CHEST pulmonary最新文献

{"title":"Machines Are Learning Chest Auscultation. Will They Also Become Our Teachers?","authors":"Hans Pasterkamp MD ,&nbsp;Hasse Melbye MD, PhD","doi":"10.1016/j.chpulm.2024.100079","DOIUrl":"10.1016/j.chpulm.2024.100079","url":null,"abstract":"<div><div>Great strides in the development of machine learning techniques are bringing applications of artificial intelligence to ever more areas of clinical medicine. Their potential in the evaluation of visual images and in speech recognition is well established. Recently, the capabilities of machine hearing have been also applied to chest auscultation (ie, the automated analysis, characterization, and classification of heart and lung sounds). Comparing strengths and limitations of human vs machine hearing can help to put these developments in perspective. Humans have multisensory perception (ie, they receive visual and tactile information while auscultating). Humans also surpass machines in the ability to focus attention on listening for specific sounds in noisy environments. Together with information on a patient’s history and presumed medical diagnosis, and with frequent repetition, chest auscultation remains a trainable and valuable human skill. Advantages of machine hearing of chest sounds with digital stethoscopes include not only objective acoustic analysis but also storage of data that allows comparisons over time, presentation in audiovisual format, and wireless communication. Machines can support patient management by relating acoustic analyses to clinical diagnoses, serving as decision support for further investigations, and by monitoring of patients over time. The potential of machines to become teachers of chest auscultation is only now coming into focus. In the near future, assessment of chest sounds will largely remain in the domain of traditional acoustic stethoscopes. However, machines may well be used for training students in different health care professions and nonmedical caregivers, provided that humans remain part of the process.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 4","pages":"Article 100079"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143140056","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":"Use of Ketamine for Conscious Sedation in Flexible Bronchoscopy","authors":"Joshua M. Boster MD ,&nbsp;Steven T. Stoffel DO ,&nbsp;S. Michael Goertzen DO ,&nbsp;Melissa M. Rosas MD ,&nbsp;Jerome C. Edelson MD ,&nbsp;Michael J. Morris MD ,&nbsp;Robert J. Walter MD ,&nbsp;John C. Hunninghake MD ,&nbsp;Edward T. McCann MD ,&nbsp;Andrew M. Hersh MD ,&nbsp;Jess T. Anderson DO","doi":"10.1016/j.chpulm.2024.100109","DOIUrl":"10.1016/j.chpulm.2024.100109","url":null,"abstract":"<div><h3>Background</h3><div>Ketamine has both analgesic and sedative properties, combined with favorable hemodynamic effects, which makes it a theoretically ideal agent for bronchoscopic sedation. Studies in the adult population that demonstrate safety, efficacy, and patient/physician satisfaction are lacking. We hypothesized that ketamine is an effective alternative to standard moderate sedation (SMS) regimens used for bronchoscopic sedation and may be preferred by patients and physicians.</div></div><div><h3>Research Question</h3><div>Is ketamine an effective alternative to SMS for flexible fiberoptic bronchoscopy?</div></div><div><h3>Study Design and Methods</h3><div>A randomized controlled trial was conducted comparing ketamine to SMS using midazolam and fentanyl for outpatient flexible fiberoptic bronchoscopy from July 2019 to March 2022. Patients who met inclusion criteria were randomized to receive either ketamine or SMS for bronchoscopic sedation. This was a single-anonymized study and the primary outcome was patient satisfaction based on the Patient Satisfaction with Sedation Instrument.</div></div><div><h3>Results</h3><div>A total of 56 patients were enrolled with 28 randomized to each cohort. There was a significant increase in reported sedation side effects based on the Patient Satisfaction with Sedation Instrument (21.8 [SD 9.1] vs 17.0 [SD 5.6], <em>P</em> = .02) in the ketamine vs SMS cohorts respectively; however, global satisfaction was similar (5.4 [SD 4.6] vs 4.6 [SD 1.5], <em>P</em> = .38). Physician global satisfaction based on the Clinician Satisfaction with Sedation Instrument was significantly worse in the ketamine cohort (50.9 [SD 23.2] vs 35.0 [SD 10.8], <em>P</em> = .002), with significantly worse satisfaction scores in the sedation administration subset (26.7 [SD 12.5] vs 17.2 [SD 5.0], <em>P</em> ≤ .001) and secretions produced category (2.97 [SD 1.8] vs 1.93 [SD 1.6], <em>P</em> = .02). There were no significant differences in adverse events, and all procedures were completed successfully.