key: cord-0077984-97x78w97
authors: Backer, Vibeke; Hilberg, Ole; Ulrik, Charlotte
title: NLC Abstracts
date: 2022-05-06
journal: nan
DOI: 10.1080/20018525.2022.2058255
sha: 797b2ab9fcf40cafa3faef56654809b625f9aade
doc_id: 77984
cord_uid: 97x78w97

nan

suggests that the effect of nebulized magnesium sulfate on lung function is better than intravenous administration. 6

Christiane Haase a , Ditte Gertz Mogensen, Kasper Aanaes, and Vibeke Backer a Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen OE, Denmark Background: There is an increased awareness, for treating both upper and lower airways (global airway) diseases simultaneously, because they have the similar inflammatory mechanisms. About 9% of the adult population suffers from chronic rhinosinusitis (CRS). Four percent of these have CRS with nasal polyps (CRSwNP) and 5% does not have nasal polyps (CRSnNP). In addition, 7-10% of the Danish population suffers from asthma. About 40-70% of these have both CRSwNP and asthma -depending of the severity of the nasal disease, the more severe the disease and the more frequent asthma as a comorbidity. All in all, there is a large population with airway diseases and a large overlap between upper and lower respiratory diseases. CRS has a multifactorial background, where CRSwNP has an impact on asthma control and well-controlled asthma has an impact at CRS-control. This can be recognized in the daily practice, where patient experience high burden of diseases who has a large impact on their daily lives and thereby also resulting in significant reduced quality of life. Several studies show that those with asthma have low adherence, but there are few studies on adherence in CRS. The patients are depended on seeing different specialists (ENT and pulmonary) to improve their adherence in the upper and lower airways. Aim: The aim is to investigate patients' adherence with diseases of the global airways, and to analyses whether their patients' adherence with diseases of the global airways should and can be improved. Method: Patients with CRS and asthma will be randomized into a control or intervention group where their adherence will be measure by . Patients in the intervention group receive systematic and structured supervision about their disease and treatment. Patients in the control group only receive usual supervision.

The study has not yet been completed. Background: Loss of the sense of taste and smell occurs in 65-88% of patients infected with corona virus. In contrast to previous post-viral olfactory loss, it is often younger patients with milder symptoms of COVID-19, who experience chemosensory dysfunction. The duration of the impaired sense of taste and smell ranges from a few days to weeks after the end of the infection. Moreover, 20-28% of the patients have persistent impaired sense of taste and smell, which is also a frequently reported sequelae after infection with . Previous studies show that loss of the sense of taste and smell is associated with a decline in quality of life. Olfactory training has been shown to be effective in other patient groups, while in olfactory dysfunction in COVID-19 there is not yet evidence on the longterm effect of olfactory training and whether it can improve quality of life. Aim: The primary aim is to investigate whether systematic olfactory training with essential oils to improve impaired sense of taste and smell following COVID-19 can improve patients' quality of life. The secondary aim is to investigate the effect of olfactory training. Method: Patients with anosmia or hyposmia following COVID-19 will be randomized to the intervention or control group. The intervention group received essential oils with scents of orange, lavender, clove, and peppermint. The control group received the four same containers, but with fragrance-free oils. Both groups will be instructed to do olfactory training with each of the oils for 30 s in the morning and evening for 3 months. Subjective olfactory status and quality of life will be evaluated with Taste and Smell Tool for Evaluation at baseline and at 3-month follow-up. The effect of olfactory training will be evaluated with Sniffin' Sticks.

The study has not yet been completed.

8 Extended-release morphine for chronic breathlessness in chronic obstructive pulmonary disease: a randomized controlled trial with blinded up-titration over 3 weeks Background: Chronic breathlessness is a major cause of suffering and limited activity in patients with chronic obstructive pulmonary disease (COPD). Regular, low-dose morphine might relieve breathlessness, but evidence on patient selection, efficacy, and optimal dose is conflicting or lacking. Methods: Multisite, phase III, double-blind, placebocontrolled, randomized trial of patients with COPD and chronic breathlessness (modified Medical Research Council score 3-4) randomized (1:1:1) to daily, oral extended-release (ER) morphine 8 mg, 16 mg, or placebo. After 1 and 2 weeks, participants were further randomized (1:1) to adding either ER morphine 8 mg or placebo. Primary endpoint was intensity of worst breathlessness (previous 24 h) after 1 week. Secondary endpoints included daily steps (Actigraphy), functional status, anxiety/depression, health-related quality of life, and adverse events, at 1 and 3 weeks. Results: A total of 156 patients with COPD (48% female) were randomized to daily morphine 8 mg (n = 55), 16 mg (n = 51), or placebo (n = 50) for week 1 and analyzed by intention-to-treat. Treatment groups after 3 weeks were as follows: morphine 8 mg (n = 39), 16 mg (n = 52), 24 mg (n = 40), 32 mg (n = 12), or placebo (n = 13). Baseline characteristics were similar between groups. Primary endpoint of worst breathlessness after 1 week was similar with morphine vs. placebo, mean difference −0.25 (95% confidence interval, −0.83-0.33) on a 0-10 numerical rating scale. Secondary endpoints were similar by treatment group both after 1 and 3 weeks. Morphine increased harms including serious adverse events. Conclusion: Morphine did not systematically improve breathlessness, physical activity or other secondary outcomes, but increased harms in COPD patients during 3 weeks up-titration. Trial registration: NCT02720822. 

Background: There is sparse literature on parental chronic obstructive pulmonary disease (COPD) as a risk factor for the development of COPD in adult offspring, and the impact on disease severity. We aimed to map the literature reporting on the prevalence of and/or association between parental COPD and COPD in offspring, and to evaluate whether or not the literature reports on the severity of COPD or other health-related outcomes in offspring with parental COPD. Methods: A systematic literature search in Embase and Ovid MEDLINE was performed in June 2021. Search terms revolved around COPD and predisposition. Results: Thirteen studies were identified: 10 case-control studies, 2 cross-sectional studies, and 1 cohort study. Population size varied from 44 to 2,668 offspring cases; the distribution of female cases varied from 5 to 80% and mean age ranged from 27 to 65. Nine studies used an antecedent approach and evaluated the prevalence of parental COPD in patients with COPD, which ranged from 19% to 58%. Four studies used a descendant approach, by identifying patients with COPD and subsequently evaluated prevalence of COPD in their offspring, and found a prevalence of 0% to 17%. Apart from one, all the studies found an increased odds ratio for COPD in individuals with parental COPD. Four studies reported on parental smoking history and nine studies reported on smoking history in offspring. Three studies evaluated the association between parental COPD and COPD-related outcomes in patients with COPD. Interpretation: This review indicates that parental COPD is associated with a higher risk of COPD in offspring. The literature is sparse, and we identified a knowledge gap on whether parental COPD is a risk factor for severe COPD and other health conditions in offspring.

Sing-a-Lung: are changes in physical exercise capacity and quality of life associated after a 10 weeks' Singing for Lung Health programme Background and aims: Recently, an RCT demonstrated that Singing for Lung Health (SLH) was effective in improving both Six-Minute Walking Test Distance (6MWD) and quality of life (St. George's Respiratory Questionnaire (SGRQ Total Score)) within a 10 week pulmonary rehabilitation (PR) programme (NCT03280355) [1] . However, associations between reaching the minimal important difference (MID) in both 6MWD (MID = ≥30 m) and SGRQ (MID = :≤-4 units) remain unknown. Methods: We performed post-hoc analyses in the perprotocol population receiving SLH. We used logistic regression models, Cohen's kappa, and Cochran-Mantel-Haenszel test to investigate correlation, association, and agreement concerning the reaching of MID in both 6MWD and SGRQ. Results: Baseline characteristics in the SLH group (n = 108) were as follows: Females: 57%; mean age 71 ± 8 years; pack years 41 ± 22; body mass index (BMI): 28 ± 6 kg/m 2 ; and FEV1% predicted: 51% ±17%. 6MWD MID was achieved by 31 (29%) patients, and SGRQ MID by 53 (49%). Baseline outcomes associated with achieving MID of either outcome were higher BMI, lower FEV1, shorter 6MWD, and higher SGRQ. Achieving MID in 6MWD did not agree significantly with achieving MID in SGRQ and vice versa (agreement: 57.4%; κ = 0.14; p = 0.14). Conclusions: Achieving MID in 6MWD or SGRQ was associated with poor baseline performance. Achieving MID in SGRQ was more common than achieving MID in 6MWD. Moreover, achieving MID in one outcome agreed surprisingly poorly with improvement in the other. . Conclusion: Inconsistencies are found between those receiving hospital treatment for anxiety and those redeeming prescribed anxiolytics. This suggests that there are several clinical manifestations of anxiety in a COPD population, dependent on age and disease severity. Further investigation is needed to understand these clinical pictures.

