CHEST pulmonary最新文献

{"title":"Dose-Response Effect of Physical Prehabilitation on Major Cardiac and Cerebrovascular Events and Disability Levels After Cardiac Surgery in Frail Patients","authors":"Anna Lee PhD, MPH ,&nbsp;Derek K.W. Yau PhD, MScMed(PainMgt) ,&nbsp;Gavin M. Joynt MBBCh, FCICM ,&nbsp;Kwok M. Ho PhD, MPH","doi":"10.1016/j.chpulm.2025.100213","DOIUrl":"10.1016/j.chpulm.2025.100213","url":null,"abstract":"<div><h3>Background</h3><div>Prehabilitation enhances patients’ resilience to surgical stress and may improve postoperative outcomes. However, the dose response of prehabilitation on outcomes remains unknown.</div></div><div><h3>Research Question</h3><div>Does a twice-weekly supervised outpatient exercise program before elective cardiac surgery in patients with frailty have dose-response effects on 90-day postoperative major cardiac and cerebrovascular events (MACCEs) and disability levels?</div></div><div><h3>Study Design and Methods</h3><div>This was a post hoc analysis of the PREhabilitation for improving QUality of recovery after ELective cardiac surgery (PREQUEL) trial that compared physical prehabilitation (up to 19 sessions over 10 weeks) with usual care in participants with very mild to moderate frailty. Primary outcomes included the 90-day risk of MACCEs and changes in disability levels measured by the World Health Organization Disability Assessment Schedule 2.0 score. Secondary outcomes were preoperative changes in the 6-minute walk test distance, submaximal metabolic equivalents of tasks, and frailty measures. We used a generalized estimating equation model to examine the association between the dose of prehabilitation and the risk of MACCEs. Causal inference was assessed by dose-response function models while allowing nonlinearity.</div></div><div><h3>Results</h3><div>Of the 143 participants, 135 underwent cardiac surgery. No exercise-induced adverse events occurred in 64 participants during 551 sessions. The dose of prehabilitation was not associated with the risk of MACCEs (16 participants with 24 episodes; adjusted OR/session, 0.98; 95% CI, 0.88-1.09). However, improvements in disability levels, 6-minute walk test distance, and metabolic equivalents of tasks were directly related to the number of consecutive doses of prehabilitation before surgery. Improvements in clinical frailty after exercise training were observed in a few patients after 7 weeks of training.</div></div><div><h3>Interpretation</h3><div>In cardiac patients with frailty, a greater number of consecutive doses of physical prehabilitation had favorable effects on improving preoperative exercise capacity and lowering disability levels at 90 days after surgery.</div></div><div><h3>Clinical Trial Registration</h3><div>Chinese Clinical Trials Registry; No.: ChiCTR1800016098; URL: <span><span>https://www.chictr.org.cn/indexEN.html</span><svg><path></path></svg></span></div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 4","pages":"Article 100213"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Additional Accuracy Gained by Cone Beam CT in Shape-Sensing Robotic Bronchoscopy","authors":"Alberto E. Revelo MD ,&nbsp;Jing Peng PhD ,&nbsp;Jianing Ma PhD ,&nbsp;Michael Woods M.Ed. ,&nbsp;Christian Ghattas MD ,&nbsp;Jasleen Pannu MBBS ,&nbsp;Jeffrey C. Horowitz MD ,&nbsp;Nicholas Pastis MD","doi":"10.1016/j.chpulm.2025.100203","DOIUrl":"10.1016/j.chpulm.2025.100203","url":null,"abstract":"<div><h3>Background</h3><div>Cone beam CT (CBCT) scan provides an intraprocedural 3-dimensional image of the biopsy tool in relation to the lesion, which may enhance the accuracy of robotic-assisted bronchoscopy (RAB) through real-time bronchoscopy adjustments. Our goal is to evaluate the ability to accurately position, in real time, a biopsy needle in the center of a pulmonary nodule using shape-sensing RAB alone vs shape-sensing RAB + CBCT guidance.</div></div><div><h3>Research Question</h3><div>Does the addition of CBCT improve the accuracy of robotic bronchoscopy?