American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Apr 2020
Is Computed Tomography Airway Count Related to Asthma Severity and Airway Structure-function?
Rationale: In patients with asthma, X-ray computed tomography (CT) has provided evidence of thickened airway walls and airway occlusions, but the total number of CT-visible airways and its relationship with disease severity is unknown. Objectives: To measure CT total airway count (TAC) in asthma and evaluate relationships with asthma severity, airway morphology, pulmonary function, and magnetic resonance imaging (MRI) ventilation. Methods: Participants underwent post-bronchodilator inspiratory CT, and prebronchodilator and post-bronchodilator spirometry and hyperpolarized 3He MRI. ⋯ Conclusions: TAC was significantly diminished in participants with greater asthma severity and was related to airway wall thickness and ventilation defects. Fewer airways in severe than in mild asthma challenges our understanding of airway disease in asthma. Clinical trial registered with www.clinicaltrials.gov (NCT02351141).
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Am. J. Respir. Crit. Care Med. · Apr 2020
Quantitative Interferon Gamma Release Assay and Tuberculin Skin Test Results to Predict Incident Tuberculosis: A Prospective Cohort Study.
Rationale: Development of diagnostic tools with improved predictive value for tuberculosis (TB) is a global research priority. Objectives: We evaluated whether implementing higher diagnostic thresholds than currently recommended for QuantiFERON Gold-in-Tube (QFT-GIT), T-SPOT. TB, and the tuberculin skin test (TST) might improve prediction of incident TB. ⋯ Conclusions: Implementation of higher thresholds for QFT-GIT, T-SPOT. TB, and TST modestly increases positive predictive value for incident TB, but markedly reduces sensitivity. Novel biomarkers or validated multivariable risk algorithms are required to improve prediction of incident TB.
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Am. J. Respir. Crit. Care Med. · Apr 2020
Income and Other Contributors to Poor Outcomes in US Sarcoidosis Patients.
Rationale: Socioeconomic factors are associated with worse disease severity at presentation in sarcoidosis, but the relative importance of socioeconomic variables on morbidity and disease burden has not been fully elucidated. Objectives: To determine the association between income and sarcoidosis outcomes after controlling for socioeconomic and disease-related factors. Methods: Using the Sarcoidosis Advanced Registry for Cures database, we analyzed data from 2,318 patients with sarcoidosis in the United States to determine the effect of income and other variables on outcomes. ⋯ Development of comorbidities after diagnosis of sarcoidosis occurred in 63% of patients and were strong independent predictors of poor outcomes. In random forest modeling, income was consistently a leading predictor of outcome. Conclusions: These results suggest the burden from sarcoidosis preferentially impacts the economically disadvantaged.