Chest最新文献

{"title":"Measuring Health-Related Quality of Life in Sarcoidosis: A Hurdle to Jump.","authors":"Ingrid H E Korenromp","doi":"10.1016/j.chest.2024.08.019","DOIUrl":"https://doi.org/10.1016/j.chest.2024.08.019","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 1","pages":"e33-e34"},"PeriodicalIF":9.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142964092","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 (PRISm) Prevalence, Risk Factors, and Outcomes: A Systematic Review and Meta-Analysis.","authors":"Nicole M Robertson, Connor S Centner, Vickram Tejwani, Shakir Hossen, Dipan Karmali, Sibei Lu, Trishul Siddharthan","doi":"10.1016/j.chest.2024.12.025","DOIUrl":"https://doi.org/10.1016/j.chest.2024.12.025","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of chronic respiratory diseases is increasing globally. There is evidence that those with spirometric impairment, and no evidence of obstruction, termed preserved ratio impaired spirometry (PRISm), have increased risk of morbidity and mortality, compared to those with normal lung function. There remain several gaps in characterizing PRISm.</p><p><strong>Research questions: </strong>What is the prevalence, risk factors and clinical outcomes associated with PRISm globally?</p><p><strong>Study design and methods: </strong>In this systematic review a comprehensive search using MEDLINE, Web of Science, CINHAL, and CENTRAL databases was conducted to include epidemiological studies with no language or data restrictions. Two reviewers independently screened citations and shortlisted full-text articles according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and data was extracted. Quality was assessed with the Effective Public Health Practice Project tool.</p><p><strong>Results: </strong>52 studies met the inclusion criteria with 33 studies included in the meta-analysis. Pooled PRISm prevalence was 12% (95% CI: 0.10, 0.15) with greater prevalence in low-and middle-income countries (LMICs) compared to high-income countries (19% vs. 11%). Comorbid diabetes was a significant risk factor associated with PRISm but data for female sex and smoking were mixed. PRISm was associated with increased all-cause (OR 1.41, 95% CI:1.08, 1.83, p=0.02), cardiovascular (OR 1.84, 95% CI:1.31, 2.58, p<0.01), and respiratory mortality (OR 1.82, 95% CI:1.08, 3.05, p=0.03). PRISm was not associated with a reduced lung cancer diagnosis (p=0.46). Quality assessment analysis revealed 34.6% (n=18) studies were rated \"strong,\" 42.3% (n=22) \"moderate,\" and 23.1% (n=12) \"weak.\" Studies conducted LMICs had lower quality ratings.</p><p><strong>Interpretation: </strong>Individuals with PRISm have increased risk of all-cause, cardiovascular, and respiratory mortality. Recognizing and targeting modifiable PRISm risk factors may reduce the growing burden of PRISm and transition to obstructive lung disease globally. Additional studies are needed in LMICs that have unique risk factors a disease trajectory.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913575","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 bronchial biopsy in the prediction of response to biological therapy in severe uncontrolled asthma: a prospective study.","authors":"Borja G Cosío, Amanda Iglesias, Hanaa Shafiek, Mar Mosteiro, Inés Escribano, Nuria Toledo-Pons, Jose Luis Valera, Cristina Gómez Bellvert, Luis Pérez de Llano","doi":"10.1016/j.chest.2024.11.045","DOIUrl":"https://doi.org/10.1016/j.chest.2024.11.045","url":null,"abstract":"<p><strong>Background: </strong>Up to two thirds of patients with severe uncontrolled asthma (SUA) who received biological therapy do not have a complete response.</p><p><strong>Research question: </strong>Can bronchial biopsy (BB) play a role in the identification of patients with SUA who has a better response to biological therapy?</p><p><strong>Study design: </strong>AND METHODS: Prospective multicentre study. Consecutive SUA patients candidate to biological therapy underwent bronchoscopy and BB prior to biological therapy and clinical response was evaluated 6 months later. BB was evaluated according to a previously validated pathological score (PS) and was compared with a score of T2 inflammation (T2 score) that includes blood eosinophil count (BEC) and FeNO in predicting response to biological therapy. Response was graded as super-response, good response and partial/no response according to a composite score that includes exacerbations, oral corticosteroid (OCS) use, asthma control test (ACT) and improvement in FEV1.