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Decreasing Pulmonary Embolism-Related Mortality

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Decreasing Pulmonary Embolism-Related Mortality
Author(s)
Parth Rali, MD

Click to view more from Pulmonology Data Trends 2023.

References
  1. Centers for Disease Control and Prevention. Data and statistics on venous thromboembolism. Last reviewed June 28, 2023. Accessed July 18, 2023. https://www.cdc.gov/ncbddd/dvt/data.html
  2. Becattini C et al. Chest. 2016;149(1):192-200. doi:10.1378/chest.15-0808
  3. Triantafyllou GA et al. Semin Respir Crit Care Med. 2021;42(2):183-198.doi:10.1055/s-0041-1722898
  4. Ng ACC et al. Respiration. 2013;85(5):408-416. doi:10.1159/000342024
  5. Phillips AR et al. J Am Heart Assoc. 2021;10(17):e021818. doi:10.1161/JAHA.121.021818
  6. Wadhera RK et al. J Am Heart Assoc. 2021;10(13):e021117. doi:10.1161/JAHA.121.021117
  7. Bashir R et al. JACC Cardiovasc Interv. 2022;15(23):2427-2436. doi:10.1016/j.jcin.2022.09.011
  8. Patel NJ et al. Int J Cardiol. 2019;287:116-117. doi:10.1016/j.ijcard.2019.04.029
  9. Li X et al. Ann Transl Med. 2021;9(10):838. doi:10.21037/atm-21-975
  10. Rivera-Lebron BN et al. Chest. 2021;159(1):347-355. doi:10.1016/j.chest.2020.07.065
  11. Noto JG, Rali P. Pulm Circ. 2022;12(1):e12021. doi:10.1002/pul2.12021
  12. Snyder DJ et al. Vasc Med. 2023;28(3):222-232. doi:10.1177/1358863X231157441
  13. Bikdeli B et al. Semin Thromb Hemost. 2023. doi:10.1055/s-0043-1764231
  14. Fleitas Sosa D et al. Eur Respir Rev. 2022;31(165):220023. doi:10.1183/16000617.0023-2022
  15. Pulmonary embolism - thrombus removal with catheter-directed therapy (PE-TRACT). ClinicalTrials.gov. Updated July 17, 2023. Accessed July 18, 2023. https://clinicaltrials.gov/ct2/show/NCT05591118
  16. The PEERLESS study (PEERLESS). ClinicalTrials.gov. Updated Jun 23, 2023. Accessed July 18, 2023. https://clinicaltrials.gov/ct2/show/NCT05111613
  17. Inari Medical, Inc. Inari Medical announces Peerless II, a randomized controlled trial evaluating clinical outcomes of the FlowTriever® system vs. anticoagulation in pulmonary embolism patients [press release]. Published May 22,2023. Accessed July 18, 2023. https://ir.inarimedical.com/news-releases/news-release-details/inari-medical-announces-peerless-ii-randomized-controlled-trial
  18. Ultrasound-facilitated, catheter-directed, thrombolysis in intermediate-high risk pulmonary embolism (HI-PEITHO). ClinicalTrials.gov. Updated July 17, 2023. Accessed July 18, 2023. https://clinicaltrials.gov/ct2/show/NCT04790370
  19. Comparison of two pulmonary embolism treatments. ClinicalTrials.gov. Updated May 31, 2023. Accessed July 18, 2023. https://clinicaltrials.gov/ct2/show/NCT05684796
  20. Pulmonary Embolism International THrOmbolysis Study-3 (PEITHO-3).ClinicalTrials.gov. Updated June 8, 2023. Accessed July 18, 2023. https://clinicaltrials.gov/ct2/show/NCT04430569
  21. Study of the long-term safety and outcomes of treating pulmonary embolism with the Indigo Aspiration System. ClinicalTrials.gov. Updated May 11, 2023. Accessed July 18, 2023. https://clinicaltrials.gov/ct2/show/NCT04798261
  22. Bashir R et al. J Am Coll Cardiol Intv. 2022;15(23):2427-2436. doi:10.1016/j.jcin.2022.09.011
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Philadelphia, PA

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Philadelphia, PA

Click to view more from Pulmonology Data Trends 2023.

Click to view more from Pulmonology Data Trends 2023.

References
  1. Centers for Disease Control and Prevention. Data and statistics on venous thromboembolism. Last reviewed June 28, 2023. Accessed July 18, 2023. https://www.cdc.gov/ncbddd/dvt/data.html
  2. Becattini C et al. Chest. 2016;149(1):192-200. doi:10.1378/chest.15-0808
  3. Triantafyllou GA et al. Semin Respir Crit Care Med. 2021;42(2):183-198.doi:10.1055/s-0041-1722898
  4. Ng ACC et al. Respiration. 2013;85(5):408-416. doi:10.1159/000342024
  5. Phillips AR et al. J Am Heart Assoc. 2021;10(17):e021818. doi:10.1161/JAHA.121.021818
  6. Wadhera RK et al. J Am Heart Assoc. 2021;10(13):e021117. doi:10.1161/JAHA.121.021117
  7. Bashir R et al. JACC Cardiovasc Interv. 2022;15(23):2427-2436. doi:10.1016/j.jcin.2022.09.011
  8. Patel NJ et al. Int J Cardiol. 2019;287:116-117. doi:10.1016/j.ijcard.2019.04.029
  9. Li X et al. Ann Transl Med. 2021;9(10):838. doi:10.21037/atm-21-975
  10. Rivera-Lebron BN et al. Chest. 2021;159(1):347-355. doi:10.1016/j.chest.2020.07.065
  11. Noto JG, Rali P. Pulm Circ. 2022;12(1):e12021. doi:10.1002/pul2.12021
  12. Snyder DJ et al. Vasc Med. 2023;28(3):222-232. doi:10.1177/1358863X231157441
  13. Bikdeli B et al. Semin Thromb Hemost. 2023. doi:10.1055/s-0043-1764231
  14. Fleitas Sosa D et al. Eur Respir Rev. 2022;31(165):220023. doi:10.1183/16000617.0023-2022
  15. Pulmonary embolism - thrombus removal with catheter-directed therapy (PE-TRACT). ClinicalTrials.gov. Updated July 17, 2023. Accessed July 18, 2023. https://clinicaltrials.gov/ct2/show/NCT05591118
  16. The PEERLESS study (PEERLESS). ClinicalTrials.gov. Updated Jun 23, 2023. Accessed July 18, 2023. https://clinicaltrials.gov/ct2/show/NCT05111613
  17. Inari Medical, Inc. Inari Medical announces Peerless II, a randomized controlled trial evaluating clinical outcomes of the FlowTriever® system vs. anticoagulation in pulmonary embolism patients [press release]. Published May 22,2023. Accessed July 18, 2023. https://ir.inarimedical.com/news-releases/news-release-details/inari-medical-announces-peerless-ii-randomized-controlled-trial
  18. Ultrasound-facilitated, catheter-directed, thrombolysis in intermediate-high risk pulmonary embolism (HI-PEITHO). ClinicalTrials.gov. Updated July 17, 2023. Accessed July 18, 2023. https://clinicaltrials.gov/ct2/show/NCT04790370
  19. Comparison of two pulmonary embolism treatments. ClinicalTrials.gov. Updated May 31, 2023. Accessed July 18, 2023. https://clinicaltrials.gov/ct2/show/NCT05684796
  20. Pulmonary Embolism International THrOmbolysis Study-3 (PEITHO-3).ClinicalTrials.gov. Updated June 8, 2023. Accessed July 18, 2023. https://clinicaltrials.gov/ct2/show/NCT04430569
  21. Study of the long-term safety and outcomes of treating pulmonary embolism with the Indigo Aspiration System. ClinicalTrials.gov. Updated May 11, 2023. Accessed July 18, 2023. https://clinicaltrials.gov/ct2/show/NCT04798261
  22. Bashir R et al. J Am Coll Cardiol Intv. 2022;15(23):2427-2436. doi:10.1016/j.jcin.2022.09.011
References
  1. Centers for Disease Control and Prevention. Data and statistics on venous thromboembolism. Last reviewed June 28, 2023. Accessed July 18, 2023. https://www.cdc.gov/ncbddd/dvt/data.html
  2. Becattini C et al. Chest. 2016;149(1):192-200. doi:10.1378/chest.15-0808
  3. Triantafyllou GA et al. Semin Respir Crit Care Med. 2021;42(2):183-198.doi:10.1055/s-0041-1722898
  4. Ng ACC et al. Respiration. 2013;85(5):408-416. doi:10.1159/000342024
  5. Phillips AR et al. J Am Heart Assoc. 2021;10(17):e021818. doi:10.1161/JAHA.121.021818
  6. Wadhera RK et al. J Am Heart Assoc. 2021;10(13):e021117. doi:10.1161/JAHA.121.021117
  7. Bashir R et al. JACC Cardiovasc Interv. 2022;15(23):2427-2436. doi:10.1016/j.jcin.2022.09.011
  8. Patel NJ et al. Int J Cardiol. 2019;287:116-117. doi:10.1016/j.ijcard.2019.04.029
  9. Li X et al. Ann Transl Med. 2021;9(10):838. doi:10.21037/atm-21-975
  10. Rivera-Lebron BN et al. Chest. 2021;159(1):347-355. doi:10.1016/j.chest.2020.07.065
  11. Noto JG, Rali P. Pulm Circ. 2022;12(1):e12021. doi:10.1002/pul2.12021
  12. Snyder DJ et al. Vasc Med. 2023;28(3):222-232. doi:10.1177/1358863X231157441
  13. Bikdeli B et al. Semin Thromb Hemost. 2023. doi:10.1055/s-0043-1764231
  14. Fleitas Sosa D et al. Eur Respir Rev. 2022;31(165):220023. doi:10.1183/16000617.0023-2022
  15. Pulmonary embolism - thrombus removal with catheter-directed therapy (PE-TRACT). ClinicalTrials.gov. Updated July 17, 2023. Accessed July 18, 2023. https://clinicaltrials.gov/ct2/show/NCT05591118
  16. The PEERLESS study (PEERLESS). ClinicalTrials.gov. Updated Jun 23, 2023. Accessed July 18, 2023. https://clinicaltrials.gov/ct2/show/NCT05111613
  17. Inari Medical, Inc. Inari Medical announces Peerless II, a randomized controlled trial evaluating clinical outcomes of the FlowTriever® system vs. anticoagulation in pulmonary embolism patients [press release]. Published May 22,2023. Accessed July 18, 2023. https://ir.inarimedical.com/news-releases/news-release-details/inari-medical-announces-peerless-ii-randomized-controlled-trial
  18. Ultrasound-facilitated, catheter-directed, thrombolysis in intermediate-high risk pulmonary embolism (HI-PEITHO). ClinicalTrials.gov. Updated July 17, 2023. Accessed July 18, 2023. https://clinicaltrials.gov/ct2/show/NCT04790370
  19. Comparison of two pulmonary embolism treatments. ClinicalTrials.gov. Updated May 31, 2023. Accessed July 18, 2023. https://clinicaltrials.gov/ct2/show/NCT05684796
  20. Pulmonary Embolism International THrOmbolysis Study-3 (PEITHO-3).ClinicalTrials.gov. Updated June 8, 2023. Accessed July 18, 2023. https://clinicaltrials.gov/ct2/show/NCT04430569
  21. Study of the long-term safety and outcomes of treating pulmonary embolism with the Indigo Aspiration System. ClinicalTrials.gov. Updated May 11, 2023. Accessed July 18, 2023. https://clinicaltrials.gov/ct2/show/NCT04798261
  22. Bashir R et al. J Am Coll Cardiol Intv. 2022;15(23):2427-2436. doi:10.1016/j.jcin.2022.09.011
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As many as 900,000 patients have deep vein thrombosis (DVT) or pulmonary embolism (PE), also called venous thromboembolism (VTE), each year in the United States, with 100,00 deaths per year.1 In patients with PE, 56% also have DVT, which can affect 30-day mortality rates.2 The field of PE is evolving to help decrease mortality from these events. Proper risk stratification is crucial to identify the best approach for each patient, while the presence of comorbidities and unmodifiable risk factors must also be considered when individualizing care and assessing likelihood of mortality.3,4 As comorbidities increase, mortality increases in PE.4 As well, racial, ethnic, and socioeconomic demographic differences affect PE, with Black patients having greater PE severity and socioeconomically underserved patients having higher follow-up mortality.5,6

