Pre-existing Chronic Obstructive Pulmonary Disease Research Articles

A mRNA panel for differentiation between acute exacerbation or pneumonia in COPD patients.

Patients suffering from chronic obstructive pulmonary disease (COPD) are prone to acute exacerbations (AECOPD) or community acquired pneumonia (CAP), both posing severe risk of morbidity and mortality. There is no available biomarker that correctly separates AECOPD from COPD. However, because CAP and AECOPD differ in aetiology, treatment and prognosis, their discrimination would be important. This study analysed the ability of selected candidate transcripts from peripheral blood mononuclear cells (PBMCs) to differentiate between patients with AECOPD, COPD & CAP, and CAP without pre-existing COPD. In a previous study, we identified differentially regulated genes between CAP and AECOPD in PBMCs. In the present new cohort, we tested the potential of selected candidate PBMC transcripts to differentiate at early time points AECOPD, CAP+COPD, and CAP without pre-existing COPD. Expression of YWHAG, E2F1 and TDRD9 held predictive power: This gene set predicted diseases markedly better (model accuracy up to 100%) than classical clinical markers like CRP, lymphocyte count and neutrophil count (model accuracy up to 82%). In summary, in our cohort expression levels of YWHAG, E2F1 and TDRD9 differentiated with high accuracy between COPD patients suffering from acute exacerbation or CAP.

County health ranking: untangling social determinants of health and other factors associated with short-term bariatric surgery outcomes

BackgroundThe complex interplay of the social determinants of health, race/ethnicity, and traditional surgical risk factors on outcomes following metabolic surgery is poorly understood. ObjectiveTo evaluate the relationship between the social determinants of health as measured by county health ranking (CHR) and short-term metabolic surgery outcomes. SettingFive accredited bariatric program sites at a national academic health system. MethodsData were collected from 5 sites of a single health system from 2010 to 2021. Current procedural terminology codes identified primary and revisional cases. Patient characteristics, procedural data, and 30-day occurrences were collected. CHRs for health factors were determined by ZIP Code and stratified into best, middle, and worst terciles. The primary outcome was 30-day complications, readmissions, or reinterventions/reoperations. Logistic regression assessed the correlation between CHR tercile and morbidity. ResultsWe analyzed 4,315 primary and 370 revisional metabolic surgery cases. Overall, 64.0%, 27.4%, and 8.6% of patients lived in the best, middle, and worst CHR terciles, respectively. Patients in the middle and worst CHR terciles were more commonly older; non-Hispanic Black or Hispanic; suffered from preexisting chronic obstructive pulmonary disease or hypertension, were dialysis dependence, were on therapeutic anticoagulation, or had inferior vena cava filters. Middle and worst CHR tercile patients were more likely to undergo index sleeve gastrectomy or robotic-assisted surgery and have surgery performed by a self-designated general surgeon. Thirty-day outcomes were similar across CHR terciles. Racial disparity in multiple short-term outcomes persisted despite adjustment for CHR tercile. ConclusionHigher-risk patients are more likely to be from counties with lower CHRs, but CHR was not independently associated with 30-day outcomes after metabolic surgery.

Clearing the Air: Understanding the Impact of Wildfire Smoke on Asthma and COPD

Wildfires are a global natural phenomenon. In North America, wildfires have not only become more frequent, but also more severe and longer in duration, a trend ascribed to climate change combined with large fuel stores left from modern fire suppression. The intensification of wildfire activity has significant implications for planetary health and public health, as exposure to fine particulate matter (PM2.5) in wildfire smoke is linked to adverse health effects. This review focuses on respiratory morbidity from wildfire smoke exposure. Inhalation of wildfire PM2.5 causes lung injury via oxidative stress, local and systemic inflammation, airway epithelium compromise, and increased vulnerability to infection. Wildfire PM2.5 exposure results in exacerbations of pre-existing asthma and chronic obstructive pulmonary disease, with an escalation in healthcare utilization, including emergency department visits and hospitalizations. Wildfire smoke exposure may be associated with asthma onset, long-term impairment of lung function, and increased all-cause mortality. Children, older adults, occupationally-exposed groups, and possibly women are the most at risk from wildfire smoke. Future research is needed to clarify best practices for risk mitigation and wildfire management.

