Chest最新文献

{"title":"Projecting the 30-Year Burden of Obstructive Sleep Apnea in the United States.","authors":"Elroy Boers,Meredith A Barrett,Adam V Benjafield,Jodi H Barnett,Laurel A Ravelo,Leanne Kaye,Peter A Cistulli,Jean-Louis Pépin,Jeff Armitstead,Kimberly L Sterling,Carlos Nunez,Paul E Peppard,Atul Malhotra","doi":"10.1016/j.chest.2025.03.029","DOIUrl":"https://doi.org/10.1016/j.chest.2025.03.029","url":null,"abstract":"IMPORTANCEObstructive sleep apnea (OSA) is a common disorder that is associated with major public health and economic burden across the United States (U.S.). Previous studies assessed the current-day prevalence of OSA, but to guide public health policies and management pathways OBJECTIVE: To estimate the burden of OSA across the U.S. through 2050.DESIGN, SETTING, AND PARTICIPANTSIn this modeling study, historical data on OSA prevalence in the U.S. were extracted from a previously published longitudinal cohort study. U.S. Population characteristics (age, sex) were obtained from relevant and validated population data sources, and data on body mass index (BMI) were obtained from the National Health and Nutrition Examination Survey (NHANES) and the Wisconsin Sleep Cohort.MAIN OUTCOMES AND MEASURESTo project the OSA burden (cases and prevalence) into 2050, an open cohort dynamic population Markov model was developed.RESULTSBased on projected changes in U.S. age, sex, and BMI population distributions, the model predicts a significant rise in obstructive sleep apnea (OSA) over the next three decades. By 2050, the prevalence of OSA (AHI≥5/h) is expected to increase by 35% to 46%, resulting in 77 million cases. We estimate that females will see a larger relative increase, with a 64% rise to 30 million cases, while males are projected to experience a more moderate increase of 19% to 55%, or 46 million cases.CONCLUSIONS AND RELEVANCEIn this modeling study of future OSA burden, projections indicate that OSA will affect nearly 77 million adults aged 30-69 years across the U.S. into 2050, with disproportionate relative growth among females. These findings highlight the urgent need for targeted public health strategies and revise access to diagnosis and follow-up pathways to address the growing prevalence of OSA, particularly among females.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"28 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143857342","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":"Characteristics, Prognosis and ESC/ERS Risk Stratification in Obese Patients with Pulmonary Arterial Hypertension (PAH).","authors":"Giulio Savonitto,Davide Barbisan,Pietro Ameri,Carlo Maria Lombardi,Mauro Driussi,Piero Gentile,Luke Howard,Matteo Toma,Matteo Pagnesi,Valentino Collini,Carolina Bauleo,Matteo Rugolotto,Giovanni Santi,Francesca Coppi,Gianluca Pagnoni,Pier Paolo Bocchino,Claudia Raineri,Alberto Giannoni,Massimo Imazio,Edoardo Airo,Marco Metra,Andrea Garascia,Gianfranco Sinagra,Francesco Lo Giudice,Davide Stolfo","doi":"10.1016/j.chest.2025.04.008","DOIUrl":"https://doi.org/10.1016/j.chest.2025.04.008","url":null,"abstract":"BACKGROUNDThe impact of obesity on pulmonary arterial hypertension (PAH) remains largely underexplored, with excess weight potentially masking symptoms and affecting the reliability of current risk stratification tools.RESEARCH QUESTIONWhat are the clinical characteristics and prognosis of obese patients with PAH, and how well do current risk stratification tools perform in this population?STUDY DESIGN AND METHODSWe retrospectively included patients with incident PAH diagnosis enrolled at ten European tertiary care centers for PAH management and compared patients with and without obesity, defined by a BMI ≥30 kg/m2. Uni- and multivariable Cox regression models were fitted to assess the association between obesity and 5-years all-cause mortality. Accuracy of the ESC/ERS risk stratification tool for the prediction of annual mortality at baseline and follow up in patients with and without obesity was assessed by ROC curve analysis.RESULTSAmong 581 patients included (median age 58 years, IQR 41-75; 61% females), 139 (24%) were obese. Obese patients had more comorbidities and worse symptoms/functional capacity. 