Society News

How I do it: Transitioning asthma care from adolescents to adults: Severe Asthma Series. By Dr. A. Nanzer.



Outpatient management of patients with COVID-19: Multicenter prospective validation of the HOME-CoV Rule to safely discharge patients. By Dr. D. Douillet, et al.



Emphysema progression and lung function decline among angiotensin converting enzyme inhibitors (ACEi) and angiotensin-receptor blockade (ARB) users in the COPDGene Cohort. By Dr. V. Tejwani, et al.



Sarcoidosis: An occupational disease? By Dr. C.L. Oliver, et al.



Pulmonary thrombosis and thromboembolism in COVID-19. By Dr. H. Poor.



How I do it: Mediastinal staging for lung cancer. By Dr. F. Farjah, et al.




 

How I do it: Transitioning asthma care from adolescents to adults: Severe Asthma Series. By Dr. A. Nanzer.



Outpatient management of patients with COVID-19: Multicenter prospective validation of the HOME-CoV Rule to safely discharge patients. By Dr. D. Douillet, et al.



Emphysema progression and lung function decline among angiotensin converting enzyme inhibitors (ACEi) and angiotensin-receptor blockade (ARB) users in the COPDGene Cohort. By Dr. V. Tejwani, et al.



Sarcoidosis: An occupational disease? By Dr. C.L. Oliver, et al.



Pulmonary thrombosis and thromboembolism in COVID-19. By Dr. H. Poor.



How I do it: Mediastinal staging for lung cancer. By Dr. F. Farjah, et al.




 

How I do it: Transitioning asthma care from adolescents to adults: Severe Asthma Series. By Dr. A. Nanzer.



Outpatient management of patients with COVID-19: Multicenter prospective validation of the HOME-CoV Rule to safely discharge patients. By Dr. D. Douillet, et al.



Emphysema progression and lung function decline among angiotensin converting enzyme inhibitors (ACEi) and angiotensin-receptor blockade (ARB) users in the COPDGene Cohort. By Dr. V. Tejwani, et al.



Sarcoidosis: An occupational disease? By Dr. C.L. Oliver, et al.



Pulmonary thrombosis and thromboembolism in COVID-19. By Dr. H. Poor.



How I do it: Mediastinal staging for lung cancer. By Dr. F. Farjah, et al.




 

We’ve launched a new app designed to help AGA trainees and early career members navigate each step along their GI career path. Once users get started by setting up their professional profile, AGA Career Compass offers curated resources on topics like career planning, clinical education, and leadership skills.

The Connections Corner section hosts experienced mentors and matches them with users based on profile compatibility and shared topics of interest, such as grant writing, setting up a lab, navigating career options in academic medicine, managing burnout, and more. Download the app today to branch out from your institution or practice and receive personalized career guidance.

Now available in Apple and Google Play stores.

We’ve launched a new app designed to help AGA trainees and early career members navigate each step along their GI career path. Once users get started by setting up their professional profile, AGA Career Compass offers curated resources on topics like career planning, clinical education, and leadership skills.

The Connections Corner section hosts experienced mentors and matches them with users based on profile compatibility and shared topics of interest, such as grant writing, setting up a lab, navigating career options in academic medicine, managing burnout, and more. Download the app today to branch out from your institution or practice and receive personalized career guidance.

Now available in Apple and Google Play stores.

We’ve launched a new app designed to help AGA trainees and early career members navigate each step along their GI career path. Once users get started by setting up their professional profile, AGA Career Compass offers curated resources on topics like career planning, clinical education, and leadership skills.

The Connections Corner section hosts experienced mentors and matches them with users based on profile compatibility and shared topics of interest, such as grant writing, setting up a lab, navigating career options in academic medicine, managing burnout, and more. Download the app today to branch out from your institution or practice and receive personalized career guidance.

Now available in Apple and Google Play stores.

Physicians with difficult patient scenarios regularly bring their questions to the AGA Community to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses. Here’s a preview of a recent popular clinical discussion:  

Junaid Beig, MBBS, FRACP wrote the following in “Subtherapeutic Azathioprine metabolites despite being adherent to medication”:

“I have an Ulcerative patient (Pancolitis) on Mesalazine and Azathioprine 150mg since 2018. His levels are subtherapeutic (6TGN 159 and 6MMP 70) despite being adherent to medication. He drinks 2 liters of wine per week.

“Questions: Is there any way we can find if he has high TPMT activity (Level is normal 6.1)? Does alcohol have an impact on TPMT activity? Does he warrant alternative treatment?”

See how AGA members responded and join the discussion: https://community.gastro.org/posts/25109.
 

Physicians with difficult patient scenarios regularly bring their questions to the AGA Community to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses. Here’s a preview of a recent popular clinical discussion:  

Junaid Beig, MBBS, FRACP wrote the following in “Subtherapeutic Azathioprine metabolites despite being adherent to medication”:

“I have an Ulcerative patient (Pancolitis) on Mesalazine and Azathioprine 150mg since 2018. His levels are subtherapeutic (6TGN 159 and 6MMP 70) despite being adherent to medication. He drinks 2 liters of wine per week.

“Questions: Is there any way we can find if he has high TPMT activity (Level is normal 6.1)? Does alcohol have an impact on TPMT activity? Does he warrant alternative treatment?”

See how AGA members responded and join the discussion: https://community.gastro.org/posts/25109.
 

Physicians with difficult patient scenarios regularly bring their questions to the AGA Community to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses. Here’s a preview of a recent popular clinical discussion:  

Junaid Beig, MBBS, FRACP wrote the following in “Subtherapeutic Azathioprine metabolites despite being adherent to medication”:

“I have an Ulcerative patient (Pancolitis) on Mesalazine and Azathioprine 150mg since 2018. His levels are subtherapeutic (6TGN 159 and 6MMP 70) despite being adherent to medication. He drinks 2 liters of wine per week.

“Questions: Is there any way we can find if he has high TPMT activity (Level is normal 6.1)? Does alcohol have an impact on TPMT activity? Does he warrant alternative treatment?”

See how AGA members responded and join the discussion: https://community.gastro.org/posts/25109.
 

On July 9, Philip Morris International Inc. (PMI) issued a statement of intent to purchase Vectura Group plc (Vectura), a provider of inhaled drug delivery solutions. According to the statement, the acquisition contributes to the PMI goal to move “beyond nicotine” by leveraging Vectura’s expertise in inhalation and aerosolization into adjacent areas.

Given PMI’s strong ties to tobacco, the acquisition raises concerns across the medical field. D. Robert McCaffree, MD, Master FCCP, shares his thoughts on the prospective acquisition in the following guest feature.

August 2021: D. Robert McCaffree, MD, Master FCCP

In 2018, Dr. Neeraj Desai and I published an editorial in the journal CHEST®. The title was, in part, “Is Big Tobacco Still Trying to Deceive the Public? ... ”¹ Before I give an opinion about the answer, I should give some background on events eliciting the editorial.

In 1999, the U.S. Department of Justice (DOJ) sued major tobacco companies (Philip Morris, USA; Altria; RJ Reynolds; and Lorillard) for being in violation of the Racketeer Influenced Corrupt Organization Act (RICO) in that they colluded for decades to mislead the public about the risks of smoking and risks of secondhand smoke, downplayed the addictiveness of nicotine, manipulated nicotine levels, marketed cigarettes as “low tar” or “light” when they knew these were no less hazardous than full-flavored cigarettes, purposefully targeted youth, and failed to produce a safer cigarette.

In 2006, Judge Gladys Kessler of the D.C. District Court issued a1 700-page opinion finding the defendants had violated RICO. In her words,

• “[This case] is about an industry, and in particular these defendants, that survives, and profits, from selling a highly addictive product which causes diseases that lead to ... [an] immeasurable amount of human suffering ... they have consistently, repeatedly and with enormous skill and sophistication, denied these facts to the public, the Government, and to the public health community.”

“Defendants have marketed and sold their lethal products with zeal, with deception, with a single-minded focus on their financial success, and without regard for the human tragedy ... exacted.”

• “Over the course of more than 50 years, defendants lied, misrepresented, and deceived the American public, including ... the young people they avidly sought as ‘replacement’ smokers.”

• “The evidence in this case clearly establishes that defendants have not ceased engaging in unlawful activity ... ”

Since, under RICO, the government could not recover monetary damages but only require corrective actions going forward, the court ordered them to publish “corrective statements” (five different ones in total) in major publications and on television during prime time over the course of several months, as well as at the point of sale. (They are still appealing the point-of-sale display.)

Of course, the defendants appealed, but those appeals were largely thwarted until the (almost) final order in 2017, which then led to our editorial in 2018.

While this is a rather long introduction, I thought it necessary to depict the long-standing nature and behavioral patterns of deception, distortion, and destructive behavior of this industry – all designed to maintain their incredible profits - before trying to answer the question posed in our editorial.

Since all of the above, is there evidence the industry’s behaviors have changed? On the negative side, there is a recent study published on the Tobacco Free Kids website documenting the past and continued marketing to women and girls, with all the adverse consequences to women’s health.² The industry continues to produce and market cigarettes to everyone, including youths and focused markets such as Blacks and LGBTQ populations. However, they are quite aware that the future of combustible tobacco, the major source of their incredible profits, is threatened.

Currently, most of the profits from Philip Morris International (PMI), as well as the other major players, come from combustible products. But, the CEO of PMI has stated that he thinks combustible tobacco products will be gone in 10 to 15 years and PMI will be selling only smoke-free products by 2025. So, to preserve similar profits as their combustible products diminish, they have made major investments in vaping products, such as Juul, and development of other noncombustible tobacco products. But these are still addictive, and any reduction in health consequences is still being evaluated. A prime example of trying to change their image is Philip Morris’ Beyond Nicotine campaign. However, currently all the companies continue to produce combustible products in large amounts, both locally and internationally.

One way of assessing the vision of any company is to see where it is putting its money. Currently, all major tobacco companies are investing in marijuana companies. For example, Philip Morris has invested $2.4 billion into Cosmos, a Canadian marijuana company.

They also recently purchased Vectura, Fertin, and Kraft Foods. I know, it’s hard to see where Kraft Foods fits in here, but Vectura, an inhalational device manufacturer, and Fertin, which makes nicotine gum, as well as vehicles such as powders, pouches that dissolve in the mouth, and lozenges, certainly do fit in.

My take on these recent acquisitions is that tobacco companies realize combustibles are dying. However, they continue to develop and market nicotine in noncombustible forms. They are likely looking to move into marijuana, at least as an investment. It’s not a huge leap to consider the possibility that the purchase of Vectura will help develop delivery systems for nicotine, marijuana, and possibly medications. It’s unclear whether PMI intends to get further into inhaled pharmaceuticals.

Bottom line is that, as pulmonary physicians, we need to be aware of all developments in inhaled substances and delivery methods. On the upside, everything the industry is currently doing is apparently more transparent than they have been in the past. They are not yet, however, ceasing production and marketing of cigarettes.

It’s also important that we remind ourselves of their past actions because, personally, that past still bothers me, and I’m not quite ready to trust them. When it comes to “Big Tobacco,” it is appropriate that we always keep in mind the immortal words, often repeated in various forms, of Edgar Allen Poe, master teller of horror stories, “Believe nothing you hear and only half that you see.”³

References

1. McCaffree DR and Desai NR. Is big tobacco still trying to deceive the public? This is no time to rest on our laurels. Chest. 2018 May;153(5):1085-6. doi: 10.1016/j.chest.2018.01.012.

