CHEST pulmonary最新文献

{"title":"Racialized Economic Segregation and Disparities in Non-Small Cell Lung Cancer Care and Outcomes","authors":"Pratibha Shrestha MPH, PhD ,&nbsp;Min Lian MD, PhD ,&nbsp;James Struthers BA ,&nbsp;Oumarou Nabi PhD ,&nbsp;Bayu B. Bekele MPH, PhD ,&nbsp;Benjamin Kozower MD ,&nbsp;Maria Baggstrom MD ,&nbsp;Ying Liu MD, PhD","doi":"10.1016/j.chpulm.2024.100101","DOIUrl":"10.1016/j.chpulm.2024.100101","url":null,"abstract":"<div><h3>Background</h3><div>Little is known about the impact of residential segregation on early detection, treatment, and prognosis of non-small cell lung cancer (NSCLC), a predominant type of lung cancers.</div></div><div><h3>Research Question</h3><div>Does racialized economic segregation play a role in NSCLC treatment and outcomes and contribute to racial disparities?</div></div><div><h3>Study Design and Methods</h3><div>This study included non-Hispanic White (NHW) and non-Hispanic Black (NHB) patients with NSCLC diagnosed between 2007 and 2015 and identified from the Surveillance, Epidemiology, and End Results data set. County-level racialized economic segregation was estimated by using the Index of Concentration at the Extremes (ICE). Multilevel logistic regression and multilevel Cox regression accounting for county-level clustering were used to estimate ORs for late-stage diagnosis and treatment underutilization, and hazard ratios (HRs) were used for mortality.</div></div><div><h3>Results</h3><div>Of 203,441 patients, 85.8% were NHW, and 14.2% were NHB. Compared with patients living in the counties with the highest concentration of high-income NHW households (lowest ICE quintile), patients living in the counties with the highest concentration of low-income NHB households (highest ICE quintile) had higher risks of late-stage diagnosis (OR, 1.09; 95% CI, 1.02-1.16; <em>P</em>_trend &lt; .001), underutilization of guideline-recommended treatment (OR, 1.28; 95% CI, 1.16-1.41; <em>P</em>_trend &lt; .0001), lung cancer-specific mortality (HR, 1.10; 95% CI, 1.07-1.14; <em>P</em>_trend &lt; .0001), and overall mortality (HR, 1.12; 95% CI, 1.09-1.16; <em>P</em>_trend &lt; .0001). The association between segregation and treatment underutilization was stronger in NHW patients than in NHB patients (<em>P</em>_interaction = .02). There was no significant difference in the segregation-related risk of late-stage diagnosis, lung cancer-specific mortality, or overall mortality between NHW and NHB patients.</div></div><div><h3>Interpretation</h3><div>Living in segregated, low-income counties with predominately NHB residents has adverse impacts on early detection, treatment, and outcomes of NSCLC. However, residential segregation did not explain the excess risks of NSCLC care underutilization and mortality in NHB patients compared with NHW patients.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 1","pages":"Article 100101"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143578830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Occurrence of Emphysema in Individuals With Williams-Beuren Syndrome","authors":"Uddalak Majumdar MD ,&nbsp;Theresa M. Kline MLIS, AHIP ,&nbsp;James K. Stoller MD","doi":"10.1016/j.chpulm.2024.100063","DOIUrl":"10.1016/j.chpulm.2024.100063","url":null,"abstract":"<div><h3>Background</h3><div>Williams-Beuren syndrome (WBS) is a multisystem genetic condition characterized by a submicroscopic deletion on the seventh chromosome (7q11.23), which usually includes the elastin gene.</div></div><div><h3>Research Question</h3><div>Although the elastin deficiency in WBS can predispose individuals to emphysema, the prevalence of emphysema in WBS is unknown. This narrative review aims to address this gap by estimating the frequency of emphysema (or suggestive features thereof) in patients with WBS, with a special focus on concomitant alpha-1 antitrypsin deficiency.</div></div><div><h3>Study Design and Methods</h3><div>Literature was reviewed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.</div></div><div><h3>Results</h3><div>Of 419 studies identified by the search strategy, 19 eligible studies reported 393 adult patients with WBS. The criteria by which emphysema was assessed varied greatly among the relatively few reports addressing this issue. Chest CT evidence of emphysema was reported in three of 26 patients (11.5%). Physiologic evidence of airflow obstruction, although not definitive for emphysema (ie, with asthma not excluded), was present in as many as 38.6% of patients. Considering studies that reported multiorgan clinical manifestations of WBS, irrespective of whether chest CT imaging and/or pulmonary function testing was reported, the frequency of spirometric and imaging signs suggestive of emphysema was 4.3%. Emphysema was not reported in any of the 11 patients with concomitant PI∗MZ heterozygous alpha-1 antitrypsin deficiency.