5-years crude and adjusted all-cause mortality risk was similar in obese and non-obese. Both the three- (AUC 0.71, 95% CI 0.62-0.81 vs 0.64, 95%CI 0.48-0.80) and the four-strata (AUC 0.79 95% CI 0.69-0.89 vs 0.64 95% CI 0.40-0.88) ESC/ERS risk stratification tool demonstrated lower accuracy for prediction of annual mortality in obese vs non-obese patients, although not statistically significant. However, most components of the risk stratification tool lack a significant prognostic association in obese patients.INTERPRETATIONDespite the higher burden of comorbidity and the worse functional class, prognosis is similar in obese compared with non-obese patients with PAH. Currently recommended risk stratification strategies might not be sufficient in patients with obesity claiming for focused research to improve risk stratification across subgroups of patients with PAH.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"18 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143851079","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":"Echocardiographic Parameters Enhance Risk Prediction Scores in Pulmonary Arterial Hypertension: Insights from the PVDOMICS Network.","authors":"Monica Mukherjee,Vivek P Jani,Ryan Osgueritchian,Hoda Mombeini,Aiden Abidov,Gerald Beck,Serpil Erzurum,Robert P Frantz,Paul M Hassoun,Anna R Hemnes,Nicholas S Hill,Evelyn M Horn,Jiwon Kim,Deborah Kwon,A Brett Larive,Peter J Leary,Jane A Leopold,Stephen C Mathai,Reena Mehra,Margaret M Park,Erika B Rosenzweig,W H Wilson Tang,Christine L Jellis,Franz P Rischard,Roberto Badagliacca,","doi":"10.1016/j.chest.2025.04.007","DOIUrl":"https://doi.org/10.1016/j.chest.2025.04.007","url":null,"abstract":"BACKGROUNDEchocardiographic metrics of right ventricular (RV) chamber size and function enhance prognostication, risk stratification, and measurement of therapeutic response in patients with pulmonary arterial hypertension (PAH), though the most effective metrics remain unclear.RESEARCH QUESTIONIn a well phenotyped cohort of patients with incident and prevalent PAH, can qualitative grades of RV echocardiographic function be established based on their association with functional outcomes, and do they demonstrate prognostic value beyond traditional risk scores?METHODSIn the Redefining Pulmonary Hypertension through Pulmonary Vascular Disease Phenomics program (PVDOMICS), 405 (336 prevalent, 69 incident) participants were investigated. Multivariable linear regression examined associations with six-minute walk distance and COMPERA and REVEAL Lite 2.0 PAH risk scores. Penalized Cox Regression was used to develop new models combining prior risk score variables with echo parameters, and cluster analysis combined with survival analysis adjusting for potential confounders to demonstrate prognostic significance.RESULTSIn both incident and prevalent PAH, reduced RV function was associated with increased NT-proBNP, reduced six-minute walk distance, and increased COMPERA and REVEAL Lite 2.0 risk scores after adjusting for duration of PAH and relevant confounders. Addition of echocardiographic variables to models incorporating the COMPERA and REVEAL 2.0 scores yielded a 10% increase in the C-statistic compared to either score alone. Mild, moderate, and severe categories of RV dysfunction associated with increased all-cause mortality, with up to a 3.0-fold increase in mortality in multivariable models adjusted for relevant confounders, PAH duration, and invasive pulmonary vascular resistance.INTERPRETATIONReduced RV function on echocardiography in PAH associates with worsened outcomes in incident and prevalent PAH. Echocardiographic assessment of RV function provides additional value to existing PH risk prediction scores and invasive hemodynamics. Furthermore, defining severity of RV function through cluster analysis has important implications for risk prognostication with potential application to monitor response to therapy.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"251 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143831493","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":"Machine Listening for Obstructive Sleep Apnea Diagnosis: A Bayesian Meta-Analysis.","authors":"Benjamin Kye Jyn Tan,Esther Yanxin Gao,Nicole Kye Wen Tan,Brian Sheng Yep Yeo,Claire Jing-Wen Tan,Adele Chin Wei Ng,Zhou Hao Leong,Chu Qin Phua,Maythad Uataya,Liang Chye Goh,Thun How Ong,Leong Chai Leow,Guang-Bin Huang,Song Tar Toh","doi":"10.1016/j.chest.2025.04.006","DOIUrl":"https://doi.org/10.1016/j.chest.2025.04.006","url":null,"abstract":"BACKGROUNDAmong 1 billion patients worldwide with obstructive sleep apnea (OSA), 90% remain undiagnosed. Their main barrier is the overnight