Chest最新文献

{"title":"Neighborhood Level Socioeconomic Disadvantage and Adherence to Guidelines for the Evaluation of Patients with Incidentally Detected Pulmonary Nodules.","authors":"Jacob M Abrahams, Beth Creekmur, Janet Shin Lee, In-Lu Amy Liu, Mayra Macias, Michael K Gould","doi":"10.1016/j.chest.2024.12.011","DOIUrl":"https://doi.org/10.1016/j.chest.2024.12.011","url":null,"abstract":"<p><strong>Background: </strong>The management of incidental pulmonary nodules is guided by recommendations set forth by the Fleischner Society. While most pulmonary nodules are benign, timely and evidence-based follow-up can reduce morbidity and mortality. There are known socioeconomic disparities for engagement with recommended cancer screenings, however it is unclear whether disparities exist for follow-up of incidentally detected pulmonary lesions.</p><p><strong>Research question: </strong>Do patients residing in more socioeconomically deprived neighborhoods have reduced likelihood of adherence to guideline-recommended follow-up of incidentally detected pulmonary nodules?</p><p><strong>Study design and methods: </strong>We assembled a retrospective cohort of 32,965 patients within a large, regional integrated healthcare system with a defined membership who had a pulmonary nodule ≤30mm identified on diagnostic CT between 2012 and 2016. Patients with prior history of malignancy were excluded. Participants were subsequently divided into quartiles utilizing the Neighborhood Deprivation Index as a metric for socioeconomic status. Adherence was ascertained utilizing ICD-9 or CPT coded imaging or biopsy to determine if follow-up was performed within an interval specified by 2005 Fleischner Society Guidelines (with a +/-33% margin of error), based on each patient's nodule characteristics. Negative binomial regression was performed to determine the association between neighborhood level deprivation and adherence to guideline-concordant care, with and without adjustment for plausible confounders.</p><p><strong>Results: </strong>Only 49.6% of patients had follow-up imaging or other diagnostic procedure performed within the guideline-recommended timeframe. There was a 3% reduction in adherence to follow-up for patients residing in the most socioeconomically deprived neighborhood quartile (relative risk [RR]=0.97; 95% CI 0.94 to 1.0) compared with the least deprived quartile. Smoking status was also associated with worse adherence (former vs never, RR= 0.67; 95% CI 0.65 to 0.69) current vs never, RR= 0.73; 95% CI 0.70 to 0.76). Multi-morbidity, and CHF in particular, was associated with decreased adherence to guideline-recommended care (Charlson Comorbidity Index of 3 vs 0, RR:0.93; 95% CI 0.89 to 0.97; History of CHF, RR: 0.93; 95% CI 0.90 to 0.97).</p><p><strong>Interpretation: </strong>In the context of poor adherence overall, patients residing in the most socioeconomically deprived neighborhoods were less likely to receive care in concordance with Fleischner Society recommendations for management of incidental pulmonary nodules.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853129","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":"Managing Cavitary Coccidioidomycosis Expert Opinions for Improving Patient Outcomes.","authors":"Fariba M Donovan, George R Thompson, Janis E Blair, Royce H Johnson, Josh Malo, Waseem Albasha, Stephanie G Worrell, Staci E Beamer, Kavitha Yaddanapudi, John N Galgiani, Neil M Ampel","doi":"10.1016/j.chest.2024.12.001","DOIUrl":"10.1016/j.chest.2024.12.001","url":null,"abstract":"<p><p>Coccidioidomycosis, caused by the dimorphic fungi Coccidioides immitis and Coccidioides posadasii, is recognized as an increasing threat both nationally and worldwide. This is in large part secondary to the expanding range of Coccidioides species and increased international travel to endemic regions. Most individuals exposed to airborne Coccidioides organisms do not need medical attention, but approximately 30% will demonstrate primary pulmonary coccidioidomycosis with signs and symptoms that mimic community-acquired pneumonia or other respiratory illnesses. Further, 5% of those with a diagnosis of pulmonary coccidioidomycosis will demonstrate serious and even life-threatening manifestations, including extrapulmonary or disseminated coccidioidomycosis. Of those who demonstrate pulmonary coccidioidomycosis, past evidence suggests that approximately 5% to 15% will experience long-term pulmonary sequelae in the form of nodules, abscesses, or cavitary lesions. These lesions may not be easily distinguished from malignancy or other infections, such as TB, and they add a substantial burden to both patients and the health care system. Despite the long-term consequences of cavitary coccidioidomycosis in some individuals, the current literature review and practice guidelines demonstrate a paucity of clear management strategies to treat these patients. In this report, we focus on cavitary lesions in coccidioidomycosis with the goal of presenting a description of the evaluation and management of their various forms, manifestations, and complications. These recommendations are derived from a multidisciplinary group of experts.