Pub Date : 2025-06-01DOI: 10.1016/j.chpulm.2024.100117
Domingo J. Franco-Palacios MD , Rebecca Priebe NP , Jane Simanovski PhD, NP , Lisa L. Allenspach MD , Lisa Stagner DO , Lisa K. Waynick PA , Yichu Wang BS , Mei Lu BS , Shraddha Desai MD , Daniel Kapadia MD , Avi Cohen MD
Background
Many bronchoscopic lung volume reduction (BLVR) studies have excluded patients meeting the listing criteria for lung transplantation (LT).
Research Question
What are the outcomes of BLVR in a sicker group of patients with emphysema compared with patients not meeting the criteria for LT listing?
Study Design and Methods
This was a real-world retrospective study (June 2018 to December 2022) assessing the effect of BLVR in patients with severe emphysema considered for LT. FEV1, FVC, diffusing capacity for carbon monoxide, symptoms, and 6-minute walk distance (6-MWD) were measured at baseline and 45 days and 6 months after BLVR.
Results
Of 76 fully evaluated patients (median age, 62 years; 60% female), 42 underwent BLVR (30 sicker patients met the criteria for LT listing). At baseline, patients that met the criteria for listing had shorter baseline 6-MWD (234.72 ± 68.86, P < .001), higher BODE Index score (6.79 ± 1.11, P = .001), and lower FEV1 (617.5 ± 139.2 mL, P = .005). All patients treated with BLVR experienced a decrease in BODE Index and Borg dyspnea by scores −0.5 to −2 points, respectively. Diffusing capacity for carbon monoxide % predicted increased by 4.5%, FEV1 increased by 115 mL, FVC increased by 450 mL, and 6-MWD increased by 20 meters. In the sicker group, FEV1 at 45 days after BLVR increased by 180.8 ± 231 mL (FEV1 % predicted 5.84 ± 5.66) compared with baseline; a persistent effect was seen at 6 months in 62% of patients with available data (18 of 30). Median hospital length of stay was 3.27 ± 3.07 days. Endobronchial valves were removed in 6 patients (3 in each group) due to complications. The pneumothorax rate was 24% (10 of 42; 5 in each group).
Interpretation
Improvement in lung function after BLVR was observed regardless of disease severity. BLVR might represent an alternative to LT for some patients.
{"title":"Bronchoscopic Lung Volume Reduction","authors":"Domingo J. Franco-Palacios MD , Rebecca Priebe NP , Jane Simanovski PhD, NP , Lisa L. Allenspach MD , Lisa Stagner DO , Lisa K. Waynick PA , Yichu Wang BS , Mei Lu BS , Shraddha Desai MD , Daniel Kapadia MD , Avi Cohen MD","doi":"10.1016/j.chpulm.2024.100117","DOIUrl":"10.1016/j.chpulm.2024.100117","url":null,"abstract":"<div><h3>Background</h3><div>Many bronchoscopic lung volume reduction (BLVR) studies have excluded patients meeting the listing criteria for lung transplantation (LT).</div></div><div><h3>Research Question</h3><div>What are the outcomes of BLVR in a sicker group of patients with emphysema compared with patients not meeting the criteria for LT listing?</div></div><div><h3>Study Design and Methods</h3><div>This was a real-world retrospective study (June 2018 to December 2022) assessing the effect of BLVR in patients with severe emphysema considered for LT. FEV<sub>1</sub>, FVC, diffusing capacity for carbon monoxide, symptoms, and 6-minute walk distance (6-MWD) were measured at baseline and 45 days and 6 months after BLVR.