Zibaoui, Roba El

Abstract Rationale: Pulmonary alveolar proteinosis (PAP) is a rare lung disorder characterized by the accumulation of surfactant in the alveoli, primarily seen in autoimmune PAP (aPAP), which accounts for over 90% of cases. The COVID-19 pandemic has highlighted the potential for viral infections to exacerbate or induce PAP, complicating diagnosis and treatment. Objective: This study aims to provide updated clinical and demographic characteristics of patients with pulmonary alveolar proteinosis (PAP) and to analyze trends in the use of whole lung lavage before the COVID-19 pandemic, as well as assess the impact of the pandemic on WLL utilization. Methods: Using data from the National Inpatient Sample from 2017 to 2021, the authors identified PAP, other diagnoses, and procedures. using the respective ICD-10 codes. Statistical analysis was performed on the trends of whole lung lavage and other outcomes across the five years. Results: A total of 3,030 hospitalized PAP patients were included in the study, with demographic and clinical characteristics reported for the cohort. Although the use of WLL increased from 11.55% pre-pandemic to 14.67% during the pandemic, this difference was not statistically significant. However, there was a significant rise in the incidence of acute respiratory failure during the pandemic (35.7% vs. 45.78%, p = 0.02). While transbronchial lung biopsies increased and open lung biopsies declined, these trends were not statistically significant. Conclusion: In recent years, despite a decline in the use of WLL for treating PAP and open lung biopsies for diagnosis, the rates have risen due to the impact of the COVID-19 pandemic.

Background: Previous reports have emphasized disparities in the utilization of invasive respiratory support for bacterial pneumonia among various racial and ethnic minority groups with bacterial pneumonia. However, there is a shortage of detailed epidemiological data on this, particularly after the onset of the COVID-19 pandemic. Methods: We used the National In-patient Sample to conduct a retrospective cohort analysis from 2017 to 2021. We included patients hospitalized across the United States with a primary diagnosis of bacterial pneumonia. Statistical methods used included Pearson chi-square and multivariable regression analyses. Examining racial and ethnic differences in hospitalized subjects’ usage of invasive mechanical ventilation for bacterial pneumonia was the primary outcome of the study. Secondary outcomes included mortality, use of noninvasive ventilation, and hospital stay. Results: The study found significant differences among racial and ethnic groups in pneumonia-related outcomes and the need for advanced respiratory ventilator assistance. Black and Asian American and Pacific Islander (AAPI) subjects had the highest rates of invasive mechanical ventilation compared with other racial groups, with adjusted odds ratios (ORs) indicating a higher likelihood of requiring this intervention for Black (OR 1.15) and AAPI (OR 1.31) subjects. For secondary outcomes, Black and AAPI subjects experienced longer hospital stays than other racial and ethnic groups. Noninvasive ventilation rates were comparable across groups. Mortality rates were the highest among Black subjects, but were elevated for all racial and ethnic minority subjects compared with white subjects. The pandemic exacerbated these disparities, leading to increased rates of both invasive and noninvasive ventilation and higher mortality, with particularly pronounced effects seen in AAPI patients, thereby worsening existing health inequities. Conclusions: The study suggests potential racial–ethnic disparities in invasive mechanical ventilation use among Black and AAPI subjects, but further investigation is needed to confirm these findings and explore underlying causes.