Kamran Mahmood

Positions:

Assistant Professor of Medicine

Medicine, Pulmonary, Allergy, and Critical Care Medicine
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.B.B.S. 1995

King Edward Medical University

M.P.H. 2005

University of Illinois

Resident, Internal Medicine

Nassau University Medical Center

Fellow, Pulmonary, Critical Care And Sleep Medicine

University of Illinois College of Medicine

Grants:

Lymphocyte exhaustion markers in malignanc pleural effusions of lung cancer

Administered By
Medicine, Pulmonary, Allergy, and Critical Care Medicine
Role
Principal Investigator
Start Date
End Date

AminoIndex

Administered By
Medicine, Pulmonary, Allergy, and Critical Care Medicine
Role
Principal Investigator
Start Date
End Date

Airflow 3: Multicenter randomized sham-controlled study to evaluate safety and efficacy after treatment with the Nuvaira Lung Denervation System in subjects with COPD

Administered By
Medicine, Pulmonary, Allergy, and Critical Care Medicine
Role
Principal Investigator
Start Date
End Date

Lymphocyte Exhaustion Markers in Malignant Pleural Effusions of Lung Cancer

Administered By
Medicine, Pulmonary, Allergy, and Critical Care Medicine
Role
Principal Investigator
Start Date
End Date

Publications:

Clinical and radiographic predictors of successful therapeutic bronchoscopy for the relief of malignant central airway obstruction.

BACKGROUND: Malignant central airway obstruction (CAO) occurs in approximately 20-30% of patients with lung cancer and is associated with debilitating symptoms and poor prognosis. Multimodality therapeutic bronchoscopy can relieve malignant CAO, though carries risk. Evidence to guide clinicians regarding which patients may benefit from such interventions is sparse. We aimed to assess the clinical and radiographic predictors associated with therapeutic bronchoscopy success in relieving malignant CAO. METHODS: We reviewed all cases of therapeutic bronchoscopy performed for malignant CAO at our institution from January 2010-February 2017. Therapeutic bronchoscopy success was defined as establishing airway patency of > 50%. Patient demographics and baseline characteristics, oncology history, degree of airway obstruction, procedural interventions, and complications were compared between successful and unsuccessful groups. Univariate and multivariate logistic regression identified the significant clinical and radiographic predictors for therapeutic success. The corresponding simple and conditional odds ratio were calculated. A time-to-event analysis with Kaplan-Meier plots was performed to estimate overall survival. RESULTS: During the study period, 301 therapeutic bronchoscopies were performed; 44 (14.6%) were considered unsuccessful. Factors associated with success included never vs current smoking status (OR 5.36, 95% CI:1.45-19.74, p = 0.010), patent distal airway on CT imaging (OR 15.11, 95% CI:2.98-45.83, p < 0.0001) and patent distal airway visualized during bronchoscopy (OR 10.77, 95% CI:3.63-31.95, p < 0.001) in univariate analysis. Along with patent distal airway on CT imaging, increased time from radiographic finding to therapeutic bronchoscopy was associated with lower odds of success in multivariate analysis (OR 0.96, 95% CI:0.92-1.00, p = 0.048). Median survival was longer in the successful group (10.2 months, 95% CI:4.8-20.2) compared to the unsuccessful group (6.1 months, 95% CI:2.1-10.8, log rank p = 0.015). CONCLUSIONS: Predictors associated with successful therapeutic bronchoscopy for malignant CAO include distal patent airway visualized on CT scan and during bronchoscopy. Odds of success are higher in non-smokers, and with decreased time from radiographic finding of CAO to intervention.
Authors
Giovacchini, CX; Kessler, ER; Merrick, CM; Gao, J; Wang, X; Wahidi, MM; Shofer, SL; Cheng, GZ; Mahmood, K
MLA Citation
Giovacchini, Coral X., et al. “Clinical and radiographic predictors of successful therapeutic bronchoscopy for the relief of malignant central airway obstruction..” Bmc Pulm Med, vol. 19, no. 1, Nov. 2019. Pubmed, doi:10.1186/s12890-019-0987-3.
URI
https://scholars.duke.edu/individual/pub1422331
PMID
31752776
Source
pubmed
Published In
Bmc Pulmonary Medicine
Volume
19
Published Date
Start Page
219
DOI
10.1186/s12890-019-0987-3

Development of a Tool to Assess Basic Competency in the Performance of Rigid Bronchoscopy.

