Annals of the American Thoracic Society最新文献

{"title":"Airway Remodeling in Cystic Fibrosis Is Heterogeneous.","authors":"Astrid Vermaut, Vincent Geudens, Lynn Willems, Gitte Aerts, Pieterjan Kerckhof, Charlotte Hooft, Hanne Beeckmans, Janne Kaes, Xin Jin, Charlotte De Fays, Yousry Mohamady, Jan Van Slambrouck, Lucia Aversa, Janne Verhaegen, Emanuela E Cortesi, Birgit Weynand, Matthieu N Boone, John E McDonough, Dirk E Van Raemdonck, Laurens J Ceulemans, Wim A Wuyts, Robin Vos, Ghislaine Gayan-Ramirez, Francois Vermeulen, Marijke Proesmans, Bart M Vanaudenaerde, Lieven J Dupont, Mieke Boon","doi":"10.1513/AnnalsATS.202404-446OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202404-446OC","url":null,"abstract":"<p><p>RATIONALE+OBJECTIVE/ Cystic fibrosis (CF) is characterized by bronchiectasis on imaging, while functionally evolving towards obstructive impairment. Despite its assumed importance in CF, small airway remodeling and its relation to bronchiectasis, is still poorly understood. METHOD/ On high-resolution computed tomography (HRCT, 600µm, CF=21, control=6) and micro-computed tomography (µCT, 150µm, CF=3, control=1) scans of inflated explant lungs, AV% (airway/total lung volume) was calculated as marker for bronchiectasis, while airway segmentation was used for generation analysis. Clinical data was retrospectively collected. On µCT (8.5µm) images of lung cores (±2.8cm³), extracted randomly from each lobe (3/lobe), distal airway (DA) diameter, number of airway collapses and open terminal bronchioles (oTB)/mL were analyzed. Morphometric analysis was supplemented with histological analysis of DA collapse. RESULTS/ AV% on HRCT was heterogeneous amongst CF lungs (0.7-4.6%), overlapping with controls (0.4-1.2%). However, the pattern of airway loss on µCT was homogeneous amongst CF lungs and most pronounced from generation 9-16. AV% did not correlate with the number of oTB/mL or FEV1%, which correlated with eachother. Open DA in CF were narrowed compared to DA in controls. On the other hand, collapsed DA in CF showed a varying degree of proximal dilation, with DA diameter correlating with AV%. On histology, collapsed CF DA showed constrictive bronchiolitis. CONCLUSION/ Airway remodeling in end-stage CF is heterogeneous, ranging from minimal bronchiectasis, overlapping with controls, to extensive bronchiectasis with small airway dilation. However, the degree of bronchiectasis is unrelated to functional impairment or amount of small airway loss, underscoring the importance of small airway disease.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866603","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":"Lung Function Recovery from Pulmonary Exacerbations Treated with Oral Antibiotics in Primary Ciliary Dyskinesia.","authors":"Dvir Gatt, Michelle Shaw, Valerie Waters, Fiona Kritzinger, Melinda Solomon, Sharon Dell, Felix Ratjen","doi":"10.1513/AnnalsATS.202407-771OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202407-771OC","url":null,"abstract":"<p><strong>Rationale: </strong>Patients with Primary Ciliary Dyskinesia (PCD) experience acute pulmonary exacerbations (PEx). In Cystic Fibrosis (CF), PEx treated with oral antibiotics (oPEx) were found to be related to short and long-term lung function deficits, however the impact oPEx on lung function in patients with PCD has not yet been assessed.</p><p><strong>Objective: </strong>To assess the impact of oPEx on lung function recovery in PCD and determine the factors associated with poorer response.</p><p><strong>Methods: </strong>This was a retrospective study of pediatric patients with PCD followed between 2000 to 2022 at SickKids (Toronto, Canada). PEx were defined as an increase in baseline symptoms with a physician decision to treat with systemic (intravenous (IV) or oral antibiotics. Lung function recovery was defined as a forced expiratory volume in 1 second (FEV1) measurement ≥90% of a stable baseline within 12 months before the PEx. Univariate and multivariate analyses were completed to identify risk factors for nonresponse.</p><p><strong>Results: </strong>337 PEx events in 85 patients were included in this analysis, of which 297 (88%) were treated with oral antibiotics. The mean (SD) follow up time for patients was 6.7 years (3.5) and the mean age of oPEx was 12.5 years (3.2). Patients with oPEx had a significant drop from baseline in mean FEV1 values at time of PEx (85.1% to 69.5%) with absolute and relative changes of -10.4% and -12.9%, respectively. At follow up (3 months post PEx) and up to 12 months post PEx, the mean FEV1 was 79.6% and 84.1%, respectively. 