2. A lifetime of damage: How Big Tobacco’s predatory marketing practices harms the health of women and girls. Tobacco-Free Kids. May 2021.

3. Quote Investigator. 2017 Jun 23. “The system of Dr. Tarr and Prof. Fether,” from Graham’s Magazine, November 1845.

On July 9, Philip Morris International Inc. (PMI) issued a statement of intent to purchase Vectura Group plc (Vectura), a provider of inhaled drug delivery solutions. According to the statement, the acquisition contributes to the PMI goal to move “beyond nicotine” by leveraging Vectura’s expertise in inhalation and aerosolization into adjacent areas.

Given PMI’s strong ties to tobacco, the acquisition raises concerns across the medical field. D. Robert McCaffree, MD, Master FCCP, shares his thoughts on the prospective acquisition in the following guest feature.

August 2021: D. Robert McCaffree, MD, Master FCCP

In 2018, Dr. Neeraj Desai and I published an editorial in the journal CHEST®. The title was, in part, “Is Big Tobacco Still Trying to Deceive the Public? ... ”¹ Before I give an opinion about the answer, I should give some background on events eliciting the editorial.

In 1999, the U.S. Department of Justice (DOJ) sued major tobacco companies (Philip Morris, USA; Altria; RJ Reynolds; and Lorillard) for being in violation of the Racketeer Influenced Corrupt Organization Act (RICO) in that they colluded for decades to mislead the public about the risks of smoking and risks of secondhand smoke, downplayed the addictiveness of nicotine, manipulated nicotine levels, marketed cigarettes as “low tar” or “light” when they knew these were no less hazardous than full-flavored cigarettes, purposefully targeted youth, and failed to produce a safer cigarette.

In 2006, Judge Gladys Kessler of the D.C. District Court issued a1 700-page opinion finding the defendants had violated RICO. In her words,

• “[This case] is about an industry, and in particular these defendants, that survives, and profits, from selling a highly addictive product which causes diseases that lead to ... [an] immeasurable amount of human suffering ... they have consistently, repeatedly and with enormous skill and sophistication, denied these facts to the public, the Government, and to the public health community.”

“Defendants have marketed and sold their lethal products with zeal, with deception, with a single-minded focus on their financial success, and without regard for the human tragedy ... exacted.”

• “Over the course of more than 50 years, defendants lied, misrepresented, and deceived the American public, including ... the young people they avidly sought as ‘replacement’ smokers.”

• “The evidence in this case clearly establishes that defendants have not ceased engaging in unlawful activity ... ”

Since, under RICO, the government could not recover monetary damages but only require corrective actions going forward, the court ordered them to publish “corrective statements” (five different ones in total) in major publications and on television during prime time over the course of several months, as well as at the point of sale. (They are still appealing the point-of-sale display.)

Of course, the defendants appealed, but those appeals were largely thwarted until the (almost) final order in 2017, which then led to our editorial in 2018.

While this is a rather long introduction, I thought it necessary to depict the long-standing nature and behavioral patterns of deception, distortion, and destructive behavior of this industry – all designed to maintain their incredible profits - before trying to answer the question posed in our editorial.

Since all of the above, is there evidence the industry’s behaviors have changed? On the negative side, there is a recent study published on the Tobacco Free Kids website documenting the past and continued marketing to women and girls, with all the adverse consequences to women’s health.² The industry continues to produce and market cigarettes to everyone, including youths and focused markets such as Blacks and LGBTQ populations. However, they are quite aware that the future of combustible tobacco, the major source of their incredible profits, is threatened.

Currently, most of the profits from Philip Morris International (PMI), as well as the other major players, come from combustible products. But, the CEO of PMI has stated that he thinks combustible tobacco products will be gone in 10 to 15 years and PMI will be selling only smoke-free products by 2025. So, to preserve similar profits as their combustible products diminish, they have made major investments in vaping products, such as Juul, and development of other noncombustible tobacco products. But these are still addictive, and any reduction in health consequences is still being evaluated. A prime example of trying to change their image is Philip Morris’ Beyond Nicotine campaign. However, currently all the companies continue to produce combustible products in large amounts, both locally and internationally.

One way of assessing the vision of any company is to see where it is putting its money. Currently, all major tobacco companies are investing in marijuana companies. For example, Philip Morris has invested $2.4 billion into Cosmos, a Canadian marijuana company.

They also recently purchased Vectura, Fertin, and Kraft Foods. I know, it’s hard to see where Kraft Foods fits in here, but Vectura, an inhalational device manufacturer, and Fertin, which makes nicotine gum, as well as vehicles such as powders, pouches that dissolve in the mouth, and lozenges, certainly do fit in.

My take on these recent acquisitions is that tobacco companies realize combustibles are dying. However, they continue to develop and market nicotine in noncombustible forms. They are likely looking to move into marijuana, at least as an investment. It’s not a huge leap to consider the possibility that the purchase of Vectura will help develop delivery systems for nicotine, marijuana, and possibly medications. It’s unclear whether PMI intends to get further into inhaled pharmaceuticals.

Bottom line is that, as pulmonary physicians, we need to be aware of all developments in inhaled substances and delivery methods. On the upside, everything the industry is currently doing is apparently more transparent than they have been in the past. They are not yet, however, ceasing production and marketing of cigarettes.

It’s also important that we remind ourselves of their past actions because, personally, that past still bothers me, and I’m not quite ready to trust them. When it comes to “Big Tobacco,” it is appropriate that we always keep in mind the immortal words, often repeated in various forms, of Edgar Allen Poe, master teller of horror stories, “Believe nothing you hear and only half that you see.”³

References

1. McCaffree DR and Desai NR. Is big tobacco still trying to deceive the public? This is no time to rest on our laurels. Chest. 2018 May;153(5):1085-6. doi: 10.1016/j.chest.2018.01.012.

2. A lifetime of damage: How Big Tobacco’s predatory marketing practices harms the health of women and girls. Tobacco-Free Kids. May 2021.

3. Quote Investigator. 2017 Jun 23. “The system of Dr. Tarr and Prof. Fether,” from Graham’s Magazine, November 1845.

On July 9, Philip Morris International Inc. (PMI) issued a statement of intent to purchase Vectura Group plc (Vectura), a provider of inhaled drug delivery solutions. According to the statement, the acquisition contributes to the PMI goal to move “beyond nicotine” by leveraging Vectura’s expertise in inhalation and aerosolization into adjacent areas.

Given PMI’s strong ties to tobacco, the acquisition raises concerns across the medical field. D. Robert McCaffree, MD, Master FCCP, shares his thoughts on the prospective acquisition in the following guest feature.

August 2021: D. Robert McCaffree, MD, Master FCCP

In 2018, Dr. Neeraj Desai and I published an editorial in the journal CHEST®. The title was, in part, “Is Big Tobacco Still Trying to Deceive the Public? ... ”¹ Before I give an opinion about the answer, I should give some background on events eliciting the editorial.

In 1999, the U.S. Department of Justice (DOJ) sued major tobacco companies (Philip Morris, USA; Altria; RJ Reynolds; and Lorillard) for being in violation of the Racketeer Influenced Corrupt Organization Act (RICO) in that they colluded for decades to mislead the public about the risks of smoking and risks of secondhand smoke, downplayed the addictiveness of nicotine, manipulated nicotine levels, marketed cigarettes as “low tar” or “light” when they knew these were no less hazardous than full-flavored cigarettes, purposefully targeted youth, and failed to produce a safer cigarette.

In 2006, Judge Gladys Kessler of the D.C. District Court issued a1 700-page opinion finding the defendants had violated RICO. In her words,

• “[This case] is about an industry, and in particular these defendants, that survives, and profits, from selling a highly addictive product which causes diseases that lead to ... [an] immeasurable amount of human suffering ... they have consistently, repeatedly and with enormous skill and sophistication, denied these facts to the public, the Government, and to the public health community.”

“Defendants have marketed and sold their lethal products with zeal, with deception, with a single-minded focus on their financial success, and without regard for the human tragedy ... exacted.”

• “Over the course of more than 50 years, defendants lied, misrepresented, and deceived the American public, including ... the young people they avidly sought as ‘replacement’ smokers.”

• “The evidence in this case clearly establishes that defendants have not ceased engaging in unlawful activity ... ”

Since, under RICO, the government could not recover monetary damages but only require corrective actions going forward, the court ordered them to publish “corrective statements” (five different ones in total) in major publications and on television during prime time over the course of several months, as well as at the point of sale. (They are still appealing the point-of-sale display.)

Of course, the defendants appealed, but those appeals were largely thwarted until the (almost) final order in 2017, which then led to our editorial in 2018.

While this is a rather long introduction, I thought it necessary to depict the long-standing nature and behavioral patterns of deception, distortion, and destructive behavior of this industry – all designed to maintain their incredible profits - before trying to answer the question posed in our editorial.

Since all of the above, is there evidence the industry’s behaviors have changed? On the negative side, there is a recent study published on the Tobacco Free Kids website documenting the past and continued marketing to women and girls, with all the adverse consequences to women’s health.² The industry continues to produce and market cigarettes to everyone, including youths and focused markets such as Blacks and LGBTQ populations. However, they are quite aware that the future of combustible tobacco, the major source of their incredible profits, is threatened.

Currently, most of the profits from Philip Morris International (PMI), as well as the other major players, come from combustible products. But, the CEO of PMI has stated that he thinks combustible tobacco products will be gone in 10 to 15 years and PMI will be selling only smoke-free products by 2025. So, to preserve similar profits as their combustible products diminish, they have made major investments in vaping products, such as Juul, and development of other noncombustible tobacco products. But these are still addictive, and any reduction in health consequences is still being evaluated. A prime example of trying to change their image is Philip Morris’ Beyond Nicotine campaign. However, currently all the companies continue to produce combustible products in large amounts, both locally and internationally.

One way of assessing the vision of any company is to see where it is putting its money. Currently, all major tobacco companies are investing in marijuana companies. For example, Philip Morris has invested $2.4 billion into Cosmos, a Canadian marijuana company.

They also recently purchased Vectura, Fertin, and Kraft Foods. I know, it’s hard to see where Kraft Foods fits in here, but Vectura, an inhalational device manufacturer, and Fertin, which makes nicotine gum, as well as vehicles such as powders, pouches that dissolve in the mouth, and lozenges, certainly do fit in.

My take on these recent acquisitions is that tobacco companies realize combustibles are dying. However, they continue to develop and market nicotine in noncombustible forms. They are likely looking to move into marijuana, at least as an investment. It’s not a huge leap to consider the possibility that the purchase of Vectura will help develop delivery systems for nicotine, marijuana, and possibly medications. It’s unclear whether PMI intends to get further into inhaled pharmaceuticals.

Bottom line is that, as pulmonary physicians, we need to be aware of all developments in inhaled substances and delivery methods. On the upside, everything the industry is currently doing is apparently more transparent than they have been in the past. They are not yet, however, ceasing production and marketing of cigarettes.

It’s also important that we remind ourselves of their past actions because, personally, that past still bothers me, and I’m not quite ready to trust them. When it comes to “Big Tobacco,” it is appropriate that we always keep in mind the immortal words, often repeated in various forms, of Edgar Allen Poe, master teller of horror stories, “Believe nothing you hear and only half that you see.”³

References

1. McCaffree DR and Desai NR. Is big tobacco still trying to deceive the public? This is no time to rest on our laurels. Chest. 2018 May;153(5):1085-6. doi: 10.1016/j.chest.2018.01.012.

