Previous Lung Disease Research Articles

SARS-CoV-2 pneumonia with large pneumothorax\u2014a case report

The pandemic of severe acute respiratory virus (SARS-CoV-2) is characterized by respiratory symptoms with serious consequences, mainly associated with pneumonia and extreme ARDS. There is a lack of data about pneumothorax associated with COVID-19 infections in current literature. Radiological features in SARS-CoV-2 include subpleural bilateral ground-glass appearance and many areas of irregular consolidation in the lungs. We here present a case of SARS-CoV-2 that was complicated by acute pneumothorax, and despite prompt treatment, that patient could not be saved. A 55-years-old male with no previous lung disease or any other history confirmed to have SARS-CoV-2 pneumonia developed a large pneumothorax on the third day of his presentation and was immediately intubated via a chest tube but could not be saved. SARS-CoV-2 by RT-PCR was positive. The patient expired around 12 h after chest intubation. Recommended treatment could not be started yet as the patient expired before it could be decided.

Mortality by COVID-19 Before Vaccination - One Year Experience of Hospitalized Patients in Madrid

ObjectivesThe aim of the study was to analyze the mortality and characteristics of deceased patients with COVID-19 during the first year of the pandemic.MethodsAll admissions owing to COVID-19 at a tertiary hospital in Madrid were analyzed. Three waves were considered: March 2020 to June 2020, July 2020 to November 2020, and December 2020 to April 2021.ResultsA total of 3,676 patients were identified. Among inpatients, no differences regarding age, sex, length of admission, or mortality were found between the 3 waves (p >0.05). The overall mortality rate was 12.9%. Among deceased patients, the median age was 82 years and the median Charlson Comorbidity Index was 6. Considering the main predictors for mortality by COVID-19 (age, sex, and concomitant comorbidities), only patients with previous lung disease were more prevalent in the third period (p <0.01). Finally, higher intensive care unit admission rates, a lower rate of patients coming from nursing homes, and a lower rate of patients with dementia were noted in the third period (p <0.05) among deceased patients.ConclusionOne year after the onset of the pandemic, the mortality rate of hospitalized patients and the profile of non-survivors have not changed significantly. In the absence of vaccine benefits, advanced age and multiple pathologies are uniform characteristics of non-survivors.

Alpha-1 antitrypsin deficiency and risk of lung cancer in never-smokers: a multicentre case\u2013control study

BackgroundLung cancer (LC) is the most commonly diagnosed cancer and the leading cause of cancer-related death in both sexes worldwide. Although the principal risk factor in the western world is tobacco smoking, genetic factors, including alpha-1 antitrypsin deficiency (AATD), have been associated with increased risk. This study is the continuation of an earlier one published by the same group in 2015, aimed at analysing risk of LC in never-smokers, associated with carriers of the AATD genotype.MethodsA multicentre case–control study was conducted in Spain across the period January 2011 to August 2019. Cases were non-smokers diagnosed with LC, and controls were composed of never-smoking individuals undergoing major non-cancer-related surgery. Data were collected on epidemiological characteristics, exposure to environmental tobacco smoke (ETS), residential radon levels, and alpha-1 antitrypsin (AAT) genotype.ResultsThe study included 457 cases (42%) and 631 controls (58%), with a predominance of women (72,8%). The most frequent histological type was adenocarcinoma (77.5%), followed by squamous cell carcinoma (7.7%). No association of risk of LC was found with the status of AATD genotype carrier, both overall and broken down by age, sex, or exposure to ETS.ConclusionsNo risk association was found between being a carrier of an AAT deficiency genotype and LC among never-smokers. In order to establish the existence of an association, we consider it important to expand the studies in never smokers in different geographical areas as well as to include patients with previous chronic lung diseases to assess if it influences the risk.

Comparison of respiratory muscle strength through manovacuometry in the early postoperative period of bariatric surgery by laparotomy and laparoscopy.

surgical treatment of obesity causes important changes in respiratory mechanics. Comparatively analyze respiratory muscle strength in post bariatric patients underwent to gastric bypass by laparotomy and laparoscopy during hospital stay. observational study with a non-randomized longitudinal design, of a quantitative character. Data were collected from 60 patients with BMI 40Kg/m2, divided in laparotomy group (n=30) and laparoscopy group (n=30). Smokers, patients with previous lung diseases and those unable to perform the exam correctly were excluded. Both groups were evaluated at immediate postoperative, first and second postoperative days with manovacuometry for respiratory muscle strength and visual analogue pain scale. the sample was homogeneous in age, sex and BMI. Reduction in maximal respiratory pressures was observed after surgery for those operated on by laparotomy, no return to baseline values on discharge day on the second postoperative day. This group had also more severe pain and longer operative time. There was no difference in respiratory pressure measurements after surgery in the laparoscopy group. conventional bariatric surgery reduces muscle strength in the postoperative period and leads to more intense pain during hospitalization when compared to the laparoscopy group.

