Diffusing Capacity Of Lung Research Articles

The effect of nintedanib on lung functions and survival in idiopathic pulmonary fibrosis: real-life analysis of the Czech EMPIRE registry

IntroductionThe antifibrotic drug nintedanib is used for the treatment of idiopathic pulmonary fibrosis (IPF). We analysed the effect of nintedanib on antifibrotic treatment outcome in real-world cohorts of Czech EMPIRE registry.Patients/methodsData of 611 Czech IPF subjects, 430 (70%) treated with nintedanib (NIN group), 181 (30%) with no-antifibrotic treatment (NAF group) were analysed. The influence of nintedanib on overall survival (OS), pulmonary function parameters as forced vital capacity (FVC) and diffusing lung capacity for carbon monoxide (DLCO), as well as GAP score (gender, age, physiology) and and CPI (composite physiological index) were investigated.ResultsDuring 2 year follow-up we observed that nintedanib treated patients had longer OS, compared to those treated with no-antifibrotic drugs (p < 0.00001). Nintedanib reduces risk of mortality over no-antifibrotic treatment by 55% (p < 0.001). We have observed no significant difference in the rate of FVC and DLCO decline between the NIN and NAF group. Changes within 24 months from baseline in CPI were not significant between the groups (NAF and NIN).ConclusionOur real-practice study showed the benefit of nintedanib treatment on survival. There were no significant differences between NIN and NAF groups in changes from baseline in FVC %, DLCO % predicted and CPI.

Alveolar–arterial oxygen gradient nonlinearly impacts the 28‐day mortality of patients with sepsis: Secondary data mining based on the MIMIC‐IV database

Lung is often implicated in sepsis, resulting in acute respiratory distress syndrome (ARDS). The alveolar-arterial oxygen gradient [D(A-a)O2 ] reflects lung diffusing capacity, which is usually compromised in ARDS. But whether D(A-a)O2 impacts the prognosis of patients with sepsis remains to be explored. Our study aims to investigate the association between D(A-a)O2 and 28-day mortality in patients with sepsis using a large sample, multicenter Medical Information Mart for Intensive Care (MIMIC)-IV database. We extracted a data of 35 010 patients with sepsis from the retrospective cohort MIMIC-IV database, by which the independent effects of D(A-a)O2 on 28-day death risk was investigated, with D(A-a)O2 as being the exposure variable and 28-day fatality being the outcome variable. Binary logistic regression and a two-piecewise linear model were employed to explore the relationship between D(A-a)O2 and the 28-day death risk after confounding factors were optimized including demographic indicators, Charlson comorbidity index (CCI), Sequential Organ Failure Assessment (SOFA) score, drug administration, and vital signs. A total of 18 933 patients were finally included in our analysis. The patients' average age was 66.67 ± 16.01 years, and the mortality at 28 days was 19.23% (3640/18933). Multivariate analysis demonstrated that each 10-mmHg rise of D(A-a)O2 was linked with a 3% increase in the probability of death at 28 days either in the unadjusted model or in adjustment for demographic variables (Odds ratio [OR]: 1.03, 95% CI: 1.02 to 1.03). But, each 10 mmHg increase in D(A-a)O2 was associated with a 3% increase of death (OR: 1.03, 95% CI: 1.023 to 1.033) in the case of adjustment for all covariants. Through smoothed curve fitting and generalized summation models, we found that non-linear relationship existed between D(A-a)O2 and the death at 28-day, which demonstrated that D(A-a)O2 had no any impacts on the prognosis of patients with sepsis when D(A-a)O2 was less than or equal to 300 mmHg, but once D(A-a)O2 exceeded 300 mmHg, however, every 10 mmHg elevation of D(A-a)O2 is accompanied by a 5% increase of the 28-day death (OR: 1.05; 95% CI:1.04 to 1.05, p < 0.0001). Our findings suggests that D(A-a)O2 is a valuable indicator for the management of sepsis patient, and it is recommended that D(A-a)O2 be maintained less than 300 mmHg as far as possible during sepsis process.

Interstitial lung disease (ILD) after COVID-19: a new fibro-inflammatory disease?