COVID-19-associated pulmonary aspergillosis in mechanically ventilated patients: a prospective, multicentre UK study

BackgroundInvasive pulmonary aspergillosis is a complication of severe COVID-19, with regional variation in reported incidence and mortality. We describe the incidence, risk factors and mortality associated with COVID-19-associated pulmonary aspergillosis...

Pre-diagnostic prescribing patterns in dyspnoea patients with as-yet-undiagnosed lung cancer: A longitudinal study of linked primary care and cancer registry data

IntroductionPatients with as-yet undiagnosed lung cancer (LC) can present to primary care with non-specific symptoms such as dyspnoea, often in the context of pre-existing chronic obstructive pulmonary disease (COPD). Related medication prescriptions pre-diagnosis might represent opportunities for earlier diagnosis, but UK evidence is limited. Consequently, we explored prescribing patterns of relevant medications in patients who presented with dyspnoea in primary care and were subsequently diagnosed with LC. MethodLinked primary care (Clinical Practice Research Datalink) and National Cancer Registry data were used to identify 5434 patients with incident LC within a year of a dyspnoea presentation in primary care between 2006 and 2016. Primary care prescriptions relevant to dyspnoea management were examined: antibiotics, inhaled medications, oral steroids, and opioid analgesics. Poisson regression models estimated monthly prescribing rates during the year pre-diagnosis. Variation by COPD status (52 % pre-existing, 36 % COPD-free, 12 % new-onset) was examined. Inflection points were identified indicating when prescribing rates changed from the background rate. Results63 % of patients received 1 or more relevant prescriptions 1–12 months pre-diagnosis. Pre-existing COPD patients were most prescribed inhaled medications. COPD-free and new-onset COPD patients were most prescribed antibiotics. Most patients received 2 or more relevant prescriptions. Monthly prescribing rates of all medications increased towards time of diagnosis in all patient groups and were highest in pre-existing COPD patients. Increases in prescribing activity were observed earliest in pre-existing COPD patients 5 months pre-diagnosis for inhaled medications, antibiotics, and steroids, ConclusionResults indicate that a diagnostic window of appreciable length exists for potential earlier LC diagnosis in some patients. Lung cancer diagnosis may be delayed if early symptoms are misattributed to COPD or other benign conditions.

The Complex Association between COPD and COVID-19.

Chronic obstructive pulmonary disease (COPD) is significant cause of morbidity and mortality worldwide. There is mounting evidence suggesting that COPD patients are at increased risk of severe COVID-19 outcomes; however, it remains unclear whether they are more susceptible to acquiring SARS-CoV-2 infection. In this comprehensive review, we aim to provide an up-to-date perspective of the intricate relationship between COPD and COVID-19. We conducted a thorough review of the literature to examine the evidence regarding the susceptibility of COPD patients to COVID-19 infection and the severity of their disease outcomes. While most studies have found that pre-existing COPD is associated with worse COVID-19 outcomes, some have yielded conflicting results. We also discuss confounding factors such as cigarette smoking, inhaled corticosteroids, and socioeconomic and genetic factors that may influence this association. Furthermore, we review acute COVID-19 management, treatment, rehabilitation, and recovery in COPD patients and how public health measures impact their care. In conclusion, while the association between COPD and COVID-19 is complex and requires further investigation, this review highlights the need for careful management of COPD patients during the pandemic to minimize the risk of severe COVID-19 outcomes.

Incidence and Healthcare Burden of Pertussis among Older Adults with and without Pre-Existing Chronic Obstructive Pulmonary Disease or Asthma in South Korea

