Annals of the American Thoracic Society最新文献

{"title":"Look before you individualize: Confirming treatment separation in precision medicine.","authors":"Victor B Talisa, Jooseob Lee, Faraaz A Shah","doi":"10.1093/annalsats/aaoag309","DOIUrl":"https://doi.org/10.1093/annalsats/aaoag309","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149066787","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":"Reading Tea Leaves from an Empty Cup: What Medicare Claims Data Can and Cannot Tell Us About Oxygen Access.","authors":"Angela O Suen, Matthew Griffith","doi":"10.1093/annalsats/aaoag303","DOIUrl":"https://doi.org/10.1093/annalsats/aaoag303","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149027015","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":"Molgramostim improves exercise distance and duration in autoimmune pulmonary alveolar proteinosis: exploratory IMPALA-2 trial data.","authors":"Cormac McCarthy, Francesco Bonella, Yoshikazu Inoue, Bruce C Trapnell, Tisha Wang, Ali Ataya, Ross Arena, Brian Robinson, Rosanna Fleming, Raymond Pratt, Yasmine Wasfi","doi":"10.1093/annalsats/aaoag301","DOIUrl":"https://doi.org/10.1093/annalsats/aaoag301","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149018996","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":"Vaping: Respiratory Impacts and Public Health Challenges in the Americas.","authors":"Alexandra Noël, Hasmeena Kathuria, Erika Penz, Adrián Rendón, Maria Enedina Scuarcialupi, Adam Edward Lang, Theo J Moraes, Florisel Almonte, Patricia Fernandes Barreto Machado Costa, Juan C Celedón, Laura E Crotty Alexander","doi":"10.1093/annalsats/aaoag211","DOIUrl":"https://doi.org/10.1093/annalsats/aaoag211","url":null,"abstract":"<p><p>The use of electronic nicotine delivery systems (ENDS), also known as electronic-cigarette (e-cig) or vaping, is a public health threat throughout the Americas. Teenagers and young adults have the highest rates of use of these tobacco products. However, vaping has a gateway effect, which has led to dual use of both combustible tobacco and nicotine vaping products, which is concerning given that greater adverse health effects of e-cigarettes are seen in the context of co-use with combustible tobacco. Multiple policy approaches have been used across North and South America, with varying success. Powerful anti-tobacco messaging in North America has contributed to decreased vaping in the adolescent population, while banning of all e-cigarettes in Brazil and Mexico has been associated with lower vaping rates compared to countries without bans. Great strides have been made to identify the health risks of vaping, and more work is needed, particularly longitudinal data, to fully understand both the risks of sole use of e-cigarettes and the risks of vaping in combination with other inhalants. Moreover, in some Latin American countries, basic surveillance data to define incidence and prevalence are lacking. This article describes a concerted view and shared experience from the Respiratory Societies of the Americas on how vaping is managed, regulated, and advocated against in this area of the world, with the goal to help shape the future of vaping-related product regulations, and to address public health challenges in the Americas.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149018948","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":"Does childhood respiratory disease predict lung function trajectories?","authors":"Rachel M Scott, Paul Madley-Dowd, George W Nava, Jack Grenville, Caitlin Morgan, James W Dodd","doi":"10.1093/annalsats/aaoag296","DOIUrl":"https://doi.org/10.1093/annalsats/aaoag296","url":null,"abstract":"<p><strong>Rationale: </strong>Lung function trajectories formed in early life influence long-term health. However, opportunities to intervene and improve individuals' trajectories are limited by the lack of detailed clinical phenotyping.</p><p><strong>Objective: </strong>To assess if childhood respiratory disease predicts lung function trajectory.