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Background In the current coronavirus health crisis, inhaled bronchodilators(IB) have been suggested as a possible treatment for patients hospitalized. Patients with evidence of Covid-19 pneumonia worldwide have been prescribed these medications as part of therapy for the disease, an indication for which this medications could be ineffective taken on account the pathophysiology and mechanisms of disease progression. Objective The main objective was to evaluate whether there is an association between IB use and length of stay. Primary end points were the number of days that a patient stayed in the hospital and death as a final event in a time to event analysis. Pneumonia severity, oxygen requirement, involved drugs, comorbidity, historical or current respiratory diagnoses and other drugs prescribed to treat coronavirus pneumonia were also evaluated. Methods A descriptive, observational, cross-sectional study was performed in this tertiary hospital in Madrid (Spain). Data were obtained regarding patients hospitalized with Covid-19, excluding those who were intubated. The primary and secondary outcomes such as duration of hospitalization and death were compared in patients who received IB with those in patients who did not. Results 327 patients were evaluated, mean age was 64.4±15.8 years. Median length of hospitalization stay was 10 days. Of them 292 (89.3%) overcame the disease, the remaining 35 died. Patients who had received IB did not have less mortality rate (odds ratio 0.839; 95% CI: 0.401 to 1.752) and less hospitalization period when compared with patients who did not received IB (odds ratio 1.280; 95% CI: 0.813 to 2.027). There was no significant association between IB use and recovery or death. Hypertension and diabetes were the most common comorbidities. The prevalence of chronic respiratory disease in our cohort was low (21.1%). Anticholinergics were the IB more frequently prescribed for Covid-19 pneumonia. Better response in patients treated with inhaled corticosteroids was not observed. Conclusion Off-label indication of inhaled-bronchodilators for Covid-19 patients are common in admitted patients. Taken on account our results, the use of IB for coronavirus pneumonia apparently is not associated with a significantly patient´s improvement. Our study confirms the hypothesis that inhaled bronchodilators do not improve clinical outcomes or reduce the risk of Covid-19 mortality. This could be due to the fact that the virus mainly affects the lung parenchyma and the pulmonary vasculature and probably not the airway. More researches are necessary in order to fill the gap in evidence for this new indication.

BackgroundThe use of psychiatric agents in hospitals increases the complexity of pharmacotherapy and the risk of drug–drug interactions.PurposeTo assess the frequency and clinical relevance of interactions associated with the use of antipsychotics, anxiolytics, antidepressants and sedative/hypnotics in a hospital.Material and methodsCross-sectional observational study in which the treatment of adult patients admitted to a general hospital (1,350 beds) was reviewed. The investigators, using a computerised physician order entry program, evaluated pharmacotherapy of inpatients involving antipsychotics, anxiolytics, antidepressants and sedatives/hypnotics. They assessed drug-drug interactions and their clinical significance as described in the literature. Reference sources were the Micromedex database and the Spanish Society of Hospital Pharmacist’s professional guide to drug interactions.ResultsTreatment of 393 patients was analysed. Of these, 179 (45.5%) were prescribed one of the drugs studied; 53.6% were female and 46.4% male with mean age 65 (SD ± 17.7) years. The average number of drugs prescribed per patient was 12 (SD ± 4.41). A total of 221 drug interactions was detected (9.5% pharmacokinetic, 90.5% pharmacodynamic), affecting 70.4% of patients. A total of 42.8% were due to prescription of antipsychotics, 31.1% due to antidepressants, 18.5% to anxiolytics and 7.6% to hypnotics/sedatives. The medical specialties involved were surgery (22.4%), oncology (11.1%), cardiology (8.9%), internal medicine (8.9%) and psychiatry (8.4%). Based on clinical significance, 47.5% of interactions were severe, 25.3% moderate and 27.1% mild. Potential interactions with significant clinical effects were haloperidol-tramadol (increased seizure risk), escitalopram-low molecular weight heparin (increased risk of bleeding) and midazolam-morphine (increased sedation). Three contraindicated combinations were detected: escitalopram-metoclopramide for increased QT interval, linezolid-amitriptyline for serotonin syndrome and risperidone-metoclopramide for neuroleptic syndrome and extrapyramidal reactions.ConclusionPrescription of antipsychotic drugs, antidepressants, anxiolytics and sedatives/hypnotics to inpatients is very common. These drugs cause numerous drug interactions, which can potentially have serious consequences for hospitalised patients.References and/or acknowledgementsPsychiatric DepartmentNo conflict of interest.

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