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Samant M, Krings JG, Lew D, Goss CW, Koch T, McGregor MC, Boomer J, Hall CS, Schechtman KB, Sheshadri A, Peterson S, Erzurum S, DePew Z, Morrow LE, Hogarth DK, Tejedor R, Trevor J, Wechsler ME, Sam A, Shi X, Choi J, Castro M. Use of Quantitative CT Imaging to Identify Bronchial Thermoplasty Responders. Chest 2024; 165:775-784. [PMID: 38123124 PMCID: PMC11026166 DOI: 10.1016/j.chest.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 11/12/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Bronchial thermoplasty (BT) is a treatment for patients with poorly controlled, severe asthma. However, predictors of treatment response to BT are defined poorly. RESEARCH QUESTION Do baseline radiographic and clinical characteristics exist that predict response to BT? STUDY DESIGN AND METHODS We conducted a longitudinal prospective cohort study of participants with severe asthma receiving BT across eight academic medical centers. Participants received three separate BT treatments and were monitored at 3-month intervals for 1 year after BT. Similar to prior studies, a positive response to BT was defined as either improvement in Asthma Control Test results of ≥ 3 or Asthma Quality of Life Questionnaire of ≥ 0.5. Regression analyses were used to evaluate the association between pretreatment clinical and quantitative CT scan measures with subsequent BT response. RESULTS From 2006 through 2017, 88 participants received BT, with 70 participants (79.5%) identified as responders by Asthma Control Test or Asthma Quality of Life Questionnaire criteria. Responders were less likely to undergo an asthma-related ICU admission in the prior year (3% vs 25%; P = .01). On baseline quantitative CT imaging, BT responders showed less air trapping percentage (OR, 0.90; 95% CI, 0.82-0.99; P = .03), a greater Jacobian determinant (OR, 1.49; 95% CI, 1.05-2.11), greater SD of the Jacobian determinant (OR, 1.84; 95% CI, 1.04-3.26), and greater anisotropic deformation index (OR, 3.06; 95% CI, 1.06-8.86). INTERPRETATION To our knowledge, this is the largest study to evaluate baseline quantitative CT imaging and clinical characteristics associated with BT response. Our results show that preservation of normal lung expansion, indicated by less air trapping, a greater magnitude of isotropic expansion, and greater within-lung spatial variation on quantitative CT imaging, were predictors of future BT response. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01185275; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Maanasi Samant
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, MO
| | - James G Krings
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, MO
| | - Daphne Lew
- Division of Biostatistics, Washington University in Saint Louis School of Medicine, Saint Louis, MO
| | - Charles W Goss
- Division of Biostatistics, Washington University in Saint Louis School of Medicine, Saint Louis, MO
| | - Tammy Koch
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, MO
| | - Mary Clare McGregor
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, MO
| | - Jonathan Boomer
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Kansas School of Medicine, Kansas City, KS
| | - Chase S Hall
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Kansas School of Medicine, Kansas City, KS
| | - Ken B Schechtman
- Division of Biostatistics, Washington University in Saint Louis School of Medicine, Saint Louis, MO
| | - Ajay Sheshadri
- Division of Pulmonary Critical Care Medicine, Department of Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Serpil Erzurum
- Lerner Research Institute and the Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Zachary DePew
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Creighton University Medical Center, Omaha, NE
| | - Lee E Morrow
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Creighton University Medical Center, Omaha, NE
| | - D Kyle Hogarth
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, IL
| | - Richard Tejedor
- Division of Pulmonary and Critical Care, Department of Medicine, LSU Health Sciences Center, New Orleans, LA
| | - Jennifer Trevor
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | | | - Afshin Sam
- Division of Pulmonary and Critical Care, Department of Medicine, University of Arizona, Tuscon, AZ
| | - Xiaosong Shi
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Kansas School of Medicine, Kansas City, KS
| | - Jiwoong Choi
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Kansas School of Medicine, Kansas City, KS
| | - Mario Castro
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Kansas School of Medicine, Kansas City, KS.
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Criner GJ, Mallea JM, Abu-Hijleh M, Sachdeva A, Kalhan R, Hergott CA, Lazarus DR, Mularski RA, Calero K, Reed MF, Nsiah-Dosu S, Himes D, Kubo H, Kinsey CM, Majid A, Hogarth DK, Kaplan PV, Case AH, Makani SS, Chen TM, Delage A, Zgoda M, Shepherd RW. Sustained Clinical Benefits of Spiration Valve System in Patients with Severe Emphysema: 24-Month Follow-Up of EMPROVE. Ann Am Thorac Soc 2024; 21:251-260. [PMID: 37948704 PMCID: PMC10848907 DOI: 10.1513/annalsats.202306-520oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/10/2023] [Indexed: 11/12/2023] Open
Abstract
Rationale: Follow-up of patients with emphysema treated with endobronchial valves is limited to 3-12 months after treatment in prior reports. To date, no comparative data exist between treatment and control subjects with a longer follow-up. Objectives: To assess the durability of the Spiration Valve System (SVS) in patients with severe heterogeneous emphysema over a 24-month period. Methods: EMPROVE, a multicenter randomized controlled trial, presents a rigorous comparison between treatment and control groups for up to 24 months. Lung function, respiratory symptoms, and quality-of-life (QOL) measures were assessed. Results: A significant improvement in forced expiratory volume in 1 second was maintained at 24 months in the SVS treatment group versus the control group. Similarly, significant improvements were maintained in several QOL measures, including the St. George's Respiratory Questionnaire and the COPD Assessment Test. Patients in the SVS treatment group experienced significantly less dyspnea than those in the control group, as indicated by the modified Medical Research Council dyspnea scale score. Adverse events at 24 months did not significantly differ between the SVS treatment and control groups. Acute chronic obstructive pulmonary disease exacerbation rates in the SVS treatment and control groups were 13.7% (14 of 102) and 15.6% (7 of 45), respectively. Pneumothorax rates in the SVS treatment and control groups were 1.0% (1 of 102) and 0.0% (0 of 45), respectively. Conclusions: SVS treatment resulted in statistically significant and clinically meaningful durable improvements in lung function, respiratory symptoms, and QOL, as well as a statistically significant reduction in dyspnea, for at least 24 months while maintaining an acceptable safety profile. Clinical trial registered with www.clinicaltrials.gov (NCT01812447).
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Affiliation(s)
- Gerard J. Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | | | | | | | - Ravi Kalhan
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Karel Calero
- Tampa General Hospital, University of South Florida, Tampa, Florida
| | - Michael F. Reed
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | - David Himes
- Olympus Corporation of the Americas, Westborough, Massachusetts
| | | | | | - Adnan Majid
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Philip V. Kaplan
- Detroit Clinical Research Center, Beaumont Hospital, Farmington Hills, Michigan
| | | | - Samir S. Makani
- University of California, San Diego Medical Center, San Diego, California
| | | | - Antoine Delage
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Hôpital Laval, Quebec, Quebec, Canada
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Ravikumar N, Wagh A, Holden VK, Hogarth DK. Bronchoscopic lung volume reduction in emphysema: a review. Curr Opin Pulm Med 2024; 30:58-67. [PMID: 37916600 DOI: 10.1097/mcp.0000000000001031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
PURPOSE OF REVIEW Chronic obstructive pulmonary disease (COPD) poses a substantial burden on the healthcare system and is currently considered the sixth leading cause of death in the United States. Emphysema, as evidenced by severe air-trapping in patients with COPD, leads to significant dyspnea and morbidity. Lung volume reduction via surgery or minimally invasive endobronchial interventions are currently available, which improve lung function and quality of life. RECENT FINDINGS Newer studies have noted a survival benefit in patients post bronchoscopic lung volume reduction vs. those subjected to standard of care. The presence of collateral ventilation is one of the most common impeding factors to placing endobronchial valves, and if placed, these patients might not achieve lobar atelectasis; however, there are newer modalities that are now available for patients with collateral ventilation which we have described. SUMMARY Combining standard of care treatment that includes smoking cessation, bronchodilators, preventive care including vaccinations, pulmonary rehabilitation, and endobronchial treatment using various interventions in decreasing hyperinflation improves quality of life and may improve survival and hence significantly reduce the burden of COPD on healthcare.
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Affiliation(s)
- Nakul Ravikumar
- Department of Medicine, Division of Pulmonary and Critical Care, UMass Chan Medical School-Baystate, Springfield, Massachusetts
| | - Ajay Wagh
- Department of Medicine, Division of Pulmonary and Critical Care, University of Chicago, Chicago, Illinois
| | - Van K Holden
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - D Kyle Hogarth
- Department of Medicine, Division of Pulmonary and Critical Care, University of Chicago, Chicago, Illinois
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Brunton SA, Hogarth DK. Overuse of long-acting β 2-agonist/inhaled corticosteroids in patients with chronic obstructive pulmonary disease: time to rethink prescribing patterns. Postgrad Med 2023; 135:784-802. [PMID: 38032494 DOI: 10.1080/00325481.2023.2284650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/14/2023] [Indexed: 12/01/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality globally. In the major revision of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 report, the scientific committee concluded that the use of long-acting β2-agonist/inhaled corticosteroids (LABA/ICS) is not encouraged in patients with COPD. However, current prescribing patterns reveal significant use of LABA/ICS. In this paper, the evidence behind the current practice and the latest treatment recommendations is reviewed. We compare the efficacy and safety of combination therapy with long-acting muscarinic antagonist (LAMA) and LABA vs LABA/ICS and note that LAMA/LABA combinations have reduced the annual rate of moderate/severe exacerbations, delayed the time to first exacerbation, and increased post-dose FEV1 vs ICS-based regimens. The GOLD 2023 report recommends treatment with LABA and LAMA combination (preferably as a single inhaler) in patients with persistent dyspnea, with initiation of ICS in patients based on the symptoms (dyspnea and exercise intolerance as indicated by modified Medical Research Council [mMRC] score ≥ 2 and COPD Assessment Test [CAT™] > 20), blood eosinophil count (≥ 300 cells/µL), and exacerbation history (history of hospitalizations for exacerbations of COPD and ≥ 2 moderate exacerbations per year despite appropriate long-acting bronchodilator maintenance therapy). We describe practical recommendations for primary care physicians to optimize therapy for their patients and prevent overuse of ICS-based regimens. We advocate adherence to current recommendations and a greater focus on effective treatments to successfully control symptoms, minimize exacerbation risk, preserve lung function, maximize patient outcomes, and reduce the burden of drug-related adverse events.
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Affiliation(s)
| | - D Kyle Hogarth
- Pulmonary and Critical Care Medicine, The University of Chicago Medicine, Chicago, IL, USA
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5
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Kristensen AE, Kurman JS, Hogarth DK, Sethi S, Sørensen SS. Systematic Review and Cost-Consequence Analysis of Ambu aScope 5 Broncho Compared with Reusable Flexible Bronchoscopes: Insights from Two US University Hospitals and an Academic Institution. Pharmacoecon Open 2023:10.1007/s41669-023-00417-y. [PMID: 37184625 PMCID: PMC10184637 DOI: 10.1007/s41669-023-00417-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVE The aim of this study was to perform a systematic review, meta-analysis and cost-consequence analysis of the single-use bronchoscope, Ambu aScopeTM 5 Broncho, in relation to reusable flexible bronchoscopes (RFB) available within three high procedure volume university hospitals and academic institutions in the USA. METHODS The primary outcome was incremental cost and the secondary outcome was incremental cross-infection risk of use for both the single-use flexible bronchoscope (SUFB) and RFBs. Cost estimates included capital, repair, and reprocessing costs derived from a prospective observational micro-costing approach within three large university hospitals and academic institutions. All costs were valued in 2022 US dollars (USD). A meta-analysis based on literature covering cross-contamination and infection from 2010 to 2020 investigated cross-infection risk following bronchoscopy procedures with RFBs. Capital costs were discounted at 3% over 5-8 years. All parameters were evaluated using both univariate deterministic and probabilistic sensitivity analyses. RESULTS In high-volume hospitals, RFBs were cost minimizing compared to SUFBs. Probabilistic sensitivity analysis showed that RFBs were cost saving in 88% of iterations. Univariate analyses illustrated sensitivity of the base-case result to the procedure volume. Data from sensitivity analyses suggest that the two interventions are cost neutral at a break-even point of 756 procedures per year or 46 procedures per bronchoscope per year. CONCLUSION Assuming equivalent clinical performance, single-use flexible bronchoscopes are not cost minimizing when including the costs associated with cross-infection in high-volume US university hospitals and academic institutions. Overall, the benefits of conversion from RFBs to SUFBs are dependent on the annual procedure volume of individual hospitals, expected cross-infection risk, and purchase price of the aScope 5 Broncho.
