Chest最新文献

{"title":"Exacerbation trajectories in biologic-eligible severe asthma patients.","authors":"Freda Yang, Dominic C Marshall, Imran Howell, Timothy S C Hinks, Kian Fan Chung, Ian D Pavord, David J Jackson, Chloe I Bloom","doi":"10.1016/j.chest.2026.09.098","DOIUrl":"https://doi.org/10.1016/j.chest.2026.09.098","url":null,"abstract":"<p><strong>Background: </strong>Asthma biologics are highly effective in reducing exacerbations. Improvement in exacerbations after biologic initiation is often attributed to treatment effect.</p><p><strong>Research question: </strong>What proportion of biologic-eligible severe asthma patients improve without biologic therapy, and what characterises those who remain frequent exacerbators?</p><p><strong>Study design and methods: </strong>Biologic-naïve adults with severe asthma were identified in nationwide UK electronic medical records. Year 0 was defined as the first year patients met severe asthma criteria with ≥3 systemic corticosteroid-treated exacerbations (biologic-eligible). Post-eligibility exacerbation trajectories were identified using longitudinal k-means. Sensitivity analyses included alternative k and a lower exacerbation threshold (≥2/year). Covariates included the highest blood eosinophil count, inhaled corticosteroid (ICS) dose and comorbidities.</p><p><strong>Results: </strong>Among 10,078 biologic-eligible adults (median age 51 years; 71% female), we identified three exacerbation trajectories: (1) Remitting-stable (70%, n=7,091), with sustained improvement to <3 exacerbations/year even though ICS reduced after peak exacerbation year; (2) Chronic-frequent (20%, n=1,969), with persistently frequent exacerbations (median 5/year); (3) Refractory-frequent (10%, n=1,018), with high ongoing oral corticosteroid exposure (median >10 courses/year). Results were consistent across sensitivity analyses. Remitting-stable patients were least likely to have bronchiectasis but were otherwise similar in demographics and allergic comorbidities. Blood eosinophil count was higher in the chronic-frequent group (Year 0 median 0.30×10⁹/L) compared with remitting-stable (0.23×10⁹/L) and refractory-frequent groups (0.21×10⁹/L, p<0.001); this was evident several years before meeting biologic exacerbation criteria.</p><p><strong>Interpretation: </strong>Over two-thirds of biologic-eligible patients improved with standard care alone. Chronic-frequent exacerbators had higher blood eosinophil counts, even years before meeting biologic criteria, suggesting a distinct disease phenotype.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104641","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":"Sotatercept in Pediatric Pulmonary Hypertension: Experience from the Pediatric Pulmonary Hypertension Network.","authors":"Paul J Critser, Usha S Krishnan, Catherine M Avitabile, Andrea L Jones, Benjamin S Frank, Dunbar D Ivy, Emily P Williams, Rachel T Sullivan, Eric D Austin, Dephine Yung, Stephanie S Handler, Edward Kirkpatrick, Mary P Mullen, Claire Parker, Megan Griffiths, Patrick D Evers, Meredith J O'Neil, Neelam D Bhatt, Rachel Capote, Erika B Rosenzweig, Nidhy P Varghese","doi":"10.1016/j.chest.2026.09.096","DOIUrl":"https://doi.org/10.1016/j.chest.2026.09.096","url":null,"abstract":"<p><strong>Background: </strong>Sotatercept, a ligand trap for TGF-β family members, has been shown to improve exercise capacity and decrease pulmonary vascular resistance (PVR) in adults with pulmonary arterial hypertension. Limited data exist describing the use of sotatercept in children with pulmonary hypertension (PH).</p><p><strong>Research question: </strong>What is the safety and efficacy of sotatercept as add-on therapy in children with PH.</p><p><strong>Study design and methods: </strong>This is a multi-center, retrospective study of children and young adults ≤ 21 years of age with pediatric PH treated by programs in the Pediatric PH Network and institutional registries. Demographic data and clinical characteristics before and after sotatercept initiation were collected.