</div></div><div><h3>Study Design and Methods</h3><div>A total of 102 nodules were biopsied using shape-sensing RAB and the position of the needle in relation to the center of the nodule identified using a ceiling-mounted CBCT scanner. Repositioning of the RAB after 1 or 2 CBCT adjustments was accomplished using information gathered from the 3-dimensional images and using an updated augmented fluoroscopy target. The primary end point was needle location and distance change of the needle tip in reference to the lesion center using RAB alone vs RAB + CBCT scan. Secondary end points were improvement in radial endobronchial ultrasound image and average number of CBCT spins required to land at the center of the target.</div></div><div><h3>Results</h3><div>Using RAB alone, the needle was placed in the center in 27 nodules (26.5%). The addition of CBCT scan to RAB greatly improved the distance of the needle toward the center of the lesion (mean ± SD, −4.08 ± 4.63 mm) in 46 nodules (61.3%) after 1 CBCT adjustment and (mean ± SD, −4.02 ± 4.21 mm) in an additional 17 nodules (58.6%) after a second CBCT adjustment (<em>P</em> &lt; .001). Radial endobronchial ultrasound image was also improved from eccentric to concentric.</div></div><div><h3>Interpretation</h3><div>The addition of CBCT scan to RAB was shown to improve the position of a biopsy tool in relation to the center of a pulmonary nodule. To our knowledge, this study is the first to quantify the accuracy achieved using both technologies, which may translate into reliability to perform diagnostic and potentially future therapeutic interventions in guided bronchoscopy.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 4","pages":"Article 100203"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cyclical Hemoptysis in a Patient With Right Lower Lobe Opacity","authors":"Shintaro Oyama MD ,&nbsp;Tomonori Makiguchi MD, PhD ,&nbsp;Yasuhito Nunomura MD ,&nbsp;Shunta Mukai MD ,&nbsp;Kengo Tani MD ,&nbsp;Takahiro Sasaki MD ,&nbsp;Daisuke Kimura MD, PhD ,&nbsp;Masamichi Itoga MD, PhD ,&nbsp;Hisashi Tanaka MD, PhD ,&nbsp;Kageaki Taima MD, PhD ,&nbsp;Sadatomo Tasaka MD, PhD, FCCP","doi":"10.1016/j.chpulm.2025.100215","DOIUrl":"10.1016/j.chpulm.2025.100215","url":null,"abstract":"<div><h3>Case Presentation</h3><div>A 33-year-old woman, who had a 6 pack-year smoking history, presented with cyclical hemoptysis for 4 months. Although she was treated for suspected pneumonia due to the opacity in posterior basal segment of the right lower lobe (Fig 1A), her symptom recurred concurrently with menstruation. She had a history of an induced abortion and a spontaneous abortion in her late 20s.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 4","pages":"Article 100215"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined Ultrasound-Guided Thoracentesis, Percutaneous Pleural Biopsy, and Indwelling Pleural Catheter Insertion as the First Intervention in Patients With High Likelihood of Malignant Pleural Effusion","authors":"Michael V. Brown MBBS, FRACP ,&nbsp;Jelena Solujic MBBS, FRACP ,&nbsp;Sarah Yeo MBBS, FRACP ,&nbsp;Julia Kim MN ,&nbsp;Phan Nguyen MBBS, F Thor Soc PhD FRACP ,&nbsp;Arash Badiei MBBS, PhD, FRACP","doi":"10.1016/j.chpulm.2025.100201","DOIUrl":"10.1016/j.chpulm.2025.100201","url":null,"abstract":"<div><h3>Background</h3><div>Malignant pleural effusion (MPE) indicates advanced disease and imposes a significant symptomatic burden to patients. Current guidelines recommend stepwise investigation and management.</div></div><div><h3>Research Question</h3><div>Is it feasible and safe to combine ultrasound (US)-guided pleural biopsy and indwelling pleural catheter (IPC) insertion as the initial diagnostic and therapeutic procedure for patients with high preprocedural probability of MPE?</div></div><div><h3>Study Design and Methods</h3><div>We retrospectively analyzed patients who underwent pleural procedures between March 1, 2021, and September 30, 2022. Sixteen patients with symptomatic unilateral pleural effusion and clinical or radiologic features suggestive of malignancy underwent combined US-guided pleural biopsy and IPC insertion as their first management step. Feasibility was determined by the number of patients requiring repeat diagnostic and therapeutic procedures, and time to diagnosis. Safety was determined by complication rates.