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The aim of this study was to determine the efficacy and safety of ciclesonide in the treatment of novel coronavirus disease 2019 (COVID-19) as gauged by pneumonia progression. This multi-center, open-label randomized trial was conducted with patients recruited from 22 hospitals across Japan. Participants were patients admitted with mild or asymptomatic COVID-19 without signs of pneumonia on chest X-rays. Asymptomatic participants were diagnosed after identification through contact tracing. Trial participants were randomized to either the ciclesonide or control arm. Participants in the treatment arm were administered 400 µg of ciclesonide three times a day over seven consecutive days. The primary endpoint was exacerbated pneumonia within seven days. Secondary outcomes were changes in clinical findings, laboratory findings, and changes over time in the amount of the viral genome. In the treatment group, 16 patients (39.0%) were classified as having exacerbated pneumonia compared to 9 (18.8%) in the control group. The risk ratio (RR) was 2.08 (95% confidence interval (CI): 1.15-3.75), indicating a worsening of pneumonia in the ciclesonide group. Significant differences were noted in participants with a fever on admission (RR: 2.62, 90% CI: 1.17-5.85, 95% CI: 1.00-6.82) and individuals 60 years of age or older (RR: 8.80, 90% CI: 1.76-44.06, 95% CI: 1.29-59.99). The current results indicated that ciclesonide exacerbates signs of pneumonia on images in individuals with mild or asymptomatic symptoms of COVID-19 without worsening clinical symptoms.

Background: Treatments for eosinophilic granulomatosis with poliangiitis (EGPA) were limited to systemic corticosteroid and immunomodulatory agent, which have serious adverse effects. In EGPA patients a reduction of corticosteroid often induces relapses. Aims: The MIRRA trial demonstrated that mepolizumab (MEPO) is a steroid-sparing agent for patients with relapsing or refractory EGPA (NEJM 2017). However, the number of enrolled patients was limited. We report 5 EGPA patients treated with MEPO to confirm the finding. Methods: This is retrospective review of five patients with EGPA treated with MEPO. Results: Case 1-4 were 3 men and 1 female and age of onset were 28-70 yo. Treatment was started with PSL 30-60 mg/day with a gradual tapering. All the cases suffered relapses with PSL tapering, and then PSL were increased. In Case 1-3, MEPO 300 mg/day were added at the time of PSL 9-10 mg/day. In Case 4, MEPO 100 mg/day was added at the time of PSL 7 mg/day and, followed by the increase of MEPO (300 mg/day) after tapering of PSL. Currently, in Case 1, 2 and 4, dose of PSL was tapering to 0.5-4 mg/day and these cases maintain remission. In Case 3, a relapse was observed after reduction of PSL even with MEPO. Case 5 was a male and onset age was 75 yo. Treatment was started with PSL 60 mg/day and MEPO 100 mg/day. A relapse was observed during the reduction of PSL. Both PSL and MEPO (300 mg/day) were increased. After that PSL was reduced to 5 mg/day without any replace. No apparent adverse events of MEPO were found in any cases. Conclusions: Remission was obtained in 5 of 3 cases. Consistent with prior published paper, MEPO is an effective steroid-sparing agent for patients with EGPA.

Background In approximately 30% of children with asthma, the condition persists into adulthood. The longer duration of asthma in these patients is a risk factor for poor asthma control. However, the characteristics of adult patients with asthma that has persisted since childhood are not well documented. Objective We sought to compare the clinical characteristics among patients with adult-onset asthma, patients who outgrew childhood asthma but relapsed, and patients with persistent asthma since childhood. Methods We conducted a cross-sectional study of adult patients with asthma who visited our hospital. We classified them into 3 groups: those with adult-onset asthma (adult-onset), those who had remitted childhood asthma that relapsed (relapsed), and those who had asthma that had persisted since childhood (persistent). The clinical characteristics of these groups were compared. Results A total of 1443 patients were enrolled. The persistent group was younger and included fewer patients with a smoking history. There were statistically significant differences among the 3 groups in the percentages of patients with a family history of asthma and comorbidities of allergic rhinitis and atopic dermatitis. The proportion of patients with severe asthma differed among the 3 groups (31% in the adult-onset group, 34% in the relapsed group, and 40% in the persistent group; P = .015). The values of forced expiratory flow at 75% of vital capacity were lower in the persistent group than the relapsed or adult-onset group. A multivariable logistic regression analysis (dependent variable: severe asthma) in each group revealed that the factors associated with severe asthma differed among the adult-onset, relapsed, and persistent groups. When we established an overall model that included interaction terms of cohort-by-other factors, there was a trend that comorbidity of allergic rhinitis affected the severity of asthma differently in the relapsed group compared with the other groups. Conclusion The clinical phenotype of asthma that persists from childhood to adulthood seems to be a distinct phenotype of adult asthma.

Background: The 2-year overall survival (OS) of c-Stage IIIA/B non-small cell lung cancer (NSCLC) is each 53% and 34% in IASLC Staging Project (7th) and the treatments remain controversial. Especially, multimodal treatment at stage III (T3/4-AOI) is poorly studied. Method: This retrospective observational study aimed to elucidate the efficacy and safety of tri-modality therapy in pts with stage III NSCLC (T3/4-AOI). We included all pts who received ICRT (2 cycles of DOC/CDDP or PAC/CBDCA plus 40–46 Gy of thoracic radiation) between 2014 and 2017 at our institution. Results: 35 pts (mean age, 66y) with stage III NSCLC (T3/4-AOI, any-N proven by EBUS-TBNA) judged as pre-ICRT resectable by a multidisciplinary tumor board, were enrolled. There were 21 T3 and 14 T4 cases; and 17 adenocarcinoma, 17 squamous cell carcinoma, and 1 not-otherwise-specified case. One pneumonectomy and 28 lobectomies; and 11 tracheobronchial, 6 chest wall, 7 great vessel, and 6 cardiac resections were performed. 26 pts (90%) achieved R0 resection. 6 pts did not undergo surgery due to disease progression (n=3), performance status decline (n=1), and severe radiation pneumonitis (n=2). No pts died during ICRT or within 6 months post-surgery. The 2-year OS and recurrence-free survival (RFS) rate in those who completed the 2-year follow-up was each 74% (17/23) and 68% (15/22), respectively. In total, each 12 and 13 pts have not reached 2-year follow-up yet. Conclusion: Surgery after ICRT in pts with stage III NSCLC (T3/4-AOI) was well tolerated and potentially benefitted survival.