Thank you for tuning in to the Editor’s Highlight Podcast for the January 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 month’s issue, Mohan and colleagues contribute a CHEST Review of the current knowledge and future needs in the evaluation and management of mild asthma. This review includes an examination of our current understanding of the pathophysiologic features and management of mild asthma, including an update of clinical research studies that explore the efficacy of as-needed inhaled corticosteroids along with rescue medications. Unmet future needs are discussed.
Next is our Chest Infections content area. Some patients who recover from mild COVID-19 infection exhibit persistent exertional limitation. In this issue, Singh and colleagues explore the pathophysiologic mechanism of exercise intolerance in patients with post-COVID-19 long-haul syndrome without cardiopulmonary disease. Invasive cardiopulmonary exercise testing was performed in 10 patients with long-haul syndrome and 10 age- and sex-matched control subjects. Those with long-haul syndrome had reduced peak exercise aerobic capacity associated with impaired systemic oxygen extraction compared with control participants, despite a preserved peak cardiac index. In addition, greater ventilatory inefficiency without an increase in dead space ventilation was noted in the patients with long-haul syndrome. These results suggest exertional limitation in COVID-19 long-haul syndrome is related to a peripheral rather than a central cardiac limit as well as an exaggerated hyperventilatory response during exercise. Also in this section is an original research article describing the occurrence and clinical relevance of Aspergillus sensitization and allergic bronchopulmonary aspergillosis (ABPA) in bronchiectasis-COPD overlap; a CHEST Review on the treatment of Mycobacterium abscessus pulmonary disease; and a Point/Counterpoint debate about the treatment goals for adults compared with children with cystic fibrosis in the era of cystic fibrosis transmembrane regulator (CFTR) protein modulator therapies.
On to our COPD content area. There are few clinically useful circulating biomarkers of lung function and lung disease. In this issue, Keefe and colleagues asked whether an integrative genomic strategy using genome-wide association studies (GWAS) of plasma soluble receptor for advanced glycation end products (sRAGE) levels in conjunction with GWAS of lung function traits could identify causal relations between sRAGE and lung function. Measurements included sRAGE levels and GWAS-identified protein quantitative trait loci variants, integrated with GWAS variants of lung traits, in 6,861 participants of the Framingham Heart Study. Colocalization of sRAGE and lung trait variants was conducted, and Mendelian randomization was performed to infer causality of sRAGE for pulmonary traits. The evaluation identified shared genetic signals and suggested protective causal relations of sRAGE to several pulmonary traits. Higher sRAGE levels were associated with preserved lung function. These results suggest a protective role of sRAGE and a possible therapeutic target for treatment and prevention of inflammation-related lung disease.
Next is our Critical Care content area. Recent medical society opinions have questioned the use of early antimicrobials in patients with sepsis but without septic shock. In this issue, Bisarya and colleagues report on a retrospective cohort study of 74,114 patient encounters with an aim of determining whether time from ED presentation to administration of antibiotics is associated with progression to septic shock among patients with suspected infection. Of these patients, 7.4% progressed to septic shock, of whom 88% had received antimicrobials within the first 5 hours from triage. Time to first antimicrobial administration was related to progression to septic shock and in-hospital mortality. Each hour delayed was associated with a 4% increase in progression to septic shock. These results support an association between delays in first antimicrobial administration in patients with suspected infection and progression to septic shock. Additional original research published in this section includes an evaluation of prehospital time as a risk factor for pneumonia in trauma patients; a systematic review and meta-analysis of the utility of the rapid shallow breathing index in predicting successful extubation; a propensity-matched cohort study evaluating early tracheostomy for managing ICU capacity during the COVID-19 pandemic; and a prospective cohort study that assesses the relationship between the Sickness Insight in Coping Questionnaire coping style of patients who are hospitalized and critically ill and health-related quality of life and recovery. Completing this section is a CHEST Review describing focused management of patients with severe acute brain injury and ARDS.
On to our Diffuse Lung Disease content area. There is limited information about mortality trends in patients with pulmonary sarcoidosis and respiratory failure who are hospitalized. In this issue, Alqalyoobi and colleagues evaluated the national temporal trends in hospitalization and inpatient mortality in patients with pulmonary sarcoidosis and respiratory failure using data from the National Inpatient Sample between 2007 and 2018. Hospitalization for respiratory failure increased from 25.9 to 239.4 per 1,000,000 over this timeframe. Inpatient mortality associated with respiratory failure declined from 17.2% to 6.6%. Independent inpatient mortality predictors were older age, respiratory failure, need for mechanical ventilation, pulmonary hypertension, pulmonary embolism, and frailty. These findings suggest that there has been an increase in hospitalization but decrease in mortality from respiratory failure in patients with pulmonary sarcoidosis. Completing this section is a How I Do It review about when and how to consider lung transplantation for patients with COVID-19.
