Thank you for tuning in to the Editor’s Highlight Podcast for the February 2023 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 Chest Infections content area, whether gastroesophageal reflux disease (GERD) is associated with an increased risk of nontuberculous mycobacterial pulmonary disease (NTM-PD) is not known. In this issue, Kim and colleagues compare the incidence and risk of NTM-PD between matched people with and without GERD from the Korean National Health Insurance Service-National Sample Cohort to determine whether GERD influences the development of NTM-PD. The incidence of NTM-PD was significantly higher in the GERD cohort than the matched cohort (HR 3.36). Age >60 and bronchiectasis were associated with an increased risk in the GERD cohort. Those with GERD and NTM-PD had higher all-cause and respiratory disease-related ED visits or hospitalization. These results suggest there is an association between GERD and NTM-PD, and the combination increases health care use. Completing this section is a CHEST Review on clinical aspects of lung disease caused by less common slow-growing NTM species.
On to our COPD content area. There are no prospective studies evaluating the suicide risk among smokers with a spectrum of pulmonary diseases and disease severity. In this issue, Adviento and colleagues evaluated the primary cause of death among 9,930 participants in the COPDGene study to determine which clinical variables are able to predict death by suicide in this cohort of patients with a heavy smoking history. Sixty-three individuals died by suicide. Current smoking, the use of sedative/hypnotics, and dyspnea were associated with death by suicide. Older age, higher BMI, and African American race were associated with a lower risk. The severity of airflow limitation was not associated with suicide risk. These results help to identify risk factors for suicide in a cohort with a smoking history, highlighting the illness experience over lung function assessment.
Next is our Critical Care content area. Hydrogen sulfide contributes to vasodilation and hypotension in septic shock. Hydroxocobalamin (vitamin B12) reduces hydrogen sulfide, which could restore vascular tone. Human studies in adults with septic shock had not been performed. In this issue, Patel and colleagues report on a phase 2, single-center, double-blind, allocation-concealed, placebo-controlled, parallel-group, pilot randomized controlled trial comparing a single 5 g dose of IV hydroxocobalamin with placebo in critically ill adults with septic shock. Twenty patients were enrolled over 19 months with 100% protocol adherence. In the treatment arm, there was a greater reduction in vasopressor dose postinfusion and 3-hour postinfusion. The plasma hydrogen sulfide level was also reduced. These results provide proof of concept for feasibility of high-dose IV hydroxocobalamin, encouraging more definitive trial designs. Also in this section are original research studies exploring the recall of awareness during paralysis among emergency department patients undergoing tracheal intubation and an evaluation of diaphragmatic thickness and excursion in infants born preterm with bronchopulmonary dysplasia. A research letter comparing helmet with facemask CPAP in COVID-19 respiratory failure and a CHEST Review on prone positioning for acute hypoxemic respiratory failure and ARDS complete this section.
On to our Diffuse Lung Disease content area. The trajectory of 6-minute walk test (6MWT) parameters and their prognostic implications in patients with fibrotic interstitial lung disease (ILD) are not known. In this issue, Khor and colleagues used prospective registries of patients with idiopathic pulmonary fibrosis (IPF) and non-IPF fibrotic ILD in Australia and Canada to evaluate the prognostic value of 6MWT parameters and hypoxemia for progressive pulmonary fibrosis (PPF). Those without PPF had a lower incidence of hypoxemia and an annualized increase in 6-minute walk distance and composite indices. Exertional and resting hypoxemia at the time of meeting criteria for PPF was associated with reduced transplant-free survival. Adding new onset hypoxemia as a criteria for PPF led to a reduced median time to develop PPF. These results suggest oxygenation status can provide prognostic information and assist in defining disease progression in fibrotic ILD. Completing this section is a research letter that explores the correlation of bronchoalveolar lavage cell count and pulmonary function tests in the era of antifibrotics and another that compares the use of genetic information and diagnostic codes to define IPF in the UK biobank.
Next is our Pulmonary Vascular content area. Inhaled treprostinil improves functional ability and delays clinical worsening in patients with pulmonary hypertension (PH) resulting from interstitial lung disease (ILD). In this issue, Nathan and colleagues report a post hoc analysis of a randomized controlled trial of inhaled treprostinil in patients with PH and ILD designed to determine whether higher doses of inhaled treprostinil improve outcomes. Two dose groups, based on the number of breaths per session, were compared between the treatment and placebo arms. Clinical worsening was noted in 17.1% of patients in the high-dose treatment group and 22.8% in the low-dose treatment group. Clinical improvement was seen in 15.7% of patients in the high-dose treatment group and 12.7% in the low-dose group, with both treatment groups having better outcomes than the placebo groups. These results suggest that higher doses of inhaled treprostinil lead to greater benefit, guiding the initiation and uptitration of this therapy in patients with PH from ILD. Completing this section is an original research article that provides insights into the assessment of daily life physical activity by actigraphy in pulmonary arterial hypertension.
Our Sleep Medicine content area is next. Excessive sleep arousal burden has been associated with increased cardiovascular risk by unclear mechanisms. In this issue, Shahrbabaki and colleagues evaluated arousals in overnight polysomnograms from 2,558 older men, with a focus on ventricular repolarization lability, to determine if arousals trigger cardiac ventricular repolarization lability that may predispose to cardiovascular mortality. During 10 years of follow-up, there were 348 cardiovascular deaths. Arousals impacted ventricular repolarization, increasing QT and RR variability and transiently decreasing the QT variability index. Excessive QT variability during arousal was independently associated with all-cause and cardiovascular mortality (HR 1.20 and 1.29). These results confirm that arousals affect ventricular repolarization, and excessive QT variability is associated with mortality. A further study to determine whether QT variability can be used for risk stratification or whether arousal suppression has clinical benefit may be warranted.
Next is our Thoracic Oncology content area. The most effective model for smoking cessation support in lung cancer screening programs is not clear. It is not known whether remote delivery of immediate smoking cessation counselling and pharmacotherapy are effective. In this issue, Williams and colleagues report the findings of a single-masked randomized controlled trial of individuals who smoke and are enrolled in a targeted lung health check, assigned to either immediate telephone smoking cessation intervention support with pharmacotherapy or usual care (brief advice to quit and signs guiding patients to smoking cessation services). Self-reported 7-day point prevalence of smoking abstinence at 3 months among the 315 people randomized were 21.1% in the intervention arm and 8.9% in the control arm (OR 2.83). These findings suggest that immediate provision of an intensive telephone-based smoking cessation intervention delivered within a targeted screening context may improve smoking abstinence at 3 months. Other original research reported in this section includes an assessment of factors associated with smoking cessation attempts in the National Lung Screening Trial and an evaluation of the diagnostic accuracy of a convolutional neural network for assessing pulmonary nodules.
Finally, I encourage you to take a look at our Humanities in Chest Medicine section, where you will find an original research investigation that identifies themes in the provision of end of life care for death resulting from COVID-19 during times of isolation and an Exhalations piece titled, “Opposition with my own flesh and bones: A patient reflection.”
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.