New research was presented at CHEST 2016, the annual international scientific assembly of the American College of Chest Physicians, from October 22 to 26, 2016 in Los Angeles. The features below highlight some of the studies emerging from the conference.
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Sleep & COPD Worsen Together
Prior research has linked poor sleep quality to reductions in health-related quality of life (QOL) among patients with COPD. To gain more insight into this relationship, researchers conducted a study in which patients with stable COPD and a mean age of 63 completed multiple questionnaires and pulmonary function tests. Patients were then categorized as having mild, moderate, or severe COPD. Quality of sleep was poor in all participants and worsened with COPD progression. The following patient factors were associated with decreasing QOL:
- COPD severity.
- Female gender.
- Sleep quality.
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Diagnosing Pulmonary Embolism With Bedside Ultrasound
Point-of-care ultrasound to test for pulmonary embolism (PE) is typically conducted by cardiologists, but these specialists are often unavailable. Time is of the essence when diagnosing and treating PE. A study sought to determine if pulmonary and critical care fellows could appropriately perform point-of-care ultrasounds for PE. Investigators asked fellows who attended a 30-day introductory course on this testing modality to evaluate right ventricular size and function at the bedside of 60 patients. Overall, their diagnostic accuracy was about 80%. Intensivists achieved accuracies higher than 90% in many cases. On average, point-of-care ultrasound was performed 1 day earlier than transthoracic echocardiogram in the analysis.
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Bronchiecstasis Common in COPD
Previous research into the importance of bronchiectasis among patients with COPD has provided mixed results. For a study, investigators sought to better understand the incidence and impact of bronchiectasis in this patient population. Among nearly 900 patients with COPD, about 42% had radiologically proven bronchiectasis. Of patients who had experienced more than one COPD exacerbation in the previous year, nearly 93% had bronchiectasis. The authors also observed the following:
| Stage of COPD | Rate of Bronchiectasis |
| Stage 1 | 25% |
| Stage 2 | 36% |
| Stage 3 | 49% |
| Stage 4 | 59% |
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More E-Cigarette Research Needed
Evidence suggests that e-cigarette use is increasing throughout the United States, but data are lacking on their safety and relevance to traditional cigarette smoking cessation. Yale researchers conducted a survey to determine what healthcare providers told patients who inquired about using e-cigarettes for smoking cessation. Nearly 70% of providers reported that e-cigarettes were intrinsically harmful to human health. However, about one-third felt they were affective as smoking-cessation aids, one-third disagreed, and one-third had no opinion. With 88% of respondents reporting that patients ask about e-cigarettes, and 80% saying some patients use them specifically as cessation aides, more research is needed to understand their safety.
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Home Visits Benefit COPD & Asthma Patients
Previous studies indicate that home visits may help increase compliance with an integrative disease management program for patients with severe asthma and COPD. For a study, researchers assessed healthcare utilization and patient adherence in the year prior to and after a single home visit. Patients were asked about why they missed scheduled office visits and assessed for asthma or COPD severity. In the year following the home visit, compliance with office visits increased significantly. In addition, intervention recipients had significantly fewer ED visits and significantly better adherence with maintenance inhalers.
Lung Biopsies & Pneumothorax Incidence
Evidence suggests that electromagnetic navigation allows for many procedures to be performed safely and with minimal invasiveness. However, data are lacking on the use of electromagnetic navigation in performing lung cancer biopsies. As part of an ongoing study, patients underwent lung biopsy using an electromagnetic navigation system. Participants had an average age of 67, more than 80% had a history of smoking or were current smokers, and 47% had COPD. Among the first 500 patients treated with the system, grade 2 or greater pneumothorax had an incidence rate of less than 3%. Electromagnetic navigation bronchoscopy-aided samples provided a diagnosis in 82% of patients.
NEWS FROM CHEST 2016
Low Rate of Pneumothorax With EM Navigation System
Once-Daily, Nebulized LAMA Shows Promise
Experts Debate: Do Sleep Labs Have a Future?
Arformoterol Safe in Combination With Tiotropium in COPD
Diffusion Capacity Testing Predicts COPD Exercise Capacity
Metformin in COPD Patients Improves Outcomes
Spirometry Underutilized in Primary Care