The Nordic countries share similar health-care systems, but the prevalence and management of severe asthma have not previously been evaluated and compared between the countries. Aim: Using data from the NORdic Dataset for aSThmA Research (NORDSTAR) cohort, we compare the prevalence of severe asthma, the use of oral corticosteroids (OCS) in severe asthma, and to which extent these patients are followed in specialist care in the Nordic countries. Methods: NORDSTAR is a population-based, observational dataset of asthma patients based on Nordic registries. Using a cross-sectional design, we identified adult patients with severe asthma according to the ERS/ ATS definition in 2018. High cumulative OCS use was defined as dispensed fillings ≥5 mg/day in 2018. Patients managed in specialist care were those with an asthma-related outpatient contact (only available in Sweden and Finland). Results: We identified N = 6,477, N = 6,999, and N = 8,476 severe asthma patients corresponding to 3.5, 5.4 and 5.2% of all asthma patients aged ≥18 in Sweden, Norway, and Finland, respectively. Most patients with severe asthma had a high cumulative use of OCS; 53, 66, and 63% in the three countries, respectively. In Sweden and Finland, 33 and 39% of the patients with high cumulative OCS use were currently managed in specialist care. Conclusion: Population-based nationwide data demonstrate a comparable prevalence of severe asthma and a high cumulative OCS use in the Nordic countries. Most patients with severe asthma and high cumulative OCS use are currently not managed by a respiratory specialist, indicating the need for increased awareness of severe asthma in primary care.

Randers, Denmark; i Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark Background: SARS-CoV-2 virus, causing Covid-19, continues to be a public health concern. Long-term sequela after infection with Covid-19 has been reported worldwide and holds the risk of becoming a major health concern. Ongoing symptoms more than 3 months after infection is now defined as long Covid. Fatigue and psychological distress are among the most common symptoms in long Covid. Aim: To investigate severe fatigue and psychological distress after hospitalization in patients with Covid-19. Methods: Patients hospitalized with Covid-19 in the Central Denmark Region were invited for follow-up 3-6 months after discharge. Psychological distress was measured by Hospital Anxiety and Depression Scale (HADS) with a HADS score ≥8 identifying cases of anxiety and depression in the two subdomains. Fatigue was assessed using Fatigue Assessment Scale (FAS) with a FAS ≥35 indicating severe fatigue. Basic characteristics from the hospitalization were registered. Results: A total of 218 patients (mean age 59.9 (95% CI 58.2, 61.7), 59% men) reported a mean HADS of 7.9 (95% CI 6.95, 8.93). Cases of anxiety and depression were found in 23 and 16% of all patients, respectively. Overall, a mean FAS of 25.6 (95% CI 24.3, 26.9) was found with 34 patients (18%) reporting severe fatigue. Patients with severe fatigue (mean age of 54.2 (95% CI 50.3, 58.1), 47% males), cases of anxiety and depression was reported by 59 and 62%, respectively. Analyses of FAS in subdomains on mental and physical fatigue showed mean scores of 19.3 (95% CI 18.5, 20.2) and 20.6 (95% CI 19.8, 21.5), respectively. Conclusion: Severe fatigue is common after hospitalization in patients with Covid-19 and includes both mental and physical fatigue. In addition, cases of anxiety and depression are common in patients with severe fatigue. Conclusions: Short-and long-term of survival rates were substantially higher in the cohort treated with higher IPAP. Our data support the current strategy of rapid increase and use of higher pressure. Background: Assessing changes in functional capacity is highly relevant in the treatment of citizens with chronic obstructive pulmonary disease (COPD). In Denmark, most citizens with COPD are followed in general practice, where traditional functional tests, like shuttle and 6-minute walk tests, require too much time and space. Therefore, there is an urgent need for a quick functional capacity test that can be performed in a limited setting such as general practice. Aims: To identify a quick test to measure functional capacity in citizens with COPD and identify which factors could affect the implementation of such a test in general practice. Method: A mixed-method feasibility study composed of a literature review and fieldwork using qualitative interviews. Studies describing short functional tests were searched and then evaluated with the COSMIN checklist. For the fieldwork, 50 general practices and 14 general practitioners (GPs) participated in interviews. Responses were categorised and thematically analysed. Results: The 1-minute sit-to-stand (1 M STS) was suitable for a general practice setting. The COSMIN checklist rated it sufficient in reliability (ICC 0.90-0.99), measurement error (MID 2.5-3), construct validity and responsiveness (AUC 0.72), and found a moderate to strong correlation in criterion validity (r = 0.4-0.75). Several GPs wished for a quick functional test and emphasised evidence, information, and limitations as essential when deciding on implementation. Other factors identified included time, other tests, and economy. Conclusion: 1 M STS is a valid, reliable, and responsive test for assessing functional capacity in citizens with COPD. The test is quick and can easily be performed within a standard consultation time. Reference values and protocols for 1 M STS are available, yet GPs still hesitate to use the 1 M STS. Background and Aims: Underuse of inhaled corticosteroids (ICS) and overuse of short acting β2-agonists (SABA) is common in asthma patients, and overuse of SABA is related to increased risk of asthma exacerbations and mortality. The aim of this study was to investigate the change in asthma treatment over time and to identify factors related to pharmacological asthma treatment. Methods: Adult patients with doctor-diagnosed asthma were randomly selected from 14 hospitals and 56 primary health-care centres in Sweden and were sent questionnaires about their symptoms, maintenance treatment and use of any rescue medication more than two times the previous week. Background: Chronic obstructive pulmonary disease (COPD) is a chronic disease with deterioration in lung function and increasing risk of hospitalization over time. This study aimed to investigate the impact of clinical factors on COPD exacerbations and hospitalizations. Methods: The study was a nationwide, populationbased cohort study utilizing Danish health registries. In total, 44,733 patients ≥40 years of age, with an inand/or outpatient diagnosis of COPD (ICD-10 J44) in 2008-2017, were identified in the nationwide Danish COPD Registry. Multiple descriptive data were registered such as marital status, education, comorbidities, MRC, smoking status, and body mass index. Patients were followed for 12 months, and Poisson regression as well as Cox Regression were used to calculate the impact of these data on exacerbations, hospitalizations, and deaths. Exacerbations were divided into moderate (short-term oral corticosteroid use) or severe (emergency visit or hospitalization). Index was the date of the first outpatient visit.

