BACKGROUND:Chronic respiratory diseases are associated with psychiatric/neurocognitive comorbidities; prevalence, clinical impact and responsiveness to in-patient pulmonary rehabilitation (PR) remain poorly characterized. AIMS:To assess prevalence of psychiatric and neurocognitive comorbidities in patients admitted to a PR programme, their associations with clinical and rehabilitation outcomes, and to explore sex- and age-related differences. METHODS:In this multicentre-observational-prospective-cohort study, consecutive admitted to in-patient PR programmes over 12 months were classified into six groups: diagnosed psychiatric disorders, psychotropic drug use without diagnosis, respiratory disease only, diagnosed neurocognitive disorders, psychiatric/cognitive impairment detected during hospitalisation and referral for diagnostic assessment. Clinical, functional and psychological data were collected at admission and discharge. Outcomes included changes in and achievement of minimal clinically important differences (MCIDs) for CAT, MRC dyspnea scale, Barthel Dyspnea Index and Six-Minute Walki Test. A composite responder outcome required achievement of all MCIDs. Multivariable logistic regression identified predictors of response. RESULTS:Among 975 patients (59% males, 70.2 years old), 49% had psychiatric (N = 245) and/or neurocognitive comorbidities (N = 45). Psychiatric disorders were more frequent in women, while cognitive impairment increased with age. PR significantly improved outcomes across all groups; however, patients with cognitive impairment showed the poorest multidimensional response, with none achieving the composite endpoint. In a relatively small group (N = 395) a formal psychiatric diagnosis independently predicted a lower probability of response. CONCLUSION:Psychiatric and neurocognitive comorbidities are highly prevalent in inpatient PR. Although PR is effective overall, cognitive impairment markedly limits multidimensional benefit, highlighting need for routine mental health, cognitive screening and multidisciplinary care.

Background: Tracheostomy is a commonly performed procedure in patients requiring prolonged mechanical ventilation (MV) in Intensive Care Units (ICUs), including COVID-19-related ARDS. However, limited data exist on the timing and predictors of decannulation. Aim: To compare time to decannulation between COVID-19 and non-COVID-19 ARDS patients and to identify predictive factors. Methods: A retrospective study including 96 COVID-19 ARDS and 32 non-COVID-19 ARDS tracheostomized patients admitted to step-down units after ICU stay from March 2020 to May 2021. Clinical, demographic data and comorbidities were analysed as well as predictors for decannulation delay. Results: Timing of decannulation was similar between the two groups. Multivariate analysis identified limb weakness assessed by the Medical Research Council (MRC) scale, duration of steroids therapy, clinical complications, PaO2/FiO2 ratio and smoking history as independent predictors of decannulation timing. Conclusions: COVID-19 did not affect timing of decannulation compared to non-COVID-19 ARDS. ICU-acquired weakness, assessed through the MRC scale, was the strongest predictor of delayed decannulation.

Background and aim:Non-Cystic Fibrosis (CF) bronchiectasis is associated with reduced exercise tolerance and symptoms such as dyspnea and fatigue, impairing functional capacity and limiting physical activity. In addition to airway clearance techniques, pulmonary rehabilitation (PR), including aerobic and resistance training, is recommended in these individuals. This retrospective, multicentric study covering a ten-year period compared in non-CF bronchiectasis people with and without COPD the effectiveness of PR, including exercise training, on exercise tolerance (primary objective) and other patient-centered outcomes. Measurements:Before and after PR, the following assessments had been performed: Six-minute walking test (6MWT), Barthel Index (BI), Barthel Index dyspnea (BId), COPD assessment test (CAT), Short physical performance battery (SPPB). Results:125 participants without and 1,346 with concomitant COPD were studied. Non-COPD bronchiectasis was more prevalent in females, showed a higher association with asthma, whereas Chronic Respiratory Failure (CRF) and pneumonia were more prevalent in COPD-related bronchiectasis, resulting in more prevalent referral from acute care hospitals or need for oxygen therapy. All baseline outcome measures, except CAT, were worse in people with concomitant COPD. After PR, 6MWT improved significantly in both groups [by 39 (11-70) and 40 (10-75) meters for non-COPD and COPD-related bronchiectasis, respectively, p = 0.7469], without any between-group difference. The other outcome measures also improved significantly in both groups. The proportions of participants reaching the minimal clinically important difference in assessed outcomes were not significantly different between the studied populations. Conclusion:Pulmonary rehabilitation, including exercise training, yields l equivalent benefits in exercise capacity and patient-reported outcomes in non-CF bronchiectasis people with or without COPD. Our results suggest the routine clinical provision of PR to people with non-CF bronchiectasis, regardless of concomitant COPD.

