Is using inhaled corticosteroid effective against COVID-19 pneumonia severity and mortality?

Introduction: It is known that the use of inhaled corticosteroids increases the incidence of pneumonia in patients followed up with the diagnosis of chronic asthma and chronic obstructive pulmonary disease (COPD). This study aimed to investigate the contribution of inhaled steroid use to pneumonia severity and mortality in cases with COVID-19 pneumonia. Materials and Methods: The study is a retrospective, observational study. Among the cases admitted to the pandemic clinic, patients diagnosed with COVID-19 pneumonia were included. The plan was to compare cases who received and did not receive inhaled corticosteroids in terms of pneumonia severity and mortality. In order to define risk factors for mortality, univariate and multivariable negative binomial regression analyses were performed. Result: In our study, it was observed that n= 540 (75%) cases did not receive inhaled corticosteroids (group 1), and 180 (25%) cases used inhaled corti costeroids (group 2). Group 1 and group 2 cases were compared in terms of pneumonia severity with no significant difference between the two groups (p= 0.11). Then, risk factors affecting mortality in all cases were examined with univariate analyses. Increasing age, applying mechanical ventilation, having severe pneumonia, having interstitial lung disease, and applying prone position were found to be statistically significant factors in mortality (p < 0.05). Conclusions: In conclusion, in our study, it was observed that the use of inhaled corticosteroids did not increase the severity of pneumonia and mortality. It was thought that the treatment they received could be continued when the patients treated with inhaled corticosteroids due to asthma and COPD had COVID-19 pneumonia.

Risk factors for the development of interstitial lung disease following severe COVID-19 pneumonia and outcomes of systemic corticosteroid therapy: 3-month follow-up.

BACKGROUND: We aimed to evaluate the pulmonary involvement status, its related factors, and pulmonary function test (PFT) results in the first month follow-up in patients who were discharged for severe Covid-19 pneumonia, and to assess the efficacy of corticosteroid treatment on these parameters in severe pulmonary involvement patients. METHODS: We retrospectively analyzed all consecutive patients who applied to our COVID-19 follow-up clinic at the end of the first month of hospital discharge. Functional and radiological differences were compared after 3 months of corticosteroid treatment in severe pulmonary involvement group. Results We analyzed 391 patients with "pulmonary parenchymal involvement" (PPIG) and 162 patients with "normal lung radiology" (NLRG). 122 patients in the PPIG (corticosteroid-required interstitial lung disease group (CRILD)) had severe pulmonary involvement with frequent symptoms and required corticosteroid prescription. Pulmonary involvement was more common in males and elder patients (P<0.001, for both). Being smoker and elderly were associated with a higher risk-ratio in predicting to be in PPIG (OR:2.250 and OR:1.057, respectively). Smokers, male and elderly patients, and HFNO2 support during hospitalization were risk factors for being a patient with CRILD (OR:2.737, OR:4.937, OR:4.756, and OR:2.872, respectively). After a three-months of methylprednisolone medication, a good response was achieved on radiological findings and PFT results in CRILD. CONCLUSIONS: In conclusion, after severe COVID-19 pneumonia, persistent clinical symptoms and pulmonary parenchymal involvement would be inevitable in elder and smoker patients. Moreover, corticosteroid treatment in patients with severe parenchymal involvement was found to be effective in the improvement of radiological and functional parameters.

Effect of chronic lung diseases on mortality of prevariant COVID-19 pneumonia patients.

Background: The aim of the study is to assess the effect of chronic lung disease on mortality in patients hospitalized with the diagnosis of prevariant COVID-19 Pneumonia compared to patients without chronic lung disease. Research design and methods: A cohort of 1,549 patients admitted to the pandemic clinic with a COVID-19 Pneumonia diagnosis was analyzed. Group 1 and Group 2 were compared in terms of the treatment they received, admission to intensive care, mortality and follow-up parameters. Results: The patient group with COVID-19 and lung disease consisted of 231 participants (14.91%) (Group 1). The patient group with COVID-19 but without lung disease had 1,318 participants (85.19%). Group 1 cases were found to receive more oxygen therapy and mechanical ventilation than Group 2 cases (p ≤ 0.001), Following univariate and multiple logistic regression analyses, it was determined that patients with chronic lung disease had a 25.76% higher mortality risk [OR: 25.763, 95% CI (Lower-Upper) (2.445-271.465), p = 0.007]. Conclusion: It was found that chronic lung disease contributed significantly to mortality in this study. Among chronic lung diseases, Chronic Obstructive Pulmonary Disease (COPD), lung cancer and interstitial lung diseases (ILDs) were shown to be more effective than other chronic lung diseases in patients with prevariant COVID-19 population.

