Annals of the American Thoracic Society最新文献

{"title":"Albuterol Reuse to Reduce the Carbon Footprint of Pulmonary Function Testing.","authors":"Alexandra M Peirce, Korin K Calkins, Tonia Allen, Daphne Lewis-Hawkins, Hallie C Prescott, Alexander S Rabin","doi":"10.1513/AnnalsATS.202410-1050RL","DOIUrl":"10.1513/AnnalsATS.202410-1050RL","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"942-944"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560215","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":"10.1513/AnnalsATS.202408-901OC","url":null,"abstract":"<p><p><b>Rationale:</b> Guidelines recommend early referral to pulmonary hypertension experts for patients with confirmed or suspected pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH), among others. Yet patients often have advanced disease at the time of referral. The drivers of these referral delays are not well known. <b>Objectives:</b> Building on our prior qualitative findings on barriers to timely pulmonary hypertension care along the care continuum, we sought to identify patient-level factors associated with referral to pulmonary hypertension experts. <b>Methods:</b> We leveraged the Massachusetts All-Payer Claims Database to identify all patients with incident pulmonary hypertension from 2015 to 2017 using a validated algorithm (sensitivity 28%, specificity 100%) and further identified subgroups with risk factors for PAH and CTEPH. Our outcome was the presence or absence of referral to a pulmonary hypertension expert during the study period. On the basis of our prior qualitative work, our three primary exposures were <i>1</i>) Medicaid enrollment, <i>2</i>) mental health diagnoses, and <i>3</i>) distance to the nearest pulmonary hypertension 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 among those with risk factors for PAH and CTEPH. <b>Results:</b> Among our entire cohort (<i>n</i> = 12,505), 704 (5.6%) were seen by pulmonary hypertension experts. Among the subset with risk factors for PAH (<i>n</i> = 2,393) and CTEPH (<i>n</i> = 3,167), 242 (10.1%) and 185 (5.8%) were seen by pulmonary hypertension experts, 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 pulmonary hypertension center (aOR, 0.78 [95% CI, 0.74-0.82] for each 10-mile increase in distance to a pulmonary hypertension center). Findings were similar among those with risk factors for PAH and CTEPH. <b>Conclusions:</b> Few patients with pulmonary hypertension are referred to pulmonary hypertension experts, including those with risk factors for PAH and CTEPH. Factors associated with expert referral identified in this study highlight barriers to timely pulmonary hypertension care and offer targeted areas of future study to improve the timeliness of pulmonary hypertension care.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"838-845"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12143429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392713","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":"Characterizing Tobacco Use Status among a National Cohort of Patients with Chronic Obstructive Pulmonary Disease.","authors":"Alyssa Anton, Anne Melzer, Chris H Wendt, Ken M Kunisaki, R Adams Dudley, Arianne K Baldomero","doi":"10.1513/AnnalsATS.202406-659RL","DOIUrl":"10.1513/AnnalsATS.202406-659RL","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"944-948"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12143428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627237","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":"Do Differences in Comorbidity Explain Sex-based Differences in Lung Cancer Screening Outcomes?","authors":"Matthew Triplette","doi":"10.1513/AnnalsATS.202504-391ED","DOIUrl":"10.1513/AnnalsATS.202504-391ED","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"824-825"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12143432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063502","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":"Priorities for Healthcare Systems Emergency Preparedness in Inpatient Settings Informed by COVID-19: An Official American Thoracic Society Workshop Report.","authors":"Lynn M Baniak, Jill Guttormson, Deena K Costa, M Melanie Lyons, Jakob I McSparron, Michele Klein-Fedyshin, Daniel Brodie, Meghan Lane-Fall, Fang Han, Thomas Penzel, Jennifer B Seaman, Jonna L Morris","doi":"10.1513/AnnalsATS.202502-221ST","DOIUrl":"10.1513/AnnalsATS.202502-221ST","url":null,"abstract":"<p><p>This