CHEST pulmonary最新文献

{"title":"A Collaborative, Interinstitutional Program to Improve the Care of Patients With Chronic Thromboembolic Pulmonary Hypertension","authors":"Bryan A. Kelly DO ,&nbsp;Vikas Aggarwal MD ,&nbsp;Prachi P. Agarwal MD ,&nbsp;Samuel Allen DO ,&nbsp;Rana Awdish MD ,&nbsp;Wael Berjaoui MD ,&nbsp;Domingo J. Franco-Palacios MD ,&nbsp;Reda E. Girgis MD ,&nbsp;Gillian Grafton DO ,&nbsp;Jonathan W. Haft MD ,&nbsp;Brandon Hooks DO ,&nbsp;Reem Ismail NP ,&nbsp;Sheila Krishnan DO ,&nbsp;Scott Visovatti MD ,&nbsp;Vallerie V. McLaughlin MD, FACC ,&nbsp;Victor M. Moles MD","doi":"10.1016/j.chpulm.2024.100092","DOIUrl":"10.1016/j.chpulm.2024.100092","url":null,"abstract":"<div><div>Chronic thromboembolic pulmonary hypertension (CTEPH), a subcategory of pulmonary hypertension and chronic sequela of acute pulmonary embolism, is often underdiagnosed due to nonspecific symptoms. Pulmonary endarterectomy remains the optimal, potentially curative therapy; however, determination of operability is based on multiple factors that may be relatively unique to each patient and largely based on physician expertise. Patients with CTEPH should be referred to CTEPH centers for comprehensive confirmatory diagnostics and operability assessments by multidisciplinary teams. Because CTEPH center experience and expertise are key to improving clinical outcomes, challenges arise when they are not available or easily accessible to patients. This article describes the Michigan Multi-Center CTEPH Collaboration, a multidisciplinary, interinstitutional collaboration program developed by health care centers in Michigan. Pulmonary hypertension and pulmonary embolism teams from centers across the state share expertise and clinical opinions in a monthly virtual conference. This collaborative approach tackles the two main challenges in the treatment of CTEPH head on: accurate diagnosis and patient access to CTEPH centers. Our collaboration model can be used as a best practice across the nation to benefit patients, multidisciplinary teams, and CTEPH centers.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 4","pages":"Article 100092"},"PeriodicalIF":0.0,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706134","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":"Looking to Philadelphia for Trends in Lung Cancer Risk and Screening Adherence Among Asian American Patients","authors":"Travis L. Dotson MD,&nbsp;Christina R. Bellinger MD","doi":"10.1016/j.chpulm.2024.100090","DOIUrl":"10.1016/j.chpulm.2024.100090","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 4","pages":"Article 100090"},"PeriodicalIF":0.0,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142719652","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":"Demographic and Clinical Factors Associated With Diagnostic Confidence in Interstitial Lung Disease","authors":"Mary Beth Scholand MD ,&nbsp;Sachin Gupta MD ,&nbsp;Kevin R. Flaherty MD ,&nbsp;Rosalinda V. Ignacio MS ,&nbsp;Zhongze Li MS ,&nbsp;Ayodeji Adegunsoye MD","doi":"10.1016/j.chpulm.2024.100084","DOIUrl":"10.1016/j.chpulm.2024.100084","url":null,"abstract":"<div><h3>Background</h3><div>Accurate diagnosis of interstitial lung disease (ILD) can be challenging. Accordingly, clinicians may attribute a diagnostic certainty based on guideline criteria and clinical judgment. However, further research is needed to refine this approach and improve diagnostic clarity.</div></div><div><h3>Research Question</h3><div>What are the real-world factors associated with diagnostic confidence in fibrotic ILD?</div></div><div><h3>Study Design and Methods</h3><div>Data were included from all patients enrolled in the Pulmonary Fibrosis Foundation Patient Registry from March 2016 to August 2018. Baseline demographic and clinical characteristics were collected at enrollment, or at the test date closest to the date of consent for longitudinal measures. Descriptive analyses were performed separately for all participants, and for subgroup participants with idiopathic pulmonary fibrosis (IPF) and participants with non-IPF ILD, stratified by the level of investigator diagnostic confidence (high vs medium/low) assigned at registry enrollment. Adjusted ORs and 95% CIs were calculated using multivariable logistic regression, with the aforementioned characteristics as predictors.