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Making an impact beyond medicine
across all career stages and practice settings, highlight the diversity of our membership, and build a sense of community by learning more about one another.
As physicians, we are fortunate to have the opportunity to meaningfully impact the lives of our patients through the practice of clinical medicine, or by spearheading groundbreaking research that improves patient outcomes. However, some physicians arguably make their greatest mark outside of medicine.
To close out the inaugural year of our Member Spotlight feature, we introduce you to gastroenterologist Eric Esrailian, MD, MPH, chair of the division of gastroenterology at UCLA. He is an Emmy-nominated film producer and distinguished human rights advocate. His story is inspirational, and poignantly highlights how one’s impact as a physician can extend far beyond the walls of the hospital. We hope to continue to feature exceptional individuals like Dr. Esrailian who leverage their unique talents for societal good. We appreciate your continued nominations as we plan our 2024 coverage.
Also in the December issue, we summarize the results of a pivotal, head-to-head trial of risankizumab (Skyrizi) and ustekinumab (Stelara) for Crohn’s disease, which was presented in October at United European Gastroenterology (UEG) Week in Copenhagen.
We also highlight the FDA’s recent approval of vonoprazan, a new pharmacologic treatment for erosive esophagitis expected to be available in the U.S. sometime this month. Finally, Dr. Lauren Feld explains how gastroenterologists can advocate for more robust parental leave and return to work policies at their institutions and why it matters.
We wish you all a wonderful holiday season and look forward to seeing you again in the New Year.
Megan A. Adams, MD, JD, MSc
across all career stages and practice settings, highlight the diversity of our membership, and build a sense of community by learning more about one another.
As physicians, we are fortunate to have the opportunity to meaningfully impact the lives of our patients through the practice of clinical medicine, or by spearheading groundbreaking research that improves patient outcomes. However, some physicians arguably make their greatest mark outside of medicine.
To close out the inaugural year of our Member Spotlight feature, we introduce you to gastroenterologist Eric Esrailian, MD, MPH, chair of the division of gastroenterology at UCLA. He is an Emmy-nominated film producer and distinguished human rights advocate. His story is inspirational, and poignantly highlights how one’s impact as a physician can extend far beyond the walls of the hospital. We hope to continue to feature exceptional individuals like Dr. Esrailian who leverage their unique talents for societal good. We appreciate your continued nominations as we plan our 2024 coverage.
Also in the December issue, we summarize the results of a pivotal, head-to-head trial of risankizumab (Skyrizi) and ustekinumab (Stelara) for Crohn’s disease, which was presented in October at United European Gastroenterology (UEG) Week in Copenhagen.
We also highlight the FDA’s recent approval of vonoprazan, a new pharmacologic treatment for erosive esophagitis expected to be available in the U.S. sometime this month. Finally, Dr. Lauren Feld explains how gastroenterologists can advocate for more robust parental leave and return to work policies at their institutions and why it matters.
We wish you all a wonderful holiday season and look forward to seeing you again in the New Year.
Megan A. Adams, MD, JD, MSc
across all career stages and practice settings, highlight the diversity of our membership, and build a sense of community by learning more about one another.
As physicians, we are fortunate to have the opportunity to meaningfully impact the lives of our patients through the practice of clinical medicine, or by spearheading groundbreaking research that improves patient outcomes. However, some physicians arguably make their greatest mark outside of medicine.
To close out the inaugural year of our Member Spotlight feature, we introduce you to gastroenterologist Eric Esrailian, MD, MPH, chair of the division of gastroenterology at UCLA. He is an Emmy-nominated film producer and distinguished human rights advocate. His story is inspirational, and poignantly highlights how one’s impact as a physician can extend far beyond the walls of the hospital. We hope to continue to feature exceptional individuals like Dr. Esrailian who leverage their unique talents for societal good. We appreciate your continued nominations as we plan our 2024 coverage.
Also in the December issue, we summarize the results of a pivotal, head-to-head trial of risankizumab (Skyrizi) and ustekinumab (Stelara) for Crohn’s disease, which was presented in October at United European Gastroenterology (UEG) Week in Copenhagen.
We also highlight the FDA’s recent approval of vonoprazan, a new pharmacologic treatment for erosive esophagitis expected to be available in the U.S. sometime this month. Finally, Dr. Lauren Feld explains how gastroenterologists can advocate for more robust parental leave and return to work policies at their institutions and why it matters.
We wish you all a wonderful holiday season and look forward to seeing you again in the New Year.
Megan A. Adams, MD, JD, MSc
The double-edged sword of virtual pulmonary rehabilitation
It offers a comprehensive approach to improving lung health and overall quality of life using a combination of tailored exercise routines, educational sessions, and emotional support. It empowers our patients to better manage their conditions, improve their fitness level, and regain a sense of control over their lives. However, the response to the COVID-19 pandemic increased the use of telemedicine as a method for providing health care (Shaver J. Prim Care. 2022;49[4]:517).
Many patients have welcomed the convenience offered by virtual care, and studies have demonstrated high levels of patient satisfaction (Polinski JM, et al. Gen Intern Med. 2016;31[3]:269). Geography also drives telehealth use. In urban areas in the United States, the median travel distance is 7.5 miles one way with a resulting travel time of 3 to 25 minutes. In rural areas, the estimated travel distance is three times as long. Distance and travel time have been recognized as major barriers to attending PR (Keating A, et al. Chron Respir Dis. 2011;8[2]:89).
Access to PR is also hindered by lack of program availability. As of 2019, there were only 831 pulmonary rehab centers in the United States serving roughly 24 million patients with COPD. Only 561 of these centers are certified by the American Association of Cardiovascular and Pulmonary Rehabilitation, leaving only one certified center for every 43,000 patients with COPD (Chan L, et al. J Rural Health. 2006;22[2]:140). As such, virtual PR is one option for augmenting availability and accessibility.
While virtual PR programs offer numerous advantages, including accessibility and convenience, there are inherent risks and challenges. There is also concern that they are inferior to in-person PR. They offer less supervision by trained health care professionals and no immediate access to medical assistance. Combined with the absence of real-time monitoring of vitals or symptoms, there may be a higher risk of adverse events despite the incorporation of safety measures. Furthermore, the lack of accountability forces an increased reliance on self-motivation, which may hinder progress (Spruit MA, et al. Am J Respir Crit Care Med. 2013;188[8]:e13).
Although the digital divide is narrowing rapidly, reliable access to technology, combined with poor internet connections or computer literacy, will prevent adoption by some patients. Even in well-resourced areas, technical issues can disrupt continuity. Finally, virtual PR lacks the intangible benefits from in-person group sessions. Social interactions in this already isolated subset of patients are lost in virtual PR, and the cultivation of motivation and support to seek a common goal goes unrealized.
While these concerns are appreciated, PR is currently highly underutilized and essentially unavailable to most pulmonary patients. As such, further study is needed to shape the future design of quality virtual PR programs. In the March 2023 issue of the journal CHEST, Huynh and colleagues published an observational cohort study comparing virtual with traditional PR programs (Huynh VC, et al. Chest. 2023; Mar;163[3]:529). Of the 554 participants in the study, 171 were enrolled in virtual and 383 to in-person PR. Attendance and drop-out rates did not differ, CAT scores significantly improved in both programs, and there were no adverse events during virtual PR. Participants in the virtual group received a TheraBand and were required to have a sturdy chair, three large step-lengths of empty space surrounding their chair, and access to internet/Zoom. They had one-on-one Zoom meetings but relied mostly on staff-made or online videos. These results replicate past investigations that have demonstrated low adverse event rates, positive overall patient satisfaction, and noninferiority in patient-centered outcomes with PR. The total volume of data remains limited though (Cox NS, et al. Cochrane Database Syst Rev. 2021;Issue 1;Art No: CD013040).
PR is an essential resource for the management of chronic lung diseases. Given existing barriers and the growing number of eligible patients, we must embrace alternative delivery strategies, all the while ensuring that a quality and useful product is deployed (Rochester CL, et al. Am J Respir Crit Care Med. 2015;192[11]:1373). Additional study is needed to standardize and validate the implementation of virtual PR. Ultimately, virtual and alternative methods of care delivery may help optimize outcomes for our patients where more traditional methods fall short.
The views and opinions of authors expressed herein do not necessarily reflect those of the Department of Veterans Affairs or the U.S. government. Dr. Cagle and Dr. Gartman are with the Warren Alpert Medical School of Brown University and Providence VA Medical Center, Division of Pulmonary, Critical Care, and Sleep Medicine. Providence, R.I.
It offers a comprehensive approach to improving lung health and overall quality of life using a combination of tailored exercise routines, educational sessions, and emotional support. It empowers our patients to better manage their conditions, improve their fitness level, and regain a sense of control over their lives. However, the response to the COVID-19 pandemic increased the use of telemedicine as a method for providing health care (Shaver J. Prim Care. 2022;49[4]:517).
Many patients have welcomed the convenience offered by virtual care, and studies have demonstrated high levels of patient satisfaction (Polinski JM, et al. Gen Intern Med. 2016;31[3]:269). Geography also drives telehealth use. In urban areas in the United States, the median travel distance is 7.5 miles one way with a resulting travel time of 3 to 25 minutes. In rural areas, the estimated travel distance is three times as long. Distance and travel time have been recognized as major barriers to attending PR (Keating A, et al. Chron Respir Dis. 2011;8[2]:89).
Access to PR is also hindered by lack of program availability. As of 2019, there were only 831 pulmonary rehab centers in the United States serving roughly 24 million patients with COPD. Only 561 of these centers are certified by the American Association of Cardiovascular and Pulmonary Rehabilitation, leaving only one certified center for every 43,000 patients with COPD (Chan L, et al. J Rural Health. 2006;22[2]:140). As such, virtual PR is one option for augmenting availability and accessibility.
While virtual PR programs offer numerous advantages, including accessibility and convenience, there are inherent risks and challenges. There is also concern that they are inferior to in-person PR. They offer less supervision by trained health care professionals and no immediate access to medical assistance. Combined with the absence of real-time monitoring of vitals or symptoms, there may be a higher risk of adverse events despite the incorporation of safety measures. Furthermore, the lack of accountability forces an increased reliance on self-motivation, which may hinder progress (Spruit MA, et al. Am J Respir Crit Care Med. 2013;188[8]:e13).
Although the digital divide is narrowing rapidly, reliable access to technology, combined with poor internet connections or computer literacy, will prevent adoption by some patients. Even in well-resourced areas, technical issues can disrupt continuity. Finally, virtual PR lacks the intangible benefits from in-person group sessions. Social interactions in this already isolated subset of patients are lost in virtual PR, and the cultivation of motivation and support to seek a common goal goes unrealized.