Results: In all, 44,733 patients with COPD (mean age, 69.2 years; 52% females) were included. COPDrelated exacerbations and hospitalizations were associated with a number of comorbidities, MRC, and FEV1. Similar results were found for hospitalization due to any diagnosis. According to survival, results were similar. Furthermore, smoking status was important for survival as never smokers had a significantly lower mortality ratio (HR 0.75, ref. former smokers) than present smokers (HR 1.2, ref.

former smokers). Conclusion: This study shows a significant impact on smoking cessation for comorbidities, exacerbations, and hospitalizations. Smoking is the most important modifiable risk factor for COPD and smoking cessation is recommended to all COPD patients. Furthermore, smoking is also an important risk factor for other diseases influencing the prognosis for COPD. Results from this study can help health-care professionals motivating patients to smoking cessation. Background: There is growing interest in the ability of biologic treatment to induce remission of severe asthma, and clinical remission on treatment has recently been defined as complete control of exacerbations, oral corticosteroid (OCS) use, lung function, and asthma symptoms. We assessed response rates and baseline characteristics associated with these outcomes in a real-life setting. Methods: The Danish Severe Asthma Registry is a nationwide register including all patients receiving biologic treatment for severe asthma in Denmark. We defined 'clinical response' to treatment after 12 months as ≥50% reduction in exacerbations, and/or a ≥50% reduction in OCS dose. 'Clinical remission on treatment' was defined by cessation of exacerbations and maintenance OCS, as well as a normalization of lung function (FEV1% >80%) and an Asthma Control Questionnaire score ≤1.50. Results: In 274 bionaïve patients, 225 (82%) had a clinical response, of whom 43 (19%) fulfilled our criteria of clinical remission, whereas 49 (18%) patients were non-responders. Compared to patients who obtained a clinical response, patients with clinical remission were more likely to be male (71% vs. 48%), have disease duration less than 10 years (47% vs. 29%), have higher baseline blood eosinophils (0.48 vs. 0.32 × 10 9 /L), and higherimmunoglobulin E levels (231 vs. 136 kUA/L). Conclusion: A majority of patients obtained a clinically significant response. Clinical remission was predicted by shorter disease duration, and higher levels of T2 biomarkers; further studies are required to assess whether timing of biological treatment is crucial for better long-term outcomes.

Characteristics and outcomes of patients with severe asthma treated with biologics, stratified according to baseline FEV1: the nationwide Danish Severe Asthma Registry (DSAR) Background: To our knowledge, there is limited evidence on whether the effect of biological treatment of severe asthma could depend on baseline FEV1. We hypothesized that real-life severe asthma patients with FEV1 ≤60% predicted have different characteristics and a poorer response to treatment. Methods: The Danish Severe Asthma Registry (DSAR) consists of all patients initiating treatment with biologics in Denmark since 2017. We studied baseline characteristics of patients with FEV1 ≤60% or >60%, differences in exacerbation rates and use of maintenance oral corticosteroids (mOCS), as well as secondary outcomes of symptoms and levels of inflammatory biomarkers (blood eosinophils, total immunoglobulin E, FeNO) at 12 months of follow-up. Results: Of 584 patients included, 197 (34%) had FEV1 ≤60% and 387 (66%) had FEV1 >60%. Patients with FEV1 ≤60% were older, had a longer disease duration and more pack-years, were more symptomatic, and had a higher prevalence of bronchiectasis, but less with allergic rhinitis and nasal polyposis at baseline. Surprisingly, patients with FEV1 ≤60% had a similar reduction in exacerbation rate (3.30-0.73 vs. 3.05-0.76, p = 0.37) and reduction in use of mOCS (27-12% vs. 30-13%, p = 0.67), and similar effect on symptoms and levels of inflammatory biomarkers after 12 months. Conclusion: In patients with severe asthma treated with biologics, stratified by FEV1, we found important baseline differences. Surprisingly, in patients with FEV1 ≤60% the effect of biologics on exacerbations, use of mOCS, and symptoms seemed similar at 12 months of follow-up.

The impact on number of hospitalizations and length of hospital stay for patients with advanced COPD affiliated with a cross-sectorial lung team Birgit Refsgaard a,b , Lotte Rodkjaer a,b , Vibeke Bregnballe b and Anders Løkke c,d a Aarhus University Hospital, Aarhus, Denmark; b Aarhus University, Aarhus, Denmark; c Vejle Hospital, Vejle, Denmark, d University of Southern Denmark, Odense, Denmark Background: As the severity of chronic obstructive pulmonary disease (COPD) advances, the risk of hospitalization due to acute exacerbations of COPD (AECOPD) becomes more frequent, and often it leads to hospitalization. The aim of this study was to investigate the effect of affiliation with a cross-sectorial lung team (lung team) on number of hospitalizations and length of hospital stay in patients with advanced COPD. Methods: In the study period 2017-2020, a randomized controlled trial was conducted. The patients were randomized to affiliation with the lung team for receiving usual care. They were included for 1 year. In case of worsening in respiratory symptoms, patients affiliated with the lung team were able to contact the team day and night. The lung team offered acute home visits and was able to initiate home treatment. The lung team consisted of respiratory nurses from the hospital and community nurses. Patients receiving usual care contacted the general practitioners, doctors on call or emergency service in case of any worsening in respiratory symptoms. The patients had to have FEV1 <50% predicted and have ≥ one severe or two moderate AECOPD events within a year. In total, 56 patients were affiliated with the lung team (Mean: age 71.6 years, FEV1 37%) and 57 patients received usual care (Mean: age 71.5 years, FEV1; 34%). Results: On average, patients affiliated with the lung team had fewer hospitalizations due to AECOPD than patients receiving usual care (lung team: 0.59 (95% CI; 0.35-0.83), usual care: 1.86 (95% CI; 1.12-2.20) (p = 0.002)). On average, patients affiliated with the lung team had shorter length of hospital stay due to AECOPD (lung team: 3.27 (95% CI; 2.39-4.15), usual care: 4.47 (95% CI; 3.70-5.24) (p = 0.045)).

Conclusions: Affiliation with the cross-sectorial lung team reduced both number of hospitalizations and length of hospital stay due to AECOPD compared to usual care.

Productive vs non-productive chronic cough associated with worse lung health and higher morbidity and mortality in the general population Background: Whether productive or non-productive chronic cough is worse in the general population is unknown. We tested the hypothesis that productive vs non-productive chronic cough is associated with worse lung health and higher morbidity and mortality in the general population. Methods: We included 44,436 random adults from the Copenhagen General Population Study and defined productive chronic cough as a cough lasting more than 8 weeks with mucus production during the day as long as 3 consecutive months a year. We investigated differences in lung function, accompanying respiratory symptoms, morbidity, and mortality. Results: Among 44,436 individuals, 1416 (3%) had productive chronic cough and 1380 (3%) nonproductive chronic cough. Individuals with productive vs non-productive chronic cough had lower lung function (FEV1 88% vs 95% predicted, FVC 97% vs 101% predicted, and FEV1/FVC 0.72 vs 0.75), and more often accompanying respiratory symptoms (dyspnoea 5% vs 3% and wheezing 53% vs 29%), gastroesophageal reflux disease (36% vs 28%), and diabetes (11% vs 7%), and higher levels of inflammatory biomarkers in blood at baseline examination. Individuals with productive chronic cough vs controls had adjusted hazard ratios (HRs) of 7.2 (95% confidence interval: 4.3-12) for COPD exacerbation, 2.9 (2.2-3.8) for pneumonia, and 2.1 (1.6-2.6) for all-cause mortality. Corresponding Background: Asthma medication adherence is of crucial importance for successful disease management. The aim of this study was to identify and rank factors associated with medication adherence among adults with asthma in the general population. Methods: We used data on physician-diagnosed asthma, medication adherence, and factors associated with asthma medication adherence from the Danish General Suburban Population Study. We ranked factors associated with asthma medication adherence based on magnitude of odds ratios, and the population attributable fractions. Results: Among 20,032 individuals from the general population, 1,128 (6%) suffered from asthma and 822 (73%) of these were adherent to asthma medications. Based on odds ratios, the three top-ranked factors associated with asthma medication adherence were asthma attacks within the past year (4.0; 95% CI: 2.9-5.5), allergy medication use (3.8; 2.6-5.6), and age above median (3.4; 2.4-4.7), followed by asthma severity markers like airway obstruction and coughing with mucus. Based on population attributable fractions, the three top-ranked factors associated with adherence to asthma medications were asthma attacks within the past year (70%), age above median (57%), and use of allergy medication (49%).

