Annals of the American Thoracic Society最新文献

{"title":"Consent Approach and Patient Notification in Pragmatic Comparative Effectiveness Trials in Critical Care.","authors":"Dustin C Krutsinger, Katherine R Courtright","doi":"10.1513/AnnalsATS.202502-218ED","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202502-218ED","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143813081","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":"The Rare Use of Respiratory Protective Equipment by Workers on Prominent Home Improvement Programs.","authors":"Andrew H Stephen, Debasree Banerjee","doi":"10.1513/AnnalsATS.202412-1257VP","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202412-1257VP","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143813097","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":"Characteristics Associated with Lung Function Trajectories: An Analysis of the SPIROMICS Cohort.","authors":"Russell G Buhr, Nicholas J Jackson, Jane C Fazio, Igor Barjaktarevic, Lori A Bateman, Surya P Bhatt, David J Couper, Jeffrey L Curtis, Brett A Dolezal, M Bradley Drummond, MeiLan K Han, Nadia N Hansel, Anand S Iyer, Jerry A Krishnan, Fernando J Martinez, Jill Ohar, Robert Paine, Stephen I Rennard, Benjamin M Smith, Donald P Tashkin, Prescott G Woodruff, Wayne H Anderson, Christopher B Cooper","doi":"10.1513/AnnalsATS.202405-500OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202405-500OC","url":null,"abstract":"<p><strong>Rationale: </strong>Discovering the biological basis of progression in chronic obstructive pulmonary disease (COPD), especially of rapid decline (RD) in FEV1, is essential to develop precision therapies.</p><p><strong>Objectives: </strong>First, to define baseline characteristic of RD (≥100 mL/year), relative to those who were stable-to-improved (S/I) or with intermediate decline (D)-categories based on spirometric data from the Framingham Offspring Cohort. Second, to examine these categories as predictors of longitudinal COPD outcomes, adjusting for baseline characteristics.</p><p><strong>Methods: </strong>Among ever-smoking SPIROMICS participants with ≥2 spirometric measurements over 8 years, we fit slopes of postbronchodilator FEV1 change by linear regression. We used ordinal regression, testing baseline characteristics as predictors of lung function change categories (S/I, D and RD) and used those categories to assess associated clinical outcomes.</p><p><strong>Measurements and main results: </strong>In this heavy smoking cohort (≥20 pack-years), there were 747 S/I (40%) and 336 RD (18%). In adjusted models of baseline factors associated with trajectories of decline, steeper decline was associated with better initial lung function (all P<0.001) and greater likelihood of baseline bronchodilator responsiveness (S/I, D, RD: 32%, 37%, 43%; P<0.001); no association between RD and race, ethnicity, socioeconomic status, medical history, or respiratory medication use. Regarding clinical endpoints, RD was associated with greater symptom burden, worse health-related quality of life and increased mortality, but not exacerbation frequency.</p><p><strong>Conclusion: </strong>Categorical definitions of S/I and RD highlight bronchodilator responsiveness and smoking as risks for adverse outcomes, including death. Contrasting these disease trajectories will support the future identification of the biological bases of COPD progression.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143813078","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":"The End of Chevron Deference: Implications for Environmental Regulations and Respiratory Health.","authors":"Sommer H Engels, Jared Radbel, Gillian Goobie, Laura M Paulin, Andrew C Mergen, Gary Ewart, Alison Lee, Nicholas J Nassikas","doi":"10.1513/AnnalsATS.202410-1079VP","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202410-1079VP","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143813095","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":"A Pilot Study to Assess the Effect of Intermittent Inhaled Nitric Oxide as Treatment of Nontuberculous Mycobacteria Lung Infection.","authors":"Rachel M Thomson, Andrew J Burke, Lucy C Morgan, Andrew A Colin","doi":"10.1513/AnnalsATS.202407-745RL","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202407-745RL","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804785","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":"Accuracy of Intensivist Prognostications of within-ICU Deterioration and Development of Persistent Critical Illness: A Prospective Cohort Study.","authors":"Elizabeth M Viglianti, Ashwatha Thenappan, Andrew J Admon, Kaitland M Byrd, Kathleen Tiffany Lee, Amy S B Bohnert, Theodore J Iwashyna, Hallie C Prescott","doi":"10.1513/AnnalsATS.202411-1174OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202411-1174OC","url":null,"abstract":"<p><strong>Rationale: </strong>Persistent critical illness (PerCI) is costly, rising in incidence, and not reliably predicted with existing risk-prediction tools.</p><p><strong>Objective: </strong>To assess whether attending intensivists can identify patients at heightened risk of developing PerCI.