Thank you for tuning in to the Editor’s Highlight Podcast for the November 2026 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.
First is our Asthma section. Little is known about the relation between diet and asthma endotypes in children and adolescents. In this issue, Joe and colleagues report findings from a cross-sectional study of dietary patterns and asthma endotypes in 465 Puerto Rican children and adolescents, as well as a longitudinal analysis of 358 of the children and adolescents, with a mean of 5.3 years between visits. The study was designed to determine if dietary patterns are associated with T-helper 17 (T17)-high asthma. With higher scores representing healthier diets, they found that each 1-point increment in dietary score (with scores from -2 to 2) was associated with decreased odds of T17-high asthma (OR, 2.31). In the longitudinal analysis, an unhealthy diet at both visits was associated with increased odds of T17-high (OR, 4.30) and T-helper 2-low/T17-low asthma (OR, 2.48). These results show that in Puerto Rican youths, an unhealthy diet is associated with T17-high asthma, suggesting that T17 pathways may mediate dietary effects on asthma.
Our Chest Infections content area is next. Investigations for primary ciliary dyskinesia (PCD) are recommended based on having a phenotype of four clinical criteria. The accuracy of these criteria has not been explored in adults. In this issue, Marino and colleagues report findings from a retrospective analysis of 156 adults referred for possible PCD, designed to determine the diagnostic accuracy of the four key PCD clinical criteria, as well as additional clinical features and nasal nitric oxide (nNO) measurements. Of the 156 adults, 41 had definite PCD. The sensitivity and specificity for two or more PCD clinical criteria were 95% and 88%, respectively. The addition of infertility or subfertility to the four criteria (five total criteria) led to a sensitivity of 100% and specificity of 84% (again for two or more criteria). nNO < 77 nL/minute had a sensitivity of 88% and specificity of 98%. These results show a high diagnostic accuracy for the key PCD clinical criteria, particularly with the addition of infertility/subfertility and nNO measurements. Also in this section is an original research article that reports longitudinal changes in lung morphology and perfusion detected by MRI in people with PCD and a CHEST Narrative Review on bone disease in noncystic fibrosis bronchiectasis.
Our COPD section is next. The effect of oxygen therapy on neuromuscular fatigue in people with COPD and chronic respiratory failure (CRF) is unclear. In this issue, Paneroni and colleagues report findings from three intermittent isometric quadriceps tests performed with different Fio2 measurements in 20 people with COPD and CRF. The study was designed to assess the impact of Fio2 levels on neuromuscular fatigue during intermittent quadriceps exercise in people with COPD and CRF. The mean maximum voluntary contraction changes were -27.6% at 21% Fio2, -24.35% at 30% Fio2, and -22.0% at 60% Fio2. Twitch force quadriceps potentiated showed mean changes of -31.1%, -31.25%, and -26.7% at the three Fio2 levels. No differences were noted in voluntary activation across Fio2 scenarios. These results suggest that acute oxygen administration reduces quadriceps neuromuscular fatigue in people with COPD and CRF, supporting further evaluation of the impact of oxygen supplementation during exercise training and with long-term use. Also in this section are two research letters. The first is a population representativeness analysis of COPD trial evidence, and the second is an evaluation of home-based rehabilitation with health coaching for rural patients living with COPD. Completing this section is a How I Do It review on using historical blood eosinophil counts to guide treatment decisions in people with COPD.
Next is our Critical Care content area. The National Institutes of Health has developed the ARDS, Pneumonia, and Sepsis (APS) Consortium. In this issue, Self and colleagues describe the development of the APS Consortium Phenotyping Study and assess its success at rapidly generating data and biospecimens from a large cohort of adults who are critically ill. The multicenter, longitudinal, prospective observational cohort study aims to enroll 4,000 adults who are critically ill with ARDS, pneumonia, sepsis, or a combination over four years, collecting data and biospecimens to characterize aspects of their health and illness. The first 1,000 participants were recruited in < 13 months. The median age was 64 years, 50% received invasive mechanical ventilation, and 25% died in the hospital within four weeks. Ninety-nine percent had blood samples collected, 98% upper respiratory swabs, 37% lower respiratory samples, 80% urine samples, and 65% gastrointestinal samples. Forty percent were classified with ARDS, 52% with pneumonia, and 89% with sepsis. This report shows a promising start to the development of the APS Consortium resource. Completing this section is a research letter that evaluates crossover to noninvasive ventilation after high-flow nasal cannula failure in the RENOVATE trial.
On to our Diffuse Lung Disease section. The Composite Allocation Score (CAS) prioritizes medical urgency, projected posttransplant survival, biological compatibility, and geographic efficiency in lung transplant candidacy ranking. A recent policy amendment increased the influence of proximity on ranking. In this issue, Valapour and colleagues report findings from a retrospective cohort study using data on adult lung transplant candidates, recipients, and donors from the Scientific Registry of Transplant Recipients. The study was designed to determine if listing transplant center location is associated with effective donor availability and how the recent policy amendment impacts candidate prioritization. Among 3,917 candidates from 61 centers, median center-level distance-adjusted donor availability was 1.9 donors per candidate-day with substantial variation across centers and regions. The amended policy was found to reduce effective donor availability and increase geographic disparities in donor access. Of the candidates who were within the top 10 under the prior CAS policy, 23.9% fell outside the top 10 under the amended CAS policy. Those with biological barriers to donor matching experienced greater deprioritization. These findings show that geographic variation in effective donor availability persists and that increasing the influence of donor-candidate proximity may increase geographic disparities in donor access. Also in this section is a research letter that presents the epidemiology and clinical characteristics of pulmonary alveolar proteinosis in China. Completing this section is a How I Do It review on counseling patients about outdoor exercise during air pollution events.