</div></div><div><h3>Results</h3><div>Of 76 fully evaluated patients (median age, 62 years; 60% female), 42 underwent BLVR (30 sicker patients met the criteria for LT listing). At baseline, patients that met the criteria for listing had shorter baseline 6-MWD (234.72 ± 68.86, <em>P</em> < .001), higher BODE Index score (6.79 ± 1.11, <em>P</em> = .001), and lower FEV<sub>1</sub> (617.5 ± 139.2 mL, <em>P</em> = .005). All patients treated with BLVR experienced a decrease in BODE Index and Borg dyspnea by scores −0.5 to −2 points, respectively. Diffusing capacity for carbon monoxide % predicted increased by 4.5%, FEV<sub>1</sub> increased by 115 mL, FVC increased by 450 mL, and 6-MWD increased by 20 meters. In the sicker group, FEV<sub>1</sub> at 45 days after BLVR increased by 180.8 ± 231 mL (FEV<sub>1</sub> % predicted 5.84 ± 5.66) compared with baseline; a persistent effect was seen at 6 months in 62% of patients with available data (18 of 30). Median hospital length of stay was 3.27 ± 3.07 days. Endobronchial valves were removed in 6 patients (3 in each group) due to complications. The pneumothorax rate was 24% (10 of 42; 5 in each group).</div></div><div><h3>Interpretation</h3><div>Improvement in lung function after BLVR was observed regardless of disease severity. BLVR might represent an alternative to LT for some patients.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 2","pages":"Article 100117"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144298043","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 : 2025-06-01DOI: 10.1016/j.chpulm.2025.100161
Kim Styrvoky MD , Xinhui Duan PhD
{"title":"Cumulative Personal Radiation Exposure for a Single Pulmonary Proceduralist Over 1 Year","authors":"Kim Styrvoky MD , Xinhui Duan PhD","doi":"10.1016/j.chpulm.2025.100161","DOIUrl":"10.1016/j.chpulm.2025.100161","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 2","pages":"Article 100161"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144243083","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 : 2025-06-01DOI: 10.1016/j.chpulm.2025.100162
Seigo Miyoshi MD, PhD, Mayuko Semba MD, Miyuki Tanabe MD, Chika Sato MD, Akira Watanabe MD, PhD, Ryoji Ito MD, PhD, Mari Kubota, Masahiro Abe MD, PhD
Background
Previous studies have identified several risk factors for death because of TB, including advanced age, HIV coinfection, multidrug-resistant TB, malnutrition, low activities of daily living, and comorbidities. In Japan, the incidence of TB and TB-related deaths is consistently higher among older individuals. However, few studies have evaluated the risk factors for death in older adult patients with TB.
Research Question
What are the risk factors for death among older adults with TB?
Study Design and Methods
This prospective cohort study included data on consecutive older adult patients (aged ≥ 65 years) who were admitted for treatment of TB between October 2016 and April 2022. We collected data on patient characteristics, chest radiography findings, and laboratory data and assessed whether these parameters were associated with patient death. We also examined the risk factors associated with TB-related and TB-unrelated deaths as a subanalysis.
Results
Multivariate Cox proportional hazards analysis showed that performance status (hazard ratio [HR], 1.434; 95% CI, 1.051-1.956; P = .023), corticosteroid use (HR, 2.679; 95% CI, 1.374-5.221; P = .004), and serum albumin levels (HR, 0.434; 95% CI, 0.235-0.804; P = .008) were significantly correlated with all-cause mortality. Subanalyses demonstrated that performance status was significantly correlated with TB-related death (HR, 2.048; 95% CI, 1.459-2.874; P < 0.001), whereas advanced age (HR, 1.073; 95% CI, 1.008-1.142; P = .027), corticosteroid use (HR, 4.131; 95% CI, 1.783-9.575; P < .001), and serum albumin levels (HR, 0.435; 95% CI, 0.225-0.842; P = .014) were significantly correlated with TB-unrelated deaths.
Interpretation
The evaluation of daily activity, physical ability, immune status, and nutritional status is considered an important factor directly related to prognosis in the treatment of TB in older adults. Large-scale prospective studies should be conducted in the future.
