Atrial fibrillation is associated with poor clinical trajectory of COVID-19

Background Atrial fibrillation (AF) has been described as a common cardiovascular manifestation in patients suffering from coronavirus disease 2019 (COVID-19) and is discussed to be a potential risk factor for a poor clinical course. AF is also already known to be associated with increased risk for all cause death. Purpose In the present study we sought to investigate the impact of AF on the clinical trajectory of patients suffering from COVID-19. Methods We included all patients hospitalized due to COVID-19 in 2020 in our Hospital. A poor clinical trajectory was defined as transfer to intensive care unit (ICU), intermediate care unit (IMC) or death from any cause. Initial ECGs were analyzed in consensus by two experienced readers. First, we compared patients with poor clinical trajectory vs. good clinical course. Secondly, the study population was categorized into two groups with or without AF on admission. A subgroup analysis was performed to differentiate between new onset AF and patients with known history of AF. To compensate for confounders (age, BMI, known cardiomyopathy (CMP), known coronary artery disease (CAD), chronic airway disease, renal insufficiency, diabetes, arterial hypertension and sex), a full clinically validated multiple logistic regression model with poor clinical trajectory as dependent target variable was performed. Results From our enrolled 666 patients in 2020 (58% male, average age: 66 (IQR:58–80)) 223 patients (33.5%) experienced a poor clinical course. 179 (27%) patients were transferred to IMC/ICU and 86 (13%) patients died. All in all, patients with poor clinical trajectory were more frequently male (70% vs. 52%; P<0.001), older (71±14 vs. 64±20; P<0.001) and had significantly more co-morbidities such as CAD, CMP, hypertension and diabetes in comparison to patients with a good clinical course. 96 (14.4%) had AF on admission. Among these 37.5% had new-onset AF, which showed similar baseline characteristics as patients without AF. Indeed, patients with COVID-19 and new onset AF were more likely to die (25% vs 12%; P=0.038), or be in need for ICU/IMC (25% vs. 62%; P<0.001) and therefore experienced a poor clinical trajectory more frequently (75% vs. 31%; P<0.001) with a confounder adjusted OR of 5.89. In the subgroup analysis of all patients with AF on admission. Patients with new onset of AF had significantly more underlying CMP, Diabetes and chronic airways disease. While mortality was not higher in patients with new onset of AF, IMC/ICU transfers (62% vs 24%; P<0.001) and as a result poor clinical trajectory (75% vs 40%; P=0.001) was significantly increased in comparison to patients with known AF. Conclusion In patients suffering from COVID-19, new onset of AF on admission was associated with a poor clinical course and higher in-hospital mortality. FUNDunding Acknowledgement Type of funding sources: None.

Spirometric phenotypes from early childhood to young adulthood: A CADSET (Chronic Airway Disease Early Stratification) study

BackgroundThe prevalences of obstructive and restrictive spirometric phenotypes, and their relation to early-life risk factors from childhood to young adulthood remain poorly understood. The aim was to explore these phenotypes and associations with well-known respiratory risk factors across ages and populations in European cohorts.MethodsWe studied 49 334 participants from 14 population-based cohorts in different age-groups (≤10, >10–15, >15–20, >20–25 years, and overall, 5–25 years). The obstructive phenotype was defined as FEV1/FVC z-score <the lower limit of normal (LLN), whereas the restrictive as FEV1/FVC z-score ≥LLN, and FVC z-score <LLN.ResultsThe prevalence of obstructive and restrictive phenotypes varied from 3.2–10.9% and 1.8–7.7%, respectively, without clear age trends. A diagnosis of asthma (adjusted odds ratio, aOR=2.55 [95% CI=2.14–3.04]), preterm birth (aOR=1.84 [1.27–2.66]), maternal smoking during pregnancy (aOR=1.16 [1.01–1.35]), and family history of asthma (aOR=1.44 [1.25–1.66]) were associated with a higher prevalence of obstructive, but not restrictive phenotype across ages (5–25 years). A higher current body mass index (BMI) was more often observed in those with the obstructive phenotype but less in those with the restrictive (aOR=1.05 [1.03–1.06] and aOR=0.81 [0.78–0.85], per kg/m2 increase in BMI, respectively). Current smoking was associated with the obstructive phenotype in participants older than 10 years (aOR=1.24 [1.05–1.46]).ConclusionObstructive and restrictive phenotypes were found to be relatively prevalent during childhood, which supports the early origins concept. Several well-known respiratory risk factors were associated with obstructive phenotype, whereas only low BMI was associated with the restrictive phenotype, suggesting different underlying pathobiology of these two phenotypes.