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Affiliation(s)
| | - Jonathan S Kurman
- Division of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA
| | - D K Hogarth
- Section of Pulmonary and Critical Care Medicine/Interventional Pulmonology, Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Sonali Sethi
- Interventional Pulmonology, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sabrina S Sørensen
- Danish Center for Healthcare Improvements, Department of Clinical Medicine, Aalborg University, Aalborg Oest, Denmark
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Potts K, Ravikumar N, Hogarth DK, Wagh A. The role of bronchoscopy as a novel approach in preoperative lung marking for early-stage lung cancer. Transl Cancer Res 2023; 12:221-225. [PMID: 36915592 PMCID: PMC10007883 DOI: 10.21037/tcr-22-2827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 12/28/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Kyle Potts
- Section of Pulmonary and Critical Care Medicine/Interventional Pulmonology, Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Nakul Ravikumar
- Section of Pulmonary and Critical Care Medicine/Interventional Pulmonology, Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - D Kyle Hogarth
- Section of Pulmonary and Critical Care Medicine/Interventional Pulmonology, Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Ajay Wagh
- Section of Pulmonary and Critical Care Medicine/Interventional Pulmonology, Department of Medicine, The University of Chicago, Chicago, IL, USA
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Xie F, Chen J, Jiang Y, Sun J, Hogarth DK, Herth FJF. Microwave ablation via a flexible catheter for the treatment of nonsurgical peripheral lung cancer: A pilot study. Thorac Cancer 2022; 13:1014-1020. [PMID: 35166043 PMCID: PMC8977152 DOI: 10.1111/1759-7714.14351] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 12/11/2022] Open
Abstract
Background Endobronchial microwave ablation via flexible catheter offers the potential for local therapy for inoperable peripheral lung cancer. The study aimed to evaluate the feasibility and safety of navigation bronchoscopy‐guided water‐cooled microwave ablation catheter for nonsurgical peripheral lung cancer. Methods This was a prospective single arm pilot study. Patients with early stage or multiple primary peripheral lung cancer who were nonsurgical candidates for surgery were enrolled in the study. Bronchoscopic microwave ablation was performed via a flexible water‐cooled microwave ablation antenna under the guidance of navigation bronchoscopy. Radial probe endobronchial ultrasound combined with fluoroscopy was used to confirm the position. Treatment outcomes were evaluated based on follow‐up chest CT and positron emission tomography scans. Primary endpoints were technical success and safety. Secondary endpoints were complete ablation rate, 2‐year local control rate, and progression‐free survival. Results Thirteen patients were enrolled in the study from April 2018 to July 2019. A total of 19 sessions of microwave ablation were performed on 14 tumors under the guidance of navigation bronchoscopy. The technical success was 100%. Treatment‐related complications occurred in two patients. The complete ablation rate was 78.6% (11/14). The 2‐year local control rate was 71.4%. Median progression‐free survival was 33 months for all patients. Conclusions In this pilot study, bronchoscopic microwave ablation appears to be feasible with acceptable occurrence of complication in the treatment of peripheral lung cancer under the guidance of navigation bronchoscopy.
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Affiliation(s)
- Fangfang Xie
- Department of Respiratory Endoscopy, Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Junxiang Chen
- Department of Respiratory Endoscopy, Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Yifeng Jiang
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jiayuan Sun
- Department of Respiratory Endoscopy, Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - D Kyle Hogarth
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Felix J F Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
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Agrawal A, Ho E, Chaddha U, Demirkol B, Bhavani SV, Hogarth DK, Murgu S. Factors Associated with Diagnostic Accuracy of Robotic Bronchoscopy with 12-month Follow-up. Ann Thorac Surg 2022; 115:1361-1368. [PMID: 35051388 DOI: 10.1016/j.athoracsur.2021.12.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 11/09/2021] [Accepted: 12/15/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Robotic Bronchoscopy (RB) aims to increase the diagnostic yield of guided bronchoscopy by providing improved navigation, farther reach, and stability during lesion sampling. METHODS We reviewed data on consecutive cases in which robotic bronchoscopy was used to diagnose lung lesions from June 15th, 2018 to December 15th, 2019 at the University of Chicago Medical Center. RESULTS The median lesion size was 20.5 mm. All patients had at least 12 months of follow-up. The overall diagnostic accuracy was 77% (95/124). The diagnostic accuracy was 85%, 84% and 38% for concentric, eccentric and absent r-EBUS views, respectively (p < 0.001). A positive r-EBUS view and lesions size of 20-30 mm had higher odds of achieving a diagnosis on multivariate analysis. The 12-month diagnostic accuracy, sensitivity, specificity, positive and negative predictive value for malignancy was 77%, 69%, 100%, 100% and 58%, respectively. Pneumothorax was noted in 1.6% (2) cases with bleeding reported in 3.2% (4) cases. No post-procedure respiratory failure was noted. CONCLUSIONS The overall diagnostic accuracy using RB for pulmonary lesion sampling in our cohort with 12-month follow-up compared favorably to established guided bronchoscopy technologies. Lesion size ≥20 mm and confirmation by r-EBUS predicted higher accuracy independent of concentric or eccentric r-EBUS patterns.
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Affiliation(s)
- Abhinav Agrawal
- Division of Pulmonary, Critical Care & Sleep Medicine, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York.
| | - Elliot Ho
- Section of Pulmonary and Critical Care, The University of Chicago, Chicago, Illinois
| | - Udit Chaddha
- Division of Pulmonary, Critical Care & Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Baris Demirkol
- Department of Pulmonary Diseases, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | | | - D Kyle Hogarth
- Section of Pulmonary and Critical Care, The University of Chicago, Chicago, Illinois
| | - Septimiu Murgu
- Section of Pulmonary and Critical Care, The University of Chicago, Chicago, Illinois
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Folch EE, Bowling MR, Pritchett MA, Murgu SD, Nead MA, Flandes J, Krimsky WS, Mahajan AK, LeMense GP, Murillo BA, Bansal S, Lau K, Gildea TR, Christensen M, Arenberg DA, Singh J, Bhadra K, Hogarth DK, Towe CW, Lamprecht B, Bezzi M, Mattingley JS, Hood KL, Lin H, Wolvers JJ, Khandhar SJ. NAVIGATE 24-Month Results: Electromagnetic navigation bronchoscopy for pulmonary lesions at 37 centers in Europe and the United States. J Thorac Oncol 2021; 17:519-531. [PMID: 34973418 DOI: 10.1016/j.jtho.2021.12.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 11/23/2021] [Accepted: 12/10/2021] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Electromagnetic navigation bronchoscopy (ENB) is a minimally invasive, image-guided approach to access lung lesions for biopsy or localization for treatment. However, no studies have reported prospective 24-month follow-up from a large, multinational, generalizable cohort. This study evaluated ENB safety, diagnostic yield, and usage patterns in an unrestricted, real-world observational design. METHODS The NAVIGATE single-arm, pragmatic cohort study (NCT02410837) enrolled subjects at 37 academic and community sites in 7 countries with prospective 24-month follow-up. Subjects underwent ENB using the superDimension navigation system versions 6.3 to 7.1. The prespecified primary endpoint was procedure-related pneumothorax requiring intervention or hospitalization. RESULTS A total of 1,388 subjects were enrolled for lung lesion biopsy (1,329; 95.7%), fiducial marker placement (272; 19.6%), dye marking (23; 1.7%), and/or lymph node biopsy (36; 2.6%). Concurrent endobronchial ultrasound-guided staging occurred in 456 subjects. General anesthesia (78.2% overall, 56.6% Europe, 81.4% US), radial endobronchial ultrasound (50.6%, 4.0%, 57.4%), fluoroscopy (85.0%, 41.7%, 91.0%), and rapid on-site evaluation use (61.7%, 17.3%, 68.5%) differed between regions. Pneumothorax and bronchopulmonary hemorrhage occurred in 4.7% and 2.7% of subjects, respectively (3.2% [primary endpoint] and 1.7% requiring intervention or hospitalization). Respiratory failure occurred in 0.6%. The diagnostic yield was 67.8% (range 61.9%-70.7%; 55.2% Europe, 69.8% US). Sensitivity for malignancy was 62.6%. Lung cancer clinical stage was I-II in 64.7% (55.3% Europe, 65.8% US). CONCLUSIONS Despite a heterogeneous cohort and regional differences in procedural techniques, ENB demonstrates low complications and a 67.8% diagnostic yield while allowing biopsy, staging, fiducial placement, and dye marking in a single procedure.
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Affiliation(s)
- Erik E Folch
- Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Bulfinch 148, Boston, MA 02114
| | - Mark R Bowling
- Brody School of Medicine, East Carolina University, 500 Moye Blvd, Greenville, NC 27834
| | - Michael A Pritchett
- FirstHealth of the Carolinas and Pinehurst Medical Clinic, 205 Page Road, Pinehurst, NC, 28374
| | - Septimiu D Murgu
- University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL 60637
| | - Michael A Nead
- University of Rochester Medical Center, 601 Elmwood Avenue, Box 692, Rochester NY 14642
| | - Javier Flandes
- Hospital Fundación Jiménez Díaz IIS-FJD Ciberes, Avda. Reyes Católicos 2, Madrid 28043, Spain
| | - William S Krimsky
- Pulmonary and Critical Care Associates of Baltimore, 9103 Franklin Square Drive, Suite 300, Baltimore, MD 21237
| | - Amit K Mahajan
- Inova Health System, Virginia Cancer Specialists, 2921 Telestar Court, Falls Church, VA, 22042
| | - Gregory P LeMense
- Blount Memorial Physicians Group(†), 266 Joule Street, Alcoa, TN 37701
| | - Boris A Murillo
- Providence Health Center and Waco Lung Associates, 340 Richland West Circle, Waco, TX 76657
| | - Sandeep Bansal
- Penn Highlands Healthcare, 100 Hospital Avenue, PO Box 447, DuBois, PA 15801
| | - Kelvin Lau
- St. Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | - Thomas R Gildea
- Cleveland Clinic, 9500 Euclid Avenue MC M2-141, Cleveland, OH 44195
| | - Merete Christensen
- Rigshospitalet, Thoraxkirurgisk klin 78ik RT 2151, Copenhagen, Denmark, Merete.Christensen
| | - Douglas A Arenberg
- University of Michigan, 1150 West Medical Center Drive, University of Michigan, Ann Arbor, MI, 48109
| | - Jaspal Singh
- Atrium Health and Levine Cancer Institute, 503B Med Ed Building, Charlotte, NC, 28203
| | - Krish Bhadra
- CHI Memorial Rees Skillern Cancer Institute, 725 Glenwood Dr E-500, Chattanooga, TN, 37401
| | - D Kyle Hogarth
- The University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL 60637
| | - Christopher W Towe
- University Hospitals Cleveland Medical Center and Case Western Reserve School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44106
| | - Bernd Lamprecht
- Kepler Universitätsklinikum, 4021 Linz, Krankenhausstraße 9, Linz, Austria
| | - Michela Bezzi
- Azienda Ospedaliero Universitaria Careggi, Largo Brambilla, 3 - 50134, Florence, Italy
| | | | - Kristin L Hood
- Medtronic, Clinical Research and Medical Science, 161 Cheshire Ln, Plymouth, MN 55441
| | - Haiying Lin
- Medtronic, Clinical Research and Medical Science, 161 Cheshire Ln, Plymouth, MN 55441
| | - Jennifer J Wolvers
- Medtronic, Clinical Research and Medical Science, 161 Cheshire Ln, Plymouth, MN 55441
| | - Sandeep J Khandhar
- Inova Health System, Virginia Cancer Specialists, 8503 Arlington Blvd, Fairfax, VA, 22031
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Chupp G, Kline JN, Khatri SB, McEvoy C, Silvestri GA, Shifren A, Castro M, Bansal S, McClelland M, Dransfield M, Trevor J, Kahlstrom N, Simoff M, Wahidi MM, Lamb CR, Ferguson JS, Haas A, Hogarth DK, Tejedor R, Toth J, Hey J, Majid A, LaCamera P, FitzGerald JM, Enfield K, Grubb GM, McMullen EA, Olson JL, Laviolette M. Bronchial Thermoplasty in Severe Asthmatics At 5 Years: The PAS2 Study. Chest 2021; 161:614-628. [PMID: 34774528 DOI: 10.1016/j.chest.2021.10.044] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/07/2021] [Accepted: 10/12/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Bronchial thermoplasty is a device-based treatment for subjects ≥18 years with severe asthma poorly controlled with inhaled corticosteroids and long-acting beta-agonists. The Post-FDA Approval Clinical Trial Evaluating Bronchial Thermoplasty in Severe Persistent Asthma (PAS2) study collected data on severe asthmatics undergoing this procedure. RESEARCH QUESTION What are the 5-year efficacy and safety results in severe asthmatics who have undergone bronchial thermoplasty? STUDY DESIGN AND METHODS This was a prospective, open-label, observational, multi-center study conducted in the United States and Canada. Subjects aged 18-65, taking inhaled corticosteroids ≥1000μg/day (beclomethasone or equivalent) and long-acting β-agonists ≥80μg/day (salmeterol or equivalent) were included. Severe exacerbations, hospitalization, emergency department visits, and medication usage were evaluated for the 12 months prior to and at years 1-5 post-treatment. Spirometry was evaluated at baseline and at years 1-5 post-treatment. RESULTS 284 subjects were enrolled at 27 centers; 227 subjects (80%) completed 5 years of follow-up. By year 5 post-treatment, the proportion of subjects with severe exacerbations, emergency department visits, and hospitalizations was 42.7%, 7.9%, and 4.8%, respectively, compared to 77.8%, 29.4%, and 16.1% in the 12 months prior to treatment. The proportion of subjects on maintenance oral corticosteroids decreased from 19.4% at baseline to 9.7% at 5 years. Analyses of subgroups based on baseline clinical and biomarker characteristics revealed a statistically significant clinical improvement among all subgroups. INTERPRETATION Five years after treatment, subjects experienced decreases in severe exacerbations, hospitalizations, emergency department visits and corticosteroid exposure. All subgroups demonstrated clinically significant improvement, suggesting that bronchial thermoplasty improves asthma control in different asthma phenotypes.