</p><p><strong>Results: </strong>92 patients were recruited and 78 completed the study, 63 of them received anti-IL5/5R (Mepolizumab, Reslizumab and Benralizumab) and 15 Dupilumab, being super-responders 36.5% and 26.6% respectively (p=0.126). The PS, but not the T2 score, was the only variable independently associated to response. Super-responders showed statistically significant higher PS. Response was better predicted by the PS compared to T2 score, in those receiving OCS and especially in those on anti-IL5/5R . Low tissue eosinophilia (<10 eosinophils/field) was associated to poor response to biological therapy.</p><p><strong>Interpretation: </strong>BB is more precise in the prediction of response to biological therapy than the T2 score, especially in those requiring OCS or receiving anti-IL5/5R . Tissue eosinophilia is the main driver of this predictive capacity, but there are other items in the PS related to bronchial remodeling that might be contributing to the identification of response to biological therapy.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Flow Rates of High-flow Nasal Cannula on Extubation Outcomes: A Randomized Controlled Trial.","authors":"Sheng-Yuan Ruan, Yao-Wen Kuo, Chun-Ta Huang, Ying-Chun Chien, Chun-Kai Huang, Lu-Cheng Kuo, Jerry Shu-Hung Kuo, Kuei-Pin Chung, Shih-Chi Ku, Jung-Yien Chien","doi":"10.1016/j.chest.2024.12.021","DOIUrl":"https://doi.org/10.1016/j.chest.2024.12.021","url":null,"abstract":"<p><strong>Background: </strong>High-flow nasal cannula (HFNC) has emerged as a promising intervention for post-extubation oxygen therapy, with the potential to reduce the need for reintubation. However, it remains unclear whether using a higher flow setting provides better outcomes than the commonly used flow rate of 30-50 L/min.</p><p><strong>Research question: </strong>Does setting the flow rate of HFNC at 60 L/min versus 40 L/min for post-extubation care result in different extubation outcomes?</p><p><strong>Study design and methods: </strong>This randomized controlled trial assigned intubated patients to receive HFNC at either a 60 L/min or 40 L/min flow rate following extubation. The assigned flow rate was maintained for 24 hours. The primary outcome was a composite of reintubation or the use of non-invasive ventilation (NIV) within 48 hours post-extubation. Key secondary outcomes included ahead-of-schedule changes in HFNC settings and mortality.</p><p><strong>Results: </strong>180 patients were randomized, with 169 (86 in the 40 L/min group and 83 in the 60 L/min group) included in the analysis. The primary outcome events occurred in 19 patients (22.1%) in the 40 L/min group and in 14 patients (16.9%) in the 60 L/min group (risk difference 5.2% [95% CI, -6.7% to 17.1%], P = 0.39). For secondary outcomes, the 40 L/min group was associated with a higher risk of escalation in respiratory support, defined as using NIV or up-titration of HFNC settings (24 [27.9%] vs 8 [9.6%], P = 0.002).</p><p><strong>Interpretation: </strong>In unselected extubated patients, setting the HFNC flow rate at 60 L/min did not reduce the risk of reintubation or NIV use compared to a flow rate of 40 L/min. Using a flow rate of 40 L/min with as-needed up-titration may be a reasonable alternative to setting the flow at 60 L/min for post-extubation care. However, this trial may not have been sufficiently powered to exclude a small between-group difference.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov; No.: NCT04934163.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913545","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":"Verifying Eligibility for Lung Cancer Screening via TiMeToAct Text Message Intervention: A Quality Improvement Initiative.","authors":"F Alonso Camacho, Gayatri Gujar, Arlette Chavez-Iniguez, Francisco Cartujano-Barrera, Kevin Fiscella, A Paula Cupertino, David H Adler, M Patricia Rivera","doi":"10.1016/j.chest.2024.12.023","DOIUrl":"https://doi.org/10.1016/j.chest.2024.12.023","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142902335","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":"Ascertainment of small airway dysfunction using oscillometry to better define asthma control and future risk: are we ready to implement it in clinical practice?","authors":"Rory Chan, Laura Gochicoa-Rangel, Marcello Cottini, Pasquale Comberiati, Erol A Gaillard, Francine M Ducharme, Stanley P Galant","doi":"10.1016/j.chest.2024.12.020","DOIUrl":"https://doi.org/10.1016/j.chest.2024.12.020","url":null,"abstract":"<p><p>The small airways comprise generations 8 to 23 of the bronchial tree, consist