Annals of the American Thoracic Society最新文献

{"title":"Phenotyping Using Polysomnography Attributes Reduced Respiratory Events after CPAP Therapy to Improved Upper Airway Collapsibility.","authors":"Thomas M Tolbert, Ankit Parekh, David M Rapoport, Indu Ayappa","doi":"10.1513/AnnalsATS.202402-171OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202402-171OC","url":null,"abstract":"<p><p><b>Rationale:</b> In patients with obstructive sleep apnea (OSA) treated with continuous positive airway pressure (CPAP), the apnea hypopnea index (AHI) measured <i>off</i> CPAP may be decreased relative to baseline AHI preceding CPAP treatment. Semi-invasive \"endo-phenotyping\" sleep studies attribute this fall in AHI primarily to improved ventilatory control stability. Phenotyping Using Polysomnography (PUP) attempts to reproduce these studies using routine polysomnography (PSG). <b>Objectives:</b> To determine whether changes in AHI following CPAP associate primarily with changes in PUP-estimated ventilatory control stability (loop gain, LG₁) or with changes in other PUP-estimated pathophysiologic mechanisms. <b>Methods:</b> PUP analyses were performed on existing PSGs in research participants who underwent baseline PSG, 4.4±2.2 months CPAP therapy, and CPAP withdrawal with repeat PSG on night 2 of withdrawal. Pre-CPAP PUP-estimated LG₁, arousal threshold (ArTH), and upper airway collapsibility (Vpassive) and compensation (Vcomp) were compared to corresponding values during CPAP withdrawal. Mixed effects models were constructed to determine which PUP estimate best explained changes in AHI. <b>Results:</b> PSG data were available for 35 participants (age 47±10.8 years; 12 female; BMI 38.5±8.6 kg/m², AHI3A 58.8±33.1 events/hr, 9 mild/moderate OSA, 26 severe OSA). Following CPAP, AHI decreased, but the change was not statistically significant. However, a significant decrease was observed in those with severe OSA (pre-CPAP 68.2 [32.6-86.3] versus CPAP withdrawal 49.0 [36.1-74.4] events/hr). Across all participants, changes in PUP estimates did not exceed test-retest agreement limits. For those with severe OSA, decrease in LG₁ (0.86 [0.61-1.13] pre-CPAP versus 0.71 [0.61-0.99] on CPAP withdrawal) and increase in Vpassive (64.8 [5.4-88.4] %Veupnea pre-CPAP versus 76.4 [20.7-92.7] %Veupnea on CPAP withdrawal) exceeded test-retest agreement limits. Increased Vpassive, decreased LG₁, and decreased ArTH were predictors of decreased AHI in mixed effects models. Vpassive had the greatest estimated effect on AHI. After accounting for Vpassive, additional estimates did not improve model performance. However, Vpassive and LG₁ were correlated, and post hoc analyses suggest these estimates may be influenced by both upper airway collapsibility and ventilatory control. <b>Conclusions:</b> According to PUP physiologic estimates, decreases in AHI following several months of CPAP therapy are primarily attributable to improved upper airway collapsibility.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142585081","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":"Home Mechanical Ventilation and Risk of Hospitalization in Obesity Hypoventilation Syndrome - The Population-based DISCOVERY Study.","authors":"Jonas Einarsson, Andreas Palm, Zainab Ahmadi, Magnus Ekström","doi":"10.1513/AnnalsATS.202402-224OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202402-224OC","url":null,"abstract":"<p><strong>Rationale: </strong>Patients with obesity hypoventilation syndrome (OHS) have high risk of hospitalization, which might be decreased by home mechanical ventilation (HMV).</p><p><strong>Objectives: </strong>To evaluate annualized hospitalization rate (AHR) and change in AHR in patients with OHS starting home mechanical ventilation (HMV), and explore if there were any difference in AHR by starting HMV acutely or electively.</p><p><strong>Methods: </strong>Population-based longitudinal study of patients with OHS starting HMV in the Swedish DISCOVERY cohort between 1996 and 2018, cross-linked with the National Patient Registry for national data on hospital admissions. AHR was calculated for each patient for three years before (Year -3, -2, -1) and three years after (Year 1, 2, 3) the year of starting HMV (Year 0; start date ± 6 months). Differences in AHR were analyzed using Wilcoxon signed-rank test (between years) and Mann-Whitney U test (between acute/elective). Proportion of patients hospitalized in each year was analyzed and comparison between years was done with McNemar´s test. Factors associated with change in AHR were identified using multivariate linear regression models.