Thank you for tuning in to the Editor’s Highlight Podcast for the July 2022 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 content area, patients with severe asthma may require chronic corticosteroid treatment. In this issue, Sher and colleagues evaluated whether the reduction in oral corticosteroid use, and the clinical efficacy observed with dupilumab treatment, is maintained long term in patients with severe asthma. One hundred eighty-seven patients participated in a multinational, multicenter, single arm, open label extension study after completion of a prior randomized controlled trial. Participants were followed while receiving dupilumab for up to 96 weeks. Oral corticosteroid dose continued to decrease in those who did and did not receive dupilumab during the initial trial. Exacerbation rates were low, and further improvements were seen in FEV1 and the Asthma Control Questionnaire score. These results confirm the durability of improved asthma outcomes with dupilumab use in the trial population.
Next is our Chest Infections content area. Concerns remain about the impact of long-term macrolide therapy on the carriage and transmission of antibiotic resistance genes. In this issue, Wang and colleagues report findings of macrolide resistance gene testing from oropharyngeal swabs of 93 individuals with chronic respiratory conditions, 53 of whom were receiving long-term macrolide therapy, and a close cohabiting contact of each patient, to determine if long-term macrolide use impacts carriage of resistance and onward transmission. Detection of resistance genes in recipients was comparable with that of nonrecipients. The gene abundance of erm(B) was significantly higher in the macrolide recipient group. Detection in macrolide recipients was associated with detection in close contacts, but the treatment group did not predict cocarriage between patients and their close contacts. These results suggest that levels of erm(B) may be higher in long-term macrolide users, but macrolide use did not increase the onward transmission risk to close contacts. Also in this section is a research letter describing the safety and outcomes of amikacin liposome inhalation suspension for mycobacterium abscessus pulmonary disease and a How I Do It review about managing pulmonary infection in adults with cystic fibrosis.
On to our COPD content area. Pulmonary rehabilitation (PR) is important for patients with COPD. In this issue, Hug and colleagues report the results of a study designed to determine the proportion of people with COPD who are eligible for PR that get referred to PR, whether clinical and sociodemographic characteristics influence who is referred, and what factors influence people’s interest in participating. They consecutively enrolled 468 people with COPD from three tertiary hospitals. Of the 156 participants who were deemed suitable for PR, 74 were referred. Interest in attending PR was the only variable that was different between those who were and were not referred. Introverted personality traits and feelings of unworthiness were associated with reduced interest in attending PR. These findings suggest referral rates are suboptimal, and patient interest in participating could be a target to intervene on. Completing this section is a systematic review and meta-analysis of the association between nonobstructive chronic bronchitis and all-cause mortality.
Next is our Critical Care content area. High-quality leadership improves resuscitation for in-hospital cardiac arrest, but experienced resuscitation leaders are not always available. In this issue, Peltan and colleagues report the findings of a multicenter, randomized controlled trial of simulated cardiac arrests, with consultation during the arrest being the intervention and observation the control. The study was designed to determine if real-time telemedical intensivist consultation improves resuscitation quality. The etiology of the simulated cardiac arrest was identified more often when supported by a consultant, but no-flow fraction and other measures of resuscitation quality, resuscitation team performance, and participant experience did not differ between intervention groups. These findings suggest consultation by a telemedical intensivist physician does not improve cardiac arrest resuscitation quality. Also in this section is an original research article evaluating the prevalence and outcomes of previously healthy adults among patients hospitalized with community-onset sepsis, a research letter describing temporal trends in rural versus urban sepsis-related mortality in the United States, and a CHEST Review on hematology emergencies in critically ill adults.
On to our Diffuse Lung Disease content area. There are no currently standardized screening approaches for pulmonary hypertension (PH) in patients with interstitial lung disease (ILD). In this issue, Rahaghi and colleagues report the results of a multidisciplinary Delphi study designed to identify PH screening strategies in patients with ILD that were supported by expert consensus. The 16 expert panelists were able to reach consensus on several triggers for suspicion of PH, including symptoms, clinical signs, findings on chest CT, abnormal oximetry, elevations in brain natriuretic peptide (BNP), and unexplained worsening of pulmonary function testing.
