Thank you for tuning in to the Editor’s Highlight Podcast for the October 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.
Starting with our Asthma section, the functional consequence of different sputum cell types on ventilation is unknown. In this issue, Serajeddini and colleagues report findings from 85 patients with severe asthma and 15 healthy control participants in a study that was designed to determine the effect of different sputum cellular phenotypes on abnormal ventilation, with abnormal ventilation evaluated by 129Xe MRI in people with severe asthma. Ventilation was abnormal in 44% of those with paucigranulocytic sputum, 64% of those with eosinophilic bronchitis, 75% of those with neutrophilic bronchitis, and 89% of those with mixed-granulocytic bronchitis. Those with paucigranulocytic phenotypes were most similar to healthy control participants. Ventilation abnormalities in this phenotype were associated with older age, higher exhaled nitric oxide, and higher CT scan mucus scores. These findings show abnormal ventilation irrespective of intraluminal cellular inflammation phenotype.
Our Chest Infections content area has a How I Do It review that walks us through a practical approach to diagnosing respiratory long COVID.
Our COPD section is next. The longitudinal, combined effects of genetic predisposition and preserved ratio impaired spirometry (PRISm) on frailty in COPD development are unknown. In this issue, Liu and colleagues report findings from a cohort study of 412,351 adults without COPD and 60,584 adults with COPD at baseline from the UK Biobank cohort. The study was designed to determine the association between physical frailty and the incidence and mortality of COPD, as well as how genetic predisposition and PRISm modify this association. They found that frailty and prefrailty were associated with an increased risk of developing COPD, with significant interactions between genetic predisposition and frailty and PRISm and frailty in the development of COPD. In those with COPD at age 45, frailty was associated with a reduction in life expectancy (8.5 years for males, 7.7 years for females). These findings identify an association between frailty and prefrailty with increased COPD risk and life expectancy. Completing this section is an original research article that forecasts the global economic and health burden of COPD from 2025 through 2050.
Next is our Critical Care content area. Whether the ventilator mode affects outcomes for patients who are critically ill is not known. In this issue, Seitz and colleagues report findings from a pragmatic, cluster-randomized, crossover pilot trial, designed to determine the feasibility of studying the effects of three common ventilator modes (volume control, pressure control, and adaptive pressure control) on death and duration of mechanical ventilation in 566 adults who are critically ill. The median proportion of ventilator mode assessments in the assigned mode was 100% in the first 72 hours. There were no differences in the median number of ventilator-free days. The median tidal volume was similar among the three groups, but the percentage of breaths > 8 mL/kg was higher in the pressure control mode. This pilot trial established the feasibility of conducting a larger trial of outcomes related to ventilator mode selection in adults who are critically ill while demonstrating differences in intermediate outcomes. Also in this section is an original research study that evaluated the association between mechanical power within the first 24 hours and ICU mortality in patients with acute hypoxemic respiratory failure who are mechanically ventilated. Completing this section is a How I Do It review about communicating with patients and families about postintensive care syndrome.
On to our Diffuse Lung Disease section. The significance of anti-Ro52 antibodies in interstitial lung disease (ILD) is unclear. In this issue, Imai and colleagues report findings from a retrospective cohort study of 1,026 patients with ILD tested for the anti-Ro52 antibody. The study was designed to determine the prognostic significance of anti-Ro52 antibody positivity in patients with ILD. Of the 1,026 patients tested for the anti-Ro52 antibody, 154 patients (15%) had positive anti-Ro52 results. ILD phenotypes in the cohort included interstitial pneumonia with autoimmune features, connective tissue disease (CTD)-associated ILD, idiopathic pulmonary fibrosis, hypersensitivity pneumonitis, and other idiopathic ILD. Those positive for anti-Ro52 were younger, were more likely to have CTD, were more frequently copositive for a myositis-specific antibody, and showed a higher risk of ILD progression, lung transplantation, or death. These findings identify an association between anti-Ro52 seropositive ILD and worse progression-free and transplant-free survival. Two additional original research studies complete this section. The first describes pregnancy outcomes in 53 female lung transplant recipients, and the second reports findings from a multicenter, survey-based study of pulmonary rehab referral practices across lung transplant centers in the United States.
