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Background Lung cancer is the leading cause of cancer death in women in the United States. Prospective randomized lung screening trials suggest a greater lung cancer mortality benefit from screening women compared with men. Research Question Do the United States Preventative Services Task Force (USPSTF) lung screening guidelines that are based solely on age and smoking history contribute to sex disparities in eligibility, and if so, does the use of the PLCOm2012 risk prediction model that is based on 11 predictors of lung cancer reduce sex disparities? Study Design and Methods This retrospective analysis of 883 lung cancer cases in the Chicago Race Eligibility for Screening Cohort (CREST) determined the sensitivity of USPSTF vs PLCOm2012 eligibility criteria, stratified according to sex. For comparisons vs the USPSTF 2013 and the recently published USPSTF 2021 (released March 9, 2021) eligibility criteria, the PLCOm2012 model was used with risk thresholds of ≥ 1.7%/6 years (6y) and ≥ 1.0%/6y, respectively. Results The sensitivities for screening by the USPSTF 2013 were 46.7% for women and 64.6% for men (P = .003) and by the USPSTF 2021 were 56.8% and 71.8%, respectively (P = .02). In contrast, the PLCOm2012 ≥ 1.7%/6y sensitivities were 64.6% and 70.4%, and the PLCOm2012 ≥ 1.0%/6y sensitivities were 77.4% and 82.4%. The PLCOm2012 differences in sensitivity using ≥ 1.7%/6y and ≥ 1.0%/6y thresholds between women and men were nonsignificant (both, P = .07). Compared with men, women were more likely to be ineligible according to the USPSTF 2021 criteria because their smoking exposures were Interpretation Although the USPSTF 2021 eligibility criteria are more sensitive than the USPSTF 2013 guidelines, sex disparities in eligibility remain. Adding the PLCOm2012 risk prediction model to the USPSTF guidelines would improve sensitivity and attenuate sex disparities.

Case Presentation We present the case of a 48-year-old South African woman with no smoking history, and seropositive rheumatoid arthritis diagnosed in 2001. She was treated with chloroquine (150 mg, 4 times per week) and methotrexate (30 mg weekly) with well-controlled symptoms until 2015, when she developed a disease flare. Her treatment regimen was changed to leflunomide (20 mg daily) monotherapy with subsequent symptom control. Biologic agents were not accessible because of cost constraints.

Case Presentation A 44-year-old man with hyperthyroidism and no smoking history presented to his internist with 5 months of intermittent cough and hemoptysis. The patient’s family history was remarkable only for non-Hodgkin’s lymphoma in his father. He had a history of a 25-day exposure to a home renovation at work 2 years prior to presentation. He was treated with oral clarithromycin with no improvement in his symptoms. A chest radiograph showed bilateral nodular opacities with a left lower lobar consolidative opacity ( Fig 1 A, 1 B); the patient underwent CT scanning of the chest, which showed areas of nodular infiltration in the lower lobes with tree-in-bud-like opacities. He was referred to a pulmonologist.

A 61-year-old man presented to the ED with fever, chills, cough, purulent sputum, and progressive shortness of breath for 7 days. The patient was an active smoker with at least 80 pack-year smoking history. He had no other medical or surgical history and was not on any medication at home.

Screening with low-dose CT scan has been shown to reduce mortality from lung cancer in those at risk based on age and smoking history. While lung cancer screening (LCS) is recommended by the United States Preventative Services Task Force and many professional societies, it has been recognized that the decision to be screened is complex due to a close balance of risk and benefit; therefore, shared decision-making is considered an essential component of effective LCS. The Centers for Medicare and Medicaid Services provides coverage for LCS following a mandated shared-decision making (SDM) visit. Here we review the concept of SDM, facilitators and barriers, evidence and knowledge gaps, and novel considerations for SDM within LCS.

Case Presentation A 37-year-old woman presented with a 2-month history of recurrent hemoptysis and coughing. Her symptoms started 2 months after the delivery of her third child. In total, she endured four episodes of hemoptysis. All pregnancies were induced by intracytoplasmic sperm injections. She lacked a pulmonary or smoking history and had no history of foreign body aspiration or intubation. There was no dyspnea, dysphagia, fever, or chest pain, and the patient did not complain of purulent sputum. She currently did not use medication and was generally in good health.

Our objective was to assess the usefulness of emphysema scores in predicting death from COPD and lung cancer.Emphysema was assessed with low-dose CT scans performed on 9,047 men and women for whom age and smoking history were documented. Each scan was scored according to the presence of emphysema as follows: none, mild, moderate, or marked. Follow-up time was calculated from time of CT scan to time of death or December 31, 2007, whichever came first. Cox regression analysis was used to calculate the hazard ratio (HR) of emphysema as a predictor of death.Median age was 65 years, 4,433 (49%) were men, and 4,133 (46%) were currently smoking or had quit within 5 years. Emphysema was identified in 2,637 (29%) and was a significant predictor of death from COPD (HR, 9.3; 95% CI, 4.3-20.2; P.0001) and from lung cancer (HR, 1.7; 95% CI, 1.1-2.5; P = .013), even when adjusted for age and smoking history.Visual assessment of emphysema on CT scan is a significant predictor of death from COPD and lung cancer.

