CHEST pulmonary最新文献

{"title":"Feasibility of Assessing the Abnormal Pediatric Airway Using Rotational Optical Coherence Tomography","authors":"Sune Rubak MD, PhD ,&nbsp;Anne Katrine Bak Poulsen MD ,&nbsp;Signe Thim MD ,&nbsp;Nagarajan Muthialu MD ,&nbsp;Thomas Kjærgaard MD, PhD ,&nbsp;Emil Nielsen Holck MD, PhD","doi":"10.1016/j.chpulm.2024.100120","DOIUrl":"10.1016/j.chpulm.2024.100120","url":null,"abstract":"<div><h3>Background</h3><div>Methods currently used to assess and diagnose abnormalities of pediatric airways have several limitations: CT scans involve a risk of ionizing radiation and diagnostic dynamic bronchoscopies have high interobserver variability. Advanced diagnostic methods for evaluating the dynamic airway are needed to enable newer interventions (eg, airway stenting) in select children. The study objective was to investigate the feasibility of optical coherence tomography (OCT) as a measuring method that facilitates accurate, quantifiable, and real-time cross-sectional imaging of the airway.</div></div><div><h3>Research Question</h3><div>Is bronchoscopy-guided quantitative OCT of the lower pediatric airway a feasible method and does it increase diagnostic possibilities?</div></div><div><h3>Study Design and Methods</h3><div>We evaluated a series of 10 children with severe persistent respiratory symptoms with a clinical indication for diagnostic dynamic bronchoscopy (DDB). Feasibility of OCT was defined as the ability to visualize and quantify airway stenoses and dynamic airway collapse in the pediatric airway without procedural complications. Furthermore, the study included a porcine model to calculate the correction constant for the OCT measurements in air in comparison with contrast fluid.</div></div><div><h3>Results</h3><div>Nine children aged 0 to 14 years were included. In total, 34 airway segments were OCT scanned. Results showed that OCT is a feasible method for visualizing and quantifying stenoses of the lower pediatric airway by measuring the mean and minimum lumen areas. The correction constant of OCT in air was 1.3 (interquartile range, 1.29-1.31) in comparison with contrast. Visual assessment of the minimum lumen area stenosis by dynamic bronchoscopy significantly varies in comparison with OCT assessment (18.416%; 95% CI, 8.93-27.91; <em>P</em> = .0018).</div></div><div><h3>Interpretation</h3><div>OCT demonstrated feasibility of providing quantitative assessments of clinical manifestations including cross-sectional imaging in the pediatric airway. The correction constant for optimal quantification was calculated and provided the possibility for precise interpretation of OCT measurements. Further studies are needed to investigate safety, accuracy, and efficacy of OCT in the lower pediatric airway.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 2","pages":"Article 100120"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144243105","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 Overlooked Epidemic","authors":"Sameer Khanijo MD","doi":"10.1016/j.chpulm.2025.100166","DOIUrl":"10.1016/j.chpulm.2025.100166","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 2","pages":"Article 100166"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144280190","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":"Bronchoscopic Lung Volume Reduction","authors":"Domingo J. Franco-Palacios MD ,&nbsp;Rebecca Priebe NP ,&nbsp;Jane Simanovski PhD, NP ,&nbsp;Lisa L. Allenspach MD ,&nbsp;Lisa Stagner DO ,&nbsp;Lisa K. Waynick PA ,&nbsp;Yichu Wang BS ,&nbsp;Mei Lu BS ,&nbsp;Shraddha Desai MD ,&nbsp;Daniel Kapadia MD ,&nbsp;Avi Cohen MD","doi":"10.1016/j.chpulm.2024.100117","DOIUrl":"10.1016/j.chpulm.2024.100117","url":null,"abstract":"<div><h3>Background</h3><div>Many bronchoscopic lung volume reduction (BLVR) studies have excluded patients meeting the listing criteria for lung transplantation (LT).</div></div><div><h3>Research Question</h3><div>What are the outcomes of BLVR in a sicker group of patients with emphysema compared with patients not meeting the criteria for LT listing?</div></div><div><h3>Study Design and Methods</h3><div>This was a real-world retrospective study (June 2018 to December 2022) assessing the effect of BLVR in patients with severe emphysema considered for LT. FEV₁, FVC, diffusing capacity for carbon monoxide, symptoms, and 6-minute walk distance (6-MWD) were measured at baseline and 45 days and 6 months after BLVR.