Annals of the American Thoracic Society最新文献

{"title":"A Proposed Consensus Definition of Severe COPD: a modified Delphi Study.","authors":"Mireille C Melles, Marlies van Dijk, Marieke L Duiverman, Frits M E Franssen, Merel E Hellemons, Daisy J A Janssen, Pascale M G A Lubbers-van Tuyn, Dirk-Jan Slebos, Alvar Agustí, Selim M Arcasoy, Surya P Bhatt, Folkert Brijker, Guy G Brusselle, Bartolome R Celli, Laurens J Ceulemans, Gerard J Criner, Michael Dreher, Leonardo M Fabbri, Mark Greer, Nicholas Hart, Anne E Holland, Nicholas Hopkinson, John R Hurst, Alvin J Ing, Wim Janssens, Huib A M Kerstjens, Janwillem W H Kocks, Coenraad F N Koegelenberg, Thérèse S Lapperre, Carli J Lehr, Federica Meloni, Masamichi Mineshita, Marc Miravitlles, Kris Mooren, Parameswaran K Nair, Hugo G de Oliveira, Hilary Pinnock, Fabio Pitta, Claudio Rabec, Nicolas Roche, Richard E K Russell, Sami O Simons, Dave Singh, Daiana Stolz, Jørgen Vestbo, Claus F Vogelmeier, Robin Vos, Wolfram Windisch, Emily F A van 't Wout, Johannes C C M In 't Veen, Pieter-Paul W Hekking","doi":"10.1093/annalsats/aaoag305","DOIUrl":"https://doi.org/10.1093/annalsats/aaoag305","url":null,"abstract":"<p><strong>Rationale: </strong>Advanced interventions are available for patients with more severe COPD despite guideline-recommended therapies, yet this population is heterogeneously defined and inconsistently recognized, and a standardized work-up is lacking, which could lead to mismanagement.</p><p><strong>Objectives: </strong>To formulate a new, expert-based consensus definition of severe COPD and a minimal set of diagnostics and characteristics to be assessed in the work-up of these patients.</p><p><strong>Methods: </strong>A modified Delphi study with two online rounds was conducted between June 2024 and January 2025 with 55 international COPD experts representing all areas of disease management. Sixty-seven (round 1) and 20 (round 2) statements were tested in seven domains: (A) the need for a definition, (B) symptoms, (C) functional impairment, (D) quality of life, (E) physiological impairment, (F) framework definition, and (G) risk factors. Consensus was defined as ≥ 75% agreement.</p><p><strong>Results: </strong>Consensus was reached for 46 (69%) statements in round 1 and 15 (75%) in round 2. Among patients with confirmed COPD, severe COPD was defined as: (1) persistent symptoms, functional impairment, or severely reduced quality of life; (2) despite optimal treatment and not due to comorbidities; and (3) including at least one clinical characteristic: severe airflow obstruction, severely impaired diffusion capacity, severe hyperinflation, frequent exacerbations, chronic respiratory insufficiency, pulmonary hypertension related to COPD, or cachexia or unintentional weight loss related to COPD. The proposed standardized work-up comprised: (1) assessment of patient-reported outcomes for symptoms, quality of life, anxiety and depression; (2) assessment of exacerbation frequency and severity; (3) comprehensive diagnostic testing, including lung function testing, blood gas analysis, imaging, cardiac assessment, and exercise-tolerance testing; and (4) assessment of risk factors for more severe and progressive disease.</p><p><strong>Conclusions: </strong>Using expert consensus, we devised an internationally-supported, proposed definition and work-up for 'severe COPD', accounting for disease heterogeneity. This definition may improve identification of the population and supports a structured evaluation of this often under-recognized and potentially undertreated population. Future studies are warranted to determine its clinical impact, prognostic value, and utility in research.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"International patterns and incidence trends of lung cancer in adolescent and young adults by histological subtype and sex.","authors":"Ke Liu, Weitao Su, Wei Shu, Bingyi Wang, Yun Liu, Ziwen Li, Yuzhu Duan, Liang Li, Jian Du, Yang Liu, Leiwen Fu","doi":"10.1093/annalsats/aaoag323","DOIUrl":"https://doi.org/10.1093/annalsats/aaoag323","url":null,"abstract":"<p><strong>Background: </strong>Lung cancer in adolescents and young adults (AYAs) presents distinct features compared to older populations.