52-year-old man was referred to our institution for evaluation of a pulmonary nodule. The patient presented to his primary-care physician with worsening cough a month prior to the current presentation when a chest radiograph revealed a questionable nodule in the right upper lung. The patient underwent a CT scan of the chest with contrast, which confi rmed the presence of a 9-mm nodule in the right upper lung. The patient was referred for work-up of this pulmonary nodule. Review of symptoms was positive only for the presence of cough associated with mucoid expectoration for the past few months. The patient had no signifi cant medical history, was a smoker (35-pack-year smoking history), and currently smoked 5 cigarettes/d. He denied any contact with sick peo ple or pets, travel, or history of malignancy in his family.

It has been proposed that acute eosinophilic pneumonia (AEP), which is characterized by the absence of recurrence, is associated with cigarette smoking (CS), because Japanese patients with AEP are young and have a high incidence of short-term smoking history. However, there has been no direct evidence that CS causes AEP. We hypothesized that tolerance might develop against repeated resumption of smoking cigarettes in CS-induced AEP cases. In this connection, we challenged a patient with CS-induced AEP with repeated resumption of CS, and it was demonstrated that CS induced AEP in conjunction with tolerance to repeated resumption of smoking.

The purpose of this study was to evaluate the burden of smoking among patients who had acute coronary syndrome seen at Philippine Heart Center in terms of its outcomes and expenditures. 199 patients (138 males and 61 females) participated in the study. Smoking habits were recorded including their co-morbidities, GRACE and TIMI scores. Financial data were gathered, tabulated and evaluated. Outcomes of ACS were tabulated in relation to patients9 smoking history and were evaluated. In this study, it shows that among those patients who have acute coronary syndromes, predominantly were smokers, both direct and passive smokers comprising 72% of the patients. In a developing country like ours, the mean amount expended for each person admitted for acute coronary syndrome who smokes (direct and passive) was two hundred forty-seven thousand two hundred sixty pesos (PhP 247, 260.00 ± 276,428.00 excluding physician9s professional fee) which is already a sumptuous that drains one9s finances. And of these, for every smoker patients who had acute coronary syndrome, the mean expenses for each person with each admission were PhP 217,160.00 ± 226,791.09 for those who survived and were discharged and PhP 517,960.00 ± 448,085.23 for those who died. Therefore, smoking is still prevalent among patients who have acute coronary syndrome and with each admission, each patient expend a sumptuous amount of money for the health resources.

The short-term effects of smoke inhalation have been little studied. This study evaluated whether firefighters experience a significant change in spirometric values following exposure to smoke from a fire. Sixty firefighters from the city of Pittsburgh completed a questionnaire (Medical Research Council) and underwent spirometric testing following exposure to house fires. The group contained 25 current smokers, 14 ever smokers, and 21 never smokers. Firefighters reporting cough, phlegm, breathlessness, and chest illnesses were more likely to be current or ever smokers than never smokers. Mean spirometric data obtained before exposure, after a minimum of four off-duty days, showed the following: FVC, 4.50 +/- 0.60L (90 percent of predicted); FEV1, 3.65 +/- 0.56L (96 percent of predicted); FEV1/FVC, 81 +/- 8 percent (106 percent of predicted); FEF25-75%, 3.71 +/- 1.13L/s (96 percent of predicted); and PEF, 7.95 +/- 1.70L/s (87 percent of predicted). After exposure, spirometry was performed on 22 firefighters. All spirometric values decreased after exposure; however, a significant decline was only seen in two indices, the FEV1 and FEF25-75%. This decline was small (3 to 11 percent). Two firefighters experienced an exaggerated decline in spirometric values after exposure, compared to the group as a whole. Neither age, smoking history, location of firefighting, intensity of smoke exposure, or use of a self-contained breathing apparatus explained the reasons for the greater decline in these two individuals. Thus, while firefighters do experience a small decrease in pulmonary function after exposure to house fires, there appears to be a small subgroup of firefighters who develop more substantial and potentially clinically important decreases in pulmonary function after smoke exposure.

A rumor that Sir William Osler was a heavy smoker and died from carcinoma of the lung has been traced to its source. An analysis of Sir William's respiratory illnesses, with the autopsy findings, published for the first time, shows that there was no substance to the rumor and though Sir William did smoke cigarettes, he was only a moderate smoker. Sir William regarded smoking as an enjoyable indulgence, harmless in moderation, but deleterious in excess. Osler felt that the adverse effects of heavy smoking were more commonly moral than physical, though he recognized the cardiovascular but not the respiratory consequences of smoking.

