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Annals of the American Thoracic Society

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https://www.readbyqxmd.com/read/28513215/presence-of-air-trapping-and-mosaic-attenuation-on-chest-ct-predicts-survival-in-chronic-hypersensitivity-pneumonitis
#1
Jonathan H Chung, Xi Zhan, Mengshu Cao, Tilman L Koelsch, Diana C Gomez, Kevin K Brown, David A Lynch, Gloria Russell, Evans R Fernández Pérez
RATIONALE: Significant heterogeneity of computed tomography (CT) presentation exists within chronic hypersensitivity pneumonitis (CHP). There is limited data aimed at delineating the prognostic value of specific CT features, distribution, and patterns in CHP. OBJECTIVES: To examine whether the presence of CT mosaic attenuation and air-trapping, and the distribution or patterns of fibrosis impact survival in subjects with CHP. METHODS: From the National Jewish Health interstitial lung disease research database, we retrospectively identified 110 consecutively enrolled well-characterized biopsy-proven CHP adult subjects between 1982 and 2015...
May 17, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28511024/cardiopulmonary-exercise-testing-and-surgery
#2
Paul O Older, Denny Zh Levett
The surgical patient population is increasingly elderly and comorbid and poses challenges to perioperative physicians. Accurate pre-operative risk stratification is important to direct perioperative care. Reduced aerobic fitness is associated with increased post-operative morbidity and mortality. Cardiopulmonary exercise testing is an integrated and dynamic test that gives an objective measure of aerobic fitness or functional capacity and identifies the cause of exercise intolerance. Cardiopulmonary exercise testing provides an individualized estimate of patient risk that can be used to predict post-operative morbidity and mortality...
May 16, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28510504/cardiopulmonary-exercise-testing-basics-of-methodology-and-measurements
#3
Alessandro Mezzani
Cardiopulmonary exercise testing adds measurement of ventilation and volume of oxygen uptake and exhaled carbon dioxide to routine physiological and performance parameters obtainable from conventional exercise testing, furnishing an all-round vision of the systems involved in both oxygen transport from air to mitochondria and its utilization during exercise. Peculiarities of cardiopulmonary exercise testing methodology are the use of ramp protocols and calibration procedures for flow meters and gas analyzers...
May 16, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28489453/association-of-decision-making-with-patients-perceptions-of-care-and-knowledge-during-longitudinal-pulmonary-nodule-surveillance
#4
Donald R Sullivan, Sara E Golden, Linda Ganzini, Renda Soylemez Wiener, Karen B Eden, Christopher G Slatore
RATIONALE: Patient participation in medical decision making is widely advocated, but outcomes are inconsistent. OBJECTIVES: We examined the associations between medical decision making roles and patients' perceptions of their care and knowledge while undergoing pulmonary nodule surveillance. METHODS: The setting was an academically-affiliated Veterans Affairs hospital network where 121 participants had 319 decision making encounters. The Control Preferences Scale was used to assess patients' decision making roles...
May 10, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28489417/a-semiquantitative-ct-grading-system-for-evaluating-therapeutic-response-in-pulmonary-alveolar-proteinosis
#5
Sayoko Tokura, Masanori Akira, Tomohisa Okuma, Ryushi Tazawa, Toru Arai, Chikatoshi Sugimoto, Akiko Matsumuro, Masaki Hirose, Toshinori Takada, Koh Nakata, Haruyuki Ishii, Yasunori Kasahara, Masayuki Hojo, Shinya Ohkouchi, Yoshiko Tsuchihashi, Masanori Yokoba, Ryosuke Eda, Hideaki Nakayama, Takahito Nei, Konosuke Morimoto, Yasuyuki Nasuhara, Masahito Ebina, Toshio Ichiwata, Koichiro Tatsumi, Etsuro Yamaguchi, Yoshikazu Inoue
RATIONALE: A useful semi-quantitative method of using CT images to evaluate therapeutic response in pulmonary alveolar proteinosis (PAP) has not been established, although the extent score or grading score of ground-glass opacities has been used. OBJECTIVES: The purpose of this study was to establish a semi-quantitative method for evaluating therapeutic response in PAP. METHODS: CT scans obtained within one month before and after the therapy from 32 patients with PAP who participated in a multicenter phase 2 trial of GM-CSF inhalation therapy were evaluated by two chest radiologists independently...
