CHEST pulmonary最新文献

{"title":"Pancytopenia and Progressive Breathlessness in a 48-Year-Old Man With a Reversed Halo Sign on Imaging","authors":"Rakesh Kodati MD, DM ,&nbsp;Narendra Kumar Narahari MD ,&nbsp;Shantveer G. Uppin MD ,&nbsp;Umabala Pamidimukkala MD ,&nbsp;Sukanya Sudhaharan MD ,&nbsp;Bhaskar Kakarla MD ,&nbsp;Paramjyothi Gongati MD","doi":"10.1016/j.chpulm.2024.100088","DOIUrl":"10.1016/j.chpulm.2024.100088","url":null,"abstract":"<div><h3>Case Presentation</h3><div>A 48-year-old man with no prior medical comorbidities was admitted to our pulmonology department with progressive breathlessness, dry cough, and low-grade fever of 2 months’ duration. Breathlessness was of insidious onset and progressed gradually from level 1 to level 4 on the modified Medical Research Council scale over 2 months. He did not report any orthopnoea or paroxysmal nocturnal dyspnea. The cough did not have any allergic triggers and had no diurnal variation. He had on-and-off low-grade fever with no specific pattern. He had no history of smoking and had no other substance dependencies. He was evaluated initially at a primary care centre with a chest CT scan, which showed patchy distribution of ground-glass opacities (GGOs) with no lobar predilection and random nodules in the left upper lobe. It also showed round lesions in the right upper lobe with central GGOs surrounded by a rim of consolidation suggestive of reversed halo sign (RHS). Routine blood investigation findings (complete blood count and kidney and liver functions tests) were normal. He was advised to undergo a lung biopsy for definite diagnosis, but he declined to do so. A provisional diagnosis of organizing pneumonia was made based on the CT scan findings of RHS and oral glucocorticoids administration was started. No clinical improvement was seen after 1 month of steroid therapy, and he was referred to us.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 4","pages":"Article 100088"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141845807","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":"Interventions to Improve Quality of Life and Knowledge in Hypersensitivity Pneumonitis","authors":"Kerri I. Aronson MD ,&nbsp;Nancy Holbrook MD ,&nbsp;Armani Edgar BS ,&nbsp;Michaela R. Anderson MD ,&nbsp;Jamuna K. Krishnan MD ,&nbsp;Robert J. Kaner MD ,&nbsp;Anna J. Podolanczuk MD ,&nbsp;Fernando J. Martinez MD ,&nbsp;Jonathan N. Tobin PhD ,&nbsp;Monika M. Safford MD","doi":"10.1016/j.chpulm.2024.100083","DOIUrl":"10.1016/j.chpulm.2024.100083","url":null,"abstract":"<div><h3>Background</h3><div>Behavioral and educational interventions are promising approaches to improve health-related quality of life (HRQOL); however, few have been studied in hypersensitivity pneumonitis (HP) or other interstitial lung diseases (ILDs). The objective of this study was to gather ILD clinicians’ current practices and perspectives on the management of HRQOL and disease-specific education in HP, level of knowledge about, and attitudes toward behavioral and educational interventions and to identify potential clinician-perceived barriers to address during intervention development.</div></div><div><h3>Study Question</h3><div>What are the current practices and perspectives of ILD clinicians regarding the management of HRQOL and disease-specific education, and what is their level of knowledge about and attitude toward a potential virtual behavioral and educational intervention to address HRQOL in HP?</div></div><div><h3>Study Design and Methods</h3><div>An electronic survey was administered to ILD clinicians across the United States. Survey data were analyzed using descriptive statistics, and open-ended questions were analyzed using qualitative content analysis.</div></div><div><h3>Results</h3><div>Seventy-four clinicians responded to the survey, of whom 93% identified as physicians. All respondents (100%) indicated that offering an intervention to improve HRQOL in their patients with HP is either very important or absolutely essential. Only 5% of clinicians reported currently using a validated assessment tool to measure HRQOL. When asked about specific behavioral intervention techniques, most clinicians (92%) reported possessing a small amount of or zero knowledge about peer coaching interventions and a small amount of or zero knowledge (69%) about cognitive behavioral therapy principles. Despite this, most clinicians (68%) desire the ability to educate their patients about these potentially effective behavioral interventions, and most clinicians (67%) indicated the desire to reinforce the principles of an intervention after completion. Perceived barriers to referring patients to a virtually delivered behavioral intervention included time constraints, availability and access for all patients, cost and reimbursement, and difficulty with technology.