Annals of the American Thoracic Society最新文献

{"title":"Gestational Age and Birthweight Predict Airflow Obstruction: A Study from the Swedish National Airway Register.","authors":"Maria Ödling, Mikael Andersson Franko, Helena Backman, Lowie E G W Vanfleteren, Caroline Stridsman, Jon R Konradsen","doi":"10.1513/AnnalsATS.202411-1236OC","DOIUrl":"10.1513/AnnalsATS.202411-1236OC","url":null,"abstract":"<p><p><b>Rationale:</b> Few studies have identified risk sets for perinatal factors and airflow obstruction into middle adulthood. <b>Objectives:</b> To investigate associations between gestational age (GA), GA-adjusted birthweight, and mode of delivery and persistent airflow obstruction among patients 7-49 years old with obstructive lung diseases. <b>Methods:</b> The study population encompassed 44,778 individuals with asthma or chronic obstructive pulmonary disease (COPD) and one or more registration of post-bronchodilator values of forced expiratory volume in 1 second (FEV₁) and forced vital capacity (FVC) recorded in the Swedish National Airway Register in 2014-2022 and with both GA and birthweight data in the Medical Birth Register between 1973-2015. Persistent airflow obstruction was defined as a FEV₁/FVC <i>z</i>-score below the lower limit of normal. Analyses were done separately for children, young adults, and middle-aged adults. <b>Results:</b> Subjects who were extremely, very, moderate, and late preterm-born all had increased odds ratios (ORs) of persistent airflow obstruction up to age 49 years compared with those term-born. Middle-aged adults born small for GA had increased OR of persistent airflow obstruction compared with those appropriate for GA (OR, 1.49; 95% confidence interval, 1.23-1.81). In the risk sets, GA was the most significant covariate for persistent airflow obstruction. GA-adjusted birthweight was an additional covariate for those born late preterm, term, or postterm. Mode of delivery did not contribute. <b>Conclusions:</b> GA was an independent covariate of persistent airflow obstruction and, in the risk sets, proved to be the most important covariate in patients of all ages with either asthma or COPD. GA-adjusted birthweight further improved the prediction.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1522-1530"},"PeriodicalIF":5.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227892","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":"More Than a Code: Getting the Epidemiology of Fibrotic Interstitial Lung Disease Right.","authors":"Qingqing Meng, Timothy M Dempsey","doi":"10.1513/AnnalsATS.202508-858ED","DOIUrl":"10.1513/AnnalsATS.202508-858ED","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1463-1464"},"PeriodicalIF":5.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982259","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":"Risk Factors of Post-Traumatic Stress Disorder Symptom Trajectories for ICU Bereaved Family Members.","authors":"Fur-Hsing Wen, Li-Pang Chuang, Tsung-Hui Hu, Chung-Chi Huang, Wen-Chi Chou, Siew Tzuh Tang","doi":"10.1513/AnnalsATS.202504-458RL","DOIUrl":"10.1513/AnnalsATS.202504-458RL","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1615-1618"},"PeriodicalIF":5.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310954","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":"The Rapid Evolution of Remotely Delivered Pulmonary Rehabilitation in the United States: Why It Matters to Clarify Terminology Now.","authors":"Marilyn L Moy, Richard Casaburi, Chris Garvey, Surya P Bhatt, Linda Nici","doi":"10.1513/AnnalsATS.202502-184PS","DOIUrl":"10.1513/AnnalsATS.202502-184PS","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1453-1456"},"PeriodicalIF":5.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144664123","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":"Effective Enforcement of Laws Prohibiting Underage Tobacco Product Sale Is Needed.","authors":"Harold J Farber","doi":"10.1513/AnnalsATS.202507-833ED","DOIUrl":"10.1513/AnnalsATS.202507-833ED","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1465-1466"},"PeriodicalIF":5.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982302","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":"Providers Consistently Delay Extubation after Successful Spontaneous Breathing Trials: A Retrospective Cohort Study.","authors":"Anna K Barker, Rachel K Hechtman, Megan Acho, Michael W Sjoding","doi":"10.1513/AnnalsATS.202502-188OC","DOIUrl":"10.1513/AnnalsATS.202502-188OC","url":null,"abstract":"<p><p><b>Rationale:</b> Many patients who pass a spontaneous breathing trial (SBT) are not extubated, leaving them at risk for life-threatening ventilator-associated complications. Determining barriers to timely extubation may facilitate shorter overall durations of mechanical ventilation. <b>Objectives:</b> We sought to identify the patient-related and patient-independent barriers to timely extubation within 6 hours of passing an SBT. <b>Methods:</b> We analyzed electronic health record data from adult patients on mechanical ventilation who had been admitted to a medical or cardiac intensive care unit at an academic, tertiary-care center between January 1, 2015, and December 31, 2023. We utilized a mixed-effects, multivariate logistic regression model to evaluate the association between timely extubation within 6 hours of first passing an SBT and 15 potential reasons to delay extubation, accounting for clustering at the attending-physician