Thank you for tuning in to the Editor’s Highlight Podcast for the June 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 Asthma content area, we currently lack biomarkers for the prediction of asthma remission from the use of biotherapies targeting IL-5. In this issue, Moermans and colleagues report the findings from an observational study designed to determine if the sputum of patients with severe eosinophilic asthma shows biomarkers of remission after therapy targeting IL-5. Eleven of 52 patients included in the study were classified as being in remission. Male sex, sputum neutrophil percentage, eotaxin-1, IL-5, and eosinophil peroxidase were identified as potential predictors of remission. These findings suggest sputum type 2 markers may help with the prediction of remission after anti-IL-5 therapy for severe eosinophilic asthma.
Next is our Chest Infections content area. It is unknown whether guideline-concordant selection of empiric antibiotic treatment for community-acquired pneumonia (CAP) is associated with long-term outcomes. In this issue, Corrales-Medina and colleagues report findings from a retrospective cohort study of 1,909 elderly patients who survived hospitalization for CAP, designed to determine if guideline-concordant initial antibiotic treatment for elderly individuals hospitalized for CAP is associated with 1-year all-cause and cardiovascular mortality. Guideline-concordant initial therapy choice was found to be associated with a reduction in cardiovascular death risk in the year following admission, with a HR of 0.53. These findings provide further support for treatment selection for elderly hospitalized patients with CAP that is aligned with current clinical practice guidelines. Completing this section is a research letter that reports the mortality by age group and intubation status in adult hospitalized patients from 21 US hospital systems during the three surges of the COVID-19 pandemic.
On to our COPD content area. Though telerehabilitation can increase access to rehabilitation services, it may be difficult to create an autonomy-supportive environment in this setting. In this issue, Cox and colleagues report the results from a substudy of a randomized controlled trial designed to assess both patient experience in an 8-week telerehab program and the degree to which the program provided an autonomy-supportive environment. One hundred thirty-six participants completed the Health Care Climate Questionnaire (HCCQ), and 30 rehab participants undertook structured interviews. The HCCQ summary scores indicated the program provided an autonomy-supportive environment, similar to those in a center-based rehab arm. The interviews identified themes including ease of participation, peer and individual support, internal and external motivation to exercise, equipment and technology support, and feelings of loss at the end of the program. These results support telerehab as an autonomy-supportive environment. Also in this section is an original research study that reports on associations between propylene oxide exposure and lung function and a Special Feature article describing the clinical utility of lung imaging in COPD.
Next is our Critical Care content area. The impact of left ventricular (LV) systolic function on outcomes in patients with sepsis is uncertain. In this issue, Dugar and colleagues report findings from a retrospective cohort study designed to determine if LV systolic dysfunction is associated with increased mortality in patients with sepsis and septic shock. The 3,151 patients included were divided into five groups based on the LV ejection fraction (LVEF). In multivariate logistic regression analysis, LVEF of <25% (OR 2.75) and >70% (OR 1.70) were associated with higher in-hospital mortality compared with those with an LVEF of 55% to 70%. These results identify a U-shaped association between LVEF and in-hospital mortality in sepsis and septic shock that may be considered when prognosticating outcome. Also in this section is an original research article that reports new and persistent sedative prescriptions among older adults after critical illness and a CHEST Review on transforming team culture through curiosity and collaboration.
On to our Diffuse Lung Disease content area. The rate of lung function decline in lymphangioleiomyomatosis (LAM) varies significantly, leading to clinical decision challenges. In this issue, Palipana and colleagues report on the development and validation of a dynamic prediction model of the probability of clinically relevant FEV1 decline. The model was developed from 216 individuals in the US National Heart, Lung, and Blood Institute LAM Registry and validated in 185 individuals from the UK LAM Natural History cohort. A joint model that estimated the risk of future lung function decline and 5-year transplant-free survival had an AUC of 0.80. The model also estimated forecasted FEV1, rate of decline of FEV1, and risk of prolonged drops in FEV1 with AUCs >0.80. The model developed may allow individualized LAM prognostication and assist in decision-making about the timing of treatment initiation. Also in this section is a research letter that describes radiographic abnormalities in first-degree relatives of patients with different subtypes of pulmonary fibrosis and a CHEST Review on the diagnosis and management of myositis-associated interstitial lung disease.
