News From CHEST Physician®

Airways disorders network, bronchiectasis section

Phenotyping bronchiectasis: Focus on eosinophilic bronchiectasis

Bronchiectasis has been often linked to neutrophilic inflammation; however, 20% may have a predominantly eosinophilic inflammation.

Eosinophilic bronchiectasis has been associated with a distinct airway microbiome. Shoemark and colleagues showed in an analysis of 1,007 patients from five countries that 22.6% of patients had blood eosinophil counts (BEC) of >300 cells/μL. BEC of <100 cells/μL were associated with higher bronchiectasis severity and increased mortality (Shoemark et al. Am J Respir Crit Care Med. 2022;205[8]:894-902).

BEC of >300 cells/μL were correlated with Streptococcus- and Pseudomonas-dominated microbiome profiles. Compared with patients with BEC of <100 cells/μL, patients with 100-299 cells/μL (hazard ratio [HR], 2.38; 95% confidence interval, 1.33–4.25; P = .003) and those with >300 cells/μL (HR, 3.99; 95% confidence interval, 2.20–7.85; P = .0001) were associated with shorter time to exacerbation.

Eosinophilic inflammation is a risk factor for exacerbations in patients with P. aeruginosa infection and may be considered as a treatable trait. Shoemark and colleagues’ data show that quality of life was improved with inhaled corticosteroid treatment in patients with bronchiectasis who had blood eosinophil counts of >3%, and eosinophils contribute to bronchiectasis exacerbations.

Diffuse lung disease and lung transplant network, occupational and environmental health section

A ubiquitous invasion: The rise of microplastics

About 6.3 billion tons of plastic waste were produced between 1950 and 2015.¹ Their degradation into submillimeter fragments of 1 μm to 5 mm, is called microplastics (MP).² MP are vectors of pollutants, pathologic microorganisms, and chemical additives used in their fabrication.³ Exposure to MP is unavoidable as they are bio-persistent and ubiquitous, even indoors.⁴ MP have been detected in the snow of large metropolitan areas and in remote locations.⁵ Humans are exposed to MP via oral ingestion and inhalation. A Brazilian study of human lung autopsy specimens revealed the presence of MP in 13 of 20 subjects.³

In vitro studies have suggested a causal role of polystyrene-MP in the development of chronic pulmonary disease through the formation of reactive oxygen species, inhibition of cell proliferation, and cellular morphology aberration.⁶ MP can cause local effects due to macrophage-induced inflammation, or alternatively, be transported distantly to the pleura and the systemic circulation.

In addition, MP may disrupt the endocrine pathway due to its estrogenic effects.⁷ Larger MPs of 8 to 10 µm, like nylon, have been associated with interstitial lung disease.⁸ Lung biopsies from workers exposed to airborne synthetic fibers (acrylic, polyester, and terylene) have revealed different degrees of inflammation, granulomas, and interstitial fibrosis.⁹ Factory workers exposed to polyvinyl chloride dust have increased risk of exertional dyspnea and decreased pulmonary function.¹⁰ Due to the pervasive nature of MP, it is essential to establish the global burden of airborne MP and to determine its role in lung health.

Bathmapriya Balakrishnan, MD 
Member-at-Large
 

*Tyler Church, DO 
Fellow-in-Training Member

*Disclaimer: The views expressed in this article are those of the author(s) and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or U.S. Government.
 

References

1. Rhodes CJ. Plastic pollution and potential solutions. Sci Prog. 2018;101(3):207-60.

2. Danopoulos E et al. Microplastic contamination of drinking water: A systematic review. PLoS One. 2020;15(7):e0236838.

3. Amato-Lourenço LF et al. Presence of airborne microplastics in human lung tissue. J Hazard Mater. 2021;416:126.

4. Al Horr Y et al. Occupant productivity and office indoor environment quality: A review of the literature. Building and Environment. 2016;105:369-89.

5. Bergmann M et al. White and wonderful? Microplastics prevail in snow from the Alps to the Arctic. Sci Adv. 2019;5:eaax1157.

6. Dong CD et al. Polystyrene microplastic particles: In vitro pulmonary toxicity assessment. J Hazard Mater. 2020;385:121575.

7. Amato-Lourenço LF et al. An emerging class of air pollutants: Potential effects of microplastics to respiratory human health. Sci Total Environ. 2020;749:141676.

8. Kern DG et al. Flock worker’s lung: Chronic interstitial lung disease in the nylon flocking industry. Ann Intern Med. 1998;129[4]:261-72. Erratum in: Ann Intern Med. 1999;130[3]:246.

9. Pimentel JC et al. Respiratory disease caused by synthetic fibers: a new occupational disease. Thorax. 1975;30:204-19.

10. Soutar CA et al. Epidemiological study of respiratory disease in workers exposed to polyvinyl chloride dust. Thorax. 1980;35:644-52.
 

Critical care network, palliative and end-of-life section

Discussing code status with families of critically ill patients

Discussing code status with patients is complex and emotional, especially when critically ill.

The complexity further increases when these conversations have to take place with family members.

Here are some practical tips to help have these conversations in a concise and compassionate manner.  

Introduction  

• Introduce yourself, and make sure to identify the correct decision-maker.   
• Get to know the patient.  

–What kind of person are they?  

–What brings them joy?  

• Find out what the family knows about the current clinical condition of their family member.   

–What have you been hearing from the medical team?  

–What are you worried about?  

Update    

• Fill in the gaps – update them on the clinical condition and ongoing management.  
• Discuss how you think they will respond to current management and further management options.   
• Allow them to process the information.  

Provide a medical recommendation    

• Example: We are worried he might die, and if his heart stops, interventions like CPR or intubation would not work, and we would not recommend them.  
• Do not pressure for a decision right away. (You can say “We do not need a decision today, so please take time to process this information.”)  

Respond to emotions    

• I can’t image how hard this must be.  
• Offer chaplain services if that is important to them.  

Things to avoid 

• Avoid aggressive language.  

–We will have to pound on their chest, break ribs.   

–They would be suffering.  

• Blaming or judgmental language.  

While this complex discussion r equires individualization, these tips will help set a framework for goals of care conversations that lead to high quality care for patients that aligns with their goals.   

Reference

Goldfish and Rosielle. Language for Routine Code Status Discussions, Fast Facts and Concepts #365, Palliative Care Network of Wisconsin.

Syed Nazeer Mahmood, MD
Fellow-in-Training Member

Anne Kelemen, LCSW
Member-at-Large

Airways disorders network, bronchiectasis section

Phenotyping bronchiectasis: Focus on eosinophilic bronchiectasis

Bronchiectasis has been often linked to neutrophilic inflammation; however, 20% may have a predominantly eosinophilic inflammation.

Eosinophilic bronchiectasis has been associated with a distinct airway microbiome. Shoemark and colleagues showed in an analysis of 1,007 patients from five countries that 22.6% of patients had blood eosinophil counts (BEC) of >300 cells/μL. BEC of <100 cells/μL were associated with higher bronchiectasis severity and increased mortality (Shoemark et al. Am J Respir Crit Care Med. 2022;205[8]:894-902).

BEC of >300 cells/μL were correlated with Streptococcus- and Pseudomonas-dominated microbiome profiles. Compared with patients with BEC of <100 cells/μL, patients with 100-299 cells/μL (hazard ratio [HR], 2.38; 95% confidence interval, 1.33–4.25; P = .003) and those with >300 cells/μL (HR, 3.99; 95% confidence interval, 2.20–7.85; P = .0001) were associated with shorter time to exacerbation.

Eosinophilic inflammation is a risk factor for exacerbations in patients with P. aeruginosa infection and may be considered as a treatable trait. Shoemark and colleagues’ data show that quality of life was improved with inhaled corticosteroid treatment in patients with bronchiectasis who had blood eosinophil counts of >3%, and eosinophils contribute to bronchiectasis exacerbations.

Diffuse lung disease and lung transplant network, occupational and environmental health section

A ubiquitous invasion: The rise of microplastics

About 6.3 billion tons of plastic waste were produced between 1950 and 2015.¹ Their degradation into submillimeter fragments of 1 μm to 5 mm, is called microplastics (MP).² MP are vectors of pollutants, pathologic microorganisms, and chemical additives used in their fabrication.³ Exposure to MP is unavoidable as they are bio-persistent and ubiquitous, even indoors.⁴ MP have been detected in the snow of large metropolitan areas and in remote locations.⁵ Humans are exposed to MP via oral ingestion and inhalation. A Brazilian study of human lung autopsy specimens revealed the presence of MP in 13 of 20 subjects.³

In vitro studies have suggested a causal role of polystyrene-MP in the development of chronic pulmonary disease through the formation of reactive oxygen species, inhibition of cell proliferation, and cellular morphology aberration.⁶ MP can cause local effects due to macrophage-induced inflammation, or alternatively, be transported distantly to the pleura and the systemic circulation.

In addition, MP may disrupt the endocrine pathway due to its estrogenic effects.⁷ Larger MPs of 8 to 10 µm, like nylon, have been associated with interstitial lung disease.⁸ Lung biopsies from workers exposed to airborne synthetic fibers (acrylic, polyester, and terylene) have revealed different degrees of inflammation, granulomas, and interstitial fibrosis.⁹ Factory workers exposed to polyvinyl chloride dust have increased risk of exertional dyspnea and decreased pulmonary function.¹⁰ Due to the pervasive nature of MP, it is essential to establish the global burden of airborne MP and to determine its role in lung health.

Bathmapriya Balakrishnan, MD 
Member-at-Large
 

*Tyler Church, DO 
Fellow-in-Training Member

*Disclaimer: The views expressed in this article are those of the author(s) and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or U.S. Government.
 

References

1. Rhodes CJ. Plastic pollution and potential solutions. Sci Prog. 2018;101(3):207-60.

2. Danopoulos E et al. Microplastic contamination of drinking water: A systematic review. PLoS One. 2020;15(7):e0236838.

3. Amato-Lourenço LF et al. Presence of airborne microplastics in human lung tissue. J Hazard Mater. 2021;416:126.

4. Al Horr Y et al. Occupant productivity and office indoor environment quality: A review of the literature. Building and Environment. 2016;105:369-89.

5. Bergmann M et al. White and wonderful? Microplastics prevail in snow from the Alps to the Arctic. Sci Adv. 2019;5:eaax1157.

6. Dong CD et al. Polystyrene microplastic particles: In vitro pulmonary toxicity assessment. J Hazard Mater. 2020;385:121575.

7. Amato-Lourenço LF et al. An emerging class of air pollutants: Potential effects of microplastics to respiratory human health. Sci Total Environ. 2020;749:141676.

8. Kern DG et al. Flock worker’s lung: Chronic interstitial lung disease in the nylon flocking industry. Ann Intern Med. 1998;129[4]:261-72. Erratum in: Ann Intern Med. 1999;130[3]:246.

9. Pimentel JC et al. Respiratory disease caused by synthetic fibers: a new occupational disease. Thorax. 1975;30:204-19.

10. Soutar CA et al. Epidemiological study of respiratory disease in workers exposed to polyvinyl chloride dust. Thorax. 1980;35:644-52.
 

Critical care network, palliative and end-of-life section

Discussing code status with families of critically ill patients

Discussing code status with patients is complex and emotional, especially when critically ill.

The complexity further increases when these conversations have to take place with family members.

Here are some practical tips to help have these conversations in a concise and compassionate manner.  

Introduction  

• Introduce yourself, and make sure to identify the correct decision-maker.   
• Get to know the patient.  

–What kind of person are they?  

–What brings them joy?  

• Find out what the family knows about the current clinical condition of their family member.   

–What have you been hearing from the medical team?  

–What are you worried about?  

Update    

• Fill in the gaps – update them on the clinical condition and ongoing management.  
• Discuss how you think they will respond to current management and further management options.   
• Allow them to process the information.  

Provide a medical recommendation    

• Example: We are worried he might die, and if his heart stops, interventions like CPR or intubation would not work, and we would not recommend them.  
• Do not pressure for a decision right away. (You can say “We do not need a decision today, so please take time to process this information.”)  

Respond to emotions    

• I can’t image how hard this must be.  
• Offer chaplain services if that is important to them.  

Things to avoid 

• Avoid aggressive language.  

–We will have to pound on their chest, break ribs.   

–They would be suffering.  

• Blaming or judgmental language.  

While this complex discussion r equires individualization, these tips will help set a framework for goals of care conversations that lead to high quality care for patients that aligns with their goals.   

Reference

Goldfish and Rosielle. Language for Routine Code Status Discussions, Fast Facts and Concepts #365, Palliative Care Network of Wisconsin.

Syed Nazeer Mahmood, MD
Fellow-in-Training Member

Anne Kelemen, LCSW
Member-at-Large

Airways disorders network, bronchiectasis section

Phenotyping bronchiectasis: Focus on eosinophilic bronchiectasis

Bronchiectasis has been often linked to neutrophilic inflammation; however, 20% may have a predominantly eosinophilic inflammation.

Eosinophilic bronchiectasis has been associated with a distinct airway microbiome. Shoemark and colleagues showed in an analysis of 1,007 patients from five countries that 22.6% of patients had blood eosinophil counts (BEC) of >300 cells/μL. BEC of <100 cells/μL were associated with higher bronchiectasis severity and increased mortality (Shoemark et al. Am J Respir Crit Care Med. 2022;205[8]:894-902).

BEC of >300 cells/μL were correlated with Streptococcus- and Pseudomonas-dominated microbiome profiles. Compared with patients with BEC of <100 cells/μL, patients with 100-299 cells/μL (hazard ratio [HR], 2.38; 95% confidence interval, 1.33–4.25; P = .003) and those with >300 cells/μL (HR, 3.99; 95% confidence interval, 2.20–7.85; P = .0001) were associated with shorter time to exacerbation.