of airways with an internal diameter <2mm, and are classically difficult to assess and treat in persistent asthma. Small airways dysfunction (SAD) is integral to the asthma management paradigm as it is associated with poorer symptom control, greater levels of type 2 inflammation, and has been proposed as a potential treatable asthma trait. Although identification of SAD by oscillometry has been found to be clinically useful in managing asthma, very few physicians, including specialists, use this technique as part of standard or adjunct evaluation of lung function to diagnose asthma, grade severity of airway obstruction, ascertain disease control or the risk for future exacerbations or to make management decisions. To rectify the unrecognized value of oscillometry in the asthma community, a consortium of authors who are investigators with knowledge and experience of oscillometry wished to address the most important clinical questions raised by our colleagues who are considering using this technique, including its clinical utility. In this article, we discuss integral concepts including applicability of oscillometry as a predictive tool for asthma exacerbations and disease control; adequacy of spirometry and oscillometry in assessing SAD; potential limitations of oscillometry; as well as treatment options for SAD.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142902332","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":"Change in sleep quality Induced by adaptive servo-ventilation for central sleep apnea: 6-month follow-up of the multicenter nationwide French FACIL-VAA cohort.","authors":"Renaud Tamisier, Carole Philippe, Arnaud Prigent, Christelle Charley-Monaca, Marie-Pia d'Ortho, Thibaut Gentina, Frédéric Gagnadoux, Claire Launois, Vanessa Bironneau, Jean Pierre Mallet, Toufik Didi, Tiphaine Guy, Frédéric Goutorbe, Christophe Perrin, Sandrine Pontier-Marchandise, Jean-François Timsit, Jean-Louis Pépin, Jean-Claude Meurice","doi":"10.1016/j.chest.2024.12.015","DOIUrl":"https://doi.org/10.1016/j.chest.2024.12.015","url":null,"abstract":"<p><strong>Background: </strong>A large number of symptomatic individuals with central sleep apnea (CSA) in clinical practice have an indication for adaptive servo-ventilation (ASV) therapy.</p><p><strong>Research question: </strong>What are the effects of ASV therapy on sleep quality and PROMs in patients with CSA across a range of devices and indications.</p><p><strong>Methods: </strong>This prospective, multicenter, observational cohort study was conducted in France and enrolled participants from June 2017 to February 2020. Adults with predominant CSA at diagnosis or obstructive sleep apnea with central events not controlled with continuous positive airway pressure who had an indication for ASV were eligible. Participants attended clinic visits at baseline, and after 1, 3, 6 and 12 months of follow-up. The primary endpoint was the change in Pittsburgh Sleep Quality Index (PSQI) score from baseline to 6-month follow-up (evaluated using a Wilcoxon signed rank test on paired data).</p><p><strong>Results: </strong>We included 526 individuals (median age 69 years, 88.2% male). The indication for ASV included CSA with cardiovascular/neurologic etiology (38.4%), treatment-emergent CSA (36.1%), idiopathic CSA (14.1%) or drug-induced CSA (11.4%). At 6-month follow-up, study participants were using ASV for a median of 6.1 h/night. The median [interquartile range] change in the PSQI score from baseline to 6 months in the overall study population was -1 [-3; 0] (p<0.001), with significant results across all indications for ASV except for drug-induced CSA, where the median change was similar to the overall result but did not achieve statistical significance (-1 [-2; 1]; p=0.0866). Overall, 65% of participants had a ≥1-point improvement in the PSQI.</p><p><strong>Interpretation: </strong>Individuals with a clinical indication for ASV therapy experienced improved sleep quality during real-world treatment, irrespective of which ASV device was used.