Introduction:Lung abscess (LA) is a rare but severe necrotizing pulmonary infection associated with substantial morbidity and mortality. Current management relies on prolonged systemic antibiotic therapy without systematic use of abscess drainage. However, small case series and retrospective studies suggest that transthoracic drainage may be a safe and effective adjunctive intervention improving treatment response. Historically, drainage has been avoided for fear of fistulation, but evidence supporting this is weak. High-quality evidence from randomized trials regarding interventional treatment of LA is lacking. This trial aims to determine whether transthoracic drainage combined with standard antibiotic therapy reduces hospital stay, compared with standard antibiotics alone in patients with LA. Methods:This is a national, multicentre, randomized open-label trial. Adults diagnosed with an LA ≥ 4 cm in diameter, containing fluid, and in contact with the outer third of the lung, will be eligible for the study. A total of 84 patients will be randomized 1:1 to either (1) transthoracic drainage combined with standard antibiotic treatment or (2) standard antibiotic treatment alone. Patients will undergo clinical assessments, laboratory testing, microbiological analyses, CT imaging, and standardized patient-reported outcome measures. Follow-up is scheduled at 1, 4, and 12 weeks post‑discharge. The primary outcome is length of hospital stay. Recruitment started February 2026 with an anticipated inclusion period of 4 years. Perspective:This study will provide the first randomized evidence on the role of transthoracic drainage in LA management. The results may inform national and international clinical guidelines and improve outcomes in patients with this severe condition. Trial registration:ClinicalTrial.gov (NCT07247461).
Background:Idiopathic chronic eosinophilic pneumonia (ICEP) is a rare eosinophilic lung disease with a high relapse rate and substantial oral corticosteroid (OCS) burden. While mepolizumab, an anti-IL-5 monoclonal antibody, has shown promise in case reports and small series, evidence from long-term follow-up studies remains limited. Methods:We conducted a single-centre, registry-based prospective observational study including a small case series of patients with ICEP and concomitant severe eosinophilic asthma who were treated with mepolizumab (100 mg every 4 weeks) for at least 36 months. Data were extracted from the Ege Severe Asthma Registry ESAR, a dynamic real-world database. ICEP relapses, asthma exacerbations, peripheral eosinophil counts, radiological findings, annual cumulative methylprednisolone dose and OCS use duration were evaluated longitudinally before and after mepolizumab initiation. Results:During the two-year inclusion period, 150 new severe asthma patients were registered in the Ege Severe Asthma Registry ESAR; among them, six patients (n:6/150) were initiated on monthly 100 mg mepolizumab based on coexisting diagnoses of severe asthma and relapsing ICEP. All patients had a history of corticosteroid-responsive disease with frequent relapses. After completing a three-year follow-up under regular mepolizumab treatment, significant reductions were observed in oral corticosteroid (OCS) use duration (p = 0.027), annual cumulative methylprednisolone dose, which decreased from 3600 mg/year [2400-4680] to 1080 mg/year [0-1440] (p = 0.028), peripheral blood eosinophil count (p = 0.028), and the number of ICEP relapses, which declined from a median of 3.5 to 0.0 (p = 0.027). Conclusion:To our knowledge, this study represents one of the longest real-world follow-up reports of patients with the rare disease ICEP receiving Anti-IL-5 mepolizumab at the severe asthma treatment dose. Our results indicate that, over a three-year course, mepolizumab 100 mg monthly provided sustained relapse control and markedly reduced OCS dependency in ICEP, a disease well known for its frequent relapses.
