Pub Date : 2025-09-01DOI: 10.1016/j.chpulm.2024.100126
Divya A. Shankar MD , Finn J. Hawkins MBBCh , Konstantinos-Dionysios Alysandratos MD, PhD , Kevin C. Wilson MD , Nicholas A. Bosch MD , Allan J. Walkey MD , Anica C. Law MD
{"title":"Practice Patterns of Pulse Dose Corticosteroid Use for Patients Hospitalized With Acute Exacerbations of Idiopathic Pulmonary Fibrosis in the United States","authors":"Divya A. Shankar MD , Finn J. Hawkins MBBCh , Konstantinos-Dionysios Alysandratos MD, PhD , Kevin C. Wilson MD , Nicholas A. Bosch MD , Allan J. Walkey MD , Anica C. Law MD","doi":"10.1016/j.chpulm.2024.100126","DOIUrl":"10.1016/j.chpulm.2024.100126","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 3","pages":"Article 100126"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048715","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}
Pub Date : 2025-09-01DOI: 10.1016/j.chpulm.2025.100143
Pieta C. Wijsman MD , Lisa H. van Smoorenburg MD , Richard M. van den Elzen MSc , Annika W.M. Goorsenberg MD, PhD , Julia N.S. d’Hooghe MD, PhD , Orestes A. Carpaij MD, PhD , Martijn C. Nawijn PhD , Paul R. Bloemen , Inge A.H. van den Berk MD , Craig J. Galban PhD , Alex J. Bell PhD , Oliver Weinheimer PhD , Daniel M. de Bruin PhD , Jouke T. Annema MD, PhD , Maarten van den Berge MD, PhD , Peter I. Bonta MD, PhD
Background
Airway remodeling is an asthma disease hallmark that relates to asthma severity and progression. We investigated airway wall remodeling using bronchoscopic optical coherence tomography (OCT) to assess airway wall composition reflecting its extracellular matrix components and high-resolution CT (HRCT) imaging to assess airway wall thickness (AWT).
Research Question
Can OCT and HRCT imaging be used to detect differences in airway remodeling among healthy control participants, patients with mild to moderate asthma, and patients with severe asthma, and how does remodeling correlate with clinical disease severity and other parameters?
Study Design and Methods
The study population included 16 healthy control participants, 15 patients with mild to moderate asthma, and 18 patients with severe asthma. All participants were characterized extensively clinically, and both OCT and HRCT imaging were performed.
Results
OCT imaging high-intensity scattering area was increased in patients with severe asthma in medium airways compared with patients with mild to moderate asthma and healthy control participants. HRCT imaging-derived AWT was significantly higher in patients with asthma when compared with that of healthy control participants, but did not differentiate between levels of asthma severity. Overall in patients with asthma, a higher HRCT imaging AWT and OCT imaging high-intensity scattering area were associated with poor asthma control. Additionally, a thicker airway wall was associated with more severe airflow obstruction and higher blood eosinophil and neutrophil counts, whereas a larger high-intensity scattering area was associated with a lower number of blood eosinophils.
Interpretation
OCT and HRCT imaging provide different and additional information on airway wall remodeling in asthma. Bronchoscopic OCT imaging high-intensity area increases with asthma severity and correlates with poor asthma control, which emphasizes the potential of OCT imaging for assessing disease severity and therapeutic responses in patients with asthma.
