investigation. We characterized pulmonary function relative to normative values and determined the relationship between measures of pulmonary function and peak pulmonary O2 uptake (V̇O2peak) in people with PASC. METHODS: Pulmonary function [including lung diffusing capacity for carbon monoxide (DLCO), and maximal inspiratory pressure (MIP)] and the cardiopulmonary responses to maximal incremental treadmill exercise (CPET) were assessed in ten adults (five females;age 41 ± 11 y;BMI 21 ± 5 kg/m2) with PASC. Time from initial SARS-CoV-2 infection to study enrollment was 6 ± 4 months. At the time of study, participants (n) reported persistent fatigue (9), breathlessness (9), headache (6), chest tightness (4), cough (2), muscle pain (4), palpitations (4), dizziness (5), and nausea (1). RESULTS: There was inter-individual heterogeneity in total lung capacity (TLC;range 68 to 117% predicted), forced vital capacity (FVC;range 73 to 123% predicted), forced expiratory volume in 1 s (FEV1;92 to 109% predicted), and maximal voluntary ventilation (MVV;range 75 to 122% predicted);however, no group mean measure of spirometric function or lung volume was different relative to normative values. Conversely, group mean DLCO (21 ± 9 vs. 27 ± 5 ml/min/mmHg, P = 0.017) and MIP (75 ± 43 vs. 102 ± 18 cmH2O, P = 0.049) were reduced relative to normative values. During the CPET, peak RER and heart rate were 1.16 ± 0.12 and 174 ± 16 beats/min (97 ± 8% predicted), respectively. V̇O2peak was 27.3 ± 6.8 ml/kg/min (90 ± 20% predicted, range 49-122% predicted, V̇O2peak <85% predicted in 4 of 10 participants), and there was no clear evidence of ventilatory or gas exchange impairment to exercise (breathing reserve 49 ± 31 L;minimum SpO2 96 ± 2%;V̇E/V̇CO2 nadir 27 ± 2;∆PETCO2 7.4 ± 2.8 mmHg). There was no relationship between percent predicted V̇O2peak and percent predicted TLC (r2 = 0.061, P = 0.492), FVC (r2 = 0.196, P = 0.200), FEV1 (r2 = 0.173, P = 0.232), MVV (r2 = 0.037, P = 0.595), DLCO (r2 = 0.007, P = 0.836), and MIP (r2 = 0.007, P = 0.820). CONCLUSIONS: Impaired pulmonary function and decreased exercise capacity are present in some but not all people with PASC who report persistent fatigue and breathlessness. Presently, we find no relationship between pulmonary function and V̇O2peak in people with PASC. CLINICAL IMPLICATIONS: Some but not all people with PASC have normal exercise capacity within ~2-12 months after recovery from SARS-CoV-2 infection. CPET may be considered when evaluating the presence and mechanistic underpinning(s) of impaired exercise capacity in such individuals. DISCLOSURES: No relevant relationships by Natalie Bonvie-Hill No relevant relationships by Igor Fernandes No relevant relationships by Augustine Lee No relevant relationships by Amy Lockwood No relevant relationships by Bala Munipalli No relevant relationships by Tathagat Narula No relevant relationships by Brian Shapiro Competitive research grant recipient relationship with Gilead Sciences Inc. Please note: 1 year Added 03/30/2022 by Bryan Taylor, value=Grant/Research Support
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SESSION TITLE: Post-COVID-19 Outcomes SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Alterations in lung function may occur in patients with HIV and who were infected with SARSCoV2. In order to describe this characteristics we created the following groups: Group (1) HIV (+) SARS-COV-2 (+), Group (2) HIV (+) SARS-COV-2 (-), Group (3) HIV (-) SARS-COV2 (+), Group (4) HIV (-) SARS-COV-2 (-). METHODS: In this prospective, longitudinal cohort we included patients with infection with SARS-CoV-2 ( RT- PCR test o Antigen Testing positive) who agreed to participate in the study. Spirometry, diffusing capacity of carbon monoxide (DLCO), body plethysmography, and 6-minute walk test (6MWT) were performed to assess lung function 3 to 6 months after SARS-CoV2 infection, clinical and laboratory characteristics were assesed. We performed descriptive statistics including means and standar deviations for normally distributed continous variables, medians and interquartile ranges for non-parametric distributions, and proportions for categorical variables. The comparisons between groups were made using Fisher´s exact test and Mann-Whitney U for categorical and continous variables respectively. RESULTS: During the between April 