polysomnogram, which requires specialized equipment, skilled technicians and inpatient beds available only in tertiary sleep centers. Recent advances in artificial intelligence (AI) have enabled OSA detection using breath sound recordings.RESEARCH QUESTIONWhat is the diagnostic accuracy and how can we optimize machine listening for OSA?STUDY DESIGN AND METHODSPubMed, Embase, Scopus, Web of Science and IEEE Xplore were systematically searched. Two blinded reviewers selected studies comparing the patient-level diagnostic performance of AI approaches using overnight audio recordings, versus conventional diagnosis (apnea-hypopnea index [AHI]) using a train-test split or k-fold cross-validation. Bayesian bivariate meta-analysis and meta-regression were performed. Publication bias was assessed using a selection model. Risk of bias and evidence quality were assessed using QUADAS-2 and GRADE.RESULTSFrom 6,254 records, we included 16 studies (41 models) trained/tested on 4,864/2,370 participants. No study had a high risk of bias. Machine listening achieved a pooled sensitivity (95% credible interval) of 90.3% (86.9-93.1%), specificity of 86.7% (83.1-89.7%), diagnostic odds ratio of 60.8 (39.4-99.9), positive and negative likelihood ratios of 6.78 (5.34-8.85) and 0.113 (0.079-0.152). At AHI cut-offs of ≥5, ≥15, ≥30: sensitivities were 94.3% (90.3-96.8%), 86.3% (80.1-90.9%), 86.3% (79.2-91.1%); specificities were 78.5% (68.0-86.9%), 87.3% (81.8-91.3%), 89.5% (84.8-93.3%). Meta-regression identified higher sensitivity for: higher audio sampling frequencies; non-contact microphones; higher OSA prevalence; train-test split model evaluation. Accuracy was equal regardless of: home smartphone versus in-laboratory professional microphone recordings; deep learning versus traditional machine learning; varying age and sex. Publication bias was not evident. The evidence was of high quality.INTERPRETATIONMachine listening achieved excellent diagnostic accuracy, superior to STOP-Bang and comparable to common home sleep tests. Digital medicine should be further explored and externally validated for accessible and equitable OSA diagnosis.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"108 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143827093","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":"Characterizing Sarcoidosis Patients with Obstructive Respiratory Physiology.","authors":"Daniel VanDerhoef,Nicholas Marka,Benjamin Langworthy,Nikhil Kapur,Bharat Thayagarajan,David M Perlman,Maneesh Bhargava","doi":"10.1016/j.chest.2025.03.027","DOIUrl":"https://doi.org/10.1016/j.chest.2025.03.027","url":null,"abstract":"BACKGROUNDLung involvement occurs in over 95% of sarcoidosis cases. The World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) organ assessment tool does not assign the likelihood of lung involvement based on Pulmonary Function Testing (PFT). Clinical characteristics linked to normal and abnormal physiologic pattern on PFT's in sarcoidosis are incompletely understood.RESEARCH QUESTIONWhat is the frequency of obstructive physiology (OP), restrictive physiology (RP) or normal physiology in sarcoidosis patients and are there laboratory parameters linked to these different patterns?STUDY DESIGN AND METHODSWe evaluated 253 sarcoidosis patients by their PFT findings and grouped them into OP, RP, and normal spirometry. We correlated these PFTs to demographic, clinical, and laboratory parameters. In some cases, we correlated the PFT abnormalities with proteins in the Olink metabolic and immune response protein panels.RESULTSOf the 253 cases studied, 64% had normal spirometry, 20% had OP, and 15% had RP. Abnormal PFTs were more frequent in males with 61.2% of the OP group and 82.1% of the RP group (p=0.002). The average lymphocyte percentage was lower in OP vs. RP (normal: 21.5%, OP: 17.3%, RP: 23.7%, p =0.04), sIL-2R was lower in OP vs normal (normal:632.1, OP 335.5, RP:563.4, p =0.026) and CRP was lower in OP vs RP, and in normal vs RP (normal:11.7, OP 8.2, RP:35.6, p =0.018). Those with RP had less splenic involvement (normal: 21.5%, OP 21.6%, RP: 2.6%, P=0.008). Five Immune Response proteins had differential abundance in the three comparison groups.INTERPRETATIONMost of our sarcoidosis cohort has normal spirometry. When abnormal, OP was more common than RP. There may be a difference in immune mechanisms in those with OP compared to those with RP or normal spirometry. Continued comprehensive assessments of serum proteins may identify biomarkers to identify physiologic abnormalities and guide management.