Annals of the American Thoracic Society最新文献

{"title":"Morphological Prediction of CPAP Associated Acute Respiratory Instability.","authors":"Thijs-Enagnon Nassi,Eline Oppersma,Gonzalo Labarca,Dirk W Donker,M Brandon Westover,Robert J Thomas","doi":"10.1513/annalsats.202311-979oc","DOIUrl":"https://doi.org/10.1513/annalsats.202311-979oc","url":null,"abstract":"RATIONALEMultiple mechanisms are involved in the pathogenesis of obstructive sleep apnea (OSA). Elevated loop gain is a key target for precision OSA care and may be associated with treatment intolerance when the upper airway is the sole therapeutic target. Morphological or computational estimation of LG is not yet widely available or fully validated - there is a need for improved phenotyping/endotyping of apnea to advance its therapy and prognosis.OBJECTIVESThis study proposes a new algorithm to assess self-similarity as a signature of elevated loop gain using respiratory effort signals and presents its use to predict the probability of acute failure (high residual event counts) of continuous positive airway pressure (CPAP) therapy.METHODSEffort signals from 2145 split-night polysomnography studies from the Massachusetts General Hospital were analyzed for SS and used to predict acute CPAP therapy effectiveness. Logistic regression models were trained and evaluated using 5-fold cross-validation.RESULTSReceiver operating characteristic (ROC) and precision-recall (PR) curves with AUC values of 0.82 and 0.84, respectively, were obtained. Self-similarity combined with the central apnea index (CAI) and hypoxic burden outperformed CAI alone. Even in those with a low CAI by conventional scoring criteria or only mild desaturation, SS was related to poor therapy outcomes.CONCLUSIONSThe proposed algorithm for assessing SS as a measure of expressed high loop gain is accurate, non-invasive, and has the potential to improve phenotyping/endotyping of apnea, leading to more precise sleep apnea treatment strategies.","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":"18 1","pages":""},"PeriodicalIF":8.3,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142262012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disparities in Discharge Support Provided to Patients Leaving 'Before Medically Advised' from Hospitalization for COPD Exacerbation.","authors":"J Henry Brems,Kevin J Psoter,Sarath Raju,Nirupama Putcha,Ashraf Fawzy,Anil C Singh,Nadia N Hansel,Robert A Wise,Aparna Balasubramanian,Meredith C McCormack","doi":"10.1513/annalsats.202405-452rl","DOIUrl":"https://doi.org/10.1513/annalsats.202405-452rl","url":null,"abstract":"","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":"50 1","pages":""},"PeriodicalIF":8.3,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142262011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rural Residence, Tobacco Use, and Nationwide COPD Prevalence: Analyses from the National Health Interview Survey (NHIS).","authors":"Sarath Raju,Alexander W Steinberg,Jenny E Ozga,James D Sargent,Zhiqun Tang,Cassandra A Stanton,Meredith C McCormack,Laura M Paulin","doi":"10.1513/annalsats.202311-973rl","DOIUrl":"https://doi.org/10.1513/annalsats.202311-973rl","url":null,"abstract":"","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":"18 1","pages":""},"PeriodicalIF":8.3,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142262013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Age of Diagnosis in Children with Primary Ciliary Dyskinesia.","authors":"Dvir Gatt,Michelle Shaw,Fiona Kritzinger,Melinda Solomon,Sharon Dell,Felix Ratjen","doi":"10.1513/annalsats.202403-230oc","DOIUrl":"https://doi.org/10.1513/annalsats.202403-230oc","url":null,"abstract":"RATIONALEThe typical symptoms for primary ciliary dyskinesia (PCD) manifest after birth and in early infancy, however diagnosis is often not confirmed during infancy. There is currently a lack of evidence in PCD regarding the impact of the age of diagnosis on clinical outcomes.OBJECTIVETo determine whether early diagnosis is related to improved long-term outcomes.METHODThis was a retrospective study of patients diagnosed with PCD between 2000 to 2022. We divided our cohort to three groups according to the age of diagnosis. 