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Launching the Moderate to Severe Asthma Center of Excellence
The American College of Chest Physicians (CHEST) announces a new partnership with Medscape focused on supporting physicians in addressing the challenges of diagnosing and treating moderate to severe asthma. The Moderate to Severe Asthma Center of Excellence (https://www.medscape.com/resource/moderate-severe-asthma) will provide news, expert commentary, and insights on challenging cases to physicians specializing in chest medicine, allergy, primary care, pediatrics, and emergency medicine.
Medscape is a leading source of clinical news, health information, and point-of-care tools for physicians and health-care professionals. This new Center of Excellence available on Medscape.com will explore the diagnostic, therapeutic, and prevention strategies associated with moderate to severe asthma, including the latest research and breakthroughs. Topics will include challenges in classifying and diagnosing disease; risks, benefits, and barriers to treatment; and impact on patients’ quality of life.
“We look forward to working with Medscape on the Center of Excellence to ensure that all physicians treating patients with asthma have access to the latest information and research on managing this pervasive and challenging disease,” said John Studdard, MD, FCCP, President, American College of Chest Physicians.
“The Moderate to Severe Asthma Center of Excellence with CHEST provides a new, accessible channel for information, practical insights, and commentary to the thousands of physicians and health-care professionals who visit Medscape daily,” said Jo-Ann Strangis, Senior Vice President, Editorial for Medscape. “We are privileged to be working with CHEST and look forward to the Center of Excellence making a meaningful difference in patient care.”
Don’t miss Dr. Aaron Holley’s video on “Diagnosing Severe Asthma: ‘Not as Easy as It Sounds” (https://www.medscape.com/viewarticle/896135?src=dpcs).
Visit the Moderate to Severe Asthma Center of Excellence: https://www.medscape.com/resource/moderate-severe-asthma
The American College of Chest Physicians (CHEST) announces a new partnership with Medscape focused on supporting physicians in addressing the challenges of diagnosing and treating moderate to severe asthma. The Moderate to Severe Asthma Center of Excellence (https://www.medscape.com/resource/moderate-severe-asthma) will provide news, expert commentary, and insights on challenging cases to physicians specializing in chest medicine, allergy, primary care, pediatrics, and emergency medicine.
Medscape is a leading source of clinical news, health information, and point-of-care tools for physicians and health-care professionals. This new Center of Excellence available on Medscape.com will explore the diagnostic, therapeutic, and prevention strategies associated with moderate to severe asthma, including the latest research and breakthroughs. Topics will include challenges in classifying and diagnosing disease; risks, benefits, and barriers to treatment; and impact on patients’ quality of life.
“We look forward to working with Medscape on the Center of Excellence to ensure that all physicians treating patients with asthma have access to the latest information and research on managing this pervasive and challenging disease,” said John Studdard, MD, FCCP, President, American College of Chest Physicians.
“The Moderate to Severe Asthma Center of Excellence with CHEST provides a new, accessible channel for information, practical insights, and commentary to the thousands of physicians and health-care professionals who visit Medscape daily,” said Jo-Ann Strangis, Senior Vice President, Editorial for Medscape. “We are privileged to be working with CHEST and look forward to the Center of Excellence making a meaningful difference in patient care.”
Don’t miss Dr. Aaron Holley’s video on “Diagnosing Severe Asthma: ‘Not as Easy as It Sounds” (https://www.medscape.com/viewarticle/896135?src=dpcs).
Visit the Moderate to Severe Asthma Center of Excellence: https://www.medscape.com/resource/moderate-severe-asthma
The American College of Chest Physicians (CHEST) announces a new partnership with Medscape focused on supporting physicians in addressing the challenges of diagnosing and treating moderate to severe asthma. The Moderate to Severe Asthma Center of Excellence (https://www.medscape.com/resource/moderate-severe-asthma) will provide news, expert commentary, and insights on challenging cases to physicians specializing in chest medicine, allergy, primary care, pediatrics, and emergency medicine.
Medscape is a leading source of clinical news, health information, and point-of-care tools for physicians and health-care professionals. This new Center of Excellence available on Medscape.com will explore the diagnostic, therapeutic, and prevention strategies associated with moderate to severe asthma, including the latest research and breakthroughs. Topics will include challenges in classifying and diagnosing disease; risks, benefits, and barriers to treatment; and impact on patients’ quality of life.
“We look forward to working with Medscape on the Center of Excellence to ensure that all physicians treating patients with asthma have access to the latest information and research on managing this pervasive and challenging disease,” said John Studdard, MD, FCCP, President, American College of Chest Physicians.
“The Moderate to Severe Asthma Center of Excellence with CHEST provides a new, accessible channel for information, practical insights, and commentary to the thousands of physicians and health-care professionals who visit Medscape daily,” said Jo-Ann Strangis, Senior Vice President, Editorial for Medscape. “We are privileged to be working with CHEST and look forward to the Center of Excellence making a meaningful difference in patient care.”
Don’t miss Dr. Aaron Holley’s video on “Diagnosing Severe Asthma: ‘Not as Easy as It Sounds” (https://www.medscape.com/viewarticle/896135?src=dpcs).
Visit the Moderate to Severe Asthma Center of Excellence: https://www.medscape.com/resource/moderate-severe-asthma
Launching the Moderate to Severe Asthma Center of Excellence
The American College of Chest Physicians (CHEST) announces a new partnership with Medscape focused on supporting physicians in addressing the challenges of diagnosing and treating moderate to severe asthma. The Moderate to Severe Asthma Center of Excellence will provide news, expert commentary, and insights on challenging cases to physicians specializing in chest medicine, allergy, primary care, pediatrics, and emergency medicine.
Medscape is a leading source of clinical news, health information, and point-of-care tools for physicians and health-care professionals. This new Center of Excellence available on Medscape.com will explore the diagnostic, therapeutic, and prevention strategies associated with moderate to severe asthma, including the latest research and breakthroughs. Topics will include challenges in classifying and diagnosing disease; risks, benefits, and barriers to treatment; and impact on patients’ quality of life.
Don’t miss Dr. Aaron Holley’s video on “Diagnosing Severe Asthma: ‘Not as Easy as It Sounds’ ”
Visit the Moderate to Severe Asthma Center of Excellence at https://www.medscape.com/resource/moderate-severe-asthma
The American College of Chest Physicians (CHEST) announces a new partnership with Medscape focused on supporting physicians in addressing the challenges of diagnosing and treating moderate to severe asthma. The Moderate to Severe Asthma Center of Excellence will provide news, expert commentary, and insights on challenging cases to physicians specializing in chest medicine, allergy, primary care, pediatrics, and emergency medicine.
Medscape is a leading source of clinical news, health information, and point-of-care tools for physicians and health-care professionals. This new Center of Excellence available on Medscape.com will explore the diagnostic, therapeutic, and prevention strategies associated with moderate to severe asthma, including the latest research and breakthroughs. Topics will include challenges in classifying and diagnosing disease; risks, benefits, and barriers to treatment; and impact on patients’ quality of life.
Don’t miss Dr. Aaron Holley’s video on “Diagnosing Severe Asthma: ‘Not as Easy as It Sounds’ ”
Visit the Moderate to Severe Asthma Center of Excellence at https://www.medscape.com/resource/moderate-severe-asthma
The American College of Chest Physicians (CHEST) announces a new partnership with Medscape focused on supporting physicians in addressing the challenges of diagnosing and treating moderate to severe asthma. The Moderate to Severe Asthma Center of Excellence will provide news, expert commentary, and insights on challenging cases to physicians specializing in chest medicine, allergy, primary care, pediatrics, and emergency medicine.
Medscape is a leading source of clinical news, health information, and point-of-care tools for physicians and health-care professionals. This new Center of Excellence available on Medscape.com will explore the diagnostic, therapeutic, and prevention strategies associated with moderate to severe asthma, including the latest research and breakthroughs. Topics will include challenges in classifying and diagnosing disease; risks, benefits, and barriers to treatment; and impact on patients’ quality of life.
Don’t miss Dr. Aaron Holley’s video on “Diagnosing Severe Asthma: ‘Not as Easy as It Sounds’ ”
Visit the Moderate to Severe Asthma Center of Excellence at https://www.medscape.com/resource/moderate-severe-asthma
NAMDRC Legislative and Regulatory Agenda Once Again Focuses on Patient Access
NAMDRC’s Mission Statement declares, “NAMDRC’s primary mission is to improve access to quality care for patients with respiratory disease by removing regulatory and legislative barriers to appropriate treatment.” This mission is clear as we review our legislative and regulatory agenda on an ongoing and continuing basis.
Home Mechanical Ventilation: Close to 20 years ago, HCFA (now CMS) was faced with an important reality: advances in technology related to home mechanical ventilation are triggering an exponential growth in availability of these life supporting devices, but a price would be paid. At that time, Medicare law was quite explicit, indicating that certain ventilators would be paid under a “frequent and substantial servicing” payment methodology, authorizing payment on an ongoing basis as long as the prescribing physician documented medical necessity. To circumvent that statutory reality, the agency created a new category of medical device – a respiratory assist device/RAD – and declared that these devices are no longer ventilators and are now subject to capped rental rules and regulations.
NAMDRC was determined to work within the system, but roadblocks were consistently encountered, ie, contractor policies that did not reflect current medical standards of care, peer reviewed literature, etc. Even defining a “respiratory assist device” was (and still is) a challenge, as the term does not appear in the medical literature or in FDA vernacular.
Spin forward to 2018 and numerous realities come into play. Physicians still struggle with the concept of RADs without a definitive, consistent definition and no FDA language to guide usage. Today, it is easier to secure a ventilator if a physician documents the patient experiences some level of respiratory failure than it is to prescribe a simple ventilator with a back-up rate. Because of that dichotomy, the growth of life support ventilator usage is well documented.
If one takes the approach that a device should be paired with the actual clinical characteristics/medical need of the patient, changes in policy are necessary. While CMS clearly has the authority to act to improve policy and match clinical need to patient access, years and years of back and forth have signaled a definite unwillingness of the agency to move in that direction; therefore, the only genuine recourse is to seek legislative relief.
NAMDRC is working closely with the United States Senate, particularly the Finance Committee, Senator Cassidy (R-LA), and the Office of Senate Legislative Counsel to craft legislative language to address the myriad of issues associated with home mechanical ventilation.
Home Oxygen Therapy: In 1986, Congress revamped the statute governing coverage and payment of home oxygen. Pondering the reality of a segment of pulmonary medicine that has seen dramatic technological improvements and enhancements over the past 30-plus years, coupled with a payment system that is stuck with e-cylinders and competitive bidding, it is no wonder that both patients and physicians experience ongoing frustration trying to match a patient’s needs with an oxygen system that reflects the patient’s needs.
It’s a challenge to even consider where to start a reasonable discussion of home oxygen therapy. While the concept of supplemental oxygen is well accepted, the actual clinical evidence relies heavily on a very small number of studies. While virtually no one challenges the concept of the therapy, the actual science has progressed modestly in 30-plus years. But the technology surrounding oxygen therapy has become an industry all to itself. There are concentrators, portable oxygen concentrators, liquid systems, transfill systems, transtracheal oxygen therapy, and so on.
Add to the environment the growing demand for high flow systems that would deliver continuous flow oxygen at rates in excess of 4 L/min, and you begin to realize that the current payment system is a barrier to access. After all, the current payment system has problematic characteristics:
1. A flawed competitive bidding methodology;
2. Payment tied to liter flow pegged at a baseline of 2 L/min, regardless of actual patient need;
3. The major shift from a “delivery model” of care to a nondelivery model that reflects these newer technologies;
4. Virtual disappearance of liquid system availability as an option for physicians/patients;
5. The total failure of CMS to monitor, let alone act on, patient concerns.
Again, taking the NAMDRC Mission Statement into context, NAMDRC is working with all the key societies to craft a broad strategy to address these problems, acknowledging that it will likely take a mix of legislative and regulatory actions to bring home oxygen therapy into the 21st century, let alone to reflect realities of care in 2018.
NAMDRC’s Mission Statement declares, “NAMDRC’s primary mission is to improve access to quality care for patients with respiratory disease by removing regulatory and legislative barriers to appropriate treatment.” This mission is clear as we review our legislative and regulatory agenda on an ongoing and continuing basis.
