Pub Date : 2025-09-01DOI: 10.1016/j.chpulm.2025.100137
Rebecca S. Steinberg MD , Tzu-Chun Chu MPH , Denny Shin MD , Binh Ha PhD , He-Ying Sun PhD , Samadhan J. Jadhao DVM , David N. Ku MD , Blaine R. Roberts PhD , Evan J. Anderson MD , Laila Hussaini MPH , Larry J. Anderson MD , Blake Anderson MD
Background
SARS-CoV-2 remains a global health issue since its discovery in 2019, and long-term noninvasive clinical testing methods are required. The current preferred method of detection is nasopharyngeal swab, which reflects sampling of the upper respiratory tract alone.
Research Question
Can we noninvasively assess detection of SARS-CoV-2 RNA and biomarkers in patients’ cough droplets captured with the PneumoniaCheck device?
Study Design and Methods
We enrolled adult patients with a recent nasopharyngeal swab that was positive for COVID-19 by polymerase chain reaction (PCR) who were receiving monoclonal antibody infusion therapy. After consent and instruction, patients coughed 5 sets of 10 coughs into the PneumoniaCheck device. Material captured on the device filter was eluted and tested for biomarkers (interferon gamma, tumor necrosis factor alpha [TNF-α], IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, and IL-13) and amylase by an enzyme activity assay, and SARS-CoV-2 RNA by PCR (3 different primer sets).
Results
A total of 44 case patients out of 50 cases and 17 control patients with adequate specimen and accompanying clinical data were included in the analysis. Thirty case patient cough specimens (68%) tested PCR positive for SARS-CoV-2 RNA, 10 (23%) tested negative, and 4 (9%) tested indeterminate. IL-13 and TNF-α levels were significantly higher, whereas IL-2 levels were significantly lower in case specimens than in control cough specimens. In the multivariable analysis of biomarkers and reported symptoms, higher IL-10 levels were associated with reduced fatigue (OR, 0.41; 95% CI, 0.15-0.87; P = .039), whereas higher IL-12p70 (OR, 2.74; 95% CI, 1.15-8.51; P = .043), IL-4 (OR, 3.56; 95% CI, 1.56-11.20; P = .008), and TNF-α (OR, 4.36; 95% CI, 1.79-14.60; P = .004) levels were associated with fever.
Interpretation
Our results show that the PneumoniaCheck device is a noninvasive method for successfully detecting SARS-CoV-2 and inflammatory cytokines in specimens from the lower respiratory tract in patients with COVID-19 and likely in patients with other lung diseases.
自2019年发现sars - cov -2以来，它仍然是一个全球性的健康问题，需要长期的非侵入性临床检测方法。目前首选的检测方法是鼻咽拭子，它反映了上呼吸道的单独采样。研究问题：我们是否可以无创性地评估使用PneumoniaCheck设备捕获的患者咳嗽飞沫中SARS-CoV-2 RNA和生物标志物的检测？研究设计和方法我们招募了近期鼻咽拭子经聚合酶链反应（PCR）检测为COVID-19阳性的成年患者，这些患者正在接受单克隆抗体输注治疗。经同意和指导后，患者咳嗽5组（每组10次）进入PneumoniaCheck装置。在设备过滤器上捕获的材料被洗脱并检测生物标志物（干扰素γ、肿瘤坏死因子α [TNF-α]、IL-1β、IL-2、IL-4、IL-6、IL-8、IL-10、IL-12p70和IL-13）和淀粉酶（酶活性测定），以及SARS-CoV-2 RNA（3种不同的引物组）。结果50例患者中44例纳入分析，17例对照患者标本齐全，临床资料齐全。30例患者咳嗽标本（68%）PCR检测为SARS-CoV-2 RNA阳性，10例（23%）检测为阴性，4例（9%）检测不确定。病例标本中IL-13和TNF-α水平显著高于对照组，IL-2水平显著低于对照组。在生物标志物和报告症状的多变量分析中，较高的IL-10水平与疲劳减轻相关（OR, 0.41; 95% CI, 0.15-0.87; P = 0.039），而较高的IL-12p70 （OR, 2.74; 95% CI, 1.15-8.51; P = 0.043）、IL-4 （OR, 3.56; 95% CI, 1.56-11.20; P = 0.008）和TNF-α (OR, 4.36; 95% CI, 1.79-14.60; P = 0.004)水平与发烧相关。我们的研究结果表明，PneumoniaCheck装置是一种无创方法，可以成功检测COVID-19患者和其他肺部疾病患者下呼吸道标本中的SARS-CoV-2和炎症细胞因子。
{"title":"Detection of SARS-CoV-2 RNA and Biomarkers in Device-Captured Droplets From the Lung","authors":"Rebecca S. Steinberg MD , Tzu-Chun Chu MPH , Denny Shin MD , Binh Ha PhD , He-Ying Sun PhD , Samadhan J. Jadhao DVM , David N. Ku MD , Blaine R. Roberts PhD , Evan J. Anderson MD , Laila Hussaini MPH , Larry J. Anderson MD , Blake Anderson MD","doi":"10.1016/j.chpulm.2025.100137","DOIUrl":"10.1016/j.chpulm.2025.100137","url":null,"abstract":"<div><h3>Background</h3><div>SARS-CoV-2 remains a global health issue since its discovery in 2019, and long-term noninvasive clinical testing methods are required. The current preferred method of detection is nasopharyngeal swab, which reflects sampling of the upper respiratory tract alone.</div></div><div><h3>Research Question</h3><div>Can we noninvasively assess detection of SARS-CoV-2 RNA and biomarkers in patients’ cough droplets captured with the PneumoniaCheck device?