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Asthma Across a Woman’s Lifespan

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Navitha Ramesh, MD, FCCP

Click to view more from Pulmonology Data Trends 2023.

References

1. Chowdhury NU et al. Eur Respir Rev. 2021;30(162):210067. doi:10.1183/16000617.0067-2021

2. Perikleous EP et al. J Pers Med. 2022;12(6):999. doi:10.3390/jpm12060999

3. Khaleva E et al. Clin Transl Allergy. 2020;10:40. doi:10.1186/s13601-020-00340-z

4. Robijn AL et al. Curr Opin Pulm Med. 2019;25(1):11-17. doi:10.1097/MCP.0000000000000538

5. Bravo-Solarte DC et al. Allergy Asthma Proc. 2023;44(1):24-34. doi:10.2500/aap.2023.44.220077

6. Wang G et al. J Matern Fetal Neonatal Med. 2014;27(9):934-942. doi:10.3109/14767058.2013.847080

7. Hough KP et al. Front Med (Lausanne). 2020;7:191. doi:10.3389/fmed.2020.00191

8. Triebner K et al. Am J Respir Crit Care Med. 2017;195(8):1058-1065. doi:10.1164/rccm.201605-0968OC

9. Bacharier LB, Jackson DJ. J Allergy Clin Immunol. 2023;151(3):581-589. doi:10.1016/j.jaci.2023.01.002

10. An amazing journey: how young lungs develop. American Lung Association. Published May 11, 2018. Accessed June 28, 2023. https://www.lung.org/blog/how-young-lungs-develop

11. Strunk RC et al. J Allergy Clin Immunol. 2006;118(5):1040-1047. doi:10.1016/j.jaci.2006.07.053

12. Kaplan A, Price D. J Asthma Allergy. 2020;13:39-49. doi:10.2147/JAA.S233268

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Author(s)
Navitha Ramesh, MD, FCCP

Click to view more from Pulmonology Data Trends 2023.

Click to view more from Pulmonology Data Trends 2023.

References

1. Chowdhury NU et al. Eur Respir Rev. 2021;30(162):210067. doi:10.1183/16000617.0067-2021

2. Perikleous EP et al. J Pers Med. 2022;12(6):999. doi:10.3390/jpm12060999

3. Khaleva E et al. Clin Transl Allergy. 2020;10:40. doi:10.1186/s13601-020-00340-z

4. Robijn AL et al. Curr Opin Pulm Med. 2019;25(1):11-17. doi:10.1097/MCP.0000000000000538

5. Bravo-Solarte DC et al. Allergy Asthma Proc. 2023;44(1):24-34. doi:10.2500/aap.2023.44.220077

6. Wang G et al. J Matern Fetal Neonatal Med. 2014;27(9):934-942. doi:10.3109/14767058.2013.847080

7. Hough KP et al. Front Med (Lausanne). 2020;7:191. doi:10.3389/fmed.2020.00191

8. Triebner K et al. Am J Respir Crit Care Med. 2017;195(8):1058-1065. doi:10.1164/rccm.201605-0968OC

9. Bacharier LB, Jackson DJ. J Allergy Clin Immunol. 2023;151(3):581-589. doi:10.1016/j.jaci.2023.01.002

10. An amazing journey: how young lungs develop. American Lung Association. Published May 11, 2018. Accessed June 28, 2023. https://www.lung.org/blog/how-young-lungs-develop

11. Strunk RC et al. J Allergy Clin Immunol. 2006;118(5):1040-1047. doi:10.1016/j.jaci.2006.07.053

12. Kaplan A, Price D. J Asthma Allergy. 2020;13:39-49. doi:10.2147/JAA.S233268

References

1. Chowdhury NU et al. Eur Respir Rev. 2021;30(162):210067. doi:10.1183/16000617.0067-2021

2. Perikleous EP et al. J Pers Med. 2022;12(6):999. doi:10.3390/jpm12060999

3. Khaleva E et al. Clin Transl Allergy. 2020;10:40. doi:10.1186/s13601-020-00340-z

4. Robijn AL et al. Curr Opin Pulm Med. 2019;25(1):11-17. doi:10.1097/MCP.0000000000000538

5. Bravo-Solarte DC et al. Allergy Asthma Proc. 2023;44(1):24-34. doi:10.2500/aap.2023.44.220077

6. Wang G et al. J Matern Fetal Neonatal Med. 2014;27(9):934-942. doi:10.3109/14767058.2013.847080

7. Hough KP et al. Front Med (Lausanne). 2020;7:191. doi:10.3389/fmed.2020.00191

8. Triebner K et al. Am J Respir Crit Care Med. 2017;195(8):1058-1065. doi:10.1164/rccm.201605-0968OC

9. Bacharier LB, Jackson DJ. J Allergy Clin Immunol. 2023;151(3):581-589. doi:10.1016/j.jaci.2023.01.002

10. An amazing journey: how young lungs develop. American Lung Association. Published May 11, 2018. Accessed June 28, 2023. https://www.lung.org/blog/how-young-lungs-develop

11. Strunk RC et al. J Allergy Clin Immunol. 2006;118(5):1040-1047. doi:10.1016/j.jaci.2006.07.053

12. Kaplan A, Price D. J Asthma Allergy. 2020;13:39-49. doi:10.2147/JAA.S233268

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The severity and symptoms of asthma vary greatly across a woman’s lifespan. Gender-based variances start early, with boys having a higher asthma prevalence than girls in childhood, and women having a higher prevalence than men starting around puberty and through adulthood, related to changes in sex hormones.1 In the pediatric age group, questions arise about both the necessity and choice of biologic therapies and how best to transition patients from pediatric to adult care.2,3 During this transition, patients often have worsening symptoms mainly due to decreased adherence to medications, lack of insurance, or lack of parental and social support.3

In adulthood, around 13% of women have asthma symptoms during pregnancy, necessitating maintenance treatment with inhalers.4 In some women, asthma symptoms tend to worsen during pregnancy due to some of the natural changes in lung function and breathing patterns during pregnancy.4,5 Uncontrolled asthma in pregnancy can lead to adverse effects for both mother and fetus. Maternal adverse outcomes include preeclampsia, placental abruption, increased risk of Caesarean sections, increased risk of gestational diabetes mellitus, and pulmonary embolism.4-6 Child adverse outcomes include low birth weight, increased risk of minor congenital malformations, and asthma.4,5 Aging in women also affects lung function, including reducing the forced expiratory volume in 1 second (FEV1).7 Menopause specifically is related todecreased lung function due to changes in sex hormones, and this effect is seen even more in women with asthma.7,8 It is important for providers to be aware of asthma manifestations throughout a woman’s lifespan and personalize care accordingly.

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Pulmonology Data Trends 2023 (Slideshow)

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CHEST Physician presents the 2023 edition of Pulmonology Data Trends (click to read). This special issue provides updates on hot topics in pulmonology through original infographics and visual storytelling.

 

 

 

 

 

 

 

 

In this issue: 

 

Long-Awaited RSV Vaccines Now Available for Older Adults and Pediatric Patients
Burton L. Lesnick, MD, FCCP

Decreasing Pulmonary Embolism-Related Mortality
Parth Rali, MD

Addressing Physician Burnout in Pulmonology and Critical Care
Kelly Vranas, MD, MCR

Updated Guidelines for COPD Management: 2023 GOLD Strategy Report
Muhammad Adrish, MD, MBA, FCCP, FCCM

Progressive Pulmonary Fibrosis: Understanding Its Many Forms
Tejaswini Kulkarni, MD, MPH, FCCP

Sleep Apnea: Comorbidities, Racial Disparities, Weight Guidelines, and Alternatives to CPAP
Lauren Tobias, MD, FCCP

Lung Cancer Screening: A Need for Adjunctive Testing
Eric S. Edell, MD, FCCP

Asthma Across a Woman’s Lifespan
Navitha Ramesh, MD, FCCP

Tuberculosis Management: Returning to Pre-Pandemic Priorities
Patricio Escalante, MD, MSc, FCCP, and Paige K. Marty, MD

Long COVID: Advocating for Patients and Implementing Effective Techniques
Kyle B. Enfield, MD, MS, FSHEA, FCCM

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CHEST Physician presents the 2023 edition of Pulmonology Data Trends (click to read). This special issue provides updates on hot topics in pulmonology through original infographics and visual storytelling.

 

 

 

 

 

 

 

 

In this issue: 

 

Long-Awaited RSV Vaccines Now Available for Older Adults and Pediatric Patients
Burton L. Lesnick, MD, FCCP

Decreasing Pulmonary Embolism-Related Mortality
Parth Rali, MD

Addressing Physician Burnout in Pulmonology and Critical Care
Kelly Vranas, MD, MCR

Updated Guidelines for COPD Management: 2023 GOLD Strategy Report
Muhammad Adrish, MD, MBA, FCCP, FCCM

Progressive Pulmonary Fibrosis: Understanding Its Many Forms
Tejaswini Kulkarni, MD, MPH, FCCP

Sleep Apnea: Comorbidities, Racial Disparities, Weight Guidelines, and Alternatives to CPAP
Lauren Tobias, MD, FCCP

Lung Cancer Screening: A Need for Adjunctive Testing
Eric S. Edell, MD, FCCP

Asthma Across a Woman’s Lifespan
Navitha Ramesh, MD, FCCP

Tuberculosis Management: Returning to Pre-Pandemic Priorities
Patricio Escalante, MD, MSc, FCCP, and Paige K. Marty, MD

Long COVID: Advocating for Patients and Implementing Effective Techniques
Kyle B. Enfield, MD, MS, FSHEA, FCCM

CHEST Physician presents the 2023 edition of Pulmonology Data Trends (click to read). This special issue provides updates on hot topics in pulmonology through original infographics and visual storytelling.