</div></div><div><h3>Interpretation</h3><div>Clinicians in this survey unanimously agree that interventions to improve HRQOL and knowledge are needed for people living with HP. Clinicians’ desire for involvement in education, referral, and reinforcement of these interventions will require clinician education in behavioral strategies and implementation-related strategies early in the development process.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 4","pages":"Article 100083"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141690120","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":"Impact of Pirfenidone on Patient-Reported Outcomes in Patients With Idiopathic Pulmonary Fibrosis From the Pulmonary Fibrosis Foundation Patient Registry","authors":"Mohleen Kang MD, MS ,&nbsp;Sachin Gupta MD ,&nbsp;Yi-Hsuan Tu PhD ,&nbsp;Karina Raimundo MS ,&nbsp;Anisha M. Patel PhD ,&nbsp;Kevin R. Flaherty MD","doi":"10.1016/j.chpulm.2024.100082","DOIUrl":"10.1016/j.chpulm.2024.100082","url":null,"abstract":"<div><h3>Background</h3><div>Patients with idiopathic pulmonary fibrosis (IPF) experience debilitating symptoms. Although antifibrotics may slow lung function decline, their impact on patients’ health-related quality of life and disease symptoms in the real world remains unknown.</div></div><div><h3>Research Question</h3><div>What is the impact of pirfenidone vs no treatment on health-related quality of life and IPF-related symptoms of cough, dyspnea, and fatigue?</div></div><div><h3>Study Design and Methods</h3><div>This retrospective analysis included patients with IPF aged ≥ 55 years enrolled in the Pulmonary Fibrosis Foundation Patient Registry between March 2016 and December 2021. Change from baseline in patient-reported outcome measures (PROMs), including the Leicester Cough Questionnaire, University of California, San Diego Shortness of Breath Questionnaire (UCSD SOBQ), Fatigue Severity Scale, and Short-Form 6-Dimension questionnaire were assessed at months 6, 12, and 18 in patients receiving pirfenidone vs no treatment. A marginal structure model accounted for time-varying confounding caused by FVC % predicted and diffusing capacity of the lungs for carbon monoxide % predicted.</div></div><div><h3>Results</h3><div>In the Leicester Cough Questionnaire population (n = 237; pirfenidone, n = 155; no treatment, n = 82), treatment groups differed in age, insurance, and FVC % predicted. In the unadjusted analyses, mean changes in PROMs differed numerically between treatment groups; however, based on the marginal structure model, no significant differences were found in adjusted mean changes in PROMs. When analyzed by Gender, Age, and Physiology score, a clinically meaningful reduction in worsening of pirfenidone vs no treatment was observed in the adjusted mean change of UCSD SOBQ score at month 12 in patients with Gender, Age, and Physiology score stage 2/3.</div></div><div><h3>Interpretation</h3><div>Similar to previous findings, the difference in UCSD SOBQ scores observed in this real-world analysis suggests that patients with more advanced IPF may experience less dyspnea when receiving pirfenidone vs no treatment. Further research is needed to confirm this finding.</div></div><div><h3>Trial Registry</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>; No.: NCT02758808; URL: <span><span>www.clinicaltrials.gov</span><svg><path></path></svg></span></div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 4","pages":"Article 100082"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141704494","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":"Lung Volume Changes in Stable Preterm Infants Weaned From Nasal CPAP to High Flow","authors":"Vanessa L. Büchler MD ,&nbsp;Vincent D. Gaertner MD ,&nbsp;Janine Thomann MD ,&nbsp;Dirk Bassler MD ,&nbsp;Christoph M. Rüegger MD","doi":"10.1016/j.chpulm.2024.100094","DOIUrl":"10.1016/j.chpulm.2024.100094","url":null,"abstract":"<div><h3>Background</h3><div>Weaning preterm infants off nasal CPAP (nCPAP) using nasal high-flow therapy has gained popularity. The effects of such a weaning strategy on lung volumes are unclear.