</div></div><div><h3>Results</h3><div>Data up to April 2022 from 1,992 participants were included. In adjusted logistic regression analyses among all participants, antifibrotic use (OR, 1.51; 95% CI, 1.09-2.07), longer time since diagnosis (OR, 0.94; 95% CI, 0.89-0.98) at the research unit of 365 days, and diabetes (OR, 2.56; 95% CI, 1.01-6.44) were significantly associated with higher diagnostic confidence, and non-IPF idiopathic interstitial pneumonia (vs IPF; OR, 0.36; 95% CI, 0.24-0.55), insurance - other (OR, 0.65; 95% CI, 0.43-0.97), and Hispanic ethnicity (OR, 0.54; 95% CI, 0.31-0.94) were significantly associated with lower diagnostic confidence. Factors associated with diagnostic confidence in the IPF and/or non-IPF ILD groups included age, male sex, region, immunomodulatory medication use, multidisciplinary team discussion, surgical lung biopsy, and definite high-resolution CT pattern.</div></div><div><h3>Interpretation</h3><div>These findings suggest that certain demographic and clinical factors may influence physicians’ confidence in diagnosis of IPF and non-IPF ILD. Tailored physician education may help to reduce biases and improve consistency in diagnosis.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 4","pages":"Article 100084"},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141709263","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":"Bronchoscopy Without Sedation in Healthy Volunteers","authors":"Dean Kellogg III MD ,&nbsp;Diego Maselli MD ,&nbsp;Kevin Proud MD ,&nbsp;Eusondia Arnett PhD ,&nbsp;Larry S. Schlesinger MD ,&nbsp;Jay I. Peters MD","doi":"10.1016/j.chpulm.2024.100075","DOIUrl":"10.1016/j.chpulm.2024.100075","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 4","pages":"Article 100075"},"PeriodicalIF":0.0,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141711904","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":"Sex Differences in Lung Function in Asthma Across the Ages","authors":"Celine Chedraoui MD ,&nbsp;Battoul Fakhry MD ,&nbsp;Joelle Sleiman MD ,&nbsp;Bo Hu PhD ,&nbsp;Amy Attaway MD ,&nbsp;Peter Bazeley MD ,&nbsp;Hyun Jo Kim MS ,&nbsp;Peng Zhang MD ,&nbsp;Joe G. Zein MD, PhD","doi":"10.1016/j.chpulm.2024.100047","DOIUrl":"10.1016/j.chpulm.2024.100047","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 2","pages":"Article 100047"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789224000138/pdfft?md5=75b83b575f4ae0481188e80fe2d808cb&pid=1-s2.0-S2949789224000138-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140271005","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 Diagnostic Yield of Cone Beam CT Combined With Radial-Endobronchial Ultrasound for the Diagnosis of Peripheral Pulmonary Nodules","authors":"Michael V. Brown ,&nbsp;Arash Badiei ,&nbsp;Matthew Arnold ,&nbsp;Hubertus Jersmann ,&nbsp;Thomas Sullivan ,&nbsp;David Fielding ,&nbsp;Phan Nguyen","doi":"10.1016/j.chpulm.2024.100037","DOIUrl":"10.1016/j.chpulm.2024.100037","url":null,"abstract":"<div><h3>Background</h3><p>Identification of peripheral pulmonary nodules (PPNs) is becoming increasingly common with modern imaging and lung cancer screening programs. Navigational bronchoscopy has been developed to augment the diagnostic yield of sampling these nodules. Cone beam CT (CBCT) scan is one navigational tool which can be used alongside the historical criterion standard of fluoroscopy and radial endobronchial ultrasound (r-EBUS).</p></div><div><h3>Research Question</h3><p>What is the diagnostic yield and safety profile of combining CBCT scan with r-EBUS for the diagnosis of PPNs?</p></div><div><h3>Study Design and Methods</h3><p>Embase, PubMed, and Cochrane Central Register of Controlled Trials were searched in March 2023. Eligible studies used CBCT scan with r-EBUS as the primary navigation technique. The primary outcome, diagnostic yield, was analyzed using random effects meta-analysis. Additional subgroup analysis was based on the use of additional navigational technologies. Risk of bias was assessed using the Critical Appraisal Skills Programme tool for diagnostic studies. The Grading of Recommendations Assessment, Development, and Evaluation tool was used to assess the quality of outcomes.