Chest最新文献

{"title":"Lung Cancer Screening Uptake Among Adults Newly Eligible Under the 2023 American Cancer Society Guideline Compared With US Preventive Services Task Force-Eligible Adults: A Nationwide Cross-Sectional Study.","authors":"Yufei Jia, Junqiang Zhao, M Patricia Rivera","doi":"10.1016/j.chest.2026.09.005","DOIUrl":"10.1016/j.chest.2026.09.005","url":null,"abstract":"<p><strong>Background: </strong>The 2023 American Cancer Society (ACS) lung cancer screening (LCS) guideline expanded eligibility beyond the 2021 US Preventive Services Task Force (USPSTF) recommendations by removing the 15-year smoking cessation criterion. Screening uptake among adults newly eligible under ACS criteria remains unclear.</p><p><strong>Research question: </strong>How does LCS uptake among adults newly eligible under the 2023 ACS criteria differ from uptake among adults eligible under the 2021 USPSTF criteria?</p><p><strong>Study design and methods: </strong>We analyzed 2024 National Health Interview Survey data for adults aged 50 to 80 years with a computable pack-year history, current or former smoking history, and no prior lung cancer diagnosis. Respondents were classified as USPSTF-eligible (≥ 20 pack-years, quit < 15 years ago, or currently smoke), ACS-only-eligible (≥ 20 pack-years or quit > 15 years ago), or neither-eligible. Outcomes were past-12-month and any reported LCS. Survey-weighted multivariable logistic regression estimated associations between eligibility group and screening uptake.</p><p><strong>Results: </strong>The analytic sample included 5,987 adults, representing approximately 37.5 million US adults with a smoking history. Overall, 35.2% were USPSTF-eligible, 13.5% ACS-only-eligible, and 51.2% neither-eligible. Past-12-month LCS prevalence was 17.8%, 8.0%, and 3.9%, respectively. Compared with neither-eligible adults, USPSTF eligibility was associated with higher odds of both past-12-month LCS (OR, 4.54; 95% CI, 3.44-5.98) and any reported LCS (OR, 3.44; 95% CI, 2.77-4.27). ACS-only eligibility was associated with higher odds of past-12-month LCS (OR, 1.62; 95% CI, 1.12-2.35) but not any reported LCS. Within the ACS-only group, non-Hispanic Black race and telehealth use were associated with higher screening uptake.</p><p><strong>Interpretation: </strong>Adults newly captured by the 2023 ACS criteria showed measurable past-12-month LCS uptake, but uptake remained less than one-half that of USPSTF-eligible adults. These findings suggest early implementation of broader ACS eligibility, while highlighting the need for equity-focused, clinician- or system-triggered strategies to identify people who formerly smoked with remote quit history.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001310","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":"Social Media and Crisis Care Principles During Pandemics and Disasters: A Consensus Report From a Subgroup of the Task Force for Mass Critical Care.","authors":"Jason Persoff, Asha Devereaux, Ryan Maves, Anuj B Mehta, Lisa Burry, Aloke Chakravarti, Deborah Levy, Henry J Feldman, Amado Alejandro Baez, Jamie R Felzer, Karyn D Baum, David J Dries, Vikramjit Mukherjee, Drew Persson, Taylor S Conrad, Tanzib Hossain, Marya Ghazipura, George L Anesi, Doug Ornoff, Natalie Freels, Charles L Sprung, Jeffrey R Dichter","doi":"10.1016/j.chest.2026.08.049","DOIUrl":"10.1016/j.chest.2026.08.049","url":null,"abstract":"<p><strong>Background: </strong>Effective communication and coordination are fundamental determinants of the health care system's performance during disasters. Failures in these domains during the COVID-19 pandemic contributed to disrupted care delivery, strained staff, resource shortages, and adverse patient outcomes.</p><p><strong>Research question: </strong>Drawing on pandemic lessons, the Task Force for Mass Critical Care (TFMCC) conducted a comprehensive assessment of peer-reviewed literature, gray sources, and firsthand experience using a modified Delphi process to develop consensus-based suggestions to strengthen communication strategies and operational coordination.</p><p><strong>Study design and methods: </strong>Methodologic frameworks from the World Health Organization and Guidelines International Network-McMaster Guideline Development Checklist for rapid guidelines were merged to establish a consensus development process, integrating evidence synthesized from the literature with expert opinions. The previously described process used a 3-round modified Delphi approach to synthesize published evidence, to collect anecdotal evidence, and to develop suggestions.