Journal CHEST®
Assessment of Abdominal Adiposity in OSA Using Combined PET Imaging and MRI: Impact of Short-Term CPAP
By Jennifer Prevot, MD
CPAP treatment does not typically result in overall weight loss—but might it modify fat deposition and thereby mitigate cardiovascular risk? In this cohort of patients who had been newly diagnosed with moderate to severe OSA, short-term CPAP use did not alter total visceral adipose tissue volume or metabolic activity as measured by PET/MRI. However, CPAP did prompt a redistribution of fat from visceral to subcutaneous tissue—a provocative finding since visceral adiposity is more strongly linked to cardiovascular disease. And in the subgroup with obesity, CPAP did, in fact, reduce visceral fat volume. These findings take us one step further toward exploring whether CPAP impacts cardiometabolic risk in a heterogenous manner. Recent trials have been unable to demonstrate that PAP reduces cardiovascular events in allcomers with OSA, but in the future we may identify with better precision whether select groups derive benefit.
Commentary by Lauren Tobias, MD, FCCP, Member of the CHEST Physician Editorial Board
CHEST® Critical Care
Visualization of Airway Dynamics in a Critically Ill Infant With Respiratory Syncytial Virus Infection Using Portable Dynamic Digital Radiography
By Satoshi Komatsu, MD, PhD, and colleagues
In this case report, the authors apply a bedside evaluation technique with dynamic digital radiography (DDR) as a diagnostic tool in a case of unremitting respiratory failure. Through the application of DDR, clinicians were able to identify airway collapse, which demonstrates the power of this emerging noninvasive radiographic technique that allows for evaluation of diaphragm excursion, tracheal and mainstem airway diameter change, ventilation heterogeneity, and noncontrasted perfusion assessment.
When compared to ultrasound, CT scan, and electrical impedance tomography, DDR is unique in its ability to be performed at the bedside and offer both an airway and peripheral lung assessment. This tool as applied in the case report provides additional information not otherwise available by conventional assessment or with a patient unable to provide a breath hold. Further investigation is needed to fully understand the utility of DDR as it pertains to respiratory failure on and off of mechanical ventilation.
Commentary by Nick Villalobos, MD, Member of the CHEST Physician Editorial Board
CHEST® Pulmonary
A Pharmacist-Led Intervention to Increase Inhaler Access and Reduce Hospital Readmission (PILLAR)
By Tate D. Parrott, PharmD, BCPS, and colleagues
The PILLAR (PHARM-DC) trial provides an important lesson for pulmonary providers: Pharmacist-led discharge interventions are most effective when targeted to patients with low medication adherence and literacy (MedAL) rather than applied universally. Intervention with all patients did not significantly reduce readmissions or emergency department visits; however, patients with low MedAL were the ones who experienced a meaningful 10.4% absolute reduction in unplanned health care utilization. This finding is particularly relevant for pulmonary patients with COPD and other chronic respiratory diseases, who often face complex medication regimens, use multiple inhalers, and experience health literacy challenges. The study suggests that screening for medication adherence and literacy can identify a small, high-risk subgroup most likely to benefit from pharmacist-led transitions of care, including medication reconciliation, education, and follow-up. For pulmonary practices focused on reducing readmissions and improving value-based outcomes, PILLAR supports a precision approach that directs pharmacist resources to patients with the greatest need and potential benefit.
Commentary by Corinne Young, MSN, FNP-C, FCCP, Member of the CHEST Physician Editorial Board