</p></div><div><h3>Results</h3><p>Fourteen studies (865 patients and 882 lesions) were included. The risk of bias was significant as assessed using the Critical Appraisal Skills Programme tool, which identified multiple confounders. The pooled diagnostic yield of combined CBCT scan and r-EBUS-guided biopsy for the diagnosis of PPNs was 80% (95% CI, 76%-84%). Subgroup analysis of diagnostic yield for CBCT scan and r-EBUS alone was 80% (95% CI, 76%-83%). The diagnostic yield of CBCT scan and r-EBUS combined with additional navigational technology (electromagnetic navigational bronchoscopy, virtual bronchoscopic navigation, and robotic-assisted bronchoscopy) was 80% (95% CI, 73%-87%). The quality of outcomes was assessed as low to very low using the Grading of Recommendations Assessment, Development, and Evaluation tool. There was a 2.01% pneumothorax rate and 1.08% bleeding rate. Although heterogeneously reported, the total radiation dose was between 19.59 and 85.9 Gy.cm², resulting in an approximate effective dose range of 3.1 to 13.8 mSv.</p></div><div><h3>Interpretation</h3><p>CBCT scan and r-EBUS for the diagnosis of PPNs has a high diagnostic yield and acceptable safety profile. Studies showed moderate heterogeneity with significant bias; hence, generalizability of the study is limited and further prospective trials are required.</p></div><div><h3>Clinical Trial Registration</h3><p>PROSPERO; No.: CRD42023410221; URL: <span>https://www.crd.york.ac.uk/prospero/</span><svg><path></path></svg>.</p></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 2","pages":"Article 100037"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789224000035/pdfft?md5=bc2aa3bf83825252aa53afcfceb99568&pid=1-s2.0-S2949789224000035-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139635622","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":"How Is Life After Severe COVID-19?","authors":"Maurizio Bernasconi MD ,&nbsp;Camelia Voinea MD ,&nbsp;Luca Sardella MD ,&nbsp;Alessandro Felice Chiesa MD ,&nbsp;Marco Previsdomini MD ,&nbsp;Andreas Perren MD ,&nbsp;Claudia Gamondi MD ,&nbsp;Adam Ogna MD","doi":"10.1016/j.chpulm.2024.100056","DOIUrl":"10.1016/j.chpulm.2024.100056","url":null,"abstract":"<div><h3>Background</h3><p>Data on long-term outcomes of COVID-19-related ARDS are scarce and rely largely on patient-reported outcomes. This study aimed to study cardiopulmonary function combined with psychosocial sequelae in a cohort of patients with severe COVID-19 requiring ICU management and intubation, with a follow-up of 12 months.</p></div><div><h3>Research Question</h3><p>What are the functional and psychosocial sequelae 1 year after severe COVID-19 requiring ICU management and intubation?</p></div><div><h3>Study Design and Methods</h3><p>We studied a longitudinal cohort of 39 mechanically ventilated patients with COVID-19 from the early phase of the pandemic. Pulmonary function test results, cardiopulmonary exercise testing findings, and subjective health perception data from 6 and 12 months after ICU admission were collected.</p></div><div><h3>Results</h3><p>Twelve months after COVID-19, 19.3% of participants showed at least moderate alteration in pulmonary function test findings, and 35.7% of participants showed a pathologically reduced effort capacity by cardiopulmonary exercise testing. A considerable impact on daily activities was reported, with only 41.7% of participants being able to resume work entirely and 71% reporting a relevant health impairment resulting from residual respiratory symptoms. The health perception scores did not correlate significantly with the measured cardiopulmonary performance or lung function.</p></div><div><h3>Interpretation</h3><p>A persistent objective limitation in physical activity was observed in this population of unvaccinated patients from the early phase of the pandemic, studied for 12 months after recovery from COVID-19-related ARDS. Patients also reported a profound impact on functional autonomy, daily activities, professional life, and health perception. Despite being attributed primarily to residual respiratory symptoms, the observed health impairment is probably multifactorial, with physical and psychological factors playing a role. The prolonged course of the symptoms and the underlying complexity should be considered in future programs for the care of patients who have recovered from COVID-19.