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"16 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143827126","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 airway mucus plugs and risk of moderate-to-severe exacerbations in COPD patients:results from a Chinese prospective cohort study.","authors":"Xueping Li,Shengchuan Feng,Yuqiong Yang,Zhenyu Liang,Aiqi Song,Jiawei Chen,Zijun Guo,Zizheng Chen,Chengyu Miao,Huajing Yang,Wenqiang He,Zifei Zhou,M Brad Drummond,Rongchang Chen,Fengyan Wang","doi":"10.1016/j.chest.2025.03.026","DOIUrl":"https://doi.org/10.1016/j.chest.2025.03.026","url":null,"abstract":"BACKGROUNDAirway mucus plugs are frequently identified on computed tomography (CT) scans of patients with chronic obstructive pulmonary disease (COPD) and are associated with worse airflow obstruction and higher mortality. However, the association between airway mucus plugs and the risk of acute exacerbation of COPD (AECOPD) has not been extensively studied.RESEARCH QUESTIONAre airway mucus plugs associated with the risk of future moderate-to-severe AECOPD?STUDY DESIGN AND METHODSIn this prospective cohort study, we identified airway mucus plugs on CT scans of COPD patients. Mucus plugs were scored from 0 to 18 based on the number of pulmonary segments affected and categorized into three groups (0, 1-3, and ≥4). Patients were followed for two years. Negative binomial regression and Cox regression were used to model the association between airway mucus plugs and moderate-to-severe AECOPD, adjusting for potential confounders.RESULTSAmong the 194 COPD patients, 22%, 35%, and 43% had mucus plugs in 0, 1-3, and ≥4 pulmonary segments, respectively. During the following year, 30% of patients experienced at least one moderate-to-severe AECOPD, with the incidence 12%, 25%, and 44% for patients with 0, 1-3, and ≥4 pulmonary segments with mucus plugs, respectively. In negative binomial regression, each 1-point increase in airway mucus plug score was associated with an 8.3% higher risk of moderate-to-severe exacerbations(RR[95% CI], 1.08[1.01-1.16], p=0.028). In multivariate Cox regression, mucus plugs in ≥4 versus 0 and ≥4 versus 1-3 pulmonary segments were associated with hazard ratios of moderate-to-severe exacerbation of 5.02(95% CI, 1.84-13.75, p=0.002) and 2.32(95% CI, 1.25-4.33, p=0.008), respectively. Consistent results were observed in the subset of patients completing the two-year follow-up (n=150).INTERPRETATIONIn COPD patients, airway mucus plugs are associated with increased future risk of subsequent moderate-to-severe AECOPD.TRIAL REGISTRATIONRegistered with the International Clinical Trials Registry (NCT03240315, 2017-07-3).","PeriodicalId":9782,"journal":{"name":"Chest","volume":"37 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822740","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":"Ventilatory Efficiency in Transgender Women: Implications of Gender-Affirming Hormone Therapy on Cardiorespiratory Responses.","authors":"Fabrício Braga,Mauricio Milani,Ana Carolina Fachetti,Bruna Kalichsztein,Gabriel Espinosa,Fernanda Domecg,Roberto Zagury,Karen De Marca,Rossano Fiorelli,Dominique Hansen,Gerson Cipriano Junior,Ricardo Mourilhe-Rocha","doi":"10.1016/j.chest.2025.04.004","DOIUrl":"https://doi.org/10.1016/j.chest.2025.04.004","url":null,"abstract":"BACKGROUNDVentilatory efficiency, a key parameter of cardiopulmonary function assessed through cardiopulmonary exercise testing (CPET), often demonstrates significant variability in transgender women due to the physiological changes induced by gender-affirming hormone therapy. Understanding these differences is essential for optimizing clinical management and enhancing health outcomes within this population.RESEARCH QUESTIONHow do ventilatory efficiency, particularly the carbon dioxide ventilatory equivalent (VE/VCO2), and other CPET variables differ between transgender women and matched cisgender controls, offering insights into the physiological impacts of gender-affirming hormone therapy?STUDY DESIGN AND METHODSThis case-control study included 51 participants, comprising 17 transgender women matched 1:1:1 by age, body mass index, and physical activity levels with cisgender women and cisgender men. CPET assessments were conducted between August 2018 and September 2019, before the COVID-19 