Chest最新文献

{"title":"Understanding the Pulmonary Function Testing Experience: A Qualitative Study in Patient-Centered Education.","authors":"Sara Shin, Mingqian Tan, Asritha Sure, Michael Ieong, Lauren E Kearney","doi":"10.1016/j.chest.2026.08.016","DOIUrl":"10.1016/j.chest.2026.08.016","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary function tests (PFTs) are essential for evaluating respiratory disease but are often accompanied by limited patient education. There is a lack of data describing how patients experience PFTs and what they need to feel prepared. Inadequate pretest counseling may contribute to anxiety, poor patient understanding, and resultant suboptimal test performance.</p><p><strong>Research question: </strong>What are patient experiences with PFTs, and how can these insights inform the content of a patient-centered educational pamphlet optimized for clinical use and ease of readability?</p><p><strong>Study design and methods: </strong>A multiphase study was conducted at a large academic safety-net hospital. Initial pamphlet development drew on a targeted literature review, observation of PFTs, and firsthand PFT experience. Six patient focus groups, 1 clinician focus group, and 1 respiratory therapist interview were held. Transcripts underwent rapid content analysis to identify themes and refine the pamphlet iteratively. Readability of the final pamphlet was assessed with the Simple Measure of Gobbledygook (SMOG) and Flesch-Kincaid grade-level tools.</p><p><strong>Results: </strong>Four major themes emerged: (1) emotional responses (anxiety, shame), (2) physical demands, (3) expectation-experience mismatches, and (4) clinician interactions. Patients reported inadequate pretest information about logistics and PFT maneuvers. They viewed the pamphlet favorably and suggested clearer wording, more visuals, and varied delivery formats, which informed revisions. The final pamphlet measured SMOG grade 6 and Flesch-Kincaid grade 7, aligning with American Medical Association recommendations.</p><p><strong>Interpretation: </strong>These findings reveal a previously under-recognized problem: patients undergoing PFTs face substantial informational, emotional, and physical challenges that are rarely documented. A concise, user-centered pamphlet codeveloped with patient and clinician input may improve understanding and reduce anxiety. Future studies should evaluate the impact of such patient educational materials on PFT result quality and post-test patient outcomes.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788303","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":"Incidental Emphysema on Health Screening Chest CT Imaging and All-Cause Mortality in a Korean Cohort.","authors":"Yoojin Nam, Hye Ree Cho, Eunji Kim, Nak Gyeong Ko, Pa Hong, Hyun Kyu Cho","doi":"10.1016/j.chest.2026.08.014","DOIUrl":"10.1016/j.chest.2026.08.014","url":null,"abstract":"<p><strong>Background: </strong>Incidental emphysema on health-screening chest CT imaging is common, yet its prognostic significance in asymptomatic populations is characterized poorly.</p><p><strong>Research question: </strong>Is incidental emphysema on health screening chest CT imaging independently associated with all-cause mortality?</p><p><strong>Study design and methods: </strong>This retrospective cohort comprised 41,291 adults undergoing chest CT imaging during routine health checkups in Korea (2002-2019). Emphysema was a binary variable from structured radiology reports, and the primary outcome was all-cause mortality via national death registry linkage. The primary analysis was a complete-case Cox model adjusted for age, sex, BMI, and smoking status; sensitivity analyses used multiple imputation, ever-smoking restriction, scanner-era adjustment, a time-varying exposure, and competing risks models.