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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.
Webinars Set on Medicare Reimbursement
The SVS and Patient Safety Organization will host a Medicare reimbursement webinar on July 26 and 27, titled "The Quality Payment Program is Not Going Away: The Merit Based Incentive Payment Model (MIPS) and the Advanced Alternative Payment Models under Medicare for Vascular Surgeons."
Presentations will be at 6 p.m. Central Daylight Time Wednesday, July 26, and at noon (CDT) on Thursday, July 27.
Participants can learn how to avoid a 4 percent penalty in 2019 and possibly obtain bonus payments. The webinar will provide step-by-step guidance on:
• How to verify your participation status so you will know whether you need to submit data to MIPS or not
• Reporting quality measures via Medicare claims forms
• How to attest to performing a clinical improvement activity to CMS
• Participating in electronic health records
The SVS and Patient Safety Organization will host a Medicare reimbursement webinar on July 26 and 27, titled "The Quality Payment Program is Not Going Away: The Merit Based Incentive Payment Model (MIPS) and the Advanced Alternative Payment Models under Medicare for Vascular Surgeons."
Presentations will be at 6 p.m. Central Daylight Time Wednesday, July 26, and at noon (CDT) on Thursday, July 27.
Participants can learn how to avoid a 4 percent penalty in 2019 and possibly obtain bonus payments. The webinar will provide step-by-step guidance on:
• How to verify your participation status so you will know whether you need to submit data to MIPS or not
• Reporting quality measures via Medicare claims forms
• How to attest to performing a clinical improvement activity to CMS
• Participating in electronic health records
The SVS and Patient Safety Organization will host a Medicare reimbursement webinar on July 26 and 27, titled "The Quality Payment Program is Not Going Away: The Merit Based Incentive Payment Model (MIPS) and the Advanced Alternative Payment Models under Medicare for Vascular Surgeons."
Presentations will be at 6 p.m. Central Daylight Time Wednesday, July 26, and at noon (CDT) on Thursday, July 27.
Participants can learn how to avoid a 4 percent penalty in 2019 and possibly obtain bonus payments. The webinar will provide step-by-step guidance on:
• How to verify your participation status so you will know whether you need to submit data to MIPS or not
• Reporting quality measures via Medicare claims forms
• How to attest to performing a clinical improvement activity to CMS
• Participating in electronic health records
Family Fun in Toronto!
While attending CHEST 2017 from October 28 to November 1, your days will be filled with cutting-edge sessions on pulmonary, critical care, and sleep medicine. However, if you take the week and bring your family along, you can have a fun and memorable vacation with the variety of family-friendly activities Toronto has to offer!
Family Escape Room - Loonie for Luck/The Moonshine Mile
Weekly Friday-Sunday
Enter these escape and mystery rooms to solve fun mysteries. Follow the clues, solve the puzzles, open the locks, and beat the clock! Enter the Loonie for Luck room, where you and your group have to recover Canada’s Lucky Loonie hockey puck and return it to Team Canada. Or, enter The Moonshine Mile room, where you play the owner of a race horse and must find the culprit who poisoned your horse, Hoof Hearted. You have 60 minutes, can you solve these mysteries? Special family pricing available.
Royal Ontario Museum - Dinosaur Gallery
Ripley’s Aquarium of Canada
Visit the many amazing galleries at Ripley’s Aquarium of Canada, including Canadian Waters, Dangerous Lagoon, Discovery Center, Planet Jellies, the dive shows at Rainbow Reef and Ray Bay, and more! There are many activities and programs you and your kids will love.
Toronto’s Ultimate Chocolate Tour
Weekly, Saturdays
1:00 PM - 4:00 PM
If you consider yourself a chocolate lover, you must go on the only chocolate tour in Toronto that divulges the art of chocolate tasting and samples chocolate from bean to bar. Enjoy chocolates and chocolatey sweets while learning more about chocolate from chocolatiers and store owners. There will even be an exclusive demonstration of chocolate making by an award-winning chocolatier!
Ontario Science Centre
An iconic cultural attraction and Toronto’s only children’s museum, the Ontario Science Centre is home to interactive and engaging experiences with science and technology. KidSpark is the extremely popular hall designed for children under eight to learn, explore and create with their caregivers. Check out exhibits like In Space with a state-of-the-art planetarium, The AstraZeneca Human Edge, A Question of Truth, Living Earth that includes a simulated tornado and a full rainforest environment, and the Science Arcade. You can also see a film at Ontario’s only IMAX® Dome theatre!
Don’t forget to make your trip to Toronto for CHEST 2017 this October where not just you, but your entire family, can have a great time! Register today at chestmeeting.chestnet.org.
While attending CHEST 2017 from October 28 to November 1, your days will be filled with cutting-edge sessions on pulmonary, critical care, and sleep medicine. However, if you take the week and bring your family along, you can have a fun and memorable vacation with the variety of family-friendly activities Toronto has to offer!
Family Escape Room - Loonie for Luck/The Moonshine Mile
Weekly Friday-Sunday
Enter these escape and mystery rooms to solve fun mysteries. Follow the clues, solve the puzzles, open the locks, and beat the clock! Enter the Loonie for Luck room, where you and your group have to recover Canada’s Lucky Loonie hockey puck and return it to Team Canada. Or, enter The Moonshine Mile room, where you play the owner of a race horse and must find the culprit who poisoned your horse, Hoof Hearted. You have 60 minutes, can you solve these mysteries? Special family pricing available.
