Chest最新文献

{"title":"The Emerging Role of Alarmin-Targeting Biologics in the Treatment of Patients With COPD.","authors":"Bartolome R Celli, Antonio Anzueto, Dave Singh, Nicola A Hanania, Leonardo Fabbri, Fernando J Martinez, Xavier Soler, Michel Djandji, Juby A Jacob-Nara, Paul J Rowe, Yamo Deniz, Amr Radwan","doi":"10.1016/j.chest.2024.09.049","DOIUrl":"10.1016/j.chest.2024.09.049","url":null,"abstract":"<p><strong>Topic importance: </strong>COPD is a complex, heterogeneous lung disease characterized by persistent airflow limitation secondary to airways and parenchymal abnormalities, and respiratory symptoms, including dyspnea, fatigue, chronic cough, and sputum production. Cigarette smoke exposure is a major contributor to COPD; however, inhalation of toxic particles and other environmental and host factors can contribute to its genesis. Over time, the clinical course is frequently punctuated by exacerbations that further accelerate lung function decline and increase exacerbation risk. Despite current optimal therapy, many patients remain symptomatic, have exacerbations, and have increased morbidity, mortality, and health care costs. This review focuses on current knowledge of COPD pathophysiology, the role of inflammatory mechanisms, and the potential use of biologics to modulate these mechanisms.</p><p><strong>Review findings: </strong>The inflammatory response in COPD includes both type 1 and type 2 immune cells. Type 2 inflammation is suggested by eosinophilia in a significant proportion of patients with COPD. Studies targeting IL-5 in patients with COPD have failed to demonstrate significant reductions in exacerbations, suggesting that eosinophil modulation alone may be insufficient to treat COPD. Based on a better understanding of the disease and role of alarmins, with a broader role in the inflammatory cascade, it is likely that some biologics may benefit certain COPD endotypes. Ongoing trials will provide information about which groups can benefit from the blocking of specific pathways (eg, IL-5, IL-4/IL-13, IL-33, thymic stromal lymphopoietin).</p><p><strong>Summary: </strong>Biologics targeting inflammatory pathways may be effective treatments for specific patients with COPD.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779478","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 Early and Late Norepinephrine Administration in Patients With Septic Shock: A Systematic Review and Meta-Analysis.","authors":"Chiwon Ahn, Gina Yu, Tae Gun Shin, Youngsuk Cho, Sunghoon Park, Gee Young Suh","doi":"10.1016/j.chest.2024.05.042","DOIUrl":"10.1016/j.chest.2024.05.042","url":null,"abstract":"<p><strong>Background: </strong>Vasopressor administration at an appropriate time is crucial, but the optimal timing remains controversial.</p><p><strong>Research question: </strong>Does early vs late norepinephrine administration impact the prognosis of septic shock?</p><p><strong>Study design and methods: </strong>Searches were conducted in PubMed, EMBASE, the Cochrane Library, and KMbase databases. We included studies of adults with sepsis and categorized patients into an early and late norepinephrine group according to specific time points or differences in norepinephrine use protocols. The primary outcome was overall mortality. The secondary outcomes included length of stay in the ICU, days free from ventilator use, days free from renal replacement therapy, days free from vasopressor use, adverse events, and total fluid volume.</p><p><strong>Results: </strong>Twelve studies (four randomized controlled trials [RCTs] and eight observational studies) comprising 7,281 patients were analyzed. For overall mortality, no significant difference was found between the early norepinephrine group and late norepinephrine group in RCTs (OR, 0.70; 95% CI, 0.41-1.19) or observational studies (OR, 0.83; 95% CI, 0.54-1.29). In the two RCTs without a restrictive fluid strategy that prioritized vasopressors and lower IV fluid volumes, the early norepinephrine group showed significantly lower mortality than the late norepinephrine group (OR, 0.49; 95%, CI, 0.25-0.96). The early norepinephrine group demonstrated more mechanical ventilator-free days in observational studies (mean difference, 4.06; 95% CI, 2.82-5.30). The incidence of pulmonary edema was lower in the early norepinephrine group in the three RCTs that reported this outcome (OR, 0.43; 95% CI, 0.25-0.74). No differences were found in the other secondary outcomes.</p><p><strong>Interpretation: </strong>Overall mortality did not differ significantly between early and late norepinephrine administration for septic shock. However, early norepinephrine administration seemed to reduce pulmonary edema incidence, and mortality improvement was observed in studies without fluid restriction interventions, favoring early norepinephrine use.