Chest最新文献

{"title":"Change in sleep quality Induced by adaptive servo-ventilation for central sleep apnea: 6-month follow-up of the multicenter nationwide French FACIL-VAA cohort.","authors":"Renaud Tamisier, Carole Philippe, Arnaud Prigent, Christelle Charley-Monaca, Marie-Pia d'Ortho, Thibaut Gentina, Frédéric Gagnadoux, Claire Launois, Vanessa Bironneau, Jean Pierre Mallet, Toufik Didi, Tiphaine Guy, Frédéric Goutorbe, Christophe Perrin, Sandrine Pontier-Marchandise, Jean-François Timsit, Jean-Louis Pépin, Jean-Claude Meurice","doi":"10.1016/j.chest.2024.12.015","DOIUrl":"https://doi.org/10.1016/j.chest.2024.12.015","url":null,"abstract":"<p><strong>Background: </strong>A large number of symptomatic individuals with central sleep apnea (CSA) in clinical practice have an indication for adaptive servo-ventilation (ASV) therapy.</p><p><strong>Research question: </strong>What are the effects of ASV therapy on sleep quality and PROMs in patients with CSA across a range of devices and indications.</p><p><strong>Methods: </strong>This prospective, multicenter, observational cohort study was conducted in France and enrolled participants from June 2017 to February 2020. Adults with predominant CSA at diagnosis or obstructive sleep apnea with central events not controlled with continuous positive airway pressure who had an indication for ASV were eligible. Participants attended clinic visits at baseline, and after 1, 3, 6 and 12 months of follow-up. The primary endpoint was the change in Pittsburgh Sleep Quality Index (PSQI) score from baseline to 6-month follow-up (evaluated using a Wilcoxon signed rank test on paired data).</p><p><strong>Results: </strong>We included 526 individuals (median age 69 years, 88.2% male). The indication for ASV included CSA with cardiovascular/neurologic etiology (38.4%), treatment-emergent CSA (36.1%), idiopathic CSA (14.1%) or drug-induced CSA (11.4%). At 6-month follow-up, study participants were using ASV for a median of 6.1 h/night. The median [interquartile range] change in the PSQI score from baseline to 6 months in the overall study population was -1 [-3; 0] (p<0.001), with significant results across all indications for ASV except for drug-induced CSA, where the median change was similar to the overall result but did not achieve statistical significance (-1 [-2; 1]; p=0.0866). Overall, 65% of participants had a ≥1-point improvement in the PSQI.</p><p><strong>Interpretation: </strong>Individuals with a clinical indication for ASV therapy experienced improved sleep quality during real-world treatment, irrespective of which ASV device was used.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vascular Disturbances of the Skin in Critically Ill Patients: Lines, Dots, Patches.","authors":"Scott M Jackson, John P Miller, S Parker Yount, John R Godke, George H Karam","doi":"10.1016/j.chest.2024.11.043","DOIUrl":"https://doi.org/10.1016/j.chest.2024.11.043","url":null,"abstract":"<p><p>When an understanding of pathogenesis exists, skin lesions that have the appearance of blood in the skin can provide insight into the mechanisms leading to a systemic process that results in cutaneous manifestations. Of the vascular disturbances of the skin that occur in critically ill patients, some result from a non-hemorrhagic process while occurs represent bleeding into the skin. The lesions of livedo, petechiae, purpura, and ecchymoses can be approached from such a perspective. In their most characteristic forms, they develop because of problems with platelets, blood vessels, and hypocoagulability. The tactile component of palpability in their clinical evaluation can denote that inflammation is part of the process. The goal of this review is to provide a conceptual approach not only to the diagnosis of vascular disturbances of the skin but also to the pathophysiology occurring that might give a clue to the underlying disease process.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"APOLLO Summary on Pulmonary Vascular Disease Fellowship Training.","authors":"Kristina Kudelko, Yon K Sung, Corey E Ventetuolo, Steven Kawut, Jeremy A Mazurek, Dana McGlothlin, Tim Lahm, Aaron Waxman, Roham Zamanian","doi":"10.1016/j.chest.2024.11.044","DOIUrl":"https://doi.org/10.1016/j.chest.2024.11.044","url":null,"abstract":"<p><p>Pulmonary vascular disease (PVD), and in particular, pulmonary hypertension (PH), is a highly specialized area of medicine comprised of complex diagnostics, classification systems, risk assessment tools, and therapeutics, the correct application of which has been shown to impact patient outcomes. The PVD scientific and patient community recognizes the importance of standardization of care patterns