2. A lifetime of damage: How Big Tobacco’s predatory marketing practices harms the health of women and girls. Tobacco-Free Kids. May 2021.

3. Quote Investigator. 2017 Jun 23. “The system of Dr. Tarr and Prof. Fether,” from Graham’s Magazine, November 1845.

Paul D. Stein, MD, Master FCCP

Past President (1992-1993) of the American College of Chest Physicians (CHEST), Dr. Paul D. Stein, Master FCCP, died on July 15, 2021, in Boynton Beach, Florida. His long career in cardiovascular research included monumental studies in pulmonary embolism, pulmonary hypertension, and valvular heart disease.

Dr. Stein was regarded as a world expert on pulmonary embolism. His contributions to medicine include hundreds of published articles, five books, and countless lectures that have given the world its current understanding of heart and pulmonary diseases. Throughout his almost 50 years as a member of CHEST, as Past President, and as a Master Fellow, Dr. Stein served the College graciously in these and many other leadership roles. We extend heartfelt condolences to the Stein family.


Editor’s Note: In 2016, Dr. Stein provided CHEST Physician with a wonderful update on his current activities. You can find it in the November 2016 issue on page 54.

Paul D. Stein, MD, Master FCCP

Past President (1992-1993) of the American College of Chest Physicians (CHEST), Dr. Paul D. Stein, Master FCCP, died on July 15, 2021, in Boynton Beach, Florida. His long career in cardiovascular research included monumental studies in pulmonary embolism, pulmonary hypertension, and valvular heart disease.

Dr. Stein was regarded as a world expert on pulmonary embolism. His contributions to medicine include hundreds of published articles, five books, and countless lectures that have given the world its current understanding of heart and pulmonary diseases. Throughout his almost 50 years as a member of CHEST, as Past President, and as a Master Fellow, Dr. Stein served the College graciously in these and many other leadership roles. We extend heartfelt condolences to the Stein family.


Editor’s Note: In 2016, Dr. Stein provided CHEST Physician with a wonderful update on his current activities. You can find it in the November 2016 issue on page 54.

Paul D. Stein, MD, Master FCCP

Past President (1992-1993) of the American College of Chest Physicians (CHEST), Dr. Paul D. Stein, Master FCCP, died on July 15, 2021, in Boynton Beach, Florida. His long career in cardiovascular research included monumental studies in pulmonary embolism, pulmonary hypertension, and valvular heart disease.

Dr. Stein was regarded as a world expert on pulmonary embolism. His contributions to medicine include hundreds of published articles, five books, and countless lectures that have given the world its current understanding of heart and pulmonary diseases. Throughout his almost 50 years as a member of CHEST, as Past President, and as a Master Fellow, Dr. Stein served the College graciously in these and many other leadership roles. We extend heartfelt condolences to the Stein family.


Editor’s Note: In 2016, Dr. Stein provided CHEST Physician with a wonderful update on his current activities. You can find it in the November 2016 issue on page 54.

The American Medical Association (AMA) conducted its June 2021 AMA Special Meeting of the AMA House of Delegates from June 11-16 virtually. Delegates from more than 170 societies (state societies, specialties, subspecialties, and uniformed services), comprised of nearly 700 physicians, residents, and medical students, gathered for the June 2021 AMA Special Meeting of the AMA House of Delegates (HOD) to consider a wide array of proposals.

CHEST is an active member, and through the HOD and Specialty and Service Society Caucus, CHEST has partnered with AMA and its sister societies to work with each other on important regulatory issues. Chest/Allergy Section Council (participants at this meeting were from the AAAAI, AAOA, AASM, ACAAI, ATS, CHEST, and SCCM) met before the proceedings of the House to discuss pending business. The meeting was hosted by the current CHEST/Allergy council chair Dr. Wesley Vander Ark (AMA Delegate AAOA) and Jami Lucas, CEO AAOA.
 

Brief updates on the Resolutions

Continuity of care of patients discharged from hospital settings (Adapted as a new policy)

The policy focuses on key issues around the continuity of care of patients. It includes protections of continuity of care for medical services and medications that are prescribed during patient hospitalizations, including when there are formulary or treatment coverage changes that have the potential to disrupt therapy following discharge.


Licensure and telehealth

The policy urges AMA to continue to support state efforts to expand physician licensure recognition across state lines in accordance with the standards and safeguards Coverage and Payment for Telemedicine. (New HOD Policy)

AMA to conduct or commission a study on the effect that telemedicine services have had on health insurance premiums, focusing on the differences between states that had telehealth payment parity provisions in effect prior to the pandemic vs those that did not, and report back at the 2021 Interim Meeting of the AMA House of Delegates. (Directive to Take Action). CHEST has taken an active role in supporting this resolution through advocating for telemedicine services and reimbursement, as well as leading the CHEST Clinician Matching Network that pairs volunteer doctors with hospitals based on their need throughout the country.
 

Vaccines (Adopted as a new policy)

The policy urges AMA to advocate for the prohibition of the use of patient/customer information collected by retail pharmacies for COVID-19 vaccination scheduling and/or the vaccine administration process for the purpose of commercial marketing or future patient recruiting purposes, especially any targeting based on medical history condition. AMA opposes the sale of medical history data and contact information accumulated through the scheduling or provision of government-funded vaccinations to third parties for use in marketing or advertising.

Additionally, as it relates to vaccines, CHEST has joined a joint society statement supporting a vaccine mandate for all health care workers.
 

Optimizing match outcomes (Directive to Take Action)

The policy urges AMA to encourage the Association of American Medical Colleges, American Association of Colleges of Osteopathic Medicine, National Resident Matching Program, and other key stakeholders to jointly create a no-fee, easily accessible clearinghouse of reliable and valid advice and tools for residency program applicants seeking cost-effective methods for applying to and successfully matching into residency.

Ensuring adequate health care resources to address the long COVID crisis and call for increased funding and research for post-viral syndromes

The policy directs AMA to support the development of an ICD-10 code or family of codes to recognize Post-Acute Sequelae of SARS-CoV-2 infection (“PASC” or “Long COVID”) and other novel post-viral syndromes as distinct diagnoses. (New HOD Policy). Further, the policy directs AMA to advocate for legislation to provide funding for research, prevention, control, and treatment of post-viral syndromes and long-term sequelae associated with viral infections, such as COVID-19 and AMA provide physicians and medical students with accurate and current information on post-viral syndromes and long-term sequelae associated with viral infections, such as COVID-19; and further that AMA collaborate with other medical and educational entities to promote education among patients about post-viral syndromes and long-term sequelae associated with viral infections, such as COVID-19, to minimize the harm and disability current and future patients face. (Directive to Take Action)

Medical misinformation in the age of social media (Directive to Take Action)

AMA encourage social media organizations to further strengthen their content moderation policies related to medical misinformation, including, but not limited to, enhanced content monitoring, augmentation of recommendation engines focused on false information, and stronger integration of verified health information. AMA should encourage social media organizations to recognize the spread of medical misinformation over dissemination networks and collaborate with relevant stakeholders, and work with public health agencies to establish relationships with journalists and news agencies to enhance the public reach in disseminating accurate medical information.

Promoting equity in global vaccine distribution

AMA call for the cooperation of all governments and international agencies to share data, research, and resources for the production and distribution of medicines, vaccines, and personal protective equipment (Directive to Take Action); and be it further, AMA promote and support efforts to supply COVID vaccines to 21health care agencies in other parts of the world to be administered to individuals who can’t afford them. (Directive to Take Action). AMA urge the US government to provide all possible assistance, including surplus vaccines and vaccines that have not had emergency use authorization, to the citizens of India and other countries in a similar situation in this humanitarian crisis (New HOD Policy).

CHEST has taken an active role in promoting equity in health care and vaccine distribution in partnership with the American Lung Association and the American Thoracic Society, including establishing a research grant program focused on this topic.
 

Addressing inflammatory and untruthful online ratings (Directive to Take Action)

AMA take action that would urge online review organizations to create internal mechanisms ensuring due process to physicians before the publication of negative reviews.

This is just a small sampling of the activities and more information, including reports from the various Councils, are available on the AMA website.

CHEST members interested in the AMA policy-making process may observe any AMA-HOD meeting or participate in the AMA’s democratic processes. Attendees will also be able to increase their knowledge and skills at no cost. They will also be able to connect with more than 1,500 peers and other meeting attendees from across the country. CHEST members with the time (there are two 5-day meetings each year) and interest are invited to apply to be an official CHEST delegate to the AMA. Contact Suzanne Sletto at [email protected] for details.

Delegates and alternate delegates to the House of Delegates (HOD) play a critical role in the democratic policy-making process that is the foundation of the AMA. Their role is multi-dimensional and includes:

• Advocacy for patients within the HOD to improve the health of the public and the health care system;
• Representation of the perspectives of their sponsoring organization to the HOD;
• Representation of their physician and medical student constituents in the decision-making process of the HOD;
• Representation of the AMA and its House of Delegates to member and nonmember physicians, medical associations, and others; and
• Solicitation of input from and provision of feedback to constituents.

Also, HOD delegates and alternate delegates are expected to foster a positive and useful two-way relationship between grassroots physicians and the CHEST leadership.
 

Dr. Desai is with the Chicago Chest Center and AMITA Health Suburban Lung Associates; and the Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago.

The American Medical Association (AMA) conducted its June 2021 AMA Special Meeting of the AMA House of Delegates from June 11-16 virtually. Delegates from more than 170 societies (state societies, specialties, subspecialties, and uniformed services), comprised of nearly 700 physicians, residents, and medical students, gathered for the June 2021 AMA Special Meeting of the AMA House of Delegates (HOD) to consider a wide array of proposals.

CHEST is an active member, and through the HOD and Specialty and Service Society Caucus, CHEST has partnered with AMA and its sister societies to work with each other on important regulatory issues. Chest/Allergy Section Council (participants at this meeting were from the AAAAI, AAOA, AASM, ACAAI, ATS, CHEST, and SCCM) met before the proceedings of the House to discuss pending business. The meeting was hosted by the current CHEST/Allergy council chair Dr. Wesley Vander Ark (AMA Delegate AAOA) and Jami Lucas, CEO AAOA.
 

Brief updates on the Resolutions

Continuity of care of patients discharged from hospital settings (Adapted as a new policy)

The policy focuses on key issues around the continuity of care of patients. It includes protections of continuity of care for medical services and medications that are prescribed during patient hospitalizations, including when there are formulary or treatment coverage changes that have the potential to disrupt therapy following discharge.


Licensure and telehealth

The policy urges AMA to continue to support state efforts to expand physician licensure recognition across state lines in accordance with the standards and safeguards Coverage and Payment for Telemedicine. (New HOD Policy)

AMA to conduct or commission a study on the effect that telemedicine services have had on health insurance premiums, focusing on the differences between states that had telehealth payment parity provisions in effect prior to the pandemic vs those that did not, and report back at the 2021 Interim Meeting of the AMA House of Delegates. (Directive to Take Action). CHEST has taken an active role in supporting this resolution through advocating for telemedicine services and reimbursement, as well as leading the CHEST Clinician Matching Network that pairs volunteer doctors with hospitals based on their need throughout the country.
 

