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1.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927926

ABSTRACT

The COVID-19 let sequelae not only in the respiratory system but also in several other systems, for instance in the skeletal muscle and in the immune response. This study evaluated the effects of 12 weeks of pulmonary rehabilitation (PR), constituted by aerobic (30 minutes of treadmill training at 75% of maximum heart rate) and resistance training (30 minutes at 75% of 1 maximum repetition) on 33 moderate and severe post-COVID-19 patients. The results demonstrated that PR effectively improved lung function, denoted by improved FVC (p<0.02), FEV1 (p<0.02), FEV1/FVC (p<0.01), MEF25% (p<0.006), MEF50% (p<0.03), and MEF75% (p<0.02). PR also improved lung mechanics, denoted by improved respiratory impedance (Z5hz, p<0.03);respiratory reactance (X5Hz, p<0.01), resistance of the whole respiratory systems (R5Hz, p<0.03), central airway resistance (RCentral, p<0.03), and peripheral airway resistance (RPeripheral, p<0.02). In addition, PR improved peripheral muscle strength denoted by increased right (p<0.02) and left (p<0.01) hand grip strength and the respiratory muscle strength, denoted by increased maximum inspiratory pressure (p<0.02) and maximum expiratory pressure (p<0.03). Of note, PR reduced pulmonary (breath condensate) inflammation, as observed by reduced levels of the pro-inflammatory cytokine IL-1beta (p<0.0001), IL-6 (p<0.0001), while increased the levels of the anti-inflammatory cytokine IL- 1RA (p<0.0004) and IL-10 (p<0.003), beyond to increase the levels of the cytokines with anti-viral properties, IFN-gamma (p<0.0002) and IFN-beta (p<0.008). Such response was also observed in the serum, as denoted by reduced levels of pro-inflammatory IL-1beta (p<0.006), and IL-6 (p<0.01), while increased the levels of anti-inflammatory cytokine IL-1RA (p<0.0001), and IL-10 (p<0.0001). PR also increased the serum levels of the cytokines with anti-viral properties, IFN-gamma (p<0.02) and IFN-beta (p<0.001). In conclusion, PR reveals to be beneficial for post-COVID-19 patients, mitigating the sequelae observed in the respiratory system, skeletal muscle and in the immune response.

2.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927925

ABSTRACT

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).

3.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927895

ABSTRACT

Rationale: Fibrotic hypersensitivity pneumonitis (FHP) is an irreversible lung disease with high morbidity and mortality. We sought to evaluate the safety and effect of pirfenidone on disease progression in such patients.Methods: In a phase 2 double-blind, single-center trial, we randomly assigned, in a 2:1 ratio, adults with FHP to receive either oral pirfenidone (2403 mg/day) or placebo for 52 weeks. Patients had to have CT lung fibrotic abnormalities affecting ≥5%, worsening respiratory symptoms, and either an increase in the extent of fibrosis on CT or relative decline in the FVC% of ≥5% within the 24-months before screening. The primary endpoint was the mean change from baseline to week 52 in %FVC. Secondary endpoints included progression-free survival (PFS, time to the first occurrence of any one of the following: a relative decline of ≥10% in FVC and/or DLCO, acute exacerbation, a decrease of ≥50 m in the 6-minute walk distance, increase in background prednisone by ≥10 mg or introduction of corticosteroids and/or steroid-sparing drugs, or death), change from baseline to week 52 in FVC slope and mean %DLCO, all-cause hospitalizations, CT progression of lung fibrosis, and safety. Results: After 40 patients had been randomized (mean age 67.1 years, 42.5% males) the study was stopped due to slow recruitment due to the COVID-19 pandemic. At baseline, demographics, smoking and inciting antigen exposure history, lung function, 6-minute walk distance, extent of CT lung fibrosis, and immunosuppressive therapy were balanced in both groups. There was no significant difference between the pirfenidone and placebo groups after adjusting for baseline %FVC and concomitant immunosuppressive therapy (p=0.88) in mean change from baseline to week 52 in %FVC. Secondary endpoints showed no difference between groups in change from baseline to week 52 in FVC slope, mean %DLCO, all-cause hospitalization and CT progression of lung fibrosis. However, a decrease in PFS favored pirfenidone (Table). The percentages of patients with any adverse events (AE) were similar in both groups. Nausea and rash, respectively, led to transient dose reduction of study treatment in 2 patients in the pirfenidone group. There were no treatment-related serious AE or AE leading to discontinuation of study treatment. No death occurred in the pirfenidone group and one death (respiratory) occurred in the placebo group. Conclusions: The trial was under powered to detect a difference in the primary endpoint. Pirfenidone was found to be tolerable and safe and compared to placebo reduced PFS in patients with FHP.