Introduction. Nowadays post-COVID respiratory symptoms that could be associated with pulmonary fibrosis progression are of concern. Objective. To compare CT and SPECT data of patients with post-COVID pulmonary fibrosis, and to define whether the lung fibrosis progression could be predictable. Material and Methods. Changes in chest CT scan, microcirculation disorders (SPECT) and impaired lung function parameters (DLCO) were analyzed in 74 post-COVID patients with residual consequences of COVID-19. Results. A year or more after the disease, 17 % of patients had isolated ground-glass areas, 24 % of patients had ventilation mosaics and air traps, most patients had compaction of the interlobular interstitial tissue of a short UIP type (67 %); consolidation zones (38 %); zones of pulmonary fibrosis of different lengths (57 %); discoid atelectasis (39 %); bronchiectasis (26 %), pulmonary hypertension (PH) (36 %). Significant decrease of the diffusion capacity and great microcirculation disorders accompanied by more than 50 % perfusion lack were detected. We demonstrated that significant radiological and functional effects of viral pneumonia were likely to be associated with post-viral interstitial lung disease. Conclusions. 1. Complete X-ray examination with lung diffusion capacity determination can contribute to optimal dispensary observation of post-COVID patients. 2. Microcirculation disorder greater than 50 % of the norm is a predictor of the lung parenchyma changes and can contribute to the prediction of long-term effects of the disease. 3. Complete radiation monitoring is required for patients over 60 years of age; post-COVID patients having severe form of the disease; patients having respiratory complaints for more than a year, regardless of the severity of COVID-19.

Rehabilitation experience of a patient with severe form of COVID-19 at the pulmonological climatic resort of the Southern Coast of Crimea

Introduction. The increase in the number of patients with post-COVID syndrome determines the relevance of their rehabilitation in sanatorium and resort institutions, of both local and climate-therapeutic resorts.Aim. To identify the possibility for the rehabilitation of patients with severe forms of COVID-19 in the conditions of the climatic pulmonological resort of the South Coast of Crimea in the winter season.Materials and methods. Clinical-anamnestic, laboratory, functional and computed-tomographic results of the examination of the thorax of a patient who had a severe form of COVID-19. Rehabilitation was carried out 21 days complexly using climatotherapy, therapeutic exercise, respiratory, medication and physiotherapy. The effectiveness of treatment was assessed using a 6-minute step test, Borg scale, mMRC dyspnea scale, oxygen assessment chart, rating of health status, Hospital Anxiety and Depression Scale (HADS), Fatigue Assessment Scale (FAS), dyspnea assessment index (DDI/TDI), questionnaires of life quality EQ-5D and SF-36.Results. At the end of the rehabilitation course, general well-being improved, shortness of breath decreased, exercise tolerance increased, positive dynamics of spirographic parameters, Borg scale scores and a 6-minute step test were noted. The indicators of depression on the HADS scale normalized, positive dynamics was noted according to the SF-36 questionnaire of the psychological component of health. The severity of pain/discomfort and anxiety/depression according to the EQ-5D questionnaire decreased. The X-ray picture has improved. When determining the diffusion capacity of the lungs (DLCО), an increase of 30% from the initial value was revealed.Conclusion. Rehabilitation of a patient who had a severe form of COVID-19 with bilateral lung damage in the conditions of the climatic pulmonology resort of the South Coast of Crimea in the winter season is effective. To assess the lung function of patients who have undergone COVID-19, the most effective method can be considered the determination of lung diffusion capacity (DLCО). Spirogram indicators do not always objectively reflect the severity of the condition.

Robotic left apicoposterior bisegmentectomy for non–small cell lung cancer

Robotic left apicoposterior bisegmentectomy for non–small cell lung cancer

Clinical Profile and Pulmonary Function Tests among Females Exposed to Household Fuel Smoke in Bhavnagar, Gujarat: A Cross-Sectional Study

