Thank you for tuning in to the Editor’s Highlight Podcast for the October 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. In this issue, Garner and colleagues provide us with a How I Do It review on the management of life-threatening asthma, one of the reviews from our Severe Asthma Series. Appropriate assessment, triage, treatment, support of oxygenation, and ventilation, as well as the potential complications of management, are outlined.
Next is our Chest Infections content area. It remains difficult to risk stratify individuals with cystic fibrosis (CF) and reduced FEV1. In this issue, Ramos and colleagues identified predictors of death or lung transplantation within 2 years for patients with CF and an FEV1 ≤50% and assessed whether these markers could predict outcomes in those with G551D taking ivacaftor. They used the least absolute shrinkage and selection operator method to select important prognostic variables from a randomly selected training set using data from the Cystic Fibrosis Foundation and United Network for Organ Sharing registries. Model accuracy was validated on an independent test set. They found that FEV1 percent predicted, number of pulmonary exacerbations treated with antibiotics, and supplemental oxygen use were associated with 2-year death or lung transplant. Only FEV1 remained associated with these outcomes among those taking ivacaftor. These findings may help to risk stratify those with CF and FEV1 ≤50% more accurately than a single FEV1 threshold. Also in this section is an original research article that validates a model of early recognition of low-risk SARS-CoV-2 and another that shares findings of a pragmatic randomized clinical trial of smartphone-guided self-prone positioning in nonintubated hospital ward patients with COVID-19.
On to our COPD content area. Military service can involve multiple traditional work-related exposures, such as to inorganic dusts. In this issue, Trupin and colleagues report the findings of an analysis of data from a military service roster, including operations beginning in 2001 in Iraq, to determine if military service is an occupational contributor to COPD risk. Forty-four percent of the 427,591 included in the final analysis were categorized as having moderate or high likelihood of inorganic dust exposure. Overall, 0.4% of the cohort had a COPD diagnosis, with a mean age at diagnosis of 40. The odds of being diagnosed with COPD was 25% higher in those with dust exposure. This increase in risk occurred mostly in those who had ever smoked. These findings suggest that military service should be considered by clinicians in evaluating patients’ occupational histories.
Next is our Critical Care content area. It is unclear whether norepinephrine and phenylephrine use are associated with different heart rates among patients with sepsis and atrial fibrillation (AF). In this issue, Law and colleagues evaluated 1,847 patients with sepsis and AF at the time of norepinephrine or phenylephrine initiation to determine if there was a difference in heart rate after their initiation. They found that phenylephrine was associated with a lower heart rate at 1 and 6 hours, with a higher heart rate before vasopressor administration being associated with larger heart rate reduction in those who received phenylephrine. These results suggest phenylephrine leads to modest reductions in heart rate in those with sepsis and AF, with a tie to potential clinical outcomes requiring further study. Also in this section is an original research article describing a reduction in the effort of breathing with the use of high-flow nasal cannula and a Special Feature article discussing oxygen-free days as an outcome measure in clinical trials of therapies for COVID-19 and other causes of hypoxemia.
On to our Diffuse Lung Disease content area. Distinguishing usual interstitial pneumonia (UIP)/idiopathic pulmonary fibrosis (IPF) from other interstitial lung disease (ILD) subtypes help guide evaluation and treatment. In this issue, Bratt and colleagues retrospectively identified a cohort of 1,239 patients with pathologically proven ILD and chest CT imaging to train and validate a custom deep learning model applied to CT imaging to determine if noninvasive diagnosis of UIP could be improved. The performance of the deep learning model was superior to visual analysis in predicting the histopathologic diagnosis (AUC 0.87 vs 0.80). The deep learning model reproducibility was also greater than radiologist inter- and intra-rater reproducibility. These results suggest that a deep learning model may be superior to visual assessment in predicting UIP/IPF histopathology from CT imaging. Completing this section is a research letter describing the association between the MUC5B promoter polymorphism and survival in Indian patients with IPF.
Our Education and Clinical Practice content area is next. A learning effect may influence the measurement of maximum respiratory pressures. In this issue, Cruickshank and colleagues report the findings of a systematic review and meta-analysis to determine the magnitude of improvement in maximum respiratory pressure in response to muscle warm-up protocols and repeated measures in healthy and clinical populations. Thirty-two articles were included in the meta-analysis. The overall effect of inspiratory muscle warm-up protocols was higher, with an effect size (ES) of 0.40, than repeated maneuvers in a single testing session (ES 0.20) and repeated testing sessions (ES 0.14). These findings suggest that warm-up protocols are more effective at obtaining the maximum performance of inspiratory muscles in one testing session. Completing this section is an original research article that describes structural and functional correlates of higher cortical brain regions in chronic refractory cough.
Next is our Pulmonary Vascular content area. It is unclear if increases in right ventricular (RV) afterload in older adults play a role in atrial fibrillation (AF) genesis, independent of the left atrium and left ventricle (LV). In this issue, Parikh and colleagues report the results of a prospective observational study of 2,246 adults over 75 years of age who did not have known cardiovascular disease, designed to determine if higher RV afterload is associated with greater AF risk. During a median of 6.3 years of follow-up, 215 participants developed AF. The AF risk was higher in the third tertile of pulmonary artery systolic pressure and pulmonary vascular resistance, independent of LV parameters and potential confounders. These results support an association between RV afterload and AF risk, providing a rationale for further study of the underlying mechanisms and their clinical impact. Completing this section is a research letter that describes the endovascular treatment of central pulmonary arterial pseudoaneurysms in the context of silicosis combined with tuberculosis.
Our Sleep Medicine content area is next. The efficacy of intranasal corticosteroid use for the treatment of OSA syndrome (OSAS) in children has not been rigorously tested. In this issue, Tapia and colleagues report the findings from a randomized, double-blind, placebo-controlled trial of intranasal corticosteroids in children age 5 to 12 years with OSAS. The 134 participants had a median age of 7.9 years and apnea-hypopnea index (AHI) of 5.8. Three months of treatment did not result in a change in the AHI, OSA symptoms, or neurobehavioral results at 3 and 12 months. Those who were treated for 12 months had a small decline in the AHI. These results do not support the regular use of intranasal corticosteroids for OSAS in children.
Next is our Thoracic Oncology content area. It is unclear if racial disparities in lung cancer outcomes following surgical treatment exist in the Veterans Health Administration (VHA) health care system. In this issue, Heiden and colleagues report findings from a retrospective cohort study of veterans with clinical stage I non-small cell lung cancer (NSCLC) who had surgical treatment in the VHA system, designed to determine if racial disparities affect early stage NSCLC outcomes following surgical therapy. Over a 10-year span, 18,800 veterans with clinical stage I NSCLC were included. The rates of definitive surgical treatment were similar between Black and White veterans. Black patients were younger and more likely to smoke. They received adequate lymph node sampling slightly less often but had similar rates of lobectomy, positive margins, 30-day readmission, 30-day mortality, and disease-free survival. Black patients had better risk-adjusted overall survival. These results suggest that Black patients receive comparable care with comparable outcomes after surgical treatment of stage I NSCLC in the VHA health care system. Also in the section is a research letter describing the association of Alu retroelement copy number and lung cancer risk in the PLCO trial. Completing this section is a CHEST Review of the information content, format, and presentation methods of decision support tools for low-dose CT lung cancer screening.
Finally, I encourage you to take a look at our Humanities in Chest Medicine section, where you will find a Consilia Historiae piece about exaggerated predictions of the demise of the stethoscope, a Vantage series article about ethical considerations regarding the use of race in pulmonary function testing, and an Exhalations series contribution titled, How to Run a Code.
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 October issue.