1) early diagnosis (<1 year); typical diagnosis (1-7 years) and late diagnosis (8-14 years). We compared various clinical long-term outcomes between the groups.RESULTSOver the study period, 110 patients were included in the analysis, with 41 patients in the early diagnosis group, 35 in the typical diagnosis group and 34 patients in the late diagnosis group. The presence of unexplained neonatal respiratory distress (NRDS) and organ laterality defect were higher in the early diagnosis group with rates between the early, typical, and late diagnosis groups for NRDS (80% vs 53% vs 61%, p=0.045) and laterality defect (64% vs 50% vs 18%, p<0.001). At the end of the first decade of life, patients in the early diagnosis and the typical age of diagnosis had better forced expiratory volume in 1 second (FEV1), compared to the late diagnosis group (93.5% and 93.1% vs 80.2%, P=0.002), respectively, but there was no significant change in the annual rate of decline between the groups once diagnosis was confirmed. Patient diagnosed late had significantly higher rates of pulmonary exacerbations (Pex) compared to typical age (1.95 vs 0.75 Pex/year, p<0.01) Conclusion: Late diagnosis (>8 years) was associated with lower FEV1 throughout childhood, although once diagnosed, the annual rate of decline was not different. These findings demonstrate the negative effect of delayed diagnosis in pediatric PCD.","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":"88 1","pages":""},"PeriodicalIF":8.3,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142261901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal Magnetic Resonance Imaging of Changes in Lung Morphology and Perfusion in Children with Cystic Fibrosis From Infancy through Adolescence.","authors":"Mark O Wielpütz,Mirjam Stahl,Simon M F Triphan,Lena Wucherpfennig,Patricia Leutz-Schmidt,Sonja Gestewitz,Eva Steinke,Simon Y Graeber,Hans-Ulrich Kauczor,Monika Eichinger,Michael U Puderbach,Abdulsattar Alrajab,Jens-Peter Schenk,Olaf Sommerburg,Marcus A Mall","doi":"10.1513/annalsats.202404-396oc","DOIUrl":"https://doi.org/10.1513/annalsats.202404-396oc","url":null,"abstract":"RATIONALEThe progression of lung changes in cystic fibrosis (CF) from infancy through adolescence remains poorly understood due to limited longitudinal imaging data.OBJECTIVESTo assess changes in lung morphology and perfusion in children with CF through the pediatric age range by longitudinal chest magnetic resonance imaging (MRI).METHODS1112 annual chest MRI were performed in 226 patients with CF aged 0-18yr. MRI was assessed using a validated MRI scoring system.MEASUREMENTS AND MAIN RESULTSThe MRI global score continuously increased from 5.5±4.6 at infancy (0yr) to 17.9±8.4 at adolescence (range 12-18yr), and the MRI morphology score from 5.0±3.9 to 12.4±6.0 (P<0.001). Bronchiectasis/wall thickening prevalence increased from 89.1% at infancy to approx. 100% from preschool age (1-5yr), and the subscore increased from 3.1±1.9 at infancy to 6.6±2.1 at adolescence (P<0.001). Mucus plugging prevalence increased from 55.4% at infancy to 83.5% at adolescence, and the subscore increased from 1.2±1.6 to 3.7±2.5 in the same period (P<0.001). Perfusion abnormalities were found in 44.4% at infancy, and increased to approx. 90% from preschool age (P<0.001). The MRI perfusion score increased from 1.1±1.6 at infancy to 5.6±3.0 at adolescence (P<0.001). Chronic Pseudomonas aeruginosa infection was associated with higher MRI scores from school age (6-11yr, P<0.05-0.001).CONCLUSIONSThis is the first study assessing longitudinal changes in lung morphology and perfusion in CF throughout the pediatric age range, providing percentiles as age-specific reference for lung disease severity. Our data may facilitate the use of MRI as an endpoint in clinical trials in children with CF.","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":"2 1","pages":""},"PeriodicalIF":8.3,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142181802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Further Insight into the Association of Long-Term Particulate Matter Exposure and Mortality in Hospitalized