Calcium channel blockers and beta-blockers could increased mortality of patients with COVID-19

BackgroundHigh incidence of cardiovascular events has been described among patients with COVID-19 and since the beginning of the pandemic concerns have been expressed with medical treatments for cardiovascular disease, as they could contribute to the severity of illness in patients with COVID-19. We aim to analyze the effect of chronic treatment with calcium channel blockers and beta-blockers on COVID 19 severity in a Spanish cohort during the 2020 pandemic.MethodsObservational study including all consecutive patients (≥40 years old) diagnosed with SARS-CoV-2 through PCR in the microbiology laboratory of our hospital, from March 2nd to 20th 2020. Clinical characteristics and drugs were recorded. The Primary end-point (PE) was all-cause death and the secondary end-point (SE) was the combined of death or the need for orotracheal intubation until 30 days of infection symptoms onset.ResultsWe included 704 patients in our study. Baseline characteristics of the overall cohort can be seen in the table. Median age was 61 years old (IQR 52.9–72.9); 52.7% were female. 34.7% and 12.6% had hypertension and diabetes respectively. After a median follow-up of 111.5 days, 58 patients (8.2%) needed orotracheal intubation and 133 patients (18.9%) died. Secondary endpoint (all-cause death or need for orotracheal intubation) was reached by 164 patients (23.3%). The table described clinical differences between survivors and deceased patients.After multivariate Cox modeling, age, male gender, diabetes, previous lung disease, BMI and the chronic intake of calcium channel blockers (HR 1.74, 95% CI (1.11–2.75), p=0.016) and beta-blockers (HR 1.71, 95% CI (1.07–2.76), p=0.026) were independently related with mortality. Other cardiovascular drugs (Antiplatelets, anticoagulants, diuretics, mineralcorticoid-receptor antagonists, angiotensin-receptor blockers, angiotensin-converting enzyme inhibitors and statins) did not influence survival after SARS-CoV 2 infection (Figure).The secondary outcome was reached by 164 patients (23.3%) and chronic treatment with calcium channel blockers remains as an independent predictor of mortality (HR 1.55, 95% CI (1.01–2.37), p=0.044).ConclusionsChronic treatment with calcium channel blockers and beta-blockers are independent predictors of mortality after SARS-CoV-2 infection. Further studies are needed to confirm these results.Funding AcknowledgementType of funding sources: None. Description of studied populationOdds-ratio and CI for all-cause death

