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      Management of patients with SARS-CoV-2 infections with focus on patients with chronic lung diseases (as of 10 January 2022) : Updated statement of the Austrian Society of Pneumology (ASP)

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      1 , 25 , , 2 , 3 , 4 , 4 , 5 , 6 , 5 , 1 , 25 , 7 , 8 , 9 , 10 , 11 , 12 , 3 , 13 , 14 , 15 , 16 , 3 , 17 , 18 , 19 , 5 , 7 , 2 , 20 , 21 , 2 , 7 , 22 , 23 , 2 , 24 , 2 , 16 , 1
      Wiener Klinische Wochenschrift
      Springer Vienna
      Mechanical ventilation, Immune modulators, Chronic lung disease, Pediatric lung disease, Long covid

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          Abstract

          The Austrian Society of Pneumology (ASP) launched a first statement on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in May 2020, at a time when in Austria 285 people had died from this disease and vaccinations were not available. Lockdown and social distancing were the only available measures to prevent more infections and the breakdown of the health system. Meanwhile, in Austria over 13,000 patients have died in association with a SARS-CoV‑2 infection and coronavirus disease 2019 (COVID-19) was among the most common causes of death; however, SARS-CoV‑2 has been mutating all the time and currently, most patients have been affected by the delta variant where the vaccination is very effective but the omicron variant is rapidly rising and becoming predominant. Particularly in children and young adults, where the vaccination rate is low, the omicron variant is expected to spread very fast. This poses a particular threat to unvaccinated people who are at elevated risk of severe COVID-19 disease but also to people with an active vaccination. There are few publications that comprehensively addressed the special issues with SARS-CoV‑2 infection in patients with chronic lung diseases. These were the reasons for this updated statement. Pulmonologists care for many patients with an elevated risk of death in case of COVID-19 but also for patients that might be at an elevated risk of vaccination reactions or vaccination failure. In addition, lung function tests, bronchoscopy, respiratory physiotherapy and training therapy may put both patients and health professionals at an increased risk of infection. The working circles of the ASP have provided statements concerning these risks and how to avoid risks for the patients.

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          Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

          Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
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            Dexamethasone in Hospitalized Patients with Covid-19 — Preliminary Report

            Abstract Background Coronavirus disease 2019 (Covid-19) is associated with diffuse lung damage. Glucocorticoids may modulate inflammation-mediated lung injury and thereby reduce progression to respiratory failure and death. Methods In this controlled, open-label trial comparing a range of possible treatments in patients who were hospitalized with Covid-19, we randomly assigned patients to receive oral or intravenous dexamethasone (at a dose of 6 mg once daily) for up to 10 days or to receive usual care alone. The primary outcome was 28-day mortality. Here, we report the preliminary results of this comparison. Results A total of 2104 patients were assigned to receive dexamethasone and 4321 to receive usual care. Overall, 482 patients (22.9%) in the dexamethasone group and 1110 patients (25.7%) in the usual care group died within 28 days after randomization (age-adjusted rate ratio, 0.83; 95% confidence interval [CI], 0.75 to 0.93; P<0.001). The proportional and absolute between-group differences in mortality varied considerably according to the level of respiratory support that the patients were receiving at the time of randomization. In the dexamethasone group, the incidence of death was lower than that in the usual care group among patients receiving invasive mechanical ventilation (29.3% vs. 41.4%; rate ratio, 0.64; 95% CI, 0.51 to 0.81) and among those receiving oxygen without invasive mechanical ventilation (23.3% vs. 26.2%; rate ratio, 0.82; 95% CI, 0.72 to 0.94) but not among those who were receiving no respiratory support at randomization (17.8% vs. 14.0%; rate ratio, 1.19; 95% CI, 0.91 to 1.55). Conclusions In patients hospitalized with Covid-19, the use of dexamethasone resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at randomization but not among those receiving no respiratory support. (Funded by the Medical Research Council and National Institute for Health Research and others; RECOVERY ClinicalTrials.gov number, NCT04381936; ISRCTN number, 50189673.)
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              Remdesivir for the Treatment of Covid-19 — Final Report