While these concerns are appreciated, PR is currently highly underutilized and essentially unavailable to most pulmonary patients. As such, further study is needed to shape the future design of quality virtual PR programs. In the March 2023 issue of the journal CHEST, Huynh and colleagues published an observational cohort study comparing virtual with traditional PR programs (Huynh VC, et al. Chest. 2023; Mar;163[3]:529). Of the 554 participants in the study, 171 were enrolled in virtual and 383 to in-person PR. Attendance and drop-out rates did not differ, CAT scores significantly improved in both programs, and there were no adverse events during virtual PR. Participants in the virtual group received a TheraBand and were required to have a sturdy chair, three large step-lengths of empty space surrounding their chair, and access to internet/Zoom. They had one-on-one Zoom meetings but relied mostly on staff-made or online videos. These results replicate past investigations that have demonstrated low adverse event rates, positive overall patient satisfaction, and noninferiority in patient-centered outcomes with PR. The total volume of data remains limited though (Cox NS, et al. Cochrane Database Syst Rev. 2021;Issue 1;Art No: CD013040).
PR is an essential resource for the management of chronic lung diseases. Given existing barriers and the growing number of eligible patients, we must embrace alternative delivery strategies, all the while ensuring that a quality and useful product is deployed (Rochester CL, et al. Am J Respir Crit Care Med. 2015;192[11]:1373). Additional study is needed to standardize and validate the implementation of virtual PR. Ultimately, virtual and alternative methods of care delivery may help optimize outcomes for our patients where more traditional methods fall short.
The views and opinions of authors expressed herein do not necessarily reflect those of the Department of Veterans Affairs or the U.S. government. Dr. Cagle and Dr. Gartman are with the Warren Alpert Medical School of Brown University and Providence VA Medical Center, Division of Pulmonary, Critical Care, and Sleep Medicine. Providence, R.I.
It offers a comprehensive approach to improving lung health and overall quality of life using a combination of tailored exercise routines, educational sessions, and emotional support. It empowers our patients to better manage their conditions, improve their fitness level, and regain a sense of control over their lives. However, the response to the COVID-19 pandemic increased the use of telemedicine as a method for providing health care (Shaver J. Prim Care. 2022;49[4]:517).
Many patients have welcomed the convenience offered by virtual care, and studies have demonstrated high levels of patient satisfaction (Polinski JM, et al. Gen Intern Med. 2016;31[3]:269). Geography also drives telehealth use. In urban areas in the United States, the median travel distance is 7.5 miles one way with a resulting travel time of 3 to 25 minutes. In rural areas, the estimated travel distance is three times as long. Distance and travel time have been recognized as major barriers to attending PR (Keating A, et al. Chron Respir Dis. 2011;8[2]:89).
Access to PR is also hindered by lack of program availability. As of 2019, there were only 831 pulmonary rehab centers in the United States serving roughly 24 million patients with COPD. Only 561 of these centers are certified by the American Association of Cardiovascular and Pulmonary Rehabilitation, leaving only one certified center for every 43,000 patients with COPD (Chan L, et al. J Rural Health. 2006;22[2]:140). As such, virtual PR is one option for augmenting availability and accessibility.
While virtual PR programs offer numerous advantages, including accessibility and convenience, there are inherent risks and challenges. There is also concern that they are inferior to in-person PR. They offer less supervision by trained health care professionals and no immediate access to medical assistance. Combined with the absence of real-time monitoring of vitals or symptoms, there may be a higher risk of adverse events despite the incorporation of safety measures. Furthermore, the lack of accountability forces an increased reliance on self-motivation, which may hinder progress (Spruit MA, et al. Am J Respir Crit Care Med. 2013;188[8]:e13).
Although the digital divide is narrowing rapidly, reliable access to technology, combined with poor internet connections or computer literacy, will prevent adoption by some patients. Even in well-resourced areas, technical issues can disrupt continuity. Finally, virtual PR lacks the intangible benefits from in-person group sessions. Social interactions in this already isolated subset of patients are lost in virtual PR, and the cultivation of motivation and support to seek a common goal goes unrealized.
While these concerns are appreciated, PR is currently highly underutilized and essentially unavailable to most pulmonary patients. As such, further study is needed to shape the future design of quality virtual PR programs. In the March 2023 issue of the journal CHEST, Huynh and colleagues published an observational cohort study comparing virtual with traditional PR programs (Huynh VC, et al. Chest. 2023; Mar;163[3]:529). Of the 554 participants in the study, 171 were enrolled in virtual and 383 to in-person PR. Attendance and drop-out rates did not differ, CAT scores significantly improved in both programs, and there were no adverse events during virtual PR. Participants in the virtual group received a TheraBand and were required to have a sturdy chair, three large step-lengths of empty space surrounding their chair, and access to internet/Zoom. They had one-on-one Zoom meetings but relied mostly on staff-made or online videos. These results replicate past investigations that have demonstrated low adverse event rates, positive overall patient satisfaction, and noninferiority in patient-centered outcomes with PR. The total volume of data remains limited though (Cox NS, et al. Cochrane Database Syst Rev. 2021;Issue 1;Art No: CD013040).
PR is an essential resource for the management of chronic lung diseases. Given existing barriers and the growing number of eligible patients, we must embrace alternative delivery strategies, all the while ensuring that a quality and useful product is deployed (Rochester CL, et al. Am J Respir Crit Care Med. 2015;192[11]:1373). Additional study is needed to standardize and validate the implementation of virtual PR. Ultimately, virtual and alternative methods of care delivery may help optimize outcomes for our patients where more traditional methods fall short.
The views and opinions of authors expressed herein do not necessarily reflect those of the Department of Veterans Affairs or the U.S. government. Dr. Cagle and Dr. Gartman are with the Warren Alpert Medical School of Brown University and Providence VA Medical Center, Division of Pulmonary, Critical Care, and Sleep Medicine. Providence, R.I.
University of Washington Fellowship director announced as mentor for Medical Educator Fellowship
It wasn’t until Başak Çoruh, MD, FCCP, was a mentee herself that she realized the value of structured mentoring. And now, she has more to give.
Dr. Çoruh, Associate Professor of Pulmonary, Critical Care, and Sleep Medicine and Director of the Pulmonary and Critical Care Medicine fellowship program at the University of Washington, was named as the mentor for the Medical Educator Diversity Scholarship Fellowship.
It was created to support a fellow who intends to pursue a career in medical education but who may have limited resources to train in teaching, formal medical education curricula, and medical education research.
“The fellowship is an incredible opportunity to increase the diversity of our medical education community,” Dr. Çoruh said.
The fellowship also closely aligns with CHEST’s newly established philanthropic pillar of “Support of the profession.” CHEST is devoted to elevating the field of chest medicine through top-notch clinical education and empowering early career clinicians from diverse backgrounds with the latest knowledge.
“I’m particularly excited to serve as a mentor for an aspiring medical educator without access to resources for coursework, teaching activities, or scholarship at their home institution,” Dr. Çoruh said. “I am fortunate to be a part of a large and welcoming education community at the University of Washington that I’m excited to share with my mentee.”
The importance of mentorship cannot be overstated, as it can shape the rest of a clinician’s career. There is immense value in not only the funding and research aspect but in the wisdom-sharing and motivational side, as well.
“It wasn’t until my own fellowship that I experienced the value of structured mentoring, and the mentoring I have received has impacted my career in countless ways. I look forward to helping [the fellow] achieve their goals.”
The fellowship recipient will be announced in early 2024.
It wasn’t until Başak Çoruh, MD, FCCP, was a mentee herself that she realized the value of structured mentoring. And now, she has more to give.
Dr. Çoruh, Associate Professor of Pulmonary, Critical Care, and Sleep Medicine and Director of the Pulmonary and Critical Care Medicine fellowship program at the University of Washington, was named as the mentor for the Medical Educator Diversity Scholarship Fellowship.
It was created to support a fellow who intends to pursue a career in medical education but who may have limited resources to train in teaching, formal medical education curricula, and medical education research.
“The fellowship is an incredible opportunity to increase the diversity of our medical education community,” Dr. Çoruh said.
The fellowship also closely aligns with CHEST’s newly established philanthropic pillar of “Support of the profession.” CHEST is devoted to elevating the field of chest medicine through top-notch clinical education and empowering early career clinicians from diverse backgrounds with the latest knowledge.
“I’m particularly excited to serve as a mentor for an aspiring medical educator without access to resources for coursework, teaching activities, or scholarship at their home institution,” Dr. Çoruh said. “I am fortunate to be a part of a large and welcoming education community at the University of Washington that I’m excited to share with my mentee.”
The importance of mentorship cannot be overstated, as it can shape the rest of a clinician’s career. There is immense value in not only the funding and research aspect but in the wisdom-sharing and motivational side, as well.
“It wasn’t until my own fellowship that I experienced the value of structured mentoring, and the mentoring I have received has impacted my career in countless ways. I look forward to helping [the fellow] achieve their goals.”
The fellowship recipient will be announced in early 2024.
It wasn’t until Başak Çoruh, MD, FCCP, was a mentee herself that she realized the value of structured mentoring. And now, she has more to give.
Dr. Çoruh, Associate Professor of Pulmonary, Critical Care, and Sleep Medicine and Director of the Pulmonary and Critical Care Medicine fellowship program at the University of Washington, was named as the mentor for the Medical Educator Diversity Scholarship Fellowship.
It was created to support a fellow who intends to pursue a career in medical education but who may have limited resources to train in teaching, formal medical education curricula, and medical education research.
“The fellowship is an incredible opportunity to increase the diversity of our medical education community,” Dr. Çoruh said.
The fellowship also closely aligns with CHEST’s newly established philanthropic pillar of “Support of the profession.” CHEST is devoted to elevating the field of chest medicine through top-notch clinical education and empowering early career clinicians from diverse backgrounds with the latest knowledge.
“I’m particularly excited to serve as a mentor for an aspiring medical educator without access to resources for coursework, teaching activities, or scholarship at their home institution,” Dr. Çoruh said. “I am fortunate to be a part of a large and welcoming education community at the University of Washington that I’m excited to share with my mentee.”
The importance of mentorship cannot be overstated, as it can shape the rest of a clinician’s career. There is immense value in not only the funding and research aspect but in the wisdom-sharing and motivational side, as well.
“It wasn’t until my own fellowship that I experienced the value of structured mentoring, and the mentoring I have received has impacted my career in countless ways. I look forward to helping [the fellow] achieve their goals.”
The fellowship recipient will be announced in early 2024.
Get to know incoming CHEST President John “Jack” D. Buckley, MD, MPH, FCCP
Starting January 1, 2024, current President-Elect John “Jack” D. Buckley, MD, MPH, FCCP, will become the new President of CHEST. Dr. Buckley is a pulmonologist and critical care physician with an extensive background in education, and he has served on the Board of Regents for the College for 8 years collectively.
What would you like to accomplish as President of CHEST?
