1
|
Soni S, Antonescu L, Ro K, Horowitz JC, Mebratu YA, Nho RS. Influenza, SARS-CoV-2, and Their Impact on Chronic Lung Diseases and Fibrosis: Exploring Therapeutic Options. THE AMERICAN JOURNAL OF PATHOLOGY 2024:S0002-9440(24)00235-9. [PMID: 39032604 DOI: 10.1016/j.ajpath.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/11/2024] [Accepted: 06/26/2024] [Indexed: 07/23/2024]
Abstract
Respiratory tract infections represent a significant global public health concern, disproportionately affecting vulnerable populations such as children, the elderly, and immunocompromised individuals. RNA viruses, particularly influenza viruses and coronaviruses, significantly contribute to respiratory illnesses, especially in immunosuppressed and elderly individuals. Influenza A viruses (IAVs) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to pose global health threats due to their capacity to cause annual epidemics, with profound implications for public health. In addition, the increase in global life expectancy is influencing the dynamics and outcomes of respiratory viral infections. Understanding the molecular mechanisms by which IAVs and SARS-CoV-2 contribute to lung disease progression is therefore crucial. The aim of this review was to comprehensively explore the impact of IAVs and SARS-CoV-2 on chronic lung diseases, with a specific focus on pulmonary fibrosis in the elderly. It also outlines potential preventive and therapeutic strategies and suggests directions for future research.
Collapse
Affiliation(s)
- Sourabh Soni
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine and The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio
| | - Laura Antonescu
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine and The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio
| | - Kaylin Ro
- Scripps Research Institute, San Diego, California
| | - Jeffrey C Horowitz
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine and The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio
| | - Yohannes A Mebratu
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine and The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio.
| | - Richard S Nho
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine and The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio.
| |
Collapse
|
2
|
Cogen JD, Quon BS. Update on the diagnosis and management of cystic fibrosis pulmonary exacerbations. J Cyst Fibros 2024:S1569-1993(24)00047-X. [PMID: 38677887 DOI: 10.1016/j.jcf.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/28/2024] [Accepted: 04/05/2024] [Indexed: 04/29/2024]
Abstract
Pulmonary exacerbations in people with cystic fibrosis are associated with significant morbidity and reduced quality of life. Pulmonary exacerbation treatment guidelines, published by an expert panel assembled by the Cystic Fibrosis Foundation nearly 15 years ago, were primarily consensus-based as there were several gaps in the evidence base. In particular, limited evidence existed regarding optimal pulmonary exacerbation treatment strategies, including duration of antibiotic therapy, treatment location, antibiotic selection, and the role of systemic corticosteroids. Over the last decade, results from observational studies and large multi-center randomized controlled trials have begun to answer important questions related to pulmonary exacerbation treatment. This review focuses on the diagnosis, etiology, and changing epidemiology of pulmonary exacerbations, and also summarizes the most recent and up-to-date studies describing pulmonary exacerbation treatment. Finally, this review provides consideration for future pulmonary exacerbation research priorities, particularly in the current highly effective modulator therapy era.
Collapse
Affiliation(s)
- Jonathan D Cogen
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA.
