Hasil untuk "Diseases of the respiratory system"

Hsieh-Cheng Chen, Jui-Chien Wu, Huan-Chang Lin et al.

ABSTRACT The emergence of diverse infectious diseases has led to the development of numerous molecular diagnostic kits for pathogen detection. These nucleic acid testing kits are typically categorized as manual or automated, with most automated kits requiring proprietary instruments, thereby limiting flexibility. GenXplore q4800 is a newly developed, open-platform, fully automated nucleic acid testing system designed to be compatible with a wide range of manual testing kits from different manufacturers. In this study, we evaluated the analytical and clinical performance of the GenXplore q4800 using manual molecular kits targeting sexually transmitted infections and respiratory viruses. The automated detection of inactivated pathogen controls demonstrated high repeatability, reproducibility, and sensitivity. The result of the contamination assessment was acceptable. For clinical validation, 120 urine specimens were tested for Neisseria gonorrhoeae and Chlamydia trachomatis. Results from the GenXplore q4800 were compared with those obtained using a semi-automated reference method. The GenXplore q4800 achieved 100% positive percent agreement, 100% negative percent agreement, and a Cohen’s kappa coefficient of 1.0 in these two pathogens, indicating strong concordance. Additionally, feedback from 16 professional users confirmed a high level of satisfaction with the system’s usability.IMPORTANCEMost fully automated nucleic acid testing systems rely on proprietary reagent kits, which limit flexibility during supply shortages or emerging outbreaks. The GenXplore q4800 is a newly developed open-platform system that allows integration of third-party nucleic acid extraction and nucleic acid testing reagents, enabling laboratories to adapt quickly to diagnostic needs. The findings demonstrate that GenXplore q4800 can serve as a reliable and flexible alternative for routine molecular diagnostics, supporting more resilient laboratory workflows and expanding options beyond closed-platform systems.

Tejaswini Kulkarni, David A. Zisman, Oksana A. Shlobin et al.

Abstract Introduction A common complication of interstitial lung disease (ILD) is pulmonary hypertension (PH), which is associated with increased morbidity and mortality and worsened quality of life. In ILD, evaluating for PH is recommended prior to lung transplantation. However, this is not standardized or routinely performed in earlier stages of ILD, and guidelines lack an evidence-based approach for PH screening in this population. Furthermore, right-heart catheterization (RHC) access can be limited in many settings. The objective of PHINDER (Pulmonary Hypertension Screening in Patients with Interstitial Lung Disease for Earlier Detection) is to prospectively develop screening strategies for PH in patients with ILD. Methods PHINDER is a prospective, non-interventional study that will enroll approximately 200 patients with ILD treated in a variety of settings in the United States (community centers, academic institutions, etc.). Patients must be diagnosed with ILD by high-resolution computed tomography (HRCT) and must not have a previously reported mean pulmonary arterial pressure (mPAP) > 20 mmHg. To enrich the population for PH, patients must meet additional criteria on Pulmonary Function Tests, HRCT, signs/symptoms, 6-min walk test, or echocardiography. Patients will undergo a variety of routine ILD clinical assessments. Lastly, patients receive a RHC to assess for PH, defined as mPAP > 20 mmHg with pulmonary arterial wedge pressure ≤ 15 mmHg and a pulmonary vascular resistance > 2 Wood Units. All treatment decisions are at the discretion of the provider and not influenced by study participation. Planned Outcomes Following study completion, statistical tools will be used to derive a practical model for a screening algorithm using the variables identified in the study as most predictive of PH in patients with ILD. Conclusions Using a previously developed list of clinical assessments from PH and ILD experts, the PHINDER study aims to be the first prospectively enrolled study to evaluate prognostic screening strategies that can be used to develop an algorithm to predict the risk of PH in patients with ILD. Trail Registration NCT05776225.

Xu K, Shao X, Lu R et al.

