Chest最新文献

{"title":"Phenotyping Exertional Breathlessness Using Cardiopulmonary Cycle Exercise Testing in People With Chronic Airflow Limitation.","authors":"Magnus Ekström, Pei Zhi Li, Hayley Lewthwaite, Jean Bourbeau, Wan C Tan, Dennis Jensen","doi":"10.1016/j.chest.2025.02.033","DOIUrl":"10.1016/j.chest.2025.02.033","url":null,"abstract":"<p><strong>Background: </strong>Exertional breathlessness is a cardinal symptom of people with chronic airflow limitation (CAL) and can be evaluated using cardiopulmonary exercise testing (CPET).</p><p><strong>Research question: </strong>Does abnormally high exertional breathlessness in relationship to the rate of oxygen uptake (V'O₂) and minute ventilation (V'_E) indicate different underlying pathophysiologic mechanisms and clinical characteristics in people with CAL?</p><p><strong>Study design and methods: </strong>Analysis of people ≥ 40 years of age with CAL (FEV₁ to FVC ratio after bronchodilation less than lower limit of normal) undergoing symptom-limited incremental cycle CPET in the Canadian Cohort Obstructive Lung Disease study. Using published normative references, breathlessness phenotypes at peak exercise were categorized as abnormal (Borg 0-10 scale intensity rating more than upper limit of normal) by V'O₂ alone, abnormal by both V'O₂ and V'_E, or normal by both V'O₂ and V'_E. Exercise physiologic responses and clinical characteristics were compared between groups.</p><p><strong>Results: </strong>We included 325 people (44% women) with CAL (mean (SD) FEV₁, 75.4 (17.5)% predicted). Compared with the normal by both V'O₂ and V'_E group (n = 237 [73%]), the abnormal by V'O₂ only group (n = 29 [9%]) showed lower pulmonary diffusing capacity and greater exercise ventilatory inefficiency, whereas the abnormal by both V'O₂ and V'_E group (n = 50 [15%]) showed even worse lung function, dynamic critical inspiratory constraints, and exertional breathlessness along with greater symptom burden in daily life, lower physical activity, and worse health status.</p><p><strong>Interpretation: </strong>Exertional breathlessness phenotyped in relationship to V'O₂ and V'_E using normative reference equations enable multivariable analyses of underlying symptom mechanisms and associated clinical characteristics.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623822","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":"Low-Intensity vs Moderate-Intensity Anticoagulation for Venovenous Extracorporeal Membrane Oxygenation: The Strategies for Anticoagulation During Venovenous Extracorporeal Membrane Oxygenation Pilot Trial.","authors":"Whitney D Gannon, Elias H Pratt, Melissa A Vogelsong, Wren H Adkisson, Matthew Bacchetta, Sarah L Bloom, Daniel J Ford, Brandon A Guenthart, Janna S Landsperger, Edward T Qian, Craig R Rackley, Todd W Rice, Vikram Fielding-Singh, John W Stokes, Joanna L Stollings, Matthew W Semler, Jonathan D Casey","doi":"10.1016/j.chest.2025.02.032","DOIUrl":"10.1016/j.chest.2025.02.032","url":null,"abstract":"<p><strong>Background: </strong>Bleeding is a common and sometimes fatal complication of venovenous extracorporeal membrane oxygenation (ECMO). Whether lowering the intensity of anticoagulation during venovenous ECMO is safe or effective is unknown.</p><p><strong>Research question: </strong>Is a large, multicenter randomized trial of low-intensity vs moderate-intensity anticoagulation during venovenous ECMO feasible?</p><p><strong>Study design and methods: </strong>In a multicenter, parallel-group, randomized pilot trial conducted at 3 centers across the United States, we randomly assigned critically ill adults undergoing venovenous ECMO to low-intensity or moderate-intensity anticoagulation. Feasibility was assessed by enrollment rate and adherence to the assigned anticoagulation strategy. The primary efficacy outcome was major bleeding, and the primary safety outcome was thromboembolic events, both assessed between enrollment and 24 hours after decannulation.