Thank you for tuning in to the Editor’s Highlight Podcast for the April 2026 issue of the journal ÀÖ²¥´«Ã½®. 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 is our Asthma section. IL-5 may contribute to airway remodeling in severe eosinophilic asthma (SEA). In this issue, Taillé and colleagues report findings from a prospective cohort of 37 patients treated with mepolizumab for SEA who had bronchial biopsies at baseline, six months, and 12 months. The study was designed to determine if mepolizumab, an anti-IL-5 antibody, can modify airway remodeling in adult patients with SEA. Treatment improved asthma control and reduced the number of exacerbations, oral corticosteroid courses, and hospitalizations. There was a reduction in reticular basement membrane thickness, airway smooth muscle mass, and proliferating cell nuclear antigen-positive airway smooth muscle cells in the bronchial mucosa. Blood eosinophil counts decreased, and eosinophils were almost completely depleted in bronchoalveolar lavage fluid at 12 months. These findings show that mepolizumab may attenuate structural airway changes, in addition to its anti-inflammatory effects, in people with SEA. Completing this section is a ÀÖ²¥´«Ã½ Narrative Review on the application of precision medicine to the heterogeneity of asthma attacks.
Our Chest Infections content area is next. The role of fungal sensitization in bronchiectasis is poorly defined. In this issue, Tiew and colleagues report findings from an international, multicenter evaluation of 277 individuals with bronchiectasis from six tertiary centers in four countries. The study used a comprehensive, expanded allergen panel with 11 crude and 24 recombinant fungal allergens to determine the prevalence and clinical implications of fungal sensitization in bronchiectasis. Sensitization to recombinant Aspergillus fumigatus was associated with bronchiectasis severity, including severe exacerbations. The association was strongest among those with low baseline exacerbations. Individuals who were sensitized and with low risk had greater disease severity and a higher occurrence of bronchiectasis-COPD overlap than individuals who were nonsensitized and with low risk. Polysensitization to the same allergens conferred further additional risks of severe exacerbations. These findings identify Aspergillus fumigatus sensitization—particularly allergens 12, 15, and 17—as a clinically significant trait in bronchiectasis. Also in this section is an original research article exploring structural and functional pulmonary MRI to predict pulmonary exacerbations in cystic fibrosis and a ÀÖ²¥´«Ã½ Narrative Review that examines the threat of H5N1 highly pathogenic avian influenza to human health.
Our COPD section is next. Disease stability is a proposed COPD treatment goal, but its clinical significance is uncertain. In this issue, Son and colleagues report findings from a nationwide, prospective cohort of 1,639 patients with COPD in South Korea, 147 (9.0%) of whom had achieved disease stability. Disease stability was defined as having no moderate or severe exacerbations, no decline in postbronchodilator FEV1, and no deterioration in health status during the first year after the baseline visit. The study was designed to determine if there are differences in lung function decline, exacerbation risk, and mortality between patients with COPD with and without disease stability. Those with disease stability had lower rates of moderate to severe exacerbations. The annual decline in FEV1 was greater in the disease stability group, while disease stability was independently associated with a significantly reduced risk of all-cause mortality. These findings show that patients with COPD and disease stability have reduced exacerbations and mortality, supporting disease stability as a meaningful treatment target.
Next is our Critical Care content area. In preterm infants receiving noninvasive ventilation, data about inspiratory effort and transpulmonary driving pressure are scarce. In this issue, De Luca and colleagues report findings from a pilot, prospective, observational cohort study designed to evaluate the characteristics of inspiratory effort and transpulmonary driving pressure in extremely preterm infants undergoing noninvasive ventilation. Measures of electrical activity of the diaphragm were used to estimate inspiratory effort and transpulmonary driving pressure. Ten patients with respiratory distress syndrome (RDS), 25 with evolving bronchopulmonary dysplasia (BPD), and five control term neonates were studied. Interpatient variability of inspiratory effort was higher in patients than controls. Breaths with inspiratory effort > 10 cm H2O occurred more often in those with BPD than RDS and control infants. Breaths with transpulmonary driving pressure > 20 cm H2O occurred more often in those with RDS and BPD than controls and correlated with the degree of oxygen impairment. These findings help to characterize inspiratory effort and transpulmonary driving pressure in preterm infants receiving noninvasive ventilation. Completing this section is a consensus statement describing challenges and recommendations for integrating circadian medicine into critical care.
On to our Diffuse Lung Disease section. Serious side effects from immunosuppressive agents and tumor necrosis factor (TNF) inhibitors used to treat severe sarcoidosis have not been compared. In this issue, Chao and colleagues report findings from a retrospective analysis of data from the TriNetX Research Network covering 2012 through 2023 across 82 health care organizations. The study was designed to evaluate the one-year risk of serious side effects among immunosuppressants and TNF inhibitors in patients with sarcoidosis. In 13,814 patients receiving immunosuppressant agents, those who received mycophenolate mofetil had higher risks for inpatient hospitalization, critical care and mechanical ventilation, mortality, and infections compared with methotrexate. Azathioprine use was associated with increased risks for mortality, hematologic toxicity, and infections compared with methotrexate. In 3,964 patients receiving TNF inhibitors, there was a slightly higher risk of anemia, thrombocytopenia, and pneumonia, but there was a lower risk of soft tissue infection in those receiving infliximab compared with those receiving adalimumab. These findings help to identify side effect profiles associated with immunosuppressant and TNF inhibitor use in people with severe sarcoidosis. Also in this section is an original research article that explores differential effects of antifibrotic treatment on outcome prediction via serial matrix metalloproteinase-degraded C-reactive protein neoepitope levels in idiopathic pulmonary fibrosis and a ÀÖ²¥´«Ã½ Narrative Review of subclinical interstitial lung disease in rheumatoid arthritis, focusing on early detection and management.
