American College of Chest Physicians, Oct. 16-19

The annual meeting of the American College of Chest Physicians was held this year from Oct. 16 to 19 in Nashville, Tennessee, and attracted participants from around the world, including specialists and health care professionals focused on pulmonary, critical care, and sleep medicine. The conference featured presentations focusing on clinical updates in thoracic medicine.

As part of the phase 3 LIBERTY ASTHMA QUEST and the LIBERTY ASTHMA TRAVERSE open-label extension studies, Mario Castro, M.D., of the University of Kansas School of Medicine in Kansas City, and colleagues found that dupilumab, a fully human monoclonal antibody, provides sustained, long-term reduction in exacerbations and improved forced expiratory volume in one second (FEV₁) in patients with uncontrolled moderate-to-severe asthma.

The authors evaluated dupilumab efficacy in QUEST patients enrolled in TRAVERSE (an extension of QUEST) with blood eosinophils ≥150 cells/mL or fractional exhaled nitric oxide ≥20 parts per billion at parent study baseline and at least one, two, or three exacerbations in the year before QUEST. The unadjusted annualized severe asthma exacerbation rate and mean change from parent study baseline in FEV₁ were analyzed. The researchers found that dupilumab had sustained efficacy and safety in the TRAVERSE study in terms of reducing exacerbations, improving lung function, and increasing asthma control out to three years.

“Physicians using dupilumab now have data to discuss with their patients — if you see a response in your patient to dupilumab, you should continue it as they will likely maintain this improvement over time,” Castro said.

Several authors disclosed financial ties to pharmaceutical companies, including Sanofi and Regeneron, which manufacture dupilumab and sponsored the study.

Abstract

In another study, Kim Styrvoky, M.D., of the University of Texas Southwestern Medical Center in Dallas, and colleagues found that shape-sensing robotic-assisted bronchoscopy (ssRAB) with cone beam computed tomography imaging (CBCT) is a novel technique for the biopsy of central and peripheral pulmonary lesions that allows for combined diagnosis and mediastinal staging in a single procedure.

The authors performed a retrospective analysis of 200 procedures to sample 209 lung lesions in 198 patients using a combination of ssRAB with radial endobronchial ultrasound, CBCT, and augmented fluoroscopy. The outcomes were based on pathology, clinical/radiographic follow-up, and additional sampling, with no size or lesion characteristic limitations. The researchers found that ssRAB with CBCT for sampling of pulmonary lesions had high diagnostic accuracy, high sensitivity and specificity, a reasonably high negative predictive value for malignancy, and a favorable safety profile.