Respiratory failure among patients with COVID-19 in Jiangsu province, China: a multicentre retrospective cohort study.

This study was a retrospective multicentre cohort study of patients with coronavirus disease 2019 (COVID-19) diagnosed at 24 hospitals in Jiangsu province, China as of 15 March 2020. The primary outcome was the occurrence of acute respiratory failure during hospital stay. Of 625 patients, 56 (9%) had respiratory failure. Some selected demographic, epidemiologic, clinical and laboratory features as well as radiologic features at admission and treatment during hospitalisation were significantly different in patients with and without respiratory failure. The multivariate logistic analysis indicated that age (in years) (odds ratio [OR], 1.07; 95% confidence interval [CI]: 1.03-1.10; P = 0.0002), respiratory rate (breaths/minute) (OR, 1.23; 95% CI: 1.08-1.40; P = 0.0020), lymphocyte count (109/l) (OR, 0.18; 95% CI: 0.05-0.69; P = 0.0157) and pulmonary opacity score (per 5%) (OR, 1.38; 95% CI: 1.19-1.61; P < 0.0001) at admission were associated with the occurrence of respiratory failure. Older age, increased respiratory rate, decreased lymphocyte count and greater pulmonary opacity score at admission were independent risk factors of respiratory failure in patients with COVID-19. Patients having these risk factors need to be intensively managed during hospitalisation.

Persistent chronic respiratory symptoms despite TB cure is poorly correlated with lung function.

BACKGROUND: Persistent respiratory symptoms and lung function deficits are common after patients with TB. We aimed to define the burden of post-TB lung disease (PTLD) and assess associations between symptoms and impairment in two high TB incidence communities.METHODS: This was a cross-sectional survey of adults in Cape Town, South Africa who completed TB treatment 1-5 years previously. Questionnaires, spirometry and 6-minute walking distance (6MWD) were used to assess relationships between outcome measures and associated factors.RESULTS: Of the 145 participants recruited (mean age: 42 years, range: 18-75; 55 [38%] women), 55 (38%) had airflow obstruction and 84 (58%) had low forced vital capacity (FVC); the mean 6MWD was 463 m (range: 240-723). Respiratory symptoms were common: chronic cough (n = 27, 19%), wheeze (n = 61, 42%) and dyspnoea (modified MRC dyspnoea score 3 or 4: n = 36, 25%). There was poor correlation between FVC or obstruction and 6MWD. Only low body mass index showed consistent association with outcomes on multivariable analyses. Only 19 (13%) participants had a diagnosis of respiratory disease, and 16 (11%) currently received inhalers.CONCLUSION: There was substantial burden of symptoms and physiological impairment in this "cured" population, but poor correlation between objective outcome measures, highlighting deficits in our understanding of PTLD.

Determinants of lung health across the life course in sub-Saharan Africa.

LUNG HEALTH ACROSS THE life course is influenced by factors affecting airway and alveolar development and growth during antenatal and perinatal periods, throughout childhood and adolescence, and into adulthood. Lung function trajectories are set in early life and childhood deficits may predispose to non-communicable respiratory diseases, such as asthma and chronic obstructive pulmonary disease, in later years. Potential risk factors are common in many sub-Saharan African (sSA) countries; adverse antenatal environments cause in utero growth restriction and prematurity; HIV and respiratory infections, including TB are common; exposure to air pollution is widespread, including household air pollution from biomass fuel use, traffic-related pollution in rapidly expanding cities, and tobacco smoke exposure. Multiple disadvantages experienced in early life require an integrated approach that addresses reproductive, maternal and child health. Public health strategies need to tackle multiple risk factors, emphasising Universal Health Coverage, to maximise lung health in the world´s poorest, most vulnerable populations. This review explores potential determinants of lung health across the life course. Due to the extensive topic and wide range of related literature, we prioritised more recent citations, especially those from sSA, focusing on risk factors for which there is most information, and which are most prevalent in the region.

Disease progression in patients with COVID-19: a retrospective cohort study in China.

OBJECTIVE: To evaluate the clinical features of disease progression among patients with COVID-19 to help early identification of patients at high risk.DESIGN: This was a retrospective, multi-centre cohort study. From 10 January to 29 February 2020, all cases diagnosed with COVID-19 at 24 hospitals (with complete medical records) in Jiangsu Province, China were recruited. The primary outcome was deterioration in condition, i.e., the dramatic progression from asymptomatic or mild or moderate status into severe or critically ill status during 14 days´ follow-up.RESULTS: Of the 625 patients in Jiangsu, none died; 597 patients were asymptomatic or had mild or moderate disease on admission, of whom 36 (6%) experienced disease deterioration to become severe or critically ill.CONCLUSION: Disease deterioration to severe or critically ill status was associated with age, pulmonary opacity score, lymphocyte count on admission and exposure to the pandemic centre in Wuhan.