</p><p><strong>Results: </strong>Sixty-six subjects received sotatercept as add-on therapy for a median duration of 323 days (Interquartile range 239, 500). Forty (60%) were female with median age 15.3 years (range 3.0 - 21.0) at initiation of sotatercept, and 61 with Group 1 (92%) PH. WHO functional class improved in 51% and did not worsen in any subjects (p < 0.0001). Subjects experienced significant improvement in six-minute walk distance (median 31 m, p=0.0003, n=40), NT-proBNP (median decrease 378 pg/ml, p< 0.0001, n=26), mean pulmonary artery pressure (median decrease 17 mmHg, p<0.0001, n=21), and PVR (median decrease 4.4 WUi, p=0.0011, n=21). Parenteral prostacyclin was weaned or discontinued in 13 of 38 patients. Adverse events occurred in 33 (50%) subjects with bleeding in 15 (23%). No patients had escalation of PH therapy, were hospitalized for clinical worsening, underwent lung transplant, or died.</p><p><strong>Interpretation: </strong>Pediatric PH patients treated with sotatercept as add-on therapy demonstrated improvement in functional class and other PH disease indicators and was generally well tolerated.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104679","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":"From Menarche to Menopause: A Narrative Review of Female Reproductive Milestones and Risk of Chronic Airway Disease.","authors":"Shilpa Sridhar, Keegan Riggs, Amanda Kaley, Dawn C Newcomb, Dharini M Bhammar, Rachel Meislin, Dawn L DeMeo, Sonali Bose, Jing Gennie Wang","doi":"10.1016/j.chest.2026.09.100","DOIUrl":"https://doi.org/10.1016/j.chest.2026.09.100","url":null,"abstract":"<p><strong>Topic importance: </strong>Female reproductive factors are underrecognized determinants of lifelong respiratory health. This narrative review examines relationships between reproductive milestones and chronic airway disease risk.</p><p><strong>Review findings: </strong>Early menarche is associated with reduced adult lung function and a higher incidence of asthma. Polyendocrine metabolic ovarian syndrome is also associated with increased asthma risk, particularly in obese individuals, through sex hormone dysregulation, metabolic dysfunction, and chronic low-grade inflammation. Adverse pregnancy outcomes are associated with lower lung function and heightened future asthma and chronic obstructive pulmonary disease (COPD) susceptibility, potentially from persistent systemic inflammation, endothelial injury, and oxidative stress beyond the perinatal period. Effects of exogenous sex hormones on the airways are complex and context-dependent. Hormonal contraception may reduce asthma risk in lean females by stabilizing estrogen and progesterone fluctuations, but increase risk in obesity, as exogenous estrogen can amplify airway inflammation. Similarly, effects of menopause hormone therapy (MHT) vary by formulation, timing of initiation, and use duration. Estrogen-only MHT - particularly when started at younger ages, before menopause, or used for longer duration - may increase asthma risk. Early menopause is linked to accelerated lung function decline, higher asthma incidence among those with obesity, and increased COPD risk.</p><p><strong>Summary: </strong>Female reproductive factors may influence susceptibility to chronic airway disease, although these relationships involve multiple pathways, with obesity as a major confounder. A dedicated life-course cohort with deep phenotyping and hormone profiling is needed to elucidate how reproductive exposures, sex hormones, metabolic determinants and other susceptibility factors interact to shape respiratory outcomes in females.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104706","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 Beyond Smoking-Based Eligibility: Evidence, Limits, and Lessons From China.","authors":"Fei He, Yuan Xu, Binghua Tu, Yuhang Liu, Weimin Ye, Yiming Zeng, Charles A Powell","doi":"10.1016/j.chest.2026.09.090","DOIUrl":"https://doi.org/10.1016/j.chest.2026.09.090","url":null,"abstract":"<p><p>Low-dose computed tomography (LDCT) screening lowers lung cancer mortality in populations with substantial cumulative tobacco exposure, and that conclusion rests on two adequately powered randomized controlled trials. Whether the same benefit extends to populations with different risk profiles remains unresolved, particularly