Chest最新文献

{"title":"Bronchiectasis in patients with inflammatory bowel diseases - prevalence, predictors, and clinical characteristics.","authors":"Ophir Freund, Amir Bar-Shai, Arik Alkhazov, Dana Stav, Yitzhac Hadad, Tal Moshe Perluk, Neta Sror, Ayal Hirsch, Yulia Ron, Tamar Thurm, Amit Herling, Haim Leibovitzh, Nitsan Maharshak, Nathaniel Aviv Cohen","doi":"10.1016/j.chest.2025.03.014","DOIUrl":"https://doi.org/10.1016/j.chest.2025.03.014","url":null,"abstract":"<p><strong>Background: </strong>Inflammatory bowel diseases (IBD) are known to be associated with bronchiectasis (BE). However, data on BE among patients with IBD (IBD-BE) is limited.</p><p><strong>Research question: </strong>What are the prevalence, risk factors, and clinical characteristics of IBD-BE?</p><p><strong>Study design and methods: </strong>This was a single center retrospective study including patients who visited an IBD unit at a tertiary center between 2022 and 2023. Data on prior chest CT scans was extracted. Radiologists blinded to clinical data analyzed all chest CT scans for BE. The overall prevalence of IBD-BE was estimated using multiple imputation analysis. Risk factors were analyzed in the whole cohort and after matching.</p><p><strong>Results: </strong>1637 patients with IBD were included, 254 had prior chest CT scans, of these, 30 (1.8% of the cohort) had BE. The estimated overall prevalence of IBD-BE was 5.17% (95% CI 3.60-8.22%). Chest cuts of available abdominal CT scans (n=1048) were also analyzed identifying 19 additional cases of IBD-BE, resulting in a minimal prevalence of 3%. Ulcerative colitis, prior IBD-related surgery, and extra-intestinal manifestations (EIMs) were risk factors for IBD-BE. Of patients with chest CT scans, 63% had evidence of BE their prior abdominal CT scans, and 70% had relevant respiratory symptoms. Despite this, most did not see a pulmonologist nor received BE-related therapy. Clinical characteristics and outcomes were similar to patients with non-IBD-related BE.</p><p><strong>Interpretation: </strong>This study shows a relatively high prevalence of IBD-BE. The low rates of BE-directed therapy and pulmonology referral indicate the need for a higher degree of suspicion and timely referral.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750409","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":"Timely Spirometry is Associated with Lower All-Cause Mortality: a Nationwide Obstructive Cohort Study.","authors":"Valerie Dehondt, Delphine Vauterin, Eric Derom, Lies Lahousse","doi":"10.1016/j.chest.2025.03.018","DOIUrl":"https://doi.org/10.1016/j.chest.2025.03.018","url":null,"abstract":"<p><strong>Background: </strong>Despite spirometry is the gold standard to diagnose chronic obstructive pulmonary disease, it is underused in clinical practice.</p><p><strong>Research question: </strong>Which factors are associated with timely spirometry (at chronic treatment initiation) in a clinically relevant population of people starting chronic treatment for respiratory symptoms? Is this diagnostic test associated with lower mortality risk?</p><p><strong>Methods: </strong>Incident adult users of chronic respiratory medication were identified in Belgian nationwide data. The odds on timely spirometry were examined by multivariable logistic regression and impact on survival by multivariable Cox regression analysis. In those not receiving timely spirometry, factors related to further delay in spirometry were analyzed with multivariable Fine-Gray subdistribution hazard regression.</p><p><strong>Results: </strong>Among 146,205 chronic treatment initiators, 20.9% had spirometry at treatment initiation, and 13.8% received spirometry during follow-up. While primary care physicians prescribed 81.1% of initiated treatments, general practitioners performed only 5.1% of all spirometry tests. People who received spirometry at treatment initiation had a 34% lower mortality risk (aHR: 0.66, 95%CI 0.63-0.70) and used less short-acting bronchodilators. Smoking, respiratory morbidities and congestive heart failure increased chance of spirometry. In contrast, female sex, age under sixty or over eighty, cognitive impairment and frailty lowered chance of spirometry both at initiation and during follow-up. Low socio-economic status, depression/anxiety, and antibiotic use were associated with a lower chance of spirometry at treatment initiation, while during follow-up, antibiotic use was associated with a higher chance of spirometry over time. Additionally, anemia and cachexia were associated with a lower chance during follow-up.