OSIMERTINIB PNEUMONITIS MASQUERADING AS COVID-19 PNEUMONIA

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Osimertinib induced lung disease may present as a COVID pneumonia. We herein present a case of a 71 year old patient with hypoxic respiratory failure initially treated for COVID pneumonia, to be later diagnosed with Osimertinib induced pneumonitis. CASE PRESENTATION: A 71 year old gentleman with a 20 pack-year smoking history, epidermal growth factor receptor mutated stage IV non-small cell lung cancer with brain metastasis treated with Osimertinib, presented to the emergency room in March 2021 with shortness of breath for three days. On presentation, his oxygen saturation was 87% on room air and increased to 92% with 6 liters per minute (L/min) of oxygen. Contrast Computed Tomography (CT) scan of the chest excluded pulmonary embolism but revealed multifocal patchy opacities along with an interval increase in the size of his primary tumor and pulmonary nodules. Laboratory investigations revealed the absence of leukocytosis with lymphopenia and slightly elevated lactate dehydrogenase and C-reactive protein. COVID pneumonia was suspected despite a negative nasopharyngeal SARS-CoV-2 PCR test. The patient was then started on treatment with Methylprednisolone (20 mg/day twice daily) and Remdesivir (200mg/day followed by 100 mg/day) due to high suspicion for COVID despite the negative test. Given the patient's immunosuppressed state, broad-spectrum antibiotics were also given for a possible bacterial infection. Over the next 24 hours, his oxygen requirements continued to escalate to 15 L/min through high flow nasal cannula. He was then transferred to the intensive care unit for management of hypoxic respiratory failure. Despite treatment for COVID and bacterial pneumonia, the patient's oxygen requirements did not improve. As a result, other differential diagnoses were investigated. Methylprednisolone pulse therapy (1g/day for three days) was started for suspected Osimertinib induced pneumonitis. His oxygenation and symptoms significantly improved over the next 48 hours to 4 L/min. Patient was discharged on Prednisone 60 mg/day and oxygen therapy was discontinued six days after initial presentation. DISCUSSION: We present a case of osimertinib induced pneumonitis. This diagnosis was confirmed based on the rapid clinical improvement following the initiation of high dose steroids. Few case reports in the literature describe this adverse complication and its incidence remains unclear [1]. In our case, pneumonitis developed after approximately five months of Osimertinib treatment in a patient with no previous parenchymal lung disease. Given that this complication could be life-threatening, it should be given urgent attention and the correct treatment should be administered as early as possible [2]. CONCLUSIONS: In conclusion, despite a typical presentation of a hypoxic respiratory failure in the era of the COVID pandemic, other differential diagnosis should always be considered. REFERENCE #1: Matsumoto Y, Kawaguchi T, Yamamoto N, et al. Interstitial Lung Disease Induced by Osimertinib for Epidermal Growth Factor Receptor (EGFR) T790M-positive Non-small Cell Lung Cancer. Intern Med. 2017;56(17):2325-2328. doi:10.2169/internalmedicine.8467-16 REFERENCE #2: Fan M, Mo T, Shen L, Yang L. Osimertinib-induced severe interstitial lung disease: A case report. Thorac Cancer. 2019;10(7):1657-1660. doi:10.1111/1759-7714.13127 DISCLOSURES: No relevant relationships by Eliane Alhalabi, source=Web Response No relevant relationships by Jayna Gardner - Gray, source=Web Response No relevant relationships by Vritti Gupta, source=Web Response

Association between previous lung diseases and lung cancer risk: a systematic review and meta-analysis.

Previous lung diseases (PLD) are known risk factors for lung cancer. However, it remains unclear how the association varies by lung cancer subtype and socio-demographic characteristics. We conducted a systematic literature search in three electronic databases from the inception of each database up until 13 January 2021. A total of 73 studies (18 cohort and 55 case-control studies) consisting of 97 322 cases and 7 761 702 controls were included. Heterogeneity was assessed using the I2 statistic. Based on the heterogeneity, either the fixed-effects or random-effects model was used to estimate the pooled summary estimate (PSE) and 95% confidence interval (CI) for the association between PLD and lung cancer risk. A history of asthma, chronic bronchitis, emphysema, pneumonia, tuberculosis, and chronic obstructive pulmonary disease (COPD) was associated with higher lung cancer risk, with a history of COPD and emphysema having at least twofold relative risk. A history of hay fever was associated with lower lung cancer risk (PSE= 0.66, 95% CI= 0.54-0.81), particularly among ever-smokers (PSE= 0.55, 95% CI= 0.41-0.73). Individuals with a diagnosis of asthma, emphysema, or pneumonia within 1-10 years prior to lung cancer diagnosis were observed to have a higher lung cancer risk as compared to those who were diagnosed more than 10 years prior to lung cancer diagnosis. Ever-smokers with a history of COPD or emphysema were observed to have at least twofold relative risk of lung cancer compared to those without this history. Due to the observed association between PLD with higher risk of lung cancer, it is advisable that individuals with PLD should be closely monitored and prioritised for lung cancer screening.

The 4-hook anchor coaxial needle with scaled suture is superior to the double spring coil for preoperative localization.

BackgroundPreoperative localization of small size pulmonary nodules is challenging, but it is necessary for surgical resection of early lung cancer. As a new device for preoperative localization, the 4-hook-anchor coaxial needle with scaled suture was tentatively applied in our department to improve the effect of preoperative localization. However, double spring coil, as a proven positioning technology, used to be our preferred method in the past. We did a retrospective single-centre research driven by the interest on which one should be the first choice for preoperative localization among these two approaches.MethodsWe performed a retrospective analysis on 100 patients undergoing surgery with the new coaxial needle from 2019 to 2020, and 98 patients undergoing double spring coil from 2017 to 2019. The duration of localization, success rate, operation time, intraoperative bleeding, and positioning-related complications of these two groups of patients were examined in this study.ResultsThere were no significant differences between the two groups of patients in terms of the success rate. However, the new coaxial needle seemed to be able to shorten the duration of preparative localization and operation time by accelerating the efficiency of exploring small nodules intraoperatively, and also decreased the risk of positioning-related pneumothorax and pulmonary hemorrhage. The logistic analysis indicated that the puncture depth was an independent risk factor for overall complications. Meanwhile, previous lung diseases and positioning time were independent risk factors for pneumothorax, besides pneumorrhagia and depth of penetration as well.ConclusionsThe new coaxial needle can save time for both radiologists and thoracic surgeons, while reducing the risk of positioning-related complications. We support its application clinically instead of the double spring coil.