</p><p><strong>Methods: </strong>The study included the first generation of children from the Avon Longitudinal Study of Parents and Children. Childhood respiratory diseases were identified using linked electronic health records. Spirometry was measured at ages 8, 15 and 24 years, from which four lung function trajectories were previously defined. Logistic and ordinal logistic models were used to assess the association between respiratory disease and lung function trajectories. To clinically phenotype the trajectory groups further, objective measures of airways disease activity, respiratory prescriptions, and social and environmental risk factors were compared across trajectory groups.</p><p><strong>Results: </strong>10,332 children were included in the study. Among the childhood respiratory diseases examined, only asthma was associated with lower lung function trajectory (OR 1.40, 95% CI 1.18-1.66). Notably, neither respiratory infection nor premature birth showed an association with lung function trajectory. Asthma was most frequently observed in individuals within subnormal trajectories, particularly in the Persistently Low group, where it was present in 44% (63/142) of cases. A substantial proportion of individuals with asthma from subnormal trajectories(33%, 177/532) had not been prescribed an inhaled corticosteroid, indicating potential undertreatment. Objective measures of airways disease were consistently more common in the subnormal trajectory groups. Interestingly, 45% (64/142) of those in the Persistently Low trajectory had no respiratory diagnosis.</p><p><strong>Conclusions: </strong>Asthma is a predictor of lung function trajectory and early life optimisation of asthma treatment represents a possible means of modifying trajectory. Many individuals in the lowest trajectories are unknown to healthcare services and further work needs to be done to better characterise this group.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149018961","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":"Not All Emphysema Behaves the Same: Emptying Emphysema as a Novel Imaging Phenotype.","authors":"Igor Barjaktarevic, Jonathan Goldin","doi":"10.1093/annalsats/aaoag298","DOIUrl":"https://doi.org/10.1093/annalsats/aaoag298","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149019016","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":"Performance Inconsistency of Pulse Oximeters Over Five Years of Clinical Use: A Single-Center Study of Masimo Devices.","authors":"Ashraf Fawzy, Michelle M Qin, Xinyi Sun, Li Yan, Chad H Hochberg, Peter H Dziedzic, Jose I Suarez, Yanxun Xu, John W Jackson, Theodore J Iwashyna","doi":"10.1093/annalsats/aaoag300","DOIUrl":"https://doi.org/10.1093/annalsats/aaoag300","url":null,"abstract":"<p><strong>Rationale: </strong>Clinical recognition and treatment of hypoxemia rely on pulse oximetry. Despite general awareness of pulse oximeter shortcomings, clinicians may assume consistent performance across time, models, and batches, an assumption essential for applying clinical trial evidence and guidelines at the bedside.</p><p><strong>Objectives: </strong>Assess whether the difference between the estimated arterial oxygen saturation from a medical-grade Masimo pulse oximeter versus gold-standard concurrent arterial blood gas changed over 5 years of clinical use in intensive care unit (ICU) patients.</p><p><strong>Methods: </strong>Patients with ≥1 concurrent arterial oxygen saturation (SaO2) and pulse oximetry (SpO2) in an ICU with high-frequency vital sign data (SpO2 recorded at 2-second intervals) from 2020-2024 were included. Occult hypoxemia (SaO2<88% with SpO2≥92%), and false hypoxemia (SpO2<88% with SaO2≥92%) were examined by calendar year, as were mean oximeter error (SpO2-SaO2), Accuracy Root Mean Square (Arms, the U.S. Food and Drug Administration (FDA)'s preferred measure), and errors >4% and <-4%. Results were stratified by race/ethnicity as recorded in the electronic medical record. An adjusted linear mixed effects model evaluated calendar-year changes.</p><p><strong>Measurements and main results: </strong>223,145 ABGs in 15,129 patients were analyzed. Occult hypoxemia and overestimation errors >4% decreased while false hypoxemia and underestimation errors <-4% increased several-fold between 2020-2024. Mean oximeter error shifted from overestimation to underestimation by mid-2022. Arms fluctuated and was consistently above 3-3.5%, the FDA's threshold for controlled laboratory testing among healthy volunteers, peaking at end of study. Fluctuation was greatest for SaO2<92% and among non-White patients. By 2024, oximeters underestimated oxygen saturation on average in adjusted models for both Black and White patients with SaO2≥92% and showed relative underestimation among Black versus White patients across SaO2 categories.