</p><p><strong>Interpretation: </strong>Only one in three initiators of chronic treatment for obstructive lung disease received spirometry. Spirometry was particularly underused in primary care. Especially (never-smoking) females and vulnerable patients may be at increased risk for underdiagnosis and suboptimal treatment. Importantly, spirometry at treatment initiation was significantly associated with better prognosis, possibly through better-tailored care.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751232","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":"The combination of pimavanserin and atomoxetine reduces obstructive sleep apnea severity: a randomized crossover trial.","authors":"Ludovico Messineo, Madison Preuss, Ali Azarbarzin, Daniel Vena, Laura Gell, Atqiya Aishah, Neda Esmaeili, Molly Kim, Isabel Burdick, Tom Chen, David White, Scott A Sands, Andrew Wellman","doi":"10.1016/j.chest.2025.03.013","DOIUrl":"https://doi.org/10.1016/j.chest.2025.03.013","url":null,"abstract":"<p><strong>Background: </strong>Obstructive sleep apnea (OSA) pharmacological interventions like the noradrenergic muscle stimulant atomoxetine have wake-promoting properties. Pimavanserin, a promising serotonin 2_A receptor antagonist, may help counteract atomoxetine's noradrenergic effects by increasing arousal threshold and possibly reduce OSA severity.</p><p><strong>Research question: </strong>What is the effect of the combination of pimavanserin and atomoxetine on apnea-hypopnea index (AHI; primary outcome), arousal index and nadir oxygen saturation (SpO₂; secondary outcomes)?</p><p><strong>Study design and methods: </strong>Following baseline polysomnography, 18 OSA participants (AHI>15events/h) took pimavanserin-plus-atomoxetine (34/80mg; 34/40mg for the first 3 days) or placebo for one-week according to a a randomized, crossover, two-period, double-blind clinical trial; follow-up polysomnography was performed to provide study outcomes. Safety outcomes, subjective sleep quality, and flow-estimated endotypes (using oronasal pneumotachograph flow) were also explored.</p><p><strong>Results: </strong>Eleven and seven participants were randomized to atomoxetine-plus-pimavanserin and placebo first, respectively. The combination reduced AHI by 42 [95%CI: 18, 60] % vs. placebo, meeting the primary outcome (P<0.001). Absolute AHI reduction was 16.9 [8.1, 23.6] events/h greater than placebo. Nadir SpO₂ and arousal index were also improved, by 5.0 [1, 8] % and 10.9 [2.4, 18.1] events/h vs. placebo. Overnight heart rate was increased (+4.8 [1.5, 8.1]), but no other change in subjective sleep quality or next-morning vital signs was evident. There was no increased risk for side effects on the combination vs. placebo. Treatment vs. placebo improved pharyngeal collapsibility (+7.9 [1.6, 14.1]%V_EUPNEA), reduced loop gain by 20% (0.15 [-0.23, -0.07]), and did not reduce the arousal threshold.</p><p><strong>Interpretation: </strong>Pimavanserin with atomoxetine is a strong pharmacological therapy candidate for OSA.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751226","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":"The Association Between Mechanical Power Within the First 24 Hours and ICU Mortality in Mechanically Ventilated Adult Patients With Acute Hypoxemic Respiratory Failure: A Registry-Based Cohort Study.","authors":"Stephan von Düring, Kuan Liu, Laveena Munshi, S Joseph Kim, Martin Urner, Neill K J Adhikari, Ken Kuljit S Parhar, Eddy Fan","doi":"10.1016/j.chest.2025.03.012","DOIUrl":"10.1016/j.chest.2025.03.012","url":null,"abstract":"<p><strong>Background: </strong>Despite the widespread adoption of lung-protective ventilation strategies, mortality among patients receiving invasive mechanical ventilation (IMV) remains high. Mechanical power (MP) integrates some variables responsible for ventilator-induced lung injury and has been associated with mortality in patients with ARDS. However, the impact of MP on ICU mortality in the larger group of patients with acute hypoxemic respiratory failure (AHRF) has not been well established, and previous studies have reported inconsistent thresholds for predicting outcomes.</p><p><strong>Research question: </strong>Is high MP (> 17 J/min) within the first 24 hours of IMV, calculated using dynamic driving pressure, associated with ICU mortality in patients with AHRF? Additionally, does a threshold exist below which IMV is considered safe?