</div></div><div><h3>Research Question</h3><div>How does the transition from nCPAP to high flow and varying flow levels affect lung volumes in stable preterm infants?</div></div><div><h3>Study Design and Methods</h3><div>This was a prospective cohort study in infants 30 to 35 weeks’ postmenstrual age. After a baseline period on nCPAP 5 cm H₂O, infants were switched to high flow 8 L/min for 30 minutes. The flow level was reduced by 2 L/min every 30 minutes to a minimum of 2 L/min and subsequently increased to the initial level of 8 L/min, followed by another nCPAP period. Using electrical impedance tomography, end-expiratory lung impedance as a proxy for end-expiratory lung volume (EELV) and cardiorespiratory parameters were recorded at each flow level and compared with baseline.</div></div><div><h3>Results</h3><div>Overall, 8,438 breaths from 19 infants were analyzed. EELV changed significantly during the study (<em>P</em> = .002), which was mainly attributable to a loss of EELV when high flow was reduced to 6 and 4 L/min and re-escalated to 4, 6, and 8 L/min. Apart from a reduction in minute ventilation (<em>P</em> = .004), no other significant changes were found in electrical impedance tomography ventilation parameters. Alterations in lung volume were accompanied by an increase in heart rate (<em>P</em> = .02) and a decrease in peripheral oxygen saturation/F<span>io</span>₂ ratio (<em>P</em> &lt; .001).</div></div><div><h3>Interpretation</h3><div>The results of this study indicate that the transition from nCPAP to high flow is likely to result in a reduced EELV, accompanied by physiological responses in heart rate and oxygenation. Despite a stepwise escalation to preweaning flow levels, we found that only partial recovery of lung volume losses was achievable with high flow.</div></div><div><h3>Clinical Trial Registration</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>; No.: <span><span>NCT05237622</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":"2 4","pages":"Article 100094"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143139934","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":"Outcomes and Clinical Practices in Follow-Up of Nonmalignant Pulmonary Nodules After Bronchoscopic Biopsy","authors":"Camilo A. Avendano ,&nbsp;Luis O. Gerena-Montano ,&nbsp;Jason A. Beattie ,&nbsp;Mihir S. Parikh ,&nbsp;Kai E. Swenson ,&nbsp;Adnan Majid ,&nbsp;Chenchen Zhang MD, PhD","doi":"10.1016/j.chpulm.2024.100112","DOIUrl":"10.1016/j.chpulm.2024.100112","url":null,"abstract":"<div><h3>Background</h3><div>Management of nonmalignant nodules after bronchoscopic biopsy lacks thorough investigation, leading to varied clinical approaches.</div></div><div><h3>Research Question</h3><div>What are the true-negative and false-negative rates of nonmalignant nodules by bronchoscopic biopsy, and what is the clinical practice pattern for follow-up?</div></div><div><h3>Study Design and Methods</h3><div>A retrospective review was conducted for pulmonary nodules biopsied via bronchoscopy between 2019 and 2020 revealing no malignancy. True-negative and false-negative rates were calculated. Clinical practice patterns for repeat biopsy and follow-up imaging studies were analyzed using time-to-event analysis. Covariates, including sex, age, smoking history, nodule size, maximum standardized uptake values, active cancer diagnosis, bronchoscopy type, and nodule pathologic findings, were evaluated for their impact on clinical decision-making.</div></div><div><h3>Results</h3><div>Among 136 patients with 139 nodules analyzed, only 39.6% of nodules were classified definitively as benign (true-negative rate), whereas 23.7% of nodules were deemed malignant (false-negative rate). Repeat biopsy was performed for 35.3% of nodules, and 66.9% of patients underwent follow-up CT imaging. Nodules initially diagnosed with suspicious or atypical pathologic results reached a final diagnosis (hazard ratio, 3.65; 95% CI, 1.33-9.99) earlier than those with nondiagnostic pathologic findings. Patients with such nodules underwent repeat biopsy sooner (χ² = 15.85; <em>P</em> = .000) and exhibited a trend toward earlier repeat CT scans (χ² = 5.93; <em>P</em> = .052).