Annals of the American Thoracic Society最新文献

{"title":"Ambient Air Pollution Exposure and Mortality in the Pulmonary Hypertension Association Registry.","authors":"Xinmei Huang, Aparna Balasubramanian, Jude Moutchia, Kayleen Williams, Nadine Al-Naamani, Melissa Batson, Amanda J Gassett, Jasleen Minhas, Joel D Kaufman, Peter J Leary, Meredith C McCormick, Stephen C Mathai, Steven M Kawut, Coralynn Sack","doi":"10.1513/AnnalsATS.202501-129OC","DOIUrl":"10.1513/AnnalsATS.202501-129OC","url":null,"abstract":"<p><p><b>Rationale:</b> The effects of long-term ambient air pollution exposure on survival in pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) remain unclear. <b>Objectives:</b> To evaluate the association between exposure to particulate matter with aerodynamic diameter ≤ 2.5 μm (PM_2.5), NO₂, and O₃ and mortality or lung transplant in the Pulmonary Hypertension Association Registry (PHAR). <b>Methods:</b> A total of 2,196 adult patients enrolled in the PHAR provided data between 2015 and 2024. Annual average concentrations of air pollutants, including PM_2.5, NO₂, and O₃, estimated from validated spatiotemporal models in 2015 were linked to each participant's residential address. Cox proportional hazards models evaluated the associations between air pollutant exposures and risk of death or lung transplant, adjusting for baseline demographics, individual and neighborhood socioeconomic factors, disease severity, and spatial confounders. Additional analyses were adjusted for and stratified by nine U.S. census divisions. <b>Results:</b> Study participants were broadly distributed across U.S. regions, with 72.0% female and a mean age of 55.7 years. A proportion of 35.6% had idiopathic PAH, 26.5% had connective tissue disease-associated PAH, and 14.5% had CTEPH. In models adjusted for demographics and individual and neighborhood socioeconomic factors, each interquartile range increase of PM_2.5 was associated with a mortality or lung transplant hazard ratio of 1.16 (95% confidence interval, 1.01-1.33). This association was marginally attenuated and not statistically significant after adjusting for spatial covariates, with a hazard ratio of 1.12 (95% confidence interval, 0.95-1.31) per interquartile range increase in PM_2.5. We noted regional variation in the observed associations. No significant associations were found with NO₂ or O₃. <b>Conclusions:</b> Long-term ambient air pollution exposure was not significantly associated with survival in PHAR patients with PAH or CTEPH. Future research should investigate potential modifying effects of regional social determinants and healthcare-related factors on the relationship between air pollution exposure and mortality in these conditions.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1351-1360"},"PeriodicalIF":5.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310951","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":"Diagnostic Persistence: A Case of Recurrent Pericarditis in a Young Man.","authors":"Maxwell Ward, Venkateswara K Kollipara, Nathalie AbiHatem, Moises Cossio","doi":"10.1513/AnnalsATS.202411-1240CC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202411-1240CC","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":"22 9","pages":"1419-1423"},"PeriodicalIF":5.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982283","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":"Visit-to-Visit FEV₁ Variation and Mortality in New York City Fire Department Rescue and Recovery Workers Exposed to World Trade Center Collapse-Related Dust.","authors":"Kaat-Renée Deforce, Lies Lahousse, David G Goldfarb, David J Prezant, Michael D Weiden","doi":"10.1513/AnnalsATS.202501-093OC","DOIUrl":"10.1513/AnnalsATS.202501-093OC","url":null,"abstract":"<p><p><b>Rationale:</b> Forced expiratory volume in 1 second (FEV₁) and its longitudinal change are mortality risk factors. Visit-to-visit FEV₁ variation is a risk factor for death in cystic fibrosis but has not been studied in other cohorts. <b>Objectives:</b> We sought to assess whether longitudinal visit-to-visit FEV₁ variation is a mortality risk factor in rescue and recovery workers in the Fire Department