Recombinant tissue plasminogen activator treatment of pulmonary embolism also improves deep venous thrombosis.

Anticoagulants are the standard form of treatment used in deep vein thrombosis (DVT). Thrombolytic therapy is another method to treat thromboembolism by using intravenous administration of streptokinase, urokinase and recombinant tissue plasminogen activator (r-tPA). We have investigated the effect of r-tPA, a systemic thrombolytic used for the treatment of pulmonary emboli, on DVT in the same patients. 130 patients who were diagnosed with both pulmonary embolism and DVT were included in this study. Lower extremity Doppler ultrasonography (DUS) was conducted on all of the patients upon admission and then on the 6th month. The patients were divided into two groups. Patients in Group 1 were initially given 100 mg thrombolytic (r-tPA) intravenously and then standard anticoagulation therapy (enoxaparin sodium and warfarin). Patients in Group 2, however, were given only standard anticoagulation therapy (enoxaparin sodium and warfarin). In the 6th month DUS follow-up control for Group 1, out of 66 cases, the venous thrombosis of 54 patients were completely resolved, and the remaining 12 patients had residual vein occlusion (RVO). In Group 2, out of 64 cases, 41 patients were found to have complete resolution, while 23 patients continued to have RVO. This difference was statistically significant (p=0.029). OR was calculated to be 2.47. In other words, the risk of RVO was increased by 2.47 times in the patients who were not treated with r-tPA. Thrombolytic therapy of DVT should be considered more frequently to avoid complications of thrombosis, and DUS monitoring should be recommended before discontinuing anticoagulant therapy.

Deteriorations of pulmonary function, elevated carbon monoxide levels and increased oxidative stress amongst water-pipe smokers.

OBJECTIVES: A water pipe (hookah) is a tobacco smoking tool which is thought to be more harmless than a cigarette, and there are no adequate studies about its hazards to health. Water-pipe smoking is threatening health of the youth in the world today. The objective of this study has been to investigate the carbon monoxide (CO) levels in breath, examine the changes in pulmonary function tests (PFT) and to assess the change of the oxidative stress parameters in blood after smoking a water pipe. MATERIAL AND METHODS: This study is a cross-sectional analytical study that has included 50 volunteers who smoke a water pipe and the control group of 50 volunteers who smoke neither a cigarette nor a water pipe. Carbon monoxide levels were measured in the breath and pulmonary function tests (PFTs) were performed before and after smoking a water pipe. Blood samples were taken from either the volunteer control group or water-pipe smokers group after smoking a water pipe for the purpose of evaluation of the parameters of oxidative stress. RESULTS: Carbon monoxide values were measured to be 8.08±7.4 ppm and 28.08±16.5 ppm before and after smoking a water pipe, respectively. This increment was found statistically significant. There were also significant reductions in PFTs after smoking a water pipe. Total oxidative status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI) were found prominently higher after smoking a water pipe for the group of water-pipe smokers than for the control group. CONCLUSIONS: This study has shown that water-pipe smoking leads to deterioration in pulmonary function and increases oxidative stress. To the best of our knowledge this study is the only one that has shown the effect of water-pipe smoking on oxidative stress. More studies must be planned to show the side effects of water-pipe habit and protective policies should be planned especially for young people in Europe. Int J Occup Med Environ Health 2017;30(5):731-742.

Exhaled carbon monoxide is a marker of heavy nicotine dependence.