</div></div><div><h3>Results</h3><div>Of 258 patients who received 384 pleural procedures, 16 patients (11 male; mean age ± SD, 77 ± 9.5 years) underwent the combined procedure. All patients had high preprocedural probability of MPE as evidenced by appropriate history, a unilateral pleural effusion (93.7%), and pleural nodularity or thickening on CT chest scan or US (87.5%). Mean time to diagnostic procedure was 9.3 days. Malignancy was confirmed in 100% of cases, with mesothelioma being the most common (50%). Pleural fluid cytology was diagnostic in 3 cases (18.8%), whereas 13 US-guided pleural biopsies (81.3%) were diagnostic. Nine patients (56.25%) had their IPC removed because of autopleurodesis or treatment response, with a mean removal time of 55.8 days. At 12 months, 5 patients (31.25%) had a documented complication, with pain and catheter blockage being the most common. One patient (6.25%) developed pleural infection. Over one-half (56.2%) received antineoplastic treatment with their IPC in situ. No patient required a repeat pleural procedure on follow-up.</div></div><div><h3>Interpretation</h3><div>A combined approach of closed, percutaneous US-guided pleural biopsy and IPC insertion as initial pleural intervention was shown to be feasible in patients with high preprocedural probability for MPE with no unexpected safety signals.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 4","pages":"Article 100201"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sarcoidosis and Risk of Nephrolithiasis in US Black Women","authors":"Theresa R. McAllister MS ,&nbsp;Praveen Govender MD ,&nbsp;Jacqueline M. Hicks PhD ,&nbsp;Shaun E.L. Wason MD ,&nbsp;Yvette C. Cozier DSc, MPH","doi":"10.1016/j.chpulm.2025.100193","DOIUrl":"10.1016/j.chpulm.2025.100193","url":null,"abstract":"<div><h3>Background</h3><div>Sarcoidosis is a systemic inflammatory disorder linked to dysregulation of vitamin D metabolism. This state can contribute to abnormalities in calcium metabolism, theoretically increasing the risk of nephrolithiasis (kidney stones). Sarcoidosis and risk factors for nephrolithiasis (type 2 diabetes mellitus and hypertension) are common among US Black women.</div></div><div><h3>Research Question</h3><div>How does sarcoidosis affect the risk of nephrolithiasis in a cohort of US Black women? Does the association change by the number and type of cooccurring metabolic condition?</div></div><div><h3>Study Design and Methods</h3><div>We conducted a cross-sectional analysis using data from the Black Women’s Health Study (BWHS), a study of 59,000 US Black women 21 to 69 years of age in 1995 (baseline). Information on sarcoidosis and covariates was obtained from baseline and biennial follow-up questionnaires through 2005. The 2005 questionnaire ascertained diagnoses of nephrolithiasis. We estimated ORs and 95% CIs using logistic regression adjusting for covariates, including calcium and vitamin D supplementation, alcohol consumption, and metabolic conditions (obesity, type 2 diabetes mellitus, hypertension, and hyperlipidemia). We repeated analyses within strata of number of metabolic conditions.</div></div><div><h3>Results</h3><div>The analytical sample consisted of 43,718 women who completed the 2005 BWHS questionnaire. Between 1995 (baseline) and 2005, a total of 832 women reported sarcoidosis. As of 2005, of the women reporting sarcoidosis, 3.9% reported a history of nephrolithiasis, compared with 1.9% of the nonsarcoidosis participants. Among women with sarcoidosis, compared with those without, the odds of nephrolithiasis were 1.80 (95% CI, 1.25-2.59). The association according to number of metabolic conditions (none, 1-2, and 3-4) was additionally increased for women with 3 to 4 cooccurring conditions: 1.96 (95% CI, 1.09-3.52).</div></div><div><h3>Interpretation</h3><div>Our results indicate that US Black women with sarcoidosis have an increased risk of nephrolithiasis. The findings highlight the importance of monitoring for signs of vitamin D and calcium dysregulation in the management of sarcoidosis, especially among those with cooccurring metabolic conditions.