Capacity Of Lung For Carbon Monoxide Research Articles

Lung ultrasound in the assessment of interstitial lung disease in patients with connective tissue disease: Performance in comparison with high-resolution computed tomography.

To investigate clinical relevance of performing lung ultrasound (LUS) in patients with connective tissue disease (CTD)-associated interstitial lung disease (ILD) in comparison with high-resolution computed tomography (HRCT). This single-centre study enrolled eligible patients with CTD-ILD from the prospective LUS registry. Total B-lines were detected by assessment at 14 sites via LUS. Forced vital capacity, diffusing lung capacity for carbon monoxide (DLCO), DLCO/alveolar volume, 6-minute walking distance, and the ILD-GAP index were used as ILD prognostic parameters. Correlations were examined using single and multiple regression analyses. Sixty-seven patients were enrolled, including 29 with idiopathic inflammatory myopathy or anti-synthetase syndrome, 25 with systemic sclerosis (SSc), 10 with rheumatoid arthritis, and 3 with mixed connective tissue disease. The total number of B-lines correlated with ILD extent on HRCT in patients with CTD-ILD (r = 0.66; P < 0.001), particularly in patients with SSc-ILD (r = 0.78; P < 0.001). Total B-lines and ILD extent on HRCT showed comparable correlations with prognostic parameters, while multiple regression analysis revealed the limited benefit of performing LUS in addition to HRCT in predicting correlations with prognostic factors. LUS serves as an alternative tool for assessing the severity and prognosis of patients with CTD-ILD.

Sleep and Circadian Health of Critical Survivors: A 12-Month Follow-Up Study.

To investigate the sleep and circadian health of critical survivors 12 months after hospital discharge and to evaluate a possible effect of the severity of the disease within this context. Observational, prospective study. Single-center study. Two hundred sixty patients admitted to the ICU due to severe acute respiratory syndrome coronavirus 2 infection. None. The cohort was composed of 260 patients (69.2% males), with a median (quartile 1-quartile 3) age of 61.5 years (52.0-67.0 yr). The median length of ICU stay was 11.0 days (6.00-21.8 d), where 56.2% of the patients required invasive mechanical ventilation (IMV). The Pittsburgh Sleep Quality Index (PSQI) revealed that 43.1% of the cohort presented poor sleep quality 12 months after hospital discharge. Actigraphy data indicated an influence of the disease severity on the fragmentation of the circadian rest-activity rhythm at the 3- and 6-month follow-ups, which was no longer significant in the long term. Still, the length of the ICU stay and the duration of IMV predicted a higher fragmentation of the rhythm at the 12-month follow-up with effect sizes (95% CI) of 0.248 (0.078-0.418) and 0.182 (0.005-0.359), respectively. Relevant associations between the PSQI and the Hospital Anxiety and Depression Scale (rho = 0.55, anxiety; rho = 0.5, depression) as well as between the fragmentation of the rhythm and the diffusing lung capacity for carbon monoxide (rho = -0.35) were observed at this time point. Our findings reveal a great prevalence of critical survivors presenting poor sleep quality 12 months after hospital discharge. Actigraphy data indicated the persistence of circadian alterations and a possible impact of the disease severity on the fragmentation of the circadian rest-activity rhythm, which was attenuated at the 12-month follow-up. This altogether highlights the relevance of considering the sleep and circadian health of critical survivors in the long term.

Factors most strongly associated with breathlessness in a population aged 50-64 years.

