The 2009 Family Smoking Prevention and Tobacco Control Act granted the US Food and Drug Administration regulatory authority over tobacco products, extended to include electronic cigarettes (ECs) in 2016. Regulatory science informs potential market restrictions based on the population health standard. The CHEST Tobacco and Vaping Workgroup is charged with prioritizing tobacco-related advocacy. To identify critical gaps in the science guiding EC regulation, wean exploration of existing evidence to develop future research recommendations.

Pulmonary exacerbations (PExs) are associated with lung function decline and poor quality of life in people with cystic fibrosis (CF). Standard clinical measurements are limited in predicting future PEx events; pulmonary MRI scan has been shown to be a sensitive measure of CF lung disease, but its ability to predict PExs is currently unknown.

The standard of care for management of asthma attacks has remained unchanged for 70 years, relying on a symptom-based, severity-stratified approach. Severe asthma attacks are defined by a worsening of asthma requiring oral corticosteroid (OCS) treatment for unresolved symptoms for at least 48 hours, decreased lung function, or both. The 1-size-fits-all strategy with OCS treatment overlooks the biological mechanisms driving attacks and may lead to suboptimal outcomes. Importantly, OCS-related toxicities lead to significant morbidity, and cumulative OCS use has been associated with increased mortality. Antibiotics, often used indiscriminately, also increase adverse events and antimicrobial resistance.

Chronic thromboembolic pulmonary disease corresponds to exercise impairment after a pulmonary embolism due to persistent chronic thrombi and exercise pulmonary hypertension (PH). Diagnosis requires exercise right heart catheterization (RHC), whereas data on noninvasive diagnosis are scarce.

A 17-year-old previously elite-level tennis player was referred with dyspnea, fatigue, and excessive sleepiness during prolonged matches. He would become somnolent between tennis sets to the point where he had several episodes of near collapse during play. He was not excessively sleepy during the day (Epworth Sleepiness Scale score 6) and did not report any non-exertional episodes of collapse or cataplexy. His medical history was notable for a significant road traffic accident at age 10, requiring endotracheal intubation and prolonged ventilation for 14 days. His recovery was complicated by subglottic stenosis that was later repaired with laryngotracheal reconstruction. At age 13, he underwent subglottic balloon dilatation as well as a left arytenoidectomy and division or interarytenoid scar band. The patient was referred to a specialized dyspnea service for further evaluation.

A 65-year-old man with a history of paroxysmal atrial fibrillation, hypertension, and OSA was admitted to the hospital with worsening dyspnea on exertion and generalized edema. He had no history of malignancy, immunosuppression, surgery, radiation, or autoimmune conditions. He was born in the United States with no recent travel, substance use, or homelessness. He did not report any fevers, night sweats, joint pain or swelling, phalangeal discoloration, nail or skin lesions, or ocular concerns. Transthoracic echocardiography demonstrated preserved systolic function. The patient was discharged with a presumed diagnosis of heart failure with preserved ejection fraction (HFpEF) after demonstrating clinical improvement with diuresis. He was readmitted after several weeks with worsening ascites, functional decline, and transaminitis. Paracentesis demonstrated an elevated ascitic total protein with a borderline serum ascitic albumin gradient slightly < 1.1 g/dL. The patient was discharged with gastroenterology follow-up to evaluate for malignancy. Several weeks later, he was readmitted to cardiology for worsening hypervolemia and suspected HFpEF exacerbation, despite adherence to outpatient diuretics.

A 28-year-old man with an unremarkable medical history, no regular medication regimen, and no recent travel history or animal exposure was admitted to the emergency department with new onset of disorientation, slurred speech, and hearing loss. One day prior, the patient had consulted his general practitioner for fever, recurrent vomiting, and myalgia. According to his family, the patient smoked cigarettes and daily ingested γ-hydroxybutyrate. Because of the patient's limited ability to communicate, recent ingestion of other substances could not be ruled out. The patient was admitted to the ICU because of severe metabolic acidosis, electrolyte imbalances, and acute renal failure of indeterminate origin. Hemodialysis was started right after admission.