</p><p><strong>Conclusions: </strong>The accuracy of the tested medical-grade pulse oximeter changed year-to-year at a large hospital compared to concurrent arterial blood gas saturation, potentially complicating safe clinical decision-making and application of evidence-based medicine. Errors of false hypoxemia became more common, threatening different clinical consequences and necessitating different adaptations than errors leading to occult hypoxemia.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149018963","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 in the Intensive Care Unit: Changing Patterns, Persistent Challenges.","authors":"Sarah E Gray, Sharmilee M Nyenhuis, Giselle S Mosnaim","doi":"10.1093/annalsats/aaoag292","DOIUrl":"https://doi.org/10.1093/annalsats/aaoag292","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013382","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 Kaminska et al.: non-invasive ventilation in COPD patients with chronic ventilatory failure-pathophysiologic heterogeneity.","authors":"Jean-Louis Pepin, Florent Lavergne, Maxime Patout, Anne Josseran, Atul Malhotra, Peter A Cistulli, Alain Palot, Arnaud Prigent","doi":"10.1093/annalsats/aaoag289","DOIUrl":"10.1093/annalsats/aaoag289","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148972637","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":"Heterogeneity of Treatment Effect by Molecular Endotype in Acute Respiratory Distress Syndrome: A Systematic Review.","authors":"Logan R Van Nynatten, Christopher McChesney, Mujtaba Basharat, Douglas D Fraser, Karen J Bosma, Aleksandra Leligdowicz, Ian Ball, Marat Slessarev, John Basmaji","doi":"10.1093/annalsats/aaoag287","DOIUrl":"https://doi.org/10.1093/annalsats/aaoag287","url":null,"abstract":"<p><strong>Rationale: </strong>Despite numerous randomized controlled trials (RCTs) in acute respiratory distress syndrome (ARDS), few have identified effective therapies. One reason may be heterogeneity of treatment effect (HTE), in which distinct subgroups respond differently to the same intervention, potentially reflective of underlying biological endotypes.</p><p><strong>Objectives: </strong>We conducted a systematic review to evaluate effect modification by molecular endotype across randomized ARDS trials and assess credibility of reported subgroup effects. In doing so, we aim to expose current knowledge gaps in how subgroups are defined and inform future clinical practice guideline recommendations.</p><p><strong>Methods: </strong>Following PRISMA guidelines, we searched OVID Medline, Embase, and the Cochrane Central Register of Controlled Trials for secondary and post-hoc analyses of RCTs in adult critically-ill patients with ARDS that evaluated treatment effects stratified by molecular endotype. We evaluated subgroup credibility using the Instrument to assess the Credibility of Effect Modification Analyses (ICEMAN).</p><p><strong>Results: </strong>Eleven secondary analyses from ten RCTs (5,514 participants) were included. Most studies identified two reproducible endotypes, hyperinflammatory and hypoinflammatory, using small panels of circulating protein biomarkers. Of 11 analyses, four demonstrated statistically significant effect modification (higher PEEP, liberal fluid strategy, vv-ECCO₂R, simvastatin). The hyperinflammatory endotype drove every observed interaction, though the direction varied by intervention. The most credible subgroup effect was observed with liberal fluid strategy in hyperinflammatory ARDS (high credibility), followed by simvastatin and vv-ECCO₂R (moderate credibility).</p><p><strong>Conclusions: </strong>Endotyping in ARDS reliably identifies biologically distinct patient groups, but evidence that endotypes consistently modify treatment response is sparse and of generally low credibility. Progress toward endotype-guided therapy will require multi-omic molecular characterization, prospective trials with pre-specified interaction hypotheses, and real-time endotype assignment.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957407","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}