I mentioned this in my address during the CHEST Annual Meeting in Honolulu, but the role of President is to guide the Board of Regents as we provide governance and direct the organization to fulfill our mission. With that in mind, my job is to advance CHEST by following our strategic plan, continuing the great work already being done, and preparing for what comes next.
As our world changes around us, we must not only adapt to the current environment but anticipate the future and take the lead by influencing the direction we believe to be important. This is the role of the Board of Regents, and we need input from CHEST’s members.
In 2023, with the guidance of an advisory board, and a tremendous amount of time and effort encompassing input from a wide range of CHEST members, leaders and staff, the organization defined its core values. The values – Community, Inclusivity, Innovation, Advocacy, and Integrity – are reflective of the CHEST organization and will guide decisions for years to come.
While looking forward, it’s also important to reflect on the past. CHEST started as an organization centered on preventing and treating tuberculosis. As progress was made, the entire pulmonary field evolved from tuberculosis experts and, from there, critical care emerged and continues to evolve. Now we’re seeing tremendous growth in the roles of advanced practice providers in our ICUs and, most recently, a resurgence of cardiology-critical care. We are excited to welcome these colleagues into CHEST as we move forward.
What do you consider to be CHEST’s greatest strength, and how will you build upon this during your presidency?
The strength of CHEST is in our community and our educational programs. Our emphasis is on delivering relevant information to our members in ways that are immediately clinically applicable – something I think we do better than anyone – to improve the care we’re able to provide to our patients. Through expanding our community and continuing to produce quality medical education, this will continue to be a focus for years to come.
What are some challenges facing CHEST, and how will you address them?
The challenges facing CHEST are the same challenges facing the whole of health care. Predominantly, providers and patients are both caught navigating complex health systems and insurance programs, costs of care, and access. The latter is particularly concerning for us as the burnout of health care providers has worsened, and people are leaving the clinical setting.
While there is no simple solution, CHEST has demonstrated commitments to making an impact through initiatives like First 5 Minutes®, which was created to address implicit bias, establish trust, and form a stronger connection between patients and their clinicians more quickly.
This will be a growing focus for CHEST, and it is reflected in the formal addition of social responsibility to our organizational pillars. The work being done in philanthropy and through our diversity, equity, inclusion, and belonging efforts will continue to develop and are now a core element of the organization.
And finally, what do you ask of the members and Fellows of CHEST to support you during your presidency?
I cannot stress enough that every person reading this should join the conversation. Meant to represent the whole of pulmonary, critical care, and sleep medicine clinicians, CHEST is stronger with every voice. Conveniently, an email address exists for this very purpose. The address [email protected] is a direct way to communicate with me, and I very much encourage you to take me up on this.
Let me know what you would like to see change in 2024 or what you think we’re doing well. I’d also like to hear if there is something neat you’re doing for the field; beyond my personal interest, CHEST loves to celebrate the accomplishments of members.
I look forward to elevating your voice and am truly elated to serve as the next President of CHEST.
Starting January 1, 2024, current President-Elect John “Jack” D. Buckley, MD, MPH, FCCP, will become the new President of CHEST. Dr. Buckley is a pulmonologist and critical care physician with an extensive background in education, and he has served on the Board of Regents for the College for 8 years collectively.
What would you like to accomplish as President of CHEST?
I mentioned this in my address during the CHEST Annual Meeting in Honolulu, but the role of President is to guide the Board of Regents as we provide governance and direct the organization to fulfill our mission. With that in mind, my job is to advance CHEST by following our strategic plan, continuing the great work already being done, and preparing for what comes next.
As our world changes around us, we must not only adapt to the current environment but anticipate the future and take the lead by influencing the direction we believe to be important. This is the role of the Board of Regents, and we need input from CHEST’s members.
In 2023, with the guidance of an advisory board, and a tremendous amount of time and effort encompassing input from a wide range of CHEST members, leaders and staff, the organization defined its core values. The values – Community, Inclusivity, Innovation, Advocacy, and Integrity – are reflective of the CHEST organization and will guide decisions for years to come.
While looking forward, it’s also important to reflect on the past. CHEST started as an organization centered on preventing and treating tuberculosis. As progress was made, the entire pulmonary field evolved from tuberculosis experts and, from there, critical care emerged and continues to evolve. Now we’re seeing tremendous growth in the roles of advanced practice providers in our ICUs and, most recently, a resurgence of cardiology-critical care. We are excited to welcome these colleagues into CHEST as we move forward.
What do you consider to be CHEST’s greatest strength, and how will you build upon this during your presidency?
The strength of CHEST is in our community and our educational programs. Our emphasis is on delivering relevant information to our members in ways that are immediately clinically applicable – something I think we do better than anyone – to improve the care we’re able to provide to our patients. Through expanding our community and continuing to produce quality medical education, this will continue to be a focus for years to come.
What are some challenges facing CHEST, and how will you address them?
The challenges facing CHEST are the same challenges facing the whole of health care. Predominantly, providers and patients are both caught navigating complex health systems and insurance programs, costs of care, and access. The latter is particularly concerning for us as the burnout of health care providers has worsened, and people are leaving the clinical setting.
While there is no simple solution, CHEST has demonstrated commitments to making an impact through initiatives like First 5 Minutes®, which was created to address implicit bias, establish trust, and form a stronger connection between patients and their clinicians more quickly.
This will be a growing focus for CHEST, and it is reflected in the formal addition of social responsibility to our organizational pillars. The work being done in philanthropy and through our diversity, equity, inclusion, and belonging efforts will continue to develop and are now a core element of the organization.
And finally, what do you ask of the members and Fellows of CHEST to support you during your presidency?
I cannot stress enough that every person reading this should join the conversation. Meant to represent the whole of pulmonary, critical care, and sleep medicine clinicians, CHEST is stronger with every voice. Conveniently, an email address exists for this very purpose. The address [email protected] is a direct way to communicate with me, and I very much encourage you to take me up on this.
Let me know what you would like to see change in 2024 or what you think we’re doing well. I’d also like to hear if there is something neat you’re doing for the field; beyond my personal interest, CHEST loves to celebrate the accomplishments of members.
I look forward to elevating your voice and am truly elated to serve as the next President of CHEST.
Starting January 1, 2024, current President-Elect John “Jack” D. Buckley, MD, MPH, FCCP, will become the new President of CHEST. Dr. Buckley is a pulmonologist and critical care physician with an extensive background in education, and he has served on the Board of Regents for the College for 8 years collectively.
What would you like to accomplish as President of CHEST?
I mentioned this in my address during the CHEST Annual Meeting in Honolulu, but the role of President is to guide the Board of Regents as we provide governance and direct the organization to fulfill our mission. With that in mind, my job is to advance CHEST by following our strategic plan, continuing the great work already being done, and preparing for what comes next.
As our world changes around us, we must not only adapt to the current environment but anticipate the future and take the lead by influencing the direction we believe to be important. This is the role of the Board of Regents, and we need input from CHEST’s members.
In 2023, with the guidance of an advisory board, and a tremendous amount of time and effort encompassing input from a wide range of CHEST members, leaders and staff, the organization defined its core values. The values – Community, Inclusivity, Innovation, Advocacy, and Integrity – are reflective of the CHEST organization and will guide decisions for years to come.
While looking forward, it’s also important to reflect on the past. CHEST started as an organization centered on preventing and treating tuberculosis. As progress was made, the entire pulmonary field evolved from tuberculosis experts and, from there, critical care emerged and continues to evolve. Now we’re seeing tremendous growth in the roles of advanced practice providers in our ICUs and, most recently, a resurgence of cardiology-critical care. We are excited to welcome these colleagues into CHEST as we move forward.
What do you consider to be CHEST’s greatest strength, and how will you build upon this during your presidency?
The strength of CHEST is in our community and our educational programs. Our emphasis is on delivering relevant information to our members in ways that are immediately clinically applicable – something I think we do better than anyone – to improve the care we’re able to provide to our patients. Through expanding our community and continuing to produce quality medical education, this will continue to be a focus for years to come.
What are some challenges facing CHEST, and how will you address them?
The challenges facing CHEST are the same challenges facing the whole of health care. Predominantly, providers and patients are both caught navigating complex health systems and insurance programs, costs of care, and access. The latter is particularly concerning for us as the burnout of health care providers has worsened, and people are leaving the clinical setting.
While there is no simple solution, CHEST has demonstrated commitments to making an impact through initiatives like First 5 Minutes®, which was created to address implicit bias, establish trust, and form a stronger connection between patients and their clinicians more quickly.
This will be a growing focus for CHEST, and it is reflected in the formal addition of social responsibility to our organizational pillars. The work being done in philanthropy and through our diversity, equity, inclusion, and belonging efforts will continue to develop and are now a core element of the organization.
And finally, what do you ask of the members and Fellows of CHEST to support you during your presidency?
I cannot stress enough that every person reading this should join the conversation. Meant to represent the whole of pulmonary, critical care, and sleep medicine clinicians, CHEST is stronger with every voice. Conveniently, an email address exists for this very purpose. The address [email protected] is a direct way to communicate with me, and I very much encourage you to take me up on this.
Let me know what you would like to see change in 2024 or what you think we’re doing well. I’d also like to hear if there is something neat you’re doing for the field; beyond my personal interest, CHEST loves to celebrate the accomplishments of members.
I look forward to elevating your voice and am truly elated to serve as the next President of CHEST.
New tests may finally diagnose long COVID
One of the biggest challenges facing clinicians who treat long COVID is a lack of consensus when it comes to recognizing and diagnosing the condition. But
Effective diagnostic testing would be a game-changer in the long COVID fight, for it’s not just the fatigue, brain fog, heart palpitations, and other persistent symptoms that affect patients. Two out of three people with long COVID also suffer mental health challenges like depression and anxiety. Some patients say their symptoms are not taken seriously by their doctors. And as many as 12% of long COVID patients are unemployed because of the severity of their illness and their employers may be skeptical of their condition.
Quick, accurate diagnosis would eliminate all that. Now a new preprint study suggests that the elevation of certain immune system proteins are a commonality in long COVID patients and identifying them may be an accurate way to diagnose the condition.
Researchers at Cardiff (Wales) University, tracked 166 patients, 79 of whom had been diagnosed with long COVID and 87 who had not. All participants had recovered from a severe bout of acute COVID-19.
In an analysis of the blood plasma of the study participants, researchers found elevated levels of certain components. Four proteins in particular – Ba, iC3b, C5a, and TCC – predicted the presence of long COVID with 78.5% accuracy.
“I was gobsmacked by the results. We’re seeing a massive dysregulation in those four biomarkers,” says study author Wioleta Zelek, PhD, a research fellow at Cardiff University. “It’s a combination that we showed was predictive of long COVID.”
The study revealed that long COVID was associated with inflammation of the immune system causing these complement proteins to remain dysregulated. Proteins like C3, C4, and C5 are important parts of the immune system because they recruit phagocytes, cells that attack and engulf bacteria and viruses at the site of infection to destroy pathogens like SARS-coV-2.
