Chest
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Asthma is increasingly recognized as an underlying risk factor for severe respiratory disease in patients with coronavirus disease 2019 (COVID-19), particularly in the United States. Here, we report the postmortem lung findings from a 37-year-old man with asthma, who met the clinical criteria for severe acute respiratory distress syndrome and died of COVID-19 less than 2 weeks after presentation to the hospital. ⋯ The presence of diffuse alveolar damage is similar to descriptions of autopsy lung findings from patients with severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome coronavirus, and the absence of a neutrophil-rich acute bronchopneumonia differs from the histologic changes typical of influenza. The relative contribution of mucus plugging to his hypoxemia is unknown.
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Case Reports
Self-Performed Lung Ultrasound for Home Monitoring of a Patient Positive for Coronavirus Disease 2019.
A subset of patients with coronavirus disease 2019 (COVID-19) and lung involvement pose a disposition challenge, particularly when hospital resources are constrained. Those not in respiratory failure are sent home, often with phone monitoring and/or respiratory rate and oxygen saturation monitoring. ⋯ Early identification of pulmonary progression may preempt emergency hospitalization for respiratory decompensation and facilitate more timely admission. With the goal of safely isolating infected patients while providing advanced monitoring, we present a first report of patient self-performed lung ultrasound in the home with a hand-held device under the guidance of a physician using a novel teleguidance platform.
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Case Reports
Nintedanib in Bronchiolitis Obliterans Syndrome After Allogeneic Hematopoietic Stem Cell Transplantation.
Bronchiolitis obliterans syndrome (BOS) after allogeneic hematopoietic cell transplantation (allo-HCT) usually confers poor prognosis and high mortality. Currently, therapeutic options are limited. ⋯ Then he started nintedanib treatment, and the symptoms of nonproductive cough and dyspnea were alleviated gradually. His pulmonary function test revealed increased FEV1 compared to baseline.
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Nonadherence to oral prednisolone is an important driver of poor control in severe asthma, and its detection is warranted to guide management. ⋯ Nonadherence to oral prednisolone is common in severe asthma and can be reliably detected in the clinic by using the LC-MS/MS assay.