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1.
Artículo en Inglés | MEDLINE | ID: mdl-39402306

RESUMEN

PURPOSE: Low-dose computed tomography lung cancer screening is effective for reducing lung cancer mortality. It is critical to understand the lung cancer screening practices for screen-eligible individuals living in Alabama and Georgia where lung cancer is the leading cause of cancer death. High lung cancer incidence and mortality rates are attributed to high smoking rates among underserved, low income, and rural populations. Therefore, the purpose of this study is to define sociodemographic and clinical characteristics of patients who were screened for lung cancer at an Academic Medical Center (AMC) in Alabama and a Safety Net Hospital (SNH) in Georgia. METHODS: A retrospective cohort study of screen-eligible patients was constructed using electronic health records between 2015 and 2020 seen at an Academic Medical Center (AMC) and a Safety Net Hospital (SNH) separately. Chi-square tests and Student t tests were used to compare screening uptake across patient demographic and clinical variables. Bivariate and multivariate logistic regressions determined significant predictors of lung cancer screening uptake. RESULTS: At the AMC, 67,355 were identified as eligible for LCS and 1,129 were screened. In bivariate analyses, there were several differences between those who were screened and those who were not screened. Screening status in the site at Alabama-those with active tobacco use are significantly more likely to be screened than former smokers (OR: 3.208, p < 0.01). For every 10-unit increase in distance, the odds of screening decreased by about 15% (OR: 0.848, p < 0.01). For every 10-year increase in age, the odds of screening decrease by about 30% (OR: 0.704, p < 0.01). Each additional comorbidity increases the odds of screening by about 7.5% (OR: 1.075, p < 0.01). Those with both private and public insurance have much higher odds of screening compared to those with only private insurance (OR: 5.403, p < 0.01). However, those with only public insurance have lower odds of screening compared to those with private insurance (OR: 0.393, p < 0.01). At the SNH-each additional comorbidity increased the odds of screening by about 11.9% (OR: 1.119, p = 0.01). Notably, those with public insurance have significantly higher odds of being screened compared to those with private insurance (OR: 2.566, p < 0.01). CONCLUSION: The study provides evidence that LCS has not reached all subgroups and that additional targeted efforts are needed to increase lung cancer screening uptake. Furthermore, disparity was noticed between adults living closer to screening institutions and those who lived farther.

2.
Am J Respir Crit Care Med ; 208(8): 837-845, 2023 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-37582154

RESUMEN

Rationale: Strict adherence to procedural protocols and diagnostic definitions is critical to understand the efficacy of new technologies. Electromagnetic navigational bronchoscopy (ENB) for lung nodule biopsy has been used for decades without a solid understanding of its efficacy, but offers the opportunity for simultaneous tissue acquisition via electromagnetic navigational transthoracic biopsy (EMN-TTNA) and staging via endobronchial ultrasound (EBUS). Objective: To evaluate the diagnostic yield of EBUS, ENB, and EMN-TTNA during a single procedure using a strict a priori definition of diagnostic yield with central pathology adjudication. Methods: A prospective, single-arm trial was conducted at eight centers enrolling participants with pulmonary nodules (<3 cm; without computed tomography [CT]- and/or positron emission tomography-positive mediastinal lymph nodes) who underwent a staged procedure with same-day CT, EBUS, ENB, and EMN-TTNA. The procedure was staged such that, when a diagnosis had been achieved via rapid on-site pathologic evaluation, the procedure was ended and subsequent biopsy modalities were not attempted. A study finding was diagnostic if an independent pathology core laboratory confirmed malignancy or a definitive benign finding. The primary endpoint was the diagnostic yield of the combination of CT, EBUS, ENB, and EMN-TTNA. Measurements and Main Results: A total of 160 participants at 8 centers with a mean nodule size of 18 ± 6 mm were enrolled. The diagnostic yield of the combined procedure was 59% (94 of 160; 95% confidence interval [CI], 51-66%). Nodule regression was found on same-day CT in 2.5% of cases (4 of 160; 95% CI, 0.69-6.3%), and EBUS confirmed malignancy in 7.1% of cases (11 of 156; 95% CI, 3.6-12%). The yield of ENB alone was 49% (74 of 150; 95% CI, 41-58%), that of EMN-TTNA alone was 27% (8 of 30; 95% CI, 12-46%), and that of ENB plus EMN-TTNA was 53% (79 of 150; 95% CI, 44-61%). Complications included a pneumothorax rate of 10% and a 2% bleeding rate. When EMN-TTNA was performed, the pneumothorax rate was 30%. Conclusions: The diagnostic yield for ENB is 49%, which increases to 59% with the addition of same-day CT, EBUS, and EMN-TTNA, lower than in prior reports in the literature. The high complication rate and low diagnostic yield of EMN-TTNA does not support its routine use. Clinical trial registered with www.clinicaltrials.gov (NCT03338049).

