Pulmonary Care Research Articles

Pulmonary care in children with sickle cell disease is paramount to quality of life and health. Early identification and treatment of common respiratory conditions such as asthma and sleep-disordered breathing can help decrease morbidity in this population. Understanding how respiratory comorbidities can lead to end-organ damage and acute chest syndrome can lead to more proactive care when the patient is at health baseline. Patient access to specialty care may be limited, but robust primary care can lead to life-saving interventions. Pediatricians, pediatric pulmonologists, and pediatric hematologists can partner together to deliver multidisciplinary care that addresses medical, ethical, and social considerations for a population of children that deserves comprehensive care.

Patients with acute pulmonary embolism (PE) may present with cardiac arrest, overt or impending cardiogenic shock and/or severe respiratory insufficiency. Immediate evaluation and management of these patients require high clinical suspicion along with (bedside) imaging to confirm the diagnosis, targeted haemodynamic and/or respiratory support, appropriate anticoagulant treatment, and in many cases reperfusion therapy. The immediate treatment decision-making is largely driven by local expertise and resources and should be guided by the individual patient's characteristics such as cardiopulmonary comorbidities, risk of bleeding and location, extent and hemodynamic impact of the clot. Over the past years, treatment options for patients with severe PE have expanded substantially. For instance, several new catheter-guided reperfusion therapies have emerged and experience with circulatory mechanical support has increased. Along with the rise of new interventional therapies has come the introduction of expert multidisciplinary pulmonary embolism (EXPERT-PE) care teams, composed of multidisciplinary specialists involved in treating severe acute PE. This model of care provides a platform for rapid decisions on individualized treatment strategies, combining expert opinion from all involved specialties, setting the quality standards for modern local and regional equity PE care, and forming the base for future research in this area. Clinical decisions should be evidence-based where possible, and incorporate the individual patient's and their carer's preferences, values, and priorities, as well as those of the managing clinicians and care team. In this review, we summarize the evidence for the introduction of EXPERT-PE care teams and provide a practical manual for their successful implementation.

IntroductionCommunication regarding serious illness is an integral part of Pulmonary and Critical Care Medicine (PCCM) fellows' day-to-day practice, however routine communication skills training is not consistently built in PCCM fellowship curricula nationwide. Geritalk, a previously validated interactive curriculum, can be adapted to address unique communication challenges in critical illness.MethodsIn 2024, after performing a needs assessment among PCCM fellows at Mount Sinai Hospital, a two-part curriculum was adapted from Geritalk through collaborations between PCCM and palliative care specialists. The curriculum consisted of a one-hour didactic followed by a one-hour small group workshop with case discussion and role-play. Pre- and post-curricular surveys were conducted among the fellows to assess changes in self-reported comfort levels in different components of communication during a family meeting.ResultsAmong 17 eligible PCCM fellows, a total of 14 (82.4%) fellows completed the pre-curricular survey, and 8 fellows (47.1%) completed the curriculum and post-curricular survey. Prior to the curriculum, fellows reported lower comfort levels in communicating prognosis (mean[SD] 3.8[1.0] on a 5-point Likert scale), responding to emotions (mean[SD] 4.0[0.8]), eliciting values (mean[SD] 3.8[0.8]), and describing comfort care (mean[SD] 3.9[1.0]). After the training, fellows reported moderate to significant increase in comfort levels, especially in responding to emotions (mean[SD] 4.3[0.7]) and eliciting values (mean[SD] 4.4[0.5]).ConclusionA two-part, critical care-focused curriculum adapted from Geritalk showed feasibility in communication training among PCCM fellows with improved self-assessed comfort levels in leading a family meeting. Future studies should incorporate objective assessment of competency and evaluate generalizability to other training programs.

Humanizing pulmonary care in the era of acoustic artificial intelligence: toward global health equity

Gastroesophageal Balloon Tamponade Simulation-Based Mastery Learning Curriculum for Critical Care Fellows.

In this narrative medicine essay, a pulmonary and critical care physician credits the songs of Raffi and Barney for bringing peace and continuity to his daughter who experienced intractable seizures and progressive functional decline.

