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1.
Therapeutic Delivery ; 13(5):275-281, 2022.
Article in English | EMBASE | ID: covidwho-2066908

ABSTRACT

This industry update covers the period from January 1 through January 31, 2022, and is based on information sourced from company press releases, scientific literature, patents and news websites. January 2022 saw Janssen and Midatech expand their collaboration on bioresorbable polymer microsphere technology for drug delivery. Takeda announced its plans to acquire UK-based Adaptate Biotherapeutics and Gandeeva raised further investment funds to support its drug discovery and development platform focused on the evaluation of protein-drug interactions. Biogen announced that it will sell its stake in a biosimilars joint venture and ABL Bio and Sanofi announced a collaboration around a novel treatment for Parkinson's disease. New regulatory announcements this month included US FDA approvals of a new insomnia treatment for Idorsia and a treatment for atopic dermatitis developed by Pfizer. Insulet gained FDA clearance for a closed-loop insulin pump and Ascendis Pharma followed up its United States approval last year for a once-weekly treatment for growth hormone deficiency with European approval. Pfizer and Ionis announced the discontinuation of the clinical development of a novel cardiovascular drug. In terms of collaborations, Novartis and Alnylam announced they will work together to explore targeted therapies to restore liver function;Scorpion Therapeutics partnered with AstraZeneca to develop novel cancer treatments and Nutriband Inc. and Kindeva Drug Delivery will work together to develop a transdermal fentanyl patch. Collaborations were also announced between Century Therapeutics and Bristol Myers Squibb and Lilly and Entos Pharmaceuticals in the areas of stem cell therapies for cancer treatment and neurology, respectively. A team from the Massachusetts Institute of Technology reported progress in developing oral mRNA treatments and West Pharmaceutical Services published a blog describing the development of a proof-of-principle system for a closed-loop feedback system targeting opioid overdose. A report on the BBC website highlighted the benefits of more sustainable inhalers.

2.
Pharmaceutical Journal ; 307(7956), 2022.
Article in English | EMBASE | ID: covidwho-2065011
3.
Chest ; 162(4):A2281, 2022.
Article in English | EMBASE | ID: covidwho-2060930

ABSTRACT

SESSION TITLE: Impact of Health Disparities and Differences SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: To address rural healthcare disparities by providing access to home based pulmonary rehabilitation (HBPR) program for eligible veterans at the Salem Veterans Affairs Medical Center (VAMC) who reside in remote areas or those with barriers of long travel time and transportation hardship. METHODS: The Pulmonary Section at the Salem VAMC received a grant from the Office of Rural Health to establish HBPR program for eligible veterans. Its goal was to improve quality of life and potentially reduce COPD hospitalizations and exacerbations (AECOPD). Under the direction of pulmonologists, the program was run by an exercise physiologist (EP). Referrals were received from inpatient and outpatient providers. After an initial in-person evaluation, weekly telehealth meetings (telephone, video) occurred over 12 weeks. Veterans were provided with the equipment, and an individualized targeted exercise program along with education and counseling on tobacco cessation, nutrition, oxygen compliance, stress management, medication adherence. Follow up appointments were scheduled at 3, 6 and 12 months post completion. RESULTS: Between September 2020 and January 2022, 312 consults were received, 206 consults were scheduled and 175 veterans enrolled. To date, 100 have completed the program with 24 ongoing. 30% declined service, citing: comorbidities, physical debility, difficulty remembering scheduled appointments, lack of motivation, social reasons, worsening health status. Mean age was 71, male predominance (95%). Referral diagnoses included: COPD (86%), chronic hypoxic respiratory failure (55%), COVID-19 (11%), Interstital Lung Diseases (10%). Mean FEV1 was 57% predicted, mean MMRC Dyspnea Scale 2.5, mean BODE score 5. 20% of enrolled veterans were active smokers, 72% were former smokers. 6 minute walk test increased from 156 meters on enrollment to 216 meters on completion. 45 veterans required hospitalization for pulmonary issues during their participation in the program. EP identified on weekly appointments 20 AECOPD that were treated as outpatient, 1 spontaneous pneumothorax that led to hospitalization, and facilitated the refill of inhalers or adjustment of medical regimen. Patient satisfaction score, including perception of benefit post completion was 29.4/30. CONCLUSIONS: HBPR at the Salem VAMC provided access to eligible veterans, overcoming barriers of rurality, transportation hardship and lack of nearby conventional programs. It also offered off business hours PR to veterans who continue to work. It allowed decrease in community care referrals thus establishing useful and cost effective service. CLINICAL IMPLICATIONS: Pulmonary Rehabilitation has been shown to reduce morbidity, improve functional status and have mortality benefit. Healthcare discrepancies and disparities have been a major obstacle for enrollment. HBPR would address these issues and contribute to decreased health service utilization and costs. DISCLOSURES: No relevant relationships by Nathalie Abi Hatem No relevant relationships by Brittany Frost No relevant relationships by Mitchell Horowitz No relevant relationships by Deepa Lala

