American College of Chest Physicians, Oct. 16-19

The annual meeting of the American College of Chest Physicians was held this year from Oct. 16 to 19 in Nashville, Tennessee, and attracted participants from around the world, including specialists and health care professionals focused on pulmonary, critical care, and sleep medicine. The conference featured presentations focusing on clinical updates in thoracic medicine.

As part of the phase 3 LIBERTY ASTHMA QUEST and the LIBERTY ASTHMA TRAVERSE open-label extension studies, Mario Castro, M.D., of the University of Kansas School of Medicine in Kansas City, and colleagues found that dupilumab, a fully human monoclonal antibody, provides sustained, long-term reduction in exacerbations and improved forced expiratory volume in one second (FEV₁) in patients with uncontrolled moderate-to-severe asthma.

The authors evaluated dupilumab efficacy in QUEST patients enrolled in TRAVERSE (an extension of QUEST) with blood eosinophils ≥150 cells/mL or fractional exhaled nitric oxide ≥20 parts per billion at parent study baseline and at least one, two, or three exacerbations in the year before QUEST. The unadjusted annualized severe asthma exacerbation rate and mean change from parent study baseline in FEV₁ were analyzed. The researchers found that dupilumab had sustained efficacy and safety in the TRAVERSE study in terms of reducing exacerbations, improving lung function, and increasing asthma control out to three years.

"Physicians using dupilumab now have data to discuss with their patients -- if you see a response in your patient to dupilumab, you should continue it as they will likely maintain this improvement over time," Castro said.

Several authors disclosed financial ties to pharmaceutical companies, including Sanofi and Regeneron, which manufacture dupilumab and sponsored the study.

Abstract

In another study, Kim Styrvoky, M.D., of the University of Texas Southwestern Medical Center in Dallas, and colleagues found that shape-sensing robotic-assisted bronchoscopy (ssRAB) with cone beam computed tomography imaging (CBCT) is a novel technique for the biopsy of central and peripheral pulmonary lesions that allows for combined diagnosis and mediastinal staging in a single procedure.

The authors performed a retrospective analysis of 200 procedures to sample 209 lung lesions in 198 patients using a combination of ssRAB with radial endobronchial ultrasound, CBCT, and augmented fluoroscopy. The outcomes were based on pathology, clinical/radiographic follow-up, and additional sampling, with no size or lesion characteristic limitations. The researchers found that ssRAB with CBCT for sampling of pulmonary lesions had high diagnostic accuracy, high sensitivity and specificity, a reasonably high negative predictive value for malignancy, and a favorable safety profile.

"If further studies confirm these findings, this combination of technologies has the potential to become the standard of care for targeted lung sampling," Styrvoky said. "These combined technologies can be utilized in patients with suspicious lesions concerning for malignancy in addition to nonmalignant disease such as localized or diffuse parenchymal diseases, immunocompromised or posttransplant patients who would benefit from targeted lung sampling."

Abstract

Mubarak Yusuf, M.D., of Lincoln Medical Center in Bronx, New York, and colleagues identified a possibly protective association between iron deficiency anemia and outcomes for hospital admission with bacterial pneumonia.

The authors assessed the impact of iron deficiency anemia on outcomes for bacterial pneumonia. Patient information was retrieved from a large national inpatient sample within the United States. The clinical outcomes measured included mortality, septic shock, cardiac arrest, and acute respiratory failure. The researchers identified a protective association between bacterial pneumonia and iron deficiency anemia in all of the measured outcomes.

"To the best of our knowledge, this is the first study investigating such an association. We believe further study is needed to validate our study and also answer some unanswered questions," Yusuf said. "The impact we think this can have on clinical practice is perhaps that clinicians should consider a delay in treatment of nonsymptomatic iron deficiency anemia in admission for bacterial pneumonia."

Abstract

Sashwath Srikanth, M.D., of the ECU Health Medical Center in Greenville, North Carolina, and colleagues believe that awareness of underdiagnosed obstructive sleep apnea (OSA), timely screening measures, and preventive strides may curtail health care disparities based on socioeconomic status and improve long-term cardiovascular outcomes in lower-income patients.

The authors sought to study the impact of household income on OSA hospitalizations/outcomes. A National Inpatient Sample database of hospitalized patients who were diagnosed with OSA was analyzed. The researchers found that although the prevalence of OSA was actually lower in hospitalized patients belonging to the lower-income group, they were disproportionately more likely to experience adverse outcomes when hospitalized with OSA, especially after adjusting for confounders. Specifically, compared with the higher-income group, patients belonging to the lower-income group (lowest income quartile) had 16 percent higher odds of major adverse cardiac and cerebrovascular events, 21 percent higher odds of cardiac arrest, and 24 percent higher odds of acute myocardial infarction. They also had 12 percent higher odds of all-cause mortality.

"These results added further evidence to our empirical observations regarding income disparity being a determinant of health outcomes," Srikanth said. "Solving the income inequality problem is complex. However, physicians must be cognizant of the above findings and have an open mind to address the health care disparities. As physicians, we can influence outcomes by paying more attention to OSA patients in the lower-income strata. Early diagnosis, ensuring treatment compliance and regular follow-ups can potentially lead to better outcomes in such patients."

Abstract