and has thus implemented a clinical accreditation process for PH care centers across the United States. However, a similar standardization system is lacking in PVD sub-specialty provider training. Non-Accreditation Council for Graduate Medical Education (ACGME) PVD advanced fellowships exist nationally, but do not provide a unified approach to trainee education. Therefore, first, a survey of all Pulmonary Hypertension Association (PHA)-accredited center directors across the U.S. was performed to gauge interest in a standardized educational initiative in the field of PVD. Second, a NAtional Consortium on PulmOnary VascuLar Disease FeLOwship Training (APOLLO) was founded to establish a common curriculum and set of training requirements across U.S. PVD programs. A particular emphasis was placed on the training requirements for provider competency in PH, because 1) reliable access to PH patients could be supported by all consortium institutions and 2) the consortium members felt that national PH training curriculums lacked standardization and detail. This article provides the results of the national survey, a guideline summary of the fellowship curriculum and training requirements, and a discussion of the impact of the consortium on PVD training and on the PVD subspecialty as a potential emerging formal discipline in internal medicine.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health System Purchasing Professionals' Approaches to Considering Equity in Procurement.","authors":"Katrina E Hauschildt, Taylor Bernstein, Deidra C Crews, Emmanuel F Drabo, Kadija Ferryman, John W Jackson, Thomas S Valley, Joseph Levy, Theodore J Iwashyna","doi":"10.1016/j.chest.2024.12.016","DOIUrl":"https://doi.org/10.1016/j.chest.2024.12.016","url":null,"abstract":"<p><strong>Background: </strong>Continuing data on racial bias in pulse oximeters and artificial intelligence has sparked calls for health systems to drive innovation against racial bias in healthcare device and artificial intelligence markets by incorporating equity concerns explicitly into purchasing decisions.</p><p><strong>Research question: </strong>How do healthcare purchasing professionals integrate equity concerns into purchasing decision-making?</p><p><strong>Study design and methods: </strong>Between 8/2023-3/2024, we conducted semi-structured interviews via videoconferencing with healthcare purchasing professionals about purchasing processes for pulse oximeters and other devices-and whether and where equity concerns arise in decision-making. An abductive approach was used to analyze perspectives on how equity and disparity concerns are currently integrated into healthcare purchasing decision-making. Healthcare purchasing professionals (N=30) worked in varied supply chain roles for various health systems and supply chain support and consulting companies across the US.</p><p><strong>Results: </strong>Healthcare purchasing professionals described limited considerations of equity in current purchasing processes. They described some receptivity to diversity, equity, and inclusion initiatives, largely focused on diversifying suppliers, rather than ensuring devices and products functioned equitably. Respondents reported that they depended on clinician partners to raise and delineate requirements for equitable performance. Respondents also depicted current sources of evidence used in making purchasing decisions as providing limited information about equitable performance, and that large contracts, including with group purchasing organizations (GPOs), may limit purchasing options.</p><p><strong>Interpretation: </strong>Health system purchasing professionals suggested interest and some nascent successes in diversity, equity, and inclusion considerations in health system purchasing processes, including diverse supplier initiatives, but also a need for strong clinical partnership to ensure equitable performance. Explicit approaches for incorporating equitable performance into healthcare purchasing are likely needed.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neighborhood Level Socioeconomic Disadvantage and Adherence to Guidelines for the Evaluation of Patients with Incidentally Detected Pulmonary Nodules.","authors":"Jacob M Abrahams, Beth Creekmur, Janet Shin Lee, In-Lu Amy Liu, Mayra Macias, Michael K Gould","doi":"10.1016/j.chest.2024.12.011","DOIUrl":"https://doi.org/10.1016/j.chest.2024.12.011","url":null,"abstract":"<p><strong>Background: </strong>The management of incidental pulmonary nodules is guided by recommendations set forth by the Fleischner Society. While most pulmonary nodules are benign, timely and evidence-based follow-up can reduce morbidity and mortality. There are known socioeconomic disparities for engagement with recommended cancer screenings, however it is unclear whether disparities exist for follow-up of incidentally detected pulmonary lesions.