Breathlessness is a troublesome and prevalent symptom in the population, but knowledge of related factors is scarce. The aim of this study was to identify the factors most strongly associated with breathlessness in the general population and to describe the shapes of the associations between the main factors and breathlessness. A cross-sectional analysis was carried out of the multicentre population-based Swedish CArdioPulmonary bioImage Study (SCAPIS) of adults aged 50 to 64 years. Breathlessness was defined as a modified Medical Research Council breathlessness rating ≥2. The machine learning algorithm extreme gradient boosting (XGBoost) was used to classify participants as either breathless or nonbreathless using 449 factors, including physiological measurements, blood samples, computed tomography cardiac and lung measurements, lifestyle, health conditions and socioeconomics. The strength of the associations between the factors and breathlessness were measured by SHapley Additive exPlanations (SHAP), with higher scores reflecting stronger associations. A total of 28 730 participants (52% women) were included in the study. The strongest associated factors for breathlessness were (in order of magnitude): body mass index ( SHAP score 0.39), forced expiratory volume in 1 s (0.32), physical activity measured by accelerometery (0.27), sleep apnoea (0.22), diffusing lung capacity for carbon monoxide (0.21), self-reported physical activity (0.17), chest pain when hurrying (0.17), high-sensitivity C-reactive protein (0.17), recent weight change (0.14) and cough (0.13). This large population-based study of men and women aged 50-64 years identified the main factors related to breathlessness that may be prevented or amenable to public health interventions.

Mycophenolate and azathioprine efficacy in interstitial lung disease: a systematic review and meta-analysis

ObjectivesMycophenolate mofetil (MMF) and azathioprine (AZA) are immunomodulatory treatments in interstitial lung disease (ILD). This systematic review aimed to evaluate the efficacy of MMF or AZA on pulmonary function in...

Post-COVID syndrome and capillary bed abnormalities detected by videocapillaroscopy

Post-COVID syndrome (PCS) is a pressing problem in clinical practice. Dyspnea, along with neurologic and cardiovascular symptoms, is the most common symptom indicating low exercise capacity (EC) that reduces quality of life. The aim of this study was to investigate shortness of breath and the capillary bed abnormalities detected video capillaroscopy (VCS) in patients with PCS.Methods. The study included patients with PCS (n = 60) suffering from shortness of breath. Dyspnea was assessed using the 6-minute walk test (6-MWT). The capillary bed abnormality was diagnosed using VCS.Results. Patients with ACL walked an average of 79.5% of the predicted distance in the 6-MWT. They also had a decrease in pulse oximetry readings. The patients were divided into 2 groups: 1st – patients with desaturation, 2nd – patients without desaturation. Significant differences were observed between patients with and without desaturation, especially in the 6-MWT distance, pulse oximetry, and dyspnea before and after the 6-MWT. Patients with desaturation had a higher desaturation-to-distance ratio, a higher O2-GAP index, and higher cardiac effort levels, as well as a significant decrease in the proportion of perfused capillaries (PPC), mean capillary density, and a marked increase in the proportion of tortuous and branched capillaries. There was a direct correlation between PPC and diffusing lung capacity for carbon monoxide (DLCO), and carbon monoxide transfer coefficient (DLCO/Va), distance traveled during the 6-MWT and percentage (%) of predicted distance, inverse correlation between PPC and cardiac effort. There was a direct correlation between the percentage (%) of capillary recovery and 6-MWT distance and the percentage (%) of predicted distance, as well as an inverse correlation with the ratio of desaturation indicators and walking distance. Similarly, there was a direct correlation between mean capillary density and DLCO/Va, while the proportion (%) of tortuous capillaries was inversely correlated with DLCO, and the proportion (%) of branched capillaries was inversely correlated with DLCO/Va.Conclusion. The multifactorial nature of the mechanisms of dyspnea in patients with PCS was demonstrated, with the important role of vasculopathy. Continuous monitoring of pulse oximetry, heart rate and VCS are effective methods to screen and assess the condition of patients with PCS and dyspnea.

Early lung diffusion abnormalities and airways' inflammation in children with type 1 diabetes.

