Thank you for tuning in to the Editor’s Highlight Podcast for the May 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.
This month in our Asthma content area, we have a research letter that evaluates the accuracy, and risk of harm, of asthma-related content on TikTok and a How I Do It review on the potential utility of the assessment of small airway dysfunction with oscillometry to define asthma control and future risk.
Next is our Chest Infections content area. The serum antiglycopeptidolipid core IgA antibody test may have a role as a broad screening test for nontuberculous mycobacteria pulmonary disease (NTM-PD). In this issue, Choi and colleagues evaluate the accuracy of the level of serum IgA antibodies against the glycopeptidolipid core in screening for NTM-PD in 282 patients from the prospective European Bronchiectasis Registry. Median antibody levels were 0.2 U/mL in those without NTM isolation or NTM-PD, 0.3 U/mL in those with NTM isolation who were felt not to have NTM-PD, and 1.5 U/mL in patients with NTM-PD. The area under the curve for NTM-PD was 0.886 and was 0.816 for discrimination of patients with NTM-PD from those with NTM isolation alone. These findings suggest the antiglycopeptidolipid core IgA antibody could accurately screen for NTM-PD in patients with bronchiectasis. Completing this section is a How I Do It review that shares expert opinions for improving patient outcomes when managing cavitary Coccidioidomycosis.
Our COPD content area is next. The joint effects of socioeconomic status and phenotypic frailty on the incidence of COPD is unclear. In this issue, Feng and colleagues describe a latent class analysis of 396,000+ UK Biobank participants without COPD at baseline, used to define the socioeconomic status (SES) of participants, and mediation and interaction analyses to explain the associations between SES and frailty on COPD risk. Compared with high SES or robust health, low SES (hazard ratio [HR], 2.69) and frailty (HR, 2.75) increased the risk of COPD. An additive interaction of low SES and frailty with COPD incidence was noted. Individuals who were frail with low SES had the highest risk of COPD (HR, 7.85) compared with individuals who were robust with high SES. These findings identify low SES and frailty as independent, synergistic risk factors for developing COPD. Also in this section is an epidemiological study of dietary pattern, sputum DNA methylation, and lung health in people who ever smoked and a CHEST Review on the emerging role of alarmin-targeting biologics in the treatment of patients with COPD.
Next is our Critical Care content area. It remains unclear whether using a higher flow nasal cannula rate provides better outcomes after extubation than commonly used flow rates of 30 to 50 L/min. In this issue, Ruan and colleagues present results of a randomized controlled trial of 180 patients, designed to determine if a 60 L/min flow rate of high-flow nasal cannula (HFNC) for postextubation care results in different extubation outcomes than a 40 L/min flow rate. The primary outcome, a composite of reintubation or the use of noninvasive ventilation (NIV) within 48 hours after extubation, occurred in 22.1% in the 40 L/min group and 16.9% in the 60 L/min group (a nonsignificant risk difference of 5.2%). Those in the 40 L/min group had a higher risk of escalation in respiratory support (use of NIV or uptitration of HFNC settings). These findings show that a HFNC flow rate of 60 L/min does not reduce reintubation or NIV use compared with a 40 L/min flow rate. Other original research published in this section includes a two-article series from the Minnesota Critical Care Working Group on monitoring and coordinating statewide critical care surge response and crisis conditions during the COVID-19 pandemic; a randomized, placebo-controlled feasibility trial of low-dose melatonin for prevention of delirium in critically ill patients; and a secondary analysis of the DEVICE trial that explored video vs direct laryngoscopy for tracheal intubation following cardiac arrest.
On to our Diffuse Lung Disease content area. There has not been a comprehensive analysis of sarcoidosis mortality in US veterans. In this issue, Seedahmed and colleagues report findings from a population-based, retrospective cohort study of 23,745 veterans diagnosed with sarcoidosis between 2004 and 2019, designed to discover the trends in all-cause mortality among US veterans with sarcoidosis and the influence of demographics and geographic variability. After adjustments, all-cause mortality increased annually by 4.7% and was 6.4% higher in Black than White veterans. Risk factors for increased all-cause mortality included older age, male sex, Black race, Northeast residence, and lower risk with other service branches. These findings identify a rise in mortality of veterans with sarcoidosis, with potential influences of different environmental exposures, and smaller racial disparities and impact of area deprivation than in prior studies. Completing this section is an original research study that evaluates quantitative CT scan analysis in rheumatoid arthritis-related interstitial lung disease and a point-counterpoint debate on whether the progressive pulmonary fibrosis clinical practice guideline should be implemented in clinical practice.