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Affiliation(s)
| | - Joel N Kline
- University of Iowa Hospitals and Clinics - Iowa City, IA/US
| | | | | | | | - Adrian Shifren
- Washington University School of Medicine - St. Louis, MO/US
| | - Mario Castro
- University of Kansas School of Medicine, Kansas City, KS
| | | | | | | | | | | | | | | | - Carla R Lamb
- Lahey Hospital and Medical Center - Burlington, MA/US
| | | | - Andrew Haas
- University of Pennsylvania - Philadelphia, PA/US
| | | | | | | | - Jamie Hey
- Pulmonary Associates of Richmond - Richmond, VA/US
| | - Adnan Majid
- Beth Israel Deaconess Medical Center - Boston, MA/US
| | - Peter LaCamera
- St. Elizabeth's Medical Center of Boston, Inc. - Boston, MA/US
| | | | - Kyle Enfield
- University of Virginia Health System - Charlottesville, VA/US
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11
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Magnaye KM, Naughton KA, Huffman J, Hogarth DK, Naureckas ET, White SR, Ober C. A-to-I editing of miR-200b-3p in airway cells is associated with moderate-to-severe asthma. Eur Respir J 2021; 58:13993003.03862-2020. [PMID: 33446603 DOI: 10.1183/13993003.03862-2020] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/19/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Asthma is a chronic lung disease characterised by persistent airway inflammation. Altered microRNA (miRNA)-mediated gene silencing in bronchial epithelial cells (BECs) has been reported in asthma, yet adenosine deaminase acting on RNA (ADAR)-mediated miRNA editing in asthma remains unexplored. METHODS We first identified adenosine to inosine (A-to-I) edited sites in miRNAs in BECs from 142 adult asthma cases and controls. A-to-I edited sites were tested for associations with asthma severity and clinical measures of asthma. Paired RNA sequencing data were used to perform pathway enrichments and test for associations with bioinformatically predicted target genes of the unedited and edited miRNAs. RESULTS Of 19 A-to-I edited sites detected in these miRNAs, one site at position 5 of miR-200b-3p was edited less frequently in cases compared with controls (pcorrected=0.013), and especially compared with cases with moderate (pcorrected=0.029) and severe (pcorrected=3.9×10-4), but not mild (pcorrected=0.38), asthma. Bioinformatic prediction revealed 232 target genes of the edited miR-200b-3p, which were enriched for both interleukin-4 and interferon-γ signalling pathways, and included the SOCS1 (suppressor of cytokine signalling 1) gene. SOCS1 was more highly expressed in moderate (pcorrected=0.017) and severe (pcorrected=5.4×10-3) asthma cases compared with controls. Moreover, both miR-200b-3p editing and SOCS1 were associated with bronchoalveolar lavage eosinophil levels. CONCLUSIONS Reduced A-to-I editing of position 5 of miR-200b-3p in lower airway cells from moderate-to-severe asthmatic subjects may lead to overexpression of SOCS1 and impaired cytokine signalling. We propose ADAR-mediated editing as an epigenetic mechanism contributing to features of moderate-to-severe asthma in adulthood.
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Affiliation(s)
- Kevin M Magnaye
- Dept of Human Genetics, University of Chicago, Chicago, IL, USA.,These two authors contributed equally to this article as lead authors and supervised the work
| | | | - Janel Huffman
- Dept of Human Genetics, University of Chicago, Chicago, IL, USA
| | - D Kyle Hogarth
- Dept of Medicine, University of Chicago, Chicago, IL, USA
| | | | - Steven R White
- Dept of Medicine, University of Chicago, Chicago, IL, USA
| | - Carole Ober
- Dept of Human Genetics, University of Chicago, Chicago, IL, USA .,These two authors contributed equally to this article as lead authors and supervised the work
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12
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van Dijk M, Sue R, Criner GJ, Gompelmann D, Herth FJ, Hogarth DK, Klooster K, Kocks JW, de Oliveira HG, Shah PL, Valipour A, Slebos DJ. Expert Statement: Pneumothorax Associated with One-Way Valve Therapy for Emphysema: 2020 Update. Respiration 2021; 100:969-978. [PMID: 34062550 PMCID: PMC8619763 DOI: 10.1159/000516326] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/14/2021] [Indexed: 11/19/2022] Open
Abstract
For selected patients with advanced emphysema, bronchoscopic lung volume reduction with one-way valves can lead to clinically relevant improvements of airflow obstruction, hyperinflation, exercise capacity, and quality of life. The most common complication of this procedure is pneumothorax with a prevalence of up to ±34% of the treated patients. Patients who develop a pneumothorax also experience meaningful clinical benefits once the pneumothorax is resolved. Timely resolution of a post-valve treatment pneumothorax requires skilled and adequate pneumothorax management. This expert panel statement is an updated recommendation of the 2014 statement developed to help guide pneumothorax management after valve placement. Additionally, mechanisms for pneumothorax development, risk assessment, prevention of pneumothorax, and outcomes after pneumothorax are addressed. This recommendation is based on a combination of the current scientific literature and expert opinion, which was obtained through a modified Delphi method.
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Affiliation(s)
- Marlies van Dijk
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rick Sue
- Advanced Lung Institute, Banner University Phoenix, Phoenix, Arizona, USA
| | - Gerard J. Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Daniela Gompelmann
- Department of Internal Medicine II, Division of Pulmonology, Medical University of Vienna, Vienna, Austria
| | - Felix J.F. Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center Heidelberg (TLRCH), University of Heidelberg, Heidelberg, Germany
| | - D. Kyle Hogarth
- Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois, USA
| | - Karin Klooster
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Janwillem W.H. Kocks
- GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- General practitioners Research Institute, Groningen, The Netherlands
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Hugo G. de Oliveira
- Serviço de Pneumologia do Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Pallav L. Shah
- Royal Brompton Hospital, London, United Kingdom
- Chelsea & Westminster Hospital, London, United Kingdom
- National Heart & Lung Institute, Imperial College, London, United Kingdom
| | - Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna Health Care Group, Vienna, Austria
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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13
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Martinez-Zayas G, Almeida FA, Yarmus L, Steinfort D, Lazarus DR, Simoff MJ, Saettele T, Murgu S, Dammad T, Duong DK, Mudambi L, Filner JJ, Molina S, Aravena C, Thiboutot J, Bonney A, Rueda AM, Debiane LG, Hogarth DK, Bedi H, Deffebach M, Sagar AES, Cicenia J, Yu DH, Cohen A, Frye L, Grosu HB, Gildea T, Feller-Kopman D, Casal RF, Machuzak M, Arain MH, Sethi S, Eapen GA, Lam L, Jimenez CA, Ribeiro M, Noor LZ, Mehta A, Song J, Choi H, Ma J, Li L, Ost DE. Predicting Lymph Node Metastasis in Non-small Cell Lung Cancer: Prospective External and Temporal Validation of the HAL and HOMER Models. Chest 2021; 160:1108-1120. [PMID: 33932466 DOI: 10.1016/j.chest.2021.04.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 04/02/2021] [Accepted: 04/08/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Two models, the Help with the Assessment of Adenopathy in Lung cancer (HAL) and Help with Oncologic Mediastinal Evaluation for Radiation (HOMER), were recently developed to estimate the probability of nodal disease in patients with non-small cell lung cancer (NSCLC) as determined by endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA). The objective of this study was to prospectively externally validate both models at multiple centers. RESEARCH QUESTION Are the HAL and HOMER models valid across multiple centers? STUDY DESIGN AND METHODS This multicenter prospective observational cohort study enrolled consecutive patients with PET-CT clinical-radiographic stages T1-3, N0-3, M0 NSCLC undergoing EBUS-TBNA staging. HOMER was used to predict the probability of N0 vs N1 vs N2 or N3 (N2|3) disease, and HAL was used to predict the probability of N2|3 (vs N0 or N1) disease. Model discrimination was assessed using the area under the receiver operating characteristics curve (ROC-AUC), and calibration was assessed using the Brier score, calibration plots, and the Hosmer-Lemeshow test. RESULTS Thirteen centers enrolled 1,799 patients. HAL and HOMER demonstrated good discrimination: HAL ROC-AUC = 0.873 (95%CI, 0.856-0.891) and HOMER ROC-AUC = 0.837 (95%CI, 0.814-0.859) for predicting N1 disease or higher (N1|2|3) and 0.876 (95%CI, 0.855-0.897) for predicting N2|3 disease. Brier scores were 0.117 and 0.349, respectively. Calibration plots demonstrated good calibration for both models. For HAL, the difference between forecast and observed probability of N2|3 disease was +0.012; for HOMER, the difference for N1|2|3 was -0.018 and for N2|3 was +0.002. The Hosmer-Lemeshow test was significant for both models (P = .034 and .002), indicating a small but statistically significant calibration error. INTERPRETATION HAL and HOMER demonstrated good discrimination and calibration in multiple centers. Although calibration error was present, the magnitude of the error is small, such that the models are informative.
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Affiliation(s)
- Gabriela Martinez-Zayas
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Lonny Yarmus
- Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD
| | - Daniel Steinfort
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Donald R Lazarus
- Department of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, TX
| | - Michael J Simoff
- Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI
| | - Timothy Saettele
- Department of Pulmonary Disease and Critical Care Medicine, Saint Luke's Hospital of Kansas City, Kansas City, MO
| | - Septimiu Murgu
- Division of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL
| | - Tarek Dammad
- Department of Pulmonary Medicine, University of New Mexico, Albuquerque, NM; Department of Pulmonary and Critical Care Medicine, CHRISTUS St. Vincent Medical Center, Santa Fe, NM
| | - D Kevin Duong
- Department of Pulmonary, Allergy and Critical Care Medicine, Stanford University Medical Center and School of Medicine, Stanford, CA
| | - Lakshmi Mudambi
- Division of Pulmonary and Critical Care, VA Portland Health Care System, Oregon Health and Science University, Portland, OR
| | - Joshua J Filner
- Department of Pulmonary Medicine, Northwest Permanente and The Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Sofia Molina
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Carlos Aravena
- Department of Respiratory Diseases, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Jeffrey Thiboutot
- Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD
| | - Asha Bonney
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia
| | - Adriana M Rueda
- Department of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, TX
| | - Labib G Debiane
- Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI
| | - D Kyle Hogarth
- Division of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL
| | - Harmeet Bedi
- Department of Pulmonary, Allergy and Critical Care Medicine, Stanford University Medical Center and School of Medicine, Stanford, CA
| | - Mark Deffebach
- Division of Pulmonary and Critical Care, VA Portland Health Care System, Oregon Health and Science University, Portland, OR
| | - Ala-Eddin S Sagar
- Department of Pulmonary Medicine, Banner MD Anderson Cancer Center, Gilbert, AZ
| | - Joseph Cicenia
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH
| | - Diana H Yu
- Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Avi Cohen
- Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI
| | - Laura Frye
- Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin, Madison, WI
| | - Horiana B Grosu
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Thomas Gildea
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH
| | - David Feller-Kopman
- Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD
| | - Roberto F Casal
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael Machuzak
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH
| | - Muhammad H Arain
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sonali Sethi
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH
| | - George A Eapen
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Louis Lam
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH
| | - Carlos A Jimenez
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Manuel Ribeiro
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH
| | - Laila Z Noor
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Atul Mehta
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH
| | - Juhee Song
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Humberto Choi
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH
| | - Junsheng Ma
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Liang Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David E Ost
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
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14
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Catenacci DVT, Moya S, Lomnicki S, Chase LM, Peterson BF, Reizine N, Alpert L, Setia N, Xiao SY, Hart J, Siddiqui UD, Hogarth DK, Eng OS, Turaga K, Roggin K, Posner MC, Chang P, Narula S, Rampurwala M, Ji Y, Karrison T, Liao CY, Polite BN, Kindler HL. Personalized Antibodies for Gastroesophageal Adenocarcinoma (PANGEA): A Phase II Study Evaluating an Individualized Treatment Strategy for Metastatic Disease. Cancer Discov 2020; 11:308-325. [PMID: 33234578 DOI: 10.1158/2159-8290.cd-20-1408] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/01/2020] [Accepted: 11/18/2020] [Indexed: 02/07/2023]
Abstract
The one-year and median overall survival (mOS) rates of advanced gastroesophageal adenocarcinomas (GEA) are ∼50% and <12 months, respectively. Baseline spatial and temporal molecular heterogeneity of targetable alterations may be a cause of failure of targeted/immunooncologic therapies. This heterogeneity, coupled with infrequent incidence of some biomarkers, has resulted in stalled therapeutic progress. We hypothesized that a personalized treatment strategy, applied at first diagnosis then serially over up to three treatment lines using monoclonal antibodies combined with optimally sequenced chemotherapy, could contend with these hurdles. This was tested using a novel clinical expansion-platform type II design with a survival primary endpoint. Of 68 patients by intention-to-treat, the one-year survival rate was 66% and mOS was 15.7 months, meeting the primary efficacy endpoint (one-sided P = 0.0024). First-line response rate (74%), disease control rate (99%), and median progression-free survival (8.2 months) were superior to historical controls. The PANGEA strategy led to improved outcomes warranting a larger randomized study. SIGNIFICANCE: This study highlights excellent outcomes achieved by individually optimizing chemotherapy, biomarker profiling, and matching of targeted therapies at baseline and over time for GEA. Testing a predefined treatment strategy resulted in improved outcomes versus historical controls. Therapeutic resistance observed in correlative analyses suggests that dual targeted inhibition may be beneficial.This article is highlighted in the In This Issue feature, p. 211.
