Pub Date : 2026-01-14DOI: 10.1016/j.chest.2025.12.041
Anthony Lieu, Jordan K. Mah, Donald C. Vinh, Salman T. Qureshi
{"title":"Pulmonary fungal infections in the immunocompetent host","authors":"Anthony Lieu, Jordan K. Mah, Donald C. Vinh, Salman T. Qureshi","doi":"10.1016/j.chest.2025.12.041","DOIUrl":"https://doi.org/10.1016/j.chest.2025.12.041","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"43 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chronic respiratory diseases (CRDs) remain one of the leading causes of preventable morbidity and disability worldwide, and affect up to one-third of the total Western population in 2025. Recognising the substantial burden of inflammatory airway diseases such as asthma, chronic obstructive pulmonary disease (COPD), chronic rhinosinusitis (CRS) and respiratory allergy, the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) organised the symposium "Shaping the Future of Respiratory Care" in April 2025 in Brussels, Belgium at the occasion of the 10 year jubilee. Featuring keynote speakers from the World Health Organization (WHO) and EUFOREA, this initiative had the following aims: (i) promoting dialogue on translating innovations into daily clinical practice, (ii) encouraging collaboration between the different stakeholders in the respiratory field, and (iii) defining strategic priorities to transform respiratory care and arrest the CRD epidemic over the next decade. The symposium highlighted the importance of moving towards predictive, preventive, and patient-centred medicine, while supporting value-based healthcare systems to improve long-term patient outcomes. This report summarises the main insights and strategic directions discussed at the meeting.
{"title":"Shaping the Future of Respiratory Care: A look into the next decade and strategic recommendations by EUFOREA.","authors":"X Bertels,Gk Scadding,V Backer,S Lau,Fokkens Wj,Pj Barnes,M Bernal Sprekelsen,L Bjermer,M Blaiss,E Borzova,Mc Brüggen,Gg Brusselle,L Cardell,Dm Conti,M Cornet,E De Corso,B De Groeve,R Djukanovic,At Fox,M Gaga,P Gevaert,P Gibson,C Gray,J Han,L Heaney,E Heffler,Hj Hoffmann,C Hopkins,D Jackson,O Jauhola,M Jesenak,P Johansen,E Khaleva,B Landis,S Lee,V Lund,M Mäkelä,M McDonald,E Melén,J Mullol,A Nieto-García,I Pavord,A Peters,D Price,S Quirce,D Ryan,P Sahlstrand-Johnson,S Scheire,P Schmid-Grendelmeier,S Schneider,B Senior,Cme Shire,P Smith,Z Szepfalusi,Mta Teeling,Me Wechsler,P Houssiau,Kf Rabe,Pw Hellings,Jl Castro","doi":"10.1016/j.chest.2025.12.043","DOIUrl":"https://doi.org/10.1016/j.chest.2025.12.043","url":null,"abstract":"Chronic respiratory diseases (CRDs) remain one of the leading causes of preventable morbidity and disability worldwide, and affect up to one-third of the total Western population in 2025. Recognising the substantial burden of inflammatory airway diseases such as asthma, chronic obstructive pulmonary disease (COPD), chronic rhinosinusitis (CRS) and respiratory allergy, the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) organised the symposium \"Shaping the Future of Respiratory Care\" in April 2025 in Brussels, Belgium at the occasion of the 10 year jubilee. Featuring keynote speakers from the World Health Organization (WHO) and EUFOREA, this initiative had the following aims: (i) promoting dialogue on translating innovations into daily clinical practice, (ii) encouraging collaboration between the different stakeholders in the respiratory field, and (iii) defining strategic priorities to transform respiratory care and arrest the CRD epidemic over the next decade. The symposium highlighted the importance of moving towards predictive, preventive, and patient-centred medicine, while supporting value-based healthcare systems to improve long-term patient outcomes. This report summarises the main insights and strategic directions discussed at the meeting.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"234 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-13DOI: 10.1016/j.chest.2025.11.043
B.Shoshana Zha, Martin Ieong, Isabella Cheng, Seth Bokser, Cynthia Fenton, Anoop Muniyappa, Jeffrey Tarnow, Vicki Jue, Catherine DeVoe, Mary Ellen Kleinhenz, Neeta Thakur
