Thank you for tuning in to the Editor’s Highlight Podcast for the August 2025 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, asthma exacerbation risk prediction is important in severe asthma management. In this issue, Yadav and colleagues developed a Bayesian network analysis using relevant predictors in categories including demographics, lung function, inflammation biomarkers, health care utilization, medications, exacerbation history, and comorbidities. The network analysis was applied to 6,814 patients with severe asthma who were biologic-naïve from the Severe Asthma Registry. The study was designed to determine how the interplays of clinically relevant predictors lead to severe exacerbations in patients with severe asthma. They found that blood eosinophil count, fractional exhaled nitric oxide level, and % predicted FEV1 directly influenced the transition between prior and future exacerbations. Chronic rhinosinusitis (CRS) indirectly affected the transition, and macrolide use independently affected the history of exacerbations. The model discrimination was moderate. These findings identify a prediction pathway of severe exacerbations and the influence of CRS and macrolide use.
Next is our Chest Infections content area. There are limited data on patients with inflammatory bowel disease-related bronchiectasis (IBD-BE). In this issue, Freund and colleagues report findings from a single-center retrospective study of patients visiting an IBD unit at a tertiary center. The study was designed to identify the prevalence, risk factors, and clinical characteristics of IBD-BE. Of 1,637 patients with IBD, 254 had a prior chest CT scan. Thirty (1.8% of the cohort) had BE, with an estimated overall prevalence of IBD-BE of 5.2%. Ulcerative colitis, prior IBD-related surgery, and extraintestinal manifestations of IBD were risk factors for IBD-BE. Despite symptoms, many patients did not see a pulmonologist nor receive BE-related therapy. Clinical characteristics and outcomes were similar to patients with non-IBD-related BE. These findings show a relatively high prevalence of IBD-BE and an opportunity for more timely referral and treatment.
Our COPD content area is next. Menthol inhalation lowers dyspnea ratings during loaded breathing in people with COPD. In this issue, Schaeffer and colleagues report findings from a trial of 20 people with COPD who completed two constant-load cycle exercise tests to exhaustion, randomized to have menthol or placebo added to the breathing circuit. The study was designed to determine whether menthol inhalation is able to alleviate exertional dyspnea in COPD. Serial dyspnea intensity ratings were lower with menthol, as were ratings of dyspnea unpleasantness, air hunger, and mental breathing effort at end-exercise. Menthol-related improvements were correlated with higher endurance time. There were no differences in ventilatory and neuromuscular parameters. Eighty-five percent reported easier inspiratory airflow with menthol. These findings suggest that menthol inhalation may be useful for management of exertional dyspnea in selected people with COPD. Other original research in this section includes an evaluation of CT scan emphysema subtypes and cardiac hemodynamics estimated by MRI (MESA COPD study) and a study that phenotypes exertional breathlessness using cardiopulmonary cycle exercise testing in people with chronic airflow limitation. Completing this section is a How I Do It review on selecting an inhaled delivery system in COPD.
Next is our Critical Care content area. There is limited evidence to support routine use of continuous glucose monitoring in the ICU. In this issue, Franck and colleagues report findings from a single-center, investigator-initiated, parallel-group, open-label randomized controlled trial of 85 adult patients admitted to a medical or surgical ICU who had diabetes mellitus or hyperglycemia and were treated with insulin. The study was designed to determine if continuous glucose monitoring in critically ill patients with hyperglycemia improves time within a target glucose range. They found no statistically significant difference between continuous glucose monitoring and standard of care for the primary outcome. The only statistically significant difference noted was related to patient satisfaction. These results do not support continuous glucose monitoring as a superior method for routine glucose monitoring in the ICU. Also in this section is a randomized trial of Normosol-R vs lactated Ringers in critically ill patients and a research letter on the epidemiology of ICU use in people with sickle cell disease in New York. Completing this section is a Special Features article on vascular disturbances of the skin in critically ill patients.
On to our Diffuse Lung Disease content area. Quality of life (QoL) is poorly correlated with conventional spirometric lung function in people with sarcoidosis. In this issue, Toumpanakis and colleagues evaluate QoL and lung function in 62 patients with pulmonary sarcoidosis in order to determine the relationship of a QoL measure with comprehensive lung function assessment using oscillometry. Oscillometric indices that describe peripheral lung dysfunction showed significant associations with the St. George’s Respiratory questionnaire (SGRQ) score. FVC % predicted, residual volume to total lung capacity ratio, and fractional exhaled nitric oxide levels were at most weakly related to SGRQ score. Measures of the elastic properties of the lung predicted an impaired QoL even in those with normal spirometry patterns. Peripheral airway function parameters and reactance at 5 Hz formed independent clusters in hierarchical clustering. These findings indicate that parameters of peripheral airway dysfunction correlate more strongly to QoL than spirometry measures in people with sarcoidosis. Also in this section is an evaluation of the relationship between changes in lung function and mortality risk in people with IPF and a CHEST Review on postoperative lung transplant considerations in the older recipient.