{"title":"Assessment of Risk Factors for Death in Older Adult Patients With TB in Japan","authors":"Seigo Miyoshi MD, PhD, Mayuko Semba MD, Miyuki Tanabe MD, Chika Sato MD, Akira Watanabe MD, PhD, Ryoji Ito MD, PhD, Mari Kubota, Masahiro Abe MD, PhD","doi":"10.1016/j.chpulm.2025.100162","DOIUrl":"10.1016/j.chpulm.2025.100162","url":null,"abstract":"<div><h3>Background</h3><div>Previous studies have identified several risk factors for death because of TB, including advanced age, HIV coinfection, multidrug-resistant TB, malnutrition, low activities of daily living, and comorbidities. In Japan, the incidence of TB and TB-related deaths is consistently higher among older individuals. However, few studies have evaluated the risk factors for death in older adult patients with TB.</div></div><div><h3>Research Question</h3><div>What are the risk factors for death among older adults with TB?</div></div><div><h3>Study Design and Methods</h3><div>This prospective cohort study included data on consecutive older adult patients (aged ≥ 65 years) who were admitted for treatment of TB between October 2016 and April 2022. We collected data on patient characteristics, chest radiography findings, and laboratory data and assessed whether these parameters were associated with patient death. We also examined the risk factors associated with TB-related and TB-unrelated deaths as a subanalysis.</div></div><div><h3>Results</h3><div>Multivariate Cox proportional hazards analysis showed that performance status (hazard ratio [HR], 1.434; 95% CI, 1.051-1.956; <em>P</em> = .023), corticosteroid use (HR, 2.679; 95% CI, 1.374-5.221; <em>P</em> = .004), and serum albumin levels (HR, 0.434; 95% CI, 0.235-0.804; <em>P</em> = .008) were significantly correlated with all-cause mortality. Subanalyses demonstrated that performance status was significantly correlated with TB-related death (HR, 2.048; 95% CI, 1.459-2.874; <em>P</em> < 0.001), whereas advanced age (HR, 1.073; 95% CI, 1.008-1.142; <em>P</em> = .027), corticosteroid use (HR, 4.131; 95% CI, 1.783-9.575; <em>P</em> < .001), and serum albumin levels (HR, 0.435; 95% CI, 0.225-0.842; <em>P</em> = .014) were significantly correlated with TB-unrelated deaths.</div></div><div><h3>Interpretation</h3><div>The evaluation of daily activity, physical ability, immune status, and nutritional status is considered an important factor directly related to prognosis in the treatment of TB in older adults. Large-scale prospective studies should be conducted in the future.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 2","pages":"Article 100162"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144243103","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 : 2025-06-01DOI: 10.1016/j.chpulm.2025.100155
William J. Healy MD , Younghoon Kwon MD
{"title":"Canary in the Coalmine?","authors":"William J. Healy MD , Younghoon Kwon MD","doi":"10.1016/j.chpulm.2025.100155","DOIUrl":"10.1016/j.chpulm.2025.100155","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 2","pages":"Article 100155"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144243255","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 : 2025-06-01DOI: 10.1016/j.chpulm.2025.100149
Shelsey W. Johnson MD , Melanie C. Kwan MD , Sarah A.M. Cuddy MD , Aaron B. Waxman MD, PhD , Lida P. Hariri MD, PhD , William M. Oldham MD, PhD
Case Presentation
A 67-year-old man who never smoked was evaluated in the emergency department for 3 months of progressive dyspnea, lower extremity edema, and 20lb weight gain. Eighteen months before this, he had presented with hemoptysis and was ultimately found to have squamous cell lung cancer invading the left pulmonary artery without lymph node involvement, stage pT4N0M0, for which he underwent left pneumonectomy. His medical history was additionally notable for paroxysmal atrial fibrillation and factor V Leiden mutation (anticoagulated on apixaban). Social history was notable for work as a grocer in a supermarket; the patient denied history of asbestos exposure and had no known TB exposure or prior infection. The patient was admitted to general cardiology where he was afebrile, in atrial fibrillation with rapid ventricular response to 127 beats/min with associated hypotension (80/55 mm Hg); his oxygen saturation was 95% on room air. Physical examination was most notable for jugular venous distension and bilateral edema to the thigh. Electrocardiogram did not demonstrate ischemia. Laboratory evaluation demonstrated a creatinine level of 1.10 mg/dL, elevated from his recent baseline level of 0.52 mg/dL. Lactic acid was normal. His cardiac biomarkers were abnormal with an elevated N-terminal pro-B-type natriuretic peptide value (3,682 pg/mL) and high sensitivity troponin T (43 ng/L). Both WBC count and hemoglobin values were normal as were his thyroid hormone levels. IV diuretic and antiarrhythmic therapies were initiated with furosemide and amiodarone, respectively.
