Chest最新文献

{"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}

{"title":"Keeping Up With Technological Innovation: The Moral Imperative for Pragmatic Clinical Trials in Interventional Pulmonology.","authors":"Fabien Maldonado, Rafael Paez, Robert J Lentz, Ankush Ratwani, Jonathan D Casey","doi":"10.1016/j.chest.2024.11.010","DOIUrl":"10.1016/j.chest.2024.11.010","url":null,"abstract":"<p><p>The advances in minimally invasive lung cancer diagnostics of the last decade have transformed patient care but have also raised important concerns about the regulatory processes used to approve new devices and the best way to generate data to support their use. Disruptive technologies, such as robotic bronchoscopy, have been widely adopted by interventional pulmonologists in the absence of robust data demonstrating improved patient outcomes. Comparative research is needed to inform patient care, but traditional methods of conducting clinical trials in which research teams operate separately from clinical teams are ill-suited to testing the safety and effectiveness of technologies being introduced on the market at unprecedented speed. Pragmatic clinical trials, which integrate trial procedures into routine clinical care, represent an appealing alternative approach for generating much-needed data to inform clinical care. In this article we illustrate the advantages and disadvantages of these research paradigms, using two recently completed randomized controlled trials in navigational bronchoscopy, and highlight the barriers and facilitators to using pragmatic trials to address the gap in comparative effectiveness research: these include the need for increased clarity of research regulations for pragmatic trials, adequate federal and private funding for such research, and alignment of incentives between clinicians, researchers, regulators, and industry.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"892-898"},"PeriodicalIF":9.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11882772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692814","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":"Health System Purchasing Professionals' Approaches to Considering Equity in Procurement.","authors":"Katrina E Hauschildt, Taylor Bernstein, Deidra C Crews, Emmanuel F Drabo, Kadija Ferryman, John W Jackson, Thomas S Valley, Joseph Levy, Theodore J Iwashyna","doi":"10.1016/j.chest.2024.12.016","DOIUrl":"10.1016/j.chest.2024.12.016","url":null,"abstract":"<p><strong>Background: </strong>Continuing data on racial bias in pulse oximeters and artificial intelligence have sparked calls for health systems to drive innovation against racial bias in health care device and artificial intelligence markets by incorporating equity concerns explicitly into purchasing decisions.</p><p><strong>Research question: </strong>How do health care purchasing professionals integrate equity concerns into purchasing decision-making?</p><p><strong>Study design and methods: </strong>Between August 2023 and March 2024, we conducted semistructured interviews via videoconferencing with health care purchasing professionals about purchasing processes for pulse oximeters and other devices-and whether and where equity concerns arise in decision-making. An abductive approach was used to analyze perspectives on how equity and disparity concerns currently are integrated into health care purchasing decision-making. Health care purchasing professionals (N = 30) worked in varied supply chain roles for various health systems and supply chain support and consulting companies across the United States.</p><p><strong>Results: </strong>Health care purchasing professionals described limited considerations of equity in current purchasing processes. They described some receptivity to diversity, equity, and inclusion initiatives, largely focused on diversifying suppliers rather than ensuring that devices and products functioned equitably. Respondents reported that they depended on clinician partners to raise and delineate requirements for equitable performance. Respondents also depicted current sources of evidence used in making purchasing decisions as providing limited information about equitable performance and that large contracts, including with group purchasing organizations, may limit purchasing options.</p><p><strong>Interpretation: </strong>Health system purchasing professionals suggested interest and some nascent successes in diversity, equity, and inclusion considerations in health system purchasing processes, including diverse supplier initiatives, but also expressed a need for strong clinical partnership to ensure equitable performance. Explicit approaches for incorporating equitable performance into health care purchasing likely are needed.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"831-841"},"PeriodicalIF":9.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871513","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":"Implementation and Effectiveness of Guideline-Recommended Clinical Activities for Children With Asthma: Population-Based Cohort.","authors":"Zainab Khalaf, Sejal Saglani, Chloe I Bloom","doi":"10.1016/j.chest.2024.10.036","DOIUrl":"10.1016/j.chest.2024.10.036","url":null,"abstract":"<p><strong>Background: </strong>Guidelines advise minimizing asthma exacerbation risk, which is achieved partially through good clinical practice activities, including scheduled asthma reviews, inhaler technique checks, and asthma management plans. We assessed how frequently these activities are provided and how effective they are in clinical practice.