</div></div><div><h3>Results</h3><div>Of 76 fully evaluated patients (median age, 62 years; 60% female), 42 underwent BLVR (30 sicker patients met the criteria for LT listing). At baseline, patients that met the criteria for listing had shorter baseline 6-MWD (234.72 ± 68.86, <em>P</em> &lt; .001), higher BODE Index score (6.79 ± 1.11, <em>P</em> = .001), and lower FEV₁ (617.5 ± 139.2 mL, <em>P</em> = .005). All patients treated with BLVR experienced a decrease in BODE Index and Borg dyspnea by scores −0.5 to −2 points, respectively. Diffusing capacity for carbon monoxide % predicted increased by 4.5%, FEV₁ increased by 115 mL, FVC increased by 450 mL, and 6-MWD increased by 20 meters. In the sicker group, FEV₁ at 45 days after BLVR increased by 180.8 ± 231 mL (FEV₁ % predicted 5.84 ± 5.66) compared with baseline; a persistent effect was seen at 6 months in 62% of patients with available data (18 of 30). Median hospital length of stay was 3.27 ± 3.07 days. Endobronchial valves were removed in 6 patients (3 in each group) due to complications. The pneumothorax rate was 24% (10 of 42; 5 in each group).</div></div><div><h3>Interpretation</h3><div>Improvement in lung function after BLVR was observed regardless of disease severity. BLVR might represent an alternative to LT for some patients.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 2","pages":"Article 100117"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144298043","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":"Cumulative Personal Radiation Exposure for a Single Pulmonary Proceduralist Over 1 Year","authors":"Kim Styrvoky MD ,&nbsp;Xinhui Duan PhD","doi":"10.1016/j.chpulm.2025.100161","DOIUrl":"10.1016/j.chpulm.2025.100161","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 2","pages":"Article 100161"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144243083","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":"Assessment of Risk Factors for Death in Older Adult Patients With TB in Japan","authors":"Seigo Miyoshi MD, PhD,&nbsp;Mayuko Semba MD,&nbsp;Miyuki Tanabe MD,&nbsp;Chika Sato MD,&nbsp;Akira Watanabe MD, PhD,&nbsp;Ryoji Ito MD, PhD,&nbsp;Mari Kubota,&nbsp;Masahiro Abe MD, PhD","doi":"10.1016/j.chpulm.2025.100162","DOIUrl":"10.1016/j.chpulm.2025.100162","url":null,"abstract":"<div><h3>Background</h3><div>Previous studies have identified several risk factors for death because of TB, including advanced age, HIV coinfection, multidrug-resistant TB, malnutrition, low activities of daily living, and comorbidities. In Japan, the incidence of TB and TB-related deaths is consistently higher among older individuals. However, few studies have evaluated the risk factors for death in older adult patients with TB.</div></div><div><h3>Research Question</h3><div>What are the risk factors for death among older adults with TB?</div></div><div><h3>Study Design and Methods</h3><div>This prospective cohort study included data on consecutive older adult patients (aged ≥ 65 years) who were admitted for treatment of TB between October 2016 and April 2022. We collected data on patient characteristics, chest radiography findings, and laboratory data and assessed whether these parameters were associated with patient death. We also examined the risk factors associated with TB-related and TB-unrelated deaths as a subanalysis.</div></div><div><h3>Results</h3><div>Multivariate Cox proportional hazards analysis showed that performance status (hazard ratio [HR], 1.434; 95% CI, 1.051-1.956; <em>P</em> = .023), corticosteroid use (HR, 2.679; 95% CI, 1.374-5.221; <em>P</em> = .004), and serum albumin levels (HR, 0.434; 95% CI, 0.235-0.804; <em>P</em> = .008) were significantly correlated with all-cause mortality. Subanalyses demonstrated that performance status was significantly correlated with TB-related death (HR, 2.048; 95% CI, 1.459-2.874; <em>P</em> &lt; 0.001), whereas advanced age (HR, 1.073; 95% CI, 1.008-1.142; <em>P</em> = .027), corticosteroid use (HR, 4.131; 95% CI, 1.783-9.575; <em>P</em> &lt; .001), and serum albumin levels (HR, 0.435; 95% CI, 0.225-0.842; <em>P</em> = .014) were significantly correlated with TB-unrelated deaths.</div></div><div><h3>Interpretation</h3><div>The evaluation of daily activity, physical ability, immune status, and nutritional status is considered an important factor directly related to prognosis in the treatment of TB in older adults. Large-scale prospective studies should be conducted in the future.