CHEST pulmonary最新文献

{"title":"Remote Patient Monitoring for Managing Interstitial Lung Disease","authors":"Genevieve Gillett MD ,&nbsp;Rupal J. Shah MD ,&nbsp;Alison M. DeDent MD ,&nbsp;Erica Farrand MD","doi":"10.1016/j.chpulm.2024.100122","DOIUrl":"10.1016/j.chpulm.2024.100122","url":null,"abstract":"<div><h3>Background</h3><div>Hybrid health care delivery uses a combination of in-person and telehealth visits to deliver interstitial lung disease (ILD) care efficiently and flexibly. However, assessments of ILD activity and progression can be limited during telehealth visits. Remote patient monitoring (RPM) is an effective approach to evaluating ILD trajectories. However, in the United States, there has been limited uptake of RPM into ILD care models.</div></div><div><h3>Research Question</h3><div>Can we define patient-level facilitators and barriers to implementing RPM into routine ILD care?</div></div><div><h3>Study Design and Methods</h3><div>RPM data from spirometers and pulse oximeters were collected weekly from participants with newly diagnosed ILD. Additional data were collected using surveys and qualitative interviews in a parallel convergent mixed-methods design, reflexively analyzed for themes, and integrated using a triangulation protocol.</div></div><div><h3>Results</h3><div>Sixty participants had a median age of 74 years; most were male (59%), White (60.7%), and diagnosed with idiopathic pulmonary fibrosis (50%). Adherence to weekly device use was high (90%) and participants thought RPM was an important (90%) and sustainable (87%) part of ILD care. Key barriers to RPM use included difficulty with spirometry technique, communication of results, and result interpretation.</div></div><div><h3>Interpretation</h3><div>Our results indicate that RPM is a feasible, valuable, and sustainable component of routine ILD care. Applying an implementation science framework, patient-level barriers would be best addressed through (1) supervised device setup, (2) more efficient and frequent communication, and (3) improved patient education. Addressing these barriers may facilitate more widespread and successful implementation of RPM, with the potential to greatly improve patient engagement in ILD care.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 1","pages":"Article 100122"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620845","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":"Reevaluating the Role of Bronchoscopy Prior to Bronchial Artery Embolization in Nonintubated Patients With Hemoptysis Due to Bronchiectasis and Chronic Pulmonary Infection","authors":"Takashi Nishihara MD ,&nbsp;Hideo Ishikawa MD ,&nbsp;Kazunari Tsuyuguchi MD, PhD ,&nbsp;Shoichi Fukuda MD, PhD ,&nbsp;Hiromitsu Sumikawa MD, PhD","doi":"10.1016/j.chpulm.2024.100128","DOIUrl":"10.1016/j.chpulm.2024.100128","url":null,"abstract":"<div><h3>Background</h3><div>When performing bronchial artery embolization (BAE), identifying the side of bleeding and thereby deciding the side of embolization is crucial for an effective and safe procedure. However, there is little evidence regarding the utility of bronchoscopy for determining the side of embolization prior to BAE in nonintubated patients with hemoptysis admitted to general wards.</div></div><div><h3>Research Question</h3><div>Is bronchoscopy necessary prior to BAE in nonintubated patients with hemoptysis following bronchiectasis and chronic pulmonary infection?</div></div><div><h3>Study Design and Methods</h3><div>Data from 93 consecutive nonintubated general ward patients with bronchiectasis and chronic pulmonary infection (nontuberculous mycobacteriosis, aspergillosis, and TB) who underwent de novo BAE from September 2017 to August 2023 were retrospectively reviewed. The contribution of bronchoscopy in deciding the side of embolization was evaluated.</div></div><div><h3>Results</h3><div>All patients underwent CT imaging and 27 also underwent bronchoscopy. Bronchoscopy identified the sides of bleeding in 9 patients, but these sides could be correctly estimated in 8 of them from the CT information alone. Bronchoscopy did not reveal the side of bleeding in 18 patients, whose sides of embolization were decided using CT imaging and angiographic information. Of 66 patients without bronchoscopy, the sides of embolization were decided in 63 patients using CT imaging and angiographic information, but the priority of the embolization side could not be decided in the remaining 3 patients. Overall, 96% (89 of 93) of patients did not require bronchoscopy as part of their embolization plan. The 90-day overall survival and hemoptysis-free survival rates were 98.9% (95% CI, 92.5-99.8) and 92.3% (95% CI, 84.6-96.3), respectively.