The study showed that in the general population, recent asthma attacks, higher age, and taking allergy medication were the three most important factors associated with asthma medication adherence.

The importance of maintaining adherence to asthma medications even in the absence of severe disease or expressed asthma symptoms should be better communicated to the general population. Background: Inhaled corticosteroids (ICS) are associated with an increased risk of clinical pneumonia among patients with chronic obstructive pulmonary disease (COPD). It is unknown whether the risk of microbiologically verified pneumonia such as pneumococcal pneumonia is increased in ICS users.

The study population consists of all patients with COPD followed in outpatient clinics in eastern Denmark during 2010-2017. ICS use was categorized into four categories based on accumulated use. A Cox proportional hazard regression model was used adjusting for age, body mass index, sex, airflow limitation, use of oral corticosteroids, smoking, and year of cohort entry. A propensity score-matched analysis was performed for sensitivity analyses. Findings: A total of 21,438 patients were included. Of these patients, 582 (2.6%) acquired a positive lower airway tract sample with S. pneumoniae during follow-up. In the multivariable adjusted analysis, ICS-use was associated with a dose-dependent risk of S. pneumoniae as follows: low ICS dose: HR 1.11, 95% CI 0.84 to 1.45, p = 0 · 5; moderate ICS dose: HR 1.47, 95% CI 1.13 to 1.90, p = 0.004; high ICS dose: HR 1.77, 95% CI 1.38-2.29, p < 0.0001. Sensitivity analyses confirmed these results. Conclusion: Interpretation use of ICS in patients with severe COPD was associated with an increased and dosedependent risk of acquiring S. pneumoniae, but only for moderate and high dose. Caution should be taken when administering high dose of ICS to patients with COPD. Low dose of ICS seemed not to carry this risk.

Kristina Kock Hansen, Kirse Bock, Anders Løkke and Ole Hilberg Sygehus Lillebaelt, Vejle Sygehus, Vejle, Denmark Background: Tularemia, known as rabbit fever, is a rare zoonotic disease caused by the bacteria Francisella tularensis. It can be transferred to humans via vector bites, direct contact with infected animals, consumption of contaminated water or food, or inhalation of aerosols.

Case 1: In October 2020, a 43-year-old woman (gardener and smoker) was admitted to hospital with pneumonia, fever, headache, skin rash, low back pain, and a nasal septum wound. She was treated with piperacillin/tazobactam. The symptoms, however, did not improve.

After 2 weeks, computed tomography and positron emission tomography-computed tomography displayed enlarged mediastinal lymph nodes and suspicious infiltrative changes.

An endoscopic bronchial ultrasound (EBUS) was performed 4 weeks after hospitalization. EBUS was without signs of cancer, molds, or bacteria. The lymph nodes revealed necrotic granulomas. Two weeks later, serological tests for F. tularensis antibodies were positive. Doxycycline treatment improved her clinical condition. The patient's nasal septum was necrotic, and an operation was required.

Case 2: In November 2020, a 42-year-old man with a medical history of rheumatoid and psoriatic arthritis presented with fever, fatigue, and lymphadenopathy in thorax. C-reactive protein and leukocytes were normal, and malignancy was not found. One month later, the patient was diagnosed with necrotizing granulomatous inflammation in the lymph nodes. In January 2021, serology tests for F. tularensis were positive. Although almost asymptomatic, the patient was treated with ciprofloxacin.

Both patients recovered completely. Conclusion: Although rare, F. tularensis should be kept in mind in the diagnostic workup for unexplained lung infiltrates.

Krefting Research Centre, University of Gothenburg, Gothenburg, Sweden Background: Incidence and clinical outcomes of COVID-19 appear to differ between allergic and non-allergic asthma, but evidence for other asthma phenotypes, such as obesity-related asthma, is scarce. We sought to determine whether pre-COVID-19 obesityrelated asthma phenotypes are associated with risk of COVID-19 incidence in a Swedish populationrepresentative adult cohort. Method: Clinical examination data from 2,006 subjects aged 16-75 years collected during 2009-2012 were linked to register data of COVID-19 diagnosis, based on real-time polymerase chain reaction or ICD-10 codes set by clinicians. Obese asthma was defined as current asthma and body mass index ≥30 kg/m 2 . Allergic obese asthma was further based on sensitization to any aeroallergen measured by specific immunoglobulin E.

Results: In total, 344 (17.1%) of the subjects had COVID-19. After adjustment for gender, age, allergy history, farm childhood, urbanization, dust exposure, smoking, education, and occupation, there was no association between having allergic obese asthma (adjusted risk ratio (aRR) 0.92, 95% CI 0.63-1.34), non-allergic obese asthma (aRR 0.94, 95% CI 0.68-1.29), or any obese asthma (aRR 0.93, 95% CI 0.72-1.19), and getting COVID-19. Stratifying by gender and age produced similar results. Conclusion: We found no association between pre-COVID-19 obesity-related asthma phenotypes and being diagnosed with COVID-19. Further analyses are needed regarding long-term outcomes and disease severity of COVID-19 in relation to obesity-related asthma phenotypes. Background: Previous studies have indicated that asthma phenotypes may play a role in the risk of COVID-19 infection and disease severity, but generalizable data with pre-COVID-19 assessment of asthma are scarce. We examined the relationship between asthma phenotypes and susceptibility of COVID-19 in a population-representative adult cohort from Sweden. Method: Register data on COVID-19 diagnosis based on real-time polymerase chain reaction or ICD-10 codes set by clinicians were linked to clinical data collected in 2012 of subjects aged 16-75 years. The definition of allergic asthma was based on atopy assessed by measurements of specific immunoglobulin E or skin prick test. Multi-symptom asthma was defined as physician-diagnosed asthma with ≥4 signs of active asthma. Results: In total, 878 subjects with current asthma underwent the clinical investigation, of which 166 (18.9%) had COVID-19. Ninety-eight (59%) of these had pre-COVID-19 allergic asthma and 47 (28.3%) had multi-symptom asthma. After adjustment for gender, age, body mass index, allergy history, farm childhood, urbanization, dust exposure, smoking, education, and occupation, there was no association between allergic asthma and COVID-19 infection (adjusted risk ratio (aRR) 1.02, 95% CI 0.76-1.37) or non-allergic asthma and COVID-19 infection (aRR 0.98, 95% CI 0.73-1.32). Multi-symptom asthma was also not associated with COVID-19 infection (aRR 1.29, 95% CI 0.96-1.76).

Conclusion: We found no association between having allergic, non-allergic, or multi-symptom asthma, and being diagnosed with COVID-19. Further analyses are needed to assess the relationship between asthma phenotypes and disease severity in patients with COVID-19. Background: Both asthma and COPD may have a relation to occupational exposure. In particular, occupational exposure in manual occupations has been linked with earlier mortality. Aim: To explore differences in mortality between different obstructive respiratory diseases together with an estimated occupational exposure with the use of a large, randomized population-based cohort. Methods: This study included 6062 individuals from the FinEsS-Helsinki study with 1014 deaths during a 24-year follow-up. We applied a Jobexposure Matrix to an occupational categorization to estimate an occupational exposure to airborne particles. The individuals were divided into groups according to their self-reported physician diagnosed asthma, COPD, or the combination of both, or without asthma or COPD, and combined with the exposure estimation. The survival model was adjusted for age, education level, sex, and tobacco smoking status, and used healthy without exposure as reference. Results: High occupational exposure together with asthma 2.06 (95% CI, 1.19-3.57), COPD 4.44 (2.62-7.53) and both diagnoses combined 8.79 (4.51-17.1), had the highest hazard ratios (HR) in in the crude model. High exposure alone had HR 1.93 (1.62-2.31). In the adjusted model, the HRs were as follows: asthma 1.71 (0.93-3.12), COPD 1.80 (1.00-3.25), combined 1.94 (1.10-3.42), and high exposure alone 1.35 (1.11-1.63). The combined group also showed a sub-hazard ratio for respiratory mortality 7.21 (3.92-13.3). Conclusions: High occupational exposure alone increases overall mortality but not respiratory related, while the combination of asthma and COPD carries the highest hazard of overall and respiratory mortality. Background: Studies have shown improved lung function after initiation treatment with cystic fibrosis transmembrane conductance regulator modulators and patient experience improved physical capacity. The aim of this study was to investigate change in exercise capacity after initiation of lumacaftor/ivacaftor and tezacaftor/ivacaftor treatment (LUM/IVA, TEZ/IVA). Methods: We performed a single-group prospective observational cohort study with follow-up at 6 and 12 months. The study examined change in exercise capacity in people with cystic fibrosis initiating treatment with LUM/IVA and TEZ/IVA, measured by cardiopulmonary exercise testing. Primary outcomes were change in VO2peak and maximal workload. Results: We included 91 patients. The mean change in VO 2 peak and maximum workload from baseline to 12months follow-up was 145.7 (91.2;200.2) ml/min and 14.2 (95% CI 9.1;19.2) watt. Conclusions: Patients improved their exercise capacity by a statistically significant increase in VO2peak and maximal workload 12 months after initiation of treatment with LUM/IVA and TEZ/IVA.