of New York who were exposed to dust related to the collapse of the World Trade Center on September 11, 2001 (9/11/2001). <b>Methods:</b> Linear mixed-effects regression of all post-9/11/2001 FEV₁ measurements defined the time effect on longitudinal FEV₁ decline (FEV₁ slope) and its standard error (visit-to-visit FEV₁ variation). Cox proportional hazards and logistic models adjusted for age and smoking assessed the association between FEV₁-related risk factors and mortality. Receiver operating characteristic area under the curve (AUC) assessed predictive model performance. <b>Results:</b> Among 11,745 workers with three or more FEV₁ measurements, 575 (4.9%) died. When all FEV₁-related risk factors were combined, each 5-ml/yr increase in visit-to-visit FEV₁ variation increased mortality 2.1-fold (hazard ratio [HR] = 2.14; 95% confidence interval [CI] = 1.84-2.48); each 10% predicted reduction in the last longitudinal FEV₁ increased mortality 15% (HR = 1.15; 95% CI, 1.09-1.21), but each 10-ml/yr longitudinal FEV₁ decline was not associated with mortality (HR = 1.04; 95% CI, 0.99-1.10). The receiver operating characteristic AUC of a fully adjusted multivariable cumulative mortality model was 0.82 (95% CI, 0.80-0.84); for unadjusted visit-to-visit FEV₁ variation, the AUC was 0.80 (95% CI, 0.78-0.82); for last longitudinal FEV₁, the AUC was 0.61 (95% CI, 0.59-0.64); and for longitudinal FEV₁ decline, the AUC was 0.58 (95% CI, 0.56-0.61). In the ratio of participants with high exposure/total number of participants (1,988/11,745; 16.9%), among patients with high exposure, defined as arrival at the World Trade Center site before noon on 9/11/2001, the risk of high visit-to-visit FEV₁ variation (top quartile, ⩾10.35 ml/yr) increased 25% (odds ratio = 1.25; 95% CI, 1.12-1.40). <b>Conclusions:</b> Visit-to-visit FEV₁ variation is a mortality risk factor in rescue and recovery workers in the Fire Department of New York City, with greater accuracy for predicting cumulative mortality than either last longitudinal FEV₁ or longitudinal FEV₁ decline. Further investigation in other cohorts is needed to assess the generalizability of this rarely studied mortality risk factor.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1343-1350"},"PeriodicalIF":5.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055328","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":"Racial and Ethnic and Sex Differences in At-Home Estimates of Obstructive Sleep Apnea Parameters among Diverse Adults.","authors":"Yue Leng, Clémence Cavaillès, Carrie Peltz, Sid E O'Bryant, Susan Redline, Kristine Yaffe","doi":"10.1513/AnnalsATS.202411-1146OC","DOIUrl":"10.1513/AnnalsATS.202411-1146OC","url":null,"abstract":"<p><p><b>Rationale:</b> Racial and ethnic and sex differences in sleep may exist, but limited data directly compare objective estimates of obstructive sleep apnea (OSA), particularly in rapid eye movement (REM) versus non-REM (NREM) sleep, among Black, Mexican American and non-Hispanic White (NHW) adults. <b>Objectives:</b> To determine whether OSA parameters during REM and NREM sleep differ by race, ethnicity, or sex in community-dwelling adults. <b>Methods:</b> The DORMIR study conducted a comprehensive sleep examination among Black, Mexican American, and NHW adults 50 years of age and older enrolled in the ongoing HABS-HD (Health and Aging Brain Study-Health Disparities) cohort (2020-2024). Here we characterize racial, ethnic, and sex differences in OSA indices assessed by a U.S. Food and Drug Administration-approved peripheral arterial tonometry-based home sleep testing system. <b>Results:</b> We examined 821 participants (mean age, 66.6 ± 8.5 yr), including 543 (66.1%) women, 284 (34.6%) Mexican American individuals, and 174 (21.2%) Black individuals. About half (50.5%) had moderate to severe OSA as defined by the respiratory event index (REI; based on 3% desaturations of ≥15 events/h), 72.7% with REM-REI ≥ 15 events/h, and 39.5% with NREM-REI ≥ 15 events/h. Significant racial, ethnic, and sex differences were observed for REM-specific but not overall OSA metrics. Black women had the highest REM-REI, and NHW men had the lowest REM-REI. After