3.
Thorax ; 77(4): 351-356, 2022 04.
Artículo en Inglés | MEDLINE | ID: mdl-34417353

RESUMEN

INTRODUCTION: COPD is a heterogeneous disorder with varied phenotypes. We aimed to determine the prevalence of asthma history, peripheral eosinophilia and elevated FeNO levels along with the diagnostic utility of peripheral eosinophilia in identifying airway eosinophilic inflammation. METHODS: National Health and Nutrition Examination Survey data were analysed for the study period 2007-2010. Subjects aged ≥40 years with postbronchodilator FEV1/FVC ratio <0.70 were included. Receiver operator curve analysis was performed for sensitivity analysis. A p value of <0.001 is considered statistically significant. RESULTS: A total of 3 110 617 weighted COPD cases were identified; predominantly male (64.4%) and non-Hispanic whites (86.1%). Among our COPD subjects, 14.6% had a history of doctor diagnosed asthma, highest among females and other race Americans. The overall prevalence of peripheral eosinophilia is 36%, 38.3% among COPD subjects with asthma history, and 35.6% among COPD without asthma history. The overall prevalence of elevated FeNO ≥25 ppb is 14.3%; 28.7% among COPD subjects with asthma history and 13.0% among COPD without asthma history. DISCUSSION: The prevalence of FeNO levels ≥25 ppb and peripheral eosinophilia was significantly higher among COPD subjects with asthma compared with COPD without asthma history. Not all COPD subjects with peripheral eosinophilia and elevated FeNO levels have a reported history of asthma. Our study supports clinically phenotyping COPD subjects with eosinophilic inflammation be independent of their asthma history and peripheral eosinophilia can be used as a surrogate marker in resource-limited settings.


Asunto(s)
Eosinofilia , Enfermedad Pulmonar Obstructiva Crónica , Pruebas Respiratorias , Eosinofilia/epidemiología , Eosinófilos , Femenino , Prueba de Óxido Nítrico Exhalado Fraccionado , Humanos , Masculino , Óxido Nítrico/análisis , Encuestas Nutricionales
5.
Curr Opin Pulm Med ; 25(2): 188-191, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30562187

RESUMEN

PURPOSE OF REVIEW: China's economy has had tremendous growth through the principle of command economy, where profitable private industries become government-owned and managed. The tobacco industry, which generates 10% of the annual governmental income from the country's over 300 million smokers, serves as a prime example. The present review takes an in-depth look at how the success of the government's tobacco industry has caused a pulmonary health crisis for the country with the world's largest population; and in turn, poses a threat to global lung health. RECENT FINDINGS: China's emergence as a world leader has allowed insight to the nation's health system. Recent studies have shown that China has the highest prevalence and the worst outcomes of smoking related pulmonary diseases such as chronic obstructive pulmonary disease. Similarly, the rates of lung cancer have grown exponentially over the last decade with China now accounting for 36% of annual new cases globally. The burden of disease is detrimental to the health system, places financial hardship on patients, and threatens the economy and work force. SUMMARY: The present review should serve as a call for research, preventive health initiatives, and governmental policy to reform tobacco production, social acceptance, and use.


Asunto(s)
Costo de Enfermedad , Enfermedades Pulmonares , Industria del Tabaco , Fumar Tabaco , China/epidemiología , Salud Global , Humanos , Enfermedades Pulmonares/economía , Enfermedades Pulmonares/epidemiología , Enfermedades Pulmonares/etiología , Prevalencia , Fumar Tabaco/epidemiología , Fumar Tabaco/prevención & control
6.
Prev Chronic Dis ; 14: E31, 2017 04 13.
Artículo en Inglés | MEDLINE | ID: mdl-28409741