</p><p><strong>Results: </strong>All of the 26 patients enrolled received the assigned intensity of anticoagulation. A major bleeding event occurred in 1 of 12 patients (8.3%) in the low-intensity anticoagulation group and in 4 of 14 patients (28.6%) in the moderate-intensity anticoagulation group (absolute risk difference, -20.2 percentage points; 95% CI, -48.6 to 8.1; P = .33). One patient experienced a thromboembolic event (8.3%) in the low-intensity anticoagulation group compared with none in the moderate-intensity group (difference, 8.3 percentage points; 95% CI, -7.3 to 24.0; P = .46). No patients died before discharge in the low-intensity anticoagulation group, compared with 2 patients (14.3%) in the moderate-intensity group, both of whom experienced major bleeding events. No patients died before discharge in the low-intensity anticoagulation group, compared with 2 patients (14.3%) in the moderate-intensity group, both of whom experienced major bleeding events.</p><p><strong>Interpretation: </strong>Enrollment and separation between groups are feasible in a multicenter randomized trial of low-intensity vs moderate-intensity anticoagulation for critically ill adults receiving venovenous ECMO. A large, multicenter, randomized trial is needed and seems to be feasible.</p><p><strong>Clinical trial registry: </strong>ClinicalTrials.gov; No.: NCT04997265; URL: www.</p><p><strong>Clinicaltrials: </strong>gov.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623820","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":"Factors Associated with No-Show Rates for Lung Cancer Screening CT Appointments.","authors":"Jingshuo D Sun, Amie L Samuylov, Jessica A Lorusso, Mark M Hammer, Suzanne C Byrne","doi":"10.1016/j.chest.2025.02.035","DOIUrl":"https://doi.org/10.1016/j.chest.2025.02.035","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623818","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":"Interventions to Improve Adherence to Clinical Guidelines for the Management and Follow-up of Pulmonary Nodules: A Systematic Review.","authors":"Justin Aunger, Kay Por Yip, Kamen Dosanjh, Katie Scandrett, Bianca Ungureanu, Michael Newnham, Alice M Turner","doi":"10.1016/j.chest.2025.02.031","DOIUrl":"10.1016/j.chest.2025.02.031","url":null,"abstract":"<p><strong>Background: </strong>Lung cancer is the leading cause of global cancer mortality. It is also the third most common cancer in the United Kingdom and the most prevalent worldwide. Pulmonary nodules can indicate early-stage lung cancer, but adherence to guidelines for radiologic surveillance is suboptimal, which affects early detection and treatment. Although interventions have been developed to improve follow-up, it remains unclear which approaches are most effective.</p><p><strong>Research question: </strong>Which interventions have been developed for improving adherence to guidelines for the management of pulmonary nodules and/or the follow-up of patients, and how effective are they?</p><p><strong>Study design and methods: </strong>A systematic review was conducted by searching the Ovid MEDLINE, Cochrane, and Embase databases in March 2024. Reports were included of interventions of all designs that measured outcomes, including follow-up completion, guideline adherence, or early diagnosis of lung cancer. Studies relating to diagnosis, reporting screening programs, or not in English were excluded. Screening and data extraction were performed independently. Risk of bias was assessed by using three measures depending on study design.</p><p><strong>Results: </strong>A total of 3,664 titles and abstracts, including 31 studies, were identified. Six intervention types were identified: tracking systems, process improvement approaches, natural language processing systems, radiologist reporting templates, clinical decision-making support tools, and patient involvement improvements. All studies reported being effective. Tracking systems and clinical decision support tools showed significant improvements in follow-up, guideline adherence, and early cancer detection. Tracking systems may have the most potential for effectiveness because they modify more of the care pathway and use automation, reducing human error. Risk of bias was serious or critical in most nonrandomized studies.</p><p><strong>Interpretation: </strong>There was significant variation in achieved follow-up rates across interventions; however, tracking systems seemed most effective in improving patient follow-up. Review limitations included high risk of bias and heterogeneity of included studies. Future evaluations should include more comprehensive outcome measures and rigorous designs.