Trial Registry
ClinicalTrials.gov; Nos.: NCT03141814 and NCT02225392; URL: www.clinicaltrials.gov
{"title":"Detection of Airway Remodeling in Asthma Using Bronchoscopic Optical Coherence Tomography","authors":"Pieta C. Wijsman MD , Lisa H. van Smoorenburg MD , Richard M. van den Elzen MSc , Annika W.M. Goorsenberg MD, PhD , Julia N.S. d’Hooghe MD, PhD , Orestes A. Carpaij MD, PhD , Martijn C. Nawijn PhD , Paul R. Bloemen , Inge A.H. van den Berk MD , Craig J. Galban PhD , Alex J. Bell PhD , Oliver Weinheimer PhD , Daniel M. de Bruin PhD , Jouke T. Annema MD, PhD , Maarten van den Berge MD, PhD , Peter I. Bonta MD, PhD","doi":"10.1016/j.chpulm.2025.100143","DOIUrl":"10.1016/j.chpulm.2025.100143","url":null,"abstract":"<div><h3>Background</h3><div>Airway remodeling is an asthma disease hallmark that relates to asthma severity and progression. We investigated airway wall remodeling using bronchoscopic optical coherence tomography (OCT) to assess airway wall composition reflecting its extracellular matrix components and <em>high-resolution</em> CT (HRCT) imaging to assess airway wall thickness (AWT).</div></div><div><h3>Research Question</h3><div>Can OCT and HRCT imaging be used to detect differences in airway remodeling among healthy control participants, patients with mild to moderate asthma, and patients with severe asthma, and how does remodeling correlate with clinical disease severity and other parameters?</div></div><div><h3>Study Design and Methods</h3><div>The study population included 16 healthy control participants, 15 patients with mild to moderate asthma, and 18 patients with severe asthma. All participants were characterized extensively clinically, and both OCT and HRCT imaging were performed.</div></div><div><h3>Results</h3><div>OCT imaging high-intensity scattering area was increased in patients with severe asthma in medium airways compared with patients with mild to moderate asthma and healthy control participants. HRCT imaging-derived AWT was significantly higher in patients with asthma when compared with that of healthy control participants, but did not differentiate between levels of asthma severity. Overall in patients with asthma, a higher HRCT imaging AWT and OCT imaging high-intensity scattering area were associated with poor asthma control. Additionally, a thicker airway wall was associated with more severe airflow obstruction and higher blood eosinophil and neutrophil counts, whereas a larger high-intensity scattering area was associated with a lower number of blood eosinophils.</div></div><div><h3>Interpretation</h3><div>OCT and HRCT imaging provide different and additional information on airway wall remodeling in asthma. Bronchoscopic OCT imaging high-intensity area increases with asthma severity and correlates with poor asthma control, which emphasizes the potential of OCT imaging for assessing disease severity and therapeutic responses in patients with asthma.</div></div><div><h3>Trial Registry</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>; Nos.: <span><span>NCT03141814</span><svg><path></path></svg></span> and <span><span>NCT02225392</span><svg><path></path></svg></span>; URL: <span><span>www.clinicaltrials.gov</span><svg><path></path></svg></span></div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 3","pages":"Article 100143"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145010217","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}
Pub Date : 2025-09-01DOI: 10.1016/j.chpulm.2024.100065
Mehran Asghari PhD , Paige Rudy BS , Miguel Peña MS , Martha Ruiz MS , Sairam Parthasarathy MD , Bilaval Javed MD , Nima Toosizadeh PhD
Background
Decisions about the intensity of treatment for patients with COPD are influenced by the ability to predict upcoming adverse outcomes after treatment. The 6-minute walk distance test is commonly used to assess functional capacity in patients with COPD for predicting adverse outcomes. Although the 6-minute walk distance showed adequate reliability and validity, it is often not feasible for frail patients. Therefore, an alternative objective, quick, and simple approach for assessing functional capacity in COPD is needed.
Research Question
Is an upper extremity test an accurate and feasible method for assessing fnctional capacity individuals with COPD?
Study Design and Methods
We previously developed and validated an upper extremity function (UEF) test, incorporating motor function kinematics and muscle force measures for assessing functional capacity in COPD. In this study, with the goal of longitudinal evaluation of the UEF test for predicting adverse outcomes, we recruited 192 hospitalized older adults that were admitted due to COPD exacerbation. In-hospital (ie, mortality, excessive length of stay, complications) and longitudinal 90-day (ie, acute COPD exacerbation, mortality, readmission) outcomes were recorded. We developed a risk stratification model using elastic net regularization for selecting optimum feature sets (kinematics and muscle model parameters) in combination with support vector machine to predict adverse outcomes.
Results
Results from 10-fold cross-validation for model prediction showed, on average, accuracy of 78% in predicting in-hospital outcomes and accuracy of 76% in predicting 30- to 90-day longitudinal outcomes.
Interpretation
Current findings suggested that the UEF test may provide an efficient method for risk stratifying older adults with COPD, with accuracy higher than other available tools within our recorded data set (ie, clinical frailty score and COPD assessment test with accuracies < 61%).