RESUMEN

INTRODUCTION: Multimorbidity, the presence of 2 or more chronic conditions, frequently affects people with chronic obstructive pulmonary disease (COPD). Many have high-cost, highly complex conditions that have a substantial impact on state Medicaid programs. We quantified the cost of Medicaid-insured patients with COPD co-diagnosed with other chronic disorders. METHODS: We used nationally representative Medicaid claims data to analyze the impact of comorbidities (other chronic conditions) on the disease burden, emergency department (ED) use, hospitalizations, and total health care costs among 291,978 adult COPD patients. We measured the prevalence of common conditions and their influence on COPD-related and non-COPD-related resource use by using the Elixhauser Comorbidity Index. Elixhauser comorbidity counts were clustered from 0 to 7 or more. We performed multivariable logistic regression to determine the odds of ED visits by Elixhauser scores adjusting for age, sex, race/ethnicity, and residence. RESULTS: Acute care, hospital bed days, and total Medicaid-reimbursed costs increased as the number of comorbidities increased. ED visits unrelated to COPD were more common than visits for COPD, especially in patients self-identified as black or African American (designated black). Hypertension, diabetes, affective disorders, hyperlipidemia, and asthma were the most prevalent comorbid disorders. Substance abuse, congestive heart failure, and asthma were commonly associated with ED visits for COPD. Female sex was associated with COPD-related and non-COPD-related ED visits. CONCLUSION: Comorbidities markedly increased health services use among people with COPD insured with Medicaid, although ED visits in this study were predominantly unrelated to COPD. Achieving excellence in clinical practice with optimal clinical and economic outcomes requires a whole-person approach to the patient and a multidisciplinary health care team.


Asunto(s)
Comorbilidad , Medicaid , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Adolescente , Adulto , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Estados Unidos/epidemiología , Adulto Joven
7.
Oncology (Williston Park) ; 28(5): 441-6, 2014 May.
Artículo en Inglés | MEDLINE | ID: mdl-25004661

RESUMEN

Lung cancer screening using helical low-dose computerized tomography (LDCT) increased drastically after publication of a successful well-designed prospective randomized screening study, the National Lung Screening Trial. This increase in screening has led to a significant increase in the diagnosis of solitary pulmonary nodules (SPNs). Some of these lesions are early cancers, and their removal can potentially prevent a lung cancer death. Some have the histologic appearance of a cancer but will never progress and cause harm. Some are non-neoplastic and are best observed. The number of lesions detected with LDCT is so great that algorithms are being developed for more efficient evaluation and management of SPNs. This article will discuss current tools, approaches, and concerns regarding patient care in this setting.


Asunto(s)
Algoritmos , Detección Precoz del Cáncer , Neoplasias Pulmonares/diagnóstico por imagen , Nódulo Pulmonar Solitario/diagnóstico por imagen , Tomografía Computarizada Espiral , Diagnóstico Diferencial , Reacciones Falso Positivas , Humanos , Neoplasias Pulmonares/terapia , Dosis de Radiación , Nódulo Pulmonar Solitario/terapia
8.
Cancers (Basel) ; 16(3)2024 Jan 31.
Artículo en Inglés | MEDLINE | ID: mdl-38339362

RESUMEN

Lung cancer remains a leading cause of death in the United States and globally, despite progress in treatment and screening efforts. While mortality rates have decreased in recent years, long-term survival of patients with lung cancer continues to be a challenge. Notably, African American (AA) men experience significant disparities in lung cancer compared to European Americans (EA) in terms of incidence, treatment, and survival. Previous studies have explored factors such as smoking patterns and complex social determinants, including socioeconomic status, personal beliefs, and systemic racism, indicating their role in these disparities. In addition to social factors, emerging evidence points to variations in tumor biology, immunity, and comorbid conditions contributing to racial disparities in this disease. This review emphasizes differences in smoking patterns, screening, and early detection and the intricate interplay of social, biological, and environmental conditions that make African Americans more susceptible to developing lung cancer and experiencing poorer outcomes.

9.
Artículo en Inglés | MEDLINE | ID: mdl-38708410

RESUMEN

Aim: Increasing evidence suggests that the inclusion of self-identified race in clinical decision algorithms may perpetuate longstanding inequities. Until recently, most pulmonary function tests utilized separate reference equations that are race/ethnicity based. Purpose: We assess the magnitude and scope of the available literature on the negative impact of race-based pulmonary function prediction equations on relevant outcomes in African Americans with COPD. Methods: We performed a scoping review utilizing an English language search on PubMed/Medline, Embase, Scopus, and Web of Science in September 2022 and updated it in December 2023. We searched for publications regarding the effect of race-specific vs race-neutral, race-free, or race-reversed lung function testing algorithms on the diagnosis of COPD and COPD-related physiologic and functional measures. Joanna Briggs Institute (JBI) guidelines were utilized for this scoping review. Eligibility criteria: The search was restricted to adults with COPD. We excluded publications on other lung disorders, non-English language publications, or studies that did not include African Americans. The search identified publications. Ultimately, six peer-reviewed publications and four conference abstracts were selected for this review. Results: Removal of race from lung function prediction equations often had opposite effects in African Americans and Whites, specifically regarding the severity of lung function impairment. Symptoms and objective findings were better aligned when race-specific reference values were not used. Race-neutral prediction algorithms uniformly resulted in reclassifying severity in the African Americans studied. Conclusion: The limited literature does not support the use of race-based lung function prediction equations. However, this assertion does not provide guidance for every specific clinical situation. For African Americans with COPD, the use of race-based prediction equations appears to fall short in enhancing diagnostic accuracy, classifying severity of impairment, or predicting subsequent clinical events. We do not have information comparing race-neutral vs race-based algorithms on prediction of progression of COPD. We conclude that the elimination of race-based reference values potentially reduces underestimation of disease severity in African Americans with COPD.