</p><p><strong>Methods: </strong>This population-based study utilized GLOBOCAN 2022 data to estimate lung cancer age-standardized incidence rates (ASIR) and mortality rates (ASMR) in individuals aged 15-39 years across 185 countries. Temporal trends in incidence stratified by histological subtype and sex (2003-2017) were analyzed using high-quality data from Cancer Incidence in Five Continents (CI5). We evaluated associations between disease burden and the Human Development Index (HDI) and calculated Average Annual Percentage Changes (AAPC) using Joinpoint regression.</p><p><strong>Results: </strong>In 2022, an estimated 31,681 new lung cancer cases and 15,189 deaths occurred among AYAs globally, with Asia accounting for 78.3% of cases and 74.2% of deaths. Incidence was positively correlated with HDI (ρ=0.390, P < 0.001), while mortality showed no significant correlation. From 2003 to 2017, temporal analysis revealed stable or declining overall incidence in males. Conversely, incidence significantly increased among females in China, India, Japan, Austria, Belarus, and Australia. Notably, the incidence of adenocarcinoma rose significantly: the increase was observed in both sexes in countries such as China, the Republic of Korea, and the UK; in females only in India, the Netherlands, and Thailand; and in males only in Australia.</p><p><strong>Conclusion: </strong>Lung cancer incidence among AYAs varied by population, sex, and histological subtype, with increases in female incidence and adenocarcinoma incidence in several registry populations. These descriptive findings identify priorities for etiological research integrating individual-level exposure data, molecular characteristics, and information on diagnostic practices.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differential effects of PM2.5 constituents on tuberculosis infection and disease progression in 40,379 student close contacts.","authors":"Zhongqi Li, Zheyue Wang, Bilin Tao, Meijuan Tian, Xiaoyan Ding, Hui Ding, Limei Zhu, Peng Lu, Qiao Liu","doi":"10.1093/annalsats/aaoag325","DOIUrl":"https://doi.org/10.1093/annalsats/aaoag325","url":null,"abstract":"<p><strong>Rationale: </strong>Outdoor PM2.5 has been increasingly implicated in tuberculosis, yet evidence has largely focused on total PM2.5 mass and has usually considered Mycobacterium tuberculosis (M. tuberculosis) infection and active tuberculosis separately. Whether specific PM2.5 chemical constituents differ in their associations with infection and subsequent progression to active disease remains unclear.</p><p><strong>Objectives: </strong>To assess the associations of PM2.5 and five major constituents with M. tuberculosis infection and subsequent progression to active tuberculosis within the same high-risk population.</p><p><strong>Methods: </strong>We conducted two complementary analyses among student close contacts of tuberculosis patients from 458 schools in 12 cities in eastern China during 2020-2024. Daily residential outdoor exposures were assigned from daily modeled estimates of PM2.5 and five major constituents (sulfate, nitrate, ammonium, organic matter, and black carbon) on an approximately 10-km grid, which were interpolated to geocoded addresses. We first assessed associations between exposure averaged over the five years preceding contact screening and M. tuberculosis infection identified by the ESAT6-CFP10 skin test during the contact investigation. We then followed infected students identified at the contact screening to examine associations between time-varying annual exposure and progression to active tuberculosis.</p><p><strong>Results: </strong>Among 40,379 students, 1,269 had M. tuberculosis infection, and 70 infected students progressed to active tuberculosis during follow-up. Each 1-µg/m3 increase in PM2.5 was associated with higher infection risk (OR: 1.043; 95% CI: 1.018, 1.068) and progression risk (HR: 1.094; 95% CI: 1.010, 1.185). All five constituents were positively associated with infection (ORs: 1.156-5.390). Sulfate, nitrate, and ammonium were also positively associated with progression to active tuberculosis (HRs: 1.462-2.680). The findings remained generally consistent in sensitivity analyses.