</p><p><strong>Results: </strong>A total of 147 evidence statements were evaluated, resulting in 22 suggestions substantiated by other supporting literature and anecdotal experiences. The TFMCC identified transparent, timely, and scientifically grounded public communication with proactive engagement through social media as indispensable for information dissemination and misinformation mitigation. Planning and coordination across federal, state, regional, and hospital systems are critical for effective disaster response, which depends on standardized crisis care frameworks, Medical Operations Coordination Centers, and interoperable health information systems enabling real-time situational awareness. Important findings include community engagement, equitable resource allocation, accessible communication strategies, and processes to avoid restrictive visitation policies that can impede surrogate decision-making. Finally, integrating emergency department expertise into hospital incident command and strengthening the so-called last mile of supply-chain distribution are necessary to sustain clinical operations.</p><p><strong>Interpretation: </strong>Our results show that communication and coordination are core operational priorities during disaster response, emphasizing their impact on patient outcomes, system performance, and public trust. Communication and coordination systems require sustained investments in interorganizational relationships and public engagement.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975815","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":"Optimizing Palliative Care Delivery in the ICU: A Multiinstitutional Qualitative Study of Palliative Care Clinicians' Views on Their Role in the ICU.","authors":"Jordan Liu, Daniel K Manson, Miguel Cid, Myrick Shinall, May Hua","doi":"10.1016/j.chest.2026.09.001","DOIUrl":"10.1016/j.chest.2026.09.001","url":null,"abstract":"<p><strong>Background: </strong>Specialty palliative care (SPC) consultation in the ICU has become increasingly common; however, intensivists face uncertainty about how to optimally integrate SPC to maximize benefit. Prior qualitative work has examined ICU clinicians' perspectives, but SPC clinicians' views on optimizing their role remain largely unexplored.</p><p><strong>Research question: </strong>When do SPC clinicians think specialist consultation is most and least beneficial for patients who are critically ill, and what integration models do they prefer?</p><p><strong>Study design and methods: </strong>We conducted semistructured interviews with a purposive sample of SPC clinicians (physicians, nurse practitioners, and social workers) from 5 academic medical centers in the US. Transcripts were analyzed using a codebook approach to thematic analysis.</p><p><strong>Results: </strong>We interviewed 19 SPC clinicians and identified the following 4 themes: (1) attending to suffering, communication, and meaning in critical illness; (2) gaps in shared understanding of need drive misallocation of specialty expertise; (3) balancing intensivists' primary palliative care skill development with specialty consultation; and (4) embedding palliative care in the ICU: presence and partnership. Participants located their distinct value in attending to the human dimensions of critical illness. They often judged whether a consult reflected a true specialist need by its proximity to decision-making, and gaps in this shared understanding of need led to perceived misallocation of specialty expertise. Participants emphasized the need to improve ICU teams' primary palliative care skills to reserve consultation for true specialist need. They favored embedded models of care for their ability to improve patient access to SPC while strengthening relationships between SPC and ICU teams.</p><p><strong>Interpretation: </strong>Optimizing SPC-ICU integration may depend on building a shared understanding of when specialist input is needed and sustaining relationships between SPC and ICU teams. These findings provide actionable guidance for intensivists on how to consult strategically and offer a framework for institutions seeking to optimize SPC-ICU collaboration.