Hot in Journal CHEST: July 2021
By: Alice Gallo de Moraes, MD
July 7, 2021
This is the first blog entry I write as one of the Social Media Editors for the journal CHEST®. I am honored and excited to help the Social Media Editorial team to highlight journal content for the July issue. I am writing from Rochester, MN, where I am a pulmonary and critical care medicine physician.
I would like to take this opportunity to thank all my colleagues taking care of patients with COVID-19. It has been a tough year, and your passion and work ethic have been an inspiration.
Now, let’s talk about some of the excellent manuscripts coming out in the journal CHEST’s July issue.
COPD is diagnosed based on a decreased FEV1/forced vital capacity (FVC) ratio; however, about 25% of smokers presenting with a normal ratio have anatomical emphysema on chest CT scans. And many high-risk patients with clinical evidence of COPD are not formally diagnosed with COPD based on currently accepted diagnostic criteria. In obstructive lung disease, the FVC could be underestimated due to dynamic compression of the airways during forced expiratory maneuver and reduced exhalation time. Therefore, slow vital capacity (SVC) could represent true vital capacity better in these patients. Fortis and colleagues hypothesized that in smokers with normal spirometry according to current standards, FEV1/FVC <0.7 is associated with respiratory symptoms, presence of emphysema on chest CT scans, and increased likelihood of developing COPD. They found that using a FEV1/SVC ratio in current and former smokers with a normal spirometry can identify patients with CT features of COPD who are at risk for severe exacerbations, and it is associated with progression with COPD.
Selexipag is an oral selective prostacyclin receptor antagonist. It addresses two main barriers for the use of prostacyclin pathway agents in pulmonary arterial hypertension (PAH): Need for tight titration to an individualized dose and complexity of their administration. GRIPHON was a randomized, placebo-controlled trial evaluating selexipag use in 1,156 patients with PAH. In GRIPHON, time from diagnosis was prognostic of morbidity and mortality, with newly diagnosed patients having a worse prognosis than patients diagnosed for a longer period of time. Additionally, the benefit of adding selexipag to PAH treatment on disease progression was seen in both groups (early and late diagnosis) but was more pronounced in patients who were treated earlier.
COVID-19 has a wide range of clinical presentations, with about 20% of hospitalized patients developing ARDS and requiring mechanical ventilation. Nineteen months into the pandemic from the first case described, the long-term respiratory consequences for ICU survivors remains unclear. In order to answer this question, González and colleagues recruited 125 consecutive COVID-19 ICU survivors and evaluated 62 of them 3 months after discharge. Pulmonary structural abnormalities, mainly reticular lesions and fibrosis, and functional impairment (subjective dyspnea in 46.7% of the patients and decreased diffusing capacity in 82% of them) were highly prevalent in COVID-19 ICU survivors. The authors recommend pulmonary evaluation of COVID-19 ARDS survivors starting at 3 months after discharge.