Home Mechanical Ventilation: Close to 20 years ago, HCFA (now CMS) was faced with an important reality: advances in technology related to home mechanical ventilation are triggering an exponential growth in availability of these life supporting devices, but a price would be paid. At that time, Medicare law was quite explicit, indicating that certain ventilators would be paid under a “frequent and substantial servicing” payment methodology, authorizing payment on an ongoing basis as long as the prescribing physician documented medical necessity. To circumvent that statutory reality, the agency created a new category of medical device – a respiratory assist device/RAD – and declared that these devices are no longer ventilators and are now subject to capped rental rules and regulations.
NAMDRC was determined to work within the system, but roadblocks were consistently encountered, ie, contractor policies that did not reflect current medical standards of care, peer reviewed literature, etc. Even defining a “respiratory assist device” was (and still is) a challenge, as the term does not appear in the medical literature or in FDA vernacular.
Spin forward to 2018 and numerous realities come into play. Physicians still struggle with the concept of RADs without a definitive, consistent definition and no FDA language to guide usage. Today, it is easier to secure a ventilator if a physician documents the patient experiences some level of respiratory failure than it is to prescribe a simple ventilator with a back-up rate. Because of that dichotomy, the growth of life support ventilator usage is well documented.
If one takes the approach that a device should be paired with the actual clinical characteristics/medical need of the patient, changes in policy are necessary. While CMS clearly has the authority to act to improve policy and match clinical need to patient access, years and years of back and forth have signaled a definite unwillingness of the agency to move in that direction; therefore, the only genuine recourse is to seek legislative relief.
NAMDRC is working closely with the United States Senate, particularly the Finance Committee, Senator Cassidy (R-LA), and the Office of Senate Legislative Counsel to craft legislative language to address the myriad of issues associated with home mechanical ventilation.
Home Oxygen Therapy: In 1986, Congress revamped the statute governing coverage and payment of home oxygen. Pondering the reality of a segment of pulmonary medicine that has seen dramatic technological improvements and enhancements over the past 30-plus years, coupled with a payment system that is stuck with e-cylinders and competitive bidding, it is no wonder that both patients and physicians experience ongoing frustration trying to match a patient’s needs with an oxygen system that reflects the patient’s needs.
It’s a challenge to even consider where to start a reasonable discussion of home oxygen therapy. While the concept of supplemental oxygen is well accepted, the actual clinical evidence relies heavily on a very small number of studies. While virtually no one challenges the concept of the therapy, the actual science has progressed modestly in 30-plus years. But the technology surrounding oxygen therapy has become an industry all to itself. There are concentrators, portable oxygen concentrators, liquid systems, transfill systems, transtracheal oxygen therapy, and so on.
Add to the environment the growing demand for high flow systems that would deliver continuous flow oxygen at rates in excess of 4 L/min, and you begin to realize that the current payment system is a barrier to access. After all, the current payment system has problematic characteristics:
1. A flawed competitive bidding methodology;
2. Payment tied to liter flow pegged at a baseline of 2 L/min, regardless of actual patient need;
3. The major shift from a “delivery model” of care to a nondelivery model that reflects these newer technologies;
4. Virtual disappearance of liquid system availability as an option for physicians/patients;
5. The total failure of CMS to monitor, let alone act on, patient concerns.
Again, taking the NAMDRC Mission Statement into context, NAMDRC is working with all the key societies to craft a broad strategy to address these problems, acknowledging that it will likely take a mix of legislative and regulatory actions to bring home oxygen therapy into the 21st century, let alone to reflect realities of care in 2018.
NAMDRC’s Mission Statement declares, “NAMDRC’s primary mission is to improve access to quality care for patients with respiratory disease by removing regulatory and legislative barriers to appropriate treatment.” This mission is clear as we review our legislative and regulatory agenda on an ongoing and continuing basis.
Home Mechanical Ventilation: Close to 20 years ago, HCFA (now CMS) was faced with an important reality: advances in technology related to home mechanical ventilation are triggering an exponential growth in availability of these life supporting devices, but a price would be paid. At that time, Medicare law was quite explicit, indicating that certain ventilators would be paid under a “frequent and substantial servicing” payment methodology, authorizing payment on an ongoing basis as long as the prescribing physician documented medical necessity. To circumvent that statutory reality, the agency created a new category of medical device – a respiratory assist device/RAD – and declared that these devices are no longer ventilators and are now subject to capped rental rules and regulations.
NAMDRC was determined to work within the system, but roadblocks were consistently encountered, ie, contractor policies that did not reflect current medical standards of care, peer reviewed literature, etc. Even defining a “respiratory assist device” was (and still is) a challenge, as the term does not appear in the medical literature or in FDA vernacular.
Spin forward to 2018 and numerous realities come into play. Physicians still struggle with the concept of RADs without a definitive, consistent definition and no FDA language to guide usage. Today, it is easier to secure a ventilator if a physician documents the patient experiences some level of respiratory failure than it is to prescribe a simple ventilator with a back-up rate. Because of that dichotomy, the growth of life support ventilator usage is well documented.
If one takes the approach that a device should be paired with the actual clinical characteristics/medical need of the patient, changes in policy are necessary. While CMS clearly has the authority to act to improve policy and match clinical need to patient access, years and years of back and forth have signaled a definite unwillingness of the agency to move in that direction; therefore, the only genuine recourse is to seek legislative relief.
NAMDRC is working closely with the United States Senate, particularly the Finance Committee, Senator Cassidy (R-LA), and the Office of Senate Legislative Counsel to craft legislative language to address the myriad of issues associated with home mechanical ventilation.
Home Oxygen Therapy: In 1986, Congress revamped the statute governing coverage and payment of home oxygen. Pondering the reality of a segment of pulmonary medicine that has seen dramatic technological improvements and enhancements over the past 30-plus years, coupled with a payment system that is stuck with e-cylinders and competitive bidding, it is no wonder that both patients and physicians experience ongoing frustration trying to match a patient’s needs with an oxygen system that reflects the patient’s needs.
It’s a challenge to even consider where to start a reasonable discussion of home oxygen therapy. While the concept of supplemental oxygen is well accepted, the actual clinical evidence relies heavily on a very small number of studies. While virtually no one challenges the concept of the therapy, the actual science has progressed modestly in 30-plus years. But the technology surrounding oxygen therapy has become an industry all to itself. There are concentrators, portable oxygen concentrators, liquid systems, transfill systems, transtracheal oxygen therapy, and so on.
Add to the environment the growing demand for high flow systems that would deliver continuous flow oxygen at rates in excess of 4 L/min, and you begin to realize that the current payment system is a barrier to access. After all, the current payment system has problematic characteristics:
1. A flawed competitive bidding methodology;
2. Payment tied to liter flow pegged at a baseline of 2 L/min, regardless of actual patient need;
3. The major shift from a “delivery model” of care to a nondelivery model that reflects these newer technologies;
4. Virtual disappearance of liquid system availability as an option for physicians/patients;
5. The total failure of CMS to monitor, let alone act on, patient concerns.
Again, taking the NAMDRC Mission Statement into context, NAMDRC is working with all the key societies to craft a broad strategy to address these problems, acknowledging that it will likely take a mix of legislative and regulatory actions to bring home oxygen therapy into the 21st century, let alone to reflect realities of care in 2018.
Catching Up With Our Past CHEST Presidents
Where are they now? What have they been up to? CHEST’s Past Presidents each forged the way for the many successes of the American College of Chest Physicians, leading to enhanced patient care around the globe. Their outstanding leadership and vision are evidenced today in many of CHEST’s strategic initiatives.
D. Robert McCaffree, MD, MSHA, Master FCCP
CHEST President 1997 - 1998
I received the chain of office (yes, there is an actual chain) from Dr. Bart Chernow in New Orleans during CHEST 1997. I remember this time as being a time of beginnings, challenges, and changes. Bart had been the stimulus for the CHEST Foundation and the form and function of this foundation was being developed. The women’s caucus (probably not the official name) was becoming more organized and more of a force under the leadership of Dr. Diane Stover and Dr. Deborah Shure and others, and the Woman, Girls, Tobacco, and Lung Cancer educational program was being refined. It was this program that got my wife, Mary Anne, involved with the CHEST, and she became a Fellow (FCCP). The American College of Chest Physicians was in the midst of the national tobacco settlement efforts at this time. Our involvement began when Mike Moore, Attorney-General of Mississippi, filed the first suit against the tobacco industry in 1994. Under the stimulus of Dr. John Studdard, our current President, the college was the only medical organization to file an amicus curiae brief supporting this, thus thrusting us into the midst of the tobacco settlement debates and in a leadership position. During the time I was President-elect and President, I was fortunate to represent us both in the ENACT Coalition (composed of national health groups, such as the American Cancer Society), as well as on the Koop-Kessler Congressional Advisory Committee. I also testified before Congress on the tobacco issues and met at the White House with DHHS Secretary Donna Shalala. On a different front, our international activities were not as developed as now, but we did make two memorable trips to India. Many thanks to Dr. Kay Guntupalli for helping make those trips so memorable. After this absolutely wonderful year, I passed the chain to Dr. Allen Goldberg in Toronto.
Among other activities, I was Chief of Staff at the Oklahoma City VAMC for 18 years, retiring from that position in 2009. I was honored by having the MICU at the VA named after me. In the community, I helped start the Hospice of Oklahoma County and then the Hospice Foundation of Oklahoma, both of which I served as first chairman. I also helped start Palliative Care Week on the OUHSC campus. I am currently the vice-chair of the Health Alliance for the Uninsured in Oklahoma City, which helps support the many free clinics in our city. My wonderful wife, Mary Anne, is also involved in many community activities. On a personal level, we try to see our two children and two grandchildren as often as possible, which is not often enough. My free time activities include reading, playing the piano, fly fishing (not often enough), and exercise.
My time as President of the American College of Chest Physicians was one of the best and most important experiences of my life. My memories of working with Al Lever, David Eubanks, Marilyn Lederer, Lynne Marcus, Steve Welch, and all the other administrative and physician leaders during that time remain very dear to me. The influence of CHEST continues to this very day. I can never repay all that I have gained from this experience. I wish I had the space allowance to expand on my experiences. But while my word allowance is limited, my gratitude is unlimited.
Where are they now? What have they been up to? CHEST’s Past Presidents each forged the way for the many successes of the American College of Chest Physicians, leading to enhanced patient care around the globe. Their outstanding leadership and vision are evidenced today in many of CHEST’s strategic initiatives.
D. Robert McCaffree, MD, MSHA, Master FCCP
CHEST President 1997 - 1998
I received the chain of office (yes, there is an actual chain) from Dr. Bart Chernow in New Orleans during CHEST 1997. I remember this time as being a time of beginnings, challenges, and changes. Bart had been the stimulus for the CHEST Foundation and the form and function of this foundation was being developed. The women’s caucus (probably not the official name) was becoming more organized and more of a force under the leadership of Dr. Diane Stover and Dr. Deborah Shure and others, and the Woman, Girls, Tobacco, and Lung Cancer educational program was being refined. It was this program that got my wife, Mary Anne, involved with the CHEST, and she became a Fellow (FCCP). The American College of Chest Physicians was in the midst of the national tobacco settlement efforts at this time. Our involvement began when Mike Moore, Attorney-General of Mississippi, filed the first suit against the tobacco industry in 1994. Under the stimulus of Dr. John Studdard, our current President, the college was the only medical organization to file an amicus curiae brief supporting this, thus thrusting us into the midst of the tobacco settlement debates and in a leadership position. During the time I was President-elect and President, I was fortunate to represent us both in the ENACT Coalition (composed of national health groups, such as the American Cancer Society), as well as on the Koop-Kessler Congressional Advisory Committee. I also testified before Congress on the tobacco issues and met at the White House with DHHS Secretary Donna Shalala. On a different front, our international activities were not as developed as now, but we did make two memorable trips to India. Many thanks to Dr. Kay Guntupalli for helping make those trips so memorable. After this absolutely wonderful year, I passed the chain to Dr. Allen Goldberg in Toronto.