4.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927888

ABSTRACT

Background: COVID-19 disease can cause a wide variety of long-term health problems, including impaired lung function, reduced exercise performance, and decreased quality of life. Objectives: Our study aimed to investigate the efficacy, feasibility and safety of pulmonary rehabilitation in patients with COVID-19 and to compare the results between patients with a mild / moderate and severe / critical course of the disease. Methodology: Patients in the post-acute phase of a mild to critical course of COVID-19 admitted to a comprehensive pulmonary rehabilitation program were included in this prospective and observational cohort study, 43 patients were included in the study (20 with mild / moderate COVID and 23 with severe / critical COVID-19). Main measures: Several measures of exercise performance, 6-minute walking distance, lung function (forced vital capacity (FVC)), and quality of life (36-question short-format health survey (SF-36 )). Results: Results: At admission, the patients had a reduced walking distance (mild: median 401 m, interquartile range (IQR) 335-467 m;severe: 108 m, 84-132 m), a deteriorated FVC (mild: 72 % ,;severe: 35%,) and a low SF-36 mental health score (mild: 52 points, severe: 32 points. The patients received sessions adjusted to their physical capacities, the patients of both subgroups improved in the test of 6 minute walk (mild / moderate: +54 m, severe / critical: +117 m, both p <0.002), FVC (mild / moderate: + 8.9%, p = 0.004;severe / critical: + 12, 4%, p <0.003) and mental component SF-36 (mild / moderate: +6.8 points, p = 0.062;severe / critical: +16.7 points, -p <0.005). Conclusions: An exercise program Well structured results in a benefit in the areas of aerobic capacity, lung volumes and quality of life, in this sense it is recommended to expand population samples to be able to apply our protocol to other centers in charge in the rehabilitation of COVID-19 patients. Key Words: Exercise, Coronavirus, Rehabilitation.

5.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927848

ABSTRACT

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).

6.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927815

ABSTRACT

Introduction: Interstitial lung disease (ILD) comprises a heterogeneous group of diseases affecting the lung interstitium often associated with significant morbidity and mortality. The Australasian Interstitial Lung Disease Registry (AILDR) launched in 2016 with the concurrent aims to: a) provide a valuable resource for high quality ILD research to further understanding of ILD and b) improve care for ILD patients across Australia and NZ. Consisting initially of four pilot sites, over time the registry has expanded to 21 sites across Australasia. Methods: Consecutive ILD patients attending any of the registered ILD centres across Australia and NZ are eligible to enrol in the AILDR following provision of informed consent. Comprehensive data including demographics, ILD diagnosis, objective functional markers (baseline and subsequent tests) and treatment parameters are collected and stored on a secure online platform. We report data from the AILDR since initiation in May 2016 to 30th September 2021 inclusive. Results: In total 2140 participants were enrolled from 16 sites at a mean rate of 43/month (mean age 65.8±13.3years;1185 (55.4%) male;982 (45.9%) ever-smokers;mean BMI 29.4±5.9kg/m2). Baseline functional parameters demonstrated mean FVC 85.6±21.7% predicted, mean DLCO 60.5±19.4%predicted, and mean six-minute walk test (6MWT) distance 434.3±126.5metres. ILD diagnoses included: idiopathic pulmonary fibrosis (IPF) n=545 (30.3%), connective tissue disease associated ILD (CTD-ILD) n=326 (18.1%), chronic hypersensitivity pneumonitis (CHP) n=155 (8.6%), sarcoidosis n=120 (6.7%) and unclassifiable ILD n=190 (10.6%). Patients with IPF were more likely to be male (n=403, 73.9%, p<0.001) and older (72.6±8.3years, p<0.001) compared to all other ILD subtypes. A female predominance was observed for CHP (n=92, 59%, p=0.001) and CTD-ILD (n=206, 63%, p<0.001). Baseline functional parameters were lowest for those with CHP (FVC 76.8±22.4% predicted, DLCO 54.1±16.9% predicted), significantly lower comparable to the IPF group (FVC 84.8±19.6%predicted, DLCO 58.7±17.8%predicted, p<0.001). The highest baseline functional parameters were observed in those with sarcoidosis. Conclusion: We demonstrate the feasibility of a bi-national ILD registry evidenced by steady recruitment despite the COVID-19 pandemic. In this study, lower functional baseline parameters were detected in the CHP group suggesting priority research should be afforded to this group. Through a routine approach across Australasia, the AILDR aims to improve standardisation of diagnosis and management of ILD patients.

