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SESSION TITLE: Occupational and Environmental Lung Disease Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: We describe a case of acute progression of chronic hypersensitivity pneumonitis (HP) in an adult, previously misdiagnosed as COPD for 13 years due to severe emphysematous changes seen on imaging. He was also found to have acutely worsened disease as a result of Covid-19. CASE PRESENTATION: A 64-year-old male presented to the pulmonary clinic with dyspnea on minimal exertion. He reported respiratory complaints for 13 years, treated with 2 L/min of oxygen overnight, and budesonide-formoterol and tiotropium inhalers. These complaints were previously associated with brief occupational mold exposure and possible COPD. His respiratory distress worsened one year ago when he was hospitalized for Covid-19. On discharge, his oxygen requirement had increased to 6 L/min. CT chest showed air-trapping in the mid-zones bilaterally, mosaic attenuation, and peri-bronchial thickening. PFTs showed an FEV1 33% and FVC 55% of predicted, consistent with severe obstruction and reduction in lung volume. As the patient was a lifetime non-smoker, alternative diagnoses were pursued. Alpha-1 antitrypsin levels and immunologic testing, including scleroderma and myositis panels, were within normal limits. Positive findings included CCP IgG/IgA antibodies at 96 units and HP panel positive for pigeon serum antibodies. Prompted by this testing, the patient revealed that he had parakeets in his home for the past 15 years. He also reported significant symptom improvement on occasions that he took a course of steroids. Based on these findings, a diagnosis of chronic fibrotic hypersensitivity pneumonitis with bronchiolitis obliterans was considered. The patient's severe airflow obstruction and respiratory failure precluded surgical lung biopsy. Empiric management was initiated with 30 mg of prednisone daily with a slow taper and instruction to eliminate exposure to exotic birds. DISCUSSION: HP is commonly caused by inhalation of and sensitization to an aerosolized environmental antigen;a common subtype is bird fancier's lung due to repetitive exposure of avian antigen. Continuous antigen exposure increases the risk for development of fibrosis, which was also seen in our patient. The most commonly described radiologic findings in HP are ground-glass opacities, ill-defined centrilobular nodules, and focal areas of air trapping resulting in mosaic attenuation and fibrosis. More than 20% lymphocytosis on bronchoalveolar lavage is also a sensitive tool in detecting alveolitis. The relationship between Covid-19 and disease progression in HP is not well studied. CONCLUSIONS: Chronic hypersensitivity pneumonitis from avian antigens, or Bird fancier's lung, can present with severe emphysematous changes on CT imaging, along with obstructive pattern of PFTs. This should be an important differential, especially in patients who are non-smokers. Covid-19 causes disease progression in HP, this relationship needs to be further explored. Reference #1: Funke M., Fellrath J.-M. Hypersensitivity pneumonitis secondary to lovebirds: a new cause of bird fancier's disease. Eur. Respir. J. 2008;32:517–521. DOI: 10.1183/09031936.00108507 Reference #2: Pereira C., Gimenez A., Kuranishi L., Storrer K. Chronic hypersensitivity pneumonitis. J. Asthma Allergy. 2016;9:171–181. DOI: 10.2147/JAA.S81540 Reference #3: C.S. Glazer, C.S. Rose, D.A. Lynch Clinical and radiologic manifestations of hypersensitivity pneumonitis J. Thorac. Imag., 17 (4) (2002), pp. 261-272. DOI: 10.1097/00005382-200210000-00003 Morell F, Roger A, Reyes L, Cruz MJ, Murio C, Muñoz X Bird fancier's lung: a series of 86 patients. Medicine (Baltimore). 2008;87(2):110-130. DOI: 10.1097/MD.0b013e31816d1dda DISCLOSURES: No relevant relationships by Momina Amjad No relevant relationships by Amit Chopra No relevant relationships by Rafeh Safdar
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Introduction: Around one in every five people in Qatar has bronchial asthma. Asthma may be associated with worse Coronavirus disease 2019 (COVID-19) outcomes. Research Question or Hypothesis: What are the characteristics and outcomes of adult asthmatic patients presenting with COVID-19 and what factors, including asthma medications, are associated with worse disease outcomes? Study Design: Retrospective observational cohort study Methods: Adult patients with documented history of asthma and laboratory-confirmed diagnosis of COVID-19 were included. Relevant data was retrieved through electronic chart review. Descriptive statistics were used to summarize the characteristics and the outcomes of the study cohort. Factors independently associated with COVID-19 related hospitalization were determined by multivariable logistic regression models. Results: Between March and August 2020, 616 patients met the inclusion criteria, of whom 52% were females. Median age was 44 years (interquartile range [IQR], 34-57 years). Forty-four percent of patients received inhaled corticosteroids (ICS) and 41.7% received long-acting beta agonists (LABA). Montelukast and tiotropium were used by 17.9% and 2.9% of patients, respectively. One patient was receiving long term oral corticosteroid and two patients were on biological agents. The most common comorbidities were hypertension (31%) and diabetes (27.1%). Two-hundred thirty-six patients (38.3%) required hospitalization for COVID-19, with a median hospital stay of 10 days (IQR, 5-15). Invasive mechanical ventilation was required in 26 patients (4.2%) and 16 patients (2.6%) died. The need for hospitalization was independently associated with older age (odds ratio [OR] for 10-years, 1.32;95% confidence interval [CI], 1.13-1.54) and hypertension (OR, 2.4;95% CI, 1.43-3.93) but not with the use of ICS, LABA, montelukast or tiotropium. Conclusion: In Qatar, adult patients with asthma appear to be at higher risk of COVID-19 related hospitalization compared to the general adult COVID-19 infected population. Older age and hypertension were associated with worse outcomes while asthma medications were not.