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Affiliation(s)
- Daniel V T Catenacci
- The University of Chicago, Section of Hematology/Oncology, Department of Medicine, Chicago, Illinois.
| | - Stephanie Moya
- The University of Chicago, Section of Hematology/Oncology, Department of Medicine, Chicago, Illinois
| | - Samantha Lomnicki
- The University of Chicago, Section of Hematology/Oncology, Department of Medicine, Chicago, Illinois
| | - Leah M Chase
- The University of Chicago, Section of Hematology/Oncology, Department of Medicine, Chicago, Illinois
| | - Bryan F Peterson
- The University of Chicago, Section of Hematology/Oncology, Department of Medicine, Chicago, Illinois
| | - Natalie Reizine
- The University of Chicago, Section of Hematology/Oncology, Department of Medicine, Chicago, Illinois
| | - Lindsay Alpert
- The University of Chicago, Department of Pathology, Chicago, Illinois
| | - Namrata Setia
- The University of Chicago, Department of Pathology, Chicago, Illinois
| | - Shu-Yuan Xiao
- The University of Chicago, Department of Pathology, Chicago, Illinois
| | - John Hart
- The University of Chicago, Department of Pathology, Chicago, Illinois
| | - Uzma D Siddiqui
- The University of Chicago, Department of Medicine, Center for Endoscopic Research and Therapeutics (CERT), Chicago, Illinois
| | - D Kyle Hogarth
- The University of Chicago, Department of Medicine, Section of Pulmonology, Chicago, Illinois
| | - Oliver S Eng
- The University of Chicago, Department of Surgery, Chicago, Illinois
| | - Kiran Turaga
- The University of Chicago, Department of Surgery, Chicago, Illinois
| | - Kevin Roggin
- The University of Chicago, Department of Surgery, Chicago, Illinois
| | | | - Paul Chang
- The University of Chicago, Department of Radiology, Chicago, Illinois
| | | | | | - Yuan Ji
- The University of Chicago, Department of Public Health Sciences, Chicago, Illinois
| | - Theodore Karrison
- The University of Chicago, Department of Public Health Sciences, Chicago, Illinois
| | - Chih-Yi Liao
- The University of Chicago, Section of Hematology/Oncology, Department of Medicine, Chicago, Illinois
| | - Blase N Polite
- The University of Chicago, Section of Hematology/Oncology, Department of Medicine, Chicago, Illinois
| | - Hedy L Kindler
- The University of Chicago, Section of Hematology/Oncology, Department of Medicine, Chicago, Illinois
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15
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Leal TA, Argento AC, Bhadra K, Hogarth DK, Grigorieva J, Hartfield RM, McDonald RC, Bonomi PD. Prognostic performance of proteomic testing in advanced non-small cell lung cancer: a systematic literature review and meta-analysis. Curr Med Res Opin 2020; 36:1497-1505. [PMID: 32615813 DOI: 10.1080/03007995.2020.1790346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Timely assessment of patient-specific prognosis is critical to oncology care involving a shared decision-making approach, but clinical prognostic factors traditionally used in NSCLC have limitations. We examine a proteomic test to address these limitations. METHODS This study examines the prognostic performance of the VeriStrat blood-based proteomic test that measures the inflammatory disease state of patients with advanced NSCLC. A systematic literature review (SLR) was performed, yielding cohorts in which the hazard ratio (HR) was reported for overall survival (OS) of patients with VeriStrat Poor (VSPoor) test results versus VeriStrat Good (VSGood). A study-level meta-analysis of OS HRs was performed in subgroups defined by lines of therapy and treatment regimens. RESULTS Twenty-four cohorts met SLR criteria. Meta-analyses in five subgroups (first-line platinum-based chemotherapy, second-line single-agent chemotherapy, first-line EGFR-tyrosine kinase inhibitor (TKI) therapy, and second- and higher-line TKI therapy, and best supportive care) resulted in statistically significant (p ≤ .001) summary effect sizes for OS HRs of 0.42, 0.54, 0.41, 0.52, and 0.50, respectively, indicating increased OS by about two-fold for patients who test VSGood. No significant heterogeneity was seen in any subgroup (p > .05). CONCLUSIONS Advanced NSCLC patients classified VSGood have significantly longer OS than those classified VSPoor. The summary effect size for OS HRs around 0.4-0.5 indicates that the expected median survival of those with a VSGood classification is approximately 2-2.5 times as long as those with VSPoor. The robust prognostic performance of the VeriStrat test across various lines of therapy and treatment regimens has clinical implications for treatment shared decision-making and potential for novel treatment strategies.
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Affiliation(s)
- Ticiana A Leal
- Carbone Cancer Center, University of Wisconsin, Madison, WI, USA
| | - Angela C Argento
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Krish Bhadra
- Rees Skillern Cancer Institute, CHI Memorial, Chattanooga, TN, USA
| | - D Kyle Hogarth
- Department of Medicine, University of Chicago, Chicago, IL, USA
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16
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Yang H, Chen H, Gao B, Xiong W, Zhang X, Hogarth DK, Sun J, Ke M, Herth FJF. Expert panel consensus statement on the applications and precaution strategies of bronchoscopy in patients with COVID-19. Endosc Ultrasound 2020; 9:211-219. [PMID: 32769235 PMCID: PMC7529002 DOI: 10.4103/eus.eus_45_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/11/2020] [Indexed: 12/23/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus with higher transmissibility compared with SARS coronavirus (SARS-CoV) and Middle East respiratory distress syndrome coronavirus. Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 is an unprecedented global crisis that has not been experienced, which is still disrupting health systems, economies, and societies around the world by the rapid spread. Bronchoscopy plays an important role in diagnosis and therapy of pulmonary diseases, especially in patients with severe pulmonary infection, however, application of bronchoscopy in patients suspected or confirmed SARS-CoV-2 infection is extremely limited for the potential airborne transmission from aerosol generated during the procedure. This consensus statement was completed by expert panel of Interventional & Minimally Invasive Respiratory Committee of China Medical Education Association, and the issues were summarized as seven key topics to define the indications of bronchoscopy and matters needing attentions on the bronchoscopy procedures in patients with COVID-19, as well as the protective precaution strategies to avoid nosocomial SARS-CoV-2 infection.
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Affiliation(s)
- Huizhen Yang
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
- Department of Respiratory Endoscopy and Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Huidong Chen
- Department of Respiratory Endoscopy, Jinyintan Hospital of Wuhan, Wuhan, Hubei Province, China
| | - Baoan Gao
- Institute of Respiratory Disease, China Three Gorges University, Yichang Central Hospital, Yichang, Sichuan Province, China
| | - Weining Xiong
- Department of Respiratory and Critical Care Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoju Zhang
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - D. Kyle Hogarth
- Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Jiayuan Sun
- Department of Respiratory Endoscopy and Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Mingyao Ke
- Department of Respiratory Centre, The second Affiliated Hospital of Xiamen Medical College, Xiamen, Fujian Province, China
| | - Felix J. F. Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
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17
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Abstract
Bronchoscopic interventions are preferred for sampling suspicious pulmonary lesions as they have lower complications and can achieve diagnosis and staging in one single procedure. Limitations in existing guided bronchoscopy platforms has led to developments in robotic assisted technologies. These devices may allow the bronchoscopist to more precisely maneuver the scope and instruments into the periphery of the lungs under direct visualization while also ensuring stability during sampling of the target lesions. These devices have the potential to improve the diagnostic yield in sampling peripheral lung lesions and may play a role in the treatment of non-operable or oligometastatic peripheral tumors using bronchoscopic ablative therapies. In this article, we review the existing robotic bronchoscopy technologies and summarize the available pre-clinical and clinical data supporting their use.
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Affiliation(s)
- Abhinav Agrawal
- Interventional Pulmonology, Section of Pulmonary & Critical Care Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - D Kyle Hogarth
- Interventional Pulmonology, Section of Pulmonary & Critical Care Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Septimiu Murgu
- Interventional Pulmonology, Section of Pulmonary & Critical Care Medicine, University of Chicago Medicine, Chicago, IL, USA
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Criner GJ, Delage A, Voelker K, Hogarth DK, Majid A, Zgoda M, Lazarus DR, Casal R, Benzaquen SB, Holladay RC, Wellikoff A, Calero K, Rumbak MJ, Branca PR, Abu-Hijleh M, Mallea JM, Kalhan R, Sachdeva A, Kinsey CM, Lamb CR, Reed MF, Abouzgheib WB, Kaplan PV, Marrujo GX, Johnstone DW, Gasparri MG, Meade AA, Hergott CA, Reddy C, Mularski RA, Case AH, Makani SS, Shepherd RW, Chen B, Holt GE, Martel S. Improving Lung Function in Severe Heterogenous Emphysema with the Spiration Valve System (EMPROVE). A Multicenter, Open-Label Randomized Controlled Clinical Trial. Am J Respir Crit Care Med 2020; 200:1354-1362. [PMID: 31365298 PMCID: PMC6884033 DOI: 10.1164/rccm.201902-0383oc] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Rationale: Less invasive, nonsurgical approaches are needed to treat severe emphysema. Objectives: To evaluate the effectiveness and safety of the Spiration Valve System (SVS) versus optimal medical management. Methods: In this multicenter, open-label, randomized, controlled trial, subjects aged 40 years or older with severe, heterogeneous emphysema were randomized 2:1 to SVS with medical management (treatment) or medical management alone (control). Measurements and Main Results: The primary efficacy outcome was the difference in mean FEV1 from baseline to 6 months. Secondary effectiveness outcomes included: difference in FEV1 responder rates, target lobe volume reduction, hyperinflation, health status, dyspnea, and exercise capacity. The primary safety outcome was the incidence of composite thoracic serious adverse events. All analyses were conducted by determining the 95% Bayesian credible intervals (BCIs) for the difference between treatment and control arms. Between October 2013 and May 2017, 172 participants (53.5% male; mean age, 67.4 yr) were randomized to treatment (n = 113) or control (n = 59). Mean FEV1 showed statistically significant improvements between the treatment and control groups—between-group difference at 6 and 12 months, respectively, of 0.101 L (95% BCI, 0.060–0.141) and 0.099 L (95% BCI, 0.048–0.151). At 6 months, the treatment group had statistically significant improvements in all secondary endpoints except 6-minute-walk distance. Composite thoracic serious adverse event incidence through 6 months was greater in the treatment group (31.0% vs. 11.9%), primarily due to a 12.4% incidence of serious pneumothorax. Conclusions: In patients with severe heterogeneous emphysema, the SVS shows significant improvement in multiple efficacy outcomes, with an acceptable safety profile. Clinical trial registered with www.clinicaltrials.gov (NCT01812447).
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Affiliation(s)
- Gerard J Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Antoine Delage
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Hôpital Laval, Quebec, Quebec, Canada
| | | | | | - Adnan Majid
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Michael Zgoda
- Carolinas Medical Center (Atrium Health), Charlotte, North Carolina
| | - Donald R Lazarus
- Michael E. DeBakey Veterans Affairs (VA) Medical Center, Dallas, Texas
| | - Roberto Casal
- Michael E. DeBakey Veterans Affairs (VA) Medical Center, Dallas, Texas
| | | | - Robert C Holladay
- Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Adam Wellikoff
- Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Karel Calero
- Tampa General Hospital, University South Florida, Tampa, Florida
| | - Mark J Rumbak
- Tampa General Hospital, University South Florida, Tampa, Florida
| | - Paul R Branca
- University of Tennessee Medical Center, Knoxville, Tennessee
| | | | | | - Ravi Kalhan
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Carla R Lamb
- Lahey Hospital & Medical Center, Burlington, Massachusetts
| | - Michael F Reed
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | - Phillip V Kaplan
- Detroit Clinical Research Center, Beaumont Botsford Hospital, Farmington Hills, Michigan
| | | | - David W Johnstone
- Froedtert Hospital, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mario G Gasparri
- Froedtert Hospital, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | | | | | | | | | - Samir S Makani
- University of California Medical Center at San Diego, San Diego, California
| | | | - Benson Chen
- California Pacific Medical Center, San Francisco, California; and
| | | | - Simon Martel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Hôpital Laval, Quebec, Quebec, Canada
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19
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Aldaghlawi F, Kurman JS, Lilly JA, Hogarth DK, Donington J, Ferguson MK, Murgu SD. A Systematic Review of Digital vs Analog Drainage for Air Leak After Surgical Resection or Spontaneous Pneumothorax. Chest 2020; 157:1346-1353. [PMID: 31958444 DOI: 10.1016/j.chest.2019.11.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 10/27/2019] [Accepted: 11/21/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The concerns regarding air leak after lung surgery or spontaneous pneumothorax include detection and duration. Prior studies have suggested that digital drainage systems permit shorter chest tube duration and hospital length of stay (LOS) by earlier detection of air leak cessation. We conducted a systematic review to assess the impact of digital drainage on chest tube duration and hospital LOS after pulmonary surgery and spontaneous pneumothorax. METHODS Ovid MEDLINE, PubMed, Embase, the Cochrane Library, Scopus, and Google Scholar were searched from inception through January 2019. We included randomized controlled trials, cohort studies, and case series of adult patients, using digital or traditional drainage devices for air leaks of either postsurgical or spontaneous pneumothorax origin. RESULTS Of 1,272 references reviewed, 23 articles were included. Nineteen articles addressed postoperative air leak, and four articles pertained to air leak after spontaneous pneumothorax. Thirteen studies were randomized controlled trials. Digital drainage resulted in significantly shorter chest tube duration in eight of 18 studies and shorter hospital LOS in six of 14 studies for postoperative air leak. For postpneumothorax air leak, digital drainage resulted in significantly shorter chest tube duration in two of three studies and hospital LOS in one of two studies with an analog control group. CONCLUSIONS Most studies show no significant differences in chest tube duration and hospital LOS with digital vs analog drainage systems for patients with air leak after pulmonary resection. For post-spontaneous pneumothorax air leak, the limited published evidence suggests shorter chest tube duration and hospital LOS with digital drainage systems.
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Affiliation(s)
- Fadi Aldaghlawi
- Department of Medicine, Indiana University Goshen Health, Goshen, IN
| | - Jonathan S Kurman
- Division of Pulmonary and Critical Care, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Jason A Lilly
- Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, IN
| | - D Kyle Hogarth
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL
| | - Jessica Donington
- Section of Thoracic Surgery, Department of Surgery, University of Chicago, Chicago, IL
| | - Mark K Ferguson
- Section of Thoracic Surgery, Department of Surgery, University of Chicago, Chicago, IL
| | - Septimiu D Murgu
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL.