              Abstract Background Although several therapeutic agents have been evaluated for the treatment of coronavirus disease 2019 (Covid-19), none have yet been shown to be efficacious. Methods We conducted a double-blind, randomized, placebo-controlled trial of intravenous remdesivir in adults hospitalized with Covid-19 with evidence of lower respiratory tract involvement. Patients were randomly assigned to receive either remdesivir (200 mg loading dose on day 1, followed by 100 mg daily for up to 9 additional days) or placebo for up to 10 days. The primary outcome was the time to recovery, defined by either discharge from the hospital or hospitalization for infection-control purposes only. Results A total of 1063 patients underwent randomization. The data and safety monitoring board recommended early unblinding of the results on the basis of findings from an analysis that showed shortened time to recovery in the remdesivir group. Preliminary results from the 1059 patients (538 assigned to remdesivir and 521 to placebo) with data available after randomization indicated that those who received remdesivir had a median recovery time of 11 days (95% confidence interval [CI], 9 to 12), as compared with 15 days (95% CI, 13 to 19) in those who received placebo (rate ratio for recovery, 1.32; 95% CI, 1.12 to 1.55; P<0.001). The Kaplan-Meier estimates of mortality by 14 days were 7.1% with remdesivir and 11.9% with placebo (hazard ratio for death, 0.70; 95% CI, 0.47 to 1.04). Serious adverse events were reported for 114 of the 541 patients in the remdesivir group who underwent randomization (21.1%) and 141 of the 522 patients in the placebo group who underwent randomization (27.0%). Conclusions Remdesivir was superior to placebo in shortening the time to recovery in adults hospitalized with Covid-19 and evidence of lower respiratory tract infection. (Funded by the National Institute of Allergy and Infectious Diseases and others; ACTT-1 ClinicalTrials.gov number, NCT04280705.)
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                Author and article information

                Contributors
                horst.olschewski@medunigraz.at
                Journal
                Wien Klin Wochenschr
                Wien Klin Wochenschr
                Wiener Klinische Wochenschrift
                Springer Vienna (Vienna )
                0043-5325
                1613-7671
                21 April 2022
                21 April 2022
                : 1-21
                Affiliations
                [1 ]GRID grid.11598.34, ISNI 0000 0000 8988 2476, Division of Pulmonology, Department of Internal Medicine, , Medical University of Graz, ; Graz, Austria
                [2 ]GRID grid.11598.34, ISNI 0000 0000 8988 2476, Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, , Medical University of Graz, ; Graz, Austria
                [3 ]GRID grid.452055.3, ISNI 0000000088571457, Department of Pulmonology, Tirol Kliniken, , Hospital Hochzirl-Natters, ; Natters, Austria
                [4 ]GRID grid.459693.4, Department of Pneumology, University Hospital Krems, , Karl Landsteiner University of Health Sciences, ; Krems, Austria
                [5 ]GRID grid.22937.3d, ISNI 0000 0000 9259 8492, Department of Thoracic Surgery, , Medical University of Vienna, ; Vienna, Austria
                [6 ]GRID grid.22937.3d, ISNI 0000 0000 9259 8492, Division of Pulmonology, Department of Medicine II, , Medical University of Vienna, ; Vienna, Austria
                [7 ]GRID grid.9970.7, ISNI 0000 0001 1941 5140, Department of Pulmonology, Faculty of Medicine, , Johannes-Kepler-University, ; Linz, Austria
                [8 ]GRID grid.5361.1, ISNI 0000 0000 8853 2677, Pulmonology, Department of Internal Medicine II, , Medical University of Innsbruck, ; Innsbruck, Austria
                [9 ]Department of Internal Medicine and Pulmonology, Klinik Floridsdorf, Vienna, Austria
                [10 ]Department of Physical Medicine and Rehabilitation, Klinik Floridsdorf, Vienna, Austria
                [11 ]Specialist for pulmonology, Innsbruck, Austria
                [12 ]Department of Internal and Respiratory Medicine, Hospital Graz II, Hospital Enzenbach, Gratwein, Austria
                [13 ]Department of Pediatric and Adolescent Medicine, Klinik Ottakring, Vienna, Austria
                [14 ]Outpatient Pulmonary Rehabilitation, Therme Wien Med, Vienna, Austria
                [15 ]GRID grid.413662.4, ISNI 0000 0000 8987 0344, First Medical Department, , Hanusch Hospital, ; Vienna, Austria
                [16 ]GRID grid.414473.1, Department of Pneumology, , Ordensklinikum Linz Elisabethinen Hospital, ; Linz, Austria
                [17 ]Specialist for pulmonology, Vienna, Austria
                [18 ]GRID grid.487248.5, Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, , Klinik Floridsdorf, ; Vienna, Austria
                [19 ]Allergy Center Vienna West, Vienna, Austria
                [20 ]Department of Pulmonology, Reha Zentrum Münster, Münster, Austria
                [21 ]Interdisciplinary sleep laboratory, Telfs, Austria
                [22 ]Department of Pulmonology, Landesklinikum Hochegg, Grimmenstein, Austria
                [23 ]Specialist for pulmonology, Salzburg, Austria
                [24 ]Department of Internal Medicine and Pulmonology, Klinik Floridsdorf, Vienna, Austria
                [25 ]GRID grid.489038.e, Ludwig Boltzmann Institute for Lung Vascular Research, ; Graz, Austria
                Author information
                http://orcid.org/0000-0002-2834-7466
                Article
                2018
                10.1007/s00508-022-02018-x
                9022736
                35449467
                a971b269-8913-4672-a0c5-512a791ae25e
                © The Author(s) 2022

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 19 January 2022
                : 17 February 2022
                Funding
                Funded by: Medical University of Graz
                Categories
                Position Paper

                Medicine
                mechanical ventilation,immune modulators,chronic lung disease,pediatric lung disease,long covid

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