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148929135","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":"General Information","authors":"","doi":"10.1016/s0012-3692(26)06221-5","DOIUrl":"https://doi.org/10.1016/s0012-3692(26)06221-5","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"1 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984656","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":"Assessing the Impact of Earlier Initiation of Biologics on Clinical Remission and Other Outcomes in a Global Real-Life Severe Asthma Cohort From CHRONICLE, the International Severe Asthma Registry, and the Optimum Patient Care Research Database.","authors":"Giorgio Walter Canonica, George C Christoff, Ming-Ju Tsai, Trung N Tran, John Townend, Ghislaine Scelo, Aaron Beastall, Lakmini Bulathsinhala, John Busby, Andrew W Lindsley, Wendy C Moore, Reynold A Panettieri, Enrico Heffler, Cristina Cardini, Giuseppe Guida, Eileen Wang, Michael E Wechsler, Nicholas Chapman, Flavia Hoyte, Rohit K Katial, Kanao Otsu, Celeste M Porsbjerg, Anne-Sofie Bjerrum, Anna von Bülow, Susanne Hansen, Ole Hilberg, Kjell Erik Julius Håkansson, Marianne Baastrup Søndergaard, Charlotte Suppli Ulrik, Liam G Heaney, David J Jackson, Pujan H Patel, Paul E Pfeffer, Dermot Ryan, Piotr Kuna, Celine Bergeron, Shawn D Aaron, Shelley Abercromby, Mohit Bhutani, Kenneth R Chapman, Andréanne Côté, Beth E Davis, Delbert R Dorscheid, Leiana Hoshyari, Brianne Philipenko, Mohsen Sadatsafavi, Hana Serajeddini, Désirée Larenas-Linnemann, Borja G Cosio, Luis Perez-de-Llano, Carlos A Torres-Duque, María José Fernández-Sánchez, Elizabeth Garcia, Fabio Bolívar-Grimaldos, Libardo Jiménez-Maldonado, Diana Jimena Cano-Rosales, Ivan Solarte, Florence Schleich, Renaud Louis, Riyad Al-Lehebi, Adeeb A Bulkhi, Yahya Habis, Mona Al-Ahmad, Bassam Mahboub, Laila Salameh, Paulo Márcio Pitrez, Takashi Iwanaga, Soichiro Hozawa, Hisako Matsumoto, Tatsuya Nagano, Tomoko Tajiri, João A Fonseca, Ana Alves da Silva, Cláudia Chaves Loureiro, Hadassa Cristhina de Azevedo Soares Dos Santos, Nikolaos G Papadopoulos, Konstantinos Kostikas, Mina Gaga, Athena Gogali, Maria Kallieri, Stelios Loukides, Michael Makris, Maria Ntakoula, Andriana I Papaioannou, Giannis Paraskevopoulos, Fotios Psarros, Diahn-Warng Perng, Yi-Han Hsiao, Pin-Kuei Fu, Chau-Chyun Sheu, Bernt Bøgvald Aarli, Todor A Popov, Mariko Siyue Koh, Mei Fong Liew, Pee Hwee Pang, Tze Lee Tan, Tunn Ren Tay, Chin Kook Rhee, Jorge Máspero, Ledit R F Ardusso, María Eugenia Franchi, Martin Sivori, Ana María Stok, Anahí Yañez, Njira Lugogo, Arjun Mohan, Patrick D Mitchell, Alan Altraja, Sundeep Salvi, Richard W Costello, Eve J Denton, Mark Hew, Christine Jenkins, David Langton, Peter G Middleton, Matthew J Peters, Lauri Lehtimäki, Arnaud Bourdin, Camille Taillé, Christian Taube, Zsuzsanna Csoma, Dóra Lúdvíksdóttir, Job F M van Boven, James Fingleton, Helena Emery, Graham Lough, Valeria Perugini, Leif Bjermer, Diego J Maselli, Roy Alton Pleasants, Christopher S Ambrose, Benjamin Emmanuel, Cathy Emmas, Andrew N Menzies-Gow, Amit D Parulekar, Victoria Carter, Nevaashni Eleangovan, Ruth B Murray, Chris A Price, John D Blakey, David B Price","doi":"10.1016/j.chest.2026.06.076","DOIUrl":"10.1016/j.chest.2026.06.076","url":null,"abstract":"<p><strong>Background: </strong>Biologics generally are reserved for severe asthma (SA) after standard treatments have failed. Their recommendation is based on randomized controlled trials, designed to assess efficacy but not the optimal timing for biologic initiation.</p><p><strong>Research question: </strong>Does the timing of biologic initiation affect SA outcomes, including remission?</p><p><strong>Study design and methods: </strong>This was a cohort study using data from the International Severe Asthma Registry, the CHRONICLE registry from the United States, and the UK Optimum Patient Care Research Database, together constituting data from 26 countries. The duration to biologic initiation was described using several proxies (eg, duration of asthma, potential SA [PSA], lung function impairment, and frequent exacerbations, all before biologic administration). The associations between these proxies and clinical remission, exacerbations, asthma control, lung function, and oral corticosteroid (OCS) use were assessed.</p><p><strong>Results: </strong>The association analyses included 9,241 patients. Overall, the likelihood of achieving improvement in each outcome after biologic administration decreased with increasing time to biologic initiation. The odds of achieving clinical remission 12 months after biologic initiation were reduced for every 10 years patients had asthma before biologic initiation (0.86 [0.84-0.88], PSA (0.78 [0.63-0.96]), and had lung function impairment (0.24 [0.21-0.28]) and for every 10-g lifetime cumulative OCS dose (0.54 [0.30-0.98]). For every 10 years patients had PSA before biologic initiation, exacerbation rates after biologic initiation were 1.08 (1.03-1.13) times higher, lung function improvement was 2.35% (-3.18% to -1.51%) less, and the odds of having well-controlled or partly controlled asthma were 12% lower (0.88 [0.53-1.47]).