A retrospective cohort study was conducted to examine trends in the incidence and burden of pertussis among adults ≥50 years in South Korea, with/without pre-existing chronic obstructive pulmonary disease (COPD) or asthma. The nationwide Health Insurance Review and Assessment Service (HIRA) database was used to identify patients ≥50 years diagnosed with pertussis (2009–2018). Mean annual incidence of pertussis per 100 000 persons and overall mean incidence rate ratios (IRR) were calculated for patients with pre-existing COPD or asthma versus those with neither. Incremental healthcare costs (all-cause and pertussis-related) and healthcare utilisation (number of outpatient visits, emergency room visits, and number and length of hospitalisations) up to 12 months after, compared to 3 months before pertussis diagnosis, were also measured for each group (matched on sex, age, and Charlson Comorbidity Index). Of 1011 pertussis cases, 175 had asthma, 96 had COPD (not mutually exclusive), and 796 had neither. Overall mean pertussis incidence was 2.5, 3.4, and 0.5 for adults with pre-existing COPD, asthma, and those with neither. IRR (95% confidence interval) of pertussis for adults with pre-existing COPD and asthma was 4.9 (4.0–‍6.1) and 6.7 (5.7–7.9). Both COPD-pertussis and asthma-pertussis groups had higher mean incremental all-cause costs and length of hospitalisations than the general-pertussis group 3 months following pertussis diagnosis. In conclusion, individuals ≥50 years in South Korea with pre-existing COPD or asthma were at an increased risk of being diagnosed with pertussis and had higher healthcare resource utilisation than those without these conditions.

Investigating the role of obstructive pulmonary diseases and eosinophil count at admission on all-cause mortality in SARS-CoV-2 patients

The impact of asthma and chronic obstructive pulmonary disease (COPD) in the setting of severe acute respiratory syndrome coronavirus 2 (SARS-CoV‑2) infection is not clearly defined. Blood eosinophil count is astandard diagnostic test which, according to the previously published literature, might have apotential prognostic role on mortality in patients with SARS-CoV‑2 infection. To investigate the potential prognostic value of peripheral blood eosinophil count on all-cause mortality of patients hospitalized with SARS-CoV‑2 infection, as well as to assess the impact of asthma or COPD premorbidity on all-cause mortality. We conducted aretrospective registry-based cohort study. Survival analysis was performed by employing the Cox proportional hazards regression model at 30days of follow-up. Prognostic value of eosinophil count on all-cause mortality was assessed using receiver-operating characteristic (ROC) curve analysis. A total of 5653participants were included in the study. Our model did not reveal that pre-existing asthma or COPD is a statistically significant covariate for all-cause mortality but, indicated that higher eosinophil count at admission might have aprotective effect (hazard ratio, HR 0.13 (95% confidence interval, CI 0.06-0.27), p = 0.0001). ROC curve analysis indicates cut-off value of 20cells/mm3 (81% specificity; 30.9% sensitivity). Our results indicate that eosinophil count at hospital admission might have apotential prognostic role for all-cause mortality at 30days of follow-up; however this was not demonstrated for pre-existing obstructive lung diseases.

Epidemiology, clinical features, and outcomes of strongyloidiasis in Taiwan from 1988 to 2020: A case series and literature review.

We described a case of Strongyloides hyperinfection syndrome, reported a case series, and reviewed published cases of strongyloidiasis in Taiwan. Confirmed cases of strongyloidiasis at the National Taiwan University Hospital (NTUH) and NTUH Hsin-Chu Branch from 1988 to 2020 were identified in the medical record database. Literature search was carried out through Pubmed, Google Scholar, and Index to Taiwan Periodical Literature System to identify published cases of strongyloidiasis in Taiwan from 1979 to 2020. Data pertaining to the demographics, underlying medical conditions, clinical manifestations, laboratory findings, and outcomes were extracted. A total of 117 cases of strongyloidiasis were identified, including 20 previously unpublished cases from the two hospitals and 97 published cases in the literature. Overall, 85 (73%) were male and the mean age was 64 years (range, 6-95 years). Classical symptoms such as diarrhea, cough, and skin rash were only observed in 43%, 37%, and 18% of the patients, respectively, whereas eosinophilia at presentation was only found in 48%. Strongyloides hyperinfection syndrome and disseminated strongyloidiasis were identified in 41 (35%) and 4 (3%) patients, respectively. Four (3%) patients had concurrent meningitis. In univariable analysis, being older and having pre-existing chronic obstructive pulmonary disease or asthma were associated with hyperinfection or dissemination (p=0.024 and 0.003, respectively). The mortality rate was 43% among those with hyperinfection or disseminated infection. Strongyloidiasis can cause serious complications and mortality. Efforts to diagnose strongyloidiasis early are urgently needed to improve the outcome of patients with strongyloidiasis in Taiwan.

Risk Factors of Pertussis Among Older Adults in South Korea: A Nationwide Health Data-Based Case-Control Study.