</div></div><div><h3>Interpretation</h3><div>Our results indicate that ketamine is safe in adult patients undergoing flexible fiberoptic bronchoscopy. However, the use of ketamine was associated with increased patient-reported side effects and decreased physician satisfaction.</div></div><div><h3>Clinical Trial Registration</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>; No.: <span><span>NCT06181188</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 100109"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143140058","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":"Using Real-World Research to Study the Impact of Chronic Daily Therapy Discontinuation in Cystic Fibrosis","authors":"Bradley H. Rosen ,&nbsp;Kevin J. Psoter ,&nbsp;Kathryn A. Sabadosa ,&nbsp;Georgene E. Hergenroeder ,&nbsp;Lisa L. Bendy ,&nbsp;Nell Meosky Luo ,&nbsp;Connie Zhang ,&nbsp;Clement L. Ren ,&nbsp;Cynthia D. Brown MD","doi":"10.1016/j.chpulm.2024.100080","DOIUrl":"10.1016/j.chpulm.2024.100080","url":null,"abstract":"<div><h3>Background</h3><div>Chronic daily therapies (CDTs) are the foundation of clinical care for people with cystic fibrosis (CF), but these therapies impose considerable burden. In the era of elexacaftor/tezacaftor/ivacaftor (ETI) therapy, it is not clear if CDT discontinuation would lead to a greater decrease in lung function.</div></div><div><h3>Research Question</h3><div>In people with CF who are taking or about to start ETI, does CDT discontinuation lead to lower lung function at 12 months?</div></div><div><h3>Study Design and Methods</h3><div>People with CF who are aged 12 years or older and receiving or about to start ETI therapy were included in the Home-Reported Outcomes in Cystic Fibrosis 2 (HERO-2) study, an observational cohort study that used real-world research principles. Recruitment for HERO-2 used a multimodal approach consisting of recruitment sites, referral sites, and community-based strategies. The sole method of study engagement for participants was through the Folia Health application, which participants used to track CDT and symptoms, while completing monthly validated patient-reported assessments. Demographic and clinical data, including spirometry findings, were collected through linkage with the Cystic Fibrosis Foundation Patient Registry (CFFPR). The study was designed to detect a difference of 3% in FEV₁ % predicted between individuals who did and did not discontinue any CDT.</div></div><div><h3>Results</h3><div>The multimodal approach to recruitment and broad inclusion criteria allowed HERO-2 to recruit rapidly from &gt; 70 sites, including smaller affiliate centers and community-based outreach sites. The protocol is still being executed, with anticipated results to be published when the complete CFFPR data are available.</div></div><div><h3>Interpretation</h3><div>To our knowledge, HERO-2 is the first study in the population with CF that was designed using real-world research principles.</div></div><div><h3>Trial Registry</h3><div>ClinicalTrials.gov; No.: <span><span>NCT04798014</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 100080"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143140064","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":"A 59-Year-Old Man With a Pulmonary Cavity Containing Fungus Balls","authors":"Takafumi Kato MD, PhD ,&nbsp;Hiroshi Igei MD ,&nbsp;Mizuki Morota MD, PhD ,&nbsp;Takuma Yotsumoto MD, PhD ,&nbsp;Takeshi Fukami MD, PhD ,&nbsp;Masashi Kitani MD ,&nbsp;Akira Hebisawa MD, PhD ,&nbsp;Junko Suzuki MD ,&nbsp;Akira Watanabe MD, PhD ,&nbsp;Nobuharu Ohshima MD, PhD ,&nbsp;Yoshiteru Morio MD, PhD ,&nbsp;Hirotoshi Matsui MD, PhD","doi":"10.1016/j.chpulm.2024.100100","DOIUrl":"10.1016/j.chpulm.2024.100100","url":null,"abstract":"<div><h3>Case Presentation</h3><div>A 59-year-old man living in the suburban area of Greater Tokyo presented to his local hospital with chronic productive cough persisting for 1 year and hemoptysis for the past 3 months. A chest CT scan revealed an uneven cavity containing multiple masses in his right upper lobe (<span><span>Fig 1</span></span>). Sputum culture turned positive twice for filamentous fungi, but species could not be identified. The patient had active tobacco use with a 25 pack-year smoking history. Additionally, he had a history of hypertension and untreated diabetes mellitus, with a hemoglobin A1C level of 12.2%. Consequently, he was referred to our hospital for further investigation and treatment.