| | - Bradley S Quon
- Division of Respiratory Medicine, Department of Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
3
|
Abolhasani FS, Moein M, Rezaie N, Sheikhimehrabadi P, Shafiei M, Afkhami H, Modaresi M. Occurrence of COVID-19 in cystic fibrosis patients: a review. Front Microbiol 2024; 15:1356926. [PMID: 38694803 PMCID: PMC11061495 DOI: 10.3389/fmicb.2024.1356926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 03/11/2024] [Indexed: 05/04/2024] Open
Abstract
Cystic fibrosis (CF) is a genetic ailment caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. This autosomal recessive disorder is characterized by diverse pathobiological abnormalities, such as the disorder of CFTR channels in mucosal surfaces, caused by inadequate clearance of mucus and sputum, in addition to the malfunctioning of mucous organs. However, the primary motive of mortality in CF patients is pulmonary failure, which is attributed to the colonization of opportunistic microorganisms, formation of resistant biofilms, and a subsequent decline in lung characteristics. In December 2019, the World Health Organization (WHO) declared the outbreak of the radical coronavirus disease 2019 (COVID-19) as a worldwide public health crisis, which unexpectedly spread not only within China but also globally. Given that the respiration system is the primary target of the COVID-19 virus, it is crucial to investigate the impact of COVID-19 on the pathogenesis and mortality of CF patients, mainly in the context of acute respiratory distress syndrome (ARDS). Therefore, the goal of this review is to comprehensively review the present literature on the relationship between cystic fibrosis, COVID-19 contamination, and development of ARDS. Several investigations performed during the early stages of the virus outbreak have discovered unexpected findings regarding the occurrence and effectiveness of COVID-19 in individuals with CF. Contrary to initial expectancies, the rate of infection and the effectiveness of the virus in CF patients are lower than those in the overall population. This finding may be attributed to different factors, including the presence of thick mucus, social avoidance, using remedies that include azithromycin, the fairly younger age of CF patients, decreased presence of ACE-2 receptors, and the effect of CFTR channel disorder on the replication cycle and infectivity of the virus. However, it is important to notice that certain situations, which include undergoing a transplant, can also doubtlessly boost the susceptibility of CF patients to COVID-19. Furthermore, with an increase in age in CF patients, it is vital to take into account the prevalence of the SARS-CoV-2 virus in this population. Therefore, ordinary surveillance of CF patients is vital to evaluate and save the population from the capability of transmission of the virus given the various factors that contribute to the spread of the SARS-CoV-2 outbreak in this precise organization.
Collapse
Affiliation(s)
- Fatemeh Sadat Abolhasani
- Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Masood Moein
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Niloofar Rezaie
- Department of Bacteriology, Pasteur Institute of Iran, Tehran, Iran
| | | | - Morvarid Shafiei
- Department of Bacteriology, Pasteur Institute of Iran, Tehran, Iran
| | - Hamed Afkhami
- Nervous System Stem Cells Research Center, Semnan University of Medical Sciences, Semnan, Iran
- Department of Medical Microbiology, School of Medicine, Shahed University, Tehran, Iran
| | - Mohammadreza Modaresi
- Pediatric Pulmonary Disease and Sleep Medicine Research Center, Pediatric Center of Excellence, Children's Medical Center, Tehran, Iran
- Cystic Fibrosis Research Center, Iran CF Foundation (ICFF), Tehran, Iran
| |
Collapse
|
4
|
Gold LS, Hansen RN, Mayer-Hamblett N, Nichols DP, Gifford AH, Kloster M, Goss CH, Kessler L. The cost of simplifying treatments for cystic fibrosis: Implications of the SIMPLIFY trial. J Manag Care Spec Pharm 2024; 30:26-33. [PMID: 38153868 PMCID: PMC10775778 DOI: 10.18553/jmcp.2024.30.1.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
BACKGROUND Dornase alfa and hypertonic saline are mucoactive therapies that can improve respiratory symptoms in people with cystic fibrosis (CF). A recent randomized control trial showed that participants with well-preserved pulmonary function taking elexacaftor + tezacaftor + ivacaftor (ETI) who discontinued dornase alfa or hypertonic saline for 6 weeks had no clinically meaningful decline in lung function. This may prompt discussions with care providers regarding ongoing use of these medications. OBJECTIVE To compare the costs of outpatient medications between people taking ETI who continued or discontinued (1) dornase alfa or (2) hypertonic saline from 2 clinical trials and project cost differences in the US CF population if these 2 medications were used only intermittently for symptom relief instead of chronically. METHODS The SIMPLIFY study was 2 parallel multicenter trials that randomized participants 1:1 to either continue or discontinue therapy. To estimate costs, we used data from the Merative MarketScan Databases to identify people with CF from 2020 to 2021. Our primary outcomes were differences in costs of outpatient prescription drugs among those who continued vs discontinued dornase alfa and, separately, hypertonic saline. We obtained adjusted differences in median costs. To estimate the annual cost savings if the population of people with CF taking ETI used these medications only intermittently, we multiplied the proportion of people in MarketScan with CF diagnoses who were taking each of these medications by the median cost savings per year and subtracted the cost of "rescue" use. RESULTS A total of 392 participants from the dornase alfa trial and 273 from the hypertonic saline trial were included in analyses. The adjusted difference in median medication costs was not significant for the hypertonic saline trial, but we observed a significantly decreased 6-week cost of medications in the dornase alfa trial (adjusted median difference in costs between discontinue and continue of $5,860 (95% CI = $4,870-$6,850); P < 0.0001). We estimated that two-thirds of people with CF use ETI and dornase alfa in the United States; if they discontinued dornase alfa except for intermittent use, the resulting annual savings would be $1.21 billion. CONCLUSIONS Although the costs of dornase alfa and hypertonic saline are smaller compared with ETI, reduction in use would lead to substantial prescription drug cost savings and reduce the treatment burden. However, individual benefits of these therapies should be considered, and decisions regarding changes in therapy remain an important discussion between people with CF and their providers. Study registration number: NCT04378153.
