Thank you for tuning in to the Editor’s Highlight Podcast for the July 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. Little is known about the effect of marijuana use on asthma attacks. In this issue, Tanu and colleagues report findings from 4,477 people participating in a longitudinal study of the impact of tobacco use on various aspects of health to assess the association of inhaling marijuana with asthma attacks in US adults with asthma. Inhaling marijuana was associated with higher rates of asthma exacerbations one year from baseline. Use of inhaled combustible marijuana products had an OR for asthma attacks of 1.64, use of electronic marijuana products had an OR of 1.81, and use of both had an OR of 1.57. These findings show that inhaling marijuana is associated with a higher risk of asthma attacks.
Our Chest Infections content area is next. Molecular diagnostic technologies have enhanced the detection of respiratory viruses. The selection of the sampling site may influence diagnostic accuracy. In this issue, Piralla and colleagues report findings from a multicenter, retrospective study of 346 patients across nine hospitals, designed to determine how the diagnostic yield and concordance for respiratory viruses differ between paired upper and lower respiratory tract samples in people with severe acute respiratory infections. Of the paired samples, 67.9% were concordant. A virus was detected in the lower respiratory tract but not the upper tract in 21.7% of cases. Median Cq values were lower in the lower respiratory tract samples, with higher viral loads noted in the lower respiratory tract in 67.3% of concordant samples and more than one-third exceeding a 10-fold difference. These findings highlight that sampling only the upper respiratory tract can miss significant viral infections in patients with severe acute respiratory infections. Also in this section are reports from a randomized controlled trial that assessed the clinical effectiveness and cost-effectiveness of pulmonary rehab for people with post-TB lung disease and a microsimulation decision analysis model of the survival impact of antimicrobial treatment of mild Mycobacterium avium complex pulmonary disease.
Our COPD section is next. The efficacy and safety of ensifentrine, a novel phosphodiesterase 3/4 inhibitor for the treatment of severe COPD in people from China, are unclear. In this issue, Zhou and colleagues report findings from a phase 3, multicenter, randomized, double-blind, placebo-controlled trial designed to determine if nebulized ensifentrine is effective and safe compared with placebo for the treatment of moderate to severe symptomatic COPD in Chinese participants. Five hundred twenty-five participants were included in the analysis. Ensifentrine improved average FEV1 area under the curve at 0 to 12 hours (110 mL) across all subgroups. The Transition Dyspnea Index, Evaluating Respiratory Symptoms, St. George’s Respiratory questionnaire scores; rate of moderate to severe exacerbations; and time to first exacerbation were also improved. These findings show that ensifentrine is able to significantly improve lung function, symptoms, quality of life, and exacerbation rates in Chinese individuals with moderate to severe COPD. Also in this section is a post hoc analysis of the phase 3 BOREAS and NOTUS studies that assesses the win ratio analysis to clarify clinical benefits and a research letter describing the impact of exercise modality on the accuracy of normative reference equations to identify abnormal exertional breathlessness.
Next is our Critical Care content area. The diagnostic yield and impact of CT imaging and point-of-care ultrasound (POCUS) after in-hospital cardiac arrest are unclear. In this issue, Andrea and colleagues report findings from a retrospective observational study of 345 adults with in-hospital cardiac arrest from four hospitals, designed to determine whether CT and POCUS imaging identify acute pathologic features that change postarrest management. The suspected cause of the arrest was identified in 20.5% of CT scans. Of those who received a CT scan, head CT scan (89.3%) was most common, followed by chest CT scan (57.1%) and abdomen CT scan (43.8%). New findings were identified in 65.2% of patients, leading to management changes in 65.8% with chest CT scan yielding the highest usefulness (92.2% with new findings and 64.1% with management change). POCUS was most commonly cardiac (98.1%) followed by chest (70.8%). New findings were identified in 57.6% of studies, with management changes in 41.3%. The suspected cause of the arrest was identified in 19.3% of patients. These findings show that CT imaging and POCUS frequently identify new pathologic features, leading to subsequent management changes in patients with in-hospital cardiac arrest. Also in this section is an original research article that evaluates the effect of targeted mild hypercapnia on right ventricular function after out-of-hospital cardiac arrest in a substudy of the TAME cardiac arrest trial. Completing this section is a ÀÖ²¥´«Ã½ Narrative Review on rhabdomyolysis.
On to our Diffuse Lung Disease section. The relationship between sarcoidosis imaging subtypes and demographic and physiological variables is not known. In this issue, Yadav and colleagues report findings from a retrospective study of 932 people with sarcoidosis from two medical centers and the Genomic Research in Alpha-1 Antitrypsin Deficiency and Sarcoidosis consortium, designed to determine if individuals with fibrotic sarcoidosis have more severe physiologic impairment and whether CT scan and fibrosis subtypes exist. Of those included, 38% had fibrosis, 41% had nonfibrotic abnormalities, and 21% had no parenchymal abnormality. Those with fibrosis had a longer time since diagnosis, more impaired spirometry and diffusing capacity, and larger pulmonary artery diameter. Those with a conglomerate mass were 9 times more likely to have a mixed pattern of spirometry impairment. These findings show that individuals with fibrotic pulmonary sarcoidosis have distinct demographic and spirometric features and subtypes. Three additional original research studies are found in this section: an analysis of the epidemiology of cryptogenic organizing pneumonia from the Nationwide Inpatient Sample, an evaluation of matrix metalloproteinase 12 as a means of differentiating idiopathic pulmonary fibrosis and fibrotic hypersensitivity pneumonitis, and a multicenter cohort study of posttransplant cyclophosphamide to reduce bronchiolitis obliterans syndrome risk by preventing graft-vs-host disease.
