Thank you for tuning in to the Editor’s Highlight Podcast for the July 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, improvements in ventilation defect percentage and airway mucus occlusion, measured by Xe MRI, after a single dose of benralizumab independently predicts improvement in the Asthma Control Questionnaire (ACQ) score. In this issue, McIntosh and colleagues report on a cohort of individuals with poorly controlled eosinophilic asthma to determine if early ventilation defect percentage improvements after benralizumab persist and whether fractional exhaled nitric oxide (FEV1) and mucus plug score improve during a 2.5-year treatment period. The ACQ 6 score improved after 1 year and 2.5 years in the 16 and 13 participants who returned for follow-up. The mean ventilation defect percentage improvement was not significantly different than at the 28-day mark, while the mucus score was significantly improved at 2.5 years. These results show that in poorly controlled eosinophilic asthma, early MRI ventilation defect percentage responses, improved mucus score, and asthma control persist 2.5 years after starting treatment with benralizumab.
Next is our Chest Infections content area. A validated patient-reported outcome measure as a treatment outcome for nontuberculous mycobacteria does not exist. In this issue, Henkle and colleagues report on the validity and responsiveness of the Quality of Life-Bronchiectasis (QOL-B) questionnaire respiratory symptoms scale and key health-related quality of life (HRQoL) measures during the first 6 months of Mycobacterium avium complex (MAC) pulmonary disease treatment using patient-reported outcome measures collected as part of an ongoing randomized, multisite pragmatic clinical trial of two vs three antibiotic regimens. One hundred forty-four individuals completed longitudinal surveys. The respiratory symptoms domain, vitality, and health perceptions domain scores all showed good psychometric properties. A minimally important difference (MID) of 6.4 to 6.9 in the respiratory symptoms domain was identified. A nonlinear improvement in respiratory symptoms and physical function scores were noted by 3 months. These results show good psychometric performance of the QOL-B respiratory symptoms and physical function scales with improvement beyond the MID noted by 3 months of treatment. Also in this section is an original research manuscript evaluating increased risk of pneumonia in long-term exposure to ambient air pollutants and a research letter reporting on microbial inflammatory networks in bronchiectasis exacerbators with Pseudomonas aeruginosa.
In our COPD content area this month, you will find a research letter describing reversible trends of oxidative stress and detoxification mechanisms, as well as mucus hypersecretion-associated gene expression and mucus production after a year of smoking cessation, and part one of a two-part Special Feature series on lung imaging in COPD.
Next is our Critical Care content area. The impact of patient expectations on quality of life (QoL) after serious illnesses has not been evaluated. In this issue, Turnbull and colleagues report findings from a prospective longitudinal cohort study of consecutively enrolled patients with acute respiratory failure managed at five medical centers to determine if patient expectations for health are associated with self-reported QoL 6 months after discharge. They found that QoL was significantly better in participants whose health expectations were met in all domains of the World Health Organization Quality of Life Brief Version (WHOQOL-BREF) questionnaire (physical health, psychological health, social relationships, and environmental health). These results suggest that fulfilling health expectations is associated with better QoL, suggesting the importance of incorporating normalization and expectation management into ICU recovery programs. Also in this section is an original research article exploring contamination of blood cultures from arterial catheters and peripheral venipuncture in critically ill patients and a systematic review and meta-analysis of monocyte distribution width as a diagnostic marker for infection. Completing this section is a consensus report from the Task Force for Mass Critical Care on critical care staffing in pandemics and disasters.
On to our Diffuse Lung Disease content area. The determinants of progression of lymphangioleiomyomatosis, mortality after the introduction of sirolimus therapy, and the value of vascular endothelial growth factor D (VEGF-D) as a biomarker have not been well defined. In this issue, Xu and colleagues evaluated 282 patients for progression evaluation and 547 for survival to assess these questions. They found patients with VEGF-D levels >800 pg/mL had a faster decline in FEV1, and >2000 pg/mL was associated with decreased survival. Rate of FEV1 decline and risk of death were reduced by sirolimus use. These results identify the prognostic value in VEGF-D levels and associate improved outcomes with sirolimus use. Also in this section is an original research article evaluating pleural plaques and the role of exposure to mineral particles in the asbestos post-exposure survey and another evaluating frailty measures and short-term outcomes after lung transplantation.
On to our Education and Clinical Practice content area. Increased central neural responses to tussive stimuli may result in maladaptive morphometric changes in central cough processing systems. In this issue, Arinze and colleagues report findings from a population-based cohort study of 3,620 individuals who underwent brain MRI and were interviewed for chronic cough. Chronic cough was prevalent in 9.6% of study participants. Those with chronic cough had significantly smaller anterior cingulate cortex volume than participants without chronic cough. The volume difference in the anterior cingulate cortex was most pronounced in the left hemisphere and in male participants. These findings suggest individuals with chronic cough have a smaller volume of the anterior cingulate cortex, a region of the brain involved in cough suppression. Also in this section is a research letter describing the impact of a multidisciplinary post-COVID-19 clinic on hospital admissions and ED visits and a Special Feature article that evaluates a potential national board for respiratory care credentialing for pulmonary disease educators.
Our Pulmonary Vascular content area includes a research letter that evaluates the risk of venous thromboembolism in nonrespiratory and respiratory presentations of COVID-19 in critically ill patients and a CHEST Review on portopulmonary hypertension management and liver transplant evaluation.
Our Sleep Medicine content area is next. The impact of obesity on the prognostic significance of OSA in patients with acute coronary syndrome remains unclear. In this issue, Hao and colleagues report findings from a prospective cohort study of consecutive patients hospitalized with acute coronary syndrome, who underwent portable sleep monitoring after clinical stabilization, to determine if the effects of OSA on subsequent cardiovascular events vary with obesity status. Approximately 53% of the 1,920 patients enrolled had OSA and 37% had obesity. OSA independently predicted the incidence of major adverse cardiovascular and cerebrovascular events only in patients without obesity, not in patients with obesity. No interaction between obesity and OSA was noted. These findings highlight the importance of identifying OSA in patients without obesity and with acute coronary syndrome. Completing this section is an original research article that evaluates the impact of single-night diagnosis of sleep apnea on inconsistent cardiovascular outcomes.
Next is our Thoracic Oncology content area. The demographic characteristics and outcomes of individuals screened for lung cancer in the United States have not been reported at the population level. In this issue, Silvestri and colleagues report on outcomes of the first million people screened and entered into the American College of Radiology’s Lung Cancer Screening Registry. Key findings included annual adherence rates of just 22.3%, with predictors of poor adherence being current smoking status and Hispanic and Black race; category 3 and 4 findings occurring in 17% of those screened; cancer detection rates of 0.56%, increasing from 0.4% for category 3 findings to 19.9% for category 4X; and 53.5% of cancers being stage I. These findings support the potential of lung cancer screening and highlight the need to improve screening adherence. Also in this section is an original research article that identifies a high yield of pleural cell-free DNA for the diagnosis of oncogenic mutations in lung adenocarcinoma and a research letter that explores hospital to outpatient transitions of care for tobacco treatment.
Finally, I encourage you to read our Humanities in Chest Medicine section, where you will find a Vantage piece titled, “Disability Rights and Life-Sustaining Treatment: Building Bridges Between Clinicians and Advocates,” and our case series publications for the month, providing 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.