4.
Chest ; 162(4):A2195, 2022.
Article in English | EMBASE | ID: covidwho-2060910

ABSTRACT

SESSION TITLE: Unique Inflammatory and Autoimmune Complications of COVID-19 Infections SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Both COVID-19 infection and sarcoidosis have been associated with long-term systemic complications with current research attempting to link these two diseases based on inflammatory properties. This case presents a patient with previously biopsy proven asymptomatic sarcoidosis who progressed to symptomatic sarcoidosis following severe COVID-19 infection. CASE PRESENTATION: A 58-year-old previously active female with known asymptomatic, biopsy proven pulmonary sarcoidosis presented to hospital in February 2021 with severe COVID-19 pneumonia requiring treatment with Decadron and Remdesivir. She was discharged home on room air but continued to have fatigue, shortness of breath, wheezing and coughing. Due to persistent respiratory symptoms and new onset vomiting with anorexia, she sought evaluation in the emergency department in July 2021. She was febrile with blood work significant for leukopenia and thrombocytopenia. She was found to have Anaplasmosis and despite adequate treatment continued to have persistent hypoxia with oxygen saturation of 82%. CT chest showed new areas of bilateral upper lobe predominant ground glass opacities and ill-defined soft tissue density in the subcarinal region. She was started on inhalers and underwent bronchoscopy with negative infectious disease work-up. She was discharged home on both inhalers and oral prednisone. Upon subsequent follow-up with pulmonology, she reported significant improvement in respiratory symptoms. Repeat CT chest after two of months of oral prednisone showed near resolution of all previous findings. After three of months of steroids, she began a prolonged steroid taper of one month. She reported absence of respiratory symptoms off of steroids. DISCUSSION: Current research is focusing on patients at greater risk of developing symptomatic sarcoidosis due to Th17 cells and the specific cytokines these cells produce. Several case reports suggest correlation between the inflammatory cascade induced by sarcoidosis and COVID-19 infection. One such case report suggests that COVID-19 infection can be a trigger for developing symptomatic pulmonary sarcoidosis. Our patient would be the first reported case of biopsy proven previously asymptomatic sarcoidosis developing into symptomatic sarcoidosis following severe COVID-19 infection. CONCLUSIONS: Therefore, COVID-19 infection may not only predispose individuals to developing pulmonary sarcoid but may also contribute to the progression of once asymptomatic sarcoid to symptomatic sarcoid. Reference #1: Capaccione, K. M., McGroder, C., Garcia, C. K., Fedyna S., Sagi, A., & Salvatore, M. M. (2022). Covid-19-induced pulmonary sarcoid: A case report and review of the literature. Clinical Imaging, 83, 152-158. https://doi.org/10.1016/j.clinimag.2021.12.021 Reference #2: Chen, Edward S. "Reassessing Th1 versus Th17.1 in Sarcoidosis: New Tricks for Old Dogma.” The European Respiratory Journal, vol. 51, no. 3, 2018, p. 1800010. Reference #3: Xu, Zhe, et al. "Pathological Findings of COVID-19 Associated with Acute Respiratory Distress Syndrome.” The Lancet Respiratory Medicine, vol. 8, no. 4, 2020, pp. 420–422. DISCLOSURES: No relevant relationships by Skylar Hartmann No relevant relationships by Jessica Wiseman