</div></div><div><h3>Interpretation</h3><div>After bronchoscopic biopsy, a 2-year follow-up revealed a notable lack of high true-negative rates for nonmalignant nodules, alongside significant false-negative rates. Diverse clinical practices, including repeat biopsy and follow-up CT scans, were observed in managing nonmalignant nodules.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 4","pages":"Article 100112"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143139932","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":"Chest Wall Deformities in Adults With Fibrotic Interstitial Lung Disease Related to Surfactant-Related Gene Mutations","authors":"Margot Delin MD ,&nbsp;Marie Pierre Debray MD ,&nbsp;Marie Legendre MD, PhD ,&nbsp;Lidwine Wemeau MD ,&nbsp;Bruno Crestani MD, PhD ,&nbsp;Emmanuel Brian MD ,&nbsp;Justine Frija-Masson MD, PhD ,&nbsp;Laurent Plantier MD, PhD ,&nbsp;Spyros A. Papiris MD ,&nbsp;Effrosyni D. Manali MD ,&nbsp;Nadia Nathan MD, PhD ,&nbsp;Raphael Borie MD, PhD","doi":"10.1016/j.chpulm.2024.100106","DOIUrl":"10.1016/j.chpulm.2024.100106","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 4","pages":"Article 100106"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143140057","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":"Cost-Effectiveness of Rapid On-Site Evaluation During Navigational Bronchoscopy","authors":"Greta J. Dahlberg MD ,&nbsp;Caroline M. Godfrey MD, MPH ,&nbsp;Stephen A. Deppen PhD ,&nbsp;Jacob Richardson ,&nbsp;Brent E. Heideman MD ,&nbsp;Ankush P. Ratwani MD ,&nbsp;Rafael Paez MD ,&nbsp;Kaele M. Leonard MD ,&nbsp;Samira Shojaee MD, MPH ,&nbsp;Robert J. Lentz MD ,&nbsp;Eric L. Grogan MD, MPH ,&nbsp;Fabien Maldonado MD","doi":"10.1016/j.chpulm.2024.100066","DOIUrl":"10.1016/j.chpulm.2024.100066","url":null,"abstract":"<div><h3>Background</h3><div>Peripheral pulmonary lesions (PPLs) are common, with &gt; 1.6 million PPLs incidentally identified in the United States annually. Navigational bronchoscopy (NB) is a cornerstone of the diagnostic evaluation of PPLs. Intraprocedural rapid on-site evaluation (ROSE) of biopsies obtained during NB is widely used, but the data for its utility are contradictory. The cost-effectiveness of ROSE has yet to be established; as such, ROSE currently has variable implementation between institutions and is not adequately reimbursed by payers.</div></div><div><h3>Research Question</h3><div>Is ROSE cost-effective during NB for PPLs from a third-party payer perspective?</div></div><div><h3>Study Design and Methods</h3><div>A cost-effectiveness model was constructed comparing NB for PPLs with vs without ROSE from a third-party payer perspective. The base case is a 60-year-old operative candidate with a 2-cm pulmonary nodule without radiographic mediastinal or hilar lymphadenopathy referred for NB. Cost per quality-adjusted life year gained was the primary outcome. Inputs for the model were estimated from published literature. One-way deterministic sensitivity analyses were conducted on all parameters. Probabilistic sensitivity analysis was performed.</div></div><div><h3>Results</h3><div>The use of ROSE resulted in a gain of 0.01 quality-adjusted life years and cost an additional $466. At a willingness-to-pay threshold of $100,000/life year, ROSE was cost-effective with an incremental cost-effectiveness ratio of $44,465.88. Sensitivity analyses on the sensitivity of NB with and without ROSE show that ROSE must increase the diagnostic sensitivity of the procedure by 3% to become cost-effective.</div></div><div><h3>Interpretation</h3><div>Our findings show that the use of ROSE during NB for PPLs is cost-effective for third-party payers at a willingness-to-pay threshold of $100,000/life year and should be reimbursed at a higher rate. The cost-effectiveness of ROSE hinges on the additional diagnostic sensitivity gained by using ROSE.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 4","pages":"Article 100066"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143139933","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":"Sleep Hypoxemia as a Predictor of Mortality in Patients with Sleep Apnea","authors":"Mohammad Masoudian Khouzani DDS, MPH ,&nbsp;Jack Botros DDS ,&nbsp;Mariela Padilla DDS, MEd ,&nbsp;Richard J. Castriotta MD, FCCP","doi":"10.1016/j.chpulm.2024.100087","DOIUrl":"10.1016/j.chpulm.2024.100087","url":null,"abstract":"<div><h3>Background</h3><div>The Sleep Heart Health Study (SHHS) was a prospective cohort study formulated to explore the risk factors for development of cardiovascular disease in OSA, diagnosed via unaccompanied home sleep apnea test. We used these data to compare the association of the apnea-hypopnea index (AHI) and amount of sleep hypoxemia with the risk of all-cause mortality.