RATIONALE: Rigid bronchoscopy is increasingly used by pulmonologists for the management of central airway disorders. However, an assessment tool to evaluate the competency of operators in the performance of this technique has not been developed. We created the Rigid Bronchoscopy Tool for Assessment of Skills and Competence (RIGID-TASC) to serve as an objective, competency-oriented assessment tool of basic rigid bronchoscopic skills, including rigid bronchoscopic intubation and central airway navigation. OBJECTIVES: To assess whether RIGID-TASC scores accurately distinguish the basic rigid bronchoscopy skills of novice, intermediate, and expert operators, and to determine whether RIGID-TASC has adequate interrater reliability when used by different independent testers. METHODS: At two academic medical centers in the United States, 30 physician volunteers were selected in three categories: 10 novices at rigid bronchoscopy (performed at least 50 flexible, but no rigid, bronchoscopies), 10 operators with intermediate experience (performed 5-20 rigid bronchoscopies), and 10 experts (performed ≥100 rigid bronchoscopies). Participants included pulmonary and critical care fellows, interventional pulmonology fellows, and faculty interventional pulmonologists. Each subject then performed rigid bronchoscopic intubation and navigation on a manikin, while being scored independently by two testers, using RIGID-TASC. MEASUREMENTS AND MAIN RESULTS: Mean scores for three categories (novice, intermediate, and expert) were 58.10 (±4.6 [SE]), 78.15 (±3.8), and 94.40 (±1.1), respectively. There was significant difference between novice and intermediate (20.05, 95% confidence interval [CI] = 7.77-32.33, P = 0.001), and intermediate and expert (16.25, 95% CI = 3.97-28.53, P = 0.008) operators. The interrater reliability (intraclass correlation coefficient) between the two testers was high (r = 0.95, 95% CI = 0.90-0.98). CONCLUSIONS: RIGID-TASC showed evidence of construct validity and interrater reliability in this setting and group of subjects. It can be used to reliably and objectively score and classify operators from novice to expert in basic rigid bronchoscopic intubation and navigation.
Authors
Mahmood, K; Wahidi, MM; Osann, KE; Coles, K; Shofer, SL; Volker, EE; Davoudi, M
MLA Citation
Mahmood, Kamran, et al. “Development of a Tool to Assess Basic Competency in the Performance of Rigid Bronchoscopy..” Ann Am Thorac Soc, vol. 13, no. 4, Apr. 2016, pp. 502–11. Pubmed, doi:10.1513/AnnalsATS.201509-593OC.
URI
https://scholars.duke.edu/individual/pub1125910
PMID
26989810
Source
pubmed
Published In
Annals of the American Thoracic Society
Volume
13
Published Date
Start Page
502
End Page
511
DOI
10.1513/AnnalsATS.201509-593OC

Alendronate tracheobronchitis.

Authors
Mahmood, K; Koubar, S; Shofer, SL; Ninan, NA; Wahidi, MM
MLA Citation
Mahmood, Kamran, et al. “Alendronate tracheobronchitis..” Ann Am Thorac Soc, vol. 10, no. 1, Feb. 2013, pp. 64–66. Pubmed, doi:10.1513/AnnalsATS.201212-124OT.
URI
https://scholars.duke.edu/individual/pub933221
PMID
23509337
Source
pubmed
Published In
Annals of the American Thoracic Society
Volume
10
Published Date
Start Page
64
End Page
66
DOI
10.1513/AnnalsATS.201212-124OT

Yield of Malignant Pleural Effusion for Detection of Oncogenic Driver Mutations in Lung Adenocarcinoma.

