User login
New Tools in Campaign to Fight Asthma
The Allergy & Asthma NetWork, the nation’s leading patient education and advocacy organization for people with allergy and asthma, has once again joined forces with the CHEST Foundation in an effort to empower patients suffering from severe asthma.
The campaign’s focus is to educate health-care providers, patients, parents of asthmatics, and the public about the most current treatment options for asthma, highlight the importance of referring to specialists to improve patient outcomes, and bring to light the role of the entire health-care team in the care of a patient with severe or difficult-to-control asthma.
Severity Assessment Tool
Available online and in print, the severity assessment tool was designed to help a patient, and the clinician, understand the severity of their asthma. Not only does the tool evaluate the severity of their condition, but it also helps the patient become more aware of their symptoms. The seven-question assessment includes questions on usage of quick-relief or rescue inhalers, visits to the ED/hospital, physical activity, controller medication, and quality of sleep.
Patient and Caregiver Testimonials
The campaign features several patient and caregiver testimonials that tell the stories of patients and parents of children with severe asthma.
“What we want people to understand, is that at the time of Ben’s passing, he was on a preventive med. He was going to the doctor routinely. We had actually just been to the asthma doctor. We were seeing somebody, had an action plan, and everybody knew what they had to do. Even with all of that, it still came to this. Benjamin still lost his life, and we never knew this was something that could happen,” stated Cristin Buckley, mother of Benjamin Buckley who was 7 years old at the time of his death. These testimonial videos will be used to raise awareness of the condition, and the importance of managing and monitoring symptoms.
Shared Decision Making Tool
Thank You to Our Supporters
The CHEST Foundation and Allergy and Asthma Network would like to thank our generous supporters, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, and Novartis for making this campaign possible. It is through supporters, who are active participants in helping grow this campaign, that these important materials are able to have an impact on patient outcomes and create long-lasting social change.
To view the campaign materials, visit us at asthma.chestnet.org.
The Allergy & Asthma NetWork, the nation’s leading patient education and advocacy organization for people with allergy and asthma, has once again joined forces with the CHEST Foundation in an effort to empower patients suffering from severe asthma.
The campaign’s focus is to educate health-care providers, patients, parents of asthmatics, and the public about the most current treatment options for asthma, highlight the importance of referring to specialists to improve patient outcomes, and bring to light the role of the entire health-care team in the care of a patient with severe or difficult-to-control asthma.
Severity Assessment Tool
Available online and in print, the severity assessment tool was designed to help a patient, and the clinician, understand the severity of their asthma. Not only does the tool evaluate the severity of their condition, but it also helps the patient become more aware of their symptoms. The seven-question assessment includes questions on usage of quick-relief or rescue inhalers, visits to the ED/hospital, physical activity, controller medication, and quality of sleep.
Patient and Caregiver Testimonials
The campaign features several patient and caregiver testimonials that tell the stories of patients and parents of children with severe asthma.
“What we want people to understand, is that at the time of Ben’s passing, he was on a preventive med. He was going to the doctor routinely. We had actually just been to the asthma doctor. We were seeing somebody, had an action plan, and everybody knew what they had to do. Even with all of that, it still came to this. Benjamin still lost his life, and we never knew this was something that could happen,” stated Cristin Buckley, mother of Benjamin Buckley who was 7 years old at the time of his death. These testimonial videos will be used to raise awareness of the condition, and the importance of managing and monitoring symptoms.
Shared Decision Making Tool
Thank You to Our Supporters
The CHEST Foundation and Allergy and Asthma Network would like to thank our generous supporters, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, and Novartis for making this campaign possible. It is through supporters, who are active participants in helping grow this campaign, that these important materials are able to have an impact on patient outcomes and create long-lasting social change.
To view the campaign materials, visit us at asthma.chestnet.org.
The Allergy & Asthma NetWork, the nation’s leading patient education and advocacy organization for people with allergy and asthma, has once again joined forces with the CHEST Foundation in an effort to empower patients suffering from severe asthma.
The campaign’s focus is to educate health-care providers, patients, parents of asthmatics, and the public about the most current treatment options for asthma, highlight the importance of referring to specialists to improve patient outcomes, and bring to light the role of the entire health-care team in the care of a patient with severe or difficult-to-control asthma.
Severity Assessment Tool
Available online and in print, the severity assessment tool was designed to help a patient, and the clinician, understand the severity of their asthma. Not only does the tool evaluate the severity of their condition, but it also helps the patient become more aware of their symptoms. The seven-question assessment includes questions on usage of quick-relief or rescue inhalers, visits to the ED/hospital, physical activity, controller medication, and quality of sleep.
Patient and Caregiver Testimonials
The campaign features several patient and caregiver testimonials that tell the stories of patients and parents of children with severe asthma.
“What we want people to understand, is that at the time of Ben’s passing, he was on a preventive med. He was going to the doctor routinely. We had actually just been to the asthma doctor. We were seeing somebody, had an action plan, and everybody knew what they had to do. Even with all of that, it still came to this. Benjamin still lost his life, and we never knew this was something that could happen,” stated Cristin Buckley, mother of Benjamin Buckley who was 7 years old at the time of his death. These testimonial videos will be used to raise awareness of the condition, and the importance of managing and monitoring symptoms.
