Chest最新文献

{"title":"Moving Beyond Responders: A Post Hoc Analysis Identifying Criteria for Chronic Cough Control.","authors":"Mustafaa Wahab, Elena Kum, Nermin Diab, Danica Brister, Ana Oliveira, Wafa Hassan, Sue Beaudin, Catie Stevens, Jennifer Wattie, Lesley Wiltshire, Karen Howie, Kieran Killian, Roma Sehmi, Gail M Gauvreau, Paul M O'Byrne, Imran Satia","doi":"10.1016/j.chest.2026.05.006","DOIUrl":"10.1016/j.chest.2026.05.006","url":null,"abstract":"<p><strong>Background: </strong>Minimally important differences (MIDs) often define treatment response in refractory chronic cough (RCC). However, MIDs represent the smallest change in an outcome that patients perceive as important and do not indicate whether cough has improved to a level that would be considered adequately controlled. Therefore, defining criteria for cough control may provide a complementary benchmark for evaluating treatment success.</p><p><strong>Research question: </strong>How can cough control be defined using thresholds anchored to patient-perceived sufficiency, and what proportion of patients achieve this state after treatment?</p><p><strong>Study design and methods: </strong>The Prospective Study to Evaluate the Effectiveness of Guideline-Based Therapy for Chronic Cough and Refractory Chronic Cough (PROCOUGH) was a prospective, single-center observational cohort study conducted at McMaster University. Patients were treated according to European Respiratory Society guidelines with pretreatment and posttreatment assessments. Post hoc analyses based on the 90% upper limit of scores among patients reporting Global Rating of Change Scale scores of 6 or 7 and a treatment response question-\"Is your cough sufficiently controlled that no additional treatment is required?\"-were used to derive criteria for cough control. Patients not meeting cough control criteria were classified as having RCC.</p><p><strong>Results: </strong>One hundred patients completed follow-up (mean [SD] age, 58 [14] years; 58% female; median cough duration, 7 years). Controlled chronic cough (ConCC) was defined as post-treatment 24-hour cough frequency (CF) of ≤ 10 coughs/h, cough severity visual analog scale (CS-VAS) score of ≤ 30 mm, and Leicester Cough Questionnaire (LCQ) score of ≥ 16. After treatment, 26% of patients met all 3 criteria, whereas 74% met the definition of RCC. Using 2 patient-reported outcomes alone, 32% met ConCC criteria. Individually, LCQ, CS-VAS, and CF criteria were met by 36%, 44%, and 50% or patients, respectively.</p><p><strong>Interpretation: </strong>Our results show that we derived the following patient-anchored criteria for cough control incorporating objective and subjective outcomes: 24-hour CF of ≤ 10 coughs/h, CS-VAS of ≤ 30 mm, and LCQ score of ≥ 16. When these composite thresholds were applied to define ConCC, only 26% of patients achieved cough control, despite substantially higher proportions meeting individual responder criteria. This discrepancy underscores the need for improved treatments and outcome definitions that capture patient-perceived cough control.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov; No.: NCT04758351; URL: www.</p><p><strong>Clinicaltrials: </strong>gov.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1152-1163"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147947813","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":"Impact of Preexisting Schizophrenia Spectrum Disorders on the Receipt of Surgery and Other Treatments for Non-Small Cell Lung Cancer: A Multicenter Nationwide Cohort Study in Japan.","authors":"Yuto Yamada, Masaki Fujiwara, Taisuke Ishii, Tomone Watanabe, Maiko Fujimori, Naoki Nakaya, Toshihiko Kawamura, Koji Otsuki, Eiki Ichihara, Taichi Shimazu, Shiro Hinotsu, Yosuke Uchitomi, Masatoshi Inagaki","doi":"10.1016/j.chest.2026.05.016","DOIUrl":"10.1016/j.chest.2026.05.016","url":null,"abstract":"<p><strong>Background: </strong>Patients with schizophrenia spectrum disorders (SSDs) experience higher cancer mortality than the general population. Disparities in treatments for non-small cell lung cancer (NSCLC) among this population remain underexamined.</p><p><strong>Research question: </strong>Are patients with SSDs less likely to receive surgery, adjuvant chemotherapy for stage II/IIIA, concurrent chemoradiotherapy for stage III, and systemic therapy for stage IV NSCLC compared with those without psychiatric disorders?