73.2% of the patients had lung function recovery at follow up visit which increased to 84.2% within one year post event. We identified two risk factors for nonresponse: being a non responder on the last PEx and younger age at time of oPEx. Conclusions oPEx in PCD show a similar pattern previously seen in CF patients with a decrease in FEV1 during exacerbation and an improvement post therapy. Most oPEx events recover to baseline FEV1 within the year post-exacerbation, with younger age and being non responder in the last PEx identified as risk factors for nonresponse.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866612","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":"Trends in the Treatment of Allergic Bronchopulmonary Aspergillosis.","authors":"Brandon Pang, Christopher M Kearney, Anica C Law, Nicholas A Bosch","doi":"10.1513/AnnalsATS.202403-306RL","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202403-306RL","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866615","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":"County Level Social Determinates of Health and Correlation with COPD Prevalence in the US.","authors":"Benjamin R E Harris, Gustavo A Cortes Puentes, Erin S DeMartino, Alexander R Zheutlin, Eric L Stulberg","doi":"10.1513/AnnalsATS.202406-667RL","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202406-667RL","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866605","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":"Pretreatment Chest X-ray Scores and HIV Serostatus Are Associated with Lung function at TB Cure.","authors":"Edwin Nuwagira, Joseph Baruch Baluku, Francis Bajunirwe, Mark J Siedner, Subba R Digumarthy, Jiyoon Kang, Stellah G Mpagama, Brian W Allwood, Peggy S Lai","doi":"10.1513/AnnalsATS.202406-607RL","DOIUrl":"10.1513/AnnalsATS.202406-607RL","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840582","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":"Deep Learning for Predicting Acute Exacerbation and Mortality of Interstitial Lung Disease.","authors":"Ryo Teramachi, Taiki Furukawa, Yasuhiro Kondoh, Masayuki Karasuyama, Hironao Hozumi, Kensuke Kataoka, Shintaro Oyama, Takafumi Suda, Yoshimune Shiratori, Makoto Ishii","doi":"10.1513/AnnalsATS.202403-284OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202403-284OC","url":null,"abstract":"<p><strong>Rationale: </strong>Some patients with interstitial lung disease (ILD) have a high mortality rate or experience acute exacerbation of ILD (AE-ILD) that results in increased mortality. Early identification of these high-risk patients and accurate prediction of the onset of these important events is important to determine treatment strategies. Although various factors that affect disease behavior among patients with ILD hinder the accurate prediction of these events, the use of longitudinal information may enable better prediction.</p><p><strong>Objectives: </strong>To develop a deep-learning (DL) model to predict composite outcomes defined as the first occurrence of AE-ILD and mortality using longitudinal data.</p><p><strong>Methods: </strong>Longitudinal clinical and environmental data were retrospectively collected from consecutive patients with ILD at two specialty centers between January 2008 and December 2015. A DL model was developed to predict composite outcomes using longitudinal data from 80% of patients from the first center, which was then validated using data from the remaining 20% patients and second center. The developed model was compared with the univariate Cox proportional hazard (CPH) model using the ILD gender-age-physiology (ILD-GAP) score and multivariate CPH model at the time of ILD diagnosis.</p><p><strong>Measurements and main results: </strong>AE-ILD was reported in 218 patients among the 1,175 patients enrolled, whereas 380 died without developing AE-ILD. The truncated concordance index (C-index) values of univariate/multivariate CPH models for composite outcomes within 12, 24, and 36 months after prediction were 0.789/0.843, 0.788/0.853, and 0.787/0.853 in internal validation, and 0.650/0.718, 0.652/0.756, and 0.640/0.756 in external validation, respectively. At 12 months after ILD diagnosis, the DL model outperformed the univariate CPH model and multivariate CPH model for composite outcomes within 12 months, with C-index values of 0.842, 0.840, and 0.839 in internal validation, and 0.803, 0.744, and 0.746 in external validation, respectively. Neutrophils, C-reactive protein, ILD-GAP score, and exposure to suspended particulate matter were strongly associated with the composite outcomes.