</p><p><strong>Results: </strong>In total, 2,445 patients were included: 47% females, mean age 62.3 ± 12.2 years, and 1,418 (58%) started HMV electively. Overall, AHR decreased with 0.88 (95%CI 0.74-1.02) hospitalization/year after start of HMV and starting treatment acutely was associated with greater decrease in AHR. There was no statistically significant difference in AHR in Year 1 between acute and elective start (<i>P</i>=0.199). The year after start of HMV, proportion of patients hospitalized decreased from 84% to 54% (<i>P</i><0.05).</p><p><strong>Conclusion: </strong>Initiation of HMV was associated with reduced hospitalization rate in patients with OHS, irrespective of acute or elective start. Majority of patients with OHS are hospitalized in the year of HMV initiation.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584999","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":"Asthma and COVID-19: Unveiling Outcome Disparities and Treatment Impact Based on Distinct Endotypes.","authors":"Benjamin Sines, Cameron B Morrison, Jenna M Donaldson, Asiyah Ahmad, Ashok Krishnamurthy, David B Peden, Camille Ehre","doi":"10.1513/AnnalsATS.202405-507OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202405-507OC","url":null,"abstract":"<p><strong>Rationale: </strong>Epidemiologic studies on asthmatics and <i>in vitro</i> data suggest a protective role of T2 inflammation in SARS-CoV-2 infection.</p><p><strong>Objective: </strong>Using a large, multisite cohort, we studied clinical outcomes following SARS-CoV-2 infection in multiple asthma endotypes and examined the effects of T2-directed biologics in infected asthmatics.in Methods: The National COVID Cohort Collaborative (N3C) Data Enclave was used to identify and stratify asthmatic patients by endotype to include non-T2 and T2 asthmatics, as well as exposure to T2-directed biologic therapy. We evaluated the risk of hospitalization, invasive mechanical ventilation, and 90-day mortality by endotype and exposure to biologics.</p><p><strong>Results: </strong>For this study, 402,376 patients met inclusion criteria, of which 138,142 (34%) were characterized as non-T2 and 264,234 (66%) as T2 asthmatics, a group further divided into 104,823 (26%) atopic, 84,440 (21%) eosinophilic, and 74,971 (19%) T2-high asthmatic endotypes. Compared to non-T2 asthmatics, atopic and T2-high asthmatics experienced decreased odds of hospitalization, and 90-day mortality. Conversely, eosinophilic asthmatics experienced higher odds of hospitalization, intubation, and 90-day mortality. Exposure to T2-directed biologic therapies did not alter outcomes after propensity score matching. In contrast, maximum eosinophil count and recent systemic corticosteroid use were directly correlated with increased odds of all outcomes.</p><p><strong>Conclusions: </strong>COVID-19 outcomes differ depending on asthma endotype, with atopic asthmatics experiencing lower odds and eosinophilic asthmatics experiencing higher odds of deleterious outcomes. T2-directed biologic treatment did not alter these outcomes but recent systemic corticosteroid use predisposes all asthmatics patients to adverse outcomes. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142585062","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":"Interprofessional Team Staffing in U.S. Intensive Care Units.","authors":"Allan Garland, Deena Costa, Hannah Wunsch, Amy L Dzierba, Danny Lizano, Hayley Gershengorn","doi":"10.1513/AnnalsATS.202404-441OC","DOIUrl":"10.1513/AnnalsATS.202404-441OC","url":null,"abstract":"<p><strong>Rationale: </strong>There is a paucity of data, and no consensus, about the composition of interdisciplinary teams of healthcare worker (HCW) that provide care in intensive care units (ICU).</p><p><strong>Objective: </strong>Delineate the nature and variation of HCW staff composition in US adult ICUs before the COVID-19 pandemic.</p><p><strong>Methods: </strong>A national survey of 574 adult ICUs inquired about ICU staffing. Two sets of survey items asked about: (a) \"availability to provide care\" in ICU for 11 HCW types, collapsed into six groupings, and (b) presence in formal ICU clinical rounds of nine HCW types, collapsed into six groupings; bedside nurses were assumed to be involved in both categories. Analysis was descriptive, seeking to examine the predominant and full range of staffing patterns.