Eosinophilic inflammation is a risk factor for exacerbations in patients with P. aeruginosa infection and may be considered as a treatable trait. Shoemark and colleagues’ data show that quality of life was improved with inhaled corticosteroid treatment in patients with bronchiectasis who had blood eosinophil counts of >3%, and eosinophils contribute to bronchiectasis exacerbations.

Diffuse lung disease and lung transplant network, occupational and environmental health section

A ubiquitous invasion: The rise of microplastics

About 6.3 billion tons of plastic waste were produced between 1950 and 2015.¹ Their degradation into submillimeter fragments of 1 μm to 5 mm, is called microplastics (MP).² MP are vectors of pollutants, pathologic microorganisms, and chemical additives used in their fabrication.³ Exposure to MP is unavoidable as they are bio-persistent and ubiquitous, even indoors.⁴ MP have been detected in the snow of large metropolitan areas and in remote locations.⁵ Humans are exposed to MP via oral ingestion and inhalation. A Brazilian study of human lung autopsy specimens revealed the presence of MP in 13 of 20 subjects.³

In vitro studies have suggested a causal role of polystyrene-MP in the development of chronic pulmonary disease through the formation of reactive oxygen species, inhibition of cell proliferation, and cellular morphology aberration.⁶ MP can cause local effects due to macrophage-induced inflammation, or alternatively, be transported distantly to the pleura and the systemic circulation.

In addition, MP may disrupt the endocrine pathway due to its estrogenic effects.⁷ Larger MPs of 8 to 10 µm, like nylon, have been associated with interstitial lung disease.⁸ Lung biopsies from workers exposed to airborne synthetic fibers (acrylic, polyester, and terylene) have revealed different degrees of inflammation, granulomas, and interstitial fibrosis.⁹ Factory workers exposed to polyvinyl chloride dust have increased risk of exertional dyspnea and decreased pulmonary function.¹⁰ Due to the pervasive nature of MP, it is essential to establish the global burden of airborne MP and to determine its role in lung health.

Bathmapriya Balakrishnan, MD 
Member-at-Large
 

*Tyler Church, DO 
Fellow-in-Training Member

*Disclaimer: The views expressed in this article are those of the author(s) and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or U.S. Government.
 

References

1. Rhodes CJ. Plastic pollution and potential solutions. Sci Prog. 2018;101(3):207-60.

2. Danopoulos E et al. Microplastic contamination of drinking water: A systematic review. PLoS One. 2020;15(7):e0236838.

3. Amato-Lourenço LF et al. Presence of airborne microplastics in human lung tissue. J Hazard Mater. 2021;416:126.

4. Al Horr Y et al. Occupant productivity and office indoor environment quality: A review of the literature. Building and Environment. 2016;105:369-89.

5. Bergmann M et al. White and wonderful? Microplastics prevail in snow from the Alps to the Arctic. Sci Adv. 2019;5:eaax1157.

6. Dong CD et al. Polystyrene microplastic particles: In vitro pulmonary toxicity assessment. J Hazard Mater. 2020;385:121575.

7. Amato-Lourenço LF et al. An emerging class of air pollutants: Potential effects of microplastics to respiratory human health. Sci Total Environ. 2020;749:141676.

8. Kern DG et al. Flock worker’s lung: Chronic interstitial lung disease in the nylon flocking industry. Ann Intern Med. 1998;129[4]:261-72. Erratum in: Ann Intern Med. 1999;130[3]:246.

9. Pimentel JC et al. Respiratory disease caused by synthetic fibers: a new occupational disease. Thorax. 1975;30:204-19.

10. Soutar CA et al. Epidemiological study of respiratory disease in workers exposed to polyvinyl chloride dust. Thorax. 1980;35:644-52.
 

Critical care network, palliative and end-of-life section

Discussing code status with families of critically ill patients

Discussing code status with patients is complex and emotional, especially when critically ill.

The complexity further increases when these conversations have to take place with family members.

Here are some practical tips to help have these conversations in a concise and compassionate manner.  

Introduction  

• Introduce yourself, and make sure to identify the correct decision-maker.   
• Get to know the patient.  

–What kind of person are they?  

–What brings them joy?  

• Find out what the family knows about the current clinical condition of their family member.   

–What have you been hearing from the medical team?  

–What are you worried about?  

Update    

• Fill in the gaps – update them on the clinical condition and ongoing management.  
• Discuss how you think they will respond to current management and further management options.   
• Allow them to process the information.  

Provide a medical recommendation    

• Example: We are worried he might die, and if his heart stops, interventions like CPR or intubation would not work, and we would not recommend them.  
• Do not pressure for a decision right away. (You can say “We do not need a decision today, so please take time to process this information.”)  

Respond to emotions    

• I can’t image how hard this must be.  
• Offer chaplain services if that is important to them.  

Things to avoid 

• Avoid aggressive language.  

–We will have to pound on their chest, break ribs.   

–They would be suffering.  

• Blaming or judgmental language.  

While this complex discussion r equires individualization, these tips will help set a framework for goals of care conversations that lead to high quality care for patients that aligns with their goals.   

Reference

Goldfish and Rosielle. Language for Routine Code Status Discussions, Fast Facts and Concepts #365, Palliative Care Network of Wisconsin.

Syed Nazeer Mahmood, MD
Fellow-in-Training Member

Anne Kelemen, LCSW
Member-at-Large

The Relationship Between Insurance Status and The Affordable Care Act on Asthma Outcomes Among Low-Income Us Adults. By Dr. Rajat Suri et al.

Characteristics and Outcomes of Intensive Care Unit Patients With Respiratory Syncytial Virus Compared to Those With Influenza Infection: A Multicentre Matched Cohort Study. By Dr. Julien Coussement et al

“Can Do, Do Do” Quadrants and 6-Year All-Cause Mortality in Patients with COPD. By Dr. Anouk W. Vaes et al.

Trends in Geriatric Conditions Among Older Adults Admitted to US ICUs Between 1998 and 2015. By Dr. Julien Cobert et al.

Setting and Titrating Positive End-Expiratory Pressure. By Dr. Scott J. Millington et al.

COVID-19 in Lymphangioleiomyomatosis: An International Study of Outcomes and Impact of Mechanistic Target of Rapamycin Inhibition. By Dr. Bruno Guedes Baldi et al.

Perceptions of Life Support and Advance Care Planning During the COVID-19 Pandemic: A Global Study of Twitter Users. By Vishal R. Patel et al.

Framework for Integrating Equity Into Machine Learning Models: A Case Study. By Dr. Juan C. Rojas et al.

Comparison of Guidelines for Evaluation of Suspected Pulmonary Embolism in Pregnancy: A Cost-Effectiveness Analysis. By John Austin McCandlish et al.

Relationship Between CPAP Termination and All-Cause Mortality: A French Nationwide Database Analysis. By Dr. Jean-Louis Pépin et al.

Clinical Outcomes of Immune Checkpoint Inhibitor Therapy in Patients With Advanced Non-small Cell Lung Cancer and Preexisting Interstitial Lung Diseases: A Systematic Review and Meta-Analysis. By Dr. Meng Zhang, et al.

The Impact of Persistent Smoking After Surgery on Long-Term Outcomes After Stage I Non–Small Cell Lung Cancer Resection. By Dr. Brendan T. Heiden et al.

The Relationship Between Insurance Status and The Affordable Care Act on Asthma Outcomes Among Low-Income Us Adults. By Dr. Rajat Suri et al.

Characteristics and Outcomes of Intensive Care Unit Patients With Respiratory Syncytial Virus Compared to Those With Influenza Infection: A Multicentre Matched Cohort Study. By Dr. Julien Coussement et al

“Can Do, Do Do” Quadrants and 6-Year All-Cause Mortality in Patients with COPD. By Dr. Anouk W. Vaes et al.

Trends in Geriatric Conditions Among Older Adults Admitted to US ICUs Between 1998 and 2015. By Dr. Julien Cobert et al.

Setting and Titrating Positive End-Expiratory Pressure. By Dr. Scott J. Millington et al.

COVID-19 in Lymphangioleiomyomatosis: An International Study of Outcomes and Impact of Mechanistic Target of Rapamycin Inhibition. By Dr. Bruno Guedes Baldi et al.

Perceptions of Life Support and Advance Care Planning During the COVID-19 Pandemic: A Global Study of Twitter Users. By Vishal R. Patel et al.

Framework for Integrating Equity Into Machine Learning Models: A Case Study. By Dr. Juan C. Rojas et al.

Comparison of Guidelines for Evaluation of Suspected Pulmonary Embolism in Pregnancy: A Cost-Effectiveness Analysis. By John Austin McCandlish et al.

Relationship Between CPAP Termination and All-Cause Mortality: A French Nationwide Database Analysis. By Dr. Jean-Louis Pépin et al.

Clinical Outcomes of Immune Checkpoint Inhibitor Therapy in Patients With Advanced Non-small Cell Lung Cancer and Preexisting Interstitial Lung Diseases: A Systematic Review and Meta-Analysis. By Dr. Meng Zhang, et al.

The Impact of Persistent Smoking After Surgery on Long-Term Outcomes After Stage I Non–Small Cell Lung Cancer Resection. By Dr. Brendan T. Heiden et al.

The Relationship Between Insurance Status and The Affordable Care Act on Asthma Outcomes Among Low-Income Us Adults. By Dr. Rajat Suri et al.

Characteristics and Outcomes of Intensive Care Unit Patients With Respiratory Syncytial Virus Compared to Those With Influenza Infection: A Multicentre Matched Cohort Study. By Dr. Julien Coussement et al

“Can Do, Do Do” Quadrants and 6-Year All-Cause Mortality in Patients with COPD. By Dr. Anouk W. Vaes et al.

Trends in Geriatric Conditions Among Older Adults Admitted to US ICUs Between 1998 and 2015. By Dr. Julien Cobert et al.

Setting and Titrating Positive End-Expiratory Pressure. By Dr. Scott J. Millington et al.

COVID-19 in Lymphangioleiomyomatosis: An International Study of Outcomes and Impact of Mechanistic Target of Rapamycin Inhibition. By Dr. Bruno Guedes Baldi et al.

Perceptions of Life Support and Advance Care Planning During the COVID-19 Pandemic: A Global Study of Twitter Users. By Vishal R. Patel et al.

Framework for Integrating Equity Into Machine Learning Models: A Case Study. By Dr. Juan C. Rojas et al.

Comparison of Guidelines for Evaluation of Suspected Pulmonary Embolism in Pregnancy: A Cost-Effectiveness Analysis. By John Austin McCandlish et al.

Relationship Between CPAP Termination and All-Cause Mortality: A French Nationwide Database Analysis. By Dr. Jean-Louis Pépin et al.

Clinical Outcomes of Immune Checkpoint Inhibitor Therapy in Patients With Advanced Non-small Cell Lung Cancer and Preexisting Interstitial Lung Diseases: A Systematic Review and Meta-Analysis. By Dr. Meng Zhang, et al.

The Impact of Persistent Smoking After Surgery on Long-Term Outcomes After Stage I Non–Small Cell Lung Cancer Resection. By Dr. Brendan T. Heiden et al.

Pulmonary vascular & cardiovascular network: Cardiovascular medicine & surgery section 

Targeted temperature management (TTM) after cardiac arrest: How cool?  

Recent randomized control trials, TTM2 (Dankiewicz J. N Engl J Med. 2021;384:2283) and HYPERION (Lascarrou J-B. N Engl J Med. 2019;381:2327), of therapeutic hypothermia, as opposed to normothermia, in patients who remain comatose after return of spontaneous circulation (ROSC) after cardiac arrest have produced conflicting results regarding survival and neurologic benefit. TTM2 reported no benefit to cooling to 33°C, while HYPERION found improved neurologic outcome at 90 days in patients cooled to 33°C.  The European Resuscitation Council (ERC) and European Society of Intensive Care Medicine (ESICM) recently released an evidence review and guideline for adults who remain comatose after cardiac arrest (Sandroni C. Intensive Care Med. 2022;48:261). These guidelines recommend continuous monitoring of core temperature in all patients who remain comatose after cardiac arrest, and preventing fever (>37.7°C) for 72 hours, but with no recommendation of target temperature of 32°C vs 36°C.  

Differences in patient populations, presenting rhythm during arrest, duration of CPR, and time to target temperature likely each contribute to the disparate conclusions of previous trials. For example, HYPERION enrolled patients with out of hospital cardiac arrest with initial nonshockable rhythms and found benefit to cooling to 33°C.  In comparison, TTM2 enrolled all patients with ROSC following arrest (regardless of rhythm), including patients with in-hospital cardiac arrest and found no benefit in therapeutic cooling. Differences in patient populations are underscored by the widely differing percentage of patients with good neurologic outcome in their respective control groups: approximately 30% in the TTM2 trial and 6% in HYPERION. The guidelines leave significant room for clinical judgment in employing therapeutic cooling but encourage the continuous monitoring of core temperature and active avoidance of fever.  

Fiore Mastroianna, MD

Section Member-at-Large 

Chest infections & disaster response network: Chest infections section

Update on LTBI treatment: Ensuring success by simplifying, shortening, and completing treatment

My patient has a positive IGRA test result – what’s next?

If TB disease is ruled out by clinical, radiographic, and microbiologic assessment (if indicated), then latent TB infection (LTBI) is established, and treatment should be offered, guided by shared-decision making between provider and patient.

Courtesy CHEST

What options are available?

