Thank you for tuning in to the Editor’s Highlight Podcast for the April 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.
First is our Asthma content area. Many patients with severe uncontrolled asthma (SUA) do not have a complete response when receiving biologic therapy. In this issue, Cosío and colleagues report findings from a prospective multicenter study that included 92 consecutive patients with SUA who underwent bronchoscopy with bronchial biopsy (BB) prior to biologic therapy initiation. The study was designed to determine if BB could help to identify patients with SUA who have a better response to biologic therapy. The pathologic score, a previously validated tool, was independently associated with the response to treatment, whereas a score of type 2 inflammation (T2 score) was not. Super-responders had a statistically significantly higher pathologic score. Low tissue eosinophilia was associated with a poor response. These findings suggest BB, particularly related to tissue eosinophilia, is a better predictor of response to biologic therapy than the T2 score. Completing this section is a EUFOREA consensus statement about promoting prevention and targeting remission of asthma.
Next is our Chest Infections content area. European guidelines previously proposed an algorithm for the empiric treatment of nosocomial pneumonia. In this issue, Calabretta and colleagues report findings from a retrospective analysis of data collected from a prospective cohort of 315 patients with microbiologically confirmed pneumonia from six ICUs at a single center. The study was designed to determine if these guideline recommendations were effective in reducing the incidence of adverse outcomes in ICU patients with nosocomial pneumonia. Overall, outcomes were similar between groups with and without guideline adherence. In the subgroup without septic shock, treatment according to the guidelines led to reductions in both ICU mortality (28.8% vs 14.5%) and adjusted 28-day mortality (hazard ratio, 3.07). No benefit was noted in those presenting with septic shock. These findings suggest that adherence to the guideline treatment algorithm may lead to reduced mortality in ICU patients with nosocomial pneumonia without septic shock. Completing this section is an original research article that explores the relationship between Aspergillus serology and clinical outcomes in patients with bronchiectasis from the European Bronchiectasis Registry.
Our COPD content area is next. Alternative methods of pulmonary rehabilitation delivery may improve program access but could affect the response to rehab. In this issue, Cox and colleagues report findings from a secondary analysis of two randomized controlled trials, totaling 266 individuals with COPD, designed to compare the rate of clinical response to home-based telerehab with that of center-based pulmonary rehab. The proportion of rehab responders was not different between the two delivery methods, either at the end of rehab or after 12 months of follow-up. Baseline outcome values, but not participant demographic characteristics, were most associated with responder status. The relative risk of program noncompletion was higher in the center-based group. These findings suggest similar responder rates between center-based pulmonary rehab and home-based telerehab, without clear findings to guide the selection of setting for an individual person. Also in this section is an original research article that evaluates risk factors and clinical impact of severe pneumothorax after endoscopic lung volume reduction with endobronchial valves and a research letter that evaluates physical capacity and physical activity as determinants of mortality in patients with COPD. Completing this section is a CHEST Review of COPD-related expiratory central airway collapse and a Canadian Thoracic Society clinical practice guideline on alpha-1 antitrypsin deficiency-targeted testing and augmentation therapy.
Next is our Critical Care content area. The impact of albumin infusions in patients with septic shock who have kidney impairment is not known. In this issue, Patanwala and colleagues report findings from a retrospective, multicenter, inverse probability-of-treatment-weighted cohort of 9,988 patients from 220 geographically diverse community and teaching hospitals in the United States. The study was designed to determine if the early use of albumin mitigates the need for renal replacement therapy (RRT) or in-hospital mortality in patients with septic shock and kidney impairment. The composite outcomes of RRT or in-hospital mortality occurred in 33.8% without albumin and 39.7% with albumin treatment (OR, 1.29). The increase was more pronounced when 25% albumin was administered, rather than 5% albumin. These findings suggest that early albumin use may lead to increased need for RRT or in-hospital mortality in patients with septic shock and kidney impairment at the time of hospital admission. Two other original research articles appear in this section. The first is a randomized multicenter study of the treatment of acute circulatory failure based on CO2-O2-derived indices, and the second is a systematic review and meta-analysis of prophylactic antibiotic use in adults with acute brain injury who are invasively ventilated in the ICU.
On to our Diffuse Lung Disease content area. The effect of hypnotics use for insomnia on the clinical course of patients with idiopathic pulmonary fibrosis (IPF) is unclear. In this issue, Hozumi and colleagues report findings from an evaluation of two hospital-based cohorts (99 and 123 patients), as well as 30,218 patients with IPF from the National Database of Health Insurance Claims and Specific Health Checkups of Japan (the NDB cohort). The study was designed to determine if hypnotics use is associated with an increased risk of mortality in patients with IPF. In both the hospital-based cohorts, the continuous use of hypnotics was associated with increased risk of all-cause mortality (hazard radio [HR], approximately 3-4). This finding was consistent regardless of sex and comorbidities. In a target trial emulation from the NDB cohort, the per-protocol analysis showed that hypnotics treatment was associated with increased mortality (HR, 1.71). These findings suggest an association between the continuous use of hypnotics and increased risk of mortality in patients with IPF. Also in this section is an original research article evaluating practice patterns of sarcoidosis treatment in the United States from 2016 to 2022 and a CHEST Review on the dawn of precision medicine in fibrotic interstitial lung disease.