{"title":"A Novel Upper-Extremity Sensor-Based Approach to Predict COPD Adverse Outcomes in an Acute Setting","authors":"Mehran Asghari PhD , Paige Rudy BS , Miguel Peña MS , Martha Ruiz MS , Sairam Parthasarathy MD , Bilaval Javed MD , Nima Toosizadeh PhD","doi":"10.1016/j.chpulm.2024.100065","DOIUrl":"10.1016/j.chpulm.2024.100065","url":null,"abstract":"<div><h3>Background</h3><div>Decisions about the intensity of treatment for patients with COPD are influenced by the ability to predict upcoming adverse outcomes after treatment. The 6-minute walk distance test is commonly used to assess functional capacity in patients with COPD for predicting adverse outcomes. Although the 6-minute walk distance showed adequate reliability and validity, it is often not feasible for frail patients. Therefore, an alternative objective, quick, and simple approach for assessing functional capacity in COPD is needed.</div></div><div><h3>Research Question</h3><div>Is an upper extremity test an accurate and feasible method for assessing fnctional capacity individuals with COPD?</div></div><div><h3>Study Design and Methods</h3><div>We previously developed and validated an upper extremity function (UEF) test, incorporating motor function kinematics and muscle force measures for assessing functional capacity in COPD. In this study, with the goal of longitudinal evaluation of the UEF test for predicting adverse outcomes, we recruited 192 hospitalized older adults that were admitted due to COPD exacerbation. In-hospital (ie, mortality, excessive length of stay, complications) and longitudinal 90-day (ie, acute COPD exacerbation, mortality, readmission) outcomes were recorded. We developed a risk stratification model using elastic net regularization for selecting optimum feature sets (kinematics and muscle model parameters) in combination with support vector machine to predict adverse outcomes.</div></div><div><h3>Results</h3><div>Results from 10-fold cross-validation for model prediction showed, on average, accuracy of 78% in predicting in-hospital outcomes and accuracy of 76% in predicting 30- to 90-day longitudinal outcomes.</div></div><div><h3>Interpretation</h3><div>Current findings suggested that the UEF test may provide an efficient method for risk stratifying older adults with COPD, with accuracy higher than other available tools within our recorded data set (ie, clinical frailty score and COPD assessment test with accuracies < 61%).</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 3","pages":"Article 100065"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145018777","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}
Pub Date : 2025-09-01DOI: 10.1016/j.chpulm.2025.100136
Alison M. DeDent MAS, MD , Jessica E. Shore PhD, RN , Rebecca Bascom MD, MPH , Janell Reichuber APRN , Mary Beth Scholand MD , Ryan Boente MD , Anoop M. Nambiar MS, MD , Sonye K. Danoff MD, PhD , Franck Rahaghi MD, MHS , Tejaswini Kulkarni MD, MPH , Hyun Joo Kim MD , Pulmonary Fibrosis Foundation Rural Health Outreach Committee
Background
The Pulmonary Fibrosis Foundation Care Center Network (PFF-CCN) provides expertise in the diagnosis and management of interstitial lung diseases (ILDs); however, most centers are in urban areas. Little is known about access to ILD care for patients living in rural areas.
Research Question
What are the perspectives of PFF-CCN providers on the accessibility and provision of ILD care for rural patients?
Study Design and Methods
A mixed methods survey designed by the Pulmonary Fibrosis Foundation Rural Health Outreach Committee was distributed with weekly reminders to all 68 PFF-CCN sites between November 2021 and February 2022 through REDCap. The survey included 21 closed-ended questions that were analyzed using descriptive statistics and 3 open-ended questions that underwent thematic analysis. Before coding, free text responses were reviewed, and nearly all were sorted into 1 of 2 groups: barriers or facilitators to ILD care. Responses were then coded inductively and sorted into categories, followed by themes drawn from the data. Only 1 survey per PFF-CCN site was analyzed.
Results
A total of 68 PFF-CCN sites (providers) completed the survey (100% response rate). Of these, 57% of providers perceived that rural patients often experience delays in diagnosis compared with their urban counterparts, and 47% perceived they often have delays in ILD treatment. The following 3 themes emerged as barriers to ILD care for rural patients: poor access to care (73% of all coded barriers), limited resources (23%), and patient preferences and concerns (3%). Three themes emerged as facilitators to ILD care: local collaboration (49% of all coded facilitators), telemedicine (30%), and patient-centered care (21%).
Interpretation
PFF-CCN providers identified several important barriers and facilitators to care for rural patients with ILD occurring at the patient, provider, and health care system levels.