Collapse
Affiliation(s)
- Laura S. Gold
- Department of Radiology, University of Washington, Seattle
| | - Ryan N. Hansen
- School of Pharmacy, University of Washington, Seattle
- Department of Health Systems and Population Health, University of Washington, Seattle
| | - Nicole Mayer-Hamblett
- Seattle Children’s Research Institute, WA
- Department of Biostatistics, University of Washington, Seattle
- Department of Pediatrics, University of Washington, Seattle
| | | | - Alex H. Gifford
- Department of Medicine, Case Western Reserve University, Cleveland, OH
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH
| | | | - Christopher H. Goss
- Seattle Children’s Research Institute, WA
- Department of Pediatrics, University of Washington, Seattle
| | - Larry Kessler
- Department of Health Systems and Population Health, University of Washington, Seattle
| |
Collapse
|
5
|
Bhatnagar R, Tecklenborg S, Segurado R, Watt P, McAuley N, Fitzpatrick P. Impact of COVID-19 pandemic on health care system, work, and mental well-being of people with cystic fibrosis. Ir J Med Sci 2023; 192:2961-2968. [PMID: 37173598 PMCID: PMC10177736 DOI: 10.1007/s11845-023-03391-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/27/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND COVID-19 pandemic has been challenging for all, particularly for high-risk groups including people with cystic fibrosis (PWCF). AIM This study aims to examine impact of COVID-19 pandemic on the lives of PWCF in relation to hospital visits, use of telemedicine, employment, and mental well-being. METHODS A cross-sectional online survey was developed by the Cystic Fibrosis (CF) Ireland research team and uploaded on SmartSurvey UK. The survey was advertised by CF Ireland via their website and social media in October 2020. The University College Dublin research partner team conducted the analysis. Logistic regression was used for the analysis, using IBM SPSS Version 26. RESULTS One hundred nineteen PWCF responded. 47.5% deferred their hospital visits, with delays ranging from 1 to 6 months. Deferrals impacted rehabilitation therapies, medical care at hospital, and diagnostic tests. For many, online consultation was a new experience (51.7%), and 87.8% were satisfied with this method. Among those who worked during lockdown (47.8%), 87.2% (n = 48) worked at home. PWCF aged < 35 years (9.6%) were more likely to work onsite as compared to those > 35 years (1.9%). When adjusted for gender and employment, PWCF aged < 35 years were more likely to feel "nervous" (OR: 3.28; P = 0.02), "nothing could cheer them up" (OR: 3.24; P = 0.04), and "tired" (OR: 2.76; P = 0.02) as compared to those > 35 years. CONCLUSION COVID 19 pandemic has greatly impacted PWCF in terms of hospital visits, access to tests, CF care, and psychological well-being. Younger PWCF reported greater impact on psychological health. Online consultation and electronic prescription were welcomed and could have a role post-pandemic.