On to our Education and Clinical Practice content area. The standard for evaluating expiratory airway function in infants is technically difficult and has a high failure rate. In this issue, Hevroni and colleagues report findings from an observational retrospective analysis of 296 infants who underwent pulmonary function testing using the raised-volume rapid thoracoabdominal compression technique. The study was designed to determine if measurements obtained during passive expiration from total lung capacity correlate with forced expiration measurements obtained by the raised-volume technique in infants. A technically acceptable passive flow-volume curve was found in 93%, while 76% had acceptable forced flow-volume curves. There was a higher success rate for producing acceptable passive curves. The Spearman correlation coefficients of vital capacity (VC), expiratory volume at 0.5 seconds, maximal expiratory flow, and expiratory flow at 50%, 75%, and 85% of VC were 0.92, 0.72, 0.83, 0.66, 0.67, and 0.68, respectively. The mean intermaneuver coefficients of variation were 5.2% and 5.4%. These findings suggest that the passive flow-volume curve offers reliable and reproducible data with high correlation to the forced flow-volume curve. Completing this section is a CHEST Review on lung nodules and masses in patients who are immunocompromised without HIV.
Our Pulmonary Vascular content area is next. The evidence regarding the role of β-blockers in the management of pulmonary arterial hypertension (PAH) with or without comorbidity indications is unclear. In this issue, Waligóra and colleagues report findings from a retrospective analysis of 806 patients with newly diagnosed PAH who were enrolled prospectively in the Database of Pulmonary Hypertension in the Polish Population. The study was designed to determine the effects of β-blocker use on clinical outcomes in patients with PAH and how these outcomes differ according to the presence of cardiovascular comorbidities. Of those enrolled, 58.2% received β-blockers at the time of PAH diagnosis. After propensity score matching, the composite end point of hospitalization due to right heart failure, syncope, or death was more likely to occur in those receiving β-blocker treatment (hazard ratio [HR], 1.44). The HR was 1.22 for mortality alone (Not significant, P = .25). β-blockers showed an adverse impact on the composite end point in patients without comorbidities and had a neutral effect in those with at least one comorbidity. These findings suggest that β-blockers may pose a risk in patients with PAH, particularly in those without coexisting hypertension, coronary artery disease, or arrhythmias. Also in this section is an original research article that evaluates the association between thrombus histopathology and hemodynamic outcomes among patients with chronic thromboembolic pulmonary hypertension who undergo pulmonary endarterectomy. Completing this section is a Special Features article—the APOLLO summary on pulmonary vascular disease fellowship training.
On to our Sleep Medicine content area. Many individuals who are symptomatic with central sleep apnea (CSA) have an indication for adaptive servoventilation (ASV) therapy. In this issue, Tamisier and colleagues report findings from a prospective, multicenter, observational cohort study of 526 patients with predominant CSA or OSA with central events not controlled with CPAP, designed to determine the effects of ASV on sleep quality and patient-reported outcome measures across a series of indications. The median change in the Pittsburgh sleep quality index (PSQI) score from baseline to six months was -1 in the overall population, with significant results across all indications except for drug-induced CSA, which had a similar impact but did not reach statistical significance. Overall, 65% of participants showed a 1-point or greater improvement in the PSQI. These findings suggest that individuals with a clinical indication for ASV therapy experience improved sleep quality during real-world treatment.
Next is our Thoracic Oncology content area. The length of follow-up required for pure ground-glass nodules (pGGNs) detected on low-dose CT imaging is unclear. In this issue, Kim and colleagues report findings from a retrospective cohort study that included 89 patients with 135 pGGNs, designed to determine the percentage of pGGNS that enlarge after 10 years of stability. They noted an increase in size in 23 (17%) of the nodules, with a median time to size change of 71 months. The increase in size was noted within five years in 35% of those that grew, between five to 10 years in 52%, and after 10 years in 13%. In 76 pGGNs that were stable for 10 years, three (4%) increased in size. These findings suggest a low rate of growth overall and a 4% chance of growth after 10 years of stability. Also in this section is an original research article on patterns and differences in lung cancer treatment in the United States from 2015 to 2020 and a How I Do It review of leveraging patient advocacy and faith-based partnerships to educate, activate, and prepare Black communities to be screened for lung cancer.
I encourage you to read our Humanities in Chest Medicine section, where you will find an original research article on conflicts of interest in bronchoscopy research, as well as our Commentary series, where you will find thoughtful pieces about bronchodilator responsiveness—a test in search of indications—and the early diagnosis and treatment of COPD and asthma. 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 April issue.