MO261LUPUS NEPHRITIS AND COVID-19 INFECTION

Background and AimsCovid-19 infection poses a serious challenge for immune-compromised patients with autoimmune systemic diseases. This is likely due to a combination of immune dysfunction, immunosuppressive therapy and excess co-morbidities.The aim of this study is to describe clinical characteristics of patients with lupus nephritis (LN) and Coronavirus disease 2019 (COVID-19), and to identify baseline variables associated with a severe infection requiring hospitalization.MethodA telephone survey investigating the impact of COVID-19 on patients with biopsy - proven LN was administered. Data extraction included diagnosis, disease activity status, demographics, occupational exposure, adherence to social distancing advise, therapy, comorbidities, and laboratory tests. Covid-19 was classified as definite diagnosis of Covid-19 disease (presence of symptomatic Covid-19 infection, confirmed by a nasopharyngeal SARS-CoV-2 polymerase chain reaction test). Comparisons between patients with or without hospitalization were performed.Results114 patients (median age 34,9 ± 12,4 years) with LN were included in the study. All were on different doses glucocorticoids, 82 were taking hydroxychloroquine and 30 took immunosuppressants. 31 patients (26 women, 5 men) developed symptomatic COVID-19 infection - they have at least one symptom (chest pain, fever, asthenia, chills, cough, sore throat, dyspnea, headache, arthralgia, myalgia, odynophagia, diarrhea, conjunctivitis, hypo-, ageusia, hypo-, anosmia) of COVID-19 and were PCR test positive. These 31 patients prior to their COVID-19 illness were treated with methylprednisolone, 16 - with cyclophosphamide, 8 - with azathioprine, 3 – with hydroxychloroquine. Six patients (4 men, 2 women) required hospitalization - these were more frequently older and with comorbidities (cardio-respiratory illness, hypertension and other) and active LN (3 –class IV LN, 2-class V LN, 1 class III LN and 1 Class II LN, according the 2003 ISN/RPS classification). Adherence to therapy and to social distancing advise was high. The median time from onset of symptoms to hospital admission was 6 (3-11) days. The median length of stay was 12 days (8-20) days. No deaths occurred.ConclusionCovid-19 is more frequent in the subgroup of LN patients without therapy with hydroxychloroquine, which might play some protective role against the most harmful manifestations of Covid-19. Male sex, previous lung disease, serum creatinine level, proteinuria, glucocorticoids use > 5 mg/day, were associated to hospitalization of patients with LN.

Echocardiographic Correlates of In-Hospital Death in Patients with Acute COVID-19 Infection: The World Alliance Societies of Echocardiography (WASE-COVID) Study

BackgroundThe novel severe acute respiratory syndrome coronavirus-2 virus, which has led to the global coronavirus disease-2019 (COVID-19) pandemic is known to adversely affect the cardiovascular system through multiple mechanisms. In this international, multicenter study conducted by the World Alliance Societies of Echocardiography, we aim to determine the clinical and echocardiographic phenotype of acute cardiac disease in COVID-19 patients, to explore phenotypic differences in different geographic regions across the world, and to identify parameters associated with in-hospital mortality.MethodsWe studied 870 patients with acute COVID-19 infection from 13 medical centers in four world regions (Asia, Europe, United States, Latin America) who had undergone transthoracic echocardiograms. Clinical and laboratory data were collected, including patient outcomes. Anonymized echocardiograms were analyzed with automated, machine learning–derived algorithms to calculate left ventricular (LV) volumes, ejection fraction, and LV longitudinal strain (LS). Right-sided echocardiographic parameters that were measured included right ventricular (RV) LS, RV free-wall strain (FWS), and RV basal diameter. Multivariate regression analysis was performed to identify clinical and echocardiographic parameters associated with in-hospital mortality.ResultsSignificant regional differences were noted in terms of patient comorbidities, severity of illness, clinical biomarkers, and LV and RV echocardiographic metrics. Overall in-hospital mortality was 21.6%. Parameters associated with mortality in a multivariate analysis were age (odds ratio [OR] = 1.12 [1.05, 1.22], P = .003), previous lung disease (OR = 7.32 [1.56, 42.2], P = .015), LVLS (OR = 1.18 [1.05, 1.36], P = .012), lactic dehydrogenase (OR = 6.17 [1.74, 28.7], P = .009), and RVFWS (OR = 1.14 [1.04, 1.26], P = .007).ConclusionsLeft ventricular dysfunction is noted in approximately 20% and RV dysfunction in approximately 30% of patients with acute COVID-19 illness and portend a poor prognosis. Age at presentation, previous lung disease, lactic dehydrogenase, LVLS, and RVFWS were independently associated with in-hospital mortality. Regional differences in cardiac phenotype highlight the significant differences in patient acuity as well as echocardiographic utilization in different parts of the world.