Among other activities, I was Chief of Staff at the Oklahoma City VAMC for 18 years, retiring from that position in 2009. I was honored by having the MICU at the VA named after me. In the community, I helped start the Hospice of Oklahoma County and then the Hospice Foundation of Oklahoma, both of which I served as first chairman. I also helped start Palliative Care Week on the OUHSC campus. I am currently the vice-chair of the Health Alliance for the Uninsured in Oklahoma City, which helps support the many free clinics in our city. My wonderful wife, Mary Anne, is also involved in many community activities. On a personal level, we try to see our two children and two grandchildren as often as possible, which is not often enough. My free time activities include reading, playing the piano, fly fishing (not often enough), and exercise.
My time as President of the American College of Chest Physicians was one of the best and most important experiences of my life. My memories of working with Al Lever, David Eubanks, Marilyn Lederer, Lynne Marcus, Steve Welch, and all the other administrative and physician leaders during that time remain very dear to me. The influence of CHEST continues to this very day. I can never repay all that I have gained from this experience. I wish I had the space allowance to expand on my experiences. But while my word allowance is limited, my gratitude is unlimited.
Where are they now? What have they been up to? CHEST’s Past Presidents each forged the way for the many successes of the American College of Chest Physicians, leading to enhanced patient care around the globe. Their outstanding leadership and vision are evidenced today in many of CHEST’s strategic initiatives.
D. Robert McCaffree, MD, MSHA, Master FCCP
CHEST President 1997 - 1998
I received the chain of office (yes, there is an actual chain) from Dr. Bart Chernow in New Orleans during CHEST 1997. I remember this time as being a time of beginnings, challenges, and changes. Bart had been the stimulus for the CHEST Foundation and the form and function of this foundation was being developed. The women’s caucus (probably not the official name) was becoming more organized and more of a force under the leadership of Dr. Diane Stover and Dr. Deborah Shure and others, and the Woman, Girls, Tobacco, and Lung Cancer educational program was being refined. It was this program that got my wife, Mary Anne, involved with the CHEST, and she became a Fellow (FCCP). The American College of Chest Physicians was in the midst of the national tobacco settlement efforts at this time. Our involvement began when Mike Moore, Attorney-General of Mississippi, filed the first suit against the tobacco industry in 1994. Under the stimulus of Dr. John Studdard, our current President, the college was the only medical organization to file an amicus curiae brief supporting this, thus thrusting us into the midst of the tobacco settlement debates and in a leadership position. During the time I was President-elect and President, I was fortunate to represent us both in the ENACT Coalition (composed of national health groups, such as the American Cancer Society), as well as on the Koop-Kessler Congressional Advisory Committee. I also testified before Congress on the tobacco issues and met at the White House with DHHS Secretary Donna Shalala. On a different front, our international activities were not as developed as now, but we did make two memorable trips to India. Many thanks to Dr. Kay Guntupalli for helping make those trips so memorable. After this absolutely wonderful year, I passed the chain to Dr. Allen Goldberg in Toronto.
Among other activities, I was Chief of Staff at the Oklahoma City VAMC for 18 years, retiring from that position in 2009. I was honored by having the MICU at the VA named after me. In the community, I helped start the Hospice of Oklahoma County and then the Hospice Foundation of Oklahoma, both of which I served as first chairman. I also helped start Palliative Care Week on the OUHSC campus. I am currently the vice-chair of the Health Alliance for the Uninsured in Oklahoma City, which helps support the many free clinics in our city. My wonderful wife, Mary Anne, is also involved in many community activities. On a personal level, we try to see our two children and two grandchildren as often as possible, which is not often enough. My free time activities include reading, playing the piano, fly fishing (not often enough), and exercise.
My time as President of the American College of Chest Physicians was one of the best and most important experiences of my life. My memories of working with Al Lever, David Eubanks, Marilyn Lederer, Lynne Marcus, Steve Welch, and all the other administrative and physician leaders during that time remain very dear to me. The influence of CHEST continues to this very day. I can never repay all that I have gained from this experience. I wish I had the space allowance to expand on my experiences. But while my word allowance is limited, my gratitude is unlimited.
San Antonio hotels for CHEST 2018
Are you ready for CHEST Annual Meeting 2018? Get ready with exclusive hotel deals for your trip to San Antonio from onPeak, the official hotel provider for CHEST 2018. Through onPeak, we are able to bring you the lowest rates, best hotels, and great amenities for your trip all along the beautiful San Antonio River Walk. onPeak also provides flexible booking policies, great group tools, and a full team of wonderful customer service agents to ensure you have a smooth booking process.
Marriott Rivercenter – HQ Hotel
The San Antonio Marriott Rivercenter, a magnificent 38-story hotel, is just steps away from premier shopping, dining, and entertainment destinations. Guests will enjoy supreme comfort conveniently located near many hot attractions, including Six Flags Fiesta Texas and the San Antonio Zoo. The Alamo, one of the nation’s most storied and revered landmarks, is within easy walking distance from the hotel.
Grand Hyatt San Antonio
Discover the distinctly diverse personality of the Alamo City in grand style. Also along the spectacular River Walk, Grand Hyatt San Antonio is steps from trendy downtown bars, Zagat-rated restaurants, and all the sites and attractions that make San Antonio one of the most culturally rich cities in the country.
Hilton Palacio Del Rio
Located in beautiful downtown San Antonio, the Hilton Palacio del Rio hotel is surrounded by Texas culture and attractions, including the Alamo, just two blocks away. The Hilton Palacio del Rio offers superior service, extensive guest amenities, and is the only hotel in downtown San Antonio that features a private balcony in every room. Tex’s Riverwalk Sports Bar & Grill, Durty Nelley’s Irish Pub, Ibiza Riverwalk Patio Restaurant & Bar, and the Rincon Allegre Lobby Bar await to satisfy individual tastes.
Hotel Contessa
Step into the marble lobby accented with glass sconces and towering palm trees and you’ll know you’ve made the right choice on where to stay. The ambiance of this 265 all-suite property with heated rooftop pool, full-service spa, gourmet restaurant, and modern meeting space is unmatched by any other downtown hotel. Our dedicated service team is devoted to making any stay – leisure or business – a memorable experience. The Hotel Contessa extends to her guests a relaxing respite in an urban setting coupled with all the amenities of a large resort.
Hyatt Regency San Antonio
Experience the heart of the River Walk at Hyatt Regency San Antonio. This is the only hotel on the River Walk directly overlooking the historic Alamo, connecting two of San Antonio’s top destinations through the 16-story atrium lobby. This four-diamond hotel includes contemporary guest rooms, a rooftop pool, Stay-Fit gym, and a relaxing spa. The experienced staff adds a genuine touch to world-class amenities.
Marriott Riverwalk
The San Antonio Marriott Riverwalk hotel charmingly captures the vibrant culture and style of this romantic city, welcoming you and ensuring an enchanting stay. This hotel is located in the heart of downtown San Antonio, offering sweeping balcony views of the fabulous River Walk district. The 30-story hotel invites guests into a contemporary lobby with Texas flair: chili-red walls, dark-wood trim, and wrought-iron accents. Explore the history, culture, and culinary delights along the River Walk.
Westin Riverwalk Hotel
The Westin Riverwalk Hotel boasts 473 rooms and luxury suites with Texan hospitality and warm residential style. This riverfront hotel is the perfect location to relax and recharge. Expect a warm welcome when you visit the best of San Antonio River Walk hotels. Enjoy delicious dark chocolates imported from Venezuela when you check in and amenities such as The Westin Heavenly Bed® and Heavenly Bath® products that will leave you feeling refreshed and rejuvenated. The hotel rooms also include sparkling city or river views and elegant, oversized marble bathrooms with pampering bath amenities.
Don’t forget to book your hotel before they sell out! View the official hotel block at http://onpeak.com/CHEST-2018.
Note that onPeak is the only official hotel provider associated with our event. While other hotel resellers may contact you offering accommodations for your trip, they are not endorsed by or affiliated with the meeting. Beware that entering into financial agreements with unendorsed companies can have costly consequences.
Hotel information provided by onPeak.
Are you ready for CHEST Annual Meeting 2018? Get ready with exclusive hotel deals for your trip to San Antonio from onPeak, the official hotel provider for CHEST 2018. Through onPeak, we are able to bring you the lowest rates, best hotels, and great amenities for your trip all along the beautiful San Antonio River Walk. onPeak also provides flexible booking policies, great group tools, and a full team of wonderful customer service agents to ensure you have a smooth booking process.
Marriott Rivercenter – HQ Hotel
The San Antonio Marriott Rivercenter, a magnificent 38-story hotel, is just steps away from premier shopping, dining, and entertainment destinations. Guests will enjoy supreme comfort conveniently located near many hot attractions, including Six Flags Fiesta Texas and the San Antonio Zoo. The Alamo, one of the nation’s most storied and revered landmarks, is within easy walking distance from the hotel.
Grand Hyatt San Antonio
Discover the distinctly diverse personality of the Alamo City in grand style. Also along the spectacular River Walk, Grand Hyatt San Antonio is steps from trendy downtown bars, Zagat-rated restaurants, and all the sites and attractions that make San Antonio one of the most culturally rich cities in the country.
Hilton Palacio Del Rio
Located in beautiful downtown San Antonio, the Hilton Palacio del Rio hotel is surrounded by Texas culture and attractions, including the Alamo, just two blocks away. The Hilton Palacio del Rio offers superior service, extensive guest amenities, and is the only hotel in downtown San Antonio that features a private balcony in every room. Tex’s Riverwalk Sports Bar & Grill, Durty Nelley’s Irish Pub, Ibiza Riverwalk Patio Restaurant & Bar, and the Rincon Allegre Lobby Bar await to satisfy individual tastes.
Hotel Contessa
Step into the marble lobby accented with glass sconces and towering palm trees and you’ll know you’ve made the right choice on where to stay. The ambiance of this 265 all-suite property with heated rooftop pool, full-service spa, gourmet restaurant, and modern meeting space is unmatched by any other downtown hotel. Our dedicated service team is devoted to making any stay – leisure or business – a memorable experience. The Hotel Contessa extends to her guests a relaxing respite in an urban setting coupled with all the amenities of a large resort.
Hyatt Regency San Antonio
Experience the heart of the River Walk at Hyatt Regency San Antonio. This is the only hotel on the River Walk directly overlooking the historic Alamo, connecting two of San Antonio’s top destinations through the 16-story atrium lobby. This four-diamond hotel includes contemporary guest rooms, a rooftop pool, Stay-Fit gym, and a relaxing spa. The experienced staff adds a genuine touch to world-class amenities.
Marriott Riverwalk
The San Antonio Marriott Riverwalk hotel charmingly captures the vibrant culture and style of this romantic city, welcoming you and ensuring an enchanting stay. This hotel is located in the heart of downtown San Antonio, offering sweeping balcony views of the fabulous River Walk district. The 30-story hotel invites guests into a contemporary lobby with Texas flair: chili-red walls, dark-wood trim, and wrought-iron accents. Explore the history, culture, and culinary delights along the River Walk.
Westin Riverwalk Hotel
The Westin Riverwalk Hotel boasts 473 rooms and luxury suites with Texan hospitality and warm residential style. This riverfront hotel is the perfect location to relax and recharge. Expect a warm welcome when you visit the best of San Antonio River Walk hotels. Enjoy delicious dark chocolates imported from Venezuela when you check in and amenities such as The Westin Heavenly Bed® and Heavenly Bath® products that will leave you feeling refreshed and rejuvenated. The hotel rooms also include sparkling city or river views and elegant, oversized marble bathrooms with pampering bath amenities.
Don’t forget to book your hotel before they sell out! View the official hotel block at http://onpeak.com/CHEST-2018.
Note that onPeak is the only official hotel provider associated with our event. While other hotel resellers may contact you offering accommodations for your trip, they are not endorsed by or affiliated with the meeting. Beware that entering into financial agreements with unendorsed companies can have costly consequences.
Hotel information provided by onPeak.
Are you ready for CHEST Annual Meeting 2018? Get ready with exclusive hotel deals for your trip to San Antonio from onPeak, the official hotel provider for CHEST 2018. Through onPeak, we are able to bring you the lowest rates, best hotels, and great amenities for your trip all along the beautiful San Antonio River Walk. onPeak also provides flexible booking policies, great group tools, and a full team of wonderful customer service agents to ensure you have a smooth booking process.
Marriott Rivercenter – HQ Hotel
The San Antonio Marriott Rivercenter, a magnificent 38-story hotel, is just steps away from premier shopping, dining, and entertainment destinations. Guests will enjoy supreme comfort conveniently located near many hot attractions, including Six Flags Fiesta Texas and the San Antonio Zoo. The Alamo, one of the nation’s most storied and revered landmarks, is within easy walking distance from the hotel.