Shared Decision Making Tool
Thank You to Our Supporters
The CHEST Foundation and Allergy and Asthma Network would like to thank our generous supporters, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, and Novartis for making this campaign possible. It is through supporters, who are active participants in helping grow this campaign, that these important materials are able to have an impact on patient outcomes and create long-lasting social change.
To view the campaign materials, visit us at asthma.chestnet.org.
CHEST Joint Congress in Basel, Switzerland
Members of CHEST leadership, faculty, and staff traveled to Basel, Switzerland, in June, to participate in the CHEST Joint Congress, which was co-hosted with the Swiss Respiratory Society, Schweizersche Gesellschaft Fur Pneumologie (SPG). Overall, there were approximately 1,100 total attendees, representing over 40 countries, who enjoyed the scientific program and gained valuable chest medicine knowledge.
The CHEST Joint Congress in Basel represented the second collaborative scientific conference endeavor with a third party, the first being the CHEST Conference held in Amsterdam May 6-9, COPD: Current Excellence and Future Development.
Members of CHEST leadership, faculty, and staff traveled to Basel, Switzerland, in June, to participate in the CHEST Joint Congress, which was co-hosted with the Swiss Respiratory Society, Schweizersche Gesellschaft Fur Pneumologie (SPG). Overall, there were approximately 1,100 total attendees, representing over 40 countries, who enjoyed the scientific program and gained valuable chest medicine knowledge.
The CHEST Joint Congress in Basel represented the second collaborative scientific conference endeavor with a third party, the first being the CHEST Conference held in Amsterdam May 6-9, COPD: Current Excellence and Future Development.
Members of CHEST leadership, faculty, and staff traveled to Basel, Switzerland, in June, to participate in the CHEST Joint Congress, which was co-hosted with the Swiss Respiratory Society, Schweizersche Gesellschaft Fur Pneumologie (SPG). Overall, there were approximately 1,100 total attendees, representing over 40 countries, who enjoyed the scientific program and gained valuable chest medicine knowledge.
The CHEST Joint Congress in Basel represented the second collaborative scientific conference endeavor with a third party, the first being the CHEST Conference held in Amsterdam May 6-9, COPD: Current Excellence and Future Development.
Ask PAs to Complete Survey on Joining 1st SVS ‘Section’
SVS President Dr. Clem Darling is asking all members to pass an email message – and survey – along to PAs and Nurse Practitioners with whom members work.
During the recent Vascular Annual Meeting, SVS leaders met with six physician assistants, all of whom work in vascular settings, and asked if they wish to work on establishing a home within the SVS. “Their response was a resounding and enthusiastic …YES!,” said Dr. Darling.
The group has now become the Steering Committee organizing the effort to create the historic first "Section" of the SVS.
SVS President Dr. Clem Darling is asking all members to pass an email message – and survey – along to PAs and Nurse Practitioners with whom members work.
During the recent Vascular Annual Meeting, SVS leaders met with six physician assistants, all of whom work in vascular settings, and asked if they wish to work on establishing a home within the SVS. “Their response was a resounding and enthusiastic …YES!,” said Dr. Darling.
The group has now become the Steering Committee organizing the effort to create the historic first "Section" of the SVS.
SVS President Dr. Clem Darling is asking all members to pass an email message – and survey – along to PAs and Nurse Practitioners with whom members work.
During the recent Vascular Annual Meeting, SVS leaders met with six physician assistants, all of whom work in vascular settings, and asked if they wish to work on establishing a home within the SVS. “Their response was a resounding and enthusiastic …YES!,” said Dr. Darling.
The group has now become the Steering Committee organizing the effort to create the historic first "Section" of the SVS.
Claim 2017 VAM Credits
Here’s how to claim Continuing Medical Education or MOC credits from the 2017 Vascular Annual Meeting.
1 Access the CME site, either through the Mobile App or through the website link: www.vsweb.org/ClaimCME
2 Log in, using either:
1 Last name and email address tied to your VAM registration OR
2 Registration ID number (no hyphens), located on registration confirmation or ID badges.
3 Follow the directions to list sessions, provide evaluations, take exams and generate credit certificates.
(Please note that the RPVI self-assessment process requires you to log in from a laptop or desktop computer.)
Credits must be claimed by Dec. 31. For more information, email [email protected].
Here’s how to claim Continuing Medical Education or MOC credits from the 2017 Vascular Annual Meeting.
1 Access the CME site, either through the Mobile App or through the website link: www.vsweb.org/ClaimCME
2 Log in, using either:
1 Last name and email address tied to your VAM registration OR
2 Registration ID number (no hyphens), located on registration confirmation or ID badges.
3 Follow the directions to list sessions, provide evaluations, take exams and generate credit certificates.
(Please note that the RPVI self-assessment process requires you to log in from a laptop or desktop computer.)
Credits must be claimed by Dec. 31. For more information, email [email protected].
Here’s how to claim Continuing Medical Education or MOC credits from the 2017 Vascular Annual Meeting.
1 Access the CME site, either through the Mobile App or through the website link: www.vsweb.org/ClaimCME
2 Log in, using either:
1 Last name and email address tied to your VAM registration OR
2 Registration ID number (no hyphens), located on registration confirmation or ID badges.
3 Follow the directions to list sessions, provide evaluations, take exams and generate credit certificates.
(Please note that the RPVI self-assessment process requires you to log in from a laptop or desktop computer.)