BACKGROUND: Pleural fluid can be used to assess targetable mutations in patients with lung adenocarcinoma. The primary objective of this study was to assess the yield of pleural fluid cytology for targetable oncogenic mutations (EGFR, KRAS, BRAF, ALK, and ROS1 gene rearrangements). We also assessed pleural fluid volume necessary for molecular testing. METHODS: Retrospective review was performed of 134 consecutive patients with lung adenocarcinoma associated malignant pleural effusions. EGFR and KRAS testing was done using PCR amplification followed by DNA sequencing, or next generation sequencing in more recent cases that included BRAF assessment. Fluorescence in situ hybridization employing break-apart probes was used to test for ALK and ROS1 rearrangements. RESULTS: Mutation analysis on pleural fluid cell-block was performed on 56 patients. It was adequate for complete analysis ordered including EGFR, KRAS, BRAF, ALK, and ROS1 rearrangements on 40 (71.4%) samples. For individual mutations, EGFR testing was possible in 38 of 49 (77.6%); KRAS 22 of 28 (78.6%); BRAF 10 of 13 (76.9%), ALK gene rearrangement 42 of 51 (82.4%) and ROS1 gene rearrangement in 21 of 28 (75%) pleural fluid specimens. The analysis was satisfactory in 13 of 19 (68.4%) samples with ≤100 mL versus 27 of 37 (72.9%) with >100 mL of fluid tested (P-value=0.7). CONCLUSION: Genetic mutation analysis can be performed on malignant pleural effusions secondary to lung adenocarcinoma, independent of fluid volume.
Authors
DeMaio, A; Clarke, JM; Dash, R; Sebastian, S; Wahidi, MM; Shofer, SL; Cheng, GZ; Li, X; Wang, X; Mahmood, K
MLA Citation
DeMaio, Andrew, et al. “Yield of Malignant Pleural Effusion for Detection of Oncogenic Driver Mutations in Lung Adenocarcinoma..” J Bronchology Interv Pulmonol, vol. 26, no. 2, Apr. 2019, pp. 96–101. Pubmed, doi:10.1097/LBR.0000000000000534.
URI
https://scholars.duke.edu/individual/pub1335654
PMID
30048416
Source
pubmed
Published In
J Bronchology Interv Pulmonol
Volume
26
Published Date
Start Page
96
End Page
101
DOI
10.1097/LBR.0000000000000534

Hypoxic Gene Expression of Donor Bronchi Linked to Airway Complications after Lung Transplantation.

RATIONALE: Central airway stenosis (CAS) after lung transplantation has been attributed in part to chronic airway ischemia; however, little is known about the time course or significance of large airway hypoxia early after transplantation. OBJECTIVES: To evaluate large airway oxygenation and hypoxic gene expression during the first month after lung transplantation and their relation to airway complications. METHODS: Subjects who underwent lung transplantation underwent endobronchial tissue oximetry of native and donor bronchi at 0, 3, and 30 days after transplantation (n = 11) and/or endobronchial biopsies (n = 14) at 30 days for real-time polymerase chain reaction of hypoxia-inducible genes. Patients were monitored for 6 months for the development of transplant-related complications. MEASUREMENTS AND MAIN RESULTS: Compared with native endobronchial tissues, donor tissue oxygen saturations (Sto2) were reduced in the upper lobes (74.1 ± 1.8% vs. 68.8 ± 1.7%; P < 0.05) and lower lobes (75.6 ± 1.6% vs. 71.5 ± 1.8%; P = 0.065) at 30 days post-transplantation. Donor upper lobe and subcarina Sto2 levels were also lower than the main carina (difference of -3.9 ± 1.5 and -4.8 ± 2.1, respectively; P < 0.05) at 30 days. Up-regulation of hypoxia-inducible genes VEGFA, FLT1, VEGFC, HMOX1, and TIE2 was significant in donor airways relative to native airways (all P < 0.05). VEGFA, KDR, and HMOX1 were associated with prolonged respiratory failure, prolonged hospitalization, extensive airway necrosis, and CAS (P < 0.05). CONCLUSIONS: These findings implicate donor bronchial hypoxia as a driving factor for post-transplantation airway complications. Strategies to improve airway oxygenation, such as bronchial artery re-anastomosis and hyperbaric oxygen therapy merit clinical investigation.
Authors
Kraft, BD; Suliman, HB; Colman, EC; Mahmood, K; Hartwig, MG; Piantadosi, CA; Shofer, SL
MLA Citation
Kraft, Bryan D., et al. “Hypoxic Gene Expression of Donor Bronchi Linked to Airway Complications after Lung Transplantation..” Am J Respir Crit Care Med, vol. 193, no. 5, Mar. 2016, pp. 552–60. Pubmed, doi:10.1164/rccm.201508-1634OC.
URI
https://scholars.duke.edu/individual/pub1094699
PMID
26488115
Source
pubmed
Published In
American Journal of Respiratory and Critical Care Medicine
Volume
193
Published Date
Start Page
552
End Page
560
DOI
10.1164/rccm.201508-1634OC