</p><p><strong>Results: </strong>Emphysema was present in 3,774 participants (9.1%), rising from 2.6% in those who had never smoked to 14.6% in those who current smoked; over a median of 8.5 years, 284 deaths occurred. Emphysema was associated with all-cause mortality in the designated complete-case analysis (hazard ratio [HR], 1.54; 95% CI, 1.05-2.25), among those who had ever smoked after pack-years adjustment (HR, 1.63; 95% CI, 1.09-2.43), and when exposure was updated at repeat imaging (HR, 1.69; 95% CI, 1.18-2.41). Full-cohort pack-years imputation was not significant (HR, 1.36; 95% CI, 0.97-1.91), diluted by those who had never smoked, among whom no participant with emphysema died. An exploratory cancer signal (HR, 2.25) was concentrated in lung cancer (13 events). Adding emphysema to a smoking-inclusive model improved discrimination by ≤ 0.004.</p><p><strong>Interpretation: </strong>Among those who had ever smoked, incidental emphysema on screening chest CT imaging was associated with mortality after adjustment for pack-years of smoking, although residual confounding because of smoking intensity cannot be excluded. After smoking history is known, the report adds almost nothing to discrimination and should not be used alone to stratify prognosis; we did not address whether it should prompt evaluation for undiagnosed COPD. In the full screening population, the association did not reach significance, but with 284 deaths, one-half the number needed for 80% power, that result is inconclusive, rather than negative.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788249","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":"Mepolizumab and Dupilumab Show No Significant Difference in Reducing Exacerbations in Patients with COPD and an Eosinophilic Phenotype: Matching-Adjusted Indirect Treatment Comparison.","authors":"Jean Bourbeau, Jeff Min, Stefanie Kolterer, Shibing Yang, Matthias Hunger, Xuan Wang, Frank C Sciurba","doi":"10.1016/j.chest.2026.07.5242","DOIUrl":"https://doi.org/10.1016/j.chest.2026.07.5242","url":null,"abstract":"<p><strong>Background: </strong>Mepolizumab and dupilumab are monoclonal antibodies targeting type 2 inflammation that are both approved as add-on maintenance treatment in patients with inadequately controlled chronic obstructive pulmonary disease (COPD) and an eosinophilic phenotype.</p><p><strong>Research question: </strong>What is the comparative efficacy of mepolizumab and dupilumab in reducing the risk of exacerbations and improving health-related quality of life in patients with COPD and an eosinophilic phenotype?</p><p><strong>Study design and methods: </strong>This study used a robust matching-adjusted indirect comparison (MAIC) approach to compare pooled efficacy data from three Phase III, randomized, placebo-controlled COPD trials of mepolizumab (METREX [NCT02105948], METREO [NCT02105961], and MATINEE [NCT04133909]) with two trials of dupilumab (BOREAS [NCT03930732] and NOTUS [NCT04456673]). An indirect comparison was performed using MAIC, reweighting individual patient data from mepolizumab trials using propensity score-based methods to match the aggregate baseline characteristics of the dupilumab trial populations. To match the more restrictive eligibility criteria of the dupilumab trials, patients from the mepolizumab studies were included in this MAIC if they had blood eosinophil counts ≥300 cells/μL at screening, modified Medical Research Council scale grade ≥2, moderate-to-severe airflow limitation, and chronic bronchitis (CB) (defined by investigator assessment or St George's Respiratory Questionnaire for COPD [SGRQ-C]). Outcomes included rate/risk of exacerbations and health-related quality of life (SGRQ-C).</p><p><strong>Results: </strong>No statistically significant differences were observed in the reduction of the annualized rate of moderate/severe exacerbations (rate ratio [95% confidence interval]: 0.91 [0.60, 1.37] using investigator-assessed CB and 1.13 [0.80, 1.58] using SGRQ-C CB definition). No statistically significant differences were observed in SGRQ-C changes.</p><p><strong>Interpretation: </strong>In this MAIC study, there were no statistically significant differences between mepolizumab and dupilumab in the magnitude of effect in reducing moderate/severe exacerbations and improving health-related quality-of-life outcomes.