Treatments are also advancing, with many upcoming catheter-based treatments in clinical trials, which have demonstrated rapid recovery of right ventricle function—a primary cause of PE-related mortality.7,8 The effect of catheter-based treatment on long-term functional outcomes is currently being explored in clinical trials. Artificial intelligence is also being used to aid in diagnosis and treatment.9 As the armamentarium of treatment options diversifies, so must our overall approach to management. The PE response team (PERT) strategy uses a multidisciplinary team of experts to further individualize patient care to help decrease mortality and improve follow-up efforts since the post-PE period is a sensitive time for new morbidity.10,11 With proven risk stratification and management strategies available and new treatments on the way, the field of PE looks to improve not only in patient acute mortality, but also long-term functional outcomes, and early detection of post-PE comorbid conditions.

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Updated guidance from USPSTF on PrEP for HIV prevention

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Updated guidance from USPSTF on PrEP for HIV prevention
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Doug Campos-Outcalt, MD, MPA

The US Preventive Services Task Force (USPSTF) recently released their final recommendation update on the use of antiretroviral therapy to prevent HIV infection in adolescents and adults who are at increased risk.1 The Task Force last addressed this topic in 2019; since then, 2 additional antiretroviral regimens have been approved for preexposure prophylaxis (PrEP). The update also includes revised wording on who should consider receiving PrEP.

HIV remains a significant public health problem in the United States. The Centers for Disease Control and Prevention (CDC) estimates that 1.2 million people in the United States are living with HIV, and approximately 30,000 new infections occur each year.2 Men who have sex with men account for 68% of new infections, and there are marked racial disparities in both incidence and prevalence of infection, with Black/African Americans accounting for 42% of new infections.2

PrEP decreases the risk for HIV by about 50% overall, with higher rates of protection correlated to higher adherence (close to 100% protection with daily adherence to oral regimens).3 The 3 approved regimens for PrEP are outlined in TABLE 13.

Medications approved for HIV preexposure prophylaxis

Who’s at increased risk? The USPSTF did not find any risk assessment tools with proven accuracy in identifying those at increased risk for HIV infection but did document risk factors and behaviors that can be used to predict risk. They encourage discussion about HIV prevention with all adults and adolescents who are sexually active or who inject drugs.

Those people for whom the Task Force recommends considering PrEP are listed in TABLE 21. However, the USPSTF recommends providing PrEP to anyone who requests it, as they may not want to disclose their risk factors.

USPSTF: Consider PrEP for these patients

What to keep in mind. Family physicians are encouraged to read the full USPSTF report and refer to CDC guidelines on prescribing PrEP, which provide details on each regimen and the routine laboratory testing that should be performed.4 The most important clinical considerations described in the USPSTF report are:

  • Before starting PrEP, document a negative HIV antigen/antibody test result and continue to test for HIV every 3 months. PrEP regimens should not be used to treat HIV.
  • Document a negative HIV RNA assay if the patient has taken oral PrEP in the past 3 months or injectable PrEP in the past 12 months.
  • At PrEP initiation, consider ordering other recommended tests, such as those for kidney function, chronic hepatitis B infection (if using tenofovir disoproxil fumarate/emtricitabine), lipid levels (if using tenofovir alafenamide/emtricitabine), and other sexually transmitted infection (STIs).
  • Encourage the use of condoms, as PrEP does not protect from other STIs.
  • Follow up regularly, and at each patient visit stress the need for medication adherence to achieve maximum protection.
References

1. USPSTF. Prevention of acquisition of HIV: preexposure prophylaxis. Final recommendation statement. Published August 22, 2023. Accessed September 28, 2023. https://uspreventiveservicestaskforce.org/uspstf/recommendation/prevention-of-human-immunodeficiency-virus-hiv-infection-pre-exposure-prophylaxis

2. CDC. HIV surveillance report: diagnoses of HIV infection in the United States and dependent areas, 2020. Published May 2022. Accessed September 29, 2023. www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2020-updated-vol-33.pdf

3. USPSTF. Prevention of acquisition of HIV: preexposure prophylaxis. Final evidence review. Published August 22, 2023. Accessed September 28, 2023. https://uspreventiveservicestaskforce.org/uspstf/document/final-evidence-review/prevention-of-human-immunodeficiency-virus-hiv-infection-pre-exposure-prophylaxis

4. CDC. Preexposure prophylaxis for the prevention of HIV infection in the United States—2021 update: a clinical practice guideline. Accessed September 28, 2023. www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2021.pdf

Author and Disclosure Information

Doug Campos-Outcalt, MD, MPA, is a clinical professor at the University of Arizona College of Medicine and a senior lecturer with the University of Arizona College of Public Health. He’s also an assistant editor at The Journal of Family Practice.

The author reported on potential conflict of interest relevant to this article.

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Doug Campos-Outcalt, MD, MPA, is a clinical professor at the University of Arizona College of Medicine and a senior lecturer with the University of Arizona College of Public Health. He’s also an assistant editor at The Journal of Family Practice.

The author reported on potential conflict of interest relevant to this article.

Author and Disclosure Information

Doug Campos-Outcalt, MD, MPA, is a clinical professor at the University of Arizona College of Medicine and a senior lecturer with the University of Arizona College of Public Health. He’s also an assistant editor at The Journal of Family Practice.

The author reported on potential conflict of interest relevant to this article.

The US Preventive Services Task Force (USPSTF) recently released their final recommendation update on the use of antiretroviral therapy to prevent HIV infection in adolescents and adults who are at increased risk.1 The Task Force last addressed this topic in 2019; since then, 2 additional antiretroviral regimens have been approved for preexposure prophylaxis (PrEP). The update also includes revised wording on who should consider receiving PrEP.

HIV remains a significant public health problem in the United States. The Centers for Disease Control and Prevention (CDC) estimates that 1.2 million people in the United States are living with HIV, and approximately 30,000 new infections occur each year.2 Men who have sex with men account for 68% of new infections, and there are marked racial disparities in both incidence and prevalence of infection, with Black/African Americans accounting for 42% of new infections.2

PrEP decreases the risk for HIV by about 50% overall, with higher rates of protection correlated to higher adherence (close to 100% protection with daily adherence to oral regimens).3 The 3 approved regimens for PrEP are outlined in TABLE 13.

Medications approved for HIV preexposure prophylaxis

Who’s at increased risk? The USPSTF did not find any risk assessment tools with proven accuracy in identifying those at increased risk for HIV infection but did document risk factors and behaviors that can be used to predict risk. They encourage discussion about HIV prevention with all adults and adolescents who are sexually active or who inject drugs.

Those people for whom the Task Force recommends considering PrEP are listed in TABLE 21. However, the USPSTF recommends providing PrEP to anyone who requests it, as they may not want to disclose their risk factors.

USPSTF: Consider PrEP for these patients

What to keep in mind. Family physicians are encouraged to read the full USPSTF report and refer to CDC guidelines on prescribing PrEP, which provide details on each regimen and the routine laboratory testing that should be performed.4 The most important clinical considerations described in the USPSTF report are:

  • Before starting PrEP, document a negative HIV antigen/antibody test result and continue to test for HIV every 3 months. PrEP regimens should not be used to treat HIV.
  • Document a negative HIV RNA assay if the patient has taken oral PrEP in the past 3 months or injectable PrEP in the past 12 months.
  • At PrEP initiation, consider ordering other recommended tests, such as those for kidney function, chronic hepatitis B infection (if using tenofovir disoproxil fumarate/emtricitabine), lipid levels (if using tenofovir alafenamide/emtricitabine), and other sexually transmitted infection (STIs).
  • Encourage the use of condoms, as PrEP does not protect from other STIs.
  • Follow up regularly, and at each patient visit stress the need for medication adherence to achieve maximum protection.

