American Journal of Respiratory and Critical Care Medicine

Chronic obstructive pulmonary disease (COPD) is a global health problem, and since 2001, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) has published its strategy document for the diagnosis and management of COPD. This executive summary presents the main contents of the second 5-year revision of the GOLD document that has implemented some of the vast knowledge about COPD accumulated over the last years. Today, GOLD recommends that spirometry is required for the clinical diagnosis of COPD to avoid misdiagnosis and to ensure proper evaluation of severity of airflow limitation. The document highlights that the assessment of the patient with COPD should always include assessment of (1) symptoms, (2) severity of airflow limitation, (3) history of exacerbations, and (4) comorbidities. The first three points can be used to evaluate level of symptoms and risk of future exacerbations, and this is done in a way that splits patients with COPD into four categories-A, B, C, and D. Nonpharmacologic and pharmacologic management of COPD match this assessment in an evidence-based attempt to relieve symptoms and reduce risk of exacerbations. Identification and treatment of comorbidities must have high priority, and a separate section in the document addresses management of comorbidities as well as COPD in the presence of comorbidities. The revised document also contains a new section on exacerbations of COPD. The GOLD initiative will continue to bring COPD to the attention of all relevant shareholders and will hopefully inspire future national and local guidelines on the management of COPD.

This document is an international evidence-based guideline on the diagnosis and management of idiopathic pulmonary fibrosis, and is a collaborative effort of the American Thoracic Society, the European Respiratory Society, the Japanese Respiratory Society, and the Latin American Thoracic Association. It represents the current state of knowledge regarding idiopathic pulmonary fibrosis (IPF), and contains sections on definition and epidemiology, risk factors, diagnosis, natural history, staging and prognosis, treatment, and monitoring disease course. For the diagnosis and treatment sections, pragmatic GRADE evidence-based methodology was applied in a question-based format. For each diagnosis and treatment question, the committee graded the quality of the evidence available (high, moderate, low, or very low), and made a recommendation (yes or no, strong or weak). Recommendations were based on majority vote. It is emphasized that clinicians must spend adequate time with patients to discuss patients' values and preferences and decide on the appropriate course of action.

The acute respiratory distress syndrome (ARDS), a process of nonhydrostatic pulmonary edema and hypoxemia associated with a variety of etiologies, carries a high morbidity, mortality (10 to 90%), and financial cost. The reported annual incidence in the United States is 150,000 cases, but this figure has been challenged, and it may be different in Europe. Part of the reason for these uncertainties are the heterogeneity of diseases underlying ARDS and the lack of uniform definitions for ARDS. Thus, those who wish to know the true incidence and outcome of this clinical syndrome are stymied. The American-European Consensus Committee on ARDS was formed to focus on these issues and on the pathophysiologic mechanisms of the process. It was felt that international coordination between North America and Europe in clinical studies of ARDS was becoming increasingly important in order to address the recent plethora of potential therapeutic agents for the prevention and treatment of ARDS.

Diagnostic Criteria of Nontuberculous Mycobacterial Lung Disease Key Laboratory Features of NTM Health Careand Hygiene-associated Disease Prevention Prophylaxis and Treatment of NTM Disease Introduction Methods Taxonomy Epidemiology Pathogenesis Host Defense and Immune Defects Pulmonary Disease Body Morphotype Tumor Necrosis Factor Inhibition Laboratory Procedures Collection, Digestion, Decontamination, and Staining of Specimens Respiratory Specimens Body Fluids, Abscesses, and Tissues Blood Specimen Processing Smear Microscopy Culture Techniques Incubation of NTM Cultures NTM Identification Antimicrobial Susceptibility Testing for NTM Molecular Typing Methods of NTM Clinical Presentations and Diagnostic Criteria Pulmonary Disease Cystic Fibrosis Hypersensitivity-like Disease Transplant Recipients Disseminated Disease Lymphatic Disease Skin, Soft Tissue, and Bone Disease

Chronic obstructive pulmonary disease (COPD) remains a major public health problem. It is the fourth leading cause of chronic morbidity and mortality in the United States, and is projected to rank fifth in 2020 in burden of disease worldwide, according to a study published by the World Bank/World Health Organization. Yet, COPD remains relatively unknown or ignored by the public as well as public health and government officials. In 1998, in an effort to bring more attention to COPD, its management, and its prevention, a committed group of scientists encouraged the U.S. National Heart, Lung, and Blood Institute and the World Health Organization to form the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Among the important objectives of GOLD are to increase awareness of COPD and to help the millions of people who suffer from this disease and die prematurely of it or its complications. The first step in the GOLD program was to prepare a consensus report, Global Strategy for the Diagnosis, Management, and Prevention of COPD, published in 2001. The present, newly revised document follows the same format as the original consensus report, but has been updated to reflect the many publications on COPD that have appeared. GOLD national leaders, a network of international experts, have initiated investigations of the causes and prevalence of COPD in their countries, and developed innovative approaches for the dissemination and implementation of COPD management guidelines. We appreciate the enormous amount of work the GOLD national leaders have done on behalf of their patients with COPD. Despite the achievements in the 5 years since the GOLD report was originally published, considerable additional work is ahead of us if we are to control this major public health problem. The GOLD initiative will continue to bring COPD to the attention of governments, public health officials, health care workers, and the general public, but a concerted effort by all involved in health care will be necessary.

