Thank you for tuning in to the Editor’s Highlight Podcast for the January 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.
Starting with our Asthma section, it is currently unclear if all children with mild asthma carry an equal risk for severe asthma exacerbations. In this issue, Sheikh and colleagues evaluate administrative claims data from children with intermittent asthma enrolled in Ohio Medicaid Managed Care Plans for three consecutive years to determine if there is a subgroup of children with mild asthma who have a very low risk of severe asthma exacerbations. From the cohort of children considered to have intermittent asthma, a low-risk group (3,935 patients) was identified based on the first two years of enrollment; then, the risk of a severe exacerbation was compared with the rest of the cohort (9,273 patients) in the third year. The RR of severe exacerbations in the low-risk group was 0.18 compared with high-risk patients. The number needed to treat to prevent one hospitalization was 5,535, and the cost to prevent one hospitalization was $780,000. These findings suggest that among children with mild asthma, there is a subgroup of low-risk patients in whom current guideline recommendations for first-step treatment may not be needed. Completing this section is a CHEST Review that describes digital respiratory technologies across the lifespan.
Our Chest Infections content area is next. The population-level impact of risk factors for unfavorable TB treatment outcomes depends on their relative prevalence in the population. In this issue, Sinha and colleagues report findings from a prospective cohort of 2,930 adults with drug-sensitive pulmonary TB from five sites in India. The study was designed to determine the proportion of unfavorable TB treatment outcomes that can be attributed to key risk factors in India. Overall, 129 failed treatment, 80 had recurrence, and 101 died. After adjustment for the presence of multiple risk factors, 29% of all unfavorable outcomes were attributed to undernutrition, 15.4% to alcohol misuse, and 17.9% to ever-smoking. These findings help to identify intervention targets to improve TB treatment outcomes in India.
Our COPD section is next. Mucus plugs occluding the airway in people with chronic bronchitis are associated with increased all-cause mortality. In this issue, Krimsky and colleagues report findings from a study of 55 patients with symptomatic chronic bronchitis designed to determine if bilateral bronchial rheoplasty by basket catheter expansion and delivery of pulsed electric fields to the airway mucosa reduce mucus plugging (MP) on CT imaging. Of those enrolled, 36 (65%) had at least one lung segment with MP before the intervention. In those with MP at baseline, the mean segmental MP score was reduced by approximately one segment, with 52.8% of patients improving by at least one segment. Disconnected airway volume increased at follow-up by 16%. These findings show that bronchial rheoplasty in people with chronic bronchitis and MP on CT imaging leads to mucus plug reduction at six months after bronchial rheoplasty, showing promise for further investigation. Completing this section is a prospective cohort study that explores the association between betel quid consumption and respiratory disease mortality in Bangladesh.
Next is our Critical Care content area. Antibiotic prophylaxis following out-of-hospital cardiac arrest (OHCA) reduces early-onset pneumonia but has an uncertain impact on mortality and noninfectious outcomes. In this issue, Gagnon and colleagues report findings from a pilot randomized controlled trial with 52 participants, designed to assess whether prophylactic ceftriaxone reduces the incidence of early-onset pneumonia without increasing the acquisition of antibiotic resistance genes after OHCA. The risk ratio (RR) for early-onset pneumonia was 0.57 in those receiving ceftriaxone. There was a reduction in the use of open-label antibiotics in those receiving ceftriaxone prophylaxis (RR, 0.64), most of which were broad-spectrum antibiotics. Those randomized to receive ceftriaxone acquired fewer antibiotic resistance genes to frequently used antibiotics in the ICU (incidence RR, 0.30). These findings suggest that ceftriaxone prophylaxis in those with OHCA is associated with less frequent administration of open-label antibiotics and reduced acquisition of antibiotic resistance genes. Two other original research articles appear in this section. The first explores the association between hospital safety-net status and delivery of rehabilitation to older adults with acute respiratory failure, and the second reports on contemporary trends in pediatric extubation failure and noninvasive respiratory support use. Completing this section is a Special Features article on quantifying practice variability to inform the design and assessment of implementation programs in critical care.
On to our Diffuse Lung Disease section. Previous mechanistic and clinical studies have suggested that angiotensin-converting enzyme (ACE) inhibitor therapy may slow disease progression and reduce mortality in idiopathic pulmonary fibrosis (IPF). In this issue, Ozaltin and colleagues report findings from a retrospective analysis of electronic health records from the Clinical Practice Research Datalink GP Online Database, designed to determine if ACE inhibitor use is associated with reduced all-cause mortality in a real-world population of patients with IPF or COPD. Of the patients, 3,579 with IPF and COPD were included (matched by age, sex, and smoking history), and 37% in the IPF cohort and 30% in the COPD cohort used ACE inhibitors. ACE inhibitor use was associated with improved survival, independent of comorbidities, in patients with IPF (HR, 0.82) but not in those with COPD (HR, 1.09). These findings identify an independent association of ACE inhibitor therapy with reduced all-cause mortality in IPF, warranting the conduct of prospective trials. Also in this section is a look at the geographical distribution of phase II/III pharmaceutical randomized controlled trials in adults with ILD and an inventory of clinical sarcoidosis status in the United States.