</div></div><div><h3>Study Design and Methods</h3><div>We enrolled adult patients with a recent nasopharyngeal swab that was positive for COVID-19 by polymerase chain reaction (PCR) who were receiving monoclonal antibody infusion therapy. After consent and instruction, patients coughed 5 sets of 10 coughs into the PneumoniaCheck device. Material captured on the device filter was eluted and tested for biomarkers (interferon gamma, tumor necrosis factor alpha [TNF-α], IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, and IL-13) and amylase by an enzyme activity assay, and SARS-CoV-2 RNA by PCR (3 different primer sets).</div></div><div><h3>Results</h3><div>A total of 44 case patients out of 50 cases and 17 control patients with adequate specimen and accompanying clinical data were included in the analysis. Thirty case patient cough specimens (68%) tested PCR positive for SARS-CoV-2 RNA, 10 (23%) tested negative, and 4 (9%) tested indeterminate. IL-13 and TNF-α levels were significantly higher, whereas IL-2 levels were significantly lower in case specimens than in control cough specimens. In the multivariable analysis of biomarkers and reported symptoms, higher IL-10 levels were associated with reduced fatigue (OR, 0.41; 95% CI, 0.15-0.87; <em>P</em> = .039), whereas higher IL-12p70 (OR, 2.74; 95% CI, 1.15-8.51; <em>P</em> = .043), IL-4 (OR, 3.56; 95% CI, 1.56-11.20; <em>P</em> = .008), and TNF-α (OR, 4.36; 95% CI, 1.79-14.60; <em>P</em> = .004) levels were associated with fever.</div></div><div><h3>Interpretation</h3><div>Our results show that the PneumoniaCheck device is a noninvasive method for successfully detecting SARS-CoV-2 and inflammatory cytokines in specimens from the lower respiratory tract in patients with COVID-19 and likely in patients with other lung diseases.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 3","pages":"Article 100137"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048712","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}
Silicosis typically presents with parenchymal lung disease in workers exposed to silica. We present a rare case of isolated pleural and lymph node silicosis without parenchymal involvement in a stone fabrication worker. A 49-year-old man with extensive occupational exposure to stone materials, including engineered stone without consistent use of personal protective equipment, was found to have mediastinal and hilar lymphadenopathy. Initial bronchoscopic and radiology evaluations were nondiagnostic. Video-assisted thoracoscopic surgery revealed pleural nodules, and pathologic examination demonstrated silicotic changes in both pleura and lymph nodes but without parenchymal involvement. This case demonstrates an unusual presentation of silicosis confined to the pleura and lymph nodes, highlighting the importance of thorough evaluation of thoracic pathology in workers with silica exposure. It adds to growing evidence regarding health risks in the engineered stone fabrication industry and emphasizes the need for improved occupational safety measures and medical surveillance.
{"title":"Cutting for Stone","authors":"Matthew Federbush MD , Alain Borczuk MD , Arunabh Talwar MD , Julissa Jurado MD , Abhinav Agrawal MD","doi":"10.1016/j.chpulm.2025.100188","DOIUrl":"10.1016/j.chpulm.2025.100188","url":null,"abstract":"<div><div>Silicosis typically presents with parenchymal lung disease in workers exposed to silica. We present a rare case of isolated pleural and lymph node silicosis without parenchymal involvement in a stone fabrication worker. A 49-year-old man with extensive occupational exposure to stone materials, including engineered stone without consistent use of personal protective equipment, was found to have mediastinal and hilar lymphadenopathy. Initial bronchoscopic and radiology evaluations were nondiagnostic. Video-assisted thoracoscopic surgery revealed pleural nodules, and pathologic examination demonstrated silicotic changes in both pleura and lymph nodes but without parenchymal involvement. This case demonstrates an unusual presentation of silicosis confined to the pleura and lymph nodes, highlighting the importance of thorough evaluation of thoracic pathology in workers with silica exposure. It adds to growing evidence regarding health risks in the engineered stone fabrication industry and emphasizes the need for improved occupational safety measures and medical surveillance.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 3","pages":"Article 100188"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048714","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.2024.100126
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}
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