</p><p><strong>Interpretation: </strong>Our results show that earlier initiation of biologics in individuals with SA is associated with better clinical outcomes, suggesting the need to modify approaches to asthma management from a reserve to a preserve approach, that is, not reserving biologics for those with long-standing SA, and instead preserving patient lung function and possibly increasing the likelihood of better clinical outcomes with earlier biologic initiation.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov; No.: NCT03373045; URL: www.</p><p><strong>Clinicaltrials: </strong>gov.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918278","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":"Physicians' Mental Models Regarding Appropriate Goals of Care in Chronic Critical Illness: A Qualitative Interview Study.","authors":"Sarah K Andersen, Yanran Yang, Erin K Kross, Barbara Haas, Joanna Hart, Sean M Bagshaw, Elizabeth Dzeng, Baruch Fischhoff, Douglas B White","doi":"10.1016/j.chest.2026.08.047","DOIUrl":"10.1016/j.chest.2026.08.047","url":null,"abstract":"<p><strong>Background: </strong>There is a need to improve shared decision-making about goals of care (GOC) for patients with chronic critical illness (CCI). Understanding the mental models that inform how physicians approach GOC decisions in CCI is necessary to improve shared decision-making.</p><p><strong>Research question: </strong>What factors prompt physicians to revisit existing GOC decisions for patients with CCI and influence their judgments of appropriate GOC in CCI? How do external health system factors, including access to long-term ventilator facilities, influence physicians' mental models about GOC in CCI?</p><p><strong>Study design and methods: </strong>Semi-structured interviews were conducted with a purposive sample of intensivists in the United States and Canada. A mental models approach from the field of decision science was used to identify factors that the intensivists described as influencing their judgments of appropriate GOC in CCI and when to revisit GOC.</p><p><strong>Results: </strong>A total of 29 physicians from 6 institutions with varying access to long-term ventilator facilities were interviewed. The primary factors that physicians described as influencing their personal judgments about GOC in CCI and their decisions to initiate new GOC discussions were an illness trajectory that remained flat over days to weeks, especially with limited apparent potential for a good functional outcome, and acceptable quality of life. Increased access to long-term ventilator facilities was perceived to delay or defer GOC decisions. Other external influences included institutional norms and priorities regarding high-intensity treatments, patient turnover, and use of palliative care.</p><p><strong>Interpretation: </strong>In this qualitative interview study, physicians described predictions about future quality of life and functional outcome as central to initiating and resolving decisions about GOC in CCI. Greater awareness of functional and quality of life outcomes in CCI, as well as how health system factors influence physician mental models, may improve GOC decision-making in chronic critical illness.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910778","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":"Days Alive and Out of Hospital Around Lung Transplantation: Predictors and Clinical Implications.","authors":"Antoine El Kik, Pauline Bian, Leïla Pellet, Gilles Chatellier, Kinan El Husseini, Laurence Beaumont, Benjamin Renaud-Picard, Martine Reynaud-Gaubert, Claire Merveilleux du Vignaux, Xavier Demant, Thomas Villeneuve, Adrien Tissot, Loïc Falque, Nicolas Carlier, Charlotte Roy, Olaf Mercier, Jérôme Le Pavec, Joconde Weller, Pauline Pradère","doi":"10.1016/j.chest.2026.08.042","DOIUrl":"10.1016/j.chest.2026.08.042","url":null,"abstract":"<p><strong>Background: </strong>Days alive and out of hospital (DAOH) is a validated patient-centered outcome that remains unexplored in lung transplantation (LT). It assesses the proportion of days a patient spends alive and outside of hospital. Quantifying DAOH trajectories around LT could provide patients with realistic expectations and could prepare them better for the demanding posttransplant period.</p><p><strong>Research question: </strong>What are the estimates of DAOH before and after LT?</p><p><strong>Study design and methods: </strong>DAOH in the year before transplantation (DAOH-BF), DAOH in the first year after first LT (DAOH-AF1), and DAOH in the second year after first LT (DAOH-AF2) were calculated for all patients who underwent transplantation in France between 2020 and 2023. Clinical variables were collected to identify predictors of DAOH-AF1 using a 2-part model.