Royal Ontario Museum - Dinosaur Gallery
Ripley’s Aquarium of Canada
Visit the many amazing galleries at Ripley’s Aquarium of Canada, including Canadian Waters, Dangerous Lagoon, Discovery Center, Planet Jellies, the dive shows at Rainbow Reef and Ray Bay, and more! There are many activities and programs you and your kids will love.
Toronto’s Ultimate Chocolate Tour
Weekly, Saturdays
1:00 PM - 4:00 PM
If you consider yourself a chocolate lover, you must go on the only chocolate tour in Toronto that divulges the art of chocolate tasting and samples chocolate from bean to bar. Enjoy chocolates and chocolatey sweets while learning more about chocolate from chocolatiers and store owners. There will even be an exclusive demonstration of chocolate making by an award-winning chocolatier!
Ontario Science Centre
An iconic cultural attraction and Toronto’s only children’s museum, the Ontario Science Centre is home to interactive and engaging experiences with science and technology. KidSpark is the extremely popular hall designed for children under eight to learn, explore and create with their caregivers. Check out exhibits like In Space with a state-of-the-art planetarium, The AstraZeneca Human Edge, A Question of Truth, Living Earth that includes a simulated tornado and a full rainforest environment, and the Science Arcade. You can also see a film at Ontario’s only IMAX® Dome theatre!
Don’t forget to make your trip to Toronto for CHEST 2017 this October where not just you, but your entire family, can have a great time! Register today at chestmeeting.chestnet.org.
While attending CHEST 2017 from October 28 to November 1, your days will be filled with cutting-edge sessions on pulmonary, critical care, and sleep medicine. However, if you take the week and bring your family along, you can have a fun and memorable vacation with the variety of family-friendly activities Toronto has to offer!
Family Escape Room - Loonie for Luck/The Moonshine Mile
Weekly Friday-Sunday
Enter these escape and mystery rooms to solve fun mysteries. Follow the clues, solve the puzzles, open the locks, and beat the clock! Enter the Loonie for Luck room, where you and your group have to recover Canada’s Lucky Loonie hockey puck and return it to Team Canada. Or, enter The Moonshine Mile room, where you play the owner of a race horse and must find the culprit who poisoned your horse, Hoof Hearted. You have 60 minutes, can you solve these mysteries? Special family pricing available.
Royal Ontario Museum - Dinosaur Gallery
Ripley’s Aquarium of Canada
Visit the many amazing galleries at Ripley’s Aquarium of Canada, including Canadian Waters, Dangerous Lagoon, Discovery Center, Planet Jellies, the dive shows at Rainbow Reef and Ray Bay, and more! There are many activities and programs you and your kids will love.
Toronto’s Ultimate Chocolate Tour
Weekly, Saturdays
1:00 PM - 4:00 PM
If you consider yourself a chocolate lover, you must go on the only chocolate tour in Toronto that divulges the art of chocolate tasting and samples chocolate from bean to bar. Enjoy chocolates and chocolatey sweets while learning more about chocolate from chocolatiers and store owners. There will even be an exclusive demonstration of chocolate making by an award-winning chocolatier!
Ontario Science Centre
An iconic cultural attraction and Toronto’s only children’s museum, the Ontario Science Centre is home to interactive and engaging experiences with science and technology. KidSpark is the extremely popular hall designed for children under eight to learn, explore and create with their caregivers. Check out exhibits like In Space with a state-of-the-art planetarium, The AstraZeneca Human Edge, A Question of Truth, Living Earth that includes a simulated tornado and a full rainforest environment, and the Science Arcade. You can also see a film at Ontario’s only IMAX® Dome theatre!
Don’t forget to make your trip to Toronto for CHEST 2017 this October where not just you, but your entire family, can have a great time! Register today at chestmeeting.chestnet.org.
NetWorks: Oxygen therapy, electronic consent, diagnosing ILD
Oxygen therapy in patients with COPD with moderate desaturation
Two landmark trials from the early 1980s demonstrated survival benefit with long-term oxygen therapy (LTOT) in patients with COPD with severe resting hypoxemia [Sao2 less than 89%; (Nocturnal Oxygen Therapy Trial Group. Ann Intern Med. 1980;93[3]:391) or Pao2 40-60 mm Hg and cor pulmonale (Report of the Medical Research Council Working Party. Lancet. 1981;1[8222]:681).
The potential benefits of LTOT in COPD with mild-moderate hypoxemia have not been clearly established. The LOTT trial (The Long-Term Oxygen Treatment Trial Research Group. N Engl J Med. 2016;375[17]:1617), a recent multicenter randomized study, attempted to answer this question. They studied 738 stable patients with COPD with mild to moderate resting desaturation (Spo2 89%-93%) or exercise-induced moderate desaturation (Spo2 greater than or equal to 80% for greater than or equal to 5 minutes and Spo2 less than 90% for greater than or equal to 10 seconds during 6- minute walk test). After a median follow-up of 18.4 months, LTOT did not demonstrate a decrease in the time to death or first hospitalization and did not show improvement in quality of life or functional status. Notable adverse events from oxygen included 23 instances of tripping over equipment, with two patients requiring hospitalization and six fires with one patient hospitalized for burns.
A Cochrane meta-analysis, which did not include LOTT data, revealed that oxygen relieved breathlessness during acute exercise in mildly-moderately hypoxemic patients with COPD, but there was insufficient evidence of benefit in daily life or in health-related quality of life (Cochrane Database Syst Rev. 2016;11:CD006429).