Next is our Education and Clinical Practice content area. Clinician perceptions of the July 2021 Veterans Health Administration (VHA) nationwide inhaler formulary change from budesonide-formoterol metered-dose inhaler to fluticasone-salmeterol dry-powder inhaler are unknown. In this issue, Peirce and colleagues report findings from a cross-sectional survey of 511 respondents (pulmonologists, pharmacists, and primary care providers), designed to present VHA clinician perspectives on the inhaler formulary change. Of the respondents, 54.4% agreed that veterans were informed of the change in advance, while 24.7% considered the inhaler education provided to be effective. Of the open-ended responses, 75.5% expressed a negative sentiment about the formulary change, 11.8% were neutral, and 3.4% were positive. Themes included poor inhaler tolerance, concerns about worsening patient outcomes, and increased provider workload. These findings underscore the importance of timely clinician communication, patient education, and specialty engagement in future formulary transitions. Also in this section is an original research article describing serial MRI measures of short-term parenchymal changes in neonatal bronchopulmonary dysplasia and a ÀÖ²¥´«Ã½ Scoping Review of evidence to support the US Food and Drug Administration review of new medical technology in pulmonary, sleep, and critical care medicine between 2014 and 2024.
Our Pulmonary Vascular content area is next. Current evidence supports risk-based treatment for pulmonary arterial hypertension (PAH). In this issue, Khan and colleagues report findings from 1,019 patients with incident PAH enrolled in the Pulmonary Hypertension Association Registry to help identify current treatment patterns for patients with newly diagnosed PAH. Of the patients, 34% received initial monotherapy, 55% received dual therapy, and 12% received triple therapy. When monotherapy was prescribed, 25.1% of recipients were low risk, 31.3% were intermediate risk, and 43.7% were high risk. When dual therapy was prescribed, 35.7% of recipients were low risk, 26.5% were intermediate risk, and 37.8% were high risk. When triple therapy was prescribed, 31.9% of recipients were low risk, 28.3% were intermediate risk, and 39.8% were high risk. These findings highlight patterns of underutilization and overuse of PAH therapies for patients with newly diagnosed PAH. Completing this section is an original research article that evaluates the Pulmonary Hypertension Functional Class Self-Report measurement properties.
Next is our Sleep Medicine content area. The association between dyspnea and OSA remains uncertain. In this issue, Mouraux and colleagues report findings from a prospective cohort of 1,200 participants from the general population, 42.9% of whom reported exertional dyspnea. The study was designed to determine if there is an association between exertional dyspnea and OSA in the general population and what polysomnographic OSA-related measures are associated with exertional dyspnea. There was a positive association between exertional dyspnea and an apnea-hypopnea index (AHI) > 15 events/hour (OR, 1.57), an AHI > 30 events/hour (OR, 1.72), moderate OSA (OR, 1.6), and severe OSA (OR, 2.25). Dyspnea was associated with the AHI, respiratory disturbance index, respiratory pulse wave drop index, sleep apnea-specific pulse-rate response, respiratory arousal index, and oxygen desaturation index 3%. These findings identify an association between exertional dyspnea and moderate and severe OSA, potentially due to heightened autonomic and cortical responses to increased respiratory efforts. Also in this section is a research letter exploring geographical variations in CPAP termination rates in patients with OSA and a ÀÖ²¥´«Ã½ Narrative Review on real-world use of consumer sleep devices.
Next is our Thoracic Oncology content area. Atelectasis during peripheral bronchoscopy can cause CT-to-body divergence, can cause false-positive radial-probe images, and can obscure a target. In this issue, Boster and colleagues report findings from a randomized controlled study in 62 patients undergoing robotic bronchoscopy for nodules < 3 cm in dependent lung zones, with patients randomized to a lateral decubitus strategy (LADS) vs a ventilatory strategy to prevent atelectasis (VESPA). The primary outcome was the development of atelectasis obscuring the target, with atelectasis detected with mobile cone-beam CT scan. No patients developed atelectasis obscuring the target in the LADS group, and nine (27.3%) did in the VESPA group. Tool in lesion was achieved in all of the patients in the LADS group and in 72.7% in the VESPA group. Diagnostic yield on index biopsy was made in 86.2% in the LADS group and 57.6% in the VESPA group. There were no differences in complications. These findings suggest that a LADS is superior to VESPA in preventing atelectasis from obscuring targets in patients with nodules in dependent areas and is associated with better procedural outcomes. Also in this section is an original research article that reports on the use of and outcomes related to intrapleural enzyme therapy for complicated parapneumonic effusion and empyema. There are also two research letters: first, one on stereotactic body radiotherapy utilization trends for stage I non-small cell lung cancer and, second, a National Health Interview Survey analysis of lung cancer screening in the United States in 2024. Completing this section is a How I Do It review on process improvement for clinical follow-up of incidental lung nodules.
I encourage you to read our Commentary series, where you will find thoughtful pieces on preparing patients for life after lung transplant, inhaler training for patients with non-English language preference, and the use of incentive spirometry; and our Humanities series, you will find an Exhalations piece titled, “Fear as the Second Diagnosis.” 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 ÀÖ²¥´«Ã½. 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 April issue.