Credits must be claimed by Dec. 31. For more information, email [email protected].
Get involved with AGA
We’re soliciting members to serve in AGA leadership positions – as committee and center members, as well as on the AGA Institute Governing Board. This is an opportunity to network with other physicians and scientists, pursue a special interest, and make an impact in an area that is important to you.
Join a committee or center
AGA and AGA Institute are seeking members to serve on several committees and centers that recommend and oversee new and existing policies and programs. Terms will start in June 2018; nominations must be received by Nov. 1, 2017. Members can either nominate themselves or other members. For more information on the positions available, take a look at the AGA Committee page, http://www.gastro.org/about/people/committees.
Serve in a leadership position
The AGA Nominating Committee is in the midst of identifying candidates to join the governing board – in the offices of vice president, clinical research councillor, and practice councillor – as well as 10 nominees for the 2018-2019 AGA Nominating Committee. To learn more, or to nominate yourself or a colleague, email [email protected]. Nominations are due by Oct. 1, 2017; earlier submissions are encouraged.
We’re soliciting members to serve in AGA leadership positions – as committee and center members, as well as on the AGA Institute Governing Board. This is an opportunity to network with other physicians and scientists, pursue a special interest, and make an impact in an area that is important to you.
Join a committee or center
AGA and AGA Institute are seeking members to serve on several committees and centers that recommend and oversee new and existing policies and programs. Terms will start in June 2018; nominations must be received by Nov. 1, 2017. Members can either nominate themselves or other members. For more information on the positions available, take a look at the AGA Committee page, http://www.gastro.org/about/people/committees.
Serve in a leadership position
The AGA Nominating Committee is in the midst of identifying candidates to join the governing board – in the offices of vice president, clinical research councillor, and practice councillor – as well as 10 nominees for the 2018-2019 AGA Nominating Committee. To learn more, or to nominate yourself or a colleague, email [email protected]. Nominations are due by Oct. 1, 2017; earlier submissions are encouraged.
We’re soliciting members to serve in AGA leadership positions – as committee and center members, as well as on the AGA Institute Governing Board. This is an opportunity to network with other physicians and scientists, pursue a special interest, and make an impact in an area that is important to you.
Join a committee or center
AGA and AGA Institute are seeking members to serve on several committees and centers that recommend and oversee new and existing policies and programs. Terms will start in June 2018; nominations must be received by Nov. 1, 2017. Members can either nominate themselves or other members. For more information on the positions available, take a look at the AGA Committee page, http://www.gastro.org/about/people/committees.
Serve in a leadership position
The AGA Nominating Committee is in the midst of identifying candidates to join the governing board – in the offices of vice president, clinical research councillor, and practice councillor – as well as 10 nominees for the 2018-2019 AGA Nominating Committee. To learn more, or to nominate yourself or a colleague, email [email protected]. Nominations are due by Oct. 1, 2017; earlier submissions are encouraged.
Mark your calendar: 2018 AGA grants cycle announced
The AGA Research Foundation is excited to announce the start of its 2018 Research Grants cycle. This year the foundation will be awarding over $2 million in funding to support researchers within gastroenterology and hepatology. Now is your chance to view upcoming opportunities and plan your applications. Learn more below about the first application due in August, and visit the AGA Research Funding website (www.gastro.org/research-funding) for the full list. Contact [email protected] with any questions.
Applications due: Aug. 4, 2017
AGA-R. Robert & Sally Funderburg Research Award in Gastric Cancer
This award provides $50,000 per year for 2 years to an established investigator working on novel approaches in gastric cancer research. For the past 25 years, this $100,000 award has enhanced the fundamental understanding of gastric cancer pathobiology toward ultimately developing a cure for the disease.
The AGA Research Foundation is excited to announce the start of its 2018 Research Grants cycle. This year the foundation will be awarding over $2 million in funding to support researchers within gastroenterology and hepatology. Now is your chance to view upcoming opportunities and plan your applications. Learn more below about the first application due in August, and visit the AGA Research Funding website (www.gastro.org/research-funding) for the full list. Contact [email protected] with any questions.
Applications due: Aug. 4, 2017
AGA-R. Robert & Sally Funderburg Research Award in Gastric Cancer
This award provides $50,000 per year for 2 years to an established investigator working on novel approaches in gastric cancer research. For the past 25 years, this $100,000 award has enhanced the fundamental understanding of gastric cancer pathobiology toward ultimately developing a cure for the disease.
The AGA Research Foundation is excited to announce the start of its 2018 Research Grants cycle. This year the foundation will be awarding over $2 million in funding to support researchers within gastroenterology and hepatology. Now is your chance to view upcoming opportunities and plan your applications. Learn more below about the first application due in August, and visit the AGA Research Funding website (www.gastro.org/research-funding) for the full list. Contact [email protected] with any questions.
Applications due: Aug. 4, 2017
AGA-R. Robert & Sally Funderburg Research Award in Gastric Cancer
This award provides $50,000 per year for 2 years to an established investigator working on novel approaches in gastric cancer research. For the past 25 years, this $100,000 award has enhanced the fundamental understanding of gastric cancer pathobiology toward ultimately developing a cure for the disease.