病例介绍：一名从不吸烟的67岁男性，因3个月进行性呼吸困难、下肢水肿和体重增加20lb而在急诊科接受评估。在此之前18个月，他曾出现咯血，最终被发现患有侵犯左肺动脉的鳞状细胞肺癌，未累及淋巴结，pT4N0M0期，为此他接受了左侧全肺切除术。他的病史还包括阵发性心房颤动和因子V Leiden突变（阿哌沙班抗凝）。在社会历史上，他曾在超市当过杂货商；患者否认有石棉接触史，也没有已知的结核接触史或既往感染史。患者在普通心脏病科住院，他发热，心房颤动，心室反应快速至127次/分，伴有低血压（80/55 mm Hg）；他的血氧饱和度在室内空气中为95%。体格检查以颈静脉扩张和双侧大腿水肿最为显著。心电图未显示缺血。实验室评估显示肌酐水平为1.10 mg/dL，高于最近的基线水平0.52 mg/dL。乳酸正常。他的心脏生物标志物异常，n端前b型利钠肽值升高（3,682 pg/mL）和高敏感性肌钙蛋白T （43 ng/L）。白细胞计数和血红蛋白值正常，甲状腺激素水平正常。静脉利尿剂和抗心律失常治疗分别开始使用速尿和胺碘酮。
{"title":"Dyspnea and Right-Sided Heart Failure in a Patient With a History of Pneumonectomy","authors":"Shelsey W. Johnson MD , Melanie C. Kwan MD , Sarah A.M. Cuddy MD , Aaron B. Waxman MD, PhD , Lida P. Hariri MD, PhD , William M. Oldham MD, PhD","doi":"10.1016/j.chpulm.2025.100149","DOIUrl":"10.1016/j.chpulm.2025.100149","url":null,"abstract":"<div><h3>Case Presentation</h3><div>A 67-year-old man who never smoked was evaluated in the emergency department for 3 months of progressive dyspnea, lower extremity edema, and 20lb weight gain. Eighteen months before this, he had presented with hemoptysis and was ultimately found to have squamous cell lung cancer invading the left pulmonary artery without lymph node involvement, stage pT4N0M0, for which he underwent left pneumonectomy. His medical history was additionally notable for paroxysmal atrial fibrillation and factor V Leiden mutation (anticoagulated on apixaban). Social history was notable for work as a grocer in a supermarket; the patient denied history of asbestos exposure and had no known TB exposure or prior infection. The patient was admitted to general cardiology where he was afebrile, in atrial fibrillation with rapid ventricular response to 127 beats/min with associated hypotension (80/55 mm Hg); his oxygen saturation was 95% on room air. Physical examination was most notable for jugular venous distension and bilateral edema to the thigh. Electrocardiogram did not demonstrate ischemia. Laboratory evaluation demonstrated a creatinine level of 1.10 mg/dL, elevated from his recent baseline level of 0.52 mg/dL. Lactic acid was normal. His cardiac biomarkers were abnormal with an elevated N-terminal pro-B-type natriuretic peptide value (3,682 pg/mL) and high sensitivity troponin T (43 ng/L). Both WBC count and hemoglobin values were normal as were his thyroid hormone levels. IV diuretic and antiarrhythmic therapies were initiated with furosemide and amiodarone, respectively.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 2","pages":"Article 100149"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144279504","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 : 2025-06-01DOI: 10.1016/j.chpulm.2025.100147
Ricardo G. Figueiredo PhD , Fernando Holguin MSc , Márcia M.M. Pizzichini PhD , Gabriela P. Pinheiro PhD , Vanessa Arata MD , Maisa F.M. Leal , Cinthia V.N. Santana PhD , José de Bessa Junior PhD , Álvaro A. Cruz PhD