Background:The timing of LAMA administration, prescribed for morning dosing, has been questioned, particularly given the nocturnal symptoms many COPD patients experience. The LAMA BY NIGHT trial investigated the impact of LAMA dosing timing (morning vs. evening) on patient-related outcomes, and found no significant effect on risk of exacerbation, but a significant association with ICU admissions. This post hoc analysis of the LAMA BY NIGHT trial explored this association further according to adherence to administration time. Objective:To determine whether the administration timing of LAMA affects the risk of ICU admission for COPD patients. Methods:The LAMA BY NIGHT trial was a digital, multicenter, randomized, open-label study that enrolled 10,011 COPD patients. Adherence was measured at 6 and 12 months, with patients considered adherent if they used LAMA at least 6 days a week at the prescribed time. ICU admissions were tracked over 12-months, and relative risks (RR) were calculated to compare admission rates between morning and evening dosing groups. The analysis was stratified by adherence, to assess the sensitivity of the results. Results:At 6 months, 6,747 patients (67%) completed follow-up questionnaires, of whom 80% were adherent. The risk of ICU admission was numerically lower in the evening dosing group among adherent patients (14/2,302 vs. 24/3,056, RR = 0.77, CI = (0.61-1.55), p = 0.55). At 12 months, ICU admissions were similar between groups (RR = 0.97, CI = (0.40-1.50), p = 1.00). Likewise, non-adherent patients showed no significant difference in ICU admissions between morning and evening dosing at 6 months or 12 months. Conclusion:In this post hoc analysis of the LAMA BY NIGHT trial, evening administration of LAMA did not reduce the risk of ICU admissions among patients with COPD, and adherence to the assigned dosing schedule did not modify this association.
Asthma is a chronic respiratory condition that can be managed using Single Maintenance and Reliever Therapy (SMART) or traditional therapy with inhaled corticosteroid (ICS)-long-acting beta-agonist (LABA) for maintenance and short-acting beta-agonist (SABA) for relief. This study evaluated whether SMART therapy affects COVID-19 severity compared to traditional therapy among patients with moderate to severe asthma. This retrospective cross-sectional study was conducted at Kaiser Permanente Southern California. Adult patients with moderate to severe asthma and confirmed COVID-19 infection in 2021-2022, were included. COVID-19 severity was classified as mild (outpatient care only) or severe (emergency department visits, hospitalization, ICU admission, or death). Patients were categorized into SMART or traditional therapy groups based on pharmacy records. Multivariable robust Poisson regression was used to adjust for potential confounders. 6,608 patients were included, with 269 (4.1%) receiving SMART and 6,339 (95.9%) receiving traditional therapy. No significant difference in COVID-19 severity was observed between SMART and traditional therapy (adjusted prevalence ratio 1.01, 95% CI: 0.71-1.38). However, higher corticosteroid use was noted in the SMART group (19.0% vs. 13.5%, p = 0.011). Severe COVID-19 outcomes were more common among older patients and those with uncontrolled asthma. SMART therapy did not significantly impact COVID-19 severity among patients with moderate to severe asthma. These findings underscore the importance of maintaining good asthma control, regardless of the chosen treatment strategy. Given the ongoing presence of COVID-19 and the potential for future respiratory viral threats, clinicians should prioritize individualized asthma management, with SMART remaining a safe and effective option for eligible patients.
Background:In an increasingly global comorbid population, there are significant challenges to diagnosing the cause of breathlessness. Furthermore, once chronic respiratory conditions have been diagnosed, there is considerable difficulty in detecting deterioration early enough to provide timely, effective intervention. Current methods of diagnosing and monitoring conditions that cause breathlessness, such as asthma and chronic heart failure, can be extensive and difficult to perform. Methods:This observational, proof-of-concept study explored the potential of high-resolution capnography to differentiate respiratory and cardiac conditions causing breathlessness. Using an early model of the N-Tidal device, we analysed capnography waveforms from participants with severe asthma, chronic heart failure, and pneumonia, and compared them to healthy baseline controls. Results:A moderate correlation was observed between alpha angle and spirometry metrics in asthma (r2 = 0.48 for FEV1/FVC), along with a moderate association between alpha angle and left ventricular ejection fraction in heart failure (r2 = 0.46). Pneumonia recovery was marked by a 12.6% median increase in end-tidal CO2. Conclusion:These results suggest that high-resolution capnography may offer promise for non-invasive diagnosis and monitoring of cardiorespiratory conditions. Trial registration:NCT03356288 (registered on 7 September 2017).