</p><p><strong>Conclusions: </strong>In this large multi-city close-contact study, PM2.5 was associated with both M. tuberculosis infection and subsequent progression to active tuberculosis. Three secondary inorganic aerosol (SIA) constituents, namely sulfate, nitrate, and ammonium, showed the most consistent association patterns across the two outcomes. These findings reinforce the importance of overall PM2.5 control and support further evaluation of coordinated reductions in SIA precursor emissions.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative CT in the real-world evaluation of progressive pulmonary fibrosis; the REVISE PPF multicentre observational study.","authors":"Ayodeji Adegunsoye, Anna J Podolanczuk, Teja Kulkarni, Christian Rennison-Jones, Steven Rothenberg, Kristin Berger, Yana Rabkova, Christine Wu, Lydia Chelala, Cathryn T Lee, Iazsmin Bauer Ventura, Mary E Strek, Finja Ottink, Wassim Bou-Zeid, Olivier Joly, Eric White, George Wj Harston, Claire Fernandez, Anand Devaraj, Peter M George","doi":"10.1093/annalsats/aaoag320","DOIUrl":"https://doi.org/10.1093/annalsats/aaoag320","url":null,"abstract":"<p><strong>Rationale and objective: </strong>We assessed whether an FDA-cleared quantitative CT (qCT) tool (Brainomix, e-Lung) identifies progressive pulmonary fibrosis (PPF) earlier than routine clinical diagnosis and evaluated the prognostic value of baseline and serial imaging biomarkers.</p><p><strong>Methods: </strong>Multicentre retrospective study involving University of Alabama (UAB), Weill Cornell Medicine (WCM) and University of Chicago (UChicago); n = 509. HRCTs were analysed with e-Lung to derive Weighted Reticulovascular Score (WRVS, %), Total Disease Extent (TDE, %), and e-Lung Volume (mL). Prespecified progression thresholds were an absolute WRVS increase of ≥ 3 percentage points, an absolute TDE increase of ≥ 1.5 percentage points, and a relative e-Lung Volume decline of ≥ 10%, over less than 2 years. We compared the earliest qCT progression date with recorded clinical PPF diagnoses, assessed clinically stable controls, and modelled associations with future PPF and mortality using adjusted time-varying Cox models.</p><p><strong>Results: </strong>Among 200 patients with PPF and serial HRCTs meeting the prespecified timing criterion, qCT identified progression earlier in 78% (UAB), 83% (WCM), and 47% (UChicago), with mean lead times of 434, 847, and 220 days, respectively. Among 187 clinically stable patients meeting the same serial-imaging criterion, progression thresholds were met in 67%, 56%, and 42%, respectively. High-risk baseline WRVS (≥15%) predicted future PPF (OR 4.09, 2.48, and 2.30) and mortality (HR 2.03 pooled UAB/WCM; 2.75 UChicago). Per 1-percentage-point increase, adjusted mortality HRs were 1.15 and 1.19 for WRVS and 1.05 and 1.04 for TDE in pooled UAB/WCM and UChicago, respectively. Threshold crossings were also associated with mortality (WRVS: HR 6.50 pooled UAB/WCM, 4.05 UChicago; TDE: 7.60 and 3.26; e-Lung Volume: 8.20 and 2.59).</p><p><strong>Conclusion: </strong>qCT detects radiological progression months to years before clinical PPF diagnoses. Integrating e-Lung into ILD pathways could accelerate treatment decisions and personalize follow-up.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Not Just a Breathing Problem: Fall Injuries in Long-Term Oxygen Therapy.","authors":"Yet H Khor, Joao A de Andrade","doi":"10.1093/annalsats/aaoag318","DOIUrl":"https://doi.org/10.1093/annalsats/aaoag318","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are Short-Term Increases in PM₂.₅ Linked to Respiratory Hospitalizations in IPF?","authors":"Athina Trachalaki","doi":"10.1093/annalsats/aaoag317","DOIUrl":"https://doi.org/10.1093/annalsats/aaoag317","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal Functional Magnetic Resonance Imaging to Assess Lung Disease in Cystic Fibrosis.","authors":"Leonie M Busack, Felix Doellinger, Grzegorz Bauman, Eva Steinke, Christine Allomba, Niklas Ziegahn, Alexandra N Schnorr, Bent R Fuhlrott, Lara Toursarkissian, Ayleen Szmala, Renée Zahl, Tobias Penzkofer, Richard Ruppel, Oliver Bieri, Simon Y Graeber, Stephanie Thee, Marcus A Mall, Mirjam Stahl","doi":"10.1093/annalsats/aaoag315","DOIUrl":"https://doi.org/10.1093/annalsats/aaoag315","url":null,"abstract":"<p><strong>Rationale: </strong>Matrix pencil decomposition magnetic resonance imaging (MP-MRI) enables quantitative assessment of lung ventilation and perfusion and was shown to correlate with contrast-enhanced (CE) perfusion MRI.