CHEST pulmonary最新文献

{"title":"Long-Term Efficacy of Dupilumab in Moderate-to-Severe Asthma Phenotyped by Blood Eosinophils and Exhaled Nitric Oxide","authors":"Michael E. Wechsler MD ,&nbsp;Ian D. Pavord MD ,&nbsp;Alberto Papi MD ,&nbsp;Kenneth R. Chapman MD ,&nbsp;Arman Altincatal MS ,&nbsp;Nami Pandit-Abid PharmD ,&nbsp;Juby A. Jacob-Nara MD ,&nbsp;Paul J. Rowe MD ,&nbsp;Yamo Deniz MD ,&nbsp;Elizabeth Laws PhD ,&nbsp;Bolanle Akinlade MD ,&nbsp;Nikhil Amin MD ,&nbsp;Heribert W. Staudinger MD ,&nbsp;David J. Lederer MD ,&nbsp;Megan Hardin MD","doi":"10.1016/j.chpulm.2024.100072","DOIUrl":"10.1016/j.chpulm.2024.100072","url":null,"abstract":"<div><h3>Background</h3><div>Asthma treatment aims to reduce symptom severity and exacerbation risk. Dupilumab, a human monoclonal antibody, blocks the shared receptor for IL-4/IL-13, key drivers of type 2 inflammation. In the Evaluation of Dupilumab in Patients With Persistent Asthma (QUEST) study (NCT02414854), add-on dupilumab every 2 weeks vs placebo was shown to significantly reduce severe asthma exacerbations and improve prebronchodilator (BD) FEV₁ in patients with uncontrolled, moderate-to-severe asthma. Treatment effects were greater in patients with elevated baseline type 2 biomarkers (blood eosinophil count ≥ 150 cells/μL or fractional exhaled nitric oxide ≥ 25 parts per billion).</div></div><div><h3>Research Question</h3><div>What is dupilumab’s long-term efficacy (up to 3 years) in patients with moderate-to-severe type 2 asthma?</div></div><div><h3>Study Design and Methods</h3><div>Patients enrolled in QUEST (receiving placebo or dupilumab), who completed 96 weeks of dupilumab treatment in the open-label extension Long-Term Safety Evaluation of Dupilumab in Patients With Asthma (TRAVERSE) study (NCT02134028), were included. This prespecified analysis evaluated long-term efficacy in patient populations identified by baseline type 2 biomarker level. End points were annualized exacerbation rate (AER) and change from baseline in pre-BD FEV₁ (L), asthma control (5-item Asthma Control Questionnaire), and asthma-related quality of life (Asthma Quality of Life Questionnaire).</div></div><div><h3>Results</h3><div>A total of 663 patients were included. AER was 1.72 to 2.24 at QUEST baseline in dupilumab groups across type 2 populations. AER decreased in populations with elevated type 2 biomarkers to 0.36 to 0.49 during QUEST’s 52-week treatment period, which was sustained over 96 weeks in TRAVERSE. In patients with low type 2 biomarker levels, there was no clinically meaningful AER reduction in QUEST or TRAVERSE, but rates remained below parent study baseline. Similar trends were seen with improvements in pre-BD FEV₁, 5-item Asthma Control Questionnaire, and Asthma Quality of Life Questionnaire; greatest improvements were seen in groups with one or more elevated type 2 biomarker.</div></div><div><h3>Intrepretation</h3><div>This study suggests that long-term dupilumab treatment results in sustained and clinically meaningful efficacy in patients with moderate-to-severe type 2 asthma characterized by elevated blood eosinophil count and/or fractional exhaled nitric oxide.</div></div><div><h3>Clinical Trial Registration</h3><div>ClinicalTrials.gov; No.: NCT02134028; 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 100072"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141691503","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":"Mental Health Changes in Adolescents and Adults With Cystic Fibrosis After Initiation of Elexacaftor/Tezacaftor/Ivacaftor Therapy","authors":"Els van der Heijden MA ,&nbsp;Rutger M. van den Bor PhD ,&nbsp;Marlou C. Bierlaagh MD ,&nbsp;Danya Muilwijk MD, PhD ,&nbsp;Jessica M. de Graaf MSc ,&nbsp;Sanne L. Nijhof MD, PhD ,&nbsp;Inez Bronsveld MD, PhD ,&nbsp;Cornelis K. van der Ent MD, PhD ,&nbsp;Sabine E.I. van der Laan MD, PhD","doi":"10.1016/j.chpulm.2025.100146","DOIUrl":"10.1016/j.chpulm.2025.100146","url":null,"abstract":"<div><h3>Background</h3><div>Starting elexacaftor/tezacaftor/ivacaftor (ETI) is considered a positive life event for people with cystic fibrosis (pwCF). Nevertheless, some individuals report a decline in mental health after commencing ETI.</div></div><div><h3>Research Question</h3><div>How do various mental health indicators of pwCF ≥ 12 years of age change after starting ETI, and can potentially more vulnerable subgroups, in terms of their mental health, be identified?