Next is our Education and Clinical Practice content area. Air pollution and extreme temperature exposure during pregnancy are associated with lung function in schoolchildren. In this issue, Hu and colleagues report findings from 429 mother-child dyads in the Programming Research in Obesity, Growth, Environment, and Social Stressors study in order to determine the critical time windows during pregnancy when exposure to air pollution and temperature affects lung function in schoolchildren. Prenatal fine particulate matter and nitrogen dioxide exposures were associated with reductions in several measures of lung function at ages 8 to 14 years when modeled as z scores that were adjusted for age, height, and sex. Both warmer temperatures at weeks one to eight and colder temperatures at weeks nine to 18 showed positive associations with the FVC z score. Stronger associations were noted in female participants, and no interactive effects of air pollution and temperature were noted. These findings highlight detrimental effects of early-life air pollution exposure on long-term respiratory health, informing the development of targeted interventions to protect child health. Also in this section is a scoping review on the failure to report sex-specific risk factors in heart failure with preserved ejection fraction research. Completing this section is a How I Do It review on transitioning from race-specific to race-neutral reference equations for pulmonary function test interpretation and a Point/Counterpoint debate on whether pulmonary and critical care medicine fellowships should require advanced cardiac point-of-care ultrasound competency.
Our Pulmonary Vascular content area is next. Manual interpretation of echocardiography can be time-consuming and prone to error. In this issue, Celestin and colleagues aim to determine if a fully automated deep learning (DL) workflow in echocardiography is reliable when assessing for pulmonary hypertension (PH). The first part of the study evaluated the bias and precision of DL reads using core lab readers as the reference in 213 healthy individuals and 221 patients with pulmonary arterial hypertension; the second part assessed the ability of DL to discriminate milder PH in 196 patients referred for right heart catheterization. No significant bias was noted for peak tricuspid regurgitation velocity (TRV), right atrial area, and tricuspid annular plane systolic excursion, while a bias of 11.46% was noted for right ventricular fractional area change. In the case-control evaluation, peak TRV had area under the curves (AUCs) of 0.99 and 0.98 for core lab and DL reads, respectively. The AUC for PH detection in the referral cohort was 0.79 for clinical lab reads and 0.75 for DL reads. These findings identify the promise of automated DL workflow for echocardiography in PH. Completing this section is a How I Do It review on the evaluation and management of PH associated with ILD.
Next is our Sleep Medicine content area. There are limitations to the use of hypoglossal nerve stimulation (HNS) to treat OSA, including cost, invasiveness, and variable efficacy. In this issue, Osman and colleagues evaluate whether HNS applied via percutaneous implantation of a linear, multipair electrode array can restore airflow to airway narrowing, obstruction, or both in 14 people with moderate to severe OSA undergoing drug-induced sleep endoscopy. Mean peak inspiratory flow was 0.43 L/s when receiving therapeutic CPAP. This fell to 0.10 L/s during CPAP reduction and increased to 0.41 L/s, similar to that achieved during therapeutic CPAP, during HNS. The mean active pharyngeal critical closing pressure was -7.2 cm H2O with HNS and 0.1 cm H2O without HNS. These results show that acute HNS via a minimally invasive, percutaneous, ultrasound-guided approach leads to airflow increases equivalent to therapeutic CPAP and improves airway collapsibility in people with OSA. Two additional original research studies appear in this section. The first evaluates the consistency of hypercapnic respiratory failure case definitions in electronic health record data. The second is a method comparison study that explores how using different oximeters may affect clinical decisions in patients using CPAP or noninvasive ventilation.
Next is our Thoracic Oncology content area. Differences in underlying characteristics between the population undergoing lung cancer screening (LCS) and LCS trial participants may alter the benefits of LCS. In this issue, Rivera and colleagues use data from the North Carolina Lung Screening Registry (NCLSR), the 2022 Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System (BRFSS) Lung Cancer Screening Module, and the National Lung Screening Trial (NLST) to determine if the risk of lung cancer developing and death resulting differ between trial participants and the general population. BRFSS and NCLSR populations were older, had higher rates of COPD and prior histories of cancer, and had a higher risk of lung cancer developing and death resulting compared with NLST participants. Median five-year lung cancer risk was 21.2 per 1,000 NLST participants, 34.5 per 1,000 2021 BRFSS participants, and 32.3 per 1,000 2021 NCLSR participants. Median five-year probability of dying of lung cancer if not screened showed similar patterns. These findings show that populations undergoing LCS have similar smoking exposure to NLST participants but higher prevalence of lung cancer risk factors and risk of developing and dying from lung cancer if not screened. Also in this section is a study that explored medical thoracoscopy with vs without prior artificial pneumothorax for patients with minimal or absent pleural effusion, a report on the implementation of a precision medicine thoracic service using in-house reflex testing in a large academic community practice, and a randomized controlled trial of behavioral support by peers who previously smoked using instant messaging for smoking cessation.
I encourage you to read our Commentary series, where you will find a description of the Bronchiectasis and NTM Care Center Network; our statistical series, where you will find a piece on a data-driven latent class analysis approach to identify subgroups in clinical research; and our Humanities series, where you will find an Exhalations piece titled, “An Evolution.” 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 January issue.