Next is our Education and Clinical Practice content area. Little is known about the impact of abortion bans on specialties other than obstetrics and gynecology. In this issue, Hauschildt and colleagues report findings from semistructured interviews with 29 pulmonary and critical care medicine (PCCM) physicians, analyzed with an abductive approach, to determine how abortion bans have impacted the clinical practice, well-being, and careers of PCCM physicians. The impacts that physicians described for patients and physicians include restricted and delayed treatment, moral distress, and impacts to training. Variable and vague institutional guidance was provided for physicians. Concerns about disparate impacts across social groups were commonly noted. Novel forms of harm mitigation and increased political activism were identified. These findings show that abortion bans are impacting patients and physicians in medical specialties outside of obstetrics and gynecology. Completing this section is a cohort study that evaluated spirometry abnormalities and immune dysfunction among adolescents with and without HIV in Kenya.
Our Pulmonary Vascular content area is next. It is unclear whether main pulmonary artery (MPA) enlargement offers additional prognostic value to validated risk scores. In this issue, Cao and colleagues report findings from a retrospective review of 351 people with pulmonary artery hypertension (PAH), designed to determine if MPA diameter is prognostic in PAH, independent of existing risk scores. MPA diameter was a predictor of primary events (the composite of death, lung transplant, and right-sided heart failure hospitalization; HR, 1.06/mm). MPA diameter remained an independent predictor after adjustment for three risk scores and their individual components. MPA growth rate also predicted the outcome (HR, 1.79/mm/y) independent of baseline MPA diameter. Using MPA diameter in addition to the REVEAL 2.0 score resulted in risk reclassification in 23% of patients. These findings indicate that MPA diameter is a significant independent predictor of adverse clinical events in people with PAH. Also in this section are two additional original research studies: The first evaluates whether characteristic pulmonary impedance with exercise could detect abnormal pulmonary vascular response and uncoupling in pulmonary hypertension due to heart failure with preserved ejection fraction, and the second was designed to determine whether echocardiographic parameters can enhance risk prediction scores in PAH.
Next is our Sleep Medicine content area. Recent advances in artificial intelligence have enabled OSA detection using breathing sound recordings. In this issue, Tan and colleagues report findings from a Bayesian bivariate meta-analysis and meta-regression of 16 studies (41 models) trained on 4,864 participants and tested on 2,370 participants. The study was designed to assess the diagnostic accuracy of machine listening for OSA. Machine listening achieved a pooled sensitivity of 90.3%, a specificity of 86.7%, a diagnostic OR of 60.8, and positive and negative likelihood ratios of 6.78 and 0.113, respectively. Increased sensitivity was related to higher audio sampling frequencies, noncontact microphones, higher OSA prevalence, and train-test split model evaluation. Home smartphone vs in-lab recordings, deep vs traditional machine learning, and variations in age and sex did not influence accuracy. These findings suggest machine listening has an excellent diagnostic accuracy, comparable with common home sleep tests.
Next is our Thoracic Oncology content area. Robotic-assisted bronchoscopy (RAB) is gaining adoption, but evidence of the outcomes in real-world settings is lacking. In this issue, Murgu and colleagues report findings from a multicenter, prospective, single-arm study that included 679 subjects from 21 sites. The study was designed to determine the clinical safety, navigational success, and diagnostic yield of RAB for biopsy of peripheral pulmonary lesions (PPLs) 8 to 50 mm in diameter. The mean lesion size was 20.9 mm with a median distance from the pleural surface of 5 mm. Complication rates were 3.8% (19 pneumothorax and seven bleeding). The lesion was reached in 98.7% of cases, and the location was confirmed with radial probe endobronchial ultrasound in 91.7%. The prevalence of malignancy was 64.1%, and the diagnostic yield, based on strict reporting criteria, was 61.6%. The sensitivity for malignancy was 78.8%. These findings suggest that RAB-guided sampling of PPLs is safe and has a diagnostic yield that compares favorably with nonrobotic bronchoscopy reports. Also in this section is an original research article that evaluates the impact of clinically significant pleural effusions on survival of US veterans with cancer, congestive heart failure, and pneumonia and a research letter that reports on factors associated with no-show rates for lung cancer screening CT scan appointments.
I encourage you to read our Commentary series, where you will find two reports from our statistical techniques for clinical researchers series, and our Humanities series, where you will find an Exhalations piece titled, “The Invitation to the Symphony.” 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 August issue.