BACKGROUND/AIM: Exhaled CO level provides an objective measure of a patient's smoking status. The relationship between CO levels and nicotine dependence is controversial. The aim of this study is to evaluate the relationship between exhaled CO levels and nicotine dependence as well as to demonstrate that exhaled CO levels may be used as a marker of nicotine dependence. MATERIALS AND METHODS: Two hundred eighty-nine patients (132 females, 157 males) were included in the study. Smoking duration, the age of smoking initiation, exhaled CO levels, and Fagerström Test for Nicotine Dependence (FTND) scores were recorded. The relationship between FTND scores and exhaled CO levels was investigated. RESULTS: There was a statistically significant correlation between FTND score and exhaled CO levels (P < 0.001). We found that a cut-off score of 7.5 ppm for exhaled CO may be useful as a marker for heavy smoking. The sensitivity and specificity of this cut-off score for exhaled CO was 69.3% and 49.3%, respectively (P < 0.001). CONCLUSION: We found that exhaled CO levels significantly correlated with FTND scores. For patients who are unable to provide reliable answers to questions in the FTND, exhaled CO measurements may be used as an alternative test for estimating the status of heavy smoking.

Byssinosis and COPD rates among factory workers manufacturing hemp and jute.

OBJECTIVES: Prior studies have been performed on cotton textile plants throughout the world. This study was planned to identify the rate of byssinosis and chronic obstructive pulmonary disease (COPD) in hemp and jute workers and those who worked with both of them. MATERIAL AND METHODS: The study was realized in a factory which consecutively processed hemp and jute. The study enrollment included 266 people, 164 of whom were active workers and 102 were retired. A questionnaire, plain chest X-rays, physical examination and pulmonary function tests were performed. Dust levels were measured in various sections of the factory during 8 h work shifts. Endotoxin levels of various quality hemp fibers and dusts were measured. RESULTS: The rate of byssinosis (28.2%) was higher among the workers that who exposed to both jute and hemp dust. The frequency of chronic bronchitis in retired workers who previously smoked was higher (20%) as compared to currently smoking workers (17%). High dust levels were measured in some parts of the factory (mean (M) = 2.69 mg/m3). Working in dense dust areas, active smoking, being older than 40 years of age, being an ex-smoker, and working in the factory for a period exceeding 15 years were significantly associated with bronchitis and emphysema development. High endotoxin levels were determined for fine hemp dust (605 EU/mg), coarse hemp dust (336 EU/mg) and poor quality hemp fibers (114 EU/mg), whereas in fresh hemp stalks the level of endotoxin was determined to be lower (0.27 EU/mg). CONCLUSIONS: Because of high exposures to jute and hemp dusts that are associated with high byssinosis rates, personal protection and environmental hygiene is crucial to prevention of byssinosis.

A case of pulmonary artery hydatid cyst observed on endobronchial ultrasound.

Hydatid cyst (HC) is a parasitic disease that may involve many organs, especially the lung and the liver. Pulmonary artery location of the hydatid cyst is extremely rare, but it may cause life-threatening complications. We report a case of a hydatid cyst that completely filled the left main pulmonary artery and its distal part without cardiac involvement. Thoracic computed tomography showed filling defects in the pulmonary arteries. Endobronchial ultrasound was performed for differential diagnosis and it showed a cystic lesion. Hydatid cyst-specific IgE and hem agglutination test results were positive. In the literature, cases like this in which the diagnosis of pulmonary hydatid cyst is made by endobronchial ultrasound are not usually seen. Although many imaging modalities such as plain chest radiography, cross-sectional imaging (MDCT and MRI), echocardiography and conventional pulmonary angiography have been used in the diagnostic approach, we recommend endobronchial ultrasound for the differential diagnosis of cases with cystic formation.

Half-dose recombinant tissue plasminogen activator treatment in venous thromboembolism.