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 4","pages":"Article 100193"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding Inpatient Sleep Studies for Sleep-Disordered Breathing","authors":"Tetyana Kendzerska MD, PhD ,&nbsp;Sachin R. Pendharkar MD, MSc ,&nbsp;Robert Talarico MSc ,&nbsp;Vanessa Luks MD ,&nbsp;George Chandy MD ,&nbsp;Sunita Mulpuru MD, MSc ,&nbsp;Kednapa Thavorn PhD ,&nbsp;Mark I. Boulos MD, MSc ,&nbsp;Michael S.B. Mak MD ,&nbsp;Marcus Povitz MDCM, MSc","doi":"10.1016/j.chpulm.2025.100182","DOIUrl":"10.1016/j.chpulm.2025.100182","url":null,"abstract":"<div><h3>Background</h3><div>The utility of inpatient vs outpatient polysomnography (PSG) for individuals with sleep-disordered breathing is unclear.</div></div><div><h3>Research Question</h3><div>How do patient characteristics and sleep medicine care patterns differ between individuals undergoing inpatient vs outpatient PSG?</div></div><div><h3>Study Design and Methods</h3><div>We conducted a retrospective population-based health administrative database study on all adult Ontarians (Canada) hospitalized and/or who underwent PSG between 2012 and 2018. We compared individuals who underwent PSG: (1) during hospitalization (inpatient PSG), (2) within the first month after discharge (delayed PSG), and (3) were not hospitalized in the last year (outpatient PSG). Outcomes included the following: baseline characteristics at the time of PSG, outpatient follow-up rates, and positive airway pressure claims in the year after PSG.</div></div><div><h3>Results</h3><div>We identified 748 individuals in the inpatient group, 9,310 in the delayed group, and 730,967 in the outpatient PSG group. Compared with delayed or outpatient PSG groups, in unadjusted analyses, individuals in the inpatient PSG group were more likely to be older, previously assessed for sleep-disordered breathing, reside in a low-income neighborhood, and have greater comorbidity burden (standardized differences &gt; 0.10). In adjusted analysis, individuals in the inpatient PSG group were less likely to be seen in the sleep clinic within the first year after PSG than the delayed or outpatient PSG group (hazard ratio [HR], 0.79; 95% CI, 0.71-0.87), with no difference between the delayed and outpatient PSG groups (HR, 1.00; 95% CI, 0.98-1.03). Compared with the delayed or outpatient PSG group, those in the inpatient PSG group were 21% (HR vs delayed group, 0.79; 95% CI, 0.67-0.94) to 53% (HR vs outpatient group, 0.47; 95% CI 0.27-0.82) less likely to initiate CPAP or auto-titrating positive airway pressure, and 2 to 10 times more likely to initiate bilevel positive airway pressure (HR vs outpatient group, 10.03; 95% CI, 7.30-13.77).</div></div><div><h3>Interpretation</h3><div>Our results indicate that individuals undergoing inpatient PSG represent a unique smaller subgroup with greater comorbidity and social disadvantage, whereas the delayed PSG group may represent an optimal model of care, informing directions for future prospective studies.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 4","pages":"Article 100182"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Clinical Associations With Phenotypic Drift From Pulmonary Arterial Hypertension to Combined Precapillary and Postcapillary Pulmonary Hypertension","authors":"Kevin T. Schwalbach MD ,&nbsp;Jeffrey Annis PhD ,&nbsp;Jonah David Garry MD ,&nbsp;Hui Nian PhD ,&nbsp;Evan L. Brittain MD ,&nbsp;Anna R. Hemnes MD","doi":"10.1016/j.chpulm.2025.100206","DOIUrl":"10.1016/j.chpulm.2025.100206","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary hypertension (PH) diagnosis relies on hemodynamic measurements from right heart catheterization (RHC). Pulmonary arterial hypertension (PAH) (group 1) is differentiated from group 2 PH (due to left-sided heart disease) by pulmonary capillary wedge pressure (PCWP), with group 2 requiring PCWP &gt; 15 mm Hg. Contemporary PAH cohorts are older with more cardiovascular comorbidities compared with early descriptions, making it harder to distinguish between PAH and group 2 PH. It is unclear whether hemodynamic shifts between PH classifications occur over time or how these shifts impact outcomes.</div></div><div><h3>Research Question</h3><div>How frequently do patients with PAH develop combined precapillary and postcapillary PH (CpcPH), marked by elevated PCWP on follow-up RHC? What baseline characteristics are associated with this change, and does it affect outcomes?