Effect of High-Risk Obstructive Sleep Apnea on Clinical Outcomes in Adults with Coronavirus Disease 2019: A Multicenter, Prospective, Observational Clinical Trial.

Rationale: Coronavirus disease (COVID-19) is an ongoing pandemic, in which obesity, hypertension, and diabetes have been linked to poor outcomes. Obstructive sleep apnea (OSA) is associated with these conditions and may influence the prognosis of adults with COVID-19. Objectives: To determine the effect of OSA on clinical outcomes in patients with COVID-19. Methods: The current prospective observational study was conducted in three hospitals in Istanbul, Turkey from March 10 to June 22, 2020. The participants were categorized as high-risk or low-risk OSA according to the Berlin questionnaire that was administered in the out-patient clinic, in hospital, or shortly after discharge from hospital blinded to the clinical outcomes. A modified high-risk (mHR)-OSA score based on the snoring patterns (intensity and/or frequency), breathing pauses, and morning/daytime sleepiness, without taking obesity and hypertension into account, were used in the regression models. Results: The primary outcome was the clinical improvement defined as a decline of two categories from admission on a 7-category ordinal scale that ranges from 1 (discharged with normal activity) to 7 (death) on Days 7, 14, 21, and 28, respectively. Secondary outcomes included clinical worsening (an increase of 1 category), need for hospitalization, supplemental oxygen, and intensive care. In total, 320 eligible patients (median [interquartile range] age, 53.2 [41.3-63.0] yr; 45.9% female) were enrolled. In all, 121 (37.8%) were categorized as known (n = 3) or high-risk OSA (n = 118). According to the modified scoring, 70 (21.9%) had mHR-OSA. Among 242 patients requiring hospitalization, clinical improvement within 2 weeks occurred in 75.4% of the mHR-OSA group compared with 88.4% of the modified low-risk-OSA group (P = 0.014). In multivariate regression analyses, mHR-OSA (adjusted odds ratio [OR], 0.42; 95% confidence interval [CI], 0.19-0.92) and male sex (OR, 0.39; 95% CI, 0.17-0.86) predicted the delayed clinical improvement. In the entire study population (n = 320), including the nonhospitalized patients, mHR-OSA was associated with clinical worsening (adjusted hazard ratio, 1.55; 95% CI, 1.00-2.39) and with the need for supplemental oxygen (OR, 1.95; 95% CI, 1.06-3.59). Snoring patterns, especially louder snoring, significantly predicted delayed clinical improvement, worsening, need for hospitalization, supplemental oxygen, and intensive care. Conclusions: Adults with mHR-OSA in our COVID-19 cohort had poorer clinical outcomes than those with modified low-risk OSA independent of age, sex, and comorbidities. Clinical trial registered with www.clinicaltrials.gov (NCT04363333).

COVID-19 Pneumonia and Idiopathic Pulmonary Fibrosis: A Novel Combination.

Coronavirus disease 2019 (COVID-19) has become a game changer in many aspects of clinical practice. Acute exacerbations of idiopathic pulmonary fibrosis (IPF) are known as serious events, which can reach a mortality rate of 50%, where viral infections may play a role. We describe the case of a 64-year-old male patient with a diagnosis of IPF under antifibrotic treatment for 1 year; the patient tested positive for COVID-19 with polymerase chain reaction test of the nasopharyngeal swab, and his chest computed tomography results were compatible with COVID-19 pneumonia described in the literature as well as the findings compatible with interstitial lung disease. The patient was successfully treated in the pulmonology ward according to official guidelines about COVID-19 along with antifibrotic treatment and required only a short course of oxygen therapy. We experienced no drug interactions, serious side effects, or complications during treatment. The patient was discharged after 1 week, and he is still in a good condition after 3 weeks. COVID-19 pneumonia in a patient with IPF who survived under antifibrotic treatment without serious deterioration is a new experience. Such cases will probably change our perspective in treating patients with IPF.

Managing Bronchiectasis: 13 Years of Experience from Sputum to Lung Transplantation.