</p><p><strong>Study design and methods: </strong>In this multicenter cohort study, we included adult patients with AHRF who received IMV. Patients were excluded if they received IMV for > 24 hours before inclusion or were receiving extracorporeal life support. We applied multivariable logistic regression models with inverse probability of treatment weighting and used change-point regression models with restricted cubic splines.</p><p><strong>Results: </strong>Of the 21,714 patients in our registry, 9,031 patients (42%) met the inclusion criteria. After adjusting for baseline characteristics, high MP was associated with increased ICU mortality (OR, 1.58; 95% CI, 1.44-1.72), with a nonlinear dose-response relationship. No consistent safe MP threshold was identified. High MP also was associated with lower extubation rates and fewer ventilator-free days.</p><p><strong>Interpretation: </strong>Exposure to high MP within the first 24 hours of IMV was associated with increased ICU mortality in patients with AHRF. The absence of a consistent safe threshold suggests that reducing MP at IMV initiation may be a strategy to improve outcomes, warranting exploration in clinical trials.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750949","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":"CT Emphysema Subtypes and Cardiac Hemodynamics Estimated on Magnetic Resonance Imaging: The MESA COPD Study.","authors":"Emilia A Hermann, Jesse X Yang, Elsa Angelini, Pallavi Balte, David A Bluemke, James Carr, Katja Derlin, Antoinette S Gomes, Mohammadali Habibi, Eric A Hoffman, Chris Johns, Steven M Kawut, David G Kiely, Andrew Laine, Joao A C Lima, Martin R Prince, Benjamin Smith, Jens Vogel-Claussen, Karol Watson, Jim M Wild, Andrew J Swift, R Graham Barr","doi":"10.1016/j.chest.2025.03.009","DOIUrl":"https://doi.org/10.1016/j.chest.2025.03.009","url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) is traditionally associated with pulmonary hypertension, but treatments targeting elevated pulmonary artery pressure (PAP) in COPD have largely failed, possibly due to an incomplete understanding of subphenotypes of disease.</p><p><strong>Research questions: </strong>Are novel, machine-learned computed tomography (CT) emphysema subtypes associated with specific cardiac hemodynamic profiles?</p><p><strong>Study design and methods: </strong>The Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study recruited participants with and without COPD aged 50-79 years with ≥10 pack-years smoking and without clinical cardiovascular disease predominantly from MESA and a lung cancer screening cohort. COPD and COPD severity were defined by standard spirometric criteria. CT emphysema subtypes were defined by unsupervised machine learning in an independent study and labeled on chest CTs. Hemodynamics were estimated on cardiac magnetic resonance imaging using validated equations. Linear regression models were weighted by the inverse probability of sampling and adjusted for potential confounders.</p><p><strong>Results: </strong>The mean age of the 300 participants was 68±7 years, 60% were male, 28% currently smoked and 47% had COPD, 45% of mild and 41% of moderate severity. More severe COPD was associated with lower estimated pulmonary arterial wedge pressure (ePAWP; p-trend=0.02) and greater estimated pulmonary vascular resistance (ePVR; p-trend=0.03) but not estimated PAP (ePAP; p-trend=0.83). Only the combined bronchitic-apical emphysema subtype was associated with greater ePAP (1.08 mmHg/10%, 95% CI 0.40, 1.75). The diffuse emphysema subtype was associated with lower ePAWP (-0.49 mmHg/10%, 95% CI -0.75, -0.24) and greater ePVR (0.36 Wood units/10%, 95% CI: 0.10, 0.61).</p><p><strong>Interpretation: </strong>In this case-control study of predominantly mild-moderate COPD, greater ePAP was specific to the combined bronchitic-apical emphysema subtype while the diffuse emphysema subtype, and COPD severity, were associated with lower ePAWP and greater ePVR. The CT emphysema subtype findings suggest more precise avenues to therapeutic interventions in cardiopulmonary dysfunction.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742359","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":"US Physicians' Perceived Impacts of Abortion Bans in Pulmonary and Critical Care Medicine.","authors":"Katrina E Hauschildt, Avnee J Kumar, Elizabeth M Viglianti, Kelly C Vranas, Taylor Bernstein, Leslie Moroz, Theodore J Iwashyna","doi":"10.1016/j.chest.2025.03.008","DOIUrl":"10.1016/j.chest.2025.03.008","url":null,"abstract":"<p><strong>Background: </strong>Eighteen US states implemented abortion bans between 2022 and 2024. Although emerging evidence shows bans have impacted obstetrics and gynecology, little is known about their impact on other specialties. We hypothesize that pulmonary and critical care medicine may be adversely impacted due to the time-sensitive, high-acuity needs of their patients.