Grand Hyatt San Antonio
Discover the distinctly diverse personality of the Alamo City in grand style. Also along the spectacular River Walk, Grand Hyatt San Antonio is steps from trendy downtown bars, Zagat-rated restaurants, and all the sites and attractions that make San Antonio one of the most culturally rich cities in the country.
Hilton Palacio Del Rio
Located in beautiful downtown San Antonio, the Hilton Palacio del Rio hotel is surrounded by Texas culture and attractions, including the Alamo, just two blocks away. The Hilton Palacio del Rio offers superior service, extensive guest amenities, and is the only hotel in downtown San Antonio that features a private balcony in every room. Tex’s Riverwalk Sports Bar & Grill, Durty Nelley’s Irish Pub, Ibiza Riverwalk Patio Restaurant & Bar, and the Rincon Allegre Lobby Bar await to satisfy individual tastes.
Hotel Contessa
Step into the marble lobby accented with glass sconces and towering palm trees and you’ll know you’ve made the right choice on where to stay. The ambiance of this 265 all-suite property with heated rooftop pool, full-service spa, gourmet restaurant, and modern meeting space is unmatched by any other downtown hotel. Our dedicated service team is devoted to making any stay – leisure or business – a memorable experience. The Hotel Contessa extends to her guests a relaxing respite in an urban setting coupled with all the amenities of a large resort.
Hyatt Regency San Antonio
Experience the heart of the River Walk at Hyatt Regency San Antonio. This is the only hotel on the River Walk directly overlooking the historic Alamo, connecting two of San Antonio’s top destinations through the 16-story atrium lobby. This four-diamond hotel includes contemporary guest rooms, a rooftop pool, Stay-Fit gym, and a relaxing spa. The experienced staff adds a genuine touch to world-class amenities.
Marriott Riverwalk
The San Antonio Marriott Riverwalk hotel charmingly captures the vibrant culture and style of this romantic city, welcoming you and ensuring an enchanting stay. This hotel is located in the heart of downtown San Antonio, offering sweeping balcony views of the fabulous River Walk district. The 30-story hotel invites guests into a contemporary lobby with Texas flair: chili-red walls, dark-wood trim, and wrought-iron accents. Explore the history, culture, and culinary delights along the River Walk.
Westin Riverwalk Hotel
The Westin Riverwalk Hotel boasts 473 rooms and luxury suites with Texan hospitality and warm residential style. This riverfront hotel is the perfect location to relax and recharge. Expect a warm welcome when you visit the best of San Antonio River Walk hotels. Enjoy delicious dark chocolates imported from Venezuela when you check in and amenities such as The Westin Heavenly Bed® and Heavenly Bath® products that will leave you feeling refreshed and rejuvenated. The hotel rooms also include sparkling city or river views and elegant, oversized marble bathrooms with pampering bath amenities.
Don’t forget to book your hotel before they sell out! View the official hotel block at http://onpeak.com/CHEST-2018.
Note that onPeak is the only official hotel provider associated with our event. While other hotel resellers may contact you offering accommodations for your trip, they are not endorsed by or affiliated with the meeting. Beware that entering into financial agreements with unendorsed companies can have costly consequences.
Hotel information provided by onPeak.
Impacting careers, impacting patient care
Thank you for all you do to champion lung health. Your donation supports projects, such as grant funding, which are boosting patient outcomes, improving community health, and advancing the research that continues to enhance the journey for those facing pulmonary illnesses. Each year, your generosity funds more than $550,000 in clinical research and community service grants, allowing CHEST members to develop and implement their ideas through securing preliminary data support, distinguishing themselves among their colleagues, and advancing chest medicine toward medical breakthroughs.
One such story of the advancements being made in communities around the world begins in New York City.
Dr. Lovinsky-Desir is a pediatric pulmonologist based at Columbia University and the recipient of the CHEST Diversity and Young Investigator Award in 2014 for her project on Urban Tree Canopy Exposure, DNA Methylation, and Allergies in Pediatric Asthma. The grant helped launch her into the research that she is most passionate about – asthma and health disparities in urban populations.
As Stephanie can attest, junior faculty often struggle to find funding for their research, especially when focusing on disparities, diversity, and socioeconomic factors that affect public health. “A lot of people can’t take the risk to pursue higher-risk careers like research, because they don’t have seed funding that allows them to dive into bigger awards or research grants.”
She made it her mission to find funding at the beginning of her research, so she could establish her reputation as a researcher and continue to receive further funding. Her plan began to fall into place when she applied for, and won, the CHEST Diversity and Young Investigator Award. Dr. Lovinsky believes the CHEST Foundation grant is what launched her research. “Much of my success in getting grant funding is because I was awarded grants in the past! Once you start getting them and conducting research that produces meaningful results, you keep getting more, and it really starts to snowball. The CHEST Foundation award was the first award I as a Principal Investigator —my idea, my metrics. I feel so proud to have accomplished this.”
The findings she concluded from her CHEST diversity grant research allowed her to modify her study and receive the following awards: an award through her institution, the National Institute of Health KL2 award, and multiple awards including an NIH K01, a children’s scholar award, and the Harold Amos Medical Faculty Development Award. Stephanie is excited for her future research after recently receiving a very competitive score from her NIHK. She believes the CHEST Foundation award jump started her research career, and these other successes have resulted from it. “It’s more than a research project. We are building a research program.” Her current research involves exploring epigenetic mechanisms, particularly DNA methylation, in pediatric and adult allergic asthmatics, as well as understanding the effects of environmental pollutants on asthma, activity, and obesity.
Though Dr. Lovinsky’s career as a researcher grew from the foundation grant, she says, “The benefit of this award specifically was the gateway to the CHEST Foundation and all of the other opportunities within CHEST.” She is actively involved in the Diversity and Inclusion Task Force and brings many ideas to the table for the future of the CHEST Foundation. “I am committed to being involved with CHEST because of how much the organization has impacted my career. I enjoy giving back by participating in the task force.” Her clinical research and involvement in CHEST demonstrates the direct impact your generous support has on physicians, patients, and lung health.
Thank you for making important research like this possible. Your generosity is the catalyst for change in a world where lung diseases are ranking as one of the top causes of death for men and women everywhere. You’re improving patient outcomes every day, and we thank you from the bottom of our hearts.
Your continued support will make it possible for the next generation of researchers to launch their careers. You can be a Champion for Lung Health and DONATE today through a new gift to the CHEST Foundation. We can meet our goals for the health professionals, patients, and caregivers we serve with your much appreciated and essential support.
To donate:
Web: chestfoundation.org/donate
Phone:224/521-9527
Again, thank you for all you do to improve patient outcomes. You are the lung health champions that patients and families count on to positively impact lung health.
Lisa K. Moores, MD, FCCP
President & Trustee
Mike E. Nelson, MD, FCCP
Immediate Past President & Trustee
Thank you for all you do to champion lung health. Your donation supports projects, such as grant funding, which are boosting patient outcomes, improving community health, and advancing the research that continues to enhance the journey for those facing pulmonary illnesses. Each year, your generosity funds more than $550,000 in clinical research and community service grants, allowing CHEST members to develop and implement their ideas through securing preliminary data support, distinguishing themselves among their colleagues, and advancing chest medicine toward medical breakthroughs.
One such story of the advancements being made in communities around the world begins in New York City.
Dr. Lovinsky-Desir is a pediatric pulmonologist based at Columbia University and the recipient of the CHEST Diversity and Young Investigator Award in 2014 for her project on Urban Tree Canopy Exposure, DNA Methylation, and Allergies in Pediatric Asthma. The grant helped launch her into the research that she is most passionate about – asthma and health disparities in urban populations.
As Stephanie can attest, junior faculty often struggle to find funding for their research, especially when focusing on disparities, diversity, and socioeconomic factors that affect public health. “A lot of people can’t take the risk to pursue higher-risk careers like research, because they don’t have seed funding that allows them to dive into bigger awards or research grants.”
She made it her mission to find funding at the beginning of her research, so she could establish her reputation as a researcher and continue to receive further funding. Her plan began to fall into place when she applied for, and won, the CHEST Diversity and Young Investigator Award. Dr. Lovinsky believes the CHEST Foundation grant is what launched her research. “Much of my success in getting grant funding is because I was awarded grants in the past! Once you start getting them and conducting research that produces meaningful results, you keep getting more, and it really starts to snowball. The CHEST Foundation award was the first award I as a Principal Investigator —my idea, my metrics. I feel so proud to have accomplished this.”
The findings she concluded from her CHEST diversity grant research allowed her to modify her study and receive the following awards: an award through her institution, the National Institute of Health KL2 award, and multiple awards including an NIH K01, a children’s scholar award, and the Harold Amos Medical Faculty Development Award. Stephanie is excited for her future research after recently receiving a very competitive score from her NIHK. She believes the CHEST Foundation award jump started her research career, and these other successes have resulted from it. “It’s more than a research project. We are building a research program.” Her current research involves exploring epigenetic mechanisms, particularly DNA methylation, in pediatric and adult allergic asthmatics, as well as understanding the effects of environmental pollutants on asthma, activity, and obesity.
Though Dr. Lovinsky’s career as a researcher grew from the foundation grant, she says, “The benefit of this award specifically was the gateway to the CHEST Foundation and all of the other opportunities within CHEST.” She is actively involved in the Diversity and Inclusion Task Force and brings many ideas to the table for the future of the CHEST Foundation. “I am committed to being involved with CHEST because of how much the organization has impacted my career. I enjoy giving back by participating in the task force.” Her clinical research and involvement in CHEST demonstrates the direct impact your generous support has on physicians, patients, and lung health.
Thank you for making important research like this possible. Your generosity is the catalyst for change in a world where lung diseases are ranking as one of the top causes of death for men and women everywhere. You’re improving patient outcomes every day, and we thank you from the bottom of our hearts.
Your continued support will make it possible for the next generation of researchers to launch their careers. You can be a Champion for Lung Health and DONATE today through a new gift to the CHEST Foundation. We can meet our goals for the health professionals, patients, and caregivers we serve with your much appreciated and essential support.
To donate:
Web: chestfoundation.org/donate
Phone:224/521-9527
Again, thank you for all you do to improve patient outcomes. You are the lung health champions that patients and families count on to positively impact lung health.
Lisa K. Moores, MD, FCCP
President & Trustee
Mike E. Nelson, MD, FCCP
Immediate Past President & Trustee
Thank you for all you do to champion lung health. Your donation supports projects, such as grant funding, which are boosting patient outcomes, improving community health, and advancing the research that continues to enhance the journey for those facing pulmonary illnesses. Each year, your generosity funds more than $550,000 in clinical research and community service grants, allowing CHEST members to develop and implement their ideas through securing preliminary data support, distinguishing themselves among their colleagues, and advancing chest medicine toward medical breakthroughs.
One such story of the advancements being made in communities around the world begins in New York City.
Dr. Lovinsky-Desir is a pediatric pulmonologist based at Columbia University and the recipient of the CHEST Diversity and Young Investigator Award in 2014 for her project on Urban Tree Canopy Exposure, DNA Methylation, and Allergies in Pediatric Asthma. The grant helped launch her into the research that she is most passionate about – asthma and health disparities in urban populations.
As Stephanie can attest, junior faculty often struggle to find funding for their research, especially when focusing on disparities, diversity, and socioeconomic factors that affect public health. “A lot of people can’t take the risk to pursue higher-risk careers like research, because they don’t have seed funding that allows them to dive into bigger awards or research grants.”
She made it her mission to find funding at the beginning of her research, so she could establish her reputation as a researcher and continue to receive further funding. Her plan began to fall into place when she applied for, and won, the CHEST Diversity and Young Investigator Award. Dr. Lovinsky believes the CHEST Foundation grant is what launched her research. “Much of my success in getting grant funding is because I was awarded grants in the past! Once you start getting them and conducting research that produces meaningful results, you keep getting more, and it really starts to snowball. The CHEST Foundation award was the first award I as a Principal Investigator —my idea, my metrics. I feel so proud to have accomplished this.”