workshop identified a set of core system-level care delivery priorities that emerged during the coronavirus disease (COVID-19) pandemic to assist global healthcare systems to respond to future similar emergencies using an informed and systematic approach. Led by a working group (<i>n</i> = 14) of nurses and physicians with diverse clinical and administrative backgrounds, we conducted a literature review of staffing, supplies, and systems in hospital inpatient settings to inform potential candidate priorities of COVID-19 care delivery challenges. We then used a modified Delphi consensus approach to elicit expert opinion from clinicians, healthcare and public health administrators, and health services researchers. Three rounds of online surveys were completed. To retain survey items, we <i>a priori</i> determined a threshold of 75% or greater endorsement for items rated \"highly important to essential.\" A total of 47 international experts responded. Forty of 71 care delivery priorities were retained. These 40 priorities comprised 25 systems (8 related to infrastructure [e.g., systemic enhanced support from federal resources during a pandemic]; 8 to care delivery [e.g., policies in place and operational for rationing of care]; and 9 to training, infection control, and communication [e.g., training for healthcare workers on protocols and/or processes for rapid testing]), 11 related to supplies (e.g., safe handling of biomedical waste), and 4 related to staffing (e.g., programs and/or systems to support staff retention). By organizing these priorities on the basis of implementation complexity and applying relevant frameworks, the project offers strategies to inform investment and guide global healthcare systems in pandemic preparedness planning for the future.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":"22 6","pages":"809-819"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12143434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188634","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":"Exploring the Dose-Response Relationship between Mandibular Protrusion and Respiratory Effort Burden in Oral Appliance Therapy for Obstructive Sleep Apnea.","authors":"Jean-Louis Pépin, Jean-Benoît Martinot, Nhat-Nam Le-Dong, Sophie Leroy, Didier Clause, Atul Malhotra, Gilles Lavigne, Peter A Cistulli","doi":"10.1513/AnnalsATS.202408-889OC","DOIUrl":"10.1513/AnnalsATS.202408-889OC","url":null,"abstract":"<p><p><b>Rationale:</b> Increased respiratory effort (RE) is a critical feature of obstructive sleep apnea (OSA). Although prior studies have established the efficacy of mandibular advancement device (MAD) therapy in reducing the apnea-hypopnea index (AHI), the impact of MAD therapy on RE burden remains unexplored. <b>Objectives:</b> In this study, we used a validated mandibular jaw movement (MJM) monitoring technology to determine the dose-response relationship between MAD protrusion levels and RE burden measured as the percentage of total sleep time (TST) spent in elevated respiratory effort (REMOV) during MAD titration. <b>Methods:</b> Ninety-three patients with OSA eligible for MAD treatment were included in this prospective cohort study. A subjective titration process involved iterative adjustments based on the persistence or worsening of OSA symptoms. Optimal AHI and REMOV responses were defined as an AHI reduction of >50% and a residual REMOV <14% TST, respectively. MJM-based home sleep tests were conducted at initial, intermediate, and final protrusion levels. The treatment effect on REMOV was estimated by regression analysis. <b>Results:</b> AHI and REMOV reductions increased progressively with higher MAD protrusion levels, with AHI decreasing by 10.3, 12.7, and 13.0 events/h and REMOV by 14.5%, 16.8%, and 18.6% TST across the three titration steps. However, a consistent discrepancy was observed between REMOV and AHI responses: at the end of titration, 68.8% of patients achieved optimal responses for both indices, whereas 15.1% had optimal REMOV response without AHI normalization, and 5.4% showed the reverse. Regression analysis showed a significant dose-response relationship for REMOV, with a 10% TST reduction within the 0-6.5 mm protrusion range and diminishing benefits beyond 6.5 mm. Of note, each millimeter advancement would yield a 2.6% TST (95% confidence interval, -3.0% to -2.1%) improvement in REMOV. <b>Conclusions:</b> Our findings demonstrate a dose-response relationship between the MAD protrusion level and the improvement in RE burden. Optimal responses in both AHI and REMOV signify greater efficacy of MAD therapy in reducing obstructive respiratory events and RE burden. This underscores the benefit of using at-home MJM analysis to monitor these two critical metrics in the management of MAD therapy to achieve better clinical outcomes and enhance MAD titration efficacy.