Thank you for tuning in to the Editor’s Highlight Podcast for the September 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, our Asthma section has a research letter that explores imaging features of asthma remission, aiming to determine if reversal and normalization of airway and pulmonary vascular remodeling accompany remission.
Next is our Chest Infections content area. There is limited information about the connection between alcohol use and COVID-19 outcomes. In this issue, Turner and colleagues explore data from the Veterans Health Administration to determine if different severity levels of preexisting alcohol use disorder (AUD), alcohol consumption, and their combination are associated with 30-day COVID-19 outcomes. Out of 463,246 veterans with COVID-19, those with every severity level of AUD had a lower probability of a mild outcome (aRR, 0.75-0.98) and greater probability of hospitalization (aRR, 1.14-2.50). This association increased with the severity of the AUD. Veterans with alcohol-related disease had a higher probability of a critical outcome and death within every level of consumption, with the highest probability seen at high-risk consumption levels. These findings connect AUD and alcohol consumption to poorer outcomes from COVID-19 infection.
Our COPD section is next. Spirometry is felt to be underused in clinical practice. In this issue, Dehondt and colleagues report findings from a nationwide cohort study of more than 146,000 initiators of chronic respiratory medication in Belgium, designed to determine the factors associated with timely spirometry and whether use of the test is associated with lower mortality risk. Of those initiating chronic respiratory medication, 20.9% had spirometry at treatment initiation, and 13.8% received spirometry during follow-up. Those who received spirometry on treatment initiation had a 34% lower mortality risk (aHR, 0.66) and less use of short-acting bronchodilators. Smoking, respiratory morbidities, and congestive heart failure increased the chance of spirometry use, and low socioeconomic status, depression/anxiety, and antibiotic use were associated with a lower chance of spirometry use at treatment initiation. These findings suggest that only a minority of initiators of chronic treatment for obstructive lung disease receive spirometry at treatment initiation, with spirometry use associated with better prognosis. Female patients who had never smoked and patients who were vulnerable were least likely to receive spirometry, potentially contributing to underdiagnosis in these groups. Also in this section is an original research study that investigated the long-term effects of COVID-19 infection on health care utilization in individuals with COPD and a prospective cohort study that evaluated the association between airway mucus plugs and risk of moderate to severe exacerbations in patients with COPD in China.
Next is our Critical Care content area. Whether lowering the intensity of anticoagulation to mitigate bleeding complications during venovenous extracorporeal membrane oxygenation (VV-ECMO) is safe or effective is unknown. In this issue, Gannon and colleagues report findings from a multicenter, parallel-group, randomized, pilot trial of 26 patients at three centers in the United States, designed to determine if a large trial of low-intensity vs moderate-intensity anticoagulation during VV-ECMO is feasible. All patients enrolled received the assigned intensity of anticoagulation. Major bleeding occurred in 8.3% vs 28.6%, a thromboembolic event occurred in 8.3% vs 0%, and deaths prior to discharge occurred in 0% vs 14.3% in the low- vs moderate-intensity anticoagulation groups. None of these differences achieved statistical significance. Both of the deaths in the moderate-intensity group occurred in individuals who experienced major bleeding events. These findings suggest that a large, multicenter, randomized trial is needed and appears to be feasible. Also in this section is an observational study that evaluates the accuracy of pulse oximetry, and risk factors associated with discrepancy from arterial oxygenation, in Asian patients in the ICU and a CHEST Clinical Practice Guideline on the transfusion of fresh frozen plasma and platelets in critically ill adults.
On to our Diffuse Lung Disease section. Admilparant is an oral lysophosphatidic acid receptor 1 antagonist under development for the treatment of idiopathic pulmonary fibrosis (IPF) and progressive pulmonary fibrosis (PPF). In this issue, Kreuter and colleagues report findings from a phase 2, randomized, double-blind, placebo-controlled study of 255 patients with IPF and 114 patients with PPF, designed to determine how admilparant affects time to disease progression. Treatment with 60 mg of admilparant delayed time to disease progression over 26 weeks compared with placebo in both cohorts of patients (IPF: HR, 0.54; PPF: HR, 0.41). A similar trend was noted in those above and below the median baseline percent predicted FVC (ppFVC). The first event was a relative decline in ppFVC in all those who progressed. These findings support further evaluation of admilparant as a therapeutic option for patients with IPF or PPF in phase 3 trials. Completing this section is an original research study designed to characterize patients with sarcoidosis with obstructive respiratory physiology.