</p><p><strong>Research question: </strong>How have abortion bans impacted pulmonary and critical care medicine clinical practice and/or the well-being and careers of physicians?</p><p><strong>Study design and methods: </strong>Between October 2022 and July 2024, we conducted semistructured interviews via videoconferencing with pulmonary and critical care medicine physicians (n = 29) working in 15 US states about the impacts of abortion bans. We used an abductive approach to analyze interview transcripts.</p><p><strong>Results: </strong>Physicians had a median 7 years in practice, and 16 were women. Physicians described varied impacts for patients and physicians, such as repeated experiences of restricted and delayed treatment, physician moral distress, and impacts to training. Institutional guidance for physicians was often experienced as variable and vague. Concerns about disparate impacts across social groups were pervasive. Physicians also described novel forms of harm mitigation and increased political activation resulting from the implementation of abortion bans.</p><p><strong>Interpretation: </strong>Abortion bans are impacting patients and physicians in medical specialties outside of obstetrics and gynecology. Additional research is needed to better understand harm mitigation approaches, which may provide policymakers and health care systems with strategies to minimize patient and workforce harms.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673296","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":"Accuracy of Pulse Oximetry and Risk Factors Associated With Discrepancy From Arterial Oxygenation in Asian Patients in the ICU: An Observational Study.","authors":"Toshishige Takagi, Tomoko Fujii, Sae Nakamura, Yusuke Tsutsumi, Shoichi Uezono","doi":"10.1016/j.chest.2025.03.006","DOIUrl":"10.1016/j.chest.2025.03.006","url":null,"abstract":"<p><strong>Background: </strong>Oxygen administration is often guided by pulse oximeter readings. However, inaccuracies have been reported, particularly in patients with darker skin tones. During the COVID-19 pandemic, racial and ethnic disparities in hypoxemia detection emerged, with studies showing a higher incidence of hidden hypoxemia in Black and Hispanic patients. However, limited data exist regarding the Asian population.</p><p><strong>Research question: </strong>How accurate are oxygen saturation (Spo₂) readings in Asian patients with critical illness, and what factors contribute to discrepancies with arterial oxygen saturation (Sao₂)?</p><p><strong>Study design and methods: </strong>We conducted a single-center observational study in an ICU at a tertiary care hospital in Japan, including all adult patients admitted from October 2013 through September 2021. We collected data from electronic records and analyzed for agreement between Spo₂ and Sao₂ using modified Bland-Altman plots. We performed multivariable regression analysis to identify factors associated with Spo₂-Sao₂ differences. We used cubic splines to model associations between the differences and mortality. To further explore potential mechanisms of dissociation, subgroups of patients with chronic dialysis and sepsis were analyzed.</p><p><strong>Results: </strong>Clinical data from 10,698 patients admitted to the ICU were analyzed. The mean bias between Spo₂ and Sao₂ was -1.23%, with the largest discrepancies occurring 24.7 hours after ICU admission. Hidden hypoxemia (Sao₂ < 88%, Spo₂ ≥ 88%) occurred in 0.8% of patients, and serious hidden hypoxemia (Spo₂ ≥ 92%) occurred in 0.6% of patients. Overestimation of Sao₂ was associated with high creatinine levels, particularly among patients with chronic hemodialysis, whereas underestimation was associated with sepsis, mechanical ventilation, and signs of impaired systemic perfusion. We observed a U-shaped relation between the Spo₂ and Sao₂ differences and mortality, indicating a nonlinear association.</p><p><strong>Interpretation: </strong>Dissociation between Spo₂ and Sao₂ in Asian patients in the ICU was small; however, overestimation and underestimation were associated with increased mortality risk, particularly among patients with chronic hemodialysis or impaired peripheral perfusion.