Vaccines (Adopted as a new policy)

The policy urges AMA to advocate for the prohibition of the use of patient/customer information collected by retail pharmacies for COVID-19 vaccination scheduling and/or the vaccine administration process for the purpose of commercial marketing or future patient recruiting purposes, especially any targeting based on medical history condition. AMA opposes the sale of medical history data and contact information accumulated through the scheduling or provision of government-funded vaccinations to third parties for use in marketing or advertising.

Additionally, as it relates to vaccines, CHEST has joined a joint society statement supporting a vaccine mandate for all health care workers.
 

Optimizing match outcomes (Directive to Take Action)

The policy urges AMA to encourage the Association of American Medical Colleges, American Association of Colleges of Osteopathic Medicine, National Resident Matching Program, and other key stakeholders to jointly create a no-fee, easily accessible clearinghouse of reliable and valid advice and tools for residency program applicants seeking cost-effective methods for applying to and successfully matching into residency.

Ensuring adequate health care resources to address the long COVID crisis and call for increased funding and research for post-viral syndromes

The policy directs AMA to support the development of an ICD-10 code or family of codes to recognize Post-Acute Sequelae of SARS-CoV-2 infection (“PASC” or “Long COVID”) and other novel post-viral syndromes as distinct diagnoses. (New HOD Policy). Further, the policy directs AMA to advocate for legislation to provide funding for research, prevention, control, and treatment of post-viral syndromes and long-term sequelae associated with viral infections, such as COVID-19 and AMA provide physicians and medical students with accurate and current information on post-viral syndromes and long-term sequelae associated with viral infections, such as COVID-19; and further that AMA collaborate with other medical and educational entities to promote education among patients about post-viral syndromes and long-term sequelae associated with viral infections, such as COVID-19, to minimize the harm and disability current and future patients face. (Directive to Take Action)

Medical misinformation in the age of social media (Directive to Take Action)

AMA encourage social media organizations to further strengthen their content moderation policies related to medical misinformation, including, but not limited to, enhanced content monitoring, augmentation of recommendation engines focused on false information, and stronger integration of verified health information. AMA should encourage social media organizations to recognize the spread of medical misinformation over dissemination networks and collaborate with relevant stakeholders, and work with public health agencies to establish relationships with journalists and news agencies to enhance the public reach in disseminating accurate medical information.

Promoting equity in global vaccine distribution

AMA call for the cooperation of all governments and international agencies to share data, research, and resources for the production and distribution of medicines, vaccines, and personal protective equipment (Directive to Take Action); and be it further, AMA promote and support efforts to supply COVID vaccines to 21health care agencies in other parts of the world to be administered to individuals who can’t afford them. (Directive to Take Action). AMA urge the US government to provide all possible assistance, including surplus vaccines and vaccines that have not had emergency use authorization, to the citizens of India and other countries in a similar situation in this humanitarian crisis (New HOD Policy).

CHEST has taken an active role in promoting equity in health care and vaccine distribution in partnership with the American Lung Association and the American Thoracic Society, including establishing a research grant program focused on this topic.
 

Addressing inflammatory and untruthful online ratings (Directive to Take Action)

AMA take action that would urge online review organizations to create internal mechanisms ensuring due process to physicians before the publication of negative reviews.

This is just a small sampling of the activities and more information, including reports from the various Councils, are available on the AMA website.

CHEST members interested in the AMA policy-making process may observe any AMA-HOD meeting or participate in the AMA’s democratic processes. Attendees will also be able to increase their knowledge and skills at no cost. They will also be able to connect with more than 1,500 peers and other meeting attendees from across the country. CHEST members with the time (there are two 5-day meetings each year) and interest are invited to apply to be an official CHEST delegate to the AMA. Contact Suzanne Sletto at [email protected] for details.

Delegates and alternate delegates to the House of Delegates (HOD) play a critical role in the democratic policy-making process that is the foundation of the AMA. Their role is multi-dimensional and includes:

• Advocacy for patients within the HOD to improve the health of the public and the health care system;
• Representation of the perspectives of their sponsoring organization to the HOD;
• Representation of their physician and medical student constituents in the decision-making process of the HOD;
• Representation of the AMA and its House of Delegates to member and nonmember physicians, medical associations, and others; and
• Solicitation of input from and provision of feedback to constituents.

Also, HOD delegates and alternate delegates are expected to foster a positive and useful two-way relationship between grassroots physicians and the CHEST leadership.
 

Dr. Desai is with the Chicago Chest Center and AMITA Health Suburban Lung Associates; and the Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago.

The American Medical Association (AMA) conducted its June 2021 AMA Special Meeting of the AMA House of Delegates from June 11-16 virtually. Delegates from more than 170 societies (state societies, specialties, subspecialties, and uniformed services), comprised of nearly 700 physicians, residents, and medical students, gathered for the June 2021 AMA Special Meeting of the AMA House of Delegates (HOD) to consider a wide array of proposals.

CHEST is an active member, and through the HOD and Specialty and Service Society Caucus, CHEST has partnered with AMA and its sister societies to work with each other on important regulatory issues. Chest/Allergy Section Council (participants at this meeting were from the AAAAI, AAOA, AASM, ACAAI, ATS, CHEST, and SCCM) met before the proceedings of the House to discuss pending business. The meeting was hosted by the current CHEST/Allergy council chair Dr. Wesley Vander Ark (AMA Delegate AAOA) and Jami Lucas, CEO AAOA.
 

Brief updates on the Resolutions

Continuity of care of patients discharged from hospital settings (Adapted as a new policy)

The policy focuses on key issues around the continuity of care of patients. It includes protections of continuity of care for medical services and medications that are prescribed during patient hospitalizations, including when there are formulary or treatment coverage changes that have the potential to disrupt therapy following discharge.


Licensure and telehealth

The policy urges AMA to continue to support state efforts to expand physician licensure recognition across state lines in accordance with the standards and safeguards Coverage and Payment for Telemedicine. (New HOD Policy)

AMA to conduct or commission a study on the effect that telemedicine services have had on health insurance premiums, focusing on the differences between states that had telehealth payment parity provisions in effect prior to the pandemic vs those that did not, and report back at the 2021 Interim Meeting of the AMA House of Delegates. (Directive to Take Action). CHEST has taken an active role in supporting this resolution through advocating for telemedicine services and reimbursement, as well as leading the CHEST Clinician Matching Network that pairs volunteer doctors with hospitals based on their need throughout the country.
 

Vaccines (Adopted as a new policy)

The policy urges AMA to advocate for the prohibition of the use of patient/customer information collected by retail pharmacies for COVID-19 vaccination scheduling and/or the vaccine administration process for the purpose of commercial marketing or future patient recruiting purposes, especially any targeting based on medical history condition. AMA opposes the sale of medical history data and contact information accumulated through the scheduling or provision of government-funded vaccinations to third parties for use in marketing or advertising.

Additionally, as it relates to vaccines, CHEST has joined a joint society statement supporting a vaccine mandate for all health care workers.
 

Optimizing match outcomes (Directive to Take Action)

The policy urges AMA to encourage the Association of American Medical Colleges, American Association of Colleges of Osteopathic Medicine, National Resident Matching Program, and other key stakeholders to jointly create a no-fee, easily accessible clearinghouse of reliable and valid advice and tools for residency program applicants seeking cost-effective methods for applying to and successfully matching into residency.

Ensuring adequate health care resources to address the long COVID crisis and call for increased funding and research for post-viral syndromes

The policy directs AMA to support the development of an ICD-10 code or family of codes to recognize Post-Acute Sequelae of SARS-CoV-2 infection (“PASC” or “Long COVID”) and other novel post-viral syndromes as distinct diagnoses. (New HOD Policy). Further, the policy directs AMA to advocate for legislation to provide funding for research, prevention, control, and treatment of post-viral syndromes and long-term sequelae associated with viral infections, such as COVID-19 and AMA provide physicians and medical students with accurate and current information on post-viral syndromes and long-term sequelae associated with viral infections, such as COVID-19; and further that AMA collaborate with other medical and educational entities to promote education among patients about post-viral syndromes and long-term sequelae associated with viral infections, such as COVID-19, to minimize the harm and disability current and future patients face. (Directive to Take Action)

Medical misinformation in the age of social media (Directive to Take Action)

AMA encourage social media organizations to further strengthen their content moderation policies related to medical misinformation, including, but not limited to, enhanced content monitoring, augmentation of recommendation engines focused on false information, and stronger integration of verified health information. AMA should encourage social media organizations to recognize the spread of medical misinformation over dissemination networks and collaborate with relevant stakeholders, and work with public health agencies to establish relationships with journalists and news agencies to enhance the public reach in disseminating accurate medical information.

Promoting equity in global vaccine distribution

AMA call for the cooperation of all governments and international agencies to share data, research, and resources for the production and distribution of medicines, vaccines, and personal protective equipment (Directive to Take Action); and be it further, AMA promote and support efforts to supply COVID vaccines to 21health care agencies in other parts of the world to be administered to individuals who can’t afford them. (Directive to Take Action). AMA urge the US government to provide all possible assistance, including surplus vaccines and vaccines that have not had emergency use authorization, to the citizens of India and other countries in a similar situation in this humanitarian crisis (New HOD Policy).

CHEST has taken an active role in promoting equity in health care and vaccine distribution in partnership with the American Lung Association and the American Thoracic Society, including establishing a research grant program focused on this topic.
 

Addressing inflammatory and untruthful online ratings (Directive to Take Action)

AMA take action that would urge online review organizations to create internal mechanisms ensuring due process to physicians before the publication of negative reviews.

This is just a small sampling of the activities and more information, including reports from the various Councils, are available on the AMA website.

CHEST members interested in the AMA policy-making process may observe any AMA-HOD meeting or participate in the AMA’s democratic processes. Attendees will also be able to increase their knowledge and skills at no cost. They will also be able to connect with more than 1,500 peers and other meeting attendees from across the country. CHEST members with the time (there are two 5-day meetings each year) and interest are invited to apply to be an official CHEST delegate to the AMA. Contact Suzanne Sletto at [email protected] for details.

Delegates and alternate delegates to the House of Delegates (HOD) play a critical role in the democratic policy-making process that is the foundation of the AMA. Their role is multi-dimensional and includes:

• Advocacy for patients within the HOD to improve the health of the public and the health care system;
• Representation of the perspectives of their sponsoring organization to the HOD;
• Representation of their physician and medical student constituents in the decision-making process of the HOD;
• Representation of the AMA and its House of Delegates to member and nonmember physicians, medical associations, and others; and
• Solicitation of input from and provision of feedback to constituents.

Also, HOD delegates and alternate delegates are expected to foster a positive and useful two-way relationship between grassroots physicians and the CHEST leadership.
 

Dr. Desai is with the Chicago Chest Center and AMITA Health Suburban Lung Associates; and the Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago.

Occupational and environmental health

Destruction in the air

Building collapse, such as that of the Surfside condominiums in Miami, Florida, results not only in tragic loss of life but also leads to devastating effects on lung health. Following the World Trade Center collapse, a massive particle dust cloud of up to 11,000 tons of PM_2.5 was dispersed, 90% of which was particles greater than 10 mcm (Rom et al. Proc Am Thorac Soc. 2010 May;7[2]:142-5).

Fine particulate matter has been associated with multiple lung conditions. Those who arrive on site in the first 24 hours may have immediate changes in FEV₁ and FVC. Acute eosinophilic pneumonia has also been described in the initial aftermath (Rom et al. Am J Respir Crit Care Med. 2002;166(6):785).