</div></div><div><h3>Research Question</h3><div>What is the relationship among hypoxemia, AHI, and mortality in OSA?</div></div><div><h3>Study Design and Methods</h3><div>We compared the association of (1) the AHI, (2) the percentage of sleep time with oxygen saturation &lt; 85% (PERC85), and (3) the duration of sleep (in minutes) with oxygen saturation &lt; 85% (MIN85) with the risk of all-cause mortality in the SHHS. Multivariable logistic regression analyses were used and adjusted for age, sex, BMI, pack-years of smoking, cardiovascular score at baseline, and treatment status.</div></div><div><h3>Results</h3><div>PERC85 was associated with an increased risk of death (OR, 1.03; 95% CI, 1.01-1.05; <em>P</em> = .003). Patients with PERC85 of 1% to 5%, 5% to 20%, and &gt; 20% showed progressively higher risks compared with those with PERC85 of &lt; 1% (1%-5%: OR, 1.37 [95% CI, 1.02-1.83]; 5%-20%: OR, 1.76 [95% CI, 1.07-2.86]; &gt; 20%: OR, 2.93 [95% CI, 1.20-6.98]; <em>P &lt; .</em>05 for all). The MIN85 predicted all-cause mortality (OR, 1.01 [95% CI, 1.00-1.01]; <em>P = .</em>009). Participants with 2 to 30 min and &gt; 30 min of PERC85 showed higher likelihoods of death vs those with PERC85 of &lt; 2 min (2-30 mins: OR, 1.29 [95% CI, 1.01-1.63]; &gt; 30 min: OR, 2.15 [95% CI, 1.22-3.76]; <em>P</em> &lt; .05 for all). AHI was not associated with an increased risk of mortality.</div></div><div><h3>Interpretation</h3><div>Our findings indicate that sleep hypoxemia with MIN85 is a better predictor of mortality in OSA than AHI. Monitoring oxygen saturation levels and duration may be important for risk stratification and assessment of treatment adequacy in OSA, although this may be confounded by hypoxemia not related to OSA.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 4","pages":"Article 100087"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141843509","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":"Safety, Efficacy, and Feasibility of Nebulized Long-Acting Bronchodilators vs Short-Acting Bronchodilators in Hospitalized Patients With Acute Exacerbations of COPD","authors":"Rajiv Dhand MD ,&nbsp;Samuel Treat MD ,&nbsp;Jennifer Ferris MSHS ,&nbsp;Paul D. Terry PhD ,&nbsp;Tracy Walker BA ,&nbsp;Scott Elder RRT ,&nbsp;Daniel Church RRT ,&nbsp;Danielle Dennis PharmD ,&nbsp;Barbara Faircloth PharmD ,&nbsp;Gulsah Onar MPH ,&nbsp;R. Eric Heidel PhD ,&nbsp;Isaac Biney MD ,&nbsp;Martin Valdes MD ,&nbsp;Milind Bhagat MBBS ,&nbsp;Nicholas Fuerst MD ,&nbsp;Shannon Cusick RN","doi":"10.1016/j.chpulm.2024.100105","DOIUrl":"10.1016/j.chpulm.2024.100105","url":null,"abstract":"<div><h3>Background</h3><div>Long-acting bronchodilators are preferred over short-acting bronchodilators in patients with stable COPD, but prospective studies are needed to determine the safety and efficacy of nebulized long-acting bronchodilators in hospitalized patients with exacerbations of COPD.</div></div><div><h3>Research Question</h3><div>In hospitalized patients with exacerbations of COPD, is a combination of nebulized long-acting formoterol/revefenacin as safe and effective as the short-acting nebulized albuterol/ipratropium combination?</div></div><div><h3>Study Design and Methods</h3><div>We conducted a prospective, randomized, parallel-group study comparing a nebulized formoterol/revefenacin combination with an albuterol/ipratropium combination among 60 hospitalized patients (30 in each group) with exacerbations of COPD who tested negative for COVID-19. Treatments were administered every 12 to 24 hours (formoterol/revefenacin) or every 6 hours (albuterol/ipratropium) by jet nebulizers for up to 7 days. Safety and efficacy assessments were recorded on days 1, 3, and 7, or at hospital discharge. Assessment of dyspnea by the Modified Borg dyspnea scale was the primary outcome. Data were analyzed with parametric or nonparametric statistical tests, and generalized estimating equations with an identity link function were used to analyze differences in the two groups. Statistical significance was assumed at an unadjusted two-sided alpha value of 0.05.