Whether or not to continue prescribing oxygen to patients with moderate desaturation remains a controversial issue. A trial of oxygen may be warranted in those who are already on maximal evidence-based therapy for COPD and still complain of severe breathlessness (Ekstrom M; N Engl J Med. 2016;375[17]:1683). Conversely, a patient with COPD and moderate desaturation who resists being placed on supplemental oxygen, can be reassured that this is a reasonable course based on current evidence (Baliksoon R. COPD. 2017;4:71).
Navitha Ramesh, MD, MBBS
Fellow-in-Training Steering Committee Member
Allen Blaivas, DO, FCCP
Steering Committee Member
Informed consent: Do we need to change our practice?
Informed consent is the keystone of clinical research and helps respect and protect the rights of the participants/subjects. While the informed consent process has been standardized, some challenges still remain, such as pieces of information that should be disclosed, how to disclose information and document understanding of participants, and how detailed that disclosure should be (Grady C. N Engl J Med. 2015;372[9]:855). Digital technology can and has been used to improve the process of obtaining informed consent. Smartphones now comprise 75% of all mobile phones sold worldwide. They are being used to reach a larger and diverse population to conduct trials.
Substituting long and complex written forms with electronic consent (e-consent), however, has issues. Few people read through online agreements before clicking “agree,” which may lead to participants consenting without a clear understanding of what they are consenting to. On the other hand, it is also possible to use e-consent to improve comprehension by including videos and graphics. Interactive quizzes can assess the understanding of the participants, and embedded links to audios or videos can further enhance the grasp of information. With e-consents, queries from participants can be answered via phone call or email, etc. When e-consent is obtained remotely, the identity can be confirmed by electronic signatures, username, password, or biometrics.
E-consent has advantages, can be done remotely, no paper is needed, etc. It has potential disadvantages like being costly, videos can add time to the process, and multicenter international trials can be difficult (Grady C, et al. N Engl J Med. 2017;376[20]:e43). Studying e-consents to identify gaps in communication between the researcher and the participant in the digitalized world may help improve the process and allow research to proceed with better understanding of the risks and benefits of involvement in clinical research.
Moshsin Ijaz, MD, FCCP
Steering Committee Member
Early ID and treatment in sepsis
PRISM, the latest meta-analysis of three multicenter trials (ProCESS, ARISE, and ProMISe) found no difference in mortality with early goal-directed therapy vs usual care (N Engl J Med. 2017; 376[23]:2223). These clinical trials promoted early recognition of sepsis and prompt delivery of IV fluids and antimicrobial agents before randomization. It seems that early identification and treatment of sepsis and the rapid administration of antibiotics (following the timing recommended for sepsis bundle protocols) are the most effective interventions in sepsis (Seymour WS, et al. N Engl J Med. 2017;376[23]:2235). Other interventions over the past decade designed to reduce mortality associated with sepsis have been unsuccessful.
Maximiliano Tamae Kakazu, MD, FCCP
Steering Committee Member
The changing landscape of home mechanical ventilation
The greatest advances in home mechanical ventilation for conditions associated with chronic respiratory failure have been associated with the implementation of noninvasivepositive pressure ventilation (NIPPV) via mask interface. This dynamic growth is accredited to NIPPV efficacy and technologic improvements in ventilator and mask. For neuromuscular and restrictive thoracic diseases, NIPPV has been shown to increase survival, decrease hospital admissions, and improve quality of life (Chatwin A, et al. Plos One. 2015;10[5]:e0125839; Annane D, et al. Cochrane Database Syst Rev. 2014;13[12]:CD001941). From this success, NIPPV has been extended to conditions associated with respiratory impairment (eg, COPD, obesity hypoventilation, sleep-disordered breathing). A recent randomized study comparing home oxygen therapy (HOT) plus NIPPV vs HOT alone in post-hospitalized patients with COPD with persistent hypercapnia showed that addition of NIPPV significantly prolonged time to readmission or death from 1.4 to 4.3 months (Murphy P, et al. JAMA. 2017;317[21]:2177). Overall, however, evidence to support NIPPV in these groups is less compelling.
Current CMS guidelines defer to the provider’s clinical judgment regarding the severity of patient’s respiratory condition and if a ventilator or RAD would be most appropriate. It is important to recognize the proper patient (and setting) who would benefit from advanced respiratory support. The choice of ventilator should be reserved for severe or progressive respiratory impairment, specifically for patients who would benefit from daytime use, and for whom interruption of respiratory support would lead to serious consequences.
Michelle Cao, DO, FCCP
Steering Committee Member
Improving diagnostic capabilities in diffuse parenchymal lung disease
With the approval of two antifibrotic drugs for the treatment of idiopathic pulmonary fibrosis, there has been renewed focus in the NetWork in improving diagnosis in interstitial lung disease. There is considerable interest in exploring novel techniques and paradigms in the classification and diagnosis of diffuse parenchymal lung diseases (DPLDs). Given the invasive nature of surgical lung biopsy and its associated morbidity in elderly patients, there is a need for safer techniques to obtain lung tissue for histopathologic analysis. Transbronchial cryobiopsy may be a safe and accurate alternative for obtaining lung tissue, and we hope to better understand the role of this procedure in disease diagnosis. It is also possible that in the future, we may be able to classify these diseases without having to obtain lung tissue. More studies are being done in novel imaging techniques, such as molecular imaging, optical coherence tomography, and confocal laser endomicroscopy, that may negate the need for lung tissue in the future. Biomarker discovery and identification of biomarker signatures that can help differentiate DPLDs and provide prognostic information are also a particular focus and of importance for our NetWork. With this increased focus on better diagnostic techniques for classification of DPLD, the NetWork is featuring a lecture at CHEST 2017 on “Molecular Endotyping of Pulmonary Fibrosis,” and two sessions that will explore the current diagnostic difficulties that confront clinicians. As we move forward in our understanding of how to classify and diagnose interstitial lung disease, there is potential for more targeted interventions in individual patients.