in China, where a substantial share of lung cancers arise in individuals without substantial smoking history. This review develops three linked arguments rather than surveying the field exhaustively. First, stage shift and risk-enrichment are necessary but not sufficient; a concurrent reduction in advanced-stage incidence is the more reliable signal of benefit. Second, risk-prediction models built on tobacco-exposed cohorts are least dependable in individuals without substantial smoking history, precisely where expanding eligibility relies on them most. Third, judging evidentiary sufficiency requires an explicit framework that treats sufficiency as a continuum rather than a binary between a randomized trial and nothing. Chinese programs illustrate all three at scale: LDCT can be delivered broadly and can enrich early-stage detection, yet still not establish reduced lung cancer mortality with acceptable harm. Stage-shift findings remain vulnerable to lead-time bias, length bias, and overdiagnosis, and recent data from China and South Korea suggest that diffusion of LDCT into populations at average risk may enlarge overdiagnosis more than net benefit. For populations without substantial smoking history, eligibility decisions should rest on prospective evidence of reduced advanced-stage incidence rather than stage-shift enrichment alone; expansion belongs within disciplined prospective evaluation.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104633","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":"CEUS- versus US- and CT-guided Biopsy for Subpleural Lung Lesions: A Prospective, Multicenter Randomized Controlled Trial.","authors":"Ke Bi, Meng-Jun Shen, Dong Xu, Qing Tang, Yi-Xue Sun, Xiao-Fei Ye, Yi Zhang, Yang Cong, Hui-Ming Zhu, Hong-Wei Chen, Chun-Hong Tang, Yin Wang","doi":"10.1016/j.chest.2026.09.089","DOIUrl":"https://doi.org/10.1016/j.chest.2026.09.089","url":null,"abstract":"<p><strong>Background: </strong>Ultrasound (US)-guided percutaneous lung needle biopsy (PLNB), the guideline-recommended approach for subpleural lung lesion (SLL) diagnosis, requires comparison with CT-guided biopsy based on high-level evidence clinical studies.</p><p><strong>Research question: </strong>Is US-guided PLNB superior to CT-guided biopsy in diagnostic performance and safety, and does CEUS provide further advantages?</p><p><strong>Study design and methods: </strong>Participants undergoing PLNB for SLLs between June 2020 and November 2023 were randomized to US-, CEUS- and CT-guided biopsies. The dual primary outcomes were diagnostic yield and disease-specific diagnostic sensitivity. Diagnostic yield was defined according to the strict ATS/ACCP definition as the proportion of biopsies yielding clinically actionable diagnoses, while sensitivity referred to the proportion of patients with a confirmed disease correctly identified by biopsy. Four secondary outcomes included complication rate, CNB/FNA utilization, puncture number, and puncture time, with the overall complication rate adopted as the key safety indicator.</p><p><strong>Results: </strong>A total of 2485 participants were randomized into the US (n=828), CEUS (n=829) and CT (n=828) groups. The CEUS-guided biopsy achieved the highest diagnostic yield (CEUS: 88.8%[736/829] vs. CT: 78.9%[653/828] vs. US: 76.0%[629/828], χ²=49.046, P <0.001) , as well as the highest diagnostic sensitivity (CEUS: 86.1%[714/829] vs. CT: 74.3%[615/828] vs. US: 68.7%[569/828], χ²=72.623, P <0.001). For disease-specific analysis, CEUS yielded superior diagnostic sensitivity for malignant subtypes (CEUS: 91.8%[563/613] vs. CT: 83.2%[520/625] vs. US: 75.2%[479/637], χ²=62.259, P <0.001) and specific benign disorders (CEUS: 69.9%[151/216] vs. CT: 46.8%[95/203] vs. US: 47.1%[90/191], χ²=29.712, P <0.001). Furthermore, the CEUS group exhibited the lowest overall complication rate (CEUS: 4.6%[38/828] vs. US: 7.5%[60/802] vs. CT: 15.8%[127/805], χ²=65.322, P <0.001).</p><p><strong>Interpretation: </strong>For SLL biopsy, CEUS-guided PLNB outperforms US- and CT-guided approaches in both diagnostic performance and procedural safety. CEUS guidance notably improves disease-specific diagnostic sensitivity for malignant subtypes and specific benign pulmonary disorders, serving as an optimal technique for clinical percutaneous lung biopsy.