Chronic lung diseases such as chronic obstructive pulmonary disease and asthma, may worsen with repeated exposure. One Swedish study demonstrated an increased incidence of chronic lower respiratory disease in cement and demolition workers compared with the general labor force (Purdue et al. Thorax. 2007 Jan;62[1]:51-6). Clean-up sites may contain a variety of materials associated with occupational lung diseases, like chrysolite asbestos, silica, and heavy metals.

Prevention remains key. In the United States, the Occupational Safety and Health Administration requires all construction and demolition sites to have a dust control plan. Primary prevention includes the use of N-95 masks and watering sites. N-95 masks protect against particulate matter PM_2.5 and smaller (Zhou et al. J Thorac Dis. 2018 Mar;10[3]:2059-69. Watering sites, while useful, can be challenging depending on the size and temperature of the area. Workers in high-risk occupations should have prior screening with pulmonary function testing. After an exposure, it is recommended pulmonary function testing be repeated, with close interval monitoring.

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

Tyler Church, DO

Jason Unger, MD

Fellow-in-training Members

Bathmapriya Balakrishnan, MD

Steering Committee Member
 

Palliative care and end of life

Empathy in the ICU

The importance of empathetic patient care has never seemed so significant with patients isolated from the standard support systems in a pandemic that has pushed health care to its limits. While empathy can clearly impact patient outcomes (Rakel DP et al. Fam Med. 2009;41[7]:494-501), the practicality of delivering empathic care is less well defined. Into this void step Dr. Jessica Bunin and colleagues (Bunin J et al. J Crit Care. 2021;29;65:156-63), who present a scoping review of the limited literature in an effort to address gaps in the practice of empathy. Perhaps unsurprising but most critically, the authors found that far from being a dichotomous construct, empathy is a “complex phenomenon” that exists on a continuum. It is inconsistently defined in the existing literature, with the inclusion of cognitive, affective, and somatic processes variable. Equally important, they identified that practicing empathy carries risk in addition to its beneficial applications for both patients and intensivists.

Far from being easily identifiable, measured, and taught, this concept of empathy as a nuanced and contextually charged skill that requires practice and reflection aligns it with other skills and tools used in the care of our critically ill patients. This group has suggested that a clear definition of empathy, transparent discussion of the risks and benefits of using empathy, attention to developing environments that minimize barriers and facilitate the practice of empathy in clinical care, and the growth of educational practice to promote attention to self-care in the use of empathy will overall benefit both patient and physician well-being. At the very least, we need to allow ourselves grace to fail and learn as we strive to provide empathic care for our patients and ourselves.

Laura Johnson, MD, FCCP

NetWork Ex-Officio
 

Respiratory care network

National campaign to address respiratory therapist shortage

As our population grows, hospitals and physician practices face a rapidly growing need for more specialized, high-quality respiratory care; but the numbers of respiratory therapists are not keeping pace. (U.S. Bureau of Labor Statistics. Occupational Outlook Handbook. Respiratory Therapists).

To inspire a new generation of respiratory therapists and promote this lifesaving profession, the American Association for Respiratory Care (AARC), the Commission on Accreditation for Respiratory Care (CoARC), and The National Board for Respiratory Care (NBRC) are pursuing a multiyear, national campaign called The World Needs More RTs. This campaign has three primary goals:

1. Enhance the value of the respiratory care profession.

2. Recruit and retain more respiratory therapists.

3. Shape future leadership in respiratory care.

There are factors behind the current and impending future inadequate numbers of respiratory therapists:

• Decrease in undergraduate enrollment.
• Increase in retirements.
• Escalation of burnout in health care.

This campaign aims to address these factors, enhance interest in the profession, and prevent further decline in RT numbers.

Respiratory therapists make an invaluable impact on patient care, and simply put, the world needs more RTs. More RTs are needed to provide lifesaving care in the critical care units, emergency departments, and clinics (Shaw RC, Benavente JL. AARC Human Resources Survey of Acute Care Hospital Employers. NBRC 2020). More RTs are needed to educate the next RT generation (Shaw RC, Benavente JL. AARC Human Resources Survey of Education Programs. NBRC 2020). To see how you can champion the campaign, visit MoreRTs.com.

Lori Tinkler, MBA

CEO, NBRC

Steering Committee Member

De De Gardner, DrPH, RRT, FCCP

Vice-Chair
 

Sleep disorders

COPD and sleep-disordered breathing: Updates and steps forward

The presence of sleep breathing disorders in individuals with COPD, in the form of COPD and OSA overlap syndrome (OVS) or chronic hypercarbic respiratory failure (CHRF), portend poor outcomes when untreated. Treatment of OVS and CHRF are among few interventions that positively impact mortality, readmission rates, and quality of life in patients with COPD.

Higher mortality and readmission rates are seen in those admitted with COPD exacerbations who have OVS compared with COPD alone. Initiation and adherence to PAP therapy decreases mortality and COPD-related hospitalizations (Ioachimescu OC et al. J Clin Sleep Med. 2020;16[2]:267-77; Singh G et al. Sleep Breath. 2019;23[1]:193).

In CHRF, initiation of high intensity noninvasive ventilation (NIV) at least 2 weeks after resolution of acute respiratory failure reduces mortality and prolongs time to readmission (Murphy PB et al. JAMA. 2017;317[21]:2177-86; Kohnlein T et al. Lancet Respir Med. 2014;2:698-705). Initiating home NIV in individuals with acute hypercarbic respiratory failure does not improve readmission rates or time to readmission (Struik FM et al. Thorax. 2014;69:826-34). The new ATS guidelines, therefore, recommend NIV initiation for stable CHRF in COPD, screening for OVS prior to NIV initiation, and targeting PaCO₂ normalization (Macrea M et al. Am J Respir Crit Care Med. 2020;202[4]:e74-e87).

Identification and treatment of OVS and CHRF pose unique challenges for clinicians, particularly when navigating current testing and reimbursement guidelines. A multisociety Technical Expert Panel, including members of CHEST, has recently published its recommendations for changes to CMS national coverage determinations for NIV to take the next steps forward (Gay PC et al. Chest. 2021;S0012-3692[21]01481-1).

Megan Lowery, MD

Sreelatha Naik, MD

Steering Committee Members
 

Thoracic oncology

CHEST releases its newest edition of the tobacco treatment toolkit

Tobacco remains the greatest single cause of morbidity and mortality. Left unaddressed, tobacco is projected to kill 1 billion people worldwide this century. Despite this, only 5% of all tobacco-dependent patients in the United States receive both a medication and even minimal counseling for their addiction.

Tobacco dependence is a severe chronic life-threatening disease. It is with this focus that CHEST released its latest iteration of the Tobacco Dependence Treatment Toolkit. This edition focuses on treating tobacco addiction as a chronic disease, titrating all seven FDA-approved medications toward tobacco abstinence, and medical practice/hospital reimbursement.

The CHEST toolkit is divided into eight sections: Motivational Interviewing, Testing/Diagnostics, Treatment Basics (pharmacologic and nonpharmacologic), Treatment Pearls, Clinical Vignettes and Studies, Special Populations, Treatment for e-Cigarettes and Other Tobacco Products, and Insurance Billing and Telehealth.

Special attention is given to tobacco addiction diagnostics and using these findings to treat the chronic disease of tobacco addiction just like any other chronic disease by aggressively and successfully titrating FDA-approved medications in various permutations and combinations, as needed. The therapeutic goal is assisting the patient to feel normal, minimizing withdrawal throughout the process, so that tobacco abstinence can ultimately be obtained and maintained.

Clinicians and medical centers can receive insurance reimbursement for these diagnostics and associated interventions. This includes both in-office procedures and via telehealth. The CHEST toolkit discusses both in-depth.

A new unique associated feature is our Clinician Interactive Toolkit. This multimedia interactive platform reviews clinician interactions with a tobacco-dependent patient via avatars and can be found here: Clinician Interactive Toolkit.

https://foundation.chestnet.org/lung-health-a-z/smoking-and-tobacco-use/?Item=For-Clinicians

The American College of Chest Physicians’ Tobacco Treatment Toolkit can be downloaded here.

The American College of Chest Physicians’ Tobacco Treatment Toolkit project also included the development of a new video game for tobacco users. Smoke Out: Tobacco Pirates is available for download for free to all at the Apple App Store for iPhones and iPads, and at Google Play (play.google.com/store/apps/details?id=com.gforcelearning.smokeout&hl=en_US&gl=US). The game is fun, the theme is immersive, and the educational content is specifically focused on tobacco users, although clinicians will enjoy it too.

Matthew Bars, MS

Steering Committee Member

Occupational and environmental health

Destruction in the air

Building collapse, such as that of the Surfside condominiums in Miami, Florida, results not only in tragic loss of life but also leads to devastating effects on lung health. Following the World Trade Center collapse, a massive particle dust cloud of up to 11,000 tons of PM_2.5 was dispersed, 90% of which was particles greater than 10 mcm (Rom et al. Proc Am Thorac Soc. 2010 May;7[2]:142-5).

Fine particulate matter has been associated with multiple lung conditions. Those who arrive on site in the first 24 hours may have immediate changes in FEV₁ and FVC. Acute eosinophilic pneumonia has also been described in the initial aftermath (Rom et al. Am J Respir Crit Care Med. 2002;166(6):785).

Chronic lung diseases such as chronic obstructive pulmonary disease and asthma, may worsen with repeated exposure. One Swedish study demonstrated an increased incidence of chronic lower respiratory disease in cement and demolition workers compared with the general labor force (Purdue et al. Thorax. 2007 Jan;62[1]:51-6). Clean-up sites may contain a variety of materials associated with occupational lung diseases, like chrysolite asbestos, silica, and heavy metals.

Prevention remains key. In the United States, the Occupational Safety and Health Administration requires all construction and demolition sites to have a dust control plan. Primary prevention includes the use of N-95 masks and watering sites. N-95 masks protect against particulate matter PM_2.5 and smaller (Zhou et al. J Thorac Dis. 2018 Mar;10[3]:2059-69. Watering sites, while useful, can be challenging depending on the size and temperature of the area. Workers in high-risk occupations should have prior screening with pulmonary function testing. After an exposure, it is recommended pulmonary function testing be repeated, with close interval monitoring.

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

Tyler Church, DO

Jason Unger, MD

Fellow-in-training Members

Bathmapriya Balakrishnan, MD

Steering Committee Member
 

Palliative care and end of life

Empathy in the ICU

The importance of empathetic patient care has never seemed so significant with patients isolated from the standard support systems in a pandemic that has pushed health care to its limits. While empathy can clearly impact patient outcomes (Rakel DP et al. Fam Med. 2009;41[7]:494-501), the practicality of delivering empathic care is less well defined. Into this void step Dr. Jessica Bunin and colleagues (Bunin J et al. J Crit Care. 2021;29;65:156-63), who present a scoping review of the limited literature in an effort to address gaps in the practice of empathy. Perhaps unsurprising but most critically, the authors found that far from being a dichotomous construct, empathy is a “complex phenomenon” that exists on a continuum. It is inconsistently defined in the existing literature, with the inclusion of cognitive, affective, and somatic processes variable. Equally important, they identified that practicing empathy carries risk in addition to its beneficial applications for both patients and intensivists.