Severe α1-antitrypsin deficiency is associated with increased risk of heart failure: nationwide and cohort studies 9 years of follow-up. We validated our findings in a nationwide cohort of 2,209 patients with AATD and 21,871 controls without AATD matched on birthday, sex, and municipality. There was no overlap between the two study cohorts. Results: Persons with severe AATD had an increased risk of heart failure hospitalization during follow-up compared with individuals without AATD (HR adjusted: 2.38, 95% CI: 2.03-2.79). In the nationwide cohort study, patients with severe AATD also had a higher risk of heart failure hospitalization compared with individuals without this condition (HR adjusted: 1.77, 1.14-2.74). The risk of heart failure hospitalization was attenuated but remained significant among patients with myocardial infarction (HR adjusted: 1.49, 1.08-2.06), atrial fibrillation (HR adjusted: 1.42, 1.07-1.89) and hypertension (HR adjusted: 1.67, 1.29-2.16). Risk of heart failure death or all-cause mortality during follow-up was higher in individuals with severe AATD compared with individuals without AATD (heart failure death: HR adjusted: 2.14, 1.47-3.11; allcause mortality: HR adjusted: 3.04, 2.79-3.30). Conclusions: Individuals with severe AATD have an increased risk of heart failure admission and death due to heart failure in the Danish general population.

Severe α1-antitrypsin deficiency associated with lower blood pressure and reduced risk of ischemic heart disease: a cohort study of 91,540 individuals and a meta-analysis Background and Aims: Increased elastase activity in α1-antitrypsin deficiency may affect elasticity of the arterial walls, and thereby blood pressure and susceptibility to cardiovascular disease. We hypothesized that severe α1-antitrypsin deficiency i sassociated with reduced blood pressure and susceptibility to cardiovascular disease. Methods: We genotyped 91,353 adults randomly selected from the Danish general population and 187 patients from the Danish α1-Antitrypsin Deficiency Registry and recorded baseline blood pressure, baseline plasma lipids, and cardiovascular events during followup. In total, 185 participants carried the ZZ genotype, 207 carried the SZ genotype, and 91,148 carried the MM genotype.

Results: α1-Antitrypsin deficiency was associated with decreases in blood pressure of up to5 mmHg for systolic blood pressure and up to 2 mmHg for diastolic blood pressure, in ZZ vs SZ vs MM individuals (trend test, Ps ≤0.01). Plasma triglycerides and remnant cholesterol were reduced in ZZ individuals compared with MM individuals (t-test, Ps <0.001). α1-Antitrypsin deficiency was associated with lower risk ofmyocardial infarction (trend test P = 0.03), but not with ischemic heart disease, ischemic cerebrovascular disease or hypertension (trend test, Ps ≥0.59). However, when results for ischemic heart disease were summarized in meta-analysis with results from four previous studies, individuals with versus without α1-antitrypsin deficiency had an odds ratio for ischemic heart disease of 0.66 (95%CI: 0.53-0.84). Conclusions: Individuals with severe α1-antitrypsin deficiency have lower systolic and diastolic blood pressure, lower plasma triglycerides and remnant cholesterol, reduced risk of myocardial infarction, and a 34% reduced risk of ischemic heart disease. Background: Nicotine use and alcohol have long been known to go hand in hand. Approximately 70% of alcoholics are heavy smokers (more than 20 cigarettes per day), compared to 10% of the general population. Tobacco smoking is the main cause of COPD. This study aims to describe the risk of hospital admission and 1-year mortality rate in COPD patients with alcohol abuse (COPDA) defined as more than 7/14 drinks/ week for women and men, compared to patients with alcohol consumption (COPDB) less than 7/14 drinks/ week. Methods: A retrospective cohort study including 675 patients admitted with acute exacerbations of COPD (AECOPD) in 2018. Outcomes were comparison in demographics, difference in readmission within 30 days, number of readmissions within 12 months, and risk of death after baseline admission with AECOPD. Binominal logistic regression was conducted for the statistical analysis. Furthermore, adjustments were made for the following co-variants: age, sex and number of comorbidities. An independent t-test was used to compare the co-variant means between the two groups Results: In total, 76 patients identified as COPDA and 599 as COPDB were included. In total, 64% (49/76) vs 42% (253/599) were male, with a mean age of 71 years. vs 79 years (p = 0.001) in COPDA and -B, respectively. No differences were found in 30-day readmission (p = 0.195, 95% CI = 0.797-3.05) or the number of readmissions within 12 months (p = 0.079, 95% CI = 0.45-1.82). Patients in the COPDA group had a significantly higher risk of death than patients with no alcohol abuse did, OR = 1.965 (95% CI = 1.15-3.36) (p = 0.014). Conclusion: Patients with alcohol abuse admitted for AECOPD were significantly younger. Patients with an alcohol consumption above 7/14 drinks/week have a significantly higher mortality risk. No differences were found between the two groups according to 30days' and 12 months' readmission. Background and Aim: Female asthma is associated with higher need for fertility treatment compared to healthy controls. Furthermore, anxiety and depression have been shown to be common comorbidities in asthma patients. This study aims to investigate symptoms of anxiety and depression in asthmatic women undergoing fertility treatment. Methods: Asthmatic women (positive asthma test) were recruited from fertility clinics in Eastern Denmark underwent clinical examination, measurements of lung function, and fractional exhaled nitric oxide. Anxiety and depressive symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS). A score greater than 7 in both the HADS-A and HADS-D subscale was defined as anxiety or depression. Data were analysed using SPSS statistical software version 28. Results: Eighty-six women (mean age 31.7 (4.7) years and mean body mass index 25.8 (4.7) kg/m 2 ) were evaluated. And, 60.5% (n = 52) had a positive skin prick test, 12.8% (n = 11) were current smokers, and 20.9% (n = 18) were former smokers. Mean values for lung function parameters were within the reference range and mean FeNO was 16.8 ppb (13.1), and 24.4% had an ACQ-5 score greater than 1.5, i.e. uncontrolled asthma. The mean HADS-A and HADS-D score was 6.02 (3.59) and 2.62 (2.28), respectively. Twenty-five patients (29.1%) had anxiety, whereas 3 (3.5%) had depression (all 3 with concomitant anxiety). Stratified according to asthma control (ACQ-5 score >/≤1.5), 42.9% of the women with uncontrolled asthma had anxiety compared to 24.6% of those with wellcontrolled asthma (p = 0.109).

Our study suggests that symptoms of anxiety are common among women with asthma undergoing fertility treatment, whereas depression is less prominent in this group.