BACKGROUND:Inhaled drug therapy is an essential treatment in Chronic Obstructive Pulmonary Disease (COPD) patients as it reduces symptoms, exacerbation rate and mortality risk. Errors in inhaler use can affect drug delivery to the lungs and minimize treatment benefits. The aim of the study was to evaluate the effect of a nurse-lead educational intervention on inhaler use in a group of patients with COPD during a Respiratory Rehabilitation Program. METHODS:COPD patients attending a Respiratory Rehabilitation Unit for a pulmonary rehabilitation program participated in the educational training program. The nurse-lead educational intervention included a specific checklist used to evaluate each patient's inhalation technique. Errors were scored and classified as device- dependent, device-independent and critical one. Patients completed a pre and post-intervention survey to compare pre and post nurse-lead educational intervention results. RESULTS:One-hundred twenty-three COPD patients attending a Respiratory Rehabilitation Unit participated in the training program. A high frequency of total errors has been found at baseline (72.1%) whose critical errors represented 35%, irrespective of the severity of airway obstruction, the length of disease history and the educational level. The structured educational intervention resulted in changes on patients' attitudes and skills on inhaler use with a significant reduction in the frequency of all types of errors (P-value < 0.01), particularly total and critical errors (35% and 12.9%, respectively), but not completely eliminated them. CONCLUSIONS:Patient training in the use of the inhaler and regular review of the patient's competence in using the devices by health care professionals remains a crucial aspect of effective inhalation therapy regardless of the disease trajectory. These interventions are feasible and may impact the ability to engage patients in the chronic care journey.

BACKGROUND:Persistence of breathlessness after recovery from SARS-CoV-2 pneumonia is frequent. Recovery from acute respiratory failure (ARF) is usually determined by normalized arterial blood gases (ABGs), but the prevalence of persistent exercise-induced desaturation (EID) and dyspnea is still unknown.METHODS:We investigated the prevalence of EID in 70 patients with normal arterial oxygen at rest after recovery from ARF due to COVID-19 pneumonia. Patients underwent a 6-min walking test (6MWT) before discharge from hospital. We recorded dyspnea score and heart rate during 6MWT. We also investigated the possible role of lung ultrasound (LU) in predicting EID. Patients underwent a LU scan and scores for each explored area were summed to give a total LU score.RESULTS:In 30 patients (43%), oxygen desaturation was >4% during 6MWT. These patients had significantly higher dyspnea and heart rate compared to non-desaturators. LU score >8.5 was significantly able to discriminate patients with EID.CONCLUSION:In SARS-CoV-2 pneumonia, ABGs at discharge cannot predict the persistence of EID, which is frequent. LU may be useful to identify patients at risk who could benefit from a rehabilitation program.

Background: Tracheotomy is a routine procedure for patients requiring prolonged mechanical ventilation (MV) in intensive care units (ICUs), included Covid-19 ARDS, for which few data about decannulation are available. Aim: To compare time to decannulation between Covid-19 and no-Covid-19 ARDS and identify possible predictive factors. Methods: In this retrospective, multicenter study, 96 tracheotomized patients, admitted from March 2020 to May 2021 in 5 pulmonary wards after an ICU stay due to Covid-19 ARDS, are compared to 32 tracheotomized ARDS patients not associated to Covid-19 admitted before its outbreak. Clinical, demographic data and comorbidities are analyzed. Results: Median age is lower in Covid-19 group; sex prevalence, body mass index (BMI) and frailty do not differ between the two groups as well as timing of decannulation (median days: 14 [IQR 9-22] vs 13 [IQR 8-18] in no-Covid-19 and Covid-19 ARDS, respectively; p=0.08). In a multivariate linear regression analysis, Medical Research Council (MRC) scale (β -0.33; p<0.0001), duration of steroids (β 0.28; p=0.001), clinical complications (β 0.27; p=0.004), PaO2/FiO2 ratio (β -0.25; p=0.007) and history of smoke (β 0.18; p=0.04) significantly predict timing of decannulation in both groups. Conclusions: Timing of decannulation in Covid-19 ARDS patients is not different from no-Covid-19 ARDS. In Covid-19 patients, past knowledge about decannulation and the need of relieve post-ICU setting avoid the delay in decannulation time if compared to no-Covid-19 patients. ICU-acquired weakness, evaluated by MRC scale, seems to be a strong predictor of longer time to decannulation in the two groups.

