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Background: Long-COVID research to date focuses on outcomes in non-hospitalised vs. hospitalised survivors. However Emergency Department attendees (post-ED) presenting with acute COVID-19 may experience less supported recovery compared to people admitted and discharged from hospital (post-hospitalised group, PH)., Objective: We evaluated outcomes and predictors of specialty care referrals (SCR) in those with ongoing symptomatic Long-COVID, comparing post-ED and PH adults., Methods: This prospective observational cohort study evaluates 800 PH and 484 post-ED adults from a single hospital in London, United Kingdom. Participants had either confirmed laboratory-positive SARS-CoV-2 infection or clinically suspected acute COVID-19 and were offered post-COVID clinical follow-up at approximately six weeks after their ED attendance or inpatient discharge, to assess ongoing symptoms and support recovery. Multiple logistic regression determined associations with specialist care referrals (SCR) to respiratory, cardiology, physiotherapy (including chest physiotherapy), and mental health services., Results: Presence of at least one Long-COVID symptom was lower in adults attending ED services with acute COVID-19 compared to those hospitalised (70.1% post-ED vs. 79.5% PH adults, p < 0.001). Total number of Long-COVID symptoms was associated with increased SCR in all patients (adjusted odds ratio (aOR) = 1.26, 95%CI:1.16, 1.36, p < 0.001), with post-ED adults more likely to need a SCR overall (aOR = 1.82, 95%CI:1.19, 2.79, p = 0.006). Post-ED adults had higher SCR to both physiotherapy (aOR = 2.59, 95%CI:1.35, 4.96, p = 0.004) and mental health services (aOR = 3.84, 95%CI:2.00, 7.37, p < 0.001), with pre-existing mental illness linked to the latter (aOR = 4.08, 95%CI:1.07, 15.6, p = 0.04)., Conclusions: We demonstrate greater specialist care referrals to mental health and physiotherapy services in patients attending the ED and discharged with acute COVID-19, compared to those admitted, despite lower ongoing COVID-19 symptom burden. Total number of symptoms, pre-existing co-morbidity such as smoking status, cardiac co-morbidities, and mental health illnesses may predict those requiring healthcare input. This information may enable better post-COVID support for ED attendees, a distinct group who should not be neglected when preparing for future pandemics., Trial Registration: This study had HRA approval (20/HRA/4928)., Competing Interests: Declarations. Ethics approval and consent to participate: This study had UK Health Research Authority (HRA) and Health and Care Research Wales approval (HRA number 20/HRA/4928). All participants consented to participate in the study at their initial follow-up consultation. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Common Variable Immunodeficiency Disorders (CVID) encompass a spectrum of immunodeficiency characterised by recurrent infections and diverse non-infectious complications (NICs). This study aimed to describe the clinical features and variation in NICs in CVID with and without interstitial lung disease (ILD) from a large UK national registry population., Methods: Retrospective, cross-sectional data from a UK multicentre database (previously known as UKPIN), categorising patients into those with CVID-ILD and those with NICs related to CVID but without pulmonary involvement (CVID-EP; EP= extra-pulmonary involvement only)., Results: 129 patients were included. Chronic lung diseases, especially CVID-ILD, are prominent complications in complex CVID, occurring in 62% of the cohort. Bronchiectasis was common (64% of the cohort) and associated with greater pulmonary function impairment in patients with CVID-ILD compared to those without bronchiectasis. Lymphadenopathy and the absence of gastrointestinal diseases were significant predictors of ILD in complex CVID. Although the presence of liver disease did not differ significantly between the groups, nearly half of the CVID-ILD patients were found to have liver disease. Patients with CVID-ILD were more likely to receive immunosuppressive treatments such as rituximab and mycophenolate mofetil than the CVID-EP group, indicating greater need for treatment and risk of complications., Conclusion: This study highlights the significant burden of CVID-ILD within the CVID population with NICs only. The lungs emerged as the most frequently affected organ, with ILD and bronchiectasis both