{"title":"Caring for Rural Patients With Interstitial Lung Disease","authors":"Alison M. DeDent MAS, MD , Jessica E. Shore PhD, RN , Rebecca Bascom MD, MPH , Janell Reichuber APRN , Mary Beth Scholand MD , Ryan Boente MD , Anoop M. Nambiar MS, MD , Sonye K. Danoff MD, PhD , Franck Rahaghi MD, MHS , Tejaswini Kulkarni MD, MPH , Hyun Joo Kim MD , Pulmonary Fibrosis Foundation Rural Health Outreach Committee","doi":"10.1016/j.chpulm.2025.100136","DOIUrl":"10.1016/j.chpulm.2025.100136","url":null,"abstract":"<div><h3>Background</h3><div>The Pulmonary Fibrosis Foundation Care Center Network (PFF-CCN) provides expertise in the diagnosis and management of interstitial lung diseases (ILDs); however, most centers are in urban areas. Little is known about access to ILD care for patients living in rural areas.</div></div><div><h3>Research Question</h3><div>What are the perspectives of PFF-CCN providers on the accessibility and provision of ILD care for rural patients?</div></div><div><h3>Study Design and Methods</h3><div>A mixed methods survey designed by the Pulmonary Fibrosis Foundation Rural Health Outreach Committee was distributed with weekly reminders to all 68 PFF-CCN sites between November 2021 and February 2022 through REDCap. The survey included 21 closed-ended questions that were analyzed using descriptive statistics and 3 open-ended questions that underwent thematic analysis. Before coding, free text responses were reviewed, and nearly all were sorted into 1 of 2 groups: barriers or facilitators to ILD care. Responses were then coded inductively and sorted into categories, followed by themes drawn from the data. Only 1 survey per PFF-CCN site was analyzed.</div></div><div><h3>Results</h3><div>A total of 68 PFF-CCN sites (providers) completed the survey (100% response rate). Of these, 57% of providers perceived that rural patients often experience delays in diagnosis compared with their urban counterparts, and 47% perceived they often have delays in ILD treatment. The following 3 themes emerged as barriers to ILD care for rural patients: poor access to care (73% of all coded barriers), limited resources (23%), and patient preferences and concerns (3%). Three themes emerged as facilitators to ILD care: local collaboration (49% of all coded facilitators), telemedicine (30%), and patient-centered care (21%).</div></div><div><h3>Interpretation</h3><div>PFF-CCN providers identified several important barriers and facilitators to care for rural patients with ILD occurring at the patient, provider, and health care system levels.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 3","pages":"Article 100136"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145010218","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}
Pub Date : 2025-09-01DOI: 10.1016/j.chpulm.2025.100160
Reid Eggleston MD , Chadi Hage MD , Ryan C. Maves MD , Cyril Varghese MD , Kelly M. Pennington MD
Topic Importance
Endemic fungal infections are increasingly recognized as important causes of community-acquired pneumonia. Despite this, diagnosis is often delayed or misattributed, resulting in significant morbidity and mortality.
Review Findings
Histoplasma capsulatum, Blastomyces species, and Coccidioides species are the most common endemic fungal infections in the United States. These infections share commonalities in modes of transmission and pathogenicity where regional climates, weather patterns, and certain exposures play a key role in infectivity. However, changes in climate and human migration patterns have altered and expanded the traditional maps of endemicity. Antigen- and antibody-based testing have improved diagnostic efficiency but are limited by host immune status. Understanding the proper use and limitations of antigen- and antibody-based testing is key to appropriate diagnosis. We also discuss the management of disseminated infection, recent developments in treatment modalities, and areas of active research.
Summary
Our results indicate that a greater number of patients are at risk of endemic fungal infections due to climate change, human migration patterns, and increased use of immunosuppressive medications. Pulmonary manifestations of these infections are similar and typically mild in immunocompetent patients, but clinical presentations can be highly variable, especially in those with disseminated infection. Azole therapy is used for most patients, with liposomal amphotericin B used in the most severe infections.