Next is our Education and Clinical Practice content area. Our understanding of the cause of cardiopulmonary issues in people with osteogenesis imperfecta (OI) is limited. In this issue, Derocher and colleagues report findings from a cross-sectional, multicenter study of 60 adults, conducted to identify the cardiopulmonary outcomes and differences in pulmonary function in adults with OI. Of the patients, 72.9% had scoliosis. Two-thirds of participants had restrictive physiology on pulmonary function testing, without correlation with the spinal curve magnitude. Bronchial wall thickening, ground glass, atelectasis, or bronchiectasis was seen in 85.7% of CT scans. Tachycardia, abnormal ventricular relaxation, and T-wave abnormalities were present in 57.7% of ECGs, and 82% had trace mitral, tricuspid, or pulmonary regurgitation on echocardiography. These findings suggest that respiratory impairment may not be primarily related to scoliosis and that many airway-related disorders are manifestations of OI. Also in this section is an economic evaluation of health care resource utilization in Maryland during a major wildfire smoke event. Completing this section is an expert consensus framework for standardizing lung ultrasound training for neonatologists from the European Society of Paediatric and Neonatal Intensive Care working group.
Our Pulmonary Vascular content area is next. The minimal important difference (MID) for N-terminal pro-brain natriuretic peptide (NT-proBNP) change in patients with pulmonary arterial hypertension (PAH) is not known. In this issue, Lammi and colleagues use data from 888 participants who participated in one of two placebo-controlled trials of treprostinil (one oral and one inhaled). The study was designed to determine the MID for NT-proBNP change and assess if the MID is associated with improved clinical outcomes. The estimated MIDs for short-term NT-proBNP improvement in PAH and pulmonary hypertension related to interstitial lung disease were 48% (for both). Those who achieved the MID at 12 weeks were 52% less likely to have clinical worsening during long-term follow-up (HR, 0.48) and at 16 weeks had a relative improvement in 6-minute walk distance of 40 m. These findings estimate the MID for short-term NT-proBNP improvement to be 48% and suggest that achievement of the MID is strongly associated with clinically important outcomes. Also in this section is a research letter on the challenges of clinical trial eligibility in PAH and a How I Do It review of the management of chronic thromboembolic pulmonary hypertension before and after pulmonary thromboendarterectomy.
Next is our Sleep Medicine content area. Comorbid insomnia and OSA (COMISA) has the potential to impair treatment efficacy. In this issue, Cole and colleagues use linked de-identified payer-sourced medical claims and objective PAP use data from 27,071 patients to determine if adherence to PAP therapy is associated with reduced health care resource use in patients with COMISA. During the first year of treatment, PAP adherence was associated with fewer emergency room (ER) visits (mean, 0.50 vs 0.68) and all-cause hospitalizations (0.10 vs 0.14). Similar results were seen in year two. Compared with patients with OSA without insomnia, those with COMISA showed lower PAP use and higher rates of resource use both before and after the index date but similar relative reductions in ER visits and hospitalizations with PAP adherence. These results support the treatment of OSA in patients with COMISA and identify the need to improve adherence to PAP therapy in this group. Completing this section is an original research article that evaluates the impact of weight loss on the physiological endotypes associated with OSA.
Next is our Thoracic Oncology content area. There is insufficient evidence to guide the use of prophylactic hemostatic agents during endobronchial biopsy. In this issue, Li and colleagues report findings from a multicenter, randomized, placebo-controlled trial of 462 participants who were scheduled to undergo endobronchial biopsy. The study was designed to determine whether prophylactic hemostatic treatment (adrenaline, ice-cold saline, saline placebo) is effective for controlling bleeding in patients undergoing endobronchial biopsy. There was no overall reduction in bleeding with prophylactic hemostasis based on the Bleeding Severity Scale or the visual analog scale. In those < 65 years of age, the incidence of bleeding in the ice-cold saline group was reduced compared with the placebo group. These findings did not suggest an improvement in biopsy-related iatrogenic bleeding with prophylactic hemostasis but left that question open for those under 65 years of age. This section also includes an evaluation of long-term major respiratory mortality among five-year survivors of adolescent and young adult cancer and an assessment of the association of sleep-related hypoxemia with survival in patients with non-small cell lung cancer.
I encourage you to read our Commentary series, where you will find a thoughtful piece on the probabilistic nature and inherent limitations of spirometry interpretation, as well as our Humanities series, where you will find an Exhalations contribution titled, “The Ghost at the Bedside.” 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 July issue.