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 4","pages":"Article 100100"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143140065","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":"Pleural Procedure Education in Fellowship","authors":"Ilana Roberts Krumm MD, MAEd ,&nbsp;Van Holden MD ,&nbsp;Lekshmi Santhosh MD, MAEd","doi":"10.1016/j.chpulm.2024.100091","DOIUrl":"10.1016/j.chpulm.2024.100091","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 4","pages":"Article 100091"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143140059","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":"Managing Silicosis in the United States","authors":"Michael R. Kahn MD, MA Teaching ,&nbsp;Chanidapa Klinhom MD ,&nbsp;William D. Wallace MD ,&nbsp;Sarah Edminster DO ,&nbsp;Toby M. Maher MD, PhD ,&nbsp;Luis E. Huerta MD, MSCI","doi":"10.1016/j.chpulm.2024.100103","DOIUrl":"10.1016/j.chpulm.2024.100103","url":null,"abstract":"<div><div>Once considered a disease of the past in developed countries, silicosis is making a worrying comeback as an irreversible and potentially fatal pulmonary disease in the United States. Silicosis has been an unfortunate mainstay of respiratory disease in the developing world, but modern industries, such as stone countertop fabrication, are causing a public health crisis in the United States. This recent uptick in silicosis cases, led by the first recent case in the United States in a stone countertop worker in 2015, may be just the beginning. Because patients seem to present at a younger age with more severe disease than prior cohorts with silicosis, we have found an absence of clear guidelines and standards of care for patients with severe silicosis, particularly for those with end-stage disease. Drawing on experiences from patients with silicosis at the Los Angeles General Medical Center/University of Southern California, we have compiled a clinical review of the topic and provide our institutional approach to screening, examination, diagnosis, management, and, if necessary, referral for lung transplantation. In this “How I Do It,” we share our experience from California to equip clinicians with tools to better diagnose silicosis, recognize end-stage disease, and support patients to lower the morbidity and mortality of this entirely preventable pneumoconiosis.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 4","pages":"Article 100103"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143140061","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":"Significance of Normal Lung Volume on Quantitative CT Imaging Analysis in Group 1 and Group 3 Pulmonary Hypertension","authors":"Tadasu Okaya MD. PhD ,&nbsp;Ayako Shigeta MD. PhD ,&nbsp;Nobuhiro Tanabe MD. PhD ,&nbsp;Koichiro Tatsumi MD. PhD ,&nbsp;Hajime Yokota MD. PhD ,&nbsp;Akira Nishiyama MD. PhD ,&nbsp;Akira Naito MD. PhD ,&nbsp;Ayumi Sekine ,&nbsp;Toshihiko Sugiura MD. PhD ,&nbsp;Seiichiro Sakao MD. PhD ,&nbsp;Takuji Suzuki MD. PhD","doi":"10.1016/j.chpulm.2024.100062","DOIUrl":"10.1016/j.chpulm.2024.100062","url":null,"abstract":"<div><h3>Background</h3><div>Patients with concurrent pulmonary hypertension (PH) and parenchymal lung diseases have a high risk of mortality. However, whether their outcomes are related to low normal lung volume (NLV) resulting from parenchymal lung diseases on chest high-resolution CT (HRCT) imaging remains unknown.</div></div><div><h3>Research Question</h3><div>Would NLV on quantitative HRCT imaging affect disease behavior in patients with PH?</div></div><div><h3>Study Design and Methods</h3><div>This retrospective observational study evaluated patients with physician-diagnosed group 1 and group 3 PH among 1,471 patients who underwent right heart catheterization. Using a 3-dimensional image analysis system for HRCT imaging, the percentage of NLV (–950 to –600 Hounsfield units) to the whole lungs (%NLV) was calculated. The optimal cutoff point of %NLV for predicting survival was examined using the receiver operating characteristic (ROC) curve. The Kaplan-Meier method and Cox proportional hazards regression were used to detect the association between %NLV and prognosis. Multivariable logistic regression was performed to examine the association of %NLV with response to pulmonary vasodilators.</div></div><div><h3>Results</h3><div>Overall, 157 patients (mean age, 53.1 ± 17.6 years; sex, n = 111 [70.7%] female patients) were included. ROC curve analysis showed that the optimal cutoff of %NLV for predicting survival was 83.2%. The patients with %NLV of ≥ 83.2% showed significantly higher 5-year survival than that of those with %NLV of &lt; 83.2% (81.7% vs 36.6%; <em>P &lt; .</em>0001). Multivariable logistic regression analysis revealed %NLV of &lt; 83.2% as an independent prognostic factor (hazard ratio, 2.49 [95% CI, 1.14–5.44]; <em>P = .</em>022). Responders showed significantly higher %NLV than nonresponders (90.0 ± 5.1% vs 84.7 ± 9.2%; <em>P = .