In the case of long COVID, these proteins remain chronically elevated. While the symptoms of long COVID have seemed largely unrelated to one another, researchers point to elevated inflammation as a connecting factor that causes various systems in the body to go haywire.
“Anything that could help to better diagnose patients with long COVID is research we’re greatly appreciative of within the clinical community,” said Nisha Viswanathan, MD, director of the University of California, Los Angeles, Long COVID program at UCLA Health.
Testing for biomarkers highlighted in the study, as well as others like serotonin and cortisol, may help doctors separate patients who have long COVID from patients who have similar symptoms caused by other conditions, said Dr. Viswanathan. For example, a recent study published in the journal Cell found lower serotonin levels in long COVID patients, compared with patients who were diagnosed with acute COVID-19 but recovered from the condition.
Dr. Viswanathan cautions that the biomarker test does not answer all the questions about diagnosing long COVID. For example, Dr. Viswanathan said scientists don’t know whether complement dysregulation is caused by long COVID and not another underlying medical issue that patients had prior to infection, because “we don’t know where patients’ levels were prior to developing long COVID.” For example, those with autoimmune issues are more likely to develop long COVID, which means their levels could have been elevated prior to a COVID infection.
It is increasingly likely, said Dr. Viswanathan, that long COVID is an umbrella term for a host of conditions that could be caused by different impacts of the virus. Other research has pointed to the different phenotypes of long COVID. For example, some are focused on cardiopulmonary issues and others on fatigue and gastrointestinal problems.
“It looks like these different phenotypes have a different mechanism for disease,” she said. This means that it’s less likely to be a one-size-fits-all condition and the next step in the research should be identifying which biomarker is aligned with which phenotype of the disease.
Better diagnostics will open the door to better treatments, Dr. Zelek said. The more doctors understand about the mechanism causing immune dysregulation in long COVID patients, the more they can treat it with existing medications. Dr. Zelek’s lab has been studying certain medications like pegcetacoplan (C3 blocker), danicopan (anti-factor D), and iptacopan (anti-factor B) that can be used to break the body’s cycle of inflammation and reduce symptoms experienced in those with long COVID.
These drugs are approved by the U.S. Food and Drug Administration for the treatment of a rare blood disease called paroxysmal nocturnal hemoglobinuria. The C5 inhibitor zilucoplan has also been used in patients hospitalized with COVID-19 and researchers have found that the drug lowered serum C5 and interleukin-8 concentration in the blood, seeming to reduce certain aspects of the immune system’s inflammatory response to the virus.
The Cardiff University research is one of the most detailed studies to highlight long COVID biomarkers to date, said infectious disease specialist Grace McComsey, MD, who leads the long COVID RECOVER study at University Hospitals Health System in Cleveland, Ohio. The research needs to be duplicated in a larger study population that might include the other biomarkers like serotonin and cortisol to see if they’re related, she said.
Researchers are learning more everyday about the various biomarkers that may be linked to long COVID, she added. This Cardiff study showed that a huge percentage of those patients had elevated levels of certain complements. The next step, said Dr. McComsey, “is to put all these puzzle pieces together” so that clinicians have a common diagnostic tool or tools that provide patients with some peace of mind in starting their road to recovery.
A version of this article first appeared on Medscape.com.
One of the biggest challenges facing clinicians who treat long COVID is a lack of consensus when it comes to recognizing and diagnosing the condition. But
Effective diagnostic testing would be a game-changer in the long COVID fight, for it’s not just the fatigue, brain fog, heart palpitations, and other persistent symptoms that affect patients. Two out of three people with long COVID also suffer mental health challenges like depression and anxiety. Some patients say their symptoms are not taken seriously by their doctors. And as many as 12% of long COVID patients are unemployed because of the severity of their illness and their employers may be skeptical of their condition.
Quick, accurate diagnosis would eliminate all that. Now a new preprint study suggests that the elevation of certain immune system proteins are a commonality in long COVID patients and identifying them may be an accurate way to diagnose the condition.
Researchers at Cardiff (Wales) University, tracked 166 patients, 79 of whom had been diagnosed with long COVID and 87 who had not. All participants had recovered from a severe bout of acute COVID-19.
In an analysis of the blood plasma of the study participants, researchers found elevated levels of certain components. Four proteins in particular – Ba, iC3b, C5a, and TCC – predicted the presence of long COVID with 78.5% accuracy.
“I was gobsmacked by the results. We’re seeing a massive dysregulation in those four biomarkers,” says study author Wioleta Zelek, PhD, a research fellow at Cardiff University. “It’s a combination that we showed was predictive of long COVID.”
The study revealed that long COVID was associated with inflammation of the immune system causing these complement proteins to remain dysregulated. Proteins like C3, C4, and C5 are important parts of the immune system because they recruit phagocytes, cells that attack and engulf bacteria and viruses at the site of infection to destroy pathogens like SARS-coV-2.
In the case of long COVID, these proteins remain chronically elevated. While the symptoms of long COVID have seemed largely unrelated to one another, researchers point to elevated inflammation as a connecting factor that causes various systems in the body to go haywire.
“Anything that could help to better diagnose patients with long COVID is research we’re greatly appreciative of within the clinical community,” said Nisha Viswanathan, MD, director of the University of California, Los Angeles, Long COVID program at UCLA Health.
Testing for biomarkers highlighted in the study, as well as others like serotonin and cortisol, may help doctors separate patients who have long COVID from patients who have similar symptoms caused by other conditions, said Dr. Viswanathan. For example, a recent study published in the journal Cell found lower serotonin levels in long COVID patients, compared with patients who were diagnosed with acute COVID-19 but recovered from the condition.
Dr. Viswanathan cautions that the biomarker test does not answer all the questions about diagnosing long COVID. For example, Dr. Viswanathan said scientists don’t know whether complement dysregulation is caused by long COVID and not another underlying medical issue that patients had prior to infection, because “we don’t know where patients’ levels were prior to developing long COVID.” For example, those with autoimmune issues are more likely to develop long COVID, which means their levels could have been elevated prior to a COVID infection.
It is increasingly likely, said Dr. Viswanathan, that long COVID is an umbrella term for a host of conditions that could be caused by different impacts of the virus. Other research has pointed to the different phenotypes of long COVID. For example, some are focused on cardiopulmonary issues and others on fatigue and gastrointestinal problems.
“It looks like these different phenotypes have a different mechanism for disease,” she said. This means that it’s less likely to be a one-size-fits-all condition and the next step in the research should be identifying which biomarker is aligned with which phenotype of the disease.
Better diagnostics will open the door to better treatments, Dr. Zelek said. The more doctors understand about the mechanism causing immune dysregulation in long COVID patients, the more they can treat it with existing medications. Dr. Zelek’s lab has been studying certain medications like pegcetacoplan (C3 blocker), danicopan (anti-factor D), and iptacopan (anti-factor B) that can be used to break the body’s cycle of inflammation and reduce symptoms experienced in those with long COVID.
These drugs are approved by the U.S. Food and Drug Administration for the treatment of a rare blood disease called paroxysmal nocturnal hemoglobinuria. The C5 inhibitor zilucoplan has also been used in patients hospitalized with COVID-19 and researchers have found that the drug lowered serum C5 and interleukin-8 concentration in the blood, seeming to reduce certain aspects of the immune system’s inflammatory response to the virus.
The Cardiff University research is one of the most detailed studies to highlight long COVID biomarkers to date, said infectious disease specialist Grace McComsey, MD, who leads the long COVID RECOVER study at University Hospitals Health System in Cleveland, Ohio. The research needs to be duplicated in a larger study population that might include the other biomarkers like serotonin and cortisol to see if they’re related, she said.
Researchers are learning more everyday about the various biomarkers that may be linked to long COVID, she added. This Cardiff study showed that a huge percentage of those patients had elevated levels of certain complements. The next step, said Dr. McComsey, “is to put all these puzzle pieces together” so that clinicians have a common diagnostic tool or tools that provide patients with some peace of mind in starting their road to recovery.
A version of this article first appeared on Medscape.com.
One of the biggest challenges facing clinicians who treat long COVID is a lack of consensus when it comes to recognizing and diagnosing the condition. But
Effective diagnostic testing would be a game-changer in the long COVID fight, for it’s not just the fatigue, brain fog, heart palpitations, and other persistent symptoms that affect patients. Two out of three people with long COVID also suffer mental health challenges like depression and anxiety. Some patients say their symptoms are not taken seriously by their doctors. And as many as 12% of long COVID patients are unemployed because of the severity of their illness and their employers may be skeptical of their condition.
Quick, accurate diagnosis would eliminate all that. Now a new preprint study suggests that the elevation of certain immune system proteins are a commonality in long COVID patients and identifying them may be an accurate way to diagnose the condition.
Researchers at Cardiff (Wales) University, tracked 166 patients, 79 of whom had been diagnosed with long COVID and 87 who had not. All participants had recovered from a severe bout of acute COVID-19.
In an analysis of the blood plasma of the study participants, researchers found elevated levels of certain components. Four proteins in particular – Ba, iC3b, C5a, and TCC – predicted the presence of long COVID with 78.5% accuracy.
“I was gobsmacked by the results. We’re seeing a massive dysregulation in those four biomarkers,” says study author Wioleta Zelek, PhD, a research fellow at Cardiff University. “It’s a combination that we showed was predictive of long COVID.”
The study revealed that long COVID was associated with inflammation of the immune system causing these complement proteins to remain dysregulated. Proteins like C3, C4, and C5 are important parts of the immune system because they recruit phagocytes, cells that attack and engulf bacteria and viruses at the site of infection to destroy pathogens like SARS-coV-2.
In the case of long COVID, these proteins remain chronically elevated. While the symptoms of long COVID have seemed largely unrelated to one another, researchers point to elevated inflammation as a connecting factor that causes various systems in the body to go haywire.
“Anything that could help to better diagnose patients with long COVID is research we’re greatly appreciative of within the clinical community,” said Nisha Viswanathan, MD, director of the University of California, Los Angeles, Long COVID program at UCLA Health.
Testing for biomarkers highlighted in the study, as well as others like serotonin and cortisol, may help doctors separate patients who have long COVID from patients who have similar symptoms caused by other conditions, said Dr. Viswanathan. For example, a recent study published in the journal Cell found lower serotonin levels in long COVID patients, compared with patients who were diagnosed with acute COVID-19 but recovered from the condition.
Dr. Viswanathan cautions that the biomarker test does not answer all the questions about diagnosing long COVID. For example, Dr. Viswanathan said scientists don’t know whether complement dysregulation is caused by long COVID and not another underlying medical issue that patients had prior to infection, because “we don’t know where patients’ levels were prior to developing long COVID.” For example, those with autoimmune issues are more likely to develop long COVID, which means their levels could have been elevated prior to a COVID infection.