Background: Studies from developing countries, suggest that exposure to smoke from household fuels like wood, animal dung, and kerosene used for domestic cooking, may be a risk factor for airway diseases among women. This study aims to find the effect of household fuel smoke among them through clinical profile and pulmonary function test.&#x0D; Methods: A cross-sectional study was conducted in respiratory medicine outpatient department of Sir T Hospital in Government Medical College, Bhavnagar. Female participants were interviewed with pretested semi-structured questionnaires. They included respiratory symptoms, housing condition, kitchen environment, type of household fuels, habits and history of passive smoking, the number of hours per day and the number of years spent for cooking (biomass exposure index). Chest x-ray and pulmonary function tests like spirometry and diffusion capacity of lungs were performed. Through purposive sampling, 100 female participants were included in the study, and data were analyzed using SPSS version 17.0 versions and Chi-square test.&#x0D; Results: The total number of participants was 100 with a mean age of 46.89±12. Three out of 10 had a history of passive smoking. Most of the patients suffered from dyspnea (84%) and cough (76%) as the main symptoms. Nearly half (43%) of them had a runny nose. 30% were passive smokers and 70% were nonsmokers. The patients’ cough and expectoration had a significant association with forced expiratory volume (FEV1)/ Forced Vital Capacity (FVC) &gt; 70 (P=0.02). The study suggested that with aging, the odds for Fev1/FVC becoming &lt;70 (OR: 4.24; 95% CI: 1.14-15.72, p=0.03) goes higher. The patients who had a history of exposure to smoking had higher odds of having FEV1/FVC&lt;70 (OR: 4.000; CI: 1.4851 to 10.7739, p=0.006).&#x0D; Conclusion: The findings suggest that clinical symptoms like dyspnea and cough are significant when there is exposure to household fuels like kerosene, animal dung and wood usage. Smoke emitted from such fuels play an important role in deterioration of lung functions. Efforts should be made to create awareness regarding household fuel smoke effect on health and reduction of their use.

The functional consequences in severe and critical covid-19 survivors – A pilot study

PurposeTo perform pulmonary function tests (PFT) in severe COVID-19 survivors one and five months after hospital discharge in order to assess the lung function, as well to identify clinical characteristics and PFT parameters associated with worse cardiopulmonary exercise testing (CPET). Material and methodsA prospective study included 75 patients with severe form of COVID-19. PFT was conducted one and five months after hospital discharge, in addition to CPET in a second assessment. Patients with a previous history of chronic respiratory diseases were excluded from our study. ResultsOne month after hospital discharge, all examined patients had diffusion lung capacity for carbon-monoxide(DLco%) below the 80% of predicted values (in mean 58%), with 40% of patients having a restrictive pattern (total lung capacity(TLC) < 80%). In a repeated assessment after five months, pathological DLco% persisted in 40% of patients, while all other PFT parameters were normal. CPET showed reduced maximum oxygen consumption during exercise testing (VO2peak%) values in 80% of patients (in mean 69%), and exercise ventilatory inefficiency in 60%. Patients with VO2peak < 60% had significantly lower values of examined PFT parameters, both one and five months after hospital discharge. Patients with VO2peak% ≥ 60% had a significantly higher increase after the second assessment for Forced expiratory volume in 1st second (FEV1%), Forced expiratory volume in 1st second and forced vital capacity ratio (FEV1/FVC), DLco% and Diffusion lung capacity for carbon monoxide corrected for alveolar volume (DLco/VA). ConclusionSignificant functional abnormalities, according to PFT and CPET, was present both one and five months in severe COVID-19 survivors, thus emphasizing the importance of a comprehensive follow-up including both resting and dynamic functional assessment in these patients.

Associations Between Patterns of Esophageal Dysmotility and Extra-Intestinal Features in Patients With Systemic Sclerosis.

The gastrointestinal tract is commonly involved in patients with systemic sclerosis (SSc) with varied manifestations. As our understanding of SSc gastrointestinal disease pathogenesis and risk stratification is limited, we sought to investigate whether patterns of esophageal dysfunction associate with specific clinical phenotypes in SSc. Patients enrolled in the Johns Hopkins Scleroderma Center Research Registry who completed high-resolution esophageal manometry (HREM) studies as part of their clinical care between 2011 and 2020 were identified. Associations between esophageal abnormalities on HREM (absent contractility [AC], ineffective esophageal motility [IEM], hypotensive lower esophageal sphincter [hypoLES]) and patient demographic information, clinical characteristics, and autoantibody profiles were examined. Ninety-five patients with SSc had HREM data. Sixty-five patients (68.4%) had AC (37 patients with only AC, 28 patients with AC and a hypoLES), 9 patients (9.5%) had IEM, and 11 patients (11.6%) had normal studies. AC was significantly associated with diffuse cutaneous disease (38.5% versus 10.0%; P < 0.01), more severe Raynaud's phenomenon, including digital pits, ulcers, or gangrene (56.9% versus 30.0%; P=0.02), and reduced median diffusing capacity of lung for carbon monoxide (50.6% versus 72.2%; P=0.03). AC was observed in most of the patients who died (13 of 14; P=0.06). These findings were not seen in patients with IEM. Among patients with SSc, AC is associated with a significantly more severe clinical phenotype. IEM may associate with a milder phenotype. Further studies are needed to evaluate AC, IEM, and their clinical impact relative to the timing of other end-organ complications in SSc.

