New research was presented at ATS 2021, the virtual American Thoracic Society International Conference, from May 14-19. The features below highlight some of the studies presented via the online conference that focus on respiratory disease.

E-Cigarettes Increase Risk of Wheeze & Shortness of Breath

Although data indicate that e-cigarettes are the most commonly used tobacco product among adolescents and young adults (AYAs), frequent co-use with combustible cigarettes and cannabis products causes difficulty in disentangling associated risk of asthma and related respiratory symptoms. To examine associations between e-cigarette, cigarette, and cannabis use with self-reported asthma diagnosis, shortness of breath (SOB), and wheeze, researchers conducted a web-based survey in August 2020 of a sample of United States AYAs with a mean age of 18.9. Among past 30-day current e-cigarette users, 15% and 37% reported current cigarette and cannabis use, respectively. Past 3-day e-cigarette use was associated with increased odds of self-reported asthma (odds ratio [OR], 1.4), wheeze (OR, 3.1), and SOB (OR, 2.9) after controlling for age, sex at birth, and race/ethnicity, when compared with never e-cigarette use. Although past 30-day e-cigarette use was no longer associated with asthma (OR, 1.11) after controlling for past 30-day cigarette and cannabis use, associations remained with increased wheeze (OR, 2.3) and SOB (OR, 2.1)


Cardiac & Other Impacts of Gender-Specific Differences in COPD
Prior research suggest gender-specific differences in symptom levels and comorbidity prevalence among patients with COPD. Investigators conducted an analysis to determine whether the relationship between these characteristics is dependent on gender and whether they hold different diagnostic values for cardiac comorbidities. Significantly different values were observed between men and women for most functional parameters of COPD and comorbidities, as well as COPD Assessment Test (CAT) items 1 (cough), 2 (phlegm), and 5 (activities). The relationship between functional parameters and comorbidities versus symptoms showed gender-specific differences, especially for single CAT items. Logistic regression showed that, in men, CAT item 8 (energy), modified Medical Research Council dyspnea scale value, smoking status, BMI, age, and spirometric lung function were related with cardiac disease (myocardial infarction, heart failure, or coronary artery disease), whereas only age was predictive of cardiac disease in women.



Aerobic Exercise Improves Cardiorespiratory Fitness in Patients With SLE
Evidence shows that physical exercise can significantly improve exercise tolerance and quality of life in patients with systemic lupus erythematosus (SLE); however its impact on cardiorespiratory fitness in this patient population is less clear. To shed light in this area, researchers conducted a systematic review and meta-analysis of 11 randomized controlled trials, comparing patients with SLE who did and did not exercise. When compared with no exercise, exercise was associated with a higher peaked oxygen consumption (mean difference [MD], 3.4) and with significant decrease in fatigue severity scale measures (MD, -0.10). Participants who exercised also had significantly higher values of heart rate recovery at 1 minute (MD, 14.69). “Despite the cardiovascular and psychosocial benefits conferred by physical activity, SLE patients do not exercise adequately in general,” wrote the study authors. “This is attributed in part to their associated fatigue and limitations in aerobic capacity. Treatments that improve aerobic fitness should be considered in the management plan of these patients.”



Case-By-Case Approach to Pulmonary Lesion Assessment Likely Best

While navigational bronchoscopy (NB) and convex-probe endobronchial ultrasound transbronchial needle aspiration (CP-EBUS-TBNA) are commonly performed in a single setting to evaluate suspicious pulmonary lesions, evidence suggests wide variation in which is performed first, with benefits for choosing each first. For a study, researchers identified procedures that included both NB and CP-EBUS-TBNA sampling, all of which had an NB first strategy. To determine incidence of NB first strategy failure, they assessed the percentage of malignant diagnoses that could have been secured by performing CP-EBUS-TBNA first, therefore making the NB component obsolete. Among 50 lesion assessments, a malignant diagnosis was obtained via NB-acquired samples in 30, among which seven (23%) were able to be obtained via CP-EBUS-TBNA and the NB component could have been avoided, potentially saving time and associated costs. “Our findings suggest that a CP-EBUS-TBNA first approach may be able to avoid NB in select cases,” write the study authors. “An NB first strategy can be advantageous in certain clinical scenarios. It is likely best to make these decisions on a case-by-case basis and tailor the strategy to the patient’s individual needs.”



Proactive Personalized Intervention Program Ups Pediatric Inhaler Adherence

Data indicate that many children with asthma have poorly controlled disease due to poor adherence with inhaled corticosteroids. To determine if an intervention can overcome this barrier, investigators administered a simplified schedule of daily budesonide inhaler for prophylaxis and salbutamol inhaler for exacerbations to children aged 5-12 with persistent asthma. All were offered a multi-dimensional intervention program centered around asthma education and counseling and followed for 3 months by telephone, daily diary keeping, a self-action plan, lifestyle modification, clinical evaluations, and dose counter and peak expiratory flow rate (PEFR) recordings. At 3 months, significant improvements were seen in symptom relief (83%), functioning at school and play (80%), implementing preventive measures (81%) and lifestyle modification (86%), correct inhaler spacer usage (90%), and achieving mediocre-good quality of life (48% & 43%, respectively). Adherence rates improved significantly, from 33.66% to 81.66%. Mean PEFR increased significantly, from 124.83 L/min to 218.33 L/min, mean number of exacerbations decreased from 6.92 to 1.93, mean number of hospitalizations reduced from 1.82 to 0.18, and mean school absences dropped from 9.33 days to 2.