Chronic respiratory diseases are risk factors for severe disease in coronavirus disease 2019 (COVID-19). Respiratory tract infection is one of the commonest causes of acute exacerbation of chronic ...obstructive pulmonary disease (AECOPD). There has not been evidence suggesting the link between COVID-19 and AECOPD, especially in places with dramatic responses in infection control with universal masking and aggressive social distancing.
This is a retrospective study to assess the number of admissions of AECOPD in the first three months of 2020 in Queen Mary Hospital with reference to the admissions in past five years. Log-linear model was used for statistical inference of covariates, including percentage of masking, air quality health index and air temperature.
The number of admissions for AECOPD significantly decreased by 44.0% (95% CI 36.4%–52.8%, p < 0.001) in the first three months of 2020 compared with the monthly average admission in 2015–2019. Compare to same period of previous years, AECOPD decreased by 1.0% with each percent of increased masking (p < 0.001) and decreased by 3.0% with increase in 1 °C in temperature (p = 0.045). The numbers of admissions for control diagnoses (heart failure, intestinal obstruction and iron deficiency anaemia) in the same period in 2020 were not reduced.
The number of admissions for AECOPD decreased in first three months of 2020, compared with previous years. This was observed with increased masking percentage and social distancing in Hong Kong. We postulated universal masking and social distancing during COVID-19 pandemics both contributed in preventing respiratory tract infections hence AECOPD.
•Admissions for COPD exacerbation decrease during COVID-19 period in Hong Kong.•Decrease in COPD admission is observed with universal masking and social distancing.•Universal masking and social distancing prevent respiratory tract infection.•Masking reduces respiratory tract infection postulate to decrease COPD exacerbation.
Abstract
Background
Coronavirus Disease 2019 (COVID-19) led to pandemic that affected almost all countries in the world. Many countries have implemented border restriction as a public health measure ...to limit local outbreak. However, there is inadequate scientific data to support such a practice, especially in the presence of an established local transmission of the disease.
Objective
To apply a metapopulation Susceptible-Exposed-Infectious-Recovered (SEIR) model with inspected migration to investigate the effect of border restriction as a public health measure to limit outbreak of coronavirus disease 2019.
Methods
We apply a modified metapopulation SEIR model with inspected migration with simulating population migration, and incorporating parameters such as efficiency of custom inspection in blocking infected travelers in the model. The population sizes were retrieved from government reports, while the number of COVID-19 patients were retrieved from Hong Kong Department of Health and China Centre for Disease Control (CDC) data. The
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was obtained from previous clinical studies.
Results
Complete border closure can help to reduce the cumulative COVID-19 case number and mortality in Hong Kong by 13.99% and 13.98% respectively. To prevent full occupancy of isolation facilities in Hong Kong; effective public health measures to reduce local
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to below 1.6 was necessary, apart from having complete border closure.
Conclusions
Early complete travel restriction is effective in reducing cumulative cases and mortality. However, additional anti-COVID-19 measures to reduce local
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to below 1.6 are necessary to prevent COVID-19 cases from overwhelming hospital isolation facilities.
