Thank you for tuning in to the Editor’s Highlight Podcast for the August issue of the journal CHEST®. We have a great lineup of diverse content in this month’s issue.
Over the next 10-15 minutes, I will provide a brief overview of key original research manuscripts published in each of our content areas.
Starting with our Asthma content area, prior studies have reported an increased risk of developing asthma following lower respiratory infections. This relationship has not been specifically evaluated in infants who develop pneumonia. In this month’s issue, Rhedin and colleagues used a nationwide registry-based cohort of >900,000 Swedish children to assess the association between pneumonia in infancy and asthma at 4 years of age. They also assessed whether this relationship has changed since the introduction of nationwide pneumococcal vaccine immunization. They noted a strong association between pneumonia in infancy and asthma at 4 years with an OR of 3.38. This relationship was a little stronger during the pneumococcal vaccination period. These results may have implications for future asthma preventive measures and suggest that asthma could be considered a morbidity attributed to pneumonia. The asthma section also includes a research letter describing the use of polarization sensitive optical coherence tomography for bronchoscopic airway smooth muscle detection after bronchial thermoplasty.
Next is our Chest Infections content area. Mycobacterium (M) abscessus pulmonary disease can be difficult to treat because of its resistance to antibiotics. In this issue, Kang and colleagues determined the outcome of 82 treatment-naïve patients with M abscessus treated with inhaled amikacin-containing multidrug regimens that also included IV amikacin, imipenem or cefoxitin, and azithromycin. Twelve month cure rates were 65% overall, 91% in those with M abscessus subspecies massiliense and 31% in those with M abscessus subspecies abscessus. Symptomatic improvement was noted in 88% and radiographic improvement in 78%. These results suggest favorable outcomes when inhaled amikacin is added to a multidrug regimen to treat M abscessus, while also highlighting that easier and more effective treatments are needed. Other original research published in this month’s issue includes an evaluation of persistent lung inflammation measured by FDG-PET/CT after resolution of community-acquired pneumonia and a description of hospital-acquired infections in critically-ill patients with COVID-19. A research letter assesses the association of long-term macrolide therapy and nontuberculous mycobacterial culture positivity in patients with bronchiectasis. A How I Do It review describes the rapid design and implementation of post-COVID-19 clinics.
On to our COPD content area. Little is known about the natural course of diffusing capacity over time, including factors that may influence DLCO progression. In this issue, Casanova and colleagues phenotyped 602 individuals who smoke, of whom 84% had COPD, measuring lung function annually over 5 years. They found a steeper decline in the DLCO of those with COPD. At baseline, women with COPD had a lower DLCO, and on follow-up, they had a steeper decline in DLCO over time. These findings suggest a slow but accelerated decline in the DLCO of those with COPD, possibly influencing the frequency of assessment, and a differential impact of sex on gas exchange. Another original research manuscript in this section assesses the association of pulmonary artery pruning with longitudinal change in percent emphysema and lung function. A Special Feature article in the COPD section describes peak inspiratory flow as a predictive therapeutic biomarker in COPD.
Next is our Critical Care content area. The approach that US hospitals took to respond to the strain on critical care resources from the COVID-19 pandemic is unknown. In this issue, Kerlin and colleagues report on a survey of chief nursing officers of a representative sample of US hospitals, recording organizational actions taken to increase or maintain critical care capacity. Responses were received from 169 hospitals. They found that 95+% canceled or postponed elective surgeries and nonsurgical procedures, while only 1 in 8 created new medical units in areas not dedicated to health care and around 1 in 20 adopted triage protocols or protocols to connect multiple patients to a single ventilator. Actions to increase or preserve ICU staff were variable. If these results can be coupled with patient outcomes, they may inform planning for future events. Other original research published in this section includes a multicenter, randomized, controlled study of continuous pneumatic regulation of tracheal cuff pressure to decrease ventilator-associated pneumonia in mechanically ventilated trauma patients; an assessment of the association between job characteristics and functional impairments on return to work after acute respiratory distress syndrome; a report on changes in pediatric intensive care unit utilization and clinical trends during the COVID-19 pandemic; and an assessment of long-term survival of critically ill patients stratified by pandemic triage categories. A research letter describes severe intraabdominal hypertension in critically-ill patients with COVID-19 and acute kidney injury, and a CHEST Review discusses the rationale and evidence for restricting or permitting family members’ physical presence during the COVID-19 pandemic.
On to our Diffuse Lung Disease content area. Obesity is known to be associated with a restrictive ventilatory defect that may be mediated by factors in addition to mechanics. In this issue, Anderson and colleagues evaluated the association of CT measures of pericardial, abdominal visceral, and subcutaneous adipose tissue with interstitial lung abnormalities (ILAs) in a large multicenter cohort to determine if adipose tissue is involved in the pathogenesis of interstitial lung disease (ILD). Associations between the amount of adipose tissue and ILAs were noted, and inflammatory markers were found to account for a portion of the associations noted. These results suggest that obesity may represent a modifiable risk factor for ILD. Other original research articles in this month’s issue include a description of a distinct type of airway involvement in subtypes of end-stage fibrotic pulmonary sarcoidosis and a description of the frequency and character of pleuritis and pericarditis in antineutrophil cytoplasmic antibody-associated vasculitis. A CHEST guideline on the diagnosis and evaluation of hypersensitivity pneumonitis completes this section.
