Annals of the American Thoracic Society最新文献

{"title":"Medication Non-Adherence in Patients with Pulmonary Arterial Hypertension: The Pulmonary Hypertension Association Registry (PHAR).","authors":"Eric W Robbins, Kaitlin Bradley, David B Badesch, Charles Burger, Amy M Chybowski, Teresa De Marco, Anna R Hemnes, Matthew Lammi, Stephen C Mathai, Lana Melendres-Groves, Farhan Raza, Jeffrey Sager, Oksana A Shlobin, Thenappan Thenappan, Roham Zamanian, James Runo, Grayson L Baird, Corey E Ventetuolo","doi":"10.1513/AnnalsATS.202312-1083OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202312-1083OC","url":null,"abstract":"<p><p><b>Rationale</b> Pulmonary arterial hypertension (PAH) is associated with significant morbidity and mortality. The extent of medication non-adherence in PAH is uncertain and may be linked to adverse outcomes. There has been a lack of multi-center, registry-based studies assessing medication non-adherence and patient-centered outcomes in PAH. <b>Objectives</b> To determine the incidence of self-reported non-adherence in Pulmonary Hypertension Association Registry (PHAR) participants with PAH or chronic thromboembolic pulmonary hypertension (CTEPH) and the relationship of non-adherence with several patient-centered outcomes (mortality, hospitalization rates, emergency department [ED] visits, and health-related quality of life [HRQoL]). <b>Methods</b> Self-reported PAH medication non-adherence was captured at PHAR enrollment and during follow-up visits. Predictors of non-adherence were modeled using generalized estimating equations (GEEs) assuming a binary distribution. Outcomes associated with non-adherence were modeled using GEEs with a Poisson distribution. <b>Results</b> A total of 1543 patients were included, of whom 1092 (70.8%) were female and 1340 (86.8%) had PAH. The overall rate of any self-reported non-adherence was 6.1% (95% confidence interval (CI) [5.3, 6.9]). Predictors of non-adherence included self-reported male sex (odds ratio (OR) 1.4; 95% CI [1.0, 1.9]; p = 0.02), poverty (OR 1.6; 95% CI [1.2, 2.3]; p = 0.01), not being partnered (OR 1.5; 95% CI [1.1, 1.9]; p = 0.01), having Medicaid or no health insurance (OR 2.1; 95% CI [1.5, 2.9]; p < 0.001), and having completed high school but not having a college degree (OR 1.7; 95% CI [1.1, 2.9]; p < 0.001). PHAR participants who reported any non-adherence had 50.0% more ED visits (p < 0.001), 13.3% more hospital admissions (p = 0.03), and 61.9% more days hospitalized (p = 0.01). No relationship was observed between non-adherence and type or number of PAH therapies or all-cause mortality. Participants reporting non-adherence had worse mean SF-12 scores (p < 0.001) and worse emPHasis-10 scores (p = 0.02). <b>Conclusions</b> The rate of self-reported non-adherence in PHAR registrants was low but was associated with male sex and several social determinants of health. While complexity or type of PAH regimen did not appear to influence non-adherence, non-adherence was associated with numerous adverse patient-centered outcomes, including higher healthcare utilization and worse HRQoL. Due to limitations in the structure of the gathered data, relationships between exposure and outcomes were not temporally definitive; these observations warrant additional prospective studies.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451277","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":"Oxygen Supplementation Goals Beyond Correcting Ambulatory Oxygen Saturation.","authors":"Paraschos Archontakis Barakakis, Spyridon Fortis","doi":"10.1513/AnnalsATS.202411-1242LE","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202411-1242LE","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416578","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":"Reply to Archontakis Barakakis and Fortis: Oxygen Supplementation Goals Beyond Correcting Ambulatory Oxygen Saturation.","authors":"Kristopher P Clark, Seyed Mehdi Nouraie, Kathleen O Lindell, Kevin F Gibson, Frank C Sciurba, Jessica Bon, Daniel J Kass","doi":"10.1513/AnnalsATS.202412-1316LE","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202412-1316LE","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416581","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":"SGLT-2 Inhibitors and the Risk of COPD Exacerbations and Mortality in COPD Patients.","authors":"Fu-Shun Yen, James Cheng-Chung Wei, Yu-Han Huang, Tzu-Ju Hsu, Sing-Ting Wang, Chii-Min Hwu, Chih-Cheng Hsu","doi":"10.1513/AnnalsATS.202407-703OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202407-703OC","url":null,"abstract":"<p><strong>Rationale: </strong>Patients with chronic obstructive pulmonary disease (COPD) are susceptible to acute exacerbations, cardiovascular disease, and premature death.</p><p><strong>Objectives: </strong>To compare the risk of COPD exacerbation, cardiovascular diseases, and mortality between sodium-glucose cotransporter-2 (SGLT-2) inhibitor use and no use in patients with type 2 diabetes mellitus (T2DM) and COPD.</p><p><strong>Methods: </strong>The study included 299,168 patients diagnosed with T2DM and COPD in the National Health Insurance Research Database from January 1, 2009, to December 31, 2020. Cox proportional hazards models were used to examine the relative hazard of major adverse cardiovascular events, hospitalization for COPD, noninvasive positive pressure ventilation (NIPPV), invasive mechanical ventilation, lung cancer, and mortality between SGLT-2 inhibitor users and nonusers. We used propensity score matching to select 1288 pairs of SGLT-2 inhibitor users and nonusers.