DIAGNOSTIC PROBLEMS AND RISK FACTORS OF BULLOUS EMPHYSEMA IN YOUNG ADULT

Bullous emphysema is a condition with the appearance of pathological bullae in the lungs caused by chronic obstruction of the airways. Bullae itself is thin-walled, air-filled pathological spaces, located in the lung parenchyma. It can be caused by congenital or genetic disease without previous lung disease or complications from COPD. Under special conditions, bullae can appear at a young age with several risk factors and underlying causes, such as COPD at a young age, genetic disorders, and cystic fibrosis. Several diseases that lead to COPD at a young age are Asthma in children, Recurrent Wheezing Infants (RWI), Broncho Pulmonary Dysplasia (BPD), Primary Ciliary Dyskinesia (PCD), Non-Cystic Fibrosis Bronchiectasis (NCFB), Plastic Bronchitis (PB), cystic fibrosis, and Bronchiolitis Obliterans (BO). A 25 year-old-woman with bullous emphysema causing a spontaneous pneumothorax, with suspected cyst rupture was reported. Among all lung diseases that can cause bullous emphysema at a young age, cystic fibrosis is the closest to our case. It needs further examination such as chromosome test and chloride sweat test analysis, and the possibility of Alfa-1 Antitrypsin (AAT) deficiency, cannot be ruled out.

The cardiovascular complications in COVID-19: Focus on acute cardiac injury.

At the end of 2019 a novel coronavirus was identified in Wuhan, China. The disease caused by the severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) was designated COVID-19 (corona virus disease 2019) by the World Health Organization in early 2020. Up to 80% of patients with COVID-19 experience mild symptoms with severe or critical disease occurring in the remaining 20%. Severe disease is manifested by the development of pneumonia, hypoxia and radiographic lung involvement while critical disease indicates multiorgan involvement with significant respiratory or cardiac compromise. The current estimated case fatality rate from COVID-19 is approximately 1%. Epidemiological studies have shown that advanced age, male gender, previous chronic lung disease, cardiovascular and kidney disease, obesity and diabetes are risk factors for the severity of disease course. In the current focused review, we present an overview of the acute cardiovascular complications of COVID-19, their detection and impact upon prognosis.

Prevalence and 30-Day Mortality in Hospitalized Patients With Covid-19 and Prior Lung Diseases

IntroductionPatients with pre-existing respiratory diseases in the setting of COVID-19 may have a greater risk of severe complications and even death. MethodsA retrospective, multicenter, cohort study with 5847 COVID-19 patients admitted to hospitals. Patients were separated in two groups, with/without previous lung disease. Evaluation of factors associated with survival and secondary composite end-point such as ICU admission and respiratory support, were explored. Results1,271 patients (22%) had a previous lung disease, mostly COPD. All-cause mortality occurred in 376 patients with lung disease (29.5%) and in 819 patients without (17.9%) (p<0.001). Kaplan–Meier curves showed that patients with lung diseases had a worse 30-day survival (HR=1.78; 95%C.I. 1.58–2.01; p<0.001) and COPD had almost 40% mortality. Multivariable Cox regression showed that prior lung disease remained a risk factor for mortality (HR, 1.21; 95%C.I. 1.02–1.44; p=0.02). Variables independently associated with all-cause mortality risk in patients with lung diseases were oxygen saturation less than 92% on admission (HR, 4.35; 95% CI 3.08–6.15) and elevated D-dimer (HR, 1.84; 95% CI 1.27–2.67). Age younger than 60 years (HR 0.37; 95% CI 0.21–0.65) was associated with decreased risk of death. ConclusionsPrevious lung disease is a risk factor for mortality in patients with COVID-19. Older age, male gender, home oxygen therapy, and respiratory failure on admission were associated with an increased mortality. Efforts must be done to identify respiratory patients to set measures to improve their clinical outcomes.

