Acute Respiratory Distress Syndrome

The first session of the Clinical Year in Review series began Sunday, May 19, at the ATS 2024 International Conference with a deep dive into acute respiratory distress syndrome (ARDS) and the proposal for a new global definition for the disease.

“The goal is to improve diagnostic accuracy with changes to chest imaging and ARDS categories,” said Shewit Giovanni, MD, MSc, assistant professor of pulmonary, allergy, and critical care medicine at Oregon Health & Science University.

Another new development discussed was a lung ultrasound (LUS) prediction model for ARDS, which may improve diagnostic accuracy.

The ARDS mortality gap between minority patients and white patients narrowed between 2000 and 2018. However, there are still opportunities to improve these metrics as minority participation in ARDS trials held steady over the same period.

New ARDS guidelines from the European Society of Intensive Care Medicine (ESICM) are similar to current ATS guidelines. The most important difference concerns the use of a neuromuscular blockade. ESIM strongly recommends against these drugs while ATS has a conditional recommendation for use in moderate-to-severe ARDS.

Asthma

Geography can have critical effects on children with asthma. A Baltimore study of housing mobility found that moving children from a high-poverty neighborhood to a low-poverty area reduced the odds of asthma exacerbation by 54 percent and days exhibiting asthma symptoms dropped by 59 percent post-move compared with the pre-move period.

Prior studies associated respiratory syncytial virus (RSV) bronchiolitis with childhood asthma, but earlier studies contained ascertainment errors. A new study found that any RSV infection is a risk factor for childhood asthma. Children without RSV had a 26 percent lower risk of childhood asthma.

“The association was stronger if RSV occurred earlier in life,” said Juan Carlos Cardet, MD, MPH, associate professor of allergy and immunology, University of South Florida.

Other trials showed that at least one biologic therapy, benralizumab, can decrease daily inhaled corticosteroid use and that biologics can lead to clinical remission in up to 20 percent of patients.

Health Equity

Hispanic patients with ARDS are more likely to be administered deep sedation than white, Black, or other patient populations. The reasons for these disparities are unclear, said Aaron Dorian Baugh, MD, assistant clinical professor of pulmonary and critical care medicine at the University of California, San Francisco, though it may have associations with language barriers between patients and providers.

Recent lung cancer screening data from the Veterans Administration found big data techniques can carry a risk of bias. Poor training sets and specifications can codify existing disparities. Less care received can be mistakenly interpreted to mean less care was required, resulting in an underestimation of risk for Black patients.

Individual provider preferences can also sometimes outweigh the evidence base. According to Dr. Baugh, the ordering physician was the most important contributing factor for patients receiving low-dose CT screening.

Another study found that the use of race-based spirometry techniques can negatively affect surgical decisions. Race-neutral spirometry for African American patients resulted in less lobectomy and more wedge resection versus race-corrected spirometry.

Lung Cancer

Lung cancer mortality is declining faster than incidence due to improvements in screening, early detection, access to care, and treatment. However, the benefits are not equitable across groups.

New data show that sublobar resection is non-inferior to lobectomy for early-stage disease, supporting current clinical practice.

At least three years of adjuvant osimertinib can significantly improve five-year and overall survival after resection of stage IB-III! EGFR+ NSCLC with a hazard ratio for death of 0.49.

“Subset analysis showed more benefit with more advanced disease,” said Matthew Triplette, MD, MPH, medical director of the Lung Screening Program, Fred Hutchinson Cancer Center and associate professor of pulmonology, critical care and sleep, University of Washington.

Since more cancer survivors are living longer than ever before, he added, there is an increased need for survivor support and research.