Thank you for tuning in to the Editor’s Highlight Podcast for the June 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. The impact of sex on the prognostic value of risk factors for asthma attacks is unclear. In this issue, Riemann and colleagues report findings from a patient-level meta-analysis of the control arms of 22 randomized asthma trials (including 4,140 female and 2,370 male patients). The meta-analysis aimed to determine if sex modifies the prognostic values of clinical characteristics, blood eosinophil count, and exhaled nitric oxide for severe asthma attacks. Crude attack rates were higher in female patients than in male patients. Prior asthma attacks were the strongest predictor of future attacks in both sexes, but with a higher adjusted rate ratio (aRR) in male patients (aRR, 2.76 vs 1.66). The prognostic utility of treatment intensity, BMI, lung function, smoking status, comorbidities, and type 2 biomarkers was similar in male and female individuals. These findings showed higher annualized asthma attack rates in female individuals and a stronger prognostic value for prior attack history in male individuals.
Our Chest Infections content area is next. With the increased use of telehealth for clinical care, there is a strong interest in including remote respiratory specimen collection as part of the remote care of people with cystic fibrosis (CF). In this issue, Hoppe and colleagues collected two samples from 164 people with CF from six CF centers, one a clinic-obtained sample and the other a self-obtained sample. The study was designed to determine if self-obtained respiratory samples are feasible and acceptable for people with CF and whether the results are comparable with clinic-obtained samples. Self-collection was feasible (99% successful) and acceptable (88% rating as very easy or easy). The agreement for any CF pathogen detection was moderate, at 78.7%. Agreement for methicillin-susceptible Staphylococcus aureus detection was 87.9%. These findings suggest self-collection is feasible and acceptable for people with CF, and self-collection could be an alternate option for microbiology surveillance. Also in this section is a systematic review and network meta-analysis of the efficacy of anti-inflammatory therapies for adults with non-CF bronchiectasis and an original research study that evaluated the prevalence and significance of pulmonary hypertension in lung transplant recipients with CF and non-CF bronchiectasis. Completing this section is a ÀÖ²¥´«Ã½ Narrative Review on pulmonary fungal infections in the immunocompetent host.
Our COPD section is next. It is unclear whether people with advanced COPD are responsive to selective pulmonary vasodilators. In this issue, Collins and colleagues report findings from a randomized, placebo-controlled, double-blind, crossover trial of 61 patients with mild to severe COPD. The trial was designed to determine the effect of inhaled nitric oxide (iNO) on exercise capacity in people with COPD without hypoxemia or pulmonary hypertension. The study showed modification of the effect of iNO by an index of small vessel perfusion—the vascular volume of blood vessels with a cross-sectional area < 5 mm2 (BV5) divided by the total vascular volume (TVV), with higher BV5/TVV associated with greater iNO-induced improvement in VO2peak, independent of other pulmonary physiology parameters. iNO-induced increases in VO2peak were associated with improved ventilatory efficiency and reduced dyspnea. These results suggest a potential COPD pulmonary vascular endotype responsive to inhaled pulmonary vasodilators. Completing this section is a phase 2, multicenter, randomized, double-blind, placebo-controlled trial of a novel dual phosphodiesterase 3 and 4 inhibitor in patients with COPD in China.
Next is our Critical Care content area. Understanding how ICU treatments align with a patient’s priorities is crucial to evaluating and improving critical care. In this issue, Donovan and colleagues report findings from a secondary analysis of a prospective observational study of patients who were mechanically ventilated in an adult medical ICU. Their study was designed to determine the extent to which ICU care delivery is associated with patient priorities as reported by their surrogate decision-makers. Treatment priorities included maximize survival, maximize comfort, and a middle ground between these two. Middle ground was the most frequently reported priority (48.4%) followed by maximize survival (34.6%). Hospital mortality was similar across groups as were other life-sustaining therapies and palliative care. A maximize comfort priority was associated with a shorter hospital length of stay. These findings highlight the need for continuing efforts to achieve individualized goal-concordant care for patients with critical illness. Also in this section is a research letter that describes the outcomes patients with severe mpox admitted to ICUs and a ÀÖ²¥´«Ã½ Narrative Review of invasive candidiasis in patients who are critically ill.
On to our Diffuse Lung Disease section. Although radiographic fibrosis extent is often used to inform treatment decisions, its usefulness as a theragnostic marker for immunomodulatory therapy is unknown. In this issue, Muegge and colleagues report findings from a retrospective cohort of 108 patients with hypersensitivity pneumonitis (HP) from two interstitial lung disease (ILD) referral centers. The study was designed to determine if visual fibrosis extent on high-resolution CT imaging is associated with differential pulmonary function response to immunomodulation in chronic HP. Patients with < 10% fibrosis had improvement in both FVC (5.83%) and DLCO (13.9%), whereas those with > 10% fibrosis did not (FVC, 0.81%; DLCO, 4.3%). Demographics, smoking history, and antigen identification were similar across fibrosis groups. These findings could support the conduct of prospective trials of fibrosis extent as a clinical tool for treatment stratification. Two additional original research studies appear in this section. The first assesses the association between recovery rate from exertional desaturation with disease progression and mortality risk in patients with fibrotic ILD. The second evaluates premelanosome protein as a diagnostic biomarker in lymphangioleiomyomatosis.