 

 

 

 

 

 

 

 

In this issue: 

 

Long-Awaited RSV Vaccines Now Available for Older Adults and Pediatric Patients
Burton L. Lesnick, MD, FCCP

Decreasing Pulmonary Embolism-Related Mortality
Parth Rali, MD

Addressing Physician Burnout in Pulmonology and Critical Care
Kelly Vranas, MD, MCR

Updated Guidelines for COPD Management: 2023 GOLD Strategy Report
Muhammad Adrish, MD, MBA, FCCP, FCCM

Progressive Pulmonary Fibrosis: Understanding Its Many Forms
Tejaswini Kulkarni, MD, MPH, FCCP

Sleep Apnea: Comorbidities, Racial Disparities, Weight Guidelines, and Alternatives to CPAP
Lauren Tobias, MD, FCCP

Lung Cancer Screening: A Need for Adjunctive Testing
Eric S. Edell, MD, FCCP

Asthma Across a Woman’s Lifespan
Navitha Ramesh, MD, FCCP

Tuberculosis Management: Returning to Pre-Pandemic Priorities
Patricio Escalante, MD, MSc, FCCP, and Paige K. Marty, MD

Long COVID: Advocating for Patients and Implementing Effective Techniques
Kyle B. Enfield, MD, MS, FSHEA, FCCM

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Sleep Apnea: Comorbidities, Racial Disparities, Weight Guidelines, and Alternatives to CPAP

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Sleep Apnea: Comorbidities, Racial Disparities, Weight Guidelines, and Alternatives to CPAP
Author(s)
Lauren Tobias, MD, FCCP

Click to view more from Pulmonology Data Trends 2023.

References

1. Gottlieb DJ, Punjabi NM. JAMA. 2020;323(14):1389-1400. doi:10.1001/jama.2020.3514
2. Slowik JM et al. Obstructive Sleep Apnea. In: StatPearls. Treasure Island (FL): StatPearls Publishing; December 11, 2022.
3. Bonsignore MR et al. Multidiscip Respir Med. 2019;14:8. doi:10.1186/s40248-019-0172-9
4. Schwartz SW et al. Sleep Breath. 2016;20(3):947-955. doi:10.1007/s11325-016-1316-1
5. Grandner MA et al. Sleep Med. 2016;18:7-18. doi:10.1016/j.sleep.2015.01.020
6. Lee YC et al. Sleep Med. 2022;90:204-213. doi:10.1016/j.sleep.2021.11.014
7. Hudgel DW et al. Am J Respir Crit Care Med. 2018;198(6):e70-e87. doi:10.1164/rccm.201807-1326ST
8. Lloyd R et al. J Clin Sleep Med. 2022;18(11):2673-2680. doi:10.5664/jcsm.10244
9. Nokes B et al. Expert Rev Respir Med. 2022;16(8):917-929. doi:10.1080/17476348.2022.2112669
10. Pinto JA et al. Int Arch Otorhinolaryngol. 2016;20(2):145-150.doi:10.1055/s-0036-1579546
11. Georgoulis M et al. J Clin Sleep Med. 2022;18(5):1251-1261. doi:10.5664/jcsm.9834
12. Askland K et al. Cochrane Database Syst Rev. 2020;4(4):CD007736. doi:10.1002/14651858.CD007736.pub3
13. Jugé L et al. Sleep. 2022;45(6):zsac044. doi:10.1093/sleep/zsac044
14. Strollo PJ Jr et al. N Engl J Med. 2014;370(2):139-149. doi:10.1056/NEJMoa1308659
15. Fattal D et al. J Clin Sleep Med. 2022;18(12):2723-2729. doi:10.5664/jcsm.10190
16. He M et al. Otolaryngol Head Neck Surg. 2019;161(3):401-411. doi:10.1177/0194599819840356

Author and Disclosure Information

Lauren Tobias, MD, FCCP
Assistant Professor
Department of Pulmonary, Critical Care & Sleep Medicine
Yale University School of Medicine;
Medical Director
Sleep Program
VA Connecticut
Yale-New Haven Hospital
New Haven, CT

Publications
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Author(s)
Lauren Tobias, MD, FCCP
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Lauren Tobias, MD, FCCP
Author and Disclosure Information

Lauren Tobias, MD, FCCP
Assistant Professor
Department of Pulmonary, Critical Care & Sleep Medicine
Yale University School of Medicine;
Medical Director
Sleep Program
VA Connecticut
Yale-New Haven Hospital
New Haven, CT

Author and Disclosure Information

Lauren Tobias, MD, FCCP
Assistant Professor
Department of Pulmonary, Critical Care & Sleep Medicine
Yale University School of Medicine;
Medical Director
Sleep Program
VA Connecticut
Yale-New Haven Hospital
New Haven, CT

Click to view more from Pulmonology Data Trends 2023.

Click to view more from Pulmonology Data Trends 2023.

References

1. Gottlieb DJ, Punjabi NM. JAMA. 2020;323(14):1389-1400. doi:10.1001/jama.2020.3514
2. Slowik JM et al. Obstructive Sleep Apnea. In: StatPearls. Treasure Island (FL): StatPearls Publishing; December 11, 2022.
3. Bonsignore MR et al. Multidiscip Respir Med. 2019;14:8. doi:10.1186/s40248-019-0172-9
4. Schwartz SW et al. Sleep Breath. 2016;20(3):947-955. doi:10.1007/s11325-016-1316-1
5. Grandner MA et al. Sleep Med. 2016;18:7-18. doi:10.1016/j.sleep.2015.01.020
6. Lee YC et al. Sleep Med. 2022;90:204-213. doi:10.1016/j.sleep.2021.11.014
7. Hudgel DW et al. Am J Respir Crit Care Med. 2018;198(6):e70-e87. doi:10.1164/rccm.201807-1326ST
8. Lloyd R et al. J Clin Sleep Med. 2022;18(11):2673-2680. doi:10.5664/jcsm.10244
9. Nokes B et al. Expert Rev Respir Med. 2022;16(8):917-929. doi:10.1080/17476348.2022.2112669
10. Pinto JA et al. Int Arch Otorhinolaryngol. 2016;20(2):145-150.doi:10.1055/s-0036-1579546
11. Georgoulis M et al. J Clin Sleep Med. 2022;18(5):1251-1261. doi:10.5664/jcsm.9834
12. Askland K et al. Cochrane Database Syst Rev. 2020;4(4):CD007736. doi:10.1002/14651858.CD007736.pub3
13. Jugé L et al. Sleep. 2022;45(6):zsac044. doi:10.1093/sleep/zsac044
14. Strollo PJ Jr et al. N Engl J Med. 2014;370(2):139-149. doi:10.1056/NEJMoa1308659
15. Fattal D et al. J Clin Sleep Med. 2022;18(12):2723-2729. doi:10.5664/jcsm.10190
16. He M et al. Otolaryngol Head Neck Surg. 2019;161(3):401-411. doi:10.1177/0194599819840356

References

1. Gottlieb DJ, Punjabi NM. JAMA. 2020;323(14):1389-1400. doi:10.1001/jama.2020.3514
2. Slowik JM et al. Obstructive Sleep Apnea. In: StatPearls. Treasure Island (FL): StatPearls Publishing; December 11, 2022.
3. Bonsignore MR et al. Multidiscip Respir Med. 2019;14:8. doi:10.1186/s40248-019-0172-9
4. Schwartz SW et al. Sleep Breath. 2016;20(3):947-955. doi:10.1007/s11325-016-1316-1
5. Grandner MA et al. Sleep Med. 2016;18:7-18. doi:10.1016/j.sleep.2015.01.020
6. Lee YC et al. Sleep Med. 2022;90:204-213. doi:10.1016/j.sleep.2021.11.014
7. Hudgel DW et al. Am J Respir Crit Care Med. 2018;198(6):e70-e87. doi:10.1164/rccm.201807-1326ST
8. Lloyd R et al. J Clin Sleep Med. 2022;18(11):2673-2680. doi:10.5664/jcsm.10244
9. Nokes B et al. Expert Rev Respir Med. 2022;16(8):917-929. doi:10.1080/17476348.2022.2112669
10. Pinto JA et al. Int Arch Otorhinolaryngol. 2016;20(2):145-150.doi:10.1055/s-0036-1579546
11. Georgoulis M et al. J Clin Sleep Med. 2022;18(5):1251-1261. doi:10.5664/jcsm.9834
12. Askland K et al. Cochrane Database Syst Rev. 2020;4(4):CD007736. doi:10.1002/14651858.CD007736.pub3
13. Jugé L et al. Sleep. 2022;45(6):zsac044. doi:10.1093/sleep/zsac044
14. Strollo PJ Jr et al. N Engl J Med. 2014;370(2):139-149. doi:10.1056/NEJMoa1308659
15. Fattal D et al. J Clin Sleep Med. 2022;18(12):2723-2729. doi:10.5664/jcsm.10190
16. He M et al. Otolaryngol Head Neck Surg. 2019;161(3):401-411. doi:10.1177/0194599819840356

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Sleep Apnea: Comorbidities, Racial Disparities, Weight Guidelines, and Alternatives to CPAP
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Obstructive sleep apnea (OSA) is a disorder in which the upper airway repeatedly collapses during sleep, resulting in hypoxemia and sleep disruption. Approximately 9-17% of women and 25-30% of men in the United States are diagnosed with OSA.1,2 Patients may present with a range of symptoms, including daytime sleepiness, snoring, breathing pauses, or unexplained awakenings from sleep.1 OSA severity is classified according to the apnea-hypopnea index (AHI), and defined by the presence of either ≥ 15 events per hour or 5-14 events per hour with symptoms such as excessive daytime sleepiness, insomnia, or impaired sleep-related quality of life.1 OSA has been associated with stroke, hypertension, atrial fibrillation, coronary artery disease, heart failure, and mood disorders.3 Continuous positive airway pressure (CPAP) is the standard of care for treating OSA in most patients and is highly cost-effective.4

Unfortunately, racial disparities exist in sleep apnea, as with sleep health generally. Black individuals have disproportionately high rates of OSA and higher OSA severity in comparison with White patients.5 Racial inequity also exists in disease outcomes and sleep apnea-related mortality.5,6 CPAP adherence may be lower in marginalized racial groups, with Black patients demonstrating lower nightly CPAP usage.4 Initiatives are needed to improve sleep health equity, such as through increased access to sleep care through telehealth, lessening barriers to sleep apnea diagnostics, and reducing structural inequities associated with CPAP treatment including cost.