The US Preventive Services Task Force (USPSTF) recently released their final recommendation update on the use of antiretroviral therapy to prevent HIV infection in adolescents and adults who are at increased risk.1 The Task Force last addressed this topic in 2019; since then, 2 additional antiretroviral regimens have been approved for preexposure prophylaxis (PrEP). The update also includes revised wording on who should consider receiving PrEP.

HIV remains a significant public health problem in the United States. The Centers for Disease Control and Prevention (CDC) estimates that 1.2 million people in the United States are living with HIV, and approximately 30,000 new infections occur each year.2 Men who have sex with men account for 68% of new infections, and there are marked racial disparities in both incidence and prevalence of infection, with Black/African Americans accounting for 42% of new infections.2

PrEP decreases the risk for HIV by about 50% overall, with higher rates of protection correlated to higher adherence (close to 100% protection with daily adherence to oral regimens).3 The 3 approved regimens for PrEP are outlined in TABLE 13.

Medications approved for HIV preexposure prophylaxis

Who’s at increased risk? The USPSTF did not find any risk assessment tools with proven accuracy in identifying those at increased risk for HIV infection but did document risk factors and behaviors that can be used to predict risk. They encourage discussion about HIV prevention with all adults and adolescents who are sexually active or who inject drugs.

Those people for whom the Task Force recommends considering PrEP are listed in TABLE 21. However, the USPSTF recommends providing PrEP to anyone who requests it, as they may not want to disclose their risk factors.

USPSTF: Consider PrEP for these patients

What to keep in mind. Family physicians are encouraged to read the full USPSTF report and refer to CDC guidelines on prescribing PrEP, which provide details on each regimen and the routine laboratory testing that should be performed.4 The most important clinical considerations described in the USPSTF report are:

  • Before starting PrEP, document a negative HIV antigen/antibody test result and continue to test for HIV every 3 months. PrEP regimens should not be used to treat HIV.
  • Document a negative HIV RNA assay if the patient has taken oral PrEP in the past 3 months or injectable PrEP in the past 12 months.
  • At PrEP initiation, consider ordering other recommended tests, such as those for kidney function, chronic hepatitis B infection (if using tenofovir disoproxil fumarate/emtricitabine), lipid levels (if using tenofovir alafenamide/emtricitabine), and other sexually transmitted infection (STIs).
  • Encourage the use of condoms, as PrEP does not protect from other STIs.
  • Follow up regularly, and at each patient visit stress the need for medication adherence to achieve maximum protection.
References

1. USPSTF. Prevention of acquisition of HIV: preexposure prophylaxis. Final recommendation statement. Published August 22, 2023. Accessed September 28, 2023. https://uspreventiveservicestaskforce.org/uspstf/recommendation/prevention-of-human-immunodeficiency-virus-hiv-infection-pre-exposure-prophylaxis

2. CDC. HIV surveillance report: diagnoses of HIV infection in the United States and dependent areas, 2020. Published May 2022. Accessed September 29, 2023. www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2020-updated-vol-33.pdf

3. USPSTF. Prevention of acquisition of HIV: preexposure prophylaxis. Final evidence review. Published August 22, 2023. Accessed September 28, 2023. https://uspreventiveservicestaskforce.org/uspstf/document/final-evidence-review/prevention-of-human-immunodeficiency-virus-hiv-infection-pre-exposure-prophylaxis

4. CDC. Preexposure prophylaxis for the prevention of HIV infection in the United States—2021 update: a clinical practice guideline. Accessed September 28, 2023. www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2021.pdf

References

1. USPSTF. Prevention of acquisition of HIV: preexposure prophylaxis. Final recommendation statement. Published August 22, 2023. Accessed September 28, 2023. https://uspreventiveservicestaskforce.org/uspstf/recommendation/prevention-of-human-immunodeficiency-virus-hiv-infection-pre-exposure-prophylaxis

2. CDC. HIV surveillance report: diagnoses of HIV infection in the United States and dependent areas, 2020. Published May 2022. Accessed September 29, 2023. www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2020-updated-vol-33.pdf

3. USPSTF. Prevention of acquisition of HIV: preexposure prophylaxis. Final evidence review. Published August 22, 2023. Accessed September 28, 2023. https://uspreventiveservicestaskforce.org/uspstf/document/final-evidence-review/prevention-of-human-immunodeficiency-virus-hiv-infection-pre-exposure-prophylaxis

4. CDC. Preexposure prophylaxis for the prevention of HIV infection in the United States—2021 update: a clinical practice guideline. Accessed September 28, 2023. www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2021.pdf

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Long-Awaited RSV Vaccines Now Available for Older Adults and Pediatric Patients

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Long-Awaited RSV Vaccines Now Available for Older Adults and Pediatric Patients
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Burton L. Lesnick, MD, FCCP

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References
  1. Jha A et al. Respiratory syncytial virus. In: Hui DS, Rossi GA, Johnston SL, eds. Respiratory Syncytial Virus. SARS, MERS and Other Viral Lung Infections. European Respiratory Society; 2016:chap 5. Accessed May 17, 2023.
  2. Ginsburg SA, Srikantiah P. Lancet Glob Health. 2021;9(12):e1644-e6145. doi:10.1016/S2214-109X(21)00455-1
  3. US Food and Drug Administration. FDA approves first respiratory syncytial virus (RSV) vaccine [press release]. Published May 3, 2023. Accessed May 17, 2023. https://www.fda.gov/news-events/press-announcements/fda-approves-first-respiratory-syncytial-virus-rsv-vaccine
  4. US Food and Drug Administration. FDA Approves New Drug to Prevent RSV in Babies and Toddlers [press release]. Published July 17, 2023. Accessed August 11, 2023. https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-prevent-rsv-babies-and-toddlers
  5. US Food and Drug Administration. FDA Approves First Vaccine for Pregnant Individuals to Prevent RSV in Infants. Published August 21, 2023. Accessed August 22, 2023. https://www.fda.gov/news-events/press-announcements/fda-approves-first-vaccine-pregnant-individuals-prevent-rsv-infants
  6. Madhi SA et al. N Engl J Med. 2020;383(5):426-439. doi:10.1056/ NEJMoa1908380
  7. Centers for Disease Control. Advisory Committee on Immunization Practices (ACIP) Meeting recommendations, August 2023. https://www.cdc.gov/vaccines/acip/recommendations.html
  8. Hammit LL et al. N Engl J Med. 2022;386(9):837-846. doi:10.1056/ NEJMoa2110275
  9. Centers for Disease Control and Prevention. RSV in infants and young children. Updated October 28, 2022. Accessed May 30, 2023. https://www.cdc.gov/rsv/ high-risk/infants-young-children.html
  10. Centers for Disease Control and Prevention. RSV in older adults and adults with chronic medical conditions. Updated October 28, 2022. Accessed May 30, 2023. https://www.cdc.gov/rsv/high-risk/older-adults.html
  11. Widmer K et al. J Infect Dis. 2012;206(1):56-62. doi:10.1093/infdis/jis309
  12. Hall CB et al. N Engl J Med. 2009;360(6):588-598. doi:10.1056/NEJMoa0804877
  13. McLaughlin JM et al. Open Forum Infect Dis. 2022;9(7):ofac300. doi:10.1093/ofid/ofac300
  14. Thompson et al. JAMA. 2003;289(2):179-186. doi:10.1001/jama.289.2.179
  15. Hansen CL et al. JAMA Netw Open. 2022;5(2):e220527. doi:10.1001/jamanetworkopen.2022.0527
  16. Walsh EE et al; RENOIR Clinical Trial Group. N Engl J Med. 2023;388(16):1465-1477. doi:10.1056/NEJMoa2213836
  17. Martin JA et al. Natl Vital Stat Rep. 2019;68(13):1-47. PMID:32501202
  18. Townsi N et al. Eur Clin Respir J. 2018;5(1):1487214. doi:10.1080/20018525.20 18.1487214
  19. Malek A et al. Am J Reprod Immunol. 1994;32(1):8-14. doi:10.1111/j.1600-0897.1994.tb00873.x
  20. Kampmann B et al; MATISSE Study Group. N Engl J Med. 2023;388(16):1451- 1464. doi:10.1056/NEJMoa2216480
  21. Synagis (palivizumab) injection prescribing information. Published June 2023. Accessed August 2023. https://www.synagis.com/synagis.pdf
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Pediatric Pulmonologist
Children’s Healthcare of Atlanta
Atlanta, GA

