Thank you for tuning in to the Editor’s Highlight Podcast for the February 2022 issue of the journal CHEST®. There is a great lineup of diverse content in this month’s issue.
Over the next 15 minutes, I will provide a brief overview of key manuscripts published in each of our content areas.
Starting with our Asthma content area, global trends in the prevalence, deaths, and disability-adjusted life-years for asthma are not well characterized. In this issue, Safiri and colleagues used publicly available data from the Global Burden of Disease study from 1990 through 2019 to address this gap. The point prevalence of asthma decreased by 24% and death rates by 51.3% between 1990 and 2019. The United States showed the highest age-standardized point prevalence rate, while the burden of asthma generally decreased with increasing sociodemographic index. High BMI, smoking, and occupational asthmagens contributed to asthma disability-adjusted life-years. These findings highlight that asthma remains an important public health issue and point to the need for future research to understand and implement interventions that reduce the burden of asthma. This section also includes a CHEST Review on asthma-COPD overlap.
Next is our Chest Infections content area. A practical list of risk factors for invasive Candida infection would help to decide when to add empirical antifungal therapy in patients with sepsis. In this issue, Thomas-Rüddel and colleagues report on a systematic review and meta-analysis to assess for risk factors for invasive Candida infection. Thirty-four studies were included, assessing 29 possible risk factors. Broad spectrum antibiotics, blood transfusion, Candida colonization, central venous catheter use, and total parenteral nutrition were found to be associated with the highest risk. This finding may help to guide the use of empiric antifungal therapy in patients with sepsis. Also in this section is a research letter describing the outcomes of lobectomy for treatment of pulmonary nontuberculous mycobacterial disease and another assessing Mycobacterium Growth Indicator Tube time-to-positivity as an early biomarker of treatment response in Mycobacterium avium complex pulmonary disease. Completing this section is a narrative review on cancer in cystic fibrosis.
On to our COPD content area. Direct-to-consumer genetic testing for alpha-1 antitrypsin deficiency (AATD) may enhance early detection. In this issue, Ashenhurst and colleagues report on a cross-sectional study of 195,014 individuals designed to determine if direct-to-consumer testing identifies previously undetected individuals with AATD and the impact of this detection. Of these individuals, 0.63% were found to have the PI*ZZ genotype, half of whom had a physician confirm the diagnosis, with 27% noting this was the first time they were aware of having AATD. The diagnostic delay for these individuals was 22.3 years. The OR for PI*ZZ smokers to report smoking reduction was 1.7, and for reduced alcohol consumption, it was 4.0. These results suggest direct-to-consumer testing can help identify previously undiagnosed AATD, resulting in positive behavior change. Also in this section is a research letter describing computed tomography-assessed dysanapsis and airflow obstruction in early and mid adulthood, and a How I Do It review about launching and nurturing a community stakeholder committee to enhance care and research for asthma and COPD.
Next is our Critical Care content area. An association between compliance with the SEP-1 quality measure and outcomes has not previously been reported. In this issue, Townsend and colleagues used propensity score matching and a hierarchical general linear model to estimate the treatment effects associated with compliance with SEP-1 from patient-level data reported to Medicare by 3,241 hospitals. In both standard matching and stringent matching, compliance was associated with a reduction in 30-day mortality with an absolute risk reduction of 4.1%-5.7%. At the subject level, compliance was associated with a lower 30-day risk-adjusted mortality with an OR of 0.83. These results suggest that rendering SEP-1 compliant care could reduce the incidence of avoidable deaths. Other original research published in this section includes an evaluation of patient-perceived health after critical illness through analysis of two prospective, longitudinal studies of ARDS survivors, and a systematic review and meta-analysis of venous thromboembolism prophylaxis in adults who are critically ill. Completing this section is a consensus statement from the Task Force for Mass Critical Care addressing the implementation of contingency strategies for mass critical care surge responses during COVID-19.
On to our Diffuse Lung Disease content area. Riociguat is effective in delaying the time to clinical worsening in patients with groups 1 and 4 pulmonary hypertension. In this issue, Baughman and colleagues report the results of a double-blind placebo-controlled trial assessing whether riociguat is more effective than placebo in prolonging time to clinical worsening in sarcoidosis-associated pulmonary hypertension. A total of 16 patients were enrolled and followed for 1 year. In the placebo, group 5 of 8 met time to clinical worsening criteria, while none of the patients who received riociguat did. In addition, the 6-minute walk distance decreased by 56 m in the control group and rose by 43 m in the treatment group. This study suggests that riociguat could be effective in preventing clinical worsening and improving exercise capacity in patients with sarcoidosis-associated pulmonary hypertension. Also in this section is an original research study that describes the association between lung function in hypersensitivity pneumonitis and alternative gene expression by Toll-interacting protein variants, and a Special Feature report of an expert survey initiative about the detection and early referral of patients with interstitial lung abnormalities.