BackgroundEscape Rooms in medical education have been shown to improve learner satisfaction and reinforce knowledge in pulmonary and critical care medicine, yet virtual escape rooms (VER) as instructional strategies have remained understudied.ObjectiveWe aimed to evaluate participants’ perception and knowledge acquisition after completing a VER as part of a national fellows’ course.MethodsWe designed a prospective study conducted during the 2022 CHEST Pulmonary and Critical Care Medicine Fellow's Virtual course. This was a 2-day back-to-back national course targeting pulmonary and critical care fellows. The course had 5 virtual and 1 VER session, each lasting 50 min. A pre- and post-course knowledge assessment included 9 clinical questions (1 for each of the 5 virtual sessions and 4 for the VER session). A summative score and an individual session score were obtained. Participant's VER perceptions were analyzed using a 5-point Likert scale (1 = strongly disagree and 5 = strongly agree).ResultsFifty-nine (34.5%) of the 165-course participants completed the pre-test, and 29 (17.8%) completed the post-course test. Higher clinical knowledge assessment total score and VER scores were seen in the post-test compared to the pre-test (77.8 ± 14.9 vs 59.6 ± 23.1 P < .001) and (77.3 ± 26.6 vs 62.5 ± 32.5, P < .05) respectively. VER perceptions in the course were positive across participants and sustained after deployment.ConclusionsImplementing an educational VER in a national pulmonary and critical care fellows’ virtual course may promote knowledge acquisition and could potentially lead to a positive perception among participants. Longitudinal studies in various contexts are required to further elucidate direct causality between gamification and learner centric outcomes.

Did COVID-19 Curb Residents' Enthusiasm for Pulmonary Disease and Critical Care Medicine/Critical Care Medicine Fellowships?

670 Integrating cystic fibrosis care principles into bronchiectasis and pulmonary NTM care: a case series of CFTR-related disease from a growing multidisciplinary program

Primary ciliary dyskinesia (PCD) is a genetically and clinically diverse disorder characterised by loss of normal ciliary function leading to chronic oto-sino-pulmonary disease, situs abnormalities and subfertility in men and women. There is limited evidence to support robust guidelines on the management of children and adults with PCD, however there is a clear clinical need to establish a framework of care for the follow-up of these patients. The ERS has published consensus statements on diagnostic and treatment approaches in children with PCD, and the BEAT-PCD network provides guidance on infection prevention and control. This is a National consensus statement to outline a set of standards for the provision of specialist care for children and adults with PCD living in England. A national PCD expert panel made up of specialists working in both paediatric and adult UK highly specialist management services, was established to create a consensus statement on the minimum standards of care for PCD. Using a modified Delphi process, consensus to a statement required at least 80% agreement within the PCD expert panel group. Patient organisation representatives were involved in reviewing the statement and have produced an accompanying layperson summary. We present a consensus statement on 15 standards covering provision of pulmonary, ENT and fertility care, screening for situs abnormalities and transition from paediatric to adult care services. It is targeted at clinicians and allied health professionals managing paediatric and adult patients with PCD, patient organisations and patients and their families.

IntroductionThere is a lack of a standardized curriculum for the appropriate use of noninvasive ventilation (NIV), which is readily accessible. Management of NIV is a core competency for physicians training in pulmonary and critical care medicine (PCCM). We present a blended model of instruction that was highly successful in our pilot program.MethodsThe curriculum targeted eight first-year PCCM fellows to assess knowledge and confidence in key competencies of NIV management. After a baseline assessment, fellows engaged in both hands-on instruction and traditional didactics in NIV. Following, fellows were encouraged to use the e-learning modules for enhanced instruction. The modules were designed to cover all major aspects of NIV management and with unique interactive patient cases for both inpatient and outpatient uses of NIV.ResultsEight first-year PCCM fellows completed the training and responded to the posttest assessment 4 weeks later. The average multiple-choice questions (MCQs) score increased from 13.5 ± 3.2 (54.0%) to 18.4 ± 1.6 (73.6%) and was significant (p = 0.004). A Likert assessment of learner confidence also showed significant improvement across several key competency domains.ConclusionThis curriculum represents a successful and novel approach to NIV education, a critical but challenging core competency in pulmonary medicine for physicians training in PCCM.

PurposeWe conducted a quality improvement study to gain insight into how the COVID-19 pandemic affected the education of trainees in pulmonary and critical care medicine (PCCM). We also sought to understand the experiences of fellows to better prepare for future pandemics.MethodsWe sent an electronic survey to fellows of an academic PCCM program and used data from the electronic survey to design semi-structured interviews for a qualitative study.ResultsThree themes were generated, centred on the emotional burden and physical demand, friendship, and education. Favourable aspects included the organizational response to the pandemic, particularly in terms of communication, personal protective equipment, and an emphasis on teamwork. Fellows became proficient in critical care procedures. The need for a trainees’ respite area was emphasized. Other areas of concern included the lack of leadership to facilitate assistance from various services in the ICU and ensuring adequate education in pulmonary medicine, despite the extended demands of critical care.ConclusionParticipants were dismayed at the lack of support from other services. The shift to virtual lectures resulted in a loss of personal contact and connections, as fellows much preferred in-person sessions. Our results highlight opportunities for learning, fulfillment, and challenges encountered while navigating a pandemic.