Obesity is a well-established risk factor for sleep apnea, and all patients whose body mass index (BMI) is elevated should be counseled on weight loss.7,8 For patients unable to acclimate to CPAP, alternatives are available; there was increased reliance upon these during the recent major CPAP recall.9 Some alternatives include mandibular advancement devices, positional therapy, and hypoglossal nerve stimulation therapy.9 Emerging research is exploring the possibility of drug therapy to manage sleep apnea in the future.9

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Decreasing Pulmonary Embolism-Related Mortality

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Decreasing Pulmonary Embolism-Related Mortality
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Parth Rali, MD

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References
  1. Centers for Disease Control and Prevention. Data and statistics on venous thromboembolism. Last reviewed June 28, 2023. Accessed July 18, 2023. https://www.cdc.gov/ncbddd/dvt/data.html
  2. Becattini C et al. Chest. 2016;149(1):192-200. doi:10.1378/chest.15-0808
  3. Triantafyllou GA et al. Semin Respir Crit Care Med. 2021;42(2):183-198.doi:10.1055/s-0041-1722898
  4. Ng ACC et al. Respiration. 2013;85(5):408-416. doi:10.1159/000342024
  5. Phillips AR et al. J Am Heart Assoc. 2021;10(17):e021818. doi:10.1161/JAHA.121.021818
  6. Wadhera RK et al. J Am Heart Assoc. 2021;10(13):e021117. doi:10.1161/JAHA.121.021117
  7. Bashir R et al. JACC Cardiovasc Interv. 2022;15(23):2427-2436. doi:10.1016/j.jcin.2022.09.011
  8. Patel NJ et al. Int J Cardiol. 2019;287:116-117. doi:10.1016/j.ijcard.2019.04.029
  9. Li X et al. Ann Transl Med. 2021;9(10):838. doi:10.21037/atm-21-975
  10. Rivera-Lebron BN et al. Chest. 2021;159(1):347-355. doi:10.1016/j.chest.2020.07.065
  11. Noto JG, Rali P. Pulm Circ. 2022;12(1):e12021. doi:10.1002/pul2.12021
  12. Snyder DJ et al. Vasc Med. 2023;28(3):222-232. doi:10.1177/1358863X231157441
  13. Bikdeli B et al. Semin Thromb Hemost. 2023. doi:10.1055/s-0043-1764231
  14. Fleitas Sosa D et al. Eur Respir Rev. 2022;31(165):220023. doi:10.1183/16000617.0023-2022
  15. Pulmonary embolism - thrombus removal with catheter-directed therapy (PE-TRACT). ClinicalTrials.gov. Updated July 17, 2023. Accessed July 18, 2023. https://clinicaltrials.gov/ct2/show/NCT05591118
  16. The PEERLESS study (PEERLESS). ClinicalTrials.gov. Updated Jun 23, 2023. Accessed July 18, 2023. https://clinicaltrials.gov/ct2/show/NCT05111613
  17. Inari Medical, Inc. Inari Medical announces Peerless II, a randomized controlled trial evaluating clinical outcomes of the FlowTriever® system vs. anticoagulation in pulmonary embolism patients [press release]. Published May 22,2023. Accessed July 18, 2023. https://ir.inarimedical.com/news-releases/news-release-details/inari-medical-announces-peerless-ii-randomized-controlled-trial
  18. Ultrasound-facilitated, catheter-directed, thrombolysis in intermediate-high risk pulmonary embolism (HI-PEITHO). ClinicalTrials.gov. Updated July 17, 2023. Accessed July 18, 2023. https://clinicaltrials.gov/ct2/show/NCT04790370
  19. Comparison of two pulmonary embolism treatments. ClinicalTrials.gov. Updated May 31, 2023. Accessed July 18, 2023. https://clinicaltrials.gov/ct2/show/NCT05684796
  20. Pulmonary Embolism International THrOmbolysis Study-3 (PEITHO-3).ClinicalTrials.gov. Updated June 8, 2023. Accessed July 18, 2023. https://clinicaltrials.gov/ct2/show/NCT04430569
  21. Study of the long-term safety and outcomes of treating pulmonary embolism with the Indigo Aspiration System. ClinicalTrials.gov. Updated May 11, 2023. Accessed July 18, 2023. https://clinicaltrials.gov/ct2/show/NCT04798261
  22. Bashir R et al. J Am Coll Cardiol Intv. 2022;15(23):2427-2436. doi:10.1016/j.jcin.2022.09.011
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Temple University Hospital
Philadelphia, PA

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Parth Rali, MD
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Philadelphia, PA

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Associate Professor
Temple University Hospital
Philadelphia, PA

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References
  1. Centers for Disease Control and Prevention. Data and statistics on venous thromboembolism. Last reviewed June 28, 2023. Accessed July 18, 2023. https://www.cdc.gov/ncbddd/dvt/data.html
  2. Becattini C et al. Chest. 2016;149(1):192-200. doi:10.1378/chest.15-0808
  3. Triantafyllou GA et al. Semin Respir Crit Care Med. 2021;42(2):183-198.doi:10.1055/s-0041-1722898
  4. Ng ACC et al. Respiration. 2013;85(5):408-416. doi:10.1159/000342024
  5. Phillips AR et al. J Am Heart Assoc. 2021;10(17):e021818. doi:10.1161/JAHA.121.021818
  6. Wadhera RK et al. J Am Heart Assoc. 2021;10(13):e021117. doi:10.1161/JAHA.121.021117
  7. Bashir R et al. JACC Cardiovasc Interv. 2022;15(23):2427-2436. doi:10.1016/j.jcin.2022.09.011
  8. Patel NJ et al. Int J Cardiol. 2019;287:116-117. doi:10.1016/j.ijcard.2019.04.029
  9. Li X et al. Ann Transl Med. 2021;9(10):838. doi:10.21037/atm-21-975
  10. Rivera-Lebron BN et al. Chest. 2021;159(1):347-355. doi:10.1016/j.chest.2020.07.065
  11. Noto JG, Rali P. Pulm Circ. 2022;12(1):e12021. doi:10.1002/pul2.12021
  12. Snyder DJ et al. Vasc Med. 2023;28(3):222-232. doi:10.1177/1358863X231157441
  13. Bikdeli B et al. Semin Thromb Hemost. 2023. doi:10.1055/s-0043-1764231
  14. Fleitas Sosa D et al. Eur Respir Rev. 2022;31(165):220023. doi:10.1183/16000617.0023-2022
  15. Pulmonary embolism - thrombus removal with catheter-directed therapy (PE-TRACT). ClinicalTrials.gov. Updated July 17, 2023. Accessed July 18, 2023. https://clinicaltrials.gov/ct2/show/NCT05591118
  16. The PEERLESS study (PEERLESS). ClinicalTrials.gov. Updated Jun 23, 2023. Accessed July 18, 2023. https://clinicaltrials.gov/ct2/show/NCT05111613
  17. Inari Medical, Inc. Inari Medical announces Peerless II, a randomized controlled trial evaluating clinical outcomes of the FlowTriever® system vs. anticoagulation in pulmonary embolism patients [press release]. Published May 22,2023. Accessed July 18, 2023. https://ir.inarimedical.com/news-releases/news-release-details/inari-medical-announces-peerless-ii-randomized-controlled-trial
  18. Ultrasound-facilitated, catheter-directed, thrombolysis in intermediate-high risk pulmonary embolism (HI-PEITHO). ClinicalTrials.gov. Updated July 17, 2023. Accessed July 18, 2023. https://clinicaltrials.gov/ct2/show/NCT04790370
  19. Comparison of two pulmonary embolism treatments. ClinicalTrials.gov. Updated May 31, 2023. Accessed July 18, 2023. https://clinicaltrials.gov/ct2/show/NCT05684796
  20. Pulmonary Embolism International THrOmbolysis Study-3 (PEITHO-3).ClinicalTrials.gov. Updated June 8, 2023. Accessed July 18, 2023. https://clinicaltrials.gov/ct2/show/NCT04430569
  21. Study of the long-term safety and outcomes of treating pulmonary embolism with the Indigo Aspiration System. ClinicalTrials.gov. Updated May 11, 2023. Accessed July 18, 2023. https://clinicaltrials.gov/ct2/show/NCT04798261
  22. Bashir R et al. J Am Coll Cardiol Intv. 2022;15(23):2427-2436. doi:10.1016/j.jcin.2022.09.011
References
  1. Centers for Disease Control and Prevention. Data and statistics on venous thromboembolism. Last reviewed June 28, 2023. Accessed July 18, 2023. https://www.cdc.gov/ncbddd/dvt/data.html
  2. Becattini C et al. Chest. 2016;149(1):192-200. doi:10.1378/chest.15-0808
  3. Triantafyllou GA et al. Semin Respir Crit Care Med. 2021;42(2):183-198.doi:10.1055/s-0041-1722898
  4. Ng ACC et al. Respiration. 2013;85(5):408-416. doi:10.1159/000342024
  5. Phillips AR et al. J Am Heart Assoc. 2021;10(17):e021818. doi:10.1161/JAHA.121.021818
  6. Wadhera RK et al. J Am Heart Assoc. 2021;10(13):e021117. doi:10.1161/JAHA.121.021117
  7. Bashir R et al. JACC Cardiovasc Interv. 2022;15(23):2427-2436. doi:10.1016/j.jcin.2022.09.011
  8. Patel NJ et al. Int J Cardiol. 2019;287:116-117. doi:10.1016/j.ijcard.2019.04.029
  9. Li X et al. Ann Transl Med. 2021;9(10):838. doi:10.21037/atm-21-975
  10. Rivera-Lebron BN et al. Chest. 2021;159(1):347-355. doi:10.1016/j.chest.2020.07.065
  11. Noto JG, Rali P. Pulm Circ. 2022;12(1):e12021. doi:10.1002/pul2.12021
  12. Snyder DJ et al. Vasc Med. 2023;28(3):222-232. doi:10.1177/1358863X231157441
  13. Bikdeli B et al. Semin Thromb Hemost. 2023. doi:10.1055/s-0043-1764231
  14. Fleitas Sosa D et al. Eur Respir Rev. 2022;31(165):220023. doi:10.1183/16000617.0023-2022
  15. Pulmonary embolism - thrombus removal with catheter-directed therapy (PE-TRACT). ClinicalTrials.gov. Updated July 17, 2023. Accessed July 18, 2023. https://clinicaltrials.gov/ct2/show/NCT05591118
  16. The PEERLESS study (PEERLESS). ClinicalTrials.gov. Updated Jun 23, 2023. Accessed July 18, 2023. https://clinicaltrials.gov/ct2/show/NCT05111613
  17. Inari Medical, Inc. Inari Medical announces Peerless II, a randomized controlled trial evaluating clinical outcomes of the FlowTriever® system vs. anticoagulation in pulmonary embolism patients [press release]. Published May 22,2023. Accessed July 18, 2023. https://ir.inarimedical.com/news-releases/news-release-details/inari-medical-announces-peerless-ii-randomized-controlled-trial
  18. Ultrasound-facilitated, catheter-directed, thrombolysis in intermediate-high risk pulmonary embolism (HI-PEITHO). ClinicalTrials.gov. Updated July 17, 2023. Accessed July 18, 2023. https://clinicaltrials.gov/ct2/show/NCT04790370
  19. Comparison of two pulmonary embolism treatments. ClinicalTrials.gov. Updated May 31, 2023. Accessed July 18, 2023. https://clinicaltrials.gov/ct2/show/NCT05684796
  20. Pulmonary Embolism International THrOmbolysis Study-3 (PEITHO-3).ClinicalTrials.gov. Updated June 8, 2023. Accessed July 18, 2023. https://clinicaltrials.gov/ct2/show/NCT04430569
  21. Study of the long-term safety and outcomes of treating pulmonary embolism with the Indigo Aspiration System. ClinicalTrials.gov. Updated May 11, 2023. Accessed July 18, 2023. https://clinicaltrials.gov/ct2/show/NCT04798261
  22. Bashir R et al. J Am Coll Cardiol Intv. 2022;15(23):2427-2436. doi:10.1016/j.jcin.2022.09.011
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As many as 900,000 patients have deep vein thrombosis (DVT) or pulmonary embolism (PE), also called venous thromboembolism (VTE), each year in the United States, with 100,00 deaths per year.1 In patients with PE, 56% also have DVT, which can affect 30-day mortality rates.2 The field of PE is evolving to help decrease mortality from these events. Proper risk stratification is crucial to identify the best approach for each patient, while the presence of comorbidities and unmodifiable risk factors must also be considered when individualizing care and assessing likelihood of mortality.3,4 As comorbidities increase, mortality increases in PE.4 As well, racial, ethnic, and socioeconomic demographic differences affect PE, with Black patients having greater PE severity and socioeconomically underserved patients having higher follow-up mortality.5,6