</div></div><div><h3>Study Design and Methods</h3><div>This was a prospective 60-week longitudinal cohort study with questionnaire-based measurements of mental health 12 weeks before (t0) and 12, 24, and 48 weeks after starting ETI (t1, t2, and t3, respectively). Subgroups were defined by age, sex, lung function at baseline, earlier use of any other modulator, and use of psychotropic medications. Data were analyzed using a covariance pattern model with a general variance covariance matrix.</div></div><div><h3>Results</h3><div>In total, 174 (98.31%), 146 (82.49%), 141 (79.66%), and 142 (80.23%) participants completed or partially completed the questionnaires at t0, t1, t2, and t3, respectively. The data showed an overall statistically significant and clinically relevant improvement in psychosocial health (<em>P</em> &lt; .001; change in [Δ] estimated marginal means [EMM] t0-t3, 7.68), no change in anxiety symptoms (<em>P</em> = .46; ΔEMM t0-t3 = −0.42), a statistically significant but not clinically relevant improvement in depressive symptoms (<em>P</em> &lt; .001; ΔEMM t0-t3 = −1.25), and a statistically significant and clinically relevant improvement in respiratory-related quality of life (<em>P</em> &lt; .001; ΔEMM t0-t3 = 19.55) after the initiation of ETI. Female patients, those with lower lung function, and those using psychotropic medications at baseline seem to be more susceptible to lower mental health scores after starting ETI on several indicators, compared with their counterparts.</div></div><div><h3>Interpretation</h3><div>In this study, pwCF experienced an improvement in all mental health indicators, except in anxiety symptoms. Clinical physicians should be aware that female patients, people with lower lung function, and those using psychotropic medications might be more prone to less favorable mental health improvement.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 3","pages":"Article 100146"},"PeriodicalIF":0.0,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144756750","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":"Minimal Clinically Important Difference for Worsening of the University of California San Diego Shortness of Breath Questionnaire in Patients With Idiopathic Pulmonary Fibrosis With Mild or Moderate Impairment in Lung Function","authors":"Kerri I. Aronson MD ,&nbsp;Ganesh Raghu MD ,&nbsp;Sachin Gupta MD ,&nbsp;Jinnie Ko PhD ,&nbsp;Jacob Devine MA ,&nbsp;Jeffrey Swigris DO","doi":"10.1016/j.chpulm.2025.100145","DOIUrl":"10.1016/j.chpulm.2025.100145","url":null,"abstract":"<div><h3>Background</h3><div>The University of California San Diego Shortness of Breath Questionnaire (UCSD-SOBQ) is used commonly in clinical trials to evaluate dyspnea in patients with idiopathic pulmonary fibrosis (IPF). Previously, the minimal clinically important difference (MCID) for UCSD-SOBQ was estimated at 8 points for patients with IPF with severe impairment as determined by lung function tests.</div></div><div><h3>Research Question</h3><div>What is the MCID threshold for UCSD-SOBQ worsening in patients with IPF and less physiologic impairment?</div></div><div><h3>Study Design and Methods</h3><div>Pooled data from patients with baseline forced vital capacity (FVC) of ≥ 50% predicted enrolled in the 2 randomized phase 3 CAPACITY trials of pirfenidone (<span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> Identifiers: <span><span>NCT00287716</span><svg><path></path></svg></span> and <span><span>NCT00287729</span><svg><path></path></svg></span>) were analyzed. Over the 72-week treatment period, the MCIDs for the UCSD-SOBQ were estimated using anchor-based methods by comparing changes in UCSD-SOBQ scores with values for stability/improvement vs worsening in 4 candidate anchors: FVC, diffusing capacity of the lungs for carbon monoxide (D<span>lco</span>), 6-minute walk distance (6MWD), and St George’s Respiratory Questionnaire activity domain (SGRQ-A). Anchors that correlated with UCSD-SOBQ scores for at least 1 measurement (correlation coefficient ≥ 0.3) were included for MCID determination in a receiver operating characteristics approach.</div></div><div><h3>Results</h3><div>Overall, UCSD-SOBQ score changes were similar within stability/improvement and worsening categories for FVC, D<span>lco</span>, and 6MWD anchors. For the SGRQ-A anchor, for stability/improvement, UCSD-SOBQ changes were lower than for the other anchors; for worsening, changes were greater. Based on suitable correlation coefficients, FVC, 6MWD, and SGRQ-A were the anchors used to triangulate the MCID. Optimal anchor cut points (MCID) for worsening were 6 for FVC, 4.3 for 6MWD, and 5.8 for SGRQ-A, which resulted in a <em>z</em>-transformed weighted average for UCSD-SOBQ worsening of 5.97.