Thank you for tuning in to the Editor’s Highlight Podcast for the May 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 way that risk predictors combine and contribute to the prediction of severe asthma exacerbations in clinical trials and real-world settings is unclear. In this issue, Yadav and colleagues compared the contribution of 17 risk predictors of severe asthma exacerbations between 345 patients in the placebo arms of two international randomized controlled trials (RCTs) and 6,814 biologic-naïve patients from the International Severe Asthma Registry. The study was designed to determine how the interactive pathways of risk predictors leading to severe asthma exacerbations compare in clinical trials and real-world settings. The main downstream prediction pathways were consistent across settings, with two key pathways noted. Total serum IgE level influenced blood eosinophils to predict severe exacerbations, and severe exacerbation history directly predicted future severe exacerbations. RCT Bayesian networks generalized better to the real-world setting than the other way around. These findings show that the core pathways predicting severe asthma exacerbations are similar in RCTs and real-world settings.
Our Chest Infections content area is next. Multidisciplinary care teams have recently emerged for the evaluation and management of bronchiectasis and pulmonary nontuberculous mycobacteria (NTM) infections. In this issue, Zha and colleagues report findings from 453 individuals cared for as part of a multidisciplinary bronchiectasis and NTM program called INTEGRATE. This retrospective study was designed to determine if a multidisciplinary care program reduces bronchiectasis exacerbations or improves sputum conversion rates in pulmonary NTM infections. The program was associated with a 36% reduction in quarterly exacerbations in the year following consultation (RR, 0.64) and a shorter time to culture conversion (HR, 0.68), indicating a higher rate of conversion over time. These findings highlight that a multidisciplinary program for bronchiectasis and pulmonary NTM disease can improve clinical outcomes, provider comfort, and perceived safety. Completing this section is a position statement on the structure of a bronchiectasis and NTM care center from the Bronchiectasis and NTM Association.
Our COPD section is next. Prior studies have shown inconsistent results regarding the use of proton pump inhibitors (PPIs) and the risk of exacerbations in people with chronic obstructive airway diseases (COADs). In this issue, Dehondt and colleagues report findings from 932,135 patients from the Belgian nationwide claims-based database of adult patients receiving long-term medication for COADs. The study was designed to determine if long-term PPI use is associated with exacerbation risk. Of those included, 416,087 (44.6%) used PPIs, of whom 102,549 (24.6%) received > 365 defined daily doses. PPI use was independently associated with an increased risk of exacerbations (HR, 1.18). The risk of exacerbations increased with cumulative defined daily doses (> 365 days; HR, 1.24). The association with exacerbation risk was most pronounced in patients without gastroesophageal reflux disease, with asthma, younger than 50 years, who were not frail, and with increased PPI plasma concentrations. These findings identify an association between cumulative PPI use in people with obstructive lung diseases and exacerbation risk.
Next is our Critical Care content area. The global prevalence of Pseudomonas aeruginosa (P aeruginosa) nosocomial respiratory infections (NRIs) and associated risk factors is unclear. In this issue, Serrano-Mayorga and colleagues report findings from a secondary analysis of the European Network for ICU-Related Respiratory Infections, a prospective cohort study conducted across 12 countries. The study was designed to determine the international prevalence of P aeruginosa in 1,059 ICU patients with NRIs and to identify clinical factors associated with increased risk. Pathogens were identified in 67% of patients, primarily through blood cultures. P aeruginosa was detected in 14.5% of samples, with antimicrobial resistance in 5.1% of samples (19.6% were multidrug-resistant). The highest prevalence was observed in Germany, Argentina, and France. Ventilator-associated pneumonia was the predominant diagnosis (66%), while septic shock and acute kidney injury (AKI) were the most frequent complications. Key risk factors included COPD Global Initiative for Chronic Obstructive Lung Disease stage D, autoimmune disease, chronic kidney disease, and AKI on day one. These findings identify P aeruginosa as a leading NRI pathogen, with variability across countries, and helps to identify key risk factors. Completing this section is an original research article that compares post-ICU care trajectories and outcomes among veterans after Veterans Affairs vs community hospital discharges.
On to our Diffuse Lung Disease section. Clinically meaningful thresholds for defining progressive pulmonary fibrosis (PPF) with quantitative CT imaging remain unclear. In this issue, Park and colleagues report findings from 476 patients with non-idiopathic pulmonary fibrosis (IPF) fibrosing interstitial lung disease (ILD) who underwent volumetric CT imaging at baseline and at one-year follow-up. The study was designed to determine the minimal clinically important differences (MCIDs) in quantitative CT imaging-based fibrosis score changes. The one-year and six-month MCIDs were 2.24% and 1.34%, respectively. Exceeding the one-year MCID was associated with poorer transplant-free survival (HR, 3.01). Patients with both visual and quantitative CT imaging-based progression showed worse outcomes than those with visual progression alone. Fibrosis score changes above the six-month MCID were also associated with increased mortality (HR, 2.82). These findings show that quantitative CT imaging-based PPF definitions are prognostic across patients with non-IPF fibrosing ILDs and can enhance risk stratification in patients with discordant PPF assessments. Also in this section is an original research article that reports on the incidence of new comorbidities after steroid use in patients with sarcoidosis from an international cross-sectional survey. Completing this section is a How I Do It review of how to create a multidisciplinary sarcoidosis care team for complex clinical management.