Our Education and Clinical Practice content area is next. There are complex relationships between ozone and other air pollutants and known lung function effects. In this issue, Holm and Balmes report on a systematic review of the association between ozone exposures and lung function from epidemiologic studies published from 2013 through 2020. Fifty three studies were included in the review. Small decreases in children’s lung function were noted with even low-level, short-term ozone exposure. The effect of short-term exposure on adult lung function was less consistent. Long-term ozone exposure has been shown to decrease lung function and lung function growth in children, with little evidence available about the impact of long-term ozone exposure on lung function in adults. These results suggest that even low-level ozone exposure, below current EPA standards, can impact the lung function of children. Other content in this section includes an original research article assessing the association between forced expiratory volume in one second, cardiac status, and outcome in chronic heart failure, and a How I Do It review about communication around time-limited trials.
Next is our Pulmonary Vascular content area. Oxidative stress, inflammation, and vascular stiffness related to combustible tobacco smoking are key components in the development and progression of atherosclerosis. The comparable effects of e-hookah are unknown. In this issue, Rezk-Hanna and colleagues report the results of a randomized crossover study of 17 healthy young adults who chronically have smoked hookah to determine the differential acute effect of e-hookah vaping vs combustible hookah smoking on oxidation, inflammation, and arterial stiffness. e-Hookah vaping led to a larger acute increase in pulse wave velocity and in the augmentation index than hookah smoking. In addition, an elevation of proinflammatory biomarkers was noted after vaping hookah but not after smoking it. These results suggest that e-hookah vaping exerts injurious effects on the vasculature that are in part mediated by inflammation. Also in this section is a research letter that assesses the association between iron deficiency and the severity of pulmonary vascular disease in pulmonary hypertension due to chronic lung disease, and a CHEST Review on the phenotypic diversity of vascular smooth muscle cells in pulmonary arterial hypertension and its implications for therapy.
Our Sleep Medicine content area is next. The combination of noradrenergic and antimuscarinic drugs has recently been shown to improve upper airway muscle function during sleep. In this issue, Perger and colleagues asked whether 1 week of reboxetine plus oxybutynin is effective in lowering OSA severity. Sixteen subjects participated in a randomized, double-blind, crossover trial comparing reboxetine-oxybutynin with placebo in patients with OSA. Treatment lowered the apnea-hypopnea index from 49 events per hour to 18 events per hour, with placebo lowering the AHI to just 39. The response rates were 81% for active treatment and 13% for placebo. The psychomotor vigilance test median reaction time and the oxygen desaturation index improved in the treatment arm. These results suggest the administration of reboxetine and oxybutynin is a potential pharmacologic treatment for OSA.
Next is our Thoracic Oncology content area. Lung cancer screening trials suggest a greater lung cancer mortality benefit from screening women than men. In this issue, Deliu and colleagues asked whether the US Preventive Services Task Force (USPSTF) lung cancer screening eligibility recommendations contribute to sex disparities in eligibility and whether the PLCOm2012 risk prediction model can reduce sex disparities. The sensitivity of the USPSTF criteria and PLCO model, stratified by sex, was evaluated in a cohort of 883 lung cancer cases. Sensitivity of the USPSTF 2013 and 2021 criteria was higher in men than in women, while those from the PLCO model, at two predefined thresholds, were not significantly different between men and women. Sensitivities were higher with the PLCO model than the USPSTF criteria. These results suggest sex disparities in eligibility could be attenuated by including lung cancer risk prediction. Other content in this section includes an original research article describing the presentation, diagnosis, and management of subglottic and tracheal stenosis during systemic inflammatory disease, and a systematic review and meta-analysis of racial differences in adherence to lung cancer screening follow-up. A research letter describes tyrosine kinase inhibitor use for acute respiratory failure due to non-small cell lung cancer involvement, and a How I Do It review describes pleural interventions in the management of hepatic hydrothorax.
Finally, I encourage you to take a look at our Humanities in Chest Medicine section, where you will find a special feature titled “Addressing Race in Pulmonary Function Testing by Aligning Intent and Evidence With Practice and Perception”; a Vantage series article about reconciling the medical device industry, clinicians, and regulation; and a thought-provoking Exhalations series contribution titled “Double Vision.”
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 January issue.