5.
Chest ; 162(4):A2006-A2007, 2022.
Article in English | EMBASE | ID: covidwho-2060886

ABSTRACT

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

6.
Chest ; 162(4):A312, 2022.
Article in English | EMBASE | ID: covidwho-2060561

ABSTRACT

SESSION TITLE: Critical Care in Chest Infections Case Report Posters 2 SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: EVALI is an acute lung injury that occurs due to the use of e-cigarettes or vaporizer products that usually contain THC or nicotine. There was an outbreak of EVALI in 2019. This is a diagnosis of exclusion with foamy macrophages with pneumocyte vacuolization being the best diagnostic clues. (1) Vitamin E acetate laced products seem to be the causing factor. CASE PRESENTATION: A 34-year-old female presented to the emergency department due to increasing shortness of breath, fever, pleuritic chest pain, cough, and headaches for the last 9 days. Two days prior she presented to urgent care where she was given an albuterol inhaler and azithromycin. At arrival, the patient was found to have tachycardia with a rate of 120-130, afebrile, SpO2 at 96% on room air, BP at 100/59. Her initial workup was grossly normal except for an elevated WBC and elevated D-Dimer. Chest X-ray revealed opacities in the lower lungs consistent with pneumonia. CTA of the chest revealed patchy pulmonary opacities consistent with COVID pneumonia. She took three separate SARS-CoV-2 PCR tests which all came back negative. The patient underwent a large workup which included infectious disease, pulmonology, and cardiology consults. She was treated with broad-spectrum antibiotics for the presumed diagnosis of pneumonia but her condition quickly deteriorated, eventually requiring 6L of O2 via nasal cannula. Screening for a large array of bacteria, fungus, and viruses all resulted negative. Upon further discussion with the patient, she admitted to smoking a THC vaporizer every night for the last seven months and that she had recently purchased a new fluid for her THC vaporizer through the internet. Bronchoscopy was also acquired but did not show any specific findings, including being negative for eosinophils. Discontinuation of antibiotics and initiation of IV steroids treatment provided rapid improvement of the patient's condition. Based on her history of THC vaping, the clinical presentation of fever, hypoxia, her chest x-ray, and chest CT showing extensive lung infiltrates, infections were ruled out and the most likely diagnosis of EVALI was made which responded well to steroids. DISCUSSION: COVID and EVALI initially can present similarly as respiratory problems, fever, and the need for oxygen. It is important to gather history on the patient as a vaping history is needed to suspect EVALI as imaging can show a wide range from ground-glass opacities to acute hypersensitivity pneumonitis. (2) CONCLUSIONS: There are some distinguishing features of EVALI from COVID one being in EVALI there is a large increase in the white count and lastly the response to steroids is the key (2). Steroids are the primary care for someone with EVALI with most patients recovering in 1-3 days with the use of steroids. (2) Reference #1: Bierwirth, A., Orellana, G., Milazzo, E. and Hamdan, A., 2020. TETRAHYDROCANNABINOL VAPING-ASSOCIATED LUNG INJURY (EVALI): A US EPIDEMIC?. Chestnet Journal. Reference #2: MacMurdo, M., Lin, C., Saeedan, M., Doxtader, E., Mukhopadhyay, S., Arrossi, V., Reynolds, J., Ghosh, S. and Choi, H., 2020. e-Cigarette or Vaping Product Use-Associated Lung Injury. Chestnet Journal. DISCLOSURES: No relevant relationships by Narden Gorgy No relevant relationships by Matheus Moreira Sanches Peraci No relevant relationships by George Walbridge No relevant relationships by John Zakhary

7.
J Drug Deliv Sci Technol ; 76: 103805, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2031441

ABSTRACT

Cannabidiol (CBD) was formulated as a metered dose inhaler (CBD-MDI) and evaluated in vitro for its efficacy as an inhaled dosage form against inflammation caused by the SARS-CoV-2 virus, lipopolysaccharide (LPS) from Escherichia coli, silica particles, nicotine, and coal tar. A CBD-MDI formulation was prepared with 50 mg of CBD in 10 mL for a CBD dose of 250 µg/puff. The formulation ingredients included CBD, absolute ethanol as a cosolvent, and HFA-134a as the propellant. High aerosol performance of CBD-MDI was obtained with mass median aerodynamic diameter of 1.25 ± 0.01 µm, geometric standard deviation of 1.75 ± 0.00, emitted dose of 244.7 ± 2.1 µg, and fine particle dose of 122.0 ± 1.6 µg. The cytotoxicity and anti-inflammatory effectiveness of CBD-MDI were performed in alveolar macrophage (NR8383) and co-culture of alveolar macrophage (NR8383) and human lung adenocarcinoma (A549) cell line. CBD delivered from an MDI was safe on respiratory cells and did not trigger an immune response in alveolar macrophages. CBD-MDI effectively reduced the generation of cytokines in immune cells treated with viral antigen S-RBD, bacterial antigen LPS, silica particles, and coal tar. The efficacy of CBD-MDI was comparable to budesonide. Furthermore, the findings demonstrated that the use of CBD-MDI was more effective in treatment rather than prevention when inflammation was induced by either a viral or bacterial stimulant.