</p><p><strong>Study design and methods: </strong>This retrospective cohort study used national Hospital-Based Cancer Registry data linked to hospital-based administrative data in Japan. It included patients who received initial treatment for NSCLC between 2018 and 2021. Presence of SSDs was defined as a diagnosis using F20 to F29 codes from International Classification of Diseases, 10th Revision. The primary outcome was receipt of surgery for NSCLC. Secondary outcomes were receipt of the following: (1) adjuvant chemotherapy within 180 days in patients with pathologic stage II/IIIA NSCLC; (2) concurrent chemoradiotherapy in clinical stage III NSCLC; and (3) systemic therapy in stage IV NSCLC. Multivariable logistic regression adjusted for age, sex, clinical stage, comorbidities, and functional status was performed.</p><p><strong>Results: </strong>The final cohort comprised 166,663 patients, 1,346 of whom had SSDs. Patients with SSDs were more likely to be diagnosed at stage IV NSCLC (45.0% vs 31.4%) and less likely to undergo surgery (31.5% vs 49.9%; adjusted OR [aOR], 0.70; 95% CI, 0.57-0.85), receive adjuvant chemotherapy (aOR, 0.31; 95% CI, 0.17-0.57), or receive systemic therapy (aOR, 0.54; 95% CI, 0.45-0.65). No significant difference was observed in concurrent chemoradiotherapy for stage III NSCLC (aOR, 0.99; 95% CI, 0.73-1.34).</p><p><strong>Interpretation: </strong>Patients with SSDs were less likely to receive surgery and other stage-appropriate treatments for NSCLC, highlighting the need for targeted interventions to promote equitable cancer care for these individuals.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1337-1345"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147986809","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":"Impact of Invasive Mold Infection-Coded Diagnoses on Utilization, Costs, and Mortality After Lung Transplantation.","authors":"Kelly M Pennington, Herb Heien, Hemang Yadav, Ali El Mokahal, Xiaoxi Yao, Steve G Peters, Patricio Escalante, Sahar A Saddoughi, Che Ngufor, Raymund R Razonable, Cassie C Kennedy","doi":"10.1016/j.chest.2026.04.020","DOIUrl":"10.1016/j.chest.2026.04.020","url":null,"abstract":"<p><strong>Background: </strong>Lung transplant recipients (LTRs) are highly susceptible to invasive mold infections (IMIs). In clinical practice, diagnostic codes for IMI serve as claims-based markers of suspected infection that often prompt antifungal therapy, but their real-world clinical and economic impact remains incompletely defined.</p><p><strong>Research question: </strong>Among LTRs, are IMI-coded diagnoses associated with increased health care utilization, costs, and mortality?</p><p><strong>Study design and methods: </strong>We conducted a retrospective cohort study using the OptumLabs Data Warehouse (2005-2023). Adult LTRs were identified by procedure codes and followed from transplant until disenrollment, death, or December 2023. IMIs were defined by International Classification of Diseases, Ninth Revision/International Statistical Classification of Diseases and Related Health Problems, 10th Revision codes. Risk factors were assessed using multivariable logistic regression. A 1:2 matched cohort (age, sex, and transplant length of stay) evaluated health care utilization, costs, and mortality. Utilization and costs were calculated per patient-month (PPM) and stratified by payer. Mortality was assessed using Cox models.</p><p><strong>Results: </strong>Among 1,120 eligible LTRs, 343 (30.6%; 95% CI, 27.9%-33.4%) had an IMI-coded diagnosis, most commonly aspergillosis (88%). Male sex (OR, 1.52; 95% CI, 1.16-1.99) and cystic fibrosis (OR, 1.93; 95% CI, 1.14-3.28) were independently associated with IMI coding, whereas higher comorbidity burden was associated with lower odds (OR, 0.65; 95% CI, 0.43-0.98). In the matched cohort (IMI: n = 243; non-IMI: n = 486), IMI coding was associated with greater emergency department use (0.13 vs 0.10 visits/PPM; P = .018) and longer inpatient stay (3.28 vs 2.23 days/PPM; P = .031). Cost patterns diverged: commercially insured recipients with IMI-coded diagnoses had lower pharmacy costs ($3,416 vs $4,504/PPM; P = .006), whereas Medicare Advantage recipients incurred significantly higher inpatient, medical, and overall costs. IMI coding was associated with nearly 2-fold higher mortality (hazard ratio, 1.83; 95% CI, 1.33-2.51; P < .001).</p><p><strong>Interpretation: </strong>Our results show that IMI-coded diagnoses are common after lung transplant and are associated with greater acute care utilization, higher costs among Medicare Advantage recipients, and increased mortality. These findings underscore the clinical and economic burden of suspected mold infections in LTRs and highlight the need for integrated claims and clinical data to refine risk reduction strategies.