Preclinical Evaluation of Recombinant Microbial Glycoside Hydrolases in the Prevention of Experimental Invasive Aspergillosis

The biofilm-forming mold Aspergillus fumigatus is a common causative agent of invasive fungal airway disease in patients with a compromised immune system or chronic airway disease. Treatment of A. fumigatus infection is limited by the few available antifungals to which fungal resistance is becoming increasingly common.

An Integrated Framework to Conceptualize and Develop the Vancouver Airways Health Literacy Tool (VAHLT)

There is currently no comprehensive tool to assess the functional health literacy (HL) skills of chronic airway disease (CAD) patients. The purpose of this article is to describe the development of a new HL measure, the Vancouver Airways Health Literacy Tool (VAHLT). The tool was developed through the following phases: (1) Tool conceptualization, consisting of: (A) a systematic review (SR), (B) focus group sessions with CAD patients to understand barriers and facilitators to CAD management, (C) a survey with key-informants to obtain strategies to mitigate self-management barriers and validate patient-derived topics, and (D) respiratory physicians’ review of the topics; (2) Scenario and item development; and (3) Tool testing and content validation. The SR identified the lack of a valid HL measurement tool for CAD patients. Patients provided an initial shortlist of disease-related self-care topics. Key-informants helped to finalize topics for inclusion. Respiratory physicians and patients contributed to the development of a scenario-based questionnaire, which was refined during three rounds of testing to develop a 44-item instrument comprising nine self-management passages. We highlight the holistic process of integrating information from the literature with knowledge gained from key stakeholders into our tool framework. Our approach to stakeholder engagement may be of interest to researchers developing similar tools, and could facilitate the development and testing of HL-based interventions to ultimately improve patient outcomes and reduce the burden on the healthcare system.

Effect of influenza vaccine on prevention of acute attack of chronic airway disease in elderly population：a randomized controlled trail.

Objective To investigate the effect of influenza vaccination on prevention of acute attack in elderly patients with chronic airway disease, and to provide evidence for the prevention and control strategy of chronic airway disease in elderly population. Methods Elderly patients in Linquan County of Anhui Province of China who under stationary phase of chronic airway disease were selected and randomly vaccinated with tetravalent or trivalent influenza vaccine. The number of patients with acute attack, the number of outpatients with acute attack, the number of outpatients, the number of inpatients, the number of inpatients, the total cost of patients, the cost of outpatients, the cost of hospitalization and the length of hospitalization were collected before vaccination and after one year follow up. Results A total of 348 subjects were included in this study, 248 were vaccinated with trivalent vaccination and 100 were vaccinated with tetravalent vaccination. There was no significant difference in age and sex ratio among two vaccination groups. The ratios of acute attack, outpatient visits and hospitalization, and number of outpatient visits, number of hospitalizations, total medical expenses, outpatient expenses and hospitalization expenses were significantly higher before vaccination than those after vaccination in both trivalent vaccination group and tetravalent vaccination group. While, there was no significant difference in the length of stay between before and after vaccination in neither trivalent vaccination group nor tetravalent vaccination group. The protection effect between trivalent vaccination group and tetravalent vaccination group was not significant. Conclusion Influenza vaccination can effectively prevent the acute attack of chronic airway disease and delay the progress of the chronic airway disease.

Prevalence of asthma chronic obstructive pulmonary disease overlap in patients attending a tertiary health care centre

Background: The study aimed to assess the magnitude of asthma chronic obstructive pulmonary disease asthma chronic obstructive (ACO) in patients with chronic airway disease.Methods: The study was conducted as cross-sectional study on patients with chronic airway disease presenting at our institute during the study period of 1 year. Global initiative for asthma management and prevention (GINA) syndromic approach table was used to diagnose patients with chronic airways disease. Syndromic and confirmatory diagnosis of ACO was made based upon clinical features and spirometry respectively.Results: About 73.6% were diagnosed as chronic obstructive pulmonary disease (COPD) and 26.4% cases were diagnosed as asthma. Overall ACO was present in 20% cases. ACO was significantly associated with advancing age, male gender, and longer duration of smoking (p<0.05) in asthma patients whereas in COPD patients ACO was associated with advancing age (p<0.05).Conclusions: Overall one fifth of the patients with chronic airway disease have asthma COPD overlap. The ACO is observed in almost equal proportions in asthma and COPD. ACO prevalence was found to increase with age in patients with asthma and COPD.