Chest
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Lymphangioleiomyomatosis (LAM) is a rare cystic lung disease affecting women and is characterized by the proliferation of abnormal smooth muscle-like cells within the lungs, kidneys, and lymphatic system. FEV1 and diffusing capacity of the lungs for carbon monoxide (Dlco) are 2 commonly used markers for evaluating the status of LAM, although the disease may be associated predominantly with changes in only 1 of these parameters. In this special feature, we trace the historical evolution of Dlco and FEV1 in LAM up to their current uses, beginning with their relationship in early studies with histopathologic features and imaging. ⋯ The LAM histologic score, which measures the involvement of cysts and LAM cells in the lung via biopsy, relates to disease stages and aligns more with Dlco than FEV1. The cyst score, calculated from high-resolution CT (HRCT) scans, is a measure of the lung parenchyma occupied by cysts and correlates with disease progression. Large cysts as visualized by HRCT imaging predominantly influence FEV1, whereas smaller cysts, which impact a greater surface area of the lung and may be underestimated, tend to affect Dlco.
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The advances in minimally invasive lung cancer diagnostics of the last decade have transformed patient care but have also raised important concerns about the regulatory processes used to approve new devices and the best way to generate data to support their use. Disruptive technologies, such as robotic bronchoscopy, have been widely adopted by interventional pulmonologists in the absence of robust data demonstrating improved patient outcomes. ⋯ Pragmatic clinical trials, which integrate trial procedures into routine clinical care, represent an appealing alternative approach for generating much-needed data to inform clinical care. In this article we illustrate the advantages and disadvantages of these research paradigms, using two recently completed randomized controlled trials in navigational bronchoscopy, and highlight the barriers and facilitators to using pragmatic trials to address the gap in comparative effectiveness research: these include the need for increased clarity of research regulations for pragmatic trials, adequate federal and private funding for such research, and alignment of incentives between clinicians, researchers, regulators, and industry.
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The incidence of pulmonary nodules and masses in non-HIV immunocompromised patients has significantly increased due to advancements in hematopoietic stem cell transplantation (HSCT) and solid organ transplantation (SOT) and the widespread use of chemotherapy and immunosuppressive therapies. Differentiating between infectious and noninfectious causes is critical for appropriate diagnosis and management, especially because radiologic and clinical presentations can be nonspecific. ⋯ Pulmonary nodules and masses in immunocompromised patients represent a diagnostic challenge due to overlapping radiologic and clinical presentations. By integrating clinical context, immune status, and imaging findings, clinicians can more accurately diagnose and manage these lesions, improving patient outcomes. This review presents an algorithmic approach for differentiating between various causes of pulmonary nodules and masses in non-HIV immunocompromised individuals, providing a valuable tool for clinical practice.
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Trastuzumab emtansine has been recently suspected to be associated with the development of pulmonary arterial hypertension (PAH). ⋯ Our results suggest that more patients exposed to trastuzumab emtansine developed PH compared with trastuzumab alone. Further assessment of this safety signal and exploration of pathophysiological mechanisms is needed.
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We previously identified a panel of sputum DNA methylation that predicts lung aging and risk for lung cancer. ⋯ We defined a novel dietary pattern for lung epigenetic aging, which linked to lung health measurements. Former smokers, especially those with airway obstruction, may benefit the most from nutritional modification.