Objectives The aim of this study was to systematically describe the findings of lung ultrasound (US) in patients with coronavirus 2019 (COVID‐19) pneumonia and to analyze its prognostic value. Methods Lung US examinations were performed in 63 patients with COVID‐19 pneumonia admitted to a university hospital. Lung involvement was evaluated on a 4‐point scale with a 12‐area pulmonary division, obtaining a lung score (LS). Ultrasound findings and clinical characteristics were recorded. Results All patients showed US involvement in at least 1 area (mean ± SD, 8 ± 3.5). The total LS was 15.3 ± 8.1, without differences between left and right lungs. Most affected regions were the lower region (95.2%) and the posterior region (73.8%). The total LS showed a strong correlation (r = −0.765) with the oxygen pressure–to–fraction of inspired oxygen ratio; by lung region, those with a higher correlation were the LS of the anterior region (r = −0.823) and the LS of the upper region (r = −0.731). In total, 22.2% of patients required noninvasive respiratory support (NIRS). A multivariate analysis showed that the anterior region LS, adjusted for age and sex, was significant (odds ratio, 2.159; 95% confidence interval, 1.309–3.561) for the risk of requiring NIRS. An anterior region LS of 4 or higher and a total LS of 19 or higher had similar characteristics to predict the need for NIRS. Conclusions Ultrasound involvement in COVID‐19 pneumonia is bilateral and heterogeneous. Most affected regions are the posterior and the lower regions. The anterior region has prognostic value because its involvement strongly correlates with the risk of requiring NIRS, and an anterior region LS of 4 or higher has high sensitivity and specificity for predicting the need for NIRS.

Objectives: The aim is to systematically describe the findings of lung ultrasound in patients with COVID-19 pneumonia and to analyze its prognostic value. Methods: Lung ultrasound was performed to 63 patients with COVID-19 pneumonia admitted to a University Hospital. Lung involvement was evaluated using a 4-point scale with a 12-area pulmonary division (lung score -LS-). Ultrasound findings, along with clinical characteristics, were recorded. Results: All patients showed ultrasound involvement in at least 1 area (mean 8 ± 3.5). Total LS was 15.3 ± 8.1, without differences between left and right lung. Most affected regions were the lower one (95.2%) and the posterior one (73.8%). Total LS showed a strong correlation (r = -0.765) with PaO2/FiO2; by lung regions, those with a higher correlation were the LS of the anterior one (r = -0.823) and the LS of the upper one (r = -0.731). 22.2% of patients required non-invasive respiratory support (NIRS). Multivariate analysis shows that anterior region LS, adjusted for age and sex, is significant (odds ratio 2.159, 95% confidence interval 1.309 to 3.561) for the risk of requiring NIRS. Anterior region LS ≥ 4 and total LS ≥ 19 have similar characteristics to predict the need for NIRS. Conclusions: Ultrasound involvement in COVID-19 pneumonia is bilateral and heterogeneous. Most affected regions are the posterior and the lower ones. The anterior region has prognostic value, because its involvement strongly correlates with the risk of requiring NIRS, and an anterior region LS ≥ 4 has high sensitivity and specificity for predicting the need for NIRS.

No abstract

No abstract

Previous studies have described that there are different types of disease in patients with established chronic obstructive pulmonary disease (COPD) with different clinical course and functional responses. The aim of this study was to evaluate if the presence of low transfer factor (LTF) values can predict the effectiveness of bronchodilator therapy, and to assess whether this group has different risk factors that may be related with the responses. Eighty patients with COPD were evaluated on three occasions. Initial assessment included a standard respiratory questionnaire, blood analysis, skin prick test and baseline lung function, all performed on the first visit. Bronchodilator response was evaluated after low (0.2 mg) and high (1 mg) doses of salbutamol, and after 2 weeks of oral prednisone. In patients with normal TLCO/VA % (NTF), a higher proportion of subjects with previous history of atopy was the only statistically significant difference compared to those with LTF (odds ratio 4.33; 95% confidence interval 1.06–25.15). Although the mean response in forced expiratory volume in 1 s (FEV₁) to treatment was analogous in both groups, when bronchodilation was expressed as percent of predicted, there was a clear trend to a lower response in patients with LTF (0.2 mg salbutamol: 6.99 ± 5.64 vs. 8.94 ± 6.61, p = 0.15; 1 mg salbutamol: 10.18 ± 6.37 vs. 13.45 ± 7.90, p < 0.05; oral prednisone: 5.51 ± 6.94 vs. 8.74 ± 10.81, p = 0.06). The percentage of patients who had >12% improvement from that predicted in FEV₁ was also lower in this group (42 vs. 72%; p < 0.05). Moreover, TLCO/VA% was significantly lower in those subjects with a negative bronchodilator trial with salbutamol (68 ± 25 vs. 81 ± 26; p < 0.05) and prednisone (69 ± 26 vs. 90 ± 22; p < 0.01). In patients with LTF and NTF, airway responsiveness was only significantly related with basal airflow limitation (LTF, r = 0.44; NTF, r = 0.38). All other interaction terms were not statistically significant. These results indicate that in patiens with similar serverity of COPD, the presence of LTF indicates a decreased probability of a positive bronchodilator response, probably reflecting different pathological lesions. We suggest that transfer factor should be taken into consideration when bronchial response is evaluated in large clinical trials.