Echocardiography and BNP were identified as screening tools and right heart catheterization as essential for confirming PH. These results can provide guidance about when and how to screen for PH in patients with ILD. Also in this section is an original research article that describes acute respiratory deterioration in rheumatoid arthritis-associated ILD; a research letter that describes severe airflow obstruction from constrictive bronchiolitis in paraneoplastic autoimmune multiorgan syndrome; and a Special Feature review that provides an algorithmic approach to the diagnosis of organizing pneumonia, correlating clinical, radiologic, and pathologic features.
Our Education and Clinical Practice content area is next. Variation in genetic ancestry among admixed racial and ethnic groups may influence the fit of spirometry reference equations. In this issue, Witonsky and colleagues report the results of a cross-sectional study that assessed the influence of genetic ancestry on the fit of race- and ethnicity-based spirometry reference equations. Five hundred ninety-nine genetically admixed children, who had participated as healthy controls in prior asthma studies, had genetic ancestry estimated using genome-wide genotype data and an assessment of reference equation fit. Those with African ancestry more than the median fit best with African American-derived equations, whereas composite equations derived from “other/mixed” populations fit better in those with African ancestry lower than the median. Similar differences in fit of reference equations were noted in Puerto Rican children based on their African ancestry estimate. These results suggest that guideline-recommended spirometry reference equations may yield biased estimates of lung function in genetically admixed children with high variation of African ancestry. Completing this section is a Commentary that nicely summarizes the AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR chest pain guidelines.
Next is our Pulmonary Vascular content area. The criteria for severe pulmonary hypertension (PH) have been defined by hemodynamic thresholds measured by right heart catheterization. In this issue, Kovacs and colleagues report a retrospective analysis of 142 consecutive patients with COPD and suspected PH who underwent an in-depth clinical evaluation, designed to determine if noninvasive clinical tools were able to predict severe PH in patients with COPD and to evaluate the mortality risk change with increasing severity of airflow limitation and pulmonary vascular disease. A multivariate model that combined echocardiographic systolic pulmonary arterial pressure, N-terminal pro-brain natriuretic peptide, and pulmonary artery to ascending aorta diameter ratio had a 94% positive and negative predictive value. Airflow limitation and PH severity were independently and comparably associated with survival. These results suggest a noninvasive assessment of severe PH in patients with COPD can be very accurate, and severe PH may contribute substantially to impaired survival. Also in this section is a prospective study, published as a research letter, which identified a very low risk of venous thromboembolism recurrence after 1 year follow-up of hospitalized patients with COVID-19 and a brief update to the CHEST guideline and expert panel report on thromboprophylaxis in patients with COVID-19.
Next is our Thoracic Oncology content area. The association between guideline-concordant invasive mediastinal staging, guideline-concordant treatment, and non-small cell lung cancer survival is not known. In this issue, Meadows-Taylor and colleagues report findings from a retrospective cohort study designed to evaluate the current practice of invasive mediastinal nodal staging in a structured multidisciplinary care setting, whether guideline-concordant staging is associated with guideline-concordant treatment, and how these relate to survival. Of 882 patients included, 456 received any invasive mediastinal staging, and 74% received guideline-concordant staging. Those who had guideline-concordant staging were more likely to receive guideline-concordant treatment (83% vs 66%). Survival was greatest in patients who received both staging and treatment that was guideline-concordant. These results show that it is feasible to have high levels of guideline-concordant staging and that the impact of guideline-concordant staging and treatment in improving survival is complementary. Also in this section is an original research article that presents patient perspectives on longitudinal adherence to lung cancer screening, a research letter describing insights from simulations on whether to start with navigation to lung nodules or endobronchial ultrasound bronchoscopy staging, and a Special Feature review outlining considerations for e-cigarette product use-associated lung injury.
Finally, I encourage you to take a look at our Humanities in Chest Medicine section, where you will find a Point/Counterpoint debate about the ethics of considering social determinants of health for fair allocation of scarce medical resources during the COVID-19 pandemic and a Consilia Historiae piece that provides insight into the language of violence during pandemic outbreaks by discussing the origins of the Black Death and COVID-19.
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 July issue.