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876325","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":"Vascular Disturbances of the Skin in Patients Who Are Critically Ill: Lines, Dots, Patches.","authors":"Scott M Jackson, John P Miller, S Parker Yount, John R Godke, George H Karam","doi":"10.1016/j.chest.2024.11.043","DOIUrl":"10.1016/j.chest.2024.11.043","url":null,"abstract":"<p><p>When an understanding of pathogenesis exists, skin lesions that have the appearance of blood in the skin can provide insight into the mechanisms leading to a systemic process that results in cutaneous manifestations. Of the vascular disturbances of the skin that occur in patients who are critically ill, some result from a nonhemorrhagic process, whereas others represent bleeding into the skin. The lesions of livedo, petechiae, purpura, and ecchymoses can be approached from such a perspective. In their most characteristic forms, they develop because of problems with platelets, blood vessels, and hypocoagulability. The tactile component of palpability in their clinical evaluation can denote that inflammation is part of the process. The goal of this review is to provide a conceptual approach not only to the diagnosis of vascular disturbances of the skin, but also to the pathophysiologic processes occurring that might offer clues to the underlying disease process.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876326","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":"APOLLO Summary on Pulmonary Vascular Disease Fellowship Training.","authors":"Kristina Kudelko, Yon K Sung, Corey E Ventetuolo, Steven Kawut, Jeremy A Mazurek, Dana McGlothlin, Tim Lahm, Aaron Waxman, Roham Zamanian","doi":"10.1016/j.chest.2024.11.044","DOIUrl":"https://doi.org/10.1016/j.chest.2024.11.044","url":null,"abstract":"<p><p>Pulmonary vascular disease (PVD), and in particular, pulmonary hypertension (PH), is a highly specialized area of medicine comprised of complex diagnostics, classification systems, risk assessment tools, and therapeutics, the correct application of which has been shown to impact patient outcomes. The PVD scientific and patient community recognizes the importance of standardization of care patterns and has thus implemented a clinical accreditation process for PH care centers across the United States. However, a similar standardization system is lacking in PVD sub-specialty provider training. Non-Accreditation Council for Graduate Medical Education (ACGME) PVD advanced fellowships exist nationally, but do not provide a unified approach to trainee education. Therefore, first, a survey of all Pulmonary Hypertension Association (PHA)-accredited center directors across the U.S. was performed to gauge interest in a standardized educational initiative in the field of PVD. Second, a NAtional Consortium on PulmOnary VascuLar Disease FeLOwship Training (APOLLO) was founded to establish a common curriculum and set of training requirements across U.S. PVD programs. A particular emphasis was placed on the training requirements for provider competency in PH, because 1) reliable access to PH patients could be supported by all consortium institutions and 2) the consortium members felt that national PH training curriculums lacked standardization and detail. This article provides the results of the national survey, a guideline summary of the fellowship curriculum and training requirements, and a discussion of the impact of the consortium on PVD training and on the PVD subspecialty as a potential emerging formal discipline in internal medicine.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876324","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":"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":"https://doi.org/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 has sparked calls for health systems to drive innovation against racial bias in healthcare device and artificial intelligence markets by incorporating equity concerns explicitly into purchasing decisions.</p><p><strong>Research question: </strong>How do healthcare purchasing professionals integrate equity concerns into purchasing decision-making?</p><p><strong>Study design and methods: </strong>Between 8/2023-3/2024, we conducted semi-structured interviews via videoconferencing with healthcare 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 are currently integrated into healthcare purchasing decision-making. Healthcare purchasing professionals (N=30) worked in varied supply chain roles for various health systems and supply chain support and consulting companies across the US.</p><p><strong>Results: </strong>Healthcare 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 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 (GPOs), 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 a need for strong clinical partnership to ensure equitable performance. Explicit approaches for incorporating equitable performance into healthcare purchasing are likely needed.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-12-19","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}