{"title":"Formation and Growth of a Bronchiectasis and Pulmonary NTM Multidisciplinary Program Using a Patient-Centered and Integrated Care Model Improves Outcomes","authors":"B.Shoshana Zha, Martin Ieong, Isabella Cheng, Seth Bokser, Cynthia Fenton, Anoop Muniyappa, Jeffrey Tarnow, Vicki Jue, Catherine DeVoe, Mary Ellen Kleinhenz, Neeta Thakur","doi":"10.1016/j.chest.2025.11.043","DOIUrl":"https://doi.org/10.1016/j.chest.2025.11.043","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"38 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-12DOI: 10.1016/j.chest.2025.12.034
Nishwant Swami, Ji Hyun Hong, Sooyeon Kho, Hae Min Kang, Laura Chun-Chia Lin, Shy Chwen Ni, Narjust Florez, Qing Lan, Nat Rothman, Edward Christopher Dee, Scarlett Lin Gomez, Iona Cheng
{"title":"Associations between Prior Lung Diseases and Risk of Lung Cancer in Populations With No Smoking History: A Systematic Review and Meta-Analysis","authors":"Nishwant Swami, Ji Hyun Hong, Sooyeon Kho, Hae Min Kang, Laura Chun-Chia Lin, Shy Chwen Ni, Narjust Florez, Qing Lan, Nat Rothman, Edward Christopher Dee, Scarlett Lin Gomez, Iona Cheng","doi":"10.1016/j.chest.2025.12.034","DOIUrl":"https://doi.org/10.1016/j.chest.2025.12.034","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"40 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145962469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-12DOI: 10.1016/j.chest.2025.12.036
Jordana E. Hoppe, Andrew Paisley, Tim Vigers, Kathryn Moffett, Veronica Indihar, Elliott Dasenbrook, Joel E. Mortensen, Marianne S. Muhlebach, Christopher Siracusa
{"title":"Reliability of clinic-obtained versus self-obtained respiratory samples from the Self-Sample Accuracy and Benefit Implementation Trial (S2wAB-IT)","authors":"Jordana E. Hoppe, Andrew Paisley, Tim Vigers, Kathryn Moffett, Veronica Indihar, Elliott Dasenbrook, Joel E. Mortensen, Marianne S. Muhlebach, Christopher Siracusa","doi":"10.1016/j.chest.2025.12.036","DOIUrl":"https://doi.org/10.1016/j.chest.2025.12.036","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"32 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-10DOI: 10.1016/j.chest.2025.11.054
Francisco Cartujano-Barrera,Delwyn Catley,Arlette Chávez-Iñiguez,Andrew T Fox,Hongmei Yang,Katherine K Rieth,Andrea Holland,Kimber Richter,Scott E Sherman,Gary Slagle,Scott Werntz,Ana Paula Cupertino
BACKGROUNDLittle is known about the use of text messages to promote enrollment in smoking cessation treatment.RESEARCH QUESTIONWhat is the impact of number of outreach messages and monetary incentives on enrollment in smoking cessation treatment among Latino adults?STUDY DESIGN AND METHODSThis pragmatic randomized clinical trial used a 3x2 factorial design. The first factor, monetary incentives, consisted of three conditions: 1) receiving a small fixed amount ($5) when enrolling, 2) getting a chance to win a large amount ($200) when enrolling, and 3) no monetary incentive when enrolling. The second factor, number of cycles, consisted of two conditions: 1) one cycle of messages, and 2) four cycles of messages. Latino adults who smoke (n=2,826) were identified in electronic medical records. Participants were randomized in a 1:1:1 ratio to receive one of three monetary incentive conditions and in a 1:2 ratio to receive one or four cycles of messages. The main outcome was enrollment in a smoking cessation text messaging intervention.RESULTSEnrollment rates ranged from 1.3% for the group that received no monetary incentive for enrollment and one cycle of messages to 5.4% for the group that received a fixed amount for enrollment and four cycles of messages. Receiving four cycles of messages was associated with a higher likelihood of enrollment compared to receiving one cycle of messages (OR 1.92 [95% CI, 1.22-3.01], p<0.01). Monetary incentives were not associated with enrollment.INTERPRETATIONAmong Latino adults, enrollment in smoking cessation treatment increased significantly with increasing number of cycles. In contrast, monetary incentives did not increase enrollment. While modest, the 5.3% enrollment rate found among participants who received four cycles of messages and no monetary incentive can inform future population-level efforts to advance smoking cessation among Latino adults.CLINICAL TRIAL REGISTRATIONClinicalTrials.gov identifier: NCT05722132.
