Latest in Pulmonary News

Latest in Pulmonary News2019-02-15T07:28:32-05:00

Impact of Famotidine Use on Clinical Outcomes of Hospitalized Patients With COVID-19


Introduction: To compare outcomes in patients hospitalized with coronavirus (COVID-19) receiving famotidine therapy with those not receiving famotidine.

Methods: Retrospective, propensity-matched observational study of consecutive COVID-19-positive patients between February 24, 2020, and May 13, 2020.

Results: Of 878 patients in the analysis, 83 (9.5%) received famotidine. In comparison to patients not treated with famotidine, patients treated with famotidine were younger (63.5 ± 15.0 vs 67.5 ± 15.8 years, P = 0.021), but did not differ with respect to baseline demographics or preexisting comorbidities. Use of famotidine was associated with a decreased risk of in-hospital mortality (odds ratio 0.37, 95% confidence interval 0.16-0.86, P = 0.021) and combined death or intubation (odds ratio 0.47, 95% confidence interval 0.23-0.96, P = 0.040). Propensity score matching to adjust for age difference between groups did not alter the effect on either outcome. In addition, patients receiving famotidine displayed lower levels of serum markers for severe disease including lower median peak C-reactive protein levels (9.4 vs 12.7 mg/dL, P = 0.002), lower median procalcitonin levels (0.16 vs 0.30 ng/mL, P = 0.004), and a nonsignificant trend to lower median mean ferritin levels (797.5 vs 964.0 ng/mL, P = 0.076). Logistic regression analysis demonstrated that famotidine was an independent predictor of both lower mortality and combined death/intubation, whereas older age, body mass index >30 kg/m, chronic kidney disease, National Early Warning Score, and higher neutrophil-lymphocyte ratio were all predictors of both adverse outcomes.

Discussion: Famotidine use in hospitalized patients with COVID-19 is associated with a lower risk of mortality, lower risk of combined outcome of mortality and intubation, and lower levels of serum markers for severe disease in hospitalized patients with COVID-19.

Source: Mather JF, Seip RL, McKay RG. Impact of Famotidine Use on Clinical Outcomes of Hospitalized Patients With COVID-19 [published online ahead of print, 2020 Aug 26]. Am J Gastroenterol. 2020;10.14309/ajg.0000000000000832. doi:10.14309/ajg.0000000000000832

Pediatric SARS-CoV-2: Clinical Presentation, Infectivity, and Immune Responses


Objectives: As schools plan for re-opening, understanding the potential role children play in the coronavirus infectious disease 2019 (COVID-19) pandemic and the factors that drive severe illness in children is critical.
Study design: Children ages 0-22 years with suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection presenting to urgent care clinics or being hospitalized for confirmed/suspected SARS-CoV-2 infection or multisystem inflammatory syndrome in children (MIS-C) at Massachusetts General Hospital (MGH) were offered enrollment in the MGH Pediatric COVID-19 Biorepository. Enrolled children provided nasopharyngeal, oropharyngeal, and/or blood specimens. SARS-CoV-2 viral load, ACE2 RNA levels, and serology for SARS-CoV-2 were quantified.
A total of 192 children (mean age 10.2 +/- 7 years) were enrolled. Forty-nine children (26%) were diagnosed with acute SARS-CoV-2 infection; an additional 18 children (9%) met criteria for MIS-C. Only 25 (51%) of children with acute SARS-CoV-2 infection presented with fever; symptoms of SARS-CoV-2 infection, if present, were non-specific. Nasopharyngeal viral load was highest in children in the first 2 days of symptoms, significantly higher than hospitalized adults with severe disease (P = .002). Age did not impact viral load, but younger children had lower ACE2 expression (P=0.004). IgM and IgG to the receptor binding domain (RBD) of the SARS-CoV-2 spike protein were increased in severe MIS-C (P<0.001), with dysregulated humoral responses observed.

Conclusion: This study reveals that children may be a potential source of contagion in the SARS-CoV-2 pandemic in spite of milder disease or lack of symptoms, and immune dysregulation is implicated in severe post-infectious MIS-C.

Source: Yonker LM, Neilan AM, Bartsch Y, Patel AB, Regan J, Arya P, Gootkind E, Park G, Hardcastle M, St. John A, Appleman L, Chiu ML, Fialkowski A, De la Flor D, Lima R, Bordt EA, Yockey LJ, D’Avino P, Fischinger S, Shui JE, Lerou PH, Bonventre JV, Yu XG, Ryan ET, Bassett IV, Irimia D, Edlow AG, Alter G, Li JZ, Fasano A, Pediatric SARS-CoV-2: Clinical Presentation, Infectivity, and Immune Responses, The Journal of Pediatrics (2020), doi: j.jpeds.2020.08.037.

