Thank you for tuning in to the Editor’s Highlight Podcast for the September 2024 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.
First, our Asthma content area includes a research letter that describes the development of an upper limit of normal for CT scan airway mucus in older people without chronic respiratory illness, providing context for airway mucus occlusions as a target for treatment in asthma and COPD studies.
Next is our Chest Infections content area. The clinical course of nontuberculous mycobacterial pulmonary disease (NTM-PD) is varied. Understanding risk factors for progression may assist with management strategies. In this issue, Hyung and colleagues present findings from an 11-year prospective observational cohort study of 477 patients designed to determine the rate of NTM-PD progression and the predictors of progression. During the study, 192 patients progressed, 21.4% at 1 year, 33.8% at 3 years, and 43.3% at 5 years, for an incidence of 11.0 cases per 100 person-years. Female sex, elevated erythrocyte sedimentation rate, FEV1 % predicted, and the presence of a cavity were predictors of progression. These findings improve our understanding of the likelihood of progression, and risk factors for progression, of NTM-PD. Two additional original research articles complete this section. The first explores the relationship between lung volumes and heterogeneity in the response to elexacaftor/tezacaftor/ivacaftor in patients with cystic fibrosis and advanced lung disease. The second reports on the association between sputum culture conversion and mortality in cavitary mycobacterium avium complex pulmonary disease.
Our COPD content area includes a research letter that reports on the identification of pulmonary cellular toxicity in alpha-1 antitrypsin deficiency and a CHEST Review on pulmonary rehabilitation for individuals with persistent symptoms following COVID-19.
Next is our Critical Care content area. Four clinical phenotypes for sepsis, differing in patterns of organ dysfunction, prognosis, and response to treatment, were recently derived from clinical and laboratory data. It is unclear whether the frequencies of acute kidney injury (AKI), acute kidney disease (AKD), chronic kidney disease (CKD), and AKI on CKD differ by sepsis phenotype. In this issue, Molinari and colleagues describe findings from a secondary analysis of a randomized clinical trial of early resuscitation that included patients with septic shock designed to address this question. Approximately 50% of 1,090 eligible patients had AKI. The frequencies of AKI varied from 26% to 78% across the 4 sepsis phenotypes. Variable frequencies of AKD, CKD, and AKI on CKD were similarly noted. The highest rates of AKI on CKD were seen in the β phenotypes, known to have patients who are older and have more chronic illness and renal dysfunction. The δ phenotype, noted for having more liver dysfunction and septic shock, showed the strongest association with AKI (OR 12.3) and AKD (OR 9.2). These findings highlight differences in rates of AKI and AKD across clinical sepsis phenotypes. Also in this section is an original research article that explores venovenous extracorporeal membrane oxygenation candidacy decision-making and another that reports results of a feasibility study of noninvasive electromagnetic phrenic nerve stimulation in critically ill patients. Completing this section is a Special Features article on the role of pediatric psychologists in critical care.
On to our Diffuse Lung Disease content area. Frailty has been shown to be an important determinant of outcomes in patients with fibrotic interstitial lung disease (ILD). In this issue, Guler and colleagues explored whether the Clinical Frailty Score (CFS) could improve risk stratification in patients with fibrotic ILD by evaluating trajectories of functional tests in 1,587 patients in the prospective, multicenter Canadian Registry for Pulmonary Fibrosis. Based on the CFS, 54% were fit, 25% were vulnerable, and 21% were frail. Frailty was a risk factor for early mortality and for larger annual declines in FVC % predicted. Adding frailty to established risk prediction parameters improved the prognostic performance. These findings support the inclusion of the CFS as a prognostic tool when assessing the risk of pulmonary and physical function decline in patients with fibrotic ILD. Completing this section is a research letter exploring sarcoidosis faculty development.
On to our Education and Clinical Practice content area. It is difficult to determine an individual’s susceptibility to immersion pulmonary edema, a form of hemodynamic edema. In this issue, Druelle and colleagues report findings from a case-control study designed to determine if assessing right ventricle (RV) systolic adaptation during immersion is a marker for immersion pulmonary edema susceptibility. Immersion was found to increase the RV preload for all 28 participants. In those without immersion pulmonary edema, this was accompanied by an improvement in RV contractility, amplified by the negative static lung load. In those with immersion pulmonary edema, there was no improvement in RV contractility, indicating altered adaptive responses. These findings suggest changes in RV systolic function induced by immersion vary among divers and may help to identify those who are susceptible to immersion pulmonary edema. Completing this section is a scoping review on point-of-care lung ultrasound in emergency medicine, including an interactive database.
Our Pulmonary Vascular content area is next. The comparative prognostic potential of available risk models for pulmonary arterial hypertension (PAH) prognosis, and the applicability of risk scores in pulmonary hypertension (PH) groups beyond group 1, have not been explored. In this issue, Yogeswaran and colleagues report findings from a comprehensive analysis of predicted outcomes among 8,565 patients with incident PH from the multicenter, worldwide Pulmonary Vascular Research Institute GoDeep meta-registry—exploring the Registry to Evaluate Early and Long-Term PAH Disease Mangement (REVEAL) Lite 2; REVEAL 2.0; Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA) 3-strata; and COMPERA 4-strata risk models—designed to address these questions. All risk scores were prognostic in the entire PH population and in each of the PH groups. The REVEAL scores had the highest statistical prognostic power, while the COMPERA 4-strata risk score provided subdifferentiation of the intermediate-risk group. Results were similar across subgroups. These findings support the predictive power of PAH-designed risk scores across a large PH cohort. Completing this section is a How I Do It review of the use of sotatercept in the care of patients with PAH.
In our Sleep Medicine content area this month, there is a CHEST Review on the cost-effectiveness of sleep apnea management.
Next is our Thoracic Oncology content area. Geographic disparities contribute to low uptake of lung cancer screening (LCS), but they do not completely explain gaps in access for underserved populations. In this issue, Welch and colleagues report on the use of the enhanced 2-step floating catchment area model to evaluate how geographic accessibility, in addition to availability of resourced LCS imaging centers, contribute to disparities. Radiology technologist volume at each facility was used to estimate the capacity at each site to meet potential demand. Of the eligible population, 95% had proximate geographic access to an American College of Radiology-accredited screening facility. However, there was significant variation in availability, with attenuation for most of the eligible population. Rural areas and areas with greater socioeconomic disadvantage were modestly correlated with lower access. These findings suggest that both geographic access and availability contribute to disparities in access to LCS. Also in this section is a research letter that describes thoracic surgery deserts in the US through a geospatial analysis and a CHEST Review article of interventions that improve uptake of LCS.
I encourage you to read our Humanities in Chest Medicine section, where you will find an original research article exploring facilitators and barriers to developing state pandemic preparedness plans during the COVID-19 pandemic, a case-based discussion of an ethically supported framework for determining patient notification and informed consent practices when using artificial intelligence in health care, and an Exhalations piece titled, "'Relative Value Units' Belie Real Value." Our Commentary series is where you will find a piece describing opportunities and challenges from the use of single-cancer and multicancer early detection tests. 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.