{"title":"Evaluating text messaging approaches to promote enrollment in smoking cessation treatment among Latino adults: A pragmatic randomized clinical trial.","authors":"Francisco Cartujano-Barrera,Delwyn Catley,Arlette Chávez-Iñiguez,Andrew T Fox,Hongmei Yang,Katherine K Rieth,Andrea Holland,Kimber Richter,Scott E Sherman,Gary Slagle,Scott Werntz,Ana Paula Cupertino","doi":"10.1016/j.chest.2025.11.054","DOIUrl":"https://doi.org/10.1016/j.chest.2025.11.054","url":null,"abstract":"BACKGROUNDLittle is known about the use of text messages to promote enrollment in smoking cessation treatment.RESEARCH QUESTIONWhat is the impact of number of outreach messages and monetary incentives on enrollment in smoking cessation treatment among Latino adults?STUDY DESIGN AND METHODSThis pragmatic randomized clinical trial used a 3x2 factorial design. The first factor, monetary incentives, consisted of three conditions: 1) receiving a small fixed amount ($5) when enrolling, 2) getting a chance to win a large amount ($200) when enrolling, and 3) no monetary incentive when enrolling. The second factor, number of cycles, consisted of two conditions: 1) one cycle of messages, and 2) four cycles of messages. Latino adults who smoke (n=2,826) were identified in electronic medical records. Participants were randomized in a 1:1:1 ratio to receive one of three monetary incentive conditions and in a 1:2 ratio to receive one or four cycles of messages. The main outcome was enrollment in a smoking cessation text messaging intervention.RESULTSEnrollment rates ranged from 1.3% for the group that received no monetary incentive for enrollment and one cycle of messages to 5.4% for the group that received a fixed amount for enrollment and four cycles of messages. Receiving four cycles of messages was associated with a higher likelihood of enrollment compared to receiving one cycle of messages (OR 1.92 [95% CI, 1.22-3.01], p<0.01). Monetary incentives were not associated with enrollment.INTERPRETATIONAmong Latino adults, enrollment in smoking cessation treatment increased significantly with increasing number of cycles. In contrast, monetary incentives did not increase enrollment. While modest, the 5.3% enrollment rate found among participants who received four cycles of messages and no monetary incentive can inform future population-level efforts to advance smoking cessation among Latino adults.CLINICAL TRIAL REGISTRATIONClinicalTrials.gov identifier: NCT05722132.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"7 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145956084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-10DOI: 10.1016/j.chest.2025.12.038
Bilal Odeh,Alexander Pohlman,Ayham Odeh,Amit Goyal,Matthew M Harkenrider,Zaid M Abdelsattar
BACKGROUNDThe use of invasive mediastinal staging (IMS) prior to radiation therapy in patients with early-stage lung cancer is variable. The reasons for this variation and whether it affects outcomes is unknown. In this context, we conducted a patient- and hospital-level analysis to better understand the impact of this variation.RESEARCH QUESTIONHow does the rate of IMS before radiation therapy for patients with early-stage lung cancer vary across hospitals nationally and does it impact survival?STUDY DESIGN AND METHODSWe used the National Cancer Database to identify patients with stage I non-small cell lung cancer treated with radiation between 2004 and 2022. The use of IMS was the main exposure variable. A hierarchical regression model was used to calculate risk- and reliability-adjusted rates of IMS using patient, tumor, and hospital characteristics. Hospitals were distributed into quintiles based on adjusted rates. Kaplan Meier survival analyses were used to estimate survival.RESULTS34,879 patients with stage I lung cancer were treated with stereotactic body radiation therapy (SBRT) at 1,210 hospitals. Of those, 4,016 (11.5%) underwent IMS, of which 3,060 (76.2%) were endobronchial ultrasound. The rates of IMS prior to radiation varied across hospitals from 0% to 100%. When stratified into risk- and reliability-adjusted quintiles, the variation persisted with the lowest and highest quintiles having IMS rates of 13.2% and 18.5% respectively, and an overall rate of 15.5%; P<0.001. Patient and tumor characteristics were similar between quintiles. Hospitals with the lowest rates had lower survival (median survival 46 vs 54 months for the highest; P<0.001). 31.4% of the variation is explained at the hospital-level.INTERPRETATIONThere is wide variation in the use of IMS prior to radiation therapy for stage I lung cancer, which isn't explained by patient or tumor characteristics. Hospitals with higher IMS rates have better overall survival.