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20
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Chaddha U, Kovacs SP, Manley C, Hogarth DK, Cumbo-Nacheli G, Bhavani SV, Kumar R, Shende M, Egan JP, Murgu S. Robot-assisted bronchoscopy for pulmonary lesion diagnosis: results from the initial multicenter experience. BMC Pulm Med 2019; 19:243. [PMID: 31829148 PMCID: PMC6907137 DOI: 10.1186/s12890-019-1010-8] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 11/25/2019] [Indexed: 12/26/2022] Open
Abstract
Background The Robotic Endoscopic System (Auris Health, Inc., Redwood City, CA) has the potential to overcome several limitations of contemporary guided-bronchoscopic technologies for the diagnosis of lung lesions. Our objective is to report on the initial post-marketing feasibility, safety and diagnostic yield of this technology. Methods We retrospectively reviewed data on consecutive cases in which robot-assisted bronchoscopy was used to sample lung lesions at four centers in the US (academic and community) from June 15th, 2018 to December 15th, 2018. Results One hundred and sixty-seven lesions in 165 patients were included in the analysis, with an average follow-up of 185 ± 55 days. The average size of target lesions was 25.0 ± 15.0 mm. Seventy-one percent were located in the peripheral third of the lung. Pneumothorax and airway bleeding occurred in 3.6 and 2.4% cases, respectively. Navigation was successful in 88.6% of cases. Tissue samples were successfully obtained in 98.8%. The diagnostic yield estimates ranged from 69.1 to 77% assuming the cases of biopsy-proven inflammation without any follow-up information (N = 13) were non-diagnostic and diagnostic, respectively. The yield was 81.5, 71.7 and 26.9% for concentric, eccentric and absent r-EBUS views, respectively. Diagnostic yield was not affected by lesion size, density, lobar location or centrality. Conclusions RAB implementation in community and academic centers is safe and feasible, with an initial diagnostic yield of 69.1–77% in patients with lung lesions that require diagnostic bronchoscopy. Comparative trials with the existing bronchoscopic technologies are needed to determine cost-effectiveness of this technology.
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Affiliation(s)
- Udit Chaddha
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1232, New York, NY, 10029, USA.
| | | | - Christopher Manley
- Section of Pulmonary Medicine, Fox Chase Cancer Center, Philadelphia, USA
| | - D Kyle Hogarth
- Section of Pulmonary and Critical Care Medicine, University of Chicago Medicine, Chicago, USA
| | - Gustavo Cumbo-Nacheli
- Interventional Pulmonology, Michigan State University College of Human Medicine Spectrum Health, East Lansing, USA
| | | | - Rohit Kumar
- Section of Pulmonary Medicine, Fox Chase Cancer Center, Philadelphia, USA
| | - Manisha Shende
- Department of Cardiothoracic Surgery, UPMC Hamot, Erie, USA
| | - John P Egan
- Interventional Pulmonology, Michigan State University College of Human Medicine Spectrum Health, East Lansing, USA
| | - Septimiu Murgu
- Section of Pulmonary and Critical Care Medicine, University of Chicago Medicine, Chicago, USA
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21
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Chaddha U, Lin J, Hogarth DK. Bronchoscopic Lung Volume Reduction Using Endobronchial Valves: How to Do It. Curr Pulmonol Rep 2019. [DOI: 10.1007/s13665-019-00236-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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22
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Bermea RS, Miller J, Wilson WW, Dugan K, Frye L, Murgu S, Hogarth DK. One-Way Endobronchial Valves as Management for Persistent Air Leaks: A Preview of What's to Come? Am J Respir Crit Care Med 2019; 200:1318-1320. [PMID: 31310162 PMCID: PMC6857487 DOI: 10.1164/rccm.201904-0761le] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Rene S. Bermea
- University of Chicago Medical CenterChicago, Illinoisand
| | | | | | - Karen Dugan
- University of Chicago Medical CenterChicago, Illinoisand
| | - Laura Frye
- University of Chicago Medical CenterChicago, Illinoisand
| | - Septimiu Murgu
- University of Chicago Medical CenterChicago, Illinoisand
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Sharma A, Laxman B, Naureckas ET, Hogarth DK, Sperling AI, Solway J, Ober C, Gilbert JA, White SR. Associations between fungal and bacterial microbiota of airways and asthma endotypes. J Allergy Clin Immunol 2019; 144:1214-1227.e7. [PMID: 31279011 PMCID: PMC6842419 DOI: 10.1016/j.jaci.2019.06.025] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/12/2019] [Accepted: 06/19/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND The relationship between asthma, atopy, and underlying type 2 (T2) airway inflammation is complex. Although the bacterial airway microbiota is known to differ in asthmatic patients, the fungal and bacterial markers that discriminate T2-high (eosinophilic) and T2-low (neutrophilic/mixed-inflammation) asthma and atopy are still incompletely identified. OBJECTIVES The aim of this study was to demonstrate the fungal microbiota structure of airways in asthmatic patients associated with T2 inflammation, atopy, and key clinical parameters. METHODS We collected endobronchial brush (EB) and bronchoalveolar lavage (BAL) samples from 39 asthmatic patients and 19 healthy subjects followed by 16S gene and internal transcribed spacer-based microbiota sequencing. The microbial sequences were classified into exact sequence variants. The T2 phenotype was defined by using a blood eosinophil count with a threshold of 300 cells/μL. RESULTS Fungal diversity was significantly lower in EB samples from patients with T2-high compared with T2-low inflammation; key fungal genera enriched in patients with T2-high inflammation included Trichoderma species, whereas Penicillium species was enriched in patients with atopy. In BAL fluid samples the dominant genera were Cladosporium, Fusarium, Aspergillus, and Alternaria. Using generalized linear models, we identified significant associations between specific fungal exact sequence variants and FEV1, fraction of exhaled nitric oxide values, BAL fluid cell counts, and corticosteroid use. Investigation of interkingdom (bacterial-fungal) co-occurrence patterns revealed different topologies between asthmatic patients and healthy control subjects. Random forest models with fungal classifiers predicted asthma status with 75% accuracy for BAL fluid samples and 80% accuracy for EB samples. CONCLUSIONS We demonstrate clear differences in bacterial and fungal microbiota in asthma-associated phenotypes. Our study provides additional support for considering microbial signatures in delineating asthma phenotypes.
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Affiliation(s)
- Anukriti Sharma
- Department of Surgery, University of Chicago, Chicago, Ill; Biosciences Division (BIO), Argonne National Laboratory, Argonne, Ill; Department of Pediatrics and Scripps Institution of Oceanography, University of California San Diego, La Jolla, Calif
| | - Bharathi Laxman
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Ill
| | - Edward T Naureckas
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Ill
| | - D Kyle Hogarth
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Ill
| | - Anne I Sperling
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Ill
| | - Julian Solway
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Ill
| | - Carole Ober
- Department of Human Genetics, University of Chicago, Chicago, Ill
| | - Jack A Gilbert
- Department of Surgery, University of Chicago, Chicago, Ill; Biosciences Division (BIO), Argonne National Laboratory, Argonne, Ill; Department of Pediatrics and Scripps Institution of Oceanography, University of California San Diego, La Jolla, Calif
| | - Steven R White
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Ill.
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24
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Abu-Hijleh M, Styrvoky K, Anand V, Woll F, Yarmus L, Machuzak MS, Nader DA, Mullett TW, Hogarth DK, Toth JW, Acash G, Casal RF, Hazelrigg S, Wood DE. Intrabronchial Valves for Air Leaks After Lobectomy, Segmentectomy, and Lung Volume Reduction Surgery. Lung 2019; 197:627-633. [PMID: 31463549 DOI: 10.1007/s00408-019-00268-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 08/21/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Air leaks are common after lobectomy, segmentectomy, and lung volume reduction surgery (LVRS). This can increase post-operative morbidity, cost, and hospital length of stay. The management of post-pulmonary resection air leaks remains challenging. Minimally invasive effective interventions are necessary. The Spiration Valve System (SVS, Olympus/Spiration Inc., Redmond, WA, US) is approved by the FDA under humanitarian use exemption for management of prolonged air leaks. METHODS This is a prospective multicenter registry of 39 patients with air leaks after lobectomy, segmentectomy, and LVRS managed with an intention to use bronchoscopic SVS to resolve air leaks. RESULTS Bronchoscopic SVS placement was feasible in 82.1% of patients (32/39 patients) and 90 valves were placed with a median of 2 valves per patient (mean of 2.7 ± 1.5 valves, range of 1 to 7 valves). Positive response to SVS placement was documented in 76.9% of all patients (30/39 patients) and in 93.8% of patients when SVS placement was feasible (30/32 patients). Air leaks ultimately resolved when SVS placement was feasible in 87.5% of patients (28/32 patients), after a median of 2.5 days (mean ± SD of 8.9 ± 12.4 days). Considering all patients with an intention to treat analysis, bronchoscopic SVS procedure likely contributed to resolution of air leaks in 71.8% of patients (28/39 patients). The post-procedure median hospital stay was 4 days (mean 6.0 ± 6.1 days). CONCLUSIONS This prospective registry adds to the growing body of literature supporting feasible and effective management of air leaks utilizing one-way valves.
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Affiliation(s)
- Muhanned Abu-Hijleh
- Division of Pulmonary and Critical Care Medicine, Interventional Pulmonology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, POB Building II, Dallas, TX, 75390, USA.
| | - Kim Styrvoky
- Division of Pulmonary and Critical Care Medicine, Interventional Pulmonology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vikram Anand
- Division of Pulmonary and Critical Care Medicine, Interventional Pulmonology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Fernando Woll
- Division of Pulmonary and Critical Care Medicine, Interventional Pulmonology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lonny Yarmus
- Division of Pulmonary and Critical Care, Section of Interventional Pulmonology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Michael S Machuzak
- Department of Pulmonary, Allergy, Critical Care Medicine and Transplant Center, Interventional Pulmonology, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Daniel A Nader
- Department of Medicine, Pulmonary and Critical Care Medicine, Interventional Pulmonology, Cancer Treatment Centers of America, Tulsa, OK, USA
| | - Timothy W Mullett
- Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - D Kyle Hogarth
- Section of Pulmonary and Critical Care Medicine, Interventional Pulmonology, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Jennifer W Toth
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Ghazwan Acash
- Department of Pulmonary and Critical Care Medicine, Interventional Pulmonology, Lahey Hospital and Medical Center, Tufts University School of Medicine, Burlington, MA, USA
| | - Roberto F Casal
- Department of Pulmonary Medicine, Interventional Pulmonology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Stephen Hazelrigg
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Douglas E Wood
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, WA, USA
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25
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Chaddha U, Hogarth DK, Murgu S. The role of endobronchial ultrasound transbronchial needle aspiration for programmed death ligand 1 testing and next generation sequencing in advanced non-small cell lung cancer. Ann Transl Med 2019; 7:351. [PMID: 31516897 PMCID: PMC6712250 DOI: 10.21037/atm.2019.03.35] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/13/2019] [Indexed: 12/25/2022]
Abstract
Guidelines recommend testing for driver mutations and programmed death ligand 1 (PD-L1) expression at the time of initial diagnosis and during disease progression to help determine prognosis and initiate personalized therapy. In this article we review the updated literature and techniques of endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) in obtaining adequate tissue for molecular analysis by using next-generation sequencing (NGS) and for assessing PD-L1 expression through immunohistochemistry.
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Affiliation(s)
- Udit Chaddha
- Division of Pulmonary and Critical Care, University of Chicago Medical Center, Chicago, USA
| | - D Kyle Hogarth
- Division of Pulmonary and Critical Care, University of Chicago Medical Center, Chicago, USA
| | - Septimiu Murgu
- Division of Pulmonary and Critical Care, University of Chicago Medical Center, Chicago, USA
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26
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Chaddha U, Hogarth DK, Murgu S. Perspective on airway stenting in inoperable patients with tracheoesophageal fistula after curative-intent treatment for esophageal cancer. J Thorac Dis 2019; 11:2165-2174. [PMID: 31285911 DOI: 10.21037/jtd.2018.12.128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Udit Chaddha
- Division of Pulmonary and Critical Care, University of Chicago Medical Center, The University of Chicago Medicine, Chicago, IL 60637, USA
| | - D Kyle Hogarth
- Division of Pulmonary and Critical Care, University of Chicago Medical Center, The University of Chicago Medicine, Chicago, IL 60637, USA
| | - Septimiu Murgu
- Division of Pulmonary and Critical Care, University of Chicago Medical Center, The University of Chicago Medicine, Chicago, IL 60637, USA
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27
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White SR, Laxman B, Naureckas ET, Hogarth DK, Solway J, Sperling AI, Ober C. Evidence for an IL-6-high asthma phenotype in asthmatic patients of African ancestry. J Allergy Clin Immunol 2019; 144:304-306.e4. [PMID: 31029772 DOI: 10.1016/j.jaci.2019.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/14/2019] [Accepted: 04/17/2019] [Indexed: 01/06/2023]
Affiliation(s)
- Steven R White
- Department of Medicine, University of Chicago, Chicago, Ill.
| | | | | | - D Kyle Hogarth
- Department of Medicine, University of Chicago, Chicago, Ill
| | - Julian Solway
- Department of Medicine, University of Chicago, Chicago, Ill
| | | | - Carole Ober
- Department of Human Genetics, University of Chicago, Chicago, Ill
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28
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Hogarth DK, Mahajan AK. The Society for Advanced Bronchoscopy: An Introduction. Chest 2019; 155:1092-1094. [PMID: 30825444 DOI: 10.1016/j.chest.2019.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/12/2019] [Accepted: 02/18/2019] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - Amit K Mahajan
- Interventional Pulmonology Program, Department of Surgery, Inova Heart and Vascular Institute, Inova Schar Cancer Institute, and Inova Fairfax Hospital, Falls Church, VA
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Abstract
With the rising number of screening and incidentally detected lung nodules, there is an increasing need for evaluation in the safest and least invasive manner. The last two decades have seen substantial evolution in bronchoscopic approaches to diagnose these nodules. Innovative bronchoscopic techniques, often used in conjunction with each other, have significantly improved our ability to navigate to almost any part of the lung. A comprehensive knowledge of available technologies and the factors affecting diagnostic yield is essential to decide on the best way to approach a particular scenario. This article provides an overview of the technical aspects, yield, and limitations of these modalities.