Type 1 diabetes (T1D) impacts lung function and exercise capacity in adults, but limited information is available in children. We hypothesize that T1D causes alterations in pulmonary function and cardiorespiratory fitness, i.e., exercise capacity, at early stages of the disease, due to the presence of inflammation and vascular damage. Therefore, we aim to investigate pulmonary function before and after exercise in children with T1D as compared to age matched healthy controls. Twenty-four children with T1D and twenty healthy controls underwent body plethysmography, diffusion lung capacity for carbon monoxide and fractional exhaled nitric oxide at rest and after cardio-pulmonary exercise test. In children with T1D, baseline total lung capacity and diffusion lung capacity for carbon monoxide were reduced as compared to healthy controls. Children with T1D also showed a reduced exercise capacity associated with poor aerobic fitness. Accordingly, diffusion lung capacity for carbon monoxide tended to increase with exercise in healthy controls, while no change was observed in children with T1D. Fractional exhaled nitric oxide was significantly higher at baseline and tended to increase with exercise in children with T1D, while no changes were observed in healthy controls. Altered diffusion lung capacity for carbon monoxide, increased fractional exhaled nitric oxide and a poor aerobic fitness to exercise suggests the presence of early pulmonary abnormalities in children with T1D.

Efficacy of non-conventional synthetic DMARDs for patients with rheumatoid arthritis-associated interstitial lung disease: a systematic review and meta-analysis

ObjectivesWe conducted a systematic review and meta-analysis to determine the efficacy of non-conventional synthetic disease-modifying antirheumatic drug (ncs-DMARD) strategies on patients with rheumatoid arthritis (RA)-associated interstitial lung disease (ILD).MethodsPubMed, EMBASE,...

Radiological pulmonary sequelae after COVID-19 and correlation with clinical and functional pulmonary evaluation: results of a prospective cohort.

Whether COVID-19 leads to long-term pulmonary sequelae or not remains unknown. The aim of this study was to assess the prevalence of persisting radiological pulmonary fibrotic lesions in patients hospitalized for COVID-19. We conducted a prospective single-center study among patients hospitalized for COVID-19 between March and May 2020. Patients with residual symptoms or admitted into intensive care units were investigated 4months after discharge by a chest CT (CCT) and pulmonary function tests (PFTs). The primary endpoint was the rate of persistent radiological fibrotic lesions after 4months. Secondary endpoints included further CCT evaluation at 9 and 16months, correlation of fibrotic lesions with clinical and PFT evaluation, and assessment of predictive factors. Among the 1151 patients hospitalized for COVID-19, 169 patients performed a CCT at 4months. CCTs showed pulmonary fibrotic lesions in 19% of the patients (32/169). These lesions were persistent at 9months and 16months in 97% (29/30) and 95% of patients (18/19) respectively. There was no significant clinical difference based on dyspnea scale in patients with pulmonary fibrosis. However, PFT evaluation showed significantly decreased diffusing lung capacity for carbon monoxide (p < 0.001) and total lung capacity (p < 0.001) in patients with radiological lesions. In multivariate analysis, the predictive factors of radiological pulmonary fibrotic lesions were pulmonary embolism (OR = 9.0), high-flow oxygen (OR = 6.37), and mechanical ventilation (OR = 3.49). At 4months, 19% of patients investigated after hospitalization for COVID-19 had radiological pulmonary fibrotic lesions; they persisted up to 16months. Whether COVID-19 leads to long-term pulmonary sequelae or not remains unknown. The aim of this study was to assess the prevalence of persisting radiological pulmonary fibrotic lesions in patients hospitalized for COVID-19. The prevalence of persisting lesions after COVID-19 remains unclear. We assessed this prevalence and predictive factors leading to fibrotic lesions in a large cohort. The respiratory clinical impact of these lesions was also assessed. • Nineteen percent of patients hospitalized for COVID-19 had radiological fibrotic lesions at 4months, remaining stable at 16months. • COVID-19 fibrotic lesions did not match any infiltrative lung disease pattern. • COVID-19 fibrotic lesions were associated with pulmonary function test abnormalities but did not lead to clinical respiratory manifestation.

Nonsurgical hypoparathyroidism is associated with skeletal muscle dysfunction and restrictive lung disease.