{"title":"Hospital Variation in Invasive Mediastinal Staging for Patients with Stage I Lung Cancer Treated with Radiation.","authors":"Bilal Odeh,Alexander Pohlman,Ayham Odeh,Amit Goyal,Matthew M Harkenrider,Zaid M Abdelsattar","doi":"10.1016/j.chest.2025.12.038","DOIUrl":"https://doi.org/10.1016/j.chest.2025.12.038","url":null,"abstract":"BACKGROUNDThe use of invasive mediastinal staging (IMS) prior to radiation therapy in patients with early-stage lung cancer is variable. The reasons for this variation and whether it affects outcomes is unknown. In this context, we conducted a patient- and hospital-level analysis to better understand the impact of this variation.RESEARCH QUESTIONHow does the rate of IMS before radiation therapy for patients with early-stage lung cancer vary across hospitals nationally and does it impact survival?STUDY DESIGN AND METHODSWe used the National Cancer Database to identify patients with stage I non-small cell lung cancer treated with radiation between 2004 and 2022. The use of IMS was the main exposure variable. A hierarchical regression model was used to calculate risk- and reliability-adjusted rates of IMS using patient, tumor, and hospital characteristics. Hospitals were distributed into quintiles based on adjusted rates. Kaplan Meier survival analyses were used to estimate survival.RESULTS34,879 patients with stage I lung cancer were treated with stereotactic body radiation therapy (SBRT) at 1,210 hospitals. Of those, 4,016 (11.5%) underwent IMS, of which 3,060 (76.2%) were endobronchial ultrasound. The rates of IMS prior to radiation varied across hospitals from 0% to 100%. When stratified into risk- and reliability-adjusted quintiles, the variation persisted with the lowest and highest quintiles having IMS rates of 13.2% and 18.5% respectively, and an overall rate of 15.5%; P<0.001. Patient and tumor characteristics were similar between quintiles. Hospitals with the lowest rates had lower survival (median survival 46 vs 54 months for the highest; P<0.001). 31.4% of the variation is explained at the hospital-level.INTERPRETATIONThere is wide variation in the use of IMS prior to radiation therapy for stage I lung cancer, which isn't explained by patient or tumor characteristics. Hospitals with higher IMS rates have better overall survival.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"22 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145955973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-09DOI: 10.1016/j.chest.2025.12.033
Cristian C Serrano-Mayorga,Juan Olivella-Gomez,Natalia Sanabria-Herrera,Saad Nseir,Antoni Torres,Ignacio Martin-Loeches,Luis F Reyes,
BACKGROUNDNosocomial respiratory infections (NRIs) are the most common complication among ICU patients, with Pseudomonas aeruginosa frequently identified. However, its global prevalence and associated risk factors remain unclear.RESEARCH QUESTIONAmong ICU patients with NRI, what is the international prevalence of P. aeruginosa, and which clinical factors are associated with an increased risk?STUDY DESIGN AND METHODSThis secondary analysis used data from the European Network for ICU-Related Respiratory Infections (ENIRRI), a prospective cohort study conducted across 12 countries from May 2016 to August 2019. Data from 1,059 NRI patients who underwent microbiological testing were analyzed. Descriptive statistics, imputation of missing data, LASSO regression, Elastic Net, Random Forest, and multivariable logistic regression were applied. Model performance was assessed using McFadden's R2 and the Hosmer-Lemeshow test.RESULTSThe median patient age was 64 years (IQR 49-73), and 72% were male. Pathogens were identified in 67% (710/1059) of cases, primarily using blood cultures (78%). P. aeruginosa was detected in 14.5% (n=153), with antimicrobial resistance mechanisms in 5.1% (n=55). Among these, 19.6% were multidrug-resistant and 11.1% produced carbapenemase. The highest prevalence was observed in Germany, Argentina, and France. Ventilator-associated pneumonia (VAP) was the predominant diagnosis, accounting for 66% of P. aeruginosa cases. Septic shock and acute kidney injury were the most frequent complications. No significant mortality differences were found between patients with and without P. aeruginosa. Key risk factors included COPD Gold D, autoimmune disease, chronic kidney disease, and acute kidney injury on day 1.INTERPRETATIONP. aeruginosa is a leading NRI pathogen, with prevalence varying across countries. A high proportion of patients received empirical anti-Pseudomonas treatment without confirmed infection by P. aeruginosa. Key risk factors identified for Pseudomonas NRI were COPD Gold D, autoimmune disease, chronic kidney disease, and acute kidney injury. These findings support the need for more personalized, evidence-based empirical therapy.