Our Education and Clinical Practice content area is next. Appropriate education about domiciliary oxygen therapy can lead to better knowledge, clearer expectations, and improved adherence. In this issue, Ang and colleagues used validated tools to evaluate the resource quality, suitability, reliability, and readability of currently available online patient resources on domiciliary oxygen therapy. Thirty-six websites met inclusion criteria. Websites from foundation or advocacy organizations scored highest in quality and suitability, while those from industry or for-profit sites had the best content score. Only five websites met the four JAMA benchmarks. Median readability scores exceeded recommended reading grades for consumer health-related education. These results suggest that the overall quality, suitability, reliability, and content of online health resources for domiciliary oxygen therapy are low to moderate standard, helping health professionals to be aware of the limitations of available resources. Completing this section is a consensus statement from the Learning Ultrasound in Critical Care Initiative about the criteria, processes, and determination of competence in basic critical care echocardiography training.
Next is our Pulmonary Vascular content area. The association between heart rate (HR) and pulmonary embolism (PE) outcomes has not been well studied. In this issue, Jaureguizar and colleagues evaluated the association between admission heart rate and 30-day all-cause and PE-specific mortality in 44,331 consecutive nonhypotensive patients with symptomatic PE in order to determine if there is an association between baseline HR and PE outcomes. A positive association between admission HR and 30-day all-cause and PE-specific mortality was found. When compared with those with a HR of 80-99, the OR for mortality increased with every 10-beat interval to a maximum of 2.4 for a HR >140 beats/min and decreased with every 10-beat interval to a low of 0.5 for HR <60 beats/min. A cutoff of 80 beats/min increased the sensitivity of the simplified Pulmonary Embolism Severity Index and a cutoff of 140 beats/min increased the specificity of the Bova score. These results support the use of a HR cutoff in prognostication of nonhypotensive patients with acute symptomatic PE. Completing this section is a research letter describing pulmonary embolectomy in patients with myeloproliferative neoplasms and a CHEST Review on the diagnostic, prognostic, and therapeutic implications of right heart-pulmonary circulation unit involvement in left-sided heart failure.
Our Sleep Medicine content area is next. The excessively sleepy subtype of moderate to severe obstructive sleep apnea has been found to be associated with a higher risk of cardiovascular death. Limited associations between the Epworth Sleepiness Scale (ESS) and other measures of daytime sleepiness have been found. In a research letter in this issue, Mazzotti and colleagues assessed whether the Epworth Sleepiness Scale was sufficient to accurately identify the excessively sleepy subtype in two clinical-based cohorts and a community-based cohort, including approximately 3,500 patients. They found higher ESS scores in excessively sleepy participants. An ESS >10 had a 96.6% sensitivity and 57.2% specificity in identifying the excessively sleepy subtype. Including the top five, sleepiness-related symptoms improved the accuracy to a sensitivity of 93% and specificity of 83.4%. These results suggest that the inclusion of sleepiness symptom items with the ESS can improve the accuracy of identifying excessively sleepy individuals, thus helping to identify patients at greatest cardiovascular risk.
Next is our Thoracic Oncology content area. The frequency of cancer and the accuracy of prediction models have not been studied in large, population-based samples of patients with incidental pulmonary nodules measuring >8 mm in diameter. In this issue, Vachani and colleagues assembled a retrospective cohort of 23,780 individuals with a nodule measuring >8 mm to determine the frequency of cancer by size and smoking history and the accuracy of two widely used nodule risk prediction models. The sample included 9.9% of individuals with a lung cancer diagnosis within 27 months of nodule identification, 5.4% of individuals who have never smoked, 12.2% of individuals who previously smoked, and 17.7% of those who continue to smoke. Cancer rates were 5.7% in those with nodules 9-15 mm, 12.1% in 15-20 mm, and 18.4% in 20-30 mm. The Mayo model, with an AUC of 0.747, was more accurate than the Brock model at 0.713, though both overestimated the probability of cancer. These results help clarify the rate of lung cancer in incidental pulmonary nodules >8 mm in diameter and the accuracy of existing prediction models. Also in this section is an original research study assessing shape-sensing robotic-assisted bronchoscopy in the diagnosis of pulmonary parenchymal lesions and research letters describing lung cancer screening rates during the COVID-19 pandemic, as well as a qualitative description of barriers faced by those charged with operationalizing lung cancer screening.
Finally, I encourage you to take a look at our Humanities in Chest Medicine section, where you will find pieces describing historical and ethical controversies surrounding the determination of cardiovascular and cardiopulmonary death, and a comparative analysis of state pandemic preparedness plans that focuses on rationing with respect to age during the pandemic.
Our case series publications for the month provide novel and educational cases to help improve your clinical skills.
I hope you enjoy reading all of the high-quality content available in this month’s issue of the journal CHEST. As always, I am grateful to the authors of this work, to the reviewers who volunteered their time to improve the quality of these manuscripts, and to our editorial board for guiding everything that we do. Until next month, I hope you enjoy the February issue.