The 2009 Family Smoking Prevention and Tobacco Control Act granted the FDA 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 (WG) 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.

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 corticosteroids (OCS) for unresolved symptoms for at least 48 hours and/or decreased lung function. . The "one-size-fits-all" strategy with OCS 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.

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.

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.

Critical illness survivors face fragmented care transitions, leading to readmissions, emergency care use, and death. The Veterans Affairs 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.

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.

Survivors of critical illness often experience new or worsening impairments in various domains of health after discharge, collectively referred to as post-intensive care syndrome (PICS). Although this condition is common, it remains unclear whether providers are communicating routinely about survivorship and PICS to patients and families and whether patients are remembering these conversations.

In preterm infants receiving noninvasive ventilation, data about inspiratory effort (ΔPes) and transpulmonary driving pressure (ΔPL) are scarce. Electrical activity of the diaphragm (EAdi) can estimate ΔPes and ΔPL when patient size precludes more accurate measurements. This estimation may reveal new insights into respiratory pathophysiology and potential risk of self-inflicted lung injury in neonates receiving noninvasive support.

A 29-year-old man with a medical history of chronic rhinosinusitis presented with a 6-month history of chronic nonproductive cough and mild exertional dyspnea. Five years ago, at the time of his chronic rhinosinusitis diagnosis, he underwent a chest radiograph that revealed an ill-defined opacity in the middle zone of the left lung, suspicious for neoplasm, and was subsequently lost to follow-up, until he presented now with cough and dyspnea. There was no history of hemoptysis, epigastric discomfort/burning sensation, dysphagia, or post-tussive vomiting associated with cough. Exertional dyspnea was graded as modified Medical Research Council grade 1, and it was not associated with any diurnal or postural variations (orthopnea/trepopnea), chest pain, palpitations, or pedal edema. There was no history of fever, malaise, weight loss, or audible wheeze. The patient had no significant medical history of asthma, COPD, nasal obstruction, urticaria, or other chronic respiratory conditions. He did not smoke and reported no significant occupational or environmental exposures to allergens. There was no history of TB contact or recurrent respiratory infections. Additionally, there was no family history of similar respiratory findings or conditions. During the intervening years, the patient remained asymptomatic until his presentation with the new concerns.

A 20-year-old previously healthy man presented to our hospital with a 2-week history of dull aching pain localized to the anterior chest wall, specifically in the sternum region. The pain was non-radiating and was exacerbated by physical activity or deep inspiration. There was no associated swelling, redness, or deformity of the chest wall. There were no associated systemic symptoms such as fever, weight loss, night sweats, and fatigue. Additionally, there was no history of recent respiratory infections, coughing, wheezing, dyspnea, hemoptysis, palpitations, edema, or orthopnea to suggest pulmonary or cardiac involvement. The patient was of Indian ethnicity and has been living in India since birth. However, he had no known exposure to individuals with active pulmonary TB. The patient reported no history of trauma, repetitive physical strain, or prior surgical interventions, such as sternotomy or chest wall procedures. His medical history was unremarkable, with no prior hospitalizations or chronic illnesses. There was no personal or family history of autoimmune disorders, such as ankylosing spondylitis, rheumatoid arthritis, or psoriatic arthritis, and he specifically denied symptoms such as morning stiffness, joint swelling, or peripheral joint pain that might suggest an inflammatory or autoimmune disorder. The absence of gastrointestinal or urogenital symptoms further reduced the likelihood of reactive arthritis or other systemic conditions. Relevant negatives also included no history of smoking, immunosuppressive therapy, or conditions such as diabetes or HIV that could increase susceptibility to infections.