Thank you for tuning in to the Editor’s Highlight Podcast for the October 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. It is unclear whether baseline CT imaging-derived metrics can help predict clinical response to benralizumab treatment. In this issue, Bourdin and colleagues report findings from a two-center prospective, open-label study of 47 patients, designed to determine if CT imaging-derived measures are prognostic of benralizumab response, with a primary outcome of exacerbation reduction and secondary outcomes including lung function and symptom control at 52 weeks. Of the 47 patients, 42 patients had a > 50% exacerbation reduction, for which a prognostic factor was not identified. Of the 47 patients, 35 patients achieved the secondary outcomes. Both parametric response mapping small airways disease voxels and sinus score were prognostic for responder status, outperforming blood eosinophil count (area under the receiver operating characteristic curve, 0.69, 0.71, and 0.63, respectively). These findings suggest that CT imaging-derived metrics could be valuable biomarkers of response prognosis, warranting additional study.
Our Chest Infections content area is next. In-hospital influenza vaccination for patients who are critically ill with chronic pulmonary disease remains limited. In this issue, Feng and colleagues report findings from a target trial emulation using 7,734 inpatients who are critically ill with chronic pulmonary disease from the Medical Information Mart for Intensive Care IV database. The study was designed to determine if in-hospital influenza vaccination improves prognosis. Of the patients, 49.2% received the influenza vaccine. Vaccination was associated with reduced one-year mortality (vaccine effectiveness 12%, number needed to vaccinate to prevent one death of 30). Ninety-day mortality was 12% lower, readmission risk was reduced by 13%, and emergency department visits were reduced by 23%. These results show that in-hospital influenza vaccination is effective for patients who are critically ill with chronic pulmonary disease. Also in this section is an original research study that evaluates the effectiveness of cystic fibrosis transmembrane conductance regulator modulator therapy on risk of death for individuals with cystic fibrosis. Completing this section is a CHEST clinical practice guideline on the management of adult bronchiectasis.
Our COPD section is next. Radiologically defined mucus plugs have not been systematically evaluated for COPD prognosis. In this issue, Pu and colleagues report findings from a systematic review and meta-analysis that evaluated whether the burden of radiologically defined mucus plugs is associated with increased risks of mortality, exacerbations, lung function decline, and impaired quality of life in adults with COPD. Seven studies including 15,702 patients were included. Those with low-grade plugs had a 14% higher risk of all-cause mortality, and those with high-grade plugs had a 48% higher risk, compared with those without mucus plugs. The risk of exacerbations also exhibited a graded increase for moderate to severe and severe events (low-grade HR, 1.07 and 1.11; high-grade HR, 1.15 and 1.41). Associations with worse lung function and quality of life were also confirmed. These findings highlight a graded association between CT scan-defined mucus plug burden and poor clinical outcomes in COPD. Completing this section is a research letter that explores the hemodynamic profile and clinical outcomes of low- and high-cardiometabolic phenotypes in COPD.
Next is our Critical Care content area. There are limited therapeutic options for ARDS. In this issue, Wang and colleagues report findings from a phase 1b/2, multicenter, double-blind, placebo-controlled trial of STSA-1002 treatment, an anti-C5a monoclonal antibody. The trial was designed to determine the benefit of STSA-1002 treatment in ARDS caused by viral pneumonia. Forty-seven patients were enrolled, with 15 patients in the placebo group, and 17 and 15 patients in the treatment group at two doses. Time to clinical improvement was 6.0 days in the high dose group, 8.4 days in the lower dose group, and 7.4 days in the control group, with an HR of 1.55 and 1.04, respectively, which were not statistically significant. Twenty-eight-day all-cause mortality was 5.88% for the higher dose group, 26.67% for the lower dose group, and 40% for the placebo group. The medication was well-tolerated. These findings show that STSA-1002 shows a favorable safety profile and the potential for efficacy, suggesting additional study is appropriate.
On to our Diffuse Lung Disease section. The impact of antifibrotic treatment adherence and dose reduction on mortality in idiopathic pulmonary fibrosis (IPF) is unknown. In this issue, Xu and colleagues report findings from a nested case-control study using a large administrative database, designed to determine if antifibrotic adherence and dosing modify all-cause mortality and hospitalization in people with IPF. Adherence was associated with lower risk of mortality (OR, 0.56; proportion of days covered > 0.75). Those taking a reduced dose had a greater risk of mortality compared with those taking a standard dose (OR, 1.57), particularly in those who started nintedanib. Adherence and dose reduction were associated with a lower risk of hospitalization only for those who started nintedanib. These results suggest that antifibrotic adherence and dosing influence mortality and hospitalization in people with IPF. Also in this section is an original research article that characterizes cough and its response to therapy in people with hypersensitivity pneumonitis and another that evaluates the impact of invasive mold infection-coded diagnoses on utilization, costs, and mortality after lung transplantation. Completing this section is a CHEST Narrative Review on systemic sclerosis-associated interstitial lung disease.
