Annals of the American Thoracic Society最新文献

{"title":"Respiratory Injuries among California Career Firefighters, 2000-2019.","authors":"Margaret Murray, Paul Blanc, Stefanos N Kales, John Balmes, Matthew Frederick, Kristin J Cummings, Robert Harrison, Sheiphali Gandhi","doi":"10.1513/AnnalsATS.202506-584OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202506-584OC","url":null,"abstract":"<p><strong>Rationale: </strong>The association between firefighting exposure and respiratory injuries remains poorly quantified, despite the inhalational hazards of firefighting.</p><p><strong>Objectives: </strong>To describe respiratory injury rates among California firefighters between 2000 to 2019 demographically, temporally, and geographically.</p><p><strong>Methods: </strong>Using data from the California Workers' Compensation Information System from 2000 to 2019, we analyzed California firefighter workers' compensation claims for respiratory injuries from 2000 to 2019. We identified firefighter respiratory claims using nature of injury codes, injury description keywords, and International Classification of Diseases Ninth or Tenth revision codes. We estimated California firefighter employment totals using the American Community Survey.</p><p><strong>Measurements: </strong>We calculated respiratory injury rates, rate ratios, and their associated confidence intervals by age and injury date and location.</p><p><strong>Main results: </strong>We identified 3,431 respiratory injury claims between 2000 to 2019 (478 respiratory claims/100,000 California career firefighters, 90% CI: 432-534) and the respiratory injury rate remained unchanged. Firefighters aged 50 to 59 years had a higher risk of respiratory injuries compared to those aged 18 to 29 years (rate ratio=1.7, 90% CI: 1.6-1.8). Firefighters during wildfire season months had significantly more respiratory injuries than during non-wildfire season months. From 2000 to 2019, firefighter's respiratory injury rate in rural and small/medium metro counties increased significantly, while firefighter's respiratory injury rate in large metro counties decreased significantly.</p><p><strong>Conclusions: </strong>Older firefighters, firefighters during wildfire season, and those in rural and small/medium metro counties may be at higher risk of respiratory injury, based on our large-scale, multi-year surveillance study among career California firefighters.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082644","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":"Evidence of T2/T3 Endotype Overlap in Mild-to-Severe Asthma with Chronic Rhinosinusitis: A Pilot Study.","authors":"Vitina Carriero, Francesca Bertolini, Elisa Arrigo, Giuseppe Guida, Stefano Levra, Mirella Profita, Isabella Gnemmi, Antonino Di Stefano, Fabio Luigi Massimo Ricciardolo","doi":"10.1513/AnnalsATS.202410-1076OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202410-1076OC","url":null,"abstract":"<p><strong>Rationale: </strong>Asthma and chronic rhinosinusitis (CRS) often co-occur and share heterogenous inflammatory processes resulting in frequent exacerbations and poor clinical control.</p><p><strong>Objectives: </strong>This observational cross-sectional study aims to characterize asthma with comorbid CRS and to understand whether CRS could influence asthma severity focusing on the bronchial immune-inflammatory and remodelling response.</p><p><strong>Methods: </strong>We assessed the number of inflammatory cells and the expression of T2/T3 and remodelling biomarkers in the bronchial mucosa of 47 mild-to-severe asthmatics' bronchial biopsies by immunohistochemistry/immunofluorescence. We compared the clinical, functional and biological data of asthmatics without (As) or with CRS (As+CRS) (As/As+CRS: N=16/31) in the presence/absence of nasal polyps (As+CRSwNP/As+CRSsNP: N=15/16) and further stratified in mild and severe asthma without CRS (MAs/SAs: N=11/5) vs mild/severe asthma with CRS (MAs+CRS/SAs+CRS: N=15/16). Measurements and main results As+CRS patients had later asthma onset and higher blood eosinophils and FENO than As (p<0.01). As+CRSwNP had a higher exacerbation rate than As (p<0.01) and higher blood eosinophilia than both As+CRSsNP and As (p<0.01). As+CRSsNP showed higher RV(%predicted) and lower FEV1/FVC than As. Immunohistochemistry and immunofluorescence showed that As+CRS, compared to As (p<0.05), had higher and concomitant expression of T2/T3 inflammatory biomarkers and remodelling evidence (number of eosinophils, CD4+, eotaxin-3+, IL-5+, IL-9+, IL-17A+, IL-22+ cells and sub-epithelial basal membrane thickness) in the bronchial lamina propria as well as higher percentage of GATA3+ cells and a greater tendency of RORγT+ cells (p>0.05). Higher expression of T2/T3 cytokines - IL-13+, eotaxin-3+, IL-9+, TSLP+, IL-17A+ and IL-17F+ cells - was observed in SAs+CRS. Two-way ANOVA showed that both comorbid CRS and asthma severity modulate IL-13 and IL-17A bronchial expression in asthma. Conclusions Our results confirm a higher proportion of T2 clinical phenotype (FENO and blood eosinophils) in asthma with comorbid CRS, but revealed a more complex bronchial immune-inflammatory response suggesting an overlapping interplay of T2/T3 processes as underlying mechanisms related to this clinical asthma phenotype.