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827568","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 Effects of Low-Dose Morphine on Sleep and Breathlessness in COPD: A Randomized Trial.","authors":"Thomas James Altree, Alison Pinczel, Barbara Toson, Kelly Loffler, Anna Hudson, Jim Zeng, Simon Proctor, Ganesh Naik, Sutapa Mukherjee, Peter Catcheside, Andrew Somogyi, David Currow, Danny Eckert","doi":"10.1016/j.chest.2024.11.040","DOIUrl":"10.1016/j.chest.2024.11.040","url":null,"abstract":"<p><strong>Background: </strong>Low-dose morphine may be prescribed to reduce chronic breathlessness in COPD. Subjective findings suggest morphine may influence breathlessness through sleep-related mechanisms. However, concerns exist regarding opioid safety in COPD. The effects of morphine during sleep in COPD have not been objectively investigated. This study aimed to objectively determine the effects of low-dose morphine on sleep in COPD.</p><p><strong>Research question: </strong>What are the effects of low-dose morphine on sleep efficiency and other sleep parameters in COPD?</p><p><strong>Study design and methods: </strong>This was a randomized, double-blind, crossover trial of sustained-release morphine (20 mg/d for 3 days) (steady-state) vs placebo in 19 breathless people with COPD (n = 7 women). The primary outcome was sleep efficiency during in-laboratory overnight polysomnography. Secondary and exploratory outcome measures included sleep-disordered breathing (events/h), oxygenation, transcutaneous CO₂ levels, blood and physiology biomarkers, the relationship between sleep and breathlessness, external resistive load responses, and driving simulator performance. Physiology outcomes and pharmacokinetics were measured before and after each polysomnogram.</p><p><strong>Results: </strong>Sleep efficiency was similar between placebo and morphine (66 ± 17% vs 67 ± 19%; P = .89). Morphine did not change the frequency of sleep-disordered breathing events but reduced breathing frequency. Morphine reduced mean and nadir overnight oxygen saturation by 2% (95% CI, -2.8% to -1.2%) and 5% (95% CI, -8% to -1%), respectively. Mean transcutaneous CO₂ was 3.3 mm Hg (95% CI, 1.6-5.1 mm Hg) higher during sleep with morphine vs placebo. Eight participants (42%) met American Academy of Sleep Medicine criteria for nocturnal hypoventilation with morphine vs four (21%) receiving placebo (P = .02). Morphine did not systematically reduce breathlessness or impair next-day driving simulator performance. Adverse events (most frequently nausea) were increased with morphine.</p><p><strong>Interpretation: </strong>Steady-state, low-dose morphine does not change sleep efficiency, sleep-disordered breathing frequency, or next-day alertness but may cause hypoventilation during sleep, a potentially harmful effect.</p><p><strong>Clinical trial registration: </strong>Australian New Zealand Clinical Trials Registry; No.: ACTRN12621000752864; URL: https://www.anzctr.org.au.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827584","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":"Performance of Lung Ultrasound as a Screening Tool for Subclinical Rheumatoid Arthritis-Associated Interstitial Lung Disease: A Multicenter Study.","authors":"Maria Otaola, Eirini Vasarmidi, Sébastien Ottaviani, Marwin Gutierrez, Marina Soledad Dalpiaz, Adrian Gaser, Pierre-Antoine Juge, Chiara Bertolazzi, Nestor Avgoustidis, Christos Skiadas, Maricel Della Maggiora, Paola Orausclio, Alan Quintana-Rodriguez, Marie-Pierre Debray, Barbara Perez Cepas, Emilce Schneeberger, Prodromos Sidiropoulos, Nicolas Lloves Schenone, Marcos Rosemffet, Sebastian Marciano, Katerina Antoniou","doi":"10.1016/j.chest.2024.11.038","DOIUrl":"10.1016/j.chest.2024.11.038","url":null,"abstract":"<p><strong>Background: </strong>The screening strategy for interstitial lung disease (ILD) in patients with rheumatoid arthritis is currently debated. Although high-resolution CT (HRCT) imaging is the gold standard for diagnosing ILD, its systematic use as a screening tool is not yet recommended. The role of lung ultrasound (LUS) in assessing ILD has been previously explored.