Collapse
Affiliation(s)
- Rini Bhatnagar
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
| | | | - Ricardo Segurado
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | | | | | - Patricia Fitzpatrick
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| |
Collapse
|
6
|
Mondejar-Lopez P, Moreno-Galarraga L, de Manuel-Gomez C, Blitz-Castro E, Bravo-Lopez M, Gartner S, Perez-Ruiz E, Caro-Aguilera P, Sanz-Santiago V, Lopez-Neyra A, Luna-Paredes C, Garcia-Gonzalez M, Costa-Colomer J, Cols-Roig M, Delgado-Pecellin I, Castillo-Corullon S, Ruiz de Valbuena-Maiz M, Garcia-Marcos PW, Aguilar-Fernandez AJ, Martin-De Vicente C, Barajas-Sanchez MV, Mesa-Medina O, Bover-Bauza C, Figuerola-Mulet J, Garcia-Aviles B, Rodriguez-Saez MJ, Garcia-Magan C, Juarez-Marruecos P, Gutierrez-Martinez JR, Cortell-Aznar I, Gomez-Pastrana D, Velasco-Gonzalez MV, Barrio MI, Sanchez-Solis M, Asensio de la Cruz O, Pastor-Vivero MD. SARS-CoV-2 infection in children with cystic fibrosis: A cross-sectional multicenter study in Spain. New waves, new knowledge. Pediatr Pulmonol 2023; 58:3195-3205. [PMID: 37589420 DOI: 10.1002/ppul.26644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/15/2023] [Accepted: 08/10/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION The association between viral infections and pulmonary exacerbations in children with cystic fibrosis (cwCF) is well established. However, the question of whether cwCF are at a higher risk of COVID-19 or its adverse consequences remains controversial. METHODS We conducted an observational, multicenter, cross-sectional study of cwCF infected by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) between March 2020 and June 2022, (first to sixth COVID-19 pandemic waves) in Spain. The study aimed to describe patients' basal characteristics, SARS-CoV-2 clinical manifestations and outcomes, and whether there were differences across the pandemic waves. RESULTS During study time, 351 SARS-CoV2 infections were reported among 341 cwCF. Median age was 8.5 years (range 0-17) and 51% were female. Cases were unevenly distributed across the pandemic, with most cases (82%) clustered between November 2021 and June 2022 (sixth wave, also known as Omicron Wave due to the higher prevalence of this strain in that period in Spain). Most cwCF were asymptomatic (24.8%) or presented with mild Covid-19 symptoms (72.9%). Among symptomatic, most prevalent symptoms were fever (62%) and increased cough (53%). Infection occurring along the sixth wave was the only independent risk factor for being symptomatic. Just eight cwCF needed hospital admission. No multisystem inflammatory syndrome, persisting symptoms, long-term sequelae, or deaths were reported. CONCLUSIONS Spanish current data indicate that cwCF do not experience higher risks of SARS-CoV-2 infection nor worse health outcomes or sequelae. Changes in patients' basal characteristics, clinical courses, and outcomes were detected across waves. While the pandemic continues, a worldwide monitoring of COVID-19 in pediatric CF patients is needed.
