Pycnogenol®-Centellicum® supplementation improves lung fibrosis and post-COVID-19 lung healing.

BACKGROUND: The aim of this study was to evaluate the combination of Pycnogenol® (150 mg/day) (Horphag Research, London, UK) and Centella asiatica (Centellicum® 3×225 mg/day; Horphag Research) (PY-CE) for 8 months in subjects with sequelae of idiopathic interstitial pneumonia (IIP). Recently, post-COVID-19 lung disease is emerging with large numbers of patients left with chronic lung conditions. Considering the antifibrotic activity of the combination PY-CE, we also tested this supplementary management in post-COVID-19 lung patients. METHODS: Nineteen subjects with idiopathic interstitial pneumonia (IIP) were included in the study. High Resolution CT scans at inclusion confirmed the presence of lung fibrosis: 10 patients were treated with the Pycnogenol® Centellicum® combination and 9 subjects with standard management (SM) served as controls. Oxidative stress that was very high in all subjects at inclusion, decreased significantly in the supplement group (P<0.05). The Karnofsky Performance Scale Index significantly improved in the supplement group in comparison with controls (P<0.05). The symptoms (fatigue, muscular pain, dyspnea) were significantly lower after 8 months in supplemented patients (P<0.05) as compared with controls. RESULTS: At the end of the study, the small cystic lesions (honeycombing) and traction bronchiectasis were stable or in partial regression in 4 subjects in the supplemented group (vs. none in the control group) with a significant improvement in tissue edema in the supplemented subjects. On ultrasound lung scans the white (more echogenic) fibrotic component at inclusion was 18.5±2.2% in the images in controls vs. 19.4±2.7% in the supplement group. At the end of the study, there was no improvement in controls (18.9±2.5%) vs. a significant improvement in supplemented subjects (16.2±2.1%; P<0.05). In addition, 18 subjects with post-COVID-19 lung disease were included in the study; 10 patients were treated with the Pycnogenol® Centellicum® combination and evaluated after 4 weeks; 8 patients served as controls. Preliminary results show that symptoms associated with post-COVID-19 lung disease after 4 weeks were significantly improved with the supplement combination (P<0.05). Oxidative stress and the Karnofsky Performance Scale Index were significantly improved in the supplements group as compared with controls (P<0.05). CONCLUSIONS: According to these observations, Pycnogenol® controls and decreases edema and Centellicum® by modulating the apposition of collagen, slows down the development of irregular cicatrization, the keloidal scarring and fibrosis. More time is needed to evaluate this effect in a larger number of post-COVID-19 patients with lung disease. This disease has affected millions of subjects worldwide, leaving severe consequences. Pycnogenol® and Centellicum® may improve the residual clinical picture in post-COVID-19 lung disease (PCL) patients and may reduce the number of subjects evolving into lung fibrosis. The evolution from edema to fibrosis seems to be slower or attenuated with this supplement combination both in Idiopathic pulmonary fibrosis (IPF) and in PCL patients.

Upper respiratory infections and barotraumas in commercial pilots: a retrospective survey.

INTRODUCTION: One of the most common causes of acute incapacitation among aircrew is barotrauma induced by pressure changes during descent in aviation. However, the incidence of ENT barotrauma during flight among commercial pilots with or without upper respiratory infections (URI) has not been described in detail. METHOD: There were 948 commercial pilots--equivalent to one-third of all commercial pilots in Denmark--visiting the Danish Aero Medical Centre during a 6-mo period who answered a questionnaire regarding signs and symptoms of URI and barotrauma incidence in relation to flying with a common cold. RESULTS: On average, every commercial pilot experienced one to two URI per year. About two-thirds of the pilots (57.2%) reported themselves unfit, while 42.8% continued with their flying duties despite signs and symptoms of a URI. Of the latter group the 78.0% reported taking decongestant medication. More than one-third of all pilots (37.6%) reported having experienced one or more episodes of ear barotrauma, mainly during descent (90%), whereas 19.5% reported one or more sinus barotrauma incidents during their flying career. Less than 2% of these had felt incapacitated prior to the flight. CONCLUSION: The results suggest that not all pilots and airline companies consider URI a valid reason for unfitness to fly despite the risk for acute incapacitation. Urgent attention to this fact and to the risk factors caused by URI are strongly recommended.

The Aeromedical Management of Allergic Rhinitis.

INTRODUCTION: Allergic rhinitis is a prevalent condition warranting special aeromedical consideration due to its potential for acute and painful manifestations involving the middle ear or paranasal sinuses during rapid barometric pressure changes. Although second generation antihistamines and intranasal steroids are safe and effective treatments for this common condition, aeromedical management varies. METHODS: An aeromedical policy review of 14 public access civil and military data repositories was undertaken. Policy within a convenience sample of nine countries (Australia, Canada, Croatia, France, New Zealand, Norway, Sweden, United Kingdom, and United States) was further ascertained through subject matter expert consultation. A convenience sample of recent primary care review articles and ENT guidelines were reviewed in order to substantiate the evidence basis for aeromedical practices. RESULTS: Policies range from disqualification of flight applicants with any history of allergic rhinitis to the authorization of short-term, select undeclared medication use for the management of mild symptoms, with military authorities applying a more conservative approach. A range of intranasal and oral therapies are approved and requirements for waiver vary across most authorities. DISCUSSION: Variation in practices must be considered when managing flight crews as part of military coalition peacetime and combat operations, as well as for international civil aviation missions conducted in support of natural disaster relief, rescue, and other stability efforts. Standardization of approved therapies for allergic rhinitis could be a useful starting point for the harmonization of aeromedical global policies in the future. Beneficial national specific policy updates may be undertaken on the basis of international experience.Powell-Dunford N, Reese C, Bushby A, Munkeby BH, Coste S, Pezer VL, Rosenkvist L. The aeromedical management of allergic rhinitis. Aerosp Med Hum Perform. 2018; 89(5):453-463.