The 3rd Annual Lung Cancer Symposium (Oslo Cancer Cluster, 25 September 2025) gathered experts from all the Nordic countries, Norway, Finland, Iceland, Denmark, Sweden, as well as Germany, the UK and the USA to present new evidence and implementation experiences in low-dose chest tomography lung cancer screening, with cross-cutting attention to risk stratification, health economics, AI-enabled workflows, and equity. The symposium was organized by Oslo Cancer Cluster, Levanger Hospital and the Norwegian University of Science and Technology, as a continuation of previous years´ annual efforts to gather and showcase the experiences and the progress of the Nordic countries with lung cancer screening. Across settings, LDCT screening is associated with stage shift and potential mortality reduction, consistent with large trials (NLST, NELSON) and maturing real-world experience (HANSE pilot study, programs in Croatia, Taiwan, the UK, and the US). Emerging Nordic pilots demonstrate feasibility, early-stage detection, and high adherence, while European coordination (SOLACE) is accelerating guideline harmonization and implementation pilots. Key themes included: (1) superiority of multivariable risk models over categorical criteria; (2) the necessity of integrating smoking cessation; (3) program economics that are likely acceptable under Nordic decision thresholds; (4) capacity and downstream pathway planning; and (5) equity-by-design to avoid widening disparities. This report synthesizes country updates and implications for Nordic and European scale-up.
Background Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with functional decline, reduced quality of life, and high rates of readmission and mortality. Although exercise is recommended following AECOPD, long-term adherence and maintenance of benefits remain challenging. Home-based, technology-supported exercise modalities may offer accessible alternatives, but evidence on long-term effectiveness remains limited.Objective To evaluate the effectiveness of a long-term, home-based, virtual cycling intervention on physical performance, physical activity, lung function, functional mobility, frailty, symptoms, health-related quality of life (HRQoL), and hospital readmission in people with COPD following AECOPD.Methods This single-centre, parallel-group, cluster randomised controlled trial recruited patients hospitalised with AECOPD. Participants were randomised in teams to 12 months of home-based virtual cycling or standard care. The intervention consisted of team-based cycling on pedal trainers guided by pre-recorded route videos. The primary outcome was the five-repetition sit-to-stand test (5RSTS). Secondary outcomes included physical performance, lung function, physical activity measured by leg-mounted triaxial accelerometers, dyspnoea, frailty, functional mobility, and HRQoL. Outcomes were assessed at baseline, 6 weeks, 6 months, and 12 months using linear mixed models.Results Forty participants were randomised (21 intervention, 19 control). Physical and respiratory outcomes remained largely stable over time with no significant between-group differences. At 12 months, the intervention group reported higher self-rated health and functional mobility compared with controls in secondary outcomes. Sedentary time remained high in both groups, and readmission and mortality rates were similar.Conclusion In older, multimorbid individuals recovering from AECOPD, long-term home-based virtual cycling did not improve physical performance, activity levels, or lung function, but was associated with higher self-perceived health and functional mobility at 12 months. However, given attrition and limited power, these findings should be cautiously interpreted. Low-threshold, technology-supported exercise may offer patient-centred benefits in populations with limited exercise reserve but research with sufficient power is needed.
Background:While guidelines recommend follow-up visits after an acute exacerbation of COPD (AECOPD), the optimal healthcare facility, timing and its effect on long-term mortality are not well known. Methods:In this retrospective case-control study, Finnish nationwide healthcare and mortality registries were linked to determine the association of a follow-up visit in secondary or primary care within 3 and 6 months after severe AECOPD on 2-year mortality. A conditional fixed-effects logistic regression analysis with 23 covariates was used. A nested case-control study design was applied with matching for age, sex, and multimorbidity in a 1:4 ratio. A time-varying Cox sensitivity analysis was performed to test result robustness. Results:In 2018, the Finnish prevalent COPD population consisted of 63 442 patients, of whom 10% experienced an AECOPD. After the AECOPD, 23% of the patients had a follow-up visit within 3 months. A follow-up in primary care wasn't associated with mortality (OR 1.06, 95% CI 0.90-1.24). However, patients with a follow-up in secondary care were at an increased mortality risk compared with controls without a follow-up (OR 1.62, 95% CI 1.37-1.92). In sensitivity analysis the effect lost statistical significance (HR 1.05, 95% CI 0.35-3.12) but a secondary care follow-up with an add-on primary care follow-up was associated with lower mortality (HR 0.56, 95% CI 0.51-0.61). The strongest predisposing factors were older age, comorbidities such as lung cancer, heart failure and atherosclerosis obliterans, home care, readmission, length of inpatient stay and prior health care use burden. By extending the follow-up time window to 6 months, the results remained largely similar. Conclusion:While we were able to quantify the effect of several patient characteristics on 2-year mortality after AECOPD, the effect of follow-up visits was unclear, likely due to residual confounding by indication. Further studies with even more robust methodology are needed.