Crohn’s & Colitis Congress registration open
Join the Crohn’s & Colitis Foundation and AGA for the inaugural Crohn’s & Colitis Congress™. Expand your knowledge, network with inflammatory bowel diseases (IBD) leaders across multiple disciplines and get inspired to improve patient care.
The Crohn’s & Colitis Congress, taking place Jan. 18-20, 2018 in Las Vegas, combines the strengths of the nation’s leading IBD patient organization, Crohn’s & Colitis Foundation, and the premier GI professional association, AGA. Together we are committed to convening the greatest minds in IBD to transform patient care and accelerate the pace of research.
The Crohn’s & Colitis Congress offers a bold multidisciplinary, clinically focused and forward-thinking program. The organizing committee and faculty represent key disciplines involved in the comprehensive care of IBD patients, as well as the foremost minds in research.
Sessions will emphasize case studies with multidisciplinary panel discussions covering:
- • Management of complicated IBD
- • Defining optimal treatment algorithms
- • Clinical and research challenges
Take a critical step toward finding cures and improving the lives of adults and children living with IBD. Learn more about the congress and register today by visiting www.crohnscolitiscongress.org.
Join the Crohn’s & Colitis Foundation and AGA for the inaugural Crohn’s & Colitis Congress™. Expand your knowledge, network with inflammatory bowel diseases (IBD) leaders across multiple disciplines and get inspired to improve patient care.
The Crohn’s & Colitis Congress, taking place Jan. 18-20, 2018 in Las Vegas, combines the strengths of the nation’s leading IBD patient organization, Crohn’s & Colitis Foundation, and the premier GI professional association, AGA. Together we are committed to convening the greatest minds in IBD to transform patient care and accelerate the pace of research.
The Crohn’s & Colitis Congress offers a bold multidisciplinary, clinically focused and forward-thinking program. The organizing committee and faculty represent key disciplines involved in the comprehensive care of IBD patients, as well as the foremost minds in research.
Sessions will emphasize case studies with multidisciplinary panel discussions covering:
- • Management of complicated IBD
- • Defining optimal treatment algorithms
- • Clinical and research challenges
Take a critical step toward finding cures and improving the lives of adults and children living with IBD. Learn more about the congress and register today by visiting www.crohnscolitiscongress.org.
Join the Crohn’s & Colitis Foundation and AGA for the inaugural Crohn’s & Colitis Congress™. Expand your knowledge, network with inflammatory bowel diseases (IBD) leaders across multiple disciplines and get inspired to improve patient care.
The Crohn’s & Colitis Congress, taking place Jan. 18-20, 2018 in Las Vegas, combines the strengths of the nation’s leading IBD patient organization, Crohn’s & Colitis Foundation, and the premier GI professional association, AGA. Together we are committed to convening the greatest minds in IBD to transform patient care and accelerate the pace of research.
The Crohn’s & Colitis Congress offers a bold multidisciplinary, clinically focused and forward-thinking program. The organizing committee and faculty represent key disciplines involved in the comprehensive care of IBD patients, as well as the foremost minds in research.
Sessions will emphasize case studies with multidisciplinary panel discussions covering:
- • Management of complicated IBD
- • Defining optimal treatment algorithms
- • Clinical and research challenges
Take a critical step toward finding cures and improving the lives of adults and children living with IBD. Learn more about the congress and register today by visiting www.crohnscolitiscongress.org.
This Month in CHEST: Editor’s Picks
Giants in Chest Medicine
John B. West, MD, PhD, DSc
By Dr. F. L. Powell
Original Research
Endothelial Permeability and Hemostasis in Septic Shock: Results From the ProCESS Trial.
By Dr. P. C. Hou, et al.
Maximal Inspiratory Pressure: Does the Choice of Reference Values Actually Matter?
By Dr. A. Rodrigues, et al.
Research Into Childhood Obstructive Sleep-Disordered Breathing:
A Systematic Review
By Dr. R. P. Venekamp, et al.
Topics in Practice Management
Low-Dose CT Scan for Lung Cancer Screening: Clinical and Coding Considerations
By Drs.Y. Shieh and M. Bohnenkamp
Giants in Chest Medicine
John B. West, MD, PhD, DSc
By Dr. F. L. Powell
Original Research
Endothelial Permeability and Hemostasis in Septic Shock: Results From the ProCESS Trial.
By Dr. P. C. Hou, et al.
Maximal Inspiratory Pressure: Does the Choice of Reference Values Actually Matter?
By Dr. A. Rodrigues, et al.
Research Into Childhood Obstructive Sleep-Disordered Breathing:
A Systematic Review
By Dr. R. P. Venekamp, et al.
Topics in Practice Management
Low-Dose CT Scan for Lung Cancer Screening: Clinical and Coding Considerations
By Drs.Y. Shieh and M. Bohnenkamp
Giants in Chest Medicine
John B. West, MD, PhD, DSc
By Dr. F. L. Powell
Original Research
Endothelial Permeability and Hemostasis in Septic Shock: Results From the ProCESS Trial.
By Dr. P. C. Hou, et al.
Maximal Inspiratory Pressure: Does the Choice of Reference Values Actually Matter?