</p><p><strong>Results: </strong>One thousand two hundred twenty-two patients were included (56% male; median age, 57 years [interquartile range (IQR), 47-62 years). Median DAOH-BF was 95% (IQR, 89%-99%), whereas median DAOH-AF1 declined to 80% (IQR, 64%-87%; P < .001). Among patients discharged after the transplantation-related hospital stay, connective tissue disease (β = -4.1; P = .05) and single LT (β = -4.0; P = .040) were associated independently with lower DAOH-AF1. Median DAOH-AF2 subsequently recovered to 98.6% (IQR, 95.1%-100%).</p><p><strong>Interpretation: </strong>Our results show that DAOH is reduced significantly during the first year after LT, particularly among patients with connective tissue disease and in case of single LT. These findings have direct implications for counselling before LT, informing patients about the demanding nature of the first year after LT while offering reassurance that DAOH improves substantially beyond this period. Identified predictors of lower DAOH-AF1 allow clinicians to tailor information provided before LT further to high-risk subgroups.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890848","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":"Impairment of Upper Airway Patency and CPAP Effectiveness During OSA Treatment With Expiratory Pressure Alleviation: A Randomized Study.","authors":"Gustavo Freitas Grad, Ivana Rosanelli, Mariana Delgado Fernandes, Aline Brunacci Monare, Marcela Yanagimori, Iris Fragoso da Silva Cruz, Paulo Mateus Madureira Soares Mariano, Geraldo Lorenzi-Filho, Pedro Rodrigues Genta","doi":"10.1016/j.chest.2026.08.041","DOIUrl":"10.1016/j.chest.2026.08.041","url":null,"abstract":"<p><strong>Background: </strong>Expiratory pressure alleviation (EPA) algorithms have been incorporated into CPAP devices to reduce expiratory discomfort during treatment of OSA. Because pharyngeal narrowing or collapse can occur during expiration, EPA may impair upper airway patency.</p><p><strong>Research question: </strong>Does EPA compromise upper airway patency and CPAP efficacy in patients with severe OSA?</p><p><strong>Study design and methods: </strong>Adults with severe OSA using nasal CPAP were considered to participate. The study was conducted in 4 steps. Steps 1 and 2 were performed during a single overnight polysomnography study. In step 1, peak inspiratory flow (PIF) was measured during inspiratory flow limitation with and without EPA. In step 2, CPAP titration was performed in randomized order with and without EPA. Steps 3 and 4 were conducted at home. Residual apnea-hypopnea index (AHI) and adherence were compared with and without EPA activation during fixed (step 3) and auto-CPAP (step 4).</p><p><strong>Results: </strong>Twenty-nine patients were studied (55% female; mean age ± SD, 63 ± 12 years; mean BMI ± SD, 37 ± 7 kg/m²; AHI, 58 events/h; 39-83). EPA activation reduced PIF compared with no EPA (0.38; 0.34-0.42 vs 0.19; 0.15-0.23 L/s, respectively; P < .001). The manually titrated CPAP level was higher with EPA than without EPA (11.40 ± 1.95 vs 9.17 ± 1.78 cm H₂O, respectively; P < .001). The residual AHI was higher with EPA than without EPA during fixed (3.7 ± 2.2 vs 1.3 ± 0.6 events/h) and automatic CPAP (1.4; 0.6-2.1 vs 0.8; 0.5-1.8 events/h, respectively; P < .05). No significant change in CPAP adherence was observed during fixed (7.0 ± 0.8 vs 7.2 ± 1.0 hours) and automatic CPAP (7.0 ± 1.3 vs 6.9 ± 1.3 hours), with (P = .497) and without (P = .506) EPA, respectively.</p><p><strong>Interpretation: </strong>Our results show that EPA application compromised upper airway patency and required higher therapeutic CPAP than without EPA. EPA also impaired OSA control but did not impact CPAP adherence.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov; No.: NCT05219591; URL: www.</p><p><strong>Clinicaltrials: </strong>gov.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886321","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":"Making Palliative Care Work in Chronic Respiratory Diseases: A Nurse-Led Model.","authors":"Ivan Guerreiro, Caroline Matis, Tanja Fusi-Schmidhauser, Samia Lounnas, Filipa Alexandra Baptista Peixoto Befecadu, Gregory Berra, Anne Bergeron, Sophie Pautex, Lisa Hentsch","doi":"10.1016/j.chest.2026.08.040","DOIUrl":"10.1016/j.chest.2026.08.040","url":null,"abstract":"<p><p>Palliative care (PC) is defined as a holistic, multidisciplinary, person-centered approach aimed at relieving symptoms and improving quality of life for individuals with serious health-related disease. Although recommended by major respiratory societies, patients with advanced chronic respiratory disease (CRD) continue to have insufficient