</p><p><strong>Results: </strong>Of surveyed ICUs: 94% were in metropolitan areas, 63% in teaching hospitals, 74% had >250 beds, 66% cared for mixed adult patient types (e.g. medical-surgical), median ICU bed count was 20 (interquartile range 12-25), 27% used some form of telemedicine. In addition to bedside nurses, the core staffing group comprised intensivists, respiratory therapists and pharmacists; in 88% of ICUs all were available to provide care. However, there were 28 different combinations of the six groupings (intensivists, respiratory therapists, pharmacists, attending physician support, advanced bedside nurse support, nurse aides), with the most common one, present in 38% of ICUs, including all six. 96% of ICUs had interprofessional rounds at least five days a week; 78% had them on weekends. Among the ICUs with rounds, 61% of weekday rounding teams included all of intensivists, respiratory therapists and pharmacists. Nutrition, rehabilitation and social support practitioners each participated in rounds in 35-80% of ICUs, and altogether in 28% of ICUs. Except for intensivists, all HCW types participated much less commonly in weekend than in weekday rounds.</p><p><strong>Conclusions: </strong>ICU care almost always included a core team of bedside nurses, intensivists, respiratory therapists, and pharmacists. Beyond that core, great variability was seen in the presence of many other HCW types. Almost all ICUs had interprofessional rounds, with three-quarters also having them on weekends.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142585075","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":"Tunneled Pleural Catheter and Endobronchial Valves for Spontaneous Pneumothorax Complicated by Persistent Air Leak and Empyema.","authors":"Gustavo A Munera, Daniel Ospina-Delgado, Kai E Swenson, Camilo A Avendano, Adnan Majid","doi":"10.1513/AnnalsATS.202402-149CC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202402-149CC","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":"21 11","pages":"1605-1609"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559704","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":"STOPTHEBURN: A Randomized Controlled Trial of Death Cafés for Burnout Prevention in Intensive Care Unit Employees.","authors":"Marjorie E Bateman, Cheng Han Chung, Erica Mascarenhas, Rachel Hammer, Nithya Ravindran, Farhanaz Panjshiri, Prakriti Mehta, Abigail Byrne, Sasha Lasky, Rebecca Denson, Margo Brown, Barley Halton, Jennifer Chiurco, Stephanie Ferrell, Brent Ruiz, Cathy Wentowski, Ira Shukla, Hannah Bauer, Arunava Sarma, Kshama Bhyravabhotla, Yuanhao Zu, Erin Peacock, John Lefante, Jessica Epere, Joshua L Denson","doi":"10.1513/AnnalsATS.202312-1024OC","DOIUrl":"10.1513/AnnalsATS.202312-1024OC","url":null,"abstract":"<p><p><b>Rationale:</b> Effective interventions to prevent burnout among intensive care unit (ICU) clinicians are urgently needed. Death cafés, group discussions about death, build a sense of community and create a space for reflection on distressing events. <b>Objective:</b> To assess whether participation in regular death cafés can prevent burnout in ICU clinicians (physicians, nurses, pharmacists, therapists). <b>Methods:</b> A randomized clinical trial was conducted from July 2020 to December 2022 in 10 ICUs in Louisiana. Subjects were randomized to attend four psychotherapist-facilitated virtual death cafés or to a control arm. The primary outcome was burnout defined by the Maslach Burnout Inventory-Human Services Survey at 6 months. Depression and anxiety scores were measured, as were qualitative data on stressors, coping, and death café experience. <b>Results:</b> Among 340 clinicians who were screened and gave consent (171 physicians, 169 nonphysicians), 251 participated (mean age, 31.0 ± 6.8 years; 63% female; 72% White; 37% nurses, 27% residents, 25% interns, 11% other). Burnout prevalence was 19% at baseline. Of 136 participants who completed the 6-month follow-up, no significant differences were found between intervention and control for the primary outcome (18% vs. 25%; unadjusted odds ratio, 0.64; 95% confidence interval, 0.26-1.57; <i>P</i> = 0.33). There were no differences in anxiety or depression. Notably, the study was limited by an inability to achieve target enrollment and a high attrition rate (46%). <b>Conclusions:</b> Virtual death cafés were unable to reduce burnout, although the study was underpowered to detect differences between groups. Clinical trial registered with clinicaltrials.gov (NCT04347811).</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1572-1582"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11568494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141763183","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}