By Dr. A. Rodrigues, et al.
Research Into Childhood Obstructive Sleep-Disordered Breathing:
A Systematic Review
By Dr. R. P. Venekamp, et al.
Topics in Practice Management
Low-Dose CT Scan for Lung Cancer Screening: Clinical and Coding Considerations
By Drs.Y. Shieh and M. Bohnenkamp
SLEEP STRATEGIES: Group 3 pulmonary hypertension linked to sleep-disordered breathing
Pulmonary hypertension (PH) is a progressive disease characterized by an increase in pulmonary arterial pressure and pulmonary vascular resistance (PVR) leading to right ventricular failure. Although substantial progress has been achieved in the treatment of PH, mostly due to improved pharmacotherapy, it remains a life-threatening disease with a poor prognosis. Increased pulmonary arterial pressure is a common feature of many chronic lung diseases, and chronic lung disease is the second most common cause of pulmonary hypertension. PH caused by chronic lung disease, including PH due to sleep-disordered breathing (SDB), is referred to as group 3 PH in the classification of pulmonary hypertension (Simonneau et al. J Am Coll Cardiol. 2013;62:D34 e41). Many reports since have linked pulmonary arterial hypertension to obstructive sleep apnea (OSA). These were validated in animal trials, when rodents were exposed to intermittent hypoxia for several hours over a few weeks, similar to what is seen in patients with OSA; this resulted in pulmonary vascular remodeling, sustained PH, and right ventricular hypertrophy. As with other chronic lung disease, prevalence rates of PH in SDB vary greatly, with some studies suggesting prevalence of pulmonary hypertension in OSA to be as high as 40%, although a lack of large-scale studies with clearly defined patient populations makes it difficult to determine the true prevalence rate. Most studies suggest that about 20% to 30% of patients with OSA have some degree of PH. OSA has been shown to be an independent causal factor for the development of PH (Hurdman et al. Eur Respir J. 2012; 39, 945–955). PH associated with OSA appears to be mild and may be due to a combination of precapillary and postcapillary factors, including pulmonary arteriolar remodeling, hyperreactivity to hypoxia, and left ventricular diastolic dysfunction resulting in left atrial enlargement. Despite differences in reported prevalence rates, most studies consistently reported mild increases in pulmonary arterial pressure with mPAP averaging less than 30 mm Hg. In one of the largest studies to date, the prevalence rate of PH in 220 patients with SDB was 17%, and the mPAP was 26 +/- 6 mm Hg (Chaouat et al. Chest. 1996;109[2]:380).
The other consistent finding in most studies was that PH correlated with the severity of obesity, daytime hypoxia and hypercapnia, obstructive airways disease, and nocturnal oxygen desaturation. PH seems to be more common and more severe in obesity hypoventilation syndrome (OHS) than in “pure” OSA patients (58% vs 9%) (Kessler et al. Chest. 2001;120[2]:369).
The incidence of OSA is rising in parallel with the rising global incide
Patients with OSA who have PH are more likely to be obese, have decreased respiratory function (FEV1, vital capacity, and FEV1/VC ratio), and lower oxygen saturation/higher carbon dioxide content in blood (Chaouat et al. Chest. 1996;109[2]:380). These patients frequently present with shortness of breath and dyspnea on exertion. Echocardiogram remains the main screening tool for evaluation of PH. With that said, right-sided heart catheterization remains the gold standard for the diagnosis of all classes of PH; however, use of right-sided heart catheterization in group 3 pulmonary hypertension is reserved for select patients. This is likely because PH in patients with OSA is accepted as a more benign prognostic marker compared with other group 3 forms. Furthermore, patients with OHS are more prone to developing PH and cor pulmonale compared with patients with isolated OSA. OSA with PH has lower survival rates than OSA without PH. Studies showed that patients with OHS tend to do worse than patients with OSA alone (Aljohara et al. J Thorac Dis. 2017;9[3]:779).
AHI and PH
Various studies have looked at different polysomnographic variables to understand the relationship between PH and OSA. Initial studies showed that the apnea hypopnea index (AHI) does not predict development of PH among patients with OSA. Decrements in nocturnal oxygen saturation, however, is predictive of the development of PH; the only predictor of developing PH among patients with OSA in one study was time spent with oxygen saturation below 70% during sleep (Wong et al. Eur Arch Otorhinolaryngol. 2017;74:2601). In addition, recent data suggest there is no statistically significant association between age, gender, body mass index, or AHI and chance for development of PH (Wong et al. 2017). It was found that the percentage of time during sleep with oxygen saturation below 90% was significant and independently associated with higher PAP. Furthermore, a recent study demonstrated that patients with moderate to severe OSA (AHI over 15/h) who develop PH tend to have worse hemodynamics (higher PVR and mPAP) and subclinical myocardial damage (evaluated by troponin T), as well as increased ventricular wall stress (assessed by proBNP) when compared with patients with mild OSA (AHI less than 15/h).