{"title":"Endemic Mycoses for Pulmonary Clinicians","authors":"Reid Eggleston MD , Chadi Hage MD , Ryan C. Maves MD , Cyril Varghese MD , Kelly M. Pennington MD","doi":"10.1016/j.chpulm.2025.100160","DOIUrl":"10.1016/j.chpulm.2025.100160","url":null,"abstract":"<div><h3>Topic Importance</h3><div>Endemic fungal infections are increasingly recognized as important causes of community-acquired pneumonia. Despite this, diagnosis is often delayed or misattributed, resulting in significant morbidity and mortality.</div></div><div><h3>Review Findings</h3><div><em>Histoplasma capsulatum</em>, <em>Blastomyces</em> species, and <em>Coccidioides</em> species are the most common endemic fungal infections in the United States. These infections share commonalities in modes of transmission and pathogenicity where regional climates, weather patterns, and certain exposures play a key role in infectivity. However, changes in climate and human migration patterns have altered and expanded the traditional maps of endemicity. Antigen- and antibody-based testing have improved diagnostic efficiency but are limited by host immune status. Understanding the proper use and limitations of antigen- and antibody-based testing is key to appropriate diagnosis. We also discuss the management of disseminated infection, recent developments in treatment modalities, and areas of active research.</div></div><div><h3>Summary</h3><div>Our results indicate that a greater number of patients are at risk of endemic fungal infections due to climate change, human migration patterns, and increased use of immunosuppressive medications. Pulmonary manifestations of these infections are similar and typically mild in immunocompetent patients, but clinical presentations can be highly variable, especially in those with disseminated infection. Azole therapy is used for most patients, with liposomal amphotericin B used in the most severe infections.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 3","pages":"Article 100160"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145018776","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}
Pub Date : 2025-09-01DOI: 10.1016/j.chpulm.2025.100164
Dieuwke Luijten MD , Josien van Es MD, PhD , Jannie J. Abbink MD, PhD , Stefano Barco MD, PhD , Johanna M.W. van den Berg MD , Waleed Ghanima MD, PhD , Menno V. Huisman MD, PhD , Coen van Kan MD, PhD , Bas Langeveld MD, PhD , Ivo van der Lee MD, PhD , Rosa Mali MD , Thijs E. van Mens MD, PhD , Timothy A. Morris MD , Maria Overbeek MD, PhD , Mart van der Plas PhD , Martijn A. Spruit PhD , Frederikus A. Klok MD, PhD , Anton Vonk Noordegraaf MD, PhD , Maarten K. Ninaber MD, PhD
Background
Cardiopulmonary exercise testing (CPET) may provide a helpful tool to assess underlying causes of dyspnea in patients with acute pulmonary embolism (PE). However, the response to exercise in the first weeks after diagnosis of an acute PE is currently unknown.
Research Question
What are the cardiopulmonary responses to and safety of performing strenuous exercise within 2 to 4 weeks postacute PE?
Study Design and Methods
A total of 100 patients with acute PE, without major comorbidities, experiencing dyspnea (Medical Research Council dyspnea scale ≥ 2) and functional limitations (Post-Venous Thromboembolism Functional Status Scale grade ≥ 2) 1 to 2 weeks after PE diagnosis, underwent CPET within 2 to 4 weeks after diagnosis. We evaluated the frequency of peak oxygen consumption < 80% predicted, a peak oxygen pulse < 80% predicted or oxygen pulseAT/oxygen pulserest < 2.6, and a ventilatory equivalent for carbon dioxide ≥ 34 at anaerobic threshold or dead space to tidal volume ratio > 30% at peak, and their association with markers of PE severity at diagnosis.
Results
There were no adverse events related to the procedure. CPET disclosed peak oxygen consumption < 80% predicted in 23% of patients, oxygen pulse < 80% predicted or oxygen pulseAT/oxygen pulserest < 2.6 in 75%, and ventilatory equivalent for carbon dioxide at anaerobic threshold ≥ 34 or peak dead space to tidal volume ratio > 30% in 49%. In 1 of 7 patients, none of the previously reported signs were present (14%). Intermediate-high risk PE and central PE were associated with increased incidence of these abnormalities.
Interpretation
There were no complications when performing strenuous exercise in the first weeks after a PE diagnosis in this study. Despite dyspnea, 1 of 7 patients had adequate cardiopulmonary reserve, suggesting that post-PE symptoms are multifactorial. Intermediate-high risk and central PE were associated with higher incidences of abnormal CPET outcomes.
