Demetria Kovelis, Anna R S Gomes, Camila Mazzarin, Samia K Biazim, Fabio Pitta, Silvia Valderramas
BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) in advanced disease stage who need long-term home oxygen therapy (LTHOT) have difficulty participating in outpatient pulmonary rehabilitation (PR) programs due to the severity of their disease, limitations involving transportation and mobility, high costs and issues related to patients' safety and individual needs. Unsupervised home-based physical training (PT) is frequently used. The main objective of this study was to investigate the effectiveness of a supervised home-based PT program on exercise capacity and other outcomes in patients with COPD on LTHOT METHODS: In a randomized clinical trial, patients with COPD on LTHOT were allocated into two groups: supervised physical training group (PTG), consisting of patients who received home-based supervised muscle strength and endurance training in twice-weekly 60-minute sessions for 12 weeks; and unsupervised activity booklet group (BG), consisting of patients who received a booklet advising them to perform exercise twice a week during 12 weeks...
March 27, 2020: Chest
Kelly C Vranas, Jennifer Y Scott, Omar Badawi, Michael O Harhay, Christopher G Slatore, Donald R Sullivan, Meeta Prasad Kerlin
BACKGROUND: Admission to high-acuity intensive care units (ICUs) has been associated with improved outcomes compared to low-acuity ICUs, although the mechanism for these findings is unclear. RESEARCH QUESTION: Do high-acuity ICUs more effectively implement evidence-based processes of care that have been associated with improved clinical outcomes? STUDY DESIGN AND METHODS: We performed a retrospective cohort study of adult ICU patients admitted to 322 ICUs in 199 hospitals in the Philips eICU database between 2010-2015...
March 27, 2020: Chest
Sarah H Cross, E Wesley Ely, Dio Kavalieratos, James A Tulsky, Haider J Warraich
BACKGROUND: Chronic lung disease is a common cause of mortality, yet little is known about where individuals with chronic lung disease die. RESEARCH QUESTION: What are the trends and factors associated with place of death among individuals with chronic lung disease? STUDY DESIGN AND METHODS: We conducted a cross-sectional analysis of natural deaths using the Centers for Disease Control and Prevention Wide-ranging OnLine Data for Epidemiologic Research from 2003 to 2017 for which chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), or cystic fibrosis (CF) was the underlying cause...
March 27, 2020: Chest
Binod Dhakal, Lisa Rein, Aniko Szabo, Anand Padmanabhan
No abstract text is available yet for this article.
March 26, 2020: Chest
Xiao Tang, Ronghui Du, Rui Wang, Tanze Cao, Lulu Guan, Chengqing Yang, Qi Zhu, Ming Hu, Xuyan Li, Ying Li, Lirong Liang, Zhaohui Tong, Bing Sun, Peng Peng, Huanzhong Shi
BACKGROUND: Since the outbreak of Coronavirus Disease 2019 (COVID-19) in China in December 2019, considerable attention has been focused on its elucidation. However, it is also important for clinicians and epidemiologists to differentiate COVID-19 from other respiratory infectious diseases, such as influenza viruses. RESEARCH QUESTION: The aim of the study was to explore the different clinical presentations between COVID-19 and influenza A (H1N1) pneumonia in patients with acute respiratory distress syndrome (ARDS)...
March 26, 2020: Chest
Daniel Combs, Jamie O Edgin, Scott Klewer, Brent J Barber, Wayne J Morgan, Chiu-Hsieh Hsu, Ivo Abraham, Sairam Parthasarathy
BACKGROUND: Children with congenital heart disease (CHD) have an increased risk of neurocognitive impairment. No prior studies have evaluated the role of obstructive sleep apnea (OSA), which is associated with neurocognitive impairment in children without CHD. RESEARCH QUESTION: Is OSA is associated with neurocognitive impairment in children with CHD? STUDY DESIGN AND METHODS: Children age 6-17 years with corrected moderate-complex CHD without syndromes that may affect neurocognition were recruited from the pediatric cardiology clinic...
March 25, 2020: Chest
Zubair Hasan, Mangala Narasimhan
No abstract text is available yet for this article.
March 25, 2020: Chest
Maxim Itkin, Deborah Rabinowitz, Gregory Nadolski, Patrick Stafler, Leo Mascarenas, Denise Adams
BACKGROUND: Pulmonary involvement in lymphatic anomalies (LA) is associated with significant morbidity and mortality. Recently described Dynamic Contrast Enhanced Magnetic Resonance lymphangiography (DCMRL) is capable of imaging the lymphatic system in a variety of pulmonary lymphatic disorders. RESEARCH QUESTION: The objective of this study is to describe the central lymphatic anatomy in patients with LA and pulmonary involvement on DCMRL. STUDY DESIGN AND METHODS: This prospective observational study enrolled 16 LA patients (mean age 17 years, range 6-63, F/M-9/7) with pulmonary involvement...