The findings she concluded from her CHEST diversity grant research allowed her to modify her study and receive the following awards: an award through her institution, the National Institute of Health KL2 award, and multiple awards including an NIH K01, a children’s scholar award, and the Harold Amos Medical Faculty Development Award. Stephanie is excited for her future research after recently receiving a very competitive score from her NIHK. She believes the CHEST Foundation award jump started her research career, and these other successes have resulted from it. “It’s more than a research project. We are building a research program.” Her current research involves exploring epigenetic mechanisms, particularly DNA methylation, in pediatric and adult allergic asthmatics, as well as understanding the effects of environmental pollutants on asthma, activity, and obesity.
Though Dr. Lovinsky’s career as a researcher grew from the foundation grant, she says, “The benefit of this award specifically was the gateway to the CHEST Foundation and all of the other opportunities within CHEST.” She is actively involved in the Diversity and Inclusion Task Force and brings many ideas to the table for the future of the CHEST Foundation. “I am committed to being involved with CHEST because of how much the organization has impacted my career. I enjoy giving back by participating in the task force.” Her clinical research and involvement in CHEST demonstrates the direct impact your generous support has on physicians, patients, and lung health.
Thank you for making important research like this possible. Your generosity is the catalyst for change in a world where lung diseases are ranking as one of the top causes of death for men and women everywhere. You’re improving patient outcomes every day, and we thank you from the bottom of our hearts.
Your continued support will make it possible for the next generation of researchers to launch their careers. You can be a Champion for Lung Health and DONATE today through a new gift to the CHEST Foundation. We can meet our goals for the health professionals, patients, and caregivers we serve with your much appreciated and essential support.
To donate:
Web: chestfoundation.org/donate
Phone:224/521-9527
Again, thank you for all you do to improve patient outcomes. You are the lung health champions that patients and families count on to positively impact lung health.
Lisa K. Moores, MD, FCCP
President & Trustee
Mike E. Nelson, MD, FCCP
Immediate Past President & Trustee
AACN releases expert consensus statement on teleICU nursing practice
To remain at the forefront of expanding evidence-based practices in all aspects of critical care, facilities must include teleICUs.
In 2013, the American Association of Critical-Care Nurses (AACN) first defined standards for the emerging telenursing practice in the ICU and has recently published an update, AACN TeleICU Nursing Practice: An Expert Consensus Statement Supporting High Acuity, Progressive and Critical Care.1
The new consensus statement, which creates a framework for implementing, evaluating, and improving teleICU nursing practice, addresses the new findings in this fast-growing area of health care. It also establishes a model for achieving excellence and optimal patient care outcomes through the following:
• Shared knowledge and goals
• Mutual respect
• Skilled communication
• True collaboration
• Authentic leadership
• Optimized technology
• Practice excellence
A 12-person task force, including teleICU nurse leaders, contributed to the statement and brought a fresh perspective to this area of practice.
Task force co-chair Pat Herr, clinical integration director of eCARE ICU at Avera Health, says it was important to harness the energy and lessons learned from experienced teleICU leaders.
“TeleICUs continue to evolve to meet the needs of patients and health systems,” Herr adds. “New technology options and new partnership models are available, and nurse leaders play an important part in using these tools to improve patient care.”
The earliest teleICU design concepts employed a physician-only model of care, but it quickly became clear that critical-care nursing was a necessary component. Today, the most effective teleICU models implement collaborative care that includes physicians, nurses, information technology, and administrative support personnel.Opportunities in teleICU are one way to retain knowledgeable nurses, who can bridge clinical expertise gaps and provide an additional layer of skilled critical care. TeleICU care ensures delivery of both optimal patient outcomes and timely knowledge to support physicians, nurses, and the entire bedside care team.
Task force member Lisa-Mae Williams, operations director of telehealth and eICU at Baptist Health South Florida, says telemedicine doesn’t mean fewer jobs for bedside nurses; it’s an extra set of eyes to surveil vitals and support a clinical workforce that may be stretched thin.
“At the bedside, when teleICU came to my unit, I was very skeptical,” Williams recalls. “But after seeing for myself what those extra nurses brought to the table – the available technology and time they had to assess trends and really delve into what’s going on – it turned out to be the best tool to care for our patients.”
In addition to knowledge gaps, nurse turnover is on the rise, according to the “2017 Survey of Registered Nurses: Viewpoints on Leadership, Nursing, Shortages and Their Profession” from AMN Healthcare, San Diego.2 The survey also finds that more than one in four nurses plan to retire within a year, and 73% of baby boomers expect to retire in 3 years or less.
The shortfall is already more pronounced in rural hospitals facing staffing challenges and in specialty areas where additional education, training, and experience are critical to improve patient safety and outcomes.
The expertise and dynamic, front-line viewpoint of teleICU experts has resulted in a comprehensive, patient-centric update. Their experience delivering both bedside and remote care was instrumental in developing valuable clinical scenarios. The scenarios in the statement are genuine examples of how each key recommendation is implemented by physicians and bedside and teleICU nurses to provide continuity of care; identify high-risk patients; and decrease mortality rates by filling gaps in monitoring and staff expertise.
As a leader in the delivery of evidence-based practices, AACN offers CCRN-E specialty certification3 for nurses who primarily provide acute or critical care for adult patients in a teleICU setting, which is connected to the bedside via audiovisual communication and computer systems. Visit www.aacn.org > Certification > Get Certified > CCRN-E Adult to learn more.
The expert consensus statement is available for AACN members to download or to purchase a hard copy.4
References
1. https://www.aacn.org/nursing-excellence/standards/aacn-teleicu-nursing-consensus-statement
2. https://www.amnhealthcare.com/uploadedFiles/MainSite/Content/Campaigns/AMN%20Healthcare%202017%20RN%20Survey%20-%20Full%20Report.pdf 3. https://www.aacn.org/certification/get-certified/ccrn-e-adult
4. https://www.aacn.org/nursing-excellence/standards/aacn-teleicu-nursing-consensus-statement
To remain at the forefront of expanding evidence-based practices in all aspects of critical care, facilities must include teleICUs.
In 2013, the American Association of Critical-Care Nurses (AACN) first defined standards for the emerging telenursing practice in the ICU and has recently published an update, AACN TeleICU Nursing Practice: An Expert Consensus Statement Supporting High Acuity, Progressive and Critical Care.1
The new consensus statement, which creates a framework for implementing, evaluating, and improving teleICU nursing practice, addresses the new findings in this fast-growing area of health care. It also establishes a model for achieving excellence and optimal patient care outcomes through the following:
• Shared knowledge and goals
• Mutual respect
• Skilled communication
• True collaboration
• Authentic leadership
• Optimized technology
• Practice excellence
A 12-person task force, including teleICU nurse leaders, contributed to the statement and brought a fresh perspective to this area of practice.
Task force co-chair Pat Herr, clinical integration director of eCARE ICU at Avera Health, says it was important to harness the energy and lessons learned from experienced teleICU leaders.
“TeleICUs continue to evolve to meet the needs of patients and health systems,” Herr adds. “New technology options and new partnership models are available, and nurse leaders play an important part in using these tools to improve patient care.”
The earliest teleICU design concepts employed a physician-only model of care, but it quickly became clear that critical-care nursing was a necessary component. Today, the most effective teleICU models implement collaborative care that includes physicians, nurses, information technology, and administrative support personnel.Opportunities in teleICU are one way to retain knowledgeable nurses, who can bridge clinical expertise gaps and provide an additional layer of skilled critical care. TeleICU care ensures delivery of both optimal patient outcomes and timely knowledge to support physicians, nurses, and the entire bedside care team.
Task force member Lisa-Mae Williams, operations director of telehealth and eICU at Baptist Health South Florida, says telemedicine doesn’t mean fewer jobs for bedside nurses; it’s an extra set of eyes to surveil vitals and support a clinical workforce that may be stretched thin.
“At the bedside, when teleICU came to my unit, I was very skeptical,” Williams recalls. “But after seeing for myself what those extra nurses brought to the table – the available technology and time they had to assess trends and really delve into what’s going on – it turned out to be the best tool to care for our patients.”
In addition to knowledge gaps, nurse turnover is on the rise, according to the “2017 Survey of Registered Nurses: Viewpoints on Leadership, Nursing, Shortages and Their Profession” from AMN Healthcare, San Diego.2 The survey also finds that more than one in four nurses plan to retire within a year, and 73% of baby boomers expect to retire in 3 years or less.
The shortfall is already more pronounced in rural hospitals facing staffing challenges and in specialty areas where additional education, training, and experience are critical to improve patient safety and outcomes.
The expertise and dynamic, front-line viewpoint of teleICU experts has resulted in a comprehensive, patient-centric update. Their experience delivering both bedside and remote care was instrumental in developing valuable clinical scenarios. The scenarios in the statement are genuine examples of how each key recommendation is implemented by physicians and bedside and teleICU nurses to provide continuity of care; identify high-risk patients; and decrease mortality rates by filling gaps in monitoring and staff expertise.
As a leader in the delivery of evidence-based practices, AACN offers CCRN-E specialty certification3 for nurses who primarily provide acute or critical care for adult patients in a teleICU setting, which is connected to the bedside via audiovisual communication and computer systems. Visit www.aacn.org > Certification > Get Certified > CCRN-E Adult to learn more.
The expert consensus statement is available for AACN members to download or to purchase a hard copy.4
References
1. https://www.aacn.org/nursing-excellence/standards/aacn-teleicu-nursing-consensus-statement
2. https://www.amnhealthcare.com/uploadedFiles/MainSite/Content/Campaigns/AMN%20Healthcare%202017%20RN%20Survey%20-%20Full%20Report.pdf 3. https://www.aacn.org/certification/get-certified/ccrn-e-adult
4. https://www.aacn.org/nursing-excellence/standards/aacn-teleicu-nursing-consensus-statement
To remain at the forefront of expanding evidence-based practices in all aspects of critical care, facilities must include teleICUs.
In 2013, the American Association of Critical-Care Nurses (AACN) first defined standards for the emerging telenursing practice in the ICU and has recently published an update, AACN TeleICU Nursing Practice: An Expert Consensus Statement Supporting High Acuity, Progressive and Critical Care.1
The new consensus statement, which creates a framework for implementing, evaluating, and improving teleICU nursing practice, addresses the new findings in this fast-growing area of health care. It also establishes a model for achieving excellence and optimal patient care outcomes through the following:
• Shared knowledge and goals
• Mutual respect
• Skilled communication
• True collaboration
• Authentic leadership
• Optimized technology
• Practice excellence
A 12-person task force, including teleICU nurse leaders, contributed to the statement and brought a fresh perspective to this area of practice.
Task force co-chair Pat Herr, clinical integration director of eCARE ICU at Avera Health, says it was important to harness the energy and lessons learned from experienced teleICU leaders.
“TeleICUs continue to evolve to meet the needs of patients and health systems,” Herr adds. “New technology options and new partnership models are available, and nurse leaders play an important part in using these tools to improve patient care.”
The earliest teleICU design concepts employed a physician-only model of care, but it quickly became clear that critical-care nursing was a necessary component. Today, the most effective teleICU models implement collaborative care that includes physicians, nurses, information technology, and administrative support personnel.Opportunities in teleICU are one way to retain knowledgeable nurses, who can bridge clinical expertise gaps and provide an additional layer of skilled critical care. TeleICU care ensures delivery of both optimal patient outcomes and timely knowledge to support physicians, nurses, and the entire bedside care team.
Task force member Lisa-Mae Williams, operations director of telehealth and eICU at Baptist Health South Florida, says telemedicine doesn’t mean fewer jobs for bedside nurses; it’s an extra set of eyes to surveil vitals and support a clinical workforce that may be stretched thin.
“At the bedside, when teleICU came to my unit, I was very skeptical,” Williams recalls. “But after seeing for myself what those extra nurses brought to the table – the available technology and time they had to assess trends and really delve into what’s going on – it turned out to be the best tool to care for our patients.”
In addition to knowledge gaps, nurse turnover is on the rise, according to the “2017 Survey of Registered Nurses: Viewpoints on Leadership, Nursing, Shortages and Their Profession” from AMN Healthcare, San Diego.2 The survey also finds that more than one in four nurses plan to retire within a year, and 73% of baby boomers expect to retire in 3 years or less.
The shortfall is already more pronounced in rural hospitals facing staffing challenges and in specialty areas where additional education, training, and experience are critical to improve patient safety and outcomes.