8.
Journal of Drug Delivery Science and Technology ; 74, 2022.
Article in English | EMBASE | ID: covidwho-1996814
9.
Journal of General Internal Medicine ; 37:S480, 2022.
Article in English | EMBASE | ID: covidwho-1995785

ABSTRACT

CASE: A 35-year-old female with history of pulmonary coccidiomycosis s/p treatment 15 years ago, ex-smoker who quit 8 years ago, unvaccinated for COVID-19 presented with two weeks of progressively worsening shortness of breath, fever, chills, generalized body aches, sore throat with hoarseness of voice, nonproductive cough, wheezing and midsternal chest pain. Denied sick contacts, recent travel, allergies or bird contact. On presentation, vitals were significant for hypoxia with SpO2 84% requiring 2L of nasal canula, sinus tachycardia to 109, tachypneic in 30s. Physical exam showed stridor and bilateral diffuse expiratory wheezing. Stridor improved with racemic epinephrine and dexamethasone 10mg IV. CBC, CMP, Procalcitonin, BNP, COVID-19 and Respiratory PCR were negative, while coccidioidomycosis antibody was positive. UDS was positive for methamphetamine. Chest X-ray showed features of atypical pneumonitis. CT Chest showed similar findings and was negative for pulmonary embolism. She was managed symptomatically with albuterol inhaler. Respiratory symptoms improved during hospitalization without any further interventions. IMPACT/DISCUSSION: Methamphetamine can cause toxic lung parenchyma injury irrespective of frequency of use. With recent increase in use of methamphetamine, paucity of literature and unclear mechanism in lung injury, it is important for physicians to be aware of methamphetamine associated lung injury as a differential diagnosis of acute/subacute respiratory distress with the risk factors of illicit drug use in the era of COVID pandemic. According to National Survey on Drug Use and Health (NSDUH) in 2018, 1.6 million people (age > 26 years) used methamphetamine in one year which is 0.5% more than 2016-2017. Crystalline methamphetamine is a widely used inhaled stimulant with few reported cases of acute respiratory distress syndrome, eosinophilic pneumonia, pneumonitis, and diffuse alveolar hemorrhage. Even though the mechanism of injury is unclear in human beings, toxicity was studied in animals. Chronic methamphetamine use causes thickened alveolar walls and reduced alveolar sacs by oxidative stress and by increased free radical formation. Patients often present with non-specific symptoms including cough, shortness of breath, sore throat or chest pain. The temporal relation of symptomatology with methamphetamine use and exclusion of infectious and other pulmonary etiology based on labs and radiological findings are crucial in establishing the diagnosis. Early diagnosis, symptomatic treatment and cessation of substance use are core management. CONCLUSION: We discussed a case of methamphetamine-induced pneumonitis, who presented with upper and lower respiratory symptoms that resolved dramatically with the early diagnosis and supportive care. We recommend considering methamphetamine-induced lung injury as a differential diagnosis in patients with risk factors of illicit drug use, especially in the era of the COVID-19 pandemic for early diagnosis and appropriate management.

10.
Tuberc Respir Dis (Seoul) ; 85(4): 283-288, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-1994280

ABSTRACT

Asthma is a chronic inflammatory disease of the airways characterized by varying and recurrent symptoms, reversible airway obstruction, and bronchospasm. In this paper, clinical important studies on asthma published between March 2021 and February 2022 were reviewed. A study on the relationship between asthma and chronic rhinosinusitis, bronchiectasis, and hormone replacement therapy was published. A journal on the usefulness of fractional exhaled nitric oxide for the prediction of severe acute exacerbation was also introduced. Studies on the effect of inhaler, one of the most important treatments for asthma, were published. Studies on the control of severe asthma continued. Phase 2 and 3 studies of new biologics were also published. As the coronavirus disease 2019 (COVID-19) pandemic has been prolonged, many studies have explored the prevalence and mortality of COVID-19 infection in asthma patients.

11.
Drug Deliv Transl Res ; 12(12): 3007-3016, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-1943385

ABSTRACT

To address the unprecedented global public health crisis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), we designed and developed a novel antiviral nano-drug, called SNAT (Smart Nano-Enabled Antiviral Therapeutic), comprised of taxoid (Tx)-decorated amino (NH2)-functionalized near-atomic size positively charged silver nanoparticles (Tx-[NH2-AgNPs]) that are stable for over 3 years. Using a hamster model, we tested the preclinical efficacy of inhaled SNAT on the body weight, virus titer, and histopathology of lungs in SARS-CoV-2-infected hamsters, including biocompatibility in human lung epithelium and dermal fibroblasts using lactase dehydrogenase (LDH) and malondialdehyde (MDA) assays. Our results showed SNAT could effectively reverse the body weight loss, reduce the virus load in oral swabs, and improve lung health in hamsters. Furthermore, LDH assay showed SNAT is noncytotoxic, and MDA assay demonstrated SNAT to be an antioxidant, potentially quenching lipid peroxidation, in both the human cells. Overall, these promising pilot preclinical findings suggest SNAT as a novel, safer antiviral drug lead against SARS-CoV-2 infection and may find applications as a platform technology against other respiratory viruses of epidemic and pandemic potential.


