Chest最新文献

{"title":"Real-world effectiveness of adjuvanted RSVPreF3 vaccination in the prevention of RSV-related hospitalization among US adults aged ≥60 years","authors":"David Singer, Andrea Steffens, Elizabeth M. La, Ami R. Buikema, Emily K. Horn, Katherine Theiss-Nyland, Maria João Fonseca, Susan I. Gerber, Alison Kawai, Mary G. Johnson, Rui Song, Sarah Hague, J. Bradley Layton","doi":"10.1016/j.chest.2026.07.5002","DOIUrl":"https://doi.org/10.1016/j.chest.2026.07.5002","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"56 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148461872","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":"Evolving Lung Cancer Navigator Practice Through Targeted Professional Development: A Long-term Outcomes Analysis","authors":"Sydney J. Lloyd, Meg Fay Mortman, Patrick O. Monahan, James E. Slaven, Cyndi Lemery, Megan Podsiad, Angela M. Barry, Sarah A. Weston, Alana S. Boyd, Joelle T. Fathi","doi":"10.1016/j.chest.2026.06.054","DOIUrl":"https://doi.org/10.1016/j.chest.2026.06.054","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"48 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148459972","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":"Efficacy and safety of riociguat in early pulmonary vascular disease (ESRA): a prospective, multicenter, randomized, double-blind, placebo-controlled phase IIa trial.","authors":"Panagiota Xanthouli,Nicola Benjamin,Gerry Coghlan,Christopher P Denton,Philipp Douschan,Éric Hachulla,Michael Halank,Melanie Heberling,Gabor Kovacs,Mona Lichtblau,Alberto M Marra,Regina Steringer-Mascherbauer,Silvia Ulrich,Ekkehard Grünig, ","doi":"10.1016/j.chest.2026.06.053","DOIUrl":"https://doi.org/10.1016/j.chest.2026.06.053","url":null,"abstract":"BACKGROUNDPulmonary arterial hypertension (PAH) therapies have not been systematically studied in early disease stages, despite potential benefit.RESEARCH QUESTIONIs riociguat safe, well tolerated, and potentially effective in early pulmonary vascular disease (PVD)?STUDY DESIGN AND METHODSIn this prospective, multicenter, double-blind phase IIa trial adults with early pulmonary vascular disease, defined as mean pulmonary arterial pressure (mPAP) ≥25 mmHg with pulmonary vascular resistance (PVR) ≥2 - <3 Wood Units (WU), or mPAP 21 - <25 mmHg with PVR ≥2 WU, were randomized and received 1:1 riociguat or placebo for 24 weeks. The primary endpoint was change in PVR from baseline to week 24. Secondary endpoints, evaluated hierarchically, comprised changes in cardiac index, total pulmonary resistance, diffusing capacity of the lung, six-minute walking distance, WHO functional class, quality of life (QoL). Complementary parameters were analyzed in an exploratory manner. Safety was monitored throughout.RESULTSOf 261 pre-screened patients, 35 eligible patients were randomized (97% female, 65.5±6.9 years; 77.1% connective tissue disease-associated PAH); 32 completed the trial. Reasons for ineligibility were documented. Riociguat significantly improved the primary endpoint PVR (riociguat -0.73±0.67 WU vs. placebo -0.02±0.67 WU, p=0.043; 27% placebo-adjusted reduction). No significant differences were observed in secondary endpoints. Of exploratory endpoints, only cardiac output showed a trend toward improvement under riociguat (0.35±0.86 l/min vs. placebo -0.19 ±0.75 l/min, p=0.084). Only mild to moderate adverse events were observed, serious events were not considered treatment related.INTERPRETATIONDespite the limited number of participants, treatment with riociguat was safe and significantly improved the primary endpoint PVR over 24 weeks.CLINICAL TRIAL REGISTRATIONClinicaltrials.gov, NCT05339087, available at https://clinicaltrials.gov/study/NCT05339087.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"51 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148451653","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":"Historically Marginalized And Minoritized Populations With PAH: A Deeper Dive Into a Complex Question.","authors":"Roberto J Bernardo,Victor E Ortega,Jason Glenn,Lancer Stephens,Karla J Cruz Morel,Jean M Elwing,Franz P Rischard","doi":"10.1016/j.chest.2026.07.5000","DOIUrl":"https://doi.org/10.1016/j.chest.2026.07.5000","url":null,"abstract":"Pulmonary arterial hypertension is a progressive cardiopulmonary disorder with disparities in epidemiology, clinical outcomes, and healthcare access that disproportionately affect historically