</em>0002). Multivariable regression analysis showed that only high %NLV predicted response (OR, 1.12 [95% CI, 1.01–1.23]; <em>P = .</em>016).</div></div><div><h3>Interpretation</h3><div>Quantitative CT imaging analysis might allow numerical quantification of the lung condition and vasodilator-treatable area beyond subjective visual assessment in patients with PH. The %NLV could be a novel predictor of prognosis and treatment response in these patients.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 4","pages":"Article 100062"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141023579","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":"Study Design and Rationale for the TETON-PPF Phase 3, Randomized, Controlled Clinical Trial of Inhaled Treprostinil in the Treatment of Progressive Pulmonary Fibrosis","authors":"Steven D. Nathan MD ,&nbsp;Juergen Behr MD ,&nbsp;Vincent Cottin MD ,&nbsp;Lisa Lancaster MD ,&nbsp;Peter Smith PharmD ,&nbsp;CQ Deng PhD ,&nbsp;Natalie Breytenbach PharmD ,&nbsp;Heidi Bell MD ,&nbsp;Leigh Peterson PhD ,&nbsp;Kevin R. Flaherty MD","doi":"10.1016/j.chpulm.2024.100124","DOIUrl":"10.1016/j.chpulm.2024.100124","url":null,"abstract":"<div><h3>Background</h3><div>Progressive pulmonary fibrosis (PPF) affects a group of patients with various underlying interstitial lung diseases (ILDs) who develop progressive fibrosis and exhibit a similar disease course to patients with idiopathic pulmonary fibrosis (IPF). In PPF, fibrosis becomes self-sustaining and behaves similarly across ILDs, irrespective of the initial trigger, with patients developing worsening respiratory symptoms, lung function, and quality of life and increased mortality despite usual treatments for the underlying ILD. Inhaled treprostinil has demonstrated improvements in FVC and reduced exacerbations of underlying lung disease in patients with pulmonary hypertension associated with ILD in post hoc analyses of a phase 3 study (Safety and Efficacy of Inhaled Treprostinil in Adult PH With ILD Including CPFE [INCREASE]) and its open-label extension. These results and preclinical evidence of treprostinil’s antifibrotic activity support its investigation in the treatment of PPF. Inhaled treprostinil is also being investigated for the treatment of IPF in the Study of Efficacy and Safety of Inhaled Treprostinil in Subjects with Idiopathic Pulmonary Fibrosis (TETON) and the Multinational Study of Efficacy and Safety of Inhaled Treprostinil in Subjects With Idiopathic Pulmonary Fibrosis (TETON-2).</div></div><div><h3>Research Question</h3><div>Does inhaled treprostinil improve absolute FVC over 52 weeks in patients with PPF?</div></div><div><h3>Study Design and Methods</h3><div>The Study of the Efficacy and Safety of Inhaled Treprostinil in Subjects With Progressive Pulmonary Fibrosis (TETON-PPF) is a 52-week, randomized, double-blind, placebo-controlled, phase 3 study enrolling 698 patients. Eligible patients must have a diagnosis of PPF (other than IPF) with radiographic fibrosis of &gt; 10% extent and FVC ≥ 45%. Background use of pirfenidone or nintedanib is allowed. The primary end point is change in absolute FVC at week 52. Secondary end points include time to first clinical worsening, time to first acute exacerbation of ILD, overall survival, change in % predicted FVC, change in the King’s Brief Interstitial Lung Disease Questionnaire, and change in lung diffusion capacity. Safety parameters include adverse events, hospitalizations, oxygenation, and laboratory parameters.</div></div><div><h3>Results</h3><div>The study was initiated in October 2023 and will continue until 698 patients enroll.</div></div><div><h3>Interpretation</h3><div>When completed, TETON-PPF will confirm whether inhaled treprostinil is safe and effective for the treatment of PPF.</div></div><div><h3>Clinical Trial Registration</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>; No.: <span><span>NCT05943535</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 2","pages":"Article 100124"},"PeriodicalIF":0.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143899549","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":"Sleep Parameters of Breathing and Cognitive Function in a Diverse Hispanic/Latino Cohort","authors":"Kevin A. González MS ,&nbsp;Wassim Tarraf PhD ,&nbsp;Shanmin Sultana BS ,&nbsp;Barbara Junco MS ,&nbsp;Eena Kosik BS ,&nbsp;Bradley Voytek PhD ,&nbsp;Hector M. González PhD ,&nbsp;Alberto R. Ramos MD, MSPH, FAASM","doi":"10.1016/j.chpulm.2024.100102","DOIUrl":"10.1016/j.chpulm.2024.100102","url":null,"abstract":"<div><h3>Background</h3><div>Sleep-disordered breathing (SDB) is common and associated with worse cardiovascular and brain health. Hispanic/Latino individuals are at increased risk for SDB. OSA is the most studied SDB; it is characterized by apnea-hypopnea events and has been linked to adverse vascular health and cognitive sequelae. Less is known about upstream factors such as parameters of breathing. Breathing dynamics such as breathing rate and breathing rate variability have been linked to changes in mood and oscillatory brain activity. Their relationships with cognitive performance, particularly in diverse and understudied Hispanic/Latino communities, are unknown.