Collapse
Affiliation(s)
- Pedro Mondejar-Lopez
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain
- Department of Surgery, Paediatrics, Obstetrics and Genecology, Biomedical Research Institute of Murcia (IMIB), Universidad de Murcia, Murcia, Spain
| | - Laura Moreno-Galarraga
- Department of Pediatrics, Complejo Hospitalario de Navarra, Servicio Navarro de Salud, Pamplona, Spain
- IdiSNA (Instituto de Investigación Sanitaria de Navarra), Navarra Institute for Health Research, Pamplona, Spain
| | - Cristina de Manuel-Gomez
- Pediatric Pulmonology Department and Cystic Fibrosis Unit, Hospital La Paz Institute for Health Research-IdiPAZ, Madrid, Spain
| | - Enrique Blitz-Castro
- Pediatric Pulmonology Department and Cystic Fibrosis Unit, Hospital Ramón y Cajal & Institute for Health Research-IRYCIS, Madrid, Spain
| | - Maynor Bravo-Lopez
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hospital Vall d'Hebron, Barcelona, Spain
| | - Silvia Gartner
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hospital Vall d'Hebron, Barcelona, Spain
| | - Estela Perez-Ruiz
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Pilar Caro-Aguilera
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Veronica Sanz-Santiago
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hospital Universitario Infantil Niño Jesús, Madrid, Spain
| | - Alejandro Lopez-Neyra
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hospital Universitario Infantil Niño Jesús, Madrid, Spain
| | - Carmen Luna-Paredes
- Multidisciplinary Unit of Cystic Fibrosis, Pediatrics, Hospital Universitario Doce de Octubre, Madrid, Spain
| | | | - Jordi Costa-Colomer
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hospital Sant Joan de Déu, Esplugues, Barcelona, Spain
| | - Maria Cols-Roig
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hospital Sant Joan de Déu, Esplugues, Barcelona, Spain
| | - Isabel Delgado-Pecellin
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hospital Universitario Virgen del Rocio, Centro de Investigación Biomedica en Red de Enfermedades Respiratorias (CIBERES), Instituto San Carlos III, Universidad de Sevilla, Madrid, Spain
| | | | - Marta Ruiz de Valbuena-Maiz
- Pediatric Pulmonology Department and Cystic Fibrosis Unit, Hospital La Paz Institute for Health Research-IdiPAZ, Madrid, Spain
| | - Patricia W Garcia-Marcos
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Antonio J Aguilar-Fernandez
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hospital Universitario Materno-Infantil de Canarias, Las Palmas, Spain
| | - Carlos Martin-De Vicente
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Orlando Mesa-Medina
- Pediatric Pulmonology Unit, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Catalina Bover-Bauza
- Pediatric Pulmonology and Allergy Unit, Hospital Universitario Son Espases, Grupo Multidisciplinar de Pediatria del Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, Spain
| | - Joan Figuerola-Mulet
- Pediatric Pulmonology and Allergy Unit, Hospital Universitario Son Espases, Grupo Multidisciplinar de Pediatria del Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, Spain
| | - Belen Garcia-Aviles
- Cystic Fibrosis Unit, Hospital Univeristario San Juan de Alicante, Alicante, Spain
| | | | - Carlos Garcia-Magan
- Pediatric Pulmonology Unit, Hospital Clinico Universitario de Santiago de, Compostela, Spain
| | | | | | - Isidoro Cortell-Aznar
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hospital Universitario La Fe, Valencia, Spain
| | | | | | - M Isabel Barrio
- Pediatric Pulmonology Department and Cystic Fibrosis Unit, Hospital La Paz Institute for Health Research-IdiPAZ, Madrid, Spain
| | - Manuel Sanchez-Solis
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain
- Department of Surgery, Paediatrics, Obstetrics and Genecology, Biomedical Research Institute of Murcia (IMIB), Universidad de Murcia, Murcia, Spain
| | | | - Maria Dolores Pastor-Vivero
- Pediatric Pulmonology Department and Cystic Fibrosis Unit, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, Barakaldo, Bizkaia, España
| |
Collapse
|
7
|
Somayaji R, Quon BS. Breath of fresh insight: unraveling the evolution of our understanding of cystic fibrosis pulmonary exacerbations. Curr Opin Pulm Med 2023; 29:587-594. [PMID: 37642491 DOI: 10.1097/mcp.0000000000001010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
PURPOSE OF REVIEW Pulmonary exacerbations are critical events with significant negative impacts in persons with cystic fibrosis, but their diagnosis and management are highly variable. Highly effective modulator therapies have greatly improved health and reduced exacerbation events, but have also reshaped how they present. This review discusses the complexities of the diagnosis and management of pulmonary exacerbations as well as the emerging work and evidence in this area. RECENT FINDINGS The shifting epidemiology and our understanding of risk factors for pulmonary exacerbations are discussed. As symptoms may be more subtle in the modulator context, novel technologies including studies of remote monitoring are presented. The continued relevance of pulmonary exacerbations, the heterogeneity in their management, as well as current and forthcoming clinical trials to optimize treatment approaches are detailed. SUMMARY In spite of the dramatic reductions in pulmonary exacerbations, airway infections persist, a proportion of persons with cystic fibrosis either on or off modulator therapies continue to experience exacerbation events, and long-term data is lacking. Innovative approaches and studies will be crucial to enable standardized and generalizable strategies to improve outcomes in persons with cystic fibrosis.