Asunto(s)
Negro o Afroamericano , Pulmón , Enfermedad Pulmonar Obstructiva Crónica , Pruebas de Función Respiratoria , Humanos , Algoritmos , Disparidades en el Estado de Salud , Disparidades en Atención de Salud/etnología , Pulmón/fisiopatología , Valor Predictivo de las Pruebas , Pronóstico , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Enfermedad Pulmonar Obstructiva Crónica/etnología , Factores Raciales , Adulto
10.
medRxiv ; 2024 Aug 08.
Artículo en Inglés | MEDLINE | ID: mdl-39148837

RESUMEN

Rationale: Identification and validation of circulating biomarkers for lung function decline in COPD remains an unmet need. Objective: Identify prognostic and dynamic plasma protein biomarkers of COPD progression. Methods: We measured plasma proteins using SomaScan from two COPD-enriched cohorts, the Subpopulations and Intermediate Outcomes Measures in COPD Study (SPIROMICS) and Genetic Epidemiology of COPD (COPDGene), and one population-based cohort, Multi-Ethnic Study of Atherosclerosis (MESA) Lung. Using SPIROMICS as a discovery cohort, linear mixed models identified baseline proteins that predicted future change in FEV1 (prognostic model) and proteins whose expression changed with change in lung function (dynamic model). Findings were replicated in COPDGene and MESA-Lung. Using the COPD-enriched cohorts, Gene Set Enrichment Analysis (GSEA) identified proteins shared between COPDGene and SPIROMICS. Metascape identified significant associated pathways. Measurements and Main Results: The prognostic model found 7 significant proteins in common (p < 0.05) among all 3 cohorts. After applying false discovery rate (adjusted p < 0.2), leptin remained significant in all three cohorts and growth hormone receptor remained significant in the two COPD cohorts. Elevated baseline levels of leptin and growth hormone receptor were associated with slower rate of decline in FEV1. Twelve proteins were nominally but not FDR significant in the dynamic model and all were distinct from the prognostic model. Metascape identified several immune related pathways unique to prognostic and dynamic proteins. Conclusion: We identified leptin as the most reproducible COPD progression biomarker. The difference between prognostic and dynamic proteins suggests disease activity signatures may be different from prognosis signatures.

11.
NPJ Genom Med ; 8(1): 36, 2023 Oct 31.
Artículo en Inglés | MEDLINE | ID: mdl-37903807

RESUMEN

The consequences of returning infectious pathogen test results identified incidentally in research studies have not been well-studied. Concerns include identification of an important health issue for individuals, accuracy of research test results, public health impact, potential emotional distress for participants, and need for IRB permissions. Blood RNA-sequencing analysis for non-human RNA in 3984 participants from the COPDGene study identified 228 participants with evidence suggestive for hepatitis C virus (HCV) infection. We hypothesized that incidentally discovered HCV results could be effectively returned to COPDGene participants with attention to the identified concerns. In conjunction with a COPDGene Participant Advisory Panel, we developed and obtained IRB approval for a process of returning HCV research results and an HCV Follow-Up Study questionnaire to capture information about previous HCV diagnosis and treatment information and participant reactions to return of HCV results. During phone calls following the initial HCV notification letter, 84 of 124 participants who could be contacted (67.7%) volunteered that they had been previously diagnosed with HCV infection. Thirty-one of these 124 COPDGene participants were enrolled in the HCV Follow-Up Study. Five of the 31 HCV Follow-Up Study participants did not report a previous diagnosis of HCV. For four of these participants, subsequent clinical HCV testing confirmed HCV infection. Thus, 30/31 Follow-Up Study participants had confirmed HCV diagnoses, supporting the accuracy of the HCV research test results. However, the limited number of participants in the Follow-Up Study precludes an accurate assessment of the false-positive and false-negative rates of the research RNA sequencing evidence for HCV. Most HCV Follow-Up Study participants (29/31) were supportive of returning HCV research results, and most participants found the process for returning HCV results to be informative and not upsetting. Newly diagnosed participants were more likely to be pleased to learn about a potentially curable infection (p = 0.027) and showed a trend toward being more frightened by the potential health risks of HCV (p = 0.11). We conclude that HCV results identified incidentally during transcriptomic research studies can be successfully returned to research study participants with a carefully designed process.