Kexin Xu,1,2 Xuejie Shao,1,2 Ruilong Lu,1,2 Yixi Liao,1,2 Yakun Zhao,1,2 Bo Wang,1,2 Zhiguang Qiu,1,2 Yange Tian1,2 1Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-Constructed by Henan Province and Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, People’s Republic of China; 2Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, People’s Republic of ChinaCorrespondence: Yange Tian, Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-Constructed by Henan Province and Education Ministry of P.R. China, Henan University of Chinese Medicine, 156 East Jinshui Road, Jinshui District, Zhengzhou, Henan, People’s Republic of China, Email yange0910@126.comPurpose: Bufei Yishen formula (BYF) is an effective treatment strategy for chronic obstructive pulmonary disease (COPD). Effective-component compatibility of BYF III (ECC-BYF III), composed of 5 active ingredients (ginsenoside Rh1, paeonol, astragaloside, icariin and nobiletin) from BYF, has similar effects to BYF in intervening COPD. The abnormal structure and hypofunction of lung air-blood barrier induces inefficiency gas exchange and promotes development of COPD. However, the role of ECC-BYF III in the air-blood barrier remains unknown. This study dedicated to exploring the effect and mechanism of ECC-BYF III improve structure and function of lung air-blood barrier in COPD.Methods: A COPD rat model was established to study the treatment of ECC-BYF III against COPD. The protective effect of ECC-BYF III on COPD was evaluated through pulmonary function and lung tissue pathology. The structure damage of the lung air-blood barrier was assessed using electron microscopy and immunofluorescence. Finally, we proved the regulating effect of ECC-BYF III in oxidative via the Nrf2 pathway.Results: The ECC-BYF III could significantly alleviate reduced pulmonary function, decrease damage of lung tissue and regulate oxidative stress in COPD rats. And ECC-BYF III reduced thickness of respiratory membrane, ameliorated damage of pulmonary capillary endothelial cells (PCECs) and alveolar epithelial cells (AECs) in COPD rats. Also, ECC-BYF III protected the function and normal cell morphology of type I alveolar epithelial cell (AT I) and type II alveolar epithelial cell (AT II) in COPD rats. Lastly, ECC-BYF III was indicated to adjust the Nrf2 pathway to improve oxidative stress and protect lung air-blood barrier in COPD rats.Conclusion: ECC-BYF III protects lung air-blood barrier in COPD by regulating oxidative stress via Nrf2 pathway. Keywords: effective-component compatibility of bufei yishen formula III, chronic obstructive pulmonary disease, lung air-blood barrier, oxidative stress, Nrf2 pathway

Carina M.E. Hansen, Anna J. Breukelman, Patricia M.L.A. van den Bemt et al.

Background In the last decade, a fundamental shift in the treatment of cystic fibrosis (CF) took place due to the introduction of CF transmembrane conductance regulator (CFTR) modulators. Adequate medication adherence is a prerequisite for their effectiveness, but little is known about adherence to CFTR modulators. We aimed to assess the extent of medication adherence to CFTR modulators in patients with CF and assess which characteristics are associated with adherence. Methods A systematic review following PRISMA guidelines was performed. Studies needed to report adherence to CFTR modulators. Main outcomes were: 1) level of medication adherence and 2) associations of demographic and/or clinical characteristics with adherence. Results In total, 4082 articles were screened and 21 full-text papers were assessed for eligibility. Ultimately, seven studies were included. Most studies were retrospective and focused on adherence to ivacaftor or lumacaftor–ivacaftor with only one focusing on elexacaftor–tezacaftor–ivacaftor. The majority used pharmacy refill data with adherence determined with the proportion of days covered (PDC) or the medication possession ratio (MPR). One study additionally used electronic monitoring and patient self-reported adherence. Adherence was 0.62–0.99 based on pharmacy data (PDC or MPR), 61% via electronic monitoring and 100% via self-report. Age <18 years appeared to be associated with good adherence, as was a higher lung function. Conclusions Despite the wide variety of adherence methods used, adherence to CFTR modulators is suboptimal, based on objective measures such as pharmacy refill data or electronic monitoring. CFTR modulator adherence measurement and definitions requires more standardisation with a preference for objective and granular methods.

Lei Zhu⁺, Yanfang Qiu⁺, Rui Zhong et al.