Far from being easily identifiable, measured, and taught, this concept of empathy as a nuanced and contextually charged skill that requires practice and reflection aligns it with other skills and tools used in the care of our critically ill patients. This group has suggested that a clear definition of empathy, transparent discussion of the risks and benefits of using empathy, attention to developing environments that minimize barriers and facilitate the practice of empathy in clinical care, and the growth of educational practice to promote attention to self-care in the use of empathy will overall benefit both patient and physician well-being. At the very least, we need to allow ourselves grace to fail and learn as we strive to provide empathic care for our patients and ourselves.

Laura Johnson, MD, FCCP

NetWork Ex-Officio
 

Respiratory care network

National campaign to address respiratory therapist shortage

As our population grows, hospitals and physician practices face a rapidly growing need for more specialized, high-quality respiratory care; but the numbers of respiratory therapists are not keeping pace. (U.S. Bureau of Labor Statistics. Occupational Outlook Handbook. Respiratory Therapists).

To inspire a new generation of respiratory therapists and promote this lifesaving profession, the American Association for Respiratory Care (AARC), the Commission on Accreditation for Respiratory Care (CoARC), and The National Board for Respiratory Care (NBRC) are pursuing a multiyear, national campaign called The World Needs More RTs. This campaign has three primary goals:

1. Enhance the value of the respiratory care profession.

2. Recruit and retain more respiratory therapists.

3. Shape future leadership in respiratory care.

There are factors behind the current and impending future inadequate numbers of respiratory therapists:

• Decrease in undergraduate enrollment.
• Increase in retirements.
• Escalation of burnout in health care.

This campaign aims to address these factors, enhance interest in the profession, and prevent further decline in RT numbers.

Respiratory therapists make an invaluable impact on patient care, and simply put, the world needs more RTs. More RTs are needed to provide lifesaving care in the critical care units, emergency departments, and clinics (Shaw RC, Benavente JL. AARC Human Resources Survey of Acute Care Hospital Employers. NBRC 2020). More RTs are needed to educate the next RT generation (Shaw RC, Benavente JL. AARC Human Resources Survey of Education Programs. NBRC 2020). To see how you can champion the campaign, visit MoreRTs.com.

Lori Tinkler, MBA

CEO, NBRC

Steering Committee Member

De De Gardner, DrPH, RRT, FCCP

Vice-Chair
 

Sleep disorders

COPD and sleep-disordered breathing: Updates and steps forward

The presence of sleep breathing disorders in individuals with COPD, in the form of COPD and OSA overlap syndrome (OVS) or chronic hypercarbic respiratory failure (CHRF), portend poor outcomes when untreated. Treatment of OVS and CHRF are among few interventions that positively impact mortality, readmission rates, and quality of life in patients with COPD.

Higher mortality and readmission rates are seen in those admitted with COPD exacerbations who have OVS compared with COPD alone. Initiation and adherence to PAP therapy decreases mortality and COPD-related hospitalizations (Ioachimescu OC et al. J Clin Sleep Med. 2020;16[2]:267-77; Singh G et al. Sleep Breath. 2019;23[1]:193).

In CHRF, initiation of high intensity noninvasive ventilation (NIV) at least 2 weeks after resolution of acute respiratory failure reduces mortality and prolongs time to readmission (Murphy PB et al. JAMA. 2017;317[21]:2177-86; Kohnlein T et al. Lancet Respir Med. 2014;2:698-705). Initiating home NIV in individuals with acute hypercarbic respiratory failure does not improve readmission rates or time to readmission (Struik FM et al. Thorax. 2014;69:826-34). The new ATS guidelines, therefore, recommend NIV initiation for stable CHRF in COPD, screening for OVS prior to NIV initiation, and targeting PaCO₂ normalization (Macrea M et al. Am J Respir Crit Care Med. 2020;202[4]:e74-e87).

Identification and treatment of OVS and CHRF pose unique challenges for clinicians, particularly when navigating current testing and reimbursement guidelines. A multisociety Technical Expert Panel, including members of CHEST, has recently published its recommendations for changes to CMS national coverage determinations for NIV to take the next steps forward (Gay PC et al. Chest. 2021;S0012-3692[21]01481-1).

Megan Lowery, MD

Sreelatha Naik, MD

Steering Committee Members
 

Thoracic oncology

CHEST releases its newest edition of the tobacco treatment toolkit

Tobacco remains the greatest single cause of morbidity and mortality. Left unaddressed, tobacco is projected to kill 1 billion people worldwide this century. Despite this, only 5% of all tobacco-dependent patients in the United States receive both a medication and even minimal counseling for their addiction.

Tobacco dependence is a severe chronic life-threatening disease. It is with this focus that CHEST released its latest iteration of the Tobacco Dependence Treatment Toolkit. This edition focuses on treating tobacco addiction as a chronic disease, titrating all seven FDA-approved medications toward tobacco abstinence, and medical practice/hospital reimbursement.

The CHEST toolkit is divided into eight sections: Motivational Interviewing, Testing/Diagnostics, Treatment Basics (pharmacologic and nonpharmacologic), Treatment Pearls, Clinical Vignettes and Studies, Special Populations, Treatment for e-Cigarettes and Other Tobacco Products, and Insurance Billing and Telehealth.

Special attention is given to tobacco addiction diagnostics and using these findings to treat the chronic disease of tobacco addiction just like any other chronic disease by aggressively and successfully titrating FDA-approved medications in various permutations and combinations, as needed. The therapeutic goal is assisting the patient to feel normal, minimizing withdrawal throughout the process, so that tobacco abstinence can ultimately be obtained and maintained.

Clinicians and medical centers can receive insurance reimbursement for these diagnostics and associated interventions. This includes both in-office procedures and via telehealth. The CHEST toolkit discusses both in-depth.

A new unique associated feature is our Clinician Interactive Toolkit. This multimedia interactive platform reviews clinician interactions with a tobacco-dependent patient via avatars and can be found here: Clinician Interactive Toolkit.

https://foundation.chestnet.org/lung-health-a-z/smoking-and-tobacco-use/?Item=For-Clinicians

The American College of Chest Physicians’ Tobacco Treatment Toolkit can be downloaded here.

The American College of Chest Physicians’ Tobacco Treatment Toolkit project also included the development of a new video game for tobacco users. Smoke Out: Tobacco Pirates is available for download for free to all at the Apple App Store for iPhones and iPads, and at Google Play (play.google.com/store/apps/details?id=com.gforcelearning.smokeout&hl=en_US&gl=US). The game is fun, the theme is immersive, and the educational content is specifically focused on tobacco users, although clinicians will enjoy it too.

Matthew Bars, MS

Steering Committee Member

Occupational and environmental health

Destruction in the air

Building collapse, such as that of the Surfside condominiums in Miami, Florida, results not only in tragic loss of life but also leads to devastating effects on lung health. Following the World Trade Center collapse, a massive particle dust cloud of up to 11,000 tons of PM_2.5 was dispersed, 90% of which was particles greater than 10 mcm (Rom et al. Proc Am Thorac Soc. 2010 May;7[2]:142-5).

Fine particulate matter has been associated with multiple lung conditions. Those who arrive on site in the first 24 hours may have immediate changes in FEV₁ and FVC. Acute eosinophilic pneumonia has also been described in the initial aftermath (Rom et al. Am J Respir Crit Care Med. 2002;166(6):785).

Chronic lung diseases such as chronic obstructive pulmonary disease and asthma, may worsen with repeated exposure. One Swedish study demonstrated an increased incidence of chronic lower respiratory disease in cement and demolition workers compared with the general labor force (Purdue et al. Thorax. 2007 Jan;62[1]:51-6). Clean-up sites may contain a variety of materials associated with occupational lung diseases, like chrysolite asbestos, silica, and heavy metals.

Prevention remains key. In the United States, the Occupational Safety and Health Administration requires all construction and demolition sites to have a dust control plan. Primary prevention includes the use of N-95 masks and watering sites. N-95 masks protect against particulate matter PM_2.5 and smaller (Zhou et al. J Thorac Dis. 2018 Mar;10[3]:2059-69. Watering sites, while useful, can be challenging depending on the size and temperature of the area. Workers in high-risk occupations should have prior screening with pulmonary function testing. After an exposure, it is recommended pulmonary function testing be repeated, with close interval monitoring.

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

Tyler Church, DO

Jason Unger, MD

Fellow-in-training Members

Bathmapriya Balakrishnan, MD

Steering Committee Member
 

Palliative care and end of life

Empathy in the ICU

The importance of empathetic patient care has never seemed so significant with patients isolated from the standard support systems in a pandemic that has pushed health care to its limits. While empathy can clearly impact patient outcomes (Rakel DP et al. Fam Med. 2009;41[7]:494-501), the practicality of delivering empathic care is less well defined. Into this void step Dr. Jessica Bunin and colleagues (Bunin J et al. J Crit Care. 2021;29;65:156-63), who present a scoping review of the limited literature in an effort to address gaps in the practice of empathy. Perhaps unsurprising but most critically, the authors found that far from being a dichotomous construct, empathy is a “complex phenomenon” that exists on a continuum. It is inconsistently defined in the existing literature, with the inclusion of cognitive, affective, and somatic processes variable. Equally important, they identified that practicing empathy carries risk in addition to its beneficial applications for both patients and intensivists.

Far from being easily identifiable, measured, and taught, this concept of empathy as a nuanced and contextually charged skill that requires practice and reflection aligns it with other skills and tools used in the care of our critically ill patients. This group has suggested that a clear definition of empathy, transparent discussion of the risks and benefits of using empathy, attention to developing environments that minimize barriers and facilitate the practice of empathy in clinical care, and the growth of educational practice to promote attention to self-care in the use of empathy will overall benefit both patient and physician well-being. At the very least, we need to allow ourselves grace to fail and learn as we strive to provide empathic care for our patients and ourselves.

Laura Johnson, MD, FCCP

NetWork Ex-Officio
 

Respiratory care network

National campaign to address respiratory therapist shortage

As our population grows, hospitals and physician practices face a rapidly growing need for more specialized, high-quality respiratory care; but the numbers of respiratory therapists are not keeping pace. (U.S. Bureau of Labor Statistics. Occupational Outlook Handbook. Respiratory Therapists).

To inspire a new generation of respiratory therapists and promote this lifesaving profession, the American Association for Respiratory Care (AARC), the Commission on Accreditation for Respiratory Care (CoARC), and The National Board for Respiratory Care (NBRC) are pursuing a multiyear, national campaign called The World Needs More RTs. This campaign has three primary goals:

1. Enhance the value of the respiratory care profession.

2. Recruit and retain more respiratory therapists.

3. Shape future leadership in respiratory care.

There are factors behind the current and impending future inadequate numbers of respiratory therapists:

• Decrease in undergraduate enrollment.
• Increase in retirements.
• Escalation of burnout in health care.

This campaign aims to address these factors, enhance interest in the profession, and prevent further decline in RT numbers.

Respiratory therapists make an invaluable impact on patient care, and simply put, the world needs more RTs. More RTs are needed to provide lifesaving care in the critical care units, emergency departments, and clinics (Shaw RC, Benavente JL. AARC Human Resources Survey of Acute Care Hospital Employers. NBRC 2020). More RTs are needed to educate the next RT generation (Shaw RC, Benavente JL. AARC Human Resources Survey of Education Programs. NBRC 2020). To see how you can champion the campaign, visit MoreRTs.com.