</p><p><strong>Clinical trial registration: </strong>Chinese Clinical Trial Registry; No.: ChiCTR2100045374; URL: www.chictr.org.cn.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104635","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":"Sputum cellularity and health services utilization among patients with asthma and COPD.","authors":"Parameswaran Nair, Kimball Zhang, Sylvia Lauks, Melanie Kjarsgaard, Sarita Thawanaphong, Jingqin Zhu, Emilie Terebessy, Teresa To","doi":"10.1016/j.chest.2026.09.091","DOIUrl":"https://doi.org/10.1016/j.chest.2026.09.091","url":null,"abstract":"<p><strong>Background: </strong>Associations between health services utilization (HSU) and objectively measured airway inflammation in severe asthma or chronic obstructive pulmonary disease (COPD) patients remain unclear.</p><p><strong>Research question: </strong>Is there an association between quantitative sputum cell counts and HSU (hospitalizations, physician visits, emergency department visits) patterns in patients with asthma and COPD?</p><p><strong>Study design and methods: </strong>In this retrospective cohort study, clinical data, spirometry, and sputum cell counts (% of eosinophils, neutrophils) obtained during routine clinical assessment of patients attending a university tertiary airway disease clinic were linked to Ontario health administrative databases (2006-2019). Sputum inflammatory cell counts were treated as fixed baseline exposure variables and negative binomial regression models using generalized estimating equations estimated RRs and 95% CIs for subsequent HSU adjusting for demographic, socioeconomic, and clinical covariates.</p><p><strong>Results: </strong>Of the 4821 patients included, 3714(77%) had asthma only and 1107(23%) had COPD only. Among patients with asthma, sputum eosinophilia (>3%) was associated with higher asthma-specific HSU. Compared with patients with sputum eosinophils <3%, both the 3-15% and >15% eosinophil groups had similarly increased rates of asthma-specific emergency department visits (RR=1.92, 95%CI:1.49-2.47 and RR=1.88, 95%CI:1.17-3.03). Conversely, sputum eosinophil counts were not significantly associated with HSU in COPD, whereas high sputum neutrophil counts were associated with increased all-cause hospitalizations (RR=1.71, 95%CI:1.11-2.64). Overall, those with higher eosinophil (>15%) and lower neutrophil counts (<65%) had significantly higher rates of asthma-specific and asthma-related HSU. In contrast, sputum eosinophil counts were not significantly associated with increased all-cause hospitalizations among patients with COPD.</p><p><strong>Interpretation: </strong>Sputum eosinophilia (>3%) is associated with increased asthma-related HSU, whereas sputum eosinophils were not associated with increased HSU in COPD. These findings support the clinical relevance of airway inflammometry in asthma and highlight important differences in inflammatory phenotypes between asthma and COPD. Further studies are needed to better understand the mechanisms underlying these associations.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104647","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":"TISA-818, an Anti-inflammatory Conjugate of Montelukast-Decapeptide, in Acute Respiratory Distress Syndrome Due to Pulmonary Infection: A Phase 2 Randomized Trial Using the 2023 Global Definition.","authors":"Linna Huang, Xu Huang, Feifei Jiao, Bing Sun, Xiaoli Han, Wancang Jiang, Weiwen Zhang, Hong Luo, Lingling Su, Ming Gu, Jun He, Longlong Jiao, Xiao Tang, Lei Jiang, Danqiong Wang, Min Yang, Xianghong Yang, Dan Li, Huaxue Wang, Xiaoliang Yuan, Hai Lin, Ziqiang Shao, Kun Lu, Bailing Yan, Yongmei Zhang, Kuan Liu, Anders Kärnell, Qingyuan Zhan","doi":"10.1016/j.chest.2026.09.095","DOIUrl":"https://doi.org/10.1016/j.chest.2026.09.095","url":null,"abstract":"<p><strong>Background: </strong>Acute respiratory distress syndrome (ARDS) remains associated with substantial mortality. The 2023 global definition includes non-intubated patients, creating an opportunity to evaluate therapies earlier in the disease course.