May 10, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28481653/accuracy-of-nasal-nitric-oxide-measurement-as-a-diagnostic-test-for-primary-ciliary-dyskinesia-a-systematic-review-and-meta-analysis
#6
Adam J Shapiro, Maureen Josephson, Margaret Rosenfeld, Ozge Yilmaz, Stephanie D Davis, Deepika Polineni, Elena Guadagno, Margaret W Leigh, Valery Lavergne
BACKGROUND: Primary Ciliary Dyskinesia (PCD) is a rare disorder causing chronic oto-sino-pulmonary disease, generally diagnosed through evaluation of respiratory cilia ultrastructure and/or genetic testing. Nasal nitric oxide (nNO) measurement is a PCD screening test, as PCD patients have low nNO levels, but its value as a diagnostic test remains unknown. OBJECTIVE: Perform a systematic review assessing the utility of nNO measurement (index test) as a diagnostic tool compared to the reference standard of electron microscopy (EM) evaluation of ciliary defects and/or detection of biallelic mutations in PCD genes...
May 8, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28481640/multiple-breath-washout-outcomes-are-sensitive-to-inflammation-and-infection-in-children-with-cystic-fibrosis
#7
Kathryn A Ramsey, Rachel E Foong, Jasmine Grdosic, Alana Harper, Billy Skoric, Charles Clem, Miriam Davis, Lidija Turkovic, Stephen M Stick, Stephanie D Davis, Sarath C Ranganathan, Graham L Hall
RATIONALE: The lung clearance index is a measure of ventilation distribution from the multiple breath washout technique. The lung clearance index is increased in the presence of lower respiratory tract inflammation and infection in infants with cystic fibrosis, however the associations during the preschool years are unknown. OBJECTIVES: We assessed the ability of the lung clearance index to detect the presence and extent of lower respiratory tract inflammation and infection in preschool children with cystic fibrosis...
May 8, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28481631/peak-inspiratory-flow-rate-as-a-criterion-for-dry-powder-inhaler-use-in-chronic-obstructive-pulmonary-disease
#8
Donald A Mahler
Dry powder bronchodilator devices have an internal resistance. Effective use depends on the patient generating an adequate inspiratory flow to break up the powder packets into particles less than five micron in diameter that can be inhaled into the loser respiratory tract. This de-aggregation takes place inside the device before the dose leaves the inhaler; this process is increased if the acceleration is fast at the start of inhalation. Peak inspiratory flow depends on an individual's effort along with strength of the respiratory muscles, which may be compromised in those with chronic obstructive pulmonary disease due to lung hyperinflation, hypoxemia, and muscle wasting...
May 8, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28463657/instrumental-activities-of-daily-living-after-critical-illness-a-systematic-review
#9
Ramona O Hopkins, Mary R Suchyta, Biren B Kamdar, Emily Darowski, James C Jackson, Dale M Needham
BACKGROUND: Poor functional status is common after critical illness, and can adversely impact intensive care unit (ICU) survivors' abilities to live independently. Instrumental activities of daily living (IADL), which encompass complex tasks necessary for independent living are a particularly important component of post-ICU functional outcome. OBJECTIVE: To conduct a systematic review of studies evaluating IADLs in survivors of critical illness. DATA SOURCES: We searched PubMed, CINAHL, Cochrane Library, SCOPUS, and Web of Science for all relevant English-language studies published through December 31, 2016...
May 2, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28443680/periodic-breathing-during-incremental-exercise
#10
Piergiuseppe Agostoni, Ugo Corrà, Michele Emdin
Periodic breathing during incremental cardiopulmonary exercise testing is a regularly recurring waxing and waning of tidal volume due to oscillations in central respiratory drive. Periodic breathing is a sign of respiratory control system instability, which may occur at rest or during exercise. The possible mechanisms responsible of exertional periodic breathing might be related to any instability of the ventilatory regulation caused by: 1) increased circulatory delay (i.e., circulation time from the lung to the brain and chemoreceptors, due to reduced cardiac index leading to delay in information transfer), 2) increase in controller gain (i...