To better understand the conditions associated with pertussis diagnosis among older adults in South Korea, a matched case-control study was conducted of individuals≥50years diagnosed with pertussis between 2009 and 2018. Pertussis cases were identified using the nationwide Health Insurance Review and Assessment service (HIRA) database. Each case was then matched to up to 10 controls identified using the National Health Insurance Service-National Sample Cohort (NHIS-NSC) by age, sex, and geographic region at index date. In the 12months and 30days prior to index date, the presence of clinical characteristics previously reported to be related to pertussis and pertussis-like conditions were assessed, respectively. A conditional multivariate logistic regression model was then used to calculate odds ratios (ORs) of pertussis diagnosis, adjusted for each of the characteristics. Pertussis cases (n=1004) generally demonstrated a higher prevalence of comorbidities compared to controls (n=9710). Pre-existing asthma and chronic obstructive pulmonary disease (COPD) within 12months of index date were associated with a two-fold increased risk of pertussis with adjusted ORs (95% confidence interval) of 2.08 (1.68-2.58) and 2.32 (1.59-3.39), respectively. Gastroesophageal reflux disease [GERD; 2.67 (2.23-3.19)], cancer [1.68 (1.23-2.31)], cardiovascular disease [1.62 (1.31-2.00)], renal disease [1.56 (1.12-2.16)], autoimmune disease [1.50 (1.25-1.79)], and hyperlipidemia [1.43 (1.16-1.77)] were also associated with pertussis diagnosis. Finally, acute respiratory events within 30days prior to index date, such as pneumonia, acute bronchitis, and upper respiratory tract infection (URTI), were highly associated with increased odds of pertussis diagnosis [adjusted ORs of 8.28 (5.10-13.44), 4.86 (3.84-6.14), and 2.90 (2.30-3.67), respectively]. This study's findings complement and expand upon previous studies on the adult pertussis population, generating real-world data to describe underlying clinical characteristics of those diagnosed with pertussis in South Korea.

Epidemiological burden, risk factors, and recent therapeutic advances in chronic obstructive pulmonary disease

Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease that is certainly preventable and treatable and is caused due to the continuous exposure to noxious substances and toxic gases and is characterized by airflow limitation and chronic inflammation in the lungs coupled with persistent symptoms in the respiratory tract leading to obstructive bronchiolitis and parenchymal emphysema. The incidence and progression of COPD is a complicated pathological phenomenon and the overall severity is due to its exacerbations and comorbidities in individuals. Further, COPD is a major contributor to the global years of life lost and by 2030 it would be the third leading causes of mortality in the world. Also, knowledge on COPD, its associated conditions and the clinical understanding of the disease date back to the 16th century. The prevalence, morbidity and mortality may vary across the globe based on their exposure to smoking, tobacco, occupational pollutants, indoor pollution, outdoor air pollution, gender, age and genetic inheritance. Considering the continuous exposure to toxic substances and aging of the general population, the burden and prevalence of COPD are estimated to increase substantially in the coming years. Furthermore, COVID-19 patients with pre-existing COPD conditions suffer from severe disease progression and delay in recovery.

Effect of asthma, COPD, and ACO on COVID-19: A systematic review and meta-analysis.

The prevalence of asthma, chronic obstructive pulmonary disease (COPD), and asthma-COPD overlap (ACO) in patients with COVID-19 varies, as well as their risks of mortality. The present study aimed to assess the prevalence of asthma, COPD, and ACO as comorbidities, and to determine their risks of mortality in patients with COVID-19 using a systematic review and meta-analysis. We systematically reviewed clinical studies that reported the comorbidities of asthma, COPD, and ACO in patients with COVID-19. We searched various databases including PubMed (from inception to 27 September 2021) for eligible studies written in English. A meta-analysis was performed using the random-effect model for measuring the prevalence of asthma, COPD, and ACO as comorbidities, and the mortality risk of asthma, COPD, and ACO in patients with COVID-19 was estimated. A stratified analysis was conducted according to country. One hundred one studies were eligible, and 1,229,434 patients with COVID-19 were identified. Among them, the estimated prevalence of asthma, COPD, and ACO using a meta-analysis was 10.04% (95% confidence interval [CI], 8.79-11.30), 8.18% (95% CI, 7.01-9.35), and 3.70% (95% CI, 2.40-5.00), respectively. The odds ratio for mortality of pre-existing asthma in COVID-19 patients was 0.89 (95% CI, 0.55-1.4; p = 0.630), while that in pre-existing COPD in COVID-19 patients was 3.79 (95% CI, 2.74-5.24; p<0.001). France showed the highest prevalence of asthma followed by the UK, while that of COPD was highest in the Netherlands followed by India. Pre-existing asthma and COPD are associated with the incidence of COVID-19. Having COPD significantly increases the risk of mortality in patients with COVID-19. These differences appear to be influenced by the difference of locations of disease pathophysiology and by the daily diagnosis and treatment policy of each country.