{"title":"Pseudomonas aeruginosa in patients with Nosocomial Respiratory Infections: A secondary analysis of the European Network for ICU-Related Respiratory Infections (ENIRRIs).","authors":"Cristian C Serrano-Mayorga,Juan Olivella-Gomez,Natalia Sanabria-Herrera,Saad Nseir,Antoni Torres,Ignacio Martin-Loeches,Luis F Reyes, ","doi":"10.1016/j.chest.2025.12.033","DOIUrl":"https://doi.org/10.1016/j.chest.2025.12.033","url":null,"abstract":"BACKGROUNDNosocomial respiratory infections (NRIs) are the most common complication among ICU patients, with Pseudomonas aeruginosa frequently identified. However, its global prevalence and associated risk factors remain unclear.RESEARCH QUESTIONAmong ICU patients with NRI, what is the international prevalence of P. aeruginosa, and which clinical factors are associated with an increased risk?STUDY DESIGN AND METHODSThis secondary analysis used data from the European Network for ICU-Related Respiratory Infections (ENIRRI), a prospective cohort study conducted across 12 countries from May 2016 to August 2019. Data from 1,059 NRI patients who underwent microbiological testing were analyzed. Descriptive statistics, imputation of missing data, LASSO regression, Elastic Net, Random Forest, and multivariable logistic regression were applied. Model performance was assessed using McFadden's R2 and the Hosmer-Lemeshow test.RESULTSThe median patient age was 64 years (IQR 49-73), and 72% were male. Pathogens were identified in 67% (710/1059) of cases, primarily using blood cultures (78%). P. aeruginosa was detected in 14.5% (n=153), with antimicrobial resistance mechanisms in 5.1% (n=55). Among these, 19.6% were multidrug-resistant and 11.1% produced carbapenemase. The highest prevalence was observed in Germany, Argentina, and France. Ventilator-associated pneumonia (VAP) was the predominant diagnosis, accounting for 66% of P. aeruginosa cases. Septic shock and acute kidney injury were the most frequent complications. No significant mortality differences were found between patients with and without P. aeruginosa. Key risk factors included COPD Gold D, autoimmune disease, chronic kidney disease, and acute kidney injury on day 1.INTERPRETATIONP. aeruginosa is a leading NRI pathogen, with prevalence varying across countries. A high proportion of patients received empirical anti-Pseudomonas treatment without confirmed infection by P. aeruginosa. Key risk factors identified for Pseudomonas NRI were COPD Gold D, autoimmune disease, chronic kidney disease, and acute kidney injury. These findings support the need for more personalized, evidence-based empirical therapy.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"34 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145949768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-08DOI: 10.1016/j.chest.2025.12.031
Muhammad O Awiwi,Xu Zhang,Vedat Burak Kandemirli,Cihan Duran,Mina F Hanna,Mohamed Aburadi,Humaira Chaudhry,Ervin Gjoni,Nahid J Rianon
BACKGROUNDOsteoporosis is an important cause for morbidity, but it remains underdiagnosed and current screening programs for osteoporosis are underutilized.RESEARCH QUESTIONCan low-dose chest CT (LDCT) obtained for lung cancer screening identify patients with osteoporosis?STUDY DESIGN AND METHODSPatients who received LDCT and Dual energy x-ray (DXA) within 4 months of each other were identified. CT was used to manually measure vertebral trabecular bone attenuation (TBA) at the T7-L1 vertebrae. Vertebral fractures seen on CT were noted. DXA was used to obtain T-scores