Pulmonology

Dynamic chest radiography shows promising accuracy for COPD screening versus PFTs

In this single-center prospective study of 553 adults, dynamic chest radiography (DCR) parameters correlated well with standard PFT indices in COPD. Bilateral change in projected lung area during deep breathing correlated with FEV1 % predicted (r=0.65) and FEV1/FVC (r=0.64). This DCR parameter alone achieved an AUC of 0.78 for COPD diagnosis, while a multifeature DCR model reached an AUC of 0.82. A combined model adding smoking status achieved an AUC of 0.85 and was visualized as a nomogram for COPD probability. Findings suggest DCR could serve as a low-radiation alternative for COPD screening when spirometry is inaccessible or impractical. 1

LAMA and ICS withdrawal in COPD transiently increases exacerbation risk

This post hoc FLAME trial analysis evaluated 3362 patients with moderate-to-severe COPD and prior exacerbations over 52 weeks. Discontinuing LAMA therapy was associated with a marked, transient rise in moderate-to-severe exacerbations in the first quarter versus later months. In subgroups least confounded by ICS, LAMA withdrawal increased moderate-to-severe exacerbation rates up to 2.2-fold. ICS discontinuation produced an early increase in severe exacerbations, while effects on moderate-to-severe events were less clear. ICS withdrawal effects did not vary by baseline blood eosinophils, suggesting broad vulnerability after ICS cessation. These data support caution and close monitoring when stepping down LAMA or ICS, especially immediately after withdrawal. 2

Full MIST2 intrapleural enzyme dosing linked to fewer escalations and shorter LOS

This retrospective cohort included adults with complicated parapneumonic effusion or empyema treated with antibiotics, chest tube, and intrapleural enzymes across 21 hospitals. Only 5.7% of 1751 encounters received full MIST2 dosing, and use varied markedly between facilities. Full MIST2 dosing was associated with a lower hazard of treatment escalation or bleeding (HR 0.61; 95% CI 0.43–0.88). Full dosing also reduced hospital length of stay by about 15%, with mean LOS 13.4 versus 11.4 days. Comorbidity and illness severity were similar between groups, suggesting practice variation rather than case-mix drove dosing differences. 3

FABP4 plus LLM-based EMR analysis improves LRTI diagnosis in critically ill adults

This study combined the host transcriptomic biomarker FABP4 with GPT-4–based EMR text analysis to diagnose lower respiratory tract infection in ICU patients. The integrated classifier achieved an AUC of 0.93 and accuracy of 84%, outperforming FABP4 alone and EMR analysis alone. In an independent validation cohort, performance improved further, with an AUC of 0.98 and accuracy of 96%. Clinician admission diagnoses had lower accuracy at 72%, underscoring potential diagnostic gains from the combined approach. 4