7.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927779

ABSTRACT

RATIONALE. Duchenne muscular dystrophy (DMD) is the most common and severe muscular dystrophy recognized in childhood. Genetically determined progressive dystrophin dysfunction in skeletal and multiple organ muscles is fatal before the age of 20 years without multi-specialized care. The most common cause of death is respiratory muscle failure. The primary task in caring for patients with DMD is the early monitoring of pulmonary functions. This has become difficult during the pandemic SARS-CoV-2 as the procedures generate aerosols, i.e. high risk of SARS-CoV-2 virus transmission. The aim of the study was to evaluate the capacity of the patients with DMD to perform longitudinal daily spirometry examinations at home. METHODS. The patients with DMD were recruited from the Rare Disease Centre, Medical University of Gdask, Poland (a member of the TREAT NMD Alliance Neuromuscular Network). Physical examination with anthropometry measurement, Vignos scale (VS), Brooke scale (BS), and Pulmonary Function Tests were measured during 3 months of monitoring. Participants used home spirometry (AioCare System, Healthup), twice every day. The adherence and correctness (separately for FEV1 and FVC) of spirometry examinations were evaluated. RESULTS. We recruited 20 boys with mean age 11.7(3.0) years (range 7-16 years) and BMI 22.3(5.5) kg/m∧2 with a median VS of 2.5 (IQR 6.5) and BS of 2 (IQR 4.0). During 3 months of monitoring 1301 spirometry examinations were performed;32% of them meet ATS/ERS criteria for FEV1 and FVC, 35% for FEV1 and 33% for FVC, however 50% of patients performed examinations with at least one maneuver with correct FVC. The mean adherence considering performance spirometry examinations twice a day was 39(26)% (range: 6%-98%). We observed a significant increase of FVC values during the monitoring period in 4/20 of patients based on linear regression model estimation. The study is still ongoing. CONCLUSIONS. The systematic pulmonary function monitoring at home in patients with restrictive diseases is an innovative project. The results showed that patients with DMD are able to monitor the lung function using a mobile spirometry system. We observed that in some cases, based on patient feedback, systematic spirometry tests were a form of pulmonary exercises and could be one of the factors that increase FVC after 3 months of monitoring. Personal spirometers could be used as a part of the therapy of patients with muscular dystrophy.

8.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927748

ABSTRACT

RATIONALE The COVID-19 pandemic has disrupted national spirometric surveillance of active and former U.S. coal miners since March 2020. Consequently data collected by the Health Resources and Services Administration (HRSA)-funded Black Lung Clinics Program (BLCP) represents the only major source of recent health data on U.S. former coal miners. Using the first available year of national BLCP data we examined associations between mining region and radiographic disease and lung function impairment. METHODS We analyzed pre-bronchodilator spirometry and International Labour Office chest radiograph classifications from miners seen across 15 BLCP grantees from July 1 2020 to June 30 2021. We calculated percent predicted (PP) and lower limits of normal (LLN) for forced expiratory volume in one second (FEV1) forced vital capacity (FVC) and FEV1/FVC ratio. We determined prevalence of patterns of spirometric abnormality (restrictive obstructive/mixed) and moderate to severe impairment (FEV1<70PP). We classified miners who worked the majority of their coal mining career in Kentucky Virginia or West Virginia as Central Appalachian miners. We examined associations between region worked and lung function impairment using logistic regression. RESULTS The 2,891 miners were predominantly non- Hispanic white (98.1%) and male (99.4%) with mean age 66 years (SD9.3). Mean coal mining tenure was 26 years (SD10.7) and 66% (n=1,900) were Central Appalachian miners. Thirty-seven percent had never smoked. Among those with chest radiographs (n=2,464 85%) Central Appalachian miners had a significant three-fold increase in progressive massive fibrosis (PMF) prevalence compared to miners who worked elsewhere in the U.S. (9% vs 3% p<.0001). Smoking history and spirometry were available in 66% (n=1,918). Of these 40% of never-smokers had abnormal spirometry (obstruction/mixed 10%;restriction 30%);among ever-smokers, 54% had abnormal spirometry (obstruction/mixed 27%;restriction 27%). Abnormal FEV1 was present in 30% of never smokers and 42% of ever-smokers. Mean FEV1PP was significantly lower among Central Appalachian miners compared to miners from other regions. Controlling for age, tenure, and pack-years, Central Appalachian miners had significantly elevated odds of having FEV1 impairment compared to non-Central Appalachian miners (OR 1.31, 95%CI 1.06,1.62). A subanalysis controlling for category of radiographic disease showed that odds of impairment remained elevated among Central Appalachian miners (OR 1.24, 95%CI 0.97,1.60). CONCLUSIONS Controlling for smoking, age, and tenure, former miners who worked most of their career in Central Appalachia have significantly increased odds of disabling impairment. These findings highlight the important role of HRSA-funded black lung clinics in understanding work-related lung disease among U.S. coal miners.