Introduction Smoking cessation (SC) clinics are a professional SC services in China. However, studies comparing the characteristics and SC rates of smoking populations in SC clinics with those using mobile SC programs are limited. We compared smokers’ characteristics, 3-month SC rates, and the factors influencing 3-month SC success, between a large hospital SC clinic and a WeChat SC miniprogram. Methods Between January and November 2021, 384 participants voluntarily enrolled in either the hospital SC clinic (Group A: n=243) or the WeChat SC miniprogram (Group B: n=141). Both groups underwent a 3-month SC intervention, and their SC status was monitored at 24 hours, 1 week, 1 month, and 3 months after quitting. SC rate was defined as the self-reported rate of continuous SC. Results The 3-month SC rate was higher in Group A (42.4%) than in Group B (24.8%). Participants with middle school education had a lower likelihood of SC success than those with primary school or lower (p=0.014). Employees in the enterprise/business/services industries were more likely to have SC success than farmers (p=0.013). Participants with SC difficulty scores of 0–60 were more successful than those with scores >60 (p=0.001, p=0.000, respectively). Participants who quit smoking due to their illness, or other reasons, had a higher likelihood of SC success than those who quit due to concerns about their own and their family's health (p=0.006, p=0.098, respectively). While the likelihood of SC success was lower in those who quit because of the influence of their environment than in those who quit due to concerns about their own and their family's health (p=0.057). Conclusions Both SC clinics and WeChat SC mini-programs achieved satisfactory SC rates. The high accessibility of mobile SC platforms, which save time spent on transportation and medical visits, renders them worth promoting and publicizing as additional SC options for smokers, particularly young smokers.

The Covid-19, Covid-19, in Finland et al.

Abstract Introduction Food allergy and atopic dermatitis are significant pediatric health problems in many developed countries. The prevalence of these conditions has been increasing over the past two decades in Western societies. However, there is a lack of epidemiological data for Bulgaria. Purpose To study the frequency of different manifestations of doctor-diagnosed allergies among families with atopy in Bulgaria. Materials and methods A cross-sectional study was conducted among 2,408 families with mothers of childbearing age hospitalized between 2017 and 2019 in the Maternity Ward of St. Anna hospital - Varna, Bulgaria. A direct individual questionnaire was applied to obtain information on social-demographic characteristics and manifestations of various forms of allergies. Data was analyzed with SPSS v. 21.0. Results The relative proportion of families with evidence of allergy on the side of the mother, father, or child was 11.63% (n = 280). The incidence of allergic diseases among mothers was 60.5% (n = 127), among fathers 38.6% (n = 8), and among children 57.8% (n = 63). Rhinconjunctivitis was the leading allergic manifestation in mothers (29.5%; n = 62) and fathers (24.8%; n = 52), and atopic dermatitis was the most common manifestation of allergy in their child (30.3%; n = 33). A significant relationship was established between atopic dermatitis in the family and the overall incidence of allergies in the child. Conclusions The data resulting from our study may serve as a basis for further research so the mechanisms of atopy to be investigated better. Prevention strategies need to be developed to address the march of allergy, characterized by the initial manifestation of allergy in childhood with atopic dermatitis and moving to food and respiratory manifestations. Key messages • The incidence of allergies has been increasing in recent years both in the world and in Bulgaria. • Тhe development of preventive measures to reduce the risk of allergic diseases could be of great importance for public health.

countries, Initiatives, in Europe et al.

Abstract Background Global food insecurity (FI) prevalence in 2020 was 30.4%. In Israel, in 2021, it was 16.2%. FI is associated with a high prevalence of chronic diseases, more hospital admissions and visits, and a shorter lifespan. Screening for FI in the health setting is less common, despite recommendations. Methods Between July 2022 - February 2023, a mixed-methods study distributed an online survey and a request for qualitative interviews among a convenience sample of registered dietitians (RDs). The survey obtained sociodemographic characteristics and information on work experience, knowledge, attitudes, and barriers toward screening for FI. Sixty-one questions were modified from existing questionnaires. An expert committee reviewed the questions. Later, the questionnaire was pilot-tested by ten RDs and amended according to their comments on the clarity. Results Overall, 140 RDs were surveyed, and 7 RDs were interviewed. 96.7% of the participants were female, with a mean of 13.36±9.9 years of experience. 97% of RDs didn't screen for FI. 65.5% didn't know the percentage of households living with FI in Israel, and 72.1% of RDs didn't know where to refer food-insecure patients for additional assistance. Positive attitudes toward screening and treating FI were documented. About 80% of RDs indicated that FI is relevant to their patients and are willing to screen for FI. Religious and traditional RDs had 10.08 times and 4.46 times, respectively, greater odds of having positive attitudes toward screening and treating food-insecure patients. The main barriers identified were a lack of time, knowledge of screening tools, and missing information on appropriate treatment and referral. Conclusions Further education and training in screening FI should be implemented among RDs. System barriers should be addressed to allow RDs routine screening for FI. Additional research is needed to explore healthcare providers’ attitudes and barriers toward screening and treating FI. Key messages • Most registered dietitians had a low level of knowledge and did not screen routinely for food insecurity. • The majority were positive towards screening, highlighting system and training barriers.