Next is our Education and Clinical Practice content area. The domain-specific knowledge in asthma of state-of-the-art large language models (LLMs) has yet to be studied. In this issue, Li and colleagues present findings from the evaluation of 14 LLM chatbots, tested in five iterations on 116 adult asthma multiple choice questions (MCQs) and three asthma Objective Structured Clinical Examinations (OSCEs). Of the 14 models, 13 exceeded an 85% accuracy on the MCQs, with five of the models exceeding 95% accuracy. The LLMs performed better at patient-oriented MCQs than clinician-oriented MCQs. OSCE accuracy was more variable, but most models achieved 70% to 86% accuracy. There was no difference in performance of open-source and proprietary models or between generic and medicine-specific LLMs. These findings indicate that current LLMs have a high accuracy across asthma-related clinical and patient-oriented questions. Completing this section is an observational study that evaluated factors influencing unit-level differences in prevalence of prematurity-associated bronchopulmonary dysplasia in a European cohort.
Our Pulmonary Vascular content area is next. The role of pathogenic variants in the BMPR2 gene and other pulmonary arterial hypertension (PAH)-related genes in systemic lupus erythematosus (SLE)-associated PAH remains unclear. In this issue, Qian and colleagues explore both the prevalence of rare variants in PAH-related genes in 241 patients with SLE-associated PAH and their impact on clinical phenotypes and outcomes from the Chinese SLE Treatment and Research Group PAH cohort. Approximately 7.4% of patients carried rare variants in PAH-related genes, higher than the control cohort (4.7%). Variant carriers had a higher proportion of PAH as the onset symptom of SLE and lower SLE disease activity. Variant carrier status was an independent prognostic factor, with an HR of 5.89 for mortality. These findings show that patients with SLE-associated PAH and rare pathogenic variants in PAH-related genes have a distinct clinical phenotype and worse outcomes. Completing this section is a prospective, multicenter, open-label, single-arm phase 2 study that investigated the pharmacokinetics, safety, tolerability, and exploratory efficacy of selexipag in children with PAH.
Next is our Sleep Medicine content area. Targeted proximal hypoglossal nerve stimulation (pHGNS) improved sleep-disordered breathing, sleep architecture, and quality of life (QOL) over one year in a prior controlled trial. Longer-term safety and efficacy have not been reported. In this issue, Schwartz and colleagues report findings from 104 patients in the STAR trial to determine the long-term safety and efficacy of pHGNS in comparison with distal HGNS (dHGNS). pHGNS led to sustained improvement in sleep-disordered breathing, oxygenation, and QOL at 24 and 36 months. Median apnea-hypopnea index reductions were -15.1/hour and -17.7/hour. Benefits in sleep-disordered breathing and QOL were sustained at 36 months and appeared to be comparable to those reported for dHGNS at three years. These findings confirm maintenance of treatment response from pHGNS through three years, with similar outcomes to dHGNS. Also in this section is an original research publication that explores sleep apnea endotyping for polygraphy via oximeter-derived autonomic arousal. Completing this section is a ÀÖ²¥´«Ã½ Narrative Review on high-altitude travel in patients with neuromuscular and thoracic restrictive disorders.
Next is our Thoracic Oncology content area. The risk factors for lung cancer in people who have never smoked (LCINS) remain poorly understood. In this issue, Kwak and colleagues report findings from a multicenter, retrospective, age- and sex-matched case-control study from South Korea (3,000 patients and 3,000 controls with negative chest CT scans from the same centers). The study was designed to determine the risk factors for LCINS. The median age of those included in the study was 60 years, and 81.1% were female. Stage I disease was present in 66.7% of patients. Chronic lung disease (OR, 2.91), noncapital region residence (OR, 2.81), unemployment (OR, 1.32), and first-degree family history of lung cancer (OR, 1.23) were independent risk factors for non-small cell lung cancer. Undergraduate level or higher education (OR, 0.53) was associated with a lower risk of LCINS. These findings identify both environmental and host factors as contributors to LCINS. Two additional original research articles are found in this section. The first is a retrospective study evaluating osteoporosis using low-dose CT scan images obtained for lung cancer screening, and the second is a thematic analysis of public comments to the Centers for Medicare & Medicaid Services National Coverage Analysis process on the lung cancer screening counseling and shared decision-making visit. Completing this section is an American College of Chest Physicians research statement on critical gaps in the scientific basis for electronic cigarette regulation.
I encourage you to read our Commentary series, where you will find thoughtful pieces on the use of lung ultrasound to preserve simplicity in the age of complexity and how to keep vaccine recommendations evidence-based and patient-centered; and our Humanities series, where you will find an Exhalations piece titled, “The Pause Between Words,” and a Vantage article on evolving representation in pulmonary hypertension. 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 May issue.