level. <b>Results:</b> Among 3,240 patients, 62.3% underwent timely extubation within 6 hours of first passing an SBT. Patients with delayed extubation experienced a median of 2.0 (interquartile range = 1.0-3.8) additional days on mechanical ventilation after passing an SBT, for a total of 3,930 days. This delay accounts for 32% of the total time on mechanical ventilation for the study population. Patients were less likely to have timely extubation if they underwent a procedure in the 24 hours after passing an SBT (average marginal effect [AME], -17.7%; 95% confidence interval [CI] = -29.2 to -6.3); had lower levels of consciousness (AME, -16.5%; 95% CI = -23.2 to -10.0); were on low-dose vasopressors (AME, -12.9%; 95% CI = -19.2 to -4.8) or high-dose vasopressors (AME, -12.2%; 95% CI = -17.8 to -8.1); or had copious secretions (AME, -8.7%; 95% CI = -13.3 to -4.1). However, 55% of patients with delayed extubation experienced none of these top five potential barriers. There was minimal physician variability in the decision to extubate after a successful SBT (median odds ratio: 1.10; 95% CI = 1.02 to 1.78). The most frequent reason documented by respiratory therapists for not extubating a patient after passing an SBT was attending-physician preference (43%). <b>Conclusions:</b> One in 3 patients remain on mechanical ventilation after passing their first SBT, with over half lacking an identifiable barrier to extubation. Future work should be pursued to address this, including the consideration of unitwide interventions to increase timely extubation attempts among patients without contraindications.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1531-1538"},"PeriodicalIF":5.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112971","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":"The Where and the Why of Obstructive Sleep Apnea.","authors":"Thomas M Tolbert","doi":"10.1513/AnnalsATS.202508-895ED","DOIUrl":"10.1513/AnnalsATS.202508-895ED","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1469-1470"},"PeriodicalIF":5.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982276","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":"Associations between Social Determinants of Health and Post-Hospitalization Rehabilitation among Critically Ill Older Adults.","authors":"Snigdha Jain, Terrence E Murphy, Jason R Falvey, Linda Leo-Summers, Emma Zang, Thomas M Gill, Harlan M Krumholz, Lauren E Ferrante","doi":"10.1513/AnnalsATS.202504-387OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202504-387OC","url":null,"abstract":"<p><strong>Rationale: </strong>Older adults who survive hospitalization with a stay in the intensive care unit (ICU) often develop new or worsened disability; those with social vulnerabilities suffer a greater burden of disability. It is unknown whether social determinants of health (SDOH) are associated with disparities in delivery of post-hospitalization rehabilitation.</p><p><strong>Objective: </strong>To evaluate whether SDOH are associated with disparities in delivery of post-discharge rehabilitation services to older adults in skilled nursing facilities (SNFs), in home health, and in outpatient rehabilitation facilities in the 100 days after an ICU hospitalization.</p><p><strong>Methods: </strong>In this observational cohort study, we used data from the National Health and Aging Trends Study (NHATS) with links to Medicare inpatient claims (2011-19), the Minimum Data Set for SNFs, the Outcomes and Assessment Information Set for home health, and outpatient claims files. We identified older adults with an ICU hospitalization who survived to discharge. The main outcome was rehabilitation delivery in the first 100 days after discharge ascertained as minutes of physical and/or occupational therapy (PT/OT) in SNFs and receipt of any PT/OT in home health and outpatient settings. We constructed multivariable regression models to evaluate the association between SDOH (socioeconomic disadvantage, race and ethnicity, education, and limited English proficiency), and rehabilitation delivery, adjusting for demographics, hospitalization, and post-hospitalization characteristics.</p><p><strong>Results: </strong>We identified 295 ICU hospitalizations with SNF stays, 205 with home health assessments, and 784 where patients were alive for ≥7 days after discharge, thereby eligible for outpatient rehabilitation. Socioeconomic disadvantage, non-White race or Hispanic ethnicity, and lower level of education were associated with reduced delivery of in-home rehabilitation [adjusted odds ratio (95% CI):0.43 (0.23, 0.81); 0.39 (0.16, 0.93); and 0.42 (0.18, 0.99)]. Although the sample sizes in their respective cohorts were small, SDOH were not associated with rehabilitation delivery in either SNFs or outpatient settings.</p><p><strong>Conclusions: </strong>We found socioeconomic disadvantage, minoritized race and ethnicity, and lower education were associated with reduced delivery of rehabilitation at home among older ICU survivors. Given its important role in promoting functional recovery, our findings warrant interventions to mitigate inequities in rehabilitation delivery at home following hospital discharge.