While the former standard 9-month regimen of isoniazid-monotherapy can be shortened to 6 months, shorter rifamycin-based regimens are now preferred in most cases and include:

4 months rifampin daily, 3 months isoniazid plus rifampin daily, or 3 months isoniazid plus rifapentine weekly. In addition, 1 month of isoniazid plus rifapentine daily has recently been shown to be effective in people with HIV.

Courtesy CHEST

Sebastian Kurz, MD, FCCP

Amee Patrawalla, MD, MPH, FCCP

Section Members-at-Large

References

Testing and Treatment of Latent Tuberculosis Infection in the United States: Clinical Recommendations. A Guide for Health Care Providers and Public Health Programs. Copyright © 2021 by the National Society of Tuberculosis Clinicians and National Tuberculosis Controllers Association

1. Shah, D. Latent tuberculosis infection. N Engl J Med. 2021;385:2271-80.

2. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of tuberculosis in adults and children. Clin Infect Dis. 2017 Jan 15;64(2):111-115.

3. Swindells et. al. One month of rifapentine plus isoniazid to prevent HIV-related tuberculosis. N Engl J Med. 2019;380:1001-11.

Thoracic oncology & chest procedures network: Lung cancer section

Adjuvant and neoadjuvant therapies in early stage lung cancer

Since the discovery of the epidermal growth factor receptor (EGFR) mutation in 2004 and the development of checkpoint blockade in 2006, personalized treatment options for non–small cell lung cancer (NSCLC) have exploded, but targeted systemic therapy medications were only recommended among patients with metastatic or locally advanced disease (Rivera MP, Matthay RA. Clin Chest Med. 2020;41[1]:ix-xi). However, in November 2020, the National Comprehensive Cancer Network (NCCN) updated guidelines to recommend EGFR testing in surgically resected stage IB-IIIA adenocarcinoma, and to consider adjuvant osimerintib in those who were mutation-positive (NCCN. Nov 2020). Interim analysis of an ongoing phase-3 trial showed 89% of patients in the osimertinib group were alive and disease-free at 24 months compared with 52% in the placebo group (hazard ratio 0.20, P < .001) (Wu YL, et al. N Engl J Med. 2020;383[18]:1711-23).   

Courtesy CHEST

The FDA has also recently approved the use of neoadjuvant and adjuvant immunotherapy in combination with platinum-based chemotherapy. Nivolumab is now approved as neoadjuvant therapy in patients with resectable IB-IIIA NSCLC regardless of PDL-1 status. The Checkmate-816 trial showed increased median event-free survival in the immunotherapy plus chemotherapy group of 31.6 months vs 20.8 months in the chemotherapy-only group (FDA.gov. 2022, Mar 4). Atezolizumab is also now approved for adjuvant treatment following resection and platinum-based chemotherapy in patients with stage II to IIIA NSCLC whose tumors have PD-L1 expression on ≥ 1% of tumor cells. Median disease-free survival was not reached in patients in the atezolizumab groups vs 35.3 months in the best supportive care group (FDA.gov. 2021, Oct 15). With so many advances in the personalized treatment among all stages of NSCLC, this is a hopeful new chapter in the care of patients with NSCLC. 

More information: https://www.nccn.org/guidelines/guidelines-process/transparency-process-and-recommendations/GetFileFromFileManager?fileManagerId=11259 
 

Sohini Ghosh, MD

Section Member-at-Large

Diffuse lung disease and lung transplant network: Lung transplant section 

Continuous distribution for lung transplant: Overhauling the wait list 

Determining how to allocate the scarce resource of donor lungs to patients is a difficult task and evaluated continuously for potential improvement. Since 2005, in the United States, lung transplant recipients have been selected based primarily on location within a Donor Service Area and by lung allocation score (LAS), a composite score of urgency for transplant. This was updated in 2017 to an allocation by highest LAS within 250 nautical miles from the donor hospital. Factors such as blood type compatibility and height are also considered. Implementation of the LAS improved the sickest patients’ access to transplants while not worsening 1-year mortality (Egan TM. Semin Respir Crit Care Med. 2018;39[02]:126-37). Unfortunately, geographic hard boundaries mean a high proportion of low LAS (<50) patients receive local donors while high LAS patients receive national offers or die while on the waitlist (Iribarne A, et al. Clin Transplant. 2016:30:688-93). 

Courtesy CHEST

A new model that employs continuous distribution has been developed based on concerns regarding equity and improving allocation. This model would prioritize patients based on factors including medical priority, efficient management of organ placement (distance), expected posttransplant outcomes, and patient access (equity). By creating a composite of these without a geographic boundary, patients would be considered more on urgency within realistic constraints of distance and outcomes.   

Courtesy CHEST

The Organ Procurement and Transplantation Network has officially approved continuous distribution, with implementation planned for 2022; details regarding the new scoring system are to be published and further research will need to be undertaken to determine if it meets the goal of overall improvement in patient access, equity, and outcomes.

Grant A. Turner, MD, MHA

Laura Frye, MD

Section Members-at-Large

Critical care network: Non-respiratory critical care section

Update from the non-respiratory critical care section

As you’ve probably noticed, there have been some changes here at CHEST involving the Networks. Leadership here at CHEST has been hard at work restructuring the networks to make them more closely aligned with relevant clinical disciplines, and, ultimately, allow for greater participation. I am proud to have been given stewardship of the new Non-Respiratory Critical Care Section of the Critical Care Network.

Courtesy CHEST

So, what exactly is Non-Respiratory Critical Care? Well, that’s where I need your help. You see this network is meant to reflect the needs and wants of CHEST members like you. We need you, dear readers, to join in this venture and help us guide the content that this section will ultimately create for our members.

If you’re interested in critical care, but you don’t see your particular area of interest anywhere else in the current structure ... guess what? You’ve found the right place!

My Infectious Diseases and Nephro peeps? Welcome! Are you a surgical or anesthesia intensivist? Don’t be shy. ECMO people, let’s hear some chatter!Is therapeutic hypothermia your thing? Come on in. The water’s freezing. 33 degrees just like you folks like it. Or is it 36? Not sure. Anyway, see what I’m talking about? We really need your help!You can get involved by clicking on the Membership & Community tab at the CHEST website. Once you’re a member, you can even nominate yourself to run for the Steering Committee elections which are held periodically. Hope to see you soon!

Deep Ramachandran, MD, FCCP

Section Chair

Sleep medicine network: Non-respiratory sleep section

Unusual suspects? Breakthrough in the treatment of idiopathic hypersomnia

Idiopathic hypersomnia (IH) is a rare and debilitating disorder defined by its excessive daytime sleepiness, sleep inertia, prolonged nighttime sleep, and long, unrefreshing naps (AASM. ICSD 3rd ed. 2014). Gamma-aminobutyric acid (GABA) is one of the main inhibitory neurotransmitters in the nervous system. It is through the potentiation of GABA that substances such as alcohol and benzodiazepines yield their effects. It is also hypothesized that the “brain fog” experienced in IH may be a consequence of either higher levels of an endogenous benzodiazepines in the cerebral spinal fluid or the presence of a GABA-enhancing peptide (Rye DB. Science Transl Med. 2012;Med 4:161ra151).

Sodium oxybate (SXB), a compound that likely has its therapeutic effect through the potentiation of GABA receptors, is an effective treatment option for cataplexy and sleepiness in narcolepsy. Although there may be some overlap between narcolepsy and IH in both diagnosis and treatment (Bassetti C, et al. Brain. 1997;120:1423), it would perhaps be entirely counterintuitive (given SXB’s pharmacology) to imagine using SXB as a plausible treatment option in IH. It was, however, investigated in the treatment of refractory hypersomnia and IH. In the retrospective study looking at 46 subjects treated with SXB, 71% experienced improvement of their severe sleep inertia, 55% had a decrease in their excessive daytime sleepiness, and 52% reported a shortened nighttime sleep time (Leu-Semenescu S, et al. Sleep Med. 2016;17:38).

In a recent double-blind, randomized control trial, the lower-sodium oxybate (LXB) was trialed in 154 patients with IH. It demonstrated statistically significant and clinically meaningful improvements (compared with placebo) in the Epworth Sleepiness Scale score (P <.0001) and in the Idiopathic Hypersomnia Severity Scale (P <.0001). The effects were seen both during the up titration of LXB and the benefits were maintained during the stable phase of the intervention (Dauvilliers Y, et al. Lancet Neurol. 2022;21(1):53). In August 2021, LXB (initially launched in 2020 for the treatment of narcolepsy) is now the first FDA-approved medication to treat IH in adults. It is curious, however, that LXB’s understood therapeutic effects are secondary to the “potentiation” of the very GABA receptor we have believed to be the root cause of the debilitating symptoms in IH. Could this discovery lend to further insights into the origins of this condition?

Ruckshanda Majid, MD, FCCP

Pulmonary vascular & cardiovascular network: Cardiovascular medicine & surgery section 

Targeted temperature management (TTM) after cardiac arrest: How cool?  

Recent randomized control trials, TTM2 (Dankiewicz J. N Engl J Med. 2021;384:2283) and HYPERION (Lascarrou J-B. N Engl J Med. 2019;381:2327), of therapeutic hypothermia, as opposed to normothermia, in patients who remain comatose after return of spontaneous circulation (ROSC) after cardiac arrest have produced conflicting results regarding survival and neurologic benefit. TTM2 reported no benefit to cooling to 33°C, while HYPERION found improved neurologic outcome at 90 days in patients cooled to 33°C.  The European Resuscitation Council (ERC) and European Society of Intensive Care Medicine (ESICM) recently released an evidence review and guideline for adults who remain comatose after cardiac arrest (Sandroni C. Intensive Care Med. 2022;48:261). These guidelines recommend continuous monitoring of core temperature in all patients who remain comatose after cardiac arrest, and preventing fever (>37.7°C) for 72 hours, but with no recommendation of target temperature of 32°C vs 36°C.  

Differences in patient populations, presenting rhythm during arrest, duration of CPR, and time to target temperature likely each contribute to the disparate conclusions of previous trials. For example, HYPERION enrolled patients with out of hospital cardiac arrest with initial nonshockable rhythms and found benefit to cooling to 33°C.  In comparison, TTM2 enrolled all patients with ROSC following arrest (regardless of rhythm), including patients with in-hospital cardiac arrest and found no benefit in therapeutic cooling. Differences in patient populations are underscored by the widely differing percentage of patients with good neurologic outcome in their respective control groups: approximately 30% in the TTM2 trial and 6% in HYPERION. The guidelines leave significant room for clinical judgment in employing therapeutic cooling but encourage the continuous monitoring of core temperature and active avoidance of fever.  

Fiore Mastroianna, MD

Section Member-at-Large 

Chest infections & disaster response network: Chest infections section

Update on LTBI treatment: Ensuring success by simplifying, shortening, and completing treatment

My patient has a positive IGRA test result – what’s next?

If TB disease is ruled out by clinical, radiographic, and microbiologic assessment (if indicated), then latent TB infection (LTBI) is established, and treatment should be offered, guided by shared-decision making between provider and patient.

Courtesy CHEST

What options are available?

While the former standard 9-month regimen of isoniazid-monotherapy can be shortened to 6 months, shorter rifamycin-based regimens are now preferred in most cases and include:

4 months rifampin daily, 3 months isoniazid plus rifampin daily, or 3 months isoniazid plus rifapentine weekly. In addition, 1 month of isoniazid plus rifapentine daily has recently been shown to be effective in people with HIV.

Courtesy CHEST

Sebastian Kurz, MD, FCCP

Amee Patrawalla, MD, MPH, FCCP

Section Members-at-Large

References

Testing and Treatment of Latent Tuberculosis Infection in the United States: Clinical Recommendations. A Guide for Health Care Providers and Public Health Programs. Copyright © 2021 by the National Society of Tuberculosis Clinicians and National Tuberculosis Controllers Association

1. Shah, D. Latent tuberculosis infection. N Engl J Med. 2021;385:2271-80.

2. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of tuberculosis in adults and children. Clin Infect Dis. 2017 Jan 15;64(2):111-115.

3. Swindells et. al. One month of rifapentine plus isoniazid to prevent HIV-related tuberculosis. N Engl J Med. 2019;380:1001-11.

Thoracic oncology & chest procedures network: Lung cancer section

Adjuvant and neoadjuvant therapies in early stage lung cancer

Since the discovery of the epidermal growth factor receptor (EGFR) mutation in 2004 and the development of checkpoint blockade in 2006, personalized treatment options for non–small cell lung cancer (NSCLC) have exploded, but targeted systemic therapy medications were only recommended among patients with metastatic or locally advanced disease (Rivera MP, Matthay RA. Clin Chest Med. 2020;41[1]:ix-xi). However, in November 2020, the National Comprehensive Cancer Network (NCCN) updated guidelines to recommend EGFR testing in surgically resected stage IB-IIIA adenocarcinoma, and to consider adjuvant osimerintib in those who were mutation-positive (NCCN. Nov 2020). Interim analysis of an ongoing phase-3 trial showed 89% of patients in the osimertinib group were alive and disease-free at 24 months compared with 52% in the placebo group (hazard ratio 0.20, P < .001) (Wu YL, et al. N Engl J Med. 2020;383[18]:1711-23).   

