Thank you for tuning in to the Editor’s Highlight Podcast for the June 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 explores the relationship between exacerbations in moderate to severe asthma and the stability of fractional exhaled nitric oxide.
Next is our Chest Infections content area. The prevalence of nontuberculous mycobacteria pulmonary disease (NTM-PD) is rising globally. In this issue, Even-dar and colleagues report on the prevalence of NTM-PD and Mycobacterium (M) simiae-PD in Northern Israel, including factors associated with mortality, from a retrospective cohort of lab-confirmed NTM between January 2010 and March 2021. From 1,501 people, 1,968 isolates showed the relative abundance of M simiae, and Mycobacterium avium complex (MAC) increased over the study period. Factors associated with mortality included age, male sex, and immunosuppression. M simiae was associated with elevated mortality compared with MAC (hazard ratio, 1.84). These findings show that M simiae is prevalent in Israel and may be more pathogenic than previously considered.
Our COPD content area is next. The effects of morphine during sleep, when used to reduce chronic breathlessness in COPD, are unclear. In this issue, Altree and colleagues report findings from a randomized, double-anonymized, crossover trial of sustained-release morphine vs placebo in 19 people with COPD who are breathless. The study was designed to determine the impact of low-dose morphine on sleep efficiency and other sleep parameters. Sleep efficiency was similar between placebo and morphine, as was the frequency of sleep-disordered breathing events. Morphine reduced mean (2%) and nadir (5%) overnight oxygen saturation. Mean transcutaneous CO2 (3.3 mm Hg) and the number of participants meeting criteria for nocturnal hypoventilation increased. Breathlessness and next-day driving simulator performance were unchanged. These findings suggest that morphine does not change sleep efficiency or next-day alertness but may cause hypoventilation during sleep. Also in this section is an original research article evaluating plasma protein biomarkers of spirometry measures of impaired lung function; a systematic review and meta-analysis of preserved ratio impaired spirometry prevalence, risk factors, and outcomes; and a journal CHEST narrative review on the determinants and outcomes of education in pulmonary rehabilitation.
Next is our Critical Care content area. The optimal PaCO2 target in patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO) after out-of-hospital cardiac arrest (OHCA) is uncertain. In this issue, Izawa and colleagues report findings from a multicenter, registry-based observational study of 1,454 patients, designed to determine if PaCO2 levels are associated with functional outcomes in patients receiving VA-ECMO after OHCA. Compared with high normocapnia (40 to < 50 mm Hg), low normocapnia (30 to < 40 mm Hg) was associated with worse functional outcomes in both initial and 24-hour PaCO2 analyses (adjusted odds ratio, 0.59 for initial and 0.56 for 24-hour). PaCO2 trajectories ending in high normocapnia also had a higher proportion of favorable functional outcomes than those ending in low normocapnia regardless of initial PaCO2 levels. These findings suggest that maintaining high normocapnia levels in patients with OHCA receiving VA-ECMO may improve functional outcomes irrespective of initial PaCO2. Also in this section is an original research article exploring the role of the ventilator bundle, ventilation practices, and health care staffing in ventilator-associated pneumonia in low- and middle-income vs high-income countries; a population-based cohort study that evaluates long-term mental health morbidity in adult survivors of COVID-19 critical illness; a research letter describing prehospital cricothyrotomy for emergency airway management; and a narrative review of an ultrasound-guided physiologic framework for evaluating volume status.
On to our Diffuse Lung Disease content area. The effect of pulmonary rehab on survival in people with interstitial lung disease (ILD) is unclear. In this issue, Dowman and colleagues report findings from the combined data of 182 participants from two previous randomized controlled trials of pulmonary rehab in ILD, designed to determine if participation in pulmonary rehab impacts survival among people with ILD. The median survival of those who completed pulmonary rehab was 6.1 years compared with 4.7 years in those who did not participate in pulmonary rehab (not statistically significant). After adjustment for baseline variables, at 5 years, completion of pulmonary rehab was associated with a 44% lower risk of mortality. There was no difference at 10 years. These findings suggest that participation in pulmonary rehab among people with ILD may impact survival at 5 years. Also in this section is a multicenter study that evaluated the performance of lung ultrasound as a screening tool for subclinical rheumatoid arthritis-associated ILD and a Special Features article that presents a historical perspective of the role of advanced imaging in the evolution of diffusing capacity of the lungs for carbon monoxide in lymphangioleiomyomatosis.
On to our Education and Clinical Practice content area. It is unclear if the use of noninvasive ventilation (NIV) during the postoperative period after heart surgery can impact the incidence of pulmonary or heart failure. In this issue, Goret and colleagues report findings from a prospective, randomized, monocentric trial of 216 patients at risk of postoperative complications, designed to determine if the use of NIV for 5 days before and 5 days after cardiac surgery is associated with a lower rate of acute pulmonary complications (atelectasis, pneumothorax, pneumonia, and acute respiratory failure) and cardiac complications (acute heart failure, arrhythmia, myocardial infarction, and tamponade). The composite outcome of predefined and adjudicated cardiorespiratory complications at 1 month after cardiac surgery occurred in 55.1% in the NIV group and 79.8% in the control group (relative risk, 0.69). No difference between the groups was found for intubation need and length of hospital stay. These findings suggest a reduction in postoperative cardiopulmonary complications with the use of perioperative NIV but similar intubation need and length of hospital stay. Completing this section is an original research study that explores the association of lung function with visceral adiposity and skeletal muscle mass.
Our Pulmonary Vascular content area is next. The effects of comorbidities, particularly cardiovascular, on the response to pulmonary arterial hypertension (PAH) treatment are not well understood. In this issue, White and colleagues report findings from a post hoc analysis of subjects from two phase 3 studies of people with PAH (TRIUMPH and FREEDOM-EV) that was designed to determine if cardiovascular comorbidities in patients with PAH influence the efficacy and tolerability of inhaled or oral treprostinil. Study subjects receiving inhaled treprostinil had similar improvements in 6-minute walk distance and reductions in N-terminal pro-brain natriuretic peptide regardless if they had no, one, or two or more cardiovascular comorbidities. Those receiving oral treprostinil had a reduced risk of clinical worsening regardless of comorbidities. Adverse event profiles did not differ with the number of comorbidities. These findings suggest that patients with PAH and cardiovascular comorbidities can benefit from combination therapy with inhaled or oral treprostinil. Completing this section is a research letter detailing factors associated with high intrathoracic pressure in patients with obesity undergoing right heart catheterization.
Next is our Thoracic Oncology content area. The management of patients with pulmonary subsolid nodules (SSNs) that are mostly ground glass remains controversial. In this issue, Li and colleagues report findings from a retrospective cohort of 1,676 patients, 67% of whom were treated with surgery and 33% with observation, to determine if upfront surgical intervention leads to higher survival than watchful waiting in patients with SSNs 2 cm or less and a consolidation tumor ratio (CTR) of < 0.25. The 5-year event-free survival rate in the observation group was 100% across all subcategories. The 5-year event-free survival rate in the surgical group ranged from 97.4% to 99.0% across all subgroups. The findings suggest that in patients with SSNs 2 cm or less and a CTR of < 0.25, watchful waiting is more appropriate than upfront surgical intervention. Completing this section is an evaluation of the diagnostic performance of the modified Lung CT Screening Reporting and Data System in a TB-endemic country from the Korean National Lung Cancer Screening Program.
I encourage you to read our Humanities in Chest Medicine section, where you will find an original research study on how clinicians use quotations in goals of care notes, as well as our Commentary series, where you will find a description of the usefulness of cross-lagged panel models for clinical research. 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 June issue.