It is increasingly likely, said Dr. Viswanathan, that long COVID is an umbrella term for a host of conditions that could be caused by different impacts of the virus. Other research has pointed to the different phenotypes of long COVID. For example, some are focused on cardiopulmonary issues and others on fatigue and gastrointestinal problems.
“It looks like these different phenotypes have a different mechanism for disease,” she said. This means that it’s less likely to be a one-size-fits-all condition and the next step in the research should be identifying which biomarker is aligned with which phenotype of the disease.
Better diagnostics will open the door to better treatments, Dr. Zelek said. The more doctors understand about the mechanism causing immune dysregulation in long COVID patients, the more they can treat it with existing medications. Dr. Zelek’s lab has been studying certain medications like pegcetacoplan (C3 blocker), danicopan (anti-factor D), and iptacopan (anti-factor B) that can be used to break the body’s cycle of inflammation and reduce symptoms experienced in those with long COVID.
These drugs are approved by the U.S. Food and Drug Administration for the treatment of a rare blood disease called paroxysmal nocturnal hemoglobinuria. The C5 inhibitor zilucoplan has also been used in patients hospitalized with COVID-19 and researchers have found that the drug lowered serum C5 and interleukin-8 concentration in the blood, seeming to reduce certain aspects of the immune system’s inflammatory response to the virus.
The Cardiff University research is one of the most detailed studies to highlight long COVID biomarkers to date, said infectious disease specialist Grace McComsey, MD, who leads the long COVID RECOVER study at University Hospitals Health System in Cleveland, Ohio. The research needs to be duplicated in a larger study population that might include the other biomarkers like serotonin and cortisol to see if they’re related, she said.
Researchers are learning more everyday about the various biomarkers that may be linked to long COVID, she added. This Cardiff study showed that a huge percentage of those patients had elevated levels of certain complements. The next step, said Dr. McComsey, “is to put all these puzzle pieces together” so that clinicians have a common diagnostic tool or tools that provide patients with some peace of mind in starting their road to recovery.
A version of this article first appeared on Medscape.com.
FROM MEDRXIV
“A physician’s secret weapon”: Why the world needs more RTs
CHEST and the National Board for Respiratory Care (NBRC) are continuing their longstanding partnership to raise awareness about the More RTs initiative, which addresses the alarming shortage of respiratory therapists (RTs) in the United States.
A survey from the American Association for Respiratory Care showed several factors driving the need for more RTs, including an aging U.S. population, growing incidences of respiratory disorders, and advances in pulmonary medical devices.
But the squeeze is coming from both internal and external forces. Retirements of RTs are outpacing new growth, while, at the same time, the need for quality respiratory care is increasing. Simply put, demand for RTs is high but the supply of RTs is dangerously low.
Lori Tinkler, Executive Officer of the NBRC, said physicians can make a difference in increasing the number of RTs and championing their success on the clinical care team. Tinkler recently shared her insights on the initiative and how physicians can get involved.
CHEST: Respiratory therapists are extremely valuable members of the clinical care team. Can you share why RTs are so important?
Lori Tinkler: I like to say respiratory therapists are a physician’s secret weapon. Respiratory therapists work under the direction of a medical director.
They really carry out the orders of physicians and help the physician determine the best pathway for patients using protocols. They [serve as] experts when it comes to ventilators and treating the patients for their pulmonary issues under the physician’s orders.
CHEST: How can physicians get more done with more RTs on the clinical team?
Tinkler: By working with protocols and relying on their respiratory therapists. Listen to what they’re saying when it comes to patient care since respiratory therapists are spending much more time with the patients than the physicians are.
It’s really the whole health care team working together with the patient. What [physicians can] keep in mind is, how are they going treat that patient the best and utilize the expertise that respiratory therapists bring to the table? They probably have the most diverse skillset, but they are highly trained and specialized in lung diseases and treatment of asthma and COPD.
CHEST: How can physicians help integrate RTs into the clinical team?
Tinkler: It’s really ensuring that their institutions recognize the value of respiratory therapists and what they bring to the table. Ensuring that their departments are adequately staffed and championing that effort, speaking up, and being a voice for the respiratory therapist and what they bring to the bedside.
CHEST: How else can physicians get involved?
Tinkler: We’re always looking for physician stories about how they utilize and champion their respiratory therapist. And, of course, we’re always looking for physicians to get involved in the credentialing process by being a consultant or board member, or by being a content expert and helping write the test questions for the respiratory therapy credentialing exams.
CHEST and the National Board for Respiratory Care (NBRC) are continuing their longstanding partnership to raise awareness about the More RTs initiative, which addresses the alarming shortage of respiratory therapists (RTs) in the United States.
A survey from the American Association for Respiratory Care showed several factors driving the need for more RTs, including an aging U.S. population, growing incidences of respiratory disorders, and advances in pulmonary medical devices.
But the squeeze is coming from both internal and external forces. Retirements of RTs are outpacing new growth, while, at the same time, the need for quality respiratory care is increasing. Simply put, demand for RTs is high but the supply of RTs is dangerously low.
Lori Tinkler, Executive Officer of the NBRC, said physicians can make a difference in increasing the number of RTs and championing their success on the clinical care team. Tinkler recently shared her insights on the initiative and how physicians can get involved.
CHEST: Respiratory therapists are extremely valuable members of the clinical care team. Can you share why RTs are so important?
Lori Tinkler: I like to say respiratory therapists are a physician’s secret weapon. Respiratory therapists work under the direction of a medical director.
They really carry out the orders of physicians and help the physician determine the best pathway for patients using protocols. They [serve as] experts when it comes to ventilators and treating the patients for their pulmonary issues under the physician’s orders.
CHEST: How can physicians get more done with more RTs on the clinical team?
Tinkler: By working with protocols and relying on their respiratory therapists. Listen to what they’re saying when it comes to patient care since respiratory therapists are spending much more time with the patients than the physicians are.
It’s really the whole health care team working together with the patient. What [physicians can] keep in mind is, how are they going treat that patient the best and utilize the expertise that respiratory therapists bring to the table? They probably have the most diverse skillset, but they are highly trained and specialized in lung diseases and treatment of asthma and COPD.
CHEST: How can physicians help integrate RTs into the clinical team?
Tinkler: It’s really ensuring that their institutions recognize the value of respiratory therapists and what they bring to the table. Ensuring that their departments are adequately staffed and championing that effort, speaking up, and being a voice for the respiratory therapist and what they bring to the bedside.
CHEST: How else can physicians get involved?
Tinkler: We’re always looking for physician stories about how they utilize and champion their respiratory therapist. And, of course, we’re always looking for physicians to get involved in the credentialing process by being a consultant or board member, or by being a content expert and helping write the test questions for the respiratory therapy credentialing exams.
CHEST and the National Board for Respiratory Care (NBRC) are continuing their longstanding partnership to raise awareness about the More RTs initiative, which addresses the alarming shortage of respiratory therapists (RTs) in the United States.
A survey from the American Association for Respiratory Care showed several factors driving the need for more RTs, including an aging U.S. population, growing incidences of respiratory disorders, and advances in pulmonary medical devices.
But the squeeze is coming from both internal and external forces. Retirements of RTs are outpacing new growth, while, at the same time, the need for quality respiratory care is increasing. Simply put, demand for RTs is high but the supply of RTs is dangerously low.
Lori Tinkler, Executive Officer of the NBRC, said physicians can make a difference in increasing the number of RTs and championing their success on the clinical care team. Tinkler recently shared her insights on the initiative and how physicians can get involved.
CHEST: Respiratory therapists are extremely valuable members of the clinical care team. Can you share why RTs are so important?
Lori Tinkler: I like to say respiratory therapists are a physician’s secret weapon. Respiratory therapists work under the direction of a medical director.
They really carry out the orders of physicians and help the physician determine the best pathway for patients using protocols. They [serve as] experts when it comes to ventilators and treating the patients for their pulmonary issues under the physician’s orders.
CHEST: How can physicians get more done with more RTs on the clinical team?
Tinkler: By working with protocols and relying on their respiratory therapists. Listen to what they’re saying when it comes to patient care since respiratory therapists are spending much more time with the patients than the physicians are.
It’s really the whole health care team working together with the patient. What [physicians can] keep in mind is, how are they going treat that patient the best and utilize the expertise that respiratory therapists bring to the table? They probably have the most diverse skillset, but they are highly trained and specialized in lung diseases and treatment of asthma and COPD.
CHEST: How can physicians help integrate RTs into the clinical team?
Tinkler: It’s really ensuring that their institutions recognize the value of respiratory therapists and what they bring to the table. Ensuring that their departments are adequately staffed and championing that effort, speaking up, and being a voice for the respiratory therapist and what they bring to the bedside.
CHEST: How else can physicians get involved?
Tinkler: We’re always looking for physician stories about how they utilize and champion their respiratory therapist. And, of course, we’re always looking for physicians to get involved in the credentialing process by being a consultant or board member, or by being a content expert and helping write the test questions for the respiratory therapy credentialing exams.
CHEST 2023 award winners
Each year, , through their commitment to educating the next generation, and so much more.
MASTER FELLOW AWARD
John E. Studdard, MD, FCCP
Masters of CHEST are national or international Fellows of CHEST who have distinguished themselves by attaining professional preeminence. Because of their personal character and leadership; extraordinary contributions to medical research, clinical practice, quality improvement, or medical education; and years of enduring and outstanding service to CHEST, they have advanced chest medicine
DISTINGUISHED SERVICE AWARD
Victor J. Test, MD, FCCP
This award is conferred to a CHEST Fellow (FCCP) who has held a CHEST leadership position; has led significant society achievements; and/or has donated time, leadership, and service to CHEST.
COLLEGE MEDALIST AWARD
Steven D. Nathan, MBBCh, FCCP
The College Medalist Award is a long-standing CHEST tradition. This award is given for meritorious service in furthering progress in the field of diseases of the chest.
EARLY CAREER CLINICIAN EDUCATOR AWARD
Viren Kaul, MD, FCCP
The Early Career Clinician Educator Award recognizes the achievements of a clinician educator who has already made significant contributions to CHEST educational activities and is committed to continuing to grow as CHEST faculty.
MASTER CLINICIAN EDUCATOR AWARD
Christopher L. Carroll, MD, FCCP
The Master Clinician Educator Award recognizes long-term achievements of one clinician educator who has made significant contributions to CHEST activities and has demonstrated a strong commitment to medical education throughout their career.
ALFRED SOFFER AWARD FOR EDITORIAL EXCELLENCE
Laura Riordan
This award honors Alfred Soffer, MD, Master FCCP, Editor-in-Chief of the journal CHEST® from 1968 to 1993, and Executive Director of CHEST from 1969 to 1992. Recipients have made significant contributions to CHEST and are often world experts in their fields, have written numerous papers and abstracts, have served as primary investigators, and/or have served as a department editor for the journal CHEST.