12.
Am J Case Rep ; 21: e928499, 2020 Dec 28.
Artículo en Inglés | MEDLINE | ID: mdl-33361740

RESUMEN

BACKGROUND Invasive pulmonary aspergillosis (IPA) is a severe form of the fungal infection with relatively high mortality rates. Risk factors that lead to IPA include immunosuppression through corticosteroid use. IPA complicated by hydropneumothorax is rare and its mechanism of formation is unknown. CASE REPORT A 72-year-old woman recently diagnosed with a right frontal meningioma that was managed with dexamethasone presented with a new 3-day history of nonproductive cough, chest pain, and dyspnea and was managed for pneumonia. The patient failed to improve, prompting a follow-up computed tomography scan, which revealed a right middle lobe cavitary lesion. During the workup of this lesion, the patient's hospital course was complicated by hemoptysis and development of a large right hydropneumothorax that was successfully managed with a chest tube. Despite initial resolution of hydropneumothorax, the patient developed a right apical pneumothorax that gradually worsened. Bronchoscopy culture revealed Aspergillus fumigatus, leading to the diagnosis of IPA, which was managed with intravenous voriconazole. CONCLUSIONS Corticosteroid use with subsequent immunosuppression is a risk factor for developing IPA. Clinicians should include IPA in their differential diagnosis for respiratory infections in patients receiving corticosteroids. Although overall prognosis of IPA is poor, outcomes can be improved with early diagnosis, early empiric initiation of antifungals, and withdrawal of immunosuppressive therapy. IPA complicated by hydropneumothorax is a rare phenomenon with a poorly understood mechanism of formation. Based on our case, we propose a mechanism of hydropneumothorax formation from IPA.


Asunto(s)
Hidroneumotórax , Aspergilosis Pulmonar Invasiva , Anciano , Antifúngicos/uso terapéutico , Femenino , Glucocorticoides/efectos adversos , Humanos , Hidroneumotórax/inducido químicamente , Hidroneumotórax/tratamiento farmacológico , Aspergilosis Pulmonar Invasiva/diagnóstico , Aspergilosis Pulmonar Invasiva/tratamiento farmacológico , Voriconazol
13.
J Racial Ethn Health Disparities ; 6(1): 22-26, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-29729002

RESUMEN

RATIONALE: The current age threshold for lung cancer screening targets individuals beginning at age 55. These guidelines were developed based on results from the National Lung Cancer Screening Trial where only 4.4% of the enrollees were African American, when they represent 12.3% of US population. African Americans were also found to have higher incidence and younger onset of lung cancer. We hypothesized that implementation of screening at age 55 would not detect a substantial fraction of early onset lung cancer cases in African American population. OBJECTIVES: We used Surveillance, Epidemiology, and End Results (SEER) Program data to determine the frequency of early-onset lung cancers and to assess the stage at diagnosis in a biracial sample. METHODS: Microscopically confirmed lung cancer (primary site code C 34) cases were identified using SEER 18 registry (2004-2014). Early-onset cancers were defined as cancers diagnosed in persons aged 45 to 54 years. Cases were stratified by race and age groups. Comparisons were evaluated with chi-square tests. RESULTS: 468,403 lung cancers were diagnosed during this period. Nearly 9% of all lung cancers were early onset, with increased frequency in African Americans vs. Whites, 14.2 vs. 8.2%, p < 0.05. Age-adjusted incidence rates were significantly higher in African Americans with highest percent difference noted for age group 50-54. African Americans were more likely to be diagnosed at advanced stages of lung cancer compared to Whites. CONCLUSIONS: We conclude that the current age threshold for lung cancer screening may potentially miss a considerable number of lung cancer cases in African Americans. Further studies are needed to determine the appropriateness of screening age criteria for African Americans.


Asunto(s)
Negro o Afroamericano/estadística & datos numéricos , Disparidades en Atención de Salud/etnología , Neoplasias Pulmonares/etnología , Tamizaje Masivo/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Neoplasias Pulmonares/diagnóstico , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Estados Unidos/epidemiología , Población Blanca/estadística & datos numéricos
14.
J Bronchology Interv Pulmonol ; 26(1): 10-14, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-29664760