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202280","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":"Predicting the Presence and Severity of Obstructive Sleep Apnea with Optical Coherence Tomography.","authors":"Maide Gözde İnam, Onur İnam, Jin Ming Lin, James Park, Doru Gucer, Tongalp H Tezel","doi":"10.1513/AnnalsATS.202506-579OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202506-579OC","url":null,"abstract":"<p><strong>Rationale: </strong>The impact of obstructive sleep apnea (OSA) on microvascular system suggests that spectral domain optical coherence tomography (SD-OCT) evaluation of the choroidal vasculature could provide clinically relevant insights into disease presence and severity.</p><p><strong>Objective: </strong>To investigate the value of choroidal vascular imaging with SD-OCT in diagnosing the presence and predicting the severity of OSA.</p><p><strong>Methods: </strong>SD-OCT images of 120 patients with OSA were analyzed to extract choroidal biomarkers. Patients were categorized into four levels of OSA severity according to their apnea-hypopnea index. ImageJ/FIJI (National Institutes of Health, Bethesda, Maryland, USA) was used to measure choroidal thickness and vascular indices in Haller's and non-Haller's layers across regions on the nasal and temporal side of the fovea. Thickness ratios of choroidal layers, total choroidal area, choroidal vascularity index, and luminal-to-stromal ratios were compared between individuals without OSA and with different severity of OSA. ANOVA, ROC analysis, and logistic regression were employed to evaluate inter-group differences and the predictive value of choroidal parameters.</p><p><strong>Results: </strong>OSA's presence and increasing severity significantly impacted the non-Haller's layer thickness and Haller's/non-Haller's layer thickness ratios, particularly in the nasal region (1000-2500 µm). The nasal 2500 µm region showed the highest discriminative power for severe OSA (AUC = 0.733, p < 0.001). Logistic regression analysis identified the Haller's/non-Haller's layer thickness ratio at nasal 2500 µm as the most significant predictor of severe OSA (Odds ratio = 2.147, p = 0.002), adjusted for age, gender, and comorbidities.</p><p><strong>Conclusions: </strong>OSA is associated with choroidal microvascular remodeling, especially nasal to the fovea. This remodeling increases the ratio of Haller's/non-Haller's layer thickness ratio, which may be a potential biomarker for OSA severity. These findings highlight the utility of SD-OCT in non-invasively detecting systemic vascular alterations linked to OSA, supporting its role in early diagnosis and monitoring of disease progression.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202295","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":"Acute Effect of Continuous Positive Airway Pressure (CPAP) on Weight in Patients with Obstructive Sleep Apnea: A Randomized Study.","authors":"Giovani F Lima, Sara Herculano, Mariana D Fernandes, José Gilvam A Lima-Junior, Rosana S C Alves, Luciano F Drager, Geraldo Lorenzi-Filho, Pedro R Genta","doi":"10.1513/AnnalsATS.202505-491OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202505-491OC","url":null,"abstract":"<p><strong>Rationale: </strong>Continuous positive airway pressure (CPAP) may lead to weight gain in patients with obstructive sleep apnea (OSA), but the mechanisms are still unclear.</p><p><strong>Objectives: </strong>To investigate the effects of the first night of CPAP therapy on body weight and nocturnal urine output in treatment-naïve patients with severe OSA.</p><p><strong>Methods: </strong>The study was conducted during 2 consecutive nights. During the first night, a baseline polysomnography (PSG) was performed. Weight, urinary parameters, and body composition change during baseline PSG were compared to the second PSG, which was randomized to either CPAP titration or repeat PSG without any intervention (Control group). Body weight and bioelectric impedance were assessed in the evening before bedtime and in the morning, after voiding. Overnight urinary volume and osmolality, antidiuretic hormone, type-B natriuretic peptide (BNP) were determined in the morning after each PSG.</p><p><strong>Results: </strong>Thirty-eight patients (60% men; aged 54±9 years; body mass index: 35.0±6.2 kg/m2; apnea-hypopnea index: 71±25 events/h) completed the study (n=19 per group). CPAP led to a significant increase in body weight (0.37±0.55 Kg) compared to the Control group (-0.30±0.46 Kg), P<.001. Urinary volume remained stable between Visits 1 (873±537mL) and 2 (915±517 mL) (P>0.999) but reduced significantly in the CPAP group from 825±389 to 556±334 mL, respectively, P<0.001. Urinary osmolality remained stable between Visits 1 (575±221 mOsm/kg) and 2 (523±225 mOsm/kg) (P=0.756) in the Control group but increased in the CPAP group from 629±183 to 746±154mOsm/kg, respectively, P=0.005. While total body water reduced overnight in the Control group, CPAP significantly attenuated the overnight reduction in total body water (P<0.001). No significant changes in antidiuretic hormone and BNP were observed.</p><p><strong>Conclusion: </strong>CPAP led to weight gain and fluid accumulation after a single night. These findings provide strong evidence that fluid accumulation is involved in weight gain associated with OSA treatment with CPAP.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov; No.: NCT05253963; URL: www.</p><p><strong>Clinicaltrials: </strong>gov Key words: Body Composition; Bioelectrical Impedance Analysis; Diuresis.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201986","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}