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Atlanta, GA

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Atlanta, GA

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References
  1. Jha A et al. Respiratory syncytial virus. In: Hui DS, Rossi GA, Johnston SL, eds. Respiratory Syncytial Virus. SARS, MERS and Other Viral Lung Infections. European Respiratory Society; 2016:chap 5. Accessed May 17, 2023.
  2. Ginsburg SA, Srikantiah P. Lancet Glob Health. 2021;9(12):e1644-e6145. doi:10.1016/S2214-109X(21)00455-1
  3. US Food and Drug Administration. FDA approves first respiratory syncytial virus (RSV) vaccine [press release]. Published May 3, 2023. Accessed May 17, 2023. https://www.fda.gov/news-events/press-announcements/fda-approves-first-respiratory-syncytial-virus-rsv-vaccine
  4. US Food and Drug Administration. FDA Approves New Drug to Prevent RSV in Babies and Toddlers [press release]. Published July 17, 2023. Accessed August 11, 2023. https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-prevent-rsv-babies-and-toddlers
  5. US Food and Drug Administration. FDA Approves First Vaccine for Pregnant Individuals to Prevent RSV in Infants. Published August 21, 2023. Accessed August 22, 2023. https://www.fda.gov/news-events/press-announcements/fda-approves-first-vaccine-pregnant-individuals-prevent-rsv-infants
  6. Madhi SA et al. N Engl J Med. 2020;383(5):426-439. doi:10.1056/ NEJMoa1908380
  7. Centers for Disease Control. Advisory Committee on Immunization Practices (ACIP) Meeting recommendations, August 2023. https://www.cdc.gov/vaccines/acip/recommendations.html
  8. Hammit LL et al. N Engl J Med. 2022;386(9):837-846. doi:10.1056/ NEJMoa2110275
  9. Centers for Disease Control and Prevention. RSV in infants and young children. Updated October 28, 2022. Accessed May 30, 2023. https://www.cdc.gov/rsv/ high-risk/infants-young-children.html
  10. Centers for Disease Control and Prevention. RSV in older adults and adults with chronic medical conditions. Updated October 28, 2022. Accessed May 30, 2023. https://www.cdc.gov/rsv/high-risk/older-adults.html
  11. Widmer K et al. J Infect Dis. 2012;206(1):56-62. doi:10.1093/infdis/jis309
  12. Hall CB et al. N Engl J Med. 2009;360(6):588-598. doi:10.1056/NEJMoa0804877
  13. McLaughlin JM et al. Open Forum Infect Dis. 2022;9(7):ofac300. doi:10.1093/ofid/ofac300
  14. Thompson et al. JAMA. 2003;289(2):179-186. doi:10.1001/jama.289.2.179
  15. Hansen CL et al. JAMA Netw Open. 2022;5(2):e220527. doi:10.1001/jamanetworkopen.2022.0527
  16. Walsh EE et al; RENOIR Clinical Trial Group. N Engl J Med. 2023;388(16):1465-1477. doi:10.1056/NEJMoa2213836
  17. Martin JA et al. Natl Vital Stat Rep. 2019;68(13):1-47. PMID:32501202
  18. Townsi N et al. Eur Clin Respir J. 2018;5(1):1487214. doi:10.1080/20018525.20 18.1487214
  19. Malek A et al. Am J Reprod Immunol. 1994;32(1):8-14. doi:10.1111/j.1600-0897.1994.tb00873.x
  20. Kampmann B et al; MATISSE Study Group. N Engl J Med. 2023;388(16):1451- 1464. doi:10.1056/NEJMoa2216480
  21. Synagis (palivizumab) injection prescribing information. Published June 2023. Accessed August 2023. https://www.synagis.com/synagis.pdf
References
  1. Jha A et al. Respiratory syncytial virus. In: Hui DS, Rossi GA, Johnston SL, eds. Respiratory Syncytial Virus. SARS, MERS and Other Viral Lung Infections. European Respiratory Society; 2016:chap 5. Accessed May 17, 2023.
  2. Ginsburg SA, Srikantiah P. Lancet Glob Health. 2021;9(12):e1644-e6145. doi:10.1016/S2214-109X(21)00455-1
  3. US Food and Drug Administration. FDA approves first respiratory syncytial virus (RSV) vaccine [press release]. Published May 3, 2023. Accessed May 17, 2023. https://www.fda.gov/news-events/press-announcements/fda-approves-first-respiratory-syncytial-virus-rsv-vaccine
  4. US Food and Drug Administration. FDA Approves New Drug to Prevent RSV in Babies and Toddlers [press release]. Published July 17, 2023. Accessed August 11, 2023. https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-prevent-rsv-babies-and-toddlers
  5. US Food and Drug Administration. FDA Approves First Vaccine for Pregnant Individuals to Prevent RSV in Infants. Published August 21, 2023. Accessed August 22, 2023. https://www.fda.gov/news-events/press-announcements/fda-approves-first-vaccine-pregnant-individuals-prevent-rsv-infants
  6. Madhi SA et al. N Engl J Med. 2020;383(5):426-439. doi:10.1056/ NEJMoa1908380
  7. Centers for Disease Control. Advisory Committee on Immunization Practices (ACIP) Meeting recommendations, August 2023. https://www.cdc.gov/vaccines/acip/recommendations.html
  8. Hammit LL et al. N Engl J Med. 2022;386(9):837-846. doi:10.1056/ NEJMoa2110275
  9. Centers for Disease Control and Prevention. RSV in infants and young children. Updated October 28, 2022. Accessed May 30, 2023. https://www.cdc.gov/rsv/ high-risk/infants-young-children.html
  10. Centers for Disease Control and Prevention. RSV in older adults and adults with chronic medical conditions. Updated October 28, 2022. Accessed May 30, 2023. https://www.cdc.gov/rsv/high-risk/older-adults.html
  11. Widmer K et al. J Infect Dis. 2012;206(1):56-62. doi:10.1093/infdis/jis309
  12. Hall CB et al. N Engl J Med. 2009;360(6):588-598. doi:10.1056/NEJMoa0804877
  13. McLaughlin JM et al. Open Forum Infect Dis. 2022;9(7):ofac300. doi:10.1093/ofid/ofac300
  14. Thompson et al. JAMA. 2003;289(2):179-186. doi:10.1001/jama.289.2.179
  15. Hansen CL et al. JAMA Netw Open. 2022;5(2):e220527. doi:10.1001/jamanetworkopen.2022.0527
  16. Walsh EE et al; RENOIR Clinical Trial Group. N Engl J Med. 2023;388(16):1465-1477. doi:10.1056/NEJMoa2213836
  17. Martin JA et al. Natl Vital Stat Rep. 2019;68(13):1-47. PMID:32501202
  18. Townsi N et al. Eur Clin Respir J. 2018;5(1):1487214. doi:10.1080/20018525.20 18.1487214
  19. Malek A et al. Am J Reprod Immunol. 1994;32(1):8-14. doi:10.1111/j.1600-0897.1994.tb00873.x
  20. Kampmann B et al; MATISSE Study Group. N Engl J Med. 2023;388(16):1451- 1464. doi:10.1056/NEJMoa2216480
  21. Synagis (palivizumab) injection prescribing information. Published June 2023. Accessed August 2023. https://www.synagis.com/synagis.pdf
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Respiratory syncytial virus (RSV) is highly contagious and transmitted by large aerosol droplets and fomites, either emitted from an infected person or by making surface-to-eye, -nose, or -mouth contact.1 Severe RSV can increase the risk of bacterial coinfections, pneumonia, and lower respiratory tract infections (LRTI)— particularly in infants and older adults.2

Thankfully, 2023 has been a landmark year for RSV approvals. The FDA approved its first RSV vaccine, called RSV prefusion F protein based (RSVpreF) vaccine, for people aged 60 and over in May 2023.3 In July 2023, the passive monoclonal antibody injection nirsevimab was approved as a preventative option for infants in their first and second winter seasons.4 Finally, the FDA approved the RSVpreF vaccine for pregnant individuals in late August 2023, with the goal of protecting infants.5 However, results from a recent phase 3 trial did not show significance with respect to the primary end point.6

Birth through 6 months is the leading timeframe of RSV-related death because of the low natural defenses and small airways of infants. On August 3, 2023, the CDC Advisory Committee on Immunization Practices unanimously recommended use of nirsevimab for all infants up to 8 months of age at the start of the RSV season and for infants at risk for severe RSV infection until 19 months of age.7 This decision was partly based on the MELODY and MEDLEY trials.8 In an unprecedented move, this monoclonal antibody will be made available through the Vaccines For Children program, the first monoclonal antibody to receive this designation. It is hoped that uptake of this therapy will result in fewer hospitalizations of infants with RSV bronchiolitis.

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Updated Guidelines for COPD Management: 2023 GOLD Strategy Report

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References

 

  1. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2023 Report). Published 2023. Accessed June 6, 2023. https://goldcopd.org/2023-gold-report-2/
  2. Celli B et al. Am J Respir Crit Care Med. 2022;206(11):1317. doi:10.1164/rccm.202204-0671PP
  3. Han M et al. Lancet Respir Med. 2013;1(1):43-50. doi:10.1016/S2213-2600(12)70044-9
  4. Klijn SL et al. NPJ Prim Care Respir Med. 2017;27(1):24. doi:10.1038/s41533-017-0022-1
  5. Chan AH et al. J Allergy Clin Immunol Pract. 2015;3(3):335-349.e1-e5. doi:10.1016/j.jaip.2015.01.024
  6. Brusselle G et al. Int J Chron Obstruct Pulmon Dis. 2015;10:2207-2217. doi:10.2147/COPD.S91694 
  7. Salvi SS, Barnes PJ. Lancet. 2009;374(9691):733-743. doi:10.1016/S0140-6736(09)61303-9
  8. Trupin L et al. Eur Respir J. 2003;22(3):462-469. doi:10.1183/09031936.03.00094203
  9. Celli BR et al. Am J Respir Crit Care Med. 2021;204(11):1251-1258. doi:10.1164/rccm.202108-1819PP
  10. Barnes PJ, Celli BR. Eur Respir J. 2009;33(5):1165-1185. doi:10.1183/09031936.00128008
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Department of Medicine
Baylor College of Medicine
Ben Taub Hospital
Houston, TX

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Ben Taub Hospital
Houston, TX

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Associate Professor
Section of Pulmonary and Critical Care Medicine
Department of Medicine
Baylor College of Medicine
Ben Taub Hospital
Houston, TX

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References

 

  1. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2023 Report). Published 2023. Accessed June 6, 2023. https://goldcopd.org/2023-gold-report-2/
  2. Celli B et al. Am J Respir Crit Care Med. 2022;206(11):1317. doi:10.1164/rccm.202204-0671PP
  3. Han M et al. Lancet Respir Med. 2013;1(1):43-50. doi:10.1016/S2213-2600(12)70044-9
  4. Klijn SL et al. NPJ Prim Care Respir Med. 2017;27(1):24. doi:10.1038/s41533-017-0022-1
  5. Chan AH et al. J Allergy Clin Immunol Pract. 2015;3(3):335-349.e1-e5. doi:10.1016/j.jaip.2015.01.024
  6. Brusselle G et al. Int J Chron Obstruct Pulmon Dis. 2015;10:2207-2217. doi:10.2147/COPD.S91694 
  7. Salvi SS, Barnes PJ. Lancet. 2009;374(9691):733-743. doi:10.1016/S0140-6736(09)61303-9
  8. Trupin L et al. Eur Respir J. 2003;22(3):462-469. doi:10.1183/09031936.03.00094203
  9. Celli BR et al. Am J Respir Crit Care Med. 2021;204(11):1251-1258. doi:10.1164/rccm.202108-1819PP
  10. Barnes PJ, Celli BR. Eur Respir J. 2009;33(5):1165-1185. doi:10.1183/09031936.00128008
References