PRESIDENTIAL CITATION
Scott Manaker, MD, PhD, FCCP
The Presidential Citation is awarded on behalf of the CHEST President to individuals who have shown their dedication to the chest medicine field and for their contributions to CHEST.
For a comprehensive list of Distinguished CHEST Educators, new FCCP designees, and scientific abstract award winners, visit chestnet.org/awards.
Each year, , through their commitment to educating the next generation, and so much more.
MASTER FELLOW AWARD
John E. Studdard, MD, FCCP
Masters of CHEST are national or international Fellows of CHEST who have distinguished themselves by attaining professional preeminence. Because of their personal character and leadership; extraordinary contributions to medical research, clinical practice, quality improvement, or medical education; and years of enduring and outstanding service to CHEST, they have advanced chest medicine
DISTINGUISHED SERVICE AWARD
Victor J. Test, MD, FCCP
This award is conferred to a CHEST Fellow (FCCP) who has held a CHEST leadership position; has led significant society achievements; and/or has donated time, leadership, and service to CHEST.
COLLEGE MEDALIST AWARD
Steven D. Nathan, MBBCh, FCCP
The College Medalist Award is a long-standing CHEST tradition. This award is given for meritorious service in furthering progress in the field of diseases of the chest.
EARLY CAREER CLINICIAN EDUCATOR AWARD
Viren Kaul, MD, FCCP
The Early Career Clinician Educator Award recognizes the achievements of a clinician educator who has already made significant contributions to CHEST educational activities and is committed to continuing to grow as CHEST faculty.
MASTER CLINICIAN EDUCATOR AWARD
Christopher L. Carroll, MD, FCCP
The Master Clinician Educator Award recognizes long-term achievements of one clinician educator who has made significant contributions to CHEST activities and has demonstrated a strong commitment to medical education throughout their career.
ALFRED SOFFER AWARD FOR EDITORIAL EXCELLENCE
Laura Riordan
This award honors Alfred Soffer, MD, Master FCCP, Editor-in-Chief of the journal CHEST® from 1968 to 1993, and Executive Director of CHEST from 1969 to 1992. Recipients have made significant contributions to CHEST and are often world experts in their fields, have written numerous papers and abstracts, have served as primary investigators, and/or have served as a department editor for the journal CHEST.
PRESIDENTIAL CITATION
Scott Manaker, MD, PhD, FCCP
The Presidential Citation is awarded on behalf of the CHEST President to individuals who have shown their dedication to the chest medicine field and for their contributions to CHEST.
For a comprehensive list of Distinguished CHEST Educators, new FCCP designees, and scientific abstract award winners, visit chestnet.org/awards.
Each year, , through their commitment to educating the next generation, and so much more.
MASTER FELLOW AWARD
John E. Studdard, MD, FCCP
Masters of CHEST are national or international Fellows of CHEST who have distinguished themselves by attaining professional preeminence. Because of their personal character and leadership; extraordinary contributions to medical research, clinical practice, quality improvement, or medical education; and years of enduring and outstanding service to CHEST, they have advanced chest medicine
DISTINGUISHED SERVICE AWARD
Victor J. Test, MD, FCCP
This award is conferred to a CHEST Fellow (FCCP) who has held a CHEST leadership position; has led significant society achievements; and/or has donated time, leadership, and service to CHEST.
COLLEGE MEDALIST AWARD
Steven D. Nathan, MBBCh, FCCP
The College Medalist Award is a long-standing CHEST tradition. This award is given for meritorious service in furthering progress in the field of diseases of the chest.
EARLY CAREER CLINICIAN EDUCATOR AWARD
Viren Kaul, MD, FCCP
The Early Career Clinician Educator Award recognizes the achievements of a clinician educator who has already made significant contributions to CHEST educational activities and is committed to continuing to grow as CHEST faculty.
MASTER CLINICIAN EDUCATOR AWARD
Christopher L. Carroll, MD, FCCP
The Master Clinician Educator Award recognizes long-term achievements of one clinician educator who has made significant contributions to CHEST activities and has demonstrated a strong commitment to medical education throughout their career.
ALFRED SOFFER AWARD FOR EDITORIAL EXCELLENCE
Laura Riordan
This award honors Alfred Soffer, MD, Master FCCP, Editor-in-Chief of the journal CHEST® from 1968 to 1993, and Executive Director of CHEST from 1969 to 1992. Recipients have made significant contributions to CHEST and are often world experts in their fields, have written numerous papers and abstracts, have served as primary investigators, and/or have served as a department editor for the journal CHEST.
PRESIDENTIAL CITATION
Scott Manaker, MD, PhD, FCCP
The Presidential Citation is awarded on behalf of the CHEST President to individuals who have shown their dedication to the chest medicine field and for their contributions to CHEST.
For a comprehensive list of Distinguished CHEST Educators, new FCCP designees, and scientific abstract award winners, visit chestnet.org/awards.
Underdiagnosed: Iron deficiency anemia during pregnancy
Jerome J. Federspiel, MD, often cares for patients who are about to deliver a baby but who have untreated iron deficiency anemia (IDA). Often, these patients require a blood transfusion after giving birth.
“I am sad to hear commonly from patients we treat that they have had iron-deficient anemia symptoms for many years. Correcting these conditions makes birth safer and, oftentimes, makes people feel much better – sometimes better than they have in years,” Dr. Federspiel, maternal-fetal medicine physician and assistant professor of obstetrics and gynecology and population health sciences at Duke University, Durham, N.C., said.
Even patients he is able to diagnose earlier “will have difficulties catching up during pregnancy.”
The condition is the most common type of anemia among people who are pregnant. IDA increases a patient’s risk of delivering preterm and developing postpartum depression and puts their infants at a risk for perinatal mortality. Without proper treatment of IDA throughout pregnancy, the condition can also lead to low birth weights in infants or failing to meet weight goals later on.
But of all women with a new diagnosis of IDA from 2021 to 2022, 10% were pregnant, according to an analysis by Komodo Health, a health care analytics company.
While estimates of the prevalence of IDA vary, research from 2021 found 6.5% of nearly 1,500 patients who were pregnant during the first trimester had the condition, a figure the researchers said might underrepresent the problem.
“In severe cases [fetal outcomes can include] abnormal fetal oxygenation, nonreassuring fetal heart rate patterns, reduced amniotic fluid volume, fetal cerebral vasodilation, and fetal death,” Alianne S. Tilley, NP, family nurse practitioner at Women’s Care of Lake Cumberland, Somerset, Ky., said.
Research has shown that adequate levels of iron are an integral component in the development of the fetal brain. Some studies have reported that IDA during pregnancy increases an infant’s risk for poor neurodevelopmental outcomes.
Lack of screening protocol
Discrepancies in guidance for testing patients who are pregnant for IDA may add to late diagnosis and low treatment, according to Katelin Zahn, MD, assistant professor of general obstetrics, gynecology, and midwifery at University of North Carolina at Chapel Hill.
“There’s no consistency, which leads to a lot of variation in individual practice, which creates variation in outcomes, too,” Dr. Zahn said. “You can only do so much as one independent physician, and you need to be able to create change in a system that functions and provides standard of care even when you aren’t there.”
The American College of Obstetricians and Gynecologists recommends screening all patients who are pregnant with a complete blood count in the first trimester and again between 24 and 27 weeks of gestation.
Patients who meet criteria for IDA based on hematocrit levels less than 33% in the first and third trimesters, and less than 32% in the second trimester, should be evaluated to determine the cause. Those with IDA should be treated with supplemental iron, in addition to prenatal vitamins, ACOG says.
But the U.S. Preventive Services Task Force in 2015 found insufficient evidence to recommend for or against screening patients without symptoms or signs of the condition. The organization is in the process of updating the recommendation.
Prevention as best practice
The most effective way to address IDA in patients who are pregnant is prevention, according to Dr. Federspiel.
“Having a systematic approach to screening and treatment is really important, and this starts before pregnancy,” Dr. Federspiel said. “On average, a typical pregnancy requires an additional 1 g of iron.”
Dr. Federspiel recommends clinicians discuss the causes and the effects of IDA with patients who are planning to or could become pregnant. Clinicians might recommend iron- and folate-rich foods and vitamins B12 and C and ask patients if they face any barriers to access.
“Prenatal vitamins with iron are the gold standard in preventing IDA in the pregnant population,” Ms. Tilley said. “Education on the significant risk factors associated with IDA in early pregnancy is key.”
A version of this article first appeared on Medscape.com.
Jerome J. Federspiel, MD, often cares for patients who are about to deliver a baby but who have untreated iron deficiency anemia (IDA). Often, these patients require a blood transfusion after giving birth.
“I am sad to hear commonly from patients we treat that they have had iron-deficient anemia symptoms for many years. Correcting these conditions makes birth safer and, oftentimes, makes people feel much better – sometimes better than they have in years,” Dr. Federspiel, maternal-fetal medicine physician and assistant professor of obstetrics and gynecology and population health sciences at Duke University, Durham, N.C., said.
Even patients he is able to diagnose earlier “will have difficulties catching up during pregnancy.”
The condition is the most common type of anemia among people who are pregnant. IDA increases a patient’s risk of delivering preterm and developing postpartum depression and puts their infants at a risk for perinatal mortality. Without proper treatment of IDA throughout pregnancy, the condition can also lead to low birth weights in infants or failing to meet weight goals later on.
But of all women with a new diagnosis of IDA from 2021 to 2022, 10% were pregnant, according to an analysis by Komodo Health, a health care analytics company.
While estimates of the prevalence of IDA vary, research from 2021 found 6.5% of nearly 1,500 patients who were pregnant during the first trimester had the condition, a figure the researchers said might underrepresent the problem.
“In severe cases [fetal outcomes can include] abnormal fetal oxygenation, nonreassuring fetal heart rate patterns, reduced amniotic fluid volume, fetal cerebral vasodilation, and fetal death,” Alianne S. Tilley, NP, family nurse practitioner at Women’s Care of Lake Cumberland, Somerset, Ky., said.
Research has shown that adequate levels of iron are an integral component in the development of the fetal brain. Some studies have reported that IDA during pregnancy increases an infant’s risk for poor neurodevelopmental outcomes.
Lack of screening protocol
Discrepancies in guidance for testing patients who are pregnant for IDA may add to late diagnosis and low treatment, according to Katelin Zahn, MD, assistant professor of general obstetrics, gynecology, and midwifery at University of North Carolina at Chapel Hill.
“There’s no consistency, which leads to a lot of variation in individual practice, which creates variation in outcomes, too,” Dr. Zahn said. “You can only do so much as one independent physician, and you need to be able to create change in a system that functions and provides standard of care even when you aren’t there.”
The American College of Obstetricians and Gynecologists recommends screening all patients who are pregnant with a complete blood count in the first trimester and again between 24 and 27 weeks of gestation.
