Annals of the American Thoracic Society最新文献

Rationale: Cough is a common symptom of undiagnosed respiratory conditions. Objectives: To investigate cough in adults with undiagnosed respiratory symptoms and its association with quality of life (QoL), sleep quality, and healthcare utilization for respiratory illness. Methods: We used a case-finding strategy to find community-dwelling adults with respiratory symptoms but no previous history of diagnosed lung disease. Pre and postbronchodilator spirometry determined if participants met diagnostic criteria for asthma, chronic obstructive pulmonary disease (COPD), or preserved ratio impaired spirometry, or if they had normal spirometry. Twelve questions from the Asthma Screening Questionnaire, COPD Assessment Test, and the St. George's Respiratory Questionnaire were used to develop a cough score. The 36-Item Short Form Survey and Global Sleep Assessment Questionnaire were used to assess QoL and sleep quality, respectively. Results: Adults with undiagnosed respiratory symptoms (n = 2,857; mean score, 57.8; 95% confidence interval [CI], 56.9 to 58.6) reported higher cough scores than age-matched control subjects (n = 231; mean score, 17.7; 95% CI, 15.6 to 19.8). Participants found to have asthma (n = 265; mean score, 61.0; 95% CI, 58.2 to 63.7) and COPD (n = 330; mean score, 61.8; 95% CI, 59.3 to 64.3) had higher cough scores than those with preserved ratio impaired spirometry (n = 172; mean score, 54.5; 95% CI, 51.1 to 58.0) or normal spirometry (n = 2,090; mean score, 57.0; 95% CI, 56.0 to 58.0). Higher cough scores were associated with decreased QoL (lower 36-Item Short Form Survey score; regression coefficient, -0.19; 95% CI, -0.22 to -0.17; P < 0.001), worse sleep quality (higher Global Sleep Assessment Questionnaire score; regression coefficient, 0.16; 95% CI, 0.14 to 0.18; P < 0.001), and higher healthcare utilization for respiratory illness (incidence rate ratio, 1.007; 95% CI, 1.004 to 1.010; P < 0.001). Conclusions: In adults with undiagnosed respiratory symptoms, cough was most severe in those with undiagnosed asthma or COPD and was independently associated with worse QoL, impaired sleep quality, and higher healthcare utilization for respiratory illness.

Rationale: Rural Americans experience higher rates of smoking and smoking-associated disease than urban Americans. Household rules limiting smoking inside the home decrease secondhand smoke exposure and may facilitate quitting among those who smoke. Limited research suggests that rural Americans are less likely to report household smoking restrictions. Objective: To study the relationship between rurality and household rules limiting combustible tobacco, noncombustible tobacco, and electronic cigarette (e-cigarette) use. Methods: Cross-sectional data for 10,126 U.S. respondents aged ⩾40 years from the Population Assessment of Tobacco and Health Study Wave 5 (2018-2019) were used to assess the relationship between residence rurality (rural, small town, suburban, urban) and household rules limiting combustible tobacco, noncombustible tobacco, or e-cigarette use. Multivariable Poisson regression analyses were adjusted for respondent age, sex, race, education, family income, and product use. Results: Rural (vs. urban) respondents more commonly allowed combustible tobacco (17.6% vs. 13.6%), noncombustible tobacco (26.4% vs. 16.4%), and e-cigarette use (20.8% vs. 15.1%) in the home. The fully adjusted risk ratios (ARRs) for rural (vs. urban) homes were 1.27 (95% confidence interval [CI], 1.12, 1.44) for combustible tobacco, 1.36 (95% CI, 1.20, 1.54) for noncombustible tobacco, and 1.34 (95% CI, 1.17, 1.55) for e-cigarettes. Small-town respondents had similarly increased ARRs, whereas suburban respondents' ARRs were not different from the urban reference group's. Conclusions: Rural and small-town Americans were more likely than urban respondents to allow household use of all tobacco product types. This pattern persisted when adjusted for socioeconomic factors and respondent product use. These findings may help address tobacco-related diseases that disproportionately affect rural Americans.