</p><p><strong>Research question: </strong>What is the performance of LUS for ILD diagnosis in asymptomatic patients with rheumatoid arthritis?</p><p><strong>Study design and methods: </strong>We conducted a multicenter, cross-sectional study involving 203 asymptomatic patients with rheumatoid arthritis from outpatient clinics in Argentina, Greece, France, and Mexico. Participants underwent clinical evaluations, pulmonary function tests, and LUS. An HRCT scan was performed on each patient within 30 days of the LUS. Statistical analyses included sensitivity, specificity, and predictive values for LUS and pulmonary function tests.</p><p><strong>Results: </strong>Of the participants, 26% were diagnosed with ILD. The median age was 63 years (52-89 years), and 161 (79.3%) patients were female. The median duration from rheumatoid arthritis diagnosis to inclusion was 7 years (range, 2-16 years). LUS exhibited a sensitivity of 83% (95% CI, 70.2%-91.9%) and a specificity of 81.2% (95% CI, 74.2%-87.2%), with a negative predictive value of 93.1% (95% CI, 87.4%-96.8%) and a positive predictive value of 61.1% (95% CI, 58.9%-72.4%). LUS outperformed pulmonary function tests, underscoring its potential as a primary screening tool.</p><p><strong>Interpretation: </strong>LUS is a promising tool for ILD screening in asymptomatic patients with rheumatoid arthritis, offering high sensitivity and negative predictive value. Its incorporation into routine clinical practice could optimize ILD screening strategies and enhance patient outcomes through early detection and intervention.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827582","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":"Missed Opportunities for Lung Cancer Screening Among Patients With Behavioral Health Disorders With Elevated Cigarette Smoking Rates: Lung Cancer Screening and Behavioral Health.","authors":"Anastasia Rogova, Lisa M Lowenstein, Lorraine R Reitzel, Kathleen Casey, Robert J Volk","doi":"10.1016/j.chest.2024.11.039","DOIUrl":"10.1016/j.chest.2024.11.039","url":null,"abstract":"<p><p>Annual lung cancer screening using low-dose CT (LDCT) imaging effectively reduces mortality from lung cancer and is recommended for people who are at high risk of developing the disease. The utilization of lung cancer screening, however, has remained low. Due to significantly higher cigarette smoking rates, patients with behavioral health disorders (those living with mental illness and/or substance use disorders) are more likely to be diagnosed with and die of lung cancer; at the same time, they are less likely to undergo cancer screenings. There is an urgent need for targeted efforts to improve access to lung cancer screening among this population disproportionately affected by the disease. In this commentary, we propose integrating lung cancer screening facilitation into services provided by behavioral health professionals who are uniquely positioned to reach these patients and deliver interventions to increase uptake of cancer screenings. We suggest several measures that could improve lung health outcomes of patients with behavioral health disorders: (1) training behavioral health professionals in lung cancer screening eligibility assessment; (2) providing patients with educational materials; (3) integrating shared decision-making counseling for lung cancer screening into behavioral health care settings; (4) providing the practical support needed to access screening; and (5) establishing effective partnerships with community organizations. Regardless of the level of engagement, possibly ranging from brief training to the implementation of comprehensive programs, any involvement will benefit patients. This integrated approach will contribute to reducing lung cancer mortality among patients with behavioral health disorders who have long experienced systemic health inequities.