{"title":"Connecting the Dots Between Asthma Control and Frailty in Older Adults With Moderate to Severe Asthma","authors":"Ricardo G. Figueiredo PhD , Fernando Holguin MSc , Márcia M.M. Pizzichini PhD , Gabriela P. Pinheiro PhD , Vanessa Arata MD , Maisa F.M. Leal , Cinthia V.N. Santana PhD , José de Bessa Junior PhD , Álvaro A. Cruz PhD","doi":"10.1016/j.chpulm.2025.100147","DOIUrl":"10.1016/j.chpulm.2025.100147","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 2","pages":"Article 100147"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144261653","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 : 2025-06-01DOI: 10.1016/j.chpulm.2025.100163
Sameer Desai PhD , Sophia Shen MD , Zosia Gryz BSc , Elizabeth Tullis MD , Anne L. Stephenson MD, PhD , Bradley S. Quon MD, MSc
Background
Biologic therapies targeting T-helper cell type 2 (Th2) eosinophilic inflammation have been used for difficult-to-treat asthma and allergic bronchopulmonary aspergillosis (ABPA), but safety and efficacy data are limited in the cystic fibrosis (CF) population.
Research Question
Are Th2 biologic therapies targeting eosinophilic inflammation effective and safe when used in adults with CF with asthma and/or ABPA overlap?
Study Design and Methods
This was a retrospective multicenter study. Individuals with CF receiving Th2 biologic therapies for asthma or ABPA at 2 large adult CF centers between 2016 and 2021 were included. Treatment safety and effectiveness up to 12 months after biologic initiation were evaluated. Outcomes of interest included percent predicted FEV1 (ppFEV1), rate of change in ppFEV1, cumulative systemic corticosteroid (SCS) dose, and frequency of pulmonary exacerbations (PExs).
Results
Forty adults with CF received Th2 biologic therapies targeting eosinophilic inflammation during the study period. A total of 38 were eligible for study inclusion, and all received IL-5-directed therapies (mepolizumab: n = 27, benralizumab: n = 11): 17 (45%) for asthma only and 21 for ABPA (55%) with or without asthma. No significant biologic-related adverse effects were observed. There was no statistical difference in ppFEV1 from baseline to 12-months postbiologic initiation, but the rate of change in ppFEV1 improved in the 12 months postbiologic vs prebiologic with a pre-to-post difference of 3.7% (95% CI, 1.2%-6.3%). SCS dose and frequency of PExs requiring hospitalization did not differ significantly in the 12 months before biologic vs after biologic initiation.
Interpretation
Our results show that in adults with CF, anti-IL-5 biologic therapies were well tolerated and can improve rate of change in lung function, but there was no impact on SCS use or PEx frequency. Further study is needed to better define the role of Th2 biologics in the era of highly effective modulator therapy.