Background Existing mental health self-report measures have been criticized for over-simplification, lack of CF-specific focus, susceptibility to measurement reactivity bias, and conflation of symptoms of anxiety and/or depression with CF-related symptoms and/or treatment side effects. The CF Mental Health and Wellness Questionnaire (CFMHWQ) is a 25-item measure assessing CF-specific mental health burden symptoms.Methods To examine common underlying factors contributing to scores on the CFMHWQ, principal component analysis (PCA) was conducted of all 25 items. We conducted cross-validation of CFMHWQ principal components, examining unadjusted correlations between each principal component, demographic characteristics (age and biological sex), negative affect (mean rank global score combining BDI-II and BAI), psychological flexibility (mean rank global score combining AAQ-II and CFQ), and clinical characteristics.Results One hundred twenty-three individuals contributed data for the PCA. A 5-factor model provided the most interpretable structure. Factors appeared to correspond to CF role-related concerns, CF symptomatic burden, social impairments due to CF, behavioral compliance, and coping/personality factors. Greater CF role impairments, behavioral adherence, symptom burden, social impairments, and poorer CF coping are all associated with greater negative affect. Similarly, greater levels of psychological flexibility are associated with lower CF role impairments, social impairments, behavioral adherence, and higher CF coping. Older age was associated with better behavioral adherence, but otherwise demographic factors were unrelated to CFMHWQ scores.Conclusions The CFMHWQ is a promising new self-report measure of CF-specific mental health burden, which associates with negative affect and psychological flexibility. Older age was associated with better behavioral adherence. Finally, more than half reported having undergone a medical procedure they experienced as traumatic, highlighting the importance of measuring the mental health burden of CF. Given the CF-specific nature of items and overfamiliarity with existing measures, we encourage the addition of the CFMHWQ by the CF community.
Aims:This study evaluated the effectiveness of multidisciplinary treatment combined with non-pharmacological airway clearance techniques in preventing stroke-associated pneumonia (SAP). Methods:A quasi-experimental study was conducted at Central People's Hospital of Siping City, China, from March to May 2024. A total of 160 stroke patients were enrolled and assigned to an intervention group (n = 80) or control group (n = 80). Group allocation was performed using a non-randomized sequential assignment approach based on the order of admission and ward availability. The intervention group received multidisciplinary care with stratified airway clearance: active cycle of breathing techniques (ACBT) for patients with preserved cooperation [National Institutes of Health Stroke Scale (NIHSS) ≤15, Glasgow Coma Scale (GCS) >8]and high-frequency chest wall oscillation (HFCWO) for those with impaired consciousness (NIHSS > 15, GCS ≤ 8). Controls received conventional care. Results:After adjusting for baseline age and GCS, the intervention group had a significantly lower incidence of SAP (34.2% vs. 68.1%; adjusted odds ratio [OR] = 0.001, 95% confidence interval [CI]: 6.3 × 10-5 -0.028, p < 0.001). There was no statistically significant difference in intubation rates between groups (27.6% vs. 31.9%, p = 0.566). Among SAP patients, clinical pulmonary infection scores (CPIS) were consistently lower in the intervention group (day 7 mean: 5.53 vs. 6.92, p < 0.001). Gas exchange improved, with lower PaCO2 (43.53 vs. 45.06 mmHg, p = 0.002) and higher PaO2 (95.38 vs. 90.92 mmHg, p = 0.002). As well as shorter intubation duration (10 vs. 16 days), cure time (8 vs. 11 days), and hospital stay (13.3 vs. 19.8 days) (all p < 0.001). whereas hospitalization costs did not differ significantly (17,716.6 vs. 17,079.5 yuan, = 0.539). Conclusion:Multidisciplinary care with stratified non-pharmacological airway clearance significantly reduced SAP incidence, lowered CPIS, improved PaCO2 and PaO2, and shortened intubation duration, cure days, and hospital stay. Although no statistically significant differences were found in intubation rate or hospitalization costs, these findings support the clinical value of individualized airway management in stroke patients.
