Chest

BACKGROUND: A higher incidence of Arnold Nerve Reflex (ANR) has been observed in patients with chronic cough. However, the different ANR response in various causes of chronic cough remains unclear. Furthermore, it is unknown whether ANR will change after effective treatment. METHODS: Patients with chronic cough were enrolled in the Guangzhou Institute of Respiratory Health. The causes of chronic cough were diagnosed via a validated management algorithm. Patients underwent an assessment of ANR response before and after one-month etiological treatment...

COPD is a heterogeneous syndrome. Many COPD subtypes have been proposed, but there is not yet consensus on how many COPD subtypes there are and how they should be defined. The COPDGene study, which has generated ten-year longitudinal chest imaging, spirometry, and molecular data, is a rich resource for relating COPD phenotypes to underlying genetic and molecular mechanisms. In this article, we place COPDGene clustering studies in context with other highly cited COPD clustering studies, and we summarize the main COPD subtype findings from COPDGene...

INTRODUCTION: The differential risk of pneumonia among inhaled corticosteroids (ICSs) in patients with chronic obstructive pulmonary disease (COPD) requires more investigation, especially for beclomethasone-containing inhalers. This study aimed to compare the risk and benefit profile of different ICS/long-acting β2 agonist (LABA) combinations in COPD patients. METHODS: We conducted a retrospective cohort study using national health insurance claims data from the years 2009-2015 in Taiwan and included COPD patients with new ICS/LABA use...

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OBJECTIVES: The etiology of idiopathic pulmonary fibrosis (IPF) is unknown. Because it shares genetic, histopathologic and radiographic features with the fibrosing interstitial lung disease seen in rheumatoid arthritis (RA), we sought to investigate RA-related autoantibodies in IPF. METHODS: We included IPF subjects from two separate cohorts at National Jewish Health and Brigham Women's Hospital (N=181), general population controls (N=160) and disease controls (N=86, 40 with RA-UIP and 46 with hypersensitivity pneumonitis)...

Sleep is important to health and well-being and studies in healthy adults have demonstrated that sleep deprivation impacts respiratory, immune and cognitive function. Historically, due to the nature of critical illness, sleep has not been considered a priority for patient care in the intensive care unit. More recently, research has demonstrated that sleep is markedly abnormal in critically ill patients. In addition, there is often disruption of circadian rhythms. Delirium is a syndrome of acute alteration in mental status that occurs in the setting of contributing factors such as serious illness, medication, drug or alcohol intoxication or withdrawal...

BACKGROUND: Veno-arterial extra-corporeal membrane oxygenation therapy (VA-ECMO) following refractory cardiogenic shock (r-CS) or cardiac arrest (r-CA) has significant morbidity and mortality. Early outcome prediction is crucial in this setting, but data on neuro-prognostication are limited. We examined the prognostic value of clinical neurological examination, using an automated device for the quantitative measurement of pupillary light reactivity. METHODS: An observational cohort of sedated mechanically ventilated VA-ECMO patients was analyzed at the early phase following ECMO insertion (first 72 hours)...

Sleep health is a multidimensional construct that includes adequate duration, quality and appropriately timed sleep, that may be influenced by environmental factors. In this review, we focus on how an individual's living and sleeping environment, both the surrounding neighborhood physical and social features and the atmosphere around them, may impact their sleep health. We explore the associations of the physical environment (urban density, recreational facilities, green space, mixed land use, healthy food stores), neighborhood deprivation (disadvantage, disorder), and the social environment (social cohesion, safety, stigma) with sleep in both adult and pediatric populations...

Accurate diagnosis is crucial for improving treatment and prognosis of respiratory disease, especially lung cancer. Tumors and lesions located deep in the lung are directly accessible via dendritic tracheal bronchus, thereby opening a new way to tackle respiratory disease. Intratracheal delivery is an innovative noninvasive approach for imaging and treating respiratory disease efficiently, when compared to other delivery methods. Intratracheal delivery of nano- and microparticles and hyperpolarized gases offers valuable clinical advantages, such as assessing lung function, monitoring ventilation and perfusion, controlling disease progression and inhibiting tumor growth...

BACKGROUND: Each year, over 1.5 million Americans are diagnosed with an incidentally-detected lung nodule. Practice guidelines attempt to balance the benefit of early detection of lung cancer with the risks of diagnostic testing, but adherence to guidelines is low. We sought to determine guideline-adherence rates in the setting of a multidisciplinary nodule clinic and describe reasons for non-adherence as well as associated outcomes. METHODS: We performed a cohort study with 3 years of follow-up on patients ≥35 years of age with an incidentally-detected lung nodule evaluated in a multidisciplinary clinic that used the 2005 Fleischner Society Guidelines...

