Chest最新文献

{"title":"Results of the SHARP Study: A Randomized, Placebo-Controlled, Double-Blind, Repeated-Measures, Crossover, Phase IV Clinical Trial of the Effect of the Wake-Promoting Agent Solriamfetol on Cognitive Function in OSA With Excessive Daytime Sleepiness and Cognitive Impairment.","authors":"Hans P A Van Dongen, Eileen B Leary, Christopher Drake, Richard Bogan, Judith Jaeger, Russell Rosenberg, Caroline Streicher, Herriot Tabuteau","doi":"10.1016/j.chest.2024.10.050","DOIUrl":"10.1016/j.chest.2024.10.050","url":null,"abstract":"<p><strong>Background: </strong>OSA causes episodes of fragmented sleep and intermittent hypoxia and leads to excessive daytime sleepiness (EDS). Deficits in cognitive function are a troublesome symptom in patients with OSA and EDS.</p><p><strong>Research question: </strong>How does solriamfetol affect cognitive function in patients with cognitive impairment associated with OSA and EDS?.</p><p><strong>Study design and methods: </strong>Solriamfetol's Effect on Cognitive Health in Apnea Participants During a Randomized Placebo-controlled Study (SHARP) was a phase IV, randomized, double-blind, placebo-controlled, crossover trial. Participants (N = 59) were randomized to receive placebo or solriamfetol (75 mg/d for 3 days, then 150 mg/d) for 2 weeks, with crossover separated by a 1-week washout period. Efficacy measures included the Coding subtest, comparable to the Digit Symbol Substitution Test (DSST), of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), the British Columbia Cognitive Complaints Inventory (BC-CCI), Patient Global Impression of Severity (PGI-S), and the Epworth Sleepiness Scale (ESS). The primary end point was change from baseline in average postdose DSST RBANS scores. Secondary end points were changes from baseline in BC-CCI, PGI-S, ESS, and DSST RBANS scores at 2, 4, 6, and 8 hours' postdose. Safety was monitored by assessment of treatment-emergent adverse events.</p><p><strong>Results: </strong>Solriamfetol significantly improved postdose average DSST RBANS scores compared with placebo (P = .009; effect size [Cohen's d], 0.37). When evaluated at each 2-hour time point, cognitive function was significantly improved at 2, 6, and 8 hours after dosing (all, P < .05). During solriamfetol treatment, there were significant improvements in BC-CCI (P = .002; d = 0.45), PGI-S (P = 0.0mixed; d = 0.29), and ESS (P = .004; d = 0.40) compared with placebo. The most common treatment-emergent adverse events were nausea (7%) and anxiety (3%).</p><p><strong>Interpretation: </strong>SHARP showed that solriamfetol can improve objective and subjective measures of cognitive function in patients with cognitive impairment associated with OSA and EDS.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov; No.: NCT04789174; ;URL: www.</p><p><strong>Clinicaltrials: </strong>gov and EudraCT; No.: 2020-004243-92; URL: https://eudract.ema.europa.eu.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615782","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":"Sarcoidosis Treatment Patterns in the United States: 2016-2022.","authors":"Ruchika Sangani, Nicholas A Bosch, Praveen Govender, Brittany Scarpato, Allan J Walkey, Julia Newman, Anica C Law, Kari R Gillmeyer, Divya A Shankar","doi":"10.1016/j.chest.2024.10.040","DOIUrl":"10.1016/j.chest.2024.10.040","url":null,"abstract":"<p><strong>Background: </strong>There are limited US Federal Drug Administration-approved medications and real-world data on sarcoidosis treatment in the United States. Concordance of practice patterns with guideline recommendations have not been well characterized.</p><p><strong>Research question: </strong>What are the practice patterns and factors associated with treatment for patients with sarcoidosis in the year following diagnosis?</p><p><strong>Study design and methods: </strong>A retrospective analysis was conducted of patients with sarcoidosis from 2016 to 2022 using a multicenter, all-payer claims database (TriNetX). Treatments with corticosteroids and/or nonsteroidal immunosuppressive medications (methotrexate, mycophenolate, leflunomide, hydroxychloroquine, cyclophosphamide, infliximab, adalimumab, azathioprine, rituximab, and Janus kinase inhibitors) within 1 year of diagnosis were ascertained. We summarized treatment rates, sequence of prescribed medications by mean rank, and used multivariable logistic regression analyses to identify factors associated with treatment.