Thank you for tuning in to the Editor’s Highlight Podcast for the May 2023 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, weight loss may improve outcomes in patients with difficult-to-treat asthma and obesity. In this issue, Sharma and colleagues report findings from a randomized, controlled single-center trial in adults with obesity and difficult-to-treat asthma designed to determine if the Counterweight-Plus Programme—an evidence-based, dietician-led total diet replacement program—can improve asthma control and quality of life. Thirty-five participants were randomized. Weight loss was greater in the intervention arm (mean difference of 12.1 kg). Both the Asthma Control Questionnaire score and the Asthma Quality of Life Questionnaire score improved to a greater degree in the intervention arm. These results suggest that a structured weight management program can result in improvement in asthma control and quality of life in adults with difficult-to-treat asthma and obesity.
Next is our Chest Infections content area. Motile ciliary disorder (MCD) has been implicated in chronic inflammatory airway diseases. In this issue, Zhang and colleagues report findings from an observational study of 167 patients with bronchiectasis and 39 healthy control participants designed to determine the characteristics of MCD in patients with bronchiectasis and the association of MCD with disease severity and inflammatory endotypes. MCD was present in 89.8% of patients with bronchiectasis, 68% as secondary MCD and 16% as primary MCD. MCD pattern scores were consistent between upper and lower airways and between large and small airways. The presence of MCD was not affected by airway or systemic inflammatory endotypes. These findings suggest nasal ciliary markers can provide complimentary information when characterizing bronchiectasis. Completing this section is an original research article exploring cardiovascular complications as the driver of mortality in hospitalized patients with SARS-CoV-2 and another that presents real-world evidence of neutralizing monoclonal antibody effectiveness for preventing hospitalization and mortality in outpatients with COVID-19.
On to our COPD content area. Alterations in body composition, including low fat-free mass index (FFMI), are common in patients with COPD. In this issue, Machado and colleagues evaluated 2,137 patients with COPD to determine if the impact of low FFMI on exercise capacity, health-related quality of life (HRQL), and systemic inflammation differed among patients with COPD stratified by their BMI. The frequency of low FFMI decreased from lower to higher BMI groups. Fat-free mass (FFM) was associated with the 6-minute walk distance in the underweight group. HRQL was not associated with FFM. Fat mass was associated with higher systemic inflammation in the normal weight and preobese groups. These findings suggest an association between higher FFMI and better exercise capacity in those with COPD and lower weight but not in those with preobesity or obesity. Completing this section is an original research article that assesses the effects of acquisition protocols and imaging parameters for emphysema quantification.
Next is our Critical Care content area. Studies comparing amiodarone and lidocaine in adult populations with in-hospital ventricular tachycardia or ventricular fibrillation (VT/VF) arrest are lacking. In this issue, Wagner and colleagues report on a retrospective cohort of 14,630 patients with in-hospital VT/VF arrest to determine if treatment with amiodarone or lidocaine impacts outcomes. Among the patients, 68.7% were treated with amiodarone and 31.3% with lidocaine. After controlling for covariates, lidocaine was associated with higher odds of return of spontaneous circulation, 24-hour survival, survival to discharge, and favorable neurologic outcome at hospital discharge. These results suggest lidocaine therapy in adult patients with in-hospital cardiac arrest from VT/VF is associated with better outcomes than amiodarone therapy. Other original research in this section includes an evaluation of moral distress in Canadian intensivists and another that explores the differential effect of induced hypothermia for temperature control after cardiac arrest according to the initial severity of illness. Completing this section is a consensus statement that provides operational definitions related to pediatric ventilator liberation.
On to our Diffuse Lung Disease content area. There is a need to develop remission-inducing therapies for lymphangioleiomyomatosis (LAM). In this issue, Gupta and colleagues report findings from a phase 2, dose-escalating, open-label trial of resveratrol in patients with LAM who are receiving a stable dose of sirolimus. Twenty-five patients were enrolled. The addition of resveratrol to sirolimus was well tolerated. Reduced levels of serum vascular endothelial growth factor D (VEGF-D) and improvement in health-related quality of life (HRQOL) were noted. These findings suggest resveratrol is safe and well tolerated in patients with LAM taking sirolimus and may lead to an improvement in HRQOL, supporting future definitive trials. Also in this section is an original research study evaluating sex- and race-based differences in the treatment of interstitial lung diseases in North America and Australasia and another reporting outcomes of lung transplantation for bronchopulmonary dysplasia.
