Annals of the American Thoracic Society最新文献

{"title":"Stepwise Add-On and Endotype-informed Targeted Combination Therapy to Treat Obstructive Sleep Apnea: A Proof-of-Concept Study.","authors":"Atqiya Aishah,&nbsp;Benjamin K Y Tong,&nbsp;Amal M Osman,&nbsp;Geoffrey Pitcher,&nbsp;Michelle Donegan,&nbsp;Benjamin C H Kwan,&nbsp;Elizabeth Brown,&nbsp;Thomas J Altree,&nbsp;Robert Adams,&nbsp;Sutapa Mukherjee,&nbsp;Danny J Eckert","doi":"10.1513/AnnalsATS.202210-892OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202210-892OC","url":null,"abstract":"<p><p><b>Rationale:</b> Oral appliance therapy (OAT) is an effective treatment for many people with obstructive sleep apnea (OSA). However, OSA pathogenesis is heterogeneous, and, in ∼50% of cases, OAT does not fully control OSA. <b>Objectives:</b> This study aimed to control OSA in individuals with an incomplete response to OAT alone by using additional targeted therapies informed by OSA endotype characterization. <b>Methods:</b> Twenty-three people with OSA (apnea-hypopnea index [AHI], 41 ± 19 events/h) not fully resolved (AHI, >10 events/h) with OAT alone were prospectively recruited. OSA endotypes were characterized pretherapy during a detailed physiology study night. Initially, an expiratory positive airway pressure (EPAP) valve and supine avoidance device therapy were added to target the impaired anatomical endotype. Those with residual OSA (AHI, >10 events/h) then received one or more nonanatomical interventions based on endotype characterization. This included O₂ (4 L/min) to reduce high loop gain (unstable respiratory control) and 80/5 mg atomoxetine-oxybutynin to increase pharyngeal muscle activity. Finally, if required, OAT was combined with EPAP and continuous positive airway pressure (CPAP) therapy. <b>Results:</b> Twenty participants completed the study. OSA was successfully controlled (AHI, <10 events/h) with combination therapy in all but one participant (17 of 20 without CPAP). OAT plus EPAP and supine avoidance therapy treated OSA in 10 (50%) participants. OSA was controlled in five (25%) participants with the addition of O₂ therapy, one with atomoxetine-oxybutynin, and one required O₂ plus atomoxetine-oxybutynin. Two participants required CPAP for their OSA, and another was CPAP intolerant. <b>Conclusions:</b> These novel prospective findings highlight the potential of precision medicine to inform targeted combination therapy to treat OSA. Clinical trial registered with the Australian New Zealand Clinical Trials Registry (ACTRN12618001995268).</p>","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":"20 9","pages":"1316-1325"},"PeriodicalIF":8.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10145131","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":"Recommendations for Addressing the Tobacco and Nicotine Use Epidemic in U.S. Military Service Members and Veterans.","authors":"Adam Edward Lang, Anne C Melzer, Chester B Good, Dona J Upson","doi":"10.1513/AnnalsATS.202302-177VP","DOIUrl":"10.1513/AnnalsATS.202302-177VP","url":null,"abstract":"","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":"20 9","pages":"1229-1232"},"PeriodicalIF":8.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10145171","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 Greatest LGBTQ+ Health Issue of All Time: Commercial Tobacco.","authors":"Jamie L Garfield, Megan E Piper, Sarah E Bauer, Hasmeena Kathuria, Michelle N Eakin","doi":"10.1513/AnnalsATS.202303-268VP","DOIUrl":"10.1513/AnnalsATS.202303-268VP","url":null,"abstract":"","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":"20 9","pages":"1227-1228"},"PeriodicalIF":8.