</div></div><div><h3>Interpretation</h3><div>In the context that only few adults with WBS have been fully characterized regarding the occurrence of emphysema, confidently estimating the prevalence of emphysema is difficult. This review shows that the frequency of imaging and pulmonary function test abnormalities suggestive of emphysema seems relatively low in the context that the elastin deficiency of WBS clearly can predispose to emphysema, and that other manifestations of elastin deficiency are present early in life. Acknowledging the challenges of studying uncommon diseases or syndromes, further systematic study of adults with WBS is needed.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 1","pages":"Article 100063"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141139258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accurate Indentification of Pathogenic Mutations Conferring α1-Antitrypsin Deficiency by a Novel Multiplexed Molecular Assay","authors":"Emily K. DeCurtis BSc ,&nbsp;Sharon K. Kuss-Duerkop PhD ,&nbsp;Iara M.P. Machado PhD ,&nbsp;Zoe P. Stewart BSc ,&nbsp;Matt Jackson MS ,&nbsp;Ellie Hasenohr BSc ,&nbsp;Jessica L. Crumby BSc ,&nbsp;Steve D. Groshong MD, PhD ,&nbsp;Claire M. Coeshott PhD ,&nbsp;Ronald J. Harbeck PhD ,&nbsp;James P. Woodrow MD ,&nbsp;Robert A. Sandhaus MD, PhD ,&nbsp;Yongbao Wang PhD","doi":"10.1016/j.chpulm.2024.100076","DOIUrl":"10.1016/j.chpulm.2024.100076","url":null,"abstract":"<div><h3>Background</h3><div>α₁-Antitrypsin deficiency (AATD) is a common, underdiagnosed disease caused by mutations in the polymorphic <em>SERPINA1</em> gene. AATD often causes COPD, other respiratory ailments, and severe liver disease. AATD underdiagnosis is associated with the lack of a quick, high-precision test for <em>SERPINA1</em> variants.</div></div><div><h3>Research Question</h3><div>Can a rapid and more accurate molecular diagnostic assay be developed that identifies AATD-associated mutations and outperforms current limited methodology?</div></div><div><h3>Study Design and Methods</h3><div>We developed a multiplexed polymerase chain reaction (PCR) assay that that uses mass spectrometry to detect 20 pathogenic <em>SERPINA1</em> mutations, two normal M allele variants, and an additional variant of unknown significance as an accessible frontline genetic test for AATD. Blood or buffy coat samples from 177 patients with AATD indication, 176 blood samples from people with presumed normal genotypes in addition to 10 buccal swabs and 10 blood spots (total of 373) were tested to validate the assay. Additionally, 760 whole blood samples from patients with AATD indications were evaluated to identify AATD-associated mutations.</div></div><div><h3>Results</h3><div>The novel genotyping assay described here accurately detected 23 <em>SERPINA1</em> single nucleotide polymorphisms (23-SNP AAT assay). Of 177 AATD samples, 96% showed abnormal single nucleotide polymorphisms (SNPs), whereas 9.1% of the 176 presumed normal samples showed abnormal SNPs. The 23-SNP AAT genotypes correlated well with known serum α₁-antitrypsin levels. This genotyping assay was more accurate and streamlined than a phenotyping isoelectric focusing assay used to identify AATD variants. For clinical testing, serum α₁-antitrypsin protein level determination and the 23-SNP AAT genotyping assay were performed. The 23-SNP AAT assay was successfully implemented using AATD indication patient samples to evaluate the most common <em>SERPINA1</em> mutations indicative of AATD. The 23-SNP AAT assay has allowed for quick and accurate α₁-antitrypsin genotyping of patients.</div></div><div><h3>Interpretation</h3><div>These findings indicate that we developed a novel, multiplexed genotyping assay that rapidly and accurately identified multiple AATD-associated <em>SERPINA1</em> SNPs. This assay may be useful to diagnose AATD quickly in patients with pulmonary or hepatic diseases or both of unknown origin.