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788306","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":"Exploring the role of autoimmune conditions in acute interstitial pneumonia","authors":"Melica Nikahd, Bronwyn Small, Brittany N. Hand","doi":"10.1016/j.chest.2026.08.010","DOIUrl":"https://doi.org/10.1016/j.chest.2026.08.010","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148754781","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":"Induction Agents for Tracheal Intubation of Critically Ill Patients: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials","authors":"Garrett McDougall, Ben Forestell, Behnam Sadeghirad, Akira Kuriyama, Priatharsini Sivananathajothy, Holden Flindall, James Choi, John Centofanti, Sheila Nainan Myatra, Jay Prakash, Jonathan D. Casey, Matthew W. Semler, Michael Sklar, Ambika Tejpal, Sameer Sharif, Bram Rochwerg","doi":"10.1016/j.chest.2026.07.5239","DOIUrl":"https://doi.org/10.1016/j.chest.2026.07.5239","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"35 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148754782","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":"Thoracic Ultrasound in Pleural Effusion: A Bedside Practical Approach Introduction","authors":"Amit Chopra, Kurt Hu, Alguili Elsheikh, Stephen Liang, Nicholas Pastis, Najib M. Rahman","doi":"10.1016/j.chest.2026.08.013","DOIUrl":"https://doi.org/10.1016/j.chest.2026.08.013","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"20 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148754783","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":"Effect of early versus delayed or no insulin therapy for moderate hyperglycemia in ICU patients: A target trial emulation","authors":"Christian Lange Gantzel, Puriya Daniel Würtz Yazdanfard, Kathrine Kold Sørensen, Johan Helleberg, Navid Soltani, Christian Torp Pedersen, Ulrik Pedersen-Bjergaard, Morten Heiberg Bestle, Johan Mårtensson","doi":"10.1016/j.chest.2026.08.007","DOIUrl":"https://doi.org/10.1016/j.chest.2026.08.007","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"46 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148754785","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":"Effect of early versus delayed or no insulin therapy for moderate hyperglycemia in ICU patients: A target trial emulation.","authors":"Christian Lange Gantzel, Puriya Daniel Würtz Yazdanfard, Kathrine Kold Sørensen, Johan Helleberg, Navid Soltani, Christian Torp Pedersen, Ulrik Pedersen-Bjergaard, Morten Heiberg Bestle, Johan Mårtensson","doi":"10.1016/j.chest.2026.08.007","DOIUrl":"https://doi.org/10.1016/j.chest.2026.08.007","url":null,"abstract":"<p><strong>Background: </strong>Hyperglycemia is common in intensive care unit (ICU) patients and associated with increased mortality. Despite several randomized clinical trials within glucose management in critical illness, the effects of insulin treatment, and its timing, in patients with moderate hyperglycemia remain uncertain.</p><p><strong>Research question: </strong>In acutely admitted ICU patients with moderate hyperglycemia, does insulin treatment improve clinical outcomes and does timing of insulin initiation matter?</p><p><strong>Study design and methods: </strong>We performed a multicenter target trial emulation using targeted minimum loss-based estimation. We included patients from four ICUs at Karolinska University Hospitals, Solna, Huddinge, from 2010 to 2021. We assessed the effect of early insulin treatment compared with delayed or no insulin treatment on 30-day all-cause mortality in acutely admitted adult ICU patients with moderate hyperglycemia (10 - 13.9 mmol/L).</p><p><strong>Results: </strong>We included 5,755 patients with moderate hyperglycemia; 3,149 (54.7%) received early insulin therapy (intervention group) and 2,606 (45.3%) received delayed or no insulin therapy (control group). The adjusted 30-day mortality was 22.1% (95% CI 21.1 - 23.1) for patients receiving insulin within 6 hours and 24.4% (95% CI 23.5 - 25.4) for patients with later or no insulin treatment, corresponding to an absolute risk reduction of 2.3% (95% CI 1.1 - 3.6). Absolute risk was reduced by 7.7%-points (CI 95% 6.5 - 8.9) when insulin was initiated within 1 hour of the first episode of moderate hyperglycemia and by 6.6%-points (CI 95% 5.4 - 7.8) with initiation within 2 hours. This effect was modified in several subgroups.</p><p><strong>Interpretations: </strong>In this target trial emulation, early insulin treatment of moderate hyperglycemia showed reduced mortality in acutely admitted adult ICU patients - particularly when insulin was initiated within 2 hours following hyperglycemia. These findings support further investigation in timing of insulin initiation.