Top reads from the CHEST journal portfolio – July 2026

Journal CHEST^®

Antimicrobial Treatment of Mild Mycobacterium avium Complex Pulmonary Disease Predicted to Increase Survival and Quality-Adjusted Life Years

By Omri A. Arbiv, and colleagues

Arbiv and colleagues address a common clinical dilemma: whether to treat or observe mild nodular-bronchiectatic Mycobacterium avium complex pulmonary disease (MAC-PD). A state of clinical equipoise remains, supported partly by reports such as Kim and colleagues, in which 41% of untreated patients achieved spontaneous culture conversion over 48.1 months, including 48% who are relatively well. However, that estimate may not reflect sustained remission or broader real-world experience among bronchiectologists [sic]. In contrast, this microsimulation modeled for a lower spontaneous conversion rate of 15.7% per year in 70-year-old patients with mild, macrolide-susceptible, treatment-naive MAC-PD and normal lung function. Across a 40-year horizon, guideline-based therapy improved mean quality-adjusted life years (QALYs) from 13.4 to 15.9 and life expectancy from 15.8 to 18.3 years, yielding gains of 2.5 QALYs and 2.5 life-years. Ten-year survival was 80% with treatment vs 73% with observation, and cure occurred in 94% vs 85%.

The model is strengthened by transparent inputs, probabilistic Monte Carlo analysis, and one- and two-way sensitivity analyses, consistent with accepted standards for state-transition microsimulation. Nonetheless, its conclusions remain assumption-dependent. Most inputs derive from short-term observational cohorts rather than randomized trials, and minor cumulative toxicities of therapy may be underrepresented. These findings support guideline-concordant early treatment but also underscore the need for high-quality clinical trials.

Commentary by O’Neil Green, MBBS, MSc-C (Oxon), FCCP, Member of the CHEST Physician Editorial Board

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CHEST^® Pulmonary

Expert Consensus to Explore the Definition and Characterization of Methamphetamine-Associated Pulmonary Arterial Hypertension and Key Treatment Considerations

By Roham Zamanian, MD, and colleagues

Methamphetamine-associated pulmonary arterial hypertension (Meth-APAH) is a distinct, high-risk subtype of pulmonary arterial hypertension (PAH), with hospitalizations increasing more than ninefold in the United States between 2008 and 2020. Compared with idiopathic PAH, patients are generally younger, more likely to be male, and have worse right ventricular (RV) function, yet they remain undertreated because of stigma and concerns regarding adherence. All newly diagnosed patients with PAH should be screened for methamphetamine use with urine immunoassay followed by confirmatory mass spectrometry, using person-first, destigmatizing communication. Management generally follows guideline-directed therapy for idiopathic PAH, and methamphetamine abstinence should not be a prerequisite for treatment. For patients who are critically ill, collective experience supports aggressive RV support and PAH-directed therapy, including parenteral prostacyclins, often as rescue therapy for severe right ventricular failure. Management requires a multidisciplinary, harm-reduction model integrating addiction medicine and supportive services.

Commentary by Marwa Oudah, MD, Member of the CHEST Physician Editorial Board

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CHEST^® Critical Care

Treatment Associations Between Liberal vs Conservative Fluid Therapy and Ventricular Systolic Function in Patients With Sepsis

By Michael J. Lanspa, MD, and colleagues

As a liberal vs conservative fluid management approach in septic shock was not shown to alter mortality in the Crystalloid Liberal or Vasopressor Early Resuscitation in Sepsis (CLOVERS) trial, Lanspa and colleagues sought to evaluate the impact of these two treatment strategies on myocardial function. Ventricular strain, a highly sensitive echocardiographic measure of chamber deformation, was assessed.

The authors conducted a multicenter, observational, retrospective cohort trial including more than 1,000 patients. Those treated with a liberal fluid strategy defined as >1L following initial resuscitation were less likely to have reduced ventricular systolic function and chronic kidney disease, as well as several additional comorbid conditions. There was no association observed between fluid treatment strategy nor vasopressor receipt and left ventricular (LV) nor right ventricular global longitudinal strain using an adjusted propensity balanced estimate. However, mechanical ventilation was associated with worsened LV systolic function.

While the current results are insufficient to alter bedside patient management, future studies may incorporate such measures of ventricular systolic function in tailoring fluid therapies.

Commentary by Eugene Yuriditsky, MD, FCCP, Member of the CHEST Physician Editorial Board

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