Systematic assessment of skeletal muscle function is lacking in patients with nonsurgical hypoparathyroidism (HP). Whether muscle dysfunction involves respiratory muscles and results in restrictive lung disease (RLD) is not studied. To assess skeletal muscle and pulmonary functions in patients with HP. Observational case-control study. Thirty patients with HP (mean age 37.7 years, 60% males) and age, sex, and body mass index-matched forty healthy-controls were assessed for skeletal muscle function by hand-grip strength, short physical performance battery (SPPB) test, dual-energy x-ray absorptiometry, and electromyography. Pulmonary function was assessed by spirometry, body plethysmography, diffusion lung capacity for carbon monoxide and diaphragmatic ultrasound. Patients with HP had lower serum calcium (2.25±0.15 vs 2.4±0.12 mmol/L, p<0.001), serum magnesium [median (interquartile-range) 0.74 (0.69-0.82) vs 0.78 (0.69-0.90) mmol/L, p=0.04], hand-grip strength (18.08±8.36 vs 22.90±7.77 kg, p=0.01) and composite SPPB score (9.5 [7-10] vs 12 [12-12], p< 0.001) compared to healthy-controls. Electromyographic evidence of myopathy was seen in 23% (5 of 22) patients with HP, but in none of the controls (p=0.08). The prevalence of RLD was higher in the HP cohort compared to that in controls (24% vs 0%, p=0.01). Diaphragmatic excursion (4.22±1.38 vs 5.18±1.53 cm, p=0.01) and thickness (3.79±1.18 vs 4.28±0.94 mm, p=0.05) on deep inspiration were reduced in patients with HP. Detailed testing of patients with HP without overt muscle and lung diseases revealed significant impairment in parameters of skeletal muscle function. Myopathy and RLD were observed in a considerable proportion of patients with HP.

Clinical Utility of Bronchoalveolar Lavage Neutrophilia and Biomarkers for Evaluating Severity of Chronic Fibrosing Interstitial Lung Diseases.

Introduction It is hypothesized that bronchoalveolar lavage (BAL) neutrophilia, Krebs von den Lungen-6 (KL-6), and C-reactive protein (CRP) predict the severity of chronic fibrosing interstitial lung diseases (CF-ILDs). Methods This cross-sectional study enrolled 30 CF-ILD patients. Using Pearson's correlation analysis, BAL neutrophils, KL-6, and CRP were correlated with forced vital capacity (FVC), diffusing lung capacity for carbon monoxide (DLCO), six-minute walk distance (6MWD), partial pressure of oxygen (PaO2), computed tomography fibrosis score (CTFS), and pulmonary artery systolic pressure (PASP). Using the receiver operator characteristic (ROC) curve, BALKL-6and CRP were evaluated against FVC% and DLCO% in isolation and combination with BAL neutrophilia for predicting the severity of CF-ILDs. Results BAL neutrophilia significantly correlated only with FVC% (r = -0.38, P = 0.04) and DLCO% (r = -0.43, P = 0.03). BAL KL-6 showed a good correlation with FVC% (r = -0.44, P < 0.05) and DLCO% (r = -0.50, P = 0.02), while BAL CRP poorly correlated with all parameters (r = 0.0-0.2). Subset analysis of BAL CRP in patients with CTFS ≤ 15 showed a better association with FVC% (r = -0.28, P = 0.05)and DLCO% (r = -0.36, P = 0.04). BAL KL-6 cut-off ≥ 72.32 U/ml and BAL CRP ≥ 14.55 mg/L predicted severe disease with area under the curve (AUC) values of 0.77 and 0.71, respectively. The combination of BAL neutrophilia, KL-6, and CRP predicted severity with an AUC value of 0.89. Conclusion The combination of BAL neutrophilia, KL-6, and CRP facilitates the severity stratification of CF-ILDs complementing existing severity parameters.

Type 2 cytokines and scleroderma interstitial lung disease.