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 1","pages":"Article 100076"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141694823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Unusual Case of Giant Bullous Disease","authors":"Kenji Yoshino MD ,&nbsp;Jonathan Ioanitescu MD ,&nbsp;Haiying Zhang MD ,&nbsp;Tiana Endicott-Yazdani MD, PhD ,&nbsp;Susan K. Mathai MD","doi":"10.1016/j.chpulm.2024.100121","DOIUrl":"10.1016/j.chpulm.2024.100121","url":null,"abstract":"<div><h3>Case Presentation</h3><div>A 50-year-old African American woman presented to the lung transplant clinic for evaluation after experiencing gradually worsening dyspnea over the preceding 5 years. She had been diagnosed with COPD by another pulmonologist. Since her diagnosis 10 years before presentation, the patient had been on continuous supplemental oxygen therapy at 2 L/min. Her treatment regimen included a once daily combination inhaler (a corticosteroid and an ultra-long-acting ß-adrenoceptor agonist) along with an albuterol inhaler used as needed. The patient’s dyspnea limited her ability to walk half a block, and she often required a few minutes to recover after these efforts. Her symptoms were partially alleviated by use of her albuterol inhaler. In addition to dyspnea, the patient reported a nonproductive cough that was exacerbated by activity and relieved by rest. The patient’s medical history included OSA requiring positive airway pressure therapy and a hospitalization for respiratory distress due to a COVID-19 infection 12 months before presentation. She had a &lt; 10-pack-year smoking history and childhood exposure to secondhand smoke. She had no known exposure to organic dusts or asbestos.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 1","pages":"Article 100121"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remote Patient Monitoring for Managing Interstitial Lung Disease","authors":"Genevieve Gillett MD ,&nbsp;Rupal J. Shah MD ,&nbsp;Alison M. DeDent MD ,&nbsp;Erica Farrand MD","doi":"10.1016/j.chpulm.2024.100122","DOIUrl":"10.1016/j.chpulm.2024.100122","url":null,"abstract":"<div><h3>Background</h3><div>Hybrid health care delivery uses a combination of in-person and telehealth visits to deliver interstitial lung disease (ILD) care efficiently and flexibly. However, assessments of ILD activity and progression can be limited during telehealth visits. Remote patient monitoring (RPM) is an effective approach to evaluating ILD trajectories. However, in the United States, there has been limited uptake of RPM into ILD care models.</div></div><div><h3>Research Question</h3><div>Can we define patient-level facilitators and barriers to implementing RPM into routine ILD care?</div></div><div><h3>Study Design and Methods</h3><div>RPM data from spirometers and pulse oximeters were collected weekly from participants with newly diagnosed ILD. Additional data were collected using surveys and qualitative interviews in a parallel convergent mixed-methods design, reflexively analyzed for themes, and integrated using a triangulation protocol.</div></div><div><h3>Results</h3><div>Sixty participants had a median age of 74 years; most were male (59%), White (60.7%), and diagnosed with idiopathic pulmonary fibrosis (50%). Adherence to weekly device use was high (90%) and participants thought RPM was an important (90%) and sustainable (87%) part of ILD care. Key barriers to RPM use included difficulty with spirometry technique, communication of results, and result interpretation.</div></div><div><h3>Interpretation</h3><div>Our results indicate that RPM is a feasible, valuable, and sustainable component of routine ILD care. Applying an implementation science framework, patient-level barriers would be best addressed through (1) supervised device setup, (2) more efficient and frequent communication, and (3) improved patient education. Addressing these barriers may facilitate more widespread and successful implementation of RPM, with the potential to greatly improve patient engagement in ILD care.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 1","pages":"Article 100122"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reevaluating the Role of Bronchoscopy Prior to Bronchial Artery Embolization in Nonintubated Patients With Hemoptysis Due to Bronchiectasis and Chronic Pulmonary Infection","authors":"Takashi Nishihara MD ,&nbsp;Hideo Ishikawa MD ,&nbsp;Kazunari Tsuyuguchi MD, PhD ,&nbsp;Shoichi Fukuda MD, PhD ,&nbsp;Hiromitsu Sumikawa MD, PhD","doi":"10.1016/j.chpulm.2024.100128","DOIUrl":"10.1016/j.chpulm.2024.100128","url":null,"abstract":"<div><h3>Background</h3><div>When performing bronchial artery embolization (BAE), identifying the side of bleeding and thereby deciding the side of embolization is crucial for an effective and safe procedure. However, there is little evidence regarding the utility of bronchoscopy for determining the side of embolization prior to BAE in nonintubated patients with hemoptysis admitted to general wards.