Rationale: Patients with chronic lung disease, such as chronic obstructive pulmonary disease (COPD), are at higher risk for severe COVID-19 disease. This study evaluated the anxiety and depressive symptoms, and attitudes about COVID-19 in a well-characterized group of patients with COPD enrolled in the Losartan Evaluation for Emphysema (LEEP) trial. Methods: This is an ancillary study of an ongoing LEEP trial evaluating the effect of losartan versus placebo on emphysema progression. From June 2017 to February 2020, 220 participants were enrolled in the 48-week LEEP trial. The main eligibility criteria were FEV1/FVC ratio 10 pack-year smoking, and a high resolution CT scan with 5-35% voxel with density 9) and 18% had elevated scores for depression (PHQ- 8>9), which was similar to the prevalence in another COPD cohort evaluated prior to the pandemic. Regardless, 57% report significant concern that COVID-19 may affect their COPD. The large majority reported practicing recommended infection control measurements and 72% reported staying home more. The majority, 66%, said they were unlikely to receive a vaccine for COVID-19 (prior to the announcement of results of first vaccine trials). Trusted sources of information about the pandemic were doctors and healthcare providers (70%), followed by local news stations (70%), and CDC (61%). Most of the participants had good understanding of the symptoms and mode of transmission route of COVID-19. Conclusion: There was no increase in symptoms of anxiety or depression in patients with moderate-to-severe COPD associated with the pandemic;the prevalence of elevated anxiety and depression were relatively low. Most followed recommended infection control measures. The majority were concerned about the potential effects of COVID-19 on COPD disease. .

B. Duchene1, M. Subramanian2, J. T. Holbrook3, L. B. Gerald4, S. Bose5, A. M. Mathews6, R. A. Wise7, A. E. Dixon8; 1Pulmonary and Critical Care Medicine, University of Vermont Medical Center, Burlington, VT, United States, 2Medicine, Vermont Lung Center, Essex Junction, VT, United States, 3Bloomberg School of Public Health, Johns Hopkins Univ, Baltimore, MD, United States, 4Arizona Respiratory Center, Univ of Arizona, Tucson, AZ, United States, 5Medicine, Icahn School of Medicine at Mount Sinai, ny, NY, United States, 6Department of Medicine, Division of Pulmonary & Critical Care, Durham, NC, United States, 7Johns Hopkins Univ, Baltimore, MD, United States, 8University of Vermont, Burlington, VT, United States.

In a study comparing low-dose theophylline to montelukast in poorly controlled asthmatics, 285 subjects consented to be screened for alpha-1 antitrypsin deficiency. Of the 284 for which complete data was available, 10.5% carried a deficiency gene and 2.4% were mildly deficient with an alpha-1 antitrypsin serum level of less than 20 mu M. In the non-African-American cohort, an abnormal phenotype occurred in 12% and 2.9% were mildly deficient. Baseline pulmonary function and asthma scores were not significantly different between those with normal and abnormal AAT phenotype. However those with the deficiency tended to show a greater bronchodilator response.

Our goal was to explore associations between β2 adrenergic receptor polymorphisms and markers of asthma severity in African American and Caucasian patients with asthma. Polymorphisms at loci −1023, −654, −47, 46, 79, 491, and 523 were genotyped and haplotypes were imputed in 143 African Americans and 336 Caucasians. C523A genotype associated with percentage of African Americans (but not of Caucasians) having an asthma exacerbation: AA, AC, and CC genotypes were 17, 29, and 40%, respectively (p = 0.018). Symptom scores, pulmonary function, and rescue inhaler use paralleled exacerbation prevalence. We conclude the 523 A allele modifies asthma severity in African Americans.