April 26, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28441030/measuring-cardiac-output-during-cardiopulmonary-exercise-testing
#11
Carlo Vignati, Gaia Cattadori
Cardiac output is a key parameter in the assessment of cardiac function, and its measurement is fundamental to the diagnosis, treatment, and prognostic evaluation of all heart diseases. Until recently, cardiac output determination during exercise had been only possible through invasive methods, which were not practical in the clinical setting. Since oxygen uptake (V.O2) is cardiac output times arteriovenous content difference [C(a-v)O2)], evaluation of cardiac output is usually included its measurement. Because of the difficulty of directly measuring peak exercise cardiac output, indirect surrogate parameters have been proposed, but with only modest clinical usefulness...
April 25, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28421817/sequential-gm-csf-inhalation-after-whole-lung-lavage-for-pulmonary-alveolar-proteinosis-a-report-of-five-intractable-cases
#12
Shinya Ohkouchi, Keiichi Akasaka, Toshio Ichiwata, Shu Hisata, Hideya Iijima, Toshinori Takada, Hiroki Tsukada, Hideaki Nakayama, Jun-Ichi Machiya, Toshiya Irokawa, Hiromasa Ogawa, Yoko Shibata, Masakazu Ichinose, Masahito Ebina, Toshihiro Nukiwa, Hajime Kurosawa, Koh Nakata, Ryushi Tazawa
Autoimmune pulmonary alveolar proteinosis (aPAP) is a rare disease characterized by the excessive accumulation of surfactant proteins within the alveolar spaces and by higher titers of autoantibodies to granulocyte/macrophage colony stimulating factor (GM-CSF) in the serum and bronchoalveolar lavage fluid (BALF). The antibodies inhibit the maturation and phagocytosis of alveolar macrophages (AMs). Although the standard therapy for aPAP has been whole-lung lavage (WLL), this procedure is invasive and needs to be repeated for several years...
April 19, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28421812/the-frequency-of-incidental-findings-and-subsequent-evaluation-in-low-dose-ct-scans-for-lung-cancer-screening
#13
Lillie Morgan, Humberto Choi, Michal Reid, Ali Khawaja, Peter J Mazzone
RATIONALE: The USPSTF recommends lung cancer screening with low-dose chest CT scans (LDCT) for a well-defined high-risk population. Data on the frequency and impact of incidental findings on LDCT scans performed within a centralized lung cancer screening program has not been reported. OBJECTIVES: Previous studies have reported IFs in the setting of clinical trials. We present our findings in a real clinical setting where the decision to manage these findings may depend on factors that are not captured in a research trial such as disclosing IFs, patient preferences, severity of comorbidities, and physician expertise...
April 19, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28418689/an-official-american-thoracic-society-workshop-report-chemical-inhalational-disasters-biology-of-lung-injury-development-of-novel-therapeutics-and-medical-preparedness
#14
Eleanor M Summerhill, Gary W Hoyle, Sven-Eric Jordt, Bronwen J Jugg, James G Martin, Sadis Matalon, Steven E Patterson, David J Prezant, Alfred M Sciuto, Erik R Svendsen, Carl W White, Livia A Veress
This report is based upon the proceedings from the Inhalational Lung Injury Workshop jointly sponsored by the American Thoracic Society (ATS) and the National Institute of Health (NIH)/National Institute of Neurologic Disorders and Stroke (NINDS) Countermeasures Against Chemical Threats (CounterACT) program on May 21, 2013 in Philadelphia, PA. The CounterACT program facilitates research leading to the development of new and improved medical countermeasures for chemical threat agents. The workshop was initiated by the Terrorism and Inhalational Disasters (TID) Section of the Environmental, Occupational, and Population Health Assembly (EOPH) of the ATS...
April 18, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28410001/respiratory-pattern-and-tidal-volumes-differ-for-pressure-support-and-volume-assured-pressure-support-in-amyotrophic-lateral-sclerosis
#15
Trevor T Nicholson, Sean B Smith, Teepu Siddique, Robert Sufit, Senda Ajroud-Driss, John M Coleman, Lisa F Wolfe
RATIONALE: Amyotrophic Lateral Sclerosis is a progressive neuromuscular disease resulting in respiratory failure and death. Use of non-invasive ventilation (NIV) improves survival. However, use of Volume-Assured Pressure Support (VAPS) has not been extensively studied in ALS. OBJECTIVES: To explore the clinical utility of a detailed evaluation of device-recorded NIV data in the management of chronic respiratory failure in ALS. To determine if there are differences in efficacy between patients using VAPS or PS...