Impact of cold spells on COPD mortality in Jiangsu Province, China.

Ambient cold is associated with substantial population attributable fraction of mortality in China, and respiratory health is vulnerable to cold exposure. This study aimed to examine the effect of cold spells on risk of deaths from chronic obstructive pulmonary disease (COPD). We collected daily data on deaths from COPD and climatic factors from 1 January 2016 to 31 December 2019 in 13 cities of Jiangsu Province, China. We used a quasi-Poisson generalized linear model coupled with a distributed lag non-linear model to quantify the association between risk of COPD deaths and exposure to cold spells (defined as 2 or more consecutive days with mean temperature ≤ 5th percentile of daily mean temperature distribution in cold months). Stratification analyses by age, sex, education, and occupation were undertaken to identify vulnerable subgroups. The results suggested that exposure to cold spells was associated with a higher risk of COPD deaths in Lianyungang (relative risk (RR): 1.70; 95% confidence interval (CI): 1.31, 2.21), Nanjing (RR: 1.54; 95% CI: 1.16, 2.04), Nantong (RR: 1.97; 95% CI: 1.68, 2.31), Suzhou (RR: 1.97; 95% CI: 1.55, 2.50), Suqian (RR: 1.68; 95% CI: 1.23, 2.29), Taizhou (RR: 1.70; 95% CI: 1.32, 2.19), Wuxi (RR: 1.99; 95% CI: 1.53, 2.60), Xuzhou (RR: 1.71; 95% CI: 1.01, 2.90), Yancheng (RR: 1.78; 95% CI: 1.53, 2.06), Yangzhou (RR: 2.78; 95% CI: 2.06, 3.76), and Zhenjiang (RR: 1.79; 95% CI: 1.26, 2.55). All subgroups seemed to be vulnerable to the effect of cold spells. The recommendation of this study is that individuals with pre-existing COPD, regardless of age, sex, education, or occupation, should be made aware of the health risk posed by cold spells and should be encouraged to take cold adaptation actions before cold season arrives. The main limitation of this study is that it is subject to ecological fallacy.

Comparative risk assessment of COVID-19 associated mucormycosis and aspergillosis: A systematic review.

COVID‐19 is not only limited to a defined array but also has expanded with several secondary infections. Two uncommon opportunistic fungal infections, COVID‐19 associated mucormycosis (CAM) and aspergillosis (CAA), have recently been highly acquainted by many worldwide cases. Two immune response deteriorating factors are considered to be responsible for immunosuppression: comorbidities and medication. Due to unlike infection sites and patterns, CAM and CAA‐associated factors deflect a few degrees of proximity, and the present study is for its assessment. The study evaluated 351 CAM cases and 191 CAA cases retrieved from 65 and 53 articles based on inclusion criteria, respectively. Most of the CAM reported from India and CAA were from four South‐European and West‐European neighbor countries. The mean ages of CAM and CAA were 52.72 ± 13.74 and 64.81 ± 11.14, correspondingly. Mortality of CAA (56.28%) was two times greater than CAM (26.02%). Nevertheless, the count of diabetes cases was very high in CAM compared to CAA. The main comorbidities of CAM were diabetes (nearly 80%) and hypertension (more than 38%). All noticeable complications were higher in CAA except diabetes, and these were diabetes (34.55%), hypertension (45.03%), and obesity (18.32%). Moreover, pre‐existing respiratory complications like asthma and chronic obstructive pulmonary disease are visible in CAA. The uses of steroids in CAM and CAA were nearly 70% and 66%, respectively. Almost one‐fourth of CAA cases were reported using immunosuppressant monoclonal antibodies, whereas only 7.69% were for CAM. The overall finding highlights diabetes, hypertension, and steroids as the risk factors for CAM, whereas obesity, chronic pulmonary disease, and immunosuppressants for CAA.