controlling for demographics, socioeconomic factors, comorbidities, and sleep medication use, Black participants had a REM-REI 3 events/h higher than NHW adults, and NREM-REI values were similar. Mexican American individuals had similar REM or NREM OSA parameters compared with NHW adults but exhibited higher average blood oxygen concentrations. <b>Conclusions:</b> In this new, diverse cohort, peripheral arterial tonometry-based measures of in-home sleep indicate more REM-stage respiratory events in Black adults, particularly Black women, compared with their NHW counterparts. Given the link between REM OSA and adverse health outcomes, clinicians should pay more attention to this sleep apnea phenotype, especially in minoritized populations.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1401-1408"},"PeriodicalIF":5.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055262","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":"A Normal Forced Vital Capacity Does Not Reliably or Equitably Exclude Restriction.","authors":"Alexander T Moffett, Aparna Balasubramanian, Meredith C McCormack, Jaya Aysola, Scott D Halpern, Gary E Weissman","doi":"10.1513/AnnalsATS.202501-009RL","DOIUrl":"10.1513/AnnalsATS.202501-009RL","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1440-1443"},"PeriodicalIF":5.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287448","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":"Endothelial Glycocalyx Integrity as a Prognostic Key in Sepsis: New Insights from the CLOVERS Trial.","authors":"Jaime Fernández-Sarmiento","doi":"10.1513/AnnalsATS.202506-692ED","DOIUrl":"10.1513/AnnalsATS.202506-692ED","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1303-1304"},"PeriodicalIF":5.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416306/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602532","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":"Beyond Ratios: Rethinking Clinician Workload and Intensive Care Unit Outcomes.","authors":"Regis Goulart Rosa","doi":"10.1513/AnnalsATS.202507-716ED","DOIUrl":"10.1513/AnnalsATS.202507-716ED","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1301-1302"},"PeriodicalIF":5.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144710250","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":"Breathing Under Pressure? Air Pollution and Mortality in Pulmonary Hypertension.","authors":"Andrew J Synn, Nicholas J Nassikas","doi":"10.1513/AnnalsATS.202507-710ED","DOIUrl":"10.1513/AnnalsATS.202507-710ED","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1299-1300"},"PeriodicalIF":5.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602530","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":"Chronic Obstructive Pulmonary Disease in Immigrants and Refugees to Ontario, Canada, 2002-2019.","authors":"Jordan Sugarman, Therese A Stukel, Zhiyin Li, Jun Guan, Azadeh Yadollahi, Andrea S Gershon","doi":"10.1513/AnnalsATS.202410-1017OC","DOIUrl":"10.1513/AnnalsATS.202410-1017OC","url":null,"abstract":"<p><p><b>Rationale:</b> Canada has welcomed millions of immigrants and refugees in the last decade, and little is known about their chronic obstructive pulmonary disease (COPD) burden. <b>Objectives:</b> To determine the prevalence of COPD among immigrants to Ontario compared with nonimmigrants. <b>Methods:</b> We conducted a population-based cross-sectional study of people aged 35 years and older living in Ontario between April 1, 2002, and March 30, 2020, using health administrative databases. The primary outcome was COPD prevalence as ascertained using a validated algorithm. The primary exposure was immigrant status; secondary exposure was refugee status. <b>Results:</b> Twenty-three percent of Ontario's population aged 35 years and older were immigrants in 2019. The overall prevalence of COPD was 12%. In adjusted analysis, immigrants <5 years, 5-14 years, and ⩾15 years from immigration were 76%, 54%, and 24%, respectively, less likely than nonimmigrants to have COPD. COPD prevalence slightly increased in immigrants over time. In comparison with nonrefugee immigrants, refugee immigrants had a higher prevalence of COPD (adjusted relative risk, 1.33; 95% confidence interval, 1.32-1.33). <b>Conclusions:</b> Immigrants have a lower risk than nonimmigrants of having COPD; however, refugee immigrants had a higher risk than nonrefugee immigrants of COPD. The lower risk in immigrants may be explained by the \"healthy immigrant effect,\" in which immigrants may be generally healthier and younger than locally born individuals. In addition, COPD may be underdiagnosed or underreported in immigrants because of structural barriers to accessing healthcare services. Further research is needed into causes of the difference.