9.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927718

ABSTRACT

Introduction: Recognition of myositis-associated interstitial lung disease (ILD) has been increasing due to the recent identification of specific antibodies that are linked to a particular phenotype of myositis-ILD such as antisynthetase syndrome. The anti-Ro52 antibody has been found in multiple connective tissue diseases but its association with ILD is unclear. In fact, the literature on the phenotype of patients with an isolated anti-Ro52 antibody is very scarce. Case Presentation: A 57-year-old retired firefighter with history of gastroesophageal reflux presented to the hospital with a 4-week history of cough and progressive dyspnea with no other symptoms. He had presented to an urgent care facility where he tested negative for SARs-CoV-2 and was given antibiotics and inhalers without a clinical response. Patient required 2L/min of oxygen on admission. He had no other signs of autoimmune disease or other organ involvement. Chest CT showed peripheral ground glass opacities with basilar reticulations and bronchiectasis (Figure 1). WBC and CPK were normal and aldolase was mildly elevated. Initial serologies revealed an ANA 1:320 and a weakly positive p-ANCA with negative PR3/MPO antibodies. Patient was started on prednisone 60 mg and discharged five days later on mycophenolate mofetil (MMF) and 2L/min of oxygen. At 2-week follow-up, his extensive autoimmune panel showed a high titer of Anti-Ro52 antibody. An in depth ILD questionnaire revealed a family history of lupus and the remote use of a short course of steroids 20 years ago after a biceps biopsy showed polymyositis. On chart review, 10 years ago the patient had elevated CPK levels of 255 to 404, in the context of a nonspecific flank pain that resolved without intervention. At his 3-month follow-up, the patient still required 40mg of prednisone, reported dyspnea on exertion and required oxygen with ambulation. Rituximab was added to his regimen and his symptoms significantly improved;at 6-month follow-up, his FVC% improved from 53% to 70% and the patient was no longer on oxygen. Prednisone was titrated down to 10mg and he was continued on MMF 3g/day and Rituximab every 6 months. Discussion: We present a patient with Anti-Ro52 antibody myositisassociated ILD who required 3 immunosuppressive agents to control his disease. This case adds to the very scarce literature on ILD secondary to Anti-Ro52 antibody and highlights the importance of an extensive antibody testing for patients with ILD of unclear etiology, for diagnostic and therapeutic purposes. Further studies describing the phenotype of these patients are warranted. (Figure Presented).

10.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927697

ABSTRACT

Introduction: We sought to determine whether a 6-week integrated rehabilitation program improved pulmonary function, physical and mental health outcomes in patients discharged alive after surviving a severe COVID-19 pneumonia. Methods: Parallel, open-label, feasibility randomized controlled trial in participants aged 18-75 years who were discharged for severe COVID-19 pneumonia. The intervention consisted of 12 in-person home respiratory rehabilitation sessions and 6 telephonebased, emotion-centered problem-solving therapy psychological sessions. We measured the 6- minute walk test (6MWT), forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), Patient Health Questionnaire (PHQ-9), General Anxiety Disorder (GAD-7), Impact of Event Scale- Revised (IES-R) and Short Form 36 health survey (SF-36). Following the recommendation by Cocks and Torgerson, we used a one-sided 80% confidence interval to determine if this feasibility trial should proceed to a phase III trial. Results: We randomized 103 participants (mean age, 48 years;71% men). There were no differences at baseline assessments of outcomes between the two groups. Intervention participants walked 15 and 45 meters more during a 6MWT at 7 and 12 weeks, respectively, than controls after accounting for baseline distance. In both instances, the onesided 80% lower bound was above 0. Intervention participants also had a greater improvement of lung function for week 7 (mean difference FEV1, 0.05 L;95% CI, -0.14 to 0.24;mean difference FVC, 0.10 L;95% CI, -0.12 to 0.31) and at week 12 (mean difference FEV1, 0.10 L;95% CI, -0.18 to 0.37;mean difference FVC, 0.15 L;95% CI, -0.17 to 0.47). Likewise, the prevalence of depression (percentage difference PHQ-9, 24.3%;95% CI, -4.3 to 44.3), anxiety (percentage difference GAD-7, 20.7%;95% CI, 0.8 to 40.6) and post-traumatic stress (percentage difference IES-R, 14.0%;95% CI, -5.7 to 33.7) were lower in the intervention group at week 2 after hospital discharge. At week 7, the intervention group had a greater improvement of physical (mean difference, 10.8;95% CI, -1.8 to 23.4) and social (mean difference, 6.43;95% CI, -0.65 to 13.5) function on the SF-36. Conclusion: We demonstrated that an integrated rehabilitation program administered over a 6-week after discharge in Lima, Peru was both feasible and acceptable, and had positive benefits on physical and pulmonary function and on mental health during the 12 weeks of follow-up. Measured improvements in the primary outcome of 6MWT distance recommend that we consider a phase III trial to test the efficacy of our integrated rehabilitation intervention in a larger sample.