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10515213","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 Burden and Impact of Cough in Patients with Idiopathic Pulmonary Fibrosis: An Analysis of the Prospective Observational PROFILE Study.","authors":"Peter Saunders, Zhe Wu, William A Fahy, Iain D Stewart, Gauri Saini, David J F Smith, Rebecca Braybrooke, Carmel Stock, Elisabetta A Renzoni, Simon R Johnson, R Gisli Jenkins, Maria G Belvisi, Jaclyn A Smith, Toby M Maher, Philip L Molyneaux","doi":"10.1513/AnnalsATS.202302-174OC","DOIUrl":"10.1513/AnnalsATS.202302-174OC","url":null,"abstract":"<p><p><b>Rationale:</b> Cough is a commonly reported symptom in idiopathic pulmonary fibrosis (IPF) that negatively impacts patient-reported quality of life (QoL). However, both the burden of cough at diagnosis and the behavior of cough over time have not been systematically described in patients with IPF. <b>Objectives:</b> By utilizing data prospectively collected as part of the PROFILE study, we sought to assess cough burden and the impact that this has on QoL within a cohort of patients with newly diagnosed IPF. We also reexamined the previously described relationship between cough and mortality and the association of cough with the MUC5B promoter polymorphism. <b>Methods:</b> The PROFILE study is a multicenter, prospective, observational, longitudinal cohort study of incident IPF. Scores on the Leicester Cough Questionnaire (LCQ) were recorded at baseline in 632 subjects and then repeated 6 monthly in a subset (<i>n</i> = 216) of the cohort. <b>Results:</b> The median LCQ score at diagnosis was 16.1 (interquartile range, 6.5). LCQ scores remained stable over the subsequent year in the majority of patients. There was a weak association between LCQ score and baseline lung function, with worse cough-related QoL associated with more severe physiological impairment. Cough scores were not associated with subsequent mortality after correcting for baseline lung function. Furthermore, there was no relationship between LCQ score and MUC5B promoter polymorphism status. <b>Conclusions:</b> The burden of cough in IPF is high. Although cough is weakly associated with disease severity at baseline, cough-specific QoL, as measured by the LCQ, confers no prognostic value. Cough-specific QoL burden remains relatively stable over time and does not associate with MUC5B promoter polymorphism.</p>","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":"20 9","pages":"1267-1273"},"PeriodicalIF":8.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10502892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10269844","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":"Relationship between Symptom Profiles and Endotypes among Patients with Obstructive Sleep Apnea: A Latent Class Analysis.","authors":"Wan-Ju Cheng, Eysteinn Finnsson, Eydís Arnardóttir, Jón S Ágústsson, Scott A Sands, Liang-Wen Hang","doi":"10.1513/AnnalsATS.202212-1054OC","DOIUrl":"10.1513/AnnalsATS.202212-1054OC","url":null,"abstract":"<p><p><b>Rationale:</b> Obstructive sleep apnea (OSA) is a heterogeneous syndrome with various endotypic traits and symptoms. A link among symptoms, endotypes, and disease prognosis has been proposed but remains unsupported by empirical data. <b>Objectives:</b> To link symptom profiles and endotypes by clustering endotypic traits estimated using polysomnographic signals. <b>Methods:</b> We recruited 509 patients with moderate to severe OSA from a single sleep center. Polysomnographic data were collected between May 2020 and January 2022. Endotypic traits, namely arousal threshold, upper airway collapsibility, loop gain, and upper airway muscle compensation, were retrieved using polysomnographic signals during non-rapid eye movement periods. We used latent class analysis to group participants into endotype clusters. Demographic and polysomnographic parameter differences were compared between clusters, and associations between endotype clusters and symptom profiles were examined using logistic regression analyses. <b>Results:</b> Three endotype clusters were identified, characterized by high collapsibility/loop gain, low arousal threshold, and low compensation, respectively. Patients in each cluster exhibited similar demographic characteristics, but those in the high collapsibility/loop gain cluster had the highest proportion of obesity and severe oxygen desaturation observed in polysomnographic studies. The low compensation cluster was characterized by fewer sleepy symptoms and exhibited a lower rate of diabetes mellitus. Compared with the excessively sleepy group, disturbed sleep symptoms were associated with the low arousal threshold cluster (odds ratio, 1.89; 95% confidence interval, 1.16-3.10). Excessively sleepy symptoms were associated with the high collapsibility/loop gain cluster (odds ratio, 2.16; 95% confidence interval, 1.39-3.37) compared with the minimally symptomatic group. <b>Conclusions:</b> Three pathological endotype clusters were identified among patients with moderate to severe OSA, each exhibiting distinct polysomnographic characteristics and clinical symptom profiles.