April 14, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28406727/the-experience-of-patients-with-alcohol-misuse-after-surviving-a-critical-illness-a-qualitative-study
#16
Brendan J Clark, Jacqueline Jones, K Diandra Reed, Rachel Marie Hodapp, Ivor S Douglas, David Van Pelt, Ellen L Burnham, Marc Moss
RATIONALE: Alcohol misuse is common in patients admitted to the intensive care unit (ICU) but there is currently no evidence-based approach to address drinking in ICU survivors. OBJECTIVES: We sought to describe the experience of ICU survivors with alcohol misuse during their hospitalization and the 3 months following hospital discharge in order to inform an alcohol specific intervention for this unique population. METHODS: We conducted a descriptive qualitative study of ICU survivors from medical ICUs in three separate hospitals with a positive screening result on the Alcohol Use Disorders Identification Test...
April 13, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28406718/pleural-touch-preparations-and-direct-visualization-of-the-pleura-during-medical-thoracoscopy-for-the-diagnosis-of-malignancy
#17
Horiana B Grosu, Macarena R Vial, Erik Vakil, Roberto F Casal, George A Eapen, Rodolfo Morice, John Stewart, Mona G Sarkiss, David E Ost
RATIONALE: During diagnostic thoracoscopy, talc pleurodesis following biopsy is appropriate if the probability of malignancy is sufficiently high. Findings on direct visual assessment of the pleura during thoracoscopy, rapid onsite evaluation (ROSE) of touch preparations (touch preps) of thoracoscopic biopsy specimens and preoperative imaging, may help predict the likelihood of malignancy; however, data on the performance of these methods are limited. OBJECTIVE: To assess the performance of ROSE of touch preps, direct visual assessment of the pleura during thoracoscopy and preoperative imaging in diagnosing malignancy...
April 13, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28406714/clinical-outcomes-associated-with-achromobacter-species-infection-in-patients-with-cystic-fibrosis
#18
Ranjani Somayaji, Sanja Stanojevic, D Elizabeth Tullis, Anne L Stephenson, Felix Ratjen, Valerie Waters
RATIONALE: Achromobacter species are increasingly identified in individuals with cystic fibrosis (CF), but the clinical outcomes in these patients remain poorly understood. OBJECTIVES: We aimed to determine the association of Achromobacter infection on clinical outcomes in pediatric and adult patients with CF. METHODS: A cohort study of pediatric and adult CF patients was conducted from 1997 - 2014 in Toronto, Canada. Achromobacter spp infection was categorized as no history of infection, intermittent, and chronic infection (≥ 2 positive cultures in preceding 12 months)...
April 13, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28406713/an-observational-study-of-outcomes-and-tolerances-in-patients-with-cystic-fibrosis-initiated-on-lumacaftor-ivacaftor
#19
Mark T Jennings, Rebecca Dezube, Shruti Paranjape, Natalie E West, Gina Hong, Andrew Braun, Jonathan Grant, Christian A Merlo, Noah Lechtzin
RATIONALE: In July 2015, the FDA approved lumacaftor/ivacaftor for use in patients with CF. This drug targets the primary defect in the CFTR protein that is conferred by the F508del CFTR mutation. OBJECTIVE: As there is limited experience with this therapy outside of clinical trials, this study aims to examine the clinical experience of this new drug in a CF population. METHODS: Retrospective cohort study of individuals followed at the Johns Hopkins CF Center, who initiated treatment with lumacaftor/ivacaftor...
April 13, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28406710/suboptimal-inspiratory-flow-rates-are-associated-with-chronic-obstructive-pulmonary-disease-and-all-cause-readmissions
#20
Chee H Loh, Stephen P Peters, Tina M Lovings, Jill A Ohar
RATIONALE: Dry powdered inhalers (DPIs) are prescribed after hospitalization for acute exacerbation of COPD (AECOPD). Peak inspiratory flow (PIF) affects DPI delivery. OBJECTIVES: To study the impact of PIF on readmission after hospitalization for AECOPD. METHODS: A retrospective analysis of hospitalized patients, enrolled in an AECOPD care plan, was performed. Data analyzed included PIF, age, gender, length of stay, Charlson Comorbidity Index, COPD Assessment Test (CAT) and Modified Medical Research Council score, % predicted FEV1, FVC and inspiratory capacity (IC)...
April 13, 2017: Annals of the American Thoracic Society
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