Next is our Education and Clinical Practice content area. Standardized management and long-term outcome data for neuroendocrine cell hyperplasia of infancy (NEHI), also known as persistent tachypnea of infancy, is limited. In this issue, Marczak and colleagues report findings from a European multicenter, retrospective, observational study of 378 children from 73 centers across 17 countries, designed to describe the treatment and outcomes for patients with NEHI. The median age at diagnosis was 9 months. Treatments included oxygen supplementation (76%), inhaled bronchodilators and/or glucocorticoids (62%), systemic glucocorticoids (37%), and nutritional support (34%). Of those receiving oxygen supplementation, 54% were weaned off (median age 24 months). Variability in treatment practices was observed across participating countries. Improvement in symptoms and imaging were noted in those with longitudinal data available. A subset of patients had persistent hypoxemia, crackles, exercise intolerance, abnormal imaging, and pulmonary function testing findings into adolescence. These findings highlight the need for evidence-based guidelines and long-term follow-up of people with NEHI. Also in this section is an original research article that evaluates cardiopulmonary abnormalities during exercise in young individuals with chronic use of e-cigarettes and a Special Features article on shaping the future of respiratory care with strategic recommendations by EUFOREA.
Our Pulmonary Vascular content area is next. Traditional assessments of people with pulmonary arterial hypertension (PAH) may not adequately capture daily physical activity or patient experience in real-world situations. In this issue, Minhas and colleagues report findings from a multicenter randomized controlled trial of anastrozole in PAH, wherein 84 patients wore hip-based accelerometers for 7 days at each of four in-person study visits over 12 months. The study was designed to determine if accelerometer-derived measures of daily physical activity reflect disease severity, functional status, and outcomes over time. Device adherence was high across visits. Activity declined over time and was lower in those with World Health Organization functional class III, worse right ventricular function, and connective tissue disease-associated pulmonary hypertension. Lower daily activity was associated with worse health-related quality of life, baseline 6-minute walk distance, baseline bone mineral density, and increased risk of clinical worsening. These findings suggest that accelerometer-derived physical activity may offer a dynamic, patient-centered complement to traditional assessments. Completing this section is a research letter that evaluates sotatercept in patients with sarcoidosis-associated pulmonary hypertension.
Next is our Sleep Medicine content area. The impact of PAP therapy adherence on health care resource use (HCRU) in patients with coronary artery disease (CAD) and newly diagnosed OSA is unclear. In this issue, Cistulli and colleagues report findings from a retrospective analysis that linked administrative claims to objective PAP use data to determine if adherence to PAP therapy is associated with reduced HCRU in 2,911 patients with CAD and OSA. Nonadherent patients were slightly younger, more commonly female, and had a higher prevalence of severe obesity and comorbidities. In years 1 and 2, adherent patients made fewer emergency room visits (-26%, -24%) and had lower all-cause hospitalizations (-35%, -39%). The threshold for minimum nightly PAP use to derive a significant HCRU benefit was < 3 hours per night for all outcomes and periods. Each additional hour per night added a 4.7% to 5.9% reduction in HCRU rates. These findings support the importance of diagnosing and treating OSA in patients with CAD. Two additional original research articles can be found in this section. The first evaluates the association of nocturnal hypoxemia with cardiovascular events in patients with acute coronary syndrome and OSA. The second describes the 12-month follow-up and economic impact of an alternative care provider clinic for severe sleep-disordered breathing.
Next is our Thoracic Oncology content area. In 2023, the American Cancer Society (ACS) recommended the quit duration criterion be removed from the US Preventive Services Task Force (USPSTF) lung cancer screening guidelines. The impact of this recommendation on racial, ethnic, and sex disparities in lung cancer screening eligibility is unclear. In this issue, Manful and colleagues report findings from 175,259 adults who currently or formerly smoked from the Black Women’s Health Study, Multiethnic Cohort Study, and Southern Community Cohort Study. The study was designed to clarify the impact of the ACS recommendation. Of those included, 27% were eligible for screening according to the USPSTF criteria, as well as 33% based on the ACS recommendations. Of those eligible based on the ACS recommendations alone, 382 (3%) developed lung cancer. The ACS criteria increased sensitivity among all participants from 34% to 44%, while decreasing the specificity from 87% to 77%. These changes differed in magnitude across racial and ethnic groups, resulting in larger eligibility disparities. The increased disparity was most evident between Black or African American and White Americans (USPSTF disparity, 7%; ACS disparity, 12%) and between Hispanic or Latino and White Americans (USPSTF disparity, 12%; ACS disparity, 22%). The findings suggest that ACS criteria could increase screening eligibility broadly, leading to increased sensitivity overall, but also an increase in unnecessary screenings of people without lung cancer and larger disparities in race, ethnicity, and sex. Also in this section is a systematic review and meta-analysis of the association between prior lung diseases and risk of lung cancer in populations with no smoking history; a pragmatic randomized clinical trial evaluating text messaging approaches to promote enrollment in smoking cessation treatment among Latino adults; and an evaluation of hospital variation in invasive mediastinal staging for patients with stage I lung cancer treated with radiation. Completing this section is a How I Do It review of the clinical approach to a pleural effusion.
I encourage you to read our Commentary series, where you will find thoughtful pieces on balancing the need for pulmonary rehabilitation centers of excellence with the need to improve access through telemedicine and the promise of robotic bronchoscopy. In our Humanities series, you will find a case-based discussion of cognitive bias in extracorporeal membrane oxygenation candidacy decision-making. 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 June issue.