Tracy Luckhardt, MD
Steering Committee Member
Oxygen therapy in patients with COPD with moderate desaturation
Two landmark trials from the early 1980s demonstrated survival benefit with long-term oxygen therapy (LTOT) in patients with COPD with severe resting hypoxemia [Sao2 less than 89%; (Nocturnal Oxygen Therapy Trial Group. Ann Intern Med. 1980;93[3]:391) or Pao2 40-60 mm Hg and cor pulmonale (Report of the Medical Research Council Working Party. Lancet. 1981;1[8222]:681).
The potential benefits of LTOT in COPD with mild-moderate hypoxemia have not been clearly established. The LOTT trial (The Long-Term Oxygen Treatment Trial Research Group. N Engl J Med. 2016;375[17]:1617), a recent multicenter randomized study, attempted to answer this question. They studied 738 stable patients with COPD with mild to moderate resting desaturation (Spo2 89%-93%) or exercise-induced moderate desaturation (Spo2 greater than or equal to 80% for greater than or equal to 5 minutes and Spo2 less than 90% for greater than or equal to 10 seconds during 6- minute walk test). After a median follow-up of 18.4 months, LTOT did not demonstrate a decrease in the time to death or first hospitalization and did not show improvement in quality of life or functional status. Notable adverse events from oxygen included 23 instances of tripping over equipment, with two patients requiring hospitalization and six fires with one patient hospitalized for burns.
A Cochrane meta-analysis, which did not include LOTT data, revealed that oxygen relieved breathlessness during acute exercise in mildly-moderately hypoxemic patients with COPD, but there was insufficient evidence of benefit in daily life or in health-related quality of life (Cochrane Database Syst Rev. 2016;11:CD006429).
Whether or not to continue prescribing oxygen to patients with moderate desaturation remains a controversial issue. A trial of oxygen may be warranted in those who are already on maximal evidence-based therapy for COPD and still complain of severe breathlessness (Ekstrom M; N Engl J Med. 2016;375[17]:1683). Conversely, a patient with COPD and moderate desaturation who resists being placed on supplemental oxygen, can be reassured that this is a reasonable course based on current evidence (Baliksoon R. COPD. 2017;4:71).
Navitha Ramesh, MD, MBBS
Fellow-in-Training Steering Committee Member
Allen Blaivas, DO, FCCP
Steering Committee Member
Informed consent: Do we need to change our practice?
Informed consent is the keystone of clinical research and helps respect and protect the rights of the participants/subjects. While the informed consent process has been standardized, some challenges still remain, such as pieces of information that should be disclosed, how to disclose information and document understanding of participants, and how detailed that disclosure should be (Grady C. N Engl J Med. 2015;372[9]:855). Digital technology can and has been used to improve the process of obtaining informed consent. Smartphones now comprise 75% of all mobile phones sold worldwide. They are being used to reach a larger and diverse population to conduct trials.
Substituting long and complex written forms with electronic consent (e-consent), however, has issues. Few people read through online agreements before clicking “agree,” which may lead to participants consenting without a clear understanding of what they are consenting to. On the other hand, it is also possible to use e-consent to improve comprehension by including videos and graphics. Interactive quizzes can assess the understanding of the participants, and embedded links to audios or videos can further enhance the grasp of information. With e-consents, queries from participants can be answered via phone call or email, etc. When e-consent is obtained remotely, the identity can be confirmed by electronic signatures, username, password, or biometrics.
E-consent has advantages, can be done remotely, no paper is needed, etc. It has potential disadvantages like being costly, videos can add time to the process, and multicenter international trials can be difficult (Grady C, et al. N Engl J Med. 2017;376[20]:e43). Studying e-consents to identify gaps in communication between the researcher and the participant in the digitalized world may help improve the process and allow research to proceed with better understanding of the risks and benefits of involvement in clinical research.
Moshsin Ijaz, MD, FCCP
Steering Committee Member
Early ID and treatment in sepsis
PRISM, the latest meta-analysis of three multicenter trials (ProCESS, ARISE, and ProMISe) found no difference in mortality with early goal-directed therapy vs usual care (N Engl J Med. 2017; 376[23]:2223). These clinical trials promoted early recognition of sepsis and prompt delivery of IV fluids and antimicrobial agents before randomization. It seems that early identification and treatment of sepsis and the rapid administration of antibiotics (following the timing recommended for sepsis bundle protocols) are the most effective interventions in sepsis (Seymour WS, et al. N Engl J Med. 2017;376[23]:2235). Other interventions over the past decade designed to reduce mortality associated with sepsis have been unsuccessful.