The expertise and dynamic, front-line viewpoint of teleICU experts has resulted in a comprehensive, patient-centric update. Their experience delivering both bedside and remote care was instrumental in developing valuable clinical scenarios. The scenarios in the statement are genuine examples of how each key recommendation is implemented by physicians and bedside and teleICU nurses to provide continuity of care; identify high-risk patients; and decrease mortality rates by filling gaps in monitoring and staff expertise.
As a leader in the delivery of evidence-based practices, AACN offers CCRN-E specialty certification3 for nurses who primarily provide acute or critical care for adult patients in a teleICU setting, which is connected to the bedside via audiovisual communication and computer systems. Visit www.aacn.org > Certification > Get Certified > CCRN-E Adult to learn more.
The expert consensus statement is available for AACN members to download or to purchase a hard copy.4
References
1. https://www.aacn.org/nursing-excellence/standards/aacn-teleicu-nursing-consensus-statement
2. https://www.amnhealthcare.com/uploadedFiles/MainSite/Content/Campaigns/AMN%20Healthcare%202017%20RN%20Survey%20-%20Full%20Report.pdf 3. https://www.aacn.org/certification/get-certified/ccrn-e-adult
4. https://www.aacn.org/nursing-excellence/standards/aacn-teleicu-nursing-consensus-statement
Update: FDA workshop on medical devices for SDB
Drs. Neil Freedman and Barbara Phillips represented CHEST at an FDA workshop on April 16 on “Study Design Considerations for Devices Including Digital Health Technologies for Sleep-Disordered Breathing (SDB) in Adults. The other organizational participants were The American Academy of Dental Sleep Medicine; The American Academy of Neurology; the American Academy of Otolaryngology, Head and Neck Surgery; The American Academy of Sleep Medicine; and The American Sleep Apnea Association. Here are the questions that the FDA asked the panelists:
1. FDA is seeking to promote innovation and expedite the clinical development of devices intended for the diagnosis and treatment of sleep-disordered breathing (SDB). How should the following conditions (including their severity, eg, mild, moderate, severe, if appropriate) be defined for the purpose of creating appropriate inclusion/exclusion criteria for a clinical study for SDB devices?
a. Apnea
b. Hypopnea
c. Sleep-Disordered Breathing (SDB)
d. Obstructive Sleep Apnea Syndrome (OSAS)
e. Central Sleep Apnea Syndrome (CSAS)
f. Primary Snoring
2. Polysomnography (PSG) has been widely accepted as the “gold standard” test for the diagnosis of OSA and primary snoring. However, home sleep apnea testing (HSAT) has emerged in recent years as an alternative or complementary diagnostic tool for SDB.
a. Can HSAT be used for establishing a baseline diagnosis and for the collection of clinical performance data for device trials for OSA, CSA, or primary snoring? If so, what are the recommended parameters that should be collected by an HSAT (eg, nasal pressure, oximetry, chest and abdominal respiratory inductance plethysmography)?
b. What constitutes a technically adequate test (either PSG or HSAT, if appropriate) for establishing a baseline diagnosis of SDB for device studies (eg, number of hours, number of nights)?
3. FDA has received an increasing number of premarket applications for devices intended to treat SDB. How should studies for the various technologies (eg, intra-oral appliances, externally worn devices, electrosurgical devices for tissue reduction, and passive or active implantable devices of the upper airway) be designed with respect to the following factors (please consider whether your recommendations would vary if the device was an implant vs an externally worn device):
a. What is the most appropriate control group (eg, comparison to baseline measures, randomization to a concurrent control group)?
b. What is the minimum duration of the study? For implants and surgical procedures, how long after the intervention should the effectiveness endpoint be assessed?
c. What objective parameter or combination of parameters should be used for the primary effectiveness endpoints (eg, AHI, ODI, T90, or other non-PSG/HSAT parameters)?
d. What would be a clinically meaningful difference for the above primary effectiveness endpoint(s) between/among study arms or within a study arm?
e. What patient-reported outcomes (PROs) are appropriate in the evaluation of SDB devices?
4. What are the safety and effectiveness concerns when a digital health device provides a diagnosis and monitoring of SDB?
a. What factors are important in developing a reference database (eg, demographics, validation)?b. What are the important safety and effectiveness concerns for SDB digital health devices used in the following settings:
i. A physician office or sleep center environment?
ii. A nonclinical environment?
iii. Prescription vs OTC use?
There was significant discussion and quite a bit of controversy. Among the recommendations to the FDA were that home testing is adequate and acceptable for clinical trials, that the ODI4 is more predictive and reliable than the AHI, and that the syndrome of OSAHS includes symptoms, one of the most important of which is sleepiness. It was acknowledged that digital health devices have the potential to greatly increase access to diagnosis, but access to treatment will need to be addressed, as well. I think this was a very important meeting, and the outcome will likely impact our members. The ultimate goal is to publish a paper about recommended techniques, outcomes, and inclusion characteristics/definitions to be used in clinical trials for new devices to diagnose or treat sleep apnea.
Drs. Neil Freedman and Barbara Phillips represented CHEST at an FDA workshop on April 16 on “Study Design Considerations for Devices Including Digital Health Technologies for Sleep-Disordered Breathing (SDB) in Adults. The other organizational participants were The American Academy of Dental Sleep Medicine; The American Academy of Neurology; the American Academy of Otolaryngology, Head and Neck Surgery; The American Academy of Sleep Medicine; and The American Sleep Apnea Association. Here are the questions that the FDA asked the panelists:
1. FDA is seeking to promote innovation and expedite the clinical development of devices intended for the diagnosis and treatment of sleep-disordered breathing (SDB). How should the following conditions (including their severity, eg, mild, moderate, severe, if appropriate) be defined for the purpose of creating appropriate inclusion/exclusion criteria for a clinical study for SDB devices?
a. Apnea
b. Hypopnea
c. Sleep-Disordered Breathing (SDB)
d. Obstructive Sleep Apnea Syndrome (OSAS)
e. Central Sleep Apnea Syndrome (CSAS)
f. Primary Snoring
2. Polysomnography (PSG) has been widely accepted as the “gold standard” test for the diagnosis of OSA and primary snoring. However, home sleep apnea testing (HSAT) has emerged in recent years as an alternative or complementary diagnostic tool for SDB.
a. Can HSAT be used for establishing a baseline diagnosis and for the collection of clinical performance data for device trials for OSA, CSA, or primary snoring? If so, what are the recommended parameters that should be collected by an HSAT (eg, nasal pressure, oximetry, chest and abdominal respiratory inductance plethysmography)?
b. What constitutes a technically adequate test (either PSG or HSAT, if appropriate) for establishing a baseline diagnosis of SDB for device studies (eg, number of hours, number of nights)?
3. FDA has received an increasing number of premarket applications for devices intended to treat SDB. How should studies for the various technologies (eg, intra-oral appliances, externally worn devices, electrosurgical devices for tissue reduction, and passive or active implantable devices of the upper airway) be designed with respect to the following factors (please consider whether your recommendations would vary if the device was an implant vs an externally worn device):
a. What is the most appropriate control group (eg, comparison to baseline measures, randomization to a concurrent control group)?
b. What is the minimum duration of the study? For implants and surgical procedures, how long after the intervention should the effectiveness endpoint be assessed?
c. What objective parameter or combination of parameters should be used for the primary effectiveness endpoints (eg, AHI, ODI, T90, or other non-PSG/HSAT parameters)?
d. What would be a clinically meaningful difference for the above primary effectiveness endpoint(s) between/among study arms or within a study arm?
e. What patient-reported outcomes (PROs) are appropriate in the evaluation of SDB devices?
4. What are the safety and effectiveness concerns when a digital health device provides a diagnosis and monitoring of SDB?
a. What factors are important in developing a reference database (eg, demographics, validation)?b. What are the important safety and effectiveness concerns for SDB digital health devices used in the following settings:
i. A physician office or sleep center environment?
ii. A nonclinical environment?
iii. Prescription vs OTC use?
There was significant discussion and quite a bit of controversy. Among the recommendations to the FDA were that home testing is adequate and acceptable for clinical trials, that the ODI4 is more predictive and reliable than the AHI, and that the syndrome of OSAHS includes symptoms, one of the most important of which is sleepiness. It was acknowledged that digital health devices have the potential to greatly increase access to diagnosis, but access to treatment will need to be addressed, as well. I think this was a very important meeting, and the outcome will likely impact our members. The ultimate goal is to publish a paper about recommended techniques, outcomes, and inclusion characteristics/definitions to be used in clinical trials for new devices to diagnose or treat sleep apnea.
Drs. Neil Freedman and Barbara Phillips represented CHEST at an FDA workshop on April 16 on “Study Design Considerations for Devices Including Digital Health Technologies for Sleep-Disordered Breathing (SDB) in Adults. The other organizational participants were The American Academy of Dental Sleep Medicine; The American Academy of Neurology; the American Academy of Otolaryngology, Head and Neck Surgery; The American Academy of Sleep Medicine; and The American Sleep Apnea Association. Here are the questions that the FDA asked the panelists:
1. FDA is seeking to promote innovation and expedite the clinical development of devices intended for the diagnosis and treatment of sleep-disordered breathing (SDB). How should the following conditions (including their severity, eg, mild, moderate, severe, if appropriate) be defined for the purpose of creating appropriate inclusion/exclusion criteria for a clinical study for SDB devices?
a. Apnea
b. Hypopnea
c. Sleep-Disordered Breathing (SDB)
d. Obstructive Sleep Apnea Syndrome (OSAS)
e. Central Sleep Apnea Syndrome (CSAS)
f. Primary Snoring
2. Polysomnography (PSG) has been widely accepted as the “gold standard” test for the diagnosis of OSA and primary snoring. However, home sleep apnea testing (HSAT) has emerged in recent years as an alternative or complementary diagnostic tool for SDB.
a. Can HSAT be used for establishing a baseline diagnosis and for the collection of clinical performance data for device trials for OSA, CSA, or primary snoring? If so, what are the recommended parameters that should be collected by an HSAT (eg, nasal pressure, oximetry, chest and abdominal respiratory inductance plethysmography)?
b. What constitutes a technically adequate test (either PSG or HSAT, if appropriate) for establishing a baseline diagnosis of SDB for device studies (eg, number of hours, number of nights)?
3. FDA has received an increasing number of premarket applications for devices intended to treat SDB. How should studies for the various technologies (eg, intra-oral appliances, externally worn devices, electrosurgical devices for tissue reduction, and passive or active implantable devices of the upper airway) be designed with respect to the following factors (please consider whether your recommendations would vary if the device was an implant vs an externally worn device):
a. What is the most appropriate control group (eg, comparison to baseline measures, randomization to a concurrent control group)?
b. What is the minimum duration of the study? For implants and surgical procedures, how long after the intervention should the effectiveness endpoint be assessed?
c. What objective parameter or combination of parameters should be used for the primary effectiveness endpoints (eg, AHI, ODI, T90, or other non-PSG/HSAT parameters)?
d. What would be a clinically meaningful difference for the above primary effectiveness endpoint(s) between/among study arms or within a study arm?
e. What patient-reported outcomes (PROs) are appropriate in the evaluation of SDB devices?
4. What are the safety and effectiveness concerns when a digital health device provides a diagnosis and monitoring of SDB?
a. What factors are important in developing a reference database (eg, demographics, validation)?b. What are the important safety and effectiveness concerns for SDB digital health devices used in the following settings:
i. A physician office or sleep center environment?
ii. A nonclinical environment?
iii. Prescription vs OTC use?
There was significant discussion and quite a bit of controversy. Among the recommendations to the FDA were that home testing is adequate and acceptable for clinical trials, that the ODI4 is more predictive and reliable than the AHI, and that the syndrome of OSAHS includes symptoms, one of the most important of which is sleepiness. It was acknowledged that digital health devices have the potential to greatly increase access to diagnosis, but access to treatment will need to be addressed, as well. I think this was a very important meeting, and the outcome will likely impact our members. The ultimate goal is to publish a paper about recommended techniques, outcomes, and inclusion characteristics/definitions to be used in clinical trials for new devices to diagnose or treat sleep apnea.