Subject(s)
COVID-19 , Metal Nanoparticles , Cricetinae , Animals , Humans , SARS-CoV-2 , COVID-19/drug therapy , Disease Models, Animal , Silver , Antiviral Agents/pharmacology , Antiviral Agents/therapeutic use
12.
Thorax ; 2022 Jul 18.
Article in English | MEDLINE | ID: covidwho-1950267

ABSTRACT

OBJECTIVE: To compare bronchodilator response after to salbutamol and budesonide/formoterol in adults with stable asthma. METHODS: A double-blind, cross-over, single-centre, placebo-controlled, non-inferiority trial. Adults with stable asthma were randomised to different orders of two treatment regimens: two actuations of placebo via MDI and one actuation of budesonide/formoterol 200/6 µg via turbuhaler; and one actuation of placebo turbuhaler and two actuations of salbutamol 100 µg via MDI. The primary outcome measure was FEV1 after 2 min. Secondary outcome measures included FEV1, mBorg Dyspnoea Scale score and visual analogue score for breathlessness over 30 min. RESULTS: Forty-nine of 50 potential participants were randomised. One participant withdrew following the first intervention visit and another could not be randomised due to COVID-19 restrictions. The mean (SD) change from baseline FEV1 2 min after treatment administration for budesonide/formoterol and salbutamol was 0.08 (0.14) L, n=49, and 0.17 (0.18) L, n=48, respectively, mean (95% CI) paired difference of -0.097 L (-0.147 to -0.047), p=0.07, against a non-inferiority bound of -0.06 L. In the secondary analysis, FEV1 over 30 min was lower for budesonide/formoterol compared with salbutamol, difference (95% CI): -0.10 (-0.12 to -0.08) L, p<0.001. There were no differences in Visual Analogue Scale score or mBorg Dyspnoea Scale score between treatments. CONCLUSION: The results do not support the primary hypothesis of non-inferiority at the boundary of -0.06 L for the difference between budesonide/formoterol 200/6 µg compared with salbutamol 200 µg for FEV1 at 2 min, and could be consistent with inferiority with a p value of 0.07. For the secondary analysis of FEV1 measurements over time, the FEV1 was higher with salbutamol. TRIAL REGISTRATION NUMBER: Australian and New Zealand Clinical Trials Registry (ACTRN 12619001387112).

13.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927759

ABSTRACT

Introduction: Before the covid pandemic we provided community respiratory nursing support for patients with chronic lung diseases especially COPD, pulmonary rehabilitation (PR) and a home oxygen service supporting/assessing patients needing oxygen in the community. The pandemic has led to refocussing our services and staff, helping to keep patients out of hospital. Group pulmonary rehabilitation classes were no longer possible. Methods: We have refocussed our service to provide covid-safe services with PPE and early staff immunisation. Some staff were seconded to a rapid response unit for those acutely ill. Others carried out a care homes initiative to review all patients with respiratory disease in care homes. The oxygen team picked up patients discharged post covid from hospital requiring oxygen at home. We identified high risk patients for regular telephone contact. Results: Referrals after admission for non-covid respiratory infections fell as patients stayed at home and reduced contacts. 1.1-1.4 2020v 2021: 236 v 79;GP referrals also fell 1.1-1.4 2020-2021;87 v 35. Both have increased post lockdown. Referrals for PR fell. Total 1.1-1.4. 2020 v 2021, 373 v 107, GP referrals 226 v 54. Post lockdown 1.7.21-1.10.21 there has been an increase, total 139:GP 81. Group PR is starting up again. Oxygen referrals after covid admissions up to 1.10.20 were only 8 from the first wave of disease, but 119 from 15.10.20-10.5.21, and 18 from 9.8.21-1.11.21 (11 ambulatory alone): all patients discharged after covid requiring oxygen at home are contacted by telephone and visited at home. We identified 380 patients who were rated as high risk, either having <3 admissions in 12 months, recent oxygen required at home or PCO2 <7.5Kpa. These were contacted weekly as they sheltered at home. Our staff reviewed 163 patients in nursing homes, 116 with respiratory disease, 31/116 already known to the service. 75% of patients needed a new reliever inhaler or spacer. 58% did not have a rescue pack of antibiotics and steroids, 85% required a salbutamol inhaler. Conclusion: Identification of “high risk patients allowed us to provide telephone support to keep them safe at home. Reviewing all residents in care homes identified unmet needs for therapy and support. Prompt review of patients requiring oxygen after admission for covid helps them once discharged. Admissions for non covid exacerbations fell as patients remained at home with limited contacts, but on re-entering the outside world, admissions for COPD have risen again.