Introduction:Rapid urbanisation over the past century has led to increased traffic density and higher levels of ambient air pollutants. We aimed to investigate whether the prevalence of respiratory symptoms, asthma, and chronic bronchitis increases with the level of self-reported exposure to traffic and occupational-related pollution. Material and methods:The study population comprised 25,889 general population subjects ages 16-75 years participating in the Swedish part of the GA2LEN study. Data were collected in the cities of Umeå, Uppsala, Stockholm, and Gothenburg. Self-reported data on disturbance of fumes from traffic in the residential area or occupational exposure to gas, dust, or smoke, as well as on patient demographics, respiratory symptoms, asthma and chronic bronchitis, were obtained from questionnaires. Results:The prevalence of respiratory symptoms, asthma, and chronic bronchitis was higher both among participants reporting traffic-related exposure and those with a history of occupational exposure to fumes, smoke, and dust than among those unexposed; (wheeze 27 vs 13%), nocturnal cough (35 vs 22%), asthma (11 vs 6%) and chronic bronchitis (22 vs 8%); all p < 0.0001. When combining traffic and occupational exposure, the highest prevalence was found amongst those exposed to both. Associations with occupational exposure were generally stronger in women, and those with traffic exposure were stronger in men. Conclusion:In this large population-based sample, self-reported residential traffic exposure and occupational exposure to dust, fumes, or smoke were associated with increased prevalence of respiratory symptoms, asthma, and chronic bronchitis. Although causality cannot be inferred, these findings underscore the importance of assessing environmental and occupational exposures in evaluating respiratory health.
Background and aim Asthma and heart failure are highly prevalent diseases with substantial impact on quality of life and life expectancy. Studies have reported on the association between cardiovascular diseases and asthma. The aim of this review is to provide an update on the current evidence for an association between asthma and heart failure (HF) with regard to prevalence and outcome.Methods A systematic literature search, last updated in ultimo May 2025, was performed on PubMed in accordance with the PRISMA guidelines. The identified articles were systematically screened for eligibility. A random-effects meta-analysis was performed to pool hazard ratios and odds ratios for HF in asthma patients.Results A total of 11 studies were included. Four studies found that asthma was statistically significantly associated with an increased risk of HF. Two studies found a non-significantly increased risk of HF in asthma patients. The pooled HR for HF incidence in asthma patients was 2.03 (95% CI: 1.55; 2.68). Similarly, the pooled OR was 1.61 (95% CI: 1.09; 2.38). Three studies found increased morbidity and mortality in asthma patients with HF compared to controls. One study showed a non-significant increase in mortality in patients with concomitant asthma and HF, whereas another reported a decreased risk compared to HF alone.Conclusions The available evidence suggests a significant association between asthma and incident HF, as well as an increased risk of hospitalization in patients with both conditions, even after adjusting for sex, age, and other known cardiovascular risk factors.
Background:Indwelling pleural catheters (IPCs) are increasingly used for recurrent pleural effusions, but carries a monthly 3% risk for developing pleural infection (PI) with a mean time from insertion to infection of 2 months, and with Staphylococci as the main pathogen. Little is known of IPC related PI in Danish patients. We aimed at filling the gap by determining monthly infection rate and to compare causative pathogens and clinical outcomes between IPC-related and non-IPC-related PI in our clinic. Methods:We conducted a single-centre retrospective review of electronic medical files to identify patients with IPC and/or PI treated in our department between 2018 and 2022. Data on basic demography, infection rate, time to IPC-related infection, RAPID score, pathogens, days of antibiotics (oral, intravenous), days in hospital, and mortality were recorded. Results:In total, the 54 patients had a median exposure to IPC of 290.9 months, and 13 (24%) developed PI with a median time to PI of 5.1 months with a monthly PI risk of 1.045 (95% CI 1.020-1.069). A comparator group of 28 patients were treated for non-IPC related PI. The causative pathogen was identified for 85% in the IPC group (Staphylococci 91%) compared to 50% in non-IPC group (Staphylococci 0%). Duration of intravenous drug therapy (10 vs 15 days) and hospital admission (13 vs 17 days) were significantly shorter (p-value 0.047). A high RAPID score (renal, age, purulence, infection source, and dietary factors) (62% vs 25%) and 30-days mortality (23% vs 4%) were significantly more common in the IPC group. However, PI-related death did not differ (8% vs 7%). Conclusion:We found that longer IPC exposure was related to increased pleural infection rate, but with the same pattern as earlier reports on shorter IPC exposure, thus a monthly infection rate below 5%, pathogens dominated by Staphylococci, and a low pleural infection-related mortality.