Smoking is a predictor of complications in all types of surgery: a machine learning-based database study Background and Aims: Machine learning algorithms (MLAs) are promising tools for smoking status classification in large patient data sets. Smoking is an established risk factor for postoperative complications in major surgery. Whether this applies to all types of surgery on a population level remains to be determined. Our study aim was to develop an MLA for smoking status classification, and determine whether smoking and former smoking predict complications in all types of surgery. Methods: This retrospective cohort study lasted from January 2015 to December 2019. We included all types of surgical procedures performed in the HUS (Helsingin ja Uudenmaan sairaanhoitopiiri) hospital district in southern Finland, retrieving data from the HUS Tietoallas database. Exclusion criteria were age below 16, unknown smoking status and unknown ASA (American Society of Anesthesiologists) class. The main outcome was complications occurring within 90 days after surgery. Secondary outcomes were complications occurring within 90 days after surgery in the orthopedic surgery and gastroenterological surgery subgroups. Results: The MLA had the precisions 0.958 for smokers, 0.974 for ex-smokers, and 0.95 for never-smokers. The sample included a total of 156,185 surgeries. Of the patients, 45,044 (28.8%) were current smokers, 22,867 (14.6%) ex-smokers, and 88,274 (56.5%) neversmokers. After adjustment for covariates, current smokers had increased odds of complications in all surgeries (OR 1.17,□95% CI 1.14-1.20□), orthopedic surgery (OR 1.33, □95% CI 1.23-1.44□) and gastroenterological surgery (OR 1.21, □95% CI 1.13-1.29□). Exsmokers only had increased odds of complications in all surgeries (OR 1.11, □95% CI 1.07-1.14□). On assessment of relative variable importance, ASA class was the most important predictor. Conclusions: Utilization of an MLA for smoking status classification appears feasible in large surgical data sets. Current smoking and, to a lesser extent, former smoking predict complications in all types of surgery. Cooperation between smoking cessation clinics and surgical units could be a future goal.

Background: Patients with chronic obstructive pulmonary disease (COPD) are at risk of progressive muscle mass reduction, but it is unclear whether there is a relationship between thoracic muscle mass and static lung volume. Aim: To investigate whether there is an association between thoracic muscle mass and static lung volume in patients with COPD. Methods: An observational study based on outpatients with stable COPD, who received a body plethysmography and high-resolution thoracic computed tomography (HRCT). Skeletal muscle tissue with Hounsfield units between −29 and +150 was segmented on an axial HRCT image at the first slice above the aortic arch using in-house software. Measures of skeletal muscle area were reported as cumulated heightadjusted skeletal muscle index (SMI, cm 2 /m 2 ), thus excluding the intercostal muscle. Baseline values were reported as median (interquartile range). Linear regression analysis was applied for SMI with the total lung capacity (TLC), residual volume (RV), inspiratory capacity/TLC ratio (IC/TLC) corrected for gender. Results: In total, 42 patients were included (21 male/21 female), age of 65 (61-69) years, SMI 56.8 cm 2 /m 2 (49.4-66.3 cm 2 /m 2 ), TLC 115.5% (105-122%), RV 160.5% (133-195%), IC/TLC .815 (.695-.991). SMI had a negative linear relationship with TLC (adj R 2 = .441) and RV (adj R 2 = .416) and a positive linear relationship with IC/TLC ratio (adj R 2 = .436) (all p-values = <.0001). Conclusion: This pilot study indicates that there is a significant linear association between the skeletal muscle measure SMI and the static lung volumes in patients with COPD. Static lunge volumes may help to identify patients with reduced muscle mass. However, further studies are needed.

This abstract is submitted for ERS 2022.

is a common comorbidity in severe asthma (SA) associated with more exacerbations and poor symptom control. Biologics have a greater effect in asthma with high levels of type 2 biomarkers; a typical feature in patients with co-existing CRS with or without nasal polyposis (NP). Our aim was to investigate the impact of co-existing CRS on the effect of biologics on asthmaand CRS-related outcomes in patients with SA. Methods: Prospective data from the nationwide Danish Severe Asthma Register were analysed (N = 493). Patients with and without comorbid CRS (including subgroups with and without NP) were compared at baseline, while the effect of treatment expressed as change in asthma-related (ACQ, exacerbation rate, FEV₁, oral corticosteroid (OCS) dose, and blood eosinophils) and CRS-related (SNOT-22 score) outcomes was assessed at 12 months after initiation of anti-IgE, anti-IL5/IL5R or anti-IL4/13 R treatment. Results: Of the 493 bionaive patients, 266 (54%) had coexisting CRS. Compared to patients without CRS, patients with CRS experienced a larger median OCS reduction (from 11.25 (10.00-17.50) to 9.25 (5.00-10.00) mg vs. from 10.00 (7.50-10.00) to 10.00 (5.00-10.00) mg, p = 0.01) and median blood eosinophil reduction (from 0.40 (0.18-0.65) to 0.08 (0.04-0.14) × 10 9 /L vs. Background: The respiratory symptoms, sleep quality, and non-invasive ventilation (NIV)-related side-effects (S 3 -NIV) questionnaire is a recently developed questionnaire for evaluating patient-centered outcomes in stable COPD patients in long-term home NIV treatment 1 . It has 11 items and was originally developed in English (UK). Objectives: The objective of this study was to translate the S 3 -NIV into Danish, using established methodology.

The following translation method (linguistic validation) was used: (1) In-depth analysis of the original (i.e. concept definition) by two independent translators and suggestion of translation alternatives;

(2) Pilot study in home-NIV-treated COPD patients and re-evaluation of the initial S 3 -NIV Danish version;

(3) Forward/backward translation; and (4) Review by a clinician. Results: Six patients with NIV-treated COPD provided feedback on the translation. There were no issues concerning the statements, but the distinction between the possible answers in the Danish translation led to reconsideration. The initial English translation of 'mostly untrue' and 'completely untrue' to the Danish 'sjaeldent rigtigt' and 'aldrig rigtigt' was changed to 'sjaeldent' and 'aldrig'. The backward translation process did not reveal any significant linguistic issues, nor did the clinical review lead to any concerns. Conclusion: The translation of S 3 -NIV into Danish followed a rigorous methodology, including patient feedback. This translation is conceptually equivalent to the original questionnaire and can be used for further validation and studies in Danish-speaking COPD-patients, treated with home-NIV. 1.Dupuis-Lozeron E et al. Development and validation of a simple tool for the assessment of home non-Sex differences in associations of environmental exposure with respiratory health have been observed, but results are not conclusive. This study investigated the associations of exposure to air pollution and greenness with natural-cause mortality in men and women in Northern Europe.

We studied 10,011 participants in the third Respiratory Health in Northern Europe (RHINE III) study in 2010 (age 40-65 years), with exposure to air pollution and greenness in the 20 years before , and with mortality (n = 368) follow-up until 2021. Cox proportional hazard models were used to estimate the associations of long-term particulate matter (PM2.5 and PM10), black carbon (BC), nitrogen dioxide (NO 2 ), ozone (O 3 ), and greenness (normalized difference vegetation index (NDVI)) with mortality, adjusting for body mass index, smoking, education, marital status, and serious respiratory infection before 5 years old. The analyses were done separately for men and women.