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623819","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":"Transfusion of Fresh Frozen Plasma and Platelets in Critically Ill Adults: An American College of Chest Physicians Clinical Practice Guideline.","authors":"Angel Coz Yataco, Israa Soghier, Paul C Hébert, Emilie Belley-Cote, Margaret Disselkamp, David Flynn, Karin Halvorson, Jonathan M Iaccarino, Wendy Lim, Christina C Lindenmeyer, Peter J Miller, Kevin O'Neil, Kathryn M Pendleton, Lisa Vande Vusse, Daniel R Ouellette","doi":"10.1016/j.chest.2025.02.029","DOIUrl":"10.1016/j.chest.2025.02.029","url":null,"abstract":"<p><strong>Background: </strong>Platelets and fresh frozen plasma (FFP) are frequently administered to critically ill patients. Considering the variability in indications and thresholds guiding these transfusions, a comprehensive review of current evidence was conducted to provide guidance to critical care practitioners. This American College of Chest Physicians guideline examined the literature on platelet transfusions in critically ill patients with thrombocytopenia, with and without active bleeding, as well as data on prophylactic platelet and FFP transfusions for common procedures in the critical care setting.</p><p><strong>Study design and methods: </strong>A panel of experts developed seven Population, Intervention, Comparator, and Outcome questions addressing platelet and FFP transfusions in critically ill patients and performed a comprehensive evidence review. The panel applied the Grading of Recommendations, Assessment, Development, and Evaluations approach to assess the certainty of evidence, and to formulate and grade recommendations. A modified Delphi technique was used to reach consensus on the recommendations.</p><p><strong>Results: </strong>The initial search identified a total of 7,172 studies, and after the initial screening, 100 articles were reviewed. Sixteen studies met inclusion criteria, comprising 1 randomized controlled trial and 15 observational studies. Overall, the certainty of the evidence for all questions was very low. The panel formulated seven conditional recommendations.</p><p><strong>Conclusions: </strong>In critically ill patients with thrombocytopenia or coagulopathy, a risk/benefit assessment should be made by providers prior to transfusion of platelets or FFP. Given the known risks of blood product transfusion, and the limited data regarding the benefits from platelet or FFP transfusion, most patients will benefit from avoiding transfusion of these blood products. In patients at high risk of bleeding, or where the bleeding complication may be catastrophic, transfusion should be considered.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613702","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":"Epidemiology of Intensive Care Use for Patients with Sickle Cell Disease in New York State.","authors":"Miguel Eduardo Cid, Zhixin Yang, Jeffrey Glassberg, Sarah McCuskee, May Hua","doi":"10.1016/j.chest.2025.02.028","DOIUrl":"https://doi.org/10.1016/j.chest.2025.02.028","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613700","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":"Association between preserved ratio impaired spirometry (PRISm) and COPD with coronary artery calcification measured by coronary computed tomography.","authors":"Purnadeo N Persaud, Lauren S Munoz Tremblay, Yanjun Wu, Peter Oro, Daniel A Culver, James K Stoller, Xiaofeng Wang, Raul Seballos, Richard H Cartabuke, Trishul Siddharthan, Vickram Tejwani","doi":"10.1016/j.chest.2025.02.030","DOIUrl":"https://doi.org/10.1016/j.chest.2025.02.030","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596283","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":"Preserved Ratio Impaired Spirometry Is an Important Risk Factor for Development of COPD, Also in Those Who Do Not Smoke.","authors":"Helena Backman, Tomi Myrberg, Linnea Hedman, Caroline Stridsman, Eva Rönmark, Anne Lindberg","doi":"10.1016/j.chest.2025.02.025","DOIUrl":"10.1016/j.chest.2025.02.025","url":null,"abstract":"<p><strong>Background: </strong>COPD largely is underdiagnosed. Active identification of cases is crucial to establish preventive measures before manifestation of clinical disease. The significance of different spirometric patterns preceding COPD, especially preserved ratio impaired spirometry (PRISm) findings, has been highlighted but remains unclear.