</div></div><div><h3>Interpretation</h3><div>Our results show that in patients with IPF and mild or moderate physiologic impairment, the UCSD-SOBQ has a MCID for worsening of 4 to 6 with a point estimate of 6.</div></div><div><h3>Trial Registry</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>; No.: <span><span>NCT00287716</span><svg><path></path></svg></span> and <span><span>NCT00287729</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 100145"},"PeriodicalIF":0.0,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144652988","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":"Limited Ventilatory Reserve During Exercise in Heart Failure with Preserved Ejection Fraction","authors":"Gizem Cifci MD,&nbsp;Daniel J. Brown BS,&nbsp;Barry A. Borlaug MD,&nbsp;Joshua R. Smith PhD","doi":"10.1016/j.chpulm.2025.100138","DOIUrl":"10.1016/j.chpulm.2025.100138","url":null,"abstract":"<div><h3>Background</h3><div>Patients with heart failure with preserved ejection fraction (HFpEF) exhibit a tachypneic breathing strategy during exercise. Patients with HFpEF have pulmonary system alterations that may contribute to the breathing strategy in HFpEF.</div></div><div><h3>Research Question</h3><div>Do patients with HFpEF have limited ventilatory reserve compared with control patients during exercise? Furthermore, does greater upper body adiposity contribute to the lower ventilatory reserves in HFpEF?</div></div><div><h3>Study Design and Methods</h3><div>Patients with HFpEF (n = 16; mean age ± SD, 70 ± 8 years) and control patients (n = 19; mean age ± SD, 69 ± 8 years) performed incremental cycling to volitional exhaustion. Trunk percent fat was quantified with dual-energy X-ray absorptiometry. Inspiratory capacity, inspiratory and expiratory reserve volumes, and ventilatory variables were compared between groups at rest and during exercise at 40 W and peak oxygen uptake.</div></div><div><h3>Results</h3><div>Patients with HFpEF had lower total lung capacity (5.4 ± 1.1 vs 6.4 ± 1.2 L), FVC (3.1 ± 0.7 vs 3.8 ± 0.6 L), and FEV₁ than control patients (all <em>P</em> &lt; .04), respectively. During exercise at 40 W, patients with HFpEF had higher breathing frequency and smaller inspiratory reserve volume (1.2 ± 0.4 vs 1.5 ± 0.3 L) and expiratory reserve volume (0.9 ± 0.4 vs 1.1 ± 0.5 L) than control patients (both <em>P</em> &lt; .05), respectively. At peak oxygen uptake, inspiratory and expiratory reserve volumes were not different between groups (both <em>P</em> &gt; .21), but patients with HFpEF had lower end-inspiratory lung volume (<em>P</em> = .02). Patients with HFpEF had higher trunk percent fat than control patients (49% ± 7% vs 40% ± 8%, respectively; <em>P</em> &lt; .01). Percent trunk fat was related to % predicted FVC (<em>r</em> = –0.57) and tidal volume to FVC ratio during exercise at 40 W (r = 0.53) for patients with HFpEF (both <em>P</em> &lt; .04) but not control patients (both <em>P</em> &gt; .72).</div></div><div><h3>Interpretation</h3><div>These findings demonstrate that patients with HFpEF have limited ventilatory reserve during exercise, in part due to their smaller lung capacity. Furthermore, our findings suggest that the greater distribution of upper body adiposity in HFpEF is an important contributor to the smaller lung capacity for these patients.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 3","pages":"Article 100138"},"PeriodicalIF":0.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144885437","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":"Delays in Referral to Multidisciplinary Care for Black Individuals With Sarcoidosis","authors":"Kristen R. Mathias MD ,&nbsp;Ofure Akhiwu MD ,&nbsp;Ali M. Mustafa MD ,&nbsp;Kevin J. Psoter PhD ,&nbsp;Edward S. Chen MD ,&nbsp;Nisha A. Gilotra MD ,&nbsp;Nancy W. Lin MD ,&nbsp;John Odackal MD ,&nbsp;Catherine A. Bonham MD ,&nbsp;Michelle Sharp MD","doi":"10.1016/j.chpulm.2024.100125","DOIUrl":"10.1016/j.chpulm.2024.100125","url":null,"abstract":"<div><h3>Background</h3><div>Sarcoidosis is a complex granulomatous disease that benefits from multidisciplinary subspecialty expertise. Inequitable access to care contributes to racial disparities in many diseases; however, to our knowledge, no studies have examined racial differences in referral times to Sarcoidosis Centers of Excellence.