</p><p><strong>Results: </strong>Of 13,330 patients with sarcoidosis meeting inclusion, 5,671 (42.5%) received treatment within 1 year of diagnosis. Of those treated, 60% received steroids alone, 13% received nonsteroidal immunosuppressives alone, and 27% received both. Furthermore, 25% of treated patients received a nonsteroidal immunosuppressive as their first medication. Corticosteroids had the lowest mean rank order, indicating they were, on average, the first medication initiated. Among those with pulmonary or cutaneous involvement, the second medication initiated, on average, was hydroxychloroquine; in those with cardiac or neurologic involvement, it was adalimumab and mycophenolate, respectively. Factors associated with higher odds of treatment were Black race, organ involvement at baseline (pulmonary, cardiac, and neurologic), and comorbid diagnoses (fatigue, hypercalcemia, and interstitial lung disease).</p><p><strong>Interpretation: </strong>Within the first year of diagnosis, 43% of patients with sarcoidosis were started on treatment. Nonsteroidal immunosuppressives were used in 40% of treated patients. Although factors associated with treatment initiation aligned with guideline recommendations, practice patterns of treatment were variable, particularly in choice and sequence of nonsteroidal immunosuppressive therapy, underscoring the need for future trials and comparative effectiveness studies.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615783","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":"Comparison of Clinically Meaningful Improvements After Center-Based and Home-Based Telerehabilitation in People With COPD.","authors":"Narelle S Cox, Christine McDonald, Angela T Burge, Catherine J Hill, Janet Bondarenko, Anne E Holland","doi":"10.1016/j.chest.2024.11.001","DOIUrl":"10.1016/j.chest.2024.11.001","url":null,"abstract":"<p><strong>Background: </strong>Response to pulmonary rehabilitation is not equal for all participants and may vary across health outcomes for any one individual. Alternative methods of pulmonary rehabilitation delivery, for example, telerehabilitation, may improve program access, but also could affect response to rehabilitation.</p><p><strong>Research question: </strong>What is the rate of clinical response to home-based telerehabilitation compared with center-based pulmonary rehabilitation, and are any participant baseline characteristics associated with pulmonary rehabilitation response relative to the model of delivery?</p><p><strong>Study design and methods: </strong>In this secondary analysis of 2 randomized controlled trials, participants were categorized as responders or nonresponders according to achievement of the minimal important difference (MID) for each outcome of interest at end rehabilitation and after the 12-month follow-up (change from baseline). Outcomes of interest were functional exercise capacity (6-minute walk distance; MID, 30 m), health-related quality of life (chronic respiratory disease questionnaire [CRQ]: MID, 2.5, 2, 3.5, and 2 points for the dyspnea, fatigue, emotion, and mastery domains, respectively; CRQ total score MID, 10 points); and symptoms (modified Medical Research Council [mMRC]: MID, -1 point).</p><p><strong>Results: </strong>Two hundred sixty-six individuals with COPD were included in the analysis. The proportion of responders was not different between center-based pulmonary rehabilitation and home-based telerehabilitation at either end rehabilitation or 12-month follow-up for any outcome (range, 39%-62%). In a binary logistic regression analysis, baseline outcome values, but not participant demographic characteristics, were associated most commonly with responder status. The relative risk of program noncompletion in the center-based group was nearly 4 times greater than for telerehabilitation (center-based pulmonary rehabilitation: n = 79 [58%] vs home-based telerehabilitation: n = 116 [90%]; relative risk, 3.89; 95% CI, 2.28-6.63).</p><p><strong>Interpretation: </strong>Responder status to pulmonary rehabilitation was not different between center-based and home-based telerehabilitation. The ability to identify patient characteristics that confer greater potential for rehabilitation response or better suitability for a particular model of rehabilitation remains a challenge.