M. Guarino, V. Cossiga, M. Capasso et al.

Worldwide, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) significantly increases mortality and morbidity. The Coronavirus Disease 2019 (COVID-19) outbreak has had a considerable impact on healthcare systems all around the world, having a significant effect on planned patient activity and established care pathways, in order to meet the difficult task of the global pandemic. Patients with hepatocellular carcinoma (HCC) are considered a particularly susceptible population and conceivably at increased risk for severe COVID-19 because of two combined risk factors: chronic advanced liver disease and HCC itself. In these challenging times, it is mandatory to reshape clinical practice in a prompt way to preserve the highest standards of patient care and safety. However, due to the stay-at-home measures instituted to stop the spread of COVID-19, HCC surveillance has incurred a dramatic drop, and care for HCC patients has been rearranged by refining the algorithm for HCC treatment to the COVID-19 pandemic, permitting these patients to be safely managed by identifying those most at risk of neoplastic disease progression.

S. Rachina, R. Kozlov, A. Kurkova et al.

COVID-19 has had a significant impact on health care systems, including drug use. The present study aimed to evaluate the patterns of community supply of antimicrobials from community pharmacies during the COVID-19 pandemic in five cities of Russia. In a cross-sectional study, a random sample of pharmacies reported all episodes of antimicrobials supply during a one-week period. Patterns of supply (age and gender of customer, drug name and formulation, prescription availability, indication, etc.) were analyzed. Altogether, 71 pharmacies took part in the study and 5270 encounters were recorded. In total, 4.2% of visits resulted in supply of more than one antimicrobial agent and 5.2% were for parenteral formulations. The rate of prescription-based purchase in participated cities varied from 40.5 to 99.1%. Systemic antibiotics and antivirals accounted for the majority of supplies (60.5 and 26.3%, respectively). Upper respiratory tract infections were reported as the indication for antimicrobials usage in 36.9% of cases, followed by skin and soft tissue infections (12.1%) and urinary tract infections (8.7%); COVID-19 accounted for 8.4% of all supplies. Amoxicillin with clavulanic acid, azithromycin and amoxicillin were indicated as the top three antimicrobials purchased for upper respiratory tract infections, and azithromycin, umifenovir and levofloxacin were the top three for COVID-19. In general, a high rate of drugs dispensing without prescription was revealed. Antibiotics for systemic use remained the most common antimicrobials, whereas presumably viral upper respiratory tract infections were the main reason for their purchase. COVID-19 infection itself was responsible for a small proportion of the supply of antimicrobial agents, but systemic antibiotics accounted for more than a half of supplies.

Rajesh Swarnakar, Yogesh Garje, Neeraj Markandeywar et al.

In coronavirus disease 2019 (COVID-19) patients, dysregulated release of matrix metalloproteinases occurs during the inflammatory phase of acute respiratory distress syndrome (ARDS), resulting in epithelial and endothelial injury with excessive fibroproliferation. COVID-19 resembles idiopathic pulmonary fibrosis (IPF) in several aspects. The fibrotic response in IPF is driven primarily by an abnormally activated alveolar epithelial cells (AECs) which release cytokines to activate fibroblasts. Endoplasmic reticulum (ER) stress is postulated to be one of the early triggers in both diseases. Systemic sclerosis (SSc) is a heterogeneous autoimmune rare connective tissue characterised by fibrosis of the skin and internal organs. Interstitial lung disease (ILD) is a common complication and the leading cause of SSc-related death. Several corollaries have been discussed in this paper for new drug development based on the pathogenic events in these three disorders associated with pulmonary fibrosis. A careful consideration of the similarities and differences in the pathogenic events associated with the development of lung fibrosis in post-COVID patients, IPF patients and patients with SSc-ILD may pave the way for precision medicine. Several questions need to be answered through research, which include the potential role of antifibrotics in managing IPF, SSc-ILD and post-COVID fibrosis. Many trials that are underway will ultimately shed light on their potency and place in therapy.

