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Background and objective: To develop targeted and efficient follow-up programmes for patients hospitalized with coronavirus disease 2019 (COVID-19), structured and detailed insights in recovery trajectory are required. We aimed to gain detailed insights in long-term recovery after COVID-19 infection, using an online home monitoring programme including home spirometry. Moreover, we evaluated patient experiences with the home monitoring programme. Methods: In this prospective multicentre study, we included adults hospitalized due to COVID-19 with radiological abnormalities. For 6 months after discharge, patients collected weekly home spirometry and pulse oximetry measurements, and reported visual analogue scales on cough, dyspnoea and fatigue. Patients completed the fatigue assessment scale (FAS), global rating of change (GRC), EuroQol-5D-5L (EQ-5D-5L) and online tool for the assessment of burden of COVID-19 (ABCoV tool). Mixed models were used to analyse the results. Results: A total of 133 patients were included in this study (70.1% male, mean age 60 years [SD 10.54]). Patients had a mean baseline forced vital capacity of 3.25 L (95% CI: 2.99-3.44 L), which increased linearly in 6 months with 19.1% (Delta 0.62 L, p < 0.005). Patients reported substantial fatigue with no improvement over time. Nevertheless, health status improved significantly. After 6 months, patients scored their general well-being almost similar as before COVID-19. Overall, patients considered home spirometry useful and not burdensome. Conclusion: Six months after hospital admission for COVID-19, patients' lung function and quality of life were still improving, although fatigue persisted. Home monitoring enables detailed follow-up for patients with COVID-19 at low burden for patients and for the healthcare system.

Interstitial lung disease (ILD) is a term used to describe a heterogeneous group of lung disorders with characteristic clinical and imaging features. Patients with ILD are at an increased risk of developing NSCLC, which is frequently medically comorbid, often precluding operative management. In this scenario, radiotherapy (RT) is generally recommended; however, ILD is known to increase the risk of RT-related toxicity. Recommendations for treatment with appropriately individualized risks and benefits are thus dependent on integration of patient-, ILD-, and cancer-specific factors. We aim to provide an overview of ILD for the thoracic oncologist, an assessment of risk of thoracic RT in patients with ILD, and evidence-based recommendations for treatment in a variety of clinical scenarios.

Stereotactic ablative radiotherapy (SABR) is the preferred treatment in medically inoperable patients with early-stage non-small cell lung cancer (NSCLC) [1]. However, there is growing awareness of...

Background We defined the frequency of respiratory community-acquired bacterial co-infection in patients with COVID-19, i.e. patients with a positive SARS-CoV-2 PCR or a COVID-19 Reporting and Data System (CO-RADS) score ≥ 4, based on a complete clinical assessment, including prior antibiotic use, clinical characteristics, inflammatory markers, chest computed tomography (CT) results and microbiological test results. Methods Our retrospective study was conducted within a cohort of prospectively included patients admitted for COVID-19 in our tertiary medical centres between 1-3-2020 and 1-6-2020. A multidisciplinary study team developed a diagnostic protocol to retrospectively categorize patients as unlikely, possible or probable bacterial co-infection based on clinical, radiological and microbiological parameters in the first 72 h of admission. Within the three categories, we summarized patient characteristics and antibiotic consumption. Results Among 281 included COVID-19 patients, bacterial co-infection was classified as unlikely in 233 patients (82.9%), possible in 35 patients (12.4%) and probable in 3 patients (1.1%). Ten patients (3.6%) could not be classified due to inconclusive data. Within 72 h of hospital admission, 81% of the total study population and 78% of patients classified as unlikely bacterial co-infection received antibiotics. Conclusions COVID-19 patients are unlikely to have a respiratory community-acquired bacterial co-infection. This study underpins recommendations for restrictive use of antibacterial drugs in patients with COVID-19.

Evaluation of an early discharge program for COVID-19-patients who still required additional oxygen support, supervised by their own general practitioner (GP) in a home setting. We evaluated safety and gathered experiences from patients, caregivers and GPs.Cohort study (prospective and retrospective inclusion) METHOD: Adult COVID-19-patients admitted to one of the three Amsterdam hospitals, the Netherlands, were eligible when clinically stable for at least 48 hours, with a minimum oxygen saturation of 94% and a maximum of 3 l/min oxygen support. Patients were included from 23-10-2020 to 26-03-2021.We included 113 patients, of whom 40 retrospectively . Median age was 58 years and median length of hospital stay 8 days. Four patients (3.7%) were readmitted within 14 days after discharge. Median duration of oxygen support at home was 8 days. Almost no home visits were conducted by GPs, but contact by telephone was regular (median 6 times in 2 weeks). All stakeholders reported feeling safe, able and confident while delivering the necessary (self) care. The program was graded by patients and GPs with an 8 (on a scale of 1 to 10).Early discharge for COVID-19-patients with a necessity for oxygen support, under supervision of the GP, is safe and was positively evaluated by all stakeholders involved.

Introduction: Transbronchial lung cryobiopsy (TBCB) is a minimally invasive diagnostic procedure for patients with diffuse parenchymal lung disease. Pneumothorax occurs in approximately 19% of procedures and severe hemorrhage in Methods: We prospectively collected data of patients that underwent TBCB. The decision to perform TBCB was taken in the multidisciplinary ILD meeting. The procedure was performed either under general anesthesia with a rigid bronchoscope or cuffed ET tube, or under propofol sedation with a Rusch Bronchoflex tube. Arndt bronchial blockers were used to block the segmental or lobar bronchus after every biopsy in order to minimize bleeding. Patients were observed for 1 night at the clinic and before discharge a chest X-ray was performed. Results: Ninety-three patients underwent TBCB. The mean number of biopsies was 3,8 ±1,3. The overall pneumothorax rate was 15,1%. The annual rate of pneumothorax declined from 29% in 2015 to 8% in 2018 and 2019 (table 1). Bleeding was controlled in all cases with the bronchial blocker. 30-day moratilty was 1/93 (1%). Conclusions: Although TBCB is a safe procedure, there seems to be a clear learning curve with respect to the incidence of pneumothorax. Careful monitoring of complications is important to learn as a team and to minimize the morbidity. References: 1. Ravaglia C et al. BMC Pulm Med 2019;19:16.