Next is our Education and Clinical Practice content area. Defining criteria for cough control may provide a complementary benchmark for evaluating treatment success. In this issue, Wahab and colleagues present findings from a post hoc analysis of a prospective, single-center observational cohort study (PROCOUGH), designed to define cough control using thresholds anchored to patient-perceived sufficiency. In the 100 patients who completed follow-up, controlled chronic cough was defined as posttreatment 24-hour cough frequency (CF) of ≤ 10 coughs/hour, cough severity visual analog scale (CS-VAS) score of ≤ 30 mm, and Leicester Cough Questionnaire (LCQ) score of ≥ 16. In the PROCOUGH study, with treatment based on the European Respiratory Society guidelines, 26% of patients met all three criteria, whereas 74% met the definition of refractory chronic cough. Using two criteria, 32% met controlled chronic cough criteria. Individually, the LCQ, CS-VAS, and CF were met by 36%, 44%, and 50% of patients, respectively. These results define patient-anchored criteria for cough control incorporating objective and subjective outcomes. Also in this section is an original research article that identifies higher respiratory muscle oxygen cost of breathing during exercise in heart failure with preserved ejection fraction and another that evaluates chest X-ray-derived age acceleration as an early marker of pulmonary dysfunction in middle-aged Asian patients. Completing this section is a CHEST Narrative Review on PET molecular imaging and theranostics in lung diseases.
Our Pulmonary Vascular content area is next. The effect of pulmonary arterial hypertension (PAH) therapies on gas exchange in people with portopulmonary hypertension (PoPH) is not well characterized. In this issue, Lacoste-Palasset and colleagues report findings from a retrospective cohort of 107 patients with PoPH to determine the effect of PAH-specific therapies on gas exchange. After a median follow-up of 4.5 months, the alveolar-arterial oxygen gradient (A-aDO2) remained stable overall, with substantial interindividual variability. Changes in A-aDO2 were not associated with 6-minute walk distance or functional class. Baseline A-aDO2 and cardiac output were associated with improvement in A-aDO2. Treatment-induced reductions in mean pulmonary artery pressure and increases in cardiac output correlated with greater A-aDO2 improvement. Hepatopulmonary syndrome was present in 39% of patients. Baseline intrapulmonary vascular dilatations (IPVDs) did not influence A-aDO2 evolution, but four patients developed new IPVDs within the first year following PAH therapy initiation. These findings show that PAH therapy in people with PoPH was not associated with overall deterioration in gas exchange, while the development of new IPVDs in some patients suggests the need for careful monitoring. Also in this section is an original research article that compares hemodynamic responses to balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension in Japan and The Netherlands and another that characterizes CT scan-derived pulmonary vascular abnormalities associated with pulmonary hypertension in chronic lung disease. Completing this section is a CHEST Narrative Review on recurrent VTE during anticoagulation and a How I Do It review on managing a patient who is critically ill with PAH.
Next is our Sleep Medicine content area. There are limited data about the impact of fixed-pressure PAP (FPAP) and autoadjusting PAP (APAP) on BP in people with OSA. In this issue, Goyal and colleagues report findings from a double-masked, randomized crossover clinical trial of 46 patients treated with both FPAP and APAP. The study was designed to determine if these PAP modes have different effects on BP. Thirty patients completed both treatment arms. FPAP showed a high probability of superior systolic BP control compared with APAP. The posterior median treatment effect was -4.4 mm Hg with a probability of direction of 91.2%. This effect was more pronounced for nighttime systolic BP, with a posterior median change of -6.8 mm Hg and a probability of direction of 94.0%. FPAP also increased the likelihood of nocturnal diastolic BP dipping. Mean FPAP pressure was higher than APAP pressures. These findings suggest that FPAP provides superior BP control compared with APAP in patients with OSA and hypertension. Completing this section is a CHEST clinical practice guideline on OSA in pregnancy.
Next is our Thoracic Oncology content area. Improved understanding of the natural history and outcomes of patients with subsolid nodules (SSNs) is needed to improve clinical decision-making and treatment recommendations. In this issue, Bader and colleagues document outcomes from 17,276 CT scans from 2017, in which 322 identified people with SSNs. The study aimed to determine the natural history of growth, likelihood of treatment, and most likely cause of mortality in people with SSNs. Over five years of follow-up, 81% of nonsolid nodules remained nonsolid and 19% developed a new solid component. Within five years, 19% (n = 60) underwent treatment, with patients with part-solid nodules being more likely to undergo treatment than those with nonsolid nodules (32% vs 11%, respectively; P < .001). Five-year overall survival was 79.8%, with 98.4% five-year SSN-related survival. Patients with SSNs were significantly more likely to die from a secondary primary cancer than their SSN at five years (8.43% vs. 1.54%). These findings suggest excellent survival associated with SSNs and high rates of developing second primary lung cancer. Also in this section is an original research article that evaluates place-based inequities in e-cigarette/vape and cannabis retail density in Massachusetts, another that evaluates the performance and utility of the Sybil deep learning model for lung cancer risk prediction in high- and low-risk Asian populations, and a final study that evaluates the impact of preexisting schizophrenia spectrum disorder on the receipt of surgery and other treatments for non-small cell lung cancer in Japan.
I encourage you to read our Commentary series, where you will find a piece that challenges the notion that four hours of PAP use at 70% adherence is adequate and another that revisits the VERITAS randomized controlled trial in light of Bayes’ theorem. In our Humanities series, you will find a case-based discussion on the role of mutual understanding in shared decision-making. 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 October issue.