highly prevalent. These findings emphasise the necessity of a comprehensive and multidisciplinary approach in managing CVID patients, considering their susceptibility to various comorbidities and complications., Competing Interests: LM received speaker fees and travel grants from Takeda, BioCryst and CSL. MA received honoraria from Takeda and Biocryst for educational activities in the past. No direct conflicts with this work. TG received consulting, advisory work and educational support from BioCryst, CSL Behring, KalVista, Novartis, Octapharma, Pharming, Pharvaris and Takeda. AH received support for attending meetings from Biocryst, Pharming and Takeda. NH has received honoraria from Dr Falk and Advanz Pharma for educational activities and has consultancy agreements with Mirum Pharma and Signant Health, none of which relate to this work. SB received grant support from CSL Behring and personal fees or travel expenses from Grifols, Pharming, GSK, CSL Behring, Baxalta US Inc and Biotest. CS: Received honoraria and educational support from BioCryst, CSL Behring, Pharming and Takeda. JH received grant support, and payment for educational and advisory work to his institution from pharmaceutical companies that make medicines to treat respiratory disease and immunodeficiency. Personal payment for educational and advisory work, and support to attend meetings from the same. SGo received Takeda sponsored meetings in the last 12 months and was paid to co-lead a workshop relating to immunodeficiency. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Bintalib, Grigoriadou, Patel, Mutlu, Sooriyakumar, Vaitla, McDermott, Drewe, Steele, Ahuja, Garcez, Gompels, Grammatikos, Herwadkar, Ayub, Halliday, Burns, Hurst and Goddard.)

Introduction: This study explores clinicians' diagnostic practices and perceptions in the context of granulomatous-lymphocytic interstitial lung disease (GLILD), a pulmonary manifestation of common variable immunodeficiency disorder. The aim was to gain valuable insights into key aspects, such as the utilization of radiological features for diagnostic purposes, indications for lung biopsy, preferred biopsy techniques, and the relative importance of different histopathological findings in confirming GLILD., Method: A survey targeting expert clinicians was conducted, focusing on their experiences, practices, and attitudes towards lung biopsy in suspected GLILD cases., Results: The survey revealed that the majority of respondents accepted high-resolution computed tomography as a sufficient alternative to biopsy for making a probable GLILD diagnosis in most patients. There was a consensus among most respondents that the presence of extrapulmonary granulomatous disease is adequate for making a diagnosis of GLILD where the chest imaging and clinical picture are consistent. When a biopsy was recommended, there was notable variation in the preferred initial biopsy technique, with 35% favouring transbronchial biopsy., Conclusion: Our findings underscore the complexity of diagnosing GLILD, indicating varied clinician opinions on the necessity and efficacy of lung biopsies. They highlight the need for further research and the development of consistent diagnostic criteria and management protocols, ultimately aiming to enhance the accuracy and safety of GLILD diagnosis and treatment strategies., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Background: Pulmonary hypertension due to chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) is classified as group 3 pulmonary hypertension. Inhaled treprostinil, a prostaglandin I 2 analogue also known as prostacyclin, has recently been approved as a first drug for patients with pulmonary hypertension secondary to ILD. However, due to a lack of evidence, no therapies are currently approved for those with COPD-associated pulmonary hypertension. Thus, this systematic review aims to summarise the current evidence to assess the impact of inhaled prostaglandin I 2 analogue use on the pulmonary hemodynamics, exercise function, lung function, and gas exchange in patients with pulmonary hypertension due to COPD., Methods: We systematically searched the electronic databases of Medline, Embase, Scopus and Cochrane from inception to 1 February 2023. Studies of adult patients with a confirmed diagnosis of COPD-associated pulmonary hypertension who received inhaled drugs targeting the prostacyclin pathway were included in the systematic review. Case reports, systematic