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669230","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":"Inhaled Menthol for Dyspnea Relief During Cycle Exercise in COPD: A Randomized Trial.","authors":"Michele R Schaeffer, Lucas Vanden Bossche, Kaat Beckers, Kristin Verbeke, Wim Janssens, Dennis Jensen, Jem I Arnold, Andreas von Leupoldt, Daniel Langer","doi":"10.1016/j.chest.2025.03.002","DOIUrl":"10.1016/j.chest.2025.03.002","url":null,"abstract":"<p><strong>Background: </strong>Menthol inhalation (MI) lowers dyspnea ratings during loaded breathing in COPD and cycle exercise in healthy adults. Proposed mechanisms include stimulation of cold receptors in the upper airways, modulating perception of breathing-related effort, and airflow.</p><p><strong>Research question: </strong>Does MI also alleviate exertional dyspnea in COPD?</p><p><strong>Study design and methods: </strong>Twenty patients with COPD (60% male; mean age ± SD, 68 ± 6 years; FEV₁, 47% ± 17% predicted) completed 2 constant-load cycle exercise tests (73% ± 7% peak power output) to exhaustion with menthol or placebo (strawberry flavoring) added to the breathing circuit in counterbalanced order and on separate days. Ventilatory and neuromuscular parameters were measured continuously. Dyspnea intensity was serially assessed using the 0 to 10 category ratio Borg scale, and dyspnea unpleasantness and related sensory qualities were assessed using the Multidimensional Dyspnea Profile at end exercise. Participants were asked in which test their inspiratory airflow felt easier.</p><p><strong>Results: </strong>Serial dyspnea intensity ratings were lower with menthol vs placebo (estimate [Δ/10% peak time]: -0.09; 95% CI, -0.15 to -0.02; P = .01), whereas ratings of dyspnea unpleasantness, air hunger, and mental breathing effort were lower at end exercise (all P < .05). Menthol-related improvements in dyspnea intensity at symptom limitation of the shorter test vs equivalent time on the other were correlated with higher endurance time (r = -0.73, P < .001). There were no differences in ventilatory and neuromuscular parameters (P > .05). Exercise endurance time was unaffected by menthol (Δ, 0.3 ± 1.6 minutes with menthol vs placebo; P = .50). A total of 85% reported easier inspiratory airflow with menthol.</p><p><strong>Interpretation: </strong>MI may be useful for management of exertional dyspnea in selected patients with COPD. Future work should investigate if MI can improve outcomes of exercise rehabilitation programs.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov; No.: NCT05785026; URL: www.</p><p><strong>Clinicaltrials: </strong>gov.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633743","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":"Peripheral Airways Dysfunction Is a Major Contributor to Poor Quality of Life in Sarcoidosis.","authors":"Dimitrios Toumpanakis, Konstantinos Karagiannis, Paolo Paredi, Andras Bikov, Martina Bonifazi, Harpreet K Lota, Harpal Kalsi, Cosetta Minelli, Nikolaos Dikaios, George A Kastis, Peter J Barnes, Athol U Wells, Omar S Usmani, Elisabetta A Renzoni","doi":"10.1016/j.chest.2025.02.036","DOIUrl":"10.1016/j.chest.2025.02.036","url":null,"abstract":"<p><strong>Background: </strong>Sarcoidosis is characterized by reduced quality of life (QoL), yet QoL is correlated poorly to conventional spirometric lung function tests.</p><p><strong>Research question: </strong>What is the relationship of a QoL measure with comprehensive lung function assessment using oscillometry in sarcoidosis?</p><p><strong>Study design and methods: </strong>Sixty-two patients with pulmonary sarcoidosis completed the St. George's Respiratory Questionnaire (SGRQ), a respiratory QoL measure, and underwent lung function assessment including oscillometry, spirometry, diffusion capacity, fractional exhaled nitric oxide (Feno), and body plethysmography. Relationships of lung function parameters with SGRQ results were determined with Spearman rank coefficient (ρ), and receiver operating characteristic curves were plotted. Logistic regression and hierarchy cluster analysis of parameters from multiple lung function techniques were performed.