</div></div><div><h3>Interpretation</h3><div>This study showed that bronchoscopy contributed little to the planning of BAE in nonintubated patients with hemoptysis following bronchiectasis and chronic pulmonary infection. Our findings do not support the routine use of bronchoscopy prior to BAE in this population.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 1","pages":"Article 100128"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143611669","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":"Spot On","authors":"Bryan S. Benn MD, PhD ,&nbsp;Hasnain Bawaadam MD, MPH ,&nbsp;Elizabeth M. Colwell MD ,&nbsp;Matthew D. Peterson PA-C ,&nbsp;William B. Tisol MD ,&nbsp;Abesh Niroula MD ,&nbsp;Wissam S. Jaber MD ,&nbsp;Onkar V. Khullar MD ,&nbsp;Kelly Daymude AGACNP-BC, MSN, CCRN ,&nbsp;Chinh T. Phan DO ,&nbsp;Luis A. Godoy MD ,&nbsp;Devon Anderson MD ,&nbsp;Michelle Lagana RN, BSN ,&nbsp;Elizabeth A. Yu MD, PhD ,&nbsp;Tomomi Oka MD ,&nbsp;Mendy Lum BS, RRT ,&nbsp;Pallav L. Shah MD ,&nbsp;Ganesh Krishna MD","doi":"10.1016/j.chpulm.2024.100131","DOIUrl":"10.1016/j.chpulm.2024.100131","url":null,"abstract":"<div><h3>Background</h3><div>Peripheral pulmonary lesions (PPLs) are increasingly identified and often require a tissue diagnosis to guide treatment. Although a surgical resection may combine diagnosis and treatment, it may lead to excessive healthy tissue being removed if the lesion is difficult to localize. Bronchoscopic PPL marking before surgery facilitates this process, but it is limited by current technologies. Advances in procedural techniques may improve this process.</div></div><div><h3>Research Question</h3><div>What is the impact of using indocyanine green-soaked fiducial markers (ICG-Fs) to mark PPLs before surgery compared with unmarked resected PPLs?</div></div><div><h3>Study Design and Methods</h3><div>A retrospective review of patients from 4 institutions with PPLs undergoing bronchoscopy with ICG-F marking (54 nodules) before resection were compared with unmarked nodules (63 nodules). Demographic data, nodule characteristics, procedural and surgical information, and final pathology results were obtained.</div></div><div><h3>Results</h3><div>Demographics were similar between the groups. PPLs were smaller in the ICG-F marked group (axial: ICG-F marked: 14.39 ± 5.39 vs unmarked: 20.31 ± 14.24 mm; <em>P</em> = .0036; coronal: ICG-F marked: 12.66 ± 5.13 vs unmarked: 16.43 ± 10.51 mm; <em>P</em> = .0214). All ICG-F marked lesions were visible with illumination at surgery immediately after bronchoscopy or up to 13 days later. Mean weight (58 ± 77 vs 145 ± 80 g; <em>P</em> &lt; .001) and size (9.07 ± 6.0 × 4.73 ± 3.6 × 2.42 ± 1.23 vs 14.63 ± 6.08 × 8.70 ± 4.36 × 4.08 ± 1.94 mm; <em>P</em> &lt; .001 for all) of the resected ICG-F specimens were significantly decreased compared with unmarked PPLs. Operative time was increased in the ICG-F marked group (165 ± 53 vs 136 ± 43 minutes; <em>P</em> = .0021).</div></div><div><h3>Interpretation</h3><div>Our findings indicate that ICG-F is a safe and accurate procedure to facilitate lung sparing surgery of otherwise undetectable PPLs immediately after bronchoscopic placement or up to 13 days later.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 1","pages":"Article 100131"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620848","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":"Treatment With Bilevel PAP Is Associated With a Reduction in Severe Exacerbations in COPD-OSA Overlap","authors":"Daniela Téllez MPH ,&nbsp;Ann Cameron PhD ,&nbsp;Fatima Sert-Kuniyoshi PhD ,&nbsp;Peter Cistulli MD, PhD ,&nbsp;Jean Louis Pépin MD ,&nbsp;Adam V. Benjafield PhD ,&nbsp;Atul Malhotra MD ,&nbsp;medXcloud Group,&nbsp;Victoria M. Pak PhD","doi":"10.1016/j.chpulm.2024.100114","DOIUrl":"10.1016/j.chpulm.2024.100114","url":null,"abstract":"<div><h3>Background</h3><div>There are no guidelines for OSA assessment in patients with COPD. Home noninvasive ventilation (NIV) studies have excluded patients with comorbid OSA. Thus, it is unclear whether home NIV is associated with reduced exacerbation risk in patients with overlap syndrome.</div></div><div><h3>Research Question</h3><div>Does home NIV impact the rate of severe exacerbations in patients with overlap syndrome 1 year after therapy initiation?</div></div><div><h3>Study Design and Methods</h3><div>A retrospective analysis was performed on administrative claims data from patients with COPD and OSA who received an NIV device claim between 2015 and 2020. Patients were characterized 1 year before NIV initiation and 1 year after NIV initiation. A modified Poisson regression model was built to identify predictors for severe exacerbation occurrence during follow-up.