Courtesy CHEST

The FDA has also recently approved the use of neoadjuvant and adjuvant immunotherapy in combination with platinum-based chemotherapy. Nivolumab is now approved as neoadjuvant therapy in patients with resectable IB-IIIA NSCLC regardless of PDL-1 status. The Checkmate-816 trial showed increased median event-free survival in the immunotherapy plus chemotherapy group of 31.6 months vs 20.8 months in the chemotherapy-only group (FDA.gov. 2022, Mar 4). Atezolizumab is also now approved for adjuvant treatment following resection and platinum-based chemotherapy in patients with stage II to IIIA NSCLC whose tumors have PD-L1 expression on ≥ 1% of tumor cells. Median disease-free survival was not reached in patients in the atezolizumab groups vs 35.3 months in the best supportive care group (FDA.gov. 2021, Oct 15). With so many advances in the personalized treatment among all stages of NSCLC, this is a hopeful new chapter in the care of patients with NSCLC. 

More information: https://www.nccn.org/guidelines/guidelines-process/transparency-process-and-recommendations/GetFileFromFileManager?fileManagerId=11259 
 

Sohini Ghosh, MD

Section Member-at-Large

Diffuse lung disease and lung transplant network: Lung transplant section 

Continuous distribution for lung transplant: Overhauling the wait list 

Determining how to allocate the scarce resource of donor lungs to patients is a difficult task and evaluated continuously for potential improvement. Since 2005, in the United States, lung transplant recipients have been selected based primarily on location within a Donor Service Area and by lung allocation score (LAS), a composite score of urgency for transplant. This was updated in 2017 to an allocation by highest LAS within 250 nautical miles from the donor hospital. Factors such as blood type compatibility and height are also considered. Implementation of the LAS improved the sickest patients’ access to transplants while not worsening 1-year mortality (Egan TM. Semin Respir Crit Care Med. 2018;39[02]:126-37). Unfortunately, geographic hard boundaries mean a high proportion of low LAS (<50) patients receive local donors while high LAS patients receive national offers or die while on the waitlist (Iribarne A, et al. Clin Transplant. 2016:30:688-93). 

Courtesy CHEST

A new model that employs continuous distribution has been developed based on concerns regarding equity and improving allocation. This model would prioritize patients based on factors including medical priority, efficient management of organ placement (distance), expected posttransplant outcomes, and patient access (equity). By creating a composite of these without a geographic boundary, patients would be considered more on urgency within realistic constraints of distance and outcomes.   

Courtesy CHEST

The Organ Procurement and Transplantation Network has officially approved continuous distribution, with implementation planned for 2022; details regarding the new scoring system are to be published and further research will need to be undertaken to determine if it meets the goal of overall improvement in patient access, equity, and outcomes.

Grant A. Turner, MD, MHA

Laura Frye, MD

Section Members-at-Large

Critical care network: Non-respiratory critical care section

Update from the non-respiratory critical care section

As you’ve probably noticed, there have been some changes here at CHEST involving the Networks. Leadership here at CHEST has been hard at work restructuring the networks to make them more closely aligned with relevant clinical disciplines, and, ultimately, allow for greater participation. I am proud to have been given stewardship of the new Non-Respiratory Critical Care Section of the Critical Care Network.

Courtesy CHEST

So, what exactly is Non-Respiratory Critical Care? Well, that’s where I need your help. You see this network is meant to reflect the needs and wants of CHEST members like you. We need you, dear readers, to join in this venture and help us guide the content that this section will ultimately create for our members.

If you’re interested in critical care, but you don’t see your particular area of interest anywhere else in the current structure ... guess what? You’ve found the right place!

My Infectious Diseases and Nephro peeps? Welcome! Are you a surgical or anesthesia intensivist? Don’t be shy. ECMO people, let’s hear some chatter!Is therapeutic hypothermia your thing? Come on in. The water’s freezing. 33 degrees just like you folks like it. Or is it 36? Not sure. Anyway, see what I’m talking about? We really need your help!You can get involved by clicking on the Membership & Community tab at the CHEST website. Once you’re a member, you can even nominate yourself to run for the Steering Committee elections which are held periodically. Hope to see you soon!

Deep Ramachandran, MD, FCCP

Section Chair

Sleep medicine network: Non-respiratory sleep section

Unusual suspects? Breakthrough in the treatment of idiopathic hypersomnia

Idiopathic hypersomnia (IH) is a rare and debilitating disorder defined by its excessive daytime sleepiness, sleep inertia, prolonged nighttime sleep, and long, unrefreshing naps (AASM. ICSD 3rd ed. 2014). Gamma-aminobutyric acid (GABA) is one of the main inhibitory neurotransmitters in the nervous system. It is through the potentiation of GABA that substances such as alcohol and benzodiazepines yield their effects. It is also hypothesized that the “brain fog” experienced in IH may be a consequence of either higher levels of an endogenous benzodiazepines in the cerebral spinal fluid or the presence of a GABA-enhancing peptide (Rye DB. Science Transl Med. 2012;Med 4:161ra151).

Sodium oxybate (SXB), a compound that likely has its therapeutic effect through the potentiation of GABA receptors, is an effective treatment option for cataplexy and sleepiness in narcolepsy. Although there may be some overlap between narcolepsy and IH in both diagnosis and treatment (Bassetti C, et al. Brain. 1997;120:1423), it would perhaps be entirely counterintuitive (given SXB’s pharmacology) to imagine using SXB as a plausible treatment option in IH. It was, however, investigated in the treatment of refractory hypersomnia and IH. In the retrospective study looking at 46 subjects treated with SXB, 71% experienced improvement of their severe sleep inertia, 55% had a decrease in their excessive daytime sleepiness, and 52% reported a shortened nighttime sleep time (Leu-Semenescu S, et al. Sleep Med. 2016;17:38).

In a recent double-blind, randomized control trial, the lower-sodium oxybate (LXB) was trialed in 154 patients with IH. It demonstrated statistically significant and clinically meaningful improvements (compared with placebo) in the Epworth Sleepiness Scale score (P <.0001) and in the Idiopathic Hypersomnia Severity Scale (P <.0001). The effects were seen both during the up titration of LXB and the benefits were maintained during the stable phase of the intervention (Dauvilliers Y, et al. Lancet Neurol. 2022;21(1):53). In August 2021, LXB (initially launched in 2020 for the treatment of narcolepsy) is now the first FDA-approved medication to treat IH in adults. It is curious, however, that LXB’s understood therapeutic effects are secondary to the “potentiation” of the very GABA receptor we have believed to be the root cause of the debilitating symptoms in IH. Could this discovery lend to further insights into the origins of this condition?

Ruckshanda Majid, MD, FCCP

Pulmonary vascular & cardiovascular network: Cardiovascular medicine & surgery section 

Targeted temperature management (TTM) after cardiac arrest: How cool?  

Recent randomized control trials, TTM2 (Dankiewicz J. N Engl J Med. 2021;384:2283) and HYPERION (Lascarrou J-B. N Engl J Med. 2019;381:2327), of therapeutic hypothermia, as opposed to normothermia, in patients who remain comatose after return of spontaneous circulation (ROSC) after cardiac arrest have produced conflicting results regarding survival and neurologic benefit. TTM2 reported no benefit to cooling to 33°C, while HYPERION found improved neurologic outcome at 90 days in patients cooled to 33°C.  The European Resuscitation Council (ERC) and European Society of Intensive Care Medicine (ESICM) recently released an evidence review and guideline for adults who remain comatose after cardiac arrest (Sandroni C. Intensive Care Med. 2022;48:261). These guidelines recommend continuous monitoring of core temperature in all patients who remain comatose after cardiac arrest, and preventing fever (>37.7°C) for 72 hours, but with no recommendation of target temperature of 32°C vs 36°C.  

Differences in patient populations, presenting rhythm during arrest, duration of CPR, and time to target temperature likely each contribute to the disparate conclusions of previous trials. For example, HYPERION enrolled patients with out of hospital cardiac arrest with initial nonshockable rhythms and found benefit to cooling to 33°C.  In comparison, TTM2 enrolled all patients with ROSC following arrest (regardless of rhythm), including patients with in-hospital cardiac arrest and found no benefit in therapeutic cooling. Differences in patient populations are underscored by the widely differing percentage of patients with good neurologic outcome in their respective control groups: approximately 30% in the TTM2 trial and 6% in HYPERION. The guidelines leave significant room for clinical judgment in employing therapeutic cooling but encourage the continuous monitoring of core temperature and active avoidance of fever.  

Fiore Mastroianna, MD

Section Member-at-Large 

Chest infections & disaster response network: Chest infections section

Update on LTBI treatment: Ensuring success by simplifying, shortening, and completing treatment

My patient has a positive IGRA test result – what’s next?

If TB disease is ruled out by clinical, radiographic, and microbiologic assessment (if indicated), then latent TB infection (LTBI) is established, and treatment should be offered, guided by shared-decision making between provider and patient.

Courtesy CHEST

What options are available?

While the former standard 9-month regimen of isoniazid-monotherapy can be shortened to 6 months, shorter rifamycin-based regimens are now preferred in most cases and include:

4 months rifampin daily, 3 months isoniazid plus rifampin daily, or 3 months isoniazid plus rifapentine weekly. In addition, 1 month of isoniazid plus rifapentine daily has recently been shown to be effective in people with HIV.

Courtesy CHEST

Sebastian Kurz, MD, FCCP

Amee Patrawalla, MD, MPH, FCCP

Section Members-at-Large

References

Testing and Treatment of Latent Tuberculosis Infection in the United States: Clinical Recommendations. A Guide for Health Care Providers and Public Health Programs. Copyright © 2021 by the National Society of Tuberculosis Clinicians and National Tuberculosis Controllers Association

1. Shah, D. Latent tuberculosis infection. N Engl J Med. 2021;385:2271-80.

2. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of tuberculosis in adults and children. Clin Infect Dis. 2017 Jan 15;64(2):111-115.

3. Swindells et. al. One month of rifapentine plus isoniazid to prevent HIV-related tuberculosis. N Engl J Med. 2019;380:1001-11.

Thoracic oncology & chest procedures network: Lung cancer section

Adjuvant and neoadjuvant therapies in early stage lung cancer

Since the discovery of the epidermal growth factor receptor (EGFR) mutation in 2004 and the development of checkpoint blockade in 2006, personalized treatment options for non–small cell lung cancer (NSCLC) have exploded, but targeted systemic therapy medications were only recommended among patients with metastatic or locally advanced disease (Rivera MP, Matthay RA. Clin Chest Med. 2020;41[1]:ix-xi). However, in November 2020, the National Comprehensive Cancer Network (NCCN) updated guidelines to recommend EGFR testing in surgically resected stage IB-IIIA adenocarcinoma, and to consider adjuvant osimerintib in those who were mutation-positive (NCCN. Nov 2020). Interim analysis of an ongoing phase-3 trial showed 89% of patients in the osimertinib group were alive and disease-free at 24 months compared with 52% in the placebo group (hazard ratio 0.20, P < .001) (Wu YL, et al. N Engl J Med. 2020;383[18]:1711-23).   

Courtesy CHEST

The FDA has also recently approved the use of neoadjuvant and adjuvant immunotherapy in combination with platinum-based chemotherapy. Nivolumab is now approved as neoadjuvant therapy in patients with resectable IB-IIIA NSCLC regardless of PDL-1 status. The Checkmate-816 trial showed increased median event-free survival in the immunotherapy plus chemotherapy group of 31.6 months vs 20.8 months in the chemotherapy-only group (FDA.gov. 2022, Mar 4). Atezolizumab is also now approved for adjuvant treatment following resection and platinum-based chemotherapy in patients with stage II to IIIA NSCLC whose tumors have PD-L1 expression on ≥ 1% of tumor cells. Median disease-free survival was not reached in patients in the atezolizumab groups vs 35.3 months in the best supportive care group (FDA.gov. 2021, Oct 15). With so many advances in the personalized treatment among all stages of NSCLC, this is a hopeful new chapter in the care of patients with NSCLC. 

More information: https://www.nccn.org/guidelines/guidelines-process/transparency-process-and-recommendations/GetFileFromFileManager?fileManagerId=11259 
 

Sohini Ghosh, MD

Section Member-at-Large

Diffuse lung disease and lung transplant network: Lung transplant section 

Continuous distribution for lung transplant: Overhauling the wait list 

Determining how to allocate the scarce resource of donor lungs to patients is a difficult task and evaluated continuously for potential improvement. Since 2005, in the United States, lung transplant recipients have been selected based primarily on location within a Donor Service Area and by lung allocation score (LAS), a composite score of urgency for transplant. This was updated in 2017 to an allocation by highest LAS within 250 nautical miles from the donor hospital. Factors such as blood type compatibility and height are also considered. Implementation of the LAS improved the sickest patients’ access to transplants while not worsening 1-year mortality (Egan TM. Semin Respir Crit Care Med. 2018;39[02]:126-37). Unfortunately, geographic hard boundaries mean a high proportion of low LAS (<50) patients receive local donors while high LAS patients receive national offers or die while on the waitlist (Iribarne A, et al. Clin Transplant. 2016:30:688-93). 

Courtesy CHEST

A new model that employs continuous distribution has been developed based on concerns regarding equity and improving allocation. This model would prioritize patients based on factors including medical priority, efficient management of organ placement (distance), expected posttransplant outcomes, and patient access (equity). By creating a composite of these without a geographic boundary, patients would be considered more on urgency within realistic constraints of distance and outcomes.   

Courtesy CHEST

The Organ Procurement and Transplantation Network has officially approved continuous distribution, with implementation planned for 2022; details regarding the new scoring system are to be published and further research will need to be undertaken to determine if it meets the goal of overall improvement in patient access, equity, and outcomes.

Grant A. Turner, MD, MHA

Laura Frye, MD

Section Members-at-Large

Critical care network: Non-respiratory critical care section

Update from the non-respiratory critical care section

As you’ve probably noticed, there have been some changes here at CHEST involving the Networks. Leadership here at CHEST has been hard at work restructuring the networks to make them more closely aligned with relevant clinical disciplines, and, ultimately, allow for greater participation. I am proud to have been given stewardship of the new Non-Respiratory Critical Care Section of the Critical Care Network.

