Recovery after admission with COVID-19 pneumonia - A follow-up study.

INTRODUCTION: We performed this study to describe clinical, radiological and pulmonary function outcomes of patients with COVID-19 pneumonia 1 year after discharge from hospital. METHODS: This is a prospective longitudinal study on patients admitted with COVID-19 pneumonia in March and April 2020. 162 patients were classified as moderate, severe or critical. Symptoms and pulmonary function were assessed at 3 months and 1 year after discharge. Chest CT scans were made during hospital admission, at 3 months and, in case of persistent radiological abnormalities, after 1 year. RESULTS: 54% of patients reported full recovery of their pre-illness fitness after 1 year. 53% still reported exertional dyspnoea, independent of illness severity. DLCOc < 80% after 1 year was found in 74% of critical, 50% of severe and 38% of moderate cases. For KCOc<80%, no between-group difference was found. Restriction (TLC<80%) was found in 28% of critical, 5% of severe, and 13% of moderate cases. At baseline, chest CT score was significantly higher for the critical illness group, but after 1 year, there was no significant difference. Most resolution of abnormalities occurred before 3 months. A high prevalence of fibrotic lesions (24%) and subpleural banding (27%) was found. CONCLUSION/CLINICAL IMPLICATION: A large proportion of patients experience consequences of COVID-19 pneumonia one year after discharge, irrespective of initial disease severity. Follow-up of patients admitted with COVID-19 is therefore warranted. An evaluation of symptoms, pulmonary function and radiology three months after discharge can discriminate between patients with early complete recovery and those with persistent abnormalities.

Long-Term Azithromycin Maintenance Treatment in Patients with Frequent Exacerbations of Chronic Obstructive Pulmonary Disease.

Macrolides are effective in reducing the number of exacerbations in COPD patients with the frequent exacerbator phenotype. Our study did not show a persistent effect of azithromycin on exacerbation frequencies after more than one year of usage.

Prevalence and abundance of selected genes conferring macrolide resistance genes in COPD patients during maintenance treatment with azithromycin.

OBJECTIVES: Maintenance treatment with macrolide antibiotics has shown to be effective in reducing exacerbations in COPD patients. A major concern with prolonged treatment with antibiotics is the development of bacterial resistance. In this study we determined the effect of azithromycin on the development and acquisition of resistance to macrolides in the nasopharyngeal flora in COPD patients. METHODS: This study was part of the COLUMBUS trial, a randomised, double-blind, placebo-controlled trial to measure the effect of maintenance treatment with azithromycin in 92 COPD patients on the exacerbation rates during a 12-month period. In order to determine resistance to macrolides, we used a targeted metagenomic approach to measure the presence and relative abundance of specific macrolide resistance genes ermB, ermF and mefA in throat samples collected at different time-points during this 12-month period. RESULTS: There was no increased risk for acquisition of macrolide resistance genes in the azithromycin group compared to the placebo group in COPD patients. However, loss of the macrolide resistance gene ermB was increased overtime in the placebo treated group compared to the azithromycin group (n = 5 for the placebo group versus n = 0 for the azithromycin group at 12 months; p = 0.012). The change in relative abundance of the three macrolide-resistance genes showed that all but one (ermF) increased during treatment with azithromycin. CONCLUSIONS: The acquisition rate of macrolide resistance genes in COPD patients treated with azithromycin maintenance therapy was limited, but the relative abundance of macrolide resistance genes increased significantly over time compared to placebo. This study was part of the COLUMBUS trial ( Clinicaltrials.gov , NCT00985244 ).