COPD-OSA overlap syndrome
Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) each affect at least 10% of the general adult population and, thus, both disorders together, commonly referred to as the overlap syndrome, could be expected in at least 1% of adults by chance alone. However, there is evidence of important interactions between the disorders that influence the prevalence of the overlap, which have implications for the development of comorbidities,and also for management (McNicholas WT. Chest. 2017; 152[6]:1318). Furthermore, sleep quality is typically poor in COPD, which has been linked to worse pulmonary function and lung hyperinflation and may contribute to daytime fatigue.
Interactions between COPD and OSA that may influence the prevalence of overlap
Previous reports have presented conflicting results regarding the likely association between COPD and OSA, which may partly reflect different definitions of OSA, patient populations, and methodologies of investigation. However, COPD represents a spectrum of clinical phenotypes ranging from the hyperinflated patient with low BMI (predominant emphysema phenotype) to the patient with higher BMI and tendency to right-sided heart failure (predominant chronic bronchitis phenotype). The predominant emphysema phenotype may predispose to a lower likelihood of OSA, and there is recent evidence that lung hyperinflation is protective against the development of OSA by lowering the critical closing pressure of the upper airway during sleep. Furthermore, the degree of emphysema and gas trapping on CT scan of the thorax correlates inversely with apnea-hypopnia index in patients with severe COPD (Krachman SL et al. Ann Am Thorac Soc. 2016;13[7]:1129).
In contrast, the predominant chronic bronchitis phenotype predisposes to a higher likelihood of OSA because of higher BMI and likelihood of right-sided heart failure. Peripheral fluid retention in such patients predisposes to OSA because of the rostral fluid shift that occurs during sleep in the supine position, predisposing to upper airway obstruction by airway narrowing. The COPDGene study reports that the chronic bronchitis phenotype has a higher prevalence of OSA even in the absence of differences in BMI and lung function (Kim V et al. Chest. 2011;140[3]:626). Upper airway inflammation associated with cigarette smoking may also contribute to the development of OSA, and corticosteroid therapy may adversely affect upper airway muscle function. OSA also appears to exacerbate lower airway inflammation in COPD. In practice, most patients with COPD have a mixture of emphysema and chronic bronchitis, and the probability of OSA will represent the balance of these protective and promoting factors in individual patients (Fig 1).
While there is evidence of increased mortality in patients with COPD and OSA alone, a recent report based on the Sleep Heart Health Study somewhat surprisingly found that the incremental contribution of declining lung function to mortality diminished with increasing severity of SDB measured by AHI (Putcha N et al. Am J Respir Crit Care Med. 2016;194[8]:1007). Thus, the epidemiologic relationship of COPD and OSA and related clinical outcomes remains an important research topic comparing different clinical phenotypes.
Mechanisms of interaction in the overlap syndrome and implications for comorbidity
COPD and OSA are associated with several overlapping physiological and biological disturbances, including hypoxia and inflammation, which may contribute to cardiovascular and other comorbidities. Thus, the probability should be high that the overlap syndrome will be associated with a greater risk of comorbidity than with either disease alone. Patients with the overlap syndrome demonstrate greater degrees of oxygen desaturation predisposing to pulmonary hypertension, which is especially common in these patients.
COPD and OSA are each associated with systemic inflammation and oxidative stress, and C-reactive protein (CRP) has been identified as a measure of systemic inflammation that is commonly elevated in both disorders, although in OSA, concurrent obesity is an important confounding factor. Systemic inflammation contributes to the development of cardiovascular disease, which is a common complication of both COPD and OSA. Thus, one could expect that cardiovascular disease is particularly prevalent in patients with overlap syndrome, but there are limited data on this relationship, which represents an important research topic.
Clinical assessment
Patients with the overlap syndrome present with typical clinical features of each disorder and additional features that reflect the higher prevalence of hypoxemia, hypercapnia, and pulmonary hypertension. Thus, morning headaches reflecting hypercapnia and peripheral edema reflecting right-sided heart failure may be especially common. Screening questionnaires may be helpful in the initial evaluation of likely OSA in patients with COPD, and objective clinical data, including anthropometrics such as age, sex, and BMI, and medical history such as cardiovascular comorbidity, are especially useful in clinical prediction (McNicholas WT. Lancet Respir Med. 2016;4[9]:683). Thus, screening for OSA in patients with COPD should not be complicated, and the widespread failure to do so may reflect a lack of awareness of the possible association by the clinician involved.
The specific diagnosis of OSA in COPD requires some form of overnight sleep study, and there is a growing move toward ambulatory studies that focus on cardiorespiratory variables. Overnight monitoring of oxygen saturation is especially useful, particularly if linked to special analysis software, and may be sufficient in many cases. Full polysomnography can be reserved for select cases where the diagnosis remains in doubt.
Management and outcomes
Nocturnal hypoxemia in patients with COPD benefits from inhaled, long-acting beta-agonist and anticholinergic therapy, and mean nocturnal oxygen saturation is 2% to 3% higher on each medication compared with placebo. Supplemental oxygen may be indicated when nocturnal oxygen desaturation persists despite optimum pharmacotherapy and does not appear to be associated with significant additional risk of hypercapnia.
However, in patients with COPD-OSA overlap, nonnvasive pressure support is the most appropriate management option. In patients with predominant OSA, continuous positive airway pressure therapy (CPAP) is the preferred option, but where COPD is the dominant component, noninvasive ventilation (NIV) in the form of bi-level positive airway pressure (BIPAP) may be more appropriate. Recent reports in severe COPD indicate that NIV targeted to markedly reduce hypercapnia is associated with improved quality of life and prolonged survival (Köhnlein T et al. Lancet Respir Med. 2014;2[9]:698), and patients with COPD with persistent hypercapnia following hospitalization with an acute exacerbation show improved clinical outcomes and survival with continuing home NIV (Murphy PB et al. JAMA. 2017;317[21]:2177).
The recognition of co-existing OSA in patients with COPD has important clinical relevance as the management of patients with overlap syndrome is different from COPD alone, and the long-term survival of patients with overlap syndrome not treated with nocturnal positive airway pressure is significantly inferior to those patients with overlap syndrome appropriately treated (Marin JM et al. Am J Respir Crit Care Med. 2010;182[3]:325).
Dr. McNicholas is with the Department of Respiratory and Sleep Medicine, St. Vincent’s University Hospital, Dublin School of Medicine, University College Dublin, Ireland.
Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) each affect at least 10% of the general adult population and, thus, both disorders together, commonly referred to as the overlap syndrome, could be expected in at least 1% of adults by chance alone. However, there is evidence of important interactions between the disorders that influence the prevalence of the overlap, which have implications for the development of comorbidities,and also for management (McNicholas WT. Chest. 2017; 152[6]:1318). Furthermore, sleep quality is typically poor in COPD, which has been linked to worse pulmonary function and lung hyperinflation and may contribute to daytime fatigue.
Interactions between COPD and OSA that may influence the prevalence of overlap
Previous reports have presented conflicting results regarding the likely association between COPD and OSA, which may partly reflect different definitions of OSA, patient populations, and methodologies of investigation. However, COPD represents a spectrum of clinical phenotypes ranging from the hyperinflated patient with low BMI (predominant emphysema phenotype) to the patient with higher BMI and tendency to right-sided heart failure (predominant chronic bronchitis phenotype). The predominant emphysema phenotype may predispose to a lower likelihood of OSA, and there is recent evidence that lung hyperinflation is protective against the development of OSA by lowering the critical closing pressure of the upper airway during sleep. Furthermore, the degree of emphysema and gas trapping on CT scan of the thorax correlates inversely with apnea-hypopnia index in patients with severe COPD (Krachman SL et al. Ann Am Thorac Soc. 2016;13[7]:1129).
In contrast, the predominant chronic bronchitis phenotype predisposes to a higher likelihood of OSA because of higher BMI and likelihood of right-sided heart failure. Peripheral fluid retention in such patients predisposes to OSA because of the rostral fluid shift that occurs during sleep in the supine position, predisposing to upper airway obstruction by airway narrowing. The COPDGene study reports that the chronic bronchitis phenotype has a higher prevalence of OSA even in the absence of differences in BMI and lung function (Kim V et al. Chest. 2011;140[3]:626). Upper airway inflammation associated with cigarette smoking may also contribute to the development of OSA, and corticosteroid therapy may adversely affect upper airway muscle function. OSA also appears to exacerbate lower airway inflammation in COPD. In practice, most patients with COPD have a mixture of emphysema and chronic bronchitis, and the probability of OSA will represent the balance of these protective and promoting factors in individual patients (Fig 1).
While there is evidence of increased mortality in patients with COPD and OSA alone, a recent report based on the Sleep Heart Health Study somewhat surprisingly found that the incremental contribution of declining lung function to mortality diminished with increasing severity of SDB measured by AHI (Putcha N et al. Am J Respir Crit Care Med. 2016;194[8]:1007). Thus, the epidemiologic relationship of COPD and OSA and related clinical outcomes remains an important research topic comparing different clinical phenotypes.
Mechanisms of interaction in the overlap syndrome and implications for comorbidity
COPD and OSA are associated with several overlapping physiological and biological disturbances, including hypoxia and inflammation, which may contribute to cardiovascular and other comorbidities. Thus, the probability should be high that the overlap syndrome will be associated with a greater risk of comorbidity than with either disease alone. Patients with the overlap syndrome demonstrate greater degrees of oxygen desaturation predisposing to pulmonary hypertension, which is especially common in these patients.
COPD and OSA are each associated with systemic inflammation and oxidative stress, and C-reactive protein (CRP) has been identified as a measure of systemic inflammation that is commonly elevated in both disorders, although in OSA, concurrent obesity is an important confounding factor. Systemic inflammation contributes to the development of cardiovascular disease, which is a common complication of both COPD and OSA. Thus, one could expect that cardiovascular disease is particularly prevalent in patients with overlap syndrome, but there are limited data on this relationship, which represents an important research topic.
Clinical assessment
Patients with the overlap syndrome present with typical clinical features of each disorder and additional features that reflect the higher prevalence of hypoxemia, hypercapnia, and pulmonary hypertension. Thus, morning headaches reflecting hypercapnia and peripheral edema reflecting right-sided heart failure may be especially common. Screening questionnaires may be helpful in the initial evaluation of likely OSA in patients with COPD, and objective clinical data, including anthropometrics such as age, sex, and BMI, and medical history such as cardiovascular comorbidity, are especially useful in clinical prediction (McNicholas WT. Lancet Respir Med. 2016;4[9]:683). Thus, screening for OSA in patients with COPD should not be complicated, and the widespread failure to do so may reflect a lack of awareness of the possible association by the clinician involved.
The specific diagnosis of OSA in COPD requires some form of overnight sleep study, and there is a growing move toward ambulatory studies that focus on cardiorespiratory variables. Overnight monitoring of oxygen saturation is especially useful, particularly if linked to special analysis software, and may be sufficient in many cases. Full polysomnography can be reserved for select cases where the diagnosis remains in doubt.
Management and outcomes
Nocturnal hypoxemia in patients with COPD benefits from inhaled, long-acting beta-agonist and anticholinergic therapy, and mean nocturnal oxygen saturation is 2% to 3% higher on each medication compared with placebo. Supplemental oxygen may be indicated when nocturnal oxygen desaturation persists despite optimum pharmacotherapy and does not appear to be associated with significant additional risk of hypercapnia.
However, in patients with COPD-OSA overlap, nonnvasive pressure support is the most appropriate management option. In patients with predominant OSA, continuous positive airway pressure therapy (CPAP) is the preferred option, but where COPD is the dominant component, noninvasive ventilation (NIV) in the form of bi-level positive airway pressure (BIPAP) may be more appropriate. Recent reports in severe COPD indicate that NIV targeted to markedly reduce hypercapnia is associated with improved quality of life and prolonged survival (Köhnlein T et al. Lancet Respir Med. 2014;2[9]:698), and patients with COPD with persistent hypercapnia following hospitalization with an acute exacerbation show improved clinical outcomes and survival with continuing home NIV (Murphy PB et al. JAMA. 2017;317[21]:2177).
The recognition of co-existing OSA in patients with COPD has important clinical relevance as the management of patients with overlap syndrome is different from COPD alone, and the long-term survival of patients with overlap syndrome not treated with nocturnal positive airway pressure is significantly inferior to those patients with overlap syndrome appropriately treated (Marin JM et al. Am J Respir Crit Care Med. 2010;182[3]:325).