Patients who meet criteria for IDA based on hematocrit levels less than 33% in the first and third trimesters, and less than 32% in the second trimester, should be evaluated to determine the cause. Those with IDA should be treated with supplemental iron, in addition to prenatal vitamins, ACOG says.
But the U.S. Preventive Services Task Force in 2015 found insufficient evidence to recommend for or against screening patients without symptoms or signs of the condition. The organization is in the process of updating the recommendation.
Prevention as best practice
The most effective way to address IDA in patients who are pregnant is prevention, according to Dr. Federspiel.
“Having a systematic approach to screening and treatment is really important, and this starts before pregnancy,” Dr. Federspiel said. “On average, a typical pregnancy requires an additional 1 g of iron.”
Dr. Federspiel recommends clinicians discuss the causes and the effects of IDA with patients who are planning to or could become pregnant. Clinicians might recommend iron- and folate-rich foods and vitamins B12 and C and ask patients if they face any barriers to access.
“Prenatal vitamins with iron are the gold standard in preventing IDA in the pregnant population,” Ms. Tilley said. “Education on the significant risk factors associated with IDA in early pregnancy is key.”
A version of this article first appeared on Medscape.com.
Jerome J. Federspiel, MD, often cares for patients who are about to deliver a baby but who have untreated iron deficiency anemia (IDA). Often, these patients require a blood transfusion after giving birth.
“I am sad to hear commonly from patients we treat that they have had iron-deficient anemia symptoms for many years. Correcting these conditions makes birth safer and, oftentimes, makes people feel much better – sometimes better than they have in years,” Dr. Federspiel, maternal-fetal medicine physician and assistant professor of obstetrics and gynecology and population health sciences at Duke University, Durham, N.C., said.
Even patients he is able to diagnose earlier “will have difficulties catching up during pregnancy.”
The condition is the most common type of anemia among people who are pregnant. IDA increases a patient’s risk of delivering preterm and developing postpartum depression and puts their infants at a risk for perinatal mortality. Without proper treatment of IDA throughout pregnancy, the condition can also lead to low birth weights in infants or failing to meet weight goals later on.
But of all women with a new diagnosis of IDA from 2021 to 2022, 10% were pregnant, according to an analysis by Komodo Health, a health care analytics company.
While estimates of the prevalence of IDA vary, research from 2021 found 6.5% of nearly 1,500 patients who were pregnant during the first trimester had the condition, a figure the researchers said might underrepresent the problem.
“In severe cases [fetal outcomes can include] abnormal fetal oxygenation, nonreassuring fetal heart rate patterns, reduced amniotic fluid volume, fetal cerebral vasodilation, and fetal death,” Alianne S. Tilley, NP, family nurse practitioner at Women’s Care of Lake Cumberland, Somerset, Ky., said.
Research has shown that adequate levels of iron are an integral component in the development of the fetal brain. Some studies have reported that IDA during pregnancy increases an infant’s risk for poor neurodevelopmental outcomes.
Lack of screening protocol
Discrepancies in guidance for testing patients who are pregnant for IDA may add to late diagnosis and low treatment, according to Katelin Zahn, MD, assistant professor of general obstetrics, gynecology, and midwifery at University of North Carolina at Chapel Hill.
“There’s no consistency, which leads to a lot of variation in individual practice, which creates variation in outcomes, too,” Dr. Zahn said. “You can only do so much as one independent physician, and you need to be able to create change in a system that functions and provides standard of care even when you aren’t there.”
The American College of Obstetricians and Gynecologists recommends screening all patients who are pregnant with a complete blood count in the first trimester and again between 24 and 27 weeks of gestation.
Patients who meet criteria for IDA based on hematocrit levels less than 33% in the first and third trimesters, and less than 32% in the second trimester, should be evaluated to determine the cause. Those with IDA should be treated with supplemental iron, in addition to prenatal vitamins, ACOG says.
But the U.S. Preventive Services Task Force in 2015 found insufficient evidence to recommend for or against screening patients without symptoms or signs of the condition. The organization is in the process of updating the recommendation.
Prevention as best practice
The most effective way to address IDA in patients who are pregnant is prevention, according to Dr. Federspiel.
“Having a systematic approach to screening and treatment is really important, and this starts before pregnancy,” Dr. Federspiel said. “On average, a typical pregnancy requires an additional 1 g of iron.”
Dr. Federspiel recommends clinicians discuss the causes and the effects of IDA with patients who are planning to or could become pregnant. Clinicians might recommend iron- and folate-rich foods and vitamins B12 and C and ask patients if they face any barriers to access.
“Prenatal vitamins with iron are the gold standard in preventing IDA in the pregnant population,” Ms. Tilley said. “Education on the significant risk factors associated with IDA in early pregnancy is key.”
A version of this article first appeared on Medscape.com.
Avoid anti-HER2 cancer therapies during pregnancy
TOPLINE:
, according to a recent analysis.
METHODOLOGY:
- Current guidelines do not recommend treating pregnant women with trastuzumab, given documented safety concerns. Other anti-HER2 agents are also discouraged in this setting because of a lack of safety data. However, when considering the efficacy of these drugs in HER2-positive breast cancer, having a better understanding of the potential toxicities in pregnant patients is important.
- In the current case-control analysis, the team explored the risk for adverse effects among pregnant women exposed to anti-HER2 agents vs other anticancer drugs.
- The researchers leveraged the World Health Organization’s pharmacovigilance database, VigiBase, to identify reports with at least one pregnancy-related complication and one suspected anticancer drug.
- The researchers classified exposure to the drugs as occurring before pregnancy, during pregnancy, or via breast milk, semen, or skin. The team then examined 30 maternal and fetal or neonatal adverse outcomes and grouped them into seven categories: abortions, stillbirths, congenital malformations, pregnancy complications, preterm birth, neonatal complications, and delivery complications.
- The most used anti-HER2 agent was trastuzumab (n = 302), followed by pertuzumab (n = 55), trastuzumab-emtansine (n = 20), and lapatinib (n = 18).
TAKEAWAY:
- Among 3,558 reports included in the analysis, 328 patients were exposed to anti-HER2 drugs compared with 3,230 patients who received other anticancer agents.
- Pregnancy, fetal, or newborn adverse outcomes were reported in 61.3% of women treated with anti-HER2 agents and 56.3% of those receiving other anticancer drugs.
- The five most frequently reported complications in the anti-HER2 group were oligohydramnios (23.8%), preterm birth (17.4%), intrauterine growth restriction (9.8%), neonatal respiratory disorder (7.3%), and spontaneous abortion (7.3%).
- Adverse outcomes overreported in women who received anti-HER2 agents included oligohydramnios (reporting odds ratio [ROR], 17.68), congenital tract disorders (ROR, 9.98), and neonatal kidney failure (ROR, 9.15). Cardiovascular malformations were also overreported among women receiving trastuzumab-emtansine (ROR, 4.46), as were intrauterine growth restrictions for those treated with lapatinib (ROR, 7.68).
IN PRACTICE:
Exposure to anti-HER2 agents was associated with “severe specific adverse pregnancy and fetal or newborn outcomes compared with exposure to other anticancer treatments,” with a “strong, highly significant overreporting of congenital respiratory tract disorders and neonatal kidney failure,” which can lead to oligohydramnios, the authors wrote. The authors also noted that when delaying anti-HER2 therapy is not possible, it’s imperative to monitor patients closely for oligohydramnios.
SOURCE:
The study, led by Paul Gougis, MD, Institut Curie Centre de Recherche, Paris, , was published online in JAMA Network Open.
LIMITATIONS:
Potential inconsistencies in the collection of pharmacovigilance data could limit the generalizability of the results in the general population. The group of women exposed to other anticancer therapies may also constitute a different patient population from that given anti-HER2 therapies.
DISCLOSURES:
Coauthor Jean-Philippe Spano, MD, PhD, declared relationships Gilead, AstraZeneca, Lilly, Pfizer, Novartis, Daiichi Sankyo, and GSK.
A version of this article appeared on Medscape.com.
TOPLINE:
, according to a recent analysis.
METHODOLOGY:
- Current guidelines do not recommend treating pregnant women with trastuzumab, given documented safety concerns. Other anti-HER2 agents are also discouraged in this setting because of a lack of safety data. However, when considering the efficacy of these drugs in HER2-positive breast cancer, having a better understanding of the potential toxicities in pregnant patients is important.
- In the current case-control analysis, the team explored the risk for adverse effects among pregnant women exposed to anti-HER2 agents vs other anticancer drugs.
- The researchers leveraged the World Health Organization’s pharmacovigilance database, VigiBase, to identify reports with at least one pregnancy-related complication and one suspected anticancer drug.
- The researchers classified exposure to the drugs as occurring before pregnancy, during pregnancy, or via breast milk, semen, or skin. The team then examined 30 maternal and fetal or neonatal adverse outcomes and grouped them into seven categories: abortions, stillbirths, congenital malformations, pregnancy complications, preterm birth, neonatal complications, and delivery complications.
- The most used anti-HER2 agent was trastuzumab (n = 302), followed by pertuzumab (n = 55), trastuzumab-emtansine (n = 20), and lapatinib (n = 18).
TAKEAWAY:
- Among 3,558 reports included in the analysis, 328 patients were exposed to anti-HER2 drugs compared with 3,230 patients who received other anticancer agents.
- Pregnancy, fetal, or newborn adverse outcomes were reported in 61.3% of women treated with anti-HER2 agents and 56.3% of those receiving other anticancer drugs.
- The five most frequently reported complications in the anti-HER2 group were oligohydramnios (23.8%), preterm birth (17.4%), intrauterine growth restriction (9.8%), neonatal respiratory disorder (7.3%), and spontaneous abortion (7.3%).
- Adverse outcomes overreported in women who received anti-HER2 agents included oligohydramnios (reporting odds ratio [ROR], 17.68), congenital tract disorders (ROR, 9.98), and neonatal kidney failure (ROR, 9.15). Cardiovascular malformations were also overreported among women receiving trastuzumab-emtansine (ROR, 4.46), as were intrauterine growth restrictions for those treated with lapatinib (ROR, 7.68).
IN PRACTICE:
Exposure to anti-HER2 agents was associated with “severe specific adverse pregnancy and fetal or newborn outcomes compared with exposure to other anticancer treatments,” with a “strong, highly significant overreporting of congenital respiratory tract disorders and neonatal kidney failure,” which can lead to oligohydramnios, the authors wrote. The authors also noted that when delaying anti-HER2 therapy is not possible, it’s imperative to monitor patients closely for oligohydramnios.
SOURCE:
The study, led by Paul Gougis, MD, Institut Curie Centre de Recherche, Paris, , was published online in JAMA Network Open.