背景：靶向t辅助细胞2型（Th2）嗜酸性粒细胞炎症的生物疗法已被用于治疗难以治疗的哮喘和过敏性支气管肺曲霉病（ABPA），但在囊性纤维化（CF）人群中的安全性和有效性数据有限。研究问题：针对嗜酸性粒细胞炎症的Th2生物疗法用于合并哮喘和/或ABPA重叠的成人CF患者是否有效和安全？研究设计与方法本研究为回顾性多中心研究。纳入了2016年至2021年间在2家大型成人CF中心接受Th2生物疗法治疗哮喘或ABPA的CF患者。评估生物起始治疗后12个月的安全性和有效性。结果包括预测FEV1百分比（ppFEV1）， ppFEV1变化率，累积全身皮质类固醇（SCS）剂量和肺恶化频率（PExs）。结果40例成年CF患者在研究期间接受了针对嗜酸性粒细胞炎症的Th2生物治疗。共有38例患者符合纳入研究的条件，所有患者均接受了il -5定向治疗（mepolizumab: n = 27, benralizumab: n = 11）：仅哮喘患者17例（45%），合并或不合并哮喘的ABPA患者21例（55%）。未观察到明显的生物相关不良反应。从基线到生物起始后12个月ppFEV1无统计学差异，但生物起始后12个月ppFEV1变变率与生物起始前相比有所改善，前后差异为3.7% （95% CI, 1.2%-6.3%）。在生物制剂开始前和生物制剂开始后的12个月内，需要住院治疗的PExs的SCS剂量和频率没有显着差异。我们的研究结果表明，在成年CF患者中，抗il -5生物疗法耐受性良好，可以改善肺功能变化率，但对SCS的使用或PEx频率没有影响。需要进一步的研究来更好地定义Th2生物制剂在高效调节剂治疗时代的作用。
{"title":"A Multicenter Retrospective Study Evaluating IL-5-Targeted Biologic Therapies for the Treatment of Asthma and Allergic Bronchopulmonary Aspergillosis in Adults With Cystic Fibrosis","authors":"Sameer Desai PhD , Sophia Shen MD , Zosia Gryz BSc , Elizabeth Tullis MD , Anne L. Stephenson MD, PhD , Bradley S. Quon MD, MSc","doi":"10.1016/j.chpulm.2025.100163","DOIUrl":"10.1016/j.chpulm.2025.100163","url":null,"abstract":"<div><h3>Background</h3><div>Biologic therapies targeting T-helper cell type 2 (Th2) eosinophilic inflammation have been used for difficult-to-treat asthma and allergic bronchopulmonary aspergillosis (ABPA), but safety and efficacy data are limited in the cystic fibrosis (CF) population.</div></div><div><h3>Research Question</h3><div>Are Th2 biologic therapies targeting eosinophilic inflammation effective and safe when used in adults with CF with asthma and/or ABPA overlap?</div></div><div><h3>Study Design and Methods</h3><div>This was a retrospective multicenter study. Individuals with CF receiving Th2 biologic therapies for asthma or ABPA at 2 large adult CF centers between 2016 and 2021 were included. Treatment safety and effectiveness up to 12 months after biologic initiation were evaluated. Outcomes of interest included percent predicted FEV<sub>1</sub> (ppFEV<sub>1</sub>), rate of change in ppFEV<sub>1</sub>, cumulative systemic corticosteroid (SCS) dose, and frequency of pulmonary exacerbations (PExs).</div></div><div><h3>Results</h3><div>Forty adults with CF received Th2 biologic therapies targeting eosinophilic inflammation during the study period. A total of 38 were eligible for study inclusion, and all received IL-5-directed therapies (mepolizumab: n = 27, benralizumab: n = 11): 17 (45%) for asthma only and 21 for ABPA (55%) with or without asthma. No significant biologic-related adverse effects were observed. There was no statistical difference in ppFEV<sub>1</sub> from baseline to 12-months postbiologic initiation, but the rate of change in ppFEV<sub>1</sub> improved in the 12 months postbiologic vs prebiologic with a pre-to-post difference of 3.7% (95% CI, 1.2%-6.3%). SCS dose and frequency of PExs requiring hospitalization did not differ significantly in the 12 months before biologic vs after biologic initiation.</div></div><div><h3>Interpretation</h3><div>Our results show that in adults with CF, anti-IL-5 biologic therapies were well tolerated and can improve rate of change in lung function, but there was no impact on SCS use or PEx frequency. Further study is needed to better define the role of Th2 biologics in the era of highly effective modulator therapy.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 2","pages":"Article 100163"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144243263","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 : 2025-06-01DOI: 10.1016/j.chpulm.2024.100089
Emily S. Wan MD, MPH , Josephine Decherd MPH , Christine Stella NP , Jonathan R. Venne PT , Brenda McKeon NP , Stephanie A. Robinson PhD , Patricia Bamonti PhD , Marilyn L. Moy MD, MSc
Background
Given limited access to center-based, in-person pulmonary rehabilitation (PR), alternative delivery strategies are needed.