OBJECTIVE:To analyze damage occurring in patients with Wegener's granulomatosis (WG) enrolled in the WG Etanercept Trial (WGET) and to correlate that damage with disease activity, adverse events, and quality of life.METHODS:The Vasculitis Damage Index (VDI) was applied to all 180 patients at trial entry and every 6 months throughout the trial. Items of damage were analyzed by presumed etiology (i.e., secondary to WG, to therapy, or both) and time of occurrence. Spearman's rank correlation coefficients were calculated between VDI scores and the Birmingham Vasculitis Activity Score for WG (BVAS/WG), frequency of flares, number of adverse events, and the patients' quality-of-life assessments.RESULTS:The mean VDI score was 1.3 at the study enrollment and 1.8 at the end of the trial. This increase was due to damage that occurred despite (or because of) therapy, including visual impairment, hearing loss, nasal blockade, pulmonary fibrosis, hypertension, renal insufficiency, peripheral neuropathy, gonadal failure, and diabetes mellitus. Only 11% of the enrolled patients had not sustained a single VDI item after 1 year of enrollment. When adjusted for baseline VDI, the baseline BVAS/WG correlated moderately well with the VDI score at 1 year (r = 0.20, P = 0.015). Increases in adjusted VDI scores also correlated with the number of adverse events, particularly among patients with limited WG (P = 0.06).CONCLUSION:Damage from both active disease and its treatment remain important problems for patients with WG. Despite the dramatic improvements in patient survival achieved over the last several decades, only a few patients with WG emerge from a period of active disease without sustaining some damage from the disease itself, its treatment, or both. An important measure of future therapeutic approaches will be their ability to reduce the damage accrued over time.

BACKGROUND:The majority of patients with Wegener's granulomatosis have disease flares after conventional medications are tapered. There is no consistently safe, effective treatment for the maintenance of remission.METHODS:We conducted a randomized, placebo-controlled trial at eight centers to evaluate etanercept for the maintenance of remission in 180 patients with Wegener's granulomatosis. The primary outcome was sustained remission, defined as a Birmingham Vasculitis Activity Score for Wegener's Granulomatosis of 0 for at least six months (scores can range from 0 to 67, with higher scores indicating more active disease). In addition to etanercept or placebo, patients received standard therapy (glucocorticoids plus cyclophosphamide or methotrexate). After remission, standard medications were tapered according to the protocol.RESULTS:The mean follow-up for the overall cohort was 27 months. Of the 174 patients who could be evaluated, 126 (72.4 percent) had a sustained remission, but only 86 (49.4 percent) remained in remission for the remainder of the trial. There were no significant differences between the etanercept and control groups in the rates of sustained remission (69.7 percent vs. 75.3 percent, P=0.39), sustained periods of low-level disease activity (86.5 percent vs. 90.6 percent, P=0.32), or the time required to achieve those measures. Disease flares were common in both groups, with 118 flares in the etanercept group (23 severe and 95 limited) and 134 in the control group (25 severe and 109 limited). There was no significant difference between the etanercept and control groups in the relative risk of disease flares per 100 person-years of follow-up (0.89, P=0.54). During the study, 56.2 percent of patients in the etanercept group and 57.1 percent of those in the control group had at least one severe or life-threatening adverse event or died (P=0.90). Solid cancers developed in six patients in the etanercept group, as compared with none in the control group (P=0.01).CONCLUSIONS:Etanercept is not effective for the maintenance of remission in patients with Wegener's granulomatosis. Durable remissions were achieved in only a minority of the patients, and there was a high rate of treatment-related complications.

Objective: To evaluate risk factors for mortality among patients with AIDS in the era of highly active antiretroviral therapy (HAART), particularly the effect of cytomegalovirus (CMV).Design: Prospective cohort study of patients with AIDS, conducted from 1998 through 2003.Participants: One thousand five hundred eighty-three patients with AIDS, of whom 374 had CMV retinitis.Methods: Patients were contacted every 3 months, with examinations at least every 6 months, in which standardized data were collected on AIDS history and treatment, eye examinations, and hematologic, virologic, and immunologic laboratory data.Main Outcome Measure: Mortality.Results: The overall mortality rate was 0.07 deaths/person -year. In a multivariate analysis, the following baseline risk factors were associated with an increased mortality: higher human immunodeficiency virus (HIV) viral load (relative risk [RR] = 4.6 for HIV viral load > 1 00 000 copies/ml vs. < 400 copies/ml; P < 0.0001), lower CD4+ T-cell count at enrollment (RR = 3.8 for CD4+ T cell count 0-49 cells/mu l vs.; >= 200 cells/bLI; P < 0.0001), CMV viral load >= 400 copies/ml (RR = 1.9; P = 0.002), lower hemoglobin (RR = 1.7 for hemoglobin < 10 g/dl; P = 0.009), a history of cryptococcal meningitis (RR = 1.7; P = 0.02), CMV retinitis (RR = 1.6; P = 0.0002), and Karnofsky score <= 80 (RR = 1.4; P = 0.008).Conclusions: In the era of HAART, CMV disease as manifested by CMV retinitis and a detectable CMV viral load were associated with an increased risk for mortality, even after adjusting for demographic, treatment, immunologic, and HIV virologic factors. (c) 2005 by the American Academy of Ophthalmology.