Treatments are also advancing, with many upcoming catheter-based treatments in clinical trials, which have demonstrated rapid recovery of right ventricle function—a primary cause of PE-related mortality.7,8 The effect of catheter-based treatment on long-term functional outcomes is currently being explored in clinical trials. Artificial intelligence is also being used to aid in diagnosis and treatment.9 As the armamentarium of treatment options diversifies, so must our overall approach to management. The PE response team (PERT) strategy uses a multidisciplinary team of experts to further individualize patient care to help decrease mortality and improve follow-up efforts since the post-PE period is a sensitive time for new morbidity.10,11 With proven risk stratification and management strategies available and new treatments on the way, the field of PE looks to improve not only in patient acute mortality, but also long-term functional outcomes, and early detection of post-PE comorbid conditions.

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Long-Awaited RSV Vaccines Now Available for Older Adults and Pediatric Patients

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Long-Awaited RSV Vaccines Now Available for Older Adults and Pediatric Patients
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Burton L. Lesnick, MD, FCCP

Click to read more from Pulmonology Data Trends 2023.

References
  1. Jha A et al. Respiratory syncytial virus. In: Hui DS, Rossi GA, Johnston SL, eds. Respiratory Syncytial Virus. SARS, MERS and Other Viral Lung Infections. European Respiratory Society; 2016:chap 5. Accessed May 17, 2023.
  2. Ginsburg SA, Srikantiah P. Lancet Glob Health. 2021;9(12):e1644-e6145. doi:10.1016/S2214-109X(21)00455-1
  3. US Food and Drug Administration. FDA approves first respiratory syncytial virus (RSV) vaccine [press release]. Published May 3, 2023. Accessed May 17, 2023. https://www.fda.gov/news-events/press-announcements/fda-approves-first-respiratory-syncytial-virus-rsv-vaccine
  4. US Food and Drug Administration. FDA Approves New Drug to Prevent RSV in Babies and Toddlers [press release]. Published July 17, 2023. Accessed August 11, 2023. https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-prevent-rsv-babies-and-toddlers
  5. US Food and Drug Administration. FDA Approves First Vaccine for Pregnant Individuals to Prevent RSV in Infants. Published August 21, 2023. Accessed August 22, 2023. https://www.fda.gov/news-events/press-announcements/fda-approves-first-vaccine-pregnant-individuals-prevent-rsv-infants
  6. Madhi SA et al. N Engl J Med. 2020;383(5):426-439. doi:10.1056/ NEJMoa1908380
  7. Centers for Disease Control. Advisory Committee on Immunization Practices (ACIP) Meeting recommendations, August 2023. https://www.cdc.gov/vaccines/acip/recommendations.html
  8. Hammit LL et al. N Engl J Med. 2022;386(9):837-846. doi:10.1056/ NEJMoa2110275
  9. Centers for Disease Control and Prevention. RSV in infants and young children. Updated October 28, 2022. Accessed May 30, 2023. https://www.cdc.gov/rsv/ high-risk/infants-young-children.html
  10. Centers for Disease Control and Prevention. RSV in older adults and adults with chronic medical conditions. Updated October 28, 2022. Accessed May 30, 2023. https://www.cdc.gov/rsv/high-risk/older-adults.html
  11. Widmer K et al. J Infect Dis. 2012;206(1):56-62. doi:10.1093/infdis/jis309
  12. Hall CB et al. N Engl J Med. 2009;360(6):588-598. doi:10.1056/NEJMoa0804877
  13. McLaughlin JM et al. Open Forum Infect Dis. 2022;9(7):ofac300. doi:10.1093/ofid/ofac300
  14. Thompson et al. JAMA. 2003;289(2):179-186. doi:10.1001/jama.289.2.179
  15. Hansen CL et al. JAMA Netw Open. 2022;5(2):e220527. doi:10.1001/jamanetworkopen.2022.0527
  16. Walsh EE et al; RENOIR Clinical Trial Group. N Engl J Med. 2023;388(16):1465-1477. doi:10.1056/NEJMoa2213836
  17. Martin JA et al. Natl Vital Stat Rep. 2019;68(13):1-47. PMID:32501202
  18. Townsi N et al. Eur Clin Respir J. 2018;5(1):1487214. doi:10.1080/20018525.20 18.1487214
  19. Malek A et al. Am J Reprod Immunol. 1994;32(1):8-14. doi:10.1111/j.1600-0897.1994.tb00873.x
  20. Kampmann B et al; MATISSE Study Group. N Engl J Med. 2023;388(16):1451- 1464. doi:10.1056/NEJMoa2216480
  21. Synagis (palivizumab) injection prescribing information. Published June 2023. Accessed August 2023. https://www.synagis.com/synagis.pdf
Author and Disclosure Information

Burton L. Lesnick, MD, FCCP
Pediatric Pulmonologist
Children’s Healthcare of Atlanta
Atlanta, GA

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Pediatric Pulmonologist
Children’s Healthcare of Atlanta
Atlanta, GA

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Pediatric Pulmonologist
Children’s Healthcare of Atlanta
Atlanta, GA

Click to read more from Pulmonology Data Trends 2023.