 

  1. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2023 Report). Published 2023. Accessed June 6, 2023. https://goldcopd.org/2023-gold-report-2/
  2. Celli B et al. Am J Respir Crit Care Med. 2022;206(11):1317. doi:10.1164/rccm.202204-0671PP
  3. Han M et al. Lancet Respir Med. 2013;1(1):43-50. doi:10.1016/S2213-2600(12)70044-9
  4. Klijn SL et al. NPJ Prim Care Respir Med. 2017;27(1):24. doi:10.1038/s41533-017-0022-1
  5. Chan AH et al. J Allergy Clin Immunol Pract. 2015;3(3):335-349.e1-e5. doi:10.1016/j.jaip.2015.01.024
  6. Brusselle G et al. Int J Chron Obstruct Pulmon Dis. 2015;10:2207-2217. doi:10.2147/COPD.S91694 
  7. Salvi SS, Barnes PJ. Lancet. 2009;374(9691):733-743. doi:10.1016/S0140-6736(09)61303-9
  8. Trupin L et al. Eur Respir J. 2003;22(3):462-469. doi:10.1183/09031936.03.00094203
  9. Celli BR et al. Am J Respir Crit Care Med. 2021;204(11):1251-1258. doi:10.1164/rccm.202108-1819PP
  10. Barnes PJ, Celli BR. Eur Respir J. 2009;33(5):1165-1185. doi:10.1183/09031936.00128008
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The Global Initiative for Chronic Obstructive Lung Disease (GOLD) Strategy Report is an evidence-based strategy document for chronic obstructive pulmonary disease (COPD) diagnosis, treatment, and prevention; the GOLD report is used worldwide as a tool for implementing effective COPD management.1 The annual report reviews the major research publications published from the previous years and provides important updated recommendations for care providers.

The 2023 GOLD report includes several new updates, such as a new proposed definition2; strategies for terminology and taxonomy2; etiotypes for COPD2; screening and risk factor updates1; and vaccination recommendations.1 The ABCD Assessment Tool has been revised to recognize the clinical relevance of exacerbations,3 and the section on Interventional and Surgical Therapies for COPD has been expanded.1 Information on imaging and computed tomography (CT) has been included,1 and issues related to inhaled delivery4 and adherence5 have been addressed. Also included is an expanded role of triple inhaled therapy in select patient populations,6 and the complexity of COPD is also examined— which involves not only cigarette smoking, but other exposures as well.7

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Lung Cancer Screening: A Need for Adjunctive Testing

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References
  1. Naidch DP et al. Radiology. 1990;175(3):729-731. doi:10.1148/radiology.175.3.2343122
  2. Kaneko M et al. Radiology. 1996;201(3):798-802. doi:10.1148/radiology.201.3.8939234
  3. National Lung Screening Trial Research Team. Radiology. 2011;258(1):243-253. doi:10.1148/radiol.10091808
  4. National Lung Screening Trial Research Team. J Thorac Oncol. 2019;14(10):1732-1742. doi:10.1016/j.jtho.2019.05.044
  5. Mazzone PJ et al. Chest. 2021;160(5):e427-e494. doi:10.1016/j.chest.2021.06.063
  6. Tanner NT et al. Chest. 2023;S0012-3692(23)00175-7. doi:10.1016/j.chest.2023.02.003
  7. National Lung Screening Trial Research Team. N Engl J Med. 2011;365(5):395- 409. doi:10.1056/NEJMoa1102873
  8. Marmor HN et al. Curr Chall Thorac Surg. 2023;5:5. doi:10.21037/ccts-20-171
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References
  1. Naidch DP et al. Radiology. 1990;175(3):729-731. doi:10.1148/radiology.175.3.2343122
  2. Kaneko M et al. Radiology. 1996;201(3):798-802. doi:10.1148/radiology.201.3.8939234
  3. National Lung Screening Trial Research Team. Radiology. 2011;258(1):243-253. doi:10.1148/radiol.10091808
  4. National Lung Screening Trial Research Team. J Thorac Oncol. 2019;14(10):1732-1742. doi:10.1016/j.jtho.2019.05.044
  5. Mazzone PJ et al. Chest. 2021;160(5):e427-e494. doi:10.1016/j.chest.2021.06.063
  6. Tanner NT et al. Chest. 2023;S0012-3692(23)00175-7. doi:10.1016/j.chest.2023.02.003
  7. National Lung Screening Trial Research Team. N Engl J Med. 2011;365(5):395- 409. doi:10.1056/NEJMoa1102873
  8. Marmor HN et al. Curr Chall Thorac Surg. 2023;5:5. doi:10.21037/ccts-20-171
References
  1. Naidch DP et al. Radiology. 1990;175(3):729-731. doi:10.1148/radiology.175.3.2343122
  2. Kaneko M et al. Radiology. 1996;201(3):798-802. doi:10.1148/radiology.201.3.8939234
  3. National Lung Screening Trial Research Team. Radiology. 2011;258(1):243-253. doi:10.1148/radiol.10091808
  4. National Lung Screening Trial Research Team. J Thorac Oncol. 2019;14(10):1732-1742. doi:10.1016/j.jtho.2019.05.044
  5. Mazzone PJ et al. Chest. 2021;160(5):e427-e494. doi:10.1016/j.chest.2021.06.063
  6. Tanner NT et al. Chest. 2023;S0012-3692(23)00175-7. doi:10.1016/j.chest.2023.02.003
  7. National Lung Screening Trial Research Team. N Engl J Med. 2011;365(5):395- 409. doi:10.1056/NEJMoa1102873
  8. Marmor HN et al. Curr Chall Thorac Surg. 2023;5:5. doi:10.21037/ccts-20-171
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Early detection of lung cancer by screening with low dose computed tomography (LDCT) scanning has long been investigated as a potential means of reducing related deaths.1,2 The 2011 National Lung Screening Trial (NLST) compared LDCT scanning with standard chest radiograph (CXR). Results showed a significant reduction in mortality in high-risk current and former smokers who were screened annually (3×) with LDCT scan vs CXR.3

LDCT scanning for lung cancer is currently a standard of care, partially due to the results of the NLST.4,5 In 2013, LDCT scanning was recommended by the US Preventive Services Task Force (USPSTF), making about 8 million Americans eligible for screening.6 In 2019, an extended NLST cohort follow-up study showed that earlier detection with LDCT scanning not only delayed lung cancer death, but also prevented it—or at least delayed it by a decade or more.4,7 This sparked another change in eligibility criteria in the 2021 USPSTF guidelines, allowing an additional 6.5 million people to be eligible for screening.6

Unfortunately, LDCT scanning has some negative aspects to its use, such as high false-positive rates, repeated radiation exposure, and the lack of ability to distinguish between nodules that are benign or malignant.8 There is a need for adjunctive testing for screening. Some current research is focusing on the development of liquid biomarkers intended to be complementary to imaging as a method of using noninvasive lung cancer diagnostics.

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Tuberculosis Management: Returning to Pre-Pandemic Priorities

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Tuberculosis Management: Returning to Pre-Pandemic Priorities
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Patricio Escalante, MD, MSc, FCCP, and Paige K. Marty, MD