Maximiliano Tamae Kakazu, MD, FCCP
Steering Committee Member
The changing landscape of home mechanical ventilation
The greatest advances in home mechanical ventilation for conditions associated with chronic respiratory failure have been associated with the implementation of noninvasivepositive pressure ventilation (NIPPV) via mask interface. This dynamic growth is accredited to NIPPV efficacy and technologic improvements in ventilator and mask. For neuromuscular and restrictive thoracic diseases, NIPPV has been shown to increase survival, decrease hospital admissions, and improve quality of life (Chatwin A, et al. Plos One. 2015;10[5]:e0125839; Annane D, et al. Cochrane Database Syst Rev. 2014;13[12]:CD001941). From this success, NIPPV has been extended to conditions associated with respiratory impairment (eg, COPD, obesity hypoventilation, sleep-disordered breathing). A recent randomized study comparing home oxygen therapy (HOT) plus NIPPV vs HOT alone in post-hospitalized patients with COPD with persistent hypercapnia showed that addition of NIPPV significantly prolonged time to readmission or death from 1.4 to 4.3 months (Murphy P, et al. JAMA. 2017;317[21]:2177). Overall, however, evidence to support NIPPV in these groups is less compelling.
Current CMS guidelines defer to the provider’s clinical judgment regarding the severity of patient’s respiratory condition and if a ventilator or RAD would be most appropriate. It is important to recognize the proper patient (and setting) who would benefit from advanced respiratory support. The choice of ventilator should be reserved for severe or progressive respiratory impairment, specifically for patients who would benefit from daytime use, and for whom interruption of respiratory support would lead to serious consequences.
Michelle Cao, DO, FCCP
Steering Committee Member
Improving diagnostic capabilities in diffuse parenchymal lung disease
With the approval of two antifibrotic drugs for the treatment of idiopathic pulmonary fibrosis, there has been renewed focus in the NetWork in improving diagnosis in interstitial lung disease. There is considerable interest in exploring novel techniques and paradigms in the classification and diagnosis of diffuse parenchymal lung diseases (DPLDs). Given the invasive nature of surgical lung biopsy and its associated morbidity in elderly patients, there is a need for safer techniques to obtain lung tissue for histopathologic analysis. Transbronchial cryobiopsy may be a safe and accurate alternative for obtaining lung tissue, and we hope to better understand the role of this procedure in disease diagnosis. It is also possible that in the future, we may be able to classify these diseases without having to obtain lung tissue. More studies are being done in novel imaging techniques, such as molecular imaging, optical coherence tomography, and confocal laser endomicroscopy, that may negate the need for lung tissue in the future. Biomarker discovery and identification of biomarker signatures that can help differentiate DPLDs and provide prognostic information are also a particular focus and of importance for our NetWork. With this increased focus on better diagnostic techniques for classification of DPLD, the NetWork is featuring a lecture at CHEST 2017 on “Molecular Endotyping of Pulmonary Fibrosis,” and two sessions that will explore the current diagnostic difficulties that confront clinicians. As we move forward in our understanding of how to classify and diagnose interstitial lung disease, there is potential for more targeted interventions in individual patients.
Tracy Luckhardt, MD
Steering Committee Member
Oxygen therapy in patients with COPD with moderate desaturation
Two landmark trials from the early 1980s demonstrated survival benefit with long-term oxygen therapy (LTOT) in patients with COPD with severe resting hypoxemia [Sao2 less than 89%; (Nocturnal Oxygen Therapy Trial Group. Ann Intern Med. 1980;93[3]:391) or Pao2 40-60 mm Hg and cor pulmonale (Report of the Medical Research Council Working Party. Lancet. 1981;1[8222]:681).
The potential benefits of LTOT in COPD with mild-moderate hypoxemia have not been clearly established. The LOTT trial (The Long-Term Oxygen Treatment Trial Research Group. N Engl J Med. 2016;375[17]:1617), a recent multicenter randomized study, attempted to answer this question. They studied 738 stable patients with COPD with mild to moderate resting desaturation (Spo2 89%-93%) or exercise-induced moderate desaturation (Spo2 greater than or equal to 80% for greater than or equal to 5 minutes and Spo2 less than 90% for greater than or equal to 10 seconds during 6- minute walk test). After a median follow-up of 18.4 months, LTOT did not demonstrate a decrease in the time to death or first hospitalization and did not show improvement in quality of life or functional status. Notable adverse events from oxygen included 23 instances of tripping over equipment, with two patients requiring hospitalization and six fires with one patient hospitalized for burns.
A Cochrane meta-analysis, which did not include LOTT data, revealed that oxygen relieved breathlessness during acute exercise in mildly-moderately hypoxemic patients with COPD, but there was insufficient evidence of benefit in daily life or in health-related quality of life (Cochrane Database Syst Rev. 2016;11:CD006429).
Whether or not to continue prescribing oxygen to patients with moderate desaturation remains a controversial issue. A trial of oxygen may be warranted in those who are already on maximal evidence-based therapy for COPD and still complain of severe breathlessness (Ekstrom M; N Engl J Med. 2016;375[17]:1683). Conversely, a patient with COPD and moderate desaturation who resists being placed on supplemental oxygen, can be reassured that this is a reasonable course based on current evidence (Baliksoon R. COPD. 2017;4:71).
Navitha Ramesh, MD, MBBS
Fellow-in-Training Steering Committee Member
Allen Blaivas, DO, FCCP
Steering Committee Member
Informed consent: Do we need to change our practice?
Informed consent is the keystone of clinical research and helps respect and protect the rights of the participants/subjects. While the informed consent process has been standardized, some challenges still remain, such as pieces of information that should be disclosed, how to disclose information and document understanding of participants, and how detailed that disclosure should be (Grady C. N Engl J Med. 2015;372[9]:855). Digital technology can and has been used to improve the process of obtaining informed consent. Smartphones now comprise 75% of all mobile phones sold worldwide. They are being used to reach a larger and diverse population to conduct trials.