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1126-1137"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811645","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":"From P Values to Priors: Revisiting the VERITAS Randomized Controlled Trial in Light of Bayes' Theorem.","authors":"Fabien Maldonado, Michael N Kammer, Robert J Lentz, Tatsuki Koyama","doi":"10.1016/j.chest.2026.06.010","DOIUrl":"10.1016/j.chest.2026.06.010","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1021-1023"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148276189","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":"Response.","authors":"Bettia E Celestin, Francois Haddad","doi":"10.1016/j.chest.2026.05.031","DOIUrl":"https://doi.org/10.1016/j.chest.2026.05.031","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"170 4","pages":"e139-e140"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135280","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":"Response.","authors":"Sarah L Khan, Sonye K Danoff, Stephen C Mathai","doi":"10.1016/j.chest.2026.05.029","DOIUrl":"https://doi.org/10.1016/j.chest.2026.05.029","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"170 4","pages":"e137-e138"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135307","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":"Predicting Clinical Response to Benralizumab Using CT Imaging: Prognostic CT Air-Trapping for the Early Identification of Benralizumab Responders Among Eosinophilic Asthma Patients (BenraliScan) Study.","authors":"Arnaud Bourdin, Marie Felicia Beclin, Pascal Chanez, Isabelle Vachier, Laurie Pahus, Erika Nogue, Sarah Skinner, David Galeazzi, Myriam Boulhais, Zakaria Lahmar, Mathilde Volpato, Joana Pissarra, Pierre Lafaye de Micheaux, Sebastien Bommart, Nicolas Molinari","doi":"10.1016/j.chest.2026.04.040","DOIUrl":"10.1016/j.chest.2026.04.040","url":null,"abstract":"<p><strong>Background: </strong>Benralizumab reduces eosinophilia and improves outcomes in most, but not all, patients with asthma. We evaluated whether baseline CT imaging-derived metrics assist in clinical response prognosis after 52 weeks.</p><p><strong>Research question: </strong>Are CT imaging-derived measures prognostic of benralizumab response, assessed by exacerbation reduction, lung function, and symptom control at 52 weeks?</p><p><strong>Study design and methods: </strong>This 2-center prospective, open-label study included patients eligible for anti-IL-5α receptor therapy who began benralizumab treatment alongside high-dose background therapy for severe eosinophilic asthma (SEA; > 300/mm³). Baseline variables included CT imaging-derived metrics (parametric response mapping [PRM] small airways disease [SAD] voxels; University of California, San Francisco, mucus plugging; and Lund-Mackay sinus score) and other potential biomarkers (blood eosinophil levels and lung function). The primary outcome was ≥ 50% reduction in exacerbation rates. The secondary outcome was a composite clinical score achieving ≥ 2 of response criteria: ≥ 50% exacerbation reduction, FEV₁ increase of > 300 mL, and 5-item Asthma Control Questionnaire score improvement of > 0.5.</p><p><strong>Results: </strong>Of 59 enrolled patients, 47 patients (60% female; median age, 54 years) completed the study with high-quality paired inspiratory and expiratory spirometrically gated CT scans. Forty-two of 47 patients achieved ≥ 50% exacerbation reduction, for which no prognostic factor could be identified. Thirty-five of 47 patients achieved the secondary outcome. Receiver operating characteristic curve analyses indicated that PRM SAD voxels (area under the receiver operating characteristic curve [AUC], 0.693; 95% CI, 0.513-0.873) and sinus score (AUC, 0.714; 95% CI, 0.501-0.928) were robust prognostic factors of responder status, both outperforming blood eosinophil count (AUC, 0.630; 95% CI, 0.428-0.832).</p><p><strong>Interpretation: </strong>Our results show that the CT imaging-derived metrics, PRM SAD voxels, and sinus score were associated with benralizumab response as defined by a composite clinical end point and could be valuable biomarkers for response prognosis in patients with SEA. The high rate of exacerbation reduction limited discrimination of the primary end point. These findings support incorporating CT imaging phenotyping into precision management of SEA and warrant validation in larger cohorts.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov; No.: NCT03976310; URL: www.</p><p><strong>Clinicaltrials: </strong>gov.