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082572","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 Clinical, Psychosocial and Economic Burden of Cystic Fibrosis Lung Disease in the Era of CFTR Modulator Therapy.","authors":"Isabelle Fajac, Raksha Jain, Marcus A Mall, Bruce K Rubin, Patrick A Flume","doi":"10.1513/AnnalsATS.202408-800FR","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202408-800FR","url":null,"abstract":"<p><p>Cystic fibrosis (CF) lung disease imposes a significant clinical, psychosocial, and economic burden on people with CF (pwCF), their caregivers, and healthcare systems. Although the introduction of CFTR modulator therapies has led to significant improvements in symptoms, lung function, exacerbations, and quality of life, substantial burden remains. A subset of pwCF taking CFTR modulator therapy experience residual infection, neutrophilic inflammation (to levels seen in non-CF bronchiectasis), exacerbations and pulmonary complications. Furthermore, 10-15% of the global CF population are either ineligible for or intolerant to current CFTR modulator therapies, with some pwCF (although in the minority) experiencing adverse events that necessitate treatment discontinuation. For these people, the burden of disease remains. The worsening of mental health experienced by some pwCF on CFTR modulator therapy adds to the psychosocial burden. Although some evidence suggests a decrease in treatment burden, in general, CFTR modulators have been added to therapeutic regimens rather than replacing symptomatic treatments. While reductions in healthcare resource use have been reported, hospitalizations and emergency department visits, and the associated costs, have not been eliminated. Given the expected improvements in life expectancy following the introduction of these therapies, the burden is likely to continue into old age. A better understanding of the residual clinical, psychosocial, and economic burden that lung disease imposes on pwCF in the era of CFTR modulator therapy highlights the remaining unmet needs and could assist healthcare systems in better planning resource allocation.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082567","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":"Non-invasive Imaging of the Neonatal Lung Using Electrical Impedance Tomography: A Narrative Review.","authors":"Vincent D Gaertner, David G Tingay, Andreas D Waldmann, Christoph M Rüegger","doi":"10.1513/AnnalsATS.202505-478FR","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202505-478FR","url":null,"abstract":"<p><p>Electrical impedance tomography (EIT) is a radiation-free, noninvasive method to measure the regional behavior of the lung which may be particularly suited to neonatal medicine. It is used more and more commonly in neonatology, particularly in the research setting. In order to harmonize efforts in terms of scientific and clinical use of this novel technology, we summarize the current knowledge on EIT use in both term and preterm infants and delineate potential future perspectives in this state-of-the-art article. We describe the current use in research and practice in neonatal medicine, including the following areas: (1) the cardiopulmonary transition immediately after birth, (2) changes in airway management including the use of different interfaces, endotracheal intubation, extubation to non-invasive respiratory support and (endotracheal) suctioning, (3) surfactant administration, (4) different body positions, (5) different modes of invasive and non-invasive respiratory support, (6) evaluation of acute pulmonary pathologies, (7) the predictive value of using EIT in neonatology, and (8) the assessment of pulmonary perfusion. In summary, EIT is a very valuable research tool in neonatal medicine where it allows us to understand physiological principles and pathogenesis of disease more deeply. It may also be useful for selected clinical situations in neonatology including major acute lung pathologies, as it allows accurate and non-invasive assessment of intrapulmonary volume changes in neonates. However, there are still some barriers to widespread implementation into clinical practice.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082651","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":"History and Future Outlook for the US Clean Air Act.","authors":"George D Thurston, R Charon Gwynn, Mark Frampton","doi":"10.1513/AnnalsATS.202501-081VP","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202501-081VP","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076874","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":"Inotrope Selection in Mixed Cardiogenic Shock with Sepsis: A Comparative Analysis between Milrinone and Dobutamine.","authors":"Boyangzi Li, Hayley B Gershengorn, Emily A Vail, Hannah Wunsch, Allan J Walkey, Anica C Law, Darae Ko, Nir Ayalon, Christopher M Kearney, Nicholas A Bosch","doi":"10.1513/AnnalsATS.202503-339OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202503-339OC","url":null,"abstract":"<p><p>Rationale Despite increasing recognition of mixed cardiogenic shock-particularly in patients with concomitant sepsis, there remains limited guidance on optimal inotropic selection, and the comparative effectiveness of different inotropes in this population is unclear. Objective To examine the association between inotrope selection and in-hospital outcomes, including all-cause mortality, among patients with cardiogenic shock and sepsis. Methods Using the PINC AI enhanced-claims Database (2016-2022), we identified patients with cardiogenic shock and sepsis using International Classification of Diseases, 10th revision codes (ICD-10) that were present on hospital admission and a pharmacy charge code for dobutamine or milrinone within 2 days of hospitalization. The primary outcome was all-cause hospital mortality. Secondary outcomes included inotrope duration, in-hospital length of stay, atrial arrhythmia, initiation of renal replacement therapy (RRT), use of mechanical circulatory support devices (MCS), and