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615774","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":"Quantitative CT Scan Analysis in Rheumatoid Arthritis-Related Interstitial Lung Disease.","authors":"Stephen M Humphries, Ayodeji Adegunsoye, M Kristen Demoruelle, Michelle Li Wei Kam, Isabelle Amigues, Tami J Bang, Shawn D Teague, David A Lynch, Jonathan H Chung, Mary E Strek, Jeffrey J Swigris, Joshua J Solomon","doi":"10.1016/j.chest.2024.10.052","DOIUrl":"10.1016/j.chest.2024.10.052","url":null,"abstract":"<p><strong>Background: </strong>Quantitative CT imaging may be a useful predictor of outcome in rheumatoid arthritis-related interstitial lung disease (RA-ILD).</p><p><strong>Research question: </strong>What is the utility of deep learning-based lung fibrosis quantitation on CT imaging in assessing disease severity, predicting mortality, and identifying progression in RA-ILD?.</p><p><strong>Study design and methods: </strong>CT scans on a primary cohort of 289 patients and a validation cohort of 50 individuals with RA-ILD were assessed quantitatively by using the data-driven texture analysis (DTA) method. We examined associations between quantitative scores for extent of lung fibrosis and pulmonary function and survival.</p><p><strong>Results: </strong>DTA fibrosis score at baseline showed moderate negative correlation with FVC percent predicted (primary cohort rho = -0.55; validation cohort rho = -0.50; both, P < .001), and diffusing capacity for carbon monoxide percent predicted (primary cohort rho = -0.67; validation cohort rho = -0.65; both, P < .001). Longitudinal change in DTA fibrosis score was associated with changes in FVC and diffusing capacity for carbon monoxide in the primary cohort (rho = -0.46 and rho = -0.43, respectively; both, P < .001). Cox multivariable models adjusted for potentially influential variables showed that the baseline DTA fibrosis score was significantly associated with mortality risk (primary cohort hazard ratio [HR], 1.04 [95% CI, 1.03-1.05; P < .001]; validation cohort HR, 1.06 [95% CI, 1.01-1.11; P = .026]). In the primary cohort, the increase in DTA fibrosis score on sequential scans was associated with increased risk of mortality (HR, 1.04; 95% CI, 1.01-1.06; P = .003) independent of baseline DTA extent.</p><p><strong>Interpretation: </strong>In two cohorts of patients with RA-ILD, quantitative assessment of lung fibrosis on CT imaging was associated with worse lung function at baseline and risk of mortality. Increase in DTA-derived lung fibrosis score on sequential scans was associated with subsequent risk of mortality. Quantitative CT imaging should be considered for use as a clinical and research outcome assessment tool in RA-ILD.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615779","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":"Parasitic Infections in Pulmonary and ICU Patients: Presentation, Diagnosis, and Treatment.","authors":"Adam C Kley, A Clinton White","doi":"10.1016/j.chest.2024.10.046","DOIUrl":"10.1016/j.chest.2024.10.046","url":null,"abstract":"<p><p>Parasitic infections in the United States are mostly seen in immigrants and travelers. In many cases, pulmonary and intensive care physicians fail to consider parasitic disease, which can result in delayed diagnosis and adverse outcomes. Almost 2000 cases of imported malaria are diagnosed in the United States each year. Severe cases can be confused with bacterial sepsis (shock, lactic acidosis, pneumonia, renal failure, respiratory failure, and jaundice). In contrast to bacterial sepsis, survival is improved by restrictive fluid therapy. Parenteral artesunate is licensed to treat severe cases but may not be readily accessible. Strongyloidiasis is endemic in warm and most tropical regions. Chronic strongyloidiasis causes few symptoms and can persist for decades after the patient leaves the endemic region. Treatment with corticosteroids may lead to hyperinfection, which may present with bacteremia and meningitis caused by enteric organisms, pulmonary hemorrhage, and gastrointestinal pain, bleeding, or obstruction. Treatment with ivermectin can be curative if initiated early. Cystic echinococcosis can present as pulmonary mass. Paragonimus presents with hemoptysis, pulmonary nodules, or pleural effusions, and usually with eosinophilia. Endemic regions include not only East Asia but also Southeast Asia, west Africa, the Pacific coast of Latin America, and even North America. Other parasitic infections can involve the lungs. This article aims to provide awareness of the most clinically relevant parasitic infections seen in pulmonary and critical care medicine.