Vaping-Associated Acute Respiratory Failure Due to Acute Lipoid Pneumonia Abstract Electronic cigarettes, pens, cartridges and other devices were developed as nicotine delivery systems not requiring combustion of tobacco leaves. This technology was subsequently employed to deliver the cannabis component tetrahydrocannabinol (THC) via products often manufactured without adequate quality oversight and sold illegally. Recently, five patients presenting within a 2-month period with acute respiratory failure due to acute lipoid pneumonia after inhaling THC-containing concentrates or oils have been described. We report a 28-year-old previously healthy man who presented in acute respiratory failure 2 weeks after initiating use of a street-purchased THC-containing vape cartridge. Bronchoalveolar lavage cytology with oil red O staining confirmed the diagnosis of acute lipoid pneumonia. Diffuse alveolar hemorrhage and eosinophilic pneumonia were excluded. Evolving evidence supports a clinical entity of acute respiratory failure due to acute, exogenous lipoid pneumonia induced by THC-containing concentrates or oils inhaled through a variety of vaping products. All six patients reported to date received intravenous corticosteroids and survived to hospital discharge.

Clinical Characteristics and Natural History of Autoimmune Forms of Interstitial Lung Disease: A Single-Center Experience Abstract Objective To describe the phenotypic characteristics and natural history of patients with autoimmune forms of interstitial lung disease (ILD). Methods Retrospective, descriptive, single-center study of patients with autoimmune forms of ILD evaluated between February 2008 and August 2014. All data were extracted from the electronic medical record. Longitudinal changes in forced vital capacity (FVC%) and diffusion capacity for carbon monoxide (DLco%) in percent predicted were analyzed and time-to-event analyses for death were performed using Cox regression. Results Of the entire cohort (n = 243), systemic sclerosis (SSc)-associated ILD (n = 88, 36%), interstitial pneumonia with autoimmune features (IPAF, n = 56, 23%), rheumatoid arthritis (RA)-associated ILD (n = 42, 17%), and idiopathic inflammatory myopathy (IIM)-associated ILD (n = 26, 11%) were the most common phenotypes. The SSc-ILD, IIM-ILD, and IPAF groups had similar features: average age in the mid-50s, strongly female predominant and more likely to have nonspecific interstitial pneumonia (NSIP). In contrast, RA-ILD patients were older, gender balanced, more likely to be past smokers and were UIP predominant. Adjusted longitudinal lung function was stable during a median follow-up period of nearly 4 years and the independent predictors for death were older age (p = 0.003), male sex (p = 0.019), and lower FVC (p =  < 0.001). Conclusions The predominant phenotypes of autoimmune ILD were SSc-ILD, IPAF, RA-ILD, and IIM-ILD. In contrast to the other subsets, those with RA-ILD may be older, gender balanced, with more smoking history, and higher proportion of UIP. Longitudinal lung function was stable among the groups and younger age, female gender, and better lung function were associated with improved survival.

Bosentan or Macitentan Therapy in Chronic Thromboembolic Pulmonary Hypertension? Abstract Objective Research comparing bosentan and macitentan in chronic thromboembolic pulmonary hypertension (CTEPH) is scarce, although macitentan might have superior pharmacologic properties. We present the first real-world, 2-year follow-up results and compare clinical outcomes of both drugs in CTEPH. Methods All consecutive, technical inoperable or residual CTEPH patients receiving bosentan or macitentan, diagnosed in our multidisciplinary team between January 2003 and January 2019, were included. We report and compare survival, clinical worsening (CW), adverse events, WHO FC, NT-proBNP and 6-min walking test (6MWT) until 2 years after medication initiation. Results In total, 112 patients receiving bosentan or macitentan (58% female, mean age 62 ± 14 years, 68% WHO FC III/IV, 51% bosentan) could be included. Mean treatment duration was 1.9 ± 0.4 years for bosentan and 1.2 ± 0.6 years for macitentan. Two-year survival rate was 91% for bosentan and 80% for macitentan (HR mortality macitentan 1.85 [0.56–6.10], p = 0.31). Two-year CW-free survival was 81% and 58%, respectively (HR CW macitentan 2.16 [0.962–4.87], p = 0.06). Right atrial pressure, cardiac output (for mortality alone) and 6MWT lowest saturation were multivariate predictors at baseline. Overall adverse event rates were comparable and WHO FC, NT-proBNP and 6MWT distance improved similar for both drugs till 2-year follow-up. Conclusion CTEPH patients receiving bosentan or macitentan have improved clinical outcomes till 2-year follow-up, without significant differences in outcomes between both therapies.

Lack of an Association Between Household Air Pollution Exposure and Previous Pulmonary Tuberculosis Abstract Context Observational studies investigating household air pollution (HAP) exposure to biomass fuel smoke as a risk factor for pulmonary tuberculosis have reported inconsistent results. Objective To evaluate the association between HAP exposure and the prevalence of self-reported previous pulmonary tuberculosis. Design We analyzed pooled data including 12,592 individuals from five population-based studies conducted in Latin America, East Africa, and Southeast Asia from 2010 to 2015. We used multivariable logistic regression to model the association between HAP exposure and self-reported previous pulmonary tuberculosis adjusted for age, sex, tobacco smoking, body mass index, secondary education, site and country of residence. Results Mean age was 54.6 years (range of mean age across settings 43.8–59.6 years) and 48.6% were women (range of % women 38.3–54.5%). The proportion of participants reporting HAP exposure was 38.8% (range in % HAP exposure 0.48–99.4%). Prevalence of previous pulmonary tuberculosis was 2.7% (range of prevalence 0.6–6.9%). While participants with previous pulmonary tuberculosis had a lower pre-bronchodilator FEV1 (mean − 0.7 SDs, 95% CI − 0.92 to − 0.57), FVC (− 0.52 SDs, 95% CI − 0.69 to − 0.33) and FEV1/FVC (− 0.59 SDs, 95% CI − 0.76 to − 0.43) as compared to those who did not, we did not find an association between HAP exposure and previous pulmonary tuberculosis (adjusted odds ratio = 0.86; 95% CI 0.56–1.32). Conclusions There was no association between HAP exposure and self-reported previous pulmonary tuberculosis in five population-based studies conducted worldwide.

