CHEST pulmonary最新文献

{"title":"Flow Profiles Identify Sources of Poor Metered Dose Inhaler Technique","authors":"Stuart D. King BS ,&nbsp;Rohan D. Milak ,&nbsp;Hartmut Schneider MD, PhD ,&nbsp;Mudiaga Sowho MD, MPH ,&nbsp;Elizabeth C. Katz PhD ,&nbsp;Alan R. Schwartz MD","doi":"10.1016/j.chpulm.2024.100116","DOIUrl":"10.1016/j.chpulm.2024.100116","url":null,"abstract":"<div><h3>Background</h3><div>Inhaled medications are commonly used as therapy for obstructive lung disease (OLD); however, poor technique from pressurized metered dose inhalers (pMDIs) can severely limit drug delivery and therapeutic efficacy. A novel flow sensor has been developed to characterize inhalation flow profiles from pMDIs.</div></div><div><h3>Research Question</h3><div>Among patients with OLD, does recording flow profiles during pMDI inhalation maneuvers expose poor patterns of pMDI use, which can be used to remediate pMDI technique?</div></div><div><h3>Study Design and Methods</h3><div>A novel flow sensor was coupled with a placebo pMDI to characterize inhalation technique in 70 participants with OLD from a pulmonary clinic. pMDI inhalation flow profiles generated actuation timing, mean inspiratory airflow, and inspired volume before and after visualizing these features. McNemar test was used to characterize the impact of training on pMDI inhalation metrics. The postactuation inspired volume was normalized to inspiratory capacity.</div></div><div><h3>Results</h3><div>Among participants with a mean ± SD of 17.4 ± 17.9 years of pMDI use, flow profiles uncovered mistimed actuations in 47.1% and poor inspiratory flow rates in 30.0% of patients. After visualizing flow profiles, participants improved actuation timing (χ² =12.042; <em>P</em> &lt; .001), mean inhaled volume (87.9% to 105.6% of inspiratory capacity; <em>P</em> &lt; .001), and the combined inhalation metrics (χ² =8.45; <em>P</em> = .003<strong>).</strong></div></div><div><h3>Interpretation</h3><div>Flow profiles helped uncover and remediate specific defects in pMDI technique in most chronic users with OLD. Flow profiles from inhaled medications can be used to enhance drug delivery to the lung.</div></div><div><h3>Clinical Trial Registration</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>; No.: <span><span>NCT05495256</span><svg><path></path></svg></span>; URL: <span><span>www.clinicaltrials.gov</span><svg><path></path></svg></span></div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 3","pages":"Article 100116"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145018680","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":"Expiratory Time Constants in Patients Undergoing Routine Spirometry","authors":"Filip Depta MD, PhD ,&nbsp;Simona Bodnárová PhD ,&nbsp;Katarína Šurinová PhD ,&nbsp;Ivana Paraničová MD ,&nbsp;Eva Sokolová MD ,&nbsp;Erika Lombartová MD ,&nbsp;Pavol Pobeha MD, PhD","doi":"10.1016/j.chpulm.2025.100181","DOIUrl":"10.1016/j.chpulm.2025.100181","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 3","pages":"Article 100181"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048713","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":"What Sex-Specific Differences Tells Us About Additive vs Synergistic Risk Prediction in Asthma","authors":"Samuel Mailhot-Larouche MD,&nbsp;Philippe Lachapelle MD,&nbsp;Simon Couillard MD","doi":"10.1016/j.chpulm.2025.100134","DOIUrl":"10.1016/j.chpulm.2025.100134","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 3","pages":"Article 100134"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145018775","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 Great Mimicker, a Rare Pleural Presentation","authors":"Jack McCarthy MB BCh BAO, MRCPI ,&nbsp;Niamh Boyle MB BCh BAO, MRCPI ,&nbsp;Mark Coyne PhD, MB BCh BAO, MRCPI, FRCPath ,&nbsp;Cormac McCarthy MD, PhD, FRCPI","doi":"10.1016/j.chpulm.2025.100176","DOIUrl":"10.1016/j.chpulm.2025.100176","url":null,"abstract":"<div><h3>Case Presentation</h3><div>A 75-year-old woman presented to the emergency department of a regional hospital with progressive dyspnea for 3 months despite treatment with antibiotics and steroids in the community. There were no associated symptoms. No clear precipitating factors were identified. She did not smoke and had worked as an arable farmer but had no known exposures. Her medical history was remarkable for hypertension and a prophylactic hysterectomy 10 years previously due to a family history of ovarian cancer. Her medications included olmesartan, lansoprazole, and calcium supplements.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 3","pages":"Article 100176"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144920304","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":"Tracheobronchial Wall Thickening in a Patient With Inflammatory Bowel Disease","authors":"Jonathan Tse MD ,&nbsp;Kevyn Ramos Laguna MD ,&nbsp;Shuman Liu MD, PhD ,&nbsp;Evan Yung MD ,&nbsp;Chongiin Kim MD ,&nbsp;Patrick Chan MD","doi":"10.1016/j.chpulm.2025.100186","DOIUrl":"10.1016/j.chpulm.2025.100186","url":null,"abstract":"<div><h3>Case Presentation</h3><div>A 43-year-old woman, born in Mexico, with a history of idiopathic thrombocytopenic purpura status after splenectomy and inflammatory bowel disease (IBD) favoring Crohn disease previously complicated by cytomegalovirus (CMV) colitis, presented with worsening abdominal and rectal pain. Over the past 6 months, she had 3 hospitalizations for biopsy-confirmed IBD flares, during which her immunosuppressive regimen was sequentially intensified from azathioprine and infliximab to high-dose corticosteroids and ultimately to upadacitinib for refractory disease.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 3","pages":"Article 100186"},"PeriodicalIF":0.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144913160","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":"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}