Identification of SARS-CoV-2 RNA in Healthcare Heating, Ventilation, and Air Conditioning Units

Available information on Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) transmission by small particle aerosols continues to evolve rapidly. To assess the potential role of heating, ventilation, and air conditioning (HVAC) systems in airborne viral transmission, this study sought to determine the viral presence, if any, on air handling units in a healthcare setting where Coronavirus Disease 2019 (COVID-19) patients were being treated. The presence of SARS-CoV-2 RNA was detected in approximately 25% of samples taken from nine different locations in multiple air handlers. While samples were not evaluated for viral infectivity, the presence of viral RNA in air handlers raises the possibility that viral particles can enter and travel within the air handling system of a hospital, from room return air through high efficiency MERV-15 filters and into supply air ducts. Although no known transmission events were determined to be associated with these specimens, the findings suggest the potential for HVAC systems to facilitate transmission by environmental contamination via shared air volumes with locations remote from areas where infected persons reside. More work is needed to further evaluate the risk of SARS-CoV-2 transmission via HVAC systems and to verify effectiveness of building operations mitigation strategies for the protection of building occupants. These results are important within and outside of healthcare settings and may present a matter of some urgency for building operators of facilities that are not equipped with high-efficiency filtration.


Source:  Patrick F Horve, Leslie Dietz, Mark Fretz, David A Constant, Andrew Wilkes, John M Townes, Robert G Martindale, William B Messer, Kevin Van Den Wymelenberg medRxiv 2020.06.26.20141085;  doi:

Additional source: Lu J, Gu J, Li K, et al. COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020. Emerging Infectious Diseases. 2020;26(7):1628-1631. doi: 10.3201/eid2607.200764

Physical distancing interventions shows moderate reduction of incidence of coronavirus disease 2019 with caveats: natural experiment in 149

Objective : To evaluate the association between physical distancing interventions and incidence of coronavirus disease 2019 (covid-19) globally.

Design : Natural experiment using interrupted time series analysis, with results synthesised using meta-analysis.

Setting : 149 countries or regions, with data on daily reported cases of covid-19 from the European Centre for Disease Prevention and Control and data on the physical distancing policies from the Oxford covid-19 Government Response Tracker.

Participants : Individual countries or regions that implemented one of the five physical distancing interventions (closures of schools, workplaces, and public transport, restrictions on mass gatherings and public events, and restrictions on movement (lockdowns)) between 1 January and 30 May 2020.

Main outcome measure : Incidence rate ratios (IRRs) of covid-19 before and after implementation of physical distancing interventions, estimated using data to 30 May 2020 or 30 days post-intervention, whichever occurred first. IRRs were synthesised across countries using random effects meta-analysis.

Results : On average, implementation of any physical distancing intervention was associated with an overall reduction in covid-19 incidence of 13% (IRR 0.87, 95% confidence interval 0.85 to 0.89; n=149 countries). Closure of public transport was not associated with any additional reduction in covid-19 incidence when the other four physical distancing interventions were in place (pooled IRR with and without public transport closure was 0.85, 0.82 to 0.88; n=72, and 0.87, 0.84 to 0.91; n=32, respectively). Data from 11 countries also suggested similar overall effectiveness (pooled IRR 0.85, 0.81 to 0.89) when school closures, workplace closures, and restrictions on mass gatherings were in place. In terms of sequence of interventions, earlier implementation of lockdown was associated with a larger reduction in covid-19 incidence (pooled IRR 0.86, 0.84 to 0.89; n=105) compared with a delayed implementation of lockdown after other physical distancing interventions were in place (pooled IRR 0.90, 0.87 to 0.94; n=41).

Conclusions : Physical distancing interventions were associated with reductions in the incidence of covid-19 globally. No evidence was found of an additional effect of public transport closure when the other four physical distancing measures were in place. Earlier implementation of lockdown was associated with a larger reduction in the incidence of covid-19. These findings might support policy decisions as countries prepare to impose or lift physical distancing measures in current or future epidemic waves.

Source: Islam N, Sharp SJ, Chowell G, et al. Physical distancing interventions and incidence of coronavirus disease 2019: natural experiment in 149 countries. BMJ. 2020;370 :m2743.

Use of N95, Surgical, and Cloth Masks to Prevent COVID-19 in Health Care and Community Settings: Living Practice Points From the American College of Physicians

Regardless of the use of respiratory PPE, other procedures to reduce the transmission of SARS-CoV-2 infection should be followed, including maintaining physical distance, self-isolation, quarantine, frequent hand hygiene (using soap and water or alcohol-based hand rub), covering coughs and sneezes by using a bent elbow or paper tissue, refraining from touching the face, and frequent disinfection of frequently touched surfaces.