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"915-924"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12143436/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451258","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 Epidemiology and Impact of Hypoxemia in Sub-Saharan Africa: Prevalence, Practices, and Outcomes.","authors":"Innocent Sulani, Lauren A Onofrey, Letizia Trevisi, Abi Beane, B Jason Brotherton, Jeanine Condo, Dingase Dula, E Wes Ely, Swati Goel, Stephen B Gordon, Rashan Haniffa, Bethany Hedt-Gauthier, Alexandra Medline, Carolyne Njoki, Peter Oduor, George Otieno, Jamie Rylance, Theogene Twagirumugabe, Nathalie Umutoni, Doris Uwamahoro, Sky Vanderburg, Wangari Waweru-Siika, Elisabeth Riviello","doi":"10.1513/AnnalsATS.202410-1092OC","DOIUrl":"10.1513/AnnalsATS.202410-1092OC","url":null,"abstract":"<p><p><b>Rationale:</b> The epidemiology of hypoxemia in sub-Saharan Africa is largely unknown. <b>Objectives:</b> To determine the prevalence, clinical care, and outcomes for hospitalized hypoxemic adults in sub-Saharan Africa. <b>Methods:</b> We prospectively screened all adults admitted to five hospitals in Kenya, Malawi, and Rwanda over four months; identified those with hypoxemia (defined as oxygen saturation as measured by pulse oximetry [Sp_O₂] < 90% or receipt of oxygen therapy); and followed hypoxemic patients to discharge. <b>Results:</b> Of the 24,724 adult patients admitted, 1,739 (7%) were hypoxemic on admission. The median imputed ratio of arterial oxygen pressure to fraction of inspired oxygen (Pa_O₂ :FI_O₂) was 168. Of all patients screened, 4,546 (18%) had complete oxygenation domains (Sp_O₂, device, and quantity) documented in their charts on admission. Among hypoxemic patients, 44% of in-hospital days (6,890 of 15,553) had chart documentation of all three oxygenation domains. Of 1,508 unique hypoxemic patients, 770 (51%) had at least one day with subtherapeutic oxygen (Sp_O₂ < 90%). Of patient-days with patients on oxygen therapy, 84% indicated supratherapeutic oxygen therapy (Sp_O₂ > 94%). Of all hypoxemic adults, 35% died in the hospital. Sixteen percent of patients were mechanically ventilated during their stays, and in-hospital mortality in this subgroup was 49%. <b>Conclusions:</b> Hypoxemia is common and associated with high mortality at five referral hospitals in three countries in sub-Saharan Africa. Monitoring and titration practices for oxygen therapy are inconsistent. Subtherapeutic and supratherapeutic oxygen therapy are common. Mortality is high among the few patients who receive mechanical ventilation. These findings suggest the urgent need to study interventions to improve survival for hypoxemic patients in sub-Saharan Africa. Prioritized investigations include the development and implementation of oxygen monitoring and titration protocols, as well as studies of advanced oxygen therapies other than mechanical ventilation.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"905-914"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12143433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517650","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 Risk of Adverse Cardiac Events after Pneumonia in Patients with Coronary Artery Disease.","authors":"Benjamin Bartlett, Frank M Sanfilippo, Silvia Lee, Herbert Ludewick, Grant Waterer, Adil Rajwani, Chrianna Bharat, Abdul Rahman Ihdayhid, Vicente Corrales-Medina, Girish Dwivedi","doi":"10.1513/AnnalsATS.202407-714OC","DOIUrl":"10.1513/AnnalsATS.202407-714OC","url":null,"abstract":"<p><p><b>Rationale:</b> Pneumonia triggers an inflammatory response that can persist even after the infection is resolved. This may further increase the risk of major adverse cardiac events (MACE) in individuals with known coronary artery disease (CAD), though this remains unclear. <b>Objectives:</b> We aimed to assess the impact of pneumonia on MACE in individuals with existing CAD. <b>Methods:</b> We identified patients who had coronary artery revascularization procedures