</div></div><div><h3>Results</h3><div>A total of 23,992 patients were included in the analysis (mean age, 61.3 ± 10.1 years; 44.9% female). The proportion of patients with ≥ 1 severe exacerbation was 10.2% in the year before NIV initiation and 5.9% in the year after NIV initiation (χ² = 440.5; <em>P</em> &lt; .0001). Occurrence of a severe exacerbation in the year prior to NIV was associated with a nearly five-fold higher risk of severe exacerbation during follow-up (risk ratio, 4.91; 95% CI, 4.39-5.48; <em>P</em> &lt; .0001). Heart failure, pneumonia, and anxiety were the comorbidities most associated with increased severe exacerbation risk.</div></div><div><h3>Interpretation</h3><div>To our knowledge, this is the first study to describe risk factors for severe exacerbations and to examine home NIV claims in this specific population. Results may be informative for overlap syndrome management, especially for preventing a first severe exacerbation and for the treatment of OSA as part of COPD management. Additional information is needed to optimize the access, timing, and benefits of NIV treatment in patients with overlap syndrome.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 1","pages":"Article 100114"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143563141","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":"Feasibility and Pathologic Outcomes of Peripheral Lung Vascular Targeted Photodynamic Therapy in a Normal Porcine Lung Model","authors":"Jason Beattie ,&nbsp;Mario Ghosn ,&nbsp;Kwanghee Kim ,&nbsp;Raymond Parrish ,&nbsp;Jie Chen ,&nbsp;Stephen B. Solomon ,&nbsp;Sebastien Monette ,&nbsp;Christopher Cheleuitte-Nieves ,&nbsp;Reza Bergemann ,&nbsp;Mohit Chawla ,&nbsp;Bryan C. Husta ,&nbsp;Or Kalchiem-Dekel ,&nbsp;Yaniv Cohen ,&nbsp;Dina Preise ,&nbsp;Zachary Sacks ,&nbsp;Avigdor Scherz ,&nbsp;Lonny Yarmus ,&nbsp;Jonathan A. Coleman ,&nbsp;Robert P. Lee","doi":"10.1016/j.chpulm.2024.100098","DOIUrl":"10.1016/j.chpulm.2024.100098","url":null,"abstract":"<div><h3>Background</h3><div>Bronchoscopic ablation of tumors in the lung periphery may offer unique advantages over traditional surgical resection or radiation. Bronchoscopic vascular targeted photodynamic therapy (VTP) is a second-generation photodynamic therapy that avoids excessive tissue extravasation and is rapidly cleared from the circulation. These advantages avoid prolonged photosensitivity and allow for infusion and illumination within the same procedure. The treatment effect and systemic inflammatory response precipitated by VTP may prove advantageous for anticancer effects, alone or in combination with immune oncology therapies.</div></div><div><h3>Research Question</h3><div>A baseline understanding of this modality’s effect on lung parenchyma is needed to provide further guidance toward its potential as a method for bronchoscopic ablation of lung tumors. We report on our initial experimentation with bronchoscopic lung VTP in normal pigs.</div></div><div><h3>Study Design and Methods</h3><div>We performed conventional bronchoscopy for deployment of optical fibers into the peripheral lung. We then infused the photosensitizer WST11 after which we immediately performed illumination of the optical fibers.</div></div><div><h3>Results</h3><div>Our results across 13 pigs with varied survival (between 1 day and 30 days) demonstrate initial feasibility and reasonable safety. Posttreatment radiology and pathology support measurable ablation fields and expected post-VTP changes.</div></div><div><h3>Interpretation</h3><div>Our preclinical evidence provides early rationale for the study of safety and feasibility of bronchoscopic VTP ablation of peripheral lung cancers in humans.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 1","pages":"Article 100098"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143578831","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":"Community-Engaged Development of Equitable and Scalable Mobile Health Tools for Tobacco Treatment","authors":"Joanna L. Hart MD ,&nbsp;Tamar Klaiman PhD, MPH ,&nbsp;Michael Scott BS ,&nbsp;George M. Fernandez ,&nbsp;Dorothy Sheu MPH ,&nbsp;Aerielle Belk BS ,&nbsp;Jasmine A. Silvestri MPH ,&nbsp;Jannie Kim MPH ,&nbsp;Scott D. Halpern MD, PhD ,&nbsp;Nsenga Farrell EdD, MA","doi":"10.1016/j.chpulm.2024.100127","DOIUrl":"10.1016/j.chpulm.2024.100127","url":null,"abstract":"<div><h3>Background</h3><div>Tobacco use has a disproportionate impact on older, medically underserved adults. Mobile health (mHealth) tools hold promise for increasing reach of treatment options, yet introduce new barriers to access and use.