2021-February 2022, a total of 104 patients were included. Group (1)44 patients (14 were hospitalized), Group (2)19 patients, Group (3)26 patients (16 were hospitalized), Group (4)15 patients. Hypertension was higher in the Group HIV (-) SARS-COV-2 (+). We didn´t find differences in lung pulmonary function (Spirometry, DLCO, body plethysmography or 6MWT between groups). Spirometry results: FEV1/FVC % Predicted Group 1: 58.0 [25.5, 74.0], Group 2:42.5 [19.5, 65.5], Group 3: 55.0 [38.5, 80.5], Group 4: 35.0 [19.0, 68.5], HIV(+)/HIV(-) p-value: 0.43. DLCO% predicted Group 1: 82.7 [71.5, 90.0], Group 2: 86.7 [76.8, 96.3], Group 3: 85.6 [76.8, 91.6], Group 4: 88.3 [85.7, 98.6], p: 0.199. Total lung capacity (TLC) % of predicted, Group 1: 101 [88.8, 109], Group 2: 99.5 [97.0, 112], Group 3: 102 [94.3, 112], Group 4: 111 [103, 115], p: 0.105. 6MWT: Group 1: 566 [529, 604], Group 2: 595 [548, 622], Group 3: 548 [493, 604], Group 4: 593 [547, 630], p: 0.702. CONCLUSIONS: To our knowledge, this is the first study to characterize pulmonary function in ill COVID-19 survivors with HIV. Our results suggest not difference between the lung function tests performed in patients coinfected with HIV and SARS-CoV 2 compared to patients infected with SARS-CoV2 HIV (-). Limitations, not pre-testing pulmonary function. Inclusion of a greater number of HIV (-) patients who required hospitalization. CLINICAL IMPLICATIONS: Beyond the effects of SARS-CoV2 on HIV outcomes, it is essential to examine whether HIV has an impact on susceptibility to COVID-19 or if it will generate changes that lead to increased sequelae in these patients. It is well known that patients with HIV may be at increased risk of lung function test abnormalities due to the infection itself, as well as some additional exposures. DISCLOSURES: No relevant relationships by Olivia Briceño No relevant relationships by GUSTAVO CASAS no disclosure on file for Mauricio Gonzalez Navarro;No relevant relationships by Alejandro Juárez Díaz No relevant relationships by William C. Lara-Vazquez No relevant relationships by María Isabel León Rodríguez No relevant relationships by JOSE CHRISTIAN RODRIGUEZ HERNANDEZ No relevant relationships by Gonzalo Salgado
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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: Post-acute sequelae of COVID-19 (PASC) infection is an area of active research, and much remains unknown about the trajectory of respiratory system recovery. While chronic dyspnea is a commonly reported PASC symptom, it is unclear how objective lung function metrics change over time. In this study, we sought to in lung function in PASC by comparing serial pulmonary function tests (PFTs) after COVID-19 infection. METHODS: Patients with prior COVID-19 infection and at least two PFTs after acute infection were identified retrospectively from our COVID-19 recovery clinic at a tertiary care center in Chicago, Illinois. PFT data and other clinical information were ed from the electronic medical record. Using a matched paired t-test, the differences between forced expiratory volume at one second (FEV1), forced vital capacity (FVC), total lung capacity (TLC), and diffusion capacity of carbon monoxide (DLCO) were compared over time. RESULTS: There were 32 patients who underwent pulmonary function testing twice after COVID-19 illness from 2020-2022, with a mean age of 56 years. The majority of the cohort were female (59%) and white (56%). 16 patients (50%) had required hospitalization for their acute COVID-19 illness, and 7 (22%) had required ICU level of care. The mean time from illness onset to first PFT was 207 days, and the mean time between the first and second PFT was 204 days. There was a statistically significant increase in FVC (2.2%, p=0.01), TLC (2.2%, p=0.01), and DLCO (2.43 mL/min/mmHg), but not in FEV1. Rate of change was calculated for each patient by dividing the difference for each parameter by the time (in years) between PFTs. TLC improved most rapidly (median 10.9% per year, IQR 0-24), followed by DLCO (median 6.6% per year, IQR -1 – 19.4). FEV1 increased by 3.9% per year (IQR -12.5 – 22), and FVC increased by 5.1% per year (IQR -4.5 – 22.7). Rate of change was calculated for each patient by dividing the difference for each parameter by the time (in years) between PFTs. TLC improved most rapidly (median 