</div></div><div><h3>Research Question</h3><div>Is bronchoscopy necessary prior to BAE in nonintubated patients with hemoptysis following bronchiectasis and chronic pulmonary infection?</div></div><div><h3>Study Design and Methods</h3><div>Data from 93 consecutive nonintubated general ward patients with bronchiectasis and chronic pulmonary infection (nontuberculous mycobacteriosis, aspergillosis, and TB) who underwent de novo BAE from September 2017 to August 2023 were retrospectively reviewed. The contribution of bronchoscopy in deciding the side of embolization was evaluated.</div></div><div><h3>Results</h3><div>All patients underwent CT imaging and 27 also underwent bronchoscopy. Bronchoscopy identified the sides of bleeding in 9 patients, but these sides could be correctly estimated in 8 of them from the CT information alone. Bronchoscopy did not reveal the side of bleeding in 18 patients, whose sides of embolization were decided using CT imaging and angiographic information. Of 66 patients without bronchoscopy, the sides of embolization were decided in 63 patients using CT imaging and angiographic information, but the priority of the embolization side could not be decided in the remaining 3 patients. Overall, 96% (89 of 93) of patients did not require bronchoscopy as part of their embolization plan. The 90-day overall survival and hemoptysis-free survival rates were 98.9% (95% CI, 92.5-99.8) and 92.3% (95% CI, 84.6-96.3), respectively.</div></div><div><h3>Interpretation</h3><div>This study showed that bronchoscopy contributed little to the planning of BAE in nonintubated patients with hemoptysis following bronchiectasis and chronic pulmonary infection. Our findings do not support the routine use of bronchoscopy prior to BAE in this population.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 1","pages":"Article 100128"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143611669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spot On","authors":"Bryan S. Benn MD, PhD ,&nbsp;Hasnain Bawaadam MD, MPH ,&nbsp;Elizabeth M. Colwell MD ,&nbsp;Matthew D. Peterson PA-C ,&nbsp;William B. Tisol MD ,&nbsp;Abesh Niroula MD ,&nbsp;Wissam S. Jaber MD ,&nbsp;Onkar V. Khullar MD ,&nbsp;Kelly Daymude AGACNP-BC, MSN, CCRN ,&nbsp;Chinh T. Phan DO ,&nbsp;Luis A. Godoy MD ,&nbsp;Devon Anderson MD ,&nbsp;Michelle Lagana RN, BSN ,&nbsp;Elizabeth A. Yu MD, PhD ,&nbsp;Tomomi Oka MD ,&nbsp;Mendy Lum BS, RRT ,&nbsp;Pallav L. Shah MD ,&nbsp;Ganesh Krishna MD","doi":"10.1016/j.chpulm.2024.100131","DOIUrl":"10.1016/j.chpulm.2024.100131","url":null,"abstract":"<div><h3>Background</h3><div>Peripheral pulmonary lesions (PPLs) are increasingly identified and often require a tissue diagnosis to guide treatment. Although a surgical resection may combine diagnosis and treatment, it may lead to excessive healthy tissue being removed if the lesion is difficult to localize. Bronchoscopic PPL marking before surgery facilitates this process, but it is limited by current technologies. Advances in procedural techniques may improve this process.</div></div><div><h3>Research Question</h3><div>What is the impact of using indocyanine green-soaked fiducial markers (ICG-Fs) to mark PPLs before surgery compared with unmarked resected PPLs?</div></div><div><h3>Study Design and Methods</h3><div>A retrospective review of patients from 4 institutions with PPLs undergoing bronchoscopy with ICG-F marking (54 nodules) before resection were compared with unmarked nodules (63 nodules). Demographic data, nodule characteristics, procedural and surgical information, and final pathology results were obtained.