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823998","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":"Promoting Prevention and Targeting Remission of Asthma: A European Forum for Research and Education in Allergy and Airway Diseases Consensus Statement on Raising the Bar in Asthma Care.","authors":"Milos Jesenak, Anna Bobcakova, Ratko Djukanovic, Mina Gaga, Nicola A Hanania, Liam G Heaney, Ian Pavord, Santiago Quirce, Dermot Ryan, Wytske Fokkens, Diego Conti, Peter W Hellings, Glenis Scadding, Elizabeth Van Staeyen, Leif H Bjermer, Zuzana Diamant","doi":"10.1016/j.chest.2024.11.035","DOIUrl":"10.1016/j.chest.2024.11.035","url":null,"abstract":"<p><p>Asthma is a common multifaceted respiratory disease with a major impact on quality of life. Despite increased insights into mechanisms underlying various asthma phenotypes and endotypes and the availability of targeted biologic treatment options, the disease remains uncontrolled in a substantial proportion of patients with risk of exacerbations, requiring systemic corticosteroids, and with progressive disease. Current international guidelines advocate a personalized management approach to patients with uncontrolled severe asthma. The European Forum for Research and Education in Allergy and Airway Diseases asthma expert panel was convened to discuss strategies to optimize asthma care and to prevent systemic corticosteroid overuse and disease progression. In this meeting report, we summarize current concepts and recommendations and provide a rationale to implement personalized asthma management at earlier stages of the disease. The ultimate goal is to move away from the current one-size-fits-most concept, which focuses on a symptom-driven treatment strategy, and shift toward a phenotype- and endotype-targeted approach aimed at curbing the disease course by improving clinical outcomes and preserving health-related quality of life. Herein, we provide a consensus view on asthma care that advocates a holistic approach and highlight some unmet needs to be addressed in future clinical trials and population studies.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142821957","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":"Virtual Reality Anatomy Trainer Turns Teaching Endobronchial Ultrasound Inside-Out.","authors":"Melissa L New, Tristan J Huie, Dru Claar, Timothy Amass, Ryan A Peterson, Max McGrath, Nicholas Jacobson, Anna Neumeier, Darlene Nelson","doi":"10.1016/j.chest.2024.11.032","DOIUrl":"10.1016/j.chest.2024.11.032","url":null,"abstract":"<p><strong>Background: </strong>Traditional approaches for learning anatomy for curvilinear endobronchial ultrasound (EBUS) require learners to mentally visualize structures relative to the position of the bronchoscope. Virtual reality (VR) can show anatomy from the perspective of bronchoscopic tools.</p><p><strong>Research question: </strong>Does the use of a VR anatomy trainer for teaching EBUS-associated anatomy improve procedural performance compared with traditional methods?</p><p><strong>Study design and methods: </strong>In this randomized, crossover study design, participants studied EBUS-related anatomy during two sequential sessions using a VR trainer and a traditional modality (two-dimensional pictures or a three-dimensional model). An EBUS simulator was used to test performance at baseline and following each training session. User experience and preferences were evaluated by using a mixed-methods approach of surveys and interviews. Spatial reasoning ability was measured by using the Mental Rotation Test.</p><p><strong>Results: </strong>Sixty-eight fellows and residents at three institutions completed the study. All three learning methods improved EBUS performance significantly following the first, but not second, learning session. Learners spent more time (1.37 minutes) with VR, but no training method produced a greater improvement. Spatial reasoning ability was associated with improved EBUS performance. This impact was modified by training method: the VR approach leveled the impact of baseline spatial reasoning. The VR approach was preferred by 96% of learners. Qualitative data revealed a positive VR user experience with focused anatomy learning, ease of use, acceptable realism, and tolerance. This novel \"inside-looking-out\" perspective helped learners understand anatomy from the vantage of procedural tools and to create a mental map, but interpreting ultrasound remained challenging.</p><p><strong>Interpretation: </strong>A VR anatomy trainer was preferred by learners because it provided visualization that aligned best with the procedural perspective. This approach helped learners of all spatial reasoning ability improve their procedural performance.