Hot in Journal CHEST: September 2020
By: Divya C. Patel (@divyacpateldo)
September 16, 2020
Each month, we ask our Social Media Co-Editors of CHEST, to weigh in on the hot topics in CHEST. It's September, so let's hear from co-editor, Dr. Patel, as she outlines her highlights. After reviewing the issue, be sure to share your hot list on our Facebook, tweet with the hashtag #journalCHEST, or discuss in the CHEST LinkedIn group.
Recently, a member of my family was diagnosed with lung cancer, and that has helped me better understand the worries and anxieties that patients with lung cancer and their families have. The past decade has seen great advances in diagnosing and treating lung cancer. My family member is lucky to have been diagnosed in a time in which progression-free survival for patients is improving rapidly and new treatment options are available. Every month, the Thoracic Oncology section of the journal CHEST® features great research in lung cancer diagnosis and treatment. There are three excellent articles about patient perspectives on lung cancer screening in the September 2020 issue.
This month, I am going to continue to highlight clinically impactful work in the “bread and butter” pulmonary medicine topics I have not highlighted yet: lung cancer, sleep medicine, and COPD.
Programmed death-ligand 1 (PD-L1) is involved in programmed cell death and an important biomarker on cancer cells of patients with non-small cell lung cancer (NSCLC) because it opens the door to additional treatment options. In a previous large randomized trial of an anti-PD-1 agent, investigators used core biopsy samples to determine immunohistochemistry expression of PD-L1. The authors of this study wanted to test whether fine needle aspiration (FNA) from endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is adequate for obtaining samples for PD-L1 assessment. They performed a multicenter pragmatic study to determine diagnostic yields of FNA, small biopsies, and lung resections. They analyzed more than 500 specimens from consecutive patients with NSCLC. Of the 189 specimens obtained from EBUS-TBNA, 94% had adequate sampling for PD-L1 expression determination, and no differences were seen in sample adequacy among the different techniques used to obtain the specimens.
In this study, the authors answered the question of whether noninvasive ventilation (NIV) is effective for patients with obesity hypoventilation syndrome (OHS) without OSA. The authors mention that phenotypes in these patients are known to be different from those of patients with both OHS and OSA. Studies have shown CPAP and NIV have similar benefits in patients with OSA and OHS; however, long-term effects of NIV and lifestyle changes in patients with OHS alone are unknown, so the authors performed a multicenter randomized trial in 16 centers in Spain to compare the effect of NIV and lifestyle changes. Ninety-eight patients were randomly assigned to an NIV group or a control group and were followed for 4.98 years. The primary outcome was number of hospitalization days for any cause, but the authors found no difference between the two groups. The authors did find important differences in secondary outcomes such as improvement in blood gas parameters, daytime sleepiness, and quality of life.
One-third of patients with COPD die owing to cardiovascular disease (CVD) and have common risk factors. Acute exacerbation of COPD has been shown to increase risk of acute myocardial infarction (AMI). In this study, the authors hypothesized that acute exacerbation of COPD requiring hospitalization may be associated with subsequent cardiovascular events such as intracranial hemorrhage (ICH), ischemic stroke (IS), and AMI. They compared mortality over a 1-year period after these events in patients with and without acute exacerbation in COPD. Using the National Health Insurance Research Database in Taiwan, they showed that hospitalization for acute exacerbation in the previous year was independently associated with 90-day mortality in patients experiencing AMI, (IS), and ICH.