</p><p><strong>Conclusions: </strong>The DL model can accurately predict the incidence of AE-ILD or mortality using longitudinal data.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840568","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 of Pulmonary Hypertension in the Echocardiography Referral Population.","authors":"Jonah D Garry, Suman Kundu, Jeffrey Annis, Chuck Alcorn, Svetlana Eden, Emily Smith, Robert Greevy, Bradley A Maron, Matthew Freiberg, Evan L Brittain","doi":"10.1513/AnnalsATS.202407-716OC","DOIUrl":"10.1513/AnnalsATS.202407-716OC","url":null,"abstract":"<p><strong>Rationale: </strong>Incidence rates for pulmonary hypertension using diagnostic data in patients with cardiopulmonary disease are not known.</p><p><strong>Objectives: </strong>To determine incidence rates of, risk factors for, and mortality hazard associated with pulmonary hypertension among patients referred for transthoracic echocardiography.</p><p><strong>Methods: </strong>Retrospective cohort study using data from the Veterans Health Administration (1999-2020) and Vanderbilt University Medical Center (1994-2020). Pulmonary hypertension was defined as pulmonary artery systolic pressure >35mmHg with prevalent cases excluded. Heart failure and chronic obstructive pulmonary disease were the primary exposures of interest. The primary outcome was incident pulmonary hypertension. Secondarily, we examined mortality rate following incident diagnosis.</p><p><strong>Measurements and main results: </strong>We identified 245,067 VA patients (94% male, 20% Black) and 117,526 Vanderbilt patients (46% male, 11% Black) without pulmonary hypertension, of whom 38,882 VA patients and 8,061 Vanderbilt patients developed pulmonary hypertension. Only 18-19% of patients with echo-based pulmonary hypertension also had a diagnostic code. Hazard of pulmonary hypertension was 4-fold higher in patients with heart failure and chronic obstructive pulmonary disease compared to patients without either. Mortality rates increased from pulmonary artery systolic pressure of 35mmHg to 45mmHg then plateaued. Independent risk factors for incident pulmonary hypertension included older age, male sex, black race, and cardiometabolic comorbidities.</p><p><strong>Conclusions: </strong>Pulmonary hypertension incidence rates estimated by diagnostic data are higher than code-based rates. Heart failure and chronic obstructive pulmonary disease strongly associate with incident pulmonary hypertension. Pulmonary artery systolic pressure >45mmHg at diagnosis is associated with high mortality. New pulmonary hypertension on echocardiography is an important prognostic sign.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840573","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":"Multimorbidity and Its Impact in Older United States Veterans Newly Treated for Advanced Non-Small Cell Lung Cancer.","authors":"Joseph R Larsen, Chunlei Zheng, Jennifer La, Julie Tsu-Yu Wu, Michael Kelley, J Michael Gaziano, Mary Brophy, Nhan V Do, Dae H Kim, Jane A Driver, Clark Dumontier, Nathanael R Fillmore","doi":"10.1513/AnnalsATS.202406-587OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202406-587OC","url":null,"abstract":"<p><strong>Rationale: </strong>Older adults make up the majority of patients with advanced non-small cell lung cancer (NSCLC) and often carry multiple other comorbidities (multimorbidity) when initiating treatment. The nature and impact of multimorbidity remain largely unknown, given the limitations of standard count-based comorbidity indices in aging patients and their exclusion from clinical trials.</p><p><strong>Objective: </strong>Our objective is to identify and define multimorbidity patterns in older U.S. veterans newly treated for advanced NSCLC in the national VA healthcare system between 2002 to 2020, and whether they are associated with mortality and healthcare utilization.</p><p><strong>Methods: </strong>We measured 63 chronic conditions in 10,160 veterans age ≥ 65 years newly treated for NSCLC in the national Veterans Affairs healthcare system from 2002 to 2020. Latent class analysis (LCA) was used to identify patterns of multimorbidity among these conditions, with final patterns determined based on model fit and clinical meaningfulness. Kaplan-Meier and Cox proportional hazards regression analyses were used to evaluate the association of multimorbidity patterns with overall survival (primary outcome), and with emergency department visits and unplanned hospitalizations (secondary outcomes).