American journal of respiratory and critical care medicine最新文献

{"title":"Particulate Matter Associations with Lung Function in Pulmonary Sarcoidosis.","authors":"Sharon E Kim,Deborah Assayag,Matthew Broerman,Xiaoping Chen,Jolene H Fisher,Kevin F Gibson,Kerri A Johannson,Daniel Kass,Nasreen Khalil,Martin R J Kolb,Helene Manganas,Veronica Marcoux,Christopher J Ryerson,Mohamed Seedahmed,Yingze Zhang,S Mehdi Nouraie,Gillian C Goobie","doi":"10.1164/rccm.202410-1925oc","DOIUrl":"https://doi.org/10.1164/rccm.202410-1925oc","url":null,"abstract":"Rationale: Sarcoidosis is a multi-system disease with pulmonary manifestations in over 90% of patients. Environmental exposures are associated with sarcoidosis incidence, but the impact on clinical outcomes remains understudied. Objectives: To evaluate the association of ambient particulate matter ≤2.5µm (PM2.5) exposures with lung function outcomes in pulmonary sarcoidosis. Methods: PM2.5 and constituent exposures were obtained by matching monthly satellite-derived hybrid measurements to each patient's residential address obtained from time of enrollment, averaged over 5-years before registry enrollment/censoring. Linear models evaluated associations of pollutants with baseline lung function (forced expiratory volume, FEV1; forced vital capacity, FVC; FEV1/FVC; diffusing capacity for carbon monoxide, DLCO). Linear mixed effects models analyzed associations of pollutants with rate of lung function change (FEV1, FVC, DLCO change per year of follow-up). Measurements and Main Results: Two prospectively enrolled cohorts of mostly middle-aged, White and non-smoking adults with specialist-diagnosed pulmonary sarcoidosis were used. The U.S. cohort (n=400) experienced higher 5-year pre-enrollment median PM2.5 exposures (12.3µg/m3) compared to the Canadian cohort (n=112) (8.0µg/m3). Each 1µg/m3 increase in PM2.5 was associated with 0.93% predicted lower baseline FEV1 (95% CI -1.76 to -0.10, p=0.03) and 1.53% predicted lower FVC (95% CI -2.26 to -0.79, p<0.001) in the U.S. cohort, but associations were not significant in the Canadian cohort. PM2.5, sulfate, nitrate, and ammonium were associated with accelerated FEV1, FVC, and DLCO decline in the U.S. cohort. Conclusions: PM2.5 was associated with worse pulmonary disease severity and progression in a higher-exposure cohort, highlighting the importance of exposure disparities in this population.","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":"147 1","pages":""},"PeriodicalIF":24.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance Characteristics for Physiological Measures of Progressive Pulmonary Fibrosis.","authors":"Chad A Newton,Ashwatha Thenappan,Gabrielle Y Liu,Leda Yazbeck,Cathryn T Lee,Janelle Vu Pugashetti,Jennifer M Wang,Ethan White,Kevin R Flaherty,Elizabeth A Belloli,Jamie S Sheth,Nisha Mohan,Nazanin Nazemi,Andrew R Yu,Sahand Ghodrati,Kerri A Johannson,Veronica Marcoux,Jolene H Fisher,Deborah Assayag,Helene Manganas,Nasreen Khalil,Martin Kolb,Julie Morisset,Christine Kim Garcia,Felix Chua,Mary E Strek,Yet H Khor,Ayodeji Adegunsoye,Christopher J Ryerson,Philip L Molyneaux,Justin M Oldham","doi":"10.1164/rccm.202501-0317oc","DOIUrl":"https://doi.org/10.1164/rccm.202501-0317oc","url":null,"abstract":"RATIONALEClinical measures of progressive pulmonary fibrosis (PPF) have been proposed, but their clinical utility remains unclear.OBJECTIVESTo determine performance characteristics of lung function-based PPF measures, including new guideline criteria for discriminating clinically relevant outcomes.METHODSA multicenter retrospective cohort analysis was performed to assess the performance characteristics of eight categorical measures of forced vital capacity (FVC) and diffusion capacity (DLCO) decline, along with PPF guideline criteria (requiring two of the following: worsening respiratory symptoms, absolute decline in FVC ≥5% or DLCO ≥15%, or radiological progression) for discriminating two-year death or lung transplant among fibrotic ILD patients from the United States, United Kingdom and Canada (n=2727). The net benefit of the top performing measures to