</div></div><div><h3>Research Question</h3><div>How can investigators incorporate patient and community input into the design and testing of accessible, scalable, and equity-promoting mHealth tobacco treatment tools?</div></div><div><h3>Study Design and Methods</h3><div>We present a model for mHealth tobacco treatment tool development using a longitudinal community-partnered design process. We iteratively developed and refined tools used in a large, pragmatic trial. First, a stakeholder advisory committee (SAC) convened with members including individual patients and representatives from patient and health equity advocacy groups, community and government public health services, clinical program leads, and health system and insurance leaders. Second, we conducted a patient needs assessment to confirm or expand on SAC recommendations using semistructured interviews among patients meeting ≥ 1 medically underserved criteria who smoked tobacco daily. Transcribed interviews were coded and analyzed for patterns of patients’ desired design elements.</div></div><div><h3>Results</h3><div>The SAC recommended key strategies to promote cultural relevance of the tools, maximize engagement of participants, and prevent attrition, which were incorporated into the intervention and trial design. To further refine the approach, we completed interviews with 39 patients from November 2020 to September 2021. Many respondents used telemedicine tools with their clinicians yet were skeptical of their use for tobacco treatment due to lack of facility with mobile technologies. Patients recommended direct support options, avoidance of novel smartphone applications, and customizable features.</div></div><div><h3>Interpretation</h3><div>We provide a model for patient-centered design that incorporates community engagement through longitudinal advisors and wider representation of patients. Longitudinal community engagement that incorporates broad patient perspectives facilitates effective development and deployment of mHealth tools to maximize responsiveness to patient and community needs.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 1","pages":"Article 100127"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620846","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":"Epidemiology and Clinical Outcomes of Cardiac Arrhythmias in Pulmonary Arterial Hypertension","authors":"Thanaboon Yinadsawaphan MD ,&nbsp;Mustafa Suppah MD ,&nbsp;Srekar N. Ravi MD ,&nbsp;Juan M. Farina MD ,&nbsp;Robert L. Scott MD, PhD ,&nbsp;Dan Sorajja MD","doi":"10.1016/j.chpulm.2024.100132","DOIUrl":"10.1016/j.chpulm.2024.100132","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac arrhythmias can exacerbate symptoms and potentially lead to death in patients with pulmonary hypertension. However, there is limited evidence regarding the impact of cardiac arrhythmias in patients with pulmonary arterial hypertension (PAH).</div></div><div><h3>Research Question</h3><div>What are the prevalence, incidence, and impact of arrhythmias in patients with PAH?</div></div><div><h3>Study Design and Methods</h3><div>In a retrospective cohort study including 512 patients with PAH from 2001 to 2021 at 3 Mayo Clinic sites, demographic data at PAH diagnosis and clinical outcomes over a 10-year period were collected. The patients with PAH were categorized into 3 groups based on arrhythmic onset: (1) patients with arrhythmia before PAH diagnosis, (2) patients diagnosed with arrhythmia during PAH follow-up, and (3) patients without arrhythmia during PAH follow-up. Survival outcomes were analyzed using multivariable Cox proportional hazards regression, adjusted with the REVEAL 2.0 risk score.</div></div><div><h3>Results</h3><div>Among the 512 patients with PAH (mean age, 56.1 years; 81.8% female), the prevalence of cardiac arrhythmias at PAH diagnosis was 10.5%, consisting of atrial fibrillation (7%), atrial flutter (2%), and supraventricular tachycardia (0.8%). The cumulative incidences of new-onset arrhythmias at 1, 5, and 10 years were 6%, 18%, and 29%, respectively. Patients with arrhythmia diagnosed before and after PAH diagnosis exhibited significantly higher all-cause mortality rates with adjusted hazard ratio of 2.06 (95% CI, 1.36-3.12) and 1.57 (95% CI, 1.17-2.20), respectively. Similarly, both arrhythmic groups demonstrated shorter median time to the first all-cause hospitalization (9.5 and 15.9 vs 21.2 months) and a higher number of all-cause hospitalizations (0.38 and 0.64 vs 0.10 times per year) compared with the nonarrhythmic group.