</p><p><strong>Results: </strong>Five multimorbidity patterns arose from the LCA, with overall survival varying across patterns (log-rank 2-sided P<0.001). Veterans with metabolic diseases (24.7% of all patients; HR [95% CI], 1.10 [1.04 -1.16]), psychiatric and substance use disorders (16.0%; HR [95% CI], 1.17 [1.10-1.24]), cardiovascular disease (14.4%; HR [95% CI], 1.22 [1.15-1.30]), and multisystem impairment (10.7%; HR [95% CI], 1.36 [1.26 -1.46]) had a higher hazard of death compared to veterans with common conditions of aging beyond their NSCLC (34.2%, reference), controlling for age, gender, race, days between diagnosis and treatment, date of diagnosis, and NSCLC stage and histology. Associations held after adjusting for the count-based Charlson Comorbidity Index. Multimorbidity patterns were also independently associated with emergency department visits and unplanned hospitalizations.</p><p><strong>Conclusion: </strong>Our findings reveal that the numerous chronic conditions present in older veterans with late-stage NSCLC cluster together into distinct multimorbidity patterns; the nature of conditions in these patterns carry value beyond their number.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840579","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":"Stakeholder Perspectives on Categorizing Care Settings for Measures of Hospital- and Institution-free Days.","authors":"Catherine L Auriemma, Melanie Bahti, Corinne Merlino, Bethany Sewell, Katherine R Courtright","doi":"10.1513/AnnalsATS.202407-768RL","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202407-768RL","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815240","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 Ventilation in Acute Asthma Exacerbations: A Systematic Review.","authors":"Collin Homer-Bouthiette, Kevin C Wilson","doi":"10.1513/AnnalsATS.202407-799OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202407-799OC","url":null,"abstract":"<p><strong>Rationale: </strong>Multiple clinical practice guidelines lack recommendations pertaining to non-invasive ventilation (NIV) in acute asthma exacerbations due to a paucity of evidence. However, the evidence syntheses for these guidelines were performed years ago and more recent randomized controlled trials (RCTs) and observational studies have been published.</p><p><strong>Objective: </strong>Update the evidence syntheses from previous guidelines to further clarify the effects of NIV in acute asthma exacerbations.</p><p><strong>Methods: </strong>A systematic search of Medline, Embase and the Cochrane Library was conducted, studies comparing NIV plus standard medical therapy to standard medical therapy alone in adults with acute asthma exacerbation were selected using a priori selection criteria, and relevant data were extracted. Weighted aggregation (meta-analysis) was performed to summarize effects, which were appraised using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach.</p><p><strong>Results: </strong>Eight RCTs and five observational studies were selected. NIV was associated with a reduced intubation rate (RCTs RR 0.46, CI 0.16-1.29 and observational studies RR 0.55, CI 0.45-0.68), admission rate (RR 0.57, CI 0.34-0.98), and time to improvement in accessory muscle use (Mean difference -1.13 hours, CI -1.28 - -0.99). Additional outcomes favored NIV plus standard medical therapy but didn't reach statistical significance including dyspnea measures and spirometry measures. There were too few deaths to reliably assess mortality. The quality of evidence ranged from low to very low for all outcomes.</p><p><strong>Conclusion: </strong>All statistically significant outcomes favored NIV plus standard medical therapy over standard medical therapy alone in adults with acute asthma exacerbation. Our aggregate data suggests that intubation rate may be reduced with NIV plus SMT, though the overall quality of the evidence is low. If this is a true effect, it may be clinically important because intubation has been shown to correlate with mortality in multiple observational trials. Given these findings, patients with acute asthma exacerbations may benefit from a trial of NIV in addition to standard medical therapy.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789720","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}