Gender Disparities in Aortoiliac Revascularization in Patients with Aortoiliac Occlusive Disease

Gender disparities have been previously reported in aortic aneurysm and critical limb ischemia outcomes; however, limited info is known about disparities in aortoiliac occlusive disease. We sought to characterize potential disparities in this specific population. Patients who underwent aortobifemoral bypass and aortic thromboendarterectomy (Current Procedural Terminology codes 35646 and 35331) between 2012 and 2019 were identified in the National Surgical Quality Improvement Program database. A binomial regression model was used to estimate gender differences in 30-day morbidity and mortality. Inverse probability weighting was used to standardize demographic and surgical characteristics. We identified 1,869 patients, of which 39.8% were female and the median age was 61years. Age, body composition, and other baseline characteristics were overall similar between genders; however, racial data were missing for 26.1% of patients. Females had a higher prevalence of preexisting chronic obstructive pulmonary disease (20.9% vs. 14.7%, prevalence difference 6.1%, P<0.01), diabetes mellitus (25.4% vs. 19.4%, prevalence difference 6.0%, P<0.01), and high-risk anatomical features (39.4% vs. 33.7%, prevalence difference 5.8%, P=0.01). Preprocedural medications included a statin in only 68.2% of patients and antiplatelet agent in 76.7% of patients. Females also had a higher incidence of bleeding events when compared to males (25.2% vs. 17.5%, standardized risk difference 7.2%, P<0.01), but were less likely to have a prolonged hospitalization greater than 10days (18.2% vs. 20.9%, standardized risk difference -5.0%, P=0.01). The 30-day mortality rate was not significantly different between genders (4.7% vs. 3.6%, standardized risk difference 1.2%, P=0.25). Female patients treated with aortobifemoral bypass or aortic thromboendarterectomy are more likely to have preexisting chronic obstructive pulmonary disease, diabetes mellitus, and high-risk anatomical features. Regardless of a patient's gender, there is poor adherence to preoperative medical optimization with both statins and antiplatelet agents. Female patients are more likely to have postoperative bleeding complications while males are more likely to have a prolonged hospital stay greater than 10days. Future work could attempt to further delineate disparities using databases with longer follow-up data and seek to create protocols for reducing these observed disparities.

Clinical course and outcomes of COVID-19 patients with chronic obstructive pulmonary disease: A retrospective observational study in Wuhan, China.

Information about coronavirus disease 2019 (COVID-19) patients with pre-existing chronic obstructive pulmonary disease (COPD) is still lacking. The aim of this study is to describe the clinical course and the outcome of COVID-19 patients with comorbid COPD.This retrospective study was performed at Wuhan Huoshenshan Hospital in China. Patients with a clear diagnosis of COVID-19 who had comorbid COPD (N = 78) were identified. COVID-19 patients without COPD were randomly selected and matched by age and sex to those with COPD. Clinical data were analyzed and compared between the two groups. The composite outcome was the onset of intensive care unit admission, use of mechanical ventilation, or death during hospitalization. Multivariable Cox regression analyses controlling for comorbidities were performed to explore the relationship between comorbid COPD and clinical outcome of COVID-19.Compared to age- and sex-matched COVID-19 patients without pre-existing COPD, patients with pre-existing COPD were more likely to present with dyspnea, necessitate expectorants, sedatives, and mechanical ventilation, suggesting the existence of acute exacerbations of COPD (AECOPD). Greater proportions of patients with COPD developed respiratory failure and yielded poor clinical outcomes. However, laboratory tests did not show severer infection, over-activated inflammatory responses, and multi-organ injury in patients with COPD. Kaplan–Meier analyses showed patients with COPD exhibited longer viral clearance time in the respiratory tract. Multifactor regression analysis showed COPD was independently correlated with poor clinical outcomes.COVID-19 patients with pre-existing COPD are more vulnerable to AECOPD and subsequent respiratory failure, which is the main culprit for unfavorable clinical outcomes. However, COPD pathophysiology itself is not associated with over-activated inflammation status seen in severe COVID-19.