inform treatment initiation were compared using decision curves.RESULTSPPF classified according to relative decline in FVC of 10%, relative decline in DLCO of 15% and PPF guideline criteria displayed best overall test performance, with area under the receiver operator curves of 0.67-0.68. Specificity was higher than sensitivity for all evaluated measures, with relative measures of lung function decline outperforming absolute measures. The net benefit of stand-alone relative decline in FVC ≥10% and DLCO ≥15% was similar to PPF guideline criteria across the range of treatment probability thresholds.CONCLUSIONClassifying PPF by stand-alone measures of FVC and DLCO decline provides similar clinical utility as PPF guideline criteria. Top performing physiology-based measures of PPF discriminate outcomes with high specificity, but low sensitivity.","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":"24 1","pages":""},"PeriodicalIF":24.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A New Generation of Clinical Endpoints for Critical Care Trials.","authors":"Patrick G Lyons,Anna Heath,Patrick R Lawler","doi":"10.1164/rccm.202505-1134ed","DOIUrl":"https://doi.org/10.1164/rccm.202505-1134ed","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":"15 1","pages":""},"PeriodicalIF":24.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Randomized Controlled Trial of a Post-ICU Telehealth Care Model (WFIT).","authors":"Rita N Bakhru,Lori Flores,J Maycee Cain,Valesha Province,Jason Fanning,Himanshu Rawal,Richa Bundy,Corey S Obermiller,Adam Moses,Ajay Dharod,Lindsey Abdelfattah,Amresh Hanchate,D Clark Files","doi":"10.1164/rccm.202411-2167oc","DOIUrl":"https://doi.org/10.1164/rccm.202411-2167oc","url":null,"abstract":"RATIONALESurvivors of critical illness are at high risk for poor long-term outcomes including readmissions, reduced quality of life, and mortality. A post-ICU telehealth care model may improve outcomes.OBJECTIVESWe sought to evaluate the cost-effectiveness and clinical efficacy of a post-ICU telehealth care model.METHODSWe performed a single center randomized controlled trial of 400 ICU patients with sepsis and/or acute respiratory failure, who had ≤2 hospital admissions in the past year, and who were not admitted from or discharged to hospice, a skilled nursing facility or a long-term acute care hospital. The intervention group had scheduled telehealth visits at 1- and 2- weeks post-ICU discharge and as needed for six months with a clinician trained in post-ICU recovery. The primary outcome is cost-effectiveness of the intervention.MEASUREMENTS AND MAIN RESULTSOverall healthcare spending on ER visits and hospitalizations were a mean (SD, in USD) $7,801.10 (15,461.03) in the attention control group vs 8,086.50 (17,464.87) in the intervention group, with a calculated incremental net benefit of $1,958.29 (-$5,779.56, $9,696.14). ER visits to our health care system were the same between groups, but patient-reported ER visits to outside hospitals were different (0.97 per 100 patients per month in the attention control group vs 2.43 in the intervention group, p=0.03). Readmissions, mortality, quality of life scores and overall patient satisfaction scores were similar between groups.CONCLUSIONSThis randomized controlled trial of a post-ICU telehealth intervention demonstrated wide variation, but no clear incremental net benefit compared to standard care.","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":"42 1","pages":""},"PeriodicalIF":24.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cavitated Pulmonary Nodules: Endemic Kaposi's Sarcoma Recurrence or Another Cause?","authors":"Edson Marchiori,Pedro Fagundes,Miriam Menna Barreto,Gláucia Zanetti","doi":"10.1164/rccm.202501-0036le","DOIUrl":"https://doi.org/10.1164/rccm.202501-0036le","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":"240 1","pages":""},"PeriodicalIF":24.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging the Gap: Small Airways, Mechanical Stress, and the Evolution of Emphysema.","authors":"MeiLan K Han,Charles Hatt","doi":"10.1164/rccm.202503-0614ed","DOIUrl":"https://doi.org/10.1164/rccm.202503-0614ed","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":"13 1","pages":""},"PeriodicalIF":24.