- |||||||||| Dulera (mometasone/formoterol) / Merck (MSD), Novartis
A 12 Year Old Male in Drug Induced Adrenal Crisis (Area B, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_4662;
He had received multiple courses of oral prednisone for asthma exacerbations earlier in his lifetime...Altered mental state resolved after initial steroid dose was given, and IV hydrocortisone (50 mg/5mL) was maintained every 6 hours during admission...Secondary AI in relation to chronic, high-dose ICS therapy is caused by the suppression of the hypothalamic-pituitary-adrenal function. Detailing patient history and medication usage are vital in distinguishing the types of AI.
- |||||||||| montelukast / Generic mfg., azithromycin / Generic mfg., fluticasone propionate/salmeterol xinafoate inhalation powder / Generic mfg.
Reversible Airflow Obstruction in Swyer-James-MacLeod Syndrome? An Unusual Combination (Area B, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_4654;
This case illustrates that bronchial reactivity is possible with this syndrome when asthma is comorbid. Conversely, severe obstruction or abnormal imaging that is disproportionate to symptom burden, as seen in this patient, should prompt suspicion of uncommon conditions like bronchiolitis obliterans.
- |||||||||| clindamycin phosphate / Generic mfg., fluticasone / Generic mfg.
A Timeline of Radiological and Symptomatic Improvement in Pediatric Post Infectious Bronchiectasis: A Case Report (Area B, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_4653;
At discharge he was started on inhaled fluticasone, 2L oxygen at night and QID airway clearance...As seen in our patient, there can be partial reversal of bronchiectatic changes in healthy pediatric patients who are diagnosed early and adhere to regular airway clearance4. Close pulmonary follow-up is required to prevent secondary infections which can exacerbate lung damage.
- |||||||||| Actemra IV (tocilizumab) / Roche, JW Pharma
A Fatal Case of Intraparenchymal Hemorrhage Masquerading as Central Diabetes Insipidus (Area A, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_4538;
CT head on admission was unremarkable.For COVID 19 ARDS, she was started on dexamethasone, tocilizumab, paralysis was achieved withcisatracurium and prone protocol was followed for refractory hypoxia...A full neurological examinationcould not be obtained as she was paralyzed, however, pupils were equal in size and reactive to light.With high clinical suspicions of diabetes insipidus she received a one-time dose of 16mcg of DDAVP andMRI of pituitary gland was ordered to delineate etiology...In ourpatient, inability to perform a full neurological exam due to paralysis limited early recognition andintervention.This case highlights the need for increased awareness in patients with features of central diabetesinsipidus and the urgency to obtain CT head immediately after a diagnosis has been established. Promptconsideration of neuroimaging should be made when features of central diabetes mellitus are notedwith limited neurological exam.
- |||||||||| dexamethasone / Generic mfg., etoposide IV / Generic mfg.
A Rare Cause of Multiple Organ Failure, With an Unusual Trigger (Area A, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_4498;
Early diagnosis allows for early treatment and the potential for improved outcomes. In this case, the postulated inciting trigger was thought to be a newly diagnosed plasma cell dyscrasia, a rare trigger of HLH.
- |||||||||| aspirin / Generic mfg., methylprednisolone sodium succinate / Generic mfg., warfarin / Generic mfg.
A Deadly Duo; Thrombotic Thrombocytopenic Purpura and Antiphospholipid Syndrome (Area A, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_4495;
This comprises conditions, several of which have common (but not identical) triggering factors, clinical manifestations (thrombocytopenia, microangiopathic hemolytic anemia, microvascular thrombosis, and antiphospholipid antibodies), and may require similar therapies (e.g., plasma exchange).A 36-year-old female with a history of APS and multiple cerebrovascular accidents on aspirin and warfarin came to the emergency department (ED) with sudden onset of generalized abdominal pain that started a few hours before presentation as per the patient...A probable diagnosis of catastrophic APS was made, and she was started on methylprednisolone 1mg/kg and Intravenous Immunoglobulins (IVIG)...All cell lines improved, and PLEX was stopped after five days. She continued an extended steroid taper and was subsequently discharged home with complete neurological recovery and return of normal renal function.Systematic testing of ADAMTS13 activity in patients who present with neurological symptoms and thrombocytopenia in the presence of APL antibodies may help diagnose the rare TTP-APS syndrome combination and guide timely initiation of lifesaving therapy (PLEX).