Treatment
The mainstay treatment for OSA and OHS is positive airway pressure (PAP). This therapy has been shown to improve sleep and respiratory parameters, including sleep quality, overall quality of life, as well as promote reduction in mean pulmonary arterial pressure. The regular use of noninvasive positive-pressure ventilation has also been shown to reverse daytime hypoxia and hypercapnia, as well as influence inflammatory markers: decrease circulating levels of endothelin-1, interleukin-6, and C-reactive protein, thereby improving vascular endothelial function and reducing platelet activation and aggregation (Yokoe et al. Circulation. 2003;107[8]:1129). Indeed, there is a decrease in mean pulmonary arterial pressure in some patients with long-term daily use of PAP, but, in some patients, both pulmonary and right ventricular dysfunction persists, suggesting vascular remodeling and/or endothelial dysfunction. These findings indicate the need for early recognition of OSA and early treatment for patients, thus preventing remodeling and further development of PH and right ventricular dysfunction. Adequate control of OSA/OHS has important long-term effects on overall health, because it significantly reduces the risk of systemic hypertension, congestive heart failure, arrhythmias, and stroke. It is imperative to control underlying SDB before considering PAH-specific medications to treat PH associated with OSA or OHS unless the patient is demonstrating signs of right-sided heart failure; in such cases, concomitant therapy may be considered upfront. It is recommended that
Dr. Singhal is a second-year fellow in Pulmonary/Critical Care and Dr. Minkin is Director, Pulmonary Hypertension Program, New York Presbyterian-Brooklyn Methodist Hospital. Dr. Minkin is also Assistant Professor of Clinical Medicine, Weill Cornell Medical College, New York.
Pulmonary hypertension (PH) is a progressive disease characterized by an increase in pulmonary arterial pressure and pulmonary vascular resistance (PVR) leading to right ventricular failure. Although substantial progress has been achieved in the treatment of PH, mostly due to improved pharmacotherapy, it remains a life-threatening disease with a poor prognosis. Increased pulmonary arterial pressure is a common feature of many chronic lung diseases, and chronic lung disease is the second most common cause of pulmonary hypertension. PH caused by chronic lung disease, including PH due to sleep-disordered breathing (SDB), is referred to as group 3 PH in the classification of pulmonary hypertension (Simonneau et al. J Am Coll Cardiol. 2013;62:D34 e41). Many reports since have linked pulmonary arterial hypertension to obstructive sleep apnea (OSA). These were validated in animal trials, when rodents were exposed to intermittent hypoxia for several hours over a few weeks, similar to what is seen in patients with OSA; this resulted in pulmonary vascular remodeling, sustained PH, and right ventricular hypertrophy. As with other chronic lung disease, prevalence rates of PH in SDB vary greatly, with some studies suggesting prevalence of pulmonary hypertension in OSA to be as high as 40%, although a lack of large-scale studies with clearly defined patient populations makes it difficult to determine the true prevalence rate. Most studies suggest that about 20% to 30% of patients with OSA have some degree of PH. OSA has been shown to be an independent causal factor for the development of PH (Hurdman et al. Eur Respir J. 2012; 39, 945–955). PH associated with OSA appears to be mild and may be due to a combination of precapillary and postcapillary factors, including pulmonary arteriolar remodeling, hyperreactivity to hypoxia, and left ventricular diastolic dysfunction resulting in left atrial enlargement. Despite differences in reported prevalence rates, most studies consistently reported mild increases in pulmonary arterial pressure with mPAP averaging less than 30 mm Hg. In one of the largest studies to date, the prevalence rate of PH in 220 patients with SDB was 17%, and the mPAP was 26 +/- 6 mm Hg (Chaouat et al. Chest. 1996;109[2]:380).
The other consistent finding in most studies was that PH correlated with the severity of obesity, daytime hypoxia and hypercapnia, obstructive airways disease, and nocturnal oxygen desaturation. PH seems to be more common and more severe in obesity hypoventilation syndrome (OHS) than in “pure” OSA patients (58% vs 9%) (Kessler et al. Chest. 2001;120[2]:369).
The incidence of OSA is rising in parallel with the rising global incide
Patients with OSA who have PH are more likely to be obese, have decreased respiratory function (FEV1, vital capacity, and FEV1/VC ratio), and lower oxygen saturation/higher carbon dioxide content in blood (Chaouat et al. Chest. 1996;109[2]:380). These patients frequently present with shortness of breath and dyspnea on exertion. Echocardiogram remains the main screening tool for evaluation of PH. With that said, right-sided heart catheterization remains the gold standard for the diagnosis of all classes of PH; however, use of right-sided heart catheterization in group 3 pulmonary hypertension is reserved for select patients. This is likely because PH in patients with OSA is accepted as a more benign prognostic marker compared with other group 3 forms. Furthermore, patients with OHS are more prone to developing PH and cor pulmonale compared with patients with isolated OSA. OSA with PH has lower survival rates than OSA without PH. Studies showed that patients with OHS tend to do worse than patients with OSA alone (Aljohara et al. J Thorac Dis. 2017;9[3]:779).