Manuel Hache-Marliere, Hyomin Lim, Hassan Patail

The diaphragm is the primary respiratory muscle, and its dysfunction predisposes patients to respiratory failure. Diaphragm function can be assessed by ultrasound measurement - Diaphragmatic Thickening Fraction (DTF). Respiratory viral infections (including SARS-CoV-2) can cause diaphragm dysfunction. Our case series follows three patients infected with COVID-19 pneumonia. Bedside diaphragmatic ultrasound assessments measuring DTF were trended over patient's hospital course until clinical improvement (i.e., off oxygen) or worsening (i.e., intubation). Our preliminary results suggest a correlation between DTF trends and respiratory status in patients requiring 100% oxygen. Further studies are required to assess DTF and its possible correlation to respiratory failure.

Chin Tong Kwok, Yiu Cheong Yeung

Abstract Good's syndrome is an acquired combined T‐ and B‐cell immunodeficiencies and patients are prone to opportunistic infections. The diagnosis is based on a characteristic immunoglobulin and lymphocyte subset profile, with clinical features of thymoma. Despite thymectomy, the immunodeficiencies persist and lifelong immunoglobulin replacement is necessary to prevent infections.

Group Chinese Clinical Practice Guidelines For Device Su, Association Resuscitation Group Of Emergency Medicine Branch O, Association Chest Pain Group Of Emergency Medicine Branch Of C et al.

M. Baldassarri, F. Fava, C. Fallerini et al.

The clinical presentation of COVID-19 is extremely heterogeneous, ranging from asymptomatic to severely ill patients. Thus, host genetic factors may be involved in determining disease presentation and progression. Given that carriers of single cystic fibrosis (CF)-causing variants of the CFTR gene—CF-carriers—are more susceptible to respiratory tract infections, our aim was to determine their likelihood of undergoing severe COVID-19. We implemented a cohort study of 874 individuals diagnosed with COVID-19, during the first pandemic wave in Italy. Whole exome sequencing was performed and validated CF-causing variants were identified. Forty subjects (16 females and 24 males) were found to be CF-carriers. Among mechanically ventilated patients, CF-carriers were more represented (8.7%) and they were significantly (p < 0.05) younger (mean age 51 years) compared to noncarriers (mean age 61.42 years). Furthermore, in the whole cohort, the age of male CF-carriers was lower, compared to noncarriers (p < 0.05). CF-carriers had a relative risk of presenting an abnormal inflammatory response (CRP ≥ 20 mg/dL) of 1.69 (p < 0.05) and their hazard ratio of death at day 14 was 3.10 (p < 0.05) in a multivariate regression model, adjusted for age, sex and comorbidities. In conclusion, CF-carriers are more susceptible to the severe form of COVID-19, showing also higher risk of 14-day death.

J. Heidepriem, C. Dahlke, R. Kobbe et al.

The current COVID-19 pandemic is caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). A better understanding of its immunogenicity can be important for the development of improved diagnostics, therapeutics, and vaccines. Here, we report the longitudinal analysis of three COVID-19 patients with moderate (#1) and mild disease (#2 and #3). Antibody serum responses were analyzed using spike glycoprotein enzyme linked immunosorbent assay (ELISA), full-proteome peptide, and glycan microarrays. ELISA immunoglobulin A, G, and M (IgA, IgG, and IgM) signals increased over time for individuals #1 and #2, whereas #3 only showed no clear positive IgG and IgM result. In contrast, peptide microarrays showed increasing IgA/G signal intensity and epitope spread only in the moderate patient #1 over time, whereas early but transient IgA and stable IgG responses were observed in the two mild cases #2 and #3. Glycan arrays showed an interaction of antibodies to fragments of high-mannose and core N-glycans, present on the viral shield. In contrast to protein ELISA, microarrays allow for a deeper understanding of IgA, IgG, and IgM antibody responses to specific epitopes of the whole proteome and glycans of SARS-CoV-2 in parallel. In the future, this may help to better understand and to monitor vaccination programs and monoclonal antibodies as therapeutics.

