Association between treatment with colchicine and improved survival in a single-centre cohort of adult hospitalised patients with COVID-19 pneumonia and acute respiratory distress syndrome.

OBJECTIVES: The outbreak of COVID-19 posed the issue of urgently identifying treatment strategies. Colchicine was considered for this purpose based on well-recognised anti-inflammatory effects and potential antiviral properties. In the present study, colchicine was proposed to patients with COVID-19, and its effects compared with 'standard-of-care' (SoC). METHODS: In the public hospital of Esine, northern Italy, 140 consecutive inpatients, with virologically and radiographically confirmed COVID-19 admitted in the period 5-19 March 2020, were treated with 'SoC' (hydroxychloroquine and/or intravenous dexamethasone; and/or lopinavir/ritonavir). They were compared with 122 consecutive inpatients, admitted between 19 March and 5 April 2020, treated with colchicine (1 mg/day) and SoC (antiviral drugs were stopped before colchicine, due to potential interaction). RESULTS: Patients treated with colchicine had a better survival rate as compared with SoC at 21 days of follow-up (84.2% (SE=3.3%) vs 63.6% (SE=4.1%), p=0.001). Cox proportional hazards regression survival analysis showed that a lower risk of death was independently associated with colchicine treatment (HR=0.151 (95% CI 0.062 to 0.368), p<0.0001), whereas older age, worse PaO2/FiO2, and higher serum levels of ferritin at entry were associated with a higher risk. CONCLUSION: This proof-of-concept study may support the rationale of use of colchicine for the treatment of COVID-19. Efficacy and safety must be determined in controlled clinical trials.

Early Identification of Lung Fungal Infections in Chronic Granulomatous Disease (CGD) Using Multidetector Computer Tomography.

PURPOSE: The purpose of this study is to evaluate the possibility of early detection of pulmonary fungal infections by lung CT scan in chronic granulomatous disease (CGD). METHODS: A retrospective study on 14 patients affected with CGD for a total of 18 infectious episodes was performed. Revision of clinical data and CT scan analysis before and after treatment was performed. RESULTS: The presence of lung nodules <30 mm was evaluated in 18 infectious episodes in 14 patients. A total of 125 nodules in 18 CT scans were identified. Identification of the infectious agent through biopsy and in vitro culture resulted positive only in 3/18 cases. The remaining cases received clinical/radiologic diagnosis of suspected pulmonary fungal infection. In all cases, the introduction of empirical antifungal treatment resulted in reduction in size or complete resolution of the pulmonary lung nodules in all patients affected with CGD. CONCLUSIONS: Lung CT scan allows for early detection of pulmonary fungal infection in CGD. Pulmonary nodules (<30 mm), single or multiple, uni- or bilateral, with or without a halo sign may represent the first radiologic sign of pulmonary fungal infection in CGD.

Congenital cystic lung disease: prenatal ultrasound and postnatal multidetector computer tomography evaluation. Correlation with surgical and pathological data.

PURPOSE: The aim of this study was to evaluate the diagnostic accuracy of postnatal multidetector computed tomography (MDCT) compared with prenatal ultrasound (US), surgical findings, and histology, in 33 patients with congenital cystic lung disease. METHODS: Thirty-three patients, 17 males and 16 females, were evaluated by MDCT. Twenty-seven of these patients underwent prenatal US between week 18 and 22, and between week 32 and 35 of gestation. Lung lobectomy, segmentectomy, atypical resection, lesion resection were performed in 31 patients and surgical specimens were analysed. RESULTS: Prenatal US and MDCT correctly diagnosed 76.9 and 94 % of the lesions, respectively. Disagreement occurred in six lesions with prenatal US and in two lesions with MDCT. No statistically significant differences were observed between the two techniques (P = 0.122). CONCLUSIONS: As most surgeons consider the surgical resection of these lesions mandatory, our study underscores the essential role of imaging, in particular CT, in providing invaluable preoperative information on congenital cystic lung diseases recognised in uterus.

Inspiratory drive is related to dynamic pulmonary hyperinflation in COPD patients.