Combination of echocardiography and pulmonary function tests could predict no complication of pulmonary hypertension during 5 years in patients with systemic sclerosis.

To determine whether complications of pulmonary hypertension (PH) can be predicted by noninvasive screening tests in systemic sclerosis (SSc). Forty-seven of 113 SSc patients underwent right heart catheterization (RHC) during 2011-2014. Clinical data, hemodynamic features, echocardiography, and pulmonary function tests had been followed up from the first RHC until 5 years later. At the first RHC, out of 44 patients, 8 were diagnosed with pre-capillary PH (mean pulmonary arterial pressure [mPAP] > 20 mm Hg), and 36 patients were defined as no-PH (mPAP ≤ 20 mm Hg). Three patients with >15 mm Hg of pulmonary artery wedge pressure were excluded. Receiver operating characteristic analyses for pre-capillary PH using estimated systolic PAP (esPAP) revealed an area under the curve (AUC) of 0.736, with a sensitivity and specificity of 62.5% and 86.1%, respectively, at a cutoff level of 35.0 mm Hg. The predicted percentage diffusing lung capacity for carbon monoxide (DLCO%) revealed an AUC of 0.840, with a sensitivity and specificity of 85.7% and 80.0%, respectively, at a cutoff level of 70.0%. Six pre-capillary PH patients, including one who died from PH 14 months after the first RHC, indicated exacerbations of mPAP or esPAP within 5 years. When esPAP < 35.0 mm Hg and DLCO% > 70% were met as the cutoff, none had been newly diagnosed with PH over 5 years. The conventional screening tests may be useful for detecting pre-capillary PH with SSc, and both esPAP < 35.0 mm Hg and DLCO% > 70% indicated a lower risk of developing PH for at least 5 years.

Chronic developmental hypoxia alters rat lung immune cell transcriptomes during allergic airway inflammation.

Populations that are born and raised at high altitude develop under conditions of chronic developmental hypoxia (CDH), which results in pulmonary adaptations of increased lung volume and diffusion capacity to increase gas exchange. It is not clear how CDH may alter allergic inflammation in the lung. In this study, we sought to characterize the impact of CDH on immune cell populations in the rat lung during a murine model of asthma. Rats were bred and raised in either hypoxic (15% oxygen, CDH) or normobaric room air (20% oxygen). At 3-weeks of age, animals were sensitized to ovalbumin (OVA) or physiologic saline (phosphate-buffered saline [PBS]) as a control, followed by three consecutive days of intra-nasal OVA or PBS at 6-weeks of age. We then assessed airway reactivity and allergic-associated cytokine levels. This was followed by single-cell transcriptomic profiling of lung cell populations. In scRNA-seq analysis, we assessed differentially expressed genes, differentially enriched functional pathways, immune cell exhaustion/activation markers, and immune cell secretory products. Our results show that while OVA heightened airway reactivity, CDH suppressed airway reactivity in OVA-challenged and control animals. Through scRNA-seq analysis, we further demonstrate that CDH alters the transcriptional landscape in the lung and alters transcriptional programs in immune cells. These data define CDH-dependent changes in the lung that impact airway reactivity.

Prolonged air leak after segmentectomy: incidence and risk factors.

We designed this study to investigate the rate and risk factors of prolonged air leak (PAL) in patients undergoing pulmonary segmentectomy in our unit. We performed a retrospective cohort study on 191 patients undergoing pulmonary segmentectomy (January 2017-August 2021). A PAL was defined as an air leak >5 days. One hundred and sixty-eight segmentectomies were performed using video-assisted thoracoscopic surgery (VATS), 13 were open operations and 10 were robotic. PAL occurred in 36 patients (19%). Their average post-operative stay was 2.4 days longer than those without PAL. Logistic regression analysis showed that a low preoperative carbon monoxide lung diffusion capacity (DLCO) (OR 0.98, P<0.001), low body mass index (BMI) (OR 0.95, P=0.002) and the performance of complex segmentectomies (OR 2.2, P<0.001). were significantly associated with PAL. Pulmonary segmentectomies are associated with a not negligible risk of PAL when using real world data, especially in patients with compromised pulmonary function and after complex segmentectomies. This finding is useful to inform the decision-making process.