reviews, conference abstracts with no full text, non-full-text articles, non-English manuscripts and book chapters were excluded from this systematic review. A risk-of-bias assessment was carried out for the studies included in this review, using two different Cochrane risk-of-bias tools for randomised and non-randomised clinical trials., Results: A total of four studies met our inclusion criteria and were included in this systematic review. The results of one prospective clinical trial showed an improvement in the pulmonary hemodynamics (e.g., cardiac index, cardiac output and mean pulmonary artery pressure) in response to inhaled prostacyclin use in patients with pulmonary hypertension secondary to COPD. However, the severity of dyspnoea, lung function, exercise capacity and gas exchange were not affected when inhaled prostacyclin was used for patients with COPD-related pulmonary hypertension., Conclusion: This systematic review demonstrated that although inhaled prostacyclin does not seem to improve COPD-related outcomes (e.g., lung function and exercise capacity), short-term use of inhaled prostacyclin has the potential to reduce mean pulmonary artery pressure and pulmonary vascular resistance without impairing ventilation-perfusion mismatch. Further studies with larger sample sizes are warranted., Systematic Review Registration: CRD42022372803, https://www.crd.york.ac.uk/prospero/display&#95;record.php?RecordID=372803., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Alqarni, Aldhahir, Bintalib, Alqahtani, Siraj, Majrshi, AlGarni, Naser, Alghamdi and Alwafi.)

Objectives: COVID-19 studies report on hospital admission outcomes across SARS-CoV-2 waves of infection but knowledge of the impact of SARS-CoV-2 variants on the development of Long COVID in hospital survivors is limited. We sought to investigate Long COVID outcomes, aiming to compare outcomes in adult hospitalised survivors with known variants of concern during our first and second UK COVID-19 waves, prior to widespread vaccination., Design: Prospective observational cross-sectional study., Setting: Secondary care tertiary hospital in the UK., Participants: This study investigated Long COVID in 673 adults with laboratory-positive SARS-CoV-2 infection or clinically suspected COVID-19, 6 weeks after hospital discharge. We compared adults with wave 1 (wildtype variant, admitted from February to April 2020) and wave 2 patients (confirmed Alpha variant on viral sequencing (B.1.1.7), admitted from December 2020 to February 2021)., Outcome Measures: Associations of Long COVID presence (one or more of 14 symptoms) and total number of Long COVID symptoms with SARS-CoV-2 variant were analysed using multiple logistic and Poisson regression, respectively., Results: 322/400 (wave 1) and 248/273 (wave 2) patients completed follow-up. Predictors of increased total number of Long COVID symptoms included: pre-existing lung disease (adjusted count ratio (aCR)=1.26, 95% CI 1.07, 1.48) and more COVID-19 admission symptoms (aCR=1.07, 95% CI 1.02, 1.12). Weaker associations included increased length of inpatient stay (aCR=1.02, 95% CI 1.00, 1.03) and later review after discharge (aCR=1.00, 95% CI 1.00, 1.01). SARS-CoV-2 variant was not associated with Long COVID presence (OR=0.99, 95% CI 0.24, 4.20) or total number of symptoms (aCR=1.09, 95% CI 0.82, 1.44)., Conclusions: Patients with chronic lung disease or greater COVID-19 admission symptoms have higher Long COVID risk. SARS-CoV-2 variant was not predictive of Long COVID though in wave 2 we identified fewer admission symptoms, improved clinical trajectory and outcomes. Addressing modifiable factors such as length of stay and timepoint of clinical review following discharge may enable clinicians to move from Long COVID risk stratification towards improving its outcome., Competing Interests: Competing interests: JRH, SM and AS report personal fees, and JRH, SM, AS and AJS report non-financial support from pharmaceutical companies that make medicines and medical devices to treat respiratory disease, outside the submitted work., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Nomophobia is common among students in many healthcare disciplines, and its association with academic performance has been explore before. However, there is no available data on its prevalence and association with academic performance among undergraduate physiotherapy (PT) students in Saudi Arabia., Methods: Between 22 December 2022 and 30 January 