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References
  1. Global tuberculosis report 2022. World Health Organization. Published October 27, 2022. Accessed June 26, 2023. https://www.who.int/publications/i/item/9789240061729
  2. WHO consolidated guidelines on tuberculosis. Module 4: treatment – drug-resistant tuberculosis treatment, 2022 update. World Health Organization. Published December 15, 2022. Accessed June 26, 2023. https://www.who.int/publications/i/item/9789240063129
  3. Migliori GB, Tiberi S. Int J Tuberc Lung Dis. 2022 ;26(7):590-591. doi:10.5588/ijtld.22.0263.
  4. Lange C et al. Am J Respir Crit Care Med. 2022;205(10):1142-1144. doi:10.1164/rccm.202202-0393ED
  5. Esmail A et al. Am J Respir Crit Care Med. 2022;205(10):1214-1227. doi:10.1164/rccm.202107-1779OC
  6. WHO BPaLM Accelerator Platform: to support the call to action for implementation of the shorter and more effective treatment for all people suffering from drug-resistant TB. World Health Organization. Published May 9, 2023. Accessed June 26, 2023. https://www.who.int/news-room/events/detail/2023/05/09/default-calendar/who-bpalm-accelerator-platform–to-support-the-call-to-action-for-implementation-of-the-shorter-and-moreeffective-
  7. Trevisi L et al. Am J Respir Crit Care Med. 2023;207(11):1525-1532. doi:10.1164/rccm.202211-2125OC
  8. Domínguez J et al; TBnet and RESIST-TB networks. Lancet Infect Dis. 2023;23(4):e122-e137. doi:10.1016/S1473-3099(22)00875-1
  9. WHO operational handbook on tuberculosis: module 3: diagnosis: rapid diagnostics for tuberculosis detection, 2021 update. World Health Organization. Published July 7, 2021. Accessed June 26, 2023. https://www.who.int/publications/i/item/9789240030589treatment-for-all-people-suffering-from-drug-resistant-tb
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References
  1. Global tuberculosis report 2022. World Health Organization. Published October 27, 2022. Accessed June 26, 2023. https://www.who.int/publications/i/item/9789240061729
  2. WHO consolidated guidelines on tuberculosis. Module 4: treatment – drug-resistant tuberculosis treatment, 2022 update. World Health Organization. Published December 15, 2022. Accessed June 26, 2023. https://www.who.int/publications/i/item/9789240063129
  3. Migliori GB, Tiberi S. Int J Tuberc Lung Dis. 2022 ;26(7):590-591. doi:10.5588/ijtld.22.0263.
  4. Lange C et al. Am J Respir Crit Care Med. 2022;205(10):1142-1144. doi:10.1164/rccm.202202-0393ED
  5. Esmail A et al. Am J Respir Crit Care Med. 2022;205(10):1214-1227. doi:10.1164/rccm.202107-1779OC
  6. WHO BPaLM Accelerator Platform: to support the call to action for implementation of the shorter and more effective treatment for all people suffering from drug-resistant TB. World Health Organization. Published May 9, 2023. Accessed June 26, 2023. https://www.who.int/news-room/events/detail/2023/05/09/default-calendar/who-bpalm-accelerator-platform–to-support-the-call-to-action-for-implementation-of-the-shorter-and-moreeffective-
  7. Trevisi L et al. Am J Respir Crit Care Med. 2023;207(11):1525-1532. doi:10.1164/rccm.202211-2125OC
  8. Domínguez J et al; TBnet and RESIST-TB networks. Lancet Infect Dis. 2023;23(4):e122-e137. doi:10.1016/S1473-3099(22)00875-1
  9. WHO operational handbook on tuberculosis: module 3: diagnosis: rapid diagnostics for tuberculosis detection, 2021 update. World Health Organization. Published July 7, 2021. Accessed June 26, 2023. https://www.who.int/publications/i/item/9789240030589treatment-for-all-people-suffering-from-drug-resistant-tb
References
  1. Global tuberculosis report 2022. World Health Organization. Published October 27, 2022. Accessed June 26, 2023. https://www.who.int/publications/i/item/9789240061729
  2. WHO consolidated guidelines on tuberculosis. Module 4: treatment – drug-resistant tuberculosis treatment, 2022 update. World Health Organization. Published December 15, 2022. Accessed June 26, 2023. https://www.who.int/publications/i/item/9789240063129
  3. Migliori GB, Tiberi S. Int J Tuberc Lung Dis. 2022 ;26(7):590-591. doi:10.5588/ijtld.22.0263.
  4. Lange C et al. Am J Respir Crit Care Med. 2022;205(10):1142-1144. doi:10.1164/rccm.202202-0393ED
  5. Esmail A et al. Am J Respir Crit Care Med. 2022;205(10):1214-1227. doi:10.1164/rccm.202107-1779OC
  6. WHO BPaLM Accelerator Platform: to support the call to action for implementation of the shorter and more effective treatment for all people suffering from drug-resistant TB. World Health Organization. Published May 9, 2023. Accessed June 26, 2023. https://www.who.int/news-room/events/detail/2023/05/09/default-calendar/who-bpalm-accelerator-platform–to-support-the-call-to-action-for-implementation-of-the-shorter-and-moreeffective-
  7. Trevisi L et al. Am J Respir Crit Care Med. 2023;207(11):1525-1532. doi:10.1164/rccm.202211-2125OC
  8. Domínguez J et al; TBnet and RESIST-TB networks. Lancet Infect Dis. 2023;23(4):e122-e137. doi:10.1016/S1473-3099(22)00875-1
  9. WHO operational handbook on tuberculosis: module 3: diagnosis: rapid diagnostics for tuberculosis detection, 2021 update. World Health Organization. Published July 7, 2021. Accessed June 26, 2023. https://www.who.int/publications/i/item/9789240030589treatment-for-all-people-suffering-from-drug-resistant-tb
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Although we are officially living in a “post-pandemic” world, some long-term global impacts of COVID-19 are still being addressed. We remain off track on global tuberculosis (TB) milestone targets due to halted progress over the last 3 years, with more people going undiagnosed and untreated for TB compared with pre-pandemic years.1 Drug-resistant TB (DR-TB) and multidrug-resistant TB (MDR-TB) continue to represent a major burden, and global spending on TB efforts remains significantly lower than what is needed to reach goals set forth by WHO.1

Despite these challenges, there are also some exciting updates. We now know that TB treatment success rates remained steady during the pandemic (86%), and strong efforts have been made to address DR-TB and MDR-TB via improved treatment options with highly effective, all-oral, shortened treatment regimens, as well as new and promising testing modalities.1-3

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Addressing Physician Burnout in Pulmonology and Critical Care

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Addressing Physician Burnout in Pulmonology and Critical Care in Pulmonology and Critical Care
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Kelly Vranas, MD, MCR

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References
  1. Moss M et al. Crit Care Med. 2016;44(7):1414-1421. doi:10.1097/CCM.000000000000188
  2. Medscape National Physician Burnout, Depression & Suicide Report 2019. Medscape. January 16, 2019. Accessed June 22, 2023. https://www.medscape.com/slideshow/2019-lifestyle-burnout-depression-6011056#1
  3. Medscape National Physician Burnout & Suicide Report 2020: The Generational Divide. Medscape. January 15, 2020. Accessed June 22, 2023. https://www.medscape.com/slideshow/2020-lifestyle-burnout-6012460#1
  4. ‘Death by 1000 Cuts’: Medscape National Physician Burnout & Suicide Report 2021. Medscape. January 22, 2021. Accessed June 22, 2023. https://www.medscape.com/slideshow/2021-lifestyle-burnout-6013456#2
  5. Physician Burnout Report 2022: Stress, Anxiety, and Anger. Medscape. January 21, 2022. Accessed June 22, 2023. https://www.medscape.com/slideshow/2022-lifestyle-burnout-6014664#1
  6. ‘I Cry but No One Cares’: Physician Burnout & Depression Report 2023. Medscape. January 27, 2023. Accessed June 22, 2023. https://www.medscape.com/slideshow/2023-lifestyle-burnout-6016058#1
  7. Murthy VH. N Engl J Med. 2022;387(7):577-579. doi:10.1056/NEJMp2207252
  8. Vranas KC et al. Chest. 2021;160(5):1714-1728. doi:10.1016/j.chest.2021.05.041
  9. Kerlin MP et al. Ann Am Thorac Soc. 2022;19(2):329-331. doi:10.1513/AnnalsATS.202105-567RL
  10. Dean W et al. Fed Pract. 2019;36(9):400-402. PMID: 31571807
  11. Association of American Medical Colleges. The Complexities of Physician Supply and Demand: Projections from 2019 to 2034. June 2021. https://www.aamc.org/media/54681/download?attachment
  12. Medscape Pulmonologist Lifestyle, Happiness & Burnout Report 2023: Contentment Amid Stress. February 24, 2023. Accessed June 28, 2023. https://www.medscape.com/slideshow/2023-lifestyle-pulmonologist-6016092#1
  13. Medscape Intensivist Lifestyle, Happiness & Burnout Report 2023: Contentment Amid Stress. February 24, 2023. Accessed June 28, 2023. https://www.medscape.com/slideshow/2023-lifestyle-intensivist-6016072#1
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Oregon Health & Science University;
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Oregon Health & Science University;
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Portland VA Medical Center
Portland, OR

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Kelly Vranas, MD, MCR
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Division of Pulmonary, Allergy, and Critical Care Medicine
Oregon Health & Science University;
Critical Care Health Services Researcher
Portland VA Medical Center
Portland, OR

Click to view more from Pulmonology Data Trends 2023.

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References
  1. Moss M et al. Crit Care Med. 2016;44(7):1414-1421. doi:10.1097/CCM.000000000000188
  2. Medscape National Physician Burnout, Depression & Suicide Report 2019. Medscape. January 16, 2019. Accessed June 22, 2023. https://www.medscape.com/slideshow/2019-lifestyle-burnout-depression-6011056#1
  3. Medscape National Physician Burnout & Suicide Report 2020: The Generational Divide. Medscape. January 15, 2020. Accessed June 22, 2023. https://www.medscape.com/slideshow/2020-lifestyle-burnout-6012460#1
  4. ‘Death by 1000 Cuts’: Medscape National Physician Burnout & Suicide Report 2021. Medscape. January 22, 2021. Accessed June 22, 2023. https://www.medscape.com/slideshow/2021-lifestyle-burnout-6013456#2
  5. Physician Burnout Report 2022: Stress, Anxiety, and Anger. Medscape. January 21, 2022. Accessed June 22, 2023. https://www.medscape.com/slideshow/2022-lifestyle-burnout-6014664#1
  6. ‘I Cry but No One Cares’: Physician Burnout & Depression Report 2023. Medscape. January 27, 2023. Accessed June 22, 2023. https://www.medscape.com/slideshow/2023-lifestyle-burnout-6016058#1
  7. Murthy VH. N Engl J Med. 2022;387(7):577-579. doi:10.1056/NEJMp2207252
  8. Vranas KC et al. Chest. 2021;160(5):1714-1728. doi:10.1016/j.chest.2021.05.041
  9. Kerlin MP et al. Ann Am Thorac Soc. 2022;19(2):329-331. doi:10.1513/AnnalsATS.202105-567RL
  10. Dean W et al. Fed Pract. 2019;36(9):400-402. PMID: 31571807
  11. Association of American Medical Colleges. The Complexities of Physician Supply and Demand: Projections from 2019 to 2034. June 2021. https://www.aamc.org/media/54681/download?attachment
  12. Medscape Pulmonologist Lifestyle, Happiness & Burnout Report 2023: Contentment Amid Stress. February 24, 2023. Accessed June 28, 2023. https://www.medscape.com/slideshow/2023-lifestyle-pulmonologist-6016092#1
  13. Medscape Intensivist Lifestyle, Happiness & Burnout Report 2023: Contentment Amid Stress. February 24, 2023. Accessed June 28, 2023. https://www.medscape.com/slideshow/2023-lifestyle-intensivist-6016072#1
References
  1. Moss M et al. Crit Care Med. 2016;44(7):1414-1421. doi:10.1097/CCM.000000000000188
  2. Medscape National Physician Burnout, Depression & Suicide Report 2019. Medscape. January 16, 2019. Accessed June 22, 2023. https://www.medscape.com/slideshow/2019-lifestyle-burnout-depression-6011056#1
  3. Medscape National Physician Burnout & Suicide Report 2020: The Generational Divide. Medscape. January 15, 2020. Accessed June 22, 2023. https://www.medscape.com/slideshow/2020-lifestyle-burnout-6012460#1
  4. ‘Death by 1000 Cuts’: Medscape National Physician Burnout & Suicide Report 2021. Medscape. January 22, 2021. Accessed June 22, 2023. https://www.medscape.com/slideshow/2021-lifestyle-burnout-6013456#2
  5. Physician Burnout Report 2022: Stress, Anxiety, and Anger. Medscape. January 21, 2022. Accessed June 22, 2023. https://www.medscape.com/slideshow/2022-lifestyle-burnout-6014664#1
  6. ‘I Cry but No One Cares’: Physician Burnout & Depression Report 2023. Medscape. January 27, 2023. Accessed June 22, 2023. https://www.medscape.com/slideshow/2023-lifestyle-burnout-6016058#1
  7. Murthy VH. N Engl J Med. 2022;387(7):577-579. doi:10.1056/NEJMp2207252
  8. Vranas KC et al. Chest. 2021;160(5):1714-1728. doi:10.1016/j.chest.2021.05.041
  9. Kerlin MP et al. Ann Am Thorac Soc. 2022;19(2):329-331. doi:10.1513/AnnalsATS.202105-567RL
  10. Dean W et al. Fed Pract. 2019;36(9):400-402. PMID: 31571807
  11. Association of American Medical Colleges. The Complexities of Physician Supply and Demand: Projections from 2019 to 2034. June 2021. https://www.aamc.org/media/54681/download?attachment
  12. Medscape Pulmonologist Lifestyle, Happiness & Burnout Report 2023: Contentment Amid Stress. February 24, 2023. Accessed June 28, 2023. https://www.medscape.com/slideshow/2023-lifestyle-pulmonologist-6016092#1
  13. Medscape Intensivist Lifestyle, Happiness & Burnout Report 2023: Contentment Amid Stress. February 24, 2023. Accessed June 28, 2023. https://www.medscape.com/slideshow/2023-lifestyle-intensivist-6016072#1
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Work-related stress has long been a concern for those working in the intensive care unit (ICU); even before the COVID-19 pandemic, it was estimated that up to 45% of critical care physicians had at least one symptom of severe burnout.1-6  In 2020 and the years following, the combination of significantly increased patient morbidity and mortality rates, excessive workloads, and resource limitations negatively impacted employee morale, decreased feelings of professional fulfillment, increased moral distress, and most importantly, heightened mental health concerns among critical care physicians.7-10