OBJECTIVES: Bronchiectasis and especially related mortality has gained growing interest in recent years. The aim of our retrospective study was to determine the factors which may influence and indicate mortality in our bronchiectasis patients throughout 13 years. MATERIAL AND METHODS: Patients with ICD-10 code J47 depicting bronchiectasis between 1.1.2003 to 31.12.2015 were evaluated using database of our hospital.694 out of 1470 patients who had high-resolution computed tomography (HRCT) scan confirming the presence of bronchiectatic lesions were included. RESULTS: Female/male ratio was 1.09. Mean age of the patients was 45.9±15.7 years. Sputum culture results were available in 365 (52.6%)of the patients. Pseudomonas aeruginosa was the leading pathogen, which was found in 68 (20.7%) patients. 28 (4%) patients have died during the 13 year period, and the overall survival was 125,3 months. In general 5 (4.4%) out of 112 patients who underwent surgery were lost, 3 of them belonging to the transplantation group. 3 out of 9 patients (33%) who underwent lung transplantation were lost within 3 years. There was no statistically significant difference in survival between patients who underwent surgery or not (p>0.05).In univariate Cox regression mortality analysis age, FEV1, P. aeruginosa, E.coli, hospitalisation and ICU admission had p value <0.01. When these factors were evaluated in the multivariate analysis, only P.aeruginosa reached statistical significance in predicting mortality. CONCLUSION: Isolation of P.aeruginosa in a patient with bronchiectasis should be taken seriously. It can be suggested that eradication treatment according to guidelines will help reduce mortality of bronchiectasis worldwide. Surgery is still an option of treatment in severe bronchiectasis and lung transplantation may be a life-saving way of managing end-stage disease.

A Basic Question: Are Patients with Chronic Obstructive Pulmonary Disease Aware of Their Disease?

OBJECTIVES: Increased awareness and understanding of chronic obstructive pulmonary disease (COPD) is important for its management, but there are limited data regarding the basic knowledge among patients with COPD. This study aimed to evaluate the basic information and knowledge of patients who were specifically provided with a medical exemption certificate for COPD. MATERIAL AND METHODS: This cross-sectional, observational, single-center study was conducted at an outpatient clinic of our hospital and included 201 consecutive ambulatory patients who visited the outpatient clinic between January 01, 2015 and June 30, 2015. Data regarding sex, age, educational level, symptoms, smoking history, years since diagnosis, years since obtaining the exemption certificate, and COPD GOLD (Global Initiative for Chronic Obstructive Lung Disease-GOLD) stage were obtained. A questionnaire comprising 15 questions was used. RESULTS: The question regarding the organ primarily affected by COPD was correctly answered as "lung" by 145 (72%) of patients. In addition, 152 (76%) patients declared that they knew the localization of the affected organ; only 44 (22%) patients correctly located the organ on an image. Only seven (3.5% of the total) patients could correctly write "chronic obstructive pulmonary disease." CONCLUSION: The lack of awareness among patients with COPD emphasizes the lack in the field of patient education. Simple questionnaires can be used to determine and also to improve the awareness and basic knowledge among patients with chronic diseases.

Clinical presentations and diagnostic work-up in sarcoidosis: a series of Turkish cases (clinics and diagnosis of sarcoidosis).

Sarcoidosis is an idiopathic granulomatous disease. It usually affects the lung. The diagnosis may be problematic since the known causes of granulomatous inflammation must be excluded. This multicenter study aimed to evaluate the clinical presentations and diagnostic approaches of sarcoidosis. The study protocol was sent via internet, and the participants were asked to send the information (clinical, radiological and diagnostic) on newly diagnosed sarcoidosis cases. 293 patients were enrolled within two years. Pulmonary symptoms were found in 73.3% of the patients, and cough was the most common one (53.2%), followed by dyspnea (40.3%). Constitutional symptoms were occured in half of the patients. The most common one was fatigue (38.6%). The most common physical sign was eritema nodosum (17.1%). The most common chest radiograhical sign was bilateral hilar lymphadenomegaly (78.8%). Staging according to chest X-ray has revealed that most of the patients were in Stage I and Stage II (51.9% and 31.7%, respectively). Sarcoidosis was confirmed histopathologically in 265 (90.4%) patients. Although one-third of the bronchoscopy was revealed normal, mucosal hyperemi (19.8%) and external compression of the bronchial wall (16.8%) were common abnormal findings. The 100% success rate was obtained in mediastinoscopy among the frequently used sampling methods. Transbronchial biopsy was the most frequently used method with 48.8% success rate. Considering sarcoidosis with its most common and also rare findings in the differential diagnosis, organizing the related procedures according to the possibly effected areas, and the expertise of the team would favour multimodality diagnosis.