The overall mean levels of air pollutants were far below the European Union (EU) standards. In single pollutant models, for women, the adjusted hazard ratios (HRs) of natural-cause mortality were 1.10 (95% confidence interval (CI): 1.06, 1,.15), 1.04 (95% CI: 1.01, 1.07), 2.99 (95% CI: 1.87, 4.77), 1.03 (95% CI: 1.01, 1.05) and 0.95 (95% CI: 0.93, 0.98) per 1 μg/m3 increase in PM2.5, PM10, BC, NO2 and O3, respectively. No significant associations were observed Background: Complement C3, the central component of the complement system, has been suggested to play a role in asthma pathogenesis and severity. We aimed to explore the association between C3-levels in small airways, the level of small airway impairment and asthma control. Methods: 20 subjects with asthma and 10 healthy controls were examined with spirometry, multiple breath washout (MBW) and the PExA® method, which samples small airway lining fluid in the form of exhaled particles. Samples were analysed with the SOMAscan proteomics platform. Subjects with asthma filled out the Asthma Control Questionnaire (ACQ). Results: Subjects with ACQ score >1 had a significantly higher abundance of C3 as compared to subjects with ACQ score ≤1 (FC = 1.38, p = 1.14E-4) and healthy controls (FC = 1.18, p = 0.042). Subjects with asthma were divided into tertiles based on the C3 abundance and comparison revealed that those with the lowest (T1) and the highest (T3) C3 abundance had lower FEF25-75 z-score (T1-T2: p = 0.022; T3-T2 : p = 0.022) and higher LCI (T1-T2: p = 0.035; T3-T2: p = 0.035) as compared to those in the median tertile (T2). Subjects in T3 also had a higher Sacin z-score (p = 0.022), hsCRP (p = 0.022), and ACQ score (p = 0.008) as compared to T2. Conclusions: We observed that both high and low levels of C3 in the lining fluid were associated with small airway impairment in asthma. Furthermore, high levels of C3 were associated with more systemic inflammation and less asthma control. These findings m 2 (8.1-12.1 cm 2 /m 2 ), TLC 115.5% (105-122%), RV 160.5% (133-195%), and IC/TLC ratio .815 (.695-.991). PMI had a negative linear relationship with TLC (adj R 2 = .258, p = .0011) and RV (adj R 2 = .214, p = .0034) and a positive linear relationship with IC/TLC (adj R 2 = .171, p = .0098). Conclusion: A linear association was seen between PMI and static lung volumes in patients with COPD, indicating that static lung volumes may be used to predict patients with low PMI. However, further studies are needed.

1 Background: The most recent guideline on acute pulmonary embolism from the European Society of Cardiology indicates possible long-term sequelae such as dyspnoea and chronic thromboembolic pulmonary hypertension after a pulmonary embolism event. However, the effects on lung function or asthma risk have not been evaluated previously in the general population. Methods: We tested whether individuals with a venous thromboembolism have reduced lung function, or greater risk of dyspnoea and asthma using data from 21,205 random adults from the Danish General Suburban Population Study. Results: Prevalence of pulmonary embolism, deep vein thrombosis, and venous thromboembolism were 0.60, 1.7, and 1.9%, respectively. Individuals with pulmonary embolism or deep vein thrombosis versus individuals without venous thromboembolism had reduced FEV1% predicted (86 and 89% versus 95%, t-test: P < 0.001) and FVC% predicted (92 and 94% versus 99%, P < 0.001). Individuals with venous thromboembolism versus those without had adjusted odds ratios for light, moderate, and severe dyspnoea of 1.6 (95% CI: 1.1-2.2), 1.8 (1.2-2.6), and 2.6 (1.8-3.8), respectively. Individuals with venous thromboembolism versus those without had adjusted odds ratios for asthma and use of asthma medication of 1.6 (1.2-2.2) and 1.9 (1.4-2.6), respectively. Adjusted odds ratios of asthma in individuals with versus without venous thromboembolism, stratified in those who received treatment and no treatment with anticoagulants, were 1.0 (0.6-1.6) and 2.0 (1.4-3.0), respectively.

The results show that individuals with venous thromboembolism have worse lung function and higher risks of severe dyspnoea and asthma in the general population. Background and Aims: Vitamin K activates vitamin K-dependent proteins or Gla proteins by a process called γ-carboxylation. The most well-described Gla proteins are coagulation factors. However, other Gla proteins, such as the Matrix Gla Protein (MGP) may also exert important functions. MGP is present in various tissues, including lung tissue. The inactive form of MGP dephosphorylated-uncarboxylated MGP (dp-ucMGP) has been associated with elastin degradation in lungs of patients with chronic obstructive pulmonary disease (COPD), and it has been associated with COVID-19 mortality. Dp-ucMGP has been proposed as a biomarker of functional vitamin K status. We aim to assess the association between functional vitamin K levels and lung function to elaborate on vitamin K's role in lung diseases.

Methods: In a cohort, representative of the Danish general population, the DanFunD study, we will assess the association between functional vitamin K status (reflected by dp-ucMGP plasma levels) and lung function. The 4,096 participants were examined between 2017 and 2020 with a general health examination, questionnaires, spirometry, step test, and blood and urine samples. Using linear regression models, we estimate the association between dp-ucMGP and continuous measurements of lung function. Furthermore, in multiple logistic regression models, we estimate the association between dp-ucMGP and dichotomous outcomes of respiratory symptoms. Results: Preliminary crude analyses suggest that higher levels of dp-ucMGP are associated with having an FEV1 below 80% of the expected value. Conclusions: Results will be presented at the Nordic Lung Congress. Background and Aims: Dupilumab, a human anti-IL -4Rα mAb, blocks interleukin-4/-13 signaling, key and central drivers of type 2 inflammation. This post-hoc analysis evaluated lung function in QUEST (NCT02414854) patients enrolled in TRAVERSE (NCT02134028). Methods: We analyzed mean change [SD] from QUEST parent study baseline (PSBL) in pre-BD FEV1, FEF25-75%, and FVC in patients with type 2 asthma (baseline blood eosinophils ≥150 cells/µL or FeNO ≥25 ppb) who received dupilumab (dupilumab/dupilumab) or placebo (placebo/dupilumab) during QUEST and dupilumab 300 mg q2w for 96 weeks in TRAVERSE. Results: Mean change from PSBL in FEV1 among 364 dupilumab/dupilumab-treated patients was sustained throughout TRAVERSE (0.35[0. 48]L at Wk96). Similar sustained improvements were observed for FEF25-75% (0.41[0. 64]L/s at Wk96) and FVC (0.29 [0. 51]L at Wk96). Upon dupilumab initiation, 185 placebo/dupilumab-treated patients achieved mean change improvements from PSBL in FEV1 (0.37[0.44] L at Wk96), FEF25-75% (0.42[0. 54]L/s at Wk96), and FVC (0.30[0. 49]L at Wk96). Conclusions: Dupilumab demonstrated clinically meaningful lung function improvements that were sustained for up to 3 years in a population with type 2 inflammatory asthma. 

Cincinnati Children's Hospital Medical

add-on dupilumab every 2 weeks (q2w) demonstrated significant improvements in percent predicted (pp) pre-bronchodilator (BD) FEV1 vs placebo at Week (Wk) 12 in children aged 6-11 years with uncontrolled, moderate-to-severe asthma and a type 2 inflammatory asthma phenotype (defined as blood eosinophils ≥150 cells/μL or FeNO ≥20 ppb at BL). We now report effects on additional lung function parameters

Similar benefits were seen in post-BD FEV1

Additionally, dupilumab vs PBO improved post-BD FEV1pp (BL mean

] for placebo/dupilumab; Wk52 LS mean difference

Conclusions: Dupilumab led to significant, rapid, and sustained improvements in lung function

