Chest最新文献

{"title":"Acquisition and Handling of Endobronchial Ultrasound Transbronchial Needle Samples: An American College of Chest Physicians Clinical Practice Guideline.","authors":"Christopher R Gilbert, Claire Dust, A Christine Argento, David Feller-Kopman, Anne V Gonzalez, Felix Herth, Jonathan M Iaccarino, Peter Illei, Kevin O'Neil, Nicholas Pastis, M Patricia Rivera, Lynette Sholl, Gerard A Silvestri, Jeffrey Thiboutot, Momen M Wahidi, Kazuhiro Yasafuku, Lonny B Yarmus","doi":"10.1016/j.chest.2024.08.056","DOIUrl":"10.1016/j.chest.2024.08.056","url":null,"abstract":"<p><strong>Background: </strong>Endobronchial ultrasound-guided transbronchial aspiration (EBUS-TBNA) has become the standard for initial lung cancer diagnosis and staging. Previous guidelines have generally focused on the \"when\" and \"how\" of EBUS-TBNA; however, little guidance is available on handling and processing specimens during and after acquisition to help optimize both diagnostic yield and tissue integrity for ancillary studies. This document examines the available literature on EBUS-TBNA specimen processing and handling.</p><p><strong>Study design and methods: </strong>Rigorous methodology was applied to provide a trustworthy evidence-based guideline and expert panel report. Panelists developed key clinical questions using the Population, Intervention, Comparator, and Outcome format, addressing specific topics in EBUS-TBNA specimen processing. MEDLINE (via PubMed) and the Cochrane Library were systematically searched to identify relevant literature, supplemented by manual searches. References were screened for inclusion with document evaluation tools to assess the quality of included studies, extract meaningful data, and grade the level of evidence to support each recommendation or suggestion.</p><p><strong>Results: </strong>Our systematic review and critical analysis of the literature of the nine Population, Intervention, Comparator, and Outcome questions related to handling and processing EBUS-TBNA specimens resulted in nine evidence-based statements.</p><p><strong>Interpretation: </strong>Evidence of the handling and processing of EBUS-TBNA specimens varies in strength but is satisfactory in some areas to guide clinicians in certain aspects of specimen handling. Additional research in many aspects of specimen handling and processing is needed to help improve our knowledge base.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"899-909"},"PeriodicalIF":9.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342560","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":"Longitudinal Assessment of Communication With Patient-Reported Outcomes During Lung Cancer Screening.","authors":"Christopher G Slatore, Sara E Golden, Liana Schweiger, Ian Ilea, Donald R Sullivan, Sean P M Rice, Renda Soylemez Wiener, Santanu Datta, James M Davis, Anne C Melzer","doi":"10.1016/j.chest.2024.06.3817","DOIUrl":"10.1016/j.chest.2024.06.3817","url":null,"abstract":"<p><strong>Background: </strong>Many organizations recommend clinicians use structured communication processes, referred to as shared decision-making, to improve patient-reported outcomes for patients considering lung cancer screening (LCS).</p><p><strong>Research question: </strong>Which components of high-quality patient-centered communication are associated with decision regret and distress?</p><p><strong>Study design and methods: </strong>We conducted a prospective, longitudinal, repeated measures cohort study among patients undergoing LCS in three different health care systems. We surveyed participants using validated measures of decision regret, decision satisfaction, distress, and patient-clinician communication domains up to 1 year after the low-dose CT (LDCT) imaging for LCS. For longitudinal analyses, we applied a series of generalized estimating equations to measure the association of the patient as person communication domain, screening knowledge, and decision concordance with decision regret and distress.</p><p><strong>Results: </strong>When assessed 2 to 4 weeks after the LDCT imaging, 202 respondents (58.9%) and eight respondents (2.3%) of 343 total respondents reported mild and moderate or severe decision regret, respectively, whereas 29 respondents (9.2%) of 315 total respondents reported mild distress and 19 respondents (6.0%) reported moderate or greater distress. The mean ± SD decision satisfaction scores (scale, 0-10) were 9.82 ± 0.89, 9.08 ± 1.54, and 6.13 ± 3.40 among those with no, mild, and moderate or severe regret, respectively. Distress scores remained low after the LDCT imaging, even among those with nodules. Patient-centered communication domains were not associated with decision regret or distress.</p><p><strong>Interpretation: </strong>Our findings show that patients undergoing LCS rarely experience moderate or greater decision regret and distress. Although many participants reported mild decision regret, most were very satisfied over the 1 year after LDCT imaging for LCS. Communication processes were not associated with regret and distress, suggesting that it may be challenging for communication interventions to reduce the harms of LCS.