Background:The Swedish National Airway Register (SNAR) includes data on asthma control, lung function, biomarkers, treatments, and comorbidities from asthma patients in primary and secondary care. This study aimed to describe patients with severe asthma receiving biologic treatment in SNAR and to explore its potential as a national registry for severe asthma. Methods:Patients with ongoing treatment with mepolizumab, benralizumab, reslizumab, dupilumab or tezepelumab and registered in SNAR between 2016 and 2024 were included. Demographic characteristics, asthma treatment, asthma control, lung function, type 2 biomarkers, and exacerbation history were described. Data were assessed at inclusion and at the most recent follow-up available. Results:A total of 416 patients were identified; 49% were female, mean age was 54.1 years, and mean BMI was 27.2. Inhaled corticosteroids were used by 94.4% of patients, while 39.2% received maintenance oral corticosteroids at inclusion. Asthma control was generally low and exacerbations were common. Patients differed across biologic classes with respect to age, comorbidities, lung function and biomarker profiles, reflecting heterogeneity. At follow-up (mean 193 days), improvements were observed in asthma control, lung function, type 2 biomarkers, and exacerbation frequency. Marked geographic variation in registry inclusion was identified, with several regions reporting no patients. Conclusion:SNAR enables nationwide characterization of patients with severe asthma treated with biologics in routine care. However, variation in inclusion and follow-up limits longitudinal interpretation. More standardized registration, particularly at treatment initiation, would strengthen SNAR's role in national monitoring, quality improvement and future research.
Background Advances in intensive care have improved survival in patients with prolonged critical illness, including those with critical COVID-19. However, prolonged stays in intensive care units are associated with impairments in physical function, mental health, and health-related quality of life.Methods This retrospective study analyzed outcomes for 30 patients admitted to a specialized intensive care rehabilitation center between August 2020 and April 2022 after critical COVID-19.Results Patients had a median age of 62 years and had spent a median of 52 days in an intensive care unit prior to admission, followed by 32 days at the center. At the center, weaning from invasive mechanical ventilation via a tracheostomy tube was achieved in 12 of 13 patients within a median of 17 days, and 23 of 25 patients with a tracheostomy were decannulated after a median of 18 days. Functional outcomes improved significantly, as measured by the Functional Oral Intake Scale, the Chelsea Critical Care Physical Assessment Tool, and the Katz Index of Independence in Activities of Daily Living (p < 0.001). One- and two-year survival rates were 90% and 86%, respectively. Assessments of health-related quality of life showed physical functioning as the most affected domain.Conclusion These findings suggest that specialized rehabilitation may support functional recovery and favorable long-term outcomes in patients recovering from critical COVID-19, consistent with reports from other populations with prolonged critical illness.
Pulmonal hyalinizing granuloma (PHG) is a rare benign disease of unknown cause, first described by Engleman in 1977 (1). Fewer than 200 cases have been reported worldwide (2). We present the case of a middle-aged male referred to the respiratory clinic after a routine chest X-ray (CXR) and chest computed topography (CT) scan revealed multiple bilateral peripheral pulmonary lesions (PPL). Over a 10-year period, the patient´s PPLs increased in size and number, with heterogeneous hypermetabolism observed on fluorodeoxyglucose -positron emission tomography (FDG-PET) imaging. Initially, the PPLs were suspected to be metastases from a salivary gland cancer due to a hypermetabolic focus in the right parotid gland. However, a biopsy of the parotid gland revealed a benign Warthin’s tumour, and CT-guided fine needle biopsies from the lung lesions did not show malignant cells. A thoracoscopic resection of one PPL was consistent with a diagnosis of hyalinizing granuloma.