Substituting long and complex written forms with electronic consent (e-consent), however, has issues. Few people read through online agreements before clicking “agree,” which may lead to participants consenting without a clear understanding of what they are consenting to. On the other hand, it is also possible to use e-consent to improve comprehension by including videos and graphics. Interactive quizzes can assess the understanding of the participants, and embedded links to audios or videos can further enhance the grasp of information. With e-consents, queries from participants can be answered via phone call or email, etc. When e-consent is obtained remotely, the identity can be confirmed by electronic signatures, username, password, or biometrics.
E-consent has advantages, can be done remotely, no paper is needed, etc. It has potential disadvantages like being costly, videos can add time to the process, and multicenter international trials can be difficult (Grady C, et al. N Engl J Med. 2017;376[20]:e43). Studying e-consents to identify gaps in communication between the researcher and the participant in the digitalized world may help improve the process and allow research to proceed with better understanding of the risks and benefits of involvement in clinical research.
Moshsin Ijaz, MD, FCCP
Steering Committee Member
Early ID and treatment in sepsis
PRISM, the latest meta-analysis of three multicenter trials (ProCESS, ARISE, and ProMISe) found no difference in mortality with early goal-directed therapy vs usual care (N Engl J Med. 2017; 376[23]:2223). These clinical trials promoted early recognition of sepsis and prompt delivery of IV fluids and antimicrobial agents before randomization. It seems that early identification and treatment of sepsis and the rapid administration of antibiotics (following the timing recommended for sepsis bundle protocols) are the most effective interventions in sepsis (Seymour WS, et al. N Engl J Med. 2017;376[23]:2235). Other interventions over the past decade designed to reduce mortality associated with sepsis have been unsuccessful.
Maximiliano Tamae Kakazu, MD, FCCP
Steering Committee Member
The changing landscape of home mechanical ventilation
The greatest advances in home mechanical ventilation for conditions associated with chronic respiratory failure have been associated with the implementation of noninvasivepositive pressure ventilation (NIPPV) via mask interface. This dynamic growth is accredited to NIPPV efficacy and technologic improvements in ventilator and mask. For neuromuscular and restrictive thoracic diseases, NIPPV has been shown to increase survival, decrease hospital admissions, and improve quality of life (Chatwin A, et al. Plos One. 2015;10[5]:e0125839; Annane D, et al. Cochrane Database Syst Rev. 2014;13[12]:CD001941). From this success, NIPPV has been extended to conditions associated with respiratory impairment (eg, COPD, obesity hypoventilation, sleep-disordered breathing). A recent randomized study comparing home oxygen therapy (HOT) plus NIPPV vs HOT alone in post-hospitalized patients with COPD with persistent hypercapnia showed that addition of NIPPV significantly prolonged time to readmission or death from 1.4 to 4.3 months (Murphy P, et al. JAMA. 2017;317[21]:2177). Overall, however, evidence to support NIPPV in these groups is less compelling.
Current CMS guidelines defer to the provider’s clinical judgment regarding the severity of patient’s respiratory condition and if a ventilator or RAD would be most appropriate. It is important to recognize the proper patient (and setting) who would benefit from advanced respiratory support. The choice of ventilator should be reserved for severe or progressive respiratory impairment, specifically for patients who would benefit from daytime use, and for whom interruption of respiratory support would lead to serious consequences.
Michelle Cao, DO, FCCP
Steering Committee Member
Improving diagnostic capabilities in diffuse parenchymal lung disease
With the approval of two antifibrotic drugs for the treatment of idiopathic pulmonary fibrosis, there has been renewed focus in the NetWork in improving diagnosis in interstitial lung disease. There is considerable interest in exploring novel techniques and paradigms in the classification and diagnosis of diffuse parenchymal lung diseases (DPLDs). Given the invasive nature of surgical lung biopsy and its associated morbidity in elderly patients, there is a need for safer techniques to obtain lung tissue for histopathologic analysis. Transbronchial cryobiopsy may be a safe and accurate alternative for obtaining lung tissue, and we hope to better understand the role of this procedure in disease diagnosis. It is also possible that in the future, we may be able to classify these diseases without having to obtain lung tissue. More studies are being done in novel imaging techniques, such as molecular imaging, optical coherence tomography, and confocal laser endomicroscopy, that may negate the need for lung tissue in the future. Biomarker discovery and identification of biomarker signatures that can help differentiate DPLDs and provide prognostic information are also a particular focus and of importance for our NetWork. With this increased focus on better diagnostic techniques for classification of DPLD, the NetWork is featuring a lecture at CHEST 2017 on “Molecular Endotyping of Pulmonary Fibrosis,” and two sessions that will explore the current diagnostic difficulties that confront clinicians. As we move forward in our understanding of how to classify and diagnose interstitial lung disease, there is potential for more targeted interventions in individual patients.
Tracy Luckhardt, MD
Steering Committee Member
In Memoriam
CHEST has been informed of the following deaths.We extend our sincere condolences.
Henry J. Heimlich MD, FCCP (December 2016)
Sylvan Lee Weinberg, MD, FCCP (Past President-1983-84) (January 2017)
Clive Deutscher, MD, FCCP (January 2017)
Sandra Willsie, DO, FCCP (March 2017)
Arthur F. Reimann, MD, FCCP (March 2017)
Cynthia Ray, MD, FCCP (April 2017)
Brian J. Sproule, MD, MS, FCCP (April 2017)
Michael R. Bye, MD, FCCP (April 2017)
Paul J. Mathews, MD, FCCP (May 2017)
CHEST has been informed of the following deaths.We extend our sincere condolences.