While most of the post-pandemic world has returned to “normal,” its effect on the health care industry has been slower to wane; in fact, reported rates of physician burnout remain higher today than they were in 2020.2-6 Almost half of physicians (49%) say their depressions affects their patient interactions, while 65% report that their personal relationships are affected.6 In order to course-correct—not only for the sake of our current workforce and patients, but also to ensure better preparation for future public health crises—we must address the more fundamental burnout contributors that the pandemic only amplified.

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Enlarging pink patches after traveling

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Enlarging pink patches after traveling

Enlarging pink patches

The patient’s multiple pink, subtly annular patches after recent travel to Lyme-endemic areas of the United States demonstrated a classic manifestation of disseminated Lyme disease. An enzyme-linked immunosorbent assay was positive for Borrelia burgdorferi IgM and IgG antibodies, confirming an acute infection.

While not usually necessary, skin biopsy shows a nonspecific perivascular cellular infiltrate that may be comprised of histiocytes, lymphocytes, and plasma cells. Spirochetes are not typically seen, but they may be identified with antibody-labeled or silver stains.

Lyme disease initially manifests as localized disease with erythema migrans, a targetoid lesion on the skin that appears at the site of the tick bite. This initial stage develops within the first few weeks of the bite and may be accompanied by fatigue and a low-grade fever.

If left untreated, the infection may progress to early disseminated disease, which occurs weeks to months after the initial bite. This second stage of Lyme disease manifests with multiple erythema migrans lesions on additional parts of the body, indicating spirochete dissemination through the bloodstream and lymphatic system. Early disseminated disease may also include borrelial lymphocytoma, Lyme neuroborreliosis, and cardiac conduction abnormalities such as AV block.

The third stage of Lyme disease, late Lyme disease, occurs months to years after an initial infection that has gone untreated. The key feature of this stage is arthritis, which tends to affect the knees and may be migratory in nature. Neurological symptoms such as encephalopathy and polyneuropathies may also develop. A minority of patients with late Lyme disease may develop acrodermatitis chronica atrophicans, a rash that typically occurs on the dorsal hands and feet as blue-red plaques that turn the affected skin atrophic.1

This patient was treated with a 3-week course of oral doxycycline 100 mg twice daily and was referred to an infectious disease specialist for further work-up of systemic symptoms, given the risk for cardiac pathology in disseminated Lyme disease.

‌

Photo courtesy of Le Wen Chiu, MD. Text courtesy of Le Wen Chiu, MD, Department of Dermatology, University of New Mexico School of Medicine, Albuquerque, and Daniel Stulberg, MD, FAAFP, Professor and Chair, Department of Family and Community Medicine, Western Michigan University Homer Stryker, MD School of Medicine, Kalamazoo.

References

1. Cardenas-de la Garza JA, De la Cruz-Valadez E, Ocampo-Candiani J, et al. Clinical spectrum of Lyme disease. Eur J Clin Microbiol Infect Dis. 2019;38:201-208. doi:10.1007/s10096-018-3417-1

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Enlarging pink patches

The patient’s multiple pink, subtly annular patches after recent travel to Lyme-endemic areas of the United States demonstrated a classic manifestation of disseminated Lyme disease. An enzyme-linked immunosorbent assay was positive for Borrelia burgdorferi IgM and IgG antibodies, confirming an acute infection.

While not usually necessary, skin biopsy shows a nonspecific perivascular cellular infiltrate that may be comprised of histiocytes, lymphocytes, and plasma cells. Spirochetes are not typically seen, but they may be identified with antibody-labeled or silver stains.

Lyme disease initially manifests as localized disease with erythema migrans, a targetoid lesion on the skin that appears at the site of the tick bite. This initial stage develops within the first few weeks of the bite and may be accompanied by fatigue and a low-grade fever.

If left untreated, the infection may progress to early disseminated disease, which occurs weeks to months after the initial bite. This second stage of Lyme disease manifests with multiple erythema migrans lesions on additional parts of the body, indicating spirochete dissemination through the bloodstream and lymphatic system. Early disseminated disease may also include borrelial lymphocytoma, Lyme neuroborreliosis, and cardiac conduction abnormalities such as AV block.

The third stage of Lyme disease, late Lyme disease, occurs months to years after an initial infection that has gone untreated. The key feature of this stage is arthritis, which tends to affect the knees and may be migratory in nature. Neurological symptoms such as encephalopathy and polyneuropathies may also develop. A minority of patients with late Lyme disease may develop acrodermatitis chronica atrophicans, a rash that typically occurs on the dorsal hands and feet as blue-red plaques that turn the affected skin atrophic.1

This patient was treated with a 3-week course of oral doxycycline 100 mg twice daily and was referred to an infectious disease specialist for further work-up of systemic symptoms, given the risk for cardiac pathology in disseminated Lyme disease.

‌

Photo courtesy of Le Wen Chiu, MD. Text courtesy of Le Wen Chiu, MD, Department of Dermatology, University of New Mexico School of Medicine, Albuquerque, and Daniel Stulberg, MD, FAAFP, Professor and Chair, Department of Family and Community Medicine, Western Michigan University Homer Stryker, MD School of Medicine, Kalamazoo.

Enlarging pink patches

The patient’s multiple pink, subtly annular patches after recent travel to Lyme-endemic areas of the United States demonstrated a classic manifestation of disseminated Lyme disease. An enzyme-linked immunosorbent assay was positive for Borrelia burgdorferi IgM and IgG antibodies, confirming an acute infection.

While not usually necessary, skin biopsy shows a nonspecific perivascular cellular infiltrate that may be comprised of histiocytes, lymphocytes, and plasma cells. Spirochetes are not typically seen, but they may be identified with antibody-labeled or silver stains.

Lyme disease initially manifests as localized disease with erythema migrans, a targetoid lesion on the skin that appears at the site of the tick bite. This initial stage develops within the first few weeks of the bite and may be accompanied by fatigue and a low-grade fever.

If left untreated, the infection may progress to early disseminated disease, which occurs weeks to months after the initial bite. This second stage of Lyme disease manifests with multiple erythema migrans lesions on additional parts of the body, indicating spirochete dissemination through the bloodstream and lymphatic system. Early disseminated disease may also include borrelial lymphocytoma, Lyme neuroborreliosis, and cardiac conduction abnormalities such as AV block.

The third stage of Lyme disease, late Lyme disease, occurs months to years after an initial infection that has gone untreated. The key feature of this stage is arthritis, which tends to affect the knees and may be migratory in nature. Neurological symptoms such as encephalopathy and polyneuropathies may also develop. A minority of patients with late Lyme disease may develop acrodermatitis chronica atrophicans, a rash that typically occurs on the dorsal hands and feet as blue-red plaques that turn the affected skin atrophic.1

This patient was treated with a 3-week course of oral doxycycline 100 mg twice daily and was referred to an infectious disease specialist for further work-up of systemic symptoms, given the risk for cardiac pathology in disseminated Lyme disease.

‌

Photo courtesy of Le Wen Chiu, MD. Text courtesy of Le Wen Chiu, MD, Department of Dermatology, University of New Mexico School of Medicine, Albuquerque, and Daniel Stulberg, MD, FAAFP, Professor and Chair, Department of Family and Community Medicine, Western Michigan University Homer Stryker, MD School of Medicine, Kalamazoo.