11.
Chinese Journal of Radiology (China) ; 56(4):377-384, 2022.
Article in Chinese | EMBASE | ID: covidwho-1896938

ABSTRACT

Objective To explore the application value of CT pulmonary function imaging in patients with Coronavirus Disease 2019 (COVID‑19) in the convalescent phase. Methods The COVID‑19 patients who were clinically cured and discharged from Union Hospital, Tongji Medical College, Huazhong University of Science and Technology were prospectively collected from January to April 2020. Clinical pulmonary function tests (PFTs) and CT pulmonary function imaging were performed 3 months after discharge. The Philips IntelliSpace Portal image post‑processing workstation was used to obtain the paired inspiratory‑expiratory CT quantitative indexes of the whole lung, left lung, right lung and five lobes. The patients were divided into two groups according to whether residual lesions remain in inspiratory CT images: non‑residual lesion group and residual lesion group. The chi‑square test was used to compare the differences in the PFT results between groups;the Mann‑Whitney U test was used to compare the differences in PFT indexes [forced expiratory volume in the first second as percentage of predicted value (FEV1%), FEV1/forced vital capacity (FEV1/FVC), total lung capacity as percentage of predicted value (TLC%), FVC% ] and the differences in quantitative CT indexes [lung volume (LV), mean lung density (MLD), volume change in inspiratory phase and expiratory phase (∆ LV)] between groups. Multiple linear regression was used to analyze the relationship between CT pulmonary function imaging and PFT indexes of convalescent COVID‑19 patients. Results Of the 90 patients with COVID‑19, 35 were males and 55 were females;45 were included in the non‑residual lesion group and 45 were included in the residual lesion group. Fifty‑three patients had clinical pulmonary dysfunction 3 months after discharge, including 22 patients in the non‑residual lesion group and 31 patients in the residual lesion group. In patients with residual disease, left lower lobe and right lower lobe LV, left lower lobe and right lower lobe ∆ LV in the inspiratory and expiratory phase were smaller than those without residual disease;whole lung, left lung, right lung, left upper lobe, left lower lobe and right lower lobe MLD in the inspiratory phase and left lower lobe and right lower lobe MLD in the expiratory phase were greater than those without residual disease (P<0.05). Since there was no significant difference in FEV1/FVC and FVC% between residual and non‑residual lesion groups (P>0.05), FEV1/FVC and FVC% of two groups were combined. Multiple linear regression analysis showed FEV1/FVC= 91.765-0.016×LVin‑right middle lobe+0.014×MLDex‑left lower lobe (R2 =0.200, P<0.001), FVC% =-184.122-0.358× MLDin‑right lung-0.024× ∆ LVleft upper lobe (R2 =0.261, P<0.001). There was significant difference in TLC% between residual and non‑residual lesion groups (P<0.05), so multiple linear regression analysis was performed both in the two groups. In the non‑residual lesion group, TLC% =80.645+0.031× (R2 =0.132, P<0.001);In the residual lesion group, TLC% =-110.237-0.163× LVex‑right lower lobe MLDin‑right upper lobe-0.098×MLDex‑left upper lobe -0.025×LVex‑right lower lobe (R2 =0.473, P<0.001). Conclusion CT pulmonary function imaging can quantitatively analyze the whole lung, unilateral lung and lobulated lung, thus reflecting the regional pulmonary function, providing more valuable diagnostic information for the assessment of ulmonar function in convalescent atients with COVID‑19

12.
Journal, Indian Academy of Clinical Medicine ; 23(1-2):17-24, 2022.
Article in English | EMBASE | ID: covidwho-1894207