neglected populations, including Black Americans, Hispanic Americans, and American Indians. This State-of-the-Art Review examines pulmonary arterial hypertension disparities through cross-cutting themes and population-specific evidence. First, we discuss the role of race and ethnicity as social constructs, the historical roots of medical mistrust arising from documented exploitation of Black, Hispanic, and American Indian communities, and the implications of genetic ancestry research within the framework of race as a social rather than biological variable. We then review population-specific evidence on clinical phenotypes, survival, and access to care, and review the significance of socioeconomic deprivation in clinical outcomes across populations. We highlight existing gaps in knowledge and propose a framework for shared efforts towards the common goal of achieving health equity in pulmonary hypertension care.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"1 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148441190","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 ARDS, Pneumonia, and Sepsis (APS) Consortium: Rationale, Design, and Feasibility of a National Platform for Phenotyping Critical Illness Syndromes.","authors":"Wesley H Self,Carolyn S Calfee,Samuel M Brown,Marc Moss,Lorraine B Ware,Robert C Hyzy,Nuala J Meyer,John P Reilly,Michael O Harhay,Michael G S Shashaty,Danielle K Sandsmark,Catherine L Auriemma,Tiffanie K Jones,Hallie C Prescott,Robert P Dickson,Kristine Nelson,Jakob I McSparron,Madeline Lagina,Scott J Denstaedt,Andrew J Admon,Bhakti K Patel,Krysta S Wolfe,R Duncan Hite,Kristin M Hudock,Julie A Bastarache,Tatsuki Koyama,V Eric Kerchberger,E Wesley Ely,James C Jackson,Pratik Sinha,Philip A Mudd,Bryan D Kraft,Richard D Fremont,Rajbir Singh,Neil R Aggarwal,Sarah E Jolley,Ellen L Burnham,Rafaela A Mantelli,William J Janssen,Camille M Moore,Ivor S Douglas,Ryan Peterson,Ithan D Peltan,Christina E Barkauskas,Elias H Pratt,Estelle S Harris,Daniel O Scharfstein,Dale M Needham,Sarina K Sahetya,Ann M Parker,Theodore J Iwashyna,Kevin Shenderov,Michael A Matthay,Narges Alipanah-Lechner,Liam Magee,Tal Shwartzman,Chelsea Lin,Melanie F Weingart,Charles R Langelier,Olivia Chao,Carolyn M Hendrickson,Lucy Z Kornblith,Suzanna Chak,Kim Bardillon,Kimberly Herrera Rodriguez,Angela J Rogers,Andrew R Moore,Joseph E Levitt,Rosemary Vojnik,Cynthia Perez,Christopher J Lindsell,Matthew S Shotwell,Bryan S Blette,Brant W Imhoff,Todd W Rice,Jillian P Rhoads,Kelsey N Womack,Alyssa R Merkel,Lillian N Ahmad,Xiaoli Zhao,Ingrid Espinoza Grandon,Michelle Ng Gong, ","doi":"10.1016/j.chest.2026.05.053","DOIUrl":"https://doi.org/10.1016/j.chest.2026.05.053","url":null,"abstract":"BACKGROUNDTo enhance biological understanding of acute respiratory distress syndrome (ARDS), pneumonia, and sepsis and accelerate therapeutic development in these areas, the National Institutes of Health developed the ARDS, Pneumonia, and Sepsis (APS) Consortium.RESEARCH QUESTIONIs the APS Consortium study rapidly generating data and biospecimens from a large cohort of critically ill adults with ARDS, pneumonia, and sepsis that will facilitate phenotyping of these syndromes?STUDY DESIGN AND METHODSThe APS Consortium Phenotyping Study is a multicenter longitudinal prospective observational cohort study aimed at enrolling 4,000 critically ill adults with ARDS, pneumonia, and/or sepsis over 4 years. Data and biospecimens are collected to characterize many aspects of each participant's chronic health, acute illness, and long-term recovery to facilitate phenotyping-that is, subclassifying ARDS, pneumonia, and sepsis into precise biologically-based subsets with shared pathophysiology. Feasibility of the study was assessed by evaluating the first 1,000 participants in terms of recruitment pace, participant characteristics, biospecimen collection, and proportion with confirmed ARDS, pneumonia, and sepsis based on expert adjudication.RESULTSThe first 1,000 participants were recruited ahead of schedule in less than 13 months. Median age was 64 years, 75% received vasopressors, 50% received invasive mechanical ventilation, and 25% died in the hospital within 4 weeks of enrollment. Biospecimen collection rates were high, with 99% of participants with blood, 98% with upper respiratory swabs, 37% with lower respiratory samples, 80% with urine, and 65% with gastrointestinal samples. Expert adjudication resulted in 40% classified with ARDS, 52% with pneumonia, and 89% with sepsis.INTERPRETATIONThe APS Consortium Phenotyping Study is producing a cohort of critically ill adults with ARDS, pneumonia, and sepsis with high severity of disease and a rich set of data and biospecimens. The study will continue to full enrollment of 4,000 participants.REGISTRATIONClinicaltrials.gov NCT06521502.