Assessing nitrogen dioxide (NO2) impact on health pre- and post-COVID-19 pandemic using IoT in India

PurposeCorona Virus Disease 2019 (COVID-19) is a deadly virus named after severe acute respiratory syndrome coronavirus 2; it affects the respiratory system of the human and sometimes leads to death. The COVID-19 mainly attacks the person with previous lung diseases; the major cause of lung diseases is the exposure to nitrogen dioxide (NO2) for a longer duration. NO2 is a gaseous air pollutant caused as an outcome of the vehicles, industrial smoke and other combustion processes. Exposure of NO2 for long-term leads to the risk of respiratory and cardiovascular diseases and sometimes leads to fatality. This paper aims to analyze the NO2 level impact in India during pre- and post-COVID-19 lockdown. The study also examines the relationship between the fatality rate of humans because of exposure to NO2 and COVID-19.Design/methodology/approachSpatial analysis has been conducted in India based on the mortality rate caused by the COVID-19 using the data obtained through Internet of Medical things. Meanwhile, the mortality rate because of the exposure of NO2 has been conducted in India to analyze the relationship. Further, NO2 level assessment is carried out using Copernicus Sentinel-5P satellite data. Moreover, aerosol optical depth analysis has been carried out based on NASA’s Earth Observing System data.FindingsThe results indicate that NO2 level has dropped 20-year low because of the COVID-19 lockdown. The results also determine that the mortality rate because of long-time exposure to NO2 is higher than COVID-19 and the mortality rate because of COVID-19 may be a circumlocutory effect owing to the inhalation of NO2.Originality/valueUsing the proposed approach, the COVID-19 spread can be identified by knowing the air pollution in major cities. The research also identifies that COVID-19 may have an effect because of the inhalation of NO2, which can severe the COVID-19 in the human body.

Clinical risk factors related to treatment failure in Mycobacterium abscessus lung disease.

The clinical importance of Mycobacterium abscessus subsp. abscessus (M. abscessus) lung disease has been increasing, but few studies have assessed the clinical characteristics associated with the treatment outcome. We retrospectively analyzed 75 consecutive patients with M. abscessus lung disease diagnosed at a tertiary hospital from January 2004 to April 2018. Among 52 patients with sufficient clinical data, 19 patients (42.2%) achieved treatment success. Compared with 26 (57.8%) patients in the treatment failure group, body mass index (BMI) (19.8 vs 17.5kg/m2, P = 0.022), previous nontuberculous mycobacterial (NTM) lung disease (26.3% vs 61.5%, P = 0.034), the presence of cavitary lesions (31.6% vs 69.2%, P = 0.017), and the bronchiectasis score (3.0 vs 5.0, P = 0.003) were significantly different in the treatment success group. Multivariate analysis showed that age (adjusted hazard ratio (aHR), 0.94; 95% confidence interval (CI), 0.90 to 0.99; P = 0.010), the presence of cavitary lesions (aHR, 0.34; 95% CI, 0.12 to 0.94; P = 0.039), and previous NTM lung disease (aHR, 0.28; 95% CI, 0.09 to 0.86; P = 0.026) were negatively associated with treatment success. This is the first study to show that previous NTM lung disease might be a clinically important factor related to unfavorable treatment outcomes in M. abscessus lung disease patients. To increase our understanding the characteristics of M. abscessus lung disease, this factor should be independently analyzed in future research.

Coronavirus disease 2019 (COVID-19) in autoimmune and inflammatory conditions: clinical characteristics of poor outcomes.

ObjectiveTo describe clinical characteristics of patients with rheumatic and musculoskeletal diseases (RMDs) and immunosuppressive therapies with Coronavirus disease 2019 (COVID-19) at an academic rheumatology center in Madrid and to identify baseline variables associated with a severe infection requiring hospitalization.MethodsWe identified SARS-CoV-2 positive cases by polymerase chain reaction performed at our center within an updated RMDs database in our clinic. Additional RMDs patients were identified when they contacted the clinic because of a positive infection. Data extraction included diagnosis, demographics, immunosuppressive treatment, comorbidities, and laboratory tests. Comparisons between patients with or without hospitalization were performed. Multivariate logistic regression was used to analyze associations between baseline variables and need for hospitalization.ResultsA total of 62 patients with COVID-19 and underlying RMDs were identified by April 24, 2020. Median age was 60.9 years, and 42% men. Forty-two patients required hospitalization; these were more frequently men, older and with comorbidities. There were no statistically significant between-group differences for rheumatologic diagnosis and for baseline use of immunosuppressive therapy except for glucocorticoids that were more frequent in hospitalized patients. Total deaths were 10 (16%) patients. In multivariate analysis, male sex (odds ratio [OR], 8.63; p = 0.018), previous lung disease (OR, 27.47; p = 0.042), and glucocorticoids use (> 5 mg/day) (OR, 9.95; p = 0.019) were significantly associated to hospitalization.ConclusionNeither specific RMD diagnoses or exposures to DMARDs were associated with increased odds of hospitalization. Being male, previous lung disease and exposure to glucocorticoids were associated with higher odds of hospitalization in RMDs patients.