heart transplantation. We used generalized full matching on the propensity score (dobutamine vs. milrinone) followed by g-computation to estimate effects of inotrope selection on outcomes. We examined heterogeneity of treatment effect in patients with renal disease, congestive heart failure, pulmonary circulatory diseases, and on epinephrine prior to inotrope initiation. Results Out of 10,447 included patients, 74.4% received dobutamine and 25.6% received milrinone. Post-matching characteristics between the milrinone and dobutamine groups were similar (all Standard Mean Differences< 0.1). The primary outcome all-cause mortality was similar between post-matched milrinone and dobutamine groups (41.6% vs. 42.7%, risk difference -1.4 (95% confidence interval [CI}: -3.7, 1.5] %, p= 0.40). Patients initiated on milrinone (vs. dobutamine) had longer inotrope durations (5.1 days vs. 3.5 days, mean difference 1.7 [95% CI: 1.4, 1.9] days, p< 0.001), longer in-hospital length of stay (10.0 days vs. 9.1 days, mean difference 0.9 [95% CI: 0.4, 1.3] days, p<0.001), and more usage of antiarrhythmic agents (56.0% vs. 44.5%, mean difference 11.5 [95% CI: 8.9, 14.1] %, p<0.001). We did not observe any heterogeneity of treatment effect for all-cause mortality based on the pre-existing conditions of interest. Conclusions Using a large multicenter cohort, we identified no differences in all-cause mortality between dobutamine and milrinone among patients with concurrent cardiogenic shock and sepsis overall. However, secondary outcomes favored dobutamine.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076938","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":"Long-term Reductions in Inflammation in People with Cystic Fibrosis Treated with Elexacaftor/Tezacaftor/Ivacaftor.","authors":"Scott D Sagel, T Spencer Poore, Brandie D Wagner, Jing Xie, Sonya L Heltshe, Mary Cross, Preston E Bratcher, Jennifer L Taylor-Cousar, Alexandra Wilson, Kimberly McBennett, Sarah J Morgan, Pradeep K Singh, David P Nichols, Andrea Kelly, George M Solomon","doi":"10.1513/AnnalsATS.202507-817OC","DOIUrl":"10.1513/AnnalsATS.202507-817OC","url":null,"abstract":"<p><strong>Rationale: </strong>Inflammation is a hallmark of cystic fibrosis (CF) and associated with bronchiectasis and lung disease progression. The effects of elexacaftor/tezacaftor/ivacaftor (ETI), a CF transmembrane conductance regulator modulator therapy, on inflammation remain incompletely understood.</p><p><strong>Objectives: </strong>Investigate two-year changes in airway and systemic inflammation in adolescents and adults with CF clinically prescribed ETI and the relationships between inflammatory changes and clinical outcomes.</p><p><strong>Methods: </strong>PROMISE is a prospective, multicenter, observational study in people with CF ≥12 years. Assessments of sputum and blood inflammatory markers occurred before and through 24-30 months of ETI therapy in participants who enrolled in the PROMISE-Inflammation sub-study. Changes in inflammation were tested with mixed effects models. Relationships between inflammatory markers and clinical outcomes were examined using Spearman correlations.</p><p><strong>Measurements and main results: </strong>The study cohort comprised 223 participants. ETI was associated with sustained reductions in sputum neutrophil elastase (NE) activity, calprotectin, IL-1β, and IL-8, increases in sputum IL-6 through 24/30 months of therapy, and reductions in circulating hsCRP through 12/18 months of therapy. Sputum NE activity reductions correlated with ppFEV1 and respiratory symptom score improvements at 24/30 months post-ETI. Sputum IL-6 increases correlated with ppFEV1 improvements. Serum hsCRP reductions were associated with ppFEV1 and respiratory symptoms improvements at 12/18 months post-ETI, and circulating calprotectin reductions were associated with respiratory symptom improvements.</p><p><strong>Conclusions: </strong>Airway and systemic inflammation decreases through 2.5 years of ETI therapy in adolescents and adults with CF. Reductions in inflammation correlate with clinical improvements. These changes in inflammation represent a disease-modifying benefit of this transformative therapy.</p><p><strong>Clinicaltrials: </strong>gov: NCT04038047.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12505497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082635","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":"Reply to Gottlieb and Fuehner: Preoxygenation and High flow Oxygen Therapy During Bronchoscopy Under Procedural Sedation in Patients with Central Airway Obstruction.","authors":"Hao Qin, Wei Zhang, Guoqiang Jing, Jie Li","doi":"10.1513/AnnalsATS.202507-755LE","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202507-755LE","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042529","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 Borrás-Blasco <i>et al.</i>: How Adherence Shapes Persistence in IPF Treatment: A Call for Real-World Insight.","authors":"Tejaswini Kulkarni, Kevin Flaherty, Sachin Gupta, Yi-Hsuan Tu, Amy Hajari Case","doi":"10.1513/AnnalsATS.202507-758LE","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202507-758LE","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042531","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":"Comment on Long-Term Pulmonary Sequelae Following Severe COVID-19: Reflections on Study Design and Interpretation.","authors":"Wei Li, Jing Jiang","doi":"10.1513/AnnalsATS.202507-762LE","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202507-762LE","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042615","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}