2023, a cross-sectional survey was conducted by dissemination using an online platform (Survey Monkey)., Results: In total, 806 PT students, with males accounting for 494 (61%), responded to the survey. The prevalence of nomophobia among PT students was 98.4% (793). The mean (±SD) of the total NMP-Q items scores was 49 (±17), indicating a mild level of nomophobia. Female PT students had significantly higher nomophobia scores than the males (47 (39-65); 44 (38-52); (p < 0.001)). Non-smokers had significant higher nomophobia scores than smokers (46 (38-61); 44 (38-49); (p = 0.004)). Regarding grade point averages (GPA), the students with a GPA of less than 3.49 had the highest nomophobia score (51 (43-74); p <0.001)). Concerning the stage of their studies, bridging students had the highest nomophobia score (51 (34-76); p = 0.023)). Regarding academic warnings, those who reported no academic warnings had the highest nomophobia score (46 (42-50); p = 0.023)). Finally, regarding study hours, the students who spent ≥ five hours studying per week had the highest nomophobia score (54 (42-68); p < 0.001))., Conclusion: Nomophobia is common among PT students, with the majority experiencing a mild level. Being female, non-smoker, and having a higher academic performance were risk factors associated with higher nomophobia levels., Competing Interests: The authors report no conflicts of interest in this work., (© 2023 Aldhahir et al.)

Introduction: Common variable immunodeficiency related interstitial lung disease (CVID-ILD, also referred to as GLILD) is generally considered a manifestation of systemic immune dysregulation occurring in up to 20% of people with CVID. There is a lack of evidence-based guidelines for the diagnosis and management of CVID-ILD., Aim: To systematically review use of diagnostic tests for assessing patients with CVID for possible ILD, and to evaluate their utility and risks., Methods: EMBASE, MEDLINE, PubMed and Cochrane databases were searched. Papers reporting information on the diagnosis of ILD in patients with CVID were included., Results: 58 studies were included. Radiology was the investigation modality most commonly used. HRCT was the most reported test, as abnormal radiology often first raised suspicion of CVID-ILD. Lung biopsy was used in 42 (72%) of studies, and surgical lung biopsy had more conclusive results compared to trans-bronchial biopsy (TBB). Analysis of broncho-alveolar lavage was reported in 24 (41%) studies, primarily to exclude infection. Pulmonary function tests, most commonly gas transfer, were widely used. However, results varied from normal to severely impaired, typically with a restrictive pattern and reduced gas transfer., Conclusion: Consensus diagnostic criteria are urgently required to support accurate assessment and monitoring in CVID-ILD. ESID and the ERS e-GLILDnet CRC have initiated a diagnostic and management guideline through international collaboration., Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022276337., Competing Interests: AV reports fees for educational activities from Takeda outside the submitted work.JJ reports fees from Boehringer Ingelheim, Roche, NHSX, Takeda and GlaxoSmithKline unrelated to the submitted work. JJ was supported by Wellcome Trust Clinical Research Career Development Fellowship 209553/Z/17/Z and the NIHR Biomedical Research Centre at University College London.JD reports fees for advisory board meetings, teaching and educational activities, and congress participation from Boehringer Ingelheim outside the submitted work.PM has received grant support from the National Institutes of Health, AAAAI Foundation, Immune Deficiency Foundation, Takeda, Horizon Pharma, and Boston University and has received consulting fees from Medscape and Pharming.KW reports honoraria for advisory board meetings, teaching and educational activities from TAKEDA, LFB biomedicaments, CSL Behring, Grifols, and Bristol-Myers Squibb outside the submitted work. In addition, KW has received a research grant by Bristol-Myers Squibb for the investigation of Abatacept for interstitial lung disease in CVID.JH has received support to attend meetings, personal payment and payment to his employer from companies that make medicines to treat respiratory disease and immunoglobulin products. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Bintalib, van de Ven, Jacob, Davidsen, Fevang, Hanitsch, Malphettes, van Montfrans, Maglione, Milito, Routes, Warnatz and Hurst.)