BACKGROUND: Baseline high neuromuscular drive is present in chronic obstructive pulmonary disease (COPD). In moderate-to-very severe COPD patients, both static and/or dynamic pulmonary hyperinflation have been demonstrated at rest. AIM: To assess the influence of dynamic hyperinflation on neuromuscular drive at rest. METHODS: We recruited 22 patients with severe-to-very severe COPD showing resting dynamic pulmonary hyperinflation, as assessed by the baseline reduction of inspiratory capacity (IC) (<80% of predicted). IC, occlusion pressure (P0.1), maximal inspiratory pressure (MIP), and their ratio were measured at end-expiratory lung volume (EELV) before and after acute inhalation of 400 mcg of albuterol (metered-dose inhaler plus spacer). In these patients the bronchodilator response was assessed also as lung volume changes. RESULTS: Only in COPD patients with a marked increase in IC (>12% of baseline and at least 200 mL) after bronchodilator, resting P0.1 showed a clinically significant decrease, despite the EELV diminution (P < 0.001). MIP was augmented following EELV reduction and therefore the P0.1/MIP ratio was markedly decreased (P < 0.001). In contrast, no changes in these indices were found after bronchodilator in COPD patients with insignificant variations of IC. Breathing pattern parameters did not vary in both sub-groups after albuterol. CONCLUSION: Following bronchodilator, significant P0.1 decrease, MIP increase, and reduction of the P0.1/MIP ratio were found only in COPD patients with a marked IC increase and these changes were closely related. These findings suggest that bronchodilators, by decreasing dynamic hyperinflation, may control exertional and/or chronic dyspnea partly through a reduction of central neuromuscular drive.

Common variable immunodeficiency: computed tomography evaluation of bronchopulmonary changes including nodular lesions in 40 patients. Correlation with clinical and immunological data.

BACKGROUND: Common variable immunodeficiency (CVID) is the most common symptomatic primary immunodeficiency characterized by recurrent respiratory tract infections, mainly sustained by encapsulated bacteria, that may cause irreversible changes in the lungs. METHODS: Forty patients with CVID were evaluated by computed tomography of the lung; 20 of these underwent computed tomographic follow-up in a 5-year period, during which immunoglobulin replacement therapy was regularly performed. RESULTS: Pulmonary changes were present in 65% of patients; bronchiectases were present in 65.38%. The incidence of pulmonary nodules was very high (38.46%) and correlated with splenomegaly (70%) and autoimmune phenomena (80%). CONCLUSIONS: Our study underscores the essential role of imaging, in particular computed tomography, in the identification and monitoring of pulmonary lesions in a large cohort of CVID patients, contributing at the same time to select patients more at risk to develop nodular lesions and potentially to use more appropriate therapeutic strategies.

Effect of preceding inspiratory speed and end-inspiratory pause on forced expiratory manoeuvre in healthy subjects and chronic obstructive pulmonary disease patients.

BACKGROUND: Lower peak expiratory flow (PEF) and forced expiratory volume in 1 s (FEV(1)) have been consistently found after slow inspiration with end-inspiratory pause (EIP). OBJECTIVES: It was the aim of this study to establish the respective influence of the speed of preceding inspiration (SPI) and EIP on the parameters obtained from the following expiratory forced vital capacity (FVC) manoeuvre. METHODS: In 8 healthy subjects and 12 patients with chronic obstructive pulmonary disease (COPD), a number of inspirations with different SPI and EIP were performed. In the subsequent FVC manoeuvre, maximal expiratory flows, including PEF, and maximal expired volumes at different times, including FEV(1), were measured. For each FVC manoeuvre, peak expiratory time, expired volume at PEF (as % of FVC), flow limitation by the negative expiratory pressure technique and FVC were checked to be sure of achieving a similar expiratory effort and starting inflation lung volume. RESULTS: The highest values of PEF and FEV(1) were found in normal subjects and COPD patients after fastest SPI without EIP (p < 0.001). In normal subjects, no significant PEF and FEV(1) changes during FVC manoeuvre were observed with different SPI, in the absence of EIP. In contrast, inspirations with slower SPI (inspiratory time >2 s) without EIP were followed by lower PEF in COPD patients (p < 0.05). As compared with inspirations without EIP, those with a presence of EIP were invariably followed by lower PEF and FEV(1), both in normal subjects and in COPD patients (p < 0.05). CONCLUSIONS: The effect of SPI on subsequent PEF and FEV(1) is irrelevant in healthy subjects as well as in COPD patients, unless SPI is too slow (inspiratory time >2 s), while any EIP decreases these indices in all individuals.