14.
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).

15.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927713

ABSTRACT

Background: Inhaled medications effectively treat Chronic Obstructive Lung Disease (COPD) through reduction of symptoms and improvement in patient outcomes, however inhaler misuse and nonadherence to treatment plans remain significant barriers to achieving optimal disease control. We investigated predictors for completion of a novel at-home self-management support program to better understand factors that promote treatment adherence and retention of inhaler technique. Methods:Hospitalized adults with COPD were enrolled in this study. Participants received inhospital inhaler education in the form of Virtual Teach-to-Goal (V-TTG). Inhaler technique was assessed using a validated checklist where inhaler misuse was categorized as getting less than or equal to 9 steps out of 12 correct. A validated questionnaire assessed the participants' quality of life (QoL) regarding their respiratory health. Upon discharge, participants were instructed to complete the V-TTG assessment at home and return for a 30-day follow up. Amendments were made to the IRB as the study progressed to further investigate the low completion rates of the VTTG module at home and to facilitate virtual follow-up options due to COVID-19 restrictions. Binary and multivariable logistic regression models were used to predict correct pre-intervention inhaler technique given external factors such as participant zip code, type of housing, and whether they had a caregiver. Results:The majority of participants were Black (97%) and female (57%), with an average age of 63 years (range: 43-79, S.D. ± 8.4). Of 70 participants, 24 completed the study by attending the 30-day follow-up (34%), and there was no significant change in inhaler misuse rates from baseline to 30-day follow up (p = 0.09). No predictors for program completion, external factors, and/or QoL measures were found to be predictive of maintained inhaler technique at the 30-day follow-up or for attending the 30-day follow-up in either binary or multi-variable logistic regression. Conclusions: These findings highlight the challenge of maintaining inhaler skills and adherence to treatment plans through self-supported, home-based interventions. There was no single parameter, or combination of parameters, predictive of attending the 30-day follow-up or adequate inhaler technique at follow-up. Research that further explores the role that personal and societal characteristics play in both treatment adherence and retention of inhaler technique is needed to improve our understanding of how to effectively engage patients in complex self-management.

16.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927712

ABSTRACT

Rationale: COPD is the fourth leading cause of US hospitalizations. The majority of hospitalized patients misuse inhalers, a factor unrecognized by many patients and clinicians. COVID-related distancing requirements and decreased in-person care has further challenged the quality and modality of care-delivery, including opportunities for inhaler education. There is a critical need for innovation to deliver this critical aspect of COPD care. This study aims to improve clinician-patient communication and access to care for patients with COPD by developing and implementing a telehealth education platform to augment the clinic visit. Methods: This mixed-methods study utilized semi-structured patient interviews and clinician survey data to obtain diverse perspectives about facilitators and barriers to our “V-M(ED)” intervention. Patients participated in the COPD V-M(ED), pharmacy-led video visits with patients to conduct inhaler technique education using teach-to-goal, during clinic visits. Eligible patients were consented to participate in semi-structured interviews assessing their experiences with prior telehealth visits, inhaler education, and feedback on V-M(ED). Clinicians recruited via email completed brief surveys focusing on barriers, facilitators, and opportunities for incorporating multi-disciplinary teams to deliver telehealth-based educational teaching for patients. Demographic and Likert-scale data were analyzed with descriptive statistics. Themes were coded for open-ended questions. Results: Of 15 clinic patients who received inhaler education, 10 were enrolled in the study. Participants were on average 73.7 years of age, 80% were female, and 90% self-identified as Black. Three major themes emerged regarding patient telehealth experience (Table): 1) the pros and cons of technology-based visits (e.g., convenience);2) setting preference for clinical visits (e.g., in-person);and 3) effectiveness of virtual inhaler education (e.g., most reported benefiting). Thirteen clinicians completed the care team perspectives survey. While the majority felt incorporating virtual teaching from clinician team-members would be beneficial to patients, only 31% reported that the benefits would outweigh barriers to use. However, of clinicians who did not have prior experience incorporating virtual education into patient encounters, nearly half reported they would use a program if it were in place. Conclusions: This study provides important insights into both patient and clinician perspectives on integrating virtual telehealth education into patient care. Despite a preference for in-person clinical encounters, using a telehealth modality for inhaler education was well-received by our patient cohort. This feedback, along with the positive attitudes of clinicians in the usefulness and desire to offer virtual video platforms for patient education, suggests virtual education can be an effective modality for disease self-management. (Table Presented).