Long-term respiratory follow-up of ICU hospitalized COVID-19 patients: Prospective cohort study.

Coronavirus disease (COVID-19) survivors exhibit multisystemic alterations after hospitalization. Little is known about long-term imaging and pulmonary function of hospitalized patients intensive care unit (ICU) who survive COVID-19. We aimed to investigate long-term consequences of COVID-19 on the respiratory system of patients discharged from hospital ICU and identify risk factors associated with chest computed tomography (CT) lesion severity. A prospective cohort study of COVID-19 patients admitted to a tertiary hospital ICU in Brazil (March-August/2020), and followed-up six-twelve months after hospital admission. Initial assessment included: modified Medical Research Council dyspnea scale, SpO2 evaluation, forced vital capacity, and chest X-Ray. Patients with alterations in at least one of these examinations were eligible for CT and pulmonary function tests (PFTs) approximately 16 months after hospital admission. Primary outcome: CT lesion severity (fibrotic-like or non-fibrotic-like). Baseline clinical variables were used to build a machine learning model (ML) to predict the severity of CT lesion. In total, 326 patients (72%) were eligible for CT and PFTs. COVID-19 CT lesions were identified in 81.8% of patients, and half of them showed mild restrictive lung impairment and impaired lung diffusion capacity. Patients with COVID-19 CT findings were stratified into two categories of lesion severity: non-fibrotic-like (50.8%-ground-glass opacities/reticulations) and fibrotic-like (49.2%-traction bronchiectasis/architectural distortion). No association between CT feature severity and altered lung diffusion or functional restrictive/obstructive patterns was found. The ML detected that male sex, ICU and invasive mechanic ventilation (IMV) period, tracheostomy and vasoactive drug need during hospitalization were predictors of CT lesion severity(sensitivity,0.78±0.02;specificity,0.79±0.01;F1-score,0.78±0.02;positive predictive rate,0.78±0.02; accuracy,0.78±0.02; and area under the curve,0.83±0.01). ICU hospitalization due to COVID-19 led to respiratory system alterations six-twelve months after hospital admission. Male sex and critical disease acute phase, characterized by a longer ICU and IMV period, and need for tracheostomy and vasoactive drugs, were risk factors for severe CT lesions six-twelve months after hospital admission.

Assessment of pulmonary function of post-COVID-19 patients of a tertiary hospital at three months following discharge

In this cross-sectional study from October 2020 to September 2021, pulmonary function was assessed in 40 (24 severe and 16 non-severe) post- COVID-19 patients at three months following hospital discharge by convenient sampling in post-COVID follow-up clinic at Department of Respiratory Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka. Among 40 subjects, 17 (42.5%) had restrictive defect, 1 (2.5%) had obstructive defect and 22 (55%) had normal spirometry. There was reduced total lung capacity (TLC) in 17 (42.5%) subjects and reduced diffusing lung capacity for carbon monoxide (DLCO) in 20 (50%) subjects. Mean six minutes walking distance (6MWD) was low (387.6±99.4 meters). Oxygen desaturation was in 4 (10%) cases. Frequency of restrictive defect was higher in severe than non-severe subjects (54.2% vs. 25%). Reduced TLC was in 62.5% of severe and 12.5% of non-severe cases. There was higher frequency of reduced DLCO in severe than non-severe casese (62.5% vs. 31.3%). 6MWD was lower in severe than non-severe group (354.0±134.9 vs. 438.2±51.4 meters, P=0.02). Pulmonary function was found significantly impaired in post-COVID patients which was more prominent in severe disease group. BSMMU J 2022; 15(3): 192-196

Key Factors Associated With Pulmonary Sequelae in the Follow-Up of Critically Ill COVID-19 Patients