</p><p><strong>Research question: </strong>Which clinical characteristics, smoking habits, and spirometric patterns, with primary focus on PRISm findings, precede the development of airway obstruction (AO)?</p><p><strong>Study design and methods: </strong>The OLIN COPD COPD Study was established from 2002 through 2004. After re-examination of population-based cohorts, individuals with AO (n = 993; FEV₁ to VC ratio < 0.70) were identified together with control participants with nonobstructive findings (n = 993; FEV₁ to VC ratio ≥ 0.70). Most of these people had participated in examinations during the 1980s or 1990s, and in total, 902 patients and 819 control participants had previous clinical data. Logistic regression was performed with case status as outcome and spirometric patterns, age, sex, smoking habits, and BMI at first examination as covariates.</p><p><strong>Results: </strong>The mean (SD) person-years between first examination and inclusion in the OLIN COPD COPD Study was 10.5 (4.0) years. At first examination, the prevalence of PRISm findings was higher in patients (18.6%) vs control participants (13.4%). Current smoking was more common in patients (45.1% vs 18.2%), whereas former smoking was similar (31.8% vs 34.9%). Patients reported more respiratory symptoms (78.0% vs 44.3%) than control participants. At first examination, PRISm findings, current smoking, and former smoking were associated strongly with becoming a case when adjusted for confounders, with adjusted OR (aOR) of 3.5, 4.1, and 1.5, respectively. When stratifying for smoking habits, aORs for PRISm findings in those with current smoking, former smoking, and never smoking status were 2.9, 3.8 and 3.7, respectively.</p><p><strong>Interpretation: </strong>PRISm findings are associated with transition into AO corresponding to COPD within 1 decade, independent of smoking habits and with similar strength of association among those who have never smoked, who formerly smoked, and who currently smoke.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584921","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":"Prevalence of Airflow Limitation and Emphysema in Lung Cancer Screening Populations: A Systematic Review and Meta-Analysis.","authors":"Hyewon Choi, Il-Youp Kwak, Chung-Ryul Oh, Jin Mo Goo, Soon Ho Yoon","doi":"10.1016/j.chest.2025.02.021","DOIUrl":"10.1016/j.chest.2025.02.021","url":null,"abstract":"<p><strong>Background: </strong>Early detection and treatment of COPD are becoming important for improving the prognosis of individuals who have a history of heavy smoking. Despite the higher risk of COPD among individuals participating in lung cancer screening, many of these patients continue to show rates of underdiagnosis of lung cancer.</p><p><strong>Research question: </strong>How many participants in lung cancer screening have emphysema or airflow limitation? If spirometry is incorporated into the screening, how many additional patients with airflow limitation could be identified?</p><p><strong>Study design and methods: </strong>The Ovid-MEDLINE and Embase databases were searched from inception through November 30, 2023. We included original studies reporting the prevalence of CT scan-confirmed emphysema and spirometry-confirmed airflow limitation. The primary outcomes were the prevalence of emphysema and airflow limitation. For studies reporting severity, we analyzed the percentage of mild vs moderate to severe disease. We also calculated the proportion of newly confirmed cases of airflow limitation via spirometry.</p><p><strong>Results: </strong>In total, 42 studies were included (emphysema, n = 18; airflow limitation, n = 13; both, n = 11), comprising 126,842 individuals with emphysema and 72,209 individuals with airflow limitation. The pooled prevalence of emphysema was 45.3% (95% CI, 39.3%-51.2%), and that of airflow limitation was 40.1% (95% CI, 33.4%-46.8%). Moderate to severe emphysema was observed in 28.8% of patients with emphysema (95% CI, 24.2%-33.4%), whereas 54.3% patients with emphysema (95% CI, 40.6%-60.6%) showed moderate to very severe airflow limitation. Furthermore, 65.2% of patients with airflow limitation (95% CI, 55.7%-74.7%) identified by spirometry had been unrecognized previously.