Correction to: Community Low-Dose CT Lung Cancer Screening: A Prospective Cohort Study The original version of this article contained an error in the usage of the term “false positive rate”. The intention of the authors in those instances was simply to compare the absolute percentage of false positive results in the study vs the NLST, not to make any observations about false positive rate in the strict statistical sense (i.e. Type I error probability).

A Prognostic Score for Brain Metastases of Non-small-cell Lung Cancer in the Era of Precision Medicine

Mucocele Presenting as Polypoid Bronchoscopic Lesion with Post-Obstructive Pneumonia

Significant Differences in Body Plethysmography Measurements Between Hospitals in Patients Referred for Bronchoscopic Lung Volume Reduction Abstract During the evaluation of potential bronchoscopic lung volume reduction (BLVR) candidates in our hospital, we frequently observe patients with a lower residual volume (RV) value compared to the value measured in their referring hospital, although both measured by body plethysmography. We explored to what degree RV and other pulmonary function measurements match between referring hospitals and our hospital. We retrospectively analyzed a total of 300 patients with severe emphysema [38% male, median age 62 years (range 38–81), median forced expiratory volume in 1 s 29% (range 14–65) of predicted, and a median of 40 packyears (range 2–125)]. We measured a median RV of 4.47 l (range 1.70–7.57), which was a median 310 ml lower than in the referring hospitals (range − 3.04 to + 1.94), P < 0.001). In conclusion, this retrospective analysis demonstrated differences in RV measurements between different hospitals in patients with severe emphysema. Overestimation of RV can lead to unnecessary referrals for BLVR and potential treatment failures. To avoid disappointment and unnecessary hospital visits, it is important that body plethysmography measurements are accurately performed by applying preferably the unlinked method in these patients.

Hospital Attendances and Acute Admissions Preceding a Diagnosis of Occupational Asthma Abstract Purpose Occupational exposures are a common cause of adult-onset asthma; rapid removal from exposure to the causative agent offers the best chance of a good outcome. Despite this, occupational asthma (OA) is widely underdiagnosed. We aimed to see whether chances of diagnosis were missed during acute hospital attendances in the period between symptom onset and the diagnosis of OA. Methods Patients diagnosed with OA at the regional occupational lung disease service in Birmingham between 2007 and 2018 whose home address had a Birmingham postcode were included. Emergency department (ED) attendances and acute admission data were retrieved from acute hospitals in the Birmingham conurbation for the period between symptom onset and diagnosis. Results OA was diagnosed in 406 patients, 147 having a Birmingham postcode. Thirty-four percent (50/147) had acute hospital attendances to a Birmingham conurbation hospital preceding their diagnosis of OA, including 35 (24%) with respiratory illnesses, which resulted in referral for investigation of possible OA in 2/35. The median delay between symptom onset and diagnosis of OA was 30 months (IQR = 13–60) and between first hospital attendance with respiratory illness and diagnosis 12 months (IQR = 12–48, range 3–96 months) Conclusions The chance to reduce the delay in the diagnosis of OA was missed in 33/35 patients admitted or seen in ED with respiratory symptoms in the period between symptom onset and diagnosis of OA. The diagnosis of OA was delayed by a median of 12 months by failure to ask about employment and work relationship of symptoms.

Prevention and Amelioration of Rodent Ventilation-Induced Lung Injury with Either Prophylactic or Therapeutic feG Administration Abstract Purpose Mechanical ventilation is a well-established therapy for patients with acute respiratory failure. However, up to 35% of mortality in acute respiratory distress syndrome may be attributed to ventilation-induced lung injury (VILI). We previously demonstrated the efficacy of the synthetic tripeptide feG for preventing and ameliorating acute pancreatitis-associated lung injury. However, as the mechanisms of induction of injury during mechanical ventilation may differ, we aimed to investigate the effect of feG in a rodent model of VILI, with or without secondary challenge, as a preventative treatment when administered before injury (prophylactic), or as a therapeutic treatment administered following initiation of injury (therapeutic). Methods Lung injury was assessed following prophylactic or therapeutic intratracheal feG administration in a rodent model of ventilation-induced lung injury, with or without secondary intratracheal lipopolysaccharide challenge. Results Prophylactic feG administration resulted in significant improvements in arterial blood oxygenation and respiratory mechanics, and decreased lung oedema, bronchoalveolar lavage protein concentration, histological tissue injury scores, blood vessel activation, bronchoalveolar lavage cell infiltration and lung myeloperoxidase activity in VILI, both with and without lipopolysaccharide. Therapeutic feG administration similarly ameliorated the severity of tissue damage and encouraged the resolution of injury. feG associated decreases in endothelial adhesion molecules may indicate a mechanism for these effects. Conclusions This study supports the potential for feG as a pharmacological agent in the prevention or treatment of lung injury associated with mechanical ventilation.