17.
JMIR Res Protoc ; 11(7): e38626, 2022 Jul 07.
Article in English | MEDLINE | ID: covidwho-1923878

ABSTRACT

BACKGROUND: Cessation of smoking can markedly reduce the incidence of cardiovascular disease, improve health economics, and benefit society. Aromatherapy has the potential to be a novel option as an adjuvant therapy for smoking cessation that may alleviate depressive symptoms. However, research on the efficacy of aromatherapy as an adjuvant therapy for smoking cessation is scarce. OBJECTIVE: The aim of this study was to examine the potential effects of aromatherapy on psychological states in smokers with depressive tendencies and to determine if it is reasonable to proceed to the next step (ie, a phase III trial). METHODS: This is a pre-post single-arm clinical trial. Smokers with depression will be subjected to aromatherapy during smoking cessation treatment for 12 weeks. We will evaluate changes in scores on the Zung Self-Rating Depression Scale and the Profile of Mood States from pretreatment screening to 4 weeks and 12 weeks after the start of aromatherapy. Moreover, we will compare the group treated with aromatherapy with the group that received standard treatment in our previous randomized controlled trial (ie, the control group in that study). Furthermore, we will compare successful smoking cessation rates after 12 weeks. In addition, we will conduct an exploratory analysis of the efficacy of aromatherapy. The target sample size is 100, which is the number of subjects expected to be enrolled in this study during the 2-year study period. RESULTS: This study was approved by the Kyoto Medical Center Institutional Review Board (IRB approval No. 19-016). Enrollment started on July 1, 2019. As of May 2022, 76 patients have been recruited. In the original plan, recruitment should have been finished on June 30, 2021. However, the number of subjects decreased due to the COVID-19 pandemic, and the study inclusion period was extended by 1 year (ie, until the end of June 2022) with the approval of the IRB on May 17, 2021. Analyses of the results will be completed subsequently. CONCLUSIONS: This study has some limitations. This is not a rigorous validation study because it compares the same subjects who received standard treatment in a previous study. Moreover, the sample size and methods of statistical analysis were not fully set with prior consideration of statistical rigor. To address these limitations, we plan to conduct a phase III trial that will reflect the exploratory findings of this study. This is the first study to evaluate the psychological effects of aromatherapy during a smoking cessation program, and it may help improve the quality of treatment for smoking cessation in the future. TRIAL REGISTRATION: UMIN Clinical Trials Registry UMIN000043102; https://tinyurl.com/tn3hvt9w. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/38626.

18.
Int J Chron Obstruct Pulmon Dis ; 17: 559-568, 2022.
Article in English | MEDLINE | ID: covidwho-1902770

ABSTRACT

Purpose: A suboptimal peak inspiratory flow (PIF) against a dry powder inhaler (DPI) may result in ineffective inhalation of medications, which may affect outcomes. The primary objective of this study was to examine the association between PIF status and COPD exacerbations among outpatients with moderate to very severe COPD. Patients and Methods: This was a prospective, observational study of patients from 7 US outpatient centers. PIF was measured using an inspiratory flow meter (In-Check™ DIAL G16) set to medium low resistance. Patients were classified by suboptimal (<60 L/min) or optimal PIF (≥60 L/min). The primary outcome was the proportion of patients with moderate/severe COPD exacerbations collected by medical record review over 12 months. Secondary outcomes were time to first exacerbation and mortality. Results: Of 474 patients screened, 38.8% had suboptimal PIF, and 71 patients with optimal PIF were excluded from the study. The enrolled sample included 184 and 219 patients with suboptimal and optimal PIF, respectively. Suboptimal PIF was associated with shorter stature (66.6±4.1 vs 67.8±3.8 inches, P = 0.002), female sex (45.1 vs 34.7%, P = 0.033), Black race (27.2 vs 11.0%, P < 0.001), and greater symptom burden (CAT: 22.3±7.7 vs 19.0±7.0, P < 0.001; mMRC: 2.0±1.1 vs 1.7±1.1, P = 0.003). The proportion of patients with COPD exacerbations at 12 months was not significantly different (29.3 vs 27.9%, P = 0.751). Suboptimal PIF was associated with shorter time to first COPD exacerbation (3.8±2.7 vs 4.9±3.0 months, P = 0.048). The mortality rate at 12 months was higher in the suboptimal cohort but not significantly different (6.5 vs 2.8%, P = 0.073). Conclusion: Over one-third of outpatients with stable moderate to very severe COPD had a suboptimal PIF against a medium low resistance DPI. The phenotype of suboptimal PIF was short stature, female, and Black. Suboptimal PIF status was associated with shorter time to moderate/severe COPD exacerbations compared with optimal PIF.


