Annals of the American Thoracic Society最新文献

Rationale: Although previous studies have assessed the clinical or economic value of specific technologies, the economic value of improving sensitivity for malignancy in lung cancer diagnoses broadly across technologies is unclear. Objectives: To identify the economic value of improving sensitivity of bronchoscopy biopsy for the diagnosis of lung cancer. Methods: A decision analytic model was developed to quantify the economic value of increased sensitivity for malignancy for bronchoscopy biopsy of peripheral pulmonary lesions. Primary clinical outcomes included time to diagnosis and survival. Economic outcomes included 1) net monetary benefit (NMB), defined as the health benefits measured in quality-adjusted life-years (QALYs) times willingness to pay ($100,000/QALY) net of changes in medical costs; and 2) incremental cost-effectiveness ratio. A decision tree modeling framework with two Markov module branches was developed. The two Markov modules corresponded to patients with cancer who were 1) diagnosed and treated or 2) undiagnosed and remained untreated. Outcomes were measured from a U.S. payer perspective over 30 years. Results: Improving sensitivity for malignancy by 10 percentage points decreased average time to diagnosis for patients with lung cancer by 0.85 month (4 wk) and increased survival by 0.36 year (19 wk) because of faster treatment initiation. Overall health outcomes improved by 0.20 QALYs per patient. Cost increased by $6,727 per patient primarily through increased treatment costs among those diagnosed with cancer. Increasing sensitivity for malignancy by 10 percentage points improved NMB by $8,729 over 30 years (incremental cost-effectiveness ratio of $34,052), driven largely by improved sensitivity to early-stage cancer (stage-specific NMB, I/II, $19,805; III, $2,101; IV, -$1,438). Forty-two percent of overall NMB ($3,668) accrued within 5 years of biopsy. The relationship between change in sensitivity and NMB was approximately linear (1% vs. 10% sensitivity improvement corresponded to NMB of $885 vs. $8,729). The model was most sensitive to cancer treatment efficacy and follow-up time after a negative result. Conclusions: Increasing sensitivity of malignancy by 10 percentage points resulted in a $8,729 improvement in net economic value. Health systems can use this information when making decisions regarding the value of new bronchoscopy technologies.

Rationale: Idiopathic pulmonary fibrosis (IPF) is a complex and heterogeneous disease. Given this, we reasoned that differences in genetic profiles may be associated with unique clinical and radiologic features. Computational image analysis, sometimes referred to as radiomics, provides objective, quantitative assessments of radiologic features in subjects with pulmonary fibrosis.

Objective: To determine if the genetic risk profile of patients with IPF identifies unique computational imaging phenotypes.

Methods: Participants with IPF were included in this study if they had genotype data and CT scans of the chest available for computational image analysis. Extent of lung fibrosis and likelihood of a usual interstitial pneumonia (UIP) pattern were scored automatically by using two separate, previously validated deep learning techniques for CT analysis. UIP pattern was also classified visually by radiologists according to established criteria.

Measurements and main results: Among 334 participants with IPF, MUC5B, FAM13A and ZKSCAN1 were independently associated with the deep learning-based UIP score. None of the common variants were associated with fibrosis extent by computational imaging. We did not find an association between MUC5B, FAM13A or ZKSCAN1 and visually assessed UIP pattern.

Conclusions: Select genetic variants are associated with computer-based classification of UIP on CT among patients with IPF. Analysis of radiologic features using deep learning may enhance our ability to identify important genotype-phenotype associations in fibrotic lung diseases.

Background: Hispanic/Latino adults commonly experience high psychosocial stress yet little is known about the pathways linking sociocultural stressors and asthma in this population.

Objective: Whether and how sociocultural stressors are associated with asthma in Hispanic/Latino adults.

Methods: Cross-sectional study of 4,759 adults aged 18 to 74 years who participated in the Sociocultural Ancillary Study of the Hispanic Community Health Study/Study of Latinos. All participants completed a sociocultural assessment including acculturative stress, perceived ethnic discrimination, neighborhood problems, neighborhood social cohesion, and a cumulative measure of all sociocultural stressors. Weighted multivariable logistic regression accounting for sampling design was used for the analysis of sociocultural stressors and current asthma or current asthma symptoms. A mediation analysis was conducted to estimate the contributions of depressive symptoms and anxiety to the cumulative sociocultural stressors-asthma association.