</div></div><div><h3>Results</h3><div>Participants’ mean age was 63.2 (SD, 9.30) years, and 39 (65.0%) reported active tobacco use. Patients’ age, sex, race, smoking history, BMI, Charlson Comorbidity Index scores, supplemental oxygen requirements, and length of hospital stay were similar in the two groups (<em>P</em> &gt; .05 for all). Patients receiving formoterol/revefenacin had similar Modified Borg dyspnea scores (<em>P</em> = .95) and required fewer total drug doses (<em>P</em> &lt; .001), but there was a nonsignificant trend for more frequent rescue treatments (<em>P</em> = .08) compared with those receiving albuterol/ipratropium. There were no serious adverse events or treatment failures in either group.</div></div><div><h3>Interpretation</h3><div>Our findings indicate that in nonventilated hospitalized patients with exacerbations of COPD, the institution of nebulized formoterol/revefenacin in combination within 24 to 36 hours of hospital admission provided convenient dosing and required fewer drug doses to achieve comparable efficacy and safety with the standard short-acting nebulized albuterol/ipratropium combination.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 4","pages":"Article 100105"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143140055","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":"Evolution of Home Mechanical Ventilation in Sweden Over 27 Years","authors":"Andreas Palm MD, PhD ,&nbsp;Ludger Grote MD, PhD ,&nbsp;Jonas Einarsson MD ,&nbsp;Daniel Hansson MD ,&nbsp;Mirjam Ljunggren MD, PhD ,&nbsp;Josefin Sundh MD, PhD ,&nbsp;Magnus Ekström MD, PhD","doi":"10.1016/j.chpulm.2024.100108","DOIUrl":"10.1016/j.chpulm.2024.100108","url":null,"abstract":"<div><h3>Background</h3><div>Home mechanical ventilation (HMV), noninvasive ventilation and invasive ventilation outside a hospital setting, is a key treatment to improve outcomes in chronic hypoventilation.</div></div><div><h3>Research Question</h3><div>What are the temporal trends observed over 27 years in Sweden regarding the incidence, prevalence, diagnostic spectrum, and patient characteristics associated with HMV?</div></div><div><h3>Study Design and Methods</h3><div>This was a national population-based longitudinal analysis of the Course of Disease in Patients Reported to the Swedish CPAP Oxygen and Ventilator Registry (DISCOVERY) study of patients initiating HMV between 1996 and 2022. Time trends stratified by the underlying diagnosis group (lung disease, predominantly COPD, restrictive thoracal diseases, obesity hypoventilation syndrome [OHS], neuromuscular diseases, amyotrophic lateral sclerosis, and other neurologic disorders) were analyzed using linear regression models.</div></div><div><h3>Results</h3><div>We included 10,555 patients aged ≥ 16 years (mean age 63 [SD, 15] years; 50% women). Between 1996 and 1998 and 2020 and 2022, the HMV incidence increased threefold to 7 per 100,000 people, and the prevalence increased sixfold to 33 per 100,000 people. The most common indication for incident HMV shifted from restrictive thoracal diseases (35% in 1996-1998 to 3% in 2020-2022) to lung disease (14% to 31%), OHS (23% to 33%), and amyotrophic lateral sclerosis (4% to 14%) by 2020 to 2022 (<em>P</em> &lt; .001). The proportion of women increased from 47% to 54% (<em>P</em> &lt; .013) and the age at initiation of HMV increased from 58 [SD, 15] to 66 [SD, 14] years (<em>P</em> &lt; .001). Lung function measured as vital capacity at treatment start increased significantly in all diagnosis groups except for OHS, where both vital capacity and FEV₁ decreased. In the registry’s first and last 3-year periods, the proportion of patients ventilated invasively decreased from 10% to 2% (<em>P</em> &lt; .001).</div></div><div><h3>Interpretation</h3><div>In the 27 years until 2022, the incidence and prevalence of HMV in Sweden have increased markedly, patient demographics have changed, and use of invasive ventilation has decreased. The average age of patients initiated on HMV has increased, but treatment is started earlier in the disease trajectory.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 4","pages":"Article 100108"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143140062","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}