</p><p><strong>Research question: </strong>Do patients residing in more socioeconomically deprived neighborhoods have reduced likelihood of adherence to guideline-recommended follow-up of incidentally detected pulmonary nodules?</p><p><strong>Study design and methods: </strong>We assembled a retrospective cohort of 32,965 patients within a large, regional integrated healthcare system with a defined membership who had a pulmonary nodule ≤30mm identified on diagnostic CT between 2012 and 2016. Patients with prior history of malignancy were excluded. Participants were subsequently divided into quartiles utilizing the Neighborhood Deprivation Index as a metric for socioeconomic status. Adherence was ascertained utilizing ICD-9 or CPT coded imaging or biopsy to determine if follow-up was performed within an interval specified by 2005 Fleischner Society Guidelines (with a +/-33% margin of error), based on each patient's nodule characteristics. Negative binomial regression was performed to determine the association between neighborhood level deprivation and adherence to guideline-concordant care, with and without adjustment for plausible confounders.</p><p><strong>Results: </strong>Only 49.6% of patients had follow-up imaging or other diagnostic procedure performed within the guideline-recommended timeframe. There was a 3% reduction in adherence to follow-up for patients residing in the most socioeconomically deprived neighborhood quartile (relative risk [RR]=0.97; 95% CI 0.94 to 1.0) compared with the least deprived quartile. Smoking status was also associated with worse adherence (former vs never, RR= 0.67; 95% CI 0.65 to 0.69) current vs never, RR= 0.73; 95% CI 0.70 to 0.76). Multi-morbidity, and CHF in particular, was associated with decreased adherence to guideline-recommended care (Charlson Comorbidity Index of 3 vs 0, RR:0.93; 95% CI 0.89 to 0.97; History of CHF, RR: 0.93; 95% CI 0.90 to 0.97).</p><p><strong>Interpretation: </strong>In the context of poor adherence overall, patients residing in the most socioeconomically deprived neighborhoods were less likely to receive care in concordance with Fleischner Society recommendations for management of incidental pulmonary nodules.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of low-dose morphine on sleep and breathlessness in COPD: A randomized trial.","authors":"Thomas James Altree, Alison Pinczel, Barbara Toson, Kelly Loffler, Anna Hudson, Jim Zeng, Simon Proctor, Ganesh Naik, Sutapa Mukherjee, Peter Catcheside, Andrew Somogyi, David Currow, Danny Eckert","doi":"10.1016/j.chest.2024.11.040","DOIUrl":"https://doi.org/10.1016/j.chest.2024.11.040","url":null,"abstract":"<p><strong>Background: </strong>Low-dose morphine may be prescribed to reduce chronic breathlessness in chronic obstructive pulmonary disease (COPD). Recent subjective findings suggest morphine may influence breathlessness through sleep-related mechanisms. However, concerns exist regarding opioid safety in COPD. The effects of morphine during sleep in COPD have not been objectively investigated. This study aimed to objectively determine the effects of low-dose morphine on sleep.</p><p><strong>Research question: </strong>What are the effects of low-dose morphine on sleep efficiency and other sleep parameters in COPD?</p><p><strong>Study design and methods: </strong>Randomized, double-blind, crossover trial of 20mg/day sustained-release morphine for three days (steady-state) versus placebo in nineteen breathless people with COPD (n=7 female). The primary outcome was sleep efficiency during in-laboratory overnight polysomnography (PSG). Secondary and exploratory outcome measures included sleep-disordered breathing frequency/hr, oxygenation, transcutaneous carbon dioxide (TcCO₂) levels, blood and physiology biomarkers, the relationship between sleep and breathlessness, external resistive load responses, and driving simulator performance. Physiology outcomes and pharmacokinetics were measured before and after each PSG.</p><p><strong>Results: </strong>Sleep efficiency was similar between placebo and morphine (66±17 vs. 67±19%, p=0.89). Morphine did not change the frequency of sleep-disordered breathing events but reduced breathing frequency. Morphine reduced mean and nadir overnight oxygen saturation by [95%CI] 2 [-2.8 to -1.2] and 5 [-8 to -1]%, respectively. Mean TcCO₂ was 3.3 [1.6 to 5.1]mmHg higher during sleep with morphine versus placebo. Eight participants (42%) met American Academy of Sleep Medicine criteria for nocturnal hypoventilation with morphine versus four (21%) on placebo, p=0.02. Morphine did not systematically reduce breathlessness or impair next day driving simulator performance. Adverse events (most frequently nausea) were increased with morphine.