Dr. McNicholas is with the Department of Respiratory and Sleep Medicine, St. Vincent’s University Hospital, Dublin School of Medicine, University College Dublin, Ireland.
Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) each affect at least 10% of the general adult population and, thus, both disorders together, commonly referred to as the overlap syndrome, could be expected in at least 1% of adults by chance alone. However, there is evidence of important interactions between the disorders that influence the prevalence of the overlap, which have implications for the development of comorbidities,and also for management (McNicholas WT. Chest. 2017; 152[6]:1318). Furthermore, sleep quality is typically poor in COPD, which has been linked to worse pulmonary function and lung hyperinflation and may contribute to daytime fatigue.
Interactions between COPD and OSA that may influence the prevalence of overlap
Previous reports have presented conflicting results regarding the likely association between COPD and OSA, which may partly reflect different definitions of OSA, patient populations, and methodologies of investigation. However, COPD represents a spectrum of clinical phenotypes ranging from the hyperinflated patient with low BMI (predominant emphysema phenotype) to the patient with higher BMI and tendency to right-sided heart failure (predominant chronic bronchitis phenotype). The predominant emphysema phenotype may predispose to a lower likelihood of OSA, and there is recent evidence that lung hyperinflation is protective against the development of OSA by lowering the critical closing pressure of the upper airway during sleep. Furthermore, the degree of emphysema and gas trapping on CT scan of the thorax correlates inversely with apnea-hypopnia index in patients with severe COPD (Krachman SL et al. Ann Am Thorac Soc. 2016;13[7]:1129).
In contrast, the predominant chronic bronchitis phenotype predisposes to a higher likelihood of OSA because of higher BMI and likelihood of right-sided heart failure. Peripheral fluid retention in such patients predisposes to OSA because of the rostral fluid shift that occurs during sleep in the supine position, predisposing to upper airway obstruction by airway narrowing. The COPDGene study reports that the chronic bronchitis phenotype has a higher prevalence of OSA even in the absence of differences in BMI and lung function (Kim V et al. Chest. 2011;140[3]:626). Upper airway inflammation associated with cigarette smoking may also contribute to the development of OSA, and corticosteroid therapy may adversely affect upper airway muscle function. OSA also appears to exacerbate lower airway inflammation in COPD. In practice, most patients with COPD have a mixture of emphysema and chronic bronchitis, and the probability of OSA will represent the balance of these protective and promoting factors in individual patients (Fig 1).
While there is evidence of increased mortality in patients with COPD and OSA alone, a recent report based on the Sleep Heart Health Study somewhat surprisingly found that the incremental contribution of declining lung function to mortality diminished with increasing severity of SDB measured by AHI (Putcha N et al. Am J Respir Crit Care Med. 2016;194[8]:1007). Thus, the epidemiologic relationship of COPD and OSA and related clinical outcomes remains an important research topic comparing different clinical phenotypes.
Mechanisms of interaction in the overlap syndrome and implications for comorbidity
COPD and OSA are associated with several overlapping physiological and biological disturbances, including hypoxia and inflammation, which may contribute to cardiovascular and other comorbidities. Thus, the probability should be high that the overlap syndrome will be associated with a greater risk of comorbidity than with either disease alone. Patients with the overlap syndrome demonstrate greater degrees of oxygen desaturation predisposing to pulmonary hypertension, which is especially common in these patients.
COPD and OSA are each associated with systemic inflammation and oxidative stress, and C-reactive protein (CRP) has been identified as a measure of systemic inflammation that is commonly elevated in both disorders, although in OSA, concurrent obesity is an important confounding factor. Systemic inflammation contributes to the development of cardiovascular disease, which is a common complication of both COPD and OSA. Thus, one could expect that cardiovascular disease is particularly prevalent in patients with overlap syndrome, but there are limited data on this relationship, which represents an important research topic.
Clinical assessment
Patients with the overlap syndrome present with typical clinical features of each disorder and additional features that reflect the higher prevalence of hypoxemia, hypercapnia, and pulmonary hypertension. Thus, morning headaches reflecting hypercapnia and peripheral edema reflecting right-sided heart failure may be especially common. Screening questionnaires may be helpful in the initial evaluation of likely OSA in patients with COPD, and objective clinical data, including anthropometrics such as age, sex, and BMI, and medical history such as cardiovascular comorbidity, are especially useful in clinical prediction (McNicholas WT. Lancet Respir Med. 2016;4[9]:683). Thus, screening for OSA in patients with COPD should not be complicated, and the widespread failure to do so may reflect a lack of awareness of the possible association by the clinician involved.
The specific diagnosis of OSA in COPD requires some form of overnight sleep study, and there is a growing move toward ambulatory studies that focus on cardiorespiratory variables. Overnight monitoring of oxygen saturation is especially useful, particularly if linked to special analysis software, and may be sufficient in many cases. Full polysomnography can be reserved for select cases where the diagnosis remains in doubt.
Management and outcomes
Nocturnal hypoxemia in patients with COPD benefits from inhaled, long-acting beta-agonist and anticholinergic therapy, and mean nocturnal oxygen saturation is 2% to 3% higher on each medication compared with placebo. Supplemental oxygen may be indicated when nocturnal oxygen desaturation persists despite optimum pharmacotherapy and does not appear to be associated with significant additional risk of hypercapnia.
However, in patients with COPD-OSA overlap, nonnvasive pressure support is the most appropriate management option. In patients with predominant OSA, continuous positive airway pressure therapy (CPAP) is the preferred option, but where COPD is the dominant component, noninvasive ventilation (NIV) in the form of bi-level positive airway pressure (BIPAP) may be more appropriate. Recent reports in severe COPD indicate that NIV targeted to markedly reduce hypercapnia is associated with improved quality of life and prolonged survival (Köhnlein T et al. Lancet Respir Med. 2014;2[9]:698), and patients with COPD with persistent hypercapnia following hospitalization with an acute exacerbation show improved clinical outcomes and survival with continuing home NIV (Murphy PB et al. JAMA. 2017;317[21]:2177).
The recognition of co-existing OSA in patients with COPD has important clinical relevance as the management of patients with overlap syndrome is different from COPD alone, and the long-term survival of patients with overlap syndrome not treated with nocturnal positive airway pressure is significantly inferior to those patients with overlap syndrome appropriately treated (Marin JM et al. Am J Respir Crit Care Med. 2010;182[3]:325).
Dr. McNicholas is with the Department of Respiratory and Sleep Medicine, St. Vincent’s University Hospital, Dublin School of Medicine, University College Dublin, Ireland.
Get social, stay connected with CHEST Twitter chats
One of the best ways to stay connected with CHEST and up-to-date on the latest news and research is through our social channels. Twitter is a social platform that is constantly growing for the organization. Since 2009, we’ve had the opportunity to connect with over 20,000 individuals and impact millions with just a simple tweet or sharing of information. As a means to inform our highly active audience and bring the conversation to a social space, we’ve utilized the platform to help drive the conversation on various topics. CHEST moderates a public conversation via Twitter (@accpchest) around topics in pulmonary, critical care, and sleep medicine every few weeks.
So, what exactly is a Twitter chat? Twitter chats are conversations that are held on the social platform and linked together by a distinct hashtag. We typically use the hashtag #pulmCC (which stands for pulmonary, critical care) and allow individuals from all across the globe to join in on the conversation and share their input. In addition to being a great networking opportunity, our chat recently began offering MOC points to CHEST members who attend Twitter chats and are eligible to receive participation points. We recently began offering CME credit for some of our chats, as well.
Over the last 6 years, we’ve hosted a wide range of Twitter chat topics, ranging from asthma to lung cancer. Some of those chats focused on the following topics:
- The Best of 2017: Highlights, Advancements, New Science
- Improving Lung Health Through Pulmonary Rehabilitation
- Caring for the Caregiver: Vulnerability and Burnout
- What Trainees Need to Know About Pulmonary, Critical Care & Sleep
- #VTEonSoMe Twitter Chat—Let’s Talk Blood Clots! Surgeries, Birth Control, and 40
This past March, we held our Twitter chat Sepsis: Revisions, Advancements, New Therapies, led by Drs. Chris Carroll, Alex Niven, and Steven Q. Simpson. We had over 4.2 million impressions!
Every Twitter chat serves a different purpose, typically based on the topic and the individuals we believe would be most interested in the topic. These chats help us spark conversations on the latest research, advancements, and potential opportunities within the pulmonary/critical care field. They also provide physicians with a great opportunity to network and get acquainted with the #pulmCC community.
One of the best ways to stay connected with CHEST and up-to-date on the latest news and research is through our social channels. Twitter is a social platform that is constantly growing for the organization. Since 2009, we’ve had the opportunity to connect with over 20,000 individuals and impact millions with just a simple tweet or sharing of information. As a means to inform our highly active audience and bring the conversation to a social space, we’ve utilized the platform to help drive the conversation on various topics. CHEST moderates a public conversation via Twitter (@accpchest) around topics in pulmonary, critical care, and sleep medicine every few weeks.
So, what exactly is a Twitter chat? Twitter chats are conversations that are held on the social platform and linked together by a distinct hashtag. We typically use the hashtag #pulmCC (which stands for pulmonary, critical care) and allow individuals from all across the globe to join in on the conversation and share their input. In addition to being a great networking opportunity, our chat recently began offering MOC points to CHEST members who attend Twitter chats and are eligible to receive participation points. We recently began offering CME credit for some of our chats, as well.
Over the last 6 years, we’ve hosted a wide range of Twitter chat topics, ranging from asthma to lung cancer. Some of those chats focused on the following topics:
- The Best of 2017: Highlights, Advancements, New Science
- Improving Lung Health Through Pulmonary Rehabilitation
- Caring for the Caregiver: Vulnerability and Burnout
- What Trainees Need to Know About Pulmonary, Critical Care & Sleep
- #VTEonSoMe Twitter Chat—Let’s Talk Blood Clots! Surgeries, Birth Control, and 40
This past March, we held our Twitter chat Sepsis: Revisions, Advancements, New Therapies, led by Drs. Chris Carroll, Alex Niven, and Steven Q. Simpson. We had over 4.2 million impressions!
Every Twitter chat serves a different purpose, typically based on the topic and the individuals we believe would be most interested in the topic. These chats help us spark conversations on the latest research, advancements, and potential opportunities within the pulmonary/critical care field. They also provide physicians with a great opportunity to network and get acquainted with the #pulmCC community.
One of the best ways to stay connected with CHEST and up-to-date on the latest news and research is through our social channels. Twitter is a social platform that is constantly growing for the organization. Since 2009, we’ve had the opportunity to connect with over 20,000 individuals and impact millions with just a simple tweet or sharing of information. As a means to inform our highly active audience and bring the conversation to a social space, we’ve utilized the platform to help drive the conversation on various topics. CHEST moderates a public conversation via Twitter (@accpchest) around topics in pulmonary, critical care, and sleep medicine every few weeks.
So, what exactly is a Twitter chat? Twitter chats are conversations that are held on the social platform and linked together by a distinct hashtag. We typically use the hashtag #pulmCC (which stands for pulmonary, critical care) and allow individuals from all across the globe to join in on the conversation and share their input. In addition to being a great networking opportunity, our chat recently began offering MOC points to CHEST members who attend Twitter chats and are eligible to receive participation points. We recently began offering CME credit for some of our chats, as well.
Over the last 6 years, we’ve hosted a wide range of Twitter chat topics, ranging from asthma to lung cancer. Some of those chats focused on the following topics:
- The Best of 2017: Highlights, Advancements, New Science
- Improving Lung Health Through Pulmonary Rehabilitation
- Caring for the Caregiver: Vulnerability and Burnout
- What Trainees Need to Know About Pulmonary, Critical Care & Sleep
- #VTEonSoMe Twitter Chat—Let’s Talk Blood Clots! Surgeries, Birth Control, and 40
This past March, we held our Twitter chat Sepsis: Revisions, Advancements, New Therapies, led by Drs. Chris Carroll, Alex Niven, and Steven Q. Simpson. We had over 4.2 million impressions!
Every Twitter chat serves a different purpose, typically based on the topic and the individuals we believe would be most interested in the topic. These chats help us spark conversations on the latest research, advancements, and potential opportunities within the pulmonary/critical care field. They also provide physicians with a great opportunity to network and get acquainted with the #pulmCC community.