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Ankura Singh, Charles Liu, Barbara Putman, Rachel Zeig-Owens, Charles B Hall, Theresa Schwartz, Mayris P Webber, Hillel W Cohen, Kenneth I Berger, Anna Nolan, David J Prezant, Michael D Weiden
BACKGROUND: Previously healthy firefighters with World Trade Center (WTC) dust exposure developed airway disease. Risk factors for irritant-associated asthma/COPD overlap are poorly defined. METHODS: The study included 2,137 WTC-exposed firefighters who received a clinically-indicated bronchodilator pulmonary function test (BD-PFT) between 9/11/2001-9/10/2017. A post-BD FEV1 increase of >12% and 200 ml from baseline defined asthma, and post-BD FEV1 /FVC ratio<0...
July 17, 2018: Chest
Bartolome R Celli
The number of pharmacological medications available to treat patients with COPD has increased over the last decades. Most of the improvement has come from the modification of older compounds that are now more potent, of longer duration and delivered in improved devices. They are now available as single, double and even triple combinations that although attempting to simplify their administration, have also resulted in a large number of preparations. These medications are clearly effective and should be used as a central component of the multidimensional approach to the patient affected with COPD...
July 17, 2018: Chest
Michael Furian, Mona Lichtblau, Sayaka S Aeschbacher, Bermet Estebesova, Berik Emilov, Ulan Sheraliev, Nuriddin H Marazhapov, Maamed Mademilov, Batyr Osmonov, Maya Bisang, Stefanie Ulrich, Tsogyal D Latshang, Silvia Ulrich, Talant M Sooronbaev, Konrad E Bloch
BACKGROUND: Patients with COPD may experience acute mountain sickness (AMS) and other altitude-related adverse health effects (ARAHE) when traveling to high altitudes. This study evaluated whether dexamethasone, a drug used for the prevention of AMS in healthy individuals, would prevent AMS/ARAHE in patients with COPD. METHODS: This placebo-controlled, double-blind, parallel-design trial included patients with COPD and Global Initiative for Obstructive Lung Disease grade 1 to 2 who were living below 800 m...
July 9, 2018: Chest
Rubin I Cohen
To improve the delivery of patient care, governments and health-care institutions adopted quality improvement methods that had been developed decades earlier in manufacturing industries. Many health-care practitioners are either unaware or are inexperienced about what these practices entail and whether they are successful in health care. This article reviews Lean, an improvement philosophy made famous by the Toyota Motor Company. Lean uses a set of instruments and incorporates a long-term vision aiming for continuous improvement...
July 9, 2018: Chest
Christopher Kniese, Khalil Diab, Marwan Ghabril, Gabriel Bosslet
BACKGROUND: Treatment of hepatic hydrothorax (HH) generally involves sodium restriction, diuretics, and serial thoracentesis. In more advanced cases, transjugular intrahepatic portosystemic shunt (TIPS) and liver transplantation may be required. In the past, indwelling tube drainage has been avoided due to concerns about high complication rates and overall poor outcomes. Recently, indwelling pleural catheters (IPCs) have been proposed as a novel treatment option for HH. METHODS: We retrospectively reviewed patients who had undergone IPC placement for HH over a 10-year period at a large liver transplant referral center...
July 7, 2018: Chest
Shannon Niedermeyer, Michael Murn, Philip J Choi
Amyotrophic lateral sclerosis is a progressive neuromuscular disease characterized by both lower motor neuron and upper motor neuron dysfunction. While clinical presentations can vary, there is no cure for ALS and the disease is universally terminal, with most patients dying from respiratory complications. Patients die on average within 3-5 years of diagnosis, unless they choose to undergo tracheostomy, in which case, they may live on average 2 more years. Up to 95% with ALS in the United States choose not to undergo tracheostomy, so management of respiratory failure is aimed at both prolonging survival as well as improving quality of life...
July 7, 2018: Chest
Emily Henkle, Timothy R Aksamit, Charles L Daley, David E Griffith, Anne E O'Donnell, Alexandra L Quittner, Elisha Malanga, Delia Prieto, Amy Leitman, Kevin L Winthrop
Non-cystic fibrosis bronchiectasis ("bronchiectasis") is an increasingly common chronic lung disease that is difficult to manage due to a lack of evidence on which to base treatment decision-making. We sought to develop a practical list of U.S.-based patient-centered research priorities and an associated roadmap to guide bronchiectasis research. We designed and administered a web-based patient needs assessment survey to establish broad research priorities; convened three stakeholder webinars to confirm the top priorities; obtained written stakeholder feedback; and completed a final consensus survey of objectives...