Patients with Wegener’s disease are known to suffer from a wide spectrum of pathology resulting from inflammatory lesions of small and medium-sized arterial vessels. Indeed, the definition of Wegener’s disease is based upon the localization of the typical lesions in the arterial vessels ([1][1

Purpose: To compare clinician and fundus photograph reading center assessments of the cytomegalovirus (CMV) retinitis area and change in the CMV retinitis area over time, and to investigate how these assessments correlate with the visual field (VF) of eyes with CMV retinitis.Design: Analysis of pooled data from 2 multicenter randomized clinical trials and 1 prospective multicenter epidemiologic study.Participants: Ninety-five eyes of 79 patients. At baseline, each eye had CMV retinitis restricted to zone 1 and/or zone 2 (approximately the photographable postequatorial retina), as assessed by the evaluating clinician.Methods: Comparison of CMV retinitis area, change in area overtime as assessed by clinicians and a fundus photograph reading center, and correlation of these assessments with VF measurement.Main Outcome Measures: Cytomegalovirus retinitis area, change in CMV retinitis area over time, and VF score.Results: Baseline assessments of the mean retinitis area were, by clinicians, 12.8% of the total retinal area and, by the reading center, 6.3% of the total retinal area (P < 0.001). There was a positive correlation between clinician and reading center assessments of retinitis area at baseline (p = 0.77 and P < 0.0001 by Pearson correlation and p = 0.54 and P < 0.001 by concordance). Both clinician and reading center size measures correlated negatively with VF (Spearman correlation ps = -0.38 and -0.52, respectively; P < 0.001 each). Mean changes in area over a 3-month interval were, by clinicians, +1.2% and, by the reading center, +1.1 % (P = 0.68). Regression analysis showed a positive concordance (p = 0.42, P < 0.001). Change in VF over a 3-month interval did not correlate with change in retinitis area as assessed by clinicians or the reading center.Conclusions: Awareness of the similarities and differences between clinician and reading center assessments of CMV retinitis area should permit clinicians to apply research data to clinical practice more effectively. Clinician assessment of retinitis area correlates negatively with VF, a clinically meaningful visual outcome in patients with CMV retinitis. (c) 2005 by the American Academy of Ophthalmology.

PURPOSE: Rhinitis and rhinosinusitis (R/RS) are frequently associated with asthma. Small cohort studies suggest that R/RS are associated with severe asthma, and can worsen asthma control. The purpose of the current study was to determine the impact of rhinitis and rhinosinusitis on disease in the lower airway in a large cohort of subjects with well-characterized asthma.

Background: Venous thrombotic events (VTEs) have been observed in Wegener granulomatosis, but the incidence rate is not known. Objective: To measure the incidence of VTEs in patients with Wegener granulomatosis. Design: Prospective, observational cohort study. Setting: A multicenter, randomized, double-blind, placebo-controlled treatment trial for Wegener granulomatosis. Patients: 180 patients with Wegener granulomatosis enrolled during periods of active disease. Measurements: Venous thrombotic events (deep venous thromboses or pulmonary emboli) were documented and confirmed prospectively. Incidence rates were calculated on the basis of time to first VTE. Results: Thirteen patients had VTEs before enrollment. During 228 person-years of prospective follow-up, 16 VTEs occurred in 167 patients with no history of VTE. Median time from enrollment to VTE for patients with an event was 2.1 months. The incidence of VTE among patients with Wegener granulomatosis was 7.0 per 100 person-years (95% CI, 4.0 to 11.4). Limitations: Although prospectively recorded, screening for VTEs did not occur. Conclusions: The incidence rate of VTEs in Wegener granulomatosis is high when compared with available rates in the general population, patients with lupus, and patients with rheumatoid arthritis. These results have important implications for clinical care of patients with Wegener granulomatosis. *For a list of members of The Wegener's Granulomatosis Etanercept Trial Research Group, see the Appendix.