Efeitos da supressão da aspiração endotraqueal na incidência de complicações pulmonares no pós operatório de cirurgia cardíaca

INTRODUÇÃO: Aspiração traqueal é utilizada rotineiramente após cirurgia cardíaca para garantir adequada ventilação. OBJETIVO: Verificar se a ausência da aspiração traqueal antes da extubação em pacientes sem sinais de secreção brônquica influencia na incidência de complicações pulmonares, além de repercussões hemodinâmicas e ventilatórias do procedimento e custos. MÉTODOS: Pacientes foram avaliados entre agosto/2012 e julho/2014, divididos igualmente em Grupo ASP (aspiração traqueal prévia à extubação) e NASP (sem aspiração prévia). Foram incluídos indivíduos com: primeira cirurgia cardíaca, idade entre 18 e 75 anos, IMC ? 30 kg/m² e sem doença pulmonar prévia. Foram excluídos indivíduos com tempo de CEC &gt; 120 minutos, necessidade de assistência circulatória mecânica, relação PaO2/FiO2 &lt; 200, SpO2 &lt; 92%, tempo de intubação &gt; 12 horas, PAM &lt; 60 mmHg e sinais de secreção pulmonar. Variáveis hemodinâmicas, ventilatórias, complicações pulmonares e custos hospitalares foram avaliados. RESULTADOS: Foram analisados 228 pacientes (ASP= 114 NASP= 114). FC, PAS, PAD e PAM elevaram-se após aspiração e pós extubação nos grupos, retornando aos valores basais no decorrer do tempo. Não houve diferença estatística na FR e SpO2. Complicações pulmonares representaram 7,8%, sem diferença entre os grupos. CONCLUSÃO: A supressão da aspiração traqueal nos pacientes em pós-operatório imediato de cirurgia cardíaca não influenciou na incidência de complicações pulmonares e evolução clínica pós-operatória. Durante aspiração, houve alterações hemodinâmicas e respiratórias, sem repercussões clínicas, porém estas mesmas alterações ocorreram no grupo NASP após extubação, em menor intensidade. Aspiração endotraqueal sem indicação mostrou-se custosa e com desperdício de tempo dos profissionais.

Abstract IA37: Lung cancer incidence and risk factors in never-smoking Asian American, Native Hawaiian, and Pacific Islander women: The development of a multilevel integrated dataset of EHR, cancer registry, and environmental data