Background: Nomophobia has been highly prevalent among health discipline students. However, there is no available data on the prevalence of nomophobia among respiratory therapy (RT) students in Saudi Arabia., Methods: A cross-sectional survey using the nomophobia questionnaire (NMP-Q) was conducted and distributed using a convenience sample of RT students through an online platform (Survey Monkey) between September and November 2022., Results: Overall, 1428 RT students, with males accounting for 773 (54%), responded to the online survey. The prevalence of nomophobia among RT students was 97.3% (1390). The mean (±SD) of the total NMP-Q items scores was 62 (±22), indicating a moderate level of nomophobia among the RT students. Female RT students had significantly higher nomophobia scores than male RT students (63 (47-80) vs 59 (43-75); p <0.001)). Single RT students had significantly higher nomophobia scores than married RT students (62 (46-78) vs 46 (37-64); p <0.001)). RT students who were living outside the family home had significantly higher nomophobia scores than RT students who were living with their family (66 (54-78) vs 60 (44-77); p = 0.001)). RT students with a GPA of 4.50 to 5.00 had the highest nomophobia score (63 (46-79); p = 0.005)). RT students who were in their third year had the highest nomophobia score (66 (48-80); p <0.001)). RT students who reported no academic warnings had the highest nomophobia score (63 (48-80); p <0.001)). RT students who spent ≥ five hours studying per week had the highest nomophobia score (64 (51-80); p <0.001))., Conclusion: Nomophobia is common among RT students, with the majority experiencing a moderate level. Being female, single, living outside the family home, and having a higher academic performance were risk factors associated with higher nomophobia levels., Competing Interests: The authors report no conflicts of interest in this work., (© 2023 Aldhahir et al.)

Aim: The aim of the study was to evaluate the response in lung function to different treatment regimens for common variable immunodeficiency patients with granulomatous lymphocytic interstitial lung disease (GLILD)., Method: A longitudinal retrospective cohort study was carried out. Patients were divided into three groups. To assess the response to different treatments, we compared baseline lung function with post-treatment tests., Results: 14 patients with GLILD were included, seven of whom were treated with acute corticosteroids for a mean duration of 132±65 days. Spirometry results were unchanged, but there was a significant improvement in diffusing capacity of the lung for carbon monoxide ( D LCO )% and transfer coefficient of the lung for carbon monoxide ( K CO )% (median change in D LCO %=7%, p=0.04, and K CO %=13%, p=0.02). Relapse occurred in three out of seven patients. Five patients were treated with long-term mycophenolate mofetil (MMF) with/without corticosteroids for a mean duration of 1277±917 days. No changes were found in spirometry; however, there was a significant increase in D LCO % and K CO % (median change in each of D LCO % and K CO %=10%, p=0.04). Four patients on steroids with MMF successfully weaned the prednisone dose over 12 months. Four patients never received immunosuppression therapy. A significant decline was found in their lung function assessed over 7.5 years. The median reduction in the forced vital capacity (FVC)%, forced expiratory volume in 1 s (FEV 1 )% and D LCO % was 15%, 7% and 15%, equivalent to 2%, 1% and 2% per year, respectively., Conclusion: Corticosteroids improve gas transfer in GLILD, but patients often relapse. The use of MMF was associated with long-term effectiveness in GLILD and permits weaning of corticosteroids. A delay in initiating and continuing maintenance treatment could lead to disease progression., Competing Interests: Conflict of interest: H.M. Bintalib has nothing to disclose. Conflict of interest: D.M. Lowe reports grants from National Institute for Health Research (UK), LifeArc, Bristol-Myers-Squibb, Blood Cancer UK, the Medical Research Council (UK) and the British Society for Antimicrobial Chemotherapy, and personal fees from CSL Behring, Merck and Gilead, outside the submitted work. Conflict of interest: G. Mancuso has nothing to disclose. Conflict of interest: G. Gkrepi has nothing to disclose. Conflict of interest: S.L. Seneviratne has nothing to disclose. Conflict of interest: S.O. Burns reports personal fees from CSL Behring, Baxalta US Inc., Biotest, the European Union, the National Institute of Health Research, UCLH and GOSH/Institute of Child Health Biomedical Research Centers, and CSL Behring, outside the submitted work. Conflict of interest: J.R. Hurst reports grants, personal fees and nonfinancial support from pharmaceutical companies that make medicines to treat respiratory and immunological diseases outside the submitted work., (Copyright ©The authors 2022.)