On to our Education and Clinical Practice content area. The impact of pulmonary alterations in respiratory mechanics in individuals with heart failure with preserved ejection fraction (HFpEF) is unknown. In this issue, Villarraga and colleagues report findings from an evaluation of respiratory mechanics during incremental cycling to volitional exhaustion to determine if operating lung volumes, work of breathing, and power of breathing are abnormal in patients with HFpEF during exercise. They found that patients with HFpEF had lower end-inspiratory lung volumes and dynamic lung compliance and higher total work of breathing, power of breathing, and inspiratory and expiratory resistive work and power of breathing than control participants. These results demonstrate that HFpEF is associated with pulmonary alterations manifesting a greater inspiratory and expiratory resistive power of breathing that elicits a greater power of breathing during exercise. Also in this section is a systematic review and meta-analysis of diagnostic test accuracy of lung ultrasound for acute chest syndrome in sickle cell disease and a CHEST Review of smart devices and their usefulness for identifying respiratory sounds.
Next is our Pulmonary Vascular content area. The pediatric pulmonary arterial hypertension (PPAH) risk assessment tool requires further evaluation in diverse populations. In this issue, Qian and colleagues evaluated 247 children, aged 3 months to 18 years and enrolled in a prospective multicenter registry from China, to determine the characteristics and long-term survival of individuals with PPAH in China and evaluate the performance of the PPAH risk model. Most patients had idiopathic PAH or PAH associated with congenital heart disease. The median diagnostic delay was 24 months, and the mean pulmonary arterial pressure and pulmonary vascular resistance were 71 mmHg and 22 Wood units. 5- and 10-year survival rates were 74.9% and 55.7%, respectively, with better survival in congenital heart disease-associated PAH. A simplified noninvasive risk score with weight, functional class, and echo right ventricular size, both at baseline and follow-up, was developed. Patients with low-risk scores had better survival. These findings detail the diagnostic delay and severity of PAH at presentation for children in China and identify a risk model capable of separating low- and high-risk individuals in this population.
Our Sleep Medicine content area is next. The impact of positive airway pressure (PAP) for OSA on health care costs is uncertain. In this issue, An and colleagues evaluate 543 participants with OSA from the Tele-OSA study, stratified into 3 PAP adherence groups based on usage patterns over 3 years, to determine if 3-year health care costs are associated with PAP adherence. They found that the high adherence group had the lowest average covariate-adjusted 6-month health care costs, with a significant cost difference ($832) noted between the high and low adherence groups. These findings support the importance of strategies to enhance long-term PAP adherence. Completing this section is an original research article identifying biomarkers for neurocognition in pediatric and young adults with congenital central hypoventilation syndrome during ventilatory and orthostatic challenges.
Next is our Thoracic Oncology content area. Hypomethylation of the aryl hydrocarbon receptor repressor (AHRR) gene indicates long-term smoking exposure. Individual longitudinal changes in AHRR methylation are unclear. In this issue, Skov-Jeppesen and colleagues evaluate 4,432 individuals from the Copenhagen City Heart Study with baseline and follow-up blood samples and smoking information collected approximately 10 years apart to determine the influence of smoking behavior and demographic variables on AHRR methylation over time. AHRR methylation recovery occurred in those who quit smoking. Higher age was associated with lower methylation recovery in those who quit smoking. These results highlight potential beneficial epigenetic changes from quitting smoking. Also in this section is an original research article evaluating health-related quality of life following robotic-assisted or video-assisted lobectomy in patients with non-small cell lung cancer, an updated meta-analysis of guided bronchoscopy for the evaluation of pulmonary lesions, and an analysis of the National Lung Cancer Audit Rapid Cancer Registration Datasets to determine the impact of COVID-19 on lung cancer incidence in England.
Finally, I encourage you to read our Humanities in Chest Medicine section, where you will find an Exhalations series article titled, “Words Matter,” and our case series publications for the month, providing novel and educational cases to help improve your clinical skills.
I hope you enjoy reading all 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 June issue.