Courtesy CHEST

So, what exactly is Non-Respiratory Critical Care? Well, that’s where I need your help. You see this network is meant to reflect the needs and wants of CHEST members like you. We need you, dear readers, to join in this venture and help us guide the content that this section will ultimately create for our members.

If you’re interested in critical care, but you don’t see your particular area of interest anywhere else in the current structure ... guess what? You’ve found the right place!

My Infectious Diseases and Nephro peeps? Welcome! Are you a surgical or anesthesia intensivist? Don’t be shy. ECMO people, let’s hear some chatter!Is therapeutic hypothermia your thing? Come on in. The water’s freezing. 33 degrees just like you folks like it. Or is it 36? Not sure. Anyway, see what I’m talking about? We really need your help!You can get involved by clicking on the Membership & Community tab at the CHEST website. Once you’re a member, you can even nominate yourself to run for the Steering Committee elections which are held periodically. Hope to see you soon!

Deep Ramachandran, MD, FCCP

Section Chair

Sleep medicine network: Non-respiratory sleep section

Unusual suspects? Breakthrough in the treatment of idiopathic hypersomnia

Idiopathic hypersomnia (IH) is a rare and debilitating disorder defined by its excessive daytime sleepiness, sleep inertia, prolonged nighttime sleep, and long, unrefreshing naps (AASM. ICSD 3rd ed. 2014). Gamma-aminobutyric acid (GABA) is one of the main inhibitory neurotransmitters in the nervous system. It is through the potentiation of GABA that substances such as alcohol and benzodiazepines yield their effects. It is also hypothesized that the “brain fog” experienced in IH may be a consequence of either higher levels of an endogenous benzodiazepines in the cerebral spinal fluid or the presence of a GABA-enhancing peptide (Rye DB. Science Transl Med. 2012;Med 4:161ra151).

Sodium oxybate (SXB), a compound that likely has its therapeutic effect through the potentiation of GABA receptors, is an effective treatment option for cataplexy and sleepiness in narcolepsy. Although there may be some overlap between narcolepsy and IH in both diagnosis and treatment (Bassetti C, et al. Brain. 1997;120:1423), it would perhaps be entirely counterintuitive (given SXB’s pharmacology) to imagine using SXB as a plausible treatment option in IH. It was, however, investigated in the treatment of refractory hypersomnia and IH. In the retrospective study looking at 46 subjects treated with SXB, 71% experienced improvement of their severe sleep inertia, 55% had a decrease in their excessive daytime sleepiness, and 52% reported a shortened nighttime sleep time (Leu-Semenescu S, et al. Sleep Med. 2016;17:38).

In a recent double-blind, randomized control trial, the lower-sodium oxybate (LXB) was trialed in 154 patients with IH. It demonstrated statistically significant and clinically meaningful improvements (compared with placebo) in the Epworth Sleepiness Scale score (P <.0001) and in the Idiopathic Hypersomnia Severity Scale (P <.0001). The effects were seen both during the up titration of LXB and the benefits were maintained during the stable phase of the intervention (Dauvilliers Y, et al. Lancet Neurol. 2022;21(1):53). In August 2021, LXB (initially launched in 2020 for the treatment of narcolepsy) is now the first FDA-approved medication to treat IH in adults. It is curious, however, that LXB’s understood therapeutic effects are secondary to the “potentiation” of the very GABA receptor we have believed to be the root cause of the debilitating symptoms in IH. Could this discovery lend to further insights into the origins of this condition?

Ruckshanda Majid, MD, FCCP

There is little I enjoy more than an opportunity to get together with old friends.

I write this missive on the return trip from a week of CHEST leadership meetings held last month, and I find myself filled with joy, awe, and great appreciation for the hard work our volunteers contribute to making the American College of Chest Physicians an extraordinarily productive and successful organization. This year’s meetings meant more than any I can ever recall from the past, in the context of a return to in-person gatherings that let our members share laughs, stories, and even a game or two of laser tag in the context of celebrating good times and friendship. And while some great works were accomplished by our committees, some of which I will enumerate below, the highlight of the week was definitely the esprit de corps that was on broad display.

Courtesy ACCP

Our Membership Committee meeting was led by Vice-Chair Marie Budev, DO, FCCP. While this committee is tasked with the critical duty of reviewing applications for the prestigious FCCP designation, they are just as importantly tasked with promoting membership, to our domestic and international colleagues. This is a challenging task, because different members prioritize the variety of benefits from CHEST differently; some focus on access to our educational offerings, both throughout the year and at our annual meeting, while others find greater value in the chance to network with colleagues from around the world and to participate in leadership in an international society. Making sure that we are helping our members realize these benefits, while also identifying (and potentially enhancing) those opportunities in which members are most interested is a challenging task, and I very much enjoyed watching these folks brainstorm ways that we could further increase the value of joining CHEST for current and potential future members.

The Guidelines Oversight Committee, chaired by Lisa Moores, MD, FCCP, is responsible for the oversight of CHEST’s evidence-based guidelines. As our clinical guidelines are among the most highly regarded of all of the things we publish, the members of this committee take special care to ensure that the subjects selected for review as part of the guideline process meet strict criteria. They receive dozens of proposals for new guidelines each year and carefully examine each one to identify the potential public health impact, to ensure the availability of literature in the space worthy of review, and to provide the opportunity to illuminate areas where there are significant clinical uncertainties, often due to new treatments or diagnostic tests. Watching committee members meticulously debate the merits of the many good ideas received to finalize a short list of topics for guideline development in the coming year was incredibly informative and validated my longstanding perception that our members are some of the best clinical minds in the pulmonary, critical care, and sleep fields in the world.

The Professional Standards Committee (PSC), chaired by Scott Manaker, MD, PhD, FCCP, has the important duty of developing CHEST’s conflict of interest (COI) policy, as well as reviewing all potential COI among CHEST leaders and members of our guideline panels. While this may sound a little dry, the fascinating part of this meeting was the ongoing discussion of what constitutes a meaningful COI. As one would expect, many of the best medical experts in the world have relationships with pharmaceutical and medical device companies, who often seek the counsel and participation of high-performing, high-volume clinicians for research trials. CHEST has extremely strict rules with regard to COI among its many levels of leadership, but the question of what constitutes a potentially problematic COI for the large number of folks who volunteer their time and energy to teach at one of our many courses is an interesting (albeit possibly philosophical) question. Since PSC members cannot observe every CHEST faculty interaction, we rely on our members to let us know if they perceive any potential bias in faculty teaching (and we so very much appreciate those of you who bring the extremely rare concerns to our attention!), but this is an area that we continue to watch very closely, as we continue to ensure that all CHEST education is accurate, unbiased, and the best available throughout the world.

The reformulated Council of Networks met under the leadership of Angel Coz Yataco, MD, FCCP, and Cassie Kennedy, MD, FCCP, to discuss how to best engage our members in the new structure, which comprises seven Networks and 22 component Sections. The Council’s primary charges are to develop educational content, to review project applications from Sections, and to serve as expert consultants to the President in their specific clinical domains. While the new configuration provides a significant increase in leadership positions for our members, as well as more formal opportunities to cultivate relationships across different Sections, I have received a few emails from colleagues who were concerned about elimination of certain former Networks, or the placement of a specific Section under a specific Network. Some of these concerns were discussed at the April meeting. While there will be some growing pains, listening to the thoughtful discussion that ensued validated my belief that Drs. Coz and Kennedy are the right folks to be leading the Council as it matures into this new and stronger structure.

While I also had the opportunity to hear reports from the Training and Transitions Committee, the Education Committee, and the Council of Global Governors, I wanted to briefly mention the Scientific Program Committee and its Innovations Group. While we are looking forward to seeing everyone in Nashville this October, I cannot tell you how excited I am about some of the new things we have in store for our first in-person annual meeting in 3 years. (Literally ... I am absolutely sworn to secrecy!) But under the leadership of Program Chair Subani Chandra, MD, FCCP, and my two other “Chief Fun Officers” Aneesa Das, MD, FCCP, and William Kelly, MD, FCCP, I can say that attendees are going to be in for a heck of a lot of fun. Oh, and there’s going to be some education there, also.

In closing, I want to reiterate how much of a pleasure and privilege it has been to sit in the President’s chair over the first few months of 2022. If any of the committees I’ve described above sound interesting to you, please strongly consider throwing your hat into the ring when nominations open up in the coming months. Getting involved at CHEST has been one of the best experiences of my career, and I expect you’ll feel the same way after you join in the fun. As always, I remain available to you, either by emailing me at [email protected] or messaging me on Twitter @ChestPrez. And, please come find me in Nashville in October, either to say hello, or to challenge me to a game of laser tag. ... I’m not very hard to beat.

Until next time,

David

There is little I enjoy more than an opportunity to get together with old friends.

I write this missive on the return trip from a week of CHEST leadership meetings held last month, and I find myself filled with joy, awe, and great appreciation for the hard work our volunteers contribute to making the American College of Chest Physicians an extraordinarily productive and successful organization. This year’s meetings meant more than any I can ever recall from the past, in the context of a return to in-person gatherings that let our members share laughs, stories, and even a game or two of laser tag in the context of celebrating good times and friendship. And while some great works were accomplished by our committees, some of which I will enumerate below, the highlight of the week was definitely the esprit de corps that was on broad display.

Courtesy ACCP

Our Membership Committee meeting was led by Vice-Chair Marie Budev, DO, FCCP. While this committee is tasked with the critical duty of reviewing applications for the prestigious FCCP designation, they are just as importantly tasked with promoting membership, to our domestic and international colleagues. This is a challenging task, because different members prioritize the variety of benefits from CHEST differently; some focus on access to our educational offerings, both throughout the year and at our annual meeting, while others find greater value in the chance to network with colleagues from around the world and to participate in leadership in an international society. Making sure that we are helping our members realize these benefits, while also identifying (and potentially enhancing) those opportunities in which members are most interested is a challenging task, and I very much enjoyed watching these folks brainstorm ways that we could further increase the value of joining CHEST for current and potential future members.

The Guidelines Oversight Committee, chaired by Lisa Moores, MD, FCCP, is responsible for the oversight of CHEST’s evidence-based guidelines. As our clinical guidelines are among the most highly regarded of all of the things we publish, the members of this committee take special care to ensure that the subjects selected for review as part of the guideline process meet strict criteria. They receive dozens of proposals for new guidelines each year and carefully examine each one to identify the potential public health impact, to ensure the availability of literature in the space worthy of review, and to provide the opportunity to illuminate areas where there are significant clinical uncertainties, often due to new treatments or diagnostic tests. Watching committee members meticulously debate the merits of the many good ideas received to finalize a short list of topics for guideline development in the coming year was incredibly informative and validated my longstanding perception that our members are some of the best clinical minds in the pulmonary, critical care, and sleep fields in the world.

The Professional Standards Committee (PSC), chaired by Scott Manaker, MD, PhD, FCCP, has the important duty of developing CHEST’s conflict of interest (COI) policy, as well as reviewing all potential COI among CHEST leaders and members of our guideline panels. While this may sound a little dry, the fascinating part of this meeting was the ongoing discussion of what constitutes a meaningful COI. As one would expect, many of the best medical experts in the world have relationships with pharmaceutical and medical device companies, who often seek the counsel and participation of high-performing, high-volume clinicians for research trials. CHEST has extremely strict rules with regard to COI among its many levels of leadership, but the question of what constitutes a potentially problematic COI for the large number of folks who volunteer their time and energy to teach at one of our many courses is an interesting (albeit possibly philosophical) question. Since PSC members cannot observe every CHEST faculty interaction, we rely on our members to let us know if they perceive any potential bias in faculty teaching (and we so very much appreciate those of you who bring the extremely rare concerns to our attention!), but this is an area that we continue to watch very closely, as we continue to ensure that all CHEST education is accurate, unbiased, and the best available throughout the world.

The reformulated Council of Networks met under the leadership of Angel Coz Yataco, MD, FCCP, and Cassie Kennedy, MD, FCCP, to discuss how to best engage our members in the new structure, which comprises seven Networks and 22 component Sections. The Council’s primary charges are to develop educational content, to review project applications from Sections, and to serve as expert consultants to the President in their specific clinical domains. While the new configuration provides a significant increase in leadership positions for our members, as well as more formal opportunities to cultivate relationships across different Sections, I have received a few emails from colleagues who were concerned about elimination of certain former Networks, or the placement of a specific Section under a specific Network. Some of these concerns were discussed at the April meeting. While there will be some growing pains, listening to the thoughtful discussion that ensued validated my belief that Drs. Coz and Kennedy are the right folks to be leading the Council as it matures into this new and stronger structure.

While I also had the opportunity to hear reports from the Training and Transitions Committee, the Education Committee, and the Council of Global Governors, I wanted to briefly mention the Scientific Program Committee and its Innovations Group. While we are looking forward to seeing everyone in Nashville this October, I cannot tell you how excited I am about some of the new things we have in store for our first in-person annual meeting in 3 years. (Literally ... I am absolutely sworn to secrecy!) But under the leadership of Program Chair Subani Chandra, MD, FCCP, and my two other “Chief Fun Officers” Aneesa Das, MD, FCCP, and William Kelly, MD, FCCP, I can say that attendees are going to be in for a heck of a lot of fun. Oh, and there’s going to be some education there, also.