{"title":"Cardiopulmonary Exercise Testing in People With Dyspnea With a Recent Acute Pulmonary Embolism","authors":"Dieuwke Luijten MD , Josien van Es MD, PhD , Jannie J. Abbink MD, PhD , Stefano Barco MD, PhD , Johanna M.W. van den Berg MD , Waleed Ghanima MD, PhD , Menno V. Huisman MD, PhD , Coen van Kan MD, PhD , Bas Langeveld MD, PhD , Ivo van der Lee MD, PhD , Rosa Mali MD , Thijs E. van Mens MD, PhD , Timothy A. Morris MD , Maria Overbeek MD, PhD , Mart van der Plas PhD , Martijn A. Spruit PhD , Frederikus A. Klok MD, PhD , Anton Vonk Noordegraaf MD, PhD , Maarten K. Ninaber MD, PhD","doi":"10.1016/j.chpulm.2025.100164","DOIUrl":"10.1016/j.chpulm.2025.100164","url":null,"abstract":"<div><h3>Background</h3><div>Cardiopulmonary exercise testing (CPET) may provide a helpful tool to assess underlying causes of dyspnea in patients with acute pulmonary embolism (PE). However, the response to exercise in the first weeks after diagnosis of an acute PE is currently unknown.</div></div><div><h3>Research Question</h3><div>What are the cardiopulmonary responses to and safety of performing strenuous exercise within 2 to 4 weeks postacute PE?</div></div><div><h3>Study Design and Methods</h3><div>A total of 100 patients with acute PE, without major comorbidities, experiencing dyspnea (Medical Research Council dyspnea scale ≥ 2) and functional limitations (Post-Venous Thromboembolism Functional Status Scale grade ≥ 2) 1 to 2 weeks after PE diagnosis, underwent CPET within 2 to 4 weeks after diagnosis. We evaluated the frequency of peak oxygen consumption < 80% predicted, a peak oxygen pulse < 80% predicted or oxygen pulse<sub>AT</sub>/oxygen pulse<sub>rest</sub> < 2.6, and a ventilatory equivalent for carbon dioxide ≥ 34 at anaerobic threshold or dead space to tidal volume ratio > 30% at peak, and their association with markers of PE severity at diagnosis.</div></div><div><h3>Results</h3><div>There were no adverse events related to the procedure. CPET disclosed peak oxygen consumption < 80% predicted in 23% of patients, oxygen pulse < 80% predicted or oxygen pulse<sub>AT</sub>/oxygen pulse<sub>rest</sub> < 2.6 in 75%, and ventilatory equivalent for carbon dioxide at anaerobic threshold ≥ 34 or peak dead space to tidal volume ratio > 30% in 49%. In 1 of 7 patients, none of the previously reported signs were present (14%). Intermediate-high risk PE and central PE were associated with increased incidence of these abnormalities.</div></div><div><h3>Interpretation</h3><div>There were no complications when performing strenuous exercise in the first weeks after a PE diagnosis in this study. Despite dyspnea, 1 of 7 patients had adequate cardiopulmonary reserve, suggesting that post-PE symptoms are multifactorial. Intermediate-high risk and central PE were associated with higher incidences of abnormal CPET outcomes.</div></div><div><h3>Clinical Trial Registration</h3><div>Dutch Trial Register; No.: NTR NL9615; URL: <span><span>https://onderzoekmetmensen.nl/en/trial/54292</span><svg><path></path></svg></span></div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 3","pages":"Article 100164"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048717","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}
Pub Date : 2025-09-01DOI: 10.1016/j.chpulm.2025.100178
Kriss Kania MD , Abdulla Ahmed MD , Salaheldin Ahmed MD , Adam Engel Sällberg MD , Karin Tran-Lundmark MD, PhD , Jørn Carlsen MD, PhD , Göran Rådegran MD, DMSc, MSc Eng Phys
Background
Multimarker panels of blood-borne biomarkers could aid in shortening the diagnostic delay of pulmonary arterial hypertension (PAH).
Research Question
Can any of the 61 proteins included in the study, related to pathways known to be involved in PAH pathophysiology (eg, coagulation, inflammation, fibrosis), differentiate PAH from other forms of pulmonary hypertension (PH) and/or dyspnea and thus aid in diagnosing PAH?
Study Design and Methods
Plasma samples were collected from 55 healthy control participants and 355 patients at diagnosis, including PAH (n = 95), chronic thromboembolic PH (n = 54), heart failure with preserved ejection fraction with PH (n = 58), heart failure with reduced ejection fraction with PH (n = 64), a non-PH dyspnea control group with heart failure (n = 45), and an independent external PAH cohort (n = 39) used as external validation of protein levels in the PAH group of the discovery cohort. Plasma levels of the 61 proteins were analyzed using proximity extension assay.
Results
ADAMTS13 plasma levels differed in patients with PAH compared with the 3 other PH groups and the non-PH dyspnea group (P < .05). In univariable (OR, 0.90; 95% CI, 0.84-0.96) and multivariable logistic regression models adjusted for age and sex (OR, 0.89; 95% CI, 0.83-0.96), ADAMTS13 was additionally able to differentiate PAH from the other combined disease groups. In the external validation cohort, plasma ADAMTS13 levels in PAH were statistically equivalent to the discovery cohort (P < .002).
Interpretation
Plasma ADAMTS13 may be a diagnostic biomarker in PAH with the ability to differentiate patients with PAH from other dyspnea groups and is an interesting protein for inclusion in future studies of multimarker panels. Further validation in larger cohorts is warranted.