</div></div><div><h3>Interpretation</h3><div>Our results demonstrate that cardiac arrhythmias can develop in nearly one-third of patients with PAH within 10 years of PAH diagnosis and independently contribute to increased hospitalization frequency and mortality, in addition to the current REVEAL 2.0 risk score.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 1","pages":"Article 100132"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620847","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 Oxygen Saturation on Home Pulse Oximetry With Telephone Triage Decision","authors":"Diana C. Bouhassira MD ,&nbsp;Taylor Bernstein MPH ,&nbsp;Ashraf Fawzy MD, MPH ,&nbsp;Theodore J. Iwashyna MD, PhD ,&nbsp;Mariah L. Robertson MD, MPH","doi":"10.1016/j.chpulm.2024.100129","DOIUrl":"10.1016/j.chpulm.2024.100129","url":null,"abstract":"<div><h3>Background</h3><div>Given limited tools for objective assessment during telephone triage, home pulse oximeters may augment clinical decision-making in patients with respiratory conditions. However, there are well-documented concerns about clinically significant, race-discrepant pulse oximetry error.</div></div><div><h3>Research Question</h3><div>Is home pulse oximetry incorporated into telephone triage decision-making and is it associated with triage disposition?</div></div><div><h3>Study Design and Methods</h3><div>In this retrospective study, we reviewed electronic medical record documentation regarding telephone calls to the pulmonary clinic triage line at a university-affiliated tertiary care center. All adults who called the triage line with an acute complaint between May 1, 2023, and October 31, 2023, were included. We tested the association between reported abnormal oxygen saturation and triage decision.</div></div><div><h3>Results</h3><div>A total of 118 telephone triage notes were reviewed. Median patient age was 50 years (interquartile range, 34-62), with 85 calls (72%) from White patients and 24 calls (20%) from Black patients. Of the calls, 70% (n = 83) were for respiratory symptoms. Pulse oximeter use was reported in 29 notes. No notes documented consideration of factors that might influence pulse oximeter accuracy. Among calls for respiratory symptoms, 24 (29%) discussed home pulse oximetry. Twenty-one calls (18%) were referred to the emergency department or hospital, and 12 (10%) were referred for an urgent visit. In multivariable analysis, patients with respiratory symptoms and peripheral oxygen saturation &lt; 90% had 22.3 times the odds (95% CI, 1.9-258.9; <em>P</em> = .01) of being triaged to in-person care.</div></div><div><h3>Interpretation</h3><div>In this study, providers documented home pulse oximetry readings in 1 in 3 patients calling the pulmonary triage line with respiratory symptoms. Patients with abnormal oxygen saturation were more likely to be triaged to in-person evaluation. Given the current state of widely available, variably accurate, and racially biased pulse oximeters, there is an opportunity for standardization of how triaging providers assess home pulse oximetry data and counsel patients on their limitations.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 1","pages":"Article 100129"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143611684","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":"Health State Utilities Associated With Treatment Burden in Cystic Fibrosis","authors":"Rory A. Cameron PhD, MScPH ,&nbsp;Jessie Matthews MSc ,&nbsp;Daniel Office BSc ,&nbsp;Mark Rowley ,&nbsp;Janice Abbott PhD ,&nbsp;Nicholas J. Simmonds MD ,&nbsp;Jennifer A. Whitty PhD ,&nbsp;Siobhán B. Carr MBBS, MSc","doi":"10.1016/j.chpulm.2024.100097","DOIUrl":"10.1016/j.chpulm.2024.100097","url":null,"abstract":"<div><h3>Background</h3><div>Although recent advancements in the treatment of cystic fibrosis (CF) have improved survival, reducing high levels of treatment burden remains a priority issue for many people with cystic fibrosis (pwCF). However, economic evaluations of novel interventions may fail to capture their impact on treatment burden due to a lack of suitable outcome measures. This study aimed to estimate health state utilities (HSUs) for changes in treatment burden associated with different CF treatments.</div></div><div><h3>Research Question</h3><div>What value do pwCF place on changes in treatment burden associated with IV antibiotic treatment of pulmonary exacerbations, use of inhaled medicines, and physiotherapy?