One hundred ten hospitalized patients with hemoptysis were reviewed to identify factors that would characterize those with malignancy and to evaluate the usefulness of fiberoptic bronchoscopy (FB) in the diagnosis of hemoptysis. Seventy patients underwent FB. This procedure was diagnostic in 22/28 (79 percent) of the carcinoma patients and in 26/42 (62 percent) of the patients with a nonmalignant cause of hemoptysis. The following three characteristics indicate a high probability of malignancy: 1) age greater than 40 years, 2) any abnormality on the chest roentgenogram, 3) hemoptysis lasting greater than one week. If any of these factors are present, FB should be done. Other factors to be considered include presence of anemia, weight loss, persistent cough, long smoking history and risk of bronchoscopic complications.

The prevalence of respiratory symptoms, as ascertained by questionnaire, was evaluated in 6,666 nonsmokers who had lived for at least 11 years in either a high photochemical pollution area (4,379 individuals) or a low photochemical pollution area (2,287 individuals). Of these, 5,178 had never smoked, and none was currently smoking. The risk estimate for "definite" COPD, as defined in this study, was 15 percent higher in the high pollution area (p = 0.03), after adjusting for sex, age, race, education, occupational exposure, and past smoking history. Past smokers had a risk estimate 22 percent higher than never smokers (p = 0.01). Multivariate analysis showed a significant effect of air pollution on the prevalence of "definite" COPD which univariate analysis failed to demonstrate.

Both the numbers and function of natural killer (NK) cells in 60 were evaluated in asbestos cement workers grouped by smoking history and chest roentgenogram findings (ILO profusion scores

This study of 130 subjects was performed to obtain more data about the smoking habits and levels of carboxyhemoglobin in various types of pipe and cigar smokers. These smokers may be divided by history into primary or secondary smokers and also into current inhalers and noninhalers. Prior studies of carboxyhemoglobin levels have yielded conflicting results, presumably due to differences in current habits of inhalation, which were often not taken into account. Cigarette, primary pipe, and secondary pipe inhalers had similar carboxyhemoglobin levels that were significantly higher than nonsmokers (5.6, 5.0, 5.4, and 1.0 percent, respectively). Cigar inhalers had markedly elevated concentrations of carboxyhemoglobin (13.8 and 11.8 percent in primary and secondary inhalers, respectively). Most secondary cigar and pipe smokers inhaled, whereas most primary smokers did not. Intentional inhalation, rather than past smoking history, is the most important factor in determining the carboxyhemoglobin level for each type of smoke.

Serum levels of angiotensin-converting enzyme were measured in a group of patients with farmer's lung and a group of precipitin-positive subjects with no history of farmer's lung. The levels did not differ significantly from control subjects matched for age and smoking history. The mean serum level of angiotensin-converting enzyme in a group of acutely ill patients with farmer's lung was significantly reduced. An acute challenge of three patients with Micropolyspora faeni did not produce an increase in serum levels of angiotensin-converting enzyme. These studies suggest that an increased serum level of angiotensin-converting enzyme can be a diagnostic aid in making a differential diagnosis between sarcoidosis and farmer's lung.

We reviewed the charts of 48 consecutive patients who had fiberoptic bronchoscopy performed in the evaluation of hemoptysis with a normal chest roentgenogram. Fiberoptic bronchoscopy provided a diagnosis other than endobronchial inflammation in only four patients--benign fibromuscular polyp in one patient, Mycobacterium tuberculosis in 1 patient, and carcinoma in two others. A literature review revealed an overall 3 percent incidence of bronchogenic carcinoma in patients with hemoptysis and normal findings on chest roentgenogram. Other than abnormal findings on chest roentgenogram, risk factors for carcinoma in patients with hemoptysis include: (1) age greater than 40; (2) significant smoking history; and (3) duration of hemoptysis for longer than one week. We concluded that in patients with hemoptysis and normal chest x-ray film findings, routine fiberoptic bronchoscopy may not always be indicated to rule out malignancy.

Eighty-eight shipyard workers with extensive asbestos exposure were evaluated in terms of dyspnea, smoking history, x-ray film abnormalities, static pulmonary function, and exercise performance. Pulmonary function abnormalities and roentgenographic pleuropulmonary disease were more frequent in smokers. Significant dyspnea was present in 41 percent of the workers and did not correlate with smoking history, pulmonary function, or exercise performance. Despite this high frequency of dyspnea, 70 percent of all workers had normal exercise tolerance by history or exercise testing. Of the 26 workers with exercise impairment, only nine had pulmonary mechanical or gas exchange limitation. Two of these workers had asbestosis, while the other seven had airways obstruction without asbestosis. The prevalence of both asbestosis and asbestos-related exercise impairment in this population was 2.3 percent.

Pulmonary function testing and questionnaires are valuable tools in epidemiologic studies of occupational lung disease. Accurate equipment and standardized methodology are vital to obtain reproducible responses. For spirometry, the FVC and FEV show the least intrasubject variability and on questionnaires, occupational and smoking history are more reproducible than symptoms. The limitations of any method used to define a lower limit of normal should be kept in mind and, whenever possible, groups should be compared by use of the distribution of observations in the two groups--not just the prevalence of "abnormal" findings.