On to our Education and Clinical Practice content area. The effectiveness of different routes of tranexamic acid administration to control hemoptysis has not been studied. In this issue, Gopinath and colleagues report findings of a pragmatic, open-label, cluster randomized, parallel, single-center, pilot trial of nebulized vs IV tranexamic acid for the control of hemoptysis in patients presenting to the ED. Fifty-five patients were recruited to each treatment arm. Nebulized tranexamic acid led to higher rates of hemoptysis cessation at 30 minutes following administration, as well as at time periods up to 24 hours. Fewer patients in the nebulized arm required bronchial artery embolization, and there were higher rates of discharge from the ED. These results suggest nebulized tranexamic acid may be more efficacious than IV in managing hemoptysis in the ED. Also in this section is an original research article that evaluates the incidence of respiratory pathogens in Naval Special Warfare SEAL candidates with swimming-induced pulmonary edema. A CHEST Review on value-based care for chest physicians and a consensus statement that provides recommendations for standardized outcome measures related to pulmonary care of individuals with osteogenesis imperfecta complete this section.
Next is our Pulmonary Vascular content area. Multiparametric risk assessment tools help individualize management strategies for patients with pulmonary arterial hypertension (PAH). In this issue, El-Kersh and colleagues aim to develop a risk score based on common echocardiographic parameters to risk-stratify patients with PAH. Using retrospective echocardiographic data from 2,400 patients, four echocardiographic parameters were included—right ventricular (RV) chamber enlargement, reduced RV systolic function, tricuspid regurgitation velocity, and pericardial effusion—as was the cause of PAH. Higher echocardiographic risk score predicted lower 12-month survival. Separation of mortality risk between low, intermediate, and high scores was noted. Augmentation of the REVEAL Lite 2 risk calculator with the echocardiographic risk score separated REVEAL Lite 2 into four categories, identifying a subgroup with low REVEAL Lite 2 risk score who was at higher risk and a group with an intermediate risk score who was at higher risk. These findings suggest the echocardiographic risk score discriminates risk and augments current risk assessment scores. Completing this section is a systematic review and meta-analysis of the perioperative management of vitamin K antagonists and direct oral anticoagulants.
Our Sleep Medicine content area is next. Previous studies showed that high residual apnea-hypopnea index (rAHI) and larger variability are associated with underlying comorbidities, OSA characteristics at diagnosis, and the type of CPAP equipment. In this issue, Rossetto and colleagues present results of a registry-based study designed to determine what factors are associated with predefined groups with low to high rAHI variability. Three distinct groups of rAHI trajectories were identified—low, moderate, and high. Age, OSA severity at diagnosis, heart failure, opioid and alcohol consumption, mental and behavioral disorders, transient ischemic attack and stroke, an oronasal mask, and level of leaks when using CPAP were associated with high rAHI. These findings will allow early intervention and the development of personalized follow-up pathways for CPAP treatment. Also in this section is an original research article evaluating night-to-night variability of polysomnography-derived physiological endotypic traits in patients with moderate to severe OSA and a Special Feature that describes challenges, pitfalls, and strategies to consider for optimal data science applications for remote monitoring of positive airway pressure data.
Next is our Thoracic Oncology content area. The relationship between pulmonary nodule (PN) management and lung cancer is not clear. In this issue, Pinsky and colleagues evaluated data from the Surveillance, Epidemiology, and End Results program Medicare database to determine how common PNs are in the Medicare population, the rate of lung cancer after detection of PNs, and the relative proportion of early-stage lung cancer for diagnoses after lung nodule evaluation. Of 627,547 patients, 5.0% demonstrated PNs over a median of 5.0 years of follow-up. One- and 2-year lung cancer rates after initial PN diagnosis were 3.2% and 4.7%. Of 44,194 patients in the lung cancer cohort, 15.7% were in the PN group, and 2.9% were in the screening group. Localized disease was noted in 58.1% in the PN group, 50.3% in the low-dose CT scan group, and 22.4% in the reference group. Three-year lung cancer-specific survival rates were 75.0%, 75.6%, and 49.4%, respectively. These results suggest PNs are a relatively common presentation of potentially curable lung cancer. Also in the section are original research articles describing the role of cancer-directed surgery for different histologic subtypes of malignant pleural mesothelioma, racial disparities in lung cancer stage of diagnosis among adults living in the southeastern US, and a multicenter, retrospective cohort study of molecular profiling of pleural biopsies.
Finally, I encourage you to take a look at our Humanities in Chest Medicine section, where you will find an original research article evaluating the association between shared decision-making during family meetings and surrogates’ trust in their ICU physicians; a Vantage article titled, “Bearing the Burden of Innovation; The Ontological Implications of Substantial Equivalence and the FDA 510(k) Pathway”; and another titled, “Quality of Life Judgments in End-of-Life Care.”
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 May issue.