Background:Exacerbations of chronic obstructive pulmonary disease (COPD) often require treatment with oral corticosteroids (OCS). While OCS can improve forced expiratory volume in first second (FEV1) in the short term, there are still concerns about their potential cardiovascular adverse effects. Evidence on whether short-term OCS use increases the risk of major adverse cardiovascular events (MACE) remains lacking. Hypothesis:We hypothesized that short-term OCS use in patients with COPD would be associated with an increased one-year risk of MACE compared with antibiotic treatment alone. Methods:We conducted a registry-based, nationwide cohort study in outpatients diagnosed with COPD in the Danish Register of COPD (DrCOPD) between 2010 and 2022. Exposure was defined as prescription of OCS and antibiotics for respiratory infections in the year before baseline (defined as DrCOPD entry). Exposed patients were propensity score matched on clinical parameters to patients prescribed antibiotics for respiratory infections but no OCS. The primary outcome was all MACE, as a composite outcome, within 365 days following baseline. Results:A total of 4,666 patients were included. Short-term OCS exposure was not associated with increased risk of MACE during one-year follow-up compared to use of antibiotics for respiratory infections (hazard ratio = 0.84, 95% CI 0.66 - 1.07, p = 0.17). The findings were consistent in a sensitivity analysis using an adjusted Cox model in the unmatched population. Secondary analyses of individual MACE components showed no significant differences in risk. An additional sensitivity analysis stratified by cumulative OCS dose revealed no dose-response relationship for the primary outcome (all MACE). Conclusion:Short-term OCS use was not associated with an increased risk of MACE within 365 days among outpatients with COPD.
Introduction Longitudinal studies of lung function following COVID-19 remain limited. This study examined lung function in COVID-19 patients for two years after discharge from an intensive care unit (ICU).Methods Patients treated for COVID-19 in Uppsala ICU (mean 11.1 days) were assessed at four months, one year, and two years post-discharge. Lung function tests included spirometry, diffusing capacity for carbon monoxide (DLco), and body plethysmography. Logistic regression adjusted for age, sex, and body mass index (BMI) assessed the association between impaired DLco and patients’ characteristics.Result A total of 104 patients (32% female, with a mean age of 60 years) participated in four months follow-up, 40 in one year follow-up, and 21 in two years follow-up after discharge. Impaired DLco was observed in 50%, 58%, and 33% of patients at four months, one year, and two years, respectively. A comparison showed that DLco% predicted declined from four months to one year (mean 79.0, SD 14.7, to 74.3, SD 15.7; p< 0.001), then improved between one and two years (p< 0.001). Forced vital capacity (FVC) % predicted improved between four months and one year (p < 0.001) and between one and two years (p = 0.004). Forced expiratory volume during the first second (FEV1) % predicted improved only between four months and one year (p = 0.002). Total lung capacity improved between the one- and two-year follow-ups (p = 0.006). Impaired DLco at four months was significantly associated with age ≥60 years (adjusted odds ratios, 95% confidence interval: 6.73 (2.64-17.12), mechanical ventilation (4.74 (1.82-12.34), longer ICU stay (5.84 (2.13-16.01), minimum lymphocyte count at ICU (0.19 (0.04-0.83), and FVC % predicted (0.93 (0.89-0.96)) and FEV1 % predicted (0.93 (0.89-0.97)).Conclusion Despite recovery between one and two years, one-third of patients exhibited impaired DLco two years after critical COVID-19, highlighting the need for pulmonary follow-up to address persistent lung function deficits.
Background:Risankizumab is used for prolongated duration by patients, necessitating further research to characterize the infectious risks involved. Case Presentation:A 30-year-old man on Risankizumab for psoriasis and alopecia presented with pleuritic chest pain, cough, hemoptysis, fever, and myalgias. Initial computed tomography (CT) scan showed a 4.9 × 7.7 × 6.1 cm irregular cavitary lesion in the medial right lower lobe with thickened walls and surrounding ground-glass opacification. Tuberculosis was ruled out with 3 negative acid-fast bacilli (AFB) samples and 2 negative samples for Mycobacterium tuberculosis and rifampin resistance assay (Xpert MTB/RIF). Empiric antibiotic therapy was initiated, though the patient remained persistently febrile and tachycardic despite reported symptomatic improvement. A repeat CT scan showed compression atelectasis of the right middle and lower lobes, and a large right pleural effusion with multiple air-fluid levels. The patient underwent a video-assisted thoracoscopic surgery (VATS) decortication. Pleural fluid culture grew methicillin-resistant Staphylococcus aureus, and sputum AFB culture from admission grew Mycobacterium avium three weeks after collection. The patient ultimately completed two weeks of oral doxycycline. Conclusion:Given the lack of notable risk factors for lung abscess, this case suggests a possible association with Risankizumab, which may have contributed to immunosuppression.