In closing, I want to reiterate how much of a pleasure and privilege it has been to sit in the President’s chair over the first few months of 2022. If any of the committees I’ve described above sound interesting to you, please strongly consider throwing your hat into the ring when nominations open up in the coming months. Getting involved at CHEST has been one of the best experiences of my career, and I expect you’ll feel the same way after you join in the fun. As always, I remain available to you, either by emailing me at [email protected] or messaging me on Twitter @ChestPrez. And, please come find me in Nashville in October, either to say hello, or to challenge me to a game of laser tag. ... I’m not very hard to beat.

Until next time,

David

There is little I enjoy more than an opportunity to get together with old friends.

I write this missive on the return trip from a week of CHEST leadership meetings held last month, and I find myself filled with joy, awe, and great appreciation for the hard work our volunteers contribute to making the American College of Chest Physicians an extraordinarily productive and successful organization. This year’s meetings meant more than any I can ever recall from the past, in the context of a return to in-person gatherings that let our members share laughs, stories, and even a game or two of laser tag in the context of celebrating good times and friendship. And while some great works were accomplished by our committees, some of which I will enumerate below, the highlight of the week was definitely the esprit de corps that was on broad display.

Courtesy ACCP

Our Membership Committee meeting was led by Vice-Chair Marie Budev, DO, FCCP. While this committee is tasked with the critical duty of reviewing applications for the prestigious FCCP designation, they are just as importantly tasked with promoting membership, to our domestic and international colleagues. This is a challenging task, because different members prioritize the variety of benefits from CHEST differently; some focus on access to our educational offerings, both throughout the year and at our annual meeting, while others find greater value in the chance to network with colleagues from around the world and to participate in leadership in an international society. Making sure that we are helping our members realize these benefits, while also identifying (and potentially enhancing) those opportunities in which members are most interested is a challenging task, and I very much enjoyed watching these folks brainstorm ways that we could further increase the value of joining CHEST for current and potential future members.

The Guidelines Oversight Committee, chaired by Lisa Moores, MD, FCCP, is responsible for the oversight of CHEST’s evidence-based guidelines. As our clinical guidelines are among the most highly regarded of all of the things we publish, the members of this committee take special care to ensure that the subjects selected for review as part of the guideline process meet strict criteria. They receive dozens of proposals for new guidelines each year and carefully examine each one to identify the potential public health impact, to ensure the availability of literature in the space worthy of review, and to provide the opportunity to illuminate areas where there are significant clinical uncertainties, often due to new treatments or diagnostic tests. Watching committee members meticulously debate the merits of the many good ideas received to finalize a short list of topics for guideline development in the coming year was incredibly informative and validated my longstanding perception that our members are some of the best clinical minds in the pulmonary, critical care, and sleep fields in the world.

The Professional Standards Committee (PSC), chaired by Scott Manaker, MD, PhD, FCCP, has the important duty of developing CHEST’s conflict of interest (COI) policy, as well as reviewing all potential COI among CHEST leaders and members of our guideline panels. While this may sound a little dry, the fascinating part of this meeting was the ongoing discussion of what constitutes a meaningful COI. As one would expect, many of the best medical experts in the world have relationships with pharmaceutical and medical device companies, who often seek the counsel and participation of high-performing, high-volume clinicians for research trials. CHEST has extremely strict rules with regard to COI among its many levels of leadership, but the question of what constitutes a potentially problematic COI for the large number of folks who volunteer their time and energy to teach at one of our many courses is an interesting (albeit possibly philosophical) question. Since PSC members cannot observe every CHEST faculty interaction, we rely on our members to let us know if they perceive any potential bias in faculty teaching (and we so very much appreciate those of you who bring the extremely rare concerns to our attention!), but this is an area that we continue to watch very closely, as we continue to ensure that all CHEST education is accurate, unbiased, and the best available throughout the world.

The reformulated Council of Networks met under the leadership of Angel Coz Yataco, MD, FCCP, and Cassie Kennedy, MD, FCCP, to discuss how to best engage our members in the new structure, which comprises seven Networks and 22 component Sections. The Council’s primary charges are to develop educational content, to review project applications from Sections, and to serve as expert consultants to the President in their specific clinical domains. While the new configuration provides a significant increase in leadership positions for our members, as well as more formal opportunities to cultivate relationships across different Sections, I have received a few emails from colleagues who were concerned about elimination of certain former Networks, or the placement of a specific Section under a specific Network. Some of these concerns were discussed at the April meeting. While there will be some growing pains, listening to the thoughtful discussion that ensued validated my belief that Drs. Coz and Kennedy are the right folks to be leading the Council as it matures into this new and stronger structure.

While I also had the opportunity to hear reports from the Training and Transitions Committee, the Education Committee, and the Council of Global Governors, I wanted to briefly mention the Scientific Program Committee and its Innovations Group. While we are looking forward to seeing everyone in Nashville this October, I cannot tell you how excited I am about some of the new things we have in store for our first in-person annual meeting in 3 years. (Literally ... I am absolutely sworn to secrecy!) But under the leadership of Program Chair Subani Chandra, MD, FCCP, and my two other “Chief Fun Officers” Aneesa Das, MD, FCCP, and William Kelly, MD, FCCP, I can say that attendees are going to be in for a heck of a lot of fun. Oh, and there’s going to be some education there, also.

In closing, I want to reiterate how much of a pleasure and privilege it has been to sit in the President’s chair over the first few months of 2022. If any of the committees I’ve described above sound interesting to you, please strongly consider throwing your hat into the ring when nominations open up in the coming months. Getting involved at CHEST has been one of the best experiences of my career, and I expect you’ll feel the same way after you join in the fun. As always, I remain available to you, either by emailing me at [email protected] or messaging me on Twitter @ChestPrez. And, please come find me in Nashville in October, either to say hello, or to challenge me to a game of laser tag. ... I’m not very hard to beat.

Until next time,

David

Welcome to Corinne Young, MSN, FNP-C, FCCP, who recently joined the CHEST Physician editorial board to represent and advocate for the perspective of advanced practice providers on the interdisciplinary team.

Young is a nurse practitioner and director of APP and Clinical Services for Colorado Springs Pulmonary Consultants in Colorado. She also is the founder and president of the Association of Pulmonary Advanced Practice Providers, which she created with support from CHEST staff and leaders, who encouraged her to create a community around advocating for and developing credentialing opportunities for this population.

Courtesy ACCP

The idea began early in Young’s career, when, after joining CHEST and attending educational events, she was struck by the lack of standardization in practice she saw among APPs.

“Every time I would be at the CHEST meeting, if I happened to bump into another APP, I would assault them with questions because I didn’t know what the norm was—and come to find out, nobody did,” she said. “Our organization came out of that, and our goal is to eventually standardize the education and knowledge base of APPs.”

Because there is not an option for a national certification specifically for pulmonary medicine for APPs, Young instead attained the FCCP to demonstrate her clinical competency and knowledge. She also immersed herself in the education and community of CHEST, working on the former Clinical Research & Quality Improvement NetWork Committee and Interprofessional Team NetWork Committee, serving on the Scientific Program Committee, and developing patient education on asthma, among other projects.

Now, as a member of the CHEST Physician Editorial Board, Young hopes to build awareness among clinicians of the importance of APPs on the care team and to support another option for APPs to access high-quality education and content to help them build their knowledge and enhance the care they deliver.

“It’s important that CHEST Physician is interested in an APP perspective being included,” she said. “It’s validation that we’re part of the team, that we’re included in all aspects of care including areas outside of direct care: in education, in the literature. ... That they feel our contributions are important.”

When she isn’t working with CHEST or caring for patients, Young and her husband competitively team rope, a rodeo event in which two people work together to rope a steer. Although they were unable to attend, they qualified for the world series in the sport last year, and hope to qualify again this year.

Please join us in welcoming Corinne Young to the CHEST Physician editorial board.

Welcome to Corinne Young, MSN, FNP-C, FCCP, who recently joined the CHEST Physician editorial board to represent and advocate for the perspective of advanced practice providers on the interdisciplinary team.

Young is a nurse practitioner and director of APP and Clinical Services for Colorado Springs Pulmonary Consultants in Colorado. She also is the founder and president of the Association of Pulmonary Advanced Practice Providers, which she created with support from CHEST staff and leaders, who encouraged her to create a community around advocating for and developing credentialing opportunities for this population.

Courtesy ACCP

The idea began early in Young’s career, when, after joining CHEST and attending educational events, she was struck by the lack of standardization in practice she saw among APPs.

“Every time I would be at the CHEST meeting, if I happened to bump into another APP, I would assault them with questions because I didn’t know what the norm was—and come to find out, nobody did,” she said. “Our organization came out of that, and our goal is to eventually standardize the education and knowledge base of APPs.”

Because there is not an option for a national certification specifically for pulmonary medicine for APPs, Young instead attained the FCCP to demonstrate her clinical competency and knowledge. She also immersed herself in the education and community of CHEST, working on the former Clinical Research & Quality Improvement NetWork Committee and Interprofessional Team NetWork Committee, serving on the Scientific Program Committee, and developing patient education on asthma, among other projects.

Now, as a member of the CHEST Physician Editorial Board, Young hopes to build awareness among clinicians of the importance of APPs on the care team and to support another option for APPs to access high-quality education and content to help them build their knowledge and enhance the care they deliver.

“It’s important that CHEST Physician is interested in an APP perspective being included,” she said. “It’s validation that we’re part of the team, that we’re included in all aspects of care including areas outside of direct care: in education, in the literature. ... That they feel our contributions are important.”

When she isn’t working with CHEST or caring for patients, Young and her husband competitively team rope, a rodeo event in which two people work together to rope a steer. Although they were unable to attend, they qualified for the world series in the sport last year, and hope to qualify again this year.

Please join us in welcoming Corinne Young to the CHEST Physician editorial board.

Welcome to Corinne Young, MSN, FNP-C, FCCP, who recently joined the CHEST Physician editorial board to represent and advocate for the perspective of advanced practice providers on the interdisciplinary team.

Young is a nurse practitioner and director of APP and Clinical Services for Colorado Springs Pulmonary Consultants in Colorado. She also is the founder and president of the Association of Pulmonary Advanced Practice Providers, which she created with support from CHEST staff and leaders, who encouraged her to create a community around advocating for and developing credentialing opportunities for this population.

Courtesy ACCP

The idea began early in Young’s career, when, after joining CHEST and attending educational events, she was struck by the lack of standardization in practice she saw among APPs.

“Every time I would be at the CHEST meeting, if I happened to bump into another APP, I would assault them with questions because I didn’t know what the norm was—and come to find out, nobody did,” she said. “Our organization came out of that, and our goal is to eventually standardize the education and knowledge base of APPs.”

Because there is not an option for a national certification specifically for pulmonary medicine for APPs, Young instead attained the FCCP to demonstrate her clinical competency and knowledge. She also immersed herself in the education and community of CHEST, working on the former Clinical Research & Quality Improvement NetWork Committee and Interprofessional Team NetWork Committee, serving on the Scientific Program Committee, and developing patient education on asthma, among other projects.

Now, as a member of the CHEST Physician Editorial Board, Young hopes to build awareness among clinicians of the importance of APPs on the care team and to support another option for APPs to access high-quality education and content to help them build their knowledge and enhance the care they deliver.

“It’s important that CHEST Physician is interested in an APP perspective being included,” she said. “It’s validation that we’re part of the team, that we’re included in all aspects of care including areas outside of direct care: in education, in the literature. ... That they feel our contributions are important.”

When she isn’t working with CHEST or caring for patients, Young and her husband competitively team rope, a rodeo event in which two people work together to rope a steer. Although they were unable to attend, they qualified for the world series in the sport last year, and hope to qualify again this year.

Please join us in welcoming Corinne Young to the CHEST Physician editorial board.

Genetic Associations and Architecture of Asthma-COPD Overlap. By Catherine John, et al.

Emerging Nonpulmonary Complications for Adults With Cystic Fibrosis. By Dr. Melanie Chin, et al.

Aspirin as a Treatment for ARDS: A Randomized, Placebo-Controlled Clinical Trial. By Dr. Philip Toner, et al.

PICU in the MICU: How Adult ICUs Can Support Pediatric Care in Public Health Emergencies. By Dr. Mary A. King, et al.

Association of BMI and Change in Weight With Mortality in Patients With Fibrotic Interstitial Lung Disease. By Dr. Alessia Comes, et al.

Off-Label Use and Inappropriate Dosing of Direct Oral Anticoagulants in Cardiopulmonary Disease. By Dr. Ayman A. Hussein, et al.

Genetic Associations and Architecture of Asthma-COPD Overlap. By Catherine John, et al.

Emerging Nonpulmonary Complications for Adults With Cystic Fibrosis. By Dr. Melanie Chin, et al.

Aspirin as a Treatment for ARDS: A Randomized, Placebo-Controlled Clinical Trial. By Dr. Philip Toner, et al.

PICU in the MICU: How Adult ICUs Can Support Pediatric Care in Public Health Emergencies. By Dr. Mary A. King, et al.

Association of BMI and Change in Weight With Mortality in Patients With Fibrotic Interstitial Lung Disease. By Dr. Alessia Comes, et al.

Off-Label Use and Inappropriate Dosing of Direct Oral Anticoagulants in Cardiopulmonary Disease. By Dr. Ayman A. Hussein, et al.

Genetic Associations and Architecture of Asthma-COPD Overlap. By Catherine John, et al.

Emerging Nonpulmonary Complications for Adults With Cystic Fibrosis. By Dr. Melanie Chin, et al.

Aspirin as a Treatment for ARDS: A Randomized, Placebo-Controlled Clinical Trial. By Dr. Philip Toner, et al.

PICU in the MICU: How Adult ICUs Can Support Pediatric Care in Public Health Emergencies. By Dr. Mary A. King, et al.