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1417-1430"},"PeriodicalIF":9.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554228","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":"An 80-Year-Old Man With Intractable Cough.","authors":"Ganjam Yasaswini, Dipti Gothi, Anshul Jain, Pranzal Garg, Anu Singhal, Sanket Joshi, Ansha Sinha","doi":"10.1016/j.chest.2024.04.041","DOIUrl":"https://doi.org/10.1016/j.chest.2024.04.041","url":null,"abstract":"<p><strong>Case presentation: </strong>An 80-year-old man with no history of substance addiction presented with complaints of cough and breathlessness for 4 months. His cough was nonproductive, waxing and waning in nature with high symptom load during daytime, but not associated with chest pain or wheezing. He gives no history of nasal or sinus symptoms, aspiration, or reflux symptoms. Breathlessness was nonparoxysmal, independent of cough and progressing from modified medical research council Grade-I to Grade II. It was not accompanied by wheezing or stridor. He denied specific triggers and seasonal, diurnal, or postural variation of symptoms. His medical history was largely unremarkable, apart from hypertension diagnosed 2 decades earlier. Despite 6 months of treatment with dual antihypertensive medications, his BP remained uncontrolled. He did not receive angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for the treatment of hypertension as per his old medical records. He denies history of atopy, occupational or environmental dust exposure. He refused history of fever, significant loss of weight or appetite. He had been treated for asthma with a combination of a long-acting beta-2 agonist and an inhaled corticosteroid inhaler, which provided no relief.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":"166 6","pages":"e185-e190"},"PeriodicalIF":9.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812020","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":"COUNTERPOINT: Is It Ethically Justifiable to Withdraw Extracorporeal Membrane Oxygenation Against the Wishes of a Patient With Decision-Making Capacity When Cure Is Not Possible? No.","authors":"Andrew M Childress","doi":"10.1016/j.chest.2024.07.174","DOIUrl":"https://doi.org/10.1016/j.chest.2024.07.174","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"166 6","pages":"1283-1285"},"PeriodicalIF":9.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812055","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":"POINT: Is It Ethically Justifiable to Withdraw Extracorporeal Membrane Oxygenation Against the Wishes of a Patient With Decision-Making Capacity When Cure Is Not Possible? Yes.","authors":"Alexander A Kon","doi":"10.1016/j.chest.2024.07.173","DOIUrl":"https://doi.org/10.1016/j.chest.2024.07.173","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"166 6","pages":"1281-1283"},"PeriodicalIF":9.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812125","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":"Response.","authors":"Krishna M Sundar, Amanda Stark, Michael J Morris","doi":"10.1016/j.chest.2024.08.009","DOIUrl":"https://doi.org/10.1016/j.chest.2024.08.009","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"166 6","pages":"e205-e206"},"PeriodicalIF":9.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812145","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":"Interstitial Lung Disease Mortality Disparities Along the US-Mexico Border, 1999-2020.","authors":"Sabrina Soin, Ramzi Ibrahim, Vinita Kusupati, Enkhtsogt Sainbayar, Hoang Nhat Pham, Bhupinder Natt, João Paulo Ferreira, Kamonpun Ussavarungsi, See-Wei Low","doi":"10.1016/j.chest.2024.07.001","DOIUrl":"10.1016/j.chest.2024.07.001","url":null,"abstract":"<p><strong>Background: </strong>Optimal diagnosis and management of interstitial lung diseases (ILDs) needs access to specialized centers, frequent monitoring, and complex therapeutic options. In underprivileged areas, these necessities can often lead to barriers in delivering care.</p><p><strong>Research question: </strong>What are the ILD mortality disparities in the regions along the US-Mexico (US-MX) border?</p><p><strong>Study design and methods: </strong>We obtained ILD mortality information through death certificate queries from the Centers for Disease Control and Prevention repository. Death data were adjusted for age and stratified by US-MX border regions and nonborder regions in the United States. Log-linear regression models were used to analyze mortality trends in the period from 1999 to 2020 followed by calculation of annual percentage changes (APCs). Age-adjusted mortality rates (AAMRs) were compared across cumulative and subdemographic populations.