access to PC, often limited to end-of-life care. Compared with patients with lung cancer, patients with CRD experience greater symptom burden, are less informed about their illness, and are less involved in decision-making. Early PC has been shown to improve quality of life, reduce depression, decrease avoidable hospitalizations, and support better end-of-life trajectories. To improve PC providing for patients living with CRD, an interdisciplinary, nurse-led, outpatient PC consultation model was developed and iteratively refined guided by the Plan-Do-Study-Act cycle as an implementation framework. Patients are referred to the consultation based on symptom burden, decline in respiratory status, frailty, need for discussion on treatment choice, or caregiver strain. During the initial consultation, a PC physician and nurse explore patient and caregiver perceptions of PC, provide information about the aim of this service, and conduct a comprehensive symptom assessment. Follow-up is primarily coordinated by the specialist PC nurse, who ensures symptom evaluation, care coordination, and knowledge on pharmacologic and nonpharmacologic interventions. Integrative therapies (eg, hypnosis, reflexology, Touch-Massage) are also offered, along with discussions around advance care planning when desired. Early needs-based PC can be effectively integrated into CRD trajectories when delivered through a nurse-led interdisciplinary model of coordination.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886442","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":"Tobacco Treatment in the Inpatient Setting: An American College of Chest Physicians Clinical Practice Guideline.","authors":"Hasmeena Kathuria, I Soghier, A C Alexander, J T Fathi, L M Fucito, J M Iaccarino, F T Leone, J Lin, J S Ostroff, K P Richter, N A Rigotti, A M Rojewski, P Selby, B A Toll","doi":"10.1016/j.chest.2026.08.038","DOIUrl":"10.1016/j.chest.2026.08.038","url":null,"abstract":"<p><strong>Background: </strong>Cigarette smoking remains the leading cause of preventable death in the United States, with high prevalence among hospitalized patients. Hospitalization presents an opportunity to initiate and engage patients in tobacco treatment, yet guidance for tobacco treatment in this setting has been limited. This clinical practice guideline provides evidence-based recommendations for tobacco treatment in the inpatient setting.</p><p><strong>Study design and methods: </strong>A multidisciplinary panel followed CHEST's standardized clinical practice guideline methodology, including systematic literature searches in MEDLINE, Embase, and the Cochrane Database. Key clinical questions were framed using the Population, Intervention, Comparator, and Outcome format. Eligible studies included randomized controlled trials and cohort studies. Evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation approach, and recommendations were formulated through a modified Delphi process to achieve consensus.</p><p><strong>Results: </strong>We identified 9,330 abstracts, assessed 252 full texts, and included 142 studies. The literature review and analysis, based on six Population, Intervention, Comparator, and Outcome questions, yielded eight recommendations. No recommendations were supported by high-certainty evidence specific to inpatient tobacco treatment settings. Of the eight recommendations, four were supported by moderate-certainty evidence, two by low-certainty evidence, and two by very low-certainty evidence, supplemented by expert consensus.</p><p><strong>Interpretation: </strong>Hospitalization offers a critical window to initiate tobacco treatment. This guideline synthesizes the existing literature to inform key components of inpatient tobacco treatment, including an opt-out population-based approach that proactively provides counseling and pharmacotherapy to all patients who smoke unless they explicitly decline; the initiation and selection of pharmacotherapies during hospitalization; counseling approaches delivered during the inpatient stay; and post-discharge counseling approaches following hospital discharge. Implementing these approaches is likely to improve smoking-cessation outcomes and reduce hospital readmissions and costs. The guideline also evaluates the strength and limitations of the current evidence base and identifies priority areas for future research, including identifying optimal implementation strategies, equity considerations, and the evaluation of cost-effectiveness across diverse hospital settings and patient populations.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879383","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}