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Impact of Pirfenidone on Patient-Reported Outcomes in Patients With Idiopathic Pulmonary Fibrosis From the Pulmonary Fibrosis Foundation Patient Registry 肺纤维化基金会患者登记中的吡非尼酮对特发性肺纤维化患者的患者报告结果的影响
CHEST pulmonary Pub Date : 2024-12-01 DOI: 10.1016/j.chpulm.2024.100082
Mohleen Kang MD, MS , Sachin Gupta MD , Yi-Hsuan Tu PhD , Karina Raimundo MS , Anisha M. Patel PhD , Kevin R. Flaherty MD
{"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}
引用次数: 0
Lung Volume Changes in Stable Preterm Infants Weaned From Nasal CPAP to High Flow 稳定早产儿从鼻CPAP断奶到高流量肺容量的变化
CHEST pulmonary Pub Date : 2024-12-01 DOI: 10.1016/j.chpulm.2024.100094
Vanessa L. Büchler MD , Vincent D. Gaertner MD , Janine Thomann MD , Dirk Bassler MD , Christoph M. Rüegger MD
{"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 H<sub>2</sub>O, 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><sub>2</sub> 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}
引用次数: 0
Outcomes and Clinical Practices in Follow-Up of Nonmalignant Pulmonary Nodules After Bronchoscopic Biopsy 支气管镜活检后非恶性肺结节的随访结果及临床实践
CHEST pulmonary Pub Date : 2024-12-01 DOI: 10.1016/j.chpulm.2024.100112
Camilo A. Avendano , Luis O. Gerena-Montano , Jason A. Beattie , Mihir S. Parikh , Kai E. Swenson , Adnan Majid , Chenchen Zhang MD, PhD
{"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 (χ<sup>2</sup> = 15.85; <em>P</em> = .000) and exhibited a trend toward earlier repeat CT scans (χ<sup>2</sup> = 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}
引用次数: 0
Chest Wall Deformities in Adults With Fibrotic Interstitial Lung Disease Related to Surfactant-Related Gene Mutations 与表面活性剂相关基因突变相关的成人纤维化间质性肺病胸壁畸形
CHEST pulmonary Pub Date : 2024-12-01 DOI: 10.1016/j.chpulm.2024.100106
Margot Delin MD , Marie Pierre Debray MD , Marie Legendre MD, PhD , Lidwine Wemeau MD , Bruno Crestani MD, PhD , Emmanuel Brian MD , Justine Frija-Masson MD, PhD , Laurent Plantier MD, PhD , Spyros A. Papiris MD , Effrosyni D. Manali MD , Nadia Nathan MD, PhD , Raphael Borie MD, PhD
{"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}
引用次数: 0
Cost-Effectiveness of Rapid On-Site Evaluation During Navigational Bronchoscopy 导航支气管镜快速现场评估的成本效益
CHEST pulmonary Pub Date : 2024-12-01 DOI: 10.1016/j.chpulm.2024.100066
Greta J. Dahlberg MD , Caroline M. Godfrey MD, MPH , Stephen A. Deppen PhD , Jacob Richardson , Brent E. Heideman MD , Ankush P. Ratwani MD , Rafael Paez MD , Kaele M. Leonard MD , Samira Shojaee MD, MPH , Robert J. Lentz MD , Eric L. Grogan MD, MPH , Fabien Maldonado MD
{"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}
引用次数: 0
Sleep Hypoxemia as a Predictor of Mortality in Patients with Sleep Apnea 睡眠低氧血症可预测睡眠呼吸暂停患者的死亡率:睡眠心脏健康研究的二次分析
CHEST pulmonary Pub Date : 2024-12-01 DOI: 10.1016/j.chpulm.2024.100087
Mohammad Masoudian Khouzani DDS, MPH , Jack Botros DDS , Mariela Padilla DDS, MEd , Richard J. Castriotta MD, FCCP
{"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}
引用次数: 0
Safety, Efficacy, and Feasibility of Nebulized Long-Acting Bronchodilators vs Short-Acting Bronchodilators in Hospitalized Patients With Acute Exacerbations of COPD 慢性阻塞性肺病急性加重期住院患者雾化长效支气管扩张剂与短效支气管扩张剂的安全性、有效性和可行性
CHEST pulmonary Pub Date : 2024-12-01 DOI: 10.1016/j.chpulm.2024.100105
Rajiv Dhand MD , Samuel Treat MD , Jennifer Ferris MSHS , Paul D. Terry PhD , Tracy Walker BA , Scott Elder RRT , Daniel Church RRT , Danielle Dennis PharmD , Barbara Faircloth PharmD , Gulsah Onar MPH , R. Eric Heidel PhD , Isaac Biney MD , Martin Valdes MD , Milind Bhagat MBBS , Nicholas Fuerst MD , Shannon Cusick RN
{"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}
引用次数: 0
Evolution of Home Mechanical Ventilation in Sweden Over 27 Years 瑞典27年来家用机械通风的演变
CHEST pulmonary Pub Date : 2024-12-01 DOI: 10.1016/j.chpulm.2024.100108
Andreas Palm MD, PhD , Ludger Grote MD, PhD , Jonas Einarsson MD , Daniel Hansson MD , Mirjam Ljunggren MD, PhD , Josefin Sundh MD, PhD , Magnus Ekström MD, PhD
{"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 FEV<sub>1</sub> 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}
引用次数: 0
Use of Ketamine for Conscious Sedation in Flexible Bronchoscopy 氯胺酮在柔性支气管镜下清醒镇静中的应用
CHEST pulmonary Pub Date : 2024-12-01 DOI: 10.1016/j.chpulm.2024.100109
Joshua M. Boster MD , Steven T. Stoffel DO , S. Michael Goertzen DO , Melissa M. Rosas MD , Jerome C. Edelson MD , Michael J. Morris MD , Robert J. Walter MD , John C. Hunninghake MD , Edward T. McCann MD , Andrew M. Hersh MD , Jess T. Anderson DO
{"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}
引用次数: 0
A 59-Year-Old Man With a Pulmonary Cavity Containing Fungus Balls 59岁男性,肺部含真菌球
CHEST pulmonary Pub Date : 2024-12-01 DOI: 10.1016/j.chpulm.2024.100100
Takafumi Kato MD, PhD , Hiroshi Igei MD , Mizuki Morota MD, PhD , Takuma Yotsumoto MD, PhD , Takeshi Fukami MD, PhD , Masashi Kitani MD , Akira Hebisawa MD, PhD , Junko Suzuki MD , Akira Watanabe MD, PhD , Nobuharu Ohshima MD, PhD , Yoshiteru Morio MD, PhD , Hirotoshi Matsui MD, PhD
{"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}
引用次数: 0
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