Our Education and Clinical Practice content area is next. Exogenous lipoid pneumonia develops when lipid-containing substances are aspirated or inhaled into the airways, inciting an inflammatory response. The clinical course of exogenous lipoid pneumonia has not been well characterized. In this issue, Samhouri and colleagues describe 34 patients with exogenous lipoid pneumonia diagnosed over 20+ years. The mean age was 71 years, and one half were asymptomatic. Most had bilateral parenchymal opacities, commonly involving the lower lobes. Fat attenuation was noted in only 41% of patients. A causative agent was identified in 79% of patients. Symptoms worsened in 50%, and imaging progressed in 39% of patients, more commonly in the elderly and those with GI disorders. These findings help to clarify the nature of exogenous lipoid pneumonia and its progression. Other original research articles appearing in this issue include a systematic review of the methodologic quality of guidelines for training or competence processes for basic point-of-care echocardiography in critical care; the characterization of particulate generation during cardiopulmonary rehabilitation classes with patients wearing procedural masks; and insights from invasive cardiopulmonary exercise testing of patients with myalgic encephalomyelitis/chronic fatigue syndrome. A CHEST Review on the utility of chest CT imaging in patients with suspected or diagnosed COVID-19 completes this section.
Next is our Pulmonary Vascular content area. The impact of pulmonary hypertension (PH) in patients with COPD is unclear. In this issue, Darrio Vizza and colleagues sought to assess which factors could determine the outcome of patients with PH and COPD. Using a large cohort, the authors compared the outcomes of patients with moderate or severe PH and COPD who received medical therapy for PH to the outcomes of patients with idiopathic pulmonary hypertension. Those with PH and COPD were older, predominantly male, and had more functional impairment. Transplant-free survival was lower in those with PH and COPD. Improvement in 6-minute walk distance with therapy was associated with a better outcome. These findings highlight just how ill patients with PH and COPD are and provide added knowledge about the potential benefit of PH treatment in these individuals.
Our Sleep Medicine content area is next. The treatment of obstructive sleep apnea (OSA) in patients living at high altitude is not well established. In this issue of the journal CHEST, Tan and colleagues sought to determine whether nocturnal oxygen supplementation improves sleep-related breathing disturbances, oxygenation, and cognitive performance in patients living at high altitude. In a crossover design, 40 patients living at 3,200 m were randomly assigned to first receive either nasal nocturnal oxygen supplementation or ambient air for one night, then the other separated by a washout period of 2 weeks. The primary outcome was the difference in apnea hypopnea index (AHI) between treatment and control nights. Nocturnal oxygen supplementation at 2 L was found to decrease the total AHI by 17.9/h, increase SpO2 by 7.0%, and decrease heart rate during sleep and pulse rate in the morning. Subjective sleep quality and cognitive performance were unchanged. These results, if confirmed in studies assessing longer treatment duration, may lead to another treatment option for highland patients with OSA. Also in this section is a Point/Counterpoint debate addressing whether hypopneas should only be scored when accompanied by oxygen desaturation and a CHEST Review about oxygen therapy in sleep-disordered breathing.
Next is our Thoracic Oncology content area. Programmed death-ligand testing is feasible in samples acquired by endobronchial ultrasound (EBUS)-guided needle aspiration. In this issue, Gonzalez and colleagues evaluated the outcomes of patients treated with immune checkpoint inhibitors based on programmed death-ligand 1 (PD-L1) expression identified from EBUS sampling compared with the outcomes of those treated on the basis of other types of histologic samples. They found that the median overall and progression-free survivals were not significantly different between the two groups, both when immune checkpoint inhibitor therapy was given in the first line or in subsequent lines of therapy. These findings suggest that therapy based on PD-L1 results obtained from EBUS-guided transbronchial needle aspiration (TBNA) can lead to similar outcomes to therapy based on other types of histology sampling. Other original research articles appearing in this month’s issue include an assessment of individual lung cancer risk perception within a screening population; a description of immune checkpoint inhibitor-related pneumonitis in real-world settings; an evaluation of the pathologic T classification for non-small cell lung cancer with visceral pleural invasion; a description of the provision of smoking cessation resources during in-person shared decision-making for lung cancer screening; and an assessment of the safety profile of the use of intrapleural thrombolytic or fibrinolytic therapy in obstructed indwelling tunneled pleural catheters in patients requiring anticoagulation.
Finally, I encourage you to take a look at our Humanities in Chest Medicine series, where a publication titled Effacement in our Exhalations series, and an essay in our Vantage series discussing payment reform as a means of achieving justice, with pulmonary rehabilitation reimbursement as an example, are very valuable reads. Our case series publications for the month 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 August issue.