Thank you for tuning in to the Editor’s Highlight Podcast for the November 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.
In our Asthma section this month, you will find a research letter that evaluates treatment with tezepelumab in patients with eosinophilic granulomatosis with polyangiitis following suboptimal response to anti-IL-5/5R therapy.
Our Chest Infections content area is next. Evidence-based strategies to manage bronchiectasis exacerbations in the pediatric population are limited. In this issue, Schutz and colleagues report findings from a multicenter, double-blind, superiority, randomized controlled trial designed to evaluate whether the use of a bronchiectasis action management plan reduces nonscheduled physician visits among children and adolescents with chronic suppurative lung disease. In the 207 children enrolled, there was no significant difference in the annualized rates of nonscheduled respiratory-related physician visits. When limited to pre-COVID-19 data, a reduction was noted with an incident rate ratio of 0.63 in the intervention arm. Timely influenza vaccination was more likely, and feedback was strongly positive, in the action plan group. These findings did not confirm fewer nonscheduled physician visits when a bronchiectasis action management plan was used but showed some promise for this approach.
Our COPD section is next. Quantitative CT (QCT) scan textures of the lung can capture local disease patterns of inflammation and related respiratory morbidity. In this issue, Awan and colleagues analyzed data from the Subpopulations and Intermediate Outcome Measures in COPD Study and Genetic Epidemiology of COPD study to determine if bronchovascular bundle (BVB) textures on QCT scan are associated with systemic inflammation, morbidity, and mortality in COPD. Increased BVB texture was associated with elevated neutrophil and monocyte counts, the neutrophil to lymphocyte ratio, CT scan-detected emphysema, and a measure of airway wall thickness. Elevated CT scan density gradient (CTDG) was also associated with inflammatory measures. Both CTDG and BVB textures were associated with lower FEV1 and 6-minute walk distance. A minor but significant association of both BVB texture and CTDG texture with all-cause mortality was noted, independent of the presence of emphysema and airway wall thickness. These findings suggest that QCT scan textures may provide imaging evidence of lung inflammation and overall disease burden in COPD. Completing this section is a CHEST Review that attempts to translate the mechanisms of hypoxia to long-term oxygen prescription in COPD.
Next is our Critical Care content area. The oxygenation target that optimizes neurologic outcomes following cardiac arrest is uncertain. In this issue, DeMasi and colleagues report findings from a secondary analysis of the Pragmatic Investigation of Optimal Oxygen Targets trial. The analysis was designed to determine if a lower oxygen saturation (SpO2) target improves neurologic outcomes compared with a higher target. The analysis included 339 individuals who experienced cardiac arrest, 59% of whom had an in-hospital cardiac arrest and 10.2% of whom had an initial shockable rhythm. Survival with a favorable neurologic outcome occurred in 22.6% of those assigned to a lower or intermediate SpO2 target (88%-96%) and 12.7% of those assigned to a higher SpO2 target (>96%). These findings suggest that a lower oxygen target may lead to a higher incidence of a favorable neurologic outcome compared with a higher target in those receiving mechanical ventilation following cardiac arrest. Also in this section is a secondary analysis of an international observational study that evaluated the impact of low-tidal-volume ventilation on mortality in patients with acute brain injury. Completing this section is a How I Do It review on high-flow nasal cannula liberation.
On to our Diffuse Lung Disease section. There is little population-level information on hospitalization rates in people with rheumatoid arthritis-related interstitial lung disease (RA-ILD). In this issue, Fidler and colleagues report findings from a retrospective observational study using 20 years of health services data from Ontario, Canada, in a study designed to determine the current rates and trends in all-cause and RA-ILD-related hospitalizations. In 7,075 patients with RA-ILD, standardized all-cause hospitalization rates increased from 6.4 to 12.9 admissions per 100,000 people from 2003 to 2022. RA-ILD-related hospitalizations increased by 37% over this period. In-hospital mortality from RA-ILD-related admissions was stable over time (19.5 deaths per 100 admissions). Diagnosis with RA-ILD during a hospitalization was associated with the lowest income quintile, residing in rural areas, and future RA-ILD-related admissions. These findings show increased rates of RA-ILD-related hospitalizations with stable in-hospital mortality. Completing this section is a research letter that evaluates the prognostic implications of combined interstitial features and emphysema in National Lung Screening Trial (NLST) participants.