</p><p><strong>Research question: </strong>Is TISA-818 safe and potentially efficacious in patients with ARDS, particularly those who are non-intubated?</p><p><strong>Study design and methods: </strong>This randomized, double-blind, placebo-controlled, multicenter phase 2 trial was, to our knowledge, the first in China to use the 2023 global ARDS definition. Fifty-eight patients were randomized 1:1:1 to intravenous TISA-818 6 mg twice daily (BID), 12 mg once daily (QD), or matched placebo for 14 days. The primary endpoint was safety. Key secondary endpoints included respiratory support-free days (RSFDs) through day 28, proportion of patients alive and free from respiratory support at day 14, clinical improvement rate at day 14, and length of stay through 28 days.</p><p><strong>Results: </strong>TISA-818 demonstrated an acceptable safety profile with comparable rates of treatment-emergent adverse events (AEs) and no unexpected safety signals. Treatment-related AEs were mild-to-moderate and occurred in 5.3%, 36.8%, and 21.1% of patients in the placebo, 6 mg BID, and 12 mg QD groups, respectively. Day-28 mortality was 5.3%, 10.5%, and 26.3%, whereas day-60 mortality was 26.3%, 21.1%, and 31.6% for placebo, 6 mg BID, and 12 mg QD, respectively. No drug-related serious AEs or deaths occurred. In the prespecified non-intubated subgroup (n=27, 9 per arm), exploratory analyses numerically favored 6 mg BID over placebo, with more RSFDs (difference, 6 days; 95% confidence interval, -3 to 15) and consistent numerical improvements across all secondary outcomes.</p><p><strong>Interpretation: </strong>TISA-818 was generally well tolerated. Day-28 mortality was numerically imbalanced but not sustained, likely reflecting small-sample variability; cautious interpretation is warranted. Consistent improvements across all efficacy endpoints, particularly with 6 mg BID in non-intubated patients, support further investigation in adequately powered trials.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104650","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":"Peering Through the \"Lens\" of Overlap in Pulmonary Vascular Diseases Due to Liver Disease: Impact of Pulmonary Arterial Hypertension Therapies on Gas Exchange in Portopulmonary Hypertension.","authors":"Arun Jose","doi":"10.1016/j.chest.2026.05.010","DOIUrl":"https://doi.org/10.1016/j.chest.2026.05.010","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"170 4","pages":"1004-1005"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135220","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":"Chest Radiograph-Derived Age Acceleration as an Early Marker of Pulmonary Dysfunction in Middle-Aged Asian Adults.","authors":"Hyungjin Kim, Yoosoo Chang, Soonho Yoon, Seungho Ryu","doi":"10.1016/j.chest.2026.05.033","DOIUrl":"10.1016/j.chest.2026.05.033","url":null,"abstract":"<p><strong>Background: </strong>Deep learning-derived chest radiographic age may capture subclinical structural changes associated with spirometric impairment.</p><p><strong>Research question: </strong>Is chest radiograph (CXR)-based accelerated aging associated with the prevalence and incidence of preserved ratio impaired spirometry (PRISm) and obstructive lung disease (OLD)?</p><p><strong>Study design and methods: </strong>This retrospective study included Korean adults who underwent CXRs and spirometry during regular health checkups between 2006 and 2019. Participants were categorized into decelerated (< -2.0 years), reference (-2.0 to 1.9 years), or accelerated (≥ 2.0 years) aging groups according to CXR-Lung-Risk scores relative to chronological age derived from baseline CXRs. Prevalent PRISm (FEV₁ < 80% predicted with FEV₁/FVC ≥ 0.70) and OLD (FEV₁/FVC < 0.70) were defined based on baseline spirometry and assessed using multivariable multinomial logistic regression. Incident PRISm and OLD were evaluated among participants with normal baseline spirometry using follow-up spirometry data through December 31, 2022, and associations were estimated using multivariable Cox proportional hazards models.