March 24, 2020: Chest
Vincent Ten Cate, Lisa Eggebrecht, Andreas Schulz, Marina Panova-Noeva, Michael Lenz, Thomas Koeck, Steffen Rapp, Natalie Arnold, Karl J Lackner, Stavros Konstantinides, Christine Espinola-Klein, Thomas Münzel, Jürgen H Prochaska, Philipp S Wild
BACKGROUND: Isolated PE is associated with a higher burden of atherosclerotic disease than other manifestations of venous thromboembolism (VTE). RESEARCH QUESTION: We hypothesized that the presence of isolated PE may signal a chronically elevated risk of arterial thrombotic disease. STUDY DESIGN AND METHODS: Data from the VTEval Study, a prospective cohort study enrolling individuals with clinical suspicion and imaging-based diagnosis or exclusion of VTE, were analyzed...
March 23, 2020: Chest
Sophie G Carter, Jayne C Carberry, Ronald R Grunstein, Danny J Eckert
BACKGROUND: Recent studies indicate that standard doses of hypnotics reduce or do not change the apnea-hypopnea index (AHI) or pharyngeal muscle activity. A 1-month trial of nightly zopiclone (7.5mg) modestly reduced the AHI versus baseline without changing other sleep parameters or next-day sleepiness. RESEARCH QUESTION: This study aimed to determine the effects of high-dose zopiclone (15mg) on AHI, arousal threshold, genioglossus muscle responsiveness and next-day alertness in selected people with obstructive sleep apnea (OSA) (low-moderate arousal thresholds without major overnight hypoxemia)...
March 17, 2020: Chest
Michelle N Eakin, Thomas Eckmann, Victor D Dinglas, Ayodele A Akinremi, Megan Hosey, Ramona O Hopkins, Dale M Needham
BACKGROUND: Participant retention is a major challenge in clinical research, especially in studies with multiple, longitudinal research assessments Despite the importance of retention methods, there is little empirical research on how cohort retention efforts are perceived by study participants. RESEARCH QUESTION: To evaluate the association between the number of attempts undertaken to contact participants for research assessments in a longitudinal cohort study and participants' feeling of being bothered regarding such contact attempts...
March 16, 2020: Chest
Boris Shkolnik, Marc A Judson, Adam Austin, Kurt Hu, Melissa D'souza, Alexis Zumbrunn, John T Huggins, Recai Yucel, Amit Chopra
BACKGROUND: There are limited data examining the diagnostic accuracy of thoracic ultrasonography (TUS) in distinguishing transudative from exudative pleural effusions. RESEARCH QUESTION: What is the diagnostic accuracy of TUS in distinguishing transudative from exudative effusions in consecutive patients with pleural effusion? STUDY DESIGN AND METHODS: Consecutive patients who underwent TUS and subsequently a diagnostic thoracentesis with a pleural fluid analysis were identified...
March 16, 2020: Chest
Jose Iglesias, Andrew V Vassallo, Vishal V Patel, Jesse B Sullivan, Joseph Cavanaugh, Yasmine Elbaga
BACKGROUND: Sepsis is a major public health burden resulting in 25-30% in-hospital mortality and accounting for over 20 billion dollars of United States hospital costs. METHODS: This was a randomized, double-blinded, placebo controlled trial conducted from February 2018 to June 2019 assessing an ascorbic acid (AA), thiamine, and hydrocortisone (HAT) treatment bundle for the management of septic and septic shock patients admitted to an intensive care unit (ICU). The primary outcomes were resolution of shock and change in Sequential Organ Failure Assessment (SOFA) score...
March 16, 2020: Chest
Patrícia Rebelo, Ana Oliveira, Lília Andrade, Carla Valente, Alda Marques
BACKGROUND: Fatigue is a burdensome and prevailing symptom in patients with chronic obstructive pulmonary disease (COPD). Pulmonary rehabilitation (PR) improves fatigue however, interpreting when such improvement is clinically relevant is challenging. Minimal clinically important differences (MCIDs) for instruments assessing fatigue are warranted to better tailor PR and guide clinical decisions. We estimated MCIDs for the functional assessment of chronic illness therapy-fatigue subscale (FACIT-FS), the modified-FACIT-FS and the checklist of individual strength-fatigue subscale (CIS-FS), in patients with COPD after PR...