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757751","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":"Integrating Quantitative CT Scan Biomarkers to Enhance COPD Detection in the Holistic Implementation Study Assessing a Northern German Interdisciplinary Lung Cancer Screening Effort Lung Cancer Screening Program.","authors":"Mustafa Abdo, Hendrik Pott, Martin Reck, Roman Martin, Benjamin-Alexander Bollmann, Sabine Bohnet, Katharina May, Sabine Dettmer, Gerald Schmid-Bindert, Henrik Watz, Jens Vogel-Claussen","doi":"10.1016/j.chest.2026.07.5237","DOIUrl":"10.1016/j.chest.2026.07.5237","url":null,"abstract":"<p><strong>Background: </strong>Lung cancer screening offers an opportunity to enhance COPD detection among adults exposed to tobacco smoke; however, guidance on CT scan-based referral for spirometry is limited.</p><p><strong>Research question: </strong>Which low-dose CT scan emphysema threshold best identifies previously undiagnosed COPD in lung cancer screening patients, and does the addition of quantitative airway biomarkers enhance detection?</p><p><strong>Study design and methods: </strong>In adults undergoing lung cancer screening, we performed spirometry to identify previously undiagnosed COPD, defined by airflow obstruction (FEV₁/FVC < 0.70) in patients who currently smoke and patients who formerly smoked with ≥ 10 pack-years. We quantified emphysema extent, airway wall thickness (standardized square root wall area of airways with a theoretical internal perimeter of 10 mm), and airway branch count on low-dose CT scan using artificial intelligence-based software and combined these measures with clinical characteristics, mainly smoking history and dyspnea, to develop an ensemble tree-based machine-learning model (Extreme Gradient Boosting) for COPD detection. A sensitivity analysis using the lower limit of normal definition for FEV₁/FVC was additionally performed.</p><p><strong>Results: </strong>Among 5,014 screening patients with available spirometry, 1,115 had previously undiagnosed COPD, corresponding to a prevalence of 22.2%. In patients without known airway disease, emphysema alone at an optimized threshold of 5.1% showed moderate performance for COPD detection (area under the receiver operating characteristic curve [AUC], 0.69; 95% CI, 0.67-0.72; accuracy, 66%; positive predictive value [PPV], 44%), where 41% of patients exceeded this threshold and met criteria for confirmatory spirometry. An integrated model combining emphysema, standardized square root wall area of airways with a theoretical internal perimeter of 10 mm, airway branch count, and clinical characteristics significantly improved detection (AUC, 0.83; 95% CI, 0.80-0.86; accuracy, 78%; PPV, 59%) while reducing the proportion requiring confirmatory spirometry to 34%. In a sensitivity analysis using the lower limit of normal definition of COPD, the best-performing model achieved an AUC of 0.86 (95% CI, 0.83-0.89), accuracy of 84%, and PPV of 53%, while referring 22% for confirmatory spirometry.</p><p><strong>Interpretation: </strong>Our results show that an integrated approach combining CT scan-derived airway biomarkers and clinical characteristics enables more efficient and targeted COPD detection within lung cancer screening programs.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov; No.: NCT04913155; URL: www.</p><p><strong>Clinicaltrials: </strong>gov.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764531","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":"Integrating Quantitative CT Biomarkers to Enhance COPD Detection in the HANSE Lung Cancer Screening Program","authors":"Mustafa Abdo, Hendrik Pott, Martin Reck, Roman Martin, Benjamin-Alexander Bollmann, Sabine Bohnet, Katharina May, Sabine Dettmer, Gerald Schmid-Bindert, Henrik Watz, Jens Vogel-Claussen","doi":"10.1016/j.chest.2026.07.5237","DOIUrl":"https://doi.org/10.1016/j.chest.2026.07.5237","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"48 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148754784","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}