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Affiliation(s)
- Udit Chaddha
- Section of Pulmonary and Critical Care, University of Chicago Medicine, Chicago, Illinois
| | - Jonathan S Kurman
- Interventional Pulmonology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Amit Mahajan
- Interventional Pulmonology, Inova Heart and Vascular Center, Inova Fairfax Hospital, Falls Church, Virginia
| | - D Kyle Hogarth
- Section of Pulmonary and Critical Care, University of Chicago Medicine, Chicago, Illinois
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31
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Abstract
The single pulmonary nodule evaluation is a complex problem. In particular, attempts to biopsy peripheral nodules with bronchoscopy have been hampered by difficulty navigating to the correct airway and then confirming the instruments' proximity to the nodule. Virtual systems in use do not provide real-time feedback of a live image of the nodule in question. Fluoroscopy has traditionally offered limited assistance as often the nodule is not visible and provides no information on airways/pathways to the nodule. We describe the use of LungVision augmented fluoroscopy to aid in real-time navigation assistance to peripheral lung nodules.
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Affiliation(s)
- D Kyle Hogarth
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, The University of Chicago Medicine, Chicago, IL 60637, USA
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32
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Abstract
Alveolar-pleural fistulas causing persistent air leaks (PALs) are associated with prolonged hospital stays and high morbidity. Prior guidelines recommend surgical repair as the gold standard for treatment, albeit it is a solution with limited success. In patients who have recently undergone thoracic surgery or in whom surgery would be contraindicated based on the severity of illness, there has been a lack of treatment options. This review describes a brief history of treatment guidelines for PALs. In the past 20 years, newer and less invasive treatment options have been developed. Aside from supportive care, the literature includes anecdotal successful reports using fibrin sealants, ethanol injection, metal coils, and Watanabe spigots. More recently, larger studies have demonstrated success with chemical pleurodesis, autologous blood patch pleurodesis, and endobronchial valves. This manuscript describes these treatment options in detail, including postprocedural adverse events. Further research, including randomized controlled trials with comparison of these options, are needed, as is long-term follow-up for these interventions.
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Affiliation(s)
- Karen C Dugan
- Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL
| | - Balaji Laxmanan
- Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL
| | - Septimiu Murgu
- Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL
| | - D Kyle Hogarth
- Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL.
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33
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Affiliation(s)
- Karen C Dugan
- Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL
| | - Balaji Laxmanan
- Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL
| | - Septimiu Murgu
- Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL
| | - D Kyle Hogarth
- Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL.
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Gildea TR, DaCosta Byfield S, Hogarth DK, Wilson DS, Quinn CC. A retrospective analysis of delays in the diagnosis of lung cancer and associated costs. Clinicoecon Outcomes Res 2017; 9:261-269. [PMID: 28553128 PMCID: PMC5440037 DOI: 10.2147/ceor.s132259] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Diagnosis of lung cancer at advanced stages can result in missed treatment opportunities, worse outcomes, and higher health care costs. This study evaluated the wait time to diagnose non-small-cell lung cancer (NSCLC) and the cost of diagnosis and treatment based on the stage at diagnosis. Patients and methods Adult patients diagnosed with NSCLC between January 2007 and September 2011 were identified from a proprietary oncology registry and linked to health insurance claims from a large US health insurance company. Continuous enrollment in the health plan was required for at least 12 months prediagnosis (baseline) and at least 3 months postdiagnosis (follow-up). Use of diagnostic tests and time to diagnosis were examined. The rates of health care utilization and per-patient per-month (PPPM) health care costs were calculated. Results A total of 1,210 patients with NSCLC were included in the analysis. Most patients (93.6%) had evidence of diagnostic tests beginning 5 to 6 months prior to diagnosis, and most were diagnosed at an advanced stage (23% Stage IIIb and 46% Stage IV). The PPPM total health care costs in USD pre- and postdiagnosis were $2,407±$3,364 (mean±standard deviation) and $16,577±$33,550, respectively. PPPM total health care costs and utilization after lung cancer diagnosis were significantly higher among patients diagnosed at Stage IV disease and lowest among patients diagnosed at Stage I disease ($7,239 Stage I, $9,484 Stage II, $11,193 Stage IIIa, $17,415 Stage IIIb, and $21,441 Stage IV). Conclusion This study showed that most patients experienced long periods of delay between their first diagnostic test for lung cancer and a definitive diagnosis, and the majority were diagnosed at advanced stages of disease. Costs associated with the management of lung cancer increased substantially with higher stages at diagnosis. Procedures that diagnose lung cancer at earlier stages may allow for less resource use and costs among patients with lung cancer.
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Affiliation(s)
- Thomas R Gildea
- Department of Pulmonary, Allergy, and Critical Care Medicine and Transplant Center, Cleveland Clinic, Cleveland, OH
| | | | - D Kyle Hogarth
- Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago Medical Center, Chicago, IL
| | - David S Wilson
- The Lung Institute, Columbus Regional Hospital, Columbus, IN
| | - Curtis C Quinn
- Cardiothoracic Surgery/Thoracic Surgery, Cardiothoracic Surgery of Charleston, Roper St. Francis Physician Partners Group, Charleston, SC, USA
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Mullon JJ, Burkart KM, Silvestri G, Hogarth DK, Almeida F, Berkowitz D, Eapen GA, Feller-Kopman D, Fessler HE, Folch E, Gillespie C, Haas A, Islam SU, Lamb C, Levine SM, Majid A, Maldonado F, Musani AI, Piquette C, Ray C, Reddy CB, Rickman O, Simoff M, Wahidi MM, Lee H. Interventional Pulmonology Fellowship Accreditation Standards. Chest 2017; 151:1114-1121. [DOI: 10.1016/j.chest.2017.01.024] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/12/2016] [Accepted: 01/05/2017] [Indexed: 11/27/2022] Open
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White SR, Nicodemus-Johnson J, Laxman B, Denner DR, Naureckas ET, Hogarth DK, Stern R, Minc A, Solway J, Sperling A, Ober C. Elevated levels of soluble humanleukocyte antigen-G in the airways are a marker for a low-inflammatory endotype of asthma. J Allergy Clin Immunol 2017; 140:857-860. [PMID: 28363527 DOI: 10.1016/j.jaci.2017.02.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 02/03/2017] [Accepted: 02/22/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Steven R White
- Department of Medicine, University of Chicago, Chicago, Ill.
| | | | | | - Darcy R Denner
- Department of Medicine, University of Chicago, Chicago, Ill
| | | | - D Kyle Hogarth
- Department of Medicine, University of Chicago, Chicago, Ill
| | - Randi Stern
- Department of Medicine, University of Chicago, Chicago, Ill
| | - Alexa Minc
- Department of Medicine, University of Chicago, Chicago, Ill
| | - Julian Solway
- Department of Medicine, University of Chicago, Chicago, Ill
| | - Anne Sperling
- Department of Medicine, University of Chicago, Chicago, Ill
| | - Carole Ober
- Department of Human Genetics, University of Chicago, Chicago, Ill
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Murtagh G, Laffin LJ, Patel KV, Patel AV, Bonham CA, Yu Z, Addetia K, El-Hangouche N, Maffesanti F, Mor-Avi V, Hogarth DK, Sweiss NJ, Beshai JF, Lang RM, Patel AR. Improved detection of myocardial damage in sarcoidosis using longitudinal strain in patients with preserved left ventricular ejection fraction. Echocardiography 2017; 33:1344-52. [PMID: 27677642 DOI: 10.1111/echo.13281] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Cardiac infiltration is an important cause of death in sarcoidosis. Transthoracic echocardiography (TTE) has limited sensitivity for the detection of cardiac sarcoidosis (CS). Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) is used to diagnose CS but has limitations of cost and availability. We sought to determine whether TTE-derived global longitudinal strain (GLS) may be used to identify individuals with CS, despite preserved left ventricular ejection fraction (LVEF), and whether abnormal GLS is associated with major cardiovascular events (MCE). METHODS We studied 31 patients with biopsy-proven extra-cardiac sarcoidosis, LVEF>50% and LGE on CMR (CS+ group), and 31 patients without LGE (CS- group), matched by age, sex, and severity of lung disease. GLS was measured using vendor-independent speckle tracking software. Parameters of left and right ventricular systolic and diastolic function were also studied. Receiver-operating characteristic curves were used to identify GLS cutoff for CS detection, and Kaplan-Meier plots to determine the ability of GLS to predict MCE. RESULTS LGE was associated with reduced GLS (-19.6±1.9% in CS- vs -14.7±2.4% in CS+, P<.01) and with reduced E/A ratio (1.1±0.3 vs 0.9±0.3, respectively, P =.01). No differences were noted in other TTE parameters. GLS magnitude inversely correlated with LGE burden (r=-.59). GLS cutoff of -17% showed sensitivity and specificity 94% for detecting CS. Patients who experienced MCE had worse GLS than those who did not (-13.4±0.9% vs -17.7±0.4%, P=.0003). CONCLUSIONS CS is associated with significantly reduced GLS in the presence of preserved LVEF. GLS measurements may become part of the TTE study performed to screen for CS.
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Affiliation(s)
- Gillian Murtagh
- Department of Medicine and Radiology, University of Chicago Medical Center, Chicago, Illinois
| | - Luke J Laffin
- Department of Medicine and Radiology, University of Chicago Medical Center, Chicago, Illinois
| | - Kershaw V Patel
- Department of Medicine and Radiology, University of Chicago Medical Center, Chicago, Illinois
| | - Amit V Patel
- Department of Medicine and Radiology, University of Chicago Medical Center, Chicago, Illinois
| | - Catherine A Bonham
- Department of Medicine and Radiology, University of Chicago Medical Center, Chicago, Illinois
| | - Zoe Yu
- Department of Medicine and Radiology, University of Chicago Medical Center, Chicago, Illinois
| | - Karima Addetia
- Department of Medicine and Radiology, University of Chicago Medical Center, Chicago, Illinois
| | - Nadia El-Hangouche
- Department of Medicine and Radiology, University of Chicago Medical Center, Chicago, Illinois
| | - Francesco Maffesanti
- Department of Medicine and Radiology, University of Chicago Medical Center, Chicago, Illinois
| | - Victor Mor-Avi
- Department of Medicine and Radiology, University of Chicago Medical Center, Chicago, Illinois.
| | - D Kyle Hogarth
- Department of Medicine and Radiology, University of Chicago Medical Center, Chicago, Illinois
| | - Nadera J Sweiss
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - John F Beshai
- Department of Medicine, Mayo Clinic, Phoenix, Arizona
| | - Roberto M Lang
- Department of Medicine and Radiology, University of Chicago Medical Center, Chicago, Illinois
| | - Amit R Patel
- Department of Medicine and Radiology, University of Chicago Medical Center, Chicago, Illinois
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Vigneswaran J, Tan YHC, Murgu SD, Won BM, Patton KA, Villaflor VM, Hoffman PC, Hensing T, Hogarth DK, Malik R, MacMahon H, Mueller J, Simon CA, Vigneswaran WT, Wigfield CH, Ferguson MK, Husain AN, Vokes EE, Salgia R. Comprehensive genetic testing identifies targetable genomic alterations in most patients with non-small cell lung cancer, specifically adenocarcinoma, single institute investigation. Oncotarget 2017; 7:18876-86. [PMID: 26934441 PMCID: PMC4951336 DOI: 10.18632/oncotarget.7739] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 01/23/2016] [Indexed: 12/20/2022] Open
Abstract
This study reviews extensive genetic analysis in advanced non-small cell lung cancer (NSCLC) patients in order to: describe how targetable mutation genes interrelate with the genes identified as variants of unknown significance; assess the percentage of patients with a potentially targetable genetic alterations; evaluate the percentage of patients who had concurrent alterations, previously considered to be mutually exclusive; and characterize the molecular subset of KRAS. Thoracic Oncology Research Program Databases at the University of Chicago provided patient demographics, pathology, and results of genetic testing. 364 patients including 289 adenocarcinoma underwent genotype testing by various platforms such as FoundationOne, Caris Molecular Intelligence, and Response Genetics Inc. For the entire adenocarcinoma cohort, 25% of patients were African Americans; 90% of KRAS mutations were detected in smokers, including current and former smokers; 46% of EGFR and 61% of ALK alterations were detected in never smokers. 99.4% of patients, whose samples were analyzed by next-generation sequencing (NGS), had genetic alterations identified with an average of 10.8 alterations/tumor throughout different tumor subtypes. However, mutations were not mutually exclusive. NGS in this study identified potentially targetable genetic alterations in the majority of patients tested, detected concurrent alterations and provided information on variants of unknown significance at this time but potentially targetable in the future.