Background: During Covid-19 pandemic, several patients (pts) suffering from ARDS underwent tracheostomy. Decannulation was managed in different step-down units and no standardized procedures are available. Aim: To compare time of decannulation and clinical management of tracheostomized pts for Covid-19 ARDS in rehabilitation (R) vs respiratory wards (RW). Methods: This retrospective, multicenter study compared tracheostomized pts for Covid-19 ARDS, admitted to RW (51 pts) and R (45 pts) from March 2020 to May 2021. Demographic and clinical data, duration of tracheostomy and standard of care in both settings were collected. Results: No differences were showed in demographic and clinical data, except the prevalence of Invasive Ventilation (IV): 59% pts in RW vs 38% pts in R (p=0.04). All pts were weaned from IV; time of weaning did not differ in the two wards (median days: 0 [IQR: 0-6.5] in R vs 1 [IQR: 0-7] in RW; p=0.17). In both settings, more than 90% of pts were decannulated and decannulation time was not different (median days: 13 [IQR: 7.5-18.5] in R vs 14 [IQR: 9-17.5] in RW; p=0.67). High flow therapy was more used in R (69% vs 47% pts in RW; p=0.03). The assessment of swallowing was performed in 93% pts in R vs 63% pts in RW (p<0.01). Dysphagia was showed in 43% vs 37% of screened pts in R e RW respectively (p=0.08). The physiotherapy (FT) was carried out in 100% pts in R vs 84% pts in RW (p=0.17). Conclusions: The setting of care does not affect time or success of decannulation in Covid-19 tracheostomized pts, probably thanks to FT implementation in both wards. High prevalence of dysphagia was detect indicating the need for swallowing screening and speech therapy.

Cytomegalovirus (CMV) disease, in particular pneumonia, is still a major problem in lung transplant recipients (LTR). Therefore, different protocols based on prophylaxis or pre-emptive therapy of CMV infections are currently in use in different transplant centres. Interest has grown recently for the evaluation of specific T-cell response in peripheral blood in order to identify LTR at a higher risk of disease. Aim of the present study was to prospectively evaluate CMV-specific T-cell response within 6 months post-transplant at peripheral and lung level in 12 de novo LTR by means of enzyme-linked immunospot assay (ELISPOT).

Respiratory viral infections are responsable of a significant morbidity in LTRs and have been considered a possible risk factor for chronic lung function decline. Aim of our study was to asses the incidence of viral respiratory infections in a cohort of 17 LTRs in the first post transplant year, and correlate BAL samples and naso-pharingeal secretions (NPS) findings with clinical, functional, and radiological data. A total of 84 BAL samples and 16 NPS were analysed with direct immunofluorescence, shell vial cultures, and molecular assays. The incidence of respiratory viral infection was 0.94 episodes per patient/year. In all a total of 16 isolates were collected from 10 LTR: 5 from NPS and and 11 from BAL: Rhinovirus (1 NPS, 4 BAL); Respiratory Syncytial Virus (2 NPS, 1 BAL), Metapneumovirus (1 NPS); Parainfluenza virus (1 BAL), human Coronavirus 229E (1 NPS) and OC43 (2 BAL), Herpesviruses (3 BAL). Nine of these 16 episodes were associated to respiratory symptoms (dyspnoea, cough, faringodynia, coriza) functional impairment (4 cases) and/or radiological signs (bibasilar infiltrates, ground glass alterations, small centrilobular opacities, pleural effusion). In addition, 4 pulmonary CMV infections were detected defined as a presence of CMV DNA > 100.000 copies/ml of BAL fluids in absence of radiological and clinical signs. CMV infections were treated with a 21 days course of i.v. gancyclovir while RSV infections were treated with nebulized ribavirin. In all other episodes only symptomatic treatment was performed with complete remission within 2 weeks. The incidence of respiratory viral infection during the first post-transplant year was relatively high, however did not persistently affect graft function in this small cohort of LTRs.