</p><p><strong>Objectives: </strong>To determine the longitudinal course of MP-MRI parameters in people with cystic fibrosis (pwCF).</p><p><strong>Methods: </strong>Morpho-functional MRI including CE perfusion MRI and MP-MRI were performed twice in 136 pwCF with a median (range) baseline age of 14.5 (0.1-56.0) years to obtain the morpho-functional MRI score. Perfusion defect percentage (QDP) and ventilation defect percentage (VDP) were calculated by automated software. Additionally, lung clearance index (LCI) and forced expiratory volume in one second (FEV1) z-score were assessed. The participants were divided in subgroups depending on the clinical course according to cystic fibrosis transmembrane conductance regulator modulator therapy, pulmonary exacerbation status and Pseudomonas aeruginosa infection status.</p><p><strong>Results: </strong>In the total cohort, VDP improved at follow up. Change in VDP correlated with change in MRI global score, MRI CE perfusion score and FEV1 z-score. Additionally, change in QDP correlated with change in MRI global score, MRI morphology score, MRI CE perfusion score and FEV1 z-score. QDP and VDP remained stable in clinically stable pwCF (n = 55) and improved in clinically improved pwCF (n = 67). In the stable and improved group, change in QDP correlated moderately with change in MRI CE perfusion score.</p><p><strong>Conclusions: </strong>MP-MRI assesses stability and improvement of lung perfusion and ventilation in pwCF. Changes correlate with those of established MRI scores. Therefore, QDP and VDP are sensitive longitudinal outcome parameters for future clinical studies.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bronchiectasis prevalence, incidence, and exacerbation rates among insured adults in the U.S.: a descriptive analysis.","authors":"Cesar N Cristancho-Rojas, Emily Henkle, Rongwei Fu, Phillip M Polgreen, Jeffrey R Curtis, Kevin L Winthrop","doi":"10.1093/annalsats/aaoag310","DOIUrl":"https://doi.org/10.1093/annalsats/aaoag310","url":null,"abstract":"<p><strong>Rationale: </strong>Contemporary population-representative data on bronchiectasis epidemiology in the United States remain limited. Existing exacerbation estimates are derived primarily from referral registries that overrepresent severe disease under subspecialty care, while incidence and prevalence calculations are largely based on outdated single-payer data, limiting generalizability.</p><p><strong>Objectives: </strong>To estimate non-cystic fibrosis bronchiectasis prevalence and incidence among insured U.S. adults during 2016-2024, characterize exacerbation rates and their composition, and identify baseline factors associated with subsequent exacerbations.</p><p><strong>Methods: </strong>We assembled a retrospective cohort of adults with bronchiectasis using MarketScan Commercial, Medicare Supplemental, and Medicaid databases. Cases required two or more bronchiectasis diagnostic claims separated by more than 30 days, excluding individuals with cystic fibrosis, human immunodeficiency virus infection, or organ transplantation. The observation time zero was the second qualifying claim. Quasi-Poisson models were used to estimate annual prevalence, incidence, and exacerbation rates during observable enrollment periods. Annual percent changes quantified temporal trends. A negative binomial model estimated associations between baseline characteristics and post-diagnosis exacerbation rates.</p><p><strong>Results: </strong>We identified 80,749 cases (64.6% female; mean age 65.9 years) and estimated prevalence and incidence of 105.3 and 32.1 per 100,000, respectively, in the combined Commercial-Medicare sample, and 66.1 and 19.0, respectively, in Medicaid. Prevalence increased steadily across payers, whereas incidence remained stable. The overall exacerbation rate was 0.88 events per person-year, declining by approximately 5% annually, with a reduction during the early pandemic period followed by a return to pre-pandemic trajectories by 2024. Outpatient events accounted for nearly 87% of exacerbations in the Commercial-Medicare sample and 65% in Medicaid. Calendar trends were attenuated by 12.3% after adjustment for follow-up. Frequent-exacerbator phenotype at cohort entry was the most strongly associated with higher subsequent exacerbation rates (adjusted rate ratio 1.96), followed by chronic airway infection and underlying respiratory conditions. Greater pulmonologist engagement at baseline was associated with lower exacerbation rates thereafter.