CT of Postacute Lung Complications of COVID-19
The acute course of coronavirus disease 2019 (COVID-19) is variable and ranges from asymptomatic infection to fulminant respiratory failure. Patients recovering from COVID-19 can have persistent symptoms and computed tomography (CT) abnormalities of variable severity. At 3 months after acute infection, a subset of patients will have CT abnormalities that include ground glass abnormalities (GGO) and subpleural bands with concomitant pulmonary function abnormalities. At 6 months after acute infection, some patients have persistent CT changes to include the resolution of GGOs seen in the early recovery phase and the persistence or development of changes suggestive of fibrosis such as reticulation with or without parenchymal distortion. Predictors of post-COVID lung disease include need for intensive care unit (ICU) admission, mechanical ventilation, higher inflammatory markers, longer hospital stay and a diagnosis of acute respiratory distress syndrome (ARDS). Treatments of post-COVID lung disease are being investigated with anti-fibrotic agents being investigated for the prevention of post-COVID lung fibrosis. The etiology of post-COVID lung disease may be a sequela of prolonged mechanical ventilation, COVID-induced ARDS or direct injury from the virus. Future research is needed to determine the long-term persistence of post-COVID lung disease, its impact on patients and ways to prevent or treat it.
Prevalence and symptomatology of post COVID syndrome in patients who required hospitalization during acute illness [Meeting Abstract]
Background The long-term effects of SARS-CoV-2 are just now coming to light. These remaining symptoms are sometimes referred to as "Post-COVID syndrome." The types and incidence of prolonged symptoms from the acute viral illness are unknown. Yet understanding the prevalence and which symptoms persist would help normalize post COVID syndrome and help providers recognize these issues in their COVID survivors. Methods We conducted a single-center retrospective analysis with patients discharged from New York University (NYU) Langone Hospital with primary diagnosis of COVID-19. Each patient was then called and given a phone survey 45-60 days post discharge. In the survey they were consented and asked about residual symptoms. Study data were collected and managed using REDCap electronic data capture tools hosted at NYU hospital. Patient surveys were then merged with their medical record from their COVID hospitalization. All statistical analysis was processed in SPSS. The study was approved through our institutional IRB. Results Overall, 101 patients were surveyed post discharge. The median age was 59, with the most common co-morbidities being DM (N = 20) and HTN (N = 45). Most patients (N= 57) reported residual lethargy and malaise as compared to prior. Thirty-eight patients continued to have limited exercise tolerance. Thirty- eight patients experienced shortness of breath more than prior to getting COVID, while 24 patients continued to have shortness of breath while walking within their house. Some experienced chest pain with breathing (N=5), dry cough (N=14) and productive cough (N=5) that was not present prior to COVID infection. Conclusion We found that COVID patients continued to have symptoms 2 months post discharge. More than half of patients reached reported continued lethargy post discharge. Other symptoms were quite common, with 1/4-1/3 having continued shortness of breath and decreased exercise tolerance. The full pathophysiology between continued symptoms and post COVID syndrome is not yet known; however, clinicians need to understand the prevalence to treat patients accordingly. Physicians should help to normalize these symptoms to patients. Treatment should include supportive care such as rehab and physical therapy with consideration of referral to post COVID centers
Comparison of Clinical Measures Among Interstitial Lung Disease (ILD) Patients with Usual Interstitial Pneumonia (UIP) Patterns on High-Resolution Computed Tomography
PURPOSE/OBJECTIVE:Idiopathic Pulmonary Fibrosis is a progressive and fatal interstitial lung disease (ILD) characterized by a typical radiographic or histologic usual interstitial pneumonia (UIP) pattern.Â In 2018, diagnostic categories of UIP based on computed tomography patterns were revised by the Fleischner Society. The study aimed to describe differences in comorbidities and spirometry in ILD patients that were characterized by high-resolution computed tomography (HRCT) images as having a typical, probable, indeterminate, and alternative diagnosis of UIP. METHODS:We retrospectively studied 80 ILD patients from 2017 to 2019. Typical UIP was defined using the Fleischner Society diagnostic criteria for IPF. Atypical UIP was reached by consensus after a multidisciplinary clinical-radiological-pathological review of patient data. Baseline characteristics, comorbidities, and spirometry were compared among the four subgroups. RESULTS:% from baseline to 6-12Â months, age, and sex, only COPD remained significantly associated with typical UIP (pâ€‰=â€‰0.018). Tobacco use was not significantly associated with any radiographic type (pâ€‰=â€‰0.199). CONCLUSION/CONCLUSIONS:Typical UIP was prevalent among COPD/emphysema patients. Although smoking has a strong association with IPF, we did not find a significant association with smoking and typical UIP in our cohort.