</p><p><strong>Measurements and main results: </strong>In the matched cohorts, SGLT-2 inhibitor use was associated with a significantly lower risk of mortality (aHR 0.64, 95% CI 0.43-0.95), NIPPV (aHR 0.48, 95% CI 0.27-0.87), and hospitalization for COPD (aHR 0.82, 95% CI 0.69-0.98) than SGLT-2 inhibitor non-use. Subgroup and dose-response analyses showed that SGLT-2 inhibitor use was associated with a significantly lower risk of mortality, NIPPV, and hospitalization for COPD (p<0.05) than no use of SGLT-2 inhibitors.</p><p><strong>Conclusions: </strong>This population-based cohort study showed that SGLT-2 inhibitors use was associated with a lower risk of COPD exacerbations, ventilator support, and mortality than non- SGLT-2 inhibitors use in patients with T2DM and COPD. SGLT-2 inhibitors may have a role in treating patients with COPD and diabetes.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412111","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":"Incidence and Predictors of Long-term Hypnotic Receipt among Patients with Chronic Obstructive Pulmonary Disease.","authors":"Jason M Castaneda, Aristotle Leonhard, Laura J Spece, Kevin I Duan, Brian N Palen, Jessica A Chen, Y Irina Li, Steve Zeliadt, Kevin Josey, Laura C Feemster, David H Au, Lucas M Donovan","doi":"10.1513/AnnalsATS.202407-798OC","DOIUrl":"10.1513/AnnalsATS.202407-798OC","url":null,"abstract":"<p><strong>Rationale: </strong>Many patients with chronic obstructive pulmonary disease (COPD) receive hypnotic prescriptions to mitigate insomnia symptoms. Although clinical practice guidelines advise short-term use, patients often receive these medications long-term. As patients with COPD may be more susceptible to adverse effects of hypnotics, it is critical that we better understand the incidence and potential influences of this practice.</p><p><strong>Objectives: </strong>To characterize the incidence and predictors of guideline-discordant long-term receipt of hypnotic medications among patients with COPD.</p><p><strong>Methods: </strong>Using nationwide Veterans Health Administration (VA) data, we identified patients with clinically diagnosed COPD from 2010-2019 without prior hypnotic receipt in the past year. To identify individuals with new hypnotic use, we restricted this sample to those who received at least 30 total days of zolpidem, melatonin, trazodone, and/or doxepin within a 90-day period. We defined long-term hypnotic receipt as continued availability of one of these hypnotic medications for at least 30 days within the subsequent 90-day period. We then used a mixed-effects logistic regression model to assess patient and site-level associations with long-term receipt.</p><p><strong>Results: </strong>Among 4,262 patients with COPD and new hypnotic receipt, 55.6% (2,371) continued to receive hypnotics long-term. Long-term receipt was positively associated with short-acting beta agonist (SABA) receipt (Every 10% increase in days with SABA availability, OR 1.03, 95%CI 1.02-1.05), maintenance inhaler prescriptions (monotherapy, OR 1.35, 95%CI 1.10-1.68, dual therapy, OR 1.43, 95%CI 1.20-1.70, triple therapy, OR 1.54, 95%CI 1.24-1.91), post-traumatic stress disorder (OR 1.21, 95%CI 1.02-1.44), major depressive disorder (OR 1.24, 95%CI 1.07-1.44), anxiety disorder (OR 1.21, 95%CI 1.03-1.44), and more frequent primary care visits (>5 visits in the past 12 months: OR 1.86, 95%CI 1.19-2.90). Long-term receipt was negatively associated with initial receipt of melatonin (OR 0.70, 95%CI 0.55-0.91) and more than one pulmonary visit in the prior 12 months (OR 0.74, 95% CI 0.56-0.97).</p><p><strong>Conclusions: </strong>Despite guideline recommendations, long-term hypnotic receipt is common among patients with COPD. Future work to prevent long-term hypnotic prescriptions should consider the role that respiratory symptoms and mental health comorbidities may have in driving this practice.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412098","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":"Comprehensive Management Algorithm for <i>Mycobacterium avium</i> Complex Pulmonary Disease in the Real-World Setting.","authors":"Kozo Morimoto, Charles L Daley","doi":"10.1513/AnnalsATS.202408-904FR","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202408-904FR","url":null,"abstract":"<p><p>The management of Mycobacterium avium complex pulmonary disease (MAC-PD) is challenging due to limited efficacy and frequent adverse events associated with standard treatments. The 2020 guidelines from ATS, ERS, ESCMID, and IDSA provide recommendations, but real-world adherence is often hindered by these issues, leading many patients to be unable to complete standard therapy. This review proposes a comprehensive management algorithm for MAC-PD, emphasizing multidisciplinary approaches and integrating non-antimicrobial management before, during, and after drug treatment to enhance patient outcomes. When a patient presents with chronic respiratory symptoms suggestive of NTM, clinicians