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ELife Aug 2023Although there are several efficacious vaccines against COVID-19, vaccination rates in many regions around the world remain insufficient to prevent continued high...
BACKGROUND
Although there are several efficacious vaccines against COVID-19, vaccination rates in many regions around the world remain insufficient to prevent continued high disease burden and emergence of viral variants. Repurposing of existing therapeutics that prevent or mitigate severe COVID-19 could help to address these challenges. The objective of this study was to determine whether prior use of bisphosphonates is associated with reduced incidence and/or severity of COVID-19.
METHODS
A retrospective cohort study utilizing payer-complete health insurance claims data from 8,239,790 patients with continuous medical and prescription insurance January 1, 2019 to June 30, 2020 was performed. The primary exposure of interest was use of any bisphosphonate from January 1, 2019 to February 29, 2020. Bisphosphonate users were identified as patients having at least one bisphosphonate claim during this period, who were then 1:1 propensity score-matched to bisphosphonate non-users by age, gender, insurance type, primary-care-provider visit in 2019, and comorbidity burden. Main outcomes of interest included: (a) any testing for SARS-CoV-2 infection; (b) COVID-19 diagnosis; and (c) hospitalization with a COVID-19 diagnosis between March 1, 2020 and June 30, 2020. Multiple sensitivity analyses were also performed to assess core study outcomes amongst more restrictive matches between BP users/non-users, as well as assessing the relationship between BP-use and other respiratory infections (pneumonia, acute bronchitis) both during the same study period as well as before the COVID outbreak.
RESULTS
A total of 7,906,603 patients for whom continuous medical and prescription insurance information was available were selected. A total of 450,366 bisphosphonate users were identified and 1:1 propensity score-matched to bisphosphonate non-users. Bisphosphonate users had lower odds ratios (OR) of testing for SARS-CoV-2 infection (OR = 0.22; 95%CI:0.21-0.23; p<0.001), COVID-19 diagnosis (OR = 0.23; 95%CI:0.22-0.24; p<0.001), and COVID-19-related hospitalization (OR = 0.26; 95%CI:0.24-0.29; p<0.001). Sensitivity analyses yielded results consistent with the primary analysis. Bisphosphonate-use was also associated with decreased odds of acute bronchitis (OR = 0.23; 95%CI:0.22-0.23; p<0.001) or pneumonia (OR = 0.32; 95%CI:0.31-0.34; p<0.001) in 2019, suggesting that bisphosphonates may protect against respiratory infections by a variety of pathogens, including but not limited to SARS-CoV-2.
CONCLUSIONS
Prior bisphosphonate-use was associated with dramatically reduced odds of SARS-CoV-2 testing, COVID-19 diagnosis, and COVID-19-related hospitalizations. Prospective clinical trials will be required to establish a causal role for bisphosphonate-use in COVID-19-related outcomes.
FUNDING
This study was supported by NIH grants, AR068383 and AI155865, a grant from MassCPR (to UHvA) and a CRI Irvington postdoctoral fellowship, CRI2453 (to PH).
Topics: Humans; COVID-19; Diphosphonates; COVID-19 Testing; SARS-CoV-2; Retrospective Studies; COVID-19 Vaccines; Prospective Studies; Respiratory Tract Infections; Bronchitis
PubMed: 37534876
DOI: 10.7554/eLife.79548 -
Archives of Disease in Childhood Sep 2023Bronchiolitis is the main acute lower respiratory tract infection in infants. Data regarding SARS-CoV-2-related bronchiolitis are limited.
BACKGROUND
Bronchiolitis is the main acute lower respiratory tract infection in infants. Data regarding SARS-CoV-2-related bronchiolitis are limited.
OBJECTIVE
To describe the main clinical characteristics of infants with SARS-CoV-2-related bronchiolitis in comparison with infants with bronchiolitis associated with other viruses.
SETTING, PATIENTS, INTERVENTIONS
A multicentre retrospective study was conducted in 22 paediatric emergency departments (PED) in Europe and Israel. Infants diagnosed with bronchiolitis, who had a test for SARS-CoV-2 and were kept in clinical observation in the PED or admitted to hospital from 1 May 2021 to 28 February 2022 were considered eligible for participation. Demographic and clinical data, diagnostic tests, treatments and outcomes were collected.
MAIN OUTCOME MEASURES
The main outcome was the need for respiratory support in infants testing positive for SARS-CoV-2 compared with infants testing negative.