</p><p><strong>Results: </strong>Oscillometric indices describing peripheral lung dysfunction showed significant associations with SGRQ score (resistance at 5 Hz [R5], ρ = 0.43 [P < .01]; R5 minus resistance at 20 Hz [R20], ρ = 0.35 [P < .01]; reactance at 5 Hz [X5], ρ = -0.42 [P < .01]; reactance area under the curve [Ax], ρ = 0.44 [P < .01]), whereas FVC % predicted and residual volume (RV) to total lung capacity (TLC) ratio, were related weakly to SGRQ score (ρ = -0.30 [P = .02] and ρ = 0.30 [P = .02], respectively). Oscillometry reactance, measuring elastic properties of the lung, predicted an impaired QoL (area under the receiver operating characteristic curve: Ax, 0.80 [P < .001] and X5, 0.78 [P < .001]), even in patients with absence of an obstructive or restrictive spirometry pattern. Ax remained associated significantly with SGRQ score even after adjustment for FVC and Scadding stage on multivariable analysis (P = .005). Feno was not associated with SGRQ score. Peripheral airway function parameters (R5 minus R20, Ax, and RV to TLC ratio) were grouped in an independent cluster, whereas X5 constituted a single cluster.</p><p><strong>Interpretation: </strong>Oscillometric lung function parameters, especially those of peripheral airway dysfunction, are correlated more strongly to a QoL measure than spirometry in patients with sarcoidosis.</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":"143623821","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 Findings and Immune Dysfunction Among Adolescents With and Without HIV in Kenya.","authors":"Laura E Ellington, Elizabeth Maleche-Obimbo, Brandon L Guthrie, Margaret Rosenfeld, T Eoin West, Christine J McGrath, Judith Lukorito, Christine Njiru, Anthony Cagle, Sherry Eskander, Michael H Chung, Kristina Crothers, Engi F Attia","doi":"10.1016/j.chest.2025.02.034","DOIUrl":"10.1016/j.chest.2025.02.034","url":null,"abstract":"<p><strong>Background: </strong>Chronic lung disease and its association with immune dysfunction are characterized poorly among adolescents with HIV (AWHIVs).</p><p><strong>Research question: </strong>Is HIV associated with spirometry abnormalities among adolescents, and what role does immune dysfunction play?</p><p><strong>Study design and methods: </strong>We conducted a cohort study of adolescents (10-19 years of age) with and without HIV in Nairobi, Kenya. We fit adjusted log binomial models using Poisson regression to determine associations between HIV, respiratory symptoms, clinical signs, and, using exploratory factor analysis, biomarkers of immune dysregulation with spirometry abnormalities. We used linear regression to examine similar associations with continuous spirometry variables.</p><p><strong>Results: </strong>We included 154 AWHIVs (median age, 15 years [interquartile range, 13-18 years]) and 159 adolescents without HIV (AWoHs; median age, 13 years [interquartile range, 11-16 years]). Preserved ratio impaired spirometry (PRISm) findings were the predominant spirometry abnormality (20% in AWHIVs; 12% in AWoHs), followed by a restrictive spirometry pattern (RSP) (18% in AWHIVs; 12% in AWoHs) and obstructive impairments (5% in AWHIVs; 6% in AWoHs). AWHIVs showed a 1.55-fold (95% CI, 1.01-fold to 2.36-fold) increased risk of any spirometry abnormality, a 2.44-fold (95% CI, 1.40-fold to 4.26-fold) increased risk of PRISm findings, and 0.23 SD (95% CI, -0.43 to -0.03 SD) lower mean FVC z score than AWoHs. We detected no associations of respiratory symptoms or clinical signs with any spirometry abnormality among AWHIVs. AWoHs with symptoms and clinical signs were more likely to have any spirometry abnormality than AWoHs without symptoms or signs (aRR, 2.26 [95% CI, 1.23-4.17] and 2.20 [95% CI, 1.22-3.97], respectively). The biomarker factor group reflecting acute inflammation (CRP, SAA) was associated with increased risk of any spirometry abnormality among AWHIVs (aRR, 1.35 [95% CI, 1.06-1.72]) and AWoHs (1.70 [95% CI, 1.34-2.17]). Among AWHIV only, the biomarker factor grouping of endothelial activation (sCD14, soluble intercellular adhesion molecule 1, or soluble vascular cell adhesion molecule 1), lower BMI for age z score, and tobacco smoke exposure were associated with increased risk of any spirometry abnormality (aRR, 1.35 [95% CI, 1.09-1.67], 0.76 [95% CI, 0.62-0.92], and 2.34 [95% CI, 1.28-4.23], respectively) and PRISm findings.</p><p><strong>Interpretation: </strong>AWHIVs showed an increased risk of any spirometry abnormality, including PRISm findings and RSP, compared with AWoHs. Immune and endothelial activation were associated with spirometry abnormalities among AWHIVs only, suggesting alternative mechanisms of disease in AWHIVs.</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":"143623823","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}