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615778","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":"Lessons Learned: Risk Factors and Clinical Impact of Severe Pneumothorax After Endoscopic Lung Volume Reduction With Endobronchial Valves.","authors":"Judith Maria Brock, Susanne Annemarie Dittrich, Florian Eichhorn, Kai Schlamp, Konstantina Kontogianni, Felix J F Herth","doi":"10.1016/j.chest.2024.10.045","DOIUrl":"10.1016/j.chest.2024.10.045","url":null,"abstract":"<p><strong>Background: </strong>Pneumothorax is a major complication after endoscopic lung volume reduction with valves, with a prevalence of up to 34%. Although some patients benefit from valve implantation despite pneumothorax, others are significantly impaired after lung collapse.</p><p><strong>Research question: </strong>What are the differences in the severity grades of pneumothorax and how do these affect clinical practice?</p><p><strong>Study design and methods: </strong>This single-center retrospective study analyzed patients undergoing endoscopic valve implantation with and without pneumothorax after intervention. Emphysema characteristics, collateral ventilation, management, and outcome of patients with pneumothorax 3 months after valve implantation were assessed. Pneumothorax was categorized as severe (chest tube insertion, prolonged air leak requiring valve removal), moderate (chest tube, no valve removal), and mild (no chest tube).</p><p><strong>Results: </strong>Pneumothorax occurred in 102 of 532 patients (19%) and was significantly more common after valve placement in the upper lobes (31.3%) compared with the lower lobes (11.3%; P < .001). Fissure integrity was significantly higher in patients with pneumothorax (mean, 96.6 ± 6.3% vs 93.4 ± 10.3%; P = .002). Of all pneumothoraces, 30.4% were mild, 30.4% were moderate, and 39.2% were severe. Severe pneumothorax caused multiple complications and prolonged hospitalization. Valve placement in the left upper lobe and a larger size of the target lobe were identified as risk factors for severe pneumothorax. Patients with pneumothorax demonstrated complete lobar atelectasis in > 60% as a sign of therapeutic success, but obviously only when valves could be left in place or reimplanted. However, valve reimplantation resulted in repeat pneumothorax in 42.9%.</p><p><strong>Interpretation: </strong>Patients could be informed more individually about their risk of pneumothorax, which varies with target lobe location, fissure integrity, and reimplantation. The poor outcome and high complication rate of severe pneumothorax calls for future research into the prediction of severe pneumothorax.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615777","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 Dawn of Precision Medicine in Fibrotic Interstitial Lung Disease.","authors":"Theodoros Karampitsakos, Bochra Tourki, Jose D Herazo-Maya","doi":"10.1016/j.chest.2024.10.042","DOIUrl":"10.1016/j.chest.2024.10.042","url":null,"abstract":"<p><strong>Topic importance: </strong>Interstitial lung diseases (ILDs) represent a broad group of heterogeneous parenchymal lung diseases. Some ILDs progress, causing architectural distortion and pulmonary fibrosis, and thus are called fibrotic ILDs. Recent studies have shown a beneficial effect of antifibrotic therapy in fibrotic ILDs other than idiopathic pulmonary fibrosis (IPF) that manifest progressive pulmonary fibrosis (PPF). However, it remains challenging to predict which patients with fibrotic ILDs will demonstrate PPF. Precision medicine approaches could identify patients at risk for progression and guide treatment in patients with IPF or PPF.</p><p><strong>Review findings: </strong>Multiple biomarkers able to highlight disease susceptibility risk, to provide an accurate diagnosis, and to prognosticate or assess treatment response have been identified. Advances in precision medicine led to the identification of endotypes that could discriminate patients with different fibrotic ILDs or patients with different disease courses. Importantly, recent studies have shown that particular compounds were efficacious only in particular endotypes. The aforementioned findings are promising. However, implementation in clinical practice remains an unmet need.