IntroductionCritical COVID-19 survivors have a high risk of respiratory sequelae. Therefore, we aimed to identify key factors associated with altered lung function and CT scan abnormalities at a follow-up visit in a cohort of critical COVID-19 survivors. MethodsMulticenter ambispective observational study in 52 Spanish intensive care units. Up to 1327 PCR-confirmed critical COVID-19 patients had sociodemographic, anthropometric, comorbidity and lifestyle characteristics collected at hospital admission; clinical and biological parameters throughout hospital stay; and, lung function and CT scan at a follow-up visit. ResultsThe median [p25–p75] time from discharge to follow-up was 3.57 [2.77–4.92] months. Median age was 60 [53–67] years, 27.8% women. The mean (SD) percentage of predicted diffusing lung capacity for carbon monoxide (DLCO) at follow-up was 72.02 (18.33)% predicted, with 66% of patients having DLCO<80% and 24% having DLCO<60%. CT scan showed persistent pulmonary infiltrates, fibrotic lesions, and emphysema in 33%, 25% and 6% of patients, respectively. Key variables associated with DLCO<60% were chronic lung disease (CLD) (OR: 1.86 (1.18–2.92)), duration of invasive mechanical ventilation (IMV) (OR: 1.56 (1.37–1.77)), age (OR [per-1-SD] (95%CI): 1.39 (1.18–1.63)), urea (OR: 1.16 (0.97–1.39)) and estimated glomerular filtration rate at ICU admission (OR: 0.88 (0.73–1.06)). Bacterial pneumonia (1.62 (1.11–2.35)) and duration of ventilation (NIMV (1.23 (1.06–1.42), IMV (1.21 (1.01–1.45)) and prone positioning (1.17 (0.98–1.39)) were associated with fibrotic lesions. ConclusionAge and CLD, reflecting patients’ baseline vulnerability, and markers of COVID-19 severity, such as duration of IMV and renal failure, were key factors associated with impaired DLCO and CT abnormalities.

Analysis of influencing factors of postoperative myasthenic crisis in 564 patients with myasthenia gravis in a single center.

To study the influencing factors of myasthenic crisis in patients with myasthenia gravis during perioperative period. A total of 564 myasthenia gravis (MG) patients who underwent standard expanded resection of thymoma/thymoma in the Department of Thoracic Surgery of Beijing Hospital from January 2011 to March 2022 were retrospectively included in the study. Clinical indicators such as gender, age, thymoma, American Society of Anesthesiologists (ASA) score, operation time, intraoperative blood loss, and some others were recorded. Osserman-stages IIB + III + IV (odds ratio [OR] 16.091, 95% confidence interval [CI] 5.170-50.076, p value < 0.001), the dosage of pyridostigmine bromide more than 240 mg (OR 6.462, 95% CI 3.110-13.427, p value < 0.001), ASA score 2 and 3 (OR 3.203, 95% CI 1.461-7.020, p value=0.004), low diffusion lung capacity for carbon monoxide (DLCO%) (OR 0.981, 95% CI 0.963-1.000 p value=0.049), and blood loss greater than 1000 ml (OR 16.590, 95% CI 1.911-144.011, p value=0.011) were independent risk factors for myasthenic crisis. Patients with poor Osserman stages, higher preoperative dosage of pyridostigmine bromide, higher ASA score, poor pulmonary function (low DLCO%), and more intraoperative bleeding should be highly vigilant for the occurrence of postoperative myasthenic crisis.

Функціональний стан дихальної системи у хворих із задишкою, які перенесли негоспітальну пневмонію, асоційовану з COVID-19

Функціональний стан дихальної системи у хворих із задишкою, які перенесли негоспітальну пневмонію, асоційовану з COVID-19

Pulmonary function abnormality in patients recovered from Covid 19 pneumonia, in a tertiary care hospital in India.

One of the most dreaded complications of COVID pneumonia is post-COVID residual lung fibrosis and lung function impairment. To find out the extent and type of pulmonary function abnormality using spirometry, diffusion capacity, and 6-minute walk test and to co-relate with the clinical severity at the time of infection, in patients who have recovered from COVID19 pneumonia, in a tertiary care hospital in India. This is a prospective, cross-sectional study with a total 100 patients. Patients who have recovered from COVID pneumonia after one month of onset of symptoms and before 3 months who come for follow-up and have respiratory complaints undergo pulmonary function test will be recruited in the study. In our study, the most common lung function abnormality detected was restrictive pattern in 55% of the patients (N = 55) followed by mixed pattern in 9% of patients (N = 9), obstructive in 5% of patients (N = 5), and normal in 31% of patients (N = 31). In our study, total lung capacity was reduced in 62% of the patients and normal in 38% of the patients and diffusion capacity of lung was reduced in 52% of the patients recovered from 52% of the individuals. Also, a 6-minute walk test was reduced in 15% of the patients and normal in 85% of the patients. Pulmonary function test can serve as an important tool in both diagnosis and follow-up of post-COVID lung fibrosis and pulmonary sequalae.