Results: Acculturative stress and neighborhood problems were associated with 1.4 to 2.1-times higher odds of current asthma or current asthma symptoms, and perceived ethnic discrimination was associated with 1.4-times higher odds of current asthma symptoms. Neighborhood social cohesion was associated with 0.6-times lower odds of asthma. Cumulative sociocultural stressors were associated with 1.6-times higher odds of current asthma symptoms (OR for < median vs ≥ median value=1.60 [95% CI=1.29, 1.99). Depressive symptoms and anxiety explained 26% and 22%, respectively, of the association between cumulative sociocultural stressors and asthma symptoms.

Conclusions: Among Hispanic/Latino adults, sociocultural stressors were associated with current asthma or asthma symptoms. Depressive symptoms and anxiety partly mediated this association. Clinicians caring for Hispanic/Latino adults with asthma should be aware of potential stressors and comorbidities such as depression and anxiety.

Rationale: Despite advancements in screening, lung cancer remains the leading cause of cancer-related mortality globally.

Objectives: To investigate respiratory function as a prognostic factor for survival in the UK Biobank, a population-based cohort of over 500,000 participants, and the National Lung Screening Trial (NLST), a high-risk screening population of over 50,000 screenees.

Methods: Participants with an incident lung cancer diagnosis and spirometry-assessed lung function were included. Lung cancer was measured as the ratio of forced expiratory volume in 1-second (FEV1) and forced vital capacity and percentage of predicted FEV1. Multivariable Cox proportional hazards models were fitted to estimate the impact of lung function on 5-year overall survival in populations with different baseline lung cancer risks.

Measurements and main results: 2,690 and 609 patients were included in the analysis from the UK Biobank and the NLST, respectively. In the UK Biobank, a higher percentage of predicted FEV1 and ratio were associated with better survival after lung cancer diagnosis with hazard ratios of 0.97 (95% CI: 0.95 - 1.00, per 10% increase) and 0.95 (95% CI: 0.90 - 1.00, per 10% increase), respectively. No statistically significant results were found when assessing the data from the NLST study.

Conclusions: Impaired lung function was associated with poorer survival for lung cancer patients in the general population, although this was less clear in a high risk, screening eligible population. This highlights the potential clinical importance of respiratory function as a prognostic factor in lung cancer in the general population and presents a possibility for personalized cancer management.

Rationale: The Bronchiectasis Health Questionnaire (BHQ) is a concise, self-administered and disease-specific instrument for measuring health-related quality-of-life (HRQoL) in bronchiectasis.

Objectives: To investigate the psychometric properties of simplified Mandarin BHQ and determine the minimum clinically important difference (MCID) as a reliable clinical endpoint for assessing the efficacy of bronchiectasis treatments.

Methods: A longitudinal, randomized controlled trial cohort of 357 patients treated with tobramycin inhalation solution or saline inhalation for Pseudomonas aeruginosa infection, along with a cross-sectional observational cohort including 436 patients with bronchiectasis were analyzed. Psychometric analyses encompassed convergent validity, known-groups validity, internal consistency, test-retest reliability, and responsiveness. Both anchor-based and distribution-based approaches were utilized to calculate the MCID for therapeutic response.

Results: There were significant positive correlations between BHQ scores and the Quality of Life - Bronchiectasis Respiratory Symptom Scale (QoL-B-RSS), with correlation coefficient 0.698 in the trial cohort and 0.567 in the clinical cohort (both P<0.0001). Known-groups validity indicated significant differences in BHQ scores stratified by baseline Bronchiectasis Severity Index. BHQ scores correlated modestly with both FEV1% predicted and exacerbation frequency within the previous year. In the trial cohort, BHQ demonstrated excellent internal consistency (Cronbach's alpha: 0.893) and test-retest reliability (intraclass correlation coefficient: 0.853). An 8-point improvement in QoL-B-RSS corresponded to a mean increase of 5.49 points in BHQ scores after 4-week treatment. The MCID for BHQ was consistently 3 points.

Conclusions: The BHQ (MCID: 3 points) represents a clinically meaningful tool for evaluating therapeutic intervention outcomes and patient-centered outcomes in patients with bronchiectasis.