Lori Tinkler, MBA

CEO, NBRC

Steering Committee Member

De De Gardner, DrPH, RRT, FCCP

Vice-Chair
 

Sleep disorders

COPD and sleep-disordered breathing: Updates and steps forward

The presence of sleep breathing disorders in individuals with COPD, in the form of COPD and OSA overlap syndrome (OVS) or chronic hypercarbic respiratory failure (CHRF), portend poor outcomes when untreated. Treatment of OVS and CHRF are among few interventions that positively impact mortality, readmission rates, and quality of life in patients with COPD.

Higher mortality and readmission rates are seen in those admitted with COPD exacerbations who have OVS compared with COPD alone. Initiation and adherence to PAP therapy decreases mortality and COPD-related hospitalizations (Ioachimescu OC et al. J Clin Sleep Med. 2020;16[2]:267-77; Singh G et al. Sleep Breath. 2019;23[1]:193).

In CHRF, initiation of high intensity noninvasive ventilation (NIV) at least 2 weeks after resolution of acute respiratory failure reduces mortality and prolongs time to readmission (Murphy PB et al. JAMA. 2017;317[21]:2177-86; Kohnlein T et al. Lancet Respir Med. 2014;2:698-705). Initiating home NIV in individuals with acute hypercarbic respiratory failure does not improve readmission rates or time to readmission (Struik FM et al. Thorax. 2014;69:826-34). The new ATS guidelines, therefore, recommend NIV initiation for stable CHRF in COPD, screening for OVS prior to NIV initiation, and targeting PaCO₂ normalization (Macrea M et al. Am J Respir Crit Care Med. 2020;202[4]:e74-e87).

Identification and treatment of OVS and CHRF pose unique challenges for clinicians, particularly when navigating current testing and reimbursement guidelines. A multisociety Technical Expert Panel, including members of CHEST, has recently published its recommendations for changes to CMS national coverage determinations for NIV to take the next steps forward (Gay PC et al. Chest. 2021;S0012-3692[21]01481-1).

Megan Lowery, MD

Sreelatha Naik, MD

Steering Committee Members
 

Thoracic oncology

CHEST releases its newest edition of the tobacco treatment toolkit

Tobacco remains the greatest single cause of morbidity and mortality. Left unaddressed, tobacco is projected to kill 1 billion people worldwide this century. Despite this, only 5% of all tobacco-dependent patients in the United States receive both a medication and even minimal counseling for their addiction.

Tobacco dependence is a severe chronic life-threatening disease. It is with this focus that CHEST released its latest iteration of the Tobacco Dependence Treatment Toolkit. This edition focuses on treating tobacco addiction as a chronic disease, titrating all seven FDA-approved medications toward tobacco abstinence, and medical practice/hospital reimbursement.

The CHEST toolkit is divided into eight sections: Motivational Interviewing, Testing/Diagnostics, Treatment Basics (pharmacologic and nonpharmacologic), Treatment Pearls, Clinical Vignettes and Studies, Special Populations, Treatment for e-Cigarettes and Other Tobacco Products, and Insurance Billing and Telehealth.

Special attention is given to tobacco addiction diagnostics and using these findings to treat the chronic disease of tobacco addiction just like any other chronic disease by aggressively and successfully titrating FDA-approved medications in various permutations and combinations, as needed. The therapeutic goal is assisting the patient to feel normal, minimizing withdrawal throughout the process, so that tobacco abstinence can ultimately be obtained and maintained.

Clinicians and medical centers can receive insurance reimbursement for these diagnostics and associated interventions. This includes both in-office procedures and via telehealth. The CHEST toolkit discusses both in-depth.

A new unique associated feature is our Clinician Interactive Toolkit. This multimedia interactive platform reviews clinician interactions with a tobacco-dependent patient via avatars and can be found here: Clinician Interactive Toolkit.

https://foundation.chestnet.org/lung-health-a-z/smoking-and-tobacco-use/?Item=For-Clinicians

The American College of Chest Physicians’ Tobacco Treatment Toolkit can be downloaded here.

The American College of Chest Physicians’ Tobacco Treatment Toolkit project also included the development of a new video game for tobacco users. Smoke Out: Tobacco Pirates is available for download for free to all at the Apple App Store for iPhones and iPads, and at Google Play (play.google.com/store/apps/details?id=com.gforcelearning.smokeout&hl=en_US&gl=US). The game is fun, the theme is immersive, and the educational content is specifically focused on tobacco users, although clinicians will enjoy it too.

Matthew Bars, MS

Steering Committee Member

Point: E-cigarettes for harm reduction in tobacco use disorder: Pro. By Dr. C. Bates.



Counterpoint: E-cigarettes for harm reduction in tobacco use disorder: Con. By Dr. H. Kathuria, et al.



Eosinophilic and non-eosinophilic asthma: an expert consensus framework to characterize phenotypes in a global real-life severe asthma cohort. By Dr. L. G. Heaney, et al.Symptoms of mental health disorders in critical care clinicians facing the COVID-19 second wave: A cross-sectional study. By Dr. E. Azoulay, et al.Tobacco smoking and risk for pulmonary fibrosis: A prospective cohort study in UK Biobank.By Dr. V. Bellow, et al.Sleep in the hospitalized child: A contemporary review. By Dr. J. Berger, et al.Avoid the Trap: Non-expanding Lung. By Dr. D. Gillett, et al.Resuscitation a la Carte: Ethical concerns about the practice and theory of partial codes. By Dr. B. Gremmels, et al.

Point: E-cigarettes for harm reduction in tobacco use disorder: Pro. By Dr. C. Bates.



Counterpoint: E-cigarettes for harm reduction in tobacco use disorder: Con. By Dr. H. Kathuria, et al.



Eosinophilic and non-eosinophilic asthma: an expert consensus framework to characterize phenotypes in a global real-life severe asthma cohort. By Dr. L. G. Heaney, et al.Symptoms of mental health disorders in critical care clinicians facing the COVID-19 second wave: A cross-sectional study. By Dr. E. Azoulay, et al.Tobacco smoking and risk for pulmonary fibrosis: A prospective cohort study in UK Biobank.By Dr. V. Bellow, et al.Sleep in the hospitalized child: A contemporary review. By Dr. J. Berger, et al.Avoid the Trap: Non-expanding Lung. By Dr. D. Gillett, et al.Resuscitation a la Carte: Ethical concerns about the practice and theory of partial codes. By Dr. B. Gremmels, et al.

Point: E-cigarettes for harm reduction in tobacco use disorder: Pro. By Dr. C. Bates.



Counterpoint: E-cigarettes for harm reduction in tobacco use disorder: Con. By Dr. H. Kathuria, et al.



Eosinophilic and non-eosinophilic asthma: an expert consensus framework to characterize phenotypes in a global real-life severe asthma cohort. By Dr. L. G. Heaney, et al.Symptoms of mental health disorders in critical care clinicians facing the COVID-19 second wave: A cross-sectional study. By Dr. E. Azoulay, et al.Tobacco smoking and risk for pulmonary fibrosis: A prospective cohort study in UK Biobank.By Dr. V. Bellow, et al.Sleep in the hospitalized child: A contemporary review. By Dr. J. Berger, et al.Avoid the Trap: Non-expanding Lung. By Dr. D. Gillett, et al.Resuscitation a la Carte: Ethical concerns about the practice and theory of partial codes. By Dr. B. Gremmels, et al.

Is this your first CHEST Annual Meeting? Co-Chair David Zielinski, MD, FCCP, shares some words of wisdom recounting his first experience at CHEST and what first-time attendees can expect from the annual meeting.

My very first CHEST meeting was 10 years ago at CHEST 2011 in Honolulu, Hawaii. I clearly remember my first session being a postgraduate course on Respiratory Management of Neuromuscular Disease and having the opportunity for hands-on teaching with devices and techniques. 

Simulation was unique at medical conferences at that time and has continued to evolve at subsequent CHEST meetings. 

Looking back, what really sticks out about this experience is what it started for me in terms of my career and learning. I was in a session with some of the biggest names in the field—people who I always looked up to as a relatively junior faculty. I was encouraged to get more involved at CHEST and with the committees. It put the bug in my ear. 

A few years later, I started to get involved in the NetWorks. Eventually, I became a faculty member myself alongside these individuals at subsequent CHEST meetings. Meeting these chest medicine professionals also led to more collaborations with them outside of CHEST. 

I never imagined this during my first meeting ten years ago. I have now been back to every meeting but one since that first one.  
The CHEST Annual Meeting has always stood out for its focus on quality clinical teaching, being ahead of the curve on interactivity and adjusting to the audience’s learning needs. 
For me personally, though, the three things that I have always enjoyed are as follows:

Simulation opportunities
One thing that sets apart CHEST 2021 from other conferences is the simulation sessions being offered online. 
These sessions are an opportunity to practice your skills and techniques with some of the best educators anywhere in the world. I have always come out of these sessions impressed. I encourage you to try it at least once.

The fun
From the receptions, the meet-ups, pop-up events, CHEST Challenge, the games… the list goes on: the fun element of CHEST makes it a more immersive atmosphere. When the meeting was solely virtual last year, CHEST still aimed to provide fun and will continue to do the same this year. Challenge your colleagues and new friends to games at the CHEST Player Hub online to see which one of you rises to the top of the leaderboard.

The community
CHEST 2021 (and CHEST the organization) helps you make connections and provides opportunities for leadership involvement. CHEST committees are always looking for leaders at all stages of their careers. Attending satellite meetings, like the NetWork open forums that are occurring online before the meeting starts this year, will allow you to begin networking with those with similar interests to your own and hopefully will spark your interest in getting more involved in the future. 
For many of us at CHEST, the NetWorks were a great place to start, and you can join one in the area that interests you most.  Through my involvement in CHEST, I have become a part of the community, meeting so many other clinicians and educators in my field. I have made great friendships, which keep me coming back every year.

Moving forward 
From the beginning, we have been planning CHEST 2021 so that if we needed to go entirely online, we could do so as seamlessly as possible. With the recent decision to cancel the in-person meeting and go fully online, plans are already underway to make CHEST 2021 just as successful as last year’s meeting. 
We can give you our commitment that your CHEST 2021 experience will live up to being a world-class event that separates itself from other current online offerings. I will be in attendance and hope to see you online.

Start planning your days with the CHEST 2021 Schedule at A Glance at chestmeeting.chestnet.org.

Is this your first CHEST Annual Meeting? Co-Chair David Zielinski, MD, FCCP, shares some words of wisdom recounting his first experience at CHEST and what first-time attendees can expect from the annual meeting.

My very first CHEST meeting was 10 years ago at CHEST 2011 in Honolulu, Hawaii. I clearly remember my first session being a postgraduate course on Respiratory Management of Neuromuscular Disease and having the opportunity for hands-on teaching with devices and techniques. 

Simulation was unique at medical conferences at that time and has continued to evolve at subsequent CHEST meetings. 

Looking back, what really sticks out about this experience is what it started for me in terms of my career and learning. I was in a session with some of the biggest names in the field—people who I always looked up to as a relatively junior faculty. I was encouraged to get more involved at CHEST and with the committees. It put the bug in my ear. 

A few years later, I started to get involved in the NetWorks. Eventually, I became a faculty member myself alongside these individuals at subsequent CHEST meetings. Meeting these chest medicine professionals also led to more collaborations with them outside of CHEST. 