</p><p><strong>Summary: </strong>Substantial progress has been observed in the context of precision medicine approaches in fibrotic ILDs in recent years. Nonetheless, infrastructure, financial, regulatory, and ethical challenges remain before precision medicine in clinical practice can be implemented. Overcoming such barriers and moving from a one-size-fits-all approach to patient-centered care could improve patient quality of life and survival substantially.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615784","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":"Trends in All-Cause Mortality Among US Veterans With Sarcoidosis, 2004-2022.","authors":"Mohamed I Seedahmed, Mohamed T Albirair, Aaron D Baugh, Walid F Gellad, S Mehdi Nouraie, Kevin F Gibson, Mary A Whooley, Charles E McCulloch, Laura L Koth, Mehrdad Arjomandi","doi":"10.1016/j.chest.2024.10.043","DOIUrl":"10.1016/j.chest.2024.10.043","url":null,"abstract":"<p><strong>Background: </strong>Sarcoidosis is an idiopathic multiorgan disease with variable clinical outcomes. Comprehensive analysis of sarcoidosis mortality in US veterans is lacking.</p><p><strong>Research question: </strong>What are the trends in all-cause mortality among US veterans with sarcoidosis, and how are these trends influenced by demographics, Black vs White racial disparities, and geographic variability in relationship to mortality?</p><p><strong>Study design and methods: </strong>Using Veterans Health Administration (VHA) electronic health records (EHRs), we conducted a population-based retrospective cohort study of adjusted all-cause mortality from 2004 through 2022 among veterans with a diagnosis of sarcoidosis who received care through the VHA. Demographics, region of residence, service branch, tobacco use, and comorbidities were extracted from the EHR. Annual trends in all-cause mortality and patient-level characteristics associated with mortality were examined with multivariable ungrouped Poisson regression. We visualized trends and analyzed state-by-state mortality using the marginal means procedure. In subgroup analysis (2015-2022), we considered the impact of neighborhood-level socioeconomic disparities using the area deprivation index (ADI).</p><p><strong>Results: </strong>In all, 23,745 veterans received a diagnosis of sarcoidosis between 2004 and 2019 and were followed up through 2022. After adjustment, including age and sex, all-cause mortality increased annually by 4.7% (P < .0001) and was 6.4% higher in Black than White veterans (mortality rate ratio, 1.064; P = .02). A subgroup analysis comparing models with and without ADI adjustment showed no meaningful change in mortality trends. Risk factors for increased all-cause mortality included older age, male sex, Black race, Northeast residence, and lower risk with other service branches. Despite distinct geographical variations in mortality rates, no clear patterns emerged.</p><p><strong>Interpretation: </strong>Mortality among veterans with sarcoidosis is rising. Differences identified by service branch and higher risk among male Veterans raise questions about differences in environmental exposures. The narrower racial disparities and smaller impact of ADI than in other studies may highlight the role of universal health care access in achieving equitable outcomes.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615785","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":"Implementation and Effectiveness of Guideline-Recommended Clinical Activities for Children With Asthma: Population-Based Cohort.","authors":"Z Khalaf, S Saglani, Chloe I Bloom","doi":"10.1016/j.chest.2024.10.036","DOIUrl":"10.1016/j.chest.2024.10.036","url":null,"abstract":"<p><strong>Background: </strong>Guidelines advise minimizing asthma exacerbation risk, which is achieved partially through good clinical practice activities, including scheduled asthma reviews, inhaler technique checks, and asthma management plans. We assessed how frequently these activities are provided and how effective they are in clinical practice.</p><p><strong>Research question: </strong>Do guideline-recommended activities such as asthma reviews, inhaler technique checks, and asthma management plans prevent asthma exacerbations?