References

1. Cardenas-de la Garza JA, De la Cruz-Valadez E, Ocampo-Candiani J, et al. Clinical spectrum of Lyme disease. Eur J Clin Microbiol Infect Dis. 2019;38:201-208. doi:10.1007/s10096-018-3417-1

References

1. Cardenas-de la Garza JA, De la Cruz-Valadez E, Ocampo-Candiani J, et al. Clinical spectrum of Lyme disease. Eur J Clin Microbiol Infect Dis. 2019;38:201-208. doi:10.1007/s10096-018-3417-1

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Data Trends 2023: Access to Women's Health Care

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References
  1. US Department of Veteran Affairs. Facts and statistics: women veterans in focus. Updated January 31, 2023. Accessed May 5, 2023. https://www.womenshealth.va.gov/materials-and-resources/facts-and-statistics.asp
  2. US Department of Defense. Department of Defense Releases Annual Demographics Report — Upward Trend in Number of Women Serving Continues. Published December 14, 2022. Accessed June 12, 2023. https://www.defense.gov/News/Releases/Release/Article/3246268/department-of-defense-releases-annual-demographics-report-upwardtrend-in-numbe/
  3. Meadows SO, Collins RL, Schuler MS, Beckman RL, Cefalu M. The Women’s Reproductive Health Survey (WRHS) of active-duty service members. RAND Corporation. Published 2022. Accessed May 5, 2023. https://www.rand.org/content/dam/rand/pubs/research_reports/RRA1000/RRA1031-1/RAND_RRA1031-1.pdf
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Click to read more from Federal Health Care Data Trends 2023.

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References
  1. US Department of Veteran Affairs. Facts and statistics: women veterans in focus. Updated January 31, 2023. Accessed May 5, 2023. https://www.womenshealth.va.gov/materials-and-resources/facts-and-statistics.asp
  2. US Department of Defense. Department of Defense Releases Annual Demographics Report — Upward Trend in Number of Women Serving Continues. Published December 14, 2022. Accessed June 12, 2023. https://www.defense.gov/News/Releases/Release/Article/3246268/department-of-defense-releases-annual-demographics-report-upwardtrend-in-numbe/
  3. Meadows SO, Collins RL, Schuler MS, Beckman RL, Cefalu M. The Women’s Reproductive Health Survey (WRHS) of active-duty service members. RAND Corporation. Published 2022. Accessed May 5, 2023. https://www.rand.org/content/dam/rand/pubs/research_reports/RRA1000/RRA1031-1/RAND_RRA1031-1.pdf
References
  1. US Department of Veteran Affairs. Facts and statistics: women veterans in focus. Updated January 31, 2023. Accessed May 5, 2023. https://www.womenshealth.va.gov/materials-and-resources/facts-and-statistics.asp
  2. US Department of Defense. Department of Defense Releases Annual Demographics Report — Upward Trend in Number of Women Serving Continues. Published December 14, 2022. Accessed June 12, 2023. https://www.defense.gov/News/Releases/Release/Article/3246268/department-of-defense-releases-annual-demographics-report-upwardtrend-in-numbe/
  3. Meadows SO, Collins RL, Schuler MS, Beckman RL, Cefalu M. The Women’s Reproductive Health Survey (WRHS) of active-duty service members. RAND Corporation. Published 2022. Accessed May 5, 2023. https://www.rand.org/content/dam/rand/pubs/research_reports/RRA1000/RRA1031-1/RAND_RRA1031-1.pdf
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There are currently more than 2 million female veterans and more than 230,000 women serving in the active-duty force, and these numbers are expected to grow every year.1,2 A recent survey of the female active-duty population examined whether they were satisfied with the care they have received from the MHS.3 Among many remaining gaps in care, nearly a third found it difficult to make an appointment with an OB/GYN, while some experienced difficulty obtaining their preferred form of birth control.

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References
  1. Morse JL et al. J Psychiatr Res. 2023;159:224-229. doi:10.1016/j.jpsychires.2023.01.039
  2. van Vollenhoven RF. BMC Med. 2009;7:12. doi:10.1186/1741-7015-7-12
  3. US Department of Veteran Affairs, National Center for Veteran Analysis and Statistics. Profile of veterans: 2017. Published March 2019. Accessed April 27, 2023. https://www.va.gov/vetdata/docs/SpecialReports/Profile_of_Veterans_2017.pdf
  4. Johnson TM et al. Arthritis Care Res (Hoboken). 2022 Nov 4. doi:10.1002/acr.25053
  5. Ebel AV et al. Arthritis Rheumatol. 2021;73(3):392-400. doi:10.1002/art.41559
  6. Sokolove J et al. Rheumatology (Oxford). 2016;55(11):1969-1977. doi:10.1093/rheumatology/kew285
  7. Alpizar-Rodriguez D et al. Rheumatology (Oxford). 2019;58(3):432-440. doi:10.1093/rheumatology/key311
  8. Chancay MG et al. Womens Midlife Health. 2019;5:3. doi:10.1186/s40695-019-0047-4
  9. Bongartz T et al. Arthritis Rheum. 2010;62(6):1583-1591. doi:10.1002/art.27405
  10. Kelly CA et al. Rheumatology (Oxford). 2014;53(9):1676-1682. doi:10.1093/rheumatology/keu165
  11. Koduri G et al. Rheumatology (Oxford). 2010;49(8):1483-1489. doi:10.1093/rheumatology/keq035
  12. Olson AL et al. Am J Respir Crit Care Med. 2011;183(3):372-378. doi:10.1164/rccm.201004-0622OC
  13. Mikuls TR et al. Rheumatology (Oxford). 2011;50(1):101-109. doi:10.1093/rheumatology/keq232
  14. England BR et al. Arthritis Care Res. 2016;68(1):36-45. doi:10.1002/acr.22642
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References
  1. Morse JL et al. J Psychiatr Res. 2023;159:224-229. doi:10.1016/j.jpsychires.2023.01.039
  2. van Vollenhoven RF. BMC Med. 2009;7:12. doi:10.1186/1741-7015-7-12
  3. US Department of Veteran Affairs, National Center for Veteran Analysis and Statistics. Profile of veterans: 2017. Published March 2019. Accessed April 27, 2023. https://www.va.gov/vetdata/docs/SpecialReports/Profile_of_Veterans_2017.pdf
  4. Johnson TM et al. Arthritis Care Res (Hoboken). 2022 Nov 4. doi:10.1002/acr.25053
  5. Ebel AV et al. Arthritis Rheumatol. 2021;73(3):392-400. doi:10.1002/art.41559
  6. Sokolove J et al. Rheumatology (Oxford). 2016;55(11):1969-1977. doi:10.1093/rheumatology/kew285
  7. Alpizar-Rodriguez D et al. Rheumatology (Oxford). 2019;58(3):432-440. doi:10.1093/rheumatology/key311
  8. Chancay MG et al. Womens Midlife Health. 2019;5:3. doi:10.1186/s40695-019-0047-4
  9. Bongartz T et al. Arthritis Rheum. 2010;62(6):1583-1591. doi:10.1002/art.27405
  10. Kelly CA et al. Rheumatology (Oxford). 2014;53(9):1676-1682. doi:10.1093/rheumatology/keu165
  11. Koduri G et al. Rheumatology (Oxford). 2010;49(8):1483-1489. doi:10.1093/rheumatology/keq035
  12. Olson AL et al. Am J Respir Crit Care Med. 2011;183(3):372-378. doi:10.1164/rccm.201004-0622OC
  13. Mikuls TR et al. Rheumatology (Oxford). 2011;50(1):101-109. doi:10.1093/rheumatology/keq232
  14. England BR et al. Arthritis Care Res. 2016;68(1):36-45. doi:10.1002/acr.22642
References
  1. Morse JL et al. J Psychiatr Res. 2023;159:224-229. doi:10.1016/j.jpsychires.2023.01.039
  2. van Vollenhoven RF. BMC Med. 2009;7:12. doi:10.1186/1741-7015-7-12
  3. US Department of Veteran Affairs, National Center for Veteran Analysis and Statistics. Profile of veterans: 2017. Published March 2019. Accessed April 27, 2023. https://www.va.gov/vetdata/docs/SpecialReports/Profile_of_Veterans_2017.pdf
  4. Johnson TM et al. Arthritis Care Res (Hoboken). 2022 Nov 4. doi:10.1002/acr.25053
  5. Ebel AV et al. Arthritis Rheumatol. 2021;73(3):392-400. doi:10.1002/art.41559
  6. Sokolove J et al. Rheumatology (Oxford). 2016;55(11):1969-1977. doi:10.1093/rheumatology/kew285
  7. Alpizar-Rodriguez D et al. Rheumatology (Oxford). 2019;58(3):432-440. doi:10.1093/rheumatology/key311
  8. Chancay MG et al. Womens Midlife Health. 2019;5:3. doi:10.1186/s40695-019-0047-4
  9. Bongartz T et al. Arthritis Rheum. 2010;62(6):1583-1591. doi:10.1002/art.27405
  10. Kelly CA et al. Rheumatology (Oxford). 2014;53(9):1676-1682. doi:10.1093/rheumatology/keu165
  11. Koduri G et al. Rheumatology (Oxford). 2010;49(8):1483-1489. doi:10.1093/rheumatology/keq035
  12. Olson AL et al. Am J Respir Crit Care Med. 2011;183(3):372-378. doi:10.1164/rccm.201004-0622OC
  13. Mikuls TR et al. Rheumatology (Oxford). 2011;50(1):101-109. doi:10.1093/rheumatology/keq232
  14. England BR et al. Arthritis Care Res. 2016;68(1):36-45. doi:10.1002/acr.22642
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One in 20 veterans have been diagnosed with rheumatoid arthritis (RA). It is more common among certain sociodemographic groups and has been associated with an enhanced mental and physical health burden.1

The 2019-2020 National Health and Resilience in Veterans Study (NHRVS) showed that RA in the veteran population is associated with several comorbid medical conditions, more severe somatic symptoms, higher occurrence of insomnia, subthreshold PTSD, and increased alcohol use.1

RA is 3 times more common in people assigned as female at birth compared with people assigned as male.2 Even though men currently comprise about 90% of the veteran population, the relevance of RA to the VA health system has grown with the continued increase in female veterans.3

A retrospective study of VHA records from the past 2 decades examined temporal trends in all-cause and cause-specific mortality in patients with RA. Excess RA-related mortality was shown to be driven by cardiovascular, cancer, respiratory, and infectious causes—particularly cardiopulmonary diseases.4 Findings have also suggested that military burn pit and waste disposal inhalant exposures are associated with autoantibody expression in RA, possibly affecting the risk of developing RA and the disease course itself.5 These findings support the predictor that not only lung disease but also smoking is a major driver of RA disease state.6

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