RESUMEN

BACKGROUND: Endobronchial ultrasonography has proven to be highly sensitive and specific in the diagnoses of patients with mediastinal and hilar adenopathy. Many of these patients are on a combination of clopidogrel (a compound that inhibits adenosine diphosphate-induced platelet aggregation) and aspirin due to neurological and/or cardiac-related comorbidities, and stopping anticoagulation may place these patients at high risk for potential complications. Our group has previously showed that thoracentesis with an 8-french catheter is safe in patients receiving clopidogrel and aspirin with low risk of complications. In this manuscript, we report the outcomes of the largest prospective multicenter series of patients undergoing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) while receiving clopidogrel. METHODS: Patients presenting to our institutions with mediastinal/hilar adenopathy, requiring EBUS-TBNA, and actively taking clopidogrel and aspirin were included in the study. If the medication could be held for 5 to 7 days before the procedure, the patient was excluded. EBUS-TBNA was performed by an interventional pulmonology faculty on a total of 42 patients. All patients received total intravenous anesthesia, and a total of 92 nodes were sampled. First, 3 passes were performed with a 22-G needle. If no complications were encountered, we followed with additional 3 passes with a 21 G. Rapid onsite evaluation was performed in all patients. Bleeding at the puncture site was considered significant if it required cold saline, topical sympathomimetic, or balloon tamponade for hemostasis. Bleeding was considered nonsignificant if no interventions were required to achieve hemostasis. RESULTS: We were able to perform all procedures successfully using both the 21 and 22-G needles. One patient required 30 mL cold saline installation to accomplish hemostasis with the 21 and 22-G needles. Our yield was comparable with the current literature. No statistically significant complications occurred during the procedure. All patients were contacted within 24 hours, and none reported bloody sputum. CONCLUSION: We suggest that EBUS-TBNA, using 22 and 21-G needles, is safe with high yields in patients with mediastinal/hilar adenopathy, actively taking clopidogrel and aspirin, and are at high risk for thrombotic complications if the medication is discontinued.


Asunto(s)
Clopidogrel/efectos adversos , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico , Neoplasias Pulmonares/diagnóstico , Pulmón/patología , Inhibidores de Agregación Plaquetaria/efectos adversos , Hemorragia Posoperatoria/inducido químicamente , Anciano , Clopidogrel/administración & dosificación , Femenino , Humanos , Neoplasias Pulmonares/patología , Masculino , Inhibidores de Agregación Plaquetaria/administración & dosificación , Estudios Prospectivos
15.
Chronic Obstr Pulm Dis ; 6(5): 384-399, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31710793

RESUMEN

BACKGROUND: Chronic obstructive pulmonary disease (COPD) remains a major cause of morbidity and mortality. Present-day diagnostic criteria are largely based solely on spirometric criteria. Accumulating evidence has identified a substantial number of individuals without spirometric evidence of COPD who suffer from respiratory symptoms and/or increased morbidity and mortality. There is a clear need for an expanded definition of COPD that is linked to physiologic, structural (computed tomography [CT]) and clinical evidence of disease. Using data from the COPD Genetic Epidemiology study (COPDGene®), we hypothesized that an integrated approach that includes environmental exposure, clinical symptoms, chest CT imaging and spirometry better defines disease and captures the likelihood of progression of respiratory obstruction and mortality. METHODS: Four key disease characteristics - environmental exposure (cigarette smoking), clinical symptoms (dyspnea and/or chronic bronchitis), chest CT imaging abnormalities (emphysema, gas trapping and/or airway wall thickening), and abnormal spirometry - were evaluated in a group of 8784 current and former smokers who were participants in COPDGene® Phase 1. Using these 4 disease characteristics, 8 categories of participants were identified and evaluated for odds of spirometric disease progression (FEV1 > 350 ml loss over 5 years), and the hazard ratio for all-cause mortality was examined. RESULTS: Using smokers without symptoms, CT imaging abnormalities or airflow obstruction as the reference population, individuals were classified as Possible COPD, Probable COPD and Definite COPD. Current Global initiative for obstructive Lung Disease (GOLD) criteria would diagnose 4062 (46%) of the 8784 study participants with COPD. The proposed COPDGene® 2019 diagnostic criteria would add an additional 3144 participants. Under the new criteria, 82% of the 8784 study participants would be diagnosed with Possible, Probable or Definite COPD. These COPD groups showed increased risk of disease progression and mortality. Mortality increased in patients as the number of their COPD characteristics increased, with a maximum hazard ratio for all cause-mortality of 5.18 (95% confidence interval [CI]: 4.15-6.48) in those with all 4 disease characteristics. CONCLUSIONS: A substantial portion of smokers with respiratory symptoms and imaging abnormalities do not manifest spirometric obstruction as defined by population normals. These individuals are at significant risk of death and spirometric disease progression. We propose to redefine the diagnosis of COPD through an integrated approach using environmental exposure, clinical symptoms, CT imaging and spirometric criteria. These expanded criteria offer the potential to stimulate both current and future interventions that could slow or halt disease progression in patients before disability or irreversible lung structural changes develop.