The first ever research prioritisation exercise in GLILD: this survey identified areas of interest in the diagnosis, treatment and management of GLILD, which can be used as a roadmap for future research https://bit.ly/3nVuzti., Competing Interests: Provenance: Submitted article, peer reviewed.Conflict of interest: J.R. Hurst reports grants, personal fees and nonfinancial support from pharmaceutical companies that make medicines to treat respiratory and immunological diseases outside the submitted work. Conflict of interest: S.M. Abbas has nothing to disclose. Conflict of interest: H.M. Bintalib has nothing to disclose. Conflict of interest: T.M. Alfaro has nothing to disclose. Conflict of interest: U. Baumann has nothing to disclose. Conflict of interest: S.O. Burns reports personal fees from CSL Behring, Baxalta US Inc., Biotest, the European Union, the National Institute of Health Research, UCLH and GOSH/Institute of Child Health Biomedical Research Centers, and CSL Behring, outside the submitted work. Conflict of interest: A. Condliffe has nothing to disclose. Conflict of interest: J.R. Davidsen has nothing to disclose. Conflict of interest: B. Fevang has nothing to disclose. Conflict of interest: A.R. Gennery has nothing to disclose. Conflict of interest: F. Haerynck has nothing to disclose. Conflict of interest: J. Jacob reports personal fees from Boehringer Ingelheim, Roche and GlaxoSmithKline, outside the submitted work. Conflict of interest: S. Jolles has nothing to disclose. Conflict of interest: O. Lamers has nothing to disclose. Conflict of interest: A. Bergeron reports grants from SOS Oxygene, personal fees from Takeda, and personal fees from AstraZeneca, Pfizer, MSD, Gilead and Enanta, outside the submitted work. Conflict of interest: M. Malphettes has nothing to disclose. Conflict of interest: V. Meignin has nothing to disclose. Conflict of interest: C. Milito has nothing to disclose. Conflict of interest: T. Milota has nothing to disclose. Conflict of interest: M. Pergent has nothing to disclose. Conflict of interest: A. Prasse reports personal fees from Boehringer Ingelheim, Roche, Novartis, Chiesi, Pliant and AstraZeneca outside the submitted work. Conflict of interest: I. Quinti has nothing to disclose. Conflict of interest: E. Renzoni reports grants from Boehringer Ingelheim, and lecture fees from Boehringer Ingelheim and Roche, outside the submitted work. Conflict of interest: A. Sediva has nothing to disclose. Conflict of interest: D. Stolz reports grants from AstraZeneca AG, Curetis AG and Boston Scientific, and payment for lectures and/or advisory boards from AstraZeneca AG, Novartis AG, GSK AG, Roche AG, Zambon, Pfizer, Schwabe Pharma AG, Vifor AG, Chiesi AG and MSD, outside the submitted work. Conflict of interest: B. Smits has nothing to disclose. Conflict of interest: F. Strauss has nothing to disclose. Conflict of interest: A.A.J.M. van de Ven has nothing to disclose. Conflict of interest: J. van Montfrans reports having participated in an advisory board for Takeda during the conduct of the study. Conflict of interest: K. Warnatz reports grants from Bristol Myers Squibb outside the submitted work., (Copyright ©The authors 2021.)