I never imagined this during my first meeting ten years ago. I have now been back to every meeting but one since that first one.  
The CHEST Annual Meeting has always stood out for its focus on quality clinical teaching, being ahead of the curve on interactivity and adjusting to the audience’s learning needs. 
For me personally, though, the three things that I have always enjoyed are as follows:

Simulation opportunities
One thing that sets apart CHEST 2021 from other conferences is the simulation sessions being offered online. 
These sessions are an opportunity to practice your skills and techniques with some of the best educators anywhere in the world. I have always come out of these sessions impressed. I encourage you to try it at least once.

The fun
From the receptions, the meet-ups, pop-up events, CHEST Challenge, the games… the list goes on: the fun element of CHEST makes it a more immersive atmosphere. When the meeting was solely virtual last year, CHEST still aimed to provide fun and will continue to do the same this year. Challenge your colleagues and new friends to games at the CHEST Player Hub online to see which one of you rises to the top of the leaderboard.

The community
CHEST 2021 (and CHEST the organization) helps you make connections and provides opportunities for leadership involvement. CHEST committees are always looking for leaders at all stages of their careers. Attending satellite meetings, like the NetWork open forums that are occurring online before the meeting starts this year, will allow you to begin networking with those with similar interests to your own and hopefully will spark your interest in getting more involved in the future. 
For many of us at CHEST, the NetWorks were a great place to start, and you can join one in the area that interests you most.  Through my involvement in CHEST, I have become a part of the community, meeting so many other clinicians and educators in my field. I have made great friendships, which keep me coming back every year.

Moving forward 
From the beginning, we have been planning CHEST 2021 so that if we needed to go entirely online, we could do so as seamlessly as possible. With the recent decision to cancel the in-person meeting and go fully online, plans are already underway to make CHEST 2021 just as successful as last year’s meeting. 
We can give you our commitment that your CHEST 2021 experience will live up to being a world-class event that separates itself from other current online offerings. I will be in attendance and hope to see you online.

Start planning your days with the CHEST 2021 Schedule at A Glance at chestmeeting.chestnet.org.

Is this your first CHEST Annual Meeting? Co-Chair David Zielinski, MD, FCCP, shares some words of wisdom recounting his first experience at CHEST and what first-time attendees can expect from the annual meeting.

My very first CHEST meeting was 10 years ago at CHEST 2011 in Honolulu, Hawaii. I clearly remember my first session being a postgraduate course on Respiratory Management of Neuromuscular Disease and having the opportunity for hands-on teaching with devices and techniques. 

Simulation was unique at medical conferences at that time and has continued to evolve at subsequent CHEST meetings. 

Looking back, what really sticks out about this experience is what it started for me in terms of my career and learning. I was in a session with some of the biggest names in the field—people who I always looked up to as a relatively junior faculty. I was encouraged to get more involved at CHEST and with the committees. It put the bug in my ear. 

A few years later, I started to get involved in the NetWorks. Eventually, I became a faculty member myself alongside these individuals at subsequent CHEST meetings. Meeting these chest medicine professionals also led to more collaborations with them outside of CHEST. 

I never imagined this during my first meeting ten years ago. I have now been back to every meeting but one since that first one.  
The CHEST Annual Meeting has always stood out for its focus on quality clinical teaching, being ahead of the curve on interactivity and adjusting to the audience’s learning needs. 
For me personally, though, the three things that I have always enjoyed are as follows:

Simulation opportunities
One thing that sets apart CHEST 2021 from other conferences is the simulation sessions being offered online. 
These sessions are an opportunity to practice your skills and techniques with some of the best educators anywhere in the world. I have always come out of these sessions impressed. I encourage you to try it at least once.

The fun
From the receptions, the meet-ups, pop-up events, CHEST Challenge, the games… the list goes on: the fun element of CHEST makes it a more immersive atmosphere. When the meeting was solely virtual last year, CHEST still aimed to provide fun and will continue to do the same this year. Challenge your colleagues and new friends to games at the CHEST Player Hub online to see which one of you rises to the top of the leaderboard.

The community
CHEST 2021 (and CHEST the organization) helps you make connections and provides opportunities for leadership involvement. CHEST committees are always looking for leaders at all stages of their careers. Attending satellite meetings, like the NetWork open forums that are occurring online before the meeting starts this year, will allow you to begin networking with those with similar interests to your own and hopefully will spark your interest in getting more involved in the future. 
For many of us at CHEST, the NetWorks were a great place to start, and you can join one in the area that interests you most.  Through my involvement in CHEST, I have become a part of the community, meeting so many other clinicians and educators in my field. I have made great friendships, which keep me coming back every year.

Moving forward 
From the beginning, we have been planning CHEST 2021 so that if we needed to go entirely online, we could do so as seamlessly as possible. With the recent decision to cancel the in-person meeting and go fully online, plans are already underway to make CHEST 2021 just as successful as last year’s meeting. 
We can give you our commitment that your CHEST 2021 experience will live up to being a world-class event that separates itself from other current online offerings. I will be in attendance and hope to see you online.

Start planning your days with the CHEST 2021 Schedule at A Glance at chestmeeting.chestnet.org.

Community service grants are one way the Foundation strives to make a tangible, lasting impact on the lives of the patients we serve – they’re not just one-off projects with limited effects. But how do we really know that we’re making a difference?

For Dr. Roberta Kato, it’s when she gets to witness an “Aha!” moment – a time when everything clicks and a parent finally understands how to better care for their child. For Marina Lima, MD, MSc, it’s knowing that one more teen isn’t gasping for air. And for Dr. Joseph Huang, it’s seeing a country of 100 million people gain access to 14 pulmonologists when there was previously only one.

Why community service grants?

The Foundation began giving community service grants in 1997 under the leadership of CHEST President D. Robert McCaffree, MD, Master FCCP. He believed the program would be the best way to support his colleagues in achieving their community service endeavors .To date, over $2 million has been given specifically to community service projects. “

Our physicians experience the limitations of our health care system first-hand – a system that isn’t built to assist the people who need help the most. Finding solutions requires a willingness to think and operate creatively. The funding the Foundation provides through our community service grants supplies the resources to do just that – implement real-world solutions that will help patients gain better access to care.
 

Cases in point

Marina Lima, MD, MSc, was seeing an inordinate number of children and teens with uncontrolled asthma symptoms in Brazil. She applied for and was awarded a grant to make Asthmaland, the first gamified pediatric asthma educational program in Portuguese.

Besides her “Aha!” moments, Dr. Roberta Kato revealed a way she knows her work is making a difference: the funding is helping to shift the nonprofit landscape in her community.

“Sometimes there is a rift between different organizations. When I ask them to collaborate or advertise together, I get resistance. However, when I’ve reached out and said that I’ve received funding for an initiative, all of a sudden, there is forward movement. That is how I am hoping to make the biggest difference,” explained Dr. Kato.

Dr. Joseph Huang, who received a grant to fund the East Africa Training Initiative (EATI), is faced with a different obstacle. “We’ve been awarded the grant many times, and I know the Foundation is focused on supporting new, up-and-coming programs. Therefore, I’m committed to ensuring that my program can continue even after we stop receiving funding.”

How is Dr. Huang going to do that? Besides procuring ICU equipment, EATI focuses on training pulmonology fellows in east Africa. The fellows who graduate will train other physicians and care team members across the continent, both in hospitals and rural clinics, safeguarding the future of his program.
 

A clear vision for the future

While the Foundation is ready to tackle new problems, community service grants will remain the constant thread woven throughout the work, and it’s obvious why. As Dr. Huang emphasized, his grant “will ensure that the people living in Africa have a better chance at getting access to the care they need.”

When you strip away everything else, community service grants boil down to one thing: helping people live healthier, more fulfilled lives. What can be more worthwhile?

Help us continue this important work

While we are privileged to award numerous grants over the past 2 decades, our community service grants have always held a special place in the hearts and minds of everyone involved with the CHEST Foundation. We hope they hold a special place in your heart too.

Please consider donating so that we can continue this work together.

Community service grants are one way the Foundation strives to make a tangible, lasting impact on the lives of the patients we serve – they’re not just one-off projects with limited effects. But how do we really know that we’re making a difference?

For Dr. Roberta Kato, it’s when she gets to witness an “Aha!” moment – a time when everything clicks and a parent finally understands how to better care for their child. For Marina Lima, MD, MSc, it’s knowing that one more teen isn’t gasping for air. And for Dr. Joseph Huang, it’s seeing a country of 100 million people gain access to 14 pulmonologists when there was previously only one.

Why community service grants?

The Foundation began giving community service grants in 1997 under the leadership of CHEST President D. Robert McCaffree, MD, Master FCCP. He believed the program would be the best way to support his colleagues in achieving their community service endeavors .To date, over $2 million has been given specifically to community service projects. “

Our physicians experience the limitations of our health care system first-hand – a system that isn’t built to assist the people who need help the most. Finding solutions requires a willingness to think and operate creatively. The funding the Foundation provides through our community service grants supplies the resources to do just that – implement real-world solutions that will help patients gain better access to care.
 

Cases in point

Marina Lima, MD, MSc, was seeing an inordinate number of children and teens with uncontrolled asthma symptoms in Brazil. She applied for and was awarded a grant to make Asthmaland, the first gamified pediatric asthma educational program in Portuguese.

Besides her “Aha!” moments, Dr. Roberta Kato revealed a way she knows her work is making a difference: the funding is helping to shift the nonprofit landscape in her community.

“Sometimes there is a rift between different organizations. When I ask them to collaborate or advertise together, I get resistance. However, when I’ve reached out and said that I’ve received funding for an initiative, all of a sudden, there is forward movement. That is how I am hoping to make the biggest difference,” explained Dr. Kato.

Dr. Joseph Huang, who received a grant to fund the East Africa Training Initiative (EATI), is faced with a different obstacle. “We’ve been awarded the grant many times, and I know the Foundation is focused on supporting new, up-and-coming programs. Therefore, I’m committed to ensuring that my program can continue even after we stop receiving funding.”

How is Dr. Huang going to do that? Besides procuring ICU equipment, EATI focuses on training pulmonology fellows in east Africa. The fellows who graduate will train other physicians and care team members across the continent, both in hospitals and rural clinics, safeguarding the future of his program.
 

A clear vision for the future

While the Foundation is ready to tackle new problems, community service grants will remain the constant thread woven throughout the work, and it’s obvious why. As Dr. Huang emphasized, his grant “will ensure that the people living in Africa have a better chance at getting access to the care they need.”

When you strip away everything else, community service grants boil down to one thing: helping people live healthier, more fulfilled lives. What can be more worthwhile?

Help us continue this important work

While we are privileged to award numerous grants over the past 2 decades, our community service grants have always held a special place in the hearts and minds of everyone involved with the CHEST Foundation. We hope they hold a special place in your heart too.

Please consider donating so that we can continue this work together.

Community service grants are one way the Foundation strives to make a tangible, lasting impact on the lives of the patients we serve – they’re not just one-off projects with limited effects. But how do we really know that we’re making a difference?

For Dr. Roberta Kato, it’s when she gets to witness an “Aha!” moment – a time when everything clicks and a parent finally understands how to better care for their child. For Marina Lima, MD, MSc, it’s knowing that one more teen isn’t gasping for air. And for Dr. Joseph Huang, it’s seeing a country of 100 million people gain access to 14 pulmonologists when there was previously only one.

Why community service grants?

The Foundation began giving community service grants in 1997 under the leadership of CHEST President D. Robert McCaffree, MD, Master FCCP. He believed the program would be the best way to support his colleagues in achieving their community service endeavors .To date, over $2 million has