16.
Chest ; 153(6): 1326-1335, 2018 06.
Artículo en Inglés | MEDLINE | ID: mdl-29452098

RESUMEN

BACKGROUND: Lung cancer is a leading cause of death and hospitalization for patients with COPD. A detailed understanding of which clinical features of COPD increase risk is needed. METHODS: We performed a nested case-control study of Genetic Epidemiology of COPD (COPDGene) Study subjects with and without lung cancer, age 45 to 80 years, who smoked at least 10-pack years to identify clinical and imaging features of smokers, with and without COPD, that are associated with an increased risk of lung cancer. The baseline evaluation included spirometry, high-resolution chest CT scanning, and respiratory questionnaires. New lung cancer diagnoses were identified over 8 years of longitudinal follow-up. Cases of lung cancer were matched 1:4 with control subjects for age, race, sex, and smoking history. Multiple logistic regression analyses were used to determine features predictive of lung cancer. RESULTS: Features associated with a future risk of lung cancer included decreased FEV1/FVC (OR, 1.28 per 10% decrease [95% CI, 1.12-1.46]), visual severity of emphysema (OR, 2.31, none-trace vs mild-advanced [95% CI, 1.41-3.86]), and respiratory exacerbations prior to study entry (OR, 1.39 per increased events [0, 1, and ≥ 2] [95% CI, 1.04-1.85]). Respiratory exacerbations were also associated with small-cell lung cancer histology (OR, 3.57 [95% CI, 1.47-10]). CONCLUSIONS: The degree of COPD severity, including airflow obstruction, visual emphysema, and respiratory exacerbations, was independently predictive of lung cancer. These risk factors should be further studied as inclusion and exclusion criteria for the survival benefit of lung cancer screening. Studies are needed to determine if reduction in respiratory exacerbations among smokers can reduce the risk of lung cancer.


Asunto(s)
Detección Precoz del Cáncer/métodos , Neoplasias Pulmonares/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Volumen Espiratorio Forzado , Humanos , Incidencia , Pulmón , Neoplasias Pulmonares/epidemiología , Neoplasias Pulmonares/etiología , Masculino , Persona de Mediana Edad , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Factores de Riesgo , Espirometría , Tasa de Supervivencia/tendencias , Factores de Tiempo , Tomografía Computarizada por Rayos X , Estados Unidos/epidemiología , Capacidad Vital
17.
Contemp Clin Trials ; 71: 88-95, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-29885373

RESUMEN

BACKGROUND: Pulmonary nodules are a common but difficult issue for physicians as most identified on imaging are benign but those identified early that are cancerous are potentially curable. Multiple diagnostic options are available, ranging from radiographic surveillance, minimally invasive biopsy (bronchoscopy or transthoracic biopsy) to more invasive surgical biopsy/resection. Each technique has differences in diagnostic yield and complication rates with no established gold standard. Currently, the safest approach is bronchoscopic but it is limited by variable diagnostic yields. Percutaneous approaches are limited by nodule location and complications. With the recent advent of electromagnetic navigation (EMN), a combined bronchoscopic and transthoracic approach is now feasible in a single, staged procedure. Here, we present the study design and rationale for a single-arm trial evaluating a staged approach for the diagnosis of pulmonary nodules. METHODS: Participants with 1-3 cm, intermediate to high-risk pulmonary nodules will undergo a staged approach with endobronchial ultrasound (EBUS) followed by EMN-bronchoscopy (ENB), then EMN-transthoracic biopsy (EMN-TTNA) with the procedure terminated at any stage after a diagnosis is made via rapid onsite cytopathology. We aim to recruit 150 EMN participants from eight academic and community settings to show significant improvements over other historic bronchoscopic guided techniques. The primary outcome is overall diagnostic yield of the staged approach. CONCLUSION: This is the first study designed to evaluate the diagnostic yield of a staged procedure using EBUS, ENB and EMN-TTNA for the diagnosis of pulmonary nodules. If effective, the staged procedure will increase minimally invasive procedural diagnostic yield for pulmonary nodules.