Association of BMI and Change in Weight With Mortality in Patients With Fibrotic Interstitial Lung Disease. By Dr. Alessia Comes, et al.

Off-Label Use and Inappropriate Dosing of Direct Oral Anticoagulants in Cardiopulmonary Disease. By Dr. Ayman A. Hussein, et al.

Although attendees will be watching “The Test of the Champion” with bated breath, the upcoming Belmont Stakes Dinner and Auction on June 11 in New York City is about much more than a famous horse race. It’s about community – the vibrant community of clinicians, patients, advocates, and more who support the mission to crush lung disease.

The event started small with a Sunday brunch at the home of CHEST President-Elect Doreen Addrizzo-Harris, MD, FCCP, where attendees gathered to learn more from their host about the CHEST Foundation’s many initiatives. However, over the years, Dr. Addrizzo-Harris leaned on her own community of colleagues, family, friends, and patients to build an event that now boasts hundreds of attendees. But despite all that has changed, the Belmont Stakes Dinner and Auction is still dedicated to raising awareness about the CHEST Foundation and fundraising for initiatives to develop patient education and improve care.

In addition to a plated dinner, silent auction, cocktail reception, and rooftop after-party, this year’s event will feature speeches from two long-time patient advocates living with chronic lung conditions, Fred Schick and Betsy Glaeser.

For Dr. Addrizzo-Harris, spotlighting that unique patient perspective is particularly meaningful because the core focus of CHEST and the CHEST Foundation is to improve care and, by extension, patients’ lives.

Visit foundation.chestnet.org to read a blog post with more information about Schick and Glaeser’s work advocating for others with lung disease, find more details about the Belmont Stakes Dinner and Auction, and reserve your seat for this night of philanthropy and fun.

Although attendees will be watching “The Test of the Champion” with bated breath, the upcoming Belmont Stakes Dinner and Auction on June 11 in New York City is about much more than a famous horse race. It’s about community – the vibrant community of clinicians, patients, advocates, and more who support the mission to crush lung disease.

The event started small with a Sunday brunch at the home of CHEST President-Elect Doreen Addrizzo-Harris, MD, FCCP, where attendees gathered to learn more from their host about the CHEST Foundation’s many initiatives. However, over the years, Dr. Addrizzo-Harris leaned on her own community of colleagues, family, friends, and patients to build an event that now boasts hundreds of attendees. But despite all that has changed, the Belmont Stakes Dinner and Auction is still dedicated to raising awareness about the CHEST Foundation and fundraising for initiatives to develop patient education and improve care.

In addition to a plated dinner, silent auction, cocktail reception, and rooftop after-party, this year’s event will feature speeches from two long-time patient advocates living with chronic lung conditions, Fred Schick and Betsy Glaeser.

For Dr. Addrizzo-Harris, spotlighting that unique patient perspective is particularly meaningful because the core focus of CHEST and the CHEST Foundation is to improve care and, by extension, patients’ lives.

Visit foundation.chestnet.org to read a blog post with more information about Schick and Glaeser’s work advocating for others with lung disease, find more details about the Belmont Stakes Dinner and Auction, and reserve your seat for this night of philanthropy and fun.

Although attendees will be watching “The Test of the Champion” with bated breath, the upcoming Belmont Stakes Dinner and Auction on June 11 in New York City is about much more than a famous horse race. It’s about community – the vibrant community of clinicians, patients, advocates, and more who support the mission to crush lung disease.

The event started small with a Sunday brunch at the home of CHEST President-Elect Doreen Addrizzo-Harris, MD, FCCP, where attendees gathered to learn more from their host about the CHEST Foundation’s many initiatives. However, over the years, Dr. Addrizzo-Harris leaned on her own community of colleagues, family, friends, and patients to build an event that now boasts hundreds of attendees. But despite all that has changed, the Belmont Stakes Dinner and Auction is still dedicated to raising awareness about the CHEST Foundation and fundraising for initiatives to develop patient education and improve care.

In addition to a plated dinner, silent auction, cocktail reception, and rooftop after-party, this year’s event will feature speeches from two long-time patient advocates living with chronic lung conditions, Fred Schick and Betsy Glaeser.

For Dr. Addrizzo-Harris, spotlighting that unique patient perspective is particularly meaningful because the core focus of CHEST and the CHEST Foundation is to improve care and, by extension, patients’ lives.

Visit foundation.chestnet.org to read a blog post with more information about Schick and Glaeser’s work advocating for others with lung disease, find more details about the Belmont Stakes Dinner and Auction, and reserve your seat for this night of philanthropy and fun.

In 2020, the CHEST Foundation embarked on a bold new initiative to build trust, identify, and remove barriers, and promote health care access for all in order to help fight lung disease. As part of that, we recognize that racial and ethnic minorities have been underrepresented in medical professions, contributing to these barriers to patient care.

We recognize that advocating for these groups and increasing the number of medical professors who represent people of color, ethnic minority groups, or who come from an historically disadvantaged community also increases the number of role models in our communities and can help stimulate greater interest among minority students in the health care professions. This year, CHEST is joining ATS and ALA in funding the Harold Amos Medical Faculty Development program, and the CHEST Foundation will be raising funds to support these fellowship recipients.

Harold Amos, PhD, was the first African American to chair a department, now the Department of Microbiology and Medical Genetics, of the Harvard Medical School. Dr. Amos worked tirelessly to recruit and mentor minority and disadvantaged students to careers in academic medicine and science. He was a founding member of the National Advisory Committee of the Robert Wood Johnson Foundation’s Minority Medical Faculty Development Program in 1983 and served as the Program’s National Program Director between 1989 and 1993. Dr. Amos remained active with the program until his death in 2003.

This program exists to continue Dr. Amos’s legacy and to increase the number of faculty from historically disadvantaged backgrounds who can achieve senior rank in academic medicine, dentistry, or nursing and who will encourage and foster the development of succeeding classes of such physicians, dentists, and nurse-scientists. The impact of this program is clear.
 

Key results

• Over the past 30 years, 241 scholars had completed all 4 years of the program (as of 2012). More than three-quarters remained in academic medicine, including 57 professors, 76 associate professors, and 56 assistant professors.
• Many program alumni have earned professional honors and become influential leaders in the health care field. For example, three direct institutes at the National Institutes of Health, and 10 have been elected to the Institute of Medicine.
• Alumni have received hundreds of awards and honors, including a MacArthur Fellowship “genius” award.
• Alumni have reached positions of influence in academia that enable them to help correct the underrepresentation of minorities in the health professions and address health disparities.

Former scholars are:

• Members of admission, intern, and faculty selection committees
• On review boards for clinical protocols and research studies
• Officers of professional societies and on editorial boards of academic journals

CHEST is proud to join with ATS and ALA to support this incredible program. We recognize that the impact on the past is only the start. By supporting this initiative, we are also looking to address the challenges of the future as the health care landscape continues to evolve. Ensuring that this program reaches the right groups and continues to promote Dr. Amos’s legacy is integral not only to the success of the program but also to aid us in being able to care for our diverse and unique patient populations. The CHEST Foundation is raising funds to support future fellowship recipients. Join us at our next Viva la Vino wine tasting event on July 14 at 7:00 PM CT. All proceeds go to benefit this important initiative, and you can learn more about the work the Foundation does in a relaxed, social environment.

In 2020, the CHEST Foundation embarked on a bold new initiative to build trust, identify, and remove barriers, and promote health care access for all in order to help fight lung disease. As part of that, we recognize that racial and ethnic minorities have been underrepresented in medical professions, contributing to these barriers to patient care.

We recognize that advocating for these groups and increasing the number of medical professors who represent people of color, ethnic minority groups, or who come from an historically disadvantaged community also increases the number of role models in our communities and can help stimulate greater interest among minority students in the health care professions. This year, CHEST is joining ATS and ALA in funding the Harold Amos Medical Faculty Development program, and the CHEST Foundation will be raising funds to support these fellowship recipients.

Harold Amos, PhD, was the first African American to chair a department, now the Department of Microbiology and Medical Genetics, of the Harvard Medical School. Dr. Amos worked tirelessly to recruit and mentor minority and disadvantaged students to careers in academic medicine and science. He was a founding member of the National Advisory Committee of the Robert Wood Johnson Foundation’s Minority Medical Faculty Development Program in 1983 and served as the Program’s National Program Director between 1989 and 1993. Dr. Amos remained active with the program until his death in 2003.

This program exists to continue Dr. Amos’s legacy and to increase the number of faculty from historically disadvantaged backgrounds who can achieve senior rank in academic medicine, dentistry, or nursing and who will encourage and foster the development of succeeding classes of such physicians, dentists, and nurse-scientists. The impact of this program is clear.
 

Key results

• Over the past 30 years, 241 scholars had completed all 4 years of the program (as of 2012). More than three-quarters remained in academic medicine, including 57 professors, 76 associate professors, and 56 assistant professors.
• Many program alumni have earned professional honors and become influential leaders in the health care field. For example, three direct institutes at the National Institutes of Health, and 10 have been elected to the Institute of Medicine.
• Alumni have received hundreds of awards and honors, including a MacArthur Fellowship “genius” award.
• Alumni have reached positions of influence in academia that enable them to help correct the underrepresentation of minorities in the health professions and address health disparities.

Former scholars are:

• Members of admission, intern, and faculty selection committees
• On review boards for clinical protocols and research studies
• Officers of professional societies and on editorial boards of academic journals

CHEST is proud to join with ATS and ALA to support this incredible program. We recognize that the impact on the past is only the start. By supporting this initiative, we are also looking to address the challenges of the future as the health care landscape continues to evolve. Ensuring that this program reaches the right groups and continues to promote Dr. Amos’s legacy is integral not only to the success of the program but also to aid us in being able to care for our diverse and unique patient populations. The CHEST Foundation is raising funds to support future fellowship recipients. Join us at our next Viva la Vino wine tasting event on July 14 at 7:00 PM CT. All proceeds go to benefit this important initiative, and you can learn more about the work the Foundation does in a relaxed, social environment.

In 2020, the CHEST Foundation embarked on a bold new initiative to build trust, identify, and remove barriers, and promote health care access for all in order to help fight lung disease. As part of that, we recognize that racial and ethnic minorities have been underrepresented in medical professions, contributing to these barriers to patient care.

We recognize that advocating for these groups and increasing the number of medical professors who represent people of color, ethnic minority groups, or who come from an historically disadvantaged community also increases the number of role models in our communities and can help stimulate greater interest among minority students in the health care professions. This year, CHEST is joining ATS and ALA in funding the Harold Amos Medical Faculty Development program, and the CHEST Foundation will be raising funds to support these fellowship recipients.

Harold Amos, PhD, was the first African American to chair a department, now the Department of Microbiology and Medical Genetics, of the Harvard Medical School. Dr. Amos worked tirelessly to recruit and mentor minority and disadvantaged students to careers in academic medicine and science. He was a founding member of the National Advisory Committee of the Robert Wood Johnson Foundation’s Minority Medical Faculty Development Program in 1983 and served as the Program’s National Program Director between 1989 and 1993. Dr. Amos remained active with the program until his death in 2003.

This program exists to continue Dr. Amos’s legacy and to increase the number of faculty from historically disadvantaged backgrounds who can achieve senior rank in academic medicine, dentistry, or nursing and who will encourage and foster the development of succeeding classes of such physicians, dentists, and nurse-scientists. The impact of this program is clear.
 

Key results

• Over the past 30 years, 241 scholars had completed all 4 years of the program (as of 2012). More than three-quarters remained in academic medicine, including 57 professors, 76 associate professors, and 56 assistant professors.
• Many program alumni have earned professional honors and become influential leaders in the health care field. For example, three direct institutes at the National Institutes of Health, and 10 have been elected to the Institute of Medicine.
• Alumni have received hundreds of awards and honors, including a MacArthur Fellowship “genius” award.
• Alumni have reached positions of influence in academia that enable them to help correct the underrepresentation of minorities in the health professions and address health disparities.

Former scholars are:

• Members of admission, intern, and faculty selection committees
• On review boards for clinical protocols and research studies
• Officers of professional societies and on editorial boards of academic journals

CHEST is proud to join with ATS and ALA to support this incredible program. We recognize that the impact on the past is only the start. By supporting this initiative, we are also looking to address the challenges of the future as the health care landscape continues to evolve. Ensuring that this program reaches the right groups and continues to promote Dr. Amos’s legacy is integral not only to the success of the program but also to aid us in being able to care for our diverse and unique patient populations. The CHEST Foundation is raising funds to support future fellowship recipients. Join us at our next Viva la Vino wine tasting event on July 14 at 7:00 PM CT. All proceeds go to benefit this important initiative, and you can learn more about the work the Foundation does in a relaxed, social environment.

There is a variety of ways to support the many impactful new programs the CHEST Foundation will launch in 2022, but one of the most anticipated options is the annual Belmont Stakes Dinner and Auction on June 11 in New York City. This fun-filled evening will include a viewing of the 154th running of “The Championship Track,” a cocktail reception and plated dinner, a silent auction, a rooftop party, and much more.

This year, the dinner and auction will support the CHEST Foundation’s work in patient education and CHEST initiatives to improve patient care. Two areas of focus are disparities in care delivery and improving patients’ quality of life through partnerships designed to encourage earlier diagnosis and treatment.

With these goals in mind, new initiatives include an extension of the 2020 Foundation Listening Tour designed to help clinicians increase trust, equity, and access to health care for patients in traditionally marginalized communities.