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References
  1. Jha A et al. Respiratory syncytial virus. In: Hui DS, Rossi GA, Johnston SL, eds. Respiratory Syncytial Virus. SARS, MERS and Other Viral Lung Infections. European Respiratory Society; 2016:chap 5. Accessed May 17, 2023.
  2. Ginsburg SA, Srikantiah P. Lancet Glob Health. 2021;9(12):e1644-e6145. doi:10.1016/S2214-109X(21)00455-1
  3. US Food and Drug Administration. FDA approves first respiratory syncytial virus (RSV) vaccine [press release]. Published May 3, 2023. Accessed May 17, 2023. https://www.fda.gov/news-events/press-announcements/fda-approves-first-respiratory-syncytial-virus-rsv-vaccine
  4. US Food and Drug Administration. FDA Approves New Drug to Prevent RSV in Babies and Toddlers [press release]. Published July 17, 2023. Accessed August 11, 2023. https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-prevent-rsv-babies-and-toddlers
  5. US Food and Drug Administration. FDA Approves First Vaccine for Pregnant Individuals to Prevent RSV in Infants. Published August 21, 2023. Accessed August 22, 2023. https://www.fda.gov/news-events/press-announcements/fda-approves-first-vaccine-pregnant-individuals-prevent-rsv-infants
  6. Madhi SA et al. N Engl J Med. 2020;383(5):426-439. doi:10.1056/ NEJMoa1908380
  7. Centers for Disease Control. Advisory Committee on Immunization Practices (ACIP) Meeting recommendations, August 2023. https://www.cdc.gov/vaccines/acip/recommendations.html
  8. Hammit LL et al. N Engl J Med. 2022;386(9):837-846. doi:10.1056/ NEJMoa2110275
  9. Centers for Disease Control and Prevention. RSV in infants and young children. Updated October 28, 2022. Accessed May 30, 2023. https://www.cdc.gov/rsv/ high-risk/infants-young-children.html
  10. Centers for Disease Control and Prevention. RSV in older adults and adults with chronic medical conditions. Updated October 28, 2022. Accessed May 30, 2023. https://www.cdc.gov/rsv/high-risk/older-adults.html
  11. Widmer K et al. J Infect Dis. 2012;206(1):56-62. doi:10.1093/infdis/jis309
  12. Hall CB et al. N Engl J Med. 2009;360(6):588-598. doi:10.1056/NEJMoa0804877
  13. McLaughlin JM et al. Open Forum Infect Dis. 2022;9(7):ofac300. doi:10.1093/ofid/ofac300
  14. Thompson et al. JAMA. 2003;289(2):179-186. doi:10.1001/jama.289.2.179
  15. Hansen CL et al. JAMA Netw Open. 2022;5(2):e220527. doi:10.1001/jamanetworkopen.2022.0527
  16. Walsh EE et al; RENOIR Clinical Trial Group. N Engl J Med. 2023;388(16):1465-1477. doi:10.1056/NEJMoa2213836
  17. Martin JA et al. Natl Vital Stat Rep. 2019;68(13):1-47. PMID:32501202
  18. Townsi N et al. Eur Clin Respir J. 2018;5(1):1487214. doi:10.1080/20018525.20 18.1487214
  19. Malek A et al. Am J Reprod Immunol. 1994;32(1):8-14. doi:10.1111/j.1600-0897.1994.tb00873.x
  20. Kampmann B et al; MATISSE Study Group. N Engl J Med. 2023;388(16):1451- 1464. doi:10.1056/NEJMoa2216480
  21. Synagis (palivizumab) injection prescribing information. Published June 2023. Accessed August 2023. https://www.synagis.com/synagis.pdf
References
  1. Jha A et al. Respiratory syncytial virus. In: Hui DS, Rossi GA, Johnston SL, eds. Respiratory Syncytial Virus. SARS, MERS and Other Viral Lung Infections. European Respiratory Society; 2016:chap 5. Accessed May 17, 2023.
  2. Ginsburg SA, Srikantiah P. Lancet Glob Health. 2021;9(12):e1644-e6145. doi:10.1016/S2214-109X(21)00455-1
  3. US Food and Drug Administration. FDA approves first respiratory syncytial virus (RSV) vaccine [press release]. Published May 3, 2023. Accessed May 17, 2023. https://www.fda.gov/news-events/press-announcements/fda-approves-first-respiratory-syncytial-virus-rsv-vaccine
  4. US Food and Drug Administration. FDA Approves New Drug to Prevent RSV in Babies and Toddlers [press release]. Published July 17, 2023. Accessed August 11, 2023. https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-prevent-rsv-babies-and-toddlers
  5. US Food and Drug Administration. FDA Approves First Vaccine for Pregnant Individuals to Prevent RSV in Infants. Published August 21, 2023. Accessed August 22, 2023. https://www.fda.gov/news-events/press-announcements/fda-approves-first-vaccine-pregnant-individuals-prevent-rsv-infants
  6. Madhi SA et al. N Engl J Med. 2020;383(5):426-439. doi:10.1056/ NEJMoa1908380
  7. Centers for Disease Control. Advisory Committee on Immunization Practices (ACIP) Meeting recommendations, August 2023. https://www.cdc.gov/vaccines/acip/recommendations.html
  8. Hammit LL et al. N Engl J Med. 2022;386(9):837-846. doi:10.1056/ NEJMoa2110275
  9. Centers for Disease Control and Prevention. RSV in infants and young children. Updated October 28, 2022. Accessed May 30, 2023. https://www.cdc.gov/rsv/ high-risk/infants-young-children.html
  10. Centers for Disease Control and Prevention. RSV in older adults and adults with chronic medical conditions. Updated October 28, 2022. Accessed May 30, 2023. https://www.cdc.gov/rsv/high-risk/older-adults.html
  11. Widmer K et al. J Infect Dis. 2012;206(1):56-62. doi:10.1093/infdis/jis309
  12. Hall CB et al. N Engl J Med. 2009;360(6):588-598. doi:10.1056/NEJMoa0804877
  13. McLaughlin JM et al. Open Forum Infect Dis. 2022;9(7):ofac300. doi:10.1093/ofid/ofac300
  14. Thompson et al. JAMA. 2003;289(2):179-186. doi:10.1001/jama.289.2.179
  15. Hansen CL et al. JAMA Netw Open. 2022;5(2):e220527. doi:10.1001/jamanetworkopen.2022.0527
  16. Walsh EE et al; RENOIR Clinical Trial Group. N Engl J Med. 2023;388(16):1465-1477. doi:10.1056/NEJMoa2213836
  17. Martin JA et al. Natl Vital Stat Rep. 2019;68(13):1-47. PMID:32501202
  18. Townsi N et al. Eur Clin Respir J. 2018;5(1):1487214. doi:10.1080/20018525.20 18.1487214
  19. Malek A et al. Am J Reprod Immunol. 1994;32(1):8-14. doi:10.1111/j.1600-0897.1994.tb00873.x
  20. Kampmann B et al; MATISSE Study Group. N Engl J Med. 2023;388(16):1451- 1464. doi:10.1056/NEJMoa2216480
  21. Synagis (palivizumab) injection prescribing information. Published June 2023. Accessed August 2023. https://www.synagis.com/synagis.pdf
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Long-Awaited RSV Vaccines Now Available for Older Adults and Pediatric Patients
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Respiratory syncytial virus (RSV) is highly contagious and transmitted by large aerosol droplets and fomites, either emitted from an infected person or by making surface-to-eye, -nose, or -mouth contact.1 Severe RSV can increase the risk of bacterial coinfections, pneumonia, and lower respiratory tract infections (LRTI)— particularly in infants and older adults.2

Thankfully, 2023 has been a landmark year for RSV approvals. The FDA approved its first RSV vaccine, called RSV prefusion F protein based (RSVpreF) vaccine, for people aged 60 and over in May 2023.3 In July 2023, the passive monoclonal antibody injection nirsevimab was approved as a preventative option for infants in their first and second winter seasons.4 Finally, the FDA approved the RSVpreF vaccine for pregnant individuals in late August 2023, with the goal of protecting infants.5 However, results from a recent phase 3 trial did not show significance with respect to the primary end point.6

Birth through 6 months is the leading timeframe of RSV-related death because of the low natural defenses and small airways of infants. On August 3, 2023, the CDC Advisory Committee on Immunization Practices unanimously recommended use of nirsevimab for all infants up to 8 months of age at the start of the RSV season and for infants at risk for severe RSV infection until 19 months of age.7 This decision was partly based on the MELODY and MEDLEY trials.8 In an unprecedented move, this monoclonal antibody will be made available through the Vaccines For Children program, the first monoclonal antibody to receive this designation. It is hoped that uptake of this therapy will result in fewer hospitalizations of infants with RSV bronchiolitis.

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Updated Guidelines for COPD Management: 2023 GOLD Strategy Report

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Muhammad Adrish, MD, MBA, FCCP, FCCM

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References

 

  1. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2023 Report). Published 2023. Accessed June 6, 2023. https://goldcopd.org/2023-gold-report-2/
  2. Celli B et al. Am J Respir Crit Care Med. 2022;206(11):1317. doi:10.1164/rccm.202204-0671PP
  3. Han M et al. Lancet Respir Med. 2013;1(1):43-50. doi:10.1016/S2213-2600(12)70044-9
  4. Klijn SL et al. NPJ Prim Care Respir Med. 2017;27(1):24. doi:10.1038/s41533-017-0022-1
  5. Chan AH et al. J Allergy Clin Immunol Pract. 2015;3(3):335-349.e1-e5. doi:10.1016/j.jaip.2015.01.024
  6. Brusselle G et al. Int J Chron Obstruct Pulmon Dis. 2015;10:2207-2217. doi:10.2147/COPD.S91694 
  7. Salvi SS, Barnes PJ. Lancet. 2009;374(9691):733-743. doi:10.1016/S0140-6736(09)61303-9
  8. Trupin L et al. Eur Respir J. 2003;22(3):462-469. doi:10.1183/09031936.03.00094203
  9. Celli BR et al. Am J Respir Crit Care Med. 2021;204(11):1251-1258. doi:10.1164/rccm.202108-1819PP
  10. Barnes PJ, Celli BR. Eur Respir J. 2009;33(5):1165-1185. doi:10.1183/09031936.00128008
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References

 

  1. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2023 Report). Published 2023. Accessed June 6, 2023. https://goldcopd.org/2023-gold-report-2/
  2. Celli B et al. Am J Respir Crit Care Med. 2022;206(11):1317. doi:10.1164/rccm.202204-0671PP
  3. Han M et al. Lancet Respir Med. 2013;1(1):43-50. doi:10.1016/S2213-2600(12)70044-9
  4. Klijn SL et al. NPJ Prim Care Respir Med. 2017;27(1):24. doi:10.1038/s41533-017-0022-1
  5. Chan AH et al. J Allergy Clin Immunol Pract. 2015;3(3):335-349.e1-e5. doi:10.1016/j.jaip.2015.01.024
  6. Brusselle G et al. Int J Chron Obstruct Pulmon Dis. 2015;10:2207-2217. doi:10.2147/COPD.S91694 
  7. Salvi SS, Barnes PJ. Lancet. 2009;374(9691):733-743. doi:10.1016/S0140-6736(09)61303-9
  8. Trupin L et al. Eur Respir J. 2003;22(3):462-469. doi:10.1183/09031936.03.00094203
  9. Celli BR et al. Am J Respir Crit Care Med. 2021;204(11):1251-1258. doi:10.1164/rccm.202108-1819PP
  10. Barnes PJ, Celli BR. Eur Respir J. 2009;33(5):1165-1185. doi:10.1183/09031936.00128008
References

 

  1. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2023 Report). Published 2023. Accessed June 6, 2023. https://goldcopd.org/2023-gold-report-2/
  2. Celli B et al. Am J Respir Crit Care Med. 2022;206(11):1317. doi:10.1164/rccm.202204-0671PP
  3. Han M et al. Lancet Respir Med. 2013;1(1):43-50. doi:10.1016/S2213-2600(12)70044-9
  4. Klijn SL et al. NPJ Prim Care Respir Med. 2017;27(1):24. doi:10.1038/s41533-017-0022-1
  5. Chan AH et al. J Allergy Clin Immunol Pract. 2015;3(3):335-349.e1-e5. doi:10.1016/j.jaip.2015.01.024
  6. Brusselle G et al. Int J Chron Obstruct Pulmon Dis. 2015;10:2207-2217. doi:10.2147/COPD.S91694 
  7. Salvi SS, Barnes PJ. Lancet. 2009;374(9691):733-743. doi:10.1016/S0140-6736(09)61303-9
  8. Trupin L et al. Eur Respir J. 2003;22(3):462-469. doi:10.1183/09031936.03.00094203
  9. Celli BR et al. Am J Respir Crit Care Med. 2021;204(11):1251-1258. doi:10.1164/rccm.202108-1819PP
  10. Barnes PJ, Celli BR. Eur Respir J. 2009;33(5):1165-1185. doi:10.1183/09031936.00128008
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The Global Initiative for Chronic Obstructive Lung Disease (GOLD) Strategy Report is an evidence-based strategy document for chronic obstructive pulmonary disease (COPD) diagnosis, treatment, and prevention; the GOLD report is used worldwide as a tool for implementing effective COPD management.1 The annual report reviews the major research publications published from the previous years and provides important updated recommendations for care providers.