AHI and PH
Various studies have looked at different polysomnographic variables to understand the relationship between PH and OSA. Initial studies showed that the apnea hypopnea index (AHI) does not predict development of PH among patients with OSA. Decrements in nocturnal oxygen saturation, however, is predictive of the development of PH; the only predictor of developing PH among patients with OSA in one study was time spent with oxygen saturation below 70% during sleep (Wong et al. Eur Arch Otorhinolaryngol. 2017;74:2601). In addition, recent data suggest there is no statistically significant association between age, gender, body mass index, or AHI and chance for development of PH (Wong et al. 2017). It was found that the percentage of time during sleep with oxygen saturation below 90% was significant and independently associated with higher PAP. Furthermore, a recent study demonstrated that patients with moderate to severe OSA (AHI over 15/h) who develop PH tend to have worse hemodynamics (higher PVR and mPAP) and subclinical myocardial damage (evaluated by troponin T), as well as increased ventricular wall stress (assessed by proBNP) when compared with patients with mild OSA (AHI less than 15/h).
Treatment
The mainstay treatment for OSA and OHS is positive airway pressure (PAP). This therapy has been shown to improve sleep and respiratory parameters, including sleep quality, overall quality of life, as well as promote reduction in mean pulmonary arterial pressure. The regular use of noninvasive positive-pressure ventilation has also been shown to reverse daytime hypoxia and hypercapnia, as well as influence inflammatory markers: decrease circulating levels of endothelin-1, interleukin-6, and C-reactive protein, thereby improving vascular endothelial function and reducing platelet activation and aggregation (Yokoe et al. Circulation. 2003;107[8]:1129). Indeed, there is a decrease in mean pulmonary arterial pressure in some patients with long-term daily use of PAP, but, in some patients, both pulmonary and right ventricular dysfunction persists, suggesting vascular remodeling and/or endothelial dysfunction. These findings indicate the need for early recognition of OSA and early treatment for patients, thus preventing remodeling and further development of PH and right ventricular dysfunction. Adequate control of OSA/OHS has important long-term effects on overall health, because it significantly reduces the risk of systemic hypertension, congestive heart failure, arrhythmias, and stroke. It is imperative to control underlying SDB before considering PAH-specific medications to treat PH associated with OSA or OHS unless the patient is demonstrating signs of right-sided heart failure; in such cases, concomitant therapy may be considered upfront. It is recommended that
Dr. Singhal is a second-year fellow in Pulmonary/Critical Care and Dr. Minkin is Director, Pulmonary Hypertension Program, New York Presbyterian-Brooklyn Methodist Hospital. Dr. Minkin is also Assistant Professor of Clinical Medicine, Weill Cornell Medical College, New York.
Pulmonary hypertension (PH) is a progressive disease characterized by an increase in pulmonary arterial pressure and pulmonary vascular resistance (PVR) leading to right ventricular failure. Although substantial progress has been achieved in the treatment of PH, mostly due to improved pharmacotherapy, it remains a life-threatening disease with a poor prognosis. Increased pulmonary arterial pressure is a common feature of many chronic lung diseases, and chronic lung disease is the second most common cause of pulmonary hypertension. PH caused by chronic lung disease, including PH due to sleep-disordered breathing (SDB), is referred to as group 3 PH in the classification of pulmonary hypertension (Simonneau et al. J Am Coll Cardiol. 2013;62:D34 e41). Many reports since have linked pulmonary arterial hypertension to obstructive sleep apnea (OSA). These were validated in animal trials, when rodents were exposed to intermittent hypoxia for several hours over a few weeks, similar to what is seen in patients with OSA; this resulted in pulmonary vascular remodeling, sustained PH, and right ventricular hypertrophy. As with other chronic lung disease, prevalence rates of PH in SDB vary greatly, with some studies suggesting prevalence of pulmonary hypertension in OSA to be as high as 40%, although a lack of large-scale studies with clearly defined patient populations makes it difficult to determine the true prevalence rate. Most studies suggest that about 20% to 30% of patients with OSA have some degree of PH. OSA has been shown to be an independent causal factor for the development of PH (Hurdman et al. Eur Respir J. 2012; 39, 945–955). PH associated with OSA appears to be mild and may be due to a combination of precapillary and postcapillary factors, including pulmonary arteriolar remodeling, hyperreactivity to hypoxia, and left ventricular diastolic dysfunction resulting in left atrial enlargement. Despite differences in reported prevalence rates, most studies consistently reported mild increases in pulmonary arterial pressure with mPAP averaging less than 30 mm Hg. In one of the largest studies to date, the prevalence rate of PH in 220 patients with SDB was 17%, and the mPAP was 26 +/- 6 mm Hg (Chaouat et al. Chest. 1996;109[2]:380).
The other consistent finding in most studies was that PH correlated with the severity of obesity, daytime hypoxia and hypercapnia, obstructive airways disease, and nocturnal oxygen desaturation. PH seems to be more common and more severe in obesity hypoventilation syndrome (OHS) than in “pure” OSA patients (58% vs 9%) (Kessler et al. Chest. 2001;120[2]:369).
The incidence of OSA is rising in parallel with the rising global incide
Patients with OSA who have PH are more likely to be obese, have decreased respiratory function (FEV1, vital capacity, and FEV1/VC ratio), and lower oxygen saturation/higher carbon dioxide content in blood (Chaouat et al. Chest. 1996;109[2]:380). These patients frequently present with shortness of breath and dyspnea on exertion. Echocardiogram remains the main screening tool for evaluation of PH. With that said, right-sided heart catheterization remains the gold standard for the diagnosis of all classes of PH; however, use of right-sided heart catheterization in group 3 pulmonary hypertension is reserved for select patients. This is likely because PH in patients with OSA is accepted as a more benign prognostic marker compared with other group 3 forms. Furthermore, patients with OHS are more prone to developing PH and cor pulmonale compared with patients with isolated OSA. OSA with PH has lower survival rates than OSA without PH. Studies showed that patients with OHS tend to do worse than patients with OSA alone (Aljohara et al. J Thorac Dis. 2017;9[3]:779).