- |||||||||| Rituxan (rituximab) / Biogen, Zenyaku Kogyo, Roche
A Rare Case of Hemophagocytic Lymphohystiocytosis Secondary to Severe Epstein Barr Infection in an Immunocompetent Individual (Area A, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_4492;
Etiology is familial children but secondary in adulthood, where triggers include viral infection, cancers.Case presentation: A 60-year-old immunocompetent female with past medical history of hypertension, asthma, deep vein thrombosis on warfarin, hypothyroidism, and hyperlipidemia who presented due to fatigue and encephalopathy...She completed two separate month treatments with doxycycline for Lyme disease (despite negative serology) but had continued intermittent symptoms...She was empirically treated with antimicrobials, Dexamethasone 10 mg/m2 body surface area and etoposide...EBV serology was completed and was positive with viral load exceeding 5 million, thus rituximab was empirically started.She continued to have mucosal bleeding with increasing amounts of frank blood being passed from her ET tube...Upon removal of the bronchoscope, she promptly arrested, with no attempt at resuscitation made on the second arrest.Summary: Described is a rare case of HLH that was secondary to severe EBV infection masquerading as Lyme disease in an immunocompetent individual. Even with rapid initiation of empiric treatment and supportive measures, she expired in the setting of severe coagulopathy leading to respiratory compromise secondary to endobronchial hemorrhage.Figure 1: Bone marrow aspirate.
- |||||||||| hydrocortisone / Generic mfg.
Systemic Capillary Leak Syndrome as Extra-Pulmonary COVID-19 Infection in a Vaccinated Patient (Area J, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_4490;
He remained intubated and hypotensive requiring three pressors, stress-dosed hydrocortisone, and broad-spectrum antibiotics...Future studies are warranted to elucidate vaccine effectiveness for both pulmonary and extra-pulmonary infections. Providers should consider SCLS as a diagnosis and have a high degree of suspicion for extra-pulmonary manifestations of COVID-19 infections as the pandemic persists regardless of vaccination status.
- |||||||||| dexamethasone / Generic mfg., prednisone / Generic mfg., terbinafine HCL / Generic mfg.
Post-Lung Transplant Brain Abscess - A Rare Case of Scedosporium Apiospermum (Area J, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_4482;
It is shown that use of dexamethasone in brain abscess was not associated with higher mortality... This case highlights a rare finding of Scedosporium apiospermum brain abscess in an immunocompromised lung transplant patient and the difficulties in therapy due to multiple factors.
- |||||||||| remdesivir / Generic mfg., dexamethasone / Generic mfg., nintedanib / Generic mfg.
Post-COVID-19 Fibrosis Presenting with Usual Interstitial Pattern (Area J, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_4476;
After contracting COVID-19 pneumonia, he was hospitalized for five days and received a five day course of remdesivir and a ten day course of dexamethasone 6 mg daily...The patient was started on nintedanib and referred to pulmonary rehabilitation...There are no standard guidelines to treat such patients. The role of antifibrotic therapy in post-COVID-19 fibrosis continues to be investigated and further research is needed in this field.
- |||||||||| remdesivir / Generic mfg., dexamethasone / Generic mfg.
Pneumothorax as a Complication of COVID-19 Interstitial Lung Disease (Area J, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_4461;
Our case shows near-complete resolution of all changes including the pneumothorax without further intervention. The natural history of chronic lung disease related to COVID-19 needs further study.
- |||||||||| Pneumothorax, Pneumomediastinum and Subcutaneous Emphysema as Complications of Asthma (Area J, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_4455;
Since pneumothorax can be missed by a chest X-ray, patients considered at risk should undergo CT scan. If patients fail to respond to medical therapy, evaluating for occult pneumothoraces or recognizing the deep sulcus sign in this clinical context should also be considered.
- |||||||||| dexamethasone / Generic mfg.
Pulmonary Fibrosis After COVID-19: What Are Risk Factors and How Reduce Extensity of Residual Lung Abnormalities? (Area E, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_4304;
If patients fail to respond to medical therapy, evaluating for occult pneumothoraces or recognizing the deep sulcus sign in this clinical context should also be considered. Fllowing post-ARDS COVID19 disease the patients have significant residual radilogical inflammatory disease,persistent ventilatory and functional deficit.There were several risk factors associated with more severe lung fibrotic and non-fibrotic residual lung abnormalities.treatment with corticosteroids at the time of ICU admission associated with decreased of extensity of radilogical lung abnormalities and functional impairment.