pandemic.RESULTSTransgender women demonstrated significantly higher VE/VCO2 ratios at rest (31.4 ± 2.9), at the first ventilatory threshold (34.9 ± 3.9), and peak exercise (39.3 ± 5.3) compared to cisgender women (28.2 ± 2.5; 31.8 ± 3.2; 35.4 ± 4.4, respectively) and cisgender men (27.4 ± 2.1; 30.8 ± 2.6; 34.3 ± 3.5, respectively), with all comparisons reaching statistical significance (p < 0.001) and large effect sizes (η2 = 0.30-0.34). The VE/VCO2 slope was also significantly elevated in transgender women (33.9 ± 4.2) compared to cisgender women (29.5 ± 5.0) and cisgender men (28.0 ± 3.5) (p < 0.001; η2 = 0.29), indicating reduced ventilatory efficiency across the effort continuum.INTERPRETATIONThis study highlights substantial ventilatory inefficiencies in transgender women, likely associated with gender-affirming hormone therapy, underscoring the need for tailored clinical strategies to address these cardiopulmonary adaptations. These findings provide critical insights into the unique health needs of transgender individuals, contributing valuable data to support evidence-based care.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"26 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822754","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 Admilparant, an LPA1 Antagonist, on Disease Progression in Pulmonary Fibrosis.","authors":"Michael Kreuter,Toby M Maher,Wim A Wuyts,Claudia Valenzuela,Mark Hamblin,Sinae Kim,Aditya Patel,Brandon Elpers,Luca Richeldi","doi":"10.1016/j.chest.2025.04.003","DOIUrl":"https://doi.org/10.1016/j.chest.2025.04.003","url":null,"abstract":"BACKGROUNDIdiopathic pulmonary fibrosis (IPF) and progressive pulmonary fibrosis (PPF) are chronic fibrosing interstitial lung diseases associated with irreversible loss of lung function and early mortality. Admilparant (BMS-986278) is an oral lysophosphatidic acid receptor 1 (LPA1) antagonist under development for treatment of IPF and PPF.RESEARCH QUESTIONHow does admilparant affect time to disease progression in patients with IPF or PPF?STUDY DESIGN AND METHODSIn a phase 2, randomized, double-blind, placebo-controlled study, parallel cohorts of patients with IPF or PPF were randomized separately 1:1:1 to receive 30-mg admilparant, 60-mg admilparant, or placebo twice daily for 26 weeks; background antifibrotics were allowed. The effect of admilparant vs placebo on time to disease progression was assessed post hoc. Disease progression was defined as a composite of relative decline of ≥10% in percentage of predicted forced vital capacity (ppFVC), acute exacerbation, all-cause hospitalization, and all-cause mortality. Subgroup analyses were performed based on median ppFVC at baseline. A Kaplan-Meier product-limit approach assessed time to first event of disease progression over 26 weeks.RESULTSIn total, 255 patients with IPF and 114 patients with PPF were included. Median ppFVC at baseline was 77.3% and 64.7% in the IPF and PPF cohorts, respectively. Treatment with 60-mg admilparant delayed time to disease progression over 26 weeks compared with placebo in both cohorts of patients (IPF: hazard ratio, 0.54 [95% CI, 0.31-0.95]; PPF: hazard ratio, 0.41 [95% CI, 0.18-0.90]). A similar trend was observed in the subgroup analysis of patients with ppFVC at baseline either below or above the median value. In both cohorts, the most frequent first event was relative decline of ≥10% in ppFVC; no deaths were reported as first progression events.INTERPRETATIONThese findings support further evaluation of admilparant as a therapeutic option for patients with IPF or PPF in phase 3 trials.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"101 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822756","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 Ventilator Mode on Ventilator-Free Days in Critically Ill Adults: A Randomized Clinical Trial.","authors":"Kevin P Seitz, Bradley D Lloyd, Li Wang, Matthew S Shotwell, Edward T Qian, Amelia L Muhs, Roger K Richardson, J Craig Rooks, Vanessa Hennings-Williams, Claire E Sandoval, Whitney D Richardson, Tracy L Morgan, Amber N Thompson, Pamela G Hastings, Terry P Ring, Joanna L Stollings, Erica M Talbot, David J Krasinski, Bailey R DeCoursey, Tanya K Marvi, Stephanie C DeMasi, Kevin W Gibbs, Wesley H Self, Amanda S Mixon, Todd W Rice, Matthew W Semler, Jonathan D Casey","doi":"10.1016/j.chest.2025.03.024","DOIUrl":"https://doi.org/10.1016/j.chest.2025.03.024","url":null,"abstract":"<p><strong>Background: </strong>Whether the choice of ventilator mode affects outcomes for critically ill patients is unknown.