Collapse
Affiliation(s)
- Ranjani Somayaji
- Department of Medicine, Cumming School of Medicine
- Department of Microbiology, Immunology and Infectious Disease
- Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Canada
| | - Bradley S Quon
- Department of Medicine, Faculty of Medicine, University of British Columbia
- Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, Canada
| |
Collapse
|
8
|
Fuchs T, Appelt D, Ellemunter H. Is There a Difference in Immune Response to SARS-CoV-2 Vaccination between Liver and Lung Transplant Patients with Cystic Fibrosis? Vaccines (Basel) 2023; 11:vaccines11030657. [PMID: 36992241 DOI: 10.3390/vaccines11030657] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/08/2023] [Accepted: 03/11/2023] [Indexed: 03/17/2023] Open
Abstract
People with Cystic Fibrosis (CF), especially solid organ transplant recipients, have been prioritized in the SARS-CoV-2 vaccination program. This study assesses antibody response of patients with CF who have undergone liver (CF-LI) or lung (CF-LU) transplantation, and compares results to published data of patients with solid organ transplantation without CF as underlying disease. Antibodies against the spike receptor-binding domain were measured within the routine visits at the CF Centre in Innsbruck, Austria, after the second and third doses of SARS-CoV-2 mRNA vaccines. We report on 13 adult CF patients who are recipients of solid organ transplant, including five CF-LI and eight CF-LU. Overall, 69% had measurable antibody response after two, and 83% after three doses of SARS-CoV-2 vaccines. In CF-LI, positive serological response amounted to 100% after two and three doses, while CF-LU showed only a 50% and a 71% response rate, respectively. Clear differences are seen between the CF-LI and CF-LU groups in our cohort, with worse response rate for lung transplant recipients. Immune response between CF-LI and CF-LU, therefore, must be considered in a differentiated manner, and the importance of booster vaccination is once more emphasized with these data.
Collapse
Affiliation(s)
- Teresa Fuchs
- Department of Child and Adolescent Health, Paediatrics III, Cystic Fibrosis Centre Innsbruck, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Dorothea Appelt
- Department of Child and Adolescent Health, Paediatrics III, Cystic Fibrosis Centre Innsbruck, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Helmut Ellemunter
- Department of Child and Adolescent Health, Paediatrics III, Cystic Fibrosis Centre Innsbruck, Medical University of Innsbruck, 6020 Innsbruck, Austria
| |
Collapse
|
9
|
Biondo C, Midiri A, Gerace E, Zummo S, Mancuso G. SARS-CoV-2 Infection in Patients with Cystic Fibrosis: What We Know So Far. Life (Basel) 2022; 12:2087. [PMID: 36556452 PMCID: PMC9786139 DOI: 10.3390/life12122087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Respiratory infections are the most common and most frequent diseases, especially in children and the elderly, characterized by a clear seasonality and with an incidence that usually tends to decrease with increasing age. These infections often resolve spontaneously, usually without the need for antibiotic treatment and/or with the possible use of symptomatic treatments aimed at reducing overproduction of mucus and decreasing coughing. However, when these infections occur in patients with weakened immune systems and/or underlying health conditions, their impact can become dramatic and in some cases life threatening. The rapid worldwide spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection has caused concern for everyone, becoming especially important for individuals with underlying lung diseases, such as CF patients, who have always paid close attention to implementing protective strategies to avoid infection. However, adult and pediatric CF patients contract coronavirus infection like everyone else. In addition, although numerous studies were published during the first wave of the pandemic on the risk for patients with cystic fibrosis (CF) to develop severe manifestations when infected with SARS-CoV-2, to date, a high risk has been found only for patients with poorer lung function and post-transplant status. In terms of preventive measures, vaccination remains key. The best protection for these patients is to strengthen preventive measures, such as social distancing and the use of masks. In this review, we aim to summarize and discuss recent advances in understanding the susceptibility of CF individuals to SARS-CoV-2 infection.