- |||||||||| remdesivir / Generic mfg., dexamethasone / Generic mfg.
Pulmonary Function Before and After COVID-19 in a Mid-South US Cohort (Room 2022/2024 (West Building, Level 2), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_4162;
Severity of illness, hospitalization and new oxygen requirement at discharge were also associated with change in DLCO. These data can inform clinical monitoring of this vulnerable population and will merit further follow-up studies of the long-term pulmonary consequence of COVID-19.
- |||||||||| hydrocortisone / Generic mfg.
Analysis of the Effects of Glucocorticoid Use on the Systemic Host Immune Response in Acute Respiratory Failure (Room 3009/3011 (West Building, Level 3), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_4063;
78 patients (40%) received glucocorticoids between baseline and follow-up samples, of which 31% received only hydrocortisone, 17% only methylprednisolone, and 41% received a combination of different types of glucocorticoids... In an exploratory study in patients with or at risk for ARDS, the use of glucocorticoids in clinical practice was varied but was still associated with alterations in the systemic host immune response.
- |||||||||| dexamethasone / Generic mfg., acetylcysteine solution / Generic mfg.
In Vitro Evaluation of Inhaled Drugs Therapies to Prevent Severe COVID19 (Room 2009/2011 (West Building, Level 2), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_3727;
Literature search supports this repurposing application. There is currently an ongoing clinical trial to test if nebulized heparin may reduce the severity of lung injury caused by COVID-19.
- |||||||||| dexamethasone / Generic mfg.
Racial Disparities Among Veterans with COVID-19 Disease (Room 3009/3011 (West Building, Level 3), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_3654;
NW patients with COVID-19 disease present younger and with a more pronounced inflammatory phenotype compared to W patients. Despite racial differences in COVID-specific treatments, hospital mortality and 30-day readmissions did not differ between both groups.
- |||||||||| erythromycin / Generic mfg., methylprednisolone sodium succinate / Generic mfg.
Early Clinical Improvement in ARDS Results from Selecting the Right Subphenotype for Anti-Inflammatory Treatment - a Preclinical Randomized Blinded Ovine Study (Room 3005/3007 (West Building, Level 3), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_3526;
Then, animals were further randomly allocated to receive either a bolus of 100mg of methylprednisolone IV followed by a 48h intravenous infusion of 2 mg/kg/24h (P2-pred and P1-pred, each n=5) or erythromycin 100mg IV every 6 hours (P2-ery and P1-ery, each n=5) or no treatment (control: P2-ctr and P1-ctr, each n=5). Treatment with methylprednisolone improves oxygenation and hemodynamic situation early in the course of ARDS, especially in the ovine hyperinflammatory subphenotype, potentially proposing personalized treatment in ARDS.
- |||||||||| budesonide/salbutamol (PT027) / AstraZeneca, Avillion
Efficacy and Safety of Albuterol/Budesonide (PT027) in Mild-to-Moderate Asthma: Results of the DENALI Study (Room 3006/3008 (West Building, Level 3), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_3508;
P3
Onset and duration of bronchodilation were similar for albuterol/budesonide vs albuterol on Day 1, and more patients experienced a nominal improvement in asthma control at Week 12. The overall clinical profile of albuterol/budesonide observed supports its potential utility as a future novel rescue therapy.
- |||||||||| Xpovio (selinexor) / Karyopharm, Menarini
Extramedullary Extension: A Parenchymal Pulmonary Plasmacytoma (Area D, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_3332;
It is important to establish a biopsy-proven diagnosis given that these EMPs tend to mimic primary malignancies on imaging such as carcinoma or lymphoma. Furthermore, while solitary EMP is easily treatable, prognosis for patients with concurrent MM and EMP remains grim despite advances in cancer treatment.