While studies have suggested increased risks of severe COVID-19 infection in chronic obstructive pulmonary disease (COPD), the persistent and delayed consequences of COVID-19 infection on patients ...with COPD upon recovery remain unknown. A prospective clinical study was conducted in Hong Kong to investigate the persistent and delayed outcomes of patients with COPD who had COVID-19 infection of different severity (mild-moderate COVID-19 and severe COVID-19), compared with those who did not. Chinese patients with COPD ≥ 40 years old were recruited from March to September 2021. They were prospectively followed up for 24.9 ± 5.0 months until 31st August 2023. The primary outcome was the deterioration in COPD control defined as the change in mMRC dyspnea scale. The secondary outcomes included the change in exacerbation frequency and non-COVID-19 respiratory mortality (including death from COPD exacerbation or bacterial pneumonia). 328 patients were included in the analysis. Patients with mild-moderate and severe COVID-19 infection had statistically significant increased risks of worsening of mMRC dyspnoea scale by increase in 1 score from baseline to follow-up with adjusted odds ratios of 4.44 (95% CI = 1.95–10.15, p < 0.001) and 6.77 (95% CI = 2.08–22.00, p = 0.001) respectively. Patients with severe COVID-19 infection had significantly increased risks of increase in severe COPD exacerbation frequency with adjusted odds ratios of 4.73 (95% CI = 1.55–14.41, p = 0.006) non-COVID-19 respiratory mortality from COPD exacerbation or pneumonia with adjusted hazard ratio of 11.25 (95% CI = 2.98–42.45, p < 0.001). After recovery from COVID-19, worsening of COPD control from worsening of dyspnea, increase in severe exacerbation frequency to non-COVID-19 respiratory mortality (COPD exacerbation and pneumonia) was observed among patients with severe COVID-19. Mild to moderate COVID-19 was also associated with symptomatic deterioration.
The availability of efficacious anti‐cancer treatments, including oral targeted therapy, do not obviate the need of definitive measures for MPE in newly diagnosed lung cancer. Both early MPE control ...measures and cancer treatments are warranted to minimize the need of pleural re‐interventions in the course of malignancy.
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ABSTRACT
Background and objective
The advent of effective anti‐cancer therapy has brought about uncertainty on the benefit of early definitive measures for newly diagnosed MPE from lung cancer. This study aims to investigate the outcomes of MPE in this setting.
Methods
Lung cancer patients with MPE at first presentation to a tertiary care hospital were followed up till death or censored from 2011 to 2018. Early MPE control measures included chemical pleurodesis or IPC before or shortly after oncological treatment. Predictors of time to MPE re‐intervention were identified with Cox proportional hazard analyses.
Results
Of the 509 records screened, 233 subjects were eligible. One hundred and twenty‐seven subjects received oral targeted therapy as first‐line treatment and 34 (26.8%) underwent early definitive MPE control measures. Early MPE control measures in addition to targeted therapy, as compared to targeted therapy alone, significantly reduced the subsequent need of MPE re‐intervention (23.5% vs 53.8%, P = 0.002). Similar benefits from MPE control measures were found in groups receiving systemic anti‐cancer therapy or best supportive care (0% vs 52%, P = 0.003; 18% vs 56.7%, P = 0.024, respectively). In the group with targetable mutations, both early MPE control measures (HR: 0.25, 95% CI: 0.12–0.53, P < 0.001) and the use of targeted therapy (HR: 0.22, 95% CI: 0.10–0.46, P < 0.001) were independently associated with longer time to MPE re‐interventions.
Conclusion
Early MPE control measures in lung cancer has additional benefits on reducing the need and prolonging the time to MPE re‐intervention, independent of anti‐cancer therapies.
While there are postulations that asthma is potentially associated with severe coronavirus disease 2019 (COVID-19), there has been conflicting results from studies on the impact mild-to-moderate ...COVID-19 on asthma control after recovery.
A case control study on the association between mild-to-moderate COVID-19 and asthma control post infection was conducted. The primary outcome was a reduction in Asthma Control Test (ACT) score by ≥ 3 points post-COVID infection. The secondary outcomes included the change in ACT score, the proportion of patient with ACT score who dropped to ≤ 15 on enrolment visit and the need for escalation of asthma maintenance therapy.
Out of the total of 221 adult patients with asthma recruited, 111 had mild-to-moderate COVID-19 within 30 to 270 days prior to study enrolment. The adjusted odds ratio (aOR) for a reduction in ACT score by ≥ 3 points after COVID-19 was 3.105 (95% CI = 1.385-6.959, p = 0.006). The odds of escalation of asthma maintenance therapy by at least 1 Global Initiative for Asthma (GINA) step was 4.733 (95% CI = 1.151-19.467, p = 0.031) and asthma patient are more likely to become uncontrolled after COVID-19 aOR = 5.509 (95% CI = 1.061-28.600, p = 0.042).