</p><p><strong>Research question: </strong>What are the effects of three common ventilator modes (volume control vs pressure control vs adaptive pressure control) on death and duration of mechanical ventilation among critically ill adults?</p><p><strong>Study design and methods: </strong>We conducted a pragmatic, cluster-randomized, crossover pilot trial among adults receiving invasive mechanical ventilation in a medical intensive care unit between November 1, 2022 and July 31, 2023. Each month, patients in the participating unit were assigned to receive volume control, pressure control, or adaptive pressure control during continuous mandatory ventilation. The primary outcome was ventilator-free days through 28 days.</p><p><strong>Results: </strong>Among 566 patients included in the primary analysis, the median proportion of ventilator mode assessments in the assigned mode during the first 72 hours was 100% in each group. The median number of ventilator-free days was 23 [IQR, 0-26] in the volume control group, 22 [0-26] in the pressure control group, and 24 [0-26] in the adaptive pressure control group (P=0.60). The median tidal volume was similar in the three groups, but the percentage of breaths larger than 8mL/kg of predicted body weight differed between volume control (median, 4.0%; IQR, 0.0-14.1), pressure control (10.6%; 0.0-31.5), and adaptive pressure control (4.7%; 0.0-19.2).</p><p><strong>Interpretation: </strong>This pilot trial establishes the feasibility of conducting a cluster-randomized, crossover trial of ventilator mode among critically ill adults receiving invasive mechanical ventilation and demonstrates differences in intermediate outcomes that warrant further investigation in a larger trial.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794613","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":"Investigating the Long-Term Effects of COVID-19 Infection on Healthcare Utilization in Individuals with Chronic Obstructive Pulmonary Disease.","authors":"Joseph Munn, Peter Austin, Clare Atzema, Stacey Butler, Candace McNaughton, Xuesong Wang, Andrea S Gershon","doi":"10.1016/j.chest.2025.02.043","DOIUrl":"https://doi.org/10.1016/j.chest.2025.02.043","url":null,"abstract":"<p><strong>Background: </strong>Individuals with chronic obstructive pulmonary disease (COPD) are at elevated risk of severe outcomes following COVID-19 infection.</p><p><strong>Research questions: </strong>Does COVID-19 have a long-term impact on healthcare utilization (HCU) for individuals with COPD?</p><p><strong>Study design and methods: </strong>We conducted a retrospective matched cohort study using health administrative data from Ontario Canada, between April 2020 and June 2022. Individuals with physician-diagnosed COPD who received a COVID-19 PCR test were included. COVID-19 positive and negative patients were matched on age, sex, vaccination status, PCR test date, and a propensity score. Patients were followed from the end of the acute infection period (12-weeks post-PCR) until the study end date. Per-person-year HCU rates were captured and compared. Analyses were stratified by COVID-19 variant eras (Wild-Type/Alpha/Beta, Delta, and Omicron) and vaccination status (0, 1, 2, and ≥3).</p><p><strong>Results: </strong>We identified 31,540 matched pairs. Mean age was 66.4 years and 49.9% were male. Individuals with positive COVID-19 tests had 9% higher HCU rates than those who tested negative (rate ratio [RR]: 1.09 CI: 1.067-1.127). Stratifying by variant, Wild-Type/Alpha/Beta and Omicron variants had 16% (RR: 1.16, CI: 1.119-1.22) and 5% (RR: 1.051, CI: 1.01-1.092) higher HCU rates respectively. Individuals with ≥3 vaccinations did not have elevated rates of HCU (RR: 1.03, CI: 0.981-1.081) compared to those who tested negative.</p><p><strong>Interpretation: </strong>COVID-19 positive COPD patients had significantly greater long-term HCU usage. Although Omicron has been considered milder than previous variants, it was still associated with significantly elevated long-term HCU. Individuals with ≥3 vaccinations who tested positive for COVID-19 had similar HCU rates to those who tested negative, suggesting that vaccinations can reduce long-term healthcare utilization.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787989","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}