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 2","pages":"Article 100162"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144243103","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":"Canary in the Coalmine?","authors":"William J. Healy MD ,&nbsp;Younghoon Kwon MD","doi":"10.1016/j.chpulm.2025.100155","DOIUrl":"10.1016/j.chpulm.2025.100155","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 2","pages":"Article 100155"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144243255","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":"Dyspnea and Right-Sided Heart Failure in a Patient With a History of Pneumonectomy","authors":"Shelsey W. Johnson MD ,&nbsp;Melanie C. Kwan MD ,&nbsp;Sarah A.M. Cuddy MD ,&nbsp;Aaron B. Waxman MD, PhD ,&nbsp;Lida P. Hariri MD, PhD ,&nbsp;William M. Oldham MD, PhD","doi":"10.1016/j.chpulm.2025.100149","DOIUrl":"10.1016/j.chpulm.2025.100149","url":null,"abstract":"<div><h3>Case Presentation</h3><div>A 67-year-old man who never smoked was evaluated in the emergency department for 3 months of progressive dyspnea, lower extremity edema, and 20lb weight gain. Eighteen months before this, he had presented with hemoptysis and was ultimately found to have squamous cell lung cancer invading the left pulmonary artery without lymph node involvement, stage pT4N0M0, for which he underwent left pneumonectomy. His medical history was additionally notable for paroxysmal atrial fibrillation and factor V Leiden mutation (anticoagulated on apixaban). Social history was notable for work as a grocer in a supermarket; the patient denied history of asbestos exposure and had no known TB exposure or prior infection. The patient was admitted to general cardiology where he was afebrile, in atrial fibrillation with rapid ventricular response to 127 beats/min with associated hypotension (80/55 mm Hg); his oxygen saturation was 95% on room air. Physical examination was most notable for jugular venous distension and bilateral edema to the thigh. Electrocardiogram did not demonstrate ischemia. Laboratory evaluation demonstrated a creatinine level of 1.10 mg/dL, elevated from his recent baseline level of 0.52 mg/dL. Lactic acid was normal. His cardiac biomarkers were abnormal with an elevated N-terminal pro-B-type natriuretic peptide value (3,682 pg/mL) and high sensitivity troponin T (43 ng/L). Both WBC count and hemoglobin values were normal as were his thyroid hormone levels. IV diuretic and antiarrhythmic therapies were initiated with furosemide and amiodarone, respectively.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 2","pages":"Article 100149"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144279504","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":"Connecting the Dots Between Asthma Control and Frailty in Older Adults With Moderate to Severe Asthma","authors":"Ricardo G. Figueiredo PhD ,&nbsp;Fernando Holguin MSc ,&nbsp;Márcia M.M. Pizzichini PhD ,&nbsp;Gabriela P. Pinheiro PhD ,&nbsp;Vanessa Arata MD ,&nbsp;Maisa F.M. Leal ,&nbsp;Cinthia V.N. Santana PhD ,&nbsp;José de Bessa Junior PhD ,&nbsp;Álvaro A. Cruz PhD","doi":"10.1016/j.chpulm.2025.100147","DOIUrl":"10.1016/j.chpulm.2025.100147","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 2","pages":"Article 100147"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144261653","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":"A Multicenter Retrospective Study Evaluating IL-5-Targeted Biologic Therapies for the Treatment of Asthma and Allergic Bronchopulmonary Aspergillosis in Adults With Cystic Fibrosis","authors":"Sameer Desai PhD ,&nbsp;Sophia Shen MD ,&nbsp;Zosia Gryz BSc ,&nbsp;Elizabeth Tullis MD ,&nbsp;Anne L. Stephenson MD, PhD ,&nbsp;Bradley S. Quon MD, MSc","doi":"10.1016/j.chpulm.2025.100163","DOIUrl":"10.1016/j.chpulm.2025.100163","url":null,"abstract":"<div><h3>Background</h3><div>Biologic therapies targeting T-helper cell type 2 (Th2) eosinophilic inflammation have been used for difficult-to-treat asthma and allergic bronchopulmonary aspergillosis (ABPA), but safety and efficacy data are limited in the cystic fibrosis (CF) population.</div></div><div><h3>Research Question</h3><div>Are Th2 biologic therapies targeting eosinophilic inflammation effective and safe when used in adults with CF with asthma and/or ABPA overlap?</div></div><div><h3>Study Design and Methods</h3><div>This was a retrospective multicenter study. Individuals with CF receiving Th2 biologic therapies for asthma or ABPA at 2 large adult CF centers between 2016 and 2021 were included. Treatment safety and effectiveness up to 12 months after biologic initiation were evaluated. Outcomes of interest included percent predicted FEV₁ (ppFEV₁), rate of change in ppFEV₁, cumulative systemic corticosteroid (SCS) dose, and frequency of pulmonary exacerbations (PExs).