INTRODUCTION: Pulmonary embolism (VTE) comes in different degrees of severity from massive pulmonary embolism to nonmassive pulmonary embolism with no symptoms or hypoxia. Thrombolytic therapy is a lifesaver especially for patients who are in the high-risk group. In this study, we aimed at evaluating symptoms and clinical and laboratory findings in patients who had a diagnosis of massive or submassive VTE and treated with 50-mg recombinant tissue plasminogen activator (rt-PA) per hour for various problems as opposed to the standard dose, which is 100 mg every 2 hours. MATERIALS AND METHODS: Forty-six patients with a diagnosis of massive or submassive VTE who received thrombolytic therapy were evaluated retrospectively. Twenty-three patients who were treated with 50-mg rt-PA per hour were included in the study group. On the other hand, 23 patients who were treated with 100 mg of intravenous infusion of rt-PA every 2 hours were included in the control group. Echocardiographic assessment of the right ventricular size, systolic pulmonary artery pressure (sPAP), oxygen saturation, systemic arterial pressure, and heart rate before the thrombolytic therapy and in the first 24 hours after the administration of therapy were checked and noted in both of the groups. RESULTS: No significant difference was found between the 2 groups with regard to demographic data, Wells scores, type of embolism, average symptom duration, sPAP, and oxygen saturation. Differences in recovery, as inferred from vital symptoms and sPAP measurements, were not significant between the 2 groups. CONCLUSIONS: Lower-dose thrombolytic therapy showed similar efficacy versus the standard dose in VTE. Thrombolytic therapy is a life-saving treatment in massive VTE. Furthermore, a harm/benefit analysis may lead to the administration of half-dose therapy in selected cases when it is contraindicated for various reasons.

Endobronchial hamartoma.

Pulmonary hamartoma is a benign lung neoplasm and it comprises 6% of solitary pulmonary nodules. Two clinical types have been defined according to its location: intraparenchymal (90%) and endobronchial (10%). We report on a case of endobronchial hamartoma resected with electrocautery by a flexible bronchoscope (FB). A 57-year-old male patient was admitted to our clinic because of worsening dyspnea. The patient had been smoking 1 pack per day for 37 years. A solid smooth lesion with calcification, located in the distal part of the left main bronchus and partially obstructing the lumen of bronchus, was detected at computerized tomography. A mass lesion that moved with coughing was observed during FB. The polypoid mass was arising from the anterior wall of the left main bronchus. Punch biopsies were taken from the polypoid lesion and a diagnosis of bronchial papilloma was made after histopathologic examination. The patient underwent endobronchial electrosurgery and the lesion was excised using FB. Pathologic evaluation revealed it to be a cartilagenous hamartoma. In conclusion, endobronchial hamartomas are benign neoplasms of the tracheobronchial tree. Endoscopic treatment with flexible bronchoscopic electrocautery is safe and less invasive in experienced hands. Therefore, it should be considered as the primary treatment approach in selected cases.

[Bronchial reversibility in the patients with bronchiectasis]. / Bronsektazide hava yolu reversibilitesi.

Pulmonary infections during childhood is an important factor in bronchiectasis ethiology. This disease sometimes may be confused with asthma in diagnosis. Because of bronchial obstruction, the bronchiectasis patients can be misdiagnosed as asthmatic. In this study we aimed to show the obstructive pattern and reversibility percentage in bronchiectasis. The 107 bronchiectasis patients that diagnosed with high resolution computed tomography scanning were included to the study. As a control group 40 volunteers that have no respiratory symptom were chosen randomly. There were 64 (59.81%) men and 43 (40.19%) women patients with a mean age of 48.89 +/- 14.33 years. In control group 40 healthy individuals with a mean age of 43.60 +/- 11.41 were present. The spirometry was done to measure FEV(1), FVC, FEF(25-75%) and reversibility of all 107 individuals and control group. Also diffusion capacity and lung volumes of patients and control group were measured. In the study group 78 (72.90%) patients had obstructive, 26 (24.30%) patients had mixed and 3 (2.80%) patients had restrictive pulmonary function abnormality. Reversibility percentage was recorded as positive for 39 patients in FEV(1) (36.45%) and as positive (> 20%) for 63 patients in FEF(25-75%) (58.9%). In this group mean reversibility percentage in FEV(1) was 19.51 +/- 6.59 and in FEF(25-75%) was 38.62 +/- 26.49. In control group reversibility ratio was 0% for FEV(1). We determined reversibility ratio as 36.45% for FEV(1) and as 58.9% for FEF(25-75%) in our study group, so bronchial reversibility is shown frequently in patients with bronchiectasis. Unfortunately bronchiectasis is often misdiagnosed and some patients are treated for presumed asthma for years. Therefore differential diagnosis of bronchiectasis and asthma should not only be evaluated by reversibility but also by radiologically.