Usefulness of Pirfenidone in Covid Lung: A Case Series

The year 2020 has been plagued by the COVID‑19 pandemic that has resulted in an additional 1,800,000 deaths worldwide. Many patients who recover from Covid-19 later present with shortness of breath and fibrosis of the lungs, while some take a long time to recover from the initial infection. A drug such as pirfenidone, which has been used for the treatment of idiopathic pulmonary fibrosis, could offer additional benefits by reverting pulmonary fibrotic damage. Here we describe a case series of five patients where addition of this drug showed marked improvement in symptoms and radiological findings. Apart from the efforts regarding understanding the pathophysiology of this new disease, we must also evaluate the proportion of patients that develop chronic lung disease due to fibrosis following COVID-19 recovery. Certainly, more attention should be given to new studies to determine the actual benefit of pirfenidone in patients with pulmonary fibrosis as a result of Covid-19 infection.

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S127 Oropharyngeal swallowing pathophysiology in patients with idiopathic pulmonary fibrosis: A consecutive descriptive case series

10.1136/thorax-2020-btsabstracts.132 ◽

2021 ◽

Author(s):

A Alamer ◽

R Jones ◽

C Ward ◽

M Drinnan ◽

AJ Simpson ◽

...

Keyword(s):

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Case Series

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Nintedanib Treatment for Idiopathic Pulmonary Fibrosis Patients Who Have Been Switched from Pirfenidone Therapy: A Retrospective Case Series Study

Journal of Clinical Medicine ◽

10.3390/jcm9020422 ◽

2020 ◽

Vol 9 (2) ◽

pp. 422 ◽

Cited By ~ 1

Author(s):

Andrea Vianello ◽

Francesco Salton ◽

Beatrice Molena ◽

Cristian Turato ◽

Maria Laura Graziani ◽

...

Keyword(s):

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Disease Progression ◽

Safety Profile ◽

Real Life ◽

Case Series ◽

First Line ◽

First Line Therapy ◽

Line Therapy ◽

Case Series Study

Background: The efficacy and effectiveness of nintedanib as a first-line therapy in idiopathic pulmonary fibrosis (IPF) patients have been demonstrated by clinical trials and real-life studies. Our aim was to examine the safety profile and effectiveness of nintedanib when it is utilized as a second-line treatment in subjects who have discontinued pirfenidone. Methods: The medical charts of 12 patients who were switched from pirfenidone to nintedanib were examined retrospectively. The drug’s safety was defined by the number of adverse events (AEs) that were reported; disease progression was evaluated based on the patient’s vital status and changes in forced vital capacity (FVC) at 12-month follow-up. Results: The numbers of patients experiencing AEs and of the AEs per patient in our study group didn’t significantly differ with respect to a group of 56 individuals who were taking nintedanib as a first-line therapy during the study period (5/12 vs. 22/56; p = 0.9999, and 0.00 (0.00–1.00) vs. 0.00 (0.00–3.00); p = 0.517, respectively). Two out of the 3 patients who had been switched to nintedanib due to a rapid disease progression showed stabilized FVC values. Conclusions: Nintedanib was found to have an acceptable safety profile in the majority of the IPF patients switched from pirfenidone. Prospective studies are warranted to determine if the drug can effectively delay disease progression in these patients.

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Buccal Hydromorphone Syrup for Managing Dyspnea in Idiopathic Pulmonary Fibrosis

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909120969126 ◽

2020 ◽

pp. 104990912096912

Author(s):

Shannon Fong ◽

Janice Richman-Eisenstat ◽

Meena Kalluri

Keyword(s):

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Case Series ◽

Symptom Burden ◽

Symptom Assessment ◽

Oral Route ◽

Poor Quality ◽

Self Management ◽

Patient Centered ◽

Onset Of Action

Context: Dyspnea is a highly distressing symptom that characterizes idiopathic pulmonary fibrosis (IPF), a common idiopathic interstitial lung disease (ILD) with a high symptom burden, poor quality of life, and early mortality. Though opioids are mentioned in guidelines for dyspnea management, guidance on how and when to initiate opioids is lacking. Different pharmacologic strategies are needed to address different types of dyspnea (baseline, incident, and crisis). Due to a longer onset of action, the oral route (swallowed) may be less effective for prevention of incident dyspnea or for rapid relief of crisis dyspnea, prompting the use of alternative drug delivery strategies for self-management. We inadvertently discovered the efficacy of buccal administration of low dose, low volume hydromorphone oral syrup for dyspnea management in ILD, which has not been previously reported in the literature. Case Series: We describe our approach to dyspnea assessment and management in IPF, including use of the Multidimensional Dyspnea Scale (MDDS), a novel instrument yet to be validated that we developed to better identify and categorize dyspnea into the types experienced by a patient with IPF over the course of a day. We then describe how buccal hydromorphone oral syrup is initiated and titrated for dyspnea management in 3 patients at different points in their disease trajectory. Conclusion: Buccal hydromorphone oral syrup is effective for dyspnea management across the spectrum of IPF. When integrated into a patient-centered algorithm for symptom assessment and management, it allows for rapid and easy self-management of dyspnea by patients and their caregivers.

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