</div></div><div><h3>Research Question</h3><div>Is there an association between race and time from sarcoidosis diagnosis to referral to an independently certified, peer-reviewed World Association of Sarcoidosis and Other Granulomatous Disorders Center of Excellence? Does a referral result in a change in sarcoidosis management?</div></div><div><h3>Study Design and Methods</h3><div>We retrospectively reviewed all 2021 referrals to the Johns Hopkins Sarcoidosis Center of Excellence. Multivariable Cox regression evaluated the association between race and time to referral, adjusting for covariates of sex, ethnicity, referral type, referral provider, insurance provider, employment status, organ involvement, and sarcoidosis medications. Changes in sarcoidosis management including treatment changes, additional organ evaluation, and/or additional subspecialty expertise were ascertained 1 year after establishing care.</div></div><div><h3>Results</h3><div>At total of 207 individuals were analyzed (40% Black, 55% White, and 5% Asian and other race). Black individuals experienced longer referral delay than White individuals, with a median of 9 vs 5 years, respectively (<em>P</em> &lt; .05). In multivariable analysis, the hazard of referral for White individuals was higher than for Black individuals (hazard ratio, 2.04; 95% CI, 1.48-2.82; <em>P</em> &lt; .001), independent of the covariates. Sarcoidosis management changed in 78% of individuals after referral.</div></div><div><h3>Interpretation</h3><div>Black patients experienced significant delays in referral to a multidisciplinary subspecialty Sarcoidosis Center of Excellence compared with other racial groups. Recognition of referral delay may offer insight and opportunity to address disparities in clinical outcomes observed in Black individuals with sarcoidosis. Future multicenter studies must quantify the impact of care received through World Association of Sarcoidosis and Other Granulomatous Disorders Sarcoidosis Centers of Excellence, define patient phenotypes in need of urgent referral, and develop targeted patient and provider outreach.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 2","pages":"Article 100125"},"PeriodicalIF":0.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143883201","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":"A 53-Year-Old Woman With Stage IV Non-Small Cell Lung Cancer and Progressive Paratracheal Lymphadenopathy","authors":"Alberto Goizueta MD ,&nbsp;Aileen Anglin APRN, ACNP-BC, AOCNP ,&nbsp;Bruce F. Sabath MD","doi":"10.1016/j.chpulm.2024.100081","DOIUrl":"10.1016/j.chpulm.2024.100081","url":null,"abstract":"<div><h3>Case Presentation</h3><div>A 53-year-old woman with a history of <em>EGFR</em> mutation-positive stage IV lung adenocarcinoma underwent scheduled surveillance imaging. The disease was stable with osimertinib treatment for the preceding 24 months. Surveillance imaging noted new paratracheal adenopathy concerning for cancer progression. She was referred to interventional pulmonology for bronchoscopic evaluation. She provided written informed consent.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 4","pages":"Article 100081"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141716748","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 Dramatic Decline in Lung Transplantation for Cystic Fibrosis in the United States","authors":"Tijana Milinic MD ,&nbsp;Kathleen J. Ramos MD, MSc ,&nbsp;Eliana R. Gill PhD ,&nbsp;Nora Burdis MD ,&nbsp;Christopher H. Goss MD, MSc ,&nbsp;Siddhartha G. Kapnadak MD","doi":"10.1016/j.chpulm.2024.100077","DOIUrl":"10.1016/j.chpulm.2024.100077","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 4","pages":"Article 100077"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143140060","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":"Is Rapid On-Site Cytology Evaluation Cost-Effective in Navigational Bronchoscopy? The Challenge of Modeling Benefit in the Rapidly Evolving Landscape of Advanced Diagnostic Bronchoscopy","authors":"Kim Styrvoky MD ,&nbsp;Dominique J. Pepper MD","doi":"10.1016/j.chpulm.2024.100078","DOIUrl":"10.1016/j.chpulm.2024.100078","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 4","pages":"Article 100078"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143140063","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":"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}