</div></div><div><h3>Results</h3><div>Demographics were similar between the groups. PPLs were smaller in the ICG-F marked group (axial: ICG-F marked: 14.39 ± 5.39 vs unmarked: 20.31 ± 14.24 mm; <em>P</em> = .0036; coronal: ICG-F marked: 12.66 ± 5.13 vs unmarked: 16.43 ± 10.51 mm; <em>P</em> = .0214). All ICG-F marked lesions were visible with illumination at surgery immediately after bronchoscopy or up to 13 days later. Mean weight (58 ± 77 vs 145 ± 80 g; <em>P</em> &lt; .001) and size (9.07 ± 6.0 × 4.73 ± 3.6 × 2.42 ± 1.23 vs 14.63 ± 6.08 × 8.70 ± 4.36 × 4.08 ± 1.94 mm; <em>P</em> &lt; .001 for all) of the resected ICG-F specimens were significantly decreased compared with unmarked PPLs. Operative time was increased in the ICG-F marked group (165 ± 53 vs 136 ± 43 minutes; <em>P</em> = .0021).</div></div><div><h3>Interpretation</h3><div>Our findings indicate that ICG-F is a safe and accurate procedure to facilitate lung sparing surgery of otherwise undetectable PPLs immediately after bronchoscopic placement or up to 13 days later.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 1","pages":"Article 100131"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment With Bilevel PAP Is Associated With a Reduction in Severe Exacerbations in COPD-OSA Overlap","authors":"Daniela Téllez MPH ,&nbsp;Ann Cameron PhD ,&nbsp;Fatima Sert-Kuniyoshi PhD ,&nbsp;Peter Cistulli MD, PhD ,&nbsp;Jean Louis Pépin MD ,&nbsp;Adam V. Benjafield PhD ,&nbsp;Atul Malhotra MD ,&nbsp;medXcloud Group,&nbsp;Victoria M. Pak PhD","doi":"10.1016/j.chpulm.2024.100114","DOIUrl":"10.1016/j.chpulm.2024.100114","url":null,"abstract":"<div><h3>Background</h3><div>There are no guidelines for OSA assessment in patients with COPD. Home noninvasive ventilation (NIV) studies have excluded patients with comorbid OSA. Thus, it is unclear whether home NIV is associated with reduced exacerbation risk in patients with overlap syndrome.</div></div><div><h3>Research Question</h3><div>Does home NIV impact the rate of severe exacerbations in patients with overlap syndrome 1 year after therapy initiation?</div></div><div><h3>Study Design and Methods</h3><div>A retrospective analysis was performed on administrative claims data from patients with COPD and OSA who received an NIV device claim between 2015 and 2020. Patients were characterized 1 year before NIV initiation and 1 year after NIV initiation. A modified Poisson regression model was built to identify predictors for severe exacerbation occurrence during follow-up.</div></div><div><h3>Results</h3><div>A total of 23,992 patients were included in the analysis (mean age, 61.3 ± 10.1 years; 44.9% female). The proportion of patients with ≥ 1 severe exacerbation was 10.2% in the year before NIV initiation and 5.9% in the year after NIV initiation (χ² = 440.5; <em>P</em> &lt; .0001). Occurrence of a severe exacerbation in the year prior to NIV was associated with a nearly five-fold higher risk of severe exacerbation during follow-up (risk ratio, 4.91; 95% CI, 4.39-5.48; <em>P</em> &lt; .0001). Heart failure, pneumonia, and anxiety were the comorbidities most associated with increased severe exacerbation risk.</div></div><div><h3>Interpretation</h3><div>To our knowledge, this is the first study to describe risk factors for severe exacerbations and to examine home NIV claims in this specific population. Results may be informative for overlap syndrome management, especially for preventing a first severe exacerbation and for the treatment of OSA as part of COPD management. Additional information is needed to optimize the access, timing, and benefits of NIV treatment in patients with overlap syndrome.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 1","pages":"Article 100114"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143563141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and Pathologic Outcomes of Peripheral Lung Vascular Targeted Photodynamic Therapy in a Normal Porcine Lung Model","authors":"Jason Beattie ,&nbsp;Mario Ghosn ,&nbsp;Kwanghee Kim ,&nbsp;Raymond Parrish ,&nbsp;Jie Chen ,&nbsp;Stephen B. Solomon ,&nbsp;Sebastien Monette ,&nbsp;Christopher Cheleuitte-Nieves ,&nbsp;Reza Bergemann ,&nbsp;Mohit Chawla ,&nbsp;Bryan C. Husta ,&nbsp;Or Kalchiem-Dekel ,&nbsp;Yaniv Cohen ,&nbsp;Dina Preise ,&nbsp;Zachary Sacks ,&nbsp;Avigdor Scherz ,&nbsp;Lonny Yarmus ,&nbsp;Jonathan A. Coleman ,&nbsp;Robert P. Lee","doi":"10.1016/j.chpulm.2024.100098","DOIUrl":"10.1016/j.chpulm.2024.100098","url":null,"abstract":"<div><h3>Background</h3><div>Bronchoscopic ablation of tumors in the lung periphery may offer unique advantages over traditional surgical resection or radiation. Bronchoscopic vascular targeted photodynamic therapy (VTP) is a second-generation photodynamic therapy that avoids excessive tissue extravasation and is rapidly cleared from the circulation. These advantages avoid prolonged photosensitivity and allow for infusion and illumination within the same procedure. The treatment effect and systemic inflammatory response precipitated by VTP may prove advantageous for anticancer effects, alone or in combination with immune oncology therapies.