BACKGROUND: Bronchoscopy is the gold standard for evaluating tracheomalacia; however, reliance on an invasive procedure limits understanding of normal airway dynamics. Self-gated ultrashort echo-time magnetic resonance imaging (UTE MRI) can assess tracheal dynamics; but has not been rigorously evaluated. METHODS: This is a validation of UTE MRI diagnosis of tracheomalacia in neonates using bronchoscopy as the gold standard. Bronchoscopies were reviewed for the severity and location of tracheomalacia based on standardized criteria...

BACKGROUND: Neighborhood circumstances have an influence on multiple health outcomes, but the association between neighborhood conditions and lung cancer incidence has not been studied in sufficient detail. We sought to understand whether neighborhood conditions are independently associated with lung cancer incidence in ever-smokers after adjusting for individual smoking exposure and other risk factors. METHODS: A cohort of ever-smokers 55 years and older was assembled from 19 years of electronic health record data from our academic community healthcare system...

Regional and/or national severe asthma registries provide valuable country-specific information. However, they are often limited in scope within the broader definitions of severe asthma, have insufficient statistical power to answer many research questions, lack intra-operability to share lessons learned, and have fundamental differences in data collected, making cross comparisons difficult. What is missing is a worldwide registry which brings all severe asthma data together in a cohesive way, under a single umbrella, based on standardized data collection protocols, permitting data to be shared seamlessly...

BACKGROUND: Stroke prevention in elderly patients with atrial fibrillation (AF) can be challenging, requiring a balance between thromboembolism prevention and serious bleeding. Comparisons of non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin in the elderly, at different age strata (age 65-74, 75-89, ≥90) in the daily practice have not been well described, particularly in Asians. We aimed to assess the clinical outcomes of NOACs compared to warfarin for stroke prevention in elderly patients with AF...

BACKGROUND: Established reference standards for the ventilatory threshold (VT) are lacking. The aim of this study was to develop reference standards for the VT derived from cardiopulmonary exercise testing (CPX) using treadmill and cycle ergometry. METHODS: Seven laboratories experienced in CPX administration with established quality control procedures contributed to the "Fitness Registry and the Importance of Exercise: A National Database" (FRIEND) from April 2014 through February 2019...

BACKGROUND: High-resolution chest CT (HRCT) is recommended after PAVM embolotherapy to assess for PAVM persistence and untreated PAVM growth. Graded transthoracic contrast echocardiography (TTCE) predicts need for embolotherapy in PAVM screening. This study sought to determine whether post-embolotherapy graded TTCE can similarly predict need for repeat embolotherapy. METHODS: Thirty-two patients (8M:24F, mean age 51.1 ± 12.6 years) with prior PAVM embolotherapy and follow-up HRCT were prospectively enrolled...

Mortality has long been used as a primary endpoint for randomized controlled trials in critical care. Recently, a plurality of trials targeting mortality endpoints as their primary outcome have failed to detect a difference between study arms. While there are a number of reasons for the preponderance of such neutral trials, the use of mortality as an outcome is one important consideration. We explore some of the reasons why such trials may be biased towards a neutral result, as well as reasons to consider alternative endpoints that are better coupled to the expected therapeutic effect...

INTRODUCTION: There are concerns that starting nicotine replacement therapy (NRT) in the immediate perioperative period may negatively impact wound healing. We investigated the association of NRT with postoperative outcomes among smokers hospitalized for a surgical procedure. METHODS: This was a retrospective study in 552 hospitals of active smokers hospitalized between 1/1/2015 and 12/31/2016 for a major surgical procedure (Medicare Severity Diagnosis-Related Group expected length of stay of ≥ 2 days)...

INTRODUCTION: The Patient Reported Outcomes Information System (PROMIS) includes two instruments to quantify sleep symptoms (sleep disturbance, SDA; sleep-related impairment, SRI) in diverse populations across a wide symptom spectrum. However, the responsiveness of PROMIS measures to treatment of sleep disorders is unknown. We examined the responsiveness of the PROMIS sleep scales to the treatment of obstructive sleep apnea (OSA). METHODS: We collected SDA, SRI and Epworth Sleepiness Scale (ESS) before and after initiation of positive airway pressure (PAP) in patients with type 2 diabetes newly diagnosed with OSA...

BACKGROUND: To date, clinical characteristics of the international severe asthma population are unknown. Inter-country comparisons are hindered by variable data collection within regional/national severe asthma registries. Our aim was to describe demographic and clinical characteristics of patients managed in severe asthma services in the USA, Europe, and Asia/Pacific region. METHODS: The International Severe Asthma Registry (ISAR) retrospectively and prospectively collected data on severe asthma patients (≥18 years old), receiving GINA Step 5 treatment or remaining uncontrolled on GINA Step 4...