Collapse
Affiliation(s)
- Carmelo Biondo
- Department of Human Pathology, University of Messina, 98125 Messina, Italy
| | - Angelina Midiri
- Department of Human Pathology, University of Messina, 98125 Messina, Italy
| | | | - Sebastiana Zummo
- Department of Human Pathology, University of Messina, 98125 Messina, Italy
| | - Giuseppe Mancuso
- Department of Human Pathology, University of Messina, 98125 Messina, Italy
| |
Collapse
|
10
|
Kos R, Neerincx AH, Fenn DW, Brinkman P, Lub R, Vonk SEM, Roukema J, Reijers MH, Terheggen‐Lagro SWJ, Altenburg J, Majoor CJ, Bos LD, Haarman EG, Maitland‐van der Zee AH. Real-life efficacy and safety of elexacaftor/tezacaftor/ivacaftor on severe cystic fibrosis lung disease patients. Pharmacol Res Perspect 2022; 10:e01015. [PMID: 36440690 PMCID: PMC9703582 DOI: 10.1002/prp2.1015] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 08/13/2022] [Indexed: 11/29/2022] Open
Abstract
Elexacaftor/tezacaftor/ivacaftor (ETI) is a cystic fibrosis (CF) transmembrane conductance regulator modulator, which has shown efficacy in CF patients (≥6 years) with ≥1 Phe508del mutation and a minimal function mutation. In October 2019, ETI became available on compassionate use basis for Dutch CF patients with severe lung disease. Our objective was to investigate safety and efficacy of ETI in this patient group in a real-life setting. A multicenter longitudinal observational study was conducted to examine changes in FEV1 , BMI, and adverse events at initiation and 1, 3, 6, and 12 months after starting ETI. The number of exacerbations was recorded in the 12 months before and the 12 months after ETI treatment. Patients eligible for compassionate use had a FEV1 <40% predicted. Wilcoxon signed-rank test analyzed changes over time. Twenty subjects were included and followed up for up to 12 months after starting ETI. Treatment was well tolerated with mild side effects reported, namely, rash (15%) and stomach ache (20%) with 80% resolving within 1 month. Mean absolute increase of FEV1 was 11.8/13.7% (p ≤ .001) and BMI was 0.49/1.87 kg/m2 (p < .001-0.02) after 1/12 months, respectively. In comparison to the number of exacerbations pretrial, there was a marked reduction in exacerbations after initiation. Our findings show long-term effects of treatment with ETI in patients with severe CF lung disease in a real-life setting. Treatment with ETI is associated with increased lung function and BMI, less exacerbations, and only mild side effects.
Collapse
Affiliation(s)
- Renate Kos
- Department of Respiratory MedicineAmsterdam University Medical Centres – loc. AMCAmsterdamThe Netherlands
| | - Anne H. Neerincx
- Department of Respiratory MedicineAmsterdam University Medical Centres – loc. AMCAmsterdamThe Netherlands
| | - Dominic W. Fenn
- Department of Respiratory MedicineAmsterdam University Medical Centres – loc. AMCAmsterdamThe Netherlands
- Laboratory of Experimental Intensive Care and AnaesthesiologyAmsterdam University Medical Centres – loc. AMCAmsterdamThe Netherlands
| | - Paul Brinkman
- Department of Respiratory MedicineAmsterdam University Medical Centres – loc. AMCAmsterdamThe Netherlands
| | - Rianne Lub
- Department of Respiratory MedicineAmsterdam University Medical Centres – loc. AMCAmsterdamThe Netherlands
| | - Steffie E. M. Vonk
- Department of Hospital PharmacyAmsterdam University Medical Centres – loc. AMCAmsterdamThe Netherlands
| | - Jolt Roukema
- Department of Paediatric Pulmonology, Amalia Children's HospitalRadboud University Medical CenterNijmegenThe Netherlands
| | - Monique H. Reijers
- Department of PulmonologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Suzanne W. J. Terheggen‐Lagro
- Department Paediatric Respiratory Medicine and Allergy, Emma Children's HospitalAmsterdam University Medical CentresAmsterdamThe Netherlands