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1329-1334"},"PeriodicalIF":5.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047163","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":"Association of Early Epinephrine with Hemodynamics and Outcome in Pediatric In-Hospital Cardiac Arrest: A Secondary Analysis of a Multicenter, Cluster-randomized Clinical Trial Intensive Care Unit Resuscitation (ICU-RESUS).","authors":"Ashley Siems, Maryam Y Naim, Robert A Berg, Ron W Reeder, Tageldin Ahmed, Michael J Bell, Robert Bishop, Matthew Bochkoris, Candice Burns, Joseph A Carcillo, Todd C Carpenter, J Wesley Diddle, Myke Federman, Richard Fernandez, Ericka L Fink, Deborah Franzon, Aisha H Frazier, Stuart H Friess, Kathryn Graham, Mark Hall, Monica L Harding, David A Hehir, Christopher M Horvat, Leanna L Huard, Todd J Kilbaugh, Tensing Maa, Arushi Manga, Patrick S McQuillen, Kathleen L Meert, Peter M Mourani, Vinay M Nadkarni, Daniel Notterman, Murray M Pollack, Danna W Qunibi, Anil Sapru, Carleen Schneiter, Matthew P Sharron, Neeraj Srivastava, Sarah Tabbutt, Bradley Tilford, Shirley Viteri, David Wessel, Heather A Wolfe, Andrew R Yates, Athena F Zuppa, Ryan W Morgan, Robert M Sutton","doi":"10.1513/AnnalsATS.202408-825OC","DOIUrl":"10.1513/AnnalsATS.202408-825OC","url":null,"abstract":"<p><p><b>Rationale:</b> Delayed (>5 minutes) epinephrine during pediatric in-hospital cardiac arrest (IHCA) is associated with worse outcomes. Epinephrine is nearly always given earlier, limiting 5 minutes as a quality target. <b>Objectives:</b> To assess early epinephrine administration (⩽2 minutes) on outcomes and hemodynamics during cardiopulmonary resuscitation (CPR) in pediatric IHCA from pulseless, nonshockable rhythms. <b>Methods:</b> This study leveraged the database of the ICU-RESUS (Intensive Care Unit Resuscitation) project (clinicaltrials.gov identifier NCT02837497). Primary exposure was the time to epinephrine bolus: early versus >2 minutes. Primary outcome was survival to discharge. Secondary outcomes included the return of spontaneous circulation (ROSC), survival with favorable neurologic outcome, change from baseline to discharge Functional Status Scale (FSS) score, total FSS score at discharge, new morbidity among survivors, and invasively measured blood pressure during the first 10 minutes of CPR. <b>Results:</b> Among 352 CPR events, median age was 1.0 (interquartile range [IQR], 0.3-8.0) year, 186 (53%) were male, and 185 (52.6%) had cardiac disease. Early epinephrine was administered in 273 (78%), and median time to administration was 1.0 (0.0-2.0) minute. Survival to discharge was similar between patients who received early epinephrine and those who did not. Early epinephrine administration was associated with higher ROSC, a change from baseline to discharge in FSS, lower total FSS scores at discharge, and lower rates of new morbidity compared with epinephrine administration at >2 minutes. The probability of ROSC and survival to discharge with favorable neurologic outcome decreased for each minute of delay in epinephrine administration. There was no difference in the invasive blood pressure targets during the first 10 minutes of CPR. <b>Conclusions:</b> Early epinephrine administration was common and was associated with higher ROSC and improved functional outcomes compared with epinephrine administration at >2 minutes in pediatric IHCA.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1361-1371"},"PeriodicalIF":5.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227939","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}