Next is our Education and Clinical Practice content area. Pulmonary endoscopy contributes substantially to medical waste generation. In this issue, Seeger and colleagues report findings from a prospective, multicenter observational study that collected waste data from 107 procedures in 79 patients. The study was designed to determine how much waste is generated by pulmonary procedures with reusable endoscopes and identify strategies for waste reduction. Standalone bronchoscopy produced 1.28 kg of waste while bronchoscopy plus endobronchial ultrasound generated 1.85 kg of waste. Extrapolated for Germany’s pulmonary endoscopies, there would be 551.6 tons of waste per year (equivalent to 270 tons of CO2 emissions). Of the waste, 74.8% originated in the examination room. The use of reusable gowns would have led to a 61% waste reduction. Of the waste, 28.7% was potentially recyclable. Using single-use endoscopes may have increased the waste per procedure. These findings identify considerable amounts of waste generated by pulmonary endoscopies. Reusable protective equipment and recycling may help to reduce waste. Also in this section is an original research article that evaluates laterality of swimming-induced pulmonary edema during sidestroke using ultrasound and chest X-ray, another that evaluates a conversation aid for climate-conscious inhaler prescribing, and a final article that evaluates the prevalence and risk factors of preserved ratio impaired spirometry in people with HIV.
Our Pulmonary Vascular content area is next. Pretreatment with pulmonary hypertension (PH)-targeted medical therapy can reduce complications during balloon pulmonary angioplasty (BPA) in people with chronic thromboembolic pulmonary hypertension (CTEPH). In this issue, Staal and colleagues report findings from a consecutive series of people with CTEPH who underwent BPA after pretreatment with either mono or dual therapy. The study was designed to determine if pretreatment with dual PH-targeted medical therapy was associated with fewer BPA complications and improved clinical outcomes compared with monotherapy. Included were 169 people with CTEPH, and 55% had received monotherapy and 45% dual PH-targeted medical therapy. On a per-BPA session basis, people pretreated with dual therapy had fewer BPA-related thoracic complications (8.4% vs 19.6%). Predictors of thoracic BPA complications included higher logarithmic N-terminal prohormone brain natriuretic peptide (OR, 1.4), higher right atrial pressure (OR, 1.09), and mono PH-targeted medical pretreatment (OR, 3.3). At six months, those pretreated with dual PH-targeted medical therapy showed greater improvement in 6-minute walking distance, cardiac index, and pulmonary vascular resistance. These findings suggest that pretreatment with dual PH-targeted medical therapy is associated with lower BPA complication rates and improved clinical outcomes. Also in this section is a research letter that reports sotatercept safety and efficacy in intermediate-low risk pulmonary arterial hypertension, a CHEST Narrative Review on the pulmonary perspective of Eisenmenger syndrome, and a guideline that describes the Pulmonary Embolism Reporting and Data System v2026 for the diagnosis of acute pulmonary embolism on CT scan and MR angiography.
Next is our Sleep Medicine content area. The comparative stability of apnea-hypopnea index (AHI) definitions, hypoxic burden, and threshold calibration on night-to-night polysomnography (PSG) findings remains unclear. In this issue, Alavi and colleagues report findings from a retrospective analysis of a prospective study of 147 participants with a high likelihood of moderate to severe OSA who underwent two PSG exams within 10 days. The study was designed to determine the night-to-night variability across PSG-derived metrics and how AHI scoring definitions and threshold calibration influence diagnostic stability in OSA. Maximum heart rate (HR), positional fractions, and sleep latency were most variable, whereas average peripheral oxygen saturation, average HR, minimum Spo2, and hypoxic burden were most stable. Respiratory event frequency metrics separated people into lower and higher respiratory variability groups. AHI of 4% showed higher classification disagreement than AHI of 3%/arousal. AHI 4% threshold of 6.2 to 6.9 events/hour and of 18.4 to 22.3 events/hour were aligned with AHI 3%/arousal cutpoints of 15 and 30 events/hour. These findings identify metrics more and less variable in night-to-night testing, threshold-driven classification disagreement with AHI 4%, and implications for hypopnea scoring.
Next is our Thoracic Oncology content area. The value of a negative low-dose CT (LDCT) screening result on long-term risk stratification remains unclear. In this issue, Liu and colleagues report findings from a prospective cohort study of 269,173 participants aged 40 to 74 years from China’s National Lung Cancer Screening Program, of whom 19,726 were in a high-risk screened group. The study was designed to determine the long-term risks of lung cancer incidence and mortality among individuals with negative screening results. Those with negative screening results had a lower risk of lung cancer incidence (HR, 0.8) and all-cause mortality (HR, 0.77) and a similar lung cancer-specific mortality (HR, 0.88) than a nonscreened high-risk group. The reduced risk was most pronounced during the first three years. Individuals who were currently smoking and had negative screening results showed a higher long-term lung cancer incidence than those in the low-risk nonscreened group. These findings show high-risk individuals with negative LDCT screening have a lower incidence of lung cancer than a nonscreened high-risk group. Those currently smoking still have a higher incidence than a low-risk group. Also in this section is an original research article that assessed the impact of symptom prevalence on lung cancer risk in the SUMMIT study, another that compared radiation exposure in conventional and robotic bronchoscopy, and two research letters. The first research letter describes state variation in the incidence of small cell lung cancer and its association with smoking, and the second explores wearable-derived activity, and physiological changes, following pleural intervention in malignant pleural effusion.
I encourage you to read our Commentary series, where you will find a piece on the importance of prevention of lung disease starting before birth and another that argues for a role of surgical lung biopsy in fibrotic lung disease. In our Humanities series, you will find Exhalations pieces titled, “Borrowed Son,” and “The Days I Lost.” Finally, please review our case series publications for the month, which 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 November issue.