{"title":"Can Plasma ADAMTS13 Differentiate Patients With Pulmonary Arterial Hypertension From Other Forms of Pulmonary Hypertension and Dyspnea Control Patients","authors":"Kriss Kania MD , Abdulla Ahmed MD , Salaheldin Ahmed MD , Adam Engel Sällberg MD , Karin Tran-Lundmark MD, PhD , Jørn Carlsen MD, PhD , Göran Rådegran MD, DMSc, MSc Eng Phys","doi":"10.1016/j.chpulm.2025.100178","DOIUrl":"10.1016/j.chpulm.2025.100178","url":null,"abstract":"<div><h3>Background</h3><div>Multimarker panels of blood-borne biomarkers could aid in shortening the diagnostic delay of pulmonary arterial hypertension (PAH).</div></div><div><h3>Research Question</h3><div>Can any of the 61 proteins included in the study, related to pathways known to be involved in PAH pathophysiology (eg, coagulation, inflammation, fibrosis), differentiate PAH from other forms of pulmonary hypertension (PH) and/or dyspnea and thus aid in diagnosing PAH?</div></div><div><h3>Study Design and Methods</h3><div>Plasma samples were collected from 55 healthy control participants and 355 patients at diagnosis, including PAH (n = 95), chronic thromboembolic PH (n = 54), heart failure with preserved ejection fraction with PH (n = 58), heart failure with reduced ejection fraction with PH (n = 64), a non-PH dyspnea control group with heart failure (n = 45), and an independent external PAH cohort (n = 39) used as external validation of protein levels in the PAH group of the discovery cohort. Plasma levels of the 61 proteins were analyzed using proximity extension assay.</div></div><div><h3>Results</h3><div>ADAMTS13 plasma levels differed in patients with PAH compared with the 3 other PH groups and the non-PH dyspnea group (<em>P</em> < .05). In univariable (OR, 0.90; 95% CI, 0.84-0.96) and multivariable logistic regression models adjusted for age and sex (OR, 0.89; 95% CI, 0.83-0.96), ADAMTS13 was additionally able to differentiate PAH from the other combined disease groups. In the external validation cohort, plasma ADAMTS13 levels in PAH were statistically equivalent to the discovery cohort (<em>P <</em> .002).</div></div><div><h3>Interpretation</h3><div>Plasma ADAMTS13 may be a diagnostic biomarker in PAH with the ability to differentiate patients with PAH from other dyspnea groups and is an interesting protein for inclusion in future studies of multimarker panels. Further validation in larger cohorts is warranted.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 3","pages":"Article 100178"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048718","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}
Pub Date : 2025-09-01DOI: 10.1016/j.chpulm.2025.100144
Donald R. Sullivan MD, MA, MCR , Nathan F. Dieckmann PhD , Heather Franklin MPH , Daniel D. Matlock MD, MPH , Clifford A. Coleman MD, MPH , Somnath Saha MD, MPH , Sara E. Golden PhD , Natalie G. Disher BA , Christopher G. Slatore MD , Kelly C. Vranas MD, MCR , Sophia Hayes MD , Peter Lee MD , Lakshmi Mudambi MD , Karen B. Eden PhD
Background
Shared decision-making (SDM) aligns patients’ values and goals with treatments as patients and clinicians work together to make decisions. Unfortunately, clinicians often lack the resources and skills necessary to support high-quality SDM.
Research Question
We sought to determine if a low-literacy conversation tool (Improving Decision-Making Encounters in Lung Cancer Treatment [iDECIDE]) was feasible and acceptable and supports SDM among patients with stages I through IV non-small cell lung cancer (NSCLC).
Study Design and Methods
In this multisite, stepped-wedge intervention study, outcomes were assessed using validated measures at baseline and the 2-month follow-up.
Results
Regarding feasibility, among 126 patients offered enrollment, 65 patients (52%) consented. Among enrollees alive and eligible at baseline and follow-up, 100% and 93% of patients completed assessments, respectively. Mean (SD) age was 71 (11) years, 31 patients (56%) were male, and 27 patients (49%) had a diagnosis of stage I or II NSCLC. iDECIDE was acceptable given that 100% of patients in the intervention group completed it. Among all patients, decisional conflict (mean difference, –19.98) and anxiety (mean difference, –1.78) decreased from baseline to follow-up. Decisional conflict decreased similarly between groups (Cohen d: control, –0.77 [95% CI, –1.4 to –0.16]; intervention, –0.65 [95% CI, –1.3 to –0.036]), but anxiety decreased slightly more in the control group compared with the intervention group (Cohen d: control, –0.35 [95% CI, –0.92 to 0.22]; intervention, –0.12 [95% CI, –0.71 to 0.48]). iDECIDE reduced decisional conflict more among those with lower education and health numeracy. Personal lung cancer knowledge at follow-up (eg, stage and treatments) was higher in the intervention group compared with the control group: 74% and 50% (Cohen h: 0.49 [95% CI, –0.13 to 1.12]), respectively. Self-efficacy decreased in the control group and increased in the intervention group at follow-up (Cohen d: control, –0.30 [95% CI, –0.87 to 0.27]; intervention, 0.062 [95% CI, –0.53 to 0.65])). The intervention group had higher patient-reported involvement in care and SDM.