</p><p><strong>Interpretation: </strong>Steady-state, low-dose morphine does not change sleep efficiency, sleep-disordered breathing frequency, or next day alertness but may cause hypoventilation during sleep, a potentially harmful effect.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of Lung Ultrasound as a Screening Tool for Subclinical Rheumatoid Arthritis-Associated Interstitial Lung Disease: a Multicenter Study.","authors":"Otaola Maria, Vasarmidi Eirini, Ottaviani Sébastien, Gutierrez Marwin, Dalpiaz Marina Soledad, Gaser Adrian, Juge Pierre-Antoine, Bertolazzi Chiara, Avgoustidis Nestor, Skiadas Christos, Della Maggiora Maricel, Orausclio Paola, Quintana-Rodriguez Alan, Debray Marie-Pierre, Perez Cepas Barbara, Schneeberger Emilce, Sidiropoulos Prodromos, Lloves Schenone Nicolas, Rosemffet Marcos, Marciano Sebastian, Antoniou Katerina","doi":"10.1016/j.chest.2024.11.038","DOIUrl":"https://doi.org/10.1016/j.chest.2024.11.038","url":null,"abstract":"<p><strong>Background: </strong>The screening strategy for interstitial lung disease (ILD) in rheumatoid arthritis patients is currently debated. While high-resolution computed tomography (HRCT) is the gold standard for diagnosing ILD, its systematic use as a screening tool is not yet recommended. The role of lung ultrasound (LUS) in assessing ILD has been previously explored.</p><p><strong>Research question: </strong>What is the performance of LUS for ILD diagnosis in asymptomatic rheumatoid arthritis patients?</p><p><strong>Study design and methods: </strong>We conducted a multicenter, cross-sectional study involving 203 asymptomatic rheumatoid arthritis patients from outpatient clinics in Argentina, Greece, France, and Mexico. Participants underwent clinical evaluations, pulmonary function tests, and lung ultrasound. HRCT scan was performed on each patient within 30 days of the lung ultrasound. Statistical analyses included sensitivity, specificity, and predictive values for LUS and pulmonary function tests.</p><p><strong>Results: </strong>Of the participants, 26% were diagnosed with ILD. The median age was 63 years (52-89), with 161 patients (79.3%) women. The median duration from rheumatoid arthritis diagnosis to inclusion was 7 years (range: 2-16). LUS demonstrated a sensitivity of 83% (95% CI 70.2%-91.9%) and specificity of 81.2% (95% CI 74.2%-87.2%), with a negative predictive value of 93.1% (95% CI 87.4%-96.8%) and a positive predictive value of 61.1% (95% CI 58.9%-72.4%). LUS outperformed pulmonary function tests, underscoring its potential as a primary screening tool.</p><p><strong>Interpretation: </strong>LUS is a promising tool for ILD screening in asymptomatic rheumatoid arthritis patients, offering high sensitivity and negative predictive value. Its incorporation into routine clinical practice could optimise ILD screening strategies and enhance patient outcomes through early detection and intervention.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How I Do It: Managing Cavitary Coccidioidomycosis Expert Opinions for Improving Patient Outcomes.","authors":"Fariba M Donovan, George R Thompson, Janis E Blair, Royce H Johnson, Josh Malo, Waseem Albasha, Stephanie G Worrell, Staci E Beamer, Kavitha Yaddanapudi, John N Galgiani, Neil M Ampel","doi":"10.1016/j.chest.2024.12.001","DOIUrl":"https://doi.org/10.1016/j.chest.2024.12.001","url":null,"abstract":"<p><p>Coccidioidomycosis (CM), caused by the dimorphic fungi Coccidioides immitis (C. immitis) and C. posadasii, is recognized as an increasing threat both nationally and worldwide. This is in large part secondary to the expanding range of Coccidioides spp. and increased international travel to endemic regions. The majority of individuals exposed to airborne Coccidioides organisms do not need medical attention, but approximately 30% will develop primary pulmonary coccidioidomycosis (PCM) with signs and symptoms that mimic community acquired pneumonia (CAP) or other respiratory illnesses. Further, 5% of those diagnosed will develop serious and even life-threatening manifestations including extrapulmonary/disseminated coccidioidomycosis (DCM). Of those who develop PCM, past evidence suggests ∼ 5% to 15% will develop long-term pulmonary sequelae in the form of nodules, abscesses, or cavitary lesions. These lesions may not be easily distinguished from malignancy or other infections, such as tuberculosis, and they add a substantial burden to both patients and the healthcare system. Despite the long-term consequences of cavitary CM in some individuals, the current literature review and practice guidelines demonstrate a paucity of clear management strategies to treat these patients. In this report we will focus on cavitary lesions in CM with the goal to present a description of the evaluation and management of their various forms, manifestations, and complications. These recommendations are derived from a multidisciplinary group of experts.