ObjectivesThe outbreak of COVID-19 posed the issue of urgently identifying treatment strategies. Colchicine was considered for this purpose based on well-recognised anti-inflammatory effects and potential antiviral properties. In the present study, colchicine was proposed to patients with COVID-19, and its effects compared with ‘standard-of-care’ (SoC).MethodsIn the public hospital of Esine, northern Italy, 140 consecutive inpatients, with virologically and radiographically confirmed COVID-19 admitted in the period 5–19 March 2020, were treated with ‘SoC’ (hydroxychloroquine and/or intravenous dexamethasone; and/or lopinavir/ritonavir). They were compared with 122 consecutive inpatients, admitted between 19 March and 5 April 2020, treated with colchicine (1 mg/day) and SoC (antiviral drugs were stopped before colchicine, due to potential interaction).ResultsPatients treated with colchicine had a better survival rate as compared with SoC at 21 days of follow-up (84.2% (SE=3.3%) vs 63.6% (SE=4.1%), p=0.001). Cox proportional hazards regression survival analysis showed that a lower risk of death was independently associated with colchicine treatment (HR=0.151 (95% CI 0.062 to 0.368), p<0.0001), whereas older age, worse PaO2/FiO2, and higher serum levels of ferritin at entry were associated with a higher risk.ConclusionThis proof-of-concept study may support the rationale of use of colchicine for the treatment of COVID-19. Efficacy and safety must be determined in controlled clinical trials.

Our study underscores the essential role of imaging, in particular computed tomography, in the identification and monitoring of pulmonary lesions in a large cohort of CVID patients, contributing at the same time to select patients more at risk to develop nodular lesions and potentially to use more appropriate therapeutic strategies.

BackgroundBaseline high neuromuscular drive is present in chronic obstructive pulmonary disease (COPD). In moderate-to-very severe COPD patients, both static and/or dynamic pulmonary hyperinflation have been demonstrated at rest.AimTo assess the influence of dynamic hyperinflation on neuromuscular drive at rest.MethodsWe recruited 22 patients with severe-to-very severe COPD showing resting dynamic pulmonary hyperinflation, as assessed by the baseline reduction of inspiratory capacity (IC) (<80% of predicted). IC, occlusion pressure (P0.1), maximal inspiratory pressure (MIP), and their ratio were measured at end-expiratory lung volume (EELV) before and after acute inhalation of 400 mcg of albuterol (metered-dose inhaler plus spacer). In these patients the bronchodilator response was assessed also as lung volume changes.ResultsOnly in COPD patients with a marked increase in IC (>12% of baseline and at least 200 mL) after bronchodilator, resting P0.1 showed a clinically significant decrease, despite the EELV diminution (P < 0.001). MIP was augmented following EELV reduction and therefore the P0.1/MIP ratio was markedly decreased (P < 0.001). In contrast, no changes in these indices were found after bronchodilator in COPD patients with insignificant variations of IC. Breathing pattern parameters did not vary in both sub-groups after albuterol.ConclusionFollowing bronchodilator, significant P0.1 decrease, MIP increase, and reduction of the P0.1/MIP ratio were found only in COPD patients with a marked IC increase and these changes were closely related. These findings suggest that bronchodilators, by decreasing dynamic hyperinflation, may control exertional and/or chronic dyspnea partly through a reduction of central neuromuscular drive.

Background: Lower peak expiratory flow (PEF) and forced expiratory volume in 1 s (FEV₁) have been consistently found after slow inspiration with end-inspiratory pause (EIP). Objectives: It was the aim of this study to establish the respective influence of the speed of preceding inspiration (SPI) and EIP on the parameters obtained from the following expiratory forced vital capacity (FVC) manoeuvre. Methods: In 8 healthy subjects and 12 patients with chronic obstructive pulmonary disease (COPD), a number of inspirations with different SPI and EIP were performed. In the subsequent FVC manoeuvre, maximal expiratory flows, including PEF, and maximal expired volumes at different times, including FEV₁, were measured. For each FVC manoeuvre, peak expiratory time, expired volume at PEF (as % of FVC), flow limitation by the negative expiratory pressure technique and FVC were checked to be sure of achieving a similar expiratory effort and starting inflation lung volume. Results: The highest values of PEF and FEV₁ were found in normal subjects and COPD patients after fastest SPI without EIP (p < 0.001). In normal subjects, no significant PEF and FEV₁ changes during FVC manoeuvre were observed with different SPI, in the absence of EIP. In contrast, inspirations with slower SPI (inspiratory time >2 s) without EIP were followed by lower PEF in COPD patients (p < 0.05). As compared with inspirations without EIP, those with a presence of EIP were invariably followed by lower PEF and FEV₁, both in normal subjects and in COPD patients (p < 0.05). Conclusions: The effect of SPI on subsequent PEF and FEV₁ is irrelevant in healthy subjects as well as in COPD patients, unless SPI is too slow (inspiratory time >2 s), while any EIP decreases these indices in all individuals.

Lung CT scan allows for early detection of pulmonary fungal infection in CGD. Pulmonary nodules (<30 mm), single or multiple, uni- or bilateral, with or without a halo sign may represent the first radiologic sign of pulmonary fungal infection in CGD.