Hui-Qi Qu, Haijun Qiu, Frank D Mentch, Christopher J Cardinale, Hakon Hakonarson; Cross-Ancestry Analysis of the 1q31 Th2-Associated Interval in Steroid-De

Atul K Mehta, Emilian Racila, Anupam Kumar; Endogenous Lipoid Pneumonia in Adult-Onset Still’s Disease Necessitating Lung Transplantation, American Journal

RATIONALE: The impact of repeated community-wide tuberculosis screening is uncertain because evidence from large-scale, multi-round screening campaigns is limited. OBJECTIVES: We evaluated whether annual, community-based, chest-radiography screening was associated with reduced tuberculosis prevalence and detection of asymptomatic disease across multiple screening rounds. METHODS: We conducted three annual chest X-ray screening rounds (2021-2023) among adults aged ≥60 years in Lanxi City, Zhejiang Province. All participants underwent chest radiography at community health centers, with referral for diagnostic evaluation and bacteriological testing. We estimated detection yields per 100,000 screened persons, assessed trends, and used direct standardization and repeated-participation analyses. MEASUREMENTS AND MAIN RESULTS: Across all rounds, 214,948 screening encounters were completed. From Round 1 to Round 3, screening-detected prevalence declined for overall tuberculosis (233.1 [95% CI, 194.2-279.7] to 146.3 [95% CI, 123.1-173.9] per 100,000 screened persons) and bacteriologically-confirmed tuberculosis (162.1 [95% CI, 130.3-201.7] to 108.6 [95% CI, 88.8-132.7] per 100,000 screened persons). From Round 1 to Round 3, asymptomatic tuberculosis decreased as both a proportion of cases (47.8% to 26.6%) and prevalence among screened participants (111.5 to 38.9 per 100,000). Compared with Round 1, tuberculosis prevalence was lower in Round 2 (-28.1% change; 95% CI, -44.0 to - 7.5) and Round 3 (-37.2% change; 95% CI, -51.2 to - 19.2). The Round 2-to-Round 3 difference was smaller and included the null (-12.8% change; 95% CI, -31.7 to 11.4). Standardization and repeated-participation analyses yielded broadly similar patterns. CONCLUSIONS: Serial community-level screening was associated with declining tuberculosis prevalence, including asymptomatic disease, with the largest reduction occurring between the first and second screening rounds.

PURPOSE: Little is known on critical care services globally. This study aimed to describe ICU resources and organization across countries and assess variability by income group, between countries, and within countries. METHODS: Participating centers provided structured data on hospital and ICU characteristics via electronic case report form (January 2018 to July 2020). Questionnaire included 237 items covering general characteristics (2 topics) and ICU resources and organization (18 topics). We computed standardized functional domain scores (ISOREA score), classified ICUs using Marshall criteria, and readiness for essential emergency and critical care using a modified Schell score. RESULTS: A total of 1,426 ICUs from five continents were recruited, and 1,225 were analyzed, from high-income countries (HICs, 58%), upper-middle-income (20%), and low/lower-middle-income countries (LLMICs, 22%). Most ICUs were in referral centers (90%) and large urban areas (80%). Most variables (93%) were significantly associated with income group, Most variables (93%) were significantly associated with income group, with 88% showing higher levels in HICs and lower levels in LLMICs. Six domains showed major disparities: extracorporeal support, respiratory support, emergency access to interventional radiology and surgery, neurology and trauma care, patient file and general monitoring, and cardiovascular and hemodynamic monitoring. According to the Marshall classification, 79% of ICUs in HICs were classified as level III, whereas 55% of ICUs in LLMICs were classified as level I. Domains with higher ISOREA scores varied primarily between countries, whereas lower-performing domains exhibited greater variability across ICUs within the same country. Adjustment for income group reduced, but did not eliminate, country-level clustering. CONCLUSION: Substantial disparities exist in ICU resources and organization across income groups, countries, and ICUs. ICU capacities appeared multidimensional, extending beyond resource limitations.

Annia Schreiber, Silvia Landini, Francesca Medici, Eno Hysi; Beyond Conventional Lung Ultrasound: Emerging quantitative studies, American Journal of Respir

Nicolas Gendron, Aurélien Philippe, Bertrand Hermann, David M Smadja, Jean-Luc Diehl; Reply to Wang et al.: Complementing the picture: adding antithrombin

Taizou Hirano; Are FVC and DLCO Thresholds Equally Calibrated to Pulmonary Fibrosis Progression?, American Journal of Respiratory and Critical Care Medicin

A McGarry Houghton, MD; Analytical and technical advances collide to produce novel insights into the tumor immune microenvironment, American Journal of Res

Brian S Wojeck, Brandon Nokes; Sweet Dreams: Incretin therapy for prevention of obstructive sleep apnea in patients with type 2 diabetes mellitus and obesi

Xiang Huang, Ph.D, Pingsheng Wu, Ph.D, Adam R Guttentag, M.D, Melanie Quintana, Ph.D, Jonathan A Kropski, M.D, Timothy S Blackwell, M.D, Margaret L Salisbu