</p><p><strong>Results: </strong>Among 231,278 participants (mean age, 50.7 ± 8.8 years; 55.0% male), the prevalence of PRISm and OLD was 2.2% (5,161 of 231,278) and 4.6% (10,557 of 231,278), respectively. Compared with those in the reference group, participants with accelerated aging had higher odds of prevalent PRISm (adjusted OR; 1.37; 95% CI, 1.28-1.46) and OLD (adjusted OR, 1.58; 95% CI, 1.51-1.65). In the longitudinal analysis including 104,158 participants (median follow-up, 4.3 years), accelerated aging was associated with higher risks of incident PRISm (adjusted hazard ratio, 1.37; 95% CI, 1.27-1.48) and OLD (adjusted hazard ratio, 1.28; 95% CI, 1.20-1.37). Associations were directionally consistent across subgroups defined by age, sex, smoking status, and BMI, with most subgroup analyses remaining statistically significant.</p><p><strong>Interpretation: </strong>Our results show that CXR-derived accelerated aging was associated with both current and future PRISm and OLD. These findings support a potential complementary role for routine CXRs in opportunistic identification of pulmonary dysfunction.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1174-1186"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148161940","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":"Impact of Pulmonary Arterial Hypertension Therapies on Gas Exchange in Portopulmonary Hypertension.","authors":"Thomas Lacoste-Palasset, Audrey Baron, Nathan Ebstein, Antoine Beurnier, Audrey K Grech, Fabien Robert, Ly Tu, Mitja Jevnikar, Xavier Jaïs, Athénaïs Boucly, Simon Valentin, Pascal Magro, Delphine Horeau-Langlard, Benoit Aguado, Christophe Guignabert, Fabrice Bauer, David Montani, Marc Humbert, Olivier Sitbon, Laurent Savale","doi":"10.1016/j.chest.2026.04.027","DOIUrl":"10.1016/j.chest.2026.04.027","url":null,"abstract":"<p><strong>Background: </strong>Portopulmonary hypertension (PoPH) may coexist with hepatopulmonary syndrome (HPS), a condition characterized by intrapulmonary vascular dilatations (IPVDs) and hypoxemia. Although pulmonary arterial hypertension (PAH) therapies are commonly used to treat PoPH, their effects on gas exchange remain insufficiently characterized.</p><p><strong>Research question: </strong>What are the effects of PAH-specific therapies on gas exchange and the development of IPVDs in patients with PoPH?</p><p><strong>Study design and methods: </strong>A retrospective cohort of patients with PoPH was used to assess changes in the alveolar-arterial oxygen gradient (A-aDO₂) following initiation of PAH therapy. A prospective cohort underwent systematic screening for IPVDs to assess their prevalence at baseline and incidence during treatment.</p><p><strong>Results: </strong>The retrospective cohort included 107 patients (70% male; mean age, 55 ± 8 years) with a baseline mean A-aDO₂ of 37.1 ± 13.0 mm Hg. Eighty-three patients received initial oral monotherapy and 24 received dual oral therapy. After a median follow-up of 4.5 months, A-aDO₂ remained stable overall (mean change, -0.92 mm Hg; 95% CI, -3.2 to 1.3; P = .42), with substantial interindividual variability. Changes in A-aDO₂ were not associated with variation in 6-minute walk distance or World Health Organization/New York Heart Association functional class. Baseline A-aDO₂ and cardiac output were independently associated with subsequent improvement in A-aDO₂. Treatment-induced reductions in mean pulmonary artery pressure and increases in cardiac output correlated with greater A-aDO₂ improvement. In the prospective cohort (n = 28), HPS was present in 39% of patients newly diagnosed with PoPH. Baseline IPVDs did not influence A-aDO₂ evolution; however, 4 patients developed new IPVDs within the first year following PAH therapy initiation.</p><p><strong>Interpretation: </strong>Our results show that PAH therapy was not associated with overall deterioration in gas exchange in PoPH, despite substantial individual variability. Changes in oxygenation were linked to baseline and treatment-induced hemodynamic parameters. The development of new IPVDs in some patients warrants careful longitudinal monitoring.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1205-1217"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811630","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}