Home CHEST Thought Leaders Hot Topics in CHEST February 2020

Hot Topics in CHEST February 2020

By: Chris Carroll, MD, FCCP

Dr. Chris CarrollEach month, we ask our Social Media Co-Editors of CHEST to weigh in on the hot topics in CHEST. It's January, so let's hear from one of our co-editors, Dr. Chris Carroll, as he outlines his highlights. After reviewing the issue, be sure to share your hot list on  Facebook, tweet with the hashtag #journalCHEST, or discuss in the CHEST LinkedIn group.

They say that February is the cruelest month, and the February issue of CHEST® comes just in time to cheer us all up from the winter doldrums! Nothing better to keep us warm then the hot topics in this month’s issue! There are some great articles this month, and these were three of my favorites.

Estimated Ventricular Size, Asthma Severity, and Exacerbations

Asthma is the most common chronic respiratory disease; but despite the prevalence, there is still much to learn about the treatment and pathophysiology of severe asthma. The use of CT scans has become increasingly common to assess patients with pulmonary disease. In this issue of CHEST, Dr. Samuel Ash and colleagues from the Severe Asthma Research Program Investigators used CT scans to assess cardiac measurements (including right, left, and total epicardial cardiac ventricular volume indices) and pulmonary arterial and ascending aortic diameter and compared these parameters with asthma severity in a cohort of 233 patients with asthma.

Dr. Ash and colleagues found that patients with severe asthma had smaller left, right, and biventricular volumes than healthy control subjects and patients with mild to moderate asthma. Additionally, in a multivariate analysis, they found that patients with smaller ventricular volumes had increased rates of asthma exacerbations, both in the year prior to enrollment and during follow-up. Reduced ventricular size may be a useful marker for severe asthma; however, further study is needed.

Use of Imaging and Diagnostic Procedures After Low-Dose CT Screening for Lung Cancer

Translating clinical trials into the real world is challenging for all fields of medicine. In 2011, the National Lung Screening Trial (NLST) showed that annual low-dose CT screening of high-risk individuals could reduce risk of lung cancer death and set high standards for subsequent screenings and testing. In an article in this month’s CHEST, Dr. Shawn Nishi and colleagues aimed to assess the rates of follow-up testing in the real world.

In a retrospective review of a national commercial insurance database, Dr. Nishi and colleagues examined the frequency of diagnostic imaging and procedures in 11,520 patients in the 12 months after screening. They found relatively low rates of diagnostic imaging after screening and lower rates than found in the NLST (13.8-17.7% vs 21.7% in the NLST).  Additionally, they found HIGHER rates of invasive procedures compared with the NLST, with nearly double the rates of bronchoscopy and triple the rates of percutaneous biopsy and thoracoscopy. This important study raises significant questions about the practice of low-dose CT screening for lung cancer and how the recommendations from the NLST are being implemented in the real world.

Mos after Index LDCT scan

Critically Ill Patients With HIV: 40 Years Later

Finally, comes this excellent review by Dr. Élie Azoulay and colleagues reflecting on the state of critical care for patients with HIV. As a trainee, I vividly remember taking care of patients with HIV and AIDS. As a third-year medical student, my first patient at the VA hospital had HIV and I still remembering him admonishing me not to stick myself as I drew his blood each morning. In the early 90s, HIV was a death sentence—but so much has changed in 40 years. Now, when admitted patients with HIV (and treated with combination antiretroviral therapies) are admitted to the ICU, they are more commonly admitted for non-AIDS-related events. In this excellent comprehensive review in this month’s CHEST, Dr. Azoulay and colleagues review the state of the art for the management of critically ill, HIV-infected patients.