in seven major hospitals in Western Australia between 2000 and 2005. Multivariable Cox regression models assessed the association between time-dependent pneumonia and MACE (composite of all-cause death + myocardial infarction + unstable angina + ischemic stroke + heart failure) and component outcomes separately, over 30 days, 1 year, and full follow-up. <b>Results:</b> There were 14,425 patients in the study cohort (mean age, 64.4 yr; 23.6% female). Over a maximum of 13 years of follow-up, 988 patients experienced one or more pneumonia hospitalization. The risk of MACE increased over time, with adjusted hazard ratios (aHRs) of 4.91 (95% confidence interval [CI], 1.21-20.00) and 4.91 (95% CI, 2.62-9.19) over 30-day and 1-year intervals, respectively, and an aHR of 11.41 (95% CI, 9.22-14.11) over the entire follow-up. Myocardial infarction risk was highest during the first 30 days (aHR, 11.34) and reduced over the 1-year interval and the remainder of follow-up (aHR, 2.27 and 2.63, respectively). Risk of heart failure and cardiovascular death were also high over the entire follow-up period (aHR, 10.39 and 12.25, respectively). <b>Conclusions:</b> Pneumonia hospitalization is associated with a significantly increased risk of MACE in patients with CAD. Underlying mechanisms should be better understood to develop targeted interventions to reduce MACE in this already high-risk population.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"855-862"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12143430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460906","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":"Confronting Hypoxemic Respiratory Failure in Africa: If Not Now, When?","authors":"Matthew J Cummings, Barnabas Bakamutumaho","doi":"10.1513/AnnalsATS.202504-377ED","DOIUrl":"10.1513/AnnalsATS.202504-377ED","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"828-829"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12143426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994103","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":"Transient Tachypnea of the Newborn and the Association with Preschool Asthma.","authors":"Mordechai Pollak, Moria Shapira, Dvir Gatt, Inbal Golan-Tripto, Aviv Goldbart, Guy Hazan","doi":"10.1513/AnnalsATS.202408-873OC","DOIUrl":"10.1513/AnnalsATS.202408-873OC","url":null,"abstract":"<p><p><b>Rationale:</b> Transient tachypnea of the newborn (TTN) is characterized by respiratory distress in neonates, resulting from delayed clearance of fetal lung fluid. Although traditionally considered a self-limited condition, recent studies have indicated a potential association between TTN and an increased risk for respiratory infections during infancy. <b>Objectives:</b> This study investigates the possible link between TTN and healthcare utilization for asthma during childhood. <b>Methods:</b> This retrospective, case-control study used nationwide electronic records from Clalit Healthcare Services, Israel. The study included term infants born between 2011 and 2018 who were diagnosed with TTN (TTN+) and a control group without TTN (TTN-). The primary outcomes were asthma-related healthcare utilization up to age 6 years. Propensity score matching was used to adjust for potential confounders. <b>Results:</b> The study included 645 children with TTN and 187,809 in the TTN- group. In prematching analysis, the TTN+ group had a higher incidence of cesarean delivery and male sex. Postmatching, demographic, and clinical differences were balanced. Children in the TTN+ group had significantly higher rates of emergency room visits for asthma (2.05 times higher; <i>P</i> value (<i>Pv</i>) < 0.001; 95% confidence interval [CI], 1.46-2.89), asthma diagnoses (38% increase; <i>Pv</i> < 0.001; 95% CI, 1.18-1.51), and prescriptions for short-acting β-agonists (28% increase; <i>Pv</i> = 0.002; 95% CI, 1.1-2.89) than control subjects. These associations remained significant after adjusting for confounders. <b>Conclusions:</b> The findings suggest that TTN may be associated with a higher risk of developing asthma in childhood. This study may enhance our understanding of the potential long-term respiratory implications of TTN and could inform clinical follow-up strategies for affected infants.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"881-886"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095440","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}