Abstract Background: For Asian American, Native Hawaiian, and Pacific Islander (AANHPI) females, lung cancer is one of the most common cancers and the leading cause of cancer death. More than half of AANHPI female lung cancers occur in never-smokers, and contributing risk factors among never-smokers remain largely unknown. Until now, there was no single sufficiently-large data source to document lung cancer incidence rates by smoking status and sex among specific AANHPI ethnic groups, which is central to understanding and reducing the burden of this disease in this population. We assembled a large-scale cohort to quantify the burden of lung cancer by smoking status among single- and multiethnic AANHPI groups, with an emphasis on identifying the underlying factors driving lung cancer risk among never-smoking AANHPI females. Methods: Assembly of the cohort involved (1) harmonizing and pooling electronic health record (EHR) data on known and putative lung cancer risk factors from two large health systems (i.e., Northern California Sutter Health system and Kaiser Permanente Hawaii [KPH]); (2) linking EHR data from Sutter and KPH with tumor and diagnosis data from the California Cancer Registry and Hawaii Tumor Registry, respectively; (3) geocoding and linking the Sutter portion of the cohort to regional air pollutant data and data on specific neighborhood contextual factors from the California Neighborhoods Data System; and (4) developing neighborhood contextual variables to enhance the geocoded data for KPH cohort members. Incidence rates stratified by sex, detailed race/ethnicity, and smoking status were calculated. Results: The cohort comprises 1.8 million individuals, including 750,000 females of whom 190,000 are AANHPI females, with up to 15 years' follow-up for incident lung cancer. It includes over 24,000 incident lung cancer cases, of which 10,595 are females and over 1,500 are single- and multiethnic AANHPI females. The cohort has high representation of Asian Indian, Chinese, Japanese, Filipino, Korean, and Pacific Islander never-smoking females in addition to multiple multiethnic AANHPI ethnic groups. Ongoing analyses, including overall and histologic cell-type specific incidence rates of lung cancer by sex, race/ethnicity, and smoking status will be presented. Conclusions: We have assembled a large, integrated dataset well suited to study multilevel risk of lung cancer that will serve as a critical evidence base to inform screening, research, and public health priorities, especially among AANHPI females. Future work will include longitudinal analyses of lung cancer risk among never-smoking AANHPI females, including absolute risk modeling, examining six exposure domains representing putative lung cancer risk factors: second-hand smoke, previous lung diseases, infections, reproductive history and hormone exposure, body size, and neighborhood environmental factors, including measures of particulate matter, traffic density, neighborhood socioeconomic status, and ethnic enclave. Citation Format: Mindy C. DeRouen, Salma Shariff-Marco, Daphne Lichtensztajn, Anqi Jin, Yihe G. Daida, Alison J. Canchola, Yuqing Li, Jennifer Jain, Laura Allen, Sixiang Nie, Carmen Wong, Robert Haile, Manali Patel, Peggy Reynolds, Heather Wakelee, Hal Luft, Caroline Thompson, Su-Ying Liang, Beth E. Waitzfelder, Iona Cheng, Scarlett L. Gomez. Lung cancer incidence and risk factors in never-smoking Asian American, Native Hawaiian, and Pacific Islander women: The development of a multilevel integrated dataset of EHR, cancer registry, and environmental data [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr IA37.

Spirometry results after treatment for pulmonary tuberculosis: comparison between patients with and without previous lung disease: a multicenter study.

ABSTRACTObjective:To compare patients with and without previous lung disease, in terms of the spirometry results after they had been treated for pulmonary tuberculosis (PTB) and cured, as well as to analyze risk factors related to functional severity. Methods:This was a cross-sectional, multicenter study conducted at four referral centers in Brazil. Patients were divided into two groups: those with a history of lung disease or smoking (LDS+ group); and those with no such history (LDS− group). Patients underwent spirometry (at least six months after being cured). Sociodemographic and clinical data were collected. Results:A total of 378 patients were included: 174 (46.1%) in the LDS+ group and 204 (53.9%) in the LDS− group. In the sample as a whole, 238 patients (62.7%) had spirometric changes. In the LDS+ group, there was a predominance of obstructive lung disease (in 33.3%), whereas restrictive lung disease predominated in the LDS− group (in 24.7%). Radiological changes were less common in the LDS− group than in the LDS+ group (p < 0.01), as were functional changes (p < 0.05). However, of the 140 (79.1%) LDS− group patients with a normal or minimally altered chest X-ray, 76 (54%) had functional changes (p < 0.01). The risk factors associated with functional severity in the LDS− group were degree of dyspnea (p = 0.03) and moderate or severe radiological changes (p = 0.01). Conclusions:Impaired pulmonary function is common after treatment for PTB, regardless of the history of lung disease or smoking. Spirometry should be suggested for patients who develop moderate/severe dyspnea or relevant radiological changes after treatment for PTB.

The mechanism and risk factors for immune checkpoint inhibitor pneumonitis in non-small cell lung cancer patients.

Immune checkpoint inhibitors (ICIs) are new and promising therapeutic agents for non-small cell lung cancer (NSCLC). However, along with demonstrating remarkable efficacy, ICIs can also trigger immune-related adverse events. Checkpoint inhibitor pneumonitis (CIP) has been reported to have a morbidity rate of 3% to 5% and a mortality rate of 10% to 17%. Moreover, the incidence of CIP in NSCLC is higher than that in other tumor types, reaching 7% to 13%. With the increased use of ICIs in NSCLC, CIP has drawn extensive attention from oncologists and cancer researchers. Identifying high risk factors for CIP and the potential mechanism of CIP are key points in preventing and monitoring serious adverse events. In this review, the results of our analysis and summary of previous studies suggested that the risk factors for CIP may include previous lung disease, prior thoracic irradiation, and combinations with other drugs. Our review also explored potential mechanisms closely related to CIP, including increased T cell activity against associated antigens in tumor and normal tissues, preexisting autoantibodies, and inflammatory cytokines.