</div></div><div><h3>Study Design and Methods</h3><div>This retrospective cohort analysis at a single academic institution examined demographic, clinical, and RHC data from diagnostic and most recent RHCs. The primary outcome was the incidence of phenotypic drift from PAH to CpcPH. Secondary objectives included identifying clinical features associated with phenotypic drift and its impact on all-cause mortality and hospitalizations.</div></div><div><h3>Results</h3><div>Of 257 patients with PAH, 58 (22.6%; 95% CI, 17.6%-28.2%) experienced phenotypic drift, whereas 199 (77.4%; 95% CI, 72%-83%) retained PAH hemodynamics. Those with drift were more likely to be Black (29.3% vs 14.1%), have atrial fibrillation (12.1% vs 3.5%), have diabetes (22.4% vs 10.5%), and have higher BMI (30.2 vs 28.1 kg/m²). Baseline hemodynamics and echocardiographic features were similar between cohorts. There was no significant difference in survival or time to hospitalization between drift and nondrift groups.</div></div><div><h3>Interpretation</h3><div>Our results indicate that phenotypic drift from PAH to CpcPH is common and associated with features of metabolic syndrome and atrial fibrillation, but not predicted by baseline RHC or imaging features. Phenotypic drift was now shown to affect survival or hospitalization outcomes and should not routinely influence initial PAH treatment decisions.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 4","pages":"Article 100206"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal Trends, Setting, and Timing of Palliative and Hospice Care in COPD in the Veterans Health Administration, 2010-2020","authors":"Natalia Smirnova MD ,&nbsp;Sarah H. Cross PhD, MSW, MPH ,&nbsp;Jordan A. Kempker MD ,&nbsp;Donald R. Sullivan MD, MCR ,&nbsp;Lynn F. Reinke PhD, ARNP ,&nbsp;Natasha Smallwood MBBS, PhD ,&nbsp;Robert Plumley ,&nbsp;Kevin Duan MD ,&nbsp;Shelli L. Feder PhD, APRN ,&nbsp;Yanru Ma MD ,&nbsp;Camille Vaughan MD ,&nbsp;David Au MD ,&nbsp;Dio Kavalieratos PhD, FAAHPM","doi":"10.1016/j.chpulm.2025.100171","DOIUrl":"10.1016/j.chpulm.2025.100171","url":null,"abstract":"<div><h3>Background</h3><div>People with COPD experience physical, psychosocial, and health care burdens that decrease their quality of life. Early specialist palliative care is recommended to alleviate these burdens.</div></div><div><h3>Research Question</h3><div>What factors are associated with palliative care use among decedents with COPD?</div></div><div><h3>Study Design and Methods</h3><div>This was a national retrospective cohort study of veterans with COPD who died between 2010 and 2020. Mixed-effects multivariate regression was used to assess the relationship between baseline patient characteristics and the primary outcome of receipt of palliative care within 1 year of death. Secondary outcomes included Veterans Affairs inpatient hospice, timing of palliative care, and trend in palliative care use over time.</div></div><div><h3>Results</h3><div>Among 332,770 decedents, 16.8% received palliative care (61.6% in the inpatient setting) in the year before death. Patient characteristics associated with receipt of palliative care included lung cancer (adjusted OR [aOR], 2.48; 95% CI, 2.40-2.55), congestive heart failure (aOR, 2.02; 95% CI, 1.97-2.06), being underweight (aOR, 1.75; 95% CI, 1.70-1.82), housing instability (aOR, 1.38; 95% CI, 1.33-1.43), Latino/Hispanic ethnicity (aOR, 1.22; 95% CI, 1.12-1.32), and Black race (aOR, 1.21; 95% CI, 1.17-1.26). In contrast, married patients (aOR, 0.88; 95% CI, 0.86-0.90) and those receiving care in a rural facility (aOR, 0.94; 95% CI, 0.91-0.97) were less likely to receive palliative care. Palliative care use increased from 10.4% to 16.0% (<em>P</em> &lt; .05). The median time between first palliative care encounter and death was 46 days (interquartile range, 12-138).