Rationale: Elexacaftor/tezacaftor/ivacaftor (ETI) has significantly improved lung function in people with cystic fibrosis (CF), prompting the need for outcome measures that can detect mild disease. In this new era of CFTR (CF transmembrane regulator) modulator therapy, more sensitive endpoints are required to evaluate the progression of early lung disease and to determine the efficacy of new CF therapies. Before the availability of highly effective therapies, xenon-129 magnetic resonance imaging (MRI) was shown to be more sensitive to regional ventilation changes compared with spirometry. Objectives: To evaluate the longitudinal changes in pulmonary function and Xe MRI outcomes after treatment with ETI in children and young people with CF. Methods: Lung function was assessed longitudinally at baseline and 1, 6, and 12 months after ETI treatment initiation in children and young people with CF between the ages of 6 and 18 years at four study sites. Ventilation defect percentage (VDP), reader defect percentage (RDP), lung clearance index (LCI) and forced expiratory volume in 1 second (FEV₁) were reported. Results: A total of 28 participants were enrolled; 25 completed at least baseline and one-month measurements. All four measures (RDP, VDP, LCI, and FEV₁) improved at one month after ETI initiation, with mean (standard deviation) absolute changes of -1.2 (1.7) in LCI, 6.9 (12.3) in FEV₁ % predicted, -4.3 (4.8) in VDP, and -7.8 (9.6) in RDP. Xe MRI outcomes (RDP and VDP) showed the largest relative treatment effects, with mean relative improvements of 43% and 72%, respectively. One-third of participants (8 of 25) had improvements in VDP and RDP but did not show improvements in FEV₁. Conclusions: Xe MRI captures sustained ventilation improvements after ETI initiation. Xe MRI metrics may provide a suitable endpoint for future interventional trials, particularly for people with CF with mild lung disease.

Rationale: Oscillometry is a feasible and safe method to measure pulmonary function in children with asthma exacerbations in the emergency department (ED), but its utility to measure respiratory impedance as an objective marker of response to initial acute asthma treatments is unknown. Objectives: We sought to determine the associations between respiratory impedance-derived metrics and asthma exacerbation severity and treatment response in the pediatric ED. Methods: We conducted a prospective study of children, ages 4-18 years, who presented to a tertiary-care pediatric ED for asthma exacerbations. Respiratory system impedance was measured with oscillometry before and after initial treatment with inhaled bronchodilators and systemic corticosteroids. Regression models estimated the associations between respiratory impedance-derived metrics (low-frequency resistance, R7, a measure of total airway obstruction; frequency dependence of resistance, R7-19, a measure of peripheral airway resistance; and reactance area, AX, a measure of lung tissue stiffness and variability in ventilation), vital signs, and clinical outcomes. Receiver operating characteristic analyses were used to quantify the ability of respiratory impedance-derived metrics and vital signs to discriminate outcomes. Results: Of 177 participants, 144 (81%) completed a valid initial oscillometry assessment. Forty-seven percent had moderate or severe exacerbations, and 61% met the treatment response definition. Frequency dependence of resistance (R7-19: adjusted odds ratio [aOR], 1.39; 95% confidence interval [CI] = 1.08-1.83) and area of reactance (AX: aOR, 1.28; 95% CI = 1.05-1.58), were associated with higher odds of moderate or severe exacerbation. Greater initial R7-19 was associated with decreased odds of treatment response (aOR, 0.75; 95% CI = 0.57-0.98). A combination of impedance-derived metrics and vital signs best differentiated exacerbation severity (area under the curve [AUC] = 0.73), treatment response (AUC = 0.69), and hospitalization (AUC = 0.78). Conclusions: Respiratory impedance-derived metrics (R7, R7-19, and AX), in combination with vital signs, can guide ED clinical decisions and improve outcomes for children with asthma exacerbations.