</p><p><strong>Methods: </strong>We conducted a prospective longitudinal assessment from August 2020 to January 2023. Intensivists were assessed on each patient within 24 hours of admission to the medical intensive care unit (ICU) and on ICU day three. We measured intensivists' prognostication of within-ICU events (late-onset shock and/or acute hypoxic respiratory failure [AHRF] and PerCI) and self-rated confidence in prognostications. Test characteristics were calculated for both outcomes, at each timepoint, and stratified by self-rated confidence.</p><p><strong>Results: </strong>1,295 assessments were completed (response rate: 87.9%), assessing 875 ICU admissions by 18 intensivists. Late-onset shock/AHRF and PerCI occurred in 7.3% and 16.0% of ICU admissions, respectively. C-statistics for intensivist prognostication of late-onset shock/AHRF were 0.5 (95%CI:0.5-0.6) and 0.6 (95%CI:0.5-0.6) on admission and day three, respectively. C-statistics for PerCI were 0.7 (95%CI:0.7-0.7) and 0.7 (95%CI:0.7-0.8), respectively. C-statistics for late-onset shock/AHRF were no different for confident vs unconfident assessments. C-statistics for PerCI were higher for confident vs unconfident assessments (0.8 vs 0.6, p<0.01) on admission, but not different on day three (0.7 vs 0.7, p=0.20).</p><p><strong>Conclusions: </strong>Intensivist prognostications have poor discriminatory accuracy for the development of late-onset shock/AHRF and moderate accuracy for development of PerCI. Further research is needed to understand what factors influence intensivists' prognostications of within-ICU deterioration and how this information is conveyed to patients and families.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804812","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":"Goals of Care Assessment During Hospitalization for Sepsis.","authors":"Leigh M Cagino, Emily Walzl, Jakob I McSparron, Megan Heath, Lakshmi Swaminathan, Douglas B White, Rania Esteitie, Elizabeth S McLaughlin, Jennifer K Horowitz, Patricia Posa, Stephanie Parks Taylor, Scott A Flanders, Hallie C Prescott","doi":"10.1513/AnnalsATS.202410-1041OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202410-1041OC","url":null,"abstract":"<p><strong>Introduction: </strong>Sepsis is a common cause of hospital mortality, as well as new morbidity among survivors. Clinical practice guidelines recommend assessing goals of care (GoC) during sepsis hospitalization to ensure goal-concordant care is provided.</p><p><strong>Objective: </strong>To determine how often GoC are assessed during sepsis hospitalization in routine practice.</p><p><strong>Methods: </strong>Cohort study of adult patients hospitalized with community-onset sepsis at 66 hospitals (2020-2023) participating in the Michigan Hospital Medicine Safety Consortium's sepsis initiative (HMS-sepsis). The primary outcomes were GoC discussion documented in the health record and GoC assessment inferred to have occurred based on: (1) documented GoC discussion, (2) treatment limitations on admission, (3) treatment limitations initiated during hospitalization, (4) palliative care consultation, or (5) discharge to hospice. We examined incidence of GoC discussion and GoC assessment among all sepsis hospitalizations, as well as in three subgroups defined by advanced age or health impairment; admission to intensive care; and presentation with shock or respiratory failure. We additionally evaluated factors associated with GoC discussion/assessment and quantified variation across hospitals using multilevel logistic regression.</p><p><strong>Results: </strong>Among 18,711 patients in the HMS-sepsis registry, 54.0% had advanced age or health impairment, 22.5% were admitted to intensive care, and 10.2% presented with shock or respiratory failure. GoC discussion and assessment occurred in 35.7% and 45.3%, respectively, in the overall cohort. 23.8% had GoC discussion within three days of presentation. Age, race, chronic conditions, pre-existing cognitive impairment, pre-existing functional limitation, admission to intensive care, and receipt of life support were each associated with GoC assessment. Median odds ratios for GoC discussion and assessment were 2.30 and 2.09, respectively, indicating substantial cross-hospital variation after accounting for patient characteristics. GoC discussion and assessment were more common among patients with advanced age or health impairment, admission to intensive care, or presentation with shock or respiratory failure, but cross-hospital variation was similar.</p><p><strong>Conclusion: </strong>GoC assessment did not occur consistently during sepsis hospitalization in this multi-hospital cohort, even among higher-risk patients, and there was marked variation in practice across hospitals. Future work is needed to better understand what drives high performance in assessing GoC.