Interpretation
iDECIDE was shown to be feasible and acceptable among patients with NSCLC who are considering treatment options. Preliminary effectiveness estimates suggest that iDECIDE improved SDM and personal lung cancer knowledge while promoting more effective treatment decision-making strategies.
{"title":"Improving Decision-Making Encounters in Lung Cancer Treatment","authors":"Donald R. Sullivan MD, MA, MCR , Nathan F. Dieckmann PhD , Heather Franklin MPH , Daniel D. Matlock MD, MPH , Clifford A. Coleman MD, MPH , Somnath Saha MD, MPH , Sara E. Golden PhD , Natalie G. Disher BA , Christopher G. Slatore MD , Kelly C. Vranas MD, MCR , Sophia Hayes MD , Peter Lee MD , Lakshmi Mudambi MD , Karen B. Eden PhD","doi":"10.1016/j.chpulm.2025.100144","DOIUrl":"10.1016/j.chpulm.2025.100144","url":null,"abstract":"<div><h3>Background</h3><div>Shared decision-making (SDM) aligns patients’ values and goals with treatments as patients and clinicians work together to make decisions. Unfortunately, clinicians often lack the resources and skills necessary to support high-quality SDM.</div></div><div><h3>Research Question</h3><div>We sought to determine if a low-literacy conversation tool (Improving Decision-Making Encounters in Lung Cancer Treatment [iDECIDE]) was feasible and acceptable and supports SDM among patients with stages I through IV non-small cell lung cancer (NSCLC).</div></div><div><h3>Study Design and Methods</h3><div>In this multisite, stepped-wedge intervention study, outcomes were assessed using validated measures at baseline and the 2-month follow-up.</div></div><div><h3>Results</h3><div>Regarding feasibility, among 126 patients offered enrollment, 65 patients (52%) consented. Among enrollees alive and eligible at baseline and follow-up, 100% and 93% of patients completed assessments, respectively. Mean (SD) age was 71 (11) years, 31 patients (56%) were male, and 27 patients (49%) had a diagnosis of stage I or II NSCLC. iDECIDE was acceptable given that 100% of patients in the intervention group completed it. Among all patients, decisional conflict (mean difference, –19.98) and anxiety (mean difference, –1.78) decreased from baseline to follow-up. Decisional conflict decreased similarly between groups (Cohen <em>d</em>: control, –0.77 [95% CI, –1.4 to –0.16]; intervention, –0.65 [95% CI, –1.3 to –0.036]), but anxiety decreased slightly more in the control group compared with the intervention group (Cohen <em>d</em>: control, –0.35 [95% CI, –0.92 to 0.22]; intervention, –0.12 [95% CI, –0.71 to 0.48]). iDECIDE reduced decisional conflict more among those with lower education and health numeracy. Personal lung cancer knowledge at follow-up (eg, stage and treatments) was higher in the intervention group compared with the control group: 74% and 50% (Cohen <em>h</em>: 0.49 [95% CI, –0.13 to 1.12]), respectively. Self-efficacy decreased in the control group and increased in the intervention group at follow-up (Cohen <em>d</em>: control, –0.30 [95% CI, –0.87 to 0.27]; intervention, 0.062 [95% CI, –0.53 to 0.65])). The intervention group had higher patient-reported involvement in care and SDM.</div></div><div><h3>Interpretation</h3><div>iDECIDE was shown to be feasible and acceptable among patients with NSCLC who are considering treatment options. Preliminary effectiveness estimates suggest that iDECIDE improved SDM and personal lung cancer knowledge while promoting more effective treatment decision-making strategies.</div></div><div><h3>Trial Registry</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>; No.: <span><span>NCT04946279</span><svg><path></path></svg></span>; URL: <span><span>www.clinicaltrials.gov</span><svg><path></path></svg></span></div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 3","pages":"Article 100144"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048709","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}
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