The 2023 GOLD report includes several new updates, such as a new proposed definition2; strategies for terminology and taxonomy2; etiotypes for COPD2; screening and risk factor updates1; and vaccination recommendations.1 The ABCD Assessment Tool has been revised to recognize the clinical relevance of exacerbations,3 and the section on Interventional and Surgical Therapies for COPD has been expanded.1 Information on imaging and computed tomography (CT) has been included,1 and issues related to inhaled delivery4 and adherence5 have been addressed. Also included is an expanded role of triple inhaled therapy in select patient populations,6 and the complexity of COPD is also examined— which involves not only cigarette smoking, but other exposures as well.7

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Lung Cancer Screening: A Need for Adjunctive Testing

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References
  1. Naidch DP et al. Radiology. 1990;175(3):729-731. doi:10.1148/radiology.175.3.2343122
  2. Kaneko M et al. Radiology. 1996;201(3):798-802. doi:10.1148/radiology.201.3.8939234
  3. National Lung Screening Trial Research Team. Radiology. 2011;258(1):243-253. doi:10.1148/radiol.10091808
  4. National Lung Screening Trial Research Team. J Thorac Oncol. 2019;14(10):1732-1742. doi:10.1016/j.jtho.2019.05.044
  5. Mazzone PJ et al. Chest. 2021;160(5):e427-e494. doi:10.1016/j.chest.2021.06.063
  6. Tanner NT et al. Chest. 2023;S0012-3692(23)00175-7. doi:10.1016/j.chest.2023.02.003
  7. National Lung Screening Trial Research Team. N Engl J Med. 2011;365(5):395- 409. doi:10.1056/NEJMoa1102873
  8. Marmor HN et al. Curr Chall Thorac Surg. 2023;5:5. doi:10.21037/ccts-20-171
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References
  1. Naidch DP et al. Radiology. 1990;175(3):729-731. doi:10.1148/radiology.175.3.2343122
  2. Kaneko M et al. Radiology. 1996;201(3):798-802. doi:10.1148/radiology.201.3.8939234
  3. National Lung Screening Trial Research Team. Radiology. 2011;258(1):243-253. doi:10.1148/radiol.10091808
  4. National Lung Screening Trial Research Team. J Thorac Oncol. 2019;14(10):1732-1742. doi:10.1016/j.jtho.2019.05.044
  5. Mazzone PJ et al. Chest. 2021;160(5):e427-e494. doi:10.1016/j.chest.2021.06.063
  6. Tanner NT et al. Chest. 2023;S0012-3692(23)00175-7. doi:10.1016/j.chest.2023.02.003
  7. National Lung Screening Trial Research Team. N Engl J Med. 2011;365(5):395- 409. doi:10.1056/NEJMoa1102873
  8. Marmor HN et al. Curr Chall Thorac Surg. 2023;5:5. doi:10.21037/ccts-20-171
References
  1. Naidch DP et al. Radiology. 1990;175(3):729-731. doi:10.1148/radiology.175.3.2343122
  2. Kaneko M et al. Radiology. 1996;201(3):798-802. doi:10.1148/radiology.201.3.8939234
  3. National Lung Screening Trial Research Team. Radiology. 2011;258(1):243-253. doi:10.1148/radiol.10091808
  4. National Lung Screening Trial Research Team. J Thorac Oncol. 2019;14(10):1732-1742. doi:10.1016/j.jtho.2019.05.044
  5. Mazzone PJ et al. Chest. 2021;160(5):e427-e494. doi:10.1016/j.chest.2021.06.063
  6. Tanner NT et al. Chest. 2023;S0012-3692(23)00175-7. doi:10.1016/j.chest.2023.02.003
  7. National Lung Screening Trial Research Team. N Engl J Med. 2011;365(5):395- 409. doi:10.1056/NEJMoa1102873
  8. Marmor HN et al. Curr Chall Thorac Surg. 2023;5:5. doi:10.21037/ccts-20-171
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Early detection of lung cancer by screening with low dose computed tomography (LDCT) scanning has long been investigated as a potential means of reducing related deaths.1,2 The 2011 National Lung Screening Trial (NLST) compared LDCT scanning with standard chest radiograph (CXR). Results showed a significant reduction in mortality in high-risk current and former smokers who were screened annually (3×) with LDCT scan vs CXR.3

LDCT scanning for lung cancer is currently a standard of care, partially due to the results of the NLST.4,5 In 2013, LDCT scanning was recommended by the US Preventive Services Task Force (USPSTF), making about 8 million Americans eligible for screening.6 In 2019, an extended NLST cohort follow-up study showed that earlier detection with LDCT scanning not only delayed lung cancer death, but also prevented it—or at least delayed it by a decade or more.4,7 This sparked another change in eligibility criteria in the 2021 USPSTF guidelines, allowing an additional 6.5 million people to be eligible for screening.6

Unfortunately, LDCT scanning has some negative aspects to its use, such as high false-positive rates, repeated radiation exposure, and the lack of ability to distinguish between nodules that are benign or malignant.8 There is a need for adjunctive testing for screening. Some current research is focusing on the development of liquid biomarkers intended to be complementary to imaging as a method of using noninvasive lung cancer diagnostics.

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Tuberculosis Management: Returning to Pre-Pandemic Priorities

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Patricio Escalante, MD, MSc, FCCP, and Paige K. Marty, MD

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References
  1. Global tuberculosis report 2022. World Health Organization. Published October 27, 2022. Accessed June 26, 2023. https://www.who.int/publications/i/item/9789240061729
  2. WHO consolidated guidelines on tuberculosis. Module 4: treatment – drug-resistant tuberculosis treatment, 2022 update. World Health Organization. Published December 15, 2022. Accessed June 26, 2023. https://www.who.int/publications/i/item/9789240063129
  3. Migliori GB, Tiberi S. Int J Tuberc Lung Dis. 2022 ;26(7):590-591. doi:10.5588/ijtld.22.0263.
  4. Lange C et al. Am J Respir Crit Care Med. 2022;205(10):1142-1144. doi:10.1164/rccm.202202-0393ED
  5. Esmail A et al. Am J Respir Crit Care Med. 2022;205(10):1214-1227. doi:10.1164/rccm.202107-1779OC
  6. WHO BPaLM Accelerator Platform: to support the call to action for implementation of the shorter and more effective treatment for all people suffering from drug-resistant TB. World Health Organization. Published May 9, 2023. Accessed June 26, 2023. https://www.who.int/news-room/events/detail/2023/05/09/default-calendar/who-bpalm-accelerator-platform–to-support-the-call-to-action-for-implementation-of-the-shorter-and-moreeffective-
  7. Trevisi L et al. Am J Respir Crit Care Med. 2023;207(11):1525-1532. doi:10.1164/rccm.202211-2125OC
  8. Domínguez J et al; TBnet and RESIST-TB networks. Lancet Infect Dis. 2023;23(4):e122-e137. doi:10.1016/S1473-3099(22)00875-1
  9. WHO operational handbook on tuberculosis: module 3: diagnosis: rapid diagnostics for tuberculosis detection, 2021 update. World Health Organization. Published July 7, 2021. Accessed June 26, 2023. https://www.who.int/publications/i/item/9789240030589treatment-for-all-people-suffering-from-drug-resistant-tb
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Mayo Clinic
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Division of Pulmonary and Critical Care Medicine
Mayo Clinic
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References
  1. Global tuberculosis report 2022. World Health Organization. Published October 27, 2022. Accessed June 26, 2023. https://www.who.int/publications/i/item/9789240061729
  2. WHO consolidated guidelines on tuberculosis. Module 4: treatment – drug-resistant tuberculosis treatment, 2022 update. World Health Organization. Published December 15, 2022. Accessed June 26, 2023. https://www.who.int/publications/i/item/9789240063129
  3. Migliori GB, Tiberi S. Int J Tuberc Lung Dis. 2022 ;26(7):590-591. doi:10.5588/ijtld.22.0263.
  4. Lange C et al. Am J Respir Crit Care Med. 2022;205(10):1142-1144. doi:10.1164/rccm.202202-0393ED
  5. Esmail A et al. Am J Respir Crit Care Med. 2022;205(10):1214-1227. doi:10.1164/rccm.202107-1779OC
  6. WHO BPaLM Accelerator Platform: to support the call to action for implementation of the shorter and more effective treatment for all people suffering from drug-resistant TB. World Health Organization. Published May 9, 2023. Accessed June 26, 2023. https://www.who.int/news-room/events/detail/2023/05/09/default-calendar/who-bpalm-accelerator-platform–to-support-the-call-to-action-for-implementation-of-the-shorter-and-moreeffective-
  7. Trevisi L et al. Am J Respir Crit Care Med. 2023;207(11):1525-1532. doi:10.1164/rccm.202211-2125OC
  8. Domínguez J et al; TBnet and RESIST-TB networks. Lancet Infect Dis. 2023;23(4):e122-e137. doi:10.1016/S1473-3099(22)00875-1
  9. WHO operational handbook on tuberculosis: module 3: diagnosis: rapid diagnostics for tuberculosis detection, 2021 update. World Health Organization. Published July 7, 2021. Accessed June 26, 2023. https://www.who.int/publications/i/item/9789240030589treatment-for-all-people-suffering-from-drug-resistant-tb
References
  1. Global tuberculosis report 2022. World Health Organization. Published October 27, 2022. Accessed June 26, 2023. https://www.who.int/publications/i/item/9789240061729
  2. WHO consolidated guidelines on tuberculosis. Module 4: treatment – drug-resistant tuberculosis treatment, 2022 update. World Health Organization. Published December 15, 2022. Accessed June 26, 2023. https://www.who.int/publications/i/item/9789240063129
  3. Migliori GB, Tiberi S. Int J Tuberc Lung Dis. 2022 ;26(7):590-591. doi:10.5588/ijtld.22.0263.
  4. Lange C et al. Am J Respir Crit Care Med. 2022;205(10):1142-1144. doi:10.1164/rccm.202202-0393ED
  5. Esmail A et al. Am J Respir Crit Care Med. 2022;205(10):1214-1227. doi:10.1164/rccm.202107-1779OC
  6. WHO BPaLM Accelerator Platform: to support the call to action for implementation of the shorter and more effective treatment for all people suffering from drug-resistant TB. World Health Organization. Published May 9, 2023. Accessed June 26, 2023. https://www.who.int/news-room/events/detail/2023/05/09/default-calendar/who-bpalm-accelerator-platform–to-support-the-call-to-action-for-implementation-of-the-shorter-and-moreeffective-
  7. Trevisi L et al. Am J Respir Crit Care Med. 2023;207(11):1525-1532. doi:10.1164/rccm.202211-2125OC
  8. Domínguez J et al; TBnet and RESIST-TB networks. Lancet Infect Dis. 2023;23(4):e122-e137. doi:10.1016/S1473-3099(22)00875-1
  9. WHO operational handbook on tuberculosis: module 3: diagnosis: rapid diagnostics for tuberculosis detection, 2021 update. World Health Organization. Published July 7, 2021. Accessed June 26, 2023. https://www.who.int/publications/i/item/9789240030589treatment-for-all-people-suffering-from-drug-resistant-tb
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Although we are officially living in a “post-pandemic” world, some long-term global impacts of COVID-19 are still being addressed. We remain off track on global tuberculosis (TB) milestone targets due to halted progress over the last 3 years, with more people going undiagnosed and untreated for TB compared with pre-pandemic years.1 Drug-resistant TB (DR-TB) and multidrug-resistant TB (MDR-TB) continue to represent a major burden, and global spending on TB efforts remains significantly lower than what is needed to reach goals set forth by WHO.1