Clinical outcome of shielded patients who have been infected with COVID-19 in Barnsley Borough- June 2020

BackgroundSevere acute respiratory syndrome – coronavirus-2 has caused a pandemic that put the life of extremely vulnerable people who are eligible for shielding from COVID-19 at a greater risk. The UK government had advised those vulnerable people to start shielding by 21st of March 2020.MethodsThis study is a retrospective review of 74 patients who had laboratory confirmed covid 19 disease (tested between 31/03/2020–13/05/2020) and identified by Barnsley hospital information database as eligible for shielding. The reviewed cases were evaluated for clinical outcome, reasons for shielding, demographic distribution, place of residence and history of recent hospital stay.Results74 patients [median age 76.4 , males – 53%] were included, of which 48.6% [n = 36, median age 81.5] had died. 43 out of all 74 patients had COPD (chronic obstructive pulmonary disease) and 24 [56%] of them had died. 24 patients [32.4%] lived in care homes.19 out of all 74 patients were in-patient after 21st March for reasons other than COVID19 and diagnosed with COVID19 following discharge from hospital.ConclusionThe study describes notably higher mortality from COVID19 in the shielding group, particularly in elderly patients and those with pre-existing COPD diagnosis. This group must be given priority when offering vaccination. The study has also revealed the need to adopt strict infection control measures to minimise infection transmission in care homes. Introducing a quicker way of testing on admission to hospital (e.g., point of care testing) would facilitate efficient triaging and bed allocation, which could subsequently reduce the risk of nosocomial infection.

CLINICAL CHARACTERISTICS AND SHORT-TERM OUTCOMES IN COVID-19 POSITIVE PATIENTS REQUIRING HEMODIALYSIS AT A TERTIARY HOSPITAL IN A DEVELOPING COUNTRY

Background: The presence of comorbidities and relative immunosuppression in chronic kidney disease patients on hemodialysis raises concerns that these patients may have an increased risk of severe COVID-19. We aimed to examine the presentation and in-hospital outcomes of COVID-19 patients with end stage renal disease requiring hemodialysis. Methods:To examine presentation and in-hospital outcomes of COVID-19 in patients with end stage renal disease requiring hemodialysis. The study was conducted in a tertiary care centre from June 2020 to December 2020. We collected clinical &amp; laboratory data of 126 COVID-19 positive in-patients requiring hemodialysis. CKD patients referred to our centre for hemodialysis patients were also included. Patients requiring invasive ventilation and management in intensive care units were excluded. Patients were categorised into two groups based on their outcomes; survivors and non-survivors. Detailed history &amp; biochemistry results were recorded and analysed using SPSS 20.0. Results: A total of 126 patients were included in our study, with male predominance, n=91(72.2%). The median age of our study population was 53 years. The main presenting complaints were fever, n=78(61.9%); cough, n=69(54.8%), dyspnea, n= 62(49.2%), fatigue, n=102(81%) and myalgia, n=51(40.5%). Eighty nine(70.6%) patients were hypertensives, 48 (38.1%) known diabetics and 13 (10.3%) had pre-existing chronic obstructive pulmonary disease. Lung involvement in CT imaging at the time of admission, were found in 93(85.5%) patients. On comparison between survivor and non-survivors, there was no statistical difference in the biochemical prole, however there was signicant chest imaging ndings (p&lt;0.001) and requirement of ventilator (p&lt;0.001) in the non-survivor group. Conclusion: In our study, mortality was high in patients showing chest imaging ndings and also in those requiring non-invasive ventilation even in non-intensive care setting, at admission. The high mortality in CKD patients on hemodialysis emphasizes the need of dedicated COVID hemodialysis units,to prevent interruption in routine outpatient stable dialysis patients.

Effective-component compatibility of Bufei Yishen formula protects COPD rats against PM2.5-induced oxidative stress via miR-155/FOXO3a pathway