Background: Progressive muscle mass reduction is common in patients with COPD, as COPD worsens. The pectoralis muscle mass (PMM) is associated with increased risk of mortality in large COPD cohorts. However, whether there is an association between the PMM and the static lung volumes is uncertain. Aim: To investigate whether there is an association between the PMM and the static lung volume. Method: A cross-sectional study including 42 stable outpatients with COPD investigated with body plethysmography and high-resolution computed tomography (HRCT). The first axial slice above the aortic arch of the HRCT was used to assess the pectoralis muscle. Segmentation was conducted by an in-house semiautomated software 'Viking slice ', and Hounsfield units (HU) between −29 and +150 HU was regarded as muscle tissue. Muscle measures were reported as height-adjusted pectoralis muscle index (PMI, cm 2 /m 2 ). Baseline data were reported as median (interquartile range). Linear regression was applied on PMI with the static lung volume, total lung capacity (TLC), residual volume (RV), and inspiratory capacity/TLC ratio (IC/TLC) corrected for gender. Background: Lipid A is the primary immunostimulatory center of the lipopolysaccharide (LPS). The inflammatory response of LPS varies, e.g. depending on the number of acyl chains in lipid A, which, in turn, depends on the bacterial species or strain. Traditional LPS quantification assays cannot distinguish between different lipid A producers, and therefore little is known about how bacteria of different inflammation potency affect lung inflammation. We aim to explore the association between oral bacteria exhibiting proinflammatory (hexa-acylated LPS) and less inflammatory (penta-acylated LPS) activity with fractional exhaled nitric oxide (FeNO). Methods: Findings are reported from the RHINESSA generally healthy adult cohort from western Norway (mean age: 28, range: 18-47 years; gender: 48% females). We applied the microbiome regressionbased kernel association test (MiRKAT) by using the Bray-Curtis distance as a single kernel, to test for associations between FeNO and composition of hexaor penta-acylated LPS-producing oral bacteria. We adjusted for gender, gum bleeding, smoking, any asthma attack, or use of asthma medication in the last 12 months, and asthma severity.Results: In total, 2.4 and 40.8% of the oral bacteria were hexa-and penta-acylated LPS-producers, respectively. The composition of hexa-acylated LPS-producers was significantly associated with increasing FeNO level regardless of covariate adjustment (p < 0.05). No association was observed between smoking, use of any asthma medication, asthma attack, or asthma severity, and the composition of hexa-acylated LPS-producers when modelled separately. No significant association was shown between the composition of penta-acylated LPSproducing oral bacteria and FeNO regardless of covariate adjustment. Conclusions: A strong association between FeNO and the composition of hexa-acylated LPS-producing oral bacteria was observed in a generally healthy adult cohort. It is likely that oral bacteria of high inflammation potency may reach the lungs through microaspiration or systemic dispersal and thereby induce lung inflammation. Background: Patients suffering frequent exacerbations of bronchiectasis (BE) are likely to experience more negative effects on quality of life (QoL) and more healthcare utilization. We aimed to study the mortality and predictive factors for poor survival in a cohort of Finnish BE patients. Methods: Non-cystic fibrosis BE patients of Helsinki University Hospital cohort were examined with chest high-resolution computed tomography. Finnish translation of the disease-specific quality of lifebronchiectasis (QoL-B) questionnaire was applied, and scores in the lowest quarter (25%) of the scale were considered to indicate poor QoL. The bronchiectasis severity index (BSI), FACED score, and modified Medical Research Council dyspnea scale were used. Results: Overall, 79% of 95 BE patients were women with mean age of 69 years (SD ± 13). High score of FACED (OR 1.9, 95% CI 1.2-3.1) and BSI (OR 1.2, 95% CI 1.0-1.4) were predictive for poor survival. In addition, high score of QoL-questionnaire results were protective for poor survival. Conclusion: In our cohort, none of the single variables were predictive for poor survival. Instead, bronchiectasis severity index or equivalent estimation for disease severity give more specific predictive values for survival. In our study, FACED was the strongest predictive tool.

Anna-Carin Olin, Alexander Holm, Per Larsson, Bengt Nellgård, Keti Dalla, Linus Schiöler and Nicolas Berguerand Sahlgrenska Akademin, Göteborg, Sweden Background: SARS-CoV-2 displays high affinity for ACE2 receptors as a vector of pathogenesis. ACE2 receptors are highly expressed on surfactant producing type 2 alveolar cells. These cells produce pulmonary surfactant -a crucial thin layer of surface-active fluid mainly composed of lipids, lining the alveolar epithelial surface. The main function, to reduce the surface tension, is fundamental for proper gas exchange. Aims and Objectives: To investigate changes in surfactant lipid composition and the relationship to longstanding symptoms of post Covid-19 among patients treated in intensive care for Covid-19 infection. Methods: We recruited 43 patients (17 women, aged 44-80 years) who had previously been treated in ICU in a major Swedish hospital, in average 6 months before inclusion. The participants answered a questionnaire regarding symptoms, we collected particles in exhaled air with PExA-instrument (PExA AB) and conducted pulmonary function tests, body plethysmography, and diffusion capacity of the lungs for carbon monoxide. Twenty-two healthy, non-infected, ageand gender-matched controls were enrolled. Lipids were analysed using liquid chromatography with a triple quadrupole mass spectrometer. Statistical analyses were performed with Qlucore.Results: Early results suggest a significant change in the composition of surfactant lipids among post-Covid -19 patients treated in intensive care compared to controls. Early analysis show significant reductions of all measured phosphatidyl-glycerols (PG, n = 14) an increase of all measured phosphatidyl-inositols (PI, n = 4), for example were PG 18:1_18:1 22% lower (p < 0.001, q = 0.04) and PI:16:0:18:1 67% higher (p < 0.001, q = 0.0003) in subjects post-Covid compared to controls.

Our findings suggest that surfactant composition is altered also in the recovery after Covid-19 infection, which could be a key component in the post-Covid syndrome and the lingering effects on the respiratory system. Objective: The aim of the study is to examine the association of percent predicted lung function with snoring and nocturnal gastroesophageal reflux (nGER) in a general population. Methods: We used data from the RHINESSA study (N = 955, 50% females) from Australia, Denmark, Estonia, Iceland, Norway, Spain, and Sweden. The mean age was 29 years (range, 18-53 years). Information on participant characteristics including habitual snoring and nGOR were assessed using structured questionnaires. Force expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were predicted according to GLI reference value and categorized into three groups, <90, 90-100, and >100%. Multinomial logistic regression was used to study the association between predicted lung function values (considering those who had FEV1 and FVC >100% predicted, respectively, as a reference group) with habitual snoring and nGER. Results: In total 542 participants (56%) reported neither snoring nor nGER, 124 (13%) reported nGER, 220 (23%) reported snoring, and 75 (8%) reported both snoring and nGER. Those who reported both snoring and nGER had higher age and body mass index (BMI) and were more likely to smoke as compared to those with neither condition. The odds ratio of reporting both snoring and nGER vs not having any was [8.5 (95% CI 2.6, 27,9)] times higher for the low predicted lung function (<90% predicted) compared to those with FVC >100% predicted, adjusting for age, gender, BMI, smoking, and study center. However, no association was observed between percentage predicted FEV1 category with snoring and nGER. Conclusion: Lower percent predicted FVC is associated with a higher prevalence of snoring and nocturnal gastroesophageal reflux in a general population. Background: Risk of future exacerbations in newly diagnosed patients with COPD can be difficult to predict. Our aim was to investigate the impact of a single moderate exacerbation on the odds of subsequent exacerbations and death in GOLD A patients. Methods: A cohort study based on data from the Danish national registers. We included all patients ≥40 years with an in-and/or outpatient ICD-10 J44 diagnosis (COPD Register, 2008 -2014 . Index was date of first registered modified Medical Research Council score 0-1; baseline period was 12 months pre-index. At index, patients were grouped as follows: A0, no exacerbation; and A1, one moderate exacerbation during the previous year, and followed for one year for moderate exacerbations (defined as short-term course of prednisolone/prednisone ± antibiotic) and severe exacerbations (emergency visit or hospitalization) and death. Using A0 as reference, a Cox model estimated the hazard ratio for exacerbation accounting for recurrent events. Multinominal logistic regression was used to estimate the odds ratio (OR) for exacerbation and death in GOLD A1. Results: In total, 7,191 patients (mean (SD) age 65.6 (10.2) years, 53.1% male) were included, of whom 3,958 had GOLD A0 and 3,233 had GOLD A1. During the 1-year follow-up, 59.6 and 44.9% of GOLD A0 and A1, respectively, had no exacerbations, whereas 40.4 and 55.1% of A0 and A1, respectively, had a severe path with moderate and/ or a severe exacerbations or death. In A1 patients,