ABSTRACT

Backgrounds: Covid-19 pandemic has affected large population across the globe. As the cases around the world rise, Covid-1related complications are also reported from various areas of the world. Pulmonary complications are mostly reported all over thworld. In this review, we emphasized the pulmonary functions in Covid-19 survivors. Objectives: To determine the impact of Covid-19 on pulmonary functions and analysis of possible lung damage in long-term aftecovid recovery. Methods: Study includes lab-confirmed RT-PCR positive, both discharged and home-isolated from Tertiary Care Centre New MedicaCollege and attached Hospitals, Kota. All subjects were to undergo 6-min. walk test (6MWT) and included only those patients foPulmonary Function Test who could perform 6MWT. Results: 109 men and 57 women with age range, 21 to 77 years from the 166 subjects. Among these, 71 (42.77%) were discharged from hospitals and 95 (57.23%) were home-isolated. The predicted FVC% was 92.83 ± 12.42, predicted FEV1% 89.94 ± 12.71 and FEV1/FVC% predicted was 98.30 ± 14.13. 6MWT walked distance was 540.50 ± 2.40. 69 subjects (41.57%) faced fatigue during 6MWT. FEV valuwas significantly(p < 0.05) higher for hospitalised patients compared to home-isolated patients. The mean FVC value was higher fohome-isolated patients compared to hospitalised patients (p < 0.05). 23% of study subjects showed restrictive and 7.2% haobstructive pattern while 70.5% had normal PFT. Conclusion: Covid-19 patients showed compromised respiratory functions, mainly restriction in close to 23% and obstruction in 7% of patients. PFTs explain the possible lung damage by Covid-19.

13.
Embase; 2022.
Preprint in English | EMBASE | ID: ppcovidwho-338091

ABSTRACT

Background Interstitial lung disease (ILD) is a known complication of rheumatoid arthritis (RA) with a lifetime risk in any individual of 7.7%. The TRAIL1 trial was a randomized, double-blinded, placebo-controlled, phase 2 study of safety, tolerability, and efficacy of pirfenidone for the treatment of patients with RA-ILD. Methods The TRAIL1 was a phase 2 trial intended to enroll 270 adult patients (18 to 85 years) with established RA-ILD at 33 sites in 4 countries. Patients were randomly assigned (1:1) to 2,403 mg oral pirfenidone or placebo daily. The primary endpoint was the incidence of the composite endpoint of decline from baseline in percent predicted forced vital capacity (FVC%) of 10% or greater or death during the 52-week treatment period. Key secondary endpoints included change in absolute and FVC% over 52 weeks. Findings. The trial was stopped early due to slow recruitment and soon after the shutdown of clinical trials as a consequence of the coronavirus disease 2019 (COVID-19) pandemic. Data from 123 patients enrolled were analyzed. The primary endpoint was met by 11.1% on pirfenidone vs. 15% on placebo [OR=0.67 (0.22, 2.03), p=0.48]. Subjects receiving pirfenidone had a slower rate of decline in lung function as measured by estimated annual change in FVC(ml) (-66 vs. -146, p=0.0082) and FVC(%) (-1.02 vs. -3.21, p=0.0028). This effect on decline was also seen when analyzed within participants with baseline usual interstitial pneumonia (UIP) pattern on HRCT (FVC(ml) (-43 vs. -169, p=0.0014) and FVC% (-0.2 vs. -3.81, p=0.0002)). There was no significant difference in the rate of treatment-emergent serious adverse events. Interpretation Due to early termination of the study, results should be interpreted with caution. Despite being underpowered to evaluate the primary endpoint, pirfenidone slowed the rate of decline of FVC over time in subjects with RA-ILD. Safety in patients with RA-ILD was similar to that seen in other pirfenidone trials.

14.
Lung India ; 39(SUPPL 1):S133-S134, 2022.
Article in English | EMBASE | ID: covidwho-1857804

ABSTRACT

Background: The COVID-19 pandemic is an ongoing global health care challenge. Upto 1/3rd of hospitalised patients develop severe pulmonary complications and ARDS. Our study aims to evaluate the pulmonary function in COVID-19 pneumonia patients at 6 months follow up. Methods: Prospective cohort study in 30 hospitalised patients with a confirmed diagnosis of COVID-19 pneumonia;belonging to mild, moderated, severe categories - 6 months after discharge. The study consists of assessing the pulmonary function with pre and post bronchodilator spirometry and 6-minute walking test for post exercise desaturation. Results: Lung function test results showed 27% patients had a normal FEV1/FVC ratio with reduction in FVC (forced vital capacity). The mean basal saturation before the 6-MWT was 96+ or - 2%. Exercise oxygen desaturation was observed in 6% cases. Conclusion: This study shows that post infection with SARS-CoV-2, severe or critical covid-19 pneumonia patients showed higher prevalence of abnormal spirometry , with a mainly restrictive pattern when compared to non severe pneumonia patients.