BackgroundMonitoring lung function course in patients with pulmonary fibrosis is crucial to guide treatment decisions. Online home spirometry holds great potential for close monitoring and improving care access in times of pressured healthcare systems. However, little data is available on its large-scale use in daily practice. We evaluated the clinical applicability of online home spirometry in pulmonary fibrosis care.MethodsWe analysed data of a nationwide Dutch cohort of patients with idiopathic pulmonary fibrosis (IPF) and other forms of pulmonary fibrosis (PF) that used a home monitoring programme with home spirometry (forced vital capacity (FVC)) as part of daily practice. Changes in FVC were evaluated with a joint model. Within-patient variability was measured using coefficient of variation. Home spirometry use over time and patient experiences were assessed.ResultsOnline home spirometry data of 334 patients (IPF 73.1%) were analysed. Patients with IPF had a mean baseline FVC of 3.02 L (95% CI: 2.27–3.79), with a mean annualised decline of 170 mL (4.0%). Patients with PF had a mean baseline FVC of 2.81 L (95% CI: 2.07–3.55) with a mean annualised decline of 88 mL (1.2%). Mean±sd within-patient variability was 5.6±4.6%. Overall patient satisfaction was high, and after 1 year 63.4% still performed online home spirometry.ConclusionOnline home spirometry is feasible on a large scale in daily clinical practice to monitor disease trajectories in patients with IPF and PF. Online home spirometry could guide management decisions and improve care access for a majority of patients with pulmonary fibrosis.

The "Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer (2025 edition)" was collaboratively completed under the leadership of Professor Han Baohui from the Department of Pulmonary and Critical Care Medicine at Shanghai Chest Hospital and Professor Wang Jie from the Department of Medical Oncology at the Cancer Hospital of the Chinese Academy of Medical Sciences & Peking Union Medical College. The guideline involved the cooperation of more than 50 lung cancer diagnosis and treatment institutions and over 100 experts across China. Since the completion of the first edition in 2018, the guideline is typically revised annually to promptly incorporate the latest advancements in the field of lung cancer. The most distinctive feature of these guidelines is that they exclusively reference the indications approved by the National Medical Products Administration of China. At the same time, particular emphasis is placed on integrating clinical research data from Chinese scholars based on Chinese patients, thereby enhancing the guidelines' authority, applicability, and drug accessibility. The "Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer (2025 edition)" was officially published in September 2025. To better introduce the key points of the guidelines to peers, this interpretation has been prepared.

BackgroundType 1 spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disease characterized by severe muscle weakness, which results in progressive spinal and chest deformities. This study aims to evaluate the effect of thoracolumbosacral orthosis (TLSO) use along with pulmonary care (PC), individualized pulmonary rehabilitation (IPR), and individualized trunk exercises (ITE) in children with Type 1 SMA.MethodsThe study enrolled 24 children with Type 1 SMA aged 2–6 years, with a scoliosis angle of 20°–40°. Participants were randomly assigned into two groups using a stratified randomization method: Group 1 (PC, IPR, ITE) and Group 2 (PC, IPR, ITE & TLSO). All participants underwent an 8-week treatment program. Pre- and post-treatment assessments included scoliosis progression measured by the Cobb angle, chest deformity evaluated through the basal upper-lower chest wall ratio and the Supine Angle of Trunk Rotation Test (SATR), and motor function levels assessed using the Children’s Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP INTEND).ResultsSignificant improvements were observed in Cobb angle, bell-shaped chest deformity, and motor function in both groups (p < 0.05). Group 2 demonstrated greater improvements in effect size (ES) across all evaluation parameters. Compared to Group 1, Group 2 showed superior improvement in Cobb angle (ES = 3.98), basal upper-lower chest wall ratio (ES = 5.00), SATRL (lower) (ES = 2.55), SATRU (upper) (ES = 1.64), and CHOP INTEND (ES = 1.23) (p < 0.05).ConclusionsThis study is the first to demonstrate that the combination of PC, IPR, ITE, and TLSO yields superior clinical outcomes in children with Type 1 SMA. The findings support current recommendations for TLSO use in patients with a Cobb angle >20°, and emphasize the potential benefits of early, proactive orthotic intervention when integrated with mobilization, trunk, and pulmonary exercise programs in managing scoliosis in this population. However, limitations such as the small sample size and short follow-up period underscore the need for larger and longer-term studies to confirm these findings. Trial Registiration:NCT05878418