List 1: Use of N95 Respirators, Surgical Masks, and Cloth Masks in Community Settings

  • ACP discourages the use of N95 respirators by asymptomatic or symptomatic persons in community settings to reduce the risk for SARS-CoV-2 infection in the absence of any demonstrated benefit.
  • The decision to use surgical masks or cloth masks to reduce the risk for transmission of SARSCoV-2 infection among asymptomatic or symptomatic persons in community settings should follow community and statewide public health guidelines for mask use, which should take into account such factors as epidemiologic data (e.g. reproduction rate, daily case counts, hospitalizations, deaths) and local demographics (e.g. high-risk populations).
  • Potential harms associated with mask use include self-contamination, breathing difficulties, and a false sense of security that could potentially detract from taking other precautions, such as physical distancing.

List 2: Use of N95 Respirators, Surgical Masks, and Cloth Masks in Health Care Settings

  • All health care personnel in close contact*  with patients suspected or known to have COVID-19 should use N95 respirators in health care settings to reduce the risk for acquiring SARS-CoV-2 infection.
  • All patients with suspected or known COVID-19 should wear surgical masks in health care settings,
  • All health care personnel, patients, and visitors who are not in close contact with patients with suspected or known COVID-19 should use surgical masks in a health care setting to reduce the risk for transmission of SARS-CoV-2 infection.
  • Health care personnel should not use cloth masks in health care settings to reduce the risk for transmission of SARS-CoV-2 infection. Cloth masks are not considered PRE in health ca re settings, given the lack of evidence of their effectiveness against transmission of SARS-CoV-2 virus.

Reuse or Extended Use of N95 Respirators in Health Care Settings

No evidence is available on the effectiveness of reuse or extended use of N95 respirators in health care settings.

COVID-19 = coronavirus disease 2019; PRE = personal protective equipment; SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2.

* Close contact refers to being within 6 feet of a patient with COVID-19 or having direct contact with infectious secretions of a patient with COVID-19 (5).

Source :

Promising Early Data from New COVID-19 Vaccine Studies Showing Safety and potential Efficacy

Around the world, more than 100 candidate vaccines against SARS-CoV-2 are in various stages of development and testing. On May 18, US biotech firm Moderna revealed the first data from a human trial: its COVID-19 vaccine triggered an immune response in people, and protected mice from lung infections with the coronavirus SARS-CoV-2. The current study was an open-label Phase I trial on 45 healthy adults. The participants received two doses four weeks apart of Moderna’s messenger RNA vaccine (mRNA-1273) at doses of 25 μg, 100 μg, or 250 μg. There was no comparison group, and, a significant limitation, the researchers did not screen the participants for SARS-CoV-2 infection by serology or polymerase chain reaction before enrollment. The study protocol calls for assessments at multiple points after each vaccination: 7, 14, 57, 119, 209, and 394 days. On days 1, 15, 29, 36, 43, and 57, the researchers tested each participant for binding antibodies and for neutralizing activity. Three of the 45 participants did not receive the second dose, one of whom developed urticaria and one who was in isolation for suspected COVID. On day 57, the researchers were able to detect binding and neutralizing antibodies with all three doses by 14 days after immunization with a peak at 28 days. The high-dose vaccine induced the greatest immunogenic responses but also the highest rate of adverse effects. Additionally, as we have observed with the new recombinant zoster vaccine, the second dose triggers more frequent adverse events: 54%, 100%, and 100% for each of the three doses, respectively. Fortunately, most of these were considered to be mild, and only three participants receiving the highest dose reported one or more serious adverse effects (21%). The adverse events included fever, arthralgias, injection site pain, headache, and chills. These are early and incomplete data from a small study with no control group, but the data provide hope that an effective vaccination is feasible.The mRNA-1273 vaccine induced anti–SARS-CoV-2 immune responses in all participants, and no trial-limiting safety concerns were identified.

Written by Henry C. Barry, MD, MS, on July 15, 2020. (Source: Jackson LA, Anderson EJ, Rouphael NG, et al. An mRNA vaccine against SARS-CoV-2—preliminary report [published online July 14, 2020]. N Engl J Med. 2020.

  1. Oxford-Astra-Zeneca Study :
  2. Pfizer-BioNTech Study:
  3. Regeneron Study:
  4. CanSino Biologics Study :

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Search Terms: Asthma, COPD, Lung Cancer, Pneumonia, Pulmonary Fibrosis