15.
Lung India ; 39(SUPPL 1):S141, 2022.
Article in English | EMBASE | ID: covidwho-1857719

ABSTRACT

Background: The multisystem involvement of covid-19 lingers in post-covid phase. The significance of baseline resting pulse rate was looked for in long-covid relating to symptoms in acute phase, 2-chair test response, and echocardiography. Methods: Serial long-covid patients attending out-patient department were included. They were evaluated on demographic (age, height, weight, and BMI), characteristics, symptom score in acute phase (symptom severity in 0 to 5 scale X duration of symptoms), variables (pulse-rate and SpO2 changes) related to 2 chair test and resting Doppler echocardiography (LV ejection fraction, TSAPSE, left and right ventricular free wall GLS, and LV filling pressure. Two groups with pulse rate below or above 90/minute were compared. Results: The mean duration of acute illness for both the group is computed to be (118.44±95.95 vs. 152.77±102.25, p- value= 0.42) respectively. The baseline pulse rate were significantly different between those above (n=12) and below 90 (n=23) per minute (101±5.83 vs.72.85±8.14;p<0.0001);so is the post-exercise maximum pulse rate (p<0.004). Subjects with lower pulse rate had better height (p=0.05), weight (p=0.06), and higher anosmia (p=0.005) but lower total symptoms score (26.4±51.02 vs.29.66±66.12;p=0.008). The spirometric parameters (FVC, FEV1, FWV1/FVC) were better (although not significant) in those with lower pulse rate. The echocardiographic parameters as LVEF, TAPSE, LVFP were similar;the free wall GLS of both RV and LV were reduced in both the groups but that of RV (and LV were affected more in lower and higher pulse rate group respectively. Conclusion: Baseline pulse-rate in post covid subjects is likely related to neuro-inflammatory symptoms (anosmia) and poor LVGLS suggesting LV myocardial dysfunction.

16.
Lung India ; 39(SUPPL 1):S158, 2022.
Article in English | EMBASE | ID: covidwho-1857706

ABSTRACT

Background: With increasing number of patients recovered, significant detrimental long-term effects of post-COVID-19 infection has been recognized.CAT score in COPD is a great tool to assess symptoms severity, same may be used in post COVID patients. Objective: 1.Assess the use of CAT scores in post COVID-19 patients.2.Use CAT score as a predictor of long term effects. Methods: An observational study conducted between October 2020-November 2021. RT-PCR/TruNAT COVID-19 positive post COVID patients were included,their symptoms severity were evaluated based on CAT score. Patients with high CAT score were evaluated for long term effects. Results: Out of 89 patients, 50 (56%) were male,39 (44%) were female. 66(74.15%) smokers, 15(16.8%) non-smokers. 51 (57.3%) were COPD, 31(34.83%) Asthma, 62 (69.7%) Diabetic, 45(50.5%) Hypertensive patients. On 1 month follow-up, >30 CAT score in 11(12.3%), 33 (37%) had CAT score 21-30, 27(30.33%) CAT score 10-20, 18(20.22%) CAT <10.3months, CAT >30 in 5 (5.6%), CAT 21-30 in 19(21.3%), CAT 10-20 in 22 (24.7%), <10 CAT was in 43 (48.3%).6 months, CAT >30 in 6 (6.14%), CAT 21-30 in 13 (14.6%), CAT 10-20 in 33(37.7%), CAT <10 in 37 (41.5%).Patients CAT >10, spirometry revealed FVC <60%, should be evaluated for ILD by CT scan after 8 weeks and for long term pulmonary fibrosis. Conclusion: CAT score, effective tool in COPD find its use to assess post COVID-19 patients. It's a ready -made tool, less cost-expenditure, easy to use in rural ,urban set up to assess patients symptom ,long term effect.

17.
Lung India ; 39(SUPPL 1):S20, 2022.
Article in English | EMBASE | ID: covidwho-1857332

ABSTRACT

Background: COVID-19 pandemic has been an unprecedented health crisis. Post COVID-19 lung sequelae comprise respiratory disease occurring after recovery from COVID-19. Objective: (1) To determine the baseline characteristics. (a) Inflammatory marker levels. (b) Spirometric values. (c) 6 minute walk distance. (d) Radiological parameters. (2) To assess the differences in above mentioned parameters, during follow up. Methods: All consecutive recovered patients of moderate to severe COVID-19 attending Post COVID-19 clinic were subjected to history taking of grade of dyspnea and preexisting co morbidities. At baseline visit, inflammatory markers (ESR, CRP, d-Dimer, Ferritin and LDH), Spirometry, 6MWD and HRCT thorax findings were determined. Spirometry and 6MWD were repeated in follow up visits (0, 3, 12, 24 weeks). Results: Of the 468 patients, 196 (41.9%) had moderate and 272 (58.1%) had severe disease. Ever smokers comprised 58 (16.2%) patients. 348 (74.3%) had comorbidities, most common being hypertension (192, 41%). The mean value of ESR, CRP, d-Dimer, LDH and Ferritin levels was higher in severe patient group, compared to moderate patient group (although statistically insignificant). Statistically significant decline was seen in ESR, CRP, ferritin and LDH levels in 1st follow up. Spirometric parameter, absolute FVC was higher in moderate group compared to severe group and statistically significant. Most common radiological finding was ground glass opacity (GGO), and treated with OCS. In OCS treatment arm, statistically significant increment in 6MWD was seen as compared to antifibrotic arm. Conclusion: Long recovery period should be expected in patients of moderate to severe COVID-19.