Mild-to-moderate COVID-19 among asthma patients, upon recovery, was associated with worsening of asthma symptom, lower ACT score, a higher need for escalation of asthma maintenance therapy and more uncontrolled asthma.
Background and Objective
Respiratory viral infection is a common trigger of bronchiectasis exacerbation. Knowledge of the intermediate to long‐term effect of COVID‐19 on bronchiectasis is poor.
...Methods
A retrospective cohort study of patient records was conducted to assess the frequency of bronchiectasis exacerbation following recovery from mild‐to‐moderate COVID‐19. The exacerbation frequency at baseline, using 2019 and 2019–2021 data, was compared with that during the 1 year following recovery.
Results
A total of 234 adult patient records who had a confirmed diagnosis of bronchiectasis were identified, of whom 52 (22.2%) were classified as the COVID‐19 group. Patients with COVID‐19 had significantly more frequent annual exacerbations of bronchiectasis (total exacerbations and hospitalizations). Compared with 2019–2021 data, the total exacerbation frequency decreased by 0.1 ± 0.51 per year among non‐COVID‐19 patients but increased by 0.68 ± 1.09 per year among the COVID‐19 group (p < 0.001). Compared with 2019 only data, exacerbation frequency decreased by 0.14 ± 0.79 per year among non‐COVID‐19 patients but increased by 0.76 ± 1.17 per year in the COVID‐19 group, p < 0.001. The annual frequency of hospitalization for bronchiectasis increased by 0.01 ± 0.32 per year among non‐COVID‐19 patients and increased by 0.39 ± 1.06 per year in the COVID‐19 group (p < 0.001) compared with 2019 to 2021 data. When compared with only 2019 data, it remained unchanged at 0 ± 0.43 per year among non‐COVID‐19 patients but increased to 0.38 ± 1.12 per year among COVID‐19 patients (p < 0.001).
Conclusion
Mild‐to‐moderate COVID‐19 was associated with an increase in frequency of bronchiectasis exacerbation and frequency of hospitalizations following recovery.
Mild‐to‐moderate COVID‐19 is associated with an increase in frequency of bronchiectasis exacerbation as well as hospitalizations following recovery.
Pseudomonas aeruginosa is one of the commonest bacteria colonizing the airway in patients with non-cystic fibrosis bronchiectasis. Pseudomonas aeruginosa colonization is associated with poor outcomes ...in patients with bronchiectasis, including rapid decline in lung function, exacerbation frequency and hospitalization.
A cross-sectional study in Queen Mary Hospital, Hong Kong that included 350 Chinese patients with non-cystic fibrosis bronchiectasis to investigate the risk factors for Pseudomonas aeruginosa colonization and clinical implications on disease outcomes.
Pseudomonas aeruginosa colonization was more commonly found in patients with longer duration of bronchiectasis and those on proton pump inhibitors (PPIs) with adjusted ORs of 1.066 (95% CI = 1.036-1.096, p < 0.001) and 2.815 (95% CI = 1.307-6.064, p = 0.008) respectively. Patients with Pseudomonas aeruginosa colonization have more extensive lung involvement and higher risks of exacerbation requiring hospitalization with adjusted ORs of 2.445 (95% CI = 1.283-4.657, p = 0.007) and 2.745 (95% CI = 1.012-7.449, p = 0.047) respectively. Pseudomonas aeruginosa colonization is more common among patients with longer duration of bronchiectasis and those on PPI. Pseudomonas aeruginosa colonization is associated with more extensive lung involvement and higher risks of exacerbation requiring hospitalization.