</p><p><strong>Conclusions: </strong>Observed prevalence-incidence widening gap suggests case accumulation over time and survival among continuously enrolled beneficiaries. Exacerbation burden was concentrated among individuals with prior exacerbations, chronic airway infection, and respiratory comorbidity, while exacerbation rates decreased over time across payers and subgroups, in part reflecting changes in cohort composition.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood pressure change after 6-minute walk test is an independent predictor of clinical worsening in patients with pulmonary hypertension.","authors":"Hai V Tran, Christopher Van Dreumel, Alison Schafer, Monica Mukherjee, Stephen C Mathai, Bennett P deBoisblanc, Matthew R Lammi","doi":"10.1093/annalsats/aaoag178","DOIUrl":"10.1093/annalsats/aaoag178","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1554-1558"},"PeriodicalIF":5.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148371132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early-life liquefied petroleum gas cooking intervention and lung function in Guatemalan children: a randomized clinical trial.","authors":"Laura M Grajeda, Keyla Castellanos, Anaité Díaz-Artiga, María R López, Alexander Ramirez, Tatiana Petrovick, Albino Barraza-Villarreal, Lisa M Thompson, Shirin Jabbarzadeh, Jiantong Wang, Lance Waller, Maggie L Clark, Amy E Lovvorn, Christina M Eckhardt, Nadia E Hoekstra, Michael A Johnson, Ajay Pillarisetti, Diddier Prada, Andrea A Baccarelli, Ye Shen, Jessica Knight, Luke P Naeher, Thomas Clasen, Jennifer Peel, Eric D McCollum, John P McCracken","doi":"10.1093/annalsats/aaoag076","DOIUrl":"10.1093/annalsats/aaoag076","url":null,"abstract":"<p><strong>Rationale: </strong>Household air pollution is a risk factor for obstructive lung diseases.</p><p><strong>Objectives: </strong>We estimated the effect of an early-life liquefied petroleum gas cooking intervention on childhood lung function.</p><p><strong>Methods: </strong>The multi-country Household Air Pollution Intervention Network trial randomized 800 pregnant women (9 to <20 weeks gestation, 18 to <35 years) in Guatemala to receive a gas cookstove and free fuel intervention or continue cooking with biomass until the child is aged 1 year. The present analysis includes only Guatemalan children. At age 3 years, we measured lung function using oscillometry at 7-41 Hz (Tremoflo C-100, Thorasys). Outcomes were resistance and reactance at 7 Hz, area of reactance, resistance at 19 Hz, resistance difference between 7 and 19 Hz, and, as exploration, resistance across frequencies. Upper airway artifacts were removed using Tremoflo software. The effect of the intervention was estimated using linear regression models, unadjusted and adjusted (height, weight, age, sex). Children with respiratory infections during a 7-day recall period were excluded.</p><p><strong>Results: </strong>Valid oscillometry was obtained from 525/750 (70%) 3-year-olds. Among the 225 missed oscillometry tests, 129/225 (57%) were due to the children not being willing to perform the measurements. We did not find evidence of an effect on prespecified oscillometry outcomes. Exploratory analysis suggested that resistance across the frequency spectrum was lower in intervention than control participants (adjusted difference: -0.31 cm H2O*S/L, 95% CI: -0.59, -0.03).</p><p><strong>Conclusions: </strong>Gas cooking compared to biomass cooking from mid-gestation through infancy was not associated with improved prespecified oscillometry outcomes in 3-year-old children. However, lowered resistance across all frequencies in the intervention arm suggests the intervention may have positively impacted airway caliber. Further studies are warranted, including exposure-response analysis and lung function trajectories.</p><p><strong>Trial registration: </strong>Clinical trial registered at ClinicalTrials.gov (NCT02944682).</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1497-1508"},"PeriodicalIF":5.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13238497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}