P. Brito-Zerón, B. Gracia-Tello, Á. Robles et al.

To analyze the clinical characteristics and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with sarcoidosis from a large multicenter cohort from Southern Europe and to identify the risk factors associated with a more complicated infection. We searched for patients with sarcoidosis presenting with SARS-CoV-2 infection (defined according to the European Centre for Disease Prevention and Control guidelines) among those included in the SarcoGEAS Registry, a nationwide, multicenter registry of patients fulfilling the American Thoracic Society/European Respiratory Society/World Association of Sarcoidosis and Other Granulomatous Disorders 1999 classification criteria for sarcoidosis. A 2:1 age-sex-matched subset of patients with sarcoidosis without SARS-CoV-2 infection was selected as control population. Forty-five patients with SARS-CoV-2 infection were identified (28 women, mean age 55 years). Thirty-six patients presented a symptomatic SARS-CoV-2 infection and 14 were hospitalized (12 required supplemental oxygen, 2 intensive care unit admission and 1 mechanical ventilation). Four patients died due to progressive respiratory failure. Patients who required hospital admission had an older mean age (64.9 vs. 51.0 years, p = 0.006), a higher frequency of baseline comorbidities including cardiovascular disease (64% vs. 23%, p = 0.016), diabetes mellitus (43% vs. 13%, p = 0.049) and chronic liver/kidney diseases (36% vs. 0%, p = 0.002) and presented more frequently fever (79% vs. 35%, p = 0.011) and dyspnea (50% vs. 3%, p = 0.001) in comparison with patients managed at home. Age- and sex-adjusted multivariate analysis identified the age at diagnosis of SARS-Cov-2 infection as the only independent variable associated with hospitalization (adjusted odds ratio 1.18, 95% conficence interval 1.04–1.35). A baseline moderate/severe pulmonary impairment in function tests was associated with a higher rate of hospitalization but the difference was not statistically significant (50% vs. 23%, p = 0.219). A close monitoring of SARS-CoV-2 infection in elderly patients with sarcoidosis, especially in those with baseline cardiopulmonary diseases and chronic liver or renal failure, is recommended. The low frequency of severe pulmonary involvement in patients with sarcoidosis from Southern Europe may explain the weak prognostic role of baseline lung impairment in our study, in contrast to studies from other geographical areas.

Pradeep Balakrishnan, Matthew Ing, Zaid Househ et al.

Abstract Pulmonary lymphomatoid granulomatosis (PLG) is a rare multisystem Epstein–Barr virus (EBV)‐associated lymphoproliferative disorder. Exact incidence is unknown and, with its variable clinical presentation, making an accurate diagnosis of PLG can be difficult. We present two distinct cases at our tertiary centre that underline PLG's non‐specific clinical presentations. This resulted in the failure of recognizing PLG early with consequently progressive fatal outcomes. The rationale is to enlighten us concisely the knowledge surrounding PLG and consider it as a potential differential diagnosis, particularly in those immunosuppressed patients with radiological evidence of worsening pulmonary infiltrates not responding to customary treatment for common diagnoses. Having a high degree of suspicion for PLG in the right setting and pursuing lung biopsy early if appropriate for histopathology examination would be justified. This is essential to correctly diagnose PLG up‐front and subsequently utilize best management approach for a better survival and mortality risk outlook.

Gareth Jones, Christopher Smith, Rebecca Nightingale et al.

Background NHS England recommends non-invasive continuous positive airway pressure (CPAP) as a possible treatment for type 1 respiratory failure associated with COVID-19 pneumonitis, either to avoid intubation or as a ceiling of care. However, data assessing this strategy are sparse, especially for the use of CPAP as a ceiling of care, and particularly when delivered outside of a traditional critical care environment. We describe a cohort of patients from Liverpool, UK, who received CPAP on a dedicated respiratory surge unit at the start of the second wave of the COVID-19 pandemic in UK.Methods Retrospective cohort analysis of consecutive patients receiving CPAP for the treatment of respiratory failure secondary to COVID-19 on the respiratory surge unit at the Royal Liverpool Hospital, Liverpool, UK from 21 September until 30 November 2020.Results 88 patients were included in the analysis. 56/88 (64%) were deemed suitable for escalation to invasive mechanical ventilation (IMV) and received CPAP as a trial; 32/88 (36%) received CPAP as a ceiling of care. Median age was 63 years (IQR: 56–74) and 58/88 (66%) were men. Median SpO2/FiO2 immediately prior to CPAP initiation was 95 (92–152). Among patients for escalation to IMV, the median time on CPAP was 6 days (IQR 4–7) and survival at day 30 was 84% (47/56) with 14/56 (25%) escalated to IMV. Of those patients for whom CPAP was ceiling of care, the median duration of CPAP was 9 days (IQR 7–11) and 18/32 (56%) survived to day 30. Pulmonary barotrauma occurred in 9% of the cohort. There were no associations found on multivariant analysis that were associated with all-cause 30-day mortality.Conclusions With adequate planning and resource redistribution, CPAP may be delivered effectively outside of a traditional critical care setting for the treatment of respiratory failure due to COVID-19. Clinicians delivering CPAP to patients with COVID-19 pneumonitis should be alert to the dangers of pulmonary barotrauma. Among patients who are for escalation of care, the use of CPAP may avoid the need for IMV in some patients. Our data support the NHS England recommendation to consider CPAP as a ceiling of care.