Endosalpingiosis, defined as ectopic fallopian tube tissue, is a rare entity usually found in the intraabdominal cavity. We present a case of pleural endosalpingiosis presenting as an exudative pleural effusion diagnosed through pleural biopsy and histologic examination. To our knowledge, no case reports in the literature have described this process occurring in the pleural cavity. This report highlights this novel entity and the diagnostic dilemma it poses.

COPD is a heterogeneous disease with progressive airflow limitation. Despite therapeutic advances, current treatments poorly halt COPD progression. Disease stability (DS) is a proposed treatment goal, but its clinical significance remains uncertain.

Adjunctive corticosteroids improve outcomes in HIV-associated Pneumocystis jirovecii pneumonia (PCP), but their role in non-HIV-associated PCP is uncertain. Prior evidence largely has been limited to binary treatment groups and rarely has accounted for daily or cumulative dose effects.

The clade 2.3.4.4b highly pathogenic avian influenza (HPAI) virus H5N1 is the etiologic agent for an ongoing panzootic with a rapidly increasing number of human infections. Although morbidity and mortality in humans with this clade seems to be limited to date, previous HPAI H5N1 viruses have been associated with mortality rates of approximately 50% in humans. Not all cases of clade 2.3.4.4b influenza A(H5N1) HPAI in humans have been associated with known exposure to infected animals. Therefore, clinicians must be aware of the changing viral ecology, human risk factors, and clinical presentations associated with H5N1 viruses to facilitate early case recognition and management of clade 2.3.4.4b A(H5N1) HPAI infection in humans.

The etiology of pulmonary arterial hypertension (PAH) is complex and the risk is heterogeneous. Growth differentiation factor-15 (GDF-15) has been reported to be associated with the prognosis of patients with PAH, but whether the use of GDF-15 as an additional prognostic biomarker can improve preexisting PAH risk stratification remains unclear.

Management of spontaneous pneumothorax often involves intercostal chest drain (ICD) insertion. Determining when to remove the ICD is controversial, with significant variation in practice. Establishing optimal ICD management in pneumothorax could reduce morbidity and improve cost-effectiveness.

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare condition caused by thromboembolic occlusions of the pulmonary arteries and characterized by elevated pulmonary pressure, vascular remodelling, and right ventricular overload, which can be treated effectively with balloon pulmonary angioplasty (BPA). The study aimed to evaluate whether elevated pulmonary arterial wedge pressure (PAWP), associated with left ventricular dysfunction, influences the effectiveness and safety of BPA treatment.

Survivors of critical illness face fragmented care transitions, leading to readmissions, emergency care use, and death. The Veterans Affairs (VA) Patient Aligned Care Team model emphasizes coordinated outpatient follow-up, yet many veterans now receive VA-purchased intensive care at community hospitals, potentially disrupting continuity.

Pulse oximetry-derived measures of autonomic vascular re-activity during sleep, quantified by pulse wave amplitude drop (PWAD) characteristics such as the PWAD index, have recently been proposed as a biomarker of cardiovascular disease (CVD) outcomes in patients with OSA.

Bronchopulmonary dysplasia (BPD) is the most common neonatal lung parenchymal disease characterized by obstructive and restrictive lung abnormalities. Evaluation of neonatal BPD lung disease using MRI has been shown to be more sensitive to short-term outcomes than standard clinical measures. However, the longitudinal trajectory of parenchymal disease remains poorly characterized.

Patients with COPD are at high risk of major adverse cardiovascular events (MACEs) developing. Existing clinical tools for risk stratification in these patients have underperformed in predicting the outcomes.

Adolescent and young adults (AYAs) diagnosed with cancer are at risk of experiencing pulmonary dysfunction years or even decades following completion of treatment.

Although spirometry is used to diagnose COPD, a new multidimensional diagnostic schema has recently been proposed to diagnose this disease. However, evidence in Chinese individuals and those who never smoked is limited.