should follow a guideline-based approach to diagnosis, as diagnostic delays are common due to nonspecific symptoms. Proper evaluation should determine the disease phenotype (existence of cavitary lesions) as it influences treatment choices. Airway clearance, nutritional support, and management of underlying conditions are essential non-antimicrobial components. Regular outpatient monitoring helps detect disease progression and optimize treatment. Treatment strategies vary based on disease severity. For non-cavitary nodular bronchiectatic disease, a thrice-weekly regimen is preferred due to better tolerability. Severe cases or those with cavitary forms may require daily treatment with additional aminoglycosides. Amikacin liposome inhalation suspension (ALIS) is recommended for patients not responding to standard regimens after six months. Recent research addresses drug intolerance, suggesting alternatives like a two-drug regimen without rifamycin in certain cases. Consultation with NTM specialists is advised for complex cases, particularly those with macrolide resistance or requiring surgical intervention. The algorithm emphasizes shared decision-making, patient education, and family support to improve adherence and 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":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143401022","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":"Factors Associated with Referral to Expert Providers among Patients with Pulmonary Hypertension.","authors":"Kari R Gillmeyer, Seppo T Rinne, Justin M Rucci, Elizabeth S Klings, A Rani Elwy, Renda Soylemez Wiener","doi":"10.1513/AnnalsATS.202408-901OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202408-901OC","url":null,"abstract":"<p><strong>Rationale: </strong>Guidelines recommend early referral to pulmonary hypertension (PH) experts for patients with confirmed or suspected pulmonary arterial hypertension (PAH) or chronic thromboembolic PH (CTEPH), among others. Yet, patients often have advanced disease at the time of referral. The drivers of these referral delays are not well known.</p><p><strong>Objectives: </strong>Building upon our prior qualitative findings on barriers to timely PH care along the care continuum, we sought to identify patient-level factors associated with referral to PH experts.</p><p><strong>Methods: </strong>We leveraged the Massachusetts All-Payer Claims Database to identify all patients with incident PH in 2015-2017 using a validated algorithm (sensitivity 28%; specificity 100%) and further identified subgroups with a risk factor for PAH and CTEPH. Our outcome was presence or absence of referral to a PH expert during the study period. Based on our prior qualitative work, our three primary exposures were 1) Medicaid recipient, 2) mental health diagnoses, and 3) distance to the nearest PH center. We conducted separate multivariable logistic regression models to determine the association between each of our primary exposures and outcome, among our entire cohort and those with a risk factor for PAH and CTEPH.</p><p><strong>Results: </strong>Among our entire cohort (n=12,505), 704 (5.6%) were seen by a PH expert. Among the subset with a risk factor for PAH (n=2,393) and CTEPH (n=3,167), 242 (10.1%) and 185 (5.8%) were seen by a PH expert, respectively. Patients less likely to be referred included Medicaid recipients (adjusted Odds Ratio [aOR] 0.64, 95% Confidence Interval [CI] 0.53-0.77), those with mental health diagnoses (aOR 0.69, 95% CI 0.58-0.83), and those living further from a PH center (aOR 0.78, 95% CI 0.74-0.82 for each 10 miles increase in distance to PH center). Findings were similar among those with a risk factor for PAH and CTEPH.</p><p><strong>Conclusions: </strong>Few patients with PH are referred to PH experts, including those with a risk factor for PAH and CTEPH. Factors associated with expert referral identified in this study highlight barriers to timely PH care and offer targeted areas of future study to improve the timeliness of PH care.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392713","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":"Neighborhood Exposome and Prevalence of Asthma and COPD in the United States.","authors":"Stephen A Mein, Michael Liu, Lucas X Marinacci, Mary B Rice, Rishi K Wadhera","doi":"10.1513/AnnalsATS.202409-991RL","DOIUrl":"10.1513/AnnalsATS.202409-991RL","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392714","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":"Extracorporeal Membrane Oxygenation Bridge to Pediatric Lung Transplantation.","authors":"Wonshill Koh, Huaiyu Zang, Nicholas J Ollberding, Don Hayes","doi":"10.1513/AnnalsATS.202407-778RL","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202407-778RL","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392712","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 Crossroads for Corticosteroid Therapy in Pediatric Interstitial and Rare Lung Diseases.","authors":"Nicholas Avdimiretz, Christian Benden, Rossa Brugha, Nicolaus Schwerk, Don Hayes","doi":"10.1513/AnnalsATS.202411-1138VP","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202411-1138VP","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371400","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}