On to our Education and Clinical Practice content area. Virtual reality (VR) is able to show the anatomy encountered during curvilinear endobronchial ultrasound (EBUS) from the perspective of the location of bronchoscopic tools. In this issue, New and colleagues report the results of a randomized, crossover study of 68 fellows and residents from three institutions, designed to determine if the use of a VR anatomy trainer for teaching EBUS-associated anatomy improves procedural performance compared with traditional methods, including 2-dimensional pictures or a 3-dimensional model. All three learning methods improved EBUS performance after the first learning session. Learners spent more time with VR, but improvement levels were similar. The VR approach leveled the impact of baseline spatial reasoning and was preferred by 96% of learners. The user experience with VR was positive for focused anatomy learning, ease of use, acceptable realism, and tolerance, but ultrasound interpretation remained challenging. These findings suggest a VR anatomy trainer is preferred by learners, helping improve procedural performance regardless of spatial reasoning ability. Also in this section is a research letter that explores the presence of lung pathology in freedivers with a history of pulmonary barotrauma and a How I Do It review of how to build a team of nurse practitioners and physician assistants and optimize practice in the medical ICU.
Our Pulmonary Vascular content area is next. Little is known about the predictors and potential impact of epicardial adipose tissue (EAT) in pulmonary arterial hypertension (PAH). In this issue, McCarthy and colleagues report findings from a retrospective cohort study of 221 patients with PAH enrolled in the Penn Pulmonary Hypertension registry, designed to determine if EAT is associated with estrogen levels, disease severity, and mortality in PAH. Of the participants, 43% had connective tissue disease-associated PAH and 35% had idiopathic or heritable PAH. EAT increased over time in 72% of participants. High EAT volume (hazard ratio [HR], 2.62) and greater accumulation of EAT over time (HR, 1.09) were independently associated with worse survival. Those with high EAT volume had lower serum estrone and estradiol levels. These findings show that high EAT and EAT accumulation are associated with worse survival in patients with PAH and with lower estrogen levels. Completing this section is an analysis of the association of pulmonary hypertension with trastuzumab emtansine from the French Pulmonary Hypertension Registry and World Health Organization pharmacovigilance database.
In our Sleep Medicine content area this month, a pilot study of glossopharyngeal nerve stimulation to stabilize the lateral pharyngeal wall and ventilation in OSA is published as a research letter.
Next is our Thoracic Oncology content area. It is unclear whether disparities exist for follow-up of incidentally detected pulmonary lesions. In this issue, Abrahams and colleagues report findings from a retrospective cohort of 32,965 patients who had a pulmonary nodule identified on diagnostic CT scans between 2012 and 2016 within a large, regional, integrated health care system. This study was designed to determine if patients residing in more socioeconomically deprived neighborhoods have a reduced likelihood of adherence to guideline-recommended follow-up of incidentally detected pulmonary nodules. Of the patients, 49.6% had follow-up imaging or other diagnostic procedure performed within the guideline-recommended time frame. There was a 3% reduction in adherence to follow-up for patients residing in the most socioeconomically deprived neighborhood quartile. Smoking status, multimorbidity, and congestive heart failure were associated with decreased adherence. These findings suggest poor overall adherence to guideline-recommended pulmonary nodule follow-up, with worse adherence in the most socioeconomically deprived neighborhoods. Completing this section is a research letter describing a quality improvement initiative to verify eligibility for lung cancer screening via a text message intervention.
I encourage you to read our Humanities in Chest Medicine section, where you will find a case-based discussion of shared decision-making in the ICU with patients who speak a language of lesser diffusion, as well as our Commentary series, where you will find thoughtful pieces about the optimal care of multiorgan disease after lung transplantation and a medical educator scholar fellowship designed to build diverse medical educators. 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 May issue.