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"876-891"},"PeriodicalIF":9.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141970703","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":"Interstitial Lung Abnormality: Narrative Review of the Approach to Diagnosis and Management.","authors":"Zein Kattih, Brett Bade, Hiroto Hatabu, Kevin Brown, Joseph Parambil, Akinori Hata, Peter J Mazzone, Stephen Machnicki, Dominick Guerrero, Muhammad Qasim Chaudhry, Liz Kellermeyer, Kaitlin Johnson, Stuart Cohen, Ramona Ramdeo, Jason Naidich, Alain Borczuck, Suhail Raoof","doi":"10.1016/j.chest.2024.09.033","DOIUrl":"10.1016/j.chest.2024.09.033","url":null,"abstract":"<p><strong>Topic importance: </strong>As interstitial lung abnormalities (ILAs) are increasingly recognized on imaging and in clinical practice, identification and appropriate management are critical. We propose an algorithmic approach to the identification and management of patients with ILAs.</p><p><strong>Review findings: </strong>The radiologist initially identifies chest CT scan findings suggestive of an ILA pattern and excludes findings that are not consistent with ILAs. The next step is to confirm that these findings occupy > 5% of a nondependent lung zone. At this point, the radiologic pattern of ILA is identified. These findings are classified as non-subpleural, subpleural nonfibrotic, and subpleural fibrotic. It is then incumbent on the clinician to ascertain if the patient has symptoms and/or abnormal pulmonary physiology that may be attributable to these radiologic changes. Based on the patient's symptoms, physiologic assessment, and risk factors for interstitial lung disease (ILD), we recommend classifying patients as having ILA, at high risk for developing ILD, probable ILD, or ILD. In patients identified as having ILA, a multidisciplinary discussion should evaluate features that indicate an increased risk of progression. If these features are present, serial monitoring is recommended to be proactive. If the patient does not have imaging or clinical features that indicate an increased risk of progression, then monitoring is recommended to be reactive. If ILD is subsequently diagnosed, the management is disease specific.</p><p><strong>Summary: </strong>We anticipate this algorithmic approach will aid clinicians in interpreting the radiologic pattern described as ILA within the clinical context of their patients.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"781-799"},"PeriodicalIF":9.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406173","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":"Parasitic Infections in Pulmonary and ICU Patients: Presentation, Diagnosis, and Treatment.","authors":"Adam C Kley, A Clinton White","doi":"10.1016/j.chest.2024.10.046","DOIUrl":"10.1016/j.chest.2024.10.046","url":null,"abstract":"<p><p>Parasitic infections in the United States are mostly seen in immigrants and travelers. In many cases, pulmonary and intensive care physicians fail to consider parasitic disease, which can result in delayed diagnosis and adverse outcomes. Almost 2,000 cases of imported malaria are diagnosed in the United States each year. Severe cases can be confused with bacterial sepsis (shock, lactic acidosis, pneumonia, renal failure, respiratory failure, and jaundice). In contrast to bacterial sepsis, survival is improved by restrictive fluid therapy. Parenteral artesunate is licensed to treat severe cases but may not be readily accessible. Strongyloidiasis is endemic in warm and most tropical regions. Chronic strongyloidiasis causes few symptoms and can persist for decades after the patient leaves the endemic region. Treatment with corticosteroids may lead to hyperinfection, which may present with bacteremia and meningitis caused by enteric organisms, pulmonary hemorrhage, and gastrointestinal pain, bleeding, or obstruction. Treatment with ivermectin can be curative if initiated early. Cystic echinococcosis can present as pulmonary mass. Paragonimus presents with hemoptysis, pulmonary nodules, or pleural effusions, and usually with eosinophilia. Endemic regions include not only East Asia but also Southeast Asia, West Africa, the Pacific coast of Latin America, and even North America. Other parasitic infections can involve the lungs. This article aims to provide awareness of the most clinically relevant parasitic infections seen in pulmonary and critical care medicine.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"686-693"},"PeriodicalIF":9.