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"225 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148432650","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":"CARDIAC FINDINGS IN SWIMMING-INDUCED PULMONARY EDEMA - IMPLICATIONS FOR ACUTE ASSESSMENT.","authors":"Claudia Seiler,Miro Torola,Ulrika Knuts,Lisa Holm,Bjarne Magnusson,Peter Rask,Kristofer F Nilsson,Maria Hårdstedt","doi":"10.1016/j.chest.2026.06.051","DOIUrl":"https://doi.org/10.1016/j.chest.2026.06.051","url":null,"abstract":"BACKGROUNDPathological cardiac findings have been described in case reports of patients with swimming-induced pulmonary edema (SIPE).RESEARCH QUESTIONTo characterize cardiac findings in patients with SIPE.STUDY DESIGN AND METHODSA cohort study evaluated patients with SIPE and asymptomatic swimmers (controls) participating in Sweden's largest open water swimming event, Vansbrosimningen, in 2022-2024. Transthoracic echocardiogram (TTE), electrocardiogram (ECG) and cardiac biomarkers were assessed within two hours after swimming and at follow-up within 12 months.RESULTSIn total, 45 patients with SIPE and 45 controls were included. Systolic ventricular function on TTE was mildly impaired after swim in 43% of patients and 10% of controls (p=0.003). Systolic pulmonary artery pressure was increased in 30% of patients but none of the controls (p=0.005). TTE pathology had improved at follow-up in all but one patient. Findings on ECG after swim showed no difference between groups (p=0.746). High-sensitivity cardiac troponin I after swim was increased in 67% of patients and 40% of controls (median 47 pg/ml vs 14 pg/ml, p<0.001). N-terminal pro-B-type natriuretic peptide was higher in patients than controls (median 169 pg/ml vs 65 pg/ml, p<0.001). Two patients with myocardial infarction concurrently with SIPE had clinically significant chest pain and high levels of cardiac troponin.INTERPRETATIONIn patients with SIPE, transient mildly affected cardiac function on TTE and a small to moderate elevation of cardiac biomarkers is likely to be found. ECG did not differ between groups. This study provides a reference of expected cardiac findings in patients with SIPE.CLINICAL TRIAL REGISTRATIONclinicaltrials.gov: NCT05391737.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"37 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148416060","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":"Community-Acquired Pneumonia in Nursing-Home Residents in the Post-HCAP Era.","authors":"Catia Cilloniz,Juan M Pericàs,Marcos I Restrepo","doi":"10.1016/j.chest.2026.06.050","DOIUrl":"https://doi.org/10.1016/j.chest.2026.06.050","url":null,"abstract":"TOPIC IMPORTANCEPneumonia remains a leading cause of morbidity and mortality among nursing-home (NH) residents, a population characterized by advanced age, frailty, multimorbidity, and functional dependence. The abandonment of the healthcare-associated pneumonia (HCAP) concept and evolving epidemiology have important implications for diagnosis and management in this setting.REVIEW FINDINGSPneumonia in NH residents often presents atypically, with non-specific symptoms such as confusion or functional decline, complicating timely diagnosis and potentially delaying appropriate treatment. Streptococcus pneumoniae remains the most commonly identified pathogen, while respiratory viruses, including influenza and respiratory syncytial virus, contribute significantly to disease burden. Although multidrug-resistant pathogens are uncommon, broad-spectrum antibiotics are used frequently, exposing patients to avoidable harm. Diagnostic challenges, including difficulty obtaining reliable respiratory samples and distinguishing colonization from infection, further complicate management. Outcomes are driven not only by infection severity but also by underlying frailty, comorbidities, and functional status.SUMMARYPneumonia in NH residents should be approached as a syndrome of vulnerability rather than a standalone infectious process. Management requires individualized, risk-based antimicrobial strategies, improved diagnostic approaches, and attention to aspiration risk and goals of care. Future efforts should focus on optimizing antibiotic stewardship, preventing aspiration-related disease, and aligning treatment decisions with patient-centered outcomes.