Advances in Targeted Therapy for Progressive Fibrosing Interstitial Lung Disease
Progressive fibrosing interstitial lung disease (PF-ILD) has been redefined as a new clinical syndrome that shares similar genetics, pathophysiology, and natural history to idiopathic pulmonary fibrosis (IPF). IPF is the most common form of idiopathic interstitial pneumonias, which is progressive in nature and is associated with significant mortality. Therapies targeting an inflammatory and/or immune response have not been consistently effective or well tolerated in patients with IPF. The two antifibrotic drugs approved for IPF treatment, nintedanib and pirfenidone, have been shown to reduce lung function decline in PF-ILD. Novel uses of antifibrotic therapy are emerging due to a paucity of evidence-based treatments for multiple ILD subtypes. In this review, we describe the current body of knowledge on antifibrotic therapy and immunomodulators in PF-ILD, drawing from experience in IPF where appropriate.
EXAMINING THE RELATIONSHIP BETWEEN SPIROMETRY AND USUAL INTERSTITIAL PNEUMONIA (UIP) PATTERNS ON CT AMONG IDIOPATHIC PULMONARY FIBROSIS (IPF) PATIENTS [Meeting Abstract]
SESSION TITLE: Tuesday Electronic Posters 3 SESSION TYPE: Original Inv Poster Discussion PRESENTED ON: 10/22/2019 01:00
Evaluation of the airway microbiome in non-tuberculous mycobacteria
Background: Aspiration is associated with non-tuberculous mycobacterial (NTM) pulmonary disease and airway dysbiosis is associated with increased inflammation. We examined whether NTM disease was associated with a distinct airway microbiota and immune profile.Methods: 297 oral wash and induced sputum samples were collected from 106 participants with respiratory symptoms and imaging abnormalities compatible with NTM. Lower airway samples were obtained in 20 participants undergoing bronchoscopy. 16S rRNA gene and a nested mycobacteriome sequencing approaches characterised microbiota composition. Inflammatory profiles of lower airway samples were also examined.Results: The prevalence of NTM+ cultures was 58%. Few changes were noted in microbiota characteristic or composition in oral wash and sputum samples among groups. Among NTM+ samples, 27% of the lower airway samples were enriched with Mycobacterium A mycobacteriome approach identified Mycobacterium in a greater percentage of samples, including some non-pathogenic strains. In NTM+ lower airway samples, taxa identified as oral commensals were associated with increased inflammatory biomarkers.Conclusions: The 16S rRNA gene sequencing approach is not sensitive in identifying NTM among airway samples which are culture positive. However, associations between lower airway inflammation and microbiota signatures suggest a potential role for these microbes in the inflammatory process in NTM disease.
Respiratory care in familial dysautonomia: Systematic review and expert consensus recommendations
BACKGROUND:Familial dysautonomia (Riley-Day syndrome, hereditary sensory autonomic neuropathy type-III) is a rare genetic disease caused by impaired development of sensory and afferent autonomic nerves. As a consequence, patients develop neurogenic dysphagia with frequent aspiration, chronic lung disease, and chemoreflex failure leading to severe sleep disordered breathing. The purpose of these guidelines is to provide recommendations for the diagnosis and treatment of respiratory disorders in familial dysautonomia. METHODS:We performed a systematic review to summarize the evidence related to our questions. When evidence was not sufficient, we used data from the New York University Familial Dysautonomia Patient Registry, a database containing ongoing prospective comprehensive clinical data from 670 cases. The evidence was summarized and discussed by a multidisciplinary panel of experts. Evidence-based and expert recommendations were then formulated, written, and graded using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. RESULTS:Recommendations were formulated for or against specific diagnostic tests and clinical interventions. Diagnostic tests reviewed included radiological evaluation, dysphagia evaluation, gastroesophageal evaluation, bronchoscopy and bronchoalveolar lavage, pulmonary function tests, laryngoscopy and polysomnography. Clinical interventions and therapies reviewed included prevention and management of aspiration, airway mucus clearance and chest physical therapy, viral respiratory infections, precautions during high altitude or air-flight travel, non-invasive ventilation during sleep, antibiotic therapy, steroid therapy, oxygen therapy, gastrostomy tube placement, Nissen fundoplication surgery, scoliosis surgery, tracheostomy and lung lobectomy. CONCLUSIONS:Expert recommendations for the diagnosis and management of respiratory disease in patients with familial dysautonomia are provided. Frequent reassessment and updating will be needed.
Bortezomib Induced Organizing Pneumonia in a Patient with Underlying Interstitial Lung Disease: The (Im)Perfect Setup [Meeting Abstract]
The Microbiota of Non-Tuberculosis Mycobacterium Leads to a Distinct Inflammatory Profile [Meeting Abstract]
The Mycobacteriome: A Nested Approach to Identify Non-Tuberculous Mycobacterium [Meeting Abstract]