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615778","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":"Peak Inspiratory Flow and Inhaler Prescription Strategies in a Specialized COPD Clinical Program: A Real-World Observational Study.","authors":"Sarah Pankovitch, Michael Frohlich, Bader AlOthman, Jeffrey Marciniuk, Joanie Bernier, Dorcas Paul-Emile, Jean Bourbeau, Bryan A Ross","doi":"10.1016/j.chest.2024.09.031","DOIUrl":"10.1016/j.chest.2024.09.031","url":null,"abstract":"<p><strong>Background: </strong>COPD inhaler regimens should be appropriate for the patient's peak inspiratory flow (PIF) and should ideally consist of single or similar device(s).</p><p><strong>Research questions: </strong>In a subspecialized COPD clinic: (1) What is the prevalence of patients with suboptimal PIF and with inappropriate device(s) for measured PIF? (2) Are there patient-related risk factors associated with suboptimal PIF? (3) What is the prevalence of patients with non-single inhaler therapy (SIT)/nonsimilar devices? (4) Does point-of-care PIF affect clinical decision-making?</p><p><strong>Study design and methods: </strong>In this single-center real-world observational study, PIF was measured systematically at every outpatient visit in a subspecialized COPD clinic, and point-of-care results were provided to the clinician. Coprimary outcomes were the prevalence of outpatients with suboptimal PIF and with inappropriate devices for measured PIF. Secondary outcomes were patient-related risk factors associated with suboptimal PIF, the prevalence of non-SIT/nonsimilar devices, the prevalence of regimens consisting of either inappropriate device(s) for measured PIF and/or non-SIT/nonsimilar devices, and the effect of point-of-care PIF on clinical decision-making.</p><p><strong>Results: </strong>Suboptimal PIF was identified in 45 of 161 participants (28%), and inappropriate device(s) for measured PIF were identified in 18 participants (11.2%). Significant associations were observed between suboptimal PIF and age (1.09; 95% CI, 1.04-1.15), female sex (10.30; 95% CI, 4.45-27.10), height (0.92; 95% CI, 0.88-0.96), BMI (0.90; 95% CI, 0.84-0.96), and FEV₁ (0.09; 95% CI, 0.03-0.26). After adjustment for age and sex, the association between suboptimal PIF and BMI, but not height, remained significant. Non-SIT and/or nonsimilar devices were identified in 50 participants (31.1%). Regimens consisting of either inappropriate device(s) for measured PIF and/or non-SIT/nonsimilar devices were observed in 59 participants (36.6%). Inhaler prescription changes were observed in this latter group (3.39; 95% CI, 1.76-6.64), as well as in patients with suboptimal PIF who already had SIT/similar regimens (2.93; 95% CI, 1.07-7.92).</p><p><strong>Interpretation: </strong>Suboptimal PIF and inappropriate devices for measured PIF were highly prevalent among outpatients from a subspecialized COPD clinic. Our results show that female sex, reduced FEV₁, and low BMI are important, readily identifiable risk factors for suboptimal PIF, and point-of-care PIF can inform clinical decision-making.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"736-745"},"PeriodicalIF":9.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11882739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COUNTERPOINT: Is Watchful Waiting an Appropriate Treatment for OSA in Children? No.","authors":"Helene K Dabbous, Ron B Mitchell","doi":"10.1016/j.chest.2024.01.054","DOIUrl":"https://doi.org/10.1016/j.chest.2024.01.054","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 3","pages":"656-657"},"PeriodicalIF":9.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613644","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":"Rebuttal From Drs Cielo and Tapia.","authors":"Christopher M Cielo, Ignacio E Tapia","doi":"10.1016/j.chest.2023.11.047","DOIUrl":"https://doi.org/10.1016/j.chest.2023.11.047","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 3","pages":"657-658"},"PeriodicalIF":9.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613671","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":"Sleepy Heads No More: Can We Improve Cognitive Performance With Wakefulness Promoters?","authors":"Julia Louise Chapman, Nathaniel Stuart Marshall","doi":"10.1016/j.chest.2024.12.032","DOIUrl":"https://doi.org/10.1016/j.chest.2024.12.032","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 3","pages":"649-651"},"PeriodicalIF":9.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613727","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":"Clinical and Prognostic Differences in Mild to Moderate COPD With and Without Emphysema.","authors":"Huajing Yang, Yuqiong Yang, Fengyan Wang, Chengyu Miao, Zizheng Chen, Shanshan Zha, Xueping Li, Jiawei Chen, Aiqi Song, Rongchang Chen, Zhenyu Liang","doi":"10.1016/j.chest.2024.10.020","DOIUrl":"10.1016/j.chest.2024.10.020","url":null,"abstract":"<p><strong>Background: </strong>The clinical and prognostic characteristics of mild-to-moderate COPD with and without emphysema remain inadequately investigated.</p><p><strong>Research question: </strong>Do the clinical and prognostic characteristics differ between mild-to-moderate COPD with and without emphysema?