Asunto(s)
Broncoscopía , Biopsia Guiada por Imagen , Neoplasias Pulmonares/diagnóstico , Pulmón , Nódulo Pulmonar Solitario/patología , Adulto , Biopsia con Aguja/efectos adversos , Biopsia con Aguja/métodos , Broncoscopía/instrumentación , Broncoscopía/métodos , Detección Precoz del Cáncer/métodos , Fenómenos Electromagnéticos , Femenino , Humanos , Biopsia Guiada por Imagen/efectos adversos , Biopsia Guiada por Imagen/instrumentación , Biopsia Guiada por Imagen/métodos , Pulmón/diagnóstico por imagen , Pulmón/patología , Masculino , Estadificación de Neoplasias , Evaluación de Procesos y Resultados en Atención de Salud , Estudios Prospectivos , Proyectos de Investigación
18.
Clin Chest Med ; 27(3): 431-9, vi, 2006 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-16880053

RESUMEN

African Americans with lung cancer have disproportionately worse outcomes than other ethnic groups. The incidence of lung cancer in blacks has remained well above the rates seen for the general population and the 5-year and overall survival rates for blacks with lung cancer are among the lowest of all racial groups. Many studies have focused on socioeconomic status of African Americans as the sole cause of these disparities. Other stu-dies, however, have identified additional factors related to risks for poor outcomes in blacks with lung cancer. This article reviews data on these risks and their relationships to the health and health care of African Americans with lung cancer.


Asunto(s)
Negro o Afroamericano , Accesibilidad a los Servicios de Salud/tendencias , Estado de Salud , Neoplasias Pulmonares/epidemiología , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/terapia , Ocupaciones , Aceptación de la Atención de Salud , Factores de Riesgo , Fumar/efectos adversos , Factores Socioeconómicos , Estados Unidos/epidemiología
19.
J Natl Med Assoc ; 97(11): 1550-2, 2005 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-16334504

RESUMEN

Leukemic pulmonary infiltration, as an initial presentation of acute leukemia, is rare and poses a therapeutic dilemma. Leukemic infiltrate of the lung may be unrecognized, as patients can present with cough, fever and localized roentgenographic infiltrate, all suggestive of bacterial pneumonia. Acute promyelocytic leukemia (APL) is a subtype of acute myeloid leukemia (AML) with distinct clinicopathologic features, such as: younger age of patients, shorter duration of symptoms before diagnosis, pulmonary infiltration with atypical promyelocytes and bleeding tendency due to disseminated intravascular coagulation (DIC). APL can become rapidly fatal if not treated early in its course. We report a case of APL with diffuse pulmonary infiltration and abnormal complete blood count. He was initially diagnosed and treated as an outpatient for community-acquired pneumonia. The patient returned with worsening pulmonary infiltrate, abnormal peripheral smear and respiratory failure, resulting in death within three months of his initial presentation. As evidenced by this case, acute leukemia should be considered in the differential diagnosis for pulmonary infiltrate and abnormal hematological findings.


Asunto(s)
Anemia/etiología , Hemoptisis/etiología , Leucemia Promielocítica Aguda/complicaciones , Leucemia Promielocítica Aguda/diagnóstico , Insuficiencia Respiratoria/etiología , Adulto , Errores Diagnósticos , Resultado Fatal , Humanos , Leucemia Promielocítica Aguda/sangre , Masculino , Neumonía/diagnóstico
20.
Am J Med Sci ; 324(5): 285-7, 2002 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-12449452

RESUMEN

Chronic bibasilar alveolar infiltrates existed for more than 2 years in a 25-year-old woman infected with HIV for more than a decade. Bronchoscopically, there were copious, purulent secretions that grew methicillin-resistant Staphylococcus aureus (MRSA). Transbronchial biopsy specimens demonstrated plasma cell interstitial pneumonia (PCIP). Focal, transient radiographic improvement occurred after antistaphylococcal antimicrobial therapy. With recurrent and progressive symptoms, sustained clinical and radiographic improvement did not occur until corticosteroid therapy was instituted with tuberculosis chemoprophylaxis. Persistent antigenic stimulation in immunosuppressed patients causes PCIP. In this instance, the stimulus is MRSA. The previous model and support for this theory is Pneumocystis carinii. There is good experimental reason for a plasma cell response in persons infected with HIV. To our knowledge, this is the first case of chronic plasma cell interstitial pneumonia caused by indolent MRSA infection.


Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones por VIH/complicaciones , Enfermedades Pulmonares Intersticiales/diagnóstico , Células Plasmáticas , Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Corticoesteroides/uso terapéutico , Adulto , Antibacterianos/uso terapéutico , Terapia Antirretroviral Altamente Activa , Enfermedad Crónica , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Isoniazida/uso terapéutico , Enfermedades Pulmonares Intersticiales/complicaciones , Enfermedades Pulmonares Intersticiales/tratamiento farmacológico , Enfermedades Pulmonares Intersticiales/patología , Resistencia a la Meticilina , Células Plasmáticas/patología , Neumonía Estafilocócica/diagnóstico , Neumonía Estafilocócica/tratamiento farmacológico , Neumonía Estafilocócica/microbiología , Resultado del Tratamiento
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