| | - Josje Altenburg
- Department of Respiratory MedicineAmsterdam University Medical Centres – loc. AMCAmsterdamThe Netherlands
| | - Christof J. Majoor
- Department of Respiratory MedicineAmsterdam University Medical Centres – loc. AMCAmsterdamThe Netherlands
| | - Lieuwe D. Bos
- Department of Respiratory MedicineAmsterdam University Medical Centres – loc. AMCAmsterdamThe Netherlands
- Department of Intensive CareAmsterdam University Medical Centres – loc. AMCAmsterdamThe Netherlands
| | - Eric G. Haarman
- Department Paediatric Respiratory Medicine and Allergy, Emma Children's HospitalAmsterdam University Medical CentresAmsterdamThe Netherlands
| | - Anke H. Maitland‐van der Zee
- Department of Respiratory MedicineAmsterdam University Medical Centres – loc. AMCAmsterdamThe Netherlands
- Department Paediatric Respiratory Medicine and Allergy, Emma Children's HospitalAmsterdam University Medical CentresAmsterdamThe Netherlands
| | | |
Collapse
|
11
|
Chiner-Vives E, Cordovilla-Pérez R, de la Rosa-Carrillo D, García-Clemente M, Izquierdo-Alonso JL, Otero-Candelera R, Pérez-de Llano L, Sellares-Torres J, de Granda-Orive JI. Short and Long-Term Impact of COVID-19 Infection on Previous Respiratory Diseases. Arch Bronconeumol 2022; 58 Suppl 1:39-50. [PMID: 35501222 PMCID: PMC9012323 DOI: 10.1016/j.arbres.2022.03.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 03/30/2022] [Indexed: 02/07/2023]
Abstract
On March 11, 2020, the World Health Organization declared Coronavirus Disease 2019 (COVID-19) a pandemic. Till now, it affected 452.4 million (Spain, 11.18 million) persons all over the world with a total of 6.04 million of deaths (Spain, 100,992). It is observed that 75% of hospitalized COVID-19 patients have at least one COVID-19 associated comorbidity. It was shown that people with underlying chronic illnesses are more likely to get it and grow seriously ill. Individuals with COVID-19 who have a past medical history of cardiovascular disorder, cancer, obesity, chronic lung disease, diabetes, or neurological disease had the worst prognosis and are more likely to develop acute respiratory distress syndrome or pneumonia. COVID-19 can affect the respiratory system in a variety of ways and across a spectrum of levels of disease severity, depending on a person's immune system, age and comorbidities. Symptoms can range from mild, such as cough, shortness of breath and fever, to critical disease, including respiratory failure, shock and multi-organ system failure. So, COVID-19 infection can cause overall worsening of these previous respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), interstitial lung disease, etc. This review aims to provide information on the impact of the COVID-19 disease on pre-existing lung comorbidities.
Collapse
Affiliation(s)
- Eusebi Chiner-Vives
- Multidisciplinary Sleep Unit, Respiratory Department, Sant Joan University Hospital, Sant Joan d'Alacant, Alicante, Spain
| | - Rosa Cordovilla-Pérez
- Respiratory Department, Salamanca University Hospital, Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | | | - Marta García-Clemente
- Lung Management Area, HUCA, Institute for Health Research of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
| | - José Luis Izquierdo-Alonso
- Department of Medicine and Medical Specialties, University of Alcalá, Madrid, Spain; Respiratory Medicine, University Hospital of Guadalajara, Guadalajara, Spain
| | | | - Luis Pérez-de Llano
- Respiratory Department, Lucus Augusti University Hospital, EOXI Lugo, Monforte, CERVO, Lugo, Spain
| | - Jacobo Sellares-Torres
- Interstitial Lung Diseases Working Group, Respiratory Department, Clinic-University Hospital-IDIBAPS, Barcelona, Spain
| | | |
Collapse
|