Subject(s)
Pulmonary Disease, Chronic Obstructive , Administration, Inhalation , Dry Powder Inhalers , Female , Humans , Outpatients , Powders/therapeutic use , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/drug therapy
19.
Journal of Investigative Medicine ; 70(4):1181-1182, 2022.
Article in English | EMBASE | ID: covidwho-1868776

ABSTRACT

Purpose of Study Today's mechanical ventilators require adjustments of respiratory rate, inspiratory time, expiratory time and tidal volume to maximize O2 delivery and CO2 removal. Pranayam was first recorded about 7000 years ago, and shows similar results to ventilation. Involving conscious inhalation, exhalation and holding of breath, Pranayam is held prominent in the Yoga Sutra (historical authoritative text on Yoga). Pranayam includes three primary principles: Puraka, Rechaka and Kumbhaka, and the techniques of Kapalbhati and Bhastrika. Slow breathing stimulates the vagus nerve and parasympathetic nervous system, easing inhibition of the sympathetic 'fight or flight' response. Pranayam also enhances nitric oxide (NO) production. Recent studies using NO for COVID-19 treatment via inhaler show promising results in shortening the course, symptom severity and resulting damage. When practiced regularly, Pranayam enhances cellular gas exchange, increasing O2 levels and enhancing detox. This study draws parallels between Pranayam and modern ventilation in management of obstetric and pediatric conditions. Methods Used Literature search of ancient Indian texts (Upanishads and Yoga Vasishta, Bhagavad Gita, Patanjali Yoga Sutras) and recent publications on modern ventilation and its clinical applications. Summary of Results Several therapies in allopathic medicine show similar principles to Pranayam in prevention and management of ailments. Maximizing O2 delivery and CO2 removal is accomplished through low tidal volumes and high rates in conventional mechanical ventilators, and extremely low tidal volumes in high frequency oscillators and jet ventilators. These can be compared to high frequency breaths in Pranayam with air exchange improvement and positive alteration of acid/base balance, aiming to avoid lung injury from high distending pressures, especially for infants. Ventilatory strategies such as high pressure and low rate also have their equivalent in Pranayam. Conclusions Breath manipulations in modern medicine and the ancient technique of Pranayam have a positive impact on preventing many human ailments, especially in the fields of perinatology and pediatrics. Breathing exercises can prevent anxiety episodes, mountain sickness and asthma exacerbations. They are also taught to expectant mothers to reduce labor pain during contractions. Human trials show increased pulmonary function and endogenous NO by regular practice of these techniques, which have been used as an adjuvant in COVID-19 patient care. These parallels between Pranayam and ventilatory techniques show a synthesis of ancient and modern therapy. (Figure Presented).

20.
J Pharm Pract ; : 8971900221101761, 2022 May 21.
Article in English | MEDLINE | ID: covidwho-1861910

ABSTRACT

BACKGROUND: The hospitals of the Saint Alphonsus Health System (SAHS) have implemented a metered dose inhaler (MDI) to nebulization therapeutic interchange program in which all orders for albuterol/ipratropium and inhaled corticosteroid/long-acting beta agonists (ICS/LABA) MDIs are therapeutically interchanged to nebulizers by pharmacy. OBJECTIVES: The primary outcome measure is to assess the percent of albuterol/ipratropium and ICS/LABA inhalers therapeutically interchanged to nebulized solutions. Secondary outcomes include assessment of readmission rates, the percentage of patients discharged with the appropriate MDI, and a financial analysis of the implementation of the therapeutic interchange program. METHODS: This retrospective observational cohort study was approved by the system's institutional review board and conducted between October 15, 2019, and February 15, 2020. Adult patients with history of asthma or COPD admitted to one of the SAHS hosptials with an order placed for ipratropium/albuterol, fluticasone/salmeterol, mometasone/formoterol, or budesonide/formoterol MDIs were eligible for inclusion. Patients were excluded if they were presumed to have or tested positive for COVID-19. RESULTS: Therapeutic interchanges were successfully completed in 94.3% of the orders included in this evaluation. Discharge discrepancies occurred in 14.3% of orders assessed. No correlation was found between discharge discrepancies and 30-day readmissions. The MDI to nebulized solution interchanges saved $13,908.16 in medication cost in the sample population. CONCLUSION: The first phase of implementing the SAHS inhaler to nebulizer therapeutic interchange program was operationally and clinically successful. The program is projected to continue to reduce medication waste and provide cost savings for the health system.

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