Prevalence of reduced lung diffusing capacity and CT scan findings in smokers without airflow limitation: a population-based study

BackgroundPopulation distribution of reduced diffusing capacity of the lungs for carbon monoxide (DLCO) in smokers and main consequences are not properly recognised. The objectives of this study were to describe...

Postkovid stanje - plućno ili sistemsko, reverzibilno ili ireverzibilno?

During the COVID-19 pandemic, many patients were completely recovered, and about 30% of patients had prolonged symptoms, independent from the severity of their clinical picture of the COVID-19. There is no correlation between severe acute COVID and severe post-COVID syndrome. According to the NICE 2020 recommendations, the term long COVID includes symptomatic COVID-19 (period 4-12 weeks after acute disease) and post-COVID-19 syndrome. According to the WHO post-COVID-19 syndrome is a condition in persons with a history of probable or confirmed COVID infection, usually 3 months from the onset of COVID-19, with symptoms lasting at least 2 months, that cannot be explained by an alternative diagnosis. Intolerance to physical exertion, experiencing breathing difficulty and neuropsychiatric disorders are the most common and the longest lasting difficulties. Most common respiratory post-COVID manifestation is persistent dyspnea, while persistent pulmonary fibrosis was extremely rare. In almost half of patients who have had severe COVID pneumonias, there was no absolute correlation between pulmonary function disorders and thoracic CT images, and disorders kept persisting after complete radiographic regression. Dominant manifestation of these disorders is reduced lung diffusion capacity for CO (TLCOc, KCOc), while spirometry values are mostly normal. Pulmonary thromboembolism, myocarditis, anxiety-depressive disorder, forgetfulness and hair loss are some of the serious post-COVID complications. A significant number of patients need physical rehabilitation.

Залежність рівня ендотеліну-1 у осіб, що перенесли негоспітальну пневмонію на тлі коронавірусної хвороби (COVID-19), від особливостей перебігу гострого й постгострого періодів

Abstract. The impairment of endothelial function is one of the mechanisms contributing to the increased risk of cardiovascular and cerebrovascular events in patients who have experienced community-acquired pneumonia associated with COVID-19. The aim of the study was to establish the connection between the level of endothelin-1 in peripheral blood of individuals who have experienced community-acquired pneumonia associated with COVID-19, with clinical-anamnestic, demographic, laboratory, and functional indicators in both the acute and post-acute periods. Materials and methods. 39 patients (age — 57.0 (48.5; 64.0) years, male — 18 (46.2 %), female — 21 (53.8 %)) survived COVID-19-associated community-acquired pneumonia were investigated. They were investigated on the 45.0 (40.0; 60.0) day from the onset of COVID-19 and had the dyspnea at the moment of the investigation. The examination included analyzing complaints, medical history and documentation, physical examination, pulse oximetry (SpO2 ), a 6-minute walk test (6MWT), measurement of lung diffusion capacity (DLco), laboratory methods (C-reactive protein (CRP), D-dimer, platelet count, endothelin-1 measurements). Results. Since it was found that patients, on one hand, had varying degrees of respiratory failure, different laboratory parameters during the acute period of COVID-19, and varying severity of dyspnea in the post-acute period of the disease, and on the other hand, exhibited wide fluctuations in endothelin-1 levels, a cluster analysis was conducted. Two clusters of patients were identified. Cluster 1 comprised 15 individuals with higher body mass index, lower SpO2 levels at the time of examination, and poorer results in the 6MWT and DLco compared to Cluster 2, which included 24 individuals. The level of endothelin-1 in Cluster 1 was significantly higher than that in Cluster 2. Clusters 1 and 2 were comparable in terms of age and gender but differed in terms of treatment conditions (outpatient or inpatient), duration of hospitalization, minimum SpO2 levels, CRP, and D-dimer levels in the acute period, and severity of the acute phase of COVID-19. Conclusion. A high level of endothelin-1 in patients who have experienced severe or critical COVID-19, accompanied by elevated levels of CRP and D-dimer, overweight or obesity, significant dyspnea, low tolerance to physical exertion, and poor DLco in post-acute period of COVID-19, indicates the necessity of careful monitoring of these individuals to prevent the development of adverse events in post-acute period of COVID-19.