Interstitial lung disease (ILD) is a life-threatening complication of systemic sclerosis (SSc). Type 2 (Th2) cytokines play a pivotal role in airway disease. Study aim was to evaluate serum level of Th2 interleukin (IL) and chemokine in SSc-ILD. Serum levels of IL-4, IL-5, IL-11, IL-13, IL-21, IL-31 and CXCL-13 were measured by Bio-Plex Multiplex Immunoassays in 60 SSc patients and 20 healthy controls (HC). Pulmonary function tests with diffusion lung capacity for carbon monoxide (DLco) and high resolution computed tomography (HRCT) were performed in SSc patients. ILD is defined as fibrotic changes (ground glass, reticular and honeycombing), assessed by Computer-Aided Lung Informatics for Pathology Evaluation and Ratings (CALIPER) software, affecting at least 10% of the lungs. Serum levels of Th2 cytokines were higher in SSc patients than HC. A linear correlation was observed between ground glass and IL-13 (r = 0.342, p < 0.01), IL-21 (r = 0.345, p < 0.01), IL-31 (r = 0.473, p < 0.001), IL-4 (r = 0.863, p < 0.001), IL-5 (r = 0.249, p < 0.05) and peripheral blood eosinophils (r = 0.463, p < 0.001). We found a negative correlation between DLco and IL-4 (r = - 0.511, p < 0.001) and peripheral blood eosinophils (r = - 0.446, p < 0.001). In the logistic regression analysis, IL-4 is associated with DLco ≤ 60% of the predicted [OR 1.039 (CI 95%: 1.015-1.064), p < 0.001], whilstmRSS [OR 1.138 (CI 95%: 1.023-1.266), p < 0.05] and IL-4 [OR 1.017 (CI 95%: 1-1.034), p < 0.05] were associated with ILD. Th2 inflammation could play a key role in early phase of SSc-ILD.

Ultra-rare RTEL1 gene variants associate with acute severity of COVID-19 and evolution to pulmonary fibrosis as a specific long COVID disorder

BackgroundSevere Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a novel coronavirus that caused an ongoing pandemic of a pathology termed Coronavirus Disease 19 (COVID-19). Several studies reported that both COVID-19 and RTEL1 variants are associated with shorter telomere length, but a direct association between the two is not generally acknowledged. Here we demonstrate that up to 8.6% of severe COVID-19 patients bear RTEL1 ultra-rare variants, and show how this subgroup can be recognized.MethodsA cohort of 2246 SARS-CoV-2-positive subjects, collected within the GEN-COVID Multicenter study, was used in this work. Whole exome sequencing analysis was performed using the NovaSeq6000 System, and machine learning methods were used for candidate gene selection of severity. A nested study, comparing severely affected patients bearing or not variants in the selected gene, was used for the characterisation of specific clinical features connected to variants in both acute and post-acute phases.ResultsOur GEN-COVID cohort revealed a total of 151 patients carrying at least one RTEL1 ultra-rare variant, which was selected as a specific acute severity feature. From a clinical point of view, these patients showed higher liver function indices, as well as increased CRP and inflammatory markers, such as IL-6. Moreover, compared to control subjects, they present autoimmune disorders more frequently. Finally, their decreased diffusion lung capacity for carbon monoxide after six months of COVID-19 suggests that RTEL1 variants can contribute to the development of SARS-CoV-2-elicited lung fibrosis.ConclusionRTEL1 ultra-rare variants can be considered as a predictive marker of COVID-19 severity, as well as a marker of pathological evolution in pulmonary fibrosis in the post-COVID phase. This notion can be used for a rapid screening in hospitalized infected people, for vaccine prioritization, and appropriate follow-up assessment for subjects at risk.Trial Registration NCT04549831 (www.clinicaltrial.org)

FVC/DLCO identifies pulmonary hypertension and predicts 5-year all-cause mortality in patients with COPD