</div></div><div><h3>Research Question</h3><div>A baseline understanding of this modality’s effect on lung parenchyma is needed to provide further guidance toward its potential as a method for bronchoscopic ablation of lung tumors. We report on our initial experimentation with bronchoscopic lung VTP in normal pigs.</div></div><div><h3>Study Design and Methods</h3><div>We performed conventional bronchoscopy for deployment of optical fibers into the peripheral lung. We then infused the photosensitizer WST11 after which we immediately performed illumination of the optical fibers.</div></div><div><h3>Results</h3><div>Our results across 13 pigs with varied survival (between 1 day and 30 days) demonstrate initial feasibility and reasonable safety. Posttreatment radiology and pathology support measurable ablation fields and expected post-VTP changes.</div></div><div><h3>Interpretation</h3><div>Our preclinical evidence provides early rationale for the study of safety and feasibility of bronchoscopic VTP ablation of peripheral lung cancers in humans.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 1","pages":"Article 100098"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143578831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community-Engaged Development of Equitable and Scalable Mobile Health Tools for Tobacco Treatment","authors":"Joanna L. Hart MD ,&nbsp;Tamar Klaiman PhD, MPH ,&nbsp;Michael Scott BS ,&nbsp;George M. Fernandez ,&nbsp;Dorothy Sheu MPH ,&nbsp;Aerielle Belk BS ,&nbsp;Jasmine A. Silvestri MPH ,&nbsp;Jannie Kim MPH ,&nbsp;Scott D. Halpern MD, PhD ,&nbsp;Nsenga Farrell EdD, MA","doi":"10.1016/j.chpulm.2024.100127","DOIUrl":"10.1016/j.chpulm.2024.100127","url":null,"abstract":"<div><h3>Background</h3><div>Tobacco use has a disproportionate impact on older, medically underserved adults. Mobile health (mHealth) tools hold promise for increasing reach of treatment options, yet introduce new barriers to access and use.</div></div><div><h3>Research Question</h3><div>How can investigators incorporate patient and community input into the design and testing of accessible, scalable, and equity-promoting mHealth tobacco treatment tools?</div></div><div><h3>Study Design and Methods</h3><div>We present a model for mHealth tobacco treatment tool development using a longitudinal community-partnered design process. We iteratively developed and refined tools used in a large, pragmatic trial. First, a stakeholder advisory committee (SAC) convened with members including individual patients and representatives from patient and health equity advocacy groups, community and government public health services, clinical program leads, and health system and insurance leaders. Second, we conducted a patient needs assessment to confirm or expand on SAC recommendations using semistructured interviews among patients meeting ≥ 1 medically underserved criteria who smoked tobacco daily. Transcribed interviews were coded and analyzed for patterns of patients’ desired design elements.</div></div><div><h3>Results</h3><div>The SAC recommended key strategies to promote cultural relevance of the tools, maximize engagement of participants, and prevent attrition, which were incorporated into the intervention and trial design. To further refine the approach, we completed interviews with 39 patients from November 2020 to September 2021. Many respondents used telemedicine tools with their clinicians yet were skeptical of their use for tobacco treatment due to lack of facility with mobile technologies. Patients recommended direct support options, avoidance of novel smartphone applications, and customizable features.</div></div><div><h3>Interpretation</h3><div>We provide a model for patient-centered design that incorporates community engagement through longitudinal advisors and wider representation of patients. Longitudinal community engagement that incorporates broad patient perspectives facilitates effective development and deployment of mHealth tools to maximize responsiveness to patient and community needs.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 1","pages":"Article 100127"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}