Background and Objective
Electronic medical record (EMR) databases can facilitate epidemiology research in various diseases including bronchiectasis. Given the diagnostic challenges of ...bronchiectasis, the validity of the coding in EMR requires clarification. We aimed to assess the validity of International Classification of Diseases, 9th Revision (ICD‐9) code algorithms for identifying bronchiectasis in the territory‐wide electronic medical health record system of Clinical Data Analysis and Reporting System (CDARS) in Hong Kong.
Materials and Methods
Adult patients who had the diagnosis of bronchiectasis input from Queen Mary Hospital in 2011–2020 were identified using the ICD‐9 code of 494 by CDARS. All patients who had high resolution computed tomography (HRCT) were reviewed by respiratory specialists to confirm the presence of bronchiectasis on HRCT.
Results
A total of 19 617 patients who had the diagnostic code of bronchiectasis among all public hospitals in Hong Kong and 1866 in Queen Mary Hospital in the same period. Six hundred and forty‐eight cases were randomly selected and validated using medical record and HRCT review by a respiratory specialist. The overall positive predictive value (PPV) was 92.7% (95% CI 90.7–94.7).
Conclusions
This was the first ICD‐9 coding validation for bronchiectasis in Hong Kong CDARS. Our study demonstrated that using ICD‐9 code of 494 was reliable to support utility of CDARS database for further clinical research on bronchiectasis.
Accessibility of diagnostic screening and treatment monitoring devices for respiratory diseases is critical in promoting healthcare and reducing sudden complications and mortality. Spirometry is the ...standard for diagnosing and monitoring several lung diseases. However, it lacks regional assessment capabilities necessary for detecting subtle regional changes in certain diseases. It also requires challenging breathing maneuvers difficult for elderlies, children, and diseased patients. Here, we actualized an affordable, portable, and self-administrable electrical impedance tomography (EIT) system for home-based lung function assessment and telemedicine. Through simultaneous EIT-spirometry trials on healthy subjects, we demonstrated that our device can predict spirometry indicators over a wide range and can provide regional mapping of these indicators. We further developed a close-to-effortless breathing paradigm and tested it by longitudinally monitoring a COVID-19 discharged subject and two healthy controls with results suggesting the paradigm can detect initial deterioration followed by recovery. Overall, the EIT system can be widely applicable for lung function screening and monitoring both at homes and clinics.
Background and Objective
Although stage I non‐small cell lung carcinoma (NSCLC) typically carries a good prognosis following complete resection, early disease recurrence can occur. An accurate ...survival prediction model would help refine a follow‐up strategy and personalize future adjuvant therapy. We developed a post‐operative prediction model based on readily available clinical information for patients with stage I adenocarcinoma.
Methods
We retrospectively studied the disease‐free survival (DFS) of 408 patients with pathologically confirmed low‐risk stage I adenocarcinoma of lung who underwent curative resection from 2013 to 2017. A tree‐based method was employed to partition the cohort into subgroups with distinct DFS outcome and stepwise risk ratio. These covariates were included in multivariate analysis to build a scoring system to predict disease recurrence. The model was subsequently validated using a 2011–2012 cohort.
Results
Non‐smoker status, stage IA disease, epidermal‐growth factor receptor mutants and female gender were associated with better DFS. Multivariate analysis identified smoking status, disease stage and gender as factors necessary for the scoring system and yielded 3 distinct risk groups for DFS 99.4 (95% CI 78.3–125.3), 62.9 (95% CI 48.2–82.0), 33.7 (95% CI 24.6–46.1) months, p < 0.005. External validation yielded an area under the curve by receiver operating characteristic analysis of 0.863 (95% CI 0.755–0.972).
Conclusion
The model could categorize post‐operative patients using readily available clinical information, and may help personalize a follow‐up strategy and future adjuvant therapy.
We developed a post‐operative prediction model for patients with stage I adenocarcinoma based on readily available clinical information, including smoking status, disease stage and gender. The model may help personalize a follow‐up strategy and future adjuvant therapy.
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