Next is our Education and Clinical Practice content area. Graduating fellows may lack confidence in managing patients with interstitial lung disease (ILD), presenting an opportunity to refine ILD education in fellowship to address this gap. In this issue, King and colleagues report the results of an exploratory, sequential, mixed-methods study, designed to determine the essential components of an ILD curriculum for general pulmonary fellowship, including the skills required to care for patients with ILD and the conditions that fellows should learn to diagnose and manage ILD. Seven themes emerged—diagnostic components, disease classification, treatment, care decisions, educational strategy, site of care, and the patient’s illness journey. Forty-eight skills and 29 conditions met consensus for inclusion in an ILD curriculum. Participants expected a higher degree of independence with diagnosis than with management. This study provides a consensus-driven content outline to guide the development of a fellowship ILD curriculum. Completing this section is an original research article that evaluates proteomic analysis of nasopharyngeal aspirate biomarkers for prematurity-related bronchopulmonary dysplasia.
Our Pulmonary Vascular content area is next. There is a paucity of data regarding pulmonary rehabilitation (PR) in people with pulmonary arterial hypertension (PAH). In this issue, Bailey and colleagues report findings from a retrospective cohort study of adults with PAH from the Pulmonary Hypertension Association Registry. The study was designed to determine the frequency of PR referrals among patients with PAH and the factors associated with PR referrals. Referral rates were 17%, 26.6%, and 32.3% at the first, second, and third follow-up visits, respectively. In multivariable analysis, race, region, PAH etiology, and disease severity as assessed by REVEAL Lite 2.0 scores, supplemental oxygen use, and lung transplantation referral were independently associated with PR referral. Fewer than one-half of patients referred to PR reported participation in PR. Participation was associated with improvements in health-related quality of life. These findings identify low rates of PR referral for patients with PAH, with referral rates influenced by demographic and socioeconomic factors as well as disease characteristics. Also in this section is a research letter that reports trends in Medicare spending on drugs for PAH from 2012 to 2022 and a CHEST Narrative Review of diagnosing pulmonary embolism during pregnancy.
Next is our Sleep Medicine content area. Little is known about the health and economic burden associated with OSA among active-duty military personnel. In this issue, Wickwire and colleagues used data from 59,203 service members with OSA matched to the same number of service members without OSA to determine the health and utilization burden of OSA among active-duty service members in the United States. Of the participants, 83% were male, and 81% were under 44 years of age. OSA was associated with an increased risk for all physical and psychological health outcomes, including a fourfold increased risk for posttraumatic stress disorder. OSA was associated with increased outpatient, inpatient, and emergency department encounters per year. These findings show that OSA is associated with a substantially increased risk for adverse physical and psychological health outcomes and health care utilization among US active-duty military personnel.
Next is our Thoracic Oncology content area. The benefits of lung cancer screening may not be immediate, impacting the benefit to patients with limited life expectancy. In this issue, Xie and colleagues report findings from a systematic review that included four population-based randomized controlled trials of lung cancer screening, encompassing 64,105 individuals. The review was designed to determine the time to benefit from low-dose CT (LDCT) screening for individuals at high risk of lung cancer. On average, it took 2.87 years to prevent one lung cancer death for every 1,000 individuals screened, 4.66 years for every 500 individuals screened, and 8.87 years for every 200 individuals screened. These findings suggest that the clinical benefits of LDCT screening may not be realized for individuals with limited life expectancy. Also in this section is a multicenter, randomized controlled factorial trial of ultrathin bronchoscopy with radial endobronchial ultrasound and rapid on-site evaluation for the diagnosis of peripheral pulmonary lesions, as well as a research letter that explores practice patterns and patient travel distances for lung cancer surgery in the United States. Completing this section is a Special Features article that evaluates the impact of health care disparities on lung cancer screening and treatment.
I encourage you to read our Commentary series, where you will find a piece on the pseudoproductivity paradox in health care and an article from our study methodology series on estimating heterogeneous treatment effects with target trial emulation—a checklist of causal machine learning for observational data. In our Humanities series, you will find an Exhalations piece titled, “Music in Practice.” 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 October issue.