Top reads from the CHEST journal portfolio – December 2025

CHEST^® Pulmonary

A Multicenter Retrospective Study Evaluating IL-5-Targeted Biologic Therapies for the Treatment of Asthma and Allergic Bronchopulmonary Aspergillosis in Adults With Cystic Fibrosis

By Sameer Desai, PhD, and colleagues

Biologics that target type 2 inflammation have had a significant impact on patients with severe asthma, COPD, and several other conditions. Because cystic fibrosis (CF), asthma, and allergic bronchopulmonary aspergillosis (ABPA) frequently coexist, there has been growing interest in evaluating the effects of these therapies in this subgroup of patients. Notably, ABPA is characterized by intense eosinophilic inflammation, making these patients potential candidates for anti-IL-5 therapies.

Desai and colleagues retrospectively evaluated the effects of biologics targeting the IL-5 pathway (mepolizumab and benralizumab) in 38 adults with CF and coexisting asthma and ABPA. The mean blood eosinophil count among participants was 540 cells/μL. Initiation of biologic therapy was associated with a numerical decrease in exacerbations and cumulative systemic corticosteroid doses. Lung function remained stable after 12 months of treatment.

Real-world retrospective studies, including Desai’s, suggest a potential benefit of biologics in CF and ABPA. However, additional randomized controlled trials with larger sample sizes and longer follow-up are needed to confirm these findings.^1–2 No new safety signals were identified.

Commentary by Diego Maselli, MD, FCCP, Member of the CHEST Physician Editorial Board

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CHEST^® Critical Care

Accuracy of Ultrasonography in Confirming Correct Positioning of Nasogastric Tube in the Intensive Care Setting

By Alessandro F. Chiesa, MD, and colleagues

Nasogastric tube (NGT) placement is a common procedure in the ICU. Traditionally, confirmation of correct positioning relies on radiographic imaging, which can delay usage, add health care cost, and expose patients to additional radiation. With growing provider proficiency in point-of-care ultrasound, alternative confirmation methods are being explored. In this study across four ICUs in Switzerland, a two-step ultrasound combining a neck scan with an epigastric injection test demonstrated a positive predictive value of 100%, a low negative predictive value (13%), and an overall accuracy of 79% for bedside confirmation of NGT placement. These findings suggest that, in skilled hands and appropriately selected patients, ultrasound-based confirmation of NGT placement may be a reliable and radiation-free alternative to conventional radiographic methods.

Commentary by Kathryn Pendleton, MD, FCCP, Member of the CHEST Physician Editorial Board

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Journal CHEST^®

Association of Hypoxic Burden With Cardiovascular Events: A Risk Stratification Analysis of the Randomized Intervention With CPAP in Coronary Artery Disease and Sleep Apnea Cohort

By Yüksel Peker, MD, PhD, ATSF, FAASM, and colleagues

While the apnea-hypopnea index (AHI) is the gold standard for diagnosing and quantifying the severity of OSA, the ability to predict major adverse cardiovascular and cerebrovascular events (MACCEs) remains unclear. This secondary analysis of the Randomized Intervention With CPAP in Coronary Artery Disease and Sleep Apnea (RICCADSA) trial sought to identify better predictive phenotypes. This study showed that when it comes to MACCEs in patients with preexisting coronary artery disease, a traditional AHI frequency of ≥ 30 events/h (severe OSA) is a poor risk predictor. Instead, hypoxic burden (HB), which quantifies the depth and duration of desaturations, is a superior prognostic marker. Patients with elevated HB faced a significantly higher risk of MACCE (HR, 1.87) compared with the low HB group.

Thus, this research helps explain the neutral results of the prior trials. It further supports a paradigm shift in cardiovascular risk stratification. By identifying a “high hypoxic burden” phenotype, clinicians can better stratify high-risk patients who are most likely to derive cardiovascular benefit from CPAP therapy.

Commentary by Ritwick Agrawal, MD, MS, FCCP, Member of the CHEST Physician Editorial Board

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