AHI and PH
Various studies have looked at different polysomnographic variables to understand the relationship between PH and OSA. Initial studies showed that the apnea hypopnea index (AHI) does not predict development of PH among patients with OSA. Decrements in nocturnal oxygen saturation, however, is predictive of the development of PH; the only predictor of developing PH among patients with OSA in one study was time spent with oxygen saturation below 70% during sleep (Wong et al. Eur Arch Otorhinolaryngol. 2017;74:2601). In addition, recent data suggest there is no statistically significant association between age, gender, body mass index, or AHI and chance for development of PH (Wong et al. 2017). It was found that the percentage of time during sleep with oxygen saturation below 90% was significant and independently associated with higher PAP. Furthermore, a recent study demonstrated that patients with moderate to severe OSA (AHI over 15/h) who develop PH tend to have worse hemodynamics (higher PVR and mPAP) and subclinical myocardial damage (evaluated by troponin T), as well as increased ventricular wall stress (assessed by proBNP) when compared with patients with mild OSA (AHI less than 15/h).
Treatment
The mainstay treatment for OSA and OHS is positive airway pressure (PAP). This therapy has been shown to improve sleep and respiratory parameters, including sleep quality, overall quality of life, as well as promote reduction in mean pulmonary arterial pressure. The regular use of noninvasive positive-pressure ventilation has also been shown to reverse daytime hypoxia and hypercapnia, as well as influence inflammatory markers: decrease circulating levels of endothelin-1, interleukin-6, and C-reactive protein, thereby improving vascular endothelial function and reducing platelet activation and aggregation (Yokoe et al. Circulation. 2003;107[8]:1129). Indeed, there is a decrease in mean pulmonary arterial pressure in some patients with long-term daily use of PAP, but, in some patients, both pulmonary and right ventricular dysfunction persists, suggesting vascular remodeling and/or endothelial dysfunction. These findings indicate the need for early recognition of OSA and early treatment for patients, thus preventing remodeling and further development of PH and right ventricular dysfunction. Adequate control of OSA/OHS has important long-term effects on overall health, because it significantly reduces the risk of systemic hypertension, congestive heart failure, arrhythmias, and stroke. It is imperative to control underlying SDB before considering PAH-specific medications to treat PH associated with OSA or OHS unless the patient is demonstrating signs of right-sided heart failure; in such cases, concomitant therapy may be considered upfront. It is recommended that
Dr. Singhal is a second-year fellow in Pulmonary/Critical Care and Dr. Minkin is Director, Pulmonary Hypertension Program, New York Presbyterian-Brooklyn Methodist Hospital. Dr. Minkin is also Assistant Professor of Clinical Medicine, Weill Cornell Medical College, New York.
Veterans' AAA Screening July 22-25; SFS Foundation a Sponsor as Part of Its Expanded Mission
The SVS Foundation is helping sponsor free abdominal aortic aneurysm screenings for veterans at the Veterans of Foreign Wars’ national convention in New Orleans July 22-25. The screenings are offered by New Orleans-based non-profit AAAneurysm Outreach in partnership with the VFW, the SVS Foundation and W.L. Gore Inc.
The SVS Foundation will distribute written materials for veterans, offering more information on AAAs and how to find a doctor who specializes in vascular diseases and abnormalities. The screening, in which as many as 2,000 veterans are expected to participate, is the SVS Foundation’s first event since expanding its mission in June to include providing patient education in vascular health.
SVS members are encouraged to spread the word about the screenings to patients who plan to attend the convention.
The SVS Foundation is helping sponsor free abdominal aortic aneurysm screenings for veterans at the Veterans of Foreign Wars’ national convention in New Orleans July 22-25. The screenings are offered by New Orleans-based non-profit AAAneurysm Outreach in partnership with the VFW, the SVS Foundation and W.L. Gore Inc.
The SVS Foundation will distribute written materials for veterans, offering more information on AAAs and how to find a doctor who specializes in vascular diseases and abnormalities. The screening, in which as many as 2,000 veterans are expected to participate, is the SVS Foundation’s first event since expanding its mission in June to include providing patient education in vascular health.
SVS members are encouraged to spread the word about the screenings to patients who plan to attend the convention.
The SVS Foundation is helping sponsor free abdominal aortic aneurysm screenings for veterans at the Veterans of Foreign Wars’ national convention in New Orleans July 22-25. The screenings are offered by New Orleans-based non-profit AAAneurysm Outreach in partnership with the VFW, the SVS Foundation and W.L. Gore Inc.
The SVS Foundation will distribute written materials for veterans, offering more information on AAAs and how to find a doctor who specializes in vascular diseases and abnormalities. The screening, in which as many as 2,000 veterans are expected to participate, is the SVS Foundation’s first event since expanding its mission in June to include providing patient education in vascular health.
SVS members are encouraged to spread the word about the screenings to patients who plan to attend the convention.