Next is our Education and Clinical Practice content area. In 2023, a single set of predicted spirometry values was developed, independent of the four different geographic ancestral groups that were part of the 2012 Global Lung Function Initiative (GLI). In this issue, Graham and colleagues evaluate the impact of differences in the proportion of participants from the four ancestral groups, in different age cohorts of the GLI database, on predicted values using the 2012 and 2023 equations. The proportional number of participants from each ancestry group in each age cohort varied considerably. The contribution of the European ancestry group (largest predicted lung volumes) was higher in younger children and in older adults. This led to the GLI 2023 spirometry reference values predicting lung volumes in older adults that were higher than the lung volumes predicted for any of the four ancestral groups using the GLI 2012 spirometry reference values. The opposite effect was found in children and adolescents. These findings suggest that the GLI 2023 spirometry reference values may progressively overestimate predicted lung volumes with increasing age in adults and underestimate those in children and adolescents. Completing this section is a research letter describing simulation-based mastery learning for ICU goals of care conversations.
Our Pulmonary Vascular content area is next. Early and precise identification of pulmonary hypertension (PH) and its subtypes is critical for effective management and timely intervention. In this issue, Huang and colleagues report findings from a retrospective cohort study, designed to determine if deep learning methods applied to chest radiographs (CXR) can accurately detect PH and its subtype, congenital heart disease-associated PAH (CHD-PAH). The cohort included 4,576 patients, including 2,288 patients with PH who underwent CXR followed by right heart catheterization (RHC) or transthoracic echo. The model achieved a sensitivity of 90.2% and an area under the receiver operating characteristic curve (AUC) of 0.964 for PH detection in the internal test set, as well as 80.3% with an AUC of 0.811 in an external RHC-confirmed dataset. The model had a sensitivity of 0.85 for CHD-PAH in the external dataset. These findings show a CXR-based deep learning model was sensitive as a screening tool for PH and CHD-PAH, potentially facilitating early detection, particularly in resource-limited settings. Completing this section is an original research article that evaluates the association of longitudinal PAP trajectories with clinical outcomes in patients undergoing a kidney transplant.
Next is our Sleep Medicine content area. There is limited real-world data on the health impacts of the Philips Respironics recall of PAP devices. In this issue, Kendzerska and colleagues report findings from a retrospective longitudinal study using Ontario health administrative databases on new adult PAP users (2012-2018). The study was designed to assess the relationship between PAP device manufacturer and obstructive lung disease (OLD) development and progression. Among 248,358 individuals, 26.3% had OLD. In those without OLD at baseline, there was no significant difference in incident COPD or asthma risk, as well as inpatient/outpatient visits for asthma/COPD, between those who received and those who did not receive a recalled PAP device. In exploratory analysis, modest increases in COPD risk within two years and inpatient COPD visits six to 10 years after the initiation of PAP were noted. These findings did not find an association of use of a PAP-recalled device with OLD development or progression, but it raised questions about early and late impacts that require additional investigation.
Next is our Thoracic Oncology content area. It is unknown whether a lung cancer screening (LCS) shared decision-making (SDM) visit improves adherence to screening. In this issue, Chung and colleagues report findings from a retrospective cohort study using Medicare fee-for-service claims data, designed to determine if an SDM visit before initial LCS is associated with improved screening adherence among Medicare beneficiaries. Of 22,670 screened beneficiaries, 11.4% underwent an SDM visit. The SDM group had an adherence rate that was 26.5% higher than the non-SDM group in the first year after initial LCS, increasing to a 32.5% higher rate in the four years after the first visit. These findings support an association between an SDM visit and significantly higher LCS adherence after initial screening. Also in this section is a research letter that evaluates the nonmalignancy rate in the NLST, addressing surgical misclassification. Completing this section is a Special Features article that provides a 10-year update on the components necessary for high-quality LCS.
I encourage you to read our Commentary series, where you will find a piece on artificial intelligence in meta-analysis, and our Humanities series, where you will find a qualitative analysis of rationing in intensive care, evaluating covert triage during the COVID-19 pandemic. 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.