10.9% per year, IQR 0-24), followed by DLCO (median 6.6% per year, IQR -1 – 19.4). FEV1 increased by 3.9% per year (IQR -12.5 – 22), and FVC increased by 5.1% per year (IQR -4.5 – 22.7). CONCLUSIONS: There was an improvement in lung function metrics in our PASC cohort. This data describes the rate of improvement for each parameter, which may be helpful in prognostication and counselling patients about expected recovery times. CLINICAL IMPLICATIONS: A large number of patients with PASC experience chronic dyspnea and have persistent radiographic changes and/or abnormal pulmonary function testing. Our data suggests that for patients with abnormal PFTs, there is gradual improvement over time. With the burden of COVID-19 illness worldwide, it is crucial that we can accurately risk stratify those at high risk for persistent symptoms as well as understand the trajectory of recovery. DISCLOSURES: no disclosure submitted for Joseph Bailey;No relevant relationships by Amy Ludwig No relevant relationships by Marc Sala
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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: Coronavirus disease 2019 (COVID-19) often causes radiological and functional pulmonary sequelae. However, evidence on 1-year follow-up of pulmonary sequelae is limited. This study aimed to elucidate (1) the proportion of residual computed tomography (CT) abnormalities 1 year after COVID-19 recovery;(2) characteristics of the remaining CT findings at 1-year follow-up;and (3) the relationship between the disease severity and time course of radiological sequelae. METHODS: We searched PubMed and EMBASE databases on February 25, 2022, and included studies with CT findings at the 1-year follow-up. We collected CT and pulmonary function tests (PFT) data at 1-year follow-up. The residual findings at mid-term (4-7 months) follow-up were also collected when available. The extracted data on CT and PFT findings were analyzed using a one-group meta-analysis. We further analyzed the data in relation to the COVID-19 severity, improvement rate, and lung function. RESULTS: Fifteen eligible studies (N = 3,134) were included. One year after COVID-19, 1,495 patients underwent CT, and 46.0% (95% confidence interval [CI] 32.7-59.4, I2 = 96.9%) presented with residual CT abnormalities. Ground-glass opacity (GGO) and fibrotic-like changes were frequently observed in 27.3% (95% CI 20.1-34.4, I2 =86.7%) and 26.1% (95% CI 14.2-38.0, I2 =94.6%) of the patients, respectively. While the proportion of GGO decreased from the mid-term to long-term follow-up (34.0% [23.4-44.5] to 27.3% [20.1-34.4]), fibrotic-like changes (14.9% [5.1-24.8] to 26.1% [14.2-38.0]), bronchiectasis (12.5% [4.1-20.9] to 13.3% [7.7-18.9]), and interlobular septal thickening (13.2% [2.9-23.5] to 12.8% [7.1-18.5]) did not improve. Furthermore, the frequency of CT abnormalities at 1-year follow-up was higher in the severe/critical cases than in the mild/moderate cases (54.8% [40.6-69.0] vs. 32.2% [1.6-62.7]). In particular, fibrotic-like changes were frequently observed among severe/critical patients 1 year after COVID-19 (30.4% [11.3-49.5]). Regarding pulmonary function tests, 29.9% (22.5-37.3) and 8.0% (5.4-10.6) of the patients presented reduced (< 80% of predicted value) diffusing capacity of the lung for carbon monoxide (DLCO) and total lung capacity (TLC) at 1-year follow-up. These residual PFT abnormalities were more prevalent in severe/critical cases (DLCO: 30.1% [21.1-39.0], TLC: 10.5% [5.0-16.0]) than mild/moderate cases (DLCO: 21.5% [9.6-33.3], TLC: 5.6% [2.6-8.6]). CONCLUSIONS: Our meta-analysis indicated that residual CT abnormalities were common in COVID-19 patients 1 year after recovery, especially fibrotic changes in severe/critical cases. CLINICAL IMPLICATIONS: Physicians should be aware of the high frequency of lung sequelae even 1 year after COVID-19. As these sequelae may last for a long time, vigilant observations and more extended follow-up periods are warranted. DISCLOSURES: no disclosure on file for Koichi Fukunaga;No relevant relationships by Masao Iwagami No relevant relationships by Hiroki Kabata No relevant relationships by Toshiki Kuno No relevant relationships by Matsuo So No relevant relationships by Hisato Takagi No relevant relationships by Atsuyuki Watanabe
ABSTRACT
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