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1024-1036"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147863639","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 40-Year-Old Woman With Respiratory Failure: Distinguishing Between Pleural and Parenchymal Fluid Collections With Lung Ultrasound Scanning.","authors":"Ghita Bouzarif, Charles Lanks","doi":"10.1016/j.chest.2026.06.031","DOIUrl":"https://doi.org/10.1016/j.chest.2026.06.031","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"170 4","pages":"e127-e131"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135179","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 Role of Mutual Understanding in Shared Decision-Making.","authors":"Erica K Salter, Mark R Tonelli","doi":"10.1016/j.chest.2026.04.028","DOIUrl":"10.1016/j.chest.2026.04.028","url":null,"abstract":"<p><p>This article addresses the challenges of shared decision-making (SDM) when a patient's request conflicts with accepted medical practice, using the case of Maria, a 72-year-old patient receiving dialysis. Maria, admitted to the ICU, insists on continuing hemodialysis sessions despite symptomatic hypotension and wants to take the herbal supplement Jin Gui Shen Qi Tang (JGSQT). We argue that understanding-the mutual effort by patient and clinician to comprehend each other's reasons, goals, and values-is a foundational element of SDM, superseding the goal of reaching agreement about the preferred intervention. For the JGSQT request, a physician should approach with curiosity and epistemic humility, acknowledging the limits of medical knowledge on alternative treatments. Given the supplement's low risk and Maria's perceived benefit, allowing its use promotes a shared process. Conversely, the request to continue dialysis during symptomatic hypotension poses a significant threat of medical harm, justifying the physician in asserting professional values to stop the session. In both instances, the physician must approach the situation with curiosity and seek truly to understand the patient's perspective and also must explain thoroughly the rationale for a decision to Maria, ensuring that she understands the risks and the basis for the decision while looking for acceptable compromises. Ultimately, although SDM may not always result in a shared final decision, the shared process of mutual understanding ensures a patient-centered approach that respects patient autonomy while acknowledging the ethical limits of autonomous patient requests.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1200-1204"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834334","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":"Effectiveness of Cystic Fibrosis Transmembrane Conductance Regulator Modulator Therapy on Risk of Death for Individuals With Cystic Fibrosis.","authors":"Katherine E Kurgansky, Joseph M Collaco, Derek K Ng, Catherine R Lesko","doi":"10.1016/j.chest.2026.04.041","DOIUrl":"10.1016/j.chest.2026.04.041","url":null,"abstract":"<p><strong>Background: </strong>To date, clinical trials of cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapies have focused on outcomes that can be captured in relatively short follow-up periods. The effectiveness of CFTR modulator therapies on survival has not been described fully.</p><p><strong>Research question: </strong>What is the population-level treatment effect of initiating any CFTR modulator therapy compared with no initiation on the risk of death in people with cystic fibrosis (CF)?</p><p><strong>Study design and methods: </strong>We conducted a retrospective cohort study using United States Cystic Fibrosis Foundation Patient Registry data from between 2012 and 2022. We included individuals who met eligibility criteria for a CFTR modulator prescription (based on age and genotype of 2020 regulatory approvals and no prior use). At every clinic or telehealth visit, we assessed eligibility and classified treatment status based on registry records. We included individuals in the analysis multiple times if eligibility was met at multiple visits. We followed individuals from each visit until death (outcome), lung transplantation, loss to follow-up, or administrative censoring. We censored untreated observations if they later initiated CFTR modulator therapy. We estimated 8-year risk curves using Kaplan-Meier and hazard ratios (HRs) from Cox regression models. We used inverse probability weighting to balance baseline covariates and to account for nonrandom censoring.</p><p><strong>Results: </strong>We included 25,103 individuals and 178,835 visits; 18,056 individuals initiated therapy. The 8-year risk difference of death resulting from initiating CFTR modulator therapy was -7.2% (95% CI, -9.6 to -4.9). The hazard for death was 66% lower after CFTR modulator initiation than without use (HR, 0.34; 95% CI, 0.28 to 0.41).</p><p><strong>Interpretation: </strong>Our results show that CFTR modulator therapies reduce the risk of death among people living with CF over 8 years. This improved understanding will allow individuals living with CF and clinical providers to have reasonable expectations about survival and to allocate care and resources aligned with increased life expectancy appropriately.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1049-1059"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147866879","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}