</p><p><strong>Interpretation: </strong>Among screening participants, 45.3% demonstrated emphysema and 40.1% demonstrated airflow limitation, with 28.8% and 54.3% of these patients showing moderate to severe disease, respectively. Furthermore, 65% of patients with airflow limitation had not received a diagnosis previously. These findings suggest that incorporating spirometry into screening programs may enhance COPD detection and management.</p><p><strong>Clinical trial registry: </strong>International Prospective Register of Systematic Reviews; No.: CRD42024513248; URL: https://www.crd.york.ac.uk/prospero/.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584884","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":"Diagnostic Evaluation and Clinical Findings in Children With Persistent Tachypnea of Infancy and Neuroendocrine Cell Hyperplasia of Infancy: A European Multicenter Retrospective Study.","authors":"Honorata Marczak, Katarzyna Krenke, Matthias Griese, Joanna Peradzyńska, Joanna Lange, Marek Kulus, Magdalena Grochowska, Elias Seidl, Jean-Christophe Dubus, Julia Rodler, Nicolaus Schwerk, Julia Carlens, Oded Breuer, Avigdor Hevroni, Silvia Castillo-Corullón, Malena Aldeco, Frederik Fouirnaies Buchvald, Kim G Nielsen, Sarah Mayell, Alba Torrent, Maynor Bravo-López, Nicolas Regamey, Florian Stehling, Philipp Latzin, Anna Zschocke, Elpis Hatziagorou, Roser Ayats, Tuğba Şişmanlar Eyüboğlu, Ela Erdem, Marijke Proesmans, Steve Cunningham, Dafni Moriki, Sevgi Pekcan, Nazan Cobanoglu, Lutz Naehrlich, Christiane Lex, Nicola Ullmann, Winfried Baden, Dora Krikovszky, Mirella Gaboli, Nuria Diez Monge, David Naranjo Vivas, Sune Leisgaard Mørck Rubak, Brigitte Willemse, Laura Petrarca, Anna Wiemers, Dirk Schramm, Christoph Mueller, Freerk Prenzel, Vaclav Koucky, Juan A López-Andreu, Nadia Nathan","doi":"10.1016/j.chest.2025.02.023","DOIUrl":"10.1016/j.chest.2025.02.023","url":null,"abstract":"<p><strong>Background: </strong>Persistent tachypnea of infancy (PTI) or neuroendocrine cell hyperplasia of infancy (NEHI) is a form of childhood interstitial lung disease (chILD) that predominantly affects young children. Although it is one of the most common chILDs, no unified diagnostic approach specific to this condition exists.</p><p><strong>Research question: </strong>Are the clinical presentation and the diagnostic approach different in patients with PTI or NEHI among the European countries?</p><p><strong>Study design and methods: </strong>This was a European multicenter, retrospective, observational study. Data on clinical characteristics and diagnostic strategies in patients with PTI or NEHI were analyzed and compared across participating countries.</p><p><strong>Results: </strong>The study included 378 children with PTI or NEHI from 17 countries (63.5% male, 97.4% White) who received a diagnosis at a median age of 9 months (interquartile range, 6-13 months). The most common baseline symptoms were tachypnea, chest retractions, crackles on auscultation, hypoxemia, and failure to thrive. High-resolution CT (HRCT) imaging was performed in all patients, with most undergoing chest radiography, echocardiography, and immunology tests. Lung biopsy was carried out in 23.5% of patients, with a decreasing trend over time and variation by country; its use was associated with longer diagnostic delay. Histopathologic examination showed a hyperplasia of pulmonary neuroendocrine cells in 52.8% of patients. Genetic testing was rare, and its application varied significantly among countries. Additional investigations that do not have an established role, such as assessment for gastroesophageal reflux disease and OSA, infant pulmonary function tests, and lung ultrasound, were limited to single countries.</p><p><strong>Interpretation: </strong>Diagnosis of PTI or NEHI relies on clinical symptoms and HRCT imaging results, with lung biopsies less commonly performed. Differences exist among countries regarding the number and type of investigations. A need exists for guidelines that will uniform the diagnostic approach.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584882","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}