</p></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 2","pages":"Article 100056"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789224000229/pdfft?md5=f1de51350138f46b2577d19100492a62&pid=1-s2.0-S2949789224000229-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140779073","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":"Cone-Beam CT Scan-Guided Peripheral Bronchoscopy","authors":"Matthew Aboudara MD, FCCP, DAABIP ,&nbsp;James Katsis MD, DAABIP","doi":"10.1016/j.chpulm.2024.100045","DOIUrl":"10.1016/j.chpulm.2024.100045","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 2","pages":"Article 100045"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789224000114/pdfft?md5=5e788aa969ce3cb5e382ce215c5ec9d9&pid=1-s2.0-S2949789224000114-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140277625","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":"Who Drives Pulmonology Evidence Synthesis?","authors":"Vivek Bhat ,&nbsp;Abhishek Kumar ,&nbsp;Sharanya Kaushik ,&nbsp;Shreyas Bellur ,&nbsp;Harsimran Singh Walia ,&nbsp;Manmeet Singh Ahluwalia ,&nbsp;Harneet Kaur Walia MD","doi":"10.1016/j.chpulm.2024.100041","DOIUrl":"10.1016/j.chpulm.2024.100041","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 2","pages":"Article 100041"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789224000072/pdfft?md5=bd2fb35978bf4c0d54252bf1df5bcf71&pid=1-s2.0-S2949789224000072-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140463033","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":"Association of Short-Term Increases in Ambient Fine Particulate Matter With Hospitalization for Asthma or COPD During Wildfire Season and Other Time Periods","authors":"Benjamin D. Horne PhD, MStat, MPH ,&nbsp;Mary M. Johnson MD, PhD ,&nbsp;Denitza P. Blagev MD ,&nbsp;Francois Haddad MD ,&nbsp;Kirk U. Knowlton MD ,&nbsp;Daniel Bride MS ,&nbsp;Tami L. Bair BS ,&nbsp;Elizabeth A. Joy MD, MPH ,&nbsp;Kari C. Nadeau MD, PhD","doi":"10.1016/j.chpulm.2024.100053","DOIUrl":"10.1016/j.chpulm.2024.100053","url":null,"abstract":"<div><h3>Background</h3><p>Short-term increases in air pollution are associated with poor asthma and COPD outcomes. Short-term elevations in fine particulate matter (PM_2.5) due to wildfire smoke are becoming more common.</p></div><div><h3>Research Question</h3><p>Are short-term increases in PM_2.5 and ozone in wildfire season and in winter inversion season associated with a composite of emergency or inpatient hospitalization for asthma and COPD?</p></div><div><h3>Study Design and Methods</h3><p>Case-crossover analyses evaluated 63,976 and 18,514 patients hospitalized for primary discharge diagnoses of asthma and COPD, respectively, between January 1999 and March 2022. Patients resided on Utah’s Wasatch Front where PM_2.5 and ozone were measured by Environmental Protection Agency-based monitors. ORs were calculated using Poisson regression adjusted for weather variables.</p></div><div><h3>Results</h3><p>Asthma risk increased on the same day that PM_2.5 increased during wildfire season (OR, 1.057 per +10 μg/m³; 95% CI, 1.019-1.097; <em>P</em> = .003) and winter inversions (OR, 1.023 per +10 μg/m³; 95% CI, 1.010-1.037; <em>P</em> = .0004). Risk decreased after 1 week, but during wildfire season risk rebounded at a 4-week lag (OR, 1.098 per +10 μg/m³; 95% CI, 1.033-1.167). Asthma risk for adults during wildfire season was highest in the first 3 days after PM_2.5 increases, but for children, the highest risk was delayed by 3 to 4 weeks. PM_2.5 exposure was weakly associated with COPD hospitalization. Ozone exposure was not associated with elevated risks.</p></div><div><h3>Interpretation</h3><p>In a large urban population, short-term increases in PM_2.5 during wildfire season were associated with asthma hospitalization, and the effect sizes were greater than for PM_2.5 during inversion season.</p></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 2","pages":"Article 100053"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789224000199/pdfft?md5=74fed2bf98142ed2aeca7c9b2d31b20c&pid=1-s2.0-S2949789224000199-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140403068","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}