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Affiliation(s)
| | - Yi-Hung Carol Tan
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Septimiu D Murgu
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Brian M Won
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Kathryn Alexa Patton
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
| | - Victoria M Villaflor
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Philip C Hoffman
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Thomas Hensing
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - D Kyle Hogarth
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Renuka Malik
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL, USA
| | - Heber MacMahon
- Department of Radiology, The University of Chicago, The University of Chicago, Chicago, IL, USA
| | - Jeffrey Mueller
- Department of Pathology, The University of Chicago, Chicago, IL, USA
| | - Cassie A Simon
- Cancer Registry, Comprehensive Cancer Center, The University of Chicago, Chicago, IL, USA
| | - Wickii T Vigneswaran
- Department of Surgery, The University of Chicago Medicine and Biologic Sciences, Chicago, IL, USA
| | - Christopher H Wigfield
- Department of Surgery, The University of Chicago Medicine and Biologic Sciences, Chicago, IL, USA
| | - Mark K Ferguson
- Department of Surgery, The University of Chicago Medicine and Biologic Sciences, Chicago, IL, USA
| | - Aliya N Husain
- Department of Pathology, The University of Chicago, Chicago, IL, USA
| | - Everett E Vokes
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Ravi Salgia
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
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Sandhaus RA, Turino G, Brantly ML, Campos M, Cross CE, Goodman K, Hogarth DK, Knight SL, Stocks JM, Stoller JK, Strange C, Teckman J. The Diagnosis and Management of Alpha-1 Antitrypsin Deficiency in the Adult. Chronic Obstr Pulm Dis 2016; 3:668-682. [PMID: 28848891 DOI: 10.15326/jcopdf.3.3.2015.0182] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background: The diagnosis and clinical management of adults with alpha-1 antitrypsin deficiency (AATD) have been the subject of ongoing debate, ever since the publication of the first American Thoracic Society guideline statement in 1989.1 In 2003, the "American Thoracic Society (ATS)/European Respiratory Society (ERS) Statement: Standards for the Diagnosis and Management of Individuals with Alpha-1 Antitrypsin Deficiency" made a series of evidence-based recommendations, including a strong recommendation for broad-based diagnostic testing of all symptomatic adults with chronic obstructive pulmonary disease (COPD).2 Even so, AATD remains widely under-recognized. To update the 2003 systematic review and clinical guidance, the Alpha-1 Foundation sponsored a committee of experts to examine all relevant, recent literature in order to provide concise recommendations for the diagnosis and management of individuals with AATD. Purpose: To provide recommendations for: (1) the performance and interpretation of diagnostic testing for AATD, and (2) the current management of adults with AATD and its associated medical conditions. Methods: A systematic review addressing the most pressing questions asked by clinicians (clinician-centric) was performed to identify citations related to AATD that were published since the 2003 comprehensive review, specifically evaluating publications between January 2002 and December 2014. Important, more recent publications were solicited from the writing committee members as well. The combined comprehensive literature reviews of the 2003 document and this current review comprise the evidence upon which the committee's conclusions and recommendations are based. Results: Recommendations for the diagnosis and management of AATD were formulated by the committee. Conclusions: The major recommendations continue to endorse and reinforce the importance of testing for AATD in all adults with symptomatic fixed airflow obstruction, whether clinically labeled as COPD or asthma. Individuals with unexplained bronchiectasis or liver disease also should be tested. Family testing of first-degree relatives is currently the most efficient detection technique. In general, individuals with AATD and emphysema, bronchiectasis, and/or liver disease should be managed according to usual guidelines for these clinical conditions. In countries where intravenous augmentation therapy with purified pooled human plasma-derived alpha-1 antitrypsin is available, recent evidence now provides strong support for its use in appropriate individuals with lung disease due to AATD.
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Affiliation(s)
- Robert A Sandhaus
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado
| | - Gerard Turino
- Pulmonary Division, Mt. Sinai Roosevelt Hospital, New York, New York
| | - Mark L Brantly
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville
| | - Michael Campos
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami School of Medicine, Miami, Florida
| | - Carroll E Cross
- Division of Pulmonary and Critical Care Medicine, University of California Davis, Sacramento
| | - Kenneth Goodman
- Institute for Bioethics and Health Policy, University of Miami School of Medicine, Miami, Florida
| | - D Kyle Hogarth
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Shandra L Knight
- Library and Knowledge Services, National Jewish Health, Denver, Colorado
| | - James M Stocks
- Department of Medicine, University of Texas Health Science Center at Tyler, Tyler
| | - James K Stoller
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Charlie Strange
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston
| | - Jeffrey Teckman
- Division of Pediatric Gastroenterology and Hepatology, St. Louis University School of Medicine, St. Louis, Missouri
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Murtagh G, Laffin LJ, Beshai JF, Maffessanti F, Bonham CA, Patel AV, Yu Z, Addetia K, Mor-Avi V, Moss JD, Hogarth DK, Sweiss NJ, Lang RM, Patel AR. Prognosis of Myocardial Damage in Sarcoidosis Patients With Preserved Left Ventricular Ejection Fraction: Risk Stratification Using Cardiovascular Magnetic Resonance. Circ Cardiovasc Imaging 2016; 9:e003738. [PMID: 26763280 PMCID: PMC4718184 DOI: 10.1161/circimaging.115.003738] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background— Cardiac sarcoidosis is associated with an increased risk of heart failure and sudden death, but its risk in patients with preserved left ventricular ejection fraction is unknown. Using cardiovascular magnetic resonance in patients with extracardiac sarcoidosis and preserved left ventricular ejection fraction, we sought to (1) determine the prevalence of cardiac sarcoidosis or associated myocardial damage, defined by the presence of late gadolinium enhancement (LGE), (2) quantify their risk of death/ventricular tachycardia (VT), and (3) identify imaging-based covariates that predict who is at greatest risk of death/VT. Methods and Results— Parameters of left and right ventricular function and LGE burden were measured in 205 patients with left ventricular ejection fraction >50% and extracardiac sarcoidosis who underwent cardiovascular magnetic resonance for LGE evaluation. The association between covariates and death/VT in the entire group and within the LGE+ group was determined using Cox proportional hazard models and time-dependent receiver–operator curves analysis. Forty-one of 205 patients (20%) had LGE; 12 of 205 (6%) died or had VT during follow-up; of these, 10 (83%) were in the LGE+ group. In the LGE+ group (1) the rate of death/VT per year was >20× higher than LGE− (4.9 versus 0.2%, P<0.01); (2) death/VT were associated with a greater burden of LGE (14±11 versus 5±5%, P<0.01) and right ventricular dysfunction (right ventricular EF 45±12 versus 53±28%, P=0.04). LGE burden was the best predictor of death/VT (area under the receiver-operating characteristics curve, 0.80); for every 1% increase of LGE burden, the hazard of death/VT increased by 8%. Conclusions— Sarcoidosis patients with LGE are at significant risk for death/VT, even with preserved left ventricular ejection fraction. Increased LGE burden and right ventricular dysfunction can identify LGE+ patients at highest risk of death/VT.
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Affiliation(s)
- Gillian Murtagh
- From the Departments of Medicine (G.M., L.J.L., F.M., C.A.B., A.V.P., Z.Y., K.A., V.M.-A., J.D.M., D.K.H., R.M.L., A.R.P.) and Radiology (R.M.L., A.R.P.), University of Chicago, IL; Department of Medicine, Mayo Clinic, Phoenix, AZ (J.F.B.); and Department of Medicine, University of Illinois at Chicago (N.J.S.)
| | - Luke J Laffin
- From the Departments of Medicine (G.M., L.J.L., F.M., C.A.B., A.V.P., Z.Y., K.A., V.M.-A., J.D.M., D.K.H., R.M.L., A.R.P.) and Radiology (R.M.L., A.R.P.), University of Chicago, IL; Department of Medicine, Mayo Clinic, Phoenix, AZ (J.F.B.); and Department of Medicine, University of Illinois at Chicago (N.J.S.)
| | - John F Beshai
- From the Departments of Medicine (G.M., L.J.L., F.M., C.A.B., A.V.P., Z.Y., K.A., V.M.-A., J.D.M., D.K.H., R.M.L., A.R.P.) and Radiology (R.M.L., A.R.P.), University of Chicago, IL; Department of Medicine, Mayo Clinic, Phoenix, AZ (J.F.B.); and Department of Medicine, University of Illinois at Chicago (N.J.S.)
| | - Francesco Maffessanti
- From the Departments of Medicine (G.M., L.J.L., F.M., C.A.B., A.V.P., Z.Y., K.A., V.M.-A., J.D.M., D.K.H., R.M.L., A.R.P.) and Radiology (R.M.L., A.R.P.), University of Chicago, IL; Department of Medicine, Mayo Clinic, Phoenix, AZ (J.F.B.); and Department of Medicine, University of Illinois at Chicago (N.J.S.)
| | - Catherine A Bonham
- From the Departments of Medicine (G.M., L.J.L., F.M., C.A.B., A.V.P., Z.Y., K.A., V.M.-A., J.D.M., D.K.H., R.M.L., A.R.P.) and Radiology (R.M.L., A.R.P.), University of Chicago, IL; Department of Medicine, Mayo Clinic, Phoenix, AZ (J.F.B.); and Department of Medicine, University of Illinois at Chicago (N.J.S.)
| | - Amit V Patel
- From the Departments of Medicine (G.M., L.J.L., F.M., C.A.B., A.V.P., Z.Y., K.A., V.M.-A., J.D.M., D.K.H., R.M.L., A.R.P.) and Radiology (R.M.L., A.R.P.), University of Chicago, IL; Department of Medicine, Mayo Clinic, Phoenix, AZ (J.F.B.); and Department of Medicine, University of Illinois at Chicago (N.J.S.)
| | - Zoe Yu
- From the Departments of Medicine (G.M., L.J.L., F.M., C.A.B., A.V.P., Z.Y., K.A., V.M.-A., J.D.M., D.K.H., R.M.L., A.R.P.) and Radiology (R.M.L., A.R.P.), University of Chicago, IL; Department of Medicine, Mayo Clinic, Phoenix, AZ (J.F.B.); and Department of Medicine, University of Illinois at Chicago (N.J.S.)
| | - Karima Addetia
- From the Departments of Medicine (G.M., L.J.L., F.M., C.A.B., A.V.P., Z.Y., K.A., V.M.-A., J.D.M., D.K.H., R.M.L., A.R.P.) and Radiology (R.M.L., A.R.P.), University of Chicago, IL; Department of Medicine, Mayo Clinic, Phoenix, AZ (J.F.B.); and Department of Medicine, University of Illinois at Chicago (N.J.S.)
| | - Victor Mor-Avi
- From the Departments of Medicine (G.M., L.J.L., F.M., C.A.B., A.V.P., Z.Y., K.A., V.M.-A., J.D.M., D.K.H., R.M.L., A.R.P.) and Radiology (R.M.L., A.R.P.), University of Chicago, IL; Department of Medicine, Mayo Clinic, Phoenix, AZ (J.F.B.); and Department of Medicine, University of Illinois at Chicago (N.J.S.)
| | - Joshua D Moss
- From the Departments of Medicine (G.M., L.J.L., F.M., C.A.B., A.V.P., Z.Y., K.A., V.M.-A., J.D.M., D.K.H., R.M.L., A.R.P.) and Radiology (R.M.L., A.R.P.), University of Chicago, IL; Department of Medicine, Mayo Clinic, Phoenix, AZ (J.F.B.); and Department of Medicine, University of Illinois at Chicago (N.J.S.)
| | - D Kyle Hogarth
- From the Departments of Medicine (G.M., L.J.L., F.M., C.A.B., A.V.P., Z.Y., K.A., V.M.-A., J.D.M., D.K.H., R.M.L., A.R.P.) and Radiology (R.M.L., A.R.P.), University of Chicago, IL; Department of Medicine, Mayo Clinic, Phoenix, AZ (J.F.B.); and Department of Medicine, University of Illinois at Chicago (N.J.S.)
| | - Nadera J Sweiss
- From the Departments of Medicine (G.M., L.J.L., F.M., C.A.B., A.V.P., Z.Y., K.A., V.M.-A., J.D.M., D.K.H., R.M.L., A.R.P.) and Radiology (R.M.L., A.R.P.), University of Chicago, IL; Department of Medicine, Mayo Clinic, Phoenix, AZ (J.F.B.); and Department of Medicine, University of Illinois at Chicago (N.J.S.)
| | - Roberto M Lang
- From the Departments of Medicine (G.M., L.J.L., F.M., C.A.B., A.V.P., Z.Y., K.A., V.M.-A., J.D.M., D.K.H., R.M.L., A.R.P.) and Radiology (R.M.L., A.R.P.), University of Chicago, IL; Department of Medicine, Mayo Clinic, Phoenix, AZ (J.F.B.); and Department of Medicine, University of Illinois at Chicago (N.J.S.)
| | - Amit R Patel
- From the Departments of Medicine (G.M., L.J.L., F.M., C.A.B., A.V.P., Z.Y., K.A., V.M.-A., J.D.M., D.K.H., R.M.L., A.R.P.) and Radiology (R.M.L., A.R.P.), University of Chicago, IL; Department of Medicine, Mayo Clinic, Phoenix, AZ (J.F.B.); and Department of Medicine, University of Illinois at Chicago (N.J.S.).
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Laxmanan B, Egressy K, Murgu SD, White SR, Hogarth DK. Advances in Bronchial Thermoplasty. Chest 2016; 150:694-704. [PMID: 27006157 DOI: 10.1016/j.chest.2016.03.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 02/02/2016] [Accepted: 03/09/2016] [Indexed: 12/28/2022] Open
Abstract
Bronchial thermoplasty (BT) is a therapeutic intervention that delivers targeted thermal energy to the airway walls with the goal of ablating the smooth muscle in patients with severe persistent asthma. Since the publication of the original preclinical studies, three large randomized clinical trials evaluating its impact on asthma control have been performed. These trials have shown improvements in asthma-related quality of life and a reduction in asthma exacerbations following treatment with BT. However, there remains significant controversy regarding the true efficacy of BT and the interpretation of these studies, particularly the Asthma Intervention Research 2 trial. In this article, we will discuss these controversies and present the latest evidence on the use of BT in asthma, specifically the 5-year longitudinal evaluation of patients. In addition, we will discuss new insights into the histopathologic changes that occur in the airways following BT, as well as the feasibility of performing the procedure in patients with very severe asthma. We also will discuss the ongoing translational and clinical investigations regarding the underlying mechanism of action and methods to improve patient selection for this procedure.
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Affiliation(s)
- Balaji Laxmanan
- Section of Pulmonary and Critical Care Medicine, University of Chicago Medicine, Chicago, IL
| | | | - Septimiu D Murgu
- Section of Pulmonary and Critical Care Medicine, University of Chicago Medicine, Chicago, IL
| | - Steven R White
- Section of Pulmonary and Critical Care Medicine, University of Chicago Medicine, Chicago, IL
| | - D Kyle Hogarth
- Section of Pulmonary and Critical Care Medicine, University of Chicago Medicine, Chicago, IL.
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Morris SM, Vachani A, Pass HI, Rom WN, Weiss GJ, Hogarth DK, Runger G, Penny RJ, Ryden K, Richards D, Shelton WT, Mallery DW. Whole blood FPR1 mRNA expression identifies both non-small cell and small cell lung cancer. J Thorac Oncol 2016. [DOI: 10.1016/j.jtho.2015.12.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Atrial fibrillation (AF) that newly occurs during critical illness presents challenges for both short- and long-term management. During critical illness, patients with new-onset AF are clinically evaluated for hemodynamic instability owing to the arrhythmia as well as for potentially reversible arrhythmia triggers. Hemodynamically significant AF that persists during critical illness may be treated with heart rate or rhythm control strategies. Recent evidence suggests that patients in whom AF develops during acute illness (eg, sepsis, postoperatively) have high long-term risks for AF recurrence and for AF-associated complications, such as stroke, heart failure, and death. Therefore, we suggest increased efforts to improve communication of AF events between inpatient and outpatient providers and to reassess patients who had experienced new-onset AF during critical illness after they transition to the post-ICU setting. We describe various strategies for the assessment and long-term management of patients with new-onset AF during critical illness.