</p>","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":"20 9","pages":"1337-1344"},"PeriodicalIF":6.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10502883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10283027","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":"A 9-Year Investigation of Healthcare Industry Payments to Pulmonologists in the United States.","authors":"Anju Murayama,&nbsp;Hinari Kugo,&nbsp;Yoshika Saito,&nbsp;Hiroaki Saito,&nbsp;Tetsuya Tanimoto,&nbsp;Akihiko Ozaki","doi":"10.1513/AnnalsATS.202209-827OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202209-827OC","url":null,"abstract":"<p><p><b>Rationale:</b> The healthcare industry sometimes makes payments to physicians for nonresearch and research purposes in the United States. <b>Objectives:</b> We aimed to evaluate the trends in nonresearch and research industry payments to pulmonologists since the inception of the Open Payments database in 2013. <b>Methods:</b> Using the Open Payments database between August 2013 and December 2021, this population-based observational cohort study examined nonresearch and research payments made by the healthcare industry to pulmonologists registered in the National Plan and Provider Enumeration System in the United States. We performed descriptive analyses on payment data and generalized estimating equations for payment trends. <b>Results:</b> Of 12,488 active pulmonologists, 11,074 (88.7%) accepted a total of 2,246,412 payments totaling $1,053,344,669. Total payments were $253,405,965 (24.1%) in nonresearch, $17,382,904 (1.7%) in direct research, and $782,555,800 (74.3%) in associated research payments between 2013 and 2021. Median per-physician payments (interquartile range) were $2,342 ($496 to $8,299) for nonresearch, $4,688 ($1,435 to $21,803) for direct research, and $95,927 ($20,300 to $344,995) for associated research payments. The top 1%, 5%, and 10% of pulmonologists accepted 37.3%, 71.9%, and 83.7% of the total nonresearch payments. The per-physician nonresearch payments increased by 2.9% (95% confidence interval [CI], 1.2 to 4.7; <i>P</i> = 0.001) annually between 2014 and 2019 and decreased by 50.2% (95% CI, -55.3 to -44.6; <i>P</i> < 0.001) in 2020, whereas there was no yearly change in research payments. <b>Conclusions:</b> Nearly 90% of pulmonologists received nonresearch and research payments from the healthcare industry in the United States. Nonresearch payments have been increasing since the inception of the Open Payments database.</p>","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":"20 9","pages":"1283-1292"},"PeriodicalIF":8.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10139063","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":"Purposeful Podiums: Ensuring Speaker Diversity at the American Thoracic Society International Conference.","authors":"Theresa A Laguna,&nbsp;Benjamin T Kopp,&nbsp;D'Ann Brown-Janowiak,&nbsp;Nancy Guerrero,&nbsp;Liliana Rose,&nbsp;Brandie Wagner,&nbsp;Paul E Moore","doi":"10.1513/AnnalsATS.202301-046RL","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202301-046RL","url":null,"abstract":"","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":"20 9","pages":"1361-1363"},"PeriodicalIF":8.