Despite these challenges, there are also some exciting updates. We now know that TB treatment success rates remained steady during the pandemic (86%), and strong efforts have been made to address DR-TB and MDR-TB via improved treatment options with highly effective, all-oral, shortened treatment regimens, as well as new and promising testing modalities.1-3

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CPAP adherence curbs severe cardiovascular disease outcomes

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Heidi Splete

Use of continuous positive-airway pressure devices for at least 4 hours a day was associated with a reduced risk of major adverse cardiac and cerebrovascular events in adults with cardiovascular disease and obstructive sleep apnea, based on data from more than 4,000 individuals.

Obstructive sleep apnea (OSA) is associated with an increased risk of cardiovascular diseases, but the association between management of OSA with a continuous positive-airway pressure device (CPAP) and major adverse cardiac or cerebrovascular events (MACCEs) remains unclear, wrote Manuel Sánchez-de-la-Torre, PhD, of the University of Lleida, Spain, and colleagues.

In a meta-analysis published in JAMA, the researchers reviewed data from 4,186 individuals with a mean age of 61.2 years; 82.1% were men. The study population included 2,097 patients who used CPAP and 2,089 who did not. The mean apnea-hypopnea index (AHI) was 31.2 events per hour, and OSA was defined as an oxygen desaturation index of 12 events or more per hour or an AHI of 15 events or more per hour. The composite primary outcome included the first MACCE, or death from cardiovascular causes, myocardial infarction, stroke, revascularization procedure, hospital admission for heart failure, hospital admission for unstable angina, or hospital admission for transient ischemic attack. Each of these components was a secondary endpoint.

Overall, the primary outcome of MACCE was similar for CPAP and non-CPAP using patients (hazard ratio, 1.01) with a total of 349 MACCE events in the CPAP group and 342 in the non-CPAP group. The mean adherence to CPAP was 3.1 hours per day. A total of 38.5% of patients in the CPAP group met the criteria for good adherence, defined as a mean of 4 or more hours per day.

However, as defined, good adherence to CPAP significantly reduced the risk of MACCE, compared with no CPAP use (HR, 0.69), and a sensitivity analysis showed a significant risk reduction, compared with patients who did not meet the criteria for good adherence (HR, 0.55; P = .005).

“Adherence to treatment is complex to determine and there are other potential factors that could affect patient adherence, such as health education, motivation, attitude, self-efficacy, psychosocial factors, and other health care system–related features,” the researchers wrote in their discussion.

The findings were limited by several factors including the evaluation only of CPAP as a treatment for OSA, and the inability to assess separate components of the composite endpoint, the researchers noted. Other limitations included the relatively small number of female patients, reliance mainly on at-home sleep apnea tests, and the potential for selection bias, they said.

However, the results suggest that CPAP adherence is important to prevention of secondary cardiovascular outcomes in OSA patients, and that implementation of specific and personalized strategies to improve adherence to treatment should be a clinical priority, they concluded.

The study was funded by the Instituto de Salud Carlos III, the European Union and FEDER, IRBLleida–Fundació Dr Pifarré, SEPAR, ResMed Ltd. (Australia), Associació Lleidatana de Respiratori, and CIBERES. Dr Sánchez-de-la-Torre also disclosed financial support from a Ramón y Cajal grant.

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Use of continuous positive-airway pressure devices for at least 4 hours a day was associated with a reduced risk of major adverse cardiac and cerebrovascular events in adults with cardiovascular disease and obstructive sleep apnea, based on data from more than 4,000 individuals.

Obstructive sleep apnea (OSA) is associated with an increased risk of cardiovascular diseases, but the association between management of OSA with a continuous positive-airway pressure device (CPAP) and major adverse cardiac or cerebrovascular events (MACCEs) remains unclear, wrote Manuel Sánchez-de-la-Torre, PhD, of the University of Lleida, Spain, and colleagues.

In a meta-analysis published in JAMA, the researchers reviewed data from 4,186 individuals with a mean age of 61.2 years; 82.1% were men. The study population included 2,097 patients who used CPAP and 2,089 who did not. The mean apnea-hypopnea index (AHI) was 31.2 events per hour, and OSA was defined as an oxygen desaturation index of 12 events or more per hour or an AHI of 15 events or more per hour. The composite primary outcome included the first MACCE, or death from cardiovascular causes, myocardial infarction, stroke, revascularization procedure, hospital admission for heart failure, hospital admission for unstable angina, or hospital admission for transient ischemic attack. Each of these components was a secondary endpoint.

Overall, the primary outcome of MACCE was similar for CPAP and non-CPAP using patients (hazard ratio, 1.01) with a total of 349 MACCE events in the CPAP group and 342 in the non-CPAP group. The mean adherence to CPAP was 3.1 hours per day. A total of 38.5% of patients in the CPAP group met the criteria for good adherence, defined as a mean of 4 or more hours per day.

However, as defined, good adherence to CPAP significantly reduced the risk of MACCE, compared with no CPAP use (HR, 0.69), and a sensitivity analysis showed a significant risk reduction, compared with patients who did not meet the criteria for good adherence (HR, 0.55; P = .005).

“Adherence to treatment is complex to determine and there are other potential factors that could affect patient adherence, such as health education, motivation, attitude, self-efficacy, psychosocial factors, and other health care system–related features,” the researchers wrote in their discussion.

The findings were limited by several factors including the evaluation only of CPAP as a treatment for OSA, and the inability to assess separate components of the composite endpoint, the researchers noted. Other limitations included the relatively small number of female patients, reliance mainly on at-home sleep apnea tests, and the potential for selection bias, they said.

However, the results suggest that CPAP adherence is important to prevention of secondary cardiovascular outcomes in OSA patients, and that implementation of specific and personalized strategies to improve adherence to treatment should be a clinical priority, they concluded.

The study was funded by the Instituto de Salud Carlos III, the European Union and FEDER, IRBLleida–Fundació Dr Pifarré, SEPAR, ResMed Ltd. (Australia), Associació Lleidatana de Respiratori, and CIBERES. Dr Sánchez-de-la-Torre also disclosed financial support from a Ramón y Cajal grant.

Use of continuous positive-airway pressure devices for at least 4 hours a day was associated with a reduced risk of major adverse cardiac and cerebrovascular events in adults with cardiovascular disease and obstructive sleep apnea, based on data from more than 4,000 individuals.

Obstructive sleep apnea (OSA) is associated with an increased risk of cardiovascular diseases, but the association between management of OSA with a continuous positive-airway pressure device (CPAP) and major adverse cardiac or cerebrovascular events (MACCEs) remains unclear, wrote Manuel Sánchez-de-la-Torre, PhD, of the University of Lleida, Spain, and colleagues.

In a meta-analysis published in JAMA, the researchers reviewed data from 4,186 individuals with a mean age of 61.2 years; 82.1% were men. The study population included 2,097 patients who used CPAP and 2,089 who did not. The mean apnea-hypopnea index (AHI) was 31.2 events per hour, and OSA was defined as an oxygen desaturation index of 12 events or more per hour or an AHI of 15 events or more per hour. The composite primary outcome included the first MACCE, or death from cardiovascular causes, myocardial infarction, stroke, revascularization procedure, hospital admission for heart failure, hospital admission for unstable angina, or hospital admission for transient ischemic attack. Each of these components was a secondary endpoint.

Overall, the primary outcome of MACCE was similar for CPAP and non-CPAP using patients (hazard ratio, 1.01) with a total of 349 MACCE events in the CPAP group and 342 in the non-CPAP group. The mean adherence to CPAP was 3.1 hours per day. A total of 38.5% of patients in the CPAP group met the criteria for good adherence, defined as a mean of 4 or more hours per day.

However, as defined, good adherence to CPAP significantly reduced the risk of MACCE, compared with no CPAP use (HR, 0.69), and a sensitivity analysis showed a significant risk reduction, compared with patients who did not meet the criteria for good adherence (HR, 0.55; P = .005).

“Adherence to treatment is complex to determine and there are other potential factors that could affect patient adherence, such as health education, motivation, attitude, self-efficacy, psychosocial factors, and other health care system–related features,” the researchers wrote in their discussion.

