Celecoxib as adjuvant therapy has been shown in a small randomized trial for Covid-19 to prevent clinical deterioration and rapidly improve thoracic computerized axial tomography (CT-chest)1. Multiple descriptive trials of high dose famotidine (both inpatient and outpatient) have demonstrated clinical response2,3,4. We describe the rapid clinical responses after increasing the celecoxib dosage to 400mg bid with high dose famotidine 80mg qid in both a critical inpatient who on baseline required 40 liters per minute high flow nasal insufflation and an outpatient who declined admission but had critical Covid-19 biomarkers.
BackgroundBronchodilators are a mainstay of treatment for patients with airflow obstruction. We hypothesized that patients with obesity and no objective documentation of airflow obstruction are inappropriately treated with bronchodilators.MethodsSpirometric results and medical records of all patients with body mass index >30 kg/m2 who were referred for testing between March 2010 and August 2011 were analyzed.Results155 patients with mean age of 52.6 ± (SE)1.1 y and BMI of 38.7 ± 0.7 kg/m2 were studied. Spirometry showed normal respiratory mechanics in 62 (40%), irreversible airflow obstruction in 36 (23.2%), flows suggestive of restriction in 35 (22.6%), reversible obstruction, suggestive of asthma in 11 (7.1%), and mixed pattern (obstructive and restrictive) in 6 (3.9%). Prior to testing, 45.2% (28 of 62) of patients with normal spirometry were being treated with medications for obstructive lung diseases and 33.9% (21 of 62) continued them despite absence of airflow obstruction on spirometry. 60% (21 of 35) of patients with a restrictive pattern in their spirometry received treatment for obstruction prior to spirometry and 51.4% (18 of 35) continued bronchodilator therapy after spirometric testing. There was no independent association of non-indicated treatment with spirometric results, age, BMI, co-morbidities or smoking history. All patients with airflow obstruction on testing who were receiving bronchodilators before spirometry continued to receive them after testing.ConclusionA substantial proportion of patients with obesity referred for pulmonary function testing did not have obstructive lung disease, but were treated nonetheless, before and after spirometry demonstrating absence of airway obstruction.
We seek to rapidly identify, test and develop combinations of repurposed drugs to enable cost-effective treatments that reduce the risk of disease or death from SARS-CoV-2 infection. We hypothesize that the morbidity and mortality of COVID-19 reflects overactive host inflammatory responses to infection and is not principally due to the primary direct cellular, organ and tissue damage attributable to viral infection. Stepwise clinical development has identified the combination of High Dose (HD) famotidine and celecoxib (famcox) as a promising adjuvant anti-inflammatory protocol. We now report results from a retrospective observational comparative cohort study designed to provide an estimate of the potential benefits, risks, prognosis and diagnostic laboratory findings associated with administration of dexamethasone in addition to famcox for treatment of newly hospitalized COVID-19 disease in a community hospital setting. Study enrollment was restricted to patients at WHO 4–5. In the group receiving adjuvant treatment with famcox without dexamethasone (active control) there were no deaths during hospitalization (0/18 = 0% mortality). A total of six deaths occurred in the group receiving famcox + dexamethasone (6/21 = 29% mortality). There was a significant difference in mortality between the two groups, Χ2 (1, N = 43) = 7.305, p < 0.007. Median time to event for reaching WHO score of < 4 was 3.5 days in the control group (famcox (–) dex) versus 10 days for the experimental group (famcox (+) dex) P < 0.001. We conclude that use of the potent non-specific anti-inflammatory corticosteroid dexamethasone in addition to the specific anti-inflammatory famcox protocol should only be considered in late stage COVID-19 disease in patients less than 70 years of age. The effects of added dexamethasone on laboratory biomarkers, and particularly on neutrophil count, lymphocyte count, and neutrophil to lymphocyte ratio raise concerns about the long-term effects of dexamethasone treatment with or without famcox during acute COVID-19 on the incidence and severity of chronic COVID (“long COVID” or PASC).
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