BackgroundPulmonary hypertension (PH) is a common complication of chronic obstructive pulmonary disease (COPD). However, it is unknown whether the ratio of forced vital capacity (FVC) to diffusing lung capacity for carbon monoxide (DLCO) can identify PH in the patients with COPD and predict its prognosis.MethodsThe study population I included 937 COPD patients who were admitted to inpatient treatments from 2010 to 2017, and finally 750 patients were available to follow-up the 5-year all-cause mortality (study population II). Clinical characteristics of the study population were recorded.ResultsCOPD patients with PH had a higher FVC/DLCO value compared with the patients without PH. The threshold for FVC/DLCO to identify PH in COPD patients was 0.44 l/mmol/min/kPa. Multivariate logistic regression analysis showed that FVC/DLCO was a significant predictor for PH in the patients with COPD. The study population II showed that the 5-year all-cause mortality of COPD patients was significantly higher in combined with PH group than without PH group. Compared with the survivor group, FVC/DLCO value was significantly increased in non-survivor group. The threshold for FVC/DLCO to predict 5-year all-cause mortality was 0.41 l/mmol/min/kPa. Kaplan–Meier survival curves showed that 5-year cumulative survival rate for COPD patients were significantly decreased when the value of FVC/DLCO was ≥ 0.41 l/mmol/min/kPa. Multivariate cox regression analysis showed that FVC/DLCO was an independent prognostic factor for 5-year all-cause mortality in COPD patients.ConclusionFVC/DLCO could identify PH in the patients with COPD and was an independent predictor for 5-year all-cause mortality of COPD.

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.

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.

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.

Effect of incentive spirometry on pulmonary function test in post COVID-19 pneumonia patients

Background. COVID-19 caused by SARS-CoV-2 virus was assigned as a pandemic by WHO. Fever, breathlessness, cough and expectoration indicates lung involvement in the form of pneumonia and its most common complications are pulmonary fibrosis, chronic respiratory failure and reduced quality of life. Incentive spirometry is the relevant therapy to enhance the normal lung function and improve quality of life. Aim. To find the effect of incentive spirometry on pulmonary function test in post COVID-19 pneumonia patients. Methodology. An experimental study with simple random sampling (lottery method) of 24 patients in age group (18-68 years). The participants were randomly divided into 2 groups. Group A received pharmacotherapy and incentive spirometry and Group B received only pharmacotherapy. Computerized spirometry and Diffusion lung capacity for carbon monoxide (DLCO) was used as diagnostic tool to measure pre &amp; post test values for both groups. Intervention was given for 4 weeks and after 4 weeks, to analyze the spirometry values post-test was taken for both groups. Outcome measures. Forced expiratory volume in the first second (FEV1), Forced vital capacity (FVC), FEV1/FVC &amp;DLCO. Results. Statistical analysis shows significant improvement (p &lt; 0.05) between pretest and post test values on Pulmonary Function Tests (PFT) in both Group A&amp;B whereas there was increase in the improvement in intervention group than control group. Conclusion. Incentive spirometry improved the lung volume and capacities on PFT in post COVID-19 pneumonia patients and also these patients have mainly restrictive lung pattern by the use of DLCO.

Efficacy and safety of abatacept for interstitial lung disease associated with antisynthetase syndrome: a case series.

This study investigated the efficacy and safety of abatacept (ABA) in interstitial lung disease (ILD) associated with antisynthetase syndrome (ASS). Eight patients were identified through retrospective analysis of the medical records of our centre. All patients fulfilled the Solomon criteria and had a disease complicated with ILD. Lung function, imaging, serum markers, clinical evaluation indicators of ILD, peripheral blood cell classification, cytokines, and prednisone doses were analysed. Seven of the eight patients were female. The mean age was 54.4 (standard deviation [SD] 6.0) years. Antibodies against Jo-1, PL-12, and PL-7 were present in three, three, and two patients respectively. At baseline, the mean diffusing lung capacity for carbon monoxide (DLCO) was 53.8% (SD 9.2%), the mean score of King's Brief Interstitial Lung Disease (KBILD) was 40.6 (SD 13.8), the median Krebs Von den Lungen-6 (KL-6) was 1612.5 (interquartile range [IQR] 1180.5-2431.5) U/ml. All patients experienced symptom alleviation after ABA therapy. The mean and median changes in DLCO percentage, KBILD, and KL-6 were 12.3% (p<0.05), 21.4 (p<0.01), and 174.5U/ml (p<0.01), respectively. No obvious adverse events related to ABA were observed during the treatment. Our study offers preliminary, but encouraging, clinical evidence in favour of ABA as a therapy for ASS-ILD. ABA demonstrated favourable effects on ILD and was well-tolerated. Well-designed randomised controlled studies are required to confirm the efficacy and safety of this strategy.