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Imatinib: A Promising Therapeutic Shining Light on Pulmonary Arterial Hypertension Treatment.","authors":"Yutong Ding, Yuting Zhang, Xiaofen Su, Yanjuan Wu, Nuofu Zhang, Kang Wu","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":"None"},"PeriodicalIF":19.3,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144289379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to Ding <i>et al.</i>: Imatinib: A Promising Therapeutic Shining Light on Pulmonary Arterial Hypertension Treatment.","authors":"Alexander Mk Rothman, Sofia Villar, Martin Law, Martin R Wilkins","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":"None"},"PeriodicalIF":19.3,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144289380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of a Typical Fibrotic Hypersensitivity Pneumonitis Pattern on Chest Computed Tomography.","authors":"Christopher J Ryerson, Daniel-Costin Marinescu, Nestor L Muller, Cameron J Hague, Darra Murphy, Andrew Churg, Joanne L Wright, Amna Al-Arnawoot, Ana-Maria Bilawich, Patrick Bourgouin, Gerard Cox, Tracy Elliot, Jennifer Ellis, Jolene H Fisher, Derek Fladeland, Amanda Grant-Orser, Gillian C Goobie, Zachary Guenther, Ehsan Haider, Nathan Hambly, James Huynh, Geoffrey Karjala, Nasreen Khalil, Martin Kolb, Jonathon Leipsic, Stacey Lok, Sarah MacIaac, Micheal McInnis, Helene Manganas, Veronica Marcoux, John Mayo, Julie Morisset, Ciaran Scallan, Tony Sedlic, Shane Shapera, Kelly Sun, Victoria Tan, Alyson W Wong, Boyang Zheng, Yet Hong Khor, Kerri A Johannson","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Guidelines have defined a \"typical hypersensitivity pneumonitis (HP)\" imaging pattern for fibrotic HP (fHP); however, the frequency, characteristics, and outcomes of different multidisciplinary diagnoses within this pattern are unknown.</p><p><strong>Methods: </strong>Patients with a typical fHP pattern on chest computed tomography (CT) were identified from a prospective registry. Multidisciplinary diagnoses were established by consensus during a research-dedicated standardized multidisciplinary discussion of all available data. Pre-specified diagnostic categories of interest included fHP with an exposure identified, fHP without an exposure identified, and connective tissue disease-associated interstitial lung disease (CTD-ILD), with each diagnosis defined by >50% likelihood after this structured multidisciplinary discussion. Clinical and radiological features and outcomes were compared across multidisciplinary diagnoses.</p><p><strong>Results: </strong>Of 164 patients with a CT pattern of typical fHP, 49 had a multidisciplinary diagnosis of fHP with a probable or possible exposure identified (30%), 56 had fHP without an exposure (34%), 36 had a CTD-ILD (22%), and 23 had another multidisciplinary diagnosis (14%). Clinical and CT features differed across multidisciplinary diagnoses. Lung function decline and time to death or transplant were worse in fHP without a probable or possible exposure. Positive autoimmune serologies or a new rheumatologist-confirmed CTD diagnosis developed in 14% of patients with fHP without an exposure identified during follow-up.</p><p><strong>Conclusion: </strong>Patients with a typical fHP pattern on chest CT frequently have non-HP diagnoses (most often CTD-ILD), have differences in baseline characteristics and disease behavior across multidisciplinary diagnoses, and more frequently develop features of CTD during follow-up when an initial HP exposure is not identified.</p>","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":"None"},"PeriodicalIF":19.3,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blurred Boundaries: Rethinking Disease Classifications in ILD Using Molecular Signals.","authors":"Scott M Matson, Philip L Molyneaux","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":"None"},"PeriodicalIF":19.3,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}