</div></div><div><h3>Interpretation</h3><div>Despite an increase in palliative care use over the past decade among veterans with COPD, our findings indicate that most did not receive palliative care or Veterans Affairs inpatient hospice within their final year of life. Those who received palliative care received it late in the illness course. These results highlight the need for targeted strategies to increase access to palliative care and hospice services for patients with COPD.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 4","pages":"Article 100171"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An 83-Year-Old Woman With Sudden-Onset Large Volume Hemoptysis During Right Heart Catheterization","authors":"Sammy Tran MD ,&nbsp;Maya Khodor MD ,&nbsp;Adam Hurwitz DO ,&nbsp;Everett Rogers DO ,&nbsp;Ryan Charpin DO ,&nbsp;Eddib Ahmed DO ,&nbsp;Salah Al-andary MD","doi":"10.1016/j.chpulm.2025.100220","DOIUrl":"10.1016/j.chpulm.2025.100220","url":null,"abstract":"<div><h3>Case Presentation</h3><div>An 83-year-old woman with a history of severe mitral and tricuspid valve regurgitation requiring surgical repair, sick sinus syndrome status after permanent pacemaker placement, and paroxysmal atrial fibrillation presented to the hospital for outpatient right heart catheterization as part of an evaluation for pulmonary hypertension and severe tricuspid regurgitation. During the procedure, the patient began to expectorate a large volume of blood. A rapid response was called due to concerns for respiratory compromise, and the patient was emergently intubated for airway protection. She was subsequently transported to the appropriate unit for further diagnostic studies.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 4","pages":"Article 100220"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supplemental Oxygen Payments and Equipment Utilization in a Low-Income Population With Interstitial Lung Disease or COPD","authors":"Kristopher P. Clark MD ,&nbsp;Daniel J. Kass MD ,&nbsp;Howard B. Degenholtz PhD","doi":"10.1016/j.chpulm.2025.100209","DOIUrl":"10.1016/j.chpulm.2025.100209","url":null,"abstract":"<div><h3>Background</h3><div>Supplemental oxygen is often prescribed to patients with interstitial lung disease (ILD) and COPD, and oxygen services are often paid through Medicare or Medicaid benefits. The specific costs to Centers for Medicaid and Medicare Services for oxygen therapy in these diseases have not been fully described.</div></div><div><h3>Research Question</h3><div>What are the estimated payments by Medicare and Medicaid for supplemental oxygen therapy, and do differences in oxygen equipment utilization or other factors impact these payments in low-income individuals with ILD or COPD?</div></div><div><h3>Study Design and Methods</h3><div>We reviewed claims data for years 2016 to 2020 for Pennsylvania residents with ILD or COPD who were dually eligible for Medicaid and Medicare and enrolled in traditional fee-for-service Medicare. A multilevel mixed-effects generalized linear model was used to identify variables associated with annual oxygen payments made by Medicare or Medicaid.</div></div><div><h3>Results</h3><div>Compared with COPD, a greater proportion of paid claims in ILD were for oxygen services (40% vs 22%) and for high flow oxygen (4.2% vs 2.2%); however, ILD represented the minority of paid oxygen claims (5.2%). The median payment for oxygen was similar at $64.53 (interquartile range, $35.04-$94.56) for ILD and $65.84 (interquartile range, $33.63-$96.70) for COPD. Most claims (≥ 94%) were for stationary concentrators. Liquid devices and stationary gas were the least used equipment. Lower payments were associated with living in a competitive bidding area and with markers of advanced age and worse health status. Higher payments were associated with living in nonmetropolitan areas, having equipment delivering high oxygen flow, and receiving liquid oxygen or a portable oxygen concentrator in addition to a stationary concentrator.</div></div><div><h3>Interpretation</h3><div>Oxygen payments and equipment utilization were similar between patients with ILD and COPD who were dually eligible for Medicare and Medicaid services; however, liquid oxygen claims were rare even among patients requiring high flow.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 4","pages":"Article 100209"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}