- |||||||||| AiRuiKa (camrelizumab) / Jiangsu Hengrui Pharma
Isolated ACTH Deficiency Probably Induced by Camrelizumab in Lung Cancer Patient (Area D, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_3307;
He then started chemotherapy with Pemetrexed /Nedaplatin...Therefore, treatment with levothyroxine 12.5 µg/day was started at this point and the doze was adjusted according to the followed up thyroid hormone results (Figure...Intravenous injection of hydrocortisone (50mg per day) was started and the patient’s general condition improved significantly...Another difference in our case is that except for ACTH, other pituitary hormones such as TSH, LSH, GH and prolactin were significantly elevated while in nivolumab-induced ACTH deficiency, other pituitary hormones were within the normal range. Therefore crucial clinical suspicion is urgently needed since ACTH deficiency usually develops insidiously in Camrelizumab treatment.
- |||||||||| dexamethasone / Generic mfg.
Differential Expression of Linear and Circular Noncoding RNAs in Mild/Moderate Versus Severe House Dust Mite (HDM) Mouse Models of Asthma (Area K, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_3177;
The effects of dexamethasone on noncoding RNA expression were also determined in order to identify targets deferentially modified by corticosteroid treatment...Transcriptomics of circular and linear noncoding RNAs suggests the pattern of circRNA expression transcription is significantly altered by allergic sensitization of the lung, which is somewhat independent of host gene expression rather than simply occurring as occasional by-products of gene transcription. The impact of our studies derives from identifying circular RNA/mRNA pairs and splicing events that could be targeted with novel anti-inflammatory oligonucleotide drugs.
- |||||||||| dexamethasone / Generic mfg.
Comparison of Clinical Profile and Management of COVID Related Pulmonary Thrombosis Between the First and Second Waves at a Community Hospital (Area J, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_3100;
COVID-PTE patients in the first wave had more ICU admissions, whereas more patients had higher cardiac interventions, oxygen requirements, inotropes, ECMO and mortality in the second wave. An inferential analysis of a larger sample size is needed to determine differences between clinical profile, management, and outcomes of PTE in the two waves or rather among the different variants.
- |||||||||| remdesivir / Generic mfg.
Delays in First Remdesivir Administration Associated with Higher Risk of Death from COVID-19 (Area J, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_3094;
Speculatively, factors such as provider hesitancy and logistical challenges could be driving these delays in giving the medication. Further research is needed, but our work suggests timely remdesivir could be another valuable component in the treatment of this deadly virus.
- |||||||||| Actemra IV (tocilizumab) / Roche, JW Pharma, VentaProst (epoprostenol inhalation) / Aerogen Pharma
Mucociliary Dysfunction in Severe COVID-19: The Other End of the Spectrum (Area J, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_3087;
This complements previous results indicating multiple functional microanatomical abnormalities of the nasal mucosa, and in particular ciliated cell dysfunction, in subjects with acute COVID-19. Our findings suggest that mucociliary dysfunction may play an important role in disease severity and risk for infectious complications.
- |||||||||| zunsemetinib (ATI-450) / Aclaris
A Trial of MK2 Inhibitor ATI-450 in Patients with Moderate-Severe Novel Coronavirus Disease 2019 (COVID-19) (Area J, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_3080;
Blood drawn at baseline and end of treatment demonstrated relative reductions in IL-6, IL-8, TNFα, and G-CSF in the ATI-450 arm compared to placebo (discussed in a separate abstract).ConclusionsOur phase 2, double-blind, randomized controlled trial demonstrated that ATI-450 is safe and well tolerated in an acutely ill patient population. Furthermore, we observe a relative- reduction (incremental to dexamethasone) in IL-6, IL-8, TNFα, and G-CSF in patients treated with ATI-450 over placebo.Table 1:
- |||||||||| Actemra IV (tocilizumab) / Roche, JW Pharma
Non-COVID Viral Pneumonia in the COVID-19 Era: A Severe Case of Human Parainfluenza Virus Infection (Area E, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_3054;
She was treated with Zosyn and Solu-Medrol for pneumonia and asthma exacerbation...Elevated interleukin (IL)-6 level was noted and treating the patient with an anti-IL6 medication such as tocilizumab was considered...Grant et al (2021) believed that COVID-19 pneumonia causes more severe destruction of the lung tissues through prolonged, slow, spatially limited alveolitis and resultant immune reaction, as opposed to other types of viral pneumonia that causes rapid multi-focal infection and resultant inflammation. This case report highlights that despite the high prevalence of COVID-19, clinicians should remain vigilant of other rare causes of viral pneumonia that can cause severe hypoxia and life-threatening illness.
- |||||||||| baclofen / Generic mfg.