July 5, 2018: Chest
Neil Freedman
As the cost of healthcare continues to escalate, payers are adapting by moving away from models based on traditional fee-for-service reimbursement to models focused on rewarding care delivery that reduces costs and improves quality. These alternative payment models (APMs) are being introduced by government and commercial payers and will likely become the norm over time. Recent changes in sleep medicine related to advances in technology and approaches by payers for the management of obstructive sleep apnea (OSA) make this an appropriate time to incorporate the delivery of sleep medicine services into APMs...
July 5, 2018: Chest
Minhee Jin, Eun Chong Lee, Seung Won Ra, Nick Fishbane, Sheena Tam, Gerard J Criner, Prescott G Woodruff, Stephen C Lazarus, Richard Albert, John E Connett, MeiLan K Han, Fernando J Martinez, Shawn D Aaron, Robert M Reed, S F Paul Man, Janice M Leung, Don D Sin
BACKGROUND: COPD is an age-related disease. The role of cellular senescence in COPD has not been fully elucidated. This study examined the relationship between telomere length of peripheral blood leukocytes and clinical outcomes, including health status, rate of exacerbations, and risk of mortality in individuals with COPD. METHODS: Using quantitative polymerase chain reaction, we measured the absolute telomere length (aTL) of DNA extracted from blood samples of 576 participants with moderate-to-severe COPD treated with either azithromycin or placebo for 12 months in the Macrolide Azithromycin for Prevention of Exacerbations of COPD (MACRO) study...
July 3, 2018: Chest
Desiree M Schumann, Diana Leeming, Eleni Papakonstantinou, Francesco Blasi, Konstantinos Kostikas, Wim Boersma, Renaud Louis, Branislava Milenkovic, Joachim Aerts, Jannie M B Sand, Emiel F M Wouters, Gernot Rohde, Christina Prat, Antoni Torres, Tobias Welte, Michael Tamm, Morten Karsdal, Daiana Stolz
The role of the extracellular matrix (ECM) structure and remodelling of thereof in lung diseases is gaining importance. Pathology-related changes in the ECM turnover may result in deleterious changes in lung architecture leading to disease in the small airways. Here, degradation fragments of type I (C1M), type IV (α1 chain, C4M2), and type IV (α3 chain, C4Ma3) collagen, all degraded by metalloproteinases (MMPs) and the pro-form of collagen type V (PRO-C5) were investigated and associated with chronic obstructive pulmonary disease (COPD) severity and outcome...
June 29, 2018: Chest
Farhan Shah, Thorbjörn Holmlund, Eva Levring Jäghagen, Diana Berggren, Karl Franklin, Sture Forsgren, Per Stål
STUDY OBJECTIVES: The pathophysiological mechanism of nocturnal obstruction and swallowing dysfunction commonly occurring in sleep apnea patients is unclear. We aimed to investigate whether nerve injuries in the upper airways of snoring and sleep apnea patients are associated with pharyngeal dysfunction and severity of sleep apnea. METHODS: Twenty-two patients undergoing palatal surgery due to snoring and sleep apnea were investigated for a swallowing dysfunction using videoradiography...
June 29, 2018: Chest
Y Dotan, A Vaidy, W Shapiro, H Zhao, C Dass, Y Toyoda, N Marchetti, K Shenoy, F Cordova, G J Criner, A J Mamary
BACKGROUND: Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) has an expected median survival of 3 months. Lung transplantation is a potentially lifesaving therapy for AE-IPF. However, the current knowledge of transplantation outcomes during AE-IPF is limited to few small retrospective studies, reporting only one year post transplantation survival. METHODS: Study population included patients with IPF consecutively listed for lung transplantation at a single institution between the years 2012 and 2016...
June 29, 2018: Chest
Allison K Guitor, Gerard D Wright
Since their introduction into healthcare and clinical practice in the early 20th century, antibiotics have revolutionized medicine. Alarmingly, these drugs are increasingly threatened by bacteria that have developed a broad diversity of resistance mechanisms. Antibiotic resistance can be transferred between bacteria, often on mobile genetic elements, acquired from the environment, or arise through mutation due to selective pressures of the drugs themselves. There are various strategies to resistance including active efflux of the drug from the bacterial cell, reduced permeability of the cell envelope, alteration of the drug's target within the bacterial cell, and modification or destruction of the antibiotic...
June 27, 2018: Chest
Nishant Gupta, Hye-Seung Lee, Jay H Ryu, Angelo M Taveira-DaSilva, Gerald J Beck, Jar-Chi Lee, Kevin McCarthy, Geraldine A Finlay, Kevin K Brown, Stephen J Ruoss, Nilo A Avila, Joel Moss, Francis X McCormack
BACKGROUND: The natural history of lymphangioleiomyomatosis is mainly derived from retrospective cohort analyses and remains incompletely understood. A National Institutes of Health LAM Registry was established to define the natural history and identify prognostic biomarkers that can help guide management and decision-making in patients with LAM. METHODS: A linear mixed effects model was employed to compute the rate of decline of FEV1, and identify variables impacting FEV1 decline among 217 registry patients who enrolled from 1998-2001...
