American College of Chest Physicians, Oct. 18-21
The annual meeting of the American College of Chest Physicians was held virtually this year from Oct. 18 to 21 and attracted participants from around the world, including specialists and health care professionals in the fields of pulmonology, critical care, and sleep medicine. The conference featured presentations focusing on clinical updates in thoracic medicine.
In one study, Sung Choi, M.D., of the Rutgers New Jersey Medical School in Newark, and colleagues found that lung transplantation recipients' smoking history impacts posttransplantation mortality rates in a dose-dependent manner.
Using the United Network for Organ Sharing Standard Transplant Analysis and Research database, the authors identified individuals older than 18 years of age who received either a single or double lung transplant between 1987 and 2017. The recipients were categorized by smoking history (no smoking history, less than 10 pack-years, 10 to 20 pack-years, and greater than 20 pack-years), and adjustments were made for various recipient and donor variables. The researchers found that recipients with a longer/more smoking history fared worse one year after transplantation compared with those with a shorter/less smoking history. In addition, recipients who were reported to have had 10 to 20 pack-years of smoking history had a 25 percent increase in the one-year posttransplantation mortality rate compared with those with no smoking history. Meanwhile, the recipients with 20 pack-years of smoking history had a 70 percent increase in the posttransplantation mortality rate compared with those with no smoking history.
"Interestingly, there was no statistically significant difference between patients with less than 10 pack-years of smoking history compared to those with no smoking history," Choi said. "Current guidelines for lung transplantation (International Society for Heart and Lung Transplantation) suggest active tobacco smoking history as an absolute contraindication, but it does not make further recommendations regarding patients' overall smoking history. As a clinician, one should consider patients' extensive smoking history when evaluating for potential lung transplantation."
In a subgroup analysis of the Efficacy and Safety of Nintedanib in Patients With Progressive Fibrosing Interstitial Lung Disease (INBUILD) study, Shane Shapera, M.D., of the Toronto General Hospital Research Institute, and colleagues found that a subset of individuals with progressive fibrosing interstitial lung disease (PF-ILD) in the United States and Canada enrolled in INBUILD had similar outcomes to the overall population enrolled in INBUILD in other parts of the world.
In this subset analysis, the authors evaluated the rate of decline in forced vital capacity and adverse events during 52 weeks in individuals with PF-ILD from the United States and Canada and compared the findings to those for participants in other parts of the world. The researchers found that nintedanib slowed the rate of forced vital capacity decline in individuals with PF-ILD in the United States and Canada enrolled in INBUILD similarly to the overall population enrolled in INBUILD in other parts of the world.
"The side effect profile of nintedanib, which is predominantly gastrointestinal effects, was similar across regions and was similar to the side effect profile seen in patients who use this drug to treat their idiopathic pulmonary fibrosis," Shapera said. "The subgroup analysis presented here provides further evidence that nintedanib has a beneficial effect in this large group of patients in the United States and Canada and puts to bed any concerns that people might have had that the findings would not apply to patients from the United States and Canada due to potential differences in genetic factors in different regions, difference in the rigor with which the differentiation between other PF-ILD and idiopathic pulmonary fibrosis might be pursued, or differences in other variables that might not be accounted for in the randomization of the study."
Multiple authors disclosed financial ties to the pharmaceutical and medical device industries.
In a single-center, retrospective chart review, Jurgena Tusha, M.D., of the Wayne State University School of Medicine in Detroit, and colleagues found that the MuLBSTA score, which includes six clinical characteristics and was designed to predict 90-day mortality in viral pneumonia patients, was effective in predicting COVID-19 disease severity and mortality risk.
The authors reviewed several clinical characteristics of 163 hospitalized patients with COVID-19 pneumonia at a community hospital in Michigan between March 15 and April 10, 2020. The researchers found that the MuLBSTA score was able to risk-stratify hospitalized patients based on severity and accurately predict overall outcome, mortality, length of stay, and need for ventilator support.
"The higher the MuLBSTA score, the higher the mortality rate. This score is a good predictor of in-hospital mortality. There was also a positive correlation with need for ventilator support and length of stay," Tusha said. "The MuLBSTA can be used at time of admission to screen patients for severity and identify patients who may have complications or higher chance of mortality."