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"157 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148416107","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":"Aspiration and GERD in Bronchiectasis: Bridging Pulmonology, Gastroenterology, and Otolaryngology in an At-Risk Population.","authors":"B Shoshana Zha,Vyvy Young,Priya Kathpalia,Cyril Varghese,Timothy R Aksamit","doi":"10.1016/j.chest.2026.04.064","DOIUrl":"https://doi.org/10.1016/j.chest.2026.04.064","url":null,"abstract":"Bronchiectasis is a heterogeneous chronic lung disease marked by irreversible airway dilation and damage, instigating symptoms of chronic cough, dyspnea, and excessive mucus production. Recurrent exacerbations or infections with ongoing inflammation can lead to impaired quality of life, reduced ability to clear mucus, and even respiratory failure. Dozens of distinct conditions can contribute or coexist with bronchiectasis, often fueling a self-perpetuating vortex of inflammation, infection, and airway remodeling. Aspiration results in foreign particles into the airway can cause chemical pneumonitis from gastric contents, airway inflammation, and/or infection, with repeated exposures producing chronic injury. As clinical expertise has grown, aspiration-related pathology has acquired attention as a potential contributor to bronchiectasis and chronic lung infections, including nontuberculous mycobacteria (NTM), extrapolating from characterized relationships in other chronic lung diseases. Nonspecific symptoms, diagnostic challenges, and incomplete data characterizing the relationship have hindered the development of clear guidelines. Additionally, the necessity for multidisciplinary care can delay timely management. Here, we assembled a multidisciplinary team of experts to evaluate retrograde and anterograde aspiration as modifiable comorbidities to bronchiectasis through case-based formatting. Using this scaffold and a narrative literature review, we provide clinical perspective on who, when, and how to test for aspiration from swallowing dysfunction and reflux disease. Our purpose is to raise awareness of aspiration, enhance evaluation by improving the pulmonologist's knowledge of test selection and interpretation, highlight the value of cross-disciplinary discussion, outline basic management strategies, and inspire further studies within bronchiectasis and chronic lung infection populations.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"44 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148416106","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)00695-1","DOIUrl":"https://doi.org/10.1016/s0012-3692(26)00695-1","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"1 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148538984","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":"Lung Cancer Screening Centralization Is Associated With Improved Screening Uptake: The Veterans Healthcare Administration’s Experience 2015-2021","authors":"Lawrence N. Benjamin MD PhD, Eduardo R. Núñez MD MS, Lillian Chen MPH, Yash Motwani, Anita Yuan PhD MA MPH, Sitaram Vangala MS, Christopher G. Slatore MD MS, Renda Soylemez Wiener MD MPH, David A. Elashoff PhD, Elizabeth M. Yano PhD MSPH, Donna L. Washington MD MPH, Carol M. Mangione MD MSPH","doi":"10.1016/j.chest.2026.06.047","DOIUrl":"https://doi.org/10.1016/j.chest.2026.06.047","url":null,"abstract":"Lung cancer is the leading cause of cancer mortality, yet lung cancer screening (LCS) remains underutilized. Centralizing LCS into dedicated teams with tracking systems (vs. decentralized, individual provider-led screening) may improve LCS uptake, but effectiveness across diverse settings and populations is uncertain. Centralization also varies: hybrid programs share responsibilities with primary care clinicians, whereas fully-centralized programs manage nearly all screening and patient navigation. Whether one model is more effective in enrolling patients remains unknown.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"33 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148402227","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}