S. Ley, L. Fidler, H. Schenk et al.

Purpose HRCT is the preferred imaging technique to evaluate Interstitial-Lung-Disease. Optimal Low-Dose-Computed-Tomography protocol for monitoring ILD with lowest radiation dose and optimal diagnostic accuracy and image quality unknown.Methods 28 Patients underwent HRCT. Image reconstructions with varying combinations of tube current (50mA, 20mA, 15 mA, 10mA) and image-thickness/increment (1/1mm, 2/2mm, 3/2.4mm, 5/4mm) were simulated from raw data. 448 CTs evaluated by 2 readers on image quality and ILD-specific features (ground glass opacification (ggo), honeycombing (hc), reticulation (ret)).Results Reduced dose settings with 20 mA did not show any significant difference to standard dose settings for all parameters in reader 1, while results were significantly altered in reader 2. Slice thickness did not significantly influence rating of typical ILD features like ggo, hc, ret or total disease extent. The correct differentiation between UIP and NSIP could be made on all dose settings and with all slice thickness. It was even found, that an increased slice thickness can compensate for the noise associated image quality degradation. Overall, for ggo detection a combination of 20 mA and 3 or 5 mm slice thickness was not different to the original evaluation.Conclusions Assessment of ILD specific CT features down to 20 mA and a slice thickness of 3 or 5 mm is feasible.

R. Sohanpal, H. Pinnock, L. Steed et al.

BackgroundPeople with chronic obstructive pulmonary disease (COPD) are at increased risk of depression and anxiety, which greatly reduces their quality of life and is associated with worse outcomes; but these psychological co-morbidities are under-recognised and undertreated in COPD patients. Pulmonary rehabilitation (PR) improves mood for up to 6 months but health practitioners under-refer, and patients commonly fail to attend/complete PR. Research suggests that complex non-pharmacological interventions, including both psychological and exercise components, may reduce anxiety and depression in COPD.We have developed a tailored, cognitive behavioural approach (CBA) intervention for patients with COPD and co-morbid anxiety and/or depression (‘TANDEM’), which precedes and optimises the benefits of currently offered PR. We hypothesise that such a psychological intervention, delivered by supervised, trained respiratory healthcare professionals, will improve mood in patients with mild to moderate anxiety and/or depression and encourage uptake and completion of PR.MethodsWe will conduct a multi-centre, pragmatic, randomised controlled trial of the TANDEM intervention compared to usual care across the Midlands, London, the South East and Bristol, UK.We will train healthcare professionals familiar with COPD to deliver the manualised, tailored, face-to-face, one-to-one intervention weekly for 6–8 weeks.We will recruit 430 participants from primary, community and secondary care with confirmed COPD and moderate to very severe airflow limitation, who are eligible for assessment for PR, and who screen positive for symptoms of mild/moderate depression and/or anxiety using the Hospital Anxiety and Depression scale (HADS). Participants will be randomised 1.25:1 (intervention: usual care).The co-primary outcomes are the HADS anxiety and depression subscale scores at 6 months; participants will be followed up to 12 months. Secondary outcomes include uptake and completion of PR and healthcare resource use. There will be a parallel process evaluation and a health economic evaluation.DiscussionThe TANDEM intervention has the potential to optimise the unrealised synergy between a psychological intervention and PR. The CBA sessions will precede PR and target individuals’ cognitions, behaviours and symptoms associated with anxiety and depression to decrease psychological morbidity and increase effective self-management amongst patients with COPD.Trial registrationISRCTN, ID: ISRCTN59537391. Registered on 20 March 2017. Protocol version 6.0, 22 April 2018.