</p><p><strong>Study design and methods: </strong>This retrospective chart review used United Kingdom primary care medical records between 2004 and 2021, linked to hospital records. Children were eligible from asthma diagnosis until age 16 years. Annual implementation of asthma review, inhaler technique check, and asthma management plan was measured. Risk factors for these activities not being undertaken were determined by using multivariable logistic regression. Self-controlled case series was adopted to assess the effectiveness of each activity over 12 months; this was divided into two 6-month periods.</p><p><strong>Results: </strong>A total of 126,483 children were eligible; 30% to 45% received each annual activity, and 8% received all 3 together. Risk factors for not receiving activities included younger age, more socioeconomic deprivation, and higher or no BMI measurement. Management plans and asthma reviews, as standalone activities, were associated with an approximately 15% exacerbation reduction over 12 months and 8% over 6 months, respectively (asthma management plan, n = 4,624; 0-6 months [incidence rate ratio (95% CI)]: 0.87 [0.79-0.96]; 6-12 months: 0.83 [0.73-0.95]; asthma review, n = 6,948; 0-6 months: 0.92 [0.85-0.99]; 6-12 months: 0.93 [0.83-1.03]). Standalone inhaler technique checks were not associated with exacerbations. Provision of all activities together was associated with an approximately 30% exacerbation reduction over 12 months (n = 3,643; 0-6 months: incidence rate ratio, 0.76 [0.68-0.85]; 6-12 months: incidence rate ratio, 0.69 [95% CI, 0.60-0.81]).</p><p><strong>Interpretation: </strong>Most children in the United Kingdom do not receive the guideline-recommended activities to monitor their asthma. This study suggests that these activities, if implemented, are effective in clinical practice and maximally effective when combined in the same visit.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615776","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":"Hypnotics and Mortality in Idiopathic Pulmonary Fibrosis: Hospital and National Data-Based Analysis.","authors":"Hironao Hozumi, Yoshinari Endo, Masato Kono, Hirotsugu Hasegawa, Koichi Miyashita, Hyogo Naoi, Yuya Aono, Yoichiro Aoshima, Yusuke Inoue, Kazutaka Mori, Hideki Yasui, Yuzo Suzuki, Masato Karayama, Kazuki Furuhashi, Noriyuki Enomoto, Tomoyuki Fujisawa, Naoki Inui, Koshi Yokomura, Takafumi Suda","doi":"10.1016/j.chest.2024.10.038","DOIUrl":"10.1016/j.chest.2024.10.038","url":null,"abstract":"<p><strong>Background: </strong>Patients with idiopathic pulmonary fibrosis (IPF) may experience insomnia and use hypnotics. However, the effect of the use of hypnotics on their clinical course remains unclear.</p><p><strong>Research question: </strong>Is the use of hypnotics associated with an increased risk of mortality in patients with IPF?</p><p><strong>Study design and participants: </strong>This study included 99 patients with IPF from the Hamamatsu hospital-based cohort and 123 patients with IPF from the Seirei hospital-based cohort, as well as 30,218 patients with IPF from the National Database of Health Insurance Claims and Specific Health Checkups of Japan (the NDB cohort). To analyze the association of hypnotics use with outcomes avoiding immortal time bias, multivariable Cox models with time-dependent covariates and target trial emulation with a new user design were used for the hospital- and NDB-based cohorts.</p><p><strong>Results: </strong>In the cohorts studied, the 3-year cumulative incidence of new use of hypnotics following the IPF diagnosis ranged from 13.4% to 24.1%. In both hospital-based cohorts, the continuous use of hypnotics was associated with an increased risk of all-cause mortality and disease progression. In the NDB cohort, the continuous use of hypnotics was also associated with an increased risk of all-cause mortality. Subgroup analysis found associations between the continuous use of hypnotics and increased mortality regardless of sex and comorbidities, excluding certain subpopulations.</p><p><strong>Interpretation: </strong>This study found that continuous use of hypnotics was associated with an increased risk of mortality in patients with IPF. Given the relatively high cumulative incidence of hypnotics use in this population, there is an urgent need to reassess the appropriate use of hypnotics for patients with IPF.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603548","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}