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812007","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":"Leveraging Patient Advocacy and Faith-Based Partnerships to Educate, Activate, and Prepare Black Communities to Be Screened for Lung Cancer.","authors":"Sydney J Lloyd, Kathy A Levy, Alana S Boyd, Joelle T Fathi","doi":"10.1016/j.chest.2024.11.030","DOIUrl":"10.1016/j.chest.2024.11.030","url":null,"abstract":"<p><p>Lung cancer is the second most common and the deadliest cancer for men and women in the United States. Historical and current-day injustices, implicit and explicit bias, stigma, social determinants, and disparities contribute to inequitable lung cancer-related health outcomes for Black and African American people comparatively. Despite being a preventive health recommendation for more than a decade, the percentage of eligible individuals screened remains low. Burgeoning lung cancer screening programs have established capacity and opened access across the country, but screening rates remain exceedingly poor, especially among people of color. More intentional efforts must be made, and socially conscious and population-specific methods must be undertaken to ensure all eligible individuals realize the benefits of screening. Partnerships between advocacy for patients with lung cancer and faith-based organizations are a natural leverage point to educate, prepare, and empower Black health ministries to disseminate lung cancer-related health information to their faith communities. This How I Do It article shares an approach to community outreach and engagement in Black churches in the South, informed by established principles and best practices and the perspectives and skills only lived experiences can offer.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791179","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":"Stability of Fractional Exhaled Nitric Oxide and Its Relationship With Exacerbation in Patients Aged 6 Years or Older With Uncontrolled, Moderate-to-Severe Asthma.","authors":"William W Busse, Ian D Pavord, Michael E Wechsler, Ignacio J Davila, Arman Altincatal, Lucia de Prado Gomez, Xavier Soler, Harry Sacks, Juby A Jacob-Nara, Yamo Deniz, Paul J Rowe","doi":"10.1016/j.chest.2024.09.048","DOIUrl":"10.1016/j.chest.2024.09.048","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779518","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":"Nontuberculous Mycobacterial Infection and Pulmonary Disease in Northern Israel: A Focus on Mycobacterium simiae.","authors":"Razi Even-Dar, Idit Raz, Maya Brodsky, Nili Stein, Yochai Adir, Walid Saliba, Shifra Ken-Dror, Ronza Najjar-Debbiny, Raya Cohen, Michal Shteinberg","doi":"10.1016/j.chest.2024.11.026","DOIUrl":"10.1016/j.chest.2024.11.026","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of nontuberculous mycobacteria (NTM) pulmonary disease is rising globally. Previously, we described a high prevalence of Mycobacterium simiae isolation in Israel.</p><p><strong>Research question: </strong>What is the prevalence of NTM pulmonary disease and M simiae pulmonary disease in Northern Israel? Which factors are associated with mortality among people with NTM?</p><p><strong>Study design and methods: </strong>We retrospectively recorded all samples from Clalit Health Services-Haifa District reference mycobacteria laboratory for growth of NTM between January 2010 and March 2021. We manually reviewed a random sample of corresponding patients' electronic medical files and extracted demographic, clinical, and radiologic data, and data on the course of the disease. Univariate and multivariate analyses were performed to assess factors associated with features of NTM pulmonary disease and mortality.</p><p><strong>Results: </strong>A total of 2,968 clinical isolates from 1,501 people yielded NTM species. The relative abundance of M simiae, Mycobacterium avium complex (MAC), and other species increased over the study period. Among the 550 patients' files reviewed, clinical presentation, fulfilment of established criteria for NTM pulmonary disease, and mortality rates were not significantly different between patients with M simiae, MAC, and Mycobacterium kansasii/Mycobacterium szulgai, with 27.7%, 35.3%, and 27.8% of people fulfilling criteria for NTM pulmonary disease. Factors associated with mortality included age, male sex, and immunosuppression. Compared with MAC isolation, M simiae was associated with elevated mortality (hazard ratio, 1.84; 95% CI, 1.05-3.23). The extrapolated national annual incidence rate of NTM pulmonary disease was 1.7 to 2.0 per 100,000 population.</p><p><strong>Interpretation: </strong>Infection with M simiae is prevalent in Israel, and although considered minimally pathogenic, demonstrated similar clinical and radiologic features to MAC pulmonary disease.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779516","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}