Proportion and predictors of FVC decline in patients with interstitial lung disease.

RATIONALE: The proportion of patients who develop progressive pulmonary fibrosis (PPF), along with risk factors for progression remain poorly understood. OBJECTIVES: To examine factors associated with an increased risk of developing PPF among patients at a referral center. METHODS: We identified patients with a diagnosis of interstitial lung disease (ILD) seen within the Cleveland Clinic Health System. Utilizing a retrospective observational approach we estimated the risk of developing progression by diagnosis group and identified key clinical predictors using the FVC component of both the original progressive fibrotic interstitial lung disease (PFILD) and the proposed PPF (ATS) criteria. RESULTS: We identified 5934 patients with a diagnosis of ILD. The cumulative incidence of progression over the 24 months was similar when assessed with the PFILD and PPF criteria (33.1 % and 37.9 % respectively). Of those who met the ATS criteria, 9.5 % did not meet the PFILD criteria. Conversely, 4.3 % of patients who met PFILD thresholds did not achieve the 5 % absolute FVC decline criteria. Significant differences in the rate of progression were seen based on underlying diagnosis. Steroid therapy (HR 1.46, CI 1.31-1.62) was associated with an increased risk of progressive fibrosis by both PFILD and PPF criteria. CONCLUSION: Regardless of the definition used, the cumulative incidence of progressive disease is high in patients with ILD in the 24 months following diagnosis. Some differences are seen in the risk of progression when assessed by PFILD and PPF criteria. Further work is needed to identify modifiable risk factors for the development of progressive fibrosis.

Mapping Mobility: Utilizing Local-Knowledge-Derived Activity Space to Estimate Exposure to Ambient Air Pollution among Individuals Experiencing Unsheltered Homelessness.

Individuals experiencing homelessness represent a growing population in the United States. Air pollution exposure among individuals experiencing homelessness has not been quantified. Utilizing local knowledge mapping, we generated activity spaces for 62 individuals experiencing homelessness residing in a semi-rural county within the United States. Satellite derived measurements of fine particulate matter (PM2.5) were utilized to estimate annual exposure to air pollution experienced by our participants, as well as differences in the variation in estimated PM2.5 at the local scale compared with stationary monitor data and point location estimates for the same period. Spatial variation in exposure to PM2.5 was detected between participants at both the point and activity space level. Among all participants, annual median PM2.5 exposure was 16.22 µg/m3, exceeding the National Air Quality Standard. Local knowledge mapping represents a novel mechanism to capture mobility patterns and investigate exposure to air pollution within vulnerable populations. Reliance on stationary monitor data to estimate air pollution exposure may lead to exposure misclassification, particularly in rural and semirural regions where monitoring is limited.

Electronic Cigarettes and Alternative Methods of Vaping.

Vaping, the inhalation of heated aerosols, received widespread attention during the outbreak of electronic-cigarette (e-cigarette) or vaping-associated acute lung injury cases in 2019. E-cigarette use is now widely recognized as a potential cause of acute lung injury. Vaping is often perceived by physicians as referring exclusively to the use of e-cigarette devices. However, inhalation of nicotine or tetrahydrocannabinol-containing aerosol through alternate methods such as "dabbing" and "dripping" are increasingly common. However, the health impact of these alternate methods remains poorly understood. The use of alternate methods and devices may go unrecognized because of lack of clinician familiarity with them. In this review, we discuss e-cigarettes devices, electronic-liquid components, the expanded spectrum of methods used to consume aerosolized substances, and the potential for lung injury.

Chronic Beryllium Disease: Update on a Moving Target.

Beryllium exposure remains an ongoing occupational health concern for workers worldwide. Since the initial Occupational Safety and Health Administration (OSHA) ruling on a permissible exposure limit (PEL) for beryllium in 1971, our understanding of the risks of beryllium sensitization and chronic beryllium disease (CBD) has evolved substantially. A new OSHA ruling released in early 2017 and implemented in late 2018 reduced the PEL for beryllium, increased requirements for medical screening and monitoring, and may ultimately enhance worker protection. This review highlights advances in our understanding of the pathway from beryllium exposure to sensitization and progression to CBD that guided the development of this OSHA ruling. Screening workers exposed to beryllium and management of CBD will also be discussed. Finally, we will discuss the role of beryllium as a cause of morbidity and mortality among exposed workers in this potentially preventable occupational lung disease.

Radiologic Review With Pathology Correlation of E-Cigarette or Vaping Product Use-associated Lung Injury.

More than 2000 cases of vaping-associated lung injury have been reported in a recent outbreak, including >40 deaths. Although chest imaging is integral in the evaluation of these patients and is often abnormal, the spectrum of findings and the role of imaging in the diagnosis are not widely appreciated. The aim of this review is to highlight the imaging findings of vaping-associated lung injury. Basilar-predominant ground-glass opacities and/or consolidations, often with areas of subpleural or lobular sparing, are the most common pattern, and many other patterns are known to occur. Radiologists are encouraged to become familiar with the different imaging patterns of vaping-associated lung injury. The diagnosis should be considered in patients who have vaped within 90 days of onset of symptoms and present with bilateral lung opacities.