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Affiliation(s)
- Allan J Walkey
- Division of Pulmonary and Critical Care Medicine, The Pulmonary Center, Boston University School of Medicine, Boston, MA.
| | - D Kyle Hogarth
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago Medicine, Chicago, IL
| | - Gregory Y H Lip
- Centre for Cardiovascular Sciences, University of Birmingham, Birmingham, England; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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45
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Denner DR, Sangwan N, Becker JB, Hogarth DK, Oldham J, Castillo J, Sperling AI, Solway J, Naureckas ET, Gilbert JA, White SR. Corticosteroid therapy and airflow obstruction influence the bronchial microbiome, which is distinct from that of bronchoalveolar lavage in asthmatic airways. J Allergy Clin Immunol 2015; 137:1398-1405.e3. [PMID: 26627545 DOI: 10.1016/j.jaci.2015.10.017] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 08/26/2015] [Accepted: 10/16/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND The lung has a diverse microbiome that is modest in biomass. This microbiome differs in asthmatic patients compared with control subjects, but the effects of clinical characteristics on the microbial community composition and structure are not clear. OBJECTIVES We examined whether the composition and structure of the lower airway microbiome correlated with clinical characteristics of chronic persistent asthma, including airflow obstruction, use of corticosteroid medications, and presence of airway eosinophilia. METHODS DNA was extracted from endobronchial brushings and bronchoalveolar lavage fluid collected from 39 asthmatic patients and 19 control subjects, along with negative control samples. 16S rRNA V4 amplicon sequencing was used to compare the relative abundance of bacterial genera with clinical characteristics. RESULTS Differential feature selection analysis revealed significant differences in microbial diversity between brush and lavage samples from asthmatic patients and control subjects. Lactobacillus, Pseudomonas, and Rickettsia species were significantly enriched in samples from asthmatic patients, whereas Prevotella, Streptococcus, and Veillonella species were enriched in brush samples from control subjects. Generalized linear models on brush samples demonstrated oral corticosteroid use as an important factor affecting the relative abundance of the taxa that were significantly enriched in asthmatic patients. In addition, bacterial α-diversity in brush samples from asthmatic patients was correlated with FEV1 and the proportion of lavage eosinophils. CONCLUSION The diversity and composition of the bronchial airway microbiome of asthmatic patients is distinct from that of nonasthmatic control subjects and influenced by worsening airflow obstruction and corticosteroid use.
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Affiliation(s)
- Darcy R Denner
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Ill
| | - Naseer Sangwan
- Biosciences Division (BIO), Argonne National Laboratory, Argonne, Ill
| | - Julia B Becker
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Ill
| | - D Kyle Hogarth
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Ill
| | - Justin Oldham
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Ill
| | - Jamee Castillo
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Ill
| | - Anne I Sperling
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Ill
| | - Julian Solway
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Ill
| | - Edward T Naureckas
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Ill
| | - Jack A Gilbert
- Biosciences Division (BIO), Argonne National Laboratory, Argonne, Ill; Departments of Ecology & Evolution and Surgery, University of Chicago, Chicago, Ill; Institute for Genetics, Genomics, and Systems Biology, University of Chicago, Chicago, Ill; Marine Biological Laboratory, Woods Hole, Mass
| | - Steven R White
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Ill.
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46
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Huang Y, Ma SF, Vij R, Oldham JM, Herazo-Maya J, Broderick SM, Strek ME, White SR, Hogarth DK, Sandbo NK, Lussier YA, Gibson KF, Kaminski N, Garcia JGN, Noth I. A functional genomic model for predicting prognosis in idiopathic pulmonary fibrosis. BMC Pulm Med 2015; 15:147. [PMID: 26589497 PMCID: PMC4654815 DOI: 10.1186/s12890-015-0142-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 11/13/2015] [Indexed: 12/11/2022] Open
Abstract
Background The course of disease for patients with idiopathic pulmonary fibrosis (IPF) is highly heterogeneous. Prognostic models rely on demographic and clinical characteristics and are not reproducible. Integrating data from genomic analyses may identify novel prognostic models and provide mechanistic insights into IPF. Methods Total RNA of peripheral blood mononuclear cells was subjected to microarray profiling in a training (45 IPF individuals) and two independent validation cohorts (21 IPF/10 controls, and 75 IPF individuals, respectively). To identify a gene set predictive of IPF prognosis, we incorporated genomic, clinical, and outcome data from the training cohort. Predictor genes were selected if all the following criteria were met: 1) Present in a gene co-expression module from Weighted Gene Co-expression Network Analysis (WGCNA) that correlated with pulmonary function (p < 0.05); 2) Differentially expressed between observed “good” vs. “poor” prognosis with fold change (FC) >1.5 and false discovery rate (FDR) < 2 %; and 3) Predictive of mortality (p < 0.05) in univariate Cox regression analysis. “Survival risk group prediction” was adopted to construct a functional genomic model that used the IPF prognostic predictor gene set to derive a prognostic index (PI) for each patient into either high or low risk for survival outcomes. Prediction accuracy was assessed with a repeated 10-fold cross-validation algorithm and independently assessed in two validation cohorts through multivariate Cox regression survival analysis. Results A set of 118 IPF prognostic predictor genes was used to derive the functional genomic model and PI. In the training cohort, high-risk IPF patients predicted by PI had significantly shorter survival compared to those labeled as low-risk patients (log rank p < 0.001). The prediction accuracy was further validated in two independent cohorts (log rank p < 0.001 and 0.002). Functional pathway analysis revealed that the canonical pathways enriched with the IPF prognostic predictor gene set were involved in T-cell biology, including iCOS, T-cell receptor, and CD28 signaling. Conclusions Using supervised and unsupervised analyses, we identified a set of IPF prognostic predictor genes and derived a functional genomic model that predicted high and low-risk IPF patients with high accuracy. This genomic model may complement current prognostic tools to deliver more personalized care for IPF patients. Electronic supplementary material The online version of this article (doi:10.1186/s12890-015-0142-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yong Huang
- Section of Pulmonary & Critical Care Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637-6076, USA.
| | - Shwu-Fan Ma
- Section of Pulmonary & Critical Care Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637-6076, USA.
| | - Rekha Vij
- Section of Pulmonary & Critical Care Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637-6076, USA.
| | - Justin M Oldham
- Section of Pulmonary & Critical Care Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637-6076, USA.
| | - Jose Herazo-Maya
- Pulmonary, Critical Care and Sleep Medicine, Yale University, New Haven, CT, USA.
| | - Steven M Broderick
- Section of Pulmonary & Critical Care Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637-6076, USA.
| | - Mary E Strek
- Section of Pulmonary & Critical Care Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637-6076, USA.
| | - Steven R White
- Section of Pulmonary & Critical Care Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637-6076, USA.
| | - D Kyle Hogarth
- Section of Pulmonary & Critical Care Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637-6076, USA.
| | - Nathan K Sandbo
- Section of Pulmonary & Critical Care Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637-6076, USA.
| | - Yves A Lussier
- Institute for Genomics and Systems Biology, University of Chicago, Chicago, IL, USA. .,Department of Medicine, Bio5 Institute, UA Cancer Center, University of Arizona, Tucson, AZ, USA.
| | - Kevin F Gibson
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Naftali Kaminski
- Pulmonary, Critical Care and Sleep Medicine, Yale University, New Haven, CT, USA.
| | - Joe G N Garcia
- Arizona Respiratory Center and Department of Medicine, The University of Arizona, Tucson, AZ, USA.
| | - Imre Noth
- Section of Pulmonary & Critical Care Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637-6076, USA.
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47
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Abstract
Bronchial thermoplasty (BT) is a novel therapy for patients with severe asthma. Using radio frequency thermal energy, it aims to reduce the airway smooth muscle mass. Several clinical trials have demonstrated improvements in asthma-related quality of life and a reduction in the number of exacerbations following treatment with BT. In addition, recent data has demonstrated the long-term safety of the procedure as well as sustained improvements in rates of asthma exacerbations, reduction in health care utilization, and improved quality of life. Further study is needed to elucidate the underlying mechanisms that result in these improvements. In addition, improved characterization of the asthma subphenotypes likely to exhibit the largest clinical benefit is a critical step in determining the precise role of BT in the management of severe asthma.
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Affiliation(s)
- Balaji Laxmanan
- Section of Pulmonary and Critical Care Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - D Kyle Hogarth
- Section of Pulmonary and Critical Care Medicine, University of Chicago Medicine, Chicago, IL, USA
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48
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Come CE, Kramer MR, Dransfield MT, Abu-Hijleh M, Berkowitz D, Bezzi M, Bhatt SP, Boyd MB, Cases E, Chen AC, Cooper CB, Flandes J, Gildea T, Gotfried M, Hogarth DK, Kolandaivelu K, Leeds W, Liesching T, Marchetti N, Marquette C, Mularski RA, Pinto-Plata VM, Pritchett MA, Rafeq S, Rubio ER, Slebos DJ, Stratakos G, Sy A, Tsai LW, Wahidi M, Walsh J, Wells JM, Whitten PE, Yusen R, Zulueta JJ, Criner GJ, Washko GR. A randomised trial of lung sealant versus medical therapy for advanced emphysema. Eur Respir J 2015; 46:651-62. [PMID: 25837041 DOI: 10.1183/09031936.00205614] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 02/23/2015] [Indexed: 11/05/2022]
Abstract
Uncontrolled pilot studies demonstrated promising results of endoscopic lung volume reduction using emphysematous lung sealant (ELS) in patients with advanced, upper lobe predominant emphysema. We aimed to evaluate the safety and efficacy of ELS in a randomised controlled setting.Patients were randomised to ELS plus medical treatment or medical treatment alone. Despite early termination for business reasons and inability to assess the primary 12-month end-point, 95 out of 300 patients were successfully randomised, providing sufficient data for 3- and 6-month analysis.57 patients (34 treatment and 23 control) had efficacy results at 3 months; 34 (21 treatment and 13 control) at 6 months. In the treatment group, 3-month lung function, dyspnoea, and quality of life improved significantly from baseline when compared to control. Improvements persisted at 6 months with >50% of treated patients experiencing clinically important improvements, including some whose lung function improved by >100%. 44% of treated patients experienced adverse events requiring hospitalisation (2.5-fold more than control, p=0.01), with two deaths in the treated cohort. Treatment responders tended to be those experiencing respiratory adverse events.Despite early termination, results show that minimally invasive ELS may be efficacious, yet significant risks (probably inflammatory) limit its current utility.
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49
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Sweiss NJ, Noth I, Mirsaeidi M, Zhang W, Naureckas ET, Hogarth DK, Strek M, Caligiuri P, Machado RF, Niewold TB, Garcia JGN, Pangan AL, Baughman RP. Efficacy Results of a 52-week Trial of Adalimumab in the Treatment of Refractory Sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2014; 31:46-54. [PMID: 24751453 PMCID: PMC4134103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 10/12/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND Infliximab, a chimeric, monoclonal, anti-TNF antibody has been shown to be safe and efficacious for refractory sarcoidosis, we investigated whether adalimumab, a fully human, anti-TNF monoclonal antibody, is similarly safe and efficacious in refractory pulmonary sarcoidosis. METHODS An open-label, single-center study was conducted in 11 patients with refractory pulmonary sarcoidosis. Patients received adalimumab 40 mg weekly for 45 weeks, with a final follow-up at Week 52. The primary endpoint was the percent change in predicted forced vital capacity (FVC) at 24 weeks. Secondary efficacy parameters included the 6-minute walk test (6MWT), Borg dyspnea score, and Physician's (PGA) and Patient's (PaGA) Global Assessments. A successful outcome of the study was defined as reduction in immunosuppressive therapy (prednisone to 10 mg or less), improvement in FVC of 5% or greater, improvement in 6-minute walk test distance (6MWD) of 50 meter or greater at the end of weeks 24 and 52. RESULTS Eleven patients received adalimumab and had 24-week follow-ups. Only ten patients had a Week 52 evaluation. FVC stabilized in seven patients, and four patients showed improvement in FVC. Five patients had improved 6MWD, and nine had lower Borg dyspnea scores. PGA and PaGA improved at weeks 24 and 52 for all patients (P<0.008 for all comparisons). Among 11 patients who underwent adalimumab treatment, 9 (82%) and 8(80%) had a successful outcome at the end of 24 and 52 weeks respectively. No severe adverse incidents were reported. CONCLUSIONS In this small, open-label study, adalimumab improved refractory pulmonary sarcoidosis and was well tolerated (ClinicalTrials.gov identifier NCT00311246).
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Affiliation(s)
- Nadera J Sweiss
- University of Illinois Hospital and Health Sciences System, and Institute for Personalized Respiratory Medicine.
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50
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Abstract
Physicians are constantly navigating the overwhelming body of medical literature available on the Internet. Although early citation managers were capable of limited searching of index databases and tedious bibliography production, modern versions of citation managers such as EndNote, Zotero, and Mendeley are powerful web-based tools for searching, organizing, and sharing medical literature. Effortless point-and-click functions provide physicians with the ability to develop robust digital libraries filled with literature relevant to their fields of interest. In addition to easily creating manuscript bibliographies, various citation managers allow physicians to readily access medical literature, share references for teaching purposes, collaborate with colleagues, and even participate in social networking. If physicians are willing to invest the time to familiarize themselves with modern citation managers, they will reap great benefits in the future.
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Affiliation(s)
- Amit K Mahajan
- Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL
| | - D Kyle Hogarth
- Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL.
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