</p><p><strong>Research question: </strong>Do guideline-recommended activities such as asthma reviews, inhaler technique checks, and asthma management plans prevent asthma exacerbations?</p><p><strong>Study design and methods: </strong>This retrospective chart review used United Kingdom primary care medical records between 2004 and 2021, linked to hospital records. Children were eligible from asthma diagnosis until age 16 years. Annual implementation of asthma review, inhaler technique check, and asthma management plan was measured. Risk factors for these activities not being undertaken were determined by using multivariable logistic regression. Self-controlled case series was adopted to assess the effectiveness of each activity over 12 months; this was divided into two 6-month periods.</p><p><strong>Results: </strong>A total of 126,483 children were eligible; 30% to 45% received each annual activity, and 8% received all three together. Risk factors for not receiving activities included younger age, more socioeconomic deprivation, and higher or no BMI measurement. Management plans and asthma reviews, as standalone activities, were associated with an approximately 15% exacerbation reduction over 12 months and 8% over 6 months, respectively (asthma management plan, n = 4,624; 0-180 days [incidence rate ratio (95% CI)]: 0.87 [0.79-0.96]; 181-365 days: 0.83 [0.73-0.95]; asthma review, n = 6,948; 0-180 days: 0.92 [0.85-0.99]; 181-365 days: 0.93 [0.83-1.03]). Standalone inhaler technique checks were not associated with exacerbations. Provision of all activities together was associated with an approximately 30% exacerbation reduction over 12 months (n = 3,643; 0-180 days: incidence rate ratio, 0.76 [0.68-0.85]; 181-365 days: incidence rate ratio, 0.69 [95% CI, 0.60-0.81]).</p><p><strong>Interpretation: </strong>Our results indicate that most children in the United Kingdom do not receive the guideline-recommended activities to monitor their asthma. This study suggests that these activities, if implemented, are effective in clinical practice and maximally effective when combined in the same visit.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"665-674"},"PeriodicalIF":9.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11882771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615776","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":"A 71-Year-Old Man With Gas Accumulation in the Left Atrium.","authors":"Xiaoyang Zhou, Chang Xu, Jianneng Pan, Tao Pan, Hua Wang, Bixin Chen, Zhaojun Xu","doi":"10.1016/j.chest.2024.10.004","DOIUrl":"https://doi.org/10.1016/j.chest.2024.10.004","url":null,"abstract":"<p><strong>Case presentation: </strong>A 71-year-old man with a history of atrial fibrillation presented to the emergency department with sudden unconsciousness after finishing lunch. Just 4 weeks ago, the patient underwent radiofrequency ablation for atrial fibrillation and regularly took rivaroxaban for anticoagulant therapy. According to the medical history, the patient suffered recurrent chest tightness and heartburn after radiofrequency ablation without other discomforts. During transportation to the hospital, the patient experienced a drop in BP after forceful vomiting.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 3","pages":"e75-e81"},"PeriodicalIF":9.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613636","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":"A 73-Year-Old Man With Right-Sided Chest Pain and Dyspnea.","authors":"Pipetius Quah, Glenn Khai Wern Yong, Seet Ju Ee","doi":"10.1016/j.chest.2024.10.005","DOIUrl":"https://doi.org/10.1016/j.chest.2024.10.005","url":null,"abstract":"<p><strong>Case presentation: </strong>A 73-year-old man presented with a 2-week history of intermittent right-sided chest pain, cough, and progressive dyspnea on exertion. He reported subjective weight loss and anorexia with early satiety over the preceding months. He denied any fevers, night sweats, or sick contacts. On further questioning, he had also noted some progressive abdominal distension, though denied any change in bowel habits, nausea, or vomiting. He had a history of hypertension and diabetes. He was a person who does not smoke and had worked in the construction industry for > 50 years prior. His daughter had passed away due to lung cancer.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 3","pages":"e89-e93"},"PeriodicalIF":9.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613638","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":"Broadening Perspectives on Socioeconomic Status, Frailty, and COPD: Unaddressed Limitations and Future Directions.","authors":"Ruyi Zhou, Senlin Ye, Jinli Liu, Lincheng Duan","doi":"10.1016/j.chest.2024.11.042","DOIUrl":"https://doi.org/10.1016/j.chest.2024.11.042","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 3","pages":"e97-e98"},"PeriodicalIF":9.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613643","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}