In addition, CHEST is partnering with the Three Lakes Foundation on a program dedicated to shortening the time to diagnosis for pulmonary fibrosis (PF). This initiative will bring together pulmonologists and primary care physicians to develop a strategy for identifying PF more quickly, ensuring treatment can begin earlier in the disease trajectory. Early detection of PF is associated with better quality of life for patients, so improving clinicians’ understanding of the signs and symptoms of this rare disease and formulating better guidance for diagnosing it could result in drastic improvements for those living with PF.

To highlight the importance of these efforts, the evening also will include speeches from two patient advocates who have turned their own experiences with living with chronic lung disease into incredible action on behalf of patients.

To learn more about the CHEST Foundation’s initiatives in 2022 and how you can attend the Belmont Stakes Dinner and Auction to support these efforts, visit foundation.chestnet.org.

There is a variety of ways to support the many impactful new programs the CHEST Foundation will launch in 2022, but one of the most anticipated options is the annual Belmont Stakes Dinner and Auction on June 11 in New York City. This fun-filled evening will include a viewing of the 154th running of “The Championship Track,” a cocktail reception and plated dinner, a silent auction, a rooftop party, and much more.

This year, the dinner and auction will support the CHEST Foundation’s work in patient education and CHEST initiatives to improve patient care. Two areas of focus are disparities in care delivery and improving patients’ quality of life through partnerships designed to encourage earlier diagnosis and treatment.

With these goals in mind, new initiatives include an extension of the 2020 Foundation Listening Tour designed to help clinicians increase trust, equity, and access to health care for patients in traditionally marginalized communities.

In addition, CHEST is partnering with the Three Lakes Foundation on a program dedicated to shortening the time to diagnosis for pulmonary fibrosis (PF). This initiative will bring together pulmonologists and primary care physicians to develop a strategy for identifying PF more quickly, ensuring treatment can begin earlier in the disease trajectory. Early detection of PF is associated with better quality of life for patients, so improving clinicians’ understanding of the signs and symptoms of this rare disease and formulating better guidance for diagnosing it could result in drastic improvements for those living with PF.

To highlight the importance of these efforts, the evening also will include speeches from two patient advocates who have turned their own experiences with living with chronic lung disease into incredible action on behalf of patients.

To learn more about the CHEST Foundation’s initiatives in 2022 and how you can attend the Belmont Stakes Dinner and Auction to support these efforts, visit foundation.chestnet.org.

There is a variety of ways to support the many impactful new programs the CHEST Foundation will launch in 2022, but one of the most anticipated options is the annual Belmont Stakes Dinner and Auction on June 11 in New York City. This fun-filled evening will include a viewing of the 154th running of “The Championship Track,” a cocktail reception and plated dinner, a silent auction, a rooftop party, and much more.

This year, the dinner and auction will support the CHEST Foundation’s work in patient education and CHEST initiatives to improve patient care. Two areas of focus are disparities in care delivery and improving patients’ quality of life through partnerships designed to encourage earlier diagnosis and treatment.

With these goals in mind, new initiatives include an extension of the 2020 Foundation Listening Tour designed to help clinicians increase trust, equity, and access to health care for patients in traditionally marginalized communities.

In addition, CHEST is partnering with the Three Lakes Foundation on a program dedicated to shortening the time to diagnosis for pulmonary fibrosis (PF). This initiative will bring together pulmonologists and primary care physicians to develop a strategy for identifying PF more quickly, ensuring treatment can begin earlier in the disease trajectory. Early detection of PF is associated with better quality of life for patients, so improving clinicians’ understanding of the signs and symptoms of this rare disease and formulating better guidance for diagnosing it could result in drastic improvements for those living with PF.

To highlight the importance of these efforts, the evening also will include speeches from two patient advocates who have turned their own experiences with living with chronic lung disease into incredible action on behalf of patients.

To learn more about the CHEST Foundation’s initiatives in 2022 and how you can attend the Belmont Stakes Dinner and Auction to support these efforts, visit foundation.chestnet.org.

A quality educational meeting starts with a great slate of programs tailored to its audience, and CHEST 2022 is on-track to offer the highest tier of education for those in pulmonary, critical care, and sleep medicine.

Although planning for the meeting started after CHEST 2021 wrapped up, the real magic started to happen a few months ago when the schedule began coming together. In mid-February, members of the Scientific Planning Committee gathered both virtually and in-person at the CHEST headquarters to solidify the schedule for the upcoming CHEST 2022 meeting taking place in Nashville, TN, October 16-19.

The excitement in the room was palpable as committee members gathered for the first time in over a year to plan what will be the first in-person meeting since CHEST 2019 in New Orleans.

Chair of CHEST 2022, Subani Chandra, MD, FCCP, has high expectations for the meeting and is excited for everyone to be together in Nashville. “There is something special about an in-person meeting and my goal for CHEST 2022 is to not only meet the academic needs of the attendees, but also to serve as a chance to recharge after a long haul in managing COVID-19,” says Dr. Chandra. “Many first-time CHEST attendees are fellows and, with the last two meetings being virtual, there are a lot of fellows who have yet to attend a meeting in-person, so that is a big responsibility for us and opportunity for them. We want to make sure they have a fun and productive meeting – learn from the best, understand how to apply the latest research, get to present their work, network, participate, and have fun doing it all!”

With something for everyone in chest medicine, the CHEST 2022 meeting will feature over 200 sessions covering eight curriculum groups:

• Obstructive lung disease
• Sleep
• Chest infections
• Cardiovascular/pulmonary vascular disease
• Pulmonary procedures/lung cancer/cardiothoracic surgery
• Interstitial lung disease/radiology
• Interdisciplinary/practice operations/education
• Critical care

Covering a large breadth of information, the sessions will include the latest trends in COVID-19 care – recommended protocols, surge-planning and best practices; deeper looks into the latest CHEST guidelines – thromboprophylaxis in patients with COVID-19, antithrombotic therapy for VTE disease, and the guidelines for lung cancer screening; and sessions speaking to diversity, inclusion, and equity within medicine, including how lung disease affects populations differently.

Dr. Chandra says diversity was top of mind throughout the planning process. When submitting session ideas, it was noted that “submissions with speakers representing one gender and/or one institution will not be considered,” and that “selection priority will be given to outstanding submissions with proposed speakers who represent diversity of race, ethnicity, and professional status.”

During February’s meeting, as the committee members confirmed each of the sessions, they took the time to ensure every single one had presenters from a variety of backgrounds, including diversity of gender, race, credentialing, and years of experience in medicine.

It was important to the committee that this not be a physician-only meeting, because both CHEST and Pulmonary/Critical Care Medicine feature an array of team members including physicians, advance practice providers, respiratory therapists, nurses and other members of the care team and the sessions will reflect that.

When asked what she hopes attendees will gain from CHEST 2022, Dr. Chandra says, “I want attendees to feel the joy that comes from not only being together, but learning together.”

She continued, “I want this meeting to remind clinicians why they fell in love with medicine and to remember why it is that we do what we do, especially after two grueling years. Attendees should leave feeling reinvigorated and charged with the latest literature and clinical expertise ready to be implemented into practice. Most of all, I want all of the attendees to have fun, because we are there to learn, but CHEST is also about enjoying medicine and those around you. I just cannot wait.”

A quality educational meeting starts with a great slate of programs tailored to its audience, and CHEST 2022 is on-track to offer the highest tier of education for those in pulmonary, critical care, and sleep medicine.

Although planning for the meeting started after CHEST 2021 wrapped up, the real magic started to happen a few months ago when the schedule began coming together. In mid-February, members of the Scientific Planning Committee gathered both virtually and in-person at the CHEST headquarters to solidify the schedule for the upcoming CHEST 2022 meeting taking place in Nashville, TN, October 16-19.

The excitement in the room was palpable as committee members gathered for the first time in over a year to plan what will be the first in-person meeting since CHEST 2019 in New Orleans.

Chair of CHEST 2022, Subani Chandra, MD, FCCP, has high expectations for the meeting and is excited for everyone to be together in Nashville. “There is something special about an in-person meeting and my goal for CHEST 2022 is to not only meet the academic needs of the attendees, but also to serve as a chance to recharge after a long haul in managing COVID-19,” says Dr. Chandra. “Many first-time CHEST attendees are fellows and, with the last two meetings being virtual, there are a lot of fellows who have yet to attend a meeting in-person, so that is a big responsibility for us and opportunity for them. We want to make sure they have a fun and productive meeting – learn from the best, understand how to apply the latest research, get to present their work, network, participate, and have fun doing it all!”

With something for everyone in chest medicine, the CHEST 2022 meeting will feature over 200 sessions covering eight curriculum groups:

• Obstructive lung disease
• Sleep
• Chest infections
• Cardiovascular/pulmonary vascular disease
• Pulmonary procedures/lung cancer/cardiothoracic surgery
• Interstitial lung disease/radiology
• Interdisciplinary/practice operations/education
• Critical care

Covering a large breadth of information, the sessions will include the latest trends in COVID-19 care – recommended protocols, surge-planning and best practices; deeper looks into the latest CHEST guidelines – thromboprophylaxis in patients with COVID-19, antithrombotic therapy for VTE disease, and the guidelines for lung cancer screening; and sessions speaking to diversity, inclusion, and equity within medicine, including how lung disease affects populations differently.

Dr. Chandra says diversity was top of mind throughout the planning process. When submitting session ideas, it was noted that “submissions with speakers representing one gender and/or one institution will not be considered,” and that “selection priority will be given to outstanding submissions with proposed speakers who represent diversity of race, ethnicity, and professional status.”

During February’s meeting, as the committee members confirmed each of the sessions, they took the time to ensure every single one had presenters from a variety of backgrounds, including diversity of gender, race, credentialing, and years of experience in medicine.

It was important to the committee that this not be a physician-only meeting, because both CHEST and Pulmonary/Critical Care Medicine feature an array of team members including physicians, advance practice providers, respiratory therapists, nurses and other members of the care team and the sessions will reflect that.

When asked what she hopes attendees will gain from CHEST 2022, Dr. Chandra says, “I want attendees to feel the joy that comes from not only being together, but learning together.”

She continued, “I want this meeting to remind clinicians why they fell in love with medicine and to remember why it is that we do what we do, especially after two grueling years. Attendees should leave feeling reinvigorated and charged with the latest literature and clinical expertise ready to be implemented into practice. Most of all, I want all of the attendees to have fun, because we are there to learn, but CHEST is also about enjoying medicine and those around you. I just cannot wait.”

A quality educational meeting starts with a great slate of programs tailored to its audience, and CHEST 2022 is on-track to offer the highest tier of education for those in pulmonary, critical care, and sleep medicine.

Although planning for the meeting started after CHEST 2021 wrapped up, the real magic started to happen a few months ago when the schedule began coming together. In mid-February, members of the Scientific Planning Committee gathered both virtually and in-person at the CHEST headquarters to solidify the schedule for the upcoming CHEST 2022 meeting taking place in Nashville, TN, October 16-19.

The excitement in the room was palpable as committee members gathered for the first time in over a year to plan what will be the first in-person meeting since CHEST 2019 in New Orleans.

Chair of CHEST 2022, Subani Chandra, MD, FCCP, has high expectations for the meeting and is excited for everyone to be together in Nashville. “There is something special about an in-person meeting and my goal for CHEST 2022 is to not only meet the academic needs of the attendees, but also to serve as a chance to recharge after a long haul in managing COVID-19,” says Dr. Chandra. “Many first-time CHEST attendees are fellows and, with the last two meetings being virtual, there are a lot of fellows who have yet to attend a meeting in-person, so that is a big responsibility for us and opportunity for them. We want to make sure they have a fun and productive meeting – learn from the best, understand how to apply the latest research, get to present their work, network, participate, and have fun doing it all!”

With something for everyone in chest medicine, the CHEST 2022 meeting will feature over 200 sessions covering eight curriculum groups:

• Obstructive lung disease
• Sleep
• Chest infections
• Cardiovascular/pulmonary vascular disease
• Pulmonary procedures/lung cancer/cardiothoracic surgery
• Interstitial lung disease/radiology
• Interdisciplinary/practice operations/education
• Critical care

Covering a large breadth of information, the sessions will include the latest trends in COVID-19 care – recommended protocols, surge-planning and best practices; deeper looks into the latest CHEST guidelines – thromboprophylaxis in patients with COVID-19, antithrombotic therapy for VTE disease, and the guidelines for lung cancer screening; and sessions speaking to diversity, inclusion, and equity within medicine, including how lung disease affects populations differently.

Dr. Chandra says diversity was top of mind throughout the planning process. When submitting session ideas, it was noted that “submissions with speakers representing one gender and/or one institution will not be considered,” and that “selection priority will be given to outstanding submissions with proposed speakers who represent diversity of race, ethnicity, and professional status.”

During February’s meeting, as the committee members confirmed each of the sessions, they took the time to ensure every single one had presenters from a variety of backgrounds, including diversity of gender, race, credentialing, and years of experience in medicine.

It was important to the committee that this not be a physician-only meeting, because both CHEST and Pulmonary/Critical Care Medicine feature an array of team members including physicians, advance practice providers, respiratory therapists, nurses and other members of the care team and the sessions will reflect that.

When asked what she hopes attendees will gain from CHEST 2022, Dr. Chandra says, “I want attendees to feel the joy that comes from not only being together, but learning together.”

She continued, “I want this meeting to remind clinicians why they fell in love with medicine and to remember why it is that we do what we do, especially after two grueling years. Attendees should leave feeling reinvigorated and charged with the latest literature and clinical expertise ready to be implemented into practice. Most of all, I want all of the attendees to have fun, because we are there to learn, but CHEST is also about enjoying medicine and those around you. I just cannot wait.”