Next is our Education and Clinical Practice content area. Understanding a pandemic’s impact on medical trainees’ cognitive performance is important for informing strategies and supporting trainee well-being during crises. In this issue, Alwakeel and colleagues report findings from a retrospective study of all pulmonary and critical care medicine (PCCM) fellows in the United States who completed the PCCM-in-training exam (ITE) between April 2015 and July 2022. The study was designed to determine the impact of the COVID-19 pandemic on the performance of PCCM fellows on the ITE. A total of 12,774 ITE scores for 8,391 individuals were evaluated. Mean total scores for fellowship year (FY) 0 and FY1 were similar to prepandemic scores, while FY2 and FY3 had higher mean total scores (2%-2.9%). Pulmonary subsection scores were 5.3% higher for FY3 trainees during COVID-19 wave 1. Critical care subsection scores were similar for FY1, FY2, and FY3 across time points and slightly lower for FY0 (2.2%-2.9%). These findings suggest the pandemic’s impacts on cognitive performance were minimal. Also in this section is an evaluation of ventilatory efficiency in transgender women and the implications of gender-affirming hormone therapy on cardiorespiratory responses, as well as a scoping review of coronary artery calcification identified on lung cancer screening CT scans.
Our Pulmonary Vascular content area is next. The impact of obesity on pulmonary arterial hypertension (PAH) is underexplored. In this issue, Savonitto and colleagues report findings from a retrospective study of 581 patients with incident PAH (139 [24%] of whom had obesity) enrolled at 10 European tertiary care centers for PAH management. The study was designed to determine the clinical characteristics and prognosis of patients with obesity and PAH and how well current risk stratification tools perform in this population. Patients with obesity had more comorbidities and worse symptoms and functional capacity. Five-year all-cause mortality was similar in groups with and without obesity. Both the three- and the four-strata European Society of Cardiology/European Respiratory Society risk stratification tool demonstrated lower accuracy for prediction of annual mortality in patients with obesity (not statistically significant). These findings highlight that individuals with obesity and PAH have a higher burden of comorbidity and worse functional class but similar prognosis to individuals without obesity and with PAH. Current risk stratification strategies may not be adequate for individuals with obesity. Also in this section is a research letter about exercise hemodynamics and the evolving definition of precapillary pulmonary hypertension and a How I Do It review on the best practices for right heart catheterization in the diagnosis of pulmonary hypertension.
Next is our Sleep Medicine content area. Tirzepatide, a dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist, promotes weight loss and reduces OSA severity. In this issue, Wu and colleagues present findings from 42,300 propensity-matched patients with OSA and obesity in the TriNetX Global Collaborative Network, designed to determine if tirzepatide affects clinical outcomes in individuals with OSA and obesity. The tirzepatide group had a lower risk of all-cause mortality (HR, 0.443), as well as reduced risks for major adverse cardiovascular events (HR, 0.731) and major adverse kidney events (HR, 0.427). These associations were consistent across age, sex, BMI, and CPAP use with the exception of the 18 to 39 years of age group. These findings suggest that tirzepatide may improve clinical outcomes in patients with OSA and obesity.
Next is our Thoracic Oncology content area. The impact of a centralized approach to lung cancer screening (LCS) on annual adherence is unclear. In this issue, Ezenwankwo and colleagues report findings from a meta-analysis of 12 cohort studies involving 17,195 patients to determine if participation in a centralized screening program is associated with higher adherence rates in individuals with negative baseline LCS results. The pooled adherence rate was 55% (10-18 months), significantly higher in centralized compared with decentralized screening programs (68.9% vs 37.1%; OR, 3.33). There was substantial heterogeneity across studies and no evidence of publication bias. Adherence in centralized programs was not associated with Lung CT Screening Reporting & Data System category, follow-up duration, age, sex, race/ethnicity, smoking status, or institutional setting. These findings support significantly higher adherence to annual LCS in centralized LCS programs. Also in this section is a research letter evaluating local anesthetic use in pleural procedures, a How I Do It review on pleural fluid analysis, and a CHEST Clinical Practice Guideline on the management of patients with early-stage non-small cell lung cancer.
I encourage you to read our Commentary series, where you will find a piece on the new age of cell-free DNA in pulmonary medicine and two articles from our Statistics for Clinical Researchers series—one on network analysis and the other on joint models for longitudinal data. In our Humanities series, you will find an original research article on exploring and supporting professional identity formation and resilience of intensivists through the humanities, as well as an Exhalations piece titled, “Permission to Cry.” 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 September issue.