LIMITATIONS:
Potential inconsistencies in the collection of pharmacovigilance data could limit the generalizability of the results in the general population. The group of women exposed to other anticancer therapies may also constitute a different patient population from that given anti-HER2 therapies.
DISCLOSURES:
Coauthor Jean-Philippe Spano, MD, PhD, declared relationships Gilead, AstraZeneca, Lilly, Pfizer, Novartis, Daiichi Sankyo, and GSK.
A version of this article appeared on Medscape.com.
TOPLINE:
, according to a recent analysis.
METHODOLOGY:
- Current guidelines do not recommend treating pregnant women with trastuzumab, given documented safety concerns. Other anti-HER2 agents are also discouraged in this setting because of a lack of safety data. However, when considering the efficacy of these drugs in HER2-positive breast cancer, having a better understanding of the potential toxicities in pregnant patients is important.
- In the current case-control analysis, the team explored the risk for adverse effects among pregnant women exposed to anti-HER2 agents vs other anticancer drugs.
- The researchers leveraged the World Health Organization’s pharmacovigilance database, VigiBase, to identify reports with at least one pregnancy-related complication and one suspected anticancer drug.
- The researchers classified exposure to the drugs as occurring before pregnancy, during pregnancy, or via breast milk, semen, or skin. The team then examined 30 maternal and fetal or neonatal adverse outcomes and grouped them into seven categories: abortions, stillbirths, congenital malformations, pregnancy complications, preterm birth, neonatal complications, and delivery complications.
- The most used anti-HER2 agent was trastuzumab (n = 302), followed by pertuzumab (n = 55), trastuzumab-emtansine (n = 20), and lapatinib (n = 18).
TAKEAWAY:
- Among 3,558 reports included in the analysis, 328 patients were exposed to anti-HER2 drugs compared with 3,230 patients who received other anticancer agents.
- Pregnancy, fetal, or newborn adverse outcomes were reported in 61.3% of women treated with anti-HER2 agents and 56.3% of those receiving other anticancer drugs.
- The five most frequently reported complications in the anti-HER2 group were oligohydramnios (23.8%), preterm birth (17.4%), intrauterine growth restriction (9.8%), neonatal respiratory disorder (7.3%), and spontaneous abortion (7.3%).
- Adverse outcomes overreported in women who received anti-HER2 agents included oligohydramnios (reporting odds ratio [ROR], 17.68), congenital tract disorders (ROR, 9.98), and neonatal kidney failure (ROR, 9.15). Cardiovascular malformations were also overreported among women receiving trastuzumab-emtansine (ROR, 4.46), as were intrauterine growth restrictions for those treated with lapatinib (ROR, 7.68).
IN PRACTICE:
Exposure to anti-HER2 agents was associated with “severe specific adverse pregnancy and fetal or newborn outcomes compared with exposure to other anticancer treatments,” with a “strong, highly significant overreporting of congenital respiratory tract disorders and neonatal kidney failure,” which can lead to oligohydramnios, the authors wrote. The authors also noted that when delaying anti-HER2 therapy is not possible, it’s imperative to monitor patients closely for oligohydramnios.
SOURCE:
The study, led by Paul Gougis, MD, Institut Curie Centre de Recherche, Paris, , was published online in JAMA Network Open.
LIMITATIONS:
Potential inconsistencies in the collection of pharmacovigilance data could limit the generalizability of the results in the general population. The group of women exposed to other anticancer therapies may also constitute a different patient population from that given anti-HER2 therapies.
DISCLOSURES:
Coauthor Jean-Philippe Spano, MD, PhD, declared relationships Gilead, AstraZeneca, Lilly, Pfizer, Novartis, Daiichi Sankyo, and GSK.
A version of this article appeared on Medscape.com.
Psychosocial environmental factors may drive persistent childhood asthma
TOPLINE:
Children with asthma exposed to worsening psychosocial environmental factors during childhood were more likely to have more severe asthma symptoms than those without such exposures.
METHODOLOGY:
- The researchers reviewed data from the Longitudinal Study of Australian Children, a nationally representative cohort that also collects data on the health, psychosocial, and environmental status of parents, and used three multivariate models to assess the impact of psychosocial environmental factors on asthma symptoms at ages 1 year, 4-5 years, and 14-15 years.
- The study population included 3,917 children aged 0-15 years who were sorted into three asthma symptom trajectory groups (low/no asthma, transient high asthma, and persistent high asthma); asthma symptoms were defined as a history of chest wheezing lasting at least a week within the past 12 months.
- The researchers identified several psychosocial environmental factors as exposure variables on the basis of literature reviews; these factors were maternal depression, parents’ financial hardship, parental availability, and parental stressful life events.
TAKEAWAY:
- The mean scores of psychosocial factors for the overall study population remained stable over time, but groups of children exposed to bad trajectories of psychosocial factors were significantly more likely to have transient high and persistent high asthma symptoms.
- In the first year of life, only parents’ stressful life events were significantly associated with the persistent high asthma symptom trajectory group in an adjusted analysis.
- At age 4-5 years, maternal depression, low parental availability, and parents’ stressful life events were significantly associated with persistent high asthma; parents’ financial hardship was significantly associated with transient high asthma symptoms.
- At age 14-15 years, children exposed to “moderate and increasing” maternal depression, “moderate and declining” parents’ financial hardship, and “moderate and increasing” parents’ stressful life events were significantly associated with persistent high asthma versus no or low asthma, with relative risk ratios of 1.55, 1.40, and 1.77, respectively.
IN PRACTICE:
The study findings highlight the need for policy makers to take action to improve asthma control in children by reducing exposure to harmful psychosocial environmental factors, the researchers concluded.
SOURCE:
The lead author of the study was K.M. Shahunja, MBBS, PhD candidate at the University of Queensland, Brisbane, Australia. The study was published online in Pediatric Pulmonology.
LIMITATIONS:
The study is the first known to examine asthma symptom trajectories at different developmental stages, but participant attrition and missing values were limiting factors, as was the inability to account for all potential psychosocial environmental factors that might influence asthma symptoms in childhood.
DISCLOSURES:
The study received no outside funding. The researchers had no financial conflicts to disclose.
A version of this article first appeared on Medscape.com.
TOPLINE:
Children with asthma exposed to worsening psychosocial environmental factors during childhood were more likely to have more severe asthma symptoms than those without such exposures.
METHODOLOGY:
- The researchers reviewed data from the Longitudinal Study of Australian Children, a nationally representative cohort that also collects data on the health, psychosocial, and environmental status of parents, and used three multivariate models to assess the impact of psychosocial environmental factors on asthma symptoms at ages 1 year, 4-5 years, and 14-15 years.
- The study population included 3,917 children aged 0-15 years who were sorted into three asthma symptom trajectory groups (low/no asthma, transient high asthma, and persistent high asthma); asthma symptoms were defined as a history of chest wheezing lasting at least a week within the past 12 months.
- The researchers identified several psychosocial environmental factors as exposure variables on the basis of literature reviews; these factors were maternal depression, parents’ financial hardship, parental availability, and parental stressful life events.
TAKEAWAY:
- The mean scores of psychosocial factors for the overall study population remained stable over time, but groups of children exposed to bad trajectories of psychosocial factors were significantly more likely to have transient high and persistent high asthma symptoms.
- In the first year of life, only parents’ stressful life events were significantly associated with the persistent high asthma symptom trajectory group in an adjusted analysis.
- At age 4-5 years, maternal depression, low parental availability, and parents’ stressful life events were significantly associated with persistent high asthma; parents’ financial hardship was significantly associated with transient high asthma symptoms.
- At age 14-15 years, children exposed to “moderate and increasing” maternal depression, “moderate and declining” parents’ financial hardship, and “moderate and increasing” parents’ stressful life events were significantly associated with persistent high asthma versus no or low asthma, with relative risk ratios of 1.55, 1.40, and 1.77, respectively.
IN PRACTICE:
The study findings highlight the need for policy makers to take action to improve asthma control in children by reducing exposure to harmful psychosocial environmental factors, the researchers concluded.
SOURCE:
The lead author of the study was K.M. Shahunja, MBBS, PhD candidate at the University of Queensland, Brisbane, Australia. The study was published online in Pediatric Pulmonology.
LIMITATIONS:
The study is the first known to examine asthma symptom trajectories at different developmental stages, but participant attrition and missing values were limiting factors, as was the inability to account for all potential psychosocial environmental factors that might influence asthma symptoms in childhood.
DISCLOSURES:
The study received no outside funding. The researchers had no financial conflicts to disclose.
A version of this article first appeared on Medscape.com.
TOPLINE:
Children with asthma exposed to worsening psychosocial environmental factors during childhood were more likely to have more severe asthma symptoms than those without such exposures.
METHODOLOGY:
- The researchers reviewed data from the Longitudinal Study of Australian Children, a nationally representative cohort that also collects data on the health, psychosocial, and environmental status of parents, and used three multivariate models to assess the impact of psychosocial environmental factors on asthma symptoms at ages 1 year, 4-5 years, and 14-15 years.
- The study population included 3,917 children aged 0-15 years who were sorted into three asthma symptom trajectory groups (low/no asthma, transient high asthma, and persistent high asthma); asthma symptoms were defined as a history of chest wheezing lasting at least a week within the past 12 months.
- The researchers identified several psychosocial environmental factors as exposure variables on the basis of literature reviews; these factors were maternal depression, parents’ financial hardship, parental availability, and parental stressful life events.
TAKEAWAY:
- The mean scores of psychosocial factors for the overall study population remained stable over time, but groups of children exposed to bad trajectories of psychosocial factors were significantly more likely to have transient high and persistent high asthma symptoms.
- In the first year of life, only parents’ stressful life events were significantly associated with the persistent high asthma symptom trajectory group in an adjusted analysis.
- At age 4-5 years, maternal depression, low parental availability, and parents’ stressful life events were significantly associated with persistent high asthma; parents’ financial hardship was significantly associated with transient high asthma symptoms.
- At age 14-15 years, children exposed to “moderate and increasing” maternal depression, “moderate and declining” parents’ financial hardship, and “moderate and increasing” parents’ stressful life events were significantly associated with persistent high asthma versus no or low asthma, with relative risk ratios of 1.55, 1.40, and 1.77, respectively.
IN PRACTICE:
The study findings highlight the need for policy makers to take action to improve asthma control in children by reducing exposure to harmful psychosocial environmental factors, the researchers concluded.
SOURCE:
The lead author of the study was K.M. Shahunja, MBBS, PhD candidate at the University of Queensland, Brisbane, Australia. The study was published online in Pediatric Pulmonology.
LIMITATIONS:
The study is the first known to examine asthma symptom trajectories at different developmental stages, but participant attrition and missing values were limiting factors, as was the inability to account for all potential psychosocial environmental factors that might influence asthma symptoms in childhood.
DISCLOSURES:
The study received no outside funding. The researchers had no financial conflicts to disclose.
A version of this article first appeared on Medscape.com.