18.
Embase; 2022.
Preprint in English | EMBASE | ID: ppcovidwho-335959

ABSTRACT

Objective: To investigate if wearing a cloth facemask could affect physiological and perceptual responses to exercise at distinct exercise intensities in healthy young individuals. Methods: In a crossover design, 9 participants (sex, female/male: 6/3;age: 13±1 years;BMI: 18.4±2.1 kg/m2;sexual maturity rating, I/II/III/IV: 0/3/4/2;VO2peak: 44.5±5.5 mL/kg/min) underwent a progressive square-wave test at four intensities: (1) at 80% of the ventilatory anaerobic threshold (VAT), (2) at VAT, and (3) at 40% between the VAT and VO2peak wearing a triple-layered cloth facemask or not. These stages represented moderate, heavy, and very heavy domains and corresponded to 46±8%, 57±10% and 87±8% of VO2peak. Participants then completed a final stage (severe) to exhaustion at a running speed equivalent to the maximum achieved during the cardiorespiratory exercise test (Peak). Physiological, metabolic, and perceptual measures were analysed. Results: Mask did not affect spirometry (forced vital capacity [FVC], peak expiratory flow [PEF1], forced expiratory volume [FEV];all p > 0.27;Figure 1), respiratory (inspiratory capacity [IC], end-expiratory volume to functional vital capacity ratio [EELV/FVC], EELV, respiratory frequency [Rf], tidal volume [VT], Rf/VT, end-tidal carbo dioxide pressure [PetCO2], ventilatory equivalent and carbon dioxide ratio [VE/VCO2];all p > 0.196), hemodynamic (heart rate [HR], systolic and diastolic blood pressure [SBP;DBP];all p > 0.41), rated perceived exertion (RPE;p = 0.04) or metabolic measures (lactate;p = 0.78 Figure 2) at rest or at any exercise intensity. In both conditions, the same number of children (4 out of 9) were unable to finish the Peak stage, whereas one child did not complete exercise at the heavy domain while wearing no mask. Conclusions: This study shows that performing moderate to severe activity is safe and tolerable for healthy youth while wearing a cloth facemask.

19.
Respiratory Care ; 67(1):i, 2022.
Article in English | EMBASE | ID: covidwho-1743993
20.
J Infect Dis ; 225(8): 1308-1316, 2022 04 19.
Article in English | MEDLINE | ID: covidwho-1705456

ABSTRACT

BACKGROUND: To quantify the potential decline in dynamic lung volumes following coronavirus disease 2019 (COVID-19) in the general population. METHODS: A prospective matched cohort study of adult Copenhagen General Population Study (CGPS) participants with a prepandemic spirometry available. CGPS individuals with positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) test performed repeat spirometry, a questionnaire regarding respiratory symptoms, and diffusing capacity test for carbon monoxide. A matched uninfected CGPS control sample was used, and simple regression and linear mixed effect models were computed to study lung function decline. RESULTS: A total of 606 individuals were included; 92/107 (85.9%) with positive SARS-CoV-2 PCR test experienced coronavirus disease 2019 (COVID-19) symptoms and 12 (11.2%) were hospitalized. Spirometry was performed at median 5.6 months (interquartile range, 3.9-12.8) after positive SARS-CoV-2 PCR test. COVID-19 was associated with adjusted 7.3 mL (95% confidence interval [CI], .3-14.3) and 22.6 mL (95% CI, 13.1-32.0) steeper decline in annual forced expiratory volume in first second (FEV1) and FVC or total 113.8 and 301.3 mL lower FEV1 and FVC from baseline to follow-up. Results were robust in analyses restricted to individuals not requiring hospitalization. CONCLUSIONS: COVID-19-related declines of dynamic lung volume in the general population not requiring hospitalization were small but measurable.


Subject(s)
COVID-19 , Adult , Cohort Studies , Humans , Lung , Prospective Studies , SARS-CoV-2 , Vital Capacity
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