The findings were limited by several factors including the evaluation only of CPAP as a treatment for OSA, and the inability to assess separate components of the composite endpoint, the researchers noted. Other limitations included the relatively small number of female patients, reliance mainly on at-home sleep apnea tests, and the potential for selection bias, they said.

However, the results suggest that CPAP adherence is important to prevention of secondary cardiovascular outcomes in OSA patients, and that implementation of specific and personalized strategies to improve adherence to treatment should be a clinical priority, they concluded.

The study was funded by the Instituto de Salud Carlos III, the European Union and FEDER, IRBLleida–Fundació Dr Pifarré, SEPAR, ResMed Ltd. (Australia), Associació Lleidatana de Respiratori, and CIBERES. Dr Sánchez-de-la-Torre also disclosed financial support from a Ramón y Cajal grant.

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Addressing Physician Burnout in Pulmonology and Critical Care

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Addressing Physician Burnout in Pulmonology and Critical Care in Pulmonology and Critical Care
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Click to view more from Pulmonology Data Trends 2023.

References
  1. Moss M et al. Crit Care Med. 2016;44(7):1414-1421. doi:10.1097/CCM.000000000000188
  2. Medscape National Physician Burnout, Depression & Suicide Report 2019. Medscape. January 16, 2019. Accessed June 22, 2023. https://www.medscape.com/slideshow/2019-lifestyle-burnout-depression-6011056#1
  3. Medscape National Physician Burnout & Suicide Report 2020: The Generational Divide. Medscape. January 15, 2020. Accessed June 22, 2023. https://www.medscape.com/slideshow/2020-lifestyle-burnout-6012460#1
  4. ‘Death by 1000 Cuts’: Medscape National Physician Burnout & Suicide Report 2021. Medscape. January 22, 2021. Accessed June 22, 2023. https://www.medscape.com/slideshow/2021-lifestyle-burnout-6013456#2
  5. Physician Burnout Report 2022: Stress, Anxiety, and Anger. Medscape. January 21, 2022. Accessed June 22, 2023. https://www.medscape.com/slideshow/2022-lifestyle-burnout-6014664#1
  6. ‘I Cry but No One Cares’: Physician Burnout & Depression Report 2023. Medscape. January 27, 2023. Accessed June 22, 2023. https://www.medscape.com/slideshow/2023-lifestyle-burnout-6016058#1
  7. Murthy VH. N Engl J Med. 2022;387(7):577-579. doi:10.1056/NEJMp2207252
  8. Vranas KC et al. Chest. 2021;160(5):1714-1728. doi:10.1016/j.chest.2021.05.041
  9. Kerlin MP et al. Ann Am Thorac Soc. 2022;19(2):329-331. doi:10.1513/AnnalsATS.202105-567RL
  10. Dean W et al. Fed Pract. 2019;36(9):400-402. PMID: 31571807
  11. Association of American Medical Colleges. The Complexities of Physician Supply and Demand: Projections from 2019 to 2034. June 2021. https://www.aamc.org/media/54681/download?attachment
  12. Medscape Pulmonologist Lifestyle, Happiness & Burnout Report 2023: Contentment Amid Stress. February 24, 2023. Accessed June 28, 2023. https://www.medscape.com/slideshow/2023-lifestyle-pulmonologist-6016092#1
  13. Medscape Intensivist Lifestyle, Happiness & Burnout Report 2023: Contentment Amid Stress. February 24, 2023. Accessed June 28, 2023. https://www.medscape.com/slideshow/2023-lifestyle-intensivist-6016072#1
Author and Disclosure Information

Kelly Vranas, MD, MCR
Assistant Professor of Medicine
Division of Pulmonary, Allergy, and Critical Care Medicine
Oregon Health & Science University;
Critical Care Health Services Researcher
Portland VA Medical Center
Portland, OR

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Author and Disclosure Information

Kelly Vranas, MD, MCR
Assistant Professor of Medicine
Division of Pulmonary, Allergy, and Critical Care Medicine
Oregon Health & Science University;
Critical Care Health Services Researcher
Portland VA Medical Center
Portland, OR

Author and Disclosure Information

Kelly Vranas, MD, MCR
Assistant Professor of Medicine
Division of Pulmonary, Allergy, and Critical Care Medicine
Oregon Health & Science University;
Critical Care Health Services Researcher
Portland VA Medical Center
Portland, OR

Click to view more from Pulmonology Data Trends 2023.

Click to view more from Pulmonology Data Trends 2023.

References
  1. Moss M et al. Crit Care Med. 2016;44(7):1414-1421. doi:10.1097/CCM.000000000000188
  2. Medscape National Physician Burnout, Depression & Suicide Report 2019. Medscape. January 16, 2019. Accessed June 22, 2023. https://www.medscape.com/slideshow/2019-lifestyle-burnout-depression-6011056#1
  3. Medscape National Physician Burnout & Suicide Report 2020: The Generational Divide. Medscape. January 15, 2020. Accessed June 22, 2023. https://www.medscape.com/slideshow/2020-lifestyle-burnout-6012460#1
  4. ‘Death by 1000 Cuts’: Medscape National Physician Burnout & Suicide Report 2021. Medscape. January 22, 2021. Accessed June 22, 2023. https://www.medscape.com/slideshow/2021-lifestyle-burnout-6013456#2
  5. Physician Burnout Report 2022: Stress, Anxiety, and Anger. Medscape. January 21, 2022. Accessed June 22, 2023. https://www.medscape.com/slideshow/2022-lifestyle-burnout-6014664#1
  6. ‘I Cry but No One Cares’: Physician Burnout & Depression Report 2023. Medscape. January 27, 2023. Accessed June 22, 2023. https://www.medscape.com/slideshow/2023-lifestyle-burnout-6016058#1
  7. Murthy VH. N Engl J Med. 2022;387(7):577-579. doi:10.1056/NEJMp2207252
  8. Vranas KC et al. Chest. 2021;160(5):1714-1728. doi:10.1016/j.chest.2021.05.041
  9. Kerlin MP et al. Ann Am Thorac Soc. 2022;19(2):329-331. doi:10.1513/AnnalsATS.202105-567RL
  10. Dean W et al. Fed Pract. 2019;36(9):400-402. PMID: 31571807
  11. Association of American Medical Colleges. The Complexities of Physician Supply and Demand: Projections from 2019 to 2034. June 2021. https://www.aamc.org/media/54681/download?attachment
  12. Medscape Pulmonologist Lifestyle, Happiness & Burnout Report 2023: Contentment Amid Stress. February 24, 2023. Accessed June 28, 2023. https://www.medscape.com/slideshow/2023-lifestyle-pulmonologist-6016092#1
  13. Medscape Intensivist Lifestyle, Happiness & Burnout Report 2023: Contentment Amid Stress. February 24, 2023. Accessed June 28, 2023. https://www.medscape.com/slideshow/2023-lifestyle-intensivist-6016072#1
References
  1. Moss M et al. Crit Care Med. 2016;44(7):1414-1421. doi:10.1097/CCM.000000000000188
  2. Medscape National Physician Burnout, Depression & Suicide Report 2019. Medscape. January 16, 2019. Accessed June 22, 2023. https://www.medscape.com/slideshow/2019-lifestyle-burnout-depression-6011056#1
  3. Medscape National Physician Burnout & Suicide Report 2020: The Generational Divide. Medscape. January 15, 2020. Accessed June 22, 2023. https://www.medscape.com/slideshow/2020-lifestyle-burnout-6012460#1
  4. ‘Death by 1000 Cuts’: Medscape National Physician Burnout & Suicide Report 2021. Medscape. January 22, 2021. Accessed June 22, 2023. https://www.medscape.com/slideshow/2021-lifestyle-burnout-6013456#2
  5. Physician Burnout Report 2022: Stress, Anxiety, and Anger. Medscape. January 21, 2022. Accessed June 22, 2023. https://www.medscape.com/slideshow/2022-lifestyle-burnout-6014664#1
  6. ‘I Cry but No One Cares’: Physician Burnout & Depression Report 2023. Medscape. January 27, 2023. Accessed June 22, 2023. https://www.medscape.com/slideshow/2023-lifestyle-burnout-6016058#1
  7. Murthy VH. N Engl J Med. 2022;387(7):577-579. doi:10.1056/NEJMp2207252
  8. Vranas KC et al. Chest. 2021;160(5):1714-1728. doi:10.1016/j.chest.2021.05.041
  9. Kerlin MP et al. Ann Am Thorac Soc. 2022;19(2):329-331. doi:10.1513/AnnalsATS.202105-567RL
  10. Dean W et al. Fed Pract. 2019;36(9):400-402. PMID: 31571807
  11. Association of American Medical Colleges. The Complexities of Physician Supply and Demand: Projections from 2019 to 2034. June 2021. https://www.aamc.org/media/54681/download?attachment
  12. Medscape Pulmonologist Lifestyle, Happiness & Burnout Report 2023: Contentment Amid Stress. February 24, 2023. Accessed June 28, 2023. https://www.medscape.com/slideshow/2023-lifestyle-pulmonologist-6016092#1
  13. Medscape Intensivist Lifestyle, Happiness & Burnout Report 2023: Contentment Amid Stress. February 24, 2023. Accessed June 28, 2023. https://www.medscape.com/slideshow/2023-lifestyle-intensivist-6016072#1
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Work-related stress has long been a concern for those working in the intensive care unit (ICU); even before the COVID-19 pandemic, it was estimated that up to 45% of critical care physicians had at least one symptom of severe burnout.1-6  In 2020 and the years following, the combination of significantly increased patient morbidity and mortality rates, excessive workloads, and resource limitations negatively impacted employee morale, decreased feelings of professional fulfillment, increased moral distress, and most importantly, heightened mental health concerns among critical care physicians.7-10

While most of the post-pandemic world has returned to “normal,” its effect on the health care industry has been slower to wane; in fact, reported rates of physician burnout remain higher today than they were in 2020.2-6 Almost half of physicians (49%) say their depressions affects their patient interactions, while 65% report that their personal relationships are affected.6 In order to course-correct—not only for the sake of our current workforce and patients, but also to ensure better preparation for future public health crises—we must address the more fundamental burnout contributors that the pandemic only amplified.

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