A Previously Healthy 21-Year Old Female Presenting with Baclofen Toxicity (Area B, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_2926;
The patient was never aware of the potential side effects and this break in patient education could have been fatal. Our case demonstrates both the potential dangers of baclofen as well as the need for proper communication with our patients.
- |||||||||| vancomycin / Generic mfg., piperacillin / Generic mfg., methylprednisolone sodium succinate / Generic mfg.
Crack Lung: A Clinical Diagnosis (Area B, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_2916;
Because of diffuse alveolar hemorrhage was in the differential, patient was continued on 80 mg of IV methylprednisolone every 8 hours...Patient was weaned down from non-rebreather to 2 Liters of oxygen and then transferred to the general floor.ConclusionPatients with crack lung often present with shortness of breath, fever, cough with or without hemoptysis and sometimes hypoxemia within 48 hours of insult. Early diagnosis based on history, physical examination, laboratory and radiographic findings can ensure prudent management.
- |||||||||| ceftriaxone / Generic mfg., azithromycin / Generic mfg., methylprednisolone sodium succinate / Generic mfg.
An Elusive Case of E-Cigarette, or Vaping, Product Use Associated Lung Injury (EVALI) Lacking Respiratory Symptoms (Area B, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_2914;
Lack of clinical effect with antibiotics prompted a suspicion for EVALI and intravenous methylprednisolone 1mg/kg every 8 hours was initiated...This has contributed to the burgeoning EVALI epidemic. Although COVID has taken the centre stage while identifying diffuse interstitial lung abnormalities, there must be a high index of suspicion regarding the incidence of EVALI, especially in young patients, considering the varied presentations and the potential absence of respiratory symptoms.
- |||||||||| remdesivir / Generic mfg., dexamethasone / Generic mfg.
Early Administration of Remdesivir and Dexamethasone Is Associated with Good Outcomes for Patients with COVID 19 (Area J, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_2905;
Our study demonstrates an important shortening of ICU length of stay and also an important improvement in ICU mortality of patients with severe COVID19 who required ICU admission and who have received REM/DEX combination before ICU admission. Before ICU admission early administration of REM/DEX combination has been associated with significantly lower rate of developing ARDS and need to MV.
- |||||||||| Actemra IV (tocilizumab) / Roche, JW Pharma
COVID-19 Waves: A Comparison of the First and Second Surges at Northwestern Memorial Hospital (Area J, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_2862;
Significant clinical differences exist between the two COVID-19 waves in the Chicagoland area, and practices evolved over time. We intend to investigate additional factors such as viral variants and bronchoalveolar lavage studies to further elucidate features associated with mortality.
- |||||||||| dexamethasone / Generic mfg., doxycycline / Generic mfg.
Hemophagocytic Lymphohistiocytosis-Associated Stress Cardiomyopathy (Area G, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_2757;
Our patient’s LV function recovered after treatment of HLH and initiation of GDMT. Cardiac function should be assessed early in patients suspected to have HLH.
- |||||||||| Valcyte (valganciclovir) / Roche, Mitsubishi Tanabe, Nulojix (belatacept) / BMS
Chronic Bronchitis Induced by Immunosuppression from Betalacept (Area B, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_2747;
3 months later, repeat chest CT is improved and clinically patient significantly improved with decreased cough, sputum and shortness of breath. This suggests his symptoms were due to an adverse effect of Belatacept.
- |||||||||| Breztri Aerosphere (budesonide/formoterol fumarate/glycopyrronium) / AstraZeneca
Reducing Environmental Impact of Pressurised Metered Dose Inhalers: Relative Bioavailability of Budesonide/Glycopyrronium/Formoterol with Novel Propellant Formulations in Healthy Subjects (Area F, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_2726;
P1
The objective of the study was to evaluate the relative bioavailabilities in the fixed-dose combination (FDC) of budesonide, glycopyrronium, and formoterol (BGF) between 3 different propellant formulations of BGF MDI, 160/7.2/4.8 mcg/actuation...The combination of BGF when administered as single doses in 3 different propellant formulations demonstrated an acceptable safety profile and was well tolerated in the studied population. Both novel low global warming potential propellants may be viable for use in a clinical setting, therefore further investigation in larger studies is warranted.Table: Comparison of budesonide, glycopyrronium and formoterol PK parameters
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