Background/Objectives: Pleural effusion is a common pulmonary condition that, if left untreated, may lead to respiratory distress and severe complications. Chest X-ray (CXR) imaging is routinely used by physicians to identify signs of pleural effusion. However, manually examining large volumes of CXR images on a daily basis can require substantial time and effort. To address this issue, this study proposes an automated pleural effusion detection system for CXR images. Methods: The proposed system integrates image cropping, image enhancement, and the EfficientNet-B0 deep learning model to assist in detecting pleural effusion, a task that is often challenging due to subtle symptom presentation. Image cropping was applied to extract the region from the heart to the costophrenic angle as the target area. Subsequently, image enhancement techniques were employed to emphasize pleural effusion features, thereby improving the model’s learning efficiency. Finally, EfficientNet-B0 was used to train and classify pleural effusion cases based on processed images. Results: In the experimental results, the proposed image enhancement approach improved the model’s recognition accuracy by approximately 4.33% compared with the non-enhanced method, confirming that enhancement effectively supports subsequent model learning. Ultimately, the proposed system achieved an accuracy of 93.27%, representing a substantial improvement of 21.30% over the 77.00% reported in previous studies, highlighting its significant advancement in pleural effusion detection. Conclusions: This system can serve as an assistive diagnostic tool for physicians, providing standardized detection results, reducing the workload associated with manual interpretation, and improving the overall efficiency of pulmonary care.

Severe pneumonia is a common clinical respiratory disease that is frequently managed by physicians in the Department of Pulmonary and Critical Care Medicine (PCCM). The development of acute respiratory distress syndrome (ARDS) and sepsis are critical factors that contribute to the disease progression and a poor prognosis in severe pneumonia patients. As a key focus in the diagnosis and treatment of critical illnesses, the management of severe pneumonia leverages the strengths of the discipline for pulmonary and critical care physicians. Significant importance is placed on emphasizing early screening, timely diagnosis, and precise treatment, mastering critical care technologies, and improving the understanding and management of severe illnesses, for the advancement of the field.

Quantifying Practice Variability to Inform the Design of Implementation Programs in Critical Care and Assess Their Impact.

Pulmonary chronic graft-versus-host disease (cGVHD), particularly bronchiolitis obliterans syndrome (BOS), is a severe complication of allogeneic haematopoietic stem cell transplantation (allo-HSCT) with significant morbidity and mortality. This report, developed collaboratively by experts from the Taiwan Society of Blood and Marrow Transplantation (TBMT) and the Taiwan Society of Pulmonary and Critical Care Medicine (TSPCCM), provides consensus statements for the diagnosis, surveillance and management of pulmonary cGVHD. Early detection through pulmonary function tests (PFTs) is critical, with serial monitoring recommended after allo-HSCT. High-resolution computed tomography (HRCT) serves as a valuable diagnostic tool, whereas bronchoalveolar lavage along with multiplex polymerase chain reaction (PCR) helps rule out infectious aetiologies. The first-line treatment approach includes inhaled and systemic corticosteroids, bronchodilators and azithromycin. The fluticasone-azithromycin-montelukast (FAM) regimen has demonstrated notable efficacy in stabilizing lung function. Emerging therapies such as ruxolitinib, belumosudil, abatacept and axatilimab offer promising benefits for refractory cases, whereas lung transplantation is a viable last resort for advanced disease. Comprehensive supportive care, encompassing pulmonary rehabilitation and infection prophylaxis, is an essential component of management. This consensus report highlights the importance of standardized PFT surveillance, early intervention and individualized immunosuppressive strategies. Future research should focus on refining diagnostic biomarkers and optimizing therapeutic approaches to improve patient outcomes.

Background:A minority of Pulmonary and Critical Care Medicine (PCCM) graduates pursue careers in academic medicine. Although compensation is only a portion of the career decision, job negotiations remain shrouded in ambiguity and inconsistency. Additionally, while role-level salary tables exist through the Association of American Medical Colleges (AAMC), to our knowledge there is no resource that includes important non-salary information such as start-up packages, full-time equivalent (FTE) breakdown, and bonus ranges.Objective:We sought to describe key components of first PCCM academic job offers for both physician scientists and clinician educators, including salary, start-up packages, non-clinical FTE, and bonuses.Methods:An electronic survey was distributed via a snowball method between May - June 2025. PCCM graduates between 2020–2025 who accepted a job in academic medicine were included. Mann-Whitney Wilcoxon tests were used for ordinal comparisons. Qualitative analysis of free text responses was performed with a social cognitive career theory framework.Results:There were 60 respondents who provided information about 103 job offers, with 50% (14/28) of physician-scientists and 66% (21/32) of clinician-educators reporting more than one job offer. Physician-scientists received lower salary offers compared to clinician-educators (respective median ranges: $150,000-$199,999 vs $250,000-$299,999, p<0.001). 35.7% physician-scientists (10/28) received a career development award prior to negotiation, which was associated with a higher start-up package offer (p<0.05). For all clinician-educator jobs (n=59), 42.4% had non-clinical FTE in the initial offer. Many respondents commented on the lack of negotiating power.Conclusion:PCCM physician-scientists and clinician-educators experience wide variability in their initial job offers. Recognizing differences is essential to improve transparency in job negotiations in academic medicine.