RESULTS
2004 infants with bronchiolitis were enrolled. Of these, 95 (4.7%) tested positive for SARS-CoV-2. Median age, gender, weight, history of prematurity and presence of comorbidities did not differ between the SARS-CoV-2-positive and SARS-CoV-2-negative infants. Human metapneumovirus and respiratory syncytial virus were the viruses most frequently detected in the group of infants negative for SARS-CoV-2.Infants testing positive for SARS-CoV-2 received oxygen supplementation less frequently compared with SARS-CoV-2-negative patients, 37 (39%) vs 1076 (56.4%), p=0.001, OR 0.49 (95% CI 0.32 to 0.75). They received less ventilatory support: 12 (12.6%) high flow nasal cannulae vs 468 (24.5%), p=0.01; 1 (1.0%) continuous positive airway pressure vs 125 (6.6%), p=0.03, OR 0.48 (95% CI 0.27 to 0.85).
CONCLUSIONS
SARS-CoV-2 rarely causes bronchiolitis in infants. SARS-CoV-2-related bronchiolitis mostly has a mild clinical course.
Topics: Infant; Child; Humans; SARS-CoV-2; Retrospective Studies; COVID-19; Bronchiolitis; Hospitalization
PubMed: 37130726
DOI: 10.1136/archdischild-2023-325448 -
Pediatric Pulmonology Feb 2023We aimed to analyze the correlation of urinary with serum N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations and its association with severity in acute... (Observational Study)
Observational Study
BACKGROUND AND AIMS
We aimed to analyze the correlation of urinary with serum N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations and its association with severity in acute bronchiolitis.
MATERIAL AND METHODS
A pilot observational study was conducted between October 1, 2021 and March 31, 2022 including acute bronchiolitis cases who attended our institution. Serum and urinary NT-proBNP concentrations were determined using the Alere i NT-proBNP assay in time-matched urine and blood samples. The Mann-Whitney U test, Spearman's correlations, and simple linear regression were utilized to analyze the association of urine NT-proBNP levels with serum NT-proBNP and with variables indicative of severe bronchiolitis.
RESULTS
Seventeen infants (median age 68 [IQR: 36-91] days) with 36 time-matched samples were included. The urine NT-proBNP was positively and strongly correlated with the serum NT-proBNP concentrations (Spearman's ρ = 0.81 & R coefficient = 0.751; p < 0.001), and increased with higher C-reactive protein, (p = 0.004), procalcitonin (p = 0.001), and pCO (p = 0.029) levels. The initial urinary NT-proBNP concentrations were higher in those infants that required ventilatory support compared with those without this outcome (1.85 [IQR: 1.16-2.44] vs. 0.63 [IQR: 0.45-0.84] pg/mg); p < 0.001); and resulted positively and strongly correlated with the duration of the ventilatory support (Spearman's ρ = 0.76; p < 0.001) and the length of stay hospitalization (Spearman's ρ = 0.84; p < 0.001).
CONCLUSION
The urinary NT-proBNP concentrations could be a reliable surrogate for serum NT-proBNP levels and resulted elevated in cases of acute bronchiolitis with complicated evolution, suggesting a potential as a noninvasive tool to assess severity in this setting.
Topics: Humans; Infant; Biomarkers; Bronchiolitis; Natriuretic Peptide, Brain; Peptide Fragments; Pilot Projects
PubMed: 36314349
DOI: 10.1002/ppul.26215 -
Complementary Therapies in Medicine Dec 2020Antibiotics are widely prescribed for acute bronchitis in the UK. Herbal medicine could be used instead to provide symptom relief. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Antibiotics are widely prescribed for acute bronchitis in the UK. Herbal medicine could be used instead to provide symptom relief.
AIM
To explore the views of patients and health professionals on using herbal medicine for acute bronchitis instead of antibiotics.
DESIGN AND SETTING
This was a nested qualitative study, conducted alongside a feasibility randomised clinical trial which ran from July 2018 to May 2019 in 20 GP practices in Wessex, UK.
METHOD
We conducted telephone semi-structured interviews with patients and with health professionals. The interview data were transcribed and analysed thematically.
RESULTS
Overall, 40 interviews were conducted with 29 patients, six GPs and five nurses. While some patients believed antibiotics are more effective, most were aware of resistance and were keen to try an alternative, including herbal medicine. Several patients believed herbals would be "less intrusive" than antibiotics, whereas a few disliked the taste or experienced side-effects after taking a herbal. Professionals were concerned about potential interactions with conventional medicines. Many patients trusted herbals because of their long history of use, while some did not understand them. Availability of herbals without a prescription enables patients to use them for self-care, but their cost was a barrier for some. Many patients were willing to take a herbal if advised by their GP. Most GPs were happy to recommend a herbal, if endorsed by evidence-based guidelines.
CONCLUSION
Many patients and health professionals would consider using herbal medicine for acute bronchitis, if based on trustworthy advice and evidence-based guidelines respectively.
Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Attitude of Health Personnel; Bronchitis; Feasibility Studies; Female; Health Personnel; Humans; Male; Middle Aged; Phytotherapy; Plant Preparations; Practice Patterns, Physicians'; Qualitative Research; United Kingdom
PubMed: 33221589
DOI: 10.1016/j.ctim.2020.102613 -
Veterinary Sciences Mar 2021Infectious bronchitis virus (IBV) is a major economic problem in commercial chicken farms with acute multiple-system infection, especially in respiratory and urogenital... (Review)
Review
Infectious bronchitis virus (IBV) is a major economic problem in commercial chicken farms with acute multiple-system infection, especially in respiratory and urogenital systems. A live-attenuated and killed vaccine is currently immunized to control IBV infection; however, repeated outbreaks occur in both unvaccinated and vaccinated birds due to the choice of inadequate vaccine candidates and continuous emergence of novel infectious bronchitis (IB) variants and failure of vaccination. However, similar clinical signs were shown in different respiratory diseases that are essential to improving the diagnostic assay to detect IBV infections. Various risk factors involved in the failure of IB vaccination, such as various routes of application of vaccination, the interval between vaccinations, and challenge with various possible immunosuppression of birds are reviewed. The review article also highlights and updates factors affecting the diagnosis of IBV disease in the poultry industry with differential diagnosis to find the nature of infections compared with non-IBV diseases. Therefore, it is essential to monitor the common reasons for failed IBV vaccinations with preventive action, and proper diagnostic facilities for identifying the infective stage, leading to earlier control and reduced economic losses from IBV disease.
PubMed: 33809420
DOI: 10.3390/vetsci8030047 -
Veterinary Research Forum : An... 2023This study aimed to report, for the first time, histopathological lesions caused by an outbreak of acute serotype 8 infections in two farms in Cyprus. Lung tissue...
This study aimed to report, for the first time, histopathological lesions caused by an outbreak of acute serotype 8 infections in two farms in Cyprus. Lung tissue samples were collected from two different affected farms (a total of eight samples) for bacterial culture, multiplex polymerase chain reaction (PCR)-based serotyping and histopathological evaluation. Severe respiratory clinical signs, vomiting, anorexia, sudden deaths, a morbidity rate of around 25.00% and a mortality rate of over 60.00% in the fattening stage were reported. Macroscopic lesions included acute to subacute fibrotic, hemorrhagic and necrotizing pneumonia with occasionally encapsulated nodule-like abscesses and fibrous pleuritis. Histopathological evaluation revealed fibrous exudate between alveolar spaces and connective tissue, areas of necrosis mixed with alveolar macrophages, lymphocytes, plasma cells and necrotic leukocytes surrounding colonies of cocci. The bronchial and bronchiolar epithelia were degenerated and replaced by eosinophilic cell debris mixed with inflammatory cells. Several arteries and capillaries were clotted and/or infiltrated by inflammatory cells. In conclusion, these serotype 8 cases were accompanied by acute illness, death and more pronounced bronchitis and bronchiolitis.
PubMed: 37564359
DOI: 10.30466/vrf.2022.556971.3539 -
Andes Pediatrica : Revista Chilena de... Oct 2022In Chile, there is a lack of information about wheezing and asthma epidemiology in children under 5 years of age.
UNLABELLED
In Chile, there is a lack of information about wheezing and asthma epidemiology in children under 5 years of age.
OBJECTIVE
To determine at the national level the hospitalization and mortality rates in children aged under 5 years with diagnosis of acute bronchitis and asthma.
PATIENTS AND METHOD
Hospitalization rates were made using discharge data provided by the Department of Health Statis tics and Information, selecting only those corresponding to the ICD10 codes for asthma and acute bronchitis. Population sizes of those at risk of hospitalization were obtained from projections of the National Institute of Statistics. The mortality rate was obtained by calculating the quotient between the number of deaths due to acute bronchitis and asthma in children under 5 years of age and the exposed population. The evolution of the global and regional hospitalization rates from 2002 to 2017 was studied.
RESULTS
Most of the patients who were hospitalized had a diagnosis of acute bronchitis (93,6%), were under two years old, were male, and were hospitalized in winter. During the analyzed period, the acute bronchitis hospitalization rate dropped from 79.7 to 56.1 per 10,000 inhabitants, meanwhile, the asthma hospitalization rate increased from 2.4 to 7.6 per 10,000 inhabitants. The mortality rate in patients with acute bronchitis was 0.52 per 100,000 inhabitants. No mortality was observed in patients diagnosed with asthma.
CONCLUSIONS
During the analyzed period, a significant reduction in hospitalization rate due to acute bronchitis was observed in children aged under 5 years, with a low mortality rate.
Topics: Child; Humans; Male; Infant; Child, Preschool; Female; Respiratory Sounds; Asthma; Bronchitis; Hospitalization; Acute Disease
PubMed: 37906890
DOI: 10.32641/andespediatr.v93i5.3686 -
Family Practice Nov 2022Most antibiotic prescribing for upper respiratory tract infections (URTIs) and acute bronchitis is inappropriate. Substantive and sustained reductions in prescribing are...