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10583591","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":"Comparison of Administrative versus Electronic Health Record-based Methods for Identifying Sepsis Hospitalizations.","authors":"Kevin J Karlic,&nbsp;Tori L Clouse,&nbsp;Cainnear K Hogan,&nbsp;Allan Garland,&nbsp;Sarah Seelye,&nbsp;Jeremy B Sussman,&nbsp;Hallie C Prescott","doi":"10.1513/AnnalsATS.202302-105OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202302-105OC","url":null,"abstract":"<p><p><b>Rationale:</b> Despite the importance of sepsis surveillance, no optimal approach for identifying sepsis hospitalizations exists. The Centers for Disease Control and Prevention Adult Sepsis Event Definition (CDC-ASE) is an electronic medical record-based algorithm that yields more stable estimates over time than diagnostic coding-based approaches but may still result in misclassification. <b>Objectives:</b> We sought to assess three approaches to identifying sepsis hospitalizations, including a modified CDC-ASE. <b>Methods:</b> This cross-sectional study included patients in the Veterans Affairs Ann Arbor Healthcare System admitted via the emergency department (February 2021 to February 2022) with at least one episode of acute organ dysfunction within 48 hours of emergency department presentation. Patients were assessed for community-onset sepsis using three methods: <i>1</i>) explicit diagnosis codes, <i>2</i>) the CDC-ASE, and <i>3</i>) a modified CDC-ASE. The modified CDC-ASE required at least two systemic inflammatory response syndrome criteria instead of blood culture collection and had a more sensitive definition of respiratory dysfunction. Each method was compared with a reference standard of physician adjudication via medical record review. Patients were considered to have sepsis if they had at least one episode of acute organ dysfunction graded as \"definitely\" or \"probably\" infection related on physician review. <b>Results:</b> Of 821 eligible hospitalizations, 449 were selected for physician review. Of these, 98 (21.8%) were classified as sepsis by medical record review, 103 (22.9%) by the CDC-ASE, 132 (29.4%) by the modified CDC-ASE, and 37 (8.2%) by diagnostic codes. Accuracy was similar across the three methods of interest (80.6% for the CDC-ASE, 79.6% for the modified CDC-ADE, and 84.2% for diagnostic codes), but sensitivity and specificity varied. The CDC-ASE algorithm had sensitivity of 58.2% (95% confidence interval [CI], 47.2-68.1%) and specificity of 86.9% (95% CI, 82.9-90.2%). The modified CDC-ASE algorithm had greater sensitivity (69.4% [95% CI, 59.3-78.3%]) but lower specificity (81.8% [95% CI, 77.3-85.7%]). Diagnostic codes had lower sensitivity (32.7% [95% CI, 23.5-42.9%]) but greater specificity (98.6% [95% CI, 96.7-99.55%]). <b>Conclusions:</b> There are several approaches to identifying sepsis hospitalizations for surveillance that have acceptable accuracy. These approaches yield varying sensitivity and specificity, so investigators should carefully consider the test characteristics of each method before determining an appropriate method for their intended use.</p>","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":"20 9","pages":"1309-1315"},"PeriodicalIF":8.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10132975","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":"Maternal Hypertensive Disorders of Pregnancy and the Risk of Childhood Asthma.","authors":"Anna Chen Arroyo, Lacey B Robinson, Kaitlyn James, Sijia Li, Mohammad Kamal Faridi, Sarah Hsu, Orianne Dumas, Anne Y Liu, Maurice Druzin, Camille E Powe, Carlos A Camargo","doi":"10.1513/AnnalsATS.202212-994RL","DOIUrl":"10.1513/AnnalsATS.202212-994RL","url":null,"abstract":"","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":"20 9","pages":"1367-1370"},"PeriodicalIF":6.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10502887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10269857","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":"Reply: Higher, but Not Too High, Dose Is Only One Determinant of Corticosteroid Treatment Success in Severe COVID-19.","authors":"Tyler Pitre,&nbsp;Dena Zeraatkar","doi":"10.1513/AnnalsATS.202305-436LE","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202305-436LE","url":null,"abstract":"","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":"20 9","pages":"1372"},"PeriodicalIF":8.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/44/ea/AnnalsATS.202305-436LE.PMC10502889.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10319889","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}