Henry J. Heimlich MD, FCCP (December 2016)
Sylvan Lee Weinberg, MD, FCCP (Past President-1983-84) (January 2017)
Clive Deutscher, MD, FCCP (January 2017)
Sandra Willsie, DO, FCCP (March 2017)
Arthur F. Reimann, MD, FCCP (March 2017)
Cynthia Ray, MD, FCCP (April 2017)
Brian J. Sproule, MD, MS, FCCP (April 2017)
Michael R. Bye, MD, FCCP (April 2017)
Paul J. Mathews, MD, FCCP (May 2017)
CHEST has been informed of the following deaths.We extend our sincere condolences.
Henry J. Heimlich MD, FCCP (December 2016)
Sylvan Lee Weinberg, MD, FCCP (Past President-1983-84) (January 2017)
Clive Deutscher, MD, FCCP (January 2017)
Sandra Willsie, DO, FCCP (March 2017)
Arthur F. Reimann, MD, FCCP (March 2017)
Cynthia Ray, MD, FCCP (April 2017)
Brian J. Sproule, MD, MS, FCCP (April 2017)
Michael R. Bye, MD, FCCP (April 2017)
Paul J. Mathews, MD, FCCP (May 2017)
Expanding Disease Awareness Campaigns
In 2017, we’ve continued to push our disease awareness efforts in lung cancer, sarcoidosis, asthma, and COPD, trading our “awareness months” for longer, more sustainable campaigns.
Lung Cancer
Our lung cancer disease awareness campaign launched mid-May and goes through World Lung Cancer Day on August 1, 2017. The foundation is partnering with the Bonnie J. Addarrio Lung Cancer Foundation and LUNGevity to produce:
• Biopsy-specific infographics
• An animated biopsy video to show the importance of collecting core tissue
• Social media shareable postcards
• An updated lung cancer guide and infographic
• New lung cancer landing page and website
Sharing these resources through the CHEST social media channels, we have so far been able to reach more than 34.2K social media accounts and earn 512 social interactions, including likes/reactions, clicks, and shares/retweets from Twitter, Facebook, and LinkedIn.
We are also excited to participate in a Lung Cancer Living Room discussion with the Bonnie J. Addario Lung Cancer Foundation. This presentation will bring lung cancer specialists, physicians, patients, and the public together to discuss lung cancer in a relaxed and comfortable setting. Attendees will have the opportunity to ask questions, share their stories, and discuss issues surrounding lung cancer. The event will also be live-streamed and archived on the Bonnie J. Addario Lung Cancer Foundation’s website.
Asthma
We launched our asthma campaign at “The Air We Breathe” Summit with The Atlantic. We were able to reach more than 24.2K social accounts through live tweeting during the event and follow up posts on CHEST’s Twitter and Facebook accounts. The Atlantic was able to earn an impressive reach of 868K social accounts through their own social media promotion for the event. To read more about the event that focused on the quality of our air and the implications on our health, visit chestfoundation.org/summit.
We continue to partner with the Allergy & Asthma Network to create and distribute our materials and messaging, which focus on severe and difficult-to-control asthma. This campaign has already garnered over 53.4K social media impressions through CHEST channels, and over 1.3K social interactions. New components to the campaign include:
• Severity assessment tool
• Shared decision making tool
• Patient testimonial videos
Our campaign also included an 8-minute segment on the Access Health program, which aired two times in May on Lifetime NetWork, with an additional 200+ airings via syndication throughout 100 US markets.
Sarcoidosis
For the third consecutive year, we’ve partnered with the Foundation for Sarcoidosis Research to spread awareness on the disease. We also partnered with the American Osteopathic Association, the COPD Foundation, and The Society of Thoracic Surgeons to create
In CHEST member communications, our campaign reached more than 20,000 people, and our social media posts have reached more than 61.7K social accounts. CHEST’s press release on sarcoidosis has reached well over 11.6M clinicians and patients.
We are very grateful and proud of the work our partners have done to help us spread awareness on these diseases, so clinicians and patients will be able to use our resources to champion lung health.
In 2017, we’ve continued to push our disease awareness efforts in lung cancer, sarcoidosis, asthma, and COPD, trading our “awareness months” for longer, more sustainable campaigns.
Lung Cancer
Our lung cancer disease awareness campaign launched mid-May and goes through World Lung Cancer Day on August 1, 2017. The foundation is partnering with the Bonnie J. Addarrio Lung Cancer Foundation and LUNGevity to produce:
• Biopsy-specific infographics
• An animated biopsy video to show the importance of collecting core tissue
• Social media shareable postcards
• An updated lung cancer guide and infographic
• New lung cancer landing page and website
Sharing these resources through the CHEST social media channels, we have so far been able to reach more than 34.2K social media accounts and earn 512 social interactions, including likes/reactions, clicks, and shares/retweets from Twitter, Facebook, and LinkedIn.
We are also excited to participate in a Lung Cancer Living Room discussion with the Bonnie J. Addario Lung Cancer Foundation. This presentation will bring lung cancer specialists, physicians, patients, and the public together to discuss lung cancer in a relaxed and comfortable setting. Attendees will have the opportunity to ask questions, share their stories, and discuss issues surrounding lung cancer. The event will also be live-streamed and archived on the Bonnie J. Addario Lung Cancer Foundation’s website.
Asthma
We launched our asthma campaign at “The Air We Breathe” Summit with The Atlantic. We were able to reach more than 24.2K social accounts through live tweeting during the event and follow up posts on CHEST’s Twitter and Facebook accounts. The Atlantic was able to earn an impressive reach of 868K social accounts through their own social media promotion for the event. To read more about the event that focused on the quality of our air and the implications on our health, visit chestfoundation.org/summit.