BACKGROUND
Most antibiotic prescribing for upper respiratory tract infections (URTIs) and acute bronchitis is inappropriate. Substantive and sustained reductions in prescribing are needed to reduce antibiotic resistance. Prescribing habits develop early in clinicians' careers. Hence, general practice (GP) trainees are an important group to target.
OBJECTIVES
We aimed to establish temporal trends in antibiotic prescribing for URTIs and acute bronchitis/bronchiolitis by Australian GP trainees (registrars).
METHODS
A longitudinal analysis, 2010-2019, of the Registrars Clinical Encounters in Training (ReCEnT) dataset. In ReCEnT, registrars record clinical and educational content of 60 consecutive consultations, on 3 occasions, 6 monthly. Analyses were of new diagnoses of URTI and acute bronchitis/bronchiolitis, with the outcome variable a systemic antibiotic being prescribed. The independent variable of interest was year of prescribing (modelled as a continuous variable).
RESULTS
28,372 diagnoses of URTI and 5,289 diagnoses of acute bronchitis/bronchiolitis were recorded by 2,839 registrars. Antibiotic prescribing for URTI decreased from 24% in 2010 to 12% in 2019. Prescribing for acute bronchitis/bronchiolitis decreased from 84% to 72%. "Year" was significantly, negatively associated with antibiotic prescribing for both URTI (odds ratio [OR] 0.90; 95% confidence interval [CI]: 0.88-0.93) and acute bronchitis/bronchiolitis (OR 0.92; 95% CI: 0.88-0.96) on multivariable analysis, with estimates representing the mean annual change.
CONCLUSIONS
GP registrars' prescribing for URTI and acute bronchitis/bronchiolitis declined over the 10-year period. Prescribing for acute bronchitis/bronchiolitis, however, remains higher than recommended benchmarks. Continued education and programme-level antibiotic stewardship interventions are required to further reduce registrars' antibiotic prescribing for acute bronchitis/bronchiolitis to appropriate levels.
Topics: Humans; General Practitioners; Inappropriate Prescribing; Anti-Bacterial Agents; Practice Patterns, Physicians'; Australia; Respiratory Tract Infections; Bronchitis; Acute Disease; Bronchiolitis
PubMed: 35640041
DOI: 10.1093/fampra/cmac052 -
Respirology (Carlton, Vic.) Aug 2022Bats are likely the primary source of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Minks are highly susceptible to infection by SARS-CoV-2. Transmission... (Review)
Review
Bats are likely the primary source of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Minks are highly susceptible to infection by SARS-CoV-2. Transmission from asymptomatic individuals was estimated to account for over 50% of all transmissions of coronavirus disease 2019 (COVID-19) cases. SARS-CoV-2 is evolving towards more efficient aerosol transmission. Remdesivir, baricitinib, tocilizumab and dexamethasone are frequently used for the treatment of patients with respiratory failure due to COVID-19. There is a rising incidence of non-tuberculous Mycobacterium pulmonary disease globally, with a higher prevalence in Asian countries than in the Western world. Protracted bacterial bronchitis is a common cause of chronic productive cough in childhood. Re-emergence of respiratory syncytial virus may occur after the relaxation of infection control measures and the reopening of borders during COVID-19 pandemic.
Topics: Asia; COVID-19; Humans; Infection Control; Pandemics; SARS-CoV-2
PubMed: 35670259
DOI: 10.1111/resp.14305 -
Monatsschrift Kinderheilkunde : Organ... 2020Acute viral bronchiolitis and wheezy bronchitis are very common disorders in infants and preschool children. They are caused by viruses, particularly by respiratory...
Acute viral bronchiolitis and wheezy bronchitis are very common disorders in infants and preschool children. They are caused by viruses, particularly by respiratory syncytial virus and rhinoviruses. Risk factors for severe disease include premature birth, tobacco smoke exposure and immune dysfunctions. Patient history and a physical examination are sufficient to establish a diagnosis; chest X-ray and laboratory investigations are not routinely necessary. For acute bronchiolitis, many treatment options have been suggested but only supportive measures, such as minimal handling, securing adequate oxygenation and hydration are generally recommended. Antibiotics, bronchodilators, corticosteroids und leukotriene receptor antagonists are not routinely recommended. Short-acting beta-2 agonists are the first choice for the treatment of wheezy bronchitis. Inhaled corticosteroids may be tried to control symptoms in children with frequently recurring and/or severe episodes of wheezy bronchitis. The development of bronchial asthma, however, cannot be prevented by any pharmacologic tretament.
PubMed: 32836401
DOI: 10.1007/s00112-020-00993-x