Ambient particulate matter <2.5 µm (PM2.5) has been identified as a critical risk factor in chronic obstructive pulmonary disease (COPD) exacerbation, but therapies for this condition are limited. Effective-component compatibility of Bufei Yishen formula (ECC-BYF) exhibits beneficial efficacy on COPD rats. However, its effect on PM2.5-aggravated COPD rats are considered to be uncertain. In this study, we used an established PM2.5-aggravated COPD rat model in vivo to evaluate the protective effect of ECC-BYF, and focused on its antioxidative role in PM2.5-stimulated bronchial epithelial cells via regulating microRNA (miR)−155/ forkhead box class O3a (FOXO3a) pathway. As expected, PM2.5-aggravated COPD rats showed a reduction of lung function, persistent lung inflammation, and remodeling of lung tissue. In comparison, ECC-BYF administration significantly enhanced lung function, alleviated alveolar destruction, inflammatory cell infiltration, mucus hypersecretion, and collagen deposition, along with diminishing inflammatory cytokine production and oxidative stress. Furthermore, ECC-BYF pretreatment markedly decreased the fluorescence intensity of reactive oxygen species (ROS) in PM2.5-induced human bronchial epithelial (Beas-2B) cells and primary mouse tracheal epithelial cells (MTECs), as well as reversing the imbalance between oxidants and antioxidants in Beas-2B. Meanwhile, ECC-BYF elevated FOXO3a while inhibiting miR-155 expression dose -dependently. In vitro transfection of miR-155 mimic into Beas-2B significantly decreased FOXO3a protein expression, accompanied by the reduced superoxide dismutase 2 (SOD2) and catalase (CAT) expressions, thus eliminating the protective effect of ECC-BYF on PM2.5-evoked oxidative stress. Nonethless, FOXO3a overexpression could partially restore the antioxidative effect of ECC-BYF. In conclusion, ECC-BYF can protect pre-existing COPD against PM2.5 contamination by exerting a profound antioxidative influence via regulating miR-155/FOXO3a signaling.

Evaluating the Benefits of Viral Respiratory Panel Test in the Reduction of Emergency Department Throughput Time for Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

IntroductionThere has been a widespread antibiotic prescription in the Emergency Department (ED) among patients presenting with acute exacerbation chronic obstructive pulmonary disease (AECOPD) irrespective of the causative agent of the disease. The viral respiratory panel (VRP) test is designed to detect viral pathogens in the respiratory tract, which may contribute to the exacerbation of chronic obstructive pulmonary disease (COPD), as the upper and lower respiratory tract infections are caused by a broad range of microbes and not only bacteria. The aim of this study is to weigh the benefits of obtaining a VRP in patients presenting with isolated symptoms pertaining to well-defined criteria of an AECOPD with preexisting COPD or reactive airway disease to find out how such test impacts patient throughput time in the ED and also investigate how obtaining a VRP affects the use of antibiotics in this patient population. It is important that ED physicians accurately diagnose the main cause of AECOPD to help optimize the use of health care resources, including antibiotics, antivirals, inpatient, and ED beds. VRP testing must be taken into consideration as it helps eliminate the need of administering antibiotics to every patient who presents to the ED with AECOPD.Design and methodThis is a case-control observational study using retrospective chart review to obtain patients’ data from our hospital data warehouse. Data on patients with the primary diagnosis of AECOPD in the past two years were retrieved. A comparison between those who had VRP on arrival in the ED and those who did not have a VRP obtained was performed. We also compared ED throughput time for patients with AECOPD who received antibiotics to those who did not receive antibiotics. Only patients between the ages of 18 and 64 were included in the study. Patients with other preexisting health conditions such as cardiac diseases, neurological problems, and abdominal complaints were excluded. Patients who required hospitalization and pregnant patients were excluded from the study.ResultsWe collected the data of 340 patients who met the study criteria. Of the 340 patients enrolled, 65 (19%) received the VRP test and 275 (81%) did not receive VRP test. Among the 65 patients who received the VRP test, 45 (70%) had a virus etiology detected and reported in the ED (p=0.001). Also, 138 (50.2%) did not receive VRP test and were not given antibiotics, and 137 (49.8%) did not receive VRP test but were treated with antibiotics; 11 patients received antibiotics despite haven tested positive to a virus. The result showed that those who received antibiotics with no VRP test on arrival in the ED had a shorter throughput time compared to patients who did not receive antibiotics but received VRP test.ConclusionThe study is a quality improvement study to help determine the efficacy and appropriateness of ordering a VRP prior to ED disposition and the impact of overall ED throughput time for each patient presenting with AECOPD. The study showed that antibiotics did play a significant role in the duration of the throughput time in patients with AECOPD. However, rapid VRP testing was indeed associated with a trend toward decreased antibiotic use in the ED.