</div></div><div><h3>Research Question</h3><div>What is the association between parameters of breathing and cognitive outcomes?</div></div><div><h3>Study Design and Methods</h3><div>The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a prospective study of diverse Hispanic/Latino participants. Individuals were given a home sleep apnea device for in-home sleep testing. Breathing information was extracted from the cannula channel, and parameters of breathing were calculated by using bycycle, a novel tool for time series analysis. A total of 6,737 individuals were included in the study.</div></div><div><h3>Results</h3><div>Faster breathing rate was linked with worse domain-specific and global cognitive performance (b_global = –0.011; <em>P</em> &lt; .01), and breathing rate variability was associated with worse global cognitive performance (β_global = –0.022; <em>P</em> &lt; .05). In interaction models, breathing rate variability was found to be significantly associated with worse verbal fluency and global cognitive performance in women but not in men.</div></div><div><h3>Interpretation</h3><div>Parameters of breathing are novel methods for understanding SDB and cognitive function. These results also suggest that faster breathing rate variability in women, but not in men, is related to worse cognitive function.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 1","pages":"Article 100102"},"PeriodicalIF":0.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444420","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":"Long-Term Clinical Efficacy of Elexacaftor-Tezacaftor-Ivacaftor in People With Cystic Fibrosis and Preexisting Advanced Lung Disease at Treatment Initiation","authors":"Leah A. Cohen MD ,&nbsp;Gregory A. Ratti MD ,&nbsp;April R. Gorman MS ,&nbsp;Bryan Garcia MD ,&nbsp;Christina M. Mingora MD","doi":"10.1016/j.chpulm.2024.100099","DOIUrl":"10.1016/j.chpulm.2024.100099","url":null,"abstract":"<div><h3>Background</h3><div>Elexacaftor-tezacaftor-ivacaftor (ETI) is associated with increased FEV₁, decreased exacerbation frequency, and BMI in people with cystic fibrosis. Landmark clinical trials excluded patients with advanced lung disease as defined by FEV₁ &lt; 40%. We have previously reported an improvement in % predicted FEV₁ of 7.9% after 3 months of ETI in people with advanced cystic fibrosis lung disease (ACFLD). The long-term effects of ETI on this cohort are unknown. This study reports the efficacy of ETI after 24 months of treatment in people with ACFLD.</div></div><div><h3>Research Question</h3><div>What are the long-term effects of ETI on people with cystic fibrosis and pre-existing advanced lung disease on lung function, BMI, and pulmonary exacerbation rates?</div></div><div><h3>Study Design and Methods</h3><div>We conducted a retrospective cohort study of adult patients with FEV₁ &lt; 40% and/or other high-risk features defined by the 2019 Cystic Fibrosis Foundation lung transplant guidelines who were started on ETI between September 2019 and February 2020. Response to therapy was assessed with repeat spirometry measured at 12 and 24 months. All measurements were taken outside of an acute exacerbation. Demographics and clinical data including BMI and pulmonary exacerbation frequency were extracted from the medical record.</div></div><div><h3>Results</h3><div>A total of 57 of 64 people with ACFLD showed improved lung function with a mean change in % predicted FEV₁ of 6.74% (<em>P</em> ≤ .001; 95% CI, 4.25%-9.23%) between baseline and 24 months of treatment. BMI increased by a mean change of 1.55 kg/m² (<em>P</em> ≤ .001; 95% CI, 0.93-2.18 kg/m²) during this interval. The annual exacerbation rate between the year before ETI and 24 months on ETI declined with a median of 1 less per year (<em>P</em> = .0007).</div></div><div><h3>Interpretation</h3><div>People with ACFLD experienced a significant increase in lung function at 24 months on ETI, but less than those with higher baseline lung function compared with prior studies. They also had an increase in BMI and a decline in the rate of annual pulmonary exacerbations.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 1","pages":"Article 100099"},"PeriodicalIF":0.0,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143452755","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}