</div></div><div><h3>Results</h3><div>Forty adults with CF received Th2 biologic therapies targeting eosinophilic inflammation during the study period. A total of 38 were eligible for study inclusion, and all received IL-5-directed therapies (mepolizumab: n = 27, benralizumab: n = 11): 17 (45%) for asthma only and 21 for ABPA (55%) with or without asthma. No significant biologic-related adverse effects were observed. There was no statistical difference in ppFEV₁ from baseline to 12-months postbiologic initiation, but the rate of change in ppFEV₁ improved in the 12 months postbiologic vs prebiologic with a pre-to-post difference of 3.7% (95% CI, 1.2%-6.3%). SCS dose and frequency of PExs requiring hospitalization did not differ significantly in the 12 months before biologic vs after biologic initiation.</div></div><div><h3>Interpretation</h3><div>Our results show that in adults with CF, anti-IL-5 biologic therapies were well tolerated and can improve rate of change in lung function, but there was no impact on SCS use or PEx frequency. Further study is needed to better define the role of Th2 biologics in the era of highly effective modulator therapy.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 2","pages":"Article 100163"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144243263","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":"Safety and Feasibility of a Two-Way Audiovisual Teleconferenced Pulmonary Rehabilitation Program","authors":"Emily S. Wan MD, MPH ,&nbsp;Josephine Decherd MPH ,&nbsp;Christine Stella NP ,&nbsp;Jonathan R. Venne PT ,&nbsp;Brenda McKeon NP ,&nbsp;Stephanie A. Robinson PhD ,&nbsp;Patricia Bamonti PhD ,&nbsp;Marilyn L. Moy MD, MSc","doi":"10.1016/j.chpulm.2024.100089","DOIUrl":"10.1016/j.chpulm.2024.100089","url":null,"abstract":"<div><h3>Background</h3><div>Given limited access to center-based, in-person pulmonary rehabilitation (PR), alternative delivery strategies are needed.</div></div><div><h3>Research Question</h3><div>We compared a virtual PR program with a conventional center-based one with respect to safety, feasibility/acceptability, and geographic catchment (primary outcomes). We explored efficacy by examining changes in functional outcomes (secondary outcomes).</div></div><div><h3>Study Design and Methods</h3><div>This single-center observational real-world report included patients enrolled from July 30, 2020, through June 30, 2023, who attended one or more PR class. Patients undergoing virtual PR exercised in their homes under direct supervision via two-way audiovisual teleconferencing. Baseline demographic information and adverse events were extracted from electronic medical records. Google Maps estimated distance and drive time from residential addresses to the PR center. Intake and exit evaluations for secondary (functional) outcomes and feedback questionnaires were completed in a subset.</div></div><div><h3>Results</h3><div>A total of 120 (52 in-person and 68 virtual) patient enrollments were examined; 84% of patients had COPD. Mean age, FEV₁ and FVC % predicted, and baseline 6-min walk test distance were similar between groups. For safety, the overall rate of PR-related adverse events was 1.2 per 1,000 person-days of observation, with no between-group differences. For feasibility, the average number of exercise classes completed (12.4 ± 6.2 vs 13.0 ± 6.1) and proportion of patients completing ≥ 70% of classes (61.5% vs 67.6%) was comparable between the in-person and virtual groups, respectively. For acceptability, among those who completed the virtual PR feedback questionnaire (n = 30), 100% felt safe exercising at home, 97% endorsed clear internet connection, and 90% agreed education sessions were easy to understand. For geographic catchment, patients in virtual PR lived farther (median, 34.1 miles; interquartile range, 16.6-45.1 vs median, 10.3 miles; interquartile range, 5.6-20.6 miles; <em>P</em> &lt; .001) and had longer drive times (mean 86.0 ± 31.6 vs 51.4 ± 31.9 min; <em>P</em> &lt; 0.001) than patients in in-person PR. In the subset with both intake and exit evaluations, similar improvements were observed in functional outcomes and dyspnea in both groups.</div></div><div><h3>Interpretation</h3><div>This study suggests that two-way audiovisual teleconferenced PR is safe, feasible/acceptable, and significantly expands geographic catchment.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 2","pages":"Article 100089"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144279502","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}