Patients with COVID-19.","authors":"Kai Zhang,Yu Shi,Mao Xun Huang","doi":"10.1513/annalsats.202406-655le","DOIUrl":"https://doi.org/10.1513/annalsats.202406-655le","url":null,"abstract":"","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":"32 1","pages":""},"PeriodicalIF":8.3,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142181800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to Zhang et al.: Further Insight into the Association of Long-Term Particulate Matter Exposure and Mortality in Hospitalized Patients with COVID-19.","authors":"Tak Kyu Oh,In-Ae Song","doi":"10.1513/annalsats.202407-679le","DOIUrl":"https://doi.org/10.1513/annalsats.202407-679le","url":null,"abstract":"","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":"22 1","pages":""},"PeriodicalIF":8.3,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142181801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep Learning-based Fibrosis Extent on Computed Tomography Predicts Outcome of Fibrosing Interstitial Lung Disease Independent of Visually Assessed Computed Tomography Pattern.","authors":"Andrea S Oh, David A Lynch, Jeffrey J Swigris, David Baraghoshi, Debra S Dyer, Valerie A Hale, Tilman L Koelsch, Cristina Marrocchio, Katherine N Parker, Shawn D Teague, Kevin R Flaherty, Stephen M Humphries","doi":"10.1513/AnnalsATS.202301-084OC","DOIUrl":"10.1513/AnnalsATS.202301-084OC","url":null,"abstract":"<p><p><b>Rationale:</b> Radiologic pattern has been shown to predict survival in patients with fibrosing interstitial lung disease. The additional prognostic value of fibrosis extent by quantitative computed tomography (CT) is unknown. <b>Objectives:</b> We hypothesized that fibrosis extent provides information beyond visually assessed CT pattern that is useful for outcome prediction. <b>Methods:</b> We performed a retrospective analysis of chest CT, demographics, longitudinal pulmonary function, and transplantation-free survival among participants in the Pulmonary Fibrosis Foundation Patient Registry. CT pattern was classified visually according to the 2018 usual interstitial pneumonia criteria. Extent of fibrosis was objectively quantified using data-driven textural analysis. We used Kaplan-Meier plots and Cox proportional hazards and linear mixed-effects models to evaluate the relationships between CT-derived metrics and outcomes. <b>Results:</b> Visual assessment and quantitative analysis were performed on 979 enrollment CT scans. Linear mixed-effect modeling showed that greater baseline fibrosis extent was significantly associated with the annual rate of decline in forced vital capacity. In multivariable models that included CT pattern and fibrosis extent, quantitative fibrosis extent was strongly associated with transplantation-free survival independent of CT pattern (hazard ratio, 1.04; 95% confidence interval, 1.04-1.05; <i>P</i> < 0.001; C statistic = 0.73). <b>Conclusions:</b> The extent of lung fibrosis by quantitative CT is a strong predictor of physiologic progression and survival, independent of visually assessed CT pattern.</p>","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"218-227"},"PeriodicalIF":8.3,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10267284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ambient Air Pollution and Outpatient Morbidities in Bronchopulmonary Dysplasia.","authors":"Jelte Kelchtermans, Brianna C Aoyama, Jessica L Rice, Amanda Martin, Joseph M Collaco, Sharon A McGrath-Morrow","doi":"10.1513/AnnalsATS.202302-096OC","DOIUrl":"10.1513/AnnalsATS.202302-096OC","url":null,"abstract":"<p><p><b>Rationale:</b> Bronchopulmonary dysplasia (BPD) is the most common long-term complication of prematurity. Although socioeconomic status is associated with BPD morbidities, the drivers of this association are poorly understood. In the United States, ambient air pollution (AAP) exposure is linked to both race/ethnicity and socioeconomic status. Furthermore, AAP exposure is known to have a detrimental effect on respiratory health in children. <b>Objectives:</b> To assess if AAP exposure is linked to BPD morbidity in the outpatient setting. <b>Methods:</b> Participants with BPD were