</p><p><strong>Study design and methods: </strong>We obtained clinical data of 989 participants with mild-to-moderate COPD from the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS). They were categorized into two groups based on their baseline low-attention lung voxels with a density < -950 Hounsfield units of < 5% on CT scans: mild-to-moderate COPD with emphysema (EC) group and mild-to-moderate COPD without emphysema (NEC) group. Linear mixed-effects models were used to assess the differences in the decline of lung function, health-related quality of life, and quantitative CT indexes between these two groups. Zero-inflated negative binomial regressions were used to evaluate the rates of acute respiratory exacerbations between the groups.</p><p><strong>Results: </strong>Among participants with mild-to-moderate COPD, 428 (43.3%) exhibited emphysema on CT scans. The annual decline in FEV₁ was -56.1 mL/y for the EC group and -46.9 mL/y for the NEC group, with a nonsignificant between-group difference of 9.1 mL/y (95% CI, -24.0 to 5.7 mL/y). The rate of emphysema progression in the EC group was significantly lower than in the NEC group (natural logarithm(%LAA_-950), -0.173%; 95% CI, -0.252% to -0.094%). The EC group also showed a more pronounced annual increase in the St. George's Respiratory Questionnaire score (0.9 points) compared with the NEC group. The EC group had a higher rate of acute respiratory exacerbations (0.36 per person-year) than the NEC group (0.25 per person-year), with a rate ratio of 1.42 (95% CI, 1.27-1.54).</p><p><strong>Interpretation: </strong>The EC group did not have accelerated rates of decline in FEV₁, but they experienced significantly worse health-related quality of life and a higher rate of acute respiratory exacerbations. The nonemphysema subtype demonstrated increased emphysema progression.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov; No.: NCT01969344; URL: www.</p><p><strong>Clinicaltrials: </strong>gov.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"724-735"},"PeriodicalIF":9.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142495982","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":"Single-Inhaler Triple vs Long-Acting Beta₂-Agonist-Inhaled Corticosteroid Therapy for COPD: Comparative Safety in Real-World Clinical Practice.","authors":"Samy Suissa, Sophie Dell'Aniello, Pierre Ernst","doi":"10.1016/j.chest.2024.10.025","DOIUrl":"10.1016/j.chest.2024.10.025","url":null,"abstract":"<p><strong>Background: </strong>Recent treatment guidelines for COPD have replaced the long-acting beta₂-agonist (LABA) and inhaled corticosteroid (ICS) combination with single-inhaler triple therapy that adds a long-acting muscarinic antagonist (LAMA). However, the corresponding trials reported numerically higher incidences of cardiovascular adverse events with triple therapy compared with LABA-ICS.</p><p><strong>Research question: </strong>Does single-inhaler triple therapy increase the incidence of major adverse cardiovascular events, compared with LABA-ICS, in a real-world clinical practice setting?</p><p><strong>Study design and methods: </strong>We identified a cohort of patients with COPD aged ≥ 40 years treated during 2017-2021 from the UK's Clinical Practice Research Datalink. Among LAMA-naive patients, initiators of single-inhaler triple therapy were matched 1:1 to LABA-ICS users on time-conditional propensity scores. They were compared on the incidence of major adverse cardiovascular events (MACEs), defined as hospitalization for myocardial infarction or stroke, or all-cause-mortality, over 1 year.</p><p><strong>Results: </strong>The cohort included 10,255 initiators of triple therapy and 10,255 matched users of LABA-ICS. The incidence rate of MACEs was 11.3 per 100 per year with triple therapy compared with 8.8 per 100 per year for LABA-ICS. The corresponding adjusted hazard ratio (HR) of MACEs with triple therapy was 1.28 (95% CI, 1.05-1.55), relative to LABA-ICS; however, the increase was mainly in the first 4 months (HR, 1.41; 95% CI, 1.14-1.74). The HR of all-cause death was 1.31 (95% CI, 1.06-1.62), whereas for acute myocardial infarction and stroke hospitalization it was 1.00 (95% CI, 0.56-1.79) and 1.06 (95% CI, 0.48-2.36), respectively, with triple therapy, relative to LABA-ICS.</p><p><strong>Interpretation: </strong>In a real-world setting of COPD treatment, patients who initiated single-inhaler triple therapy had an increased incidence of MACEs compared with similar patients treated with an LABA-ICS inhaler. This small increase was due to the all-cause mortality component, occurring mainly in the first 4 months after treatment initiation.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"712-723"},"PeriodicalIF":9.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11882741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142495995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}