</div></div><div><h3>Study Design and Methods</h3><div>Adults attending a specialist CF center were invited to participate in a web-based time trade-off interview. Participants valued their own health and five health state vignettes describing varying levels of intensity of physiotherapy, use of inhaled medicines, and IV antibiotic treatment. HSUs for additional instances of each treatment type were estimated using mixed effect linear regression models.</div></div><div><h3>Results</h3><div>Fifty one pwCF completed the interview (median age, 30 years; range, 19-66); 53% were female; mean FEV₁ % predicted was 65% (SD, 20%). Mean utility scores for own health were very similar between the EQ-5D index value (0.81; SD, 0.20) and the time trade-off value (0.82; SD, 0.20); however, limited concordance was observed at the individual level. Adjusted utility decrements associated with treatment burden were −0.037 (SE, 0.008) for an additional annual IV antibiotic treatment, −0.029 (SE, 0.014) for an additional daily physiotherapy session, and −0.019 (SE, 0.013) for an additional daily inhaled medicine.</div></div><div><h3>Interpretation</h3><div>In this study, increasing treatment burden was associated with decreasing HSU values. The utility decrements associated with treatment burden changes suggest meaningful differences in health-related quality of life for pwCF. These findings align with existing literature on the impact of treatment burden on health-related quality of life, and highlight the importance of considering treatment burden in economic evaluations of interventions in CF.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 1","pages":"Article 100097"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620843","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":"Validation of a High-Specificity Blood Autoantibody Test to Detect Lung Cancer in Pulmonary Nodules","authors":"Kathryn J. Long MD ,&nbsp;Gerard A. Silvestri MD ,&nbsp;Michael N. Kammer PhD ,&nbsp;Sarah Gibbs MD ,&nbsp;Wei Wu MD, PhD ,&nbsp;Monica Johal MPH ,&nbsp;Sudhakar Pipavath MD ,&nbsp;Trevor Pitcher PhD ,&nbsp;James Jett MD ,&nbsp;Viswam S. Nair MD","doi":"10.1016/j.chpulm.2024.100130","DOIUrl":"10.1016/j.chpulm.2024.100130","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary nodules (PNs) are frequently detected by chest CT scan, which is increasingly used in clinical practice. Accurately identifying malignant nodules can pose a diagnostic challenge; therefore, a high-specificity biomarker could help clinicians identify malignant nodules and ideally lead to the earlier diagnosis of lung cancer.</div></div><div><h3>Research Question</h3><div>What are the performance characteristics of a blood-based biomarker for identifying malignancy in patients with a CT-detected PN?</div></div><div><h3>Study Design and Methods</h3><div>Banked plasma samples from 2 independent prospective observational cohorts of patients presenting with benign or malignant PNs 8 to 30 mm in size were tested using a 7-autoantibody panel. Sensitivity, specificity, and positive predictive value of the autoantibody test (AAT) to identify cancer were calculated for the individual and combined cohorts.</div></div><div><h3>Results</h3><div>Overall, 447 patients (263 and 184 from each cohort) were included in the analysis with a prevalence of malignancy of 55%. The performance of the AAT between the 2 cohorts was similar. The AAT demonstrated a specificity of 90% (95% CI, 85%-93%), a positive predictive value of 66% (95% CI, 52%-77%), sensitivity of 16% (95% CI, 12%-22%), and false-positive rate of 10% in the combined cohort. Using a pretest probability of cancer cutoff of 20% improved the positive predictive value to 76% (95% CI, 61%-88%) and resulted in a 52% decrease in the number of false-positive test results. In the subset of patients who had 18F-fluorodeoxyglucose PET imaging performed for clinical purposes (n = 222), specificity of the AAT was higher (93% vs 58%, <em>P</em> &lt; .001), but the sensitivity was lower than 18F-fluorodeoxyglucose PET scan (17% vs 75%, <em>P</em> &lt; .001).</div></div><div><h3>Interpretation</h3><div>This study validates the specificity of a blood-based autoantibody biomarker for identifying malignancy in patients with indeterminate PNs. This rule-in biomarker may help to expedite workup of malignant nodules.</div></div><div><h3>Clinical Trial Registration</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>; No.: NCT01752114; URL: <span><span>www.clinicaltrials.gov</span><svg><path></path></svg></span></div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 1","pages":"Article 100130"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620849","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}