{"title":"Long-Term Impact of Lumacaftor/Ivacaftor Treatment on Cystic Fibrosis Disease Progression in Children 2-5 Years of Age Homozygous for <i>F508del-CFTR</i>: A Phase 2, Open-Label Clinical Trial.","authors":"Mirjam Stahl, Jobst Roehmel, Monika Eichinger, Felix Doellinger, Lutz Naehrlich, Matthias V Kopp, Anna-Maria Dittrich, Olaf Sommerburg, Partha Ray, Anita Maniktala, Tu Xu, Sarah Conner, Aniket Joshi, Molly Mascia, Mark O Wielpütz, Marcus A Mall","doi":"10.1513/AnnalsATS.202402-201OC","DOIUrl":"10.1513/AnnalsATS.202402-201OC","url":null,"abstract":"<p><p><b>Rationale:</b> Clinical trials show that lumacaftor/ivacaftor (LUM/IVA) treatment has the potential to modify early cystic fibrosis (CF) disease progression in children as young as 2 years of age. <b>Objectives:</b> To assess the long-term impact of LUM/IVA treatment on CF disease progression in children aged 2-5 years. <b>Methods:</b> This phase 2 trial had two parts: part 1, a 48-week, randomized, double-blind, placebo-controlled study of LUM/IVA in children aged 2-5 years (previously reported) was followed by a 48-week open-label treatment period in which all children received LUM/IVA (part 2; reported here). Endpoints assessed in part 2 included absolute changes from baseline in chest magnetic resonance imaging (MRI) global score at Week 96; weight-for-age, stature-for-age, and body mass index (BMI)-for-age <i>z</i>-scores at Week 96; lung clearance index based on lung volume turnover required to reach 2.5% of starting N2 concentration (LCI_2.5) through Week 96; chest MRI morphological score, chest MRI perfusion score, weight, stature, BMI, and microbiology cultures (oropharyngeal swabs) at Week 96; sweat chloride, amount of immunoreactive trypsinogen, fecal elastase-1 concentration, and fecal calprotectin through Week 96; and number of pulmonary exacerbations, time to first pulmonary exacerbation, and number of CF-related hospitalizations. <b>Results:</b> Forty-nine children received one or more doses of LUM/IVA in the open-label period (33 in the LUM/IVA to LUM/IVA group and 16 in the placebo to LUM/IVA group), with a mean exposure of 47.1 (standard deviation [SD], 5.2) weeks. The mean absolute change in MRI global score (negative value indicates improvement) from baseline at Week 96 was -2.7 (SD, 7.0; 95% confidence interval [CI], -5.2 to -0.1) in the LUM/IVA to LUM/IVA group and -5.6 (SD, 6.9; 95% CI, -9.2 to -1.9) in the placebo to LUM/IVA group. Improvements in LCI_2.5, sweat chloride concentration, and markers of pancreatic function and intestinal inflammation were also observed in both groups. Growth parameters remained stable in both groups. The majority of children had adverse events considered mild (38.8%) or moderate (40.8%). Two (4.1%) children discontinued LUM/IVA treatment because of adverse events (distal intestinal obstruction syndrome [<i>n</i> = 1] and alanine aminotransferase increase [<i>n</i> = 1]). <b>Conclusions:</b> These findings confirm the potential for early LUM/IVA treatment to alter the trajectory of CF disease progression, including CF lung disease, in children as young as 2 years of age. Clinical trial registered with ClinicalTrials.gov (NCT03625466).</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1550-1559"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037986","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":"Restrictive Spirometric Pattern and Preserved Ratio Impaired Spirometry in a Population Aged 50-64 Years.","authors":"Kjell Torén, Anders Blomberg, Linus Schiöler, Andrei Malinovschi, Helena Backman, Kenneth Caidahl, Carl-Johan Carlhäll, Emil Ekbom, Magnus Ekström, Gunnar Engström, Jan E Engvall, Maria J Eriksson, Viktor Hamrefors, Christer Janson, Åse Johnsson, Mohammad Khalil, David Kylhammar, Anne Lindberg, Ulf Nilsson, Anna-Carin Olin, Ida Pesonen, Jessica Sjölund, C Magnus Sköld, Magnus Svartengren, Carl-Johan Östgren, Per Wollmer","doi":"10.1513/AnnalsATS.202403-242OC","DOIUrl":"10.1513/AnnalsATS.202403-242OC","url":null,"abstract":"<p><p><b>Rationale:</b> Knowledge regarding the prevalence and shared and unique characteristics of the restrictive spirometric pattern (RSP) and preserved ratio impaired spirometry (PRISm) is lacking for a general population investigated with post-bronchodilator spirometry and computed tomography of the lungs. <b>Objectives:</b> To investigate shared and unique features for RSP and PRISm. <b>Methods:</b> In the Swedish CArdioPulmonary bioImage Study (SCAPIS), a general population sample of 28,555 people aged 50-64 years (including 14,558 never-smokers) was assessed. The participants answered a questionnaire and underwent computed tomography of the lungs, post-bronchodilator spirometry, and coronary artery calcification score. Odds ratios with 95% confidence intervals (CIs) were calculated using adjusted logistic regression. RSP was defined as forced expiratory volume in 1 second (FEV₁)/forced vital capacity (FVC) ≥0.70 and FVC <80%. PRISm was defined as FEV₁/FVC ≥0.70 and FEV₁ <80%. A local reference equation was applied. <b>Results:</b> The prevalence of RSP and PRISm were 5.1% (95% CI, 4.9-5.4) and 5.1% (95% CI, 4.8-5.3), respectively, with similar values seen in never-smokers. For RSP and PRISm, shared features were current smoking, dyspnea, chronic bronchitis, rheumatic disease, diabetes, ischemic heart disease, bronchial wall thickening, interstitial lung abnormalities, and bronchiectasis. Emphysema was uniquely linked to PRISm (odds ratio, 1.69; 95% CI, 1.36-2.10) versus 1.10 (95% CI, 0.84-1.43) for RSP. Coronary artery calcification score ≥300 was related to PRISm, but not among never-smokers. <b>Conclusions:</b> PRISm and RSP have respiratory, cardiovascular, and metabolic conditions as shared features. Emphysema is only associated with PRISm. Coronary atherosclerosis may be associated with PRISm. Our results indicate that RSP and PRISm may share more features than not.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1524-1532"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11568503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141857307","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}

{"title":"Type 2 Inflammation Is Associated with Emphysema on Computed Tomography.","authors":"Surya P Bhatt, Arie Nakhmani, Sandeep Bodduluri","doi":"10.1513/AnnalsATS.202404-375RL","DOIUrl":"10.1513/AnnalsATS.202404-375RL","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1628-1630"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11568500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141763185","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}

{"title":"Access to Treatment for Chronic Obstructive Pulmonary Disease in the Americas: A Call for Action. A Joint Perspective from the Brazilian Thoracic Society, Canadian Thoracic Society, Latin American Thoracic Society, and the American Thoracic Society.","authors":"Francesca Polverino, Mohit Bhutani, Gustavo Zabert, Frederico Leon Arrabal Fernandes, Karen Czischke, Luiz Fernando Pereira Ferreira, Lian Szabo, Juan P Wisnivesky, Margareth Pretti Dalcolmo, Juan C Celedón","doi":"10.1513/AnnalsATS.202404-386FR","DOIUrl":"10.1513/AnnalsATS.202404-386FR","url":null,"abstract":"<p><p>Chronic obstructive pulmonary disease (COPD) is a major public health problem in the Americas (a region of the world comprising North, Central, and South America), although there is substantial variation in disease prevalence, morbidity, and mortality between and within nations. Across the Americas, COPD disproportionately affects vulnerable populations, including minoritized populations and impoverished persons, who are more likely to be exposed to risk factors such as tobacco use, air pollution, infections such as tuberculosis, and biomass smoke, but less likely to have adequate healthcare access. Management of COPD can be challenging across the Americas, with some barriers being specific to certain countries and others shared across the United States, Canada, and Latin America. Because most cases of COPD are undiagnosed because of suboptimal access to health care and pulmonary function testing and, thus, cannot be treated, increased access to spirometry would have a substantial impact on disease management across the Americas. For individuals who are diagnosed, access to medications and other interventions is quite variable across and within nations, even in those with universal healthcare systems, such as Canada and Brazil. This emphasizes the importance of collaborative treatment guidelines, which should be adapted for the healthcare systems and policies of each nation or region, as appropriate. To have a positive impact on COPD management in the Americas, we propose actionable items, including the need for all our respiratory societies to engage key stakeholders (e.g., patient-led organizations, professional societies, and governmental and nongovernmental agencies) while advocating for campaigns and policies to ensure clean air for all; eliminate tobacco use and enhance coverage for treatment of nicotine dependence; and improve access to early case finding, diagnosis, and treatment for all patients, including underserved and vulnerable populations.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1463-1470"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11568495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861907","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}