Research Question
We compared a virtual PR program with a conventional center-based one with respect to safety, feasibility/acceptability, and geographic catchment (primary outcomes). We explored efficacy by examining changes in functional outcomes (secondary outcomes).
Study Design and Methods
This single-center observational real-world report included patients enrolled from July 30, 2020, through June 30, 2023, who attended one or more PR class. Patients undergoing virtual PR exercised in their homes under direct supervision via two-way audiovisual teleconferencing. Baseline demographic information and adverse events were extracted from electronic medical records. Google Maps estimated distance and drive time from residential addresses to the PR center. Intake and exit evaluations for secondary (functional) outcomes and feedback questionnaires were completed in a subset.
Results
A total of 120 (52 in-person and 68 virtual) patient enrollments were examined; 84% of patients had COPD. Mean age, FEV1 and FVC % predicted, and baseline 6-min walk test distance were similar between groups. For safety, the overall rate of PR-related adverse events was 1.2 per 1,000 person-days of observation, with no between-group differences. For feasibility, the average number of exercise classes completed (12.4 ± 6.2 vs 13.0 ± 6.1) and proportion of patients completing ≥ 70% of classes (61.5% vs 67.6%) was comparable between the in-person and virtual groups, respectively. For acceptability, among those who completed the virtual PR feedback questionnaire (n = 30), 100% felt safe exercising at home, 97% endorsed clear internet connection, and 90% agreed education sessions were easy to understand. For geographic catchment, patients in virtual PR lived farther (median, 34.1 miles; interquartile range, 16.6-45.1 vs median, 10.3 miles; interquartile range, 5.6-20.6 miles; P < .001) and had longer drive times (mean 86.0 ± 31.6 vs 51.4 ± 31.9 min; P < 0.001) than patients in in-person PR. In the subset with both intake and exit evaluations, similar improvements were observed in functional outcomes and dyspnea in both groups.
Interpretation
This study suggests that two-way audiovisual teleconferenced PR is safe, feasible/acceptable, and significantly expands geographic catchment.
背景：考虑到以中心为基础的、面对面的肺部康复（PR）的可及性有限，需要其他的递送策略。研究问题：我们将虚拟公关项目与传统的基于中心的项目在安全性、可行性/可接受性和地理集水区（主要结果）方面进行了比较。我们通过检查功能结局（次要结局）的变化来探讨疗效。研究设计和方法本单中心观察性真实世界报告纳入了从2020年7月30日至2023年6月30日参加一个或多个PR课程的患者。接受虚拟PR的患者在家中通过双向视听电话会议进行直接监督。从电子病历中提取基线人口统计信息和不良事件。谷歌地图估计距离和开车时间从住宅地址到公关中心。在一个子集中完成了次要（功能）结果的入院和出院评估和反馈问卷。结果共纳入120例患者（52例真人登记，68例虚拟登记）；84%的患者患有慢性阻塞性肺病。平均年龄、预测FEV1和FVC %以及基线6分钟步行测试距离在两组之间相似。在安全性方面，pr相关不良事件的总发生率为每1000人天观察1.2例，组间无差异。为了可行性，完成运动课程的平均次数（12.4±6.2 vs 13.0±6.1）和完成≥70%课程的患者比例（61.5% vs 67.6%）在真人组和虚拟组之间分别具有可比性。在接受度方面，在完成虚拟公关反馈问卷（n = 30）的受访者中，100%的人认为在家锻炼是安全的，97%的人赞同清晰的互联网连接，90%的人同意教育课程容易理解。就地理集水区而言，虚拟PR的患者住得更远(中位数为34.1英里；四分位数范围16.6-45.1 vs中位数10.3英里；四分位数范围5.6-20.6英里；P & lt;.001)，驾驶时间更长(平均86.0±31.6 vs 51.4±31.9 min；P & lt;0.001)，优于现场PR患者。在摄入和退出评估的亚组中，两组在功能结局和呼吸困难方面均观察到类似的改善。本研究表明，双向视听远程会议公关是安全、可行/可接受的，并显著扩大了地理集水区。
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