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Missed Opportunities for Lung Cancer Screening among Behavioral Health Patients with Elevated Cigarette Smoking Rates: Lung Cancer Screening and Behavioral Health.","authors":"Anastasia Rogova, Lisa M Lowenstein, Lorraine R Reitzel, Kathleen Casey, Robert J Volk","doi":"10.1016/j.chest.2024.11.039","DOIUrl":"https://doi.org/10.1016/j.chest.2024.11.039","url":null,"abstract":"<p><p>Annual lung cancer screening using low dose computed tomography (LDCT) effectively reduces mortality from lung cancer and is recommended for persons who are at high risk of developing the disease. The utilization of the lung cancer screening, however, has remained low. Due to significantly higher cigarette smoking rates, patients with behavioral health disorders (those living with mental illness and/or substance use disorders) are more likely to be diagnosed with and die from lung cancer; at the same time, they are less likely to undergo cancer screenings. There is an urgent need for targeted efforts to improve access to lung cancer screening among this population disproportionately affected by the disease. In this commentary, we propose integrating lung cancer screening facilitation into services provided by behavioral health professionals who are uniquely positioned to reach these patients and deliver interventions to increase uptake of cancer screenings. We suggest several measures that could improve lung health outcomes of patients with behavioral health disorders: (1) training behavioral health professionals in lung cancer screening eligibility assessment; (2) providing patients with education materials; (3) integrating shared decision making counseling for lung cancer screening into behavioral healthcare settings; (4) providing practical support needed to access screening; (5) establishing effective partnerships with community organizations. Regardless of the level of engagement, possibly ranging from brief training to the implementation of comprehensive programs, any involvement will benefit patients. This integrated approach will contribute to reducing lung cancer mortality among patients with behavioral health disorders who have long experienced systemic health inequities. Lung Cancer Screening Recommendations and Current Uptake.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Promoting Prevention and Targeting Remission of Asthma A EUFOREA Consensus Statement on Raising the Bar in Asthma Care.","authors":"Milos Jesenak, Dr Anna Bobcakova, Ratko Djukanovic, Mina Gaga, Nicola A Hanania, Liam G Heaney, Ian Pavord, Santiago Quirce, Dr Dermot Ryan, Wytske Fokkens, Dr Diego Conti, Peter W Hellings, Glenis Scadding, Elizabeth Van Staeyen, Leif H Bjermer, Zuzana Diamant","doi":"10.1016/j.chest.2024.11.035","DOIUrl":"https://doi.org/10.1016/j.chest.2024.11.035","url":null,"abstract":"<p><strong>Topic importance: </strong>Asthma is a common multifaceted respiratory disease with a major impact on quality of life. Despite increased insights into mechanisms underlying various asthma phenotypes/endotypes and the availability of targeted biologic treatment options, a substantial proportion of patients remains uncontrolled with risk of exacerbations, requiring systemic corticosteroids, and progressive disease. Current international guidelines advocate a personalized management approach to patients with uncontrolled severe asthma.</p><p><strong>Review findings: </strong>The EUFOREA asthma expert panel was convened to discuss strategies to optimize asthma care, prevent systemic corticosteroids overuse and disease progression. In this meeting report, we summarize current concepts and recommendations and provide a rationale to implement personalized asthma management at earlier stages of the disease. The ultimate goal is to move away from the current \"one-size-fits-most\" concept, which focuses on a symptom-driven treatment strategy, and shift towards a phenotype/endotype-targeted approach aimed at curbing the disease course by improving clinical outcomes and preserving health-related quality of life.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142821957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}