recruited from outpatient clinics at Johns Hopkins University and the Children's Hospital of Philadelphia between 2008 and 2021 (<i>N</i> = 800) and divided into low, moderate, and high AAP exposure groups, based on publicly available U.S. Environmental Protection Agency data. Clinical data were obtained by chart review and caregiver questionnaires. <b>Results:</b> Non-White race, home ventilator use, and lower median household income were associated with higher degrees of air pollution exposure. After adjustment for these factors, moderate and high air pollution exposure were associated with requiring systemic steroids (odds ratio, 1.78 and 2.17, respectively) compared with low air pollution. Similarly, high air pollution exposure was associated with emergency department visits (odds ratio, 1.59). <b>Conclusions:</b> This study demonstrates an association between AAP exposure and BPD morbidity after initial hospital discharge. AAP exposure was closely linked to race and median household income. As such, it supports the notion that AAP exposure may be contributing to health disparities in BPD outcomes. Further studies directly measuring exposure and establishing a link between biomarkers of exposure and outcomes are prerequisites to developing targeted interventions protecting this vulnerable population.</p>","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"88-93"},"PeriodicalIF":8.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10867919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10597266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Normative Reference Equations for Breathlessness Intensity during Incremental Cardiopulmonary Cycle Exercise Testing.","authors":"Magnus Ekström, Pei Zhi Li, Hayley Lewthwaite, Jean Bourbeau, Wan C Tan, Linus Schiöler, Andrew Brotto, Michael K Stickland, Dennis Jensen","doi":"10.1513/AnnalsATS.202305-394OC","DOIUrl":"10.1513/AnnalsATS.202305-394OC","url":null,"abstract":"<p><p><b>Rationale:</b> Cardiopulmonary exercise testing (CPET) is the gold standard to evaluate exertional breathlessness, a common and disabling symptom. However, the interpretation of breathlessness responses to CPET is limited by a scarcity of normative data. <b>Objectives:</b> We aimed to develop normative reference equations for breathlessness intensity (Borg 0-10 category ratio) response in men and women aged ⩾40 years during CPET, in relation to power output (watts), oxygen uptake, and minute ventilation. <b>Methods:</b> Analysis of ostensibly healthy people aged ⩾40 years undergoing symptom-limited incremental cycle CPET (10 W/min) in the CanCOLD (Canadian Cohort Obstructive Lung Disease) study. Participants had smoking histories <5 pack-years and normal lung function and exercise capacity. The probability of each Borg 0-10 category ratio breathlessness intensity rating by power output, oxygen uptake, and minute ventilation (as an absolute or a relative value [percentage of predicted maximum]) was predicted using ordinal multinomial logistic regression. Model performance was evaluated by fit, calibration, and discrimination (C statistic) and externally validated in an independent sample (<i>n</i> = 86) of healthy Canadian adults. <b>Results:</b> We included 156 participants (43% women) from CanCOLD; the mean age was 65 (range, 42-91) years, and the mean body mass index was 26.3 (standard deviation, 3.8) kg/m². Reference equations were developed for women and men separately, accounting for age and/or body mass. Model performance was high across all equations, including in the validation sample (C statistic for men = 0.81-0.92, C statistic for women = 0.81-0.96). <b>Conclusions:</b> Normative reference equations are provided to compare exertional breathlessness intensity ratings among individuals or groups and to identify and quantify abnormal breathlessness responses (scores greater than the upper limit of normal) during CPET.</p>","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"56-67"},"PeriodicalIF":8.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10867914/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10296127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}