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788984","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":"Lung Volume Recruitment and Quality of Life in Duchenne Muscular Dystrophy: Secondary Analysis of the STEADFAST Randomized Controlled Trial.","authors":"Anne Tsampalieros, Doug McKim, Nick Barrowman, Vid Bijelic, Jean K Mah, Hugh J McMillan, Craig Campbell, Franco Momoli, Henrietta Blinder, Laura McAdam, The Thanh Diem Nguyen, Mark Tarnopolsky, David F Wensley, David Zielinski, Sherri L Katz","doi":"10.1513/AnnalsATS.202404-360OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202404-360OC","url":null,"abstract":"<p><strong>Background: </strong>Lung volume recruitment (LVR) is prescribed for children with Duchenne muscular dystrophy (DMD), to maintain chest wall compliance and assist airway clearance. We aimed to determine if twice-daily LVR compared to standard treatment in children with DMD improved health related quality of life (HRQOL) over 2 years.</p><p><strong>Methods: </strong>A multicentre, assessor-blinded randomized controlled trial was conducted, including boys 6-16 years with DMD with forced vital capacity >30% predicted to undergo conventional treatment or conventional treatment and manual LVR twice-daily for two years. Outcome was HRQOL measured by two validated instruments (PedsQL, DMD PedsQL) every 6 months.</p><p><strong>Results: </strong>Sixty-two boys (33 LVR group and 29 controls), median (IQR) age 11.4 (9.4,13.4) years completed the study. Median (IQR) baseline HRQOL assessed by parent/caregiver PedsQL was 58.0 (41.9, 67.0) and 55.2 (47.8, 63.5) for the LVR and control groups. HRQOL trajectories were stable over the 2-year study period except parent communication, which improved. No statistically significant interactions were detected between visit and treatment group for any PedsQL outcomes. DMD PedsQL communication scores in the LVR group showed more positive change compared to controls. Treatment scores in the LVR group showed less positive change over time compared to controls; however, after correcting for multiple testing, were no longer significant. Respiratory symptom rate did not differ between groups and was not associated with any HRQOL outcome.</p><p><strong>Conclusion: </strong>There was no difference in HRQOL between the LVR and control groups after two years. The burden of LVR did not appear to adversely affect HRQOL.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788914","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":"A Strategy to Reduce Out-of-User-Life Utilization and Waste of Expired Budesonide-Formoterol pMDI Inhalers in Mild Asthma.","authors":"Kevin R Stein, Eliot Jost, Abigail R Barker, Suzanne M Simkovich, Charles W Goss, Mansi Agarwal, Mark D Huffman, Kaharu Sumino, Roy Pleasents, Mario Castro, Helen K Reddel, James G Krings","doi":"10.1513/AnnalsATS.202410-1115RL","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202410-1115RL","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788982","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":"<i>MUC5B</i> Genotype and Other Common Variants Are Associated with Computational Imaging Features of Usual Interstitial Pneumonia.","authors":"Rachel Z Blumhagen, Stephen M Humphries, Anna L Peljto, David A Lynch, Jonathan Cardwell, Tami J Bang, Shawn D Teague, Christopher Sigakis, Avram D Walts, Deepa Puthenvedu, Paul J Wolters, Timothy S Blackwell, Jonathan A Kropski, Kevin K Brown, Marvin I Schwarz, Ivana V Yang, Mark P Steele, David A Schwartz, Joyce S Lee","doi":"10.1513/AnnalsATS.202401-022OC","DOIUrl":"10.1513/AnnalsATS.202401-022OC","url":null,"abstract":"<p><p><b>Rationale:</b> Idiopathic pulmonary fibrosis (IPF) is a complex and heterogeneous disease. Given this, we reasoned that differences in genetic profiles may be associated with unique clinical and radiologic features. Computational image analysis, sometimes referred to as radiomics, provides objective, quantitative assessments of radiologic features in subjects with pulmonary fibrosis. <b>Objectives:</b> To determine if the genetic risk profile of patients with IPF identifies unique computational imaging phenotypes. <b>Methods:</b> Participants with IPF were included in this study if they had genotype data and computed tomography (CT) scans of the chest available for computational image analysis. The extent of lung fibrosis and the likelihood of a usual interstitial pneumonia (UIP) pattern were scored automatically using two separate, previously validated deep learning techniques for CT analysis. UIP pattern was also classified visually by radiologists according to established criteria. <b>Results:</b> Among 329 participants with IPF, <i>MUC5B</i> and <i>ZKSCAN1</i> were independently associated with the deep learning-based UIP score. None of the common variants were associated with fibrosis extent by computational imaging. We did not find an association between <i>MUC5B</i> or <i>ZKSCAN1</i> and visually assessed UIP pattern. <b>Conclusions:</b> Select genetic variants are associated with computer-based classification of UIP on CT in this IPF cohort. Analysis of radiologic features using deep learning may enhance our ability to identify important genotype-phenotype associations in fibrotic lung diseases.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"533-540"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142735312","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}