</p><p><strong>Results: </strong>ILD-related mortality among border regions (AAMR, 5.31) was higher than nonborder regions (AAMR, 4.86). Mortality within border regions remained unchanged from 1999 to 2020 (APC, 0.3; P = .269). Nonborder regions experienced a significant rise in mortality rates (APC, 2.6; P = .017) from 1999 to 2005 and remained unchanged from 2005 to 2020. Mortality was higher within both men (AAMR, 6.57) and women (AAMR, 4.36) populations among border regions compared with their nonborder counterparts (AAMR, 6.27 and 3.87, respectively). Hispanic populations among the border regions experienced higher mortality rates (AAMR, 6.15) than Hispanic populations within nonborder regions (AAMR, 5.44). Non-Hispanic populations encountered similar mortality rates between the two regions. Mortality rates among Hispanic (APC, 0.0; P = .938) and non-Hispanic (APC, 0.2; P = .531) populations in the border regions remained unchanged from 1999 to 2020.</p><p><strong>Interpretation: </strong>These results revealed ILD-related mortality disparities among the US-MX border regions, emphasizing the importance of public health measures to increase access to equitable medical care and implement targeted interventions among these vulnerable populations.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1455-1462"},"PeriodicalIF":9.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733582","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":"Evaluating US Multiple Listing Practices in Lung Transplantation: Unveiling Hidden Disparities.","authors":"Adora N Moneme, Mallory Hunt, Jacqueline Friskey, Madeline McCurry, Dun Jin, Joshua M Diamond, Michaela R Anderson, Emily S Clausen, Aya Saleh, Allie Raevsky, Jason D Christie, Douglas Schaubel, Jesse Hsu, A Russell Localio, Robert Gallop, Edward Cantu","doi":"10.1016/j.chest.2024.06.3822","DOIUrl":"10.1016/j.chest.2024.06.3822","url":null,"abstract":"<p><strong>Background: </strong>Multiple listing (ML) is a practice used to increase the potential for transplant but is controversial due to concerns that it disproportionately benefits patients with greater access to health care resources.</p><p><strong>Research question: </strong>Is there disparity in ML practices based on social deprivation in the United States and does ML lead to quicker time to transplant?</p><p><strong>Study design and methods: </strong>A retrospective cohort study of adult (≥ 18 years of age) lung transplant candidates listed for transplant (2005-2018) was conducted. Exclusion criteria included heart only or heart and lung transplant and patients relisted during the observation period. Data were obtained from the United Network for Organ Sharing Standard Transplant Analysis and Research File. The first exposure of interest was the Social Deprivation Index with a primary outcome of ML status, to assess disparities between ML and single listing (SL) participants. The second exposure of interest was ML status with a primary outcome of time to transplant, to assess whether implementation of ML leads to quicker time to transplant.</p><p><strong>Results: </strong>A total of 35,890 patients were included in the final analysis, of whom 791 (2.2%) were ML and 35,099 (97.8%) were SL. ML participants had lower median level of social deprivation (5 units, more often female: 60.0% vs 42.3%) and lower median lung allocation score (35.3 vs 37.3). ML patients were more likely to be transplanted than SL patients (OR, 1.42; 95% CI, 1.17-1.73), but there was a significantly quicker time to transplant only for those whom ML was early (within 6 months of initial listing) (subdistribution hazard ratio, 1.17; 95% CI, 1.04-1.32).</p><p><strong>Interpretation: </strong>ML is an uncommon practice with disparities existing between ML and SL patients based on several factors including social deprivation. ML patients are more likely to be transplanted, but only if they have ML status early in their transplant candidacy. With changing allocation guidelines, it is yet to be seen how ML will change with the implementation of continuous distribution.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1442-1454"},"PeriodicalIF":9.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11638548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Social Context and Health Care Access.","authors":"Kenneth M Nugent, Joanna L Harkey","doi":"10.1016/j.chest.2024.06.3807","DOIUrl":"https://doi.org/10.1016/j.chest.2024.06.3807","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"166 6","pages":"e207-e208"},"PeriodicalIF":9.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812197","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":"Palliative Care for Advanced Pulmonary Diseases: A Call to Action.","authors":"Anne Song, Joanna L Hart","doi":"10.1016/j.chest.2024.09.015","DOIUrl":"https://doi.org/10.1016/j.chest.2024.09.015","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"166 6","pages":"1277-1278"},"PeriodicalIF":9.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812124","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}