March 14, 2020: Chest
Tuang Yeow Poh, Pei Yee Tiew, Albert Yick Hou Lim, Kai Xian Thng, Nur A'tikah Binte Mohamed Ali, Jayanth Kumar Narayana, Micheál Mac Aogáin, Zhijun Tien, Wui Mei Chew, Adrian Kwok Wai Chan, Holly R Keir, Alison J Dicker, Tidi Maharani Hassan, Huiying Xu, Augustine K H Tee, Thun How Ong, Mariko Siyue Koh, John Arputhan Abisheganaden, James D Chalmers, Sanjay H Chotirmall
and Research Question: Chitinase activity is an important innate immune defence mechanism against infection including fungi. The two human chitinases: chitotriosidase (CHIT1) and acidic mammalian chitinase (AMCase) are associated to allergy, asthma and chronic obstructive pulmonary disease (COPD), however, their role in bronchiectasis and bronchiectasis-COPD overlap (BCO) is unknown STUDY DESIGN AND METHODS: A prospective cohort of n=463 individuals were recruited across five hospital sites in three countries (Singapore, Malaysia and Scotland) including non-diseased (n=35), severe asthma (n=54), COPD (n=90), bronchiectasis (n=241) and BCO (n=43)...
March 14, 2020: Chest
Janelle Vu Pugashetti, Aleksander Kitich, Shehabaldin Alqalyoobi, Anne-Catherine Maynard-Paquette, David Pritchard, Julia Graham, Noelle Boctor, Andrea Kulinich, Elyse Lafond, Elena Foster, Cesar Mendez, Saad Choudhry, Jean Chalaoui, Julie Morisset, Michael Kadoch, Justin M Oldham
BACKGROUND: Interstitial lung disease (ILD) results in high morbidity and healthcare utilization. Diagnostic delays remain common and often occur in non-pulmonology settings. Screening for ILD in these settings has the potential to reduce diagnostic delays and improve patient outcomes. RESEARCH QUESTION: Can a pulmonary function test (PFT)-derived diagnostic prediction tool (ILD-Screen) accurately identify incident ILD cases in patients undergoing PFT in non-pulmonology settings...
March 14, 2020: Chest
Aparna Balasubramanian, Todd M Kolb, Rachel L Damico, Paul M Hassoun, Meredith C McCormack, Stephen C Mathai
BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) who develop pulmonary hypertension (PH) have worse mortality than those with COPD alone. Predictors of poor outcomes in COPD-PH are not well described. Diffusing capacity of the lung (DLCO) assesses the integrity of the alveolar-capillary interface and thus may be a useful prognostic tool among those with COPD-PH. RESEARCH QUESTION: Using a single center registry, we sought to evaluate DLCO as a predictor of mortality in a cohort of COPD-PH patients...
March 14, 2020: Chest
Mai Wang, Emily Pei-Ying Lin, Li-Ching Huang, Chung-Yi Li, Yu Shyr, Chao-Han Lai
BACKGROUND: Acute exacerbation (AE) of chronic obstructive pulmonary disease (COPD) may be accompanied by the deterioration of cardiovascular comorbidities, as evidenced by the increased incidence of acute cardiovascular events. RESEARCH QUESTION: Whether preceding AE might be associated with mortality of cardiovascular events remains unknown. STUDY DESIGN AND METHODS: Using a health insurance research database in Taiwan, we identified patients with COPD who experienced first-time acute myocardial infarction (AMI; n=26,442), ischemic stroke (n=54,959) and intracranial hemorrhage (ICH; n=14,893) over a 13-year period...
March 14, 2020: Chest
Anne B Chang, John J Oppenheimer, Richard S Irwin
BACKGROUND: Cough is one of the most common presenting symptoms to general practitioners. The objective of this article is to collate the pediatric components of the CHEST chronic cough guidelines that have recently updated the 2006 guidelines to assist general and specialist medical practitioners in the evaluation and management of children who present with chronic cough. METHODS: We reviewed all current CHEST Expert Cough Panel's statements and extracted recommendations and suggestions relating to children aged ≤14-years with chronic cough (>4-weeks duration)...
March 13, 2020: Chest
Rudolf K F Oliveira, Aaron B Waxman, Paul J Hoover, Paul F Dellaripa, David M Systrom
BACKGROUND: Pulmonary hypertension (PH) adversely impact patient´s exercise capacity in interstitial lung disease (ILD). Pulmonary vascular and right ventricular (RV) dysfunction impact, however, have traditionally been thought to be mild, and clinically relevant principally in advanced lung disease states. We sought to evaluate the relative contributions of pulmonary mechanics, pulmonary vascular and RV function to the ILD exercise limit. METHODS: 49 ILD patients that underwent resting right heart catheterization followed by invasive exercise testing were evaluated...
March 12, 2020: Chest
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