We continue to partner with the Allergy & Asthma Network to create and distribute our materials and messaging, which focus on severe and difficult-to-control asthma. This campaign has already garnered over 53.4K social media impressions through CHEST channels, and over 1.3K social interactions. New components to the campaign include:
• Severity assessment tool
• Shared decision making tool
• Patient testimonial videos
Our campaign also included an 8-minute segment on the Access Health program, which aired two times in May on Lifetime NetWork, with an additional 200+ airings via syndication throughout 100 US markets.
Sarcoidosis
For the third consecutive year, we’ve partnered with the Foundation for Sarcoidosis Research to spread awareness on the disease. We also partnered with the American Osteopathic Association, the COPD Foundation, and The Society of Thoracic Surgeons to create
In CHEST member communications, our campaign reached more than 20,000 people, and our social media posts have reached more than 61.7K social accounts. CHEST’s press release on sarcoidosis has reached well over 11.6M clinicians and patients.
We are very grateful and proud of the work our partners have done to help us spread awareness on these diseases, so clinicians and patients will be able to use our resources to champion lung health.
In 2017, we’ve continued to push our disease awareness efforts in lung cancer, sarcoidosis, asthma, and COPD, trading our “awareness months” for longer, more sustainable campaigns.
Lung Cancer
Our lung cancer disease awareness campaign launched mid-May and goes through World Lung Cancer Day on August 1, 2017. The foundation is partnering with the Bonnie J. Addarrio Lung Cancer Foundation and LUNGevity to produce:
• Biopsy-specific infographics
• An animated biopsy video to show the importance of collecting core tissue
• Social media shareable postcards
• An updated lung cancer guide and infographic
• New lung cancer landing page and website
Sharing these resources through the CHEST social media channels, we have so far been able to reach more than 34.2K social media accounts and earn 512 social interactions, including likes/reactions, clicks, and shares/retweets from Twitter, Facebook, and LinkedIn.
We are also excited to participate in a Lung Cancer Living Room discussion with the Bonnie J. Addario Lung Cancer Foundation. This presentation will bring lung cancer specialists, physicians, patients, and the public together to discuss lung cancer in a relaxed and comfortable setting. Attendees will have the opportunity to ask questions, share their stories, and discuss issues surrounding lung cancer. The event will also be live-streamed and archived on the Bonnie J. Addario Lung Cancer Foundation’s website.
Asthma
We launched our asthma campaign at “The Air We Breathe” Summit with The Atlantic. We were able to reach more than 24.2K social accounts through live tweeting during the event and follow up posts on CHEST’s Twitter and Facebook accounts. The Atlantic was able to earn an impressive reach of 868K social accounts through their own social media promotion for the event. To read more about the event that focused on the quality of our air and the implications on our health, visit chestfoundation.org/summit.
We continue to partner with the Allergy & Asthma Network to create and distribute our materials and messaging, which focus on severe and difficult-to-control asthma. This campaign has already garnered over 53.4K social media impressions through CHEST channels, and over 1.3K social interactions. New components to the campaign include:
• Severity assessment tool
• Shared decision making tool
• Patient testimonial videos
Our campaign also included an 8-minute segment on the Access Health program, which aired two times in May on Lifetime NetWork, with an additional 200+ airings via syndication throughout 100 US markets.
Sarcoidosis
For the third consecutive year, we’ve partnered with the Foundation for Sarcoidosis Research to spread awareness on the disease. We also partnered with the American Osteopathic Association, the COPD Foundation, and The Society of Thoracic Surgeons to create
In CHEST member communications, our campaign reached more than 20,000 people, and our social media posts have reached more than 61.7K social accounts. CHEST’s press release on sarcoidosis has reached well over 11.6M clinicians and patients.
We are very grateful and proud of the work our partners have done to help us spread awareness on these diseases, so clinicians and patients will be able to use our resources to champion lung health.
Apply by Aug. 1 for International Scholars Program
Up to four young vascular surgeons from outside North American may receive a $5,000 award through the International Scholars Program. Each recipient gets the opportunity to visit clinical, teaching and research facilities in the United States and Canada and participate in the 2018 Vascular Annual Meeting in Boston.
Honorees are expected to spend approximately two weeks in the U.S.; clinical visits may be scheduled prior to the meeting, post-meeting or a combination of both. Each recipient also is assigned a mentor to help with scheduling activities.
The application deadline is Aug. 1.
Up to four young vascular surgeons from outside North American may receive a $5,000 award through the International Scholars Program. Each recipient gets the opportunity to visit clinical, teaching and research facilities in the United States and Canada and participate in the 2018 Vascular Annual Meeting in Boston.
Honorees are expected to spend approximately two weeks in the U.S.; clinical visits may be scheduled prior to the meeting, post-meeting or a combination of both. Each recipient also is assigned a mentor to help with scheduling activities.
The application deadline is Aug. 1.
Up to four young vascular surgeons from outside North American may receive a $5,000 award through the International Scholars Program. Each recipient gets the opportunity to visit clinical, teaching and research facilities in the United States and Canada and participate in the 2018 Vascular Annual Meeting in Boston.
Honorees are expected to spend approximately two weeks in the U.S.; clinical visits may be scheduled prior to the meeting, post-meeting or a combination of both. Each recipient also is assigned a mentor to help with scheduling activities.
The application deadline is Aug. 1.