and FRAX scores. Mean CT-TBA values were correlated with DXA T-scores. Threshold CT-TBA values below which osteoporosis was present were reported.RESULTS1336 patients were included. The median age was 68 years (64-72). Osteoporosis was diagnosed in 33.0% of the cohort based on DXA T-scores and FRAX scores. At least one vertebral fracture occurred in 11.9% of patients. Mean CT-TBAT7-L1 had a moderate correlation with DXA T-score with an r-coefficient of 0.573 (95% CI: 0.531-0.614). The AUC of mean CT TBAT7-L1 in diagnosing osteoporosis was 0.771 (95% CI; 0.744-0.798, p<0.001). A CT-TBAT7-L1 threshold value of ≤130 HU yielded a sensitivity of 90.5% and a specificity of 39.7%. A TBAT7-L1 threshold value of ≤80 HU yielded a specificity of 93.1%. The prevalence of vertebral fractures at T-score ≤-2.5 was 21%; a similar fracture prevalence occurred at a CT-TBA threshold of ≤110 HU. T-score values of ≤-2.5 failed to identify 50.9% of vertebral fractures.INTERPRETATIONCT-TBA is a promising tool for diagnosing osteoporosis using LDCT obtained for lung cancer screening. This technique can be performed after minimal training without additional software, hardware, cost, or radiation exposure.
{"title":"Evaluation for Osteoporosis Using Low-Dose Chest CT (LDCT) Obtained for Lung Cancer Screening: A Retrospective Study of 1336 Patients.","authors":"Muhammad O Awiwi,Xu Zhang,Vedat Burak Kandemirli,Cihan Duran,Mina F Hanna,Mohamed Aburadi,Humaira Chaudhry,Ervin Gjoni,Nahid J Rianon","doi":"10.1016/j.chest.2025.12.031","DOIUrl":"https://doi.org/10.1016/j.chest.2025.12.031","url":null,"abstract":"BACKGROUNDOsteoporosis is an important cause for morbidity, but it remains underdiagnosed and current screening programs for osteoporosis are underutilized.RESEARCH QUESTIONCan low-dose chest CT (LDCT) obtained for lung cancer screening identify patients with osteoporosis?STUDY DESIGN AND METHODSPatients who received LDCT and Dual energy x-ray (DXA) within 4 months of each other were identified. CT was used to manually measure vertebral trabecular bone attenuation (TBA) at the T7-L1 vertebrae. Vertebral fractures seen on CT were noted. DXA was used to obtain T-scores and FRAX scores. Mean CT-TBA values were correlated with DXA T-scores. Threshold CT-TBA values below which osteoporosis was present were reported.RESULTS1336 patients were included. The median age was 68 years (64-72). Osteoporosis was diagnosed in 33.0% of the cohort based on DXA T-scores and FRAX scores. At least one vertebral fracture occurred in 11.9% of patients. Mean CT-TBAT7-L1 had a moderate correlation with DXA T-score with an r-coefficient of 0.573 (95% CI: 0.531-0.614). The AUC of mean CT TBAT7-L1 in diagnosing osteoporosis was 0.771 (95% CI; 0.744-0.798, p<0.001). A CT-TBAT7-L1 threshold value of ≤130 HU yielded a sensitivity of 90.5% and a specificity of 39.7%. A TBAT7-L1 threshold value of ≤80 HU yielded a specificity of 93.1%. The prevalence of vertebral fractures at T-score ≤-2.5 was 21%; a similar fracture prevalence occurred at a CT-TBA threshold of ≤110 HU. T-score values of ≤-2.5 failed to identify 50.9% of vertebral fractures.INTERPRETATIONCT-TBA is a promising tool for diagnosing osteoporosis using LDCT obtained for lung cancer screening. This technique can be performed after minimal training without additional software, hardware, cost, or radiation exposure.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"94 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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