June 22, 2018: Chest
Denis Chemla, Jason Weatherald, Edmund M T Lau, Laurent Savale, Athenaïs Boucly, Pierre Attal, Xavier Jaïs, Florence Parent, Barbara Girerd, Gérald Simonneau, David Montani, Marc Humbert, Olivier Sitbon, Philippe Hervé
INTRODUCTION: The role of decreased pulmonary arterial (PA) compliance (C), equivalent to increased PA stiffness (1/C) as a critical determinant of right ventricular dysfunction and prognosis has been emphasized in pulmonary arterial hypertension (PAH). METHODS: We retrospectively reviewed all incident patients diagnosed with idiopathic PAH by right heart catheterization who were enrolled in the French PAH Network registry between 2006-2016 and who had complete baseline data allowing calculation of stiffness (PA pulse pressure/stroke volume index)...
June 22, 2018: Chest
Shintaro Yokoyama, Tomoyuki Murakami, Hiroyuki Tao, Hideko Onoda, Akio Hara, Ryohei Miyazaki, Masashi Furukawa, Masataro Hayashi, Hidetoshi Inokawa, Kazunori Okabe, Yoshito Akagi
BACKGROUND: Tumor spread through air spaces (STAS) has recently been reported as a novel form of lung adenocarcinoma invasion that can negatively impact survival; however, its role in pleomorphic carcinoma remains unclear. This study aimed to characterize tumor STAS in pleomorphic carcinoma, including its association with clinicopathological features and prognosis. METHODS: Tumor specimens obtained from 35 consecutive patients with pleomorphic carcinoma who underwent surgical resection between 2009 and 2015 were reviewed...
June 19, 2018: Chest
Chris Carlsten
Paradoxically, the vast majority of research models intended to understand the relationship between exogenous exposures and lung disease are reduced to a single inhalant. This approach is understandable given the practical challenges of investigation, but it is problematic in terms of translation to the real-world human condition. Furthermore, use of data from such models can lead to underestimation of effect, which may adversely influence regulatory imperatives to protect public health based on the most robust information...
June 15, 2018: Chest
Yang Zhang, Difan Zheng, Juntao Xie, Yuan Li, Yiyang Wang, Chenguang Li, Jiaqing Xiang, Yawei Zhang, Hong Hu, Yihua Sun, Haiquan Chen
BACKGROUND: There is currently no consensus regarding the optimal postoperative follow-up strategy for patients with completely resected non-small cell lung cancer (NSCLC). We aimed to develop web-based nomograms to precisely predict site-specific postoperative recurrence in patients with NSCLC and to guide individual surveillance strategies including when to follow up and what diagnostic tests to perform. METHODS: We investigated the pattern of recurrence in a series of 2,017 patients with NSCLC (squamous cell carcinoma and nonlepidic invasive adenocarcinoma) who underwent complete surgical resection at Fudan University Shanghai Cancer Center (development cohort), and developed web-based clinicopathologic prediction models for conditional risk of site-specific recurrence based on Cox regression...
June 15, 2018: Chest
James M Walter, Richard G Wunderink
Viral pathogens are a common cause of severe lower respiratory tract infection in adults. Our ability to rapidly and accurately identify viral infections has dramatically improved as slow culture-based techniques have been largely replaced by multiplex high-throughput systems. Given these advances, reevaluation of the role of respiratory viral testing in adults presenting with lower respiratory tract infection is important. This article reviews the potential benefits of testing, provides an overview of the most commonly used diagnostic techniques, and considers whether current evidence supports routine testing...
June 14, 2018: Chest
Lisa T Hong, Theodore G Liou, Rishi Deka, Jordan B King, Vanessa Stevens, David C Young
BACKGROUND: Several clinical trials have shown the efficacy of continuous infusion beta-lactam (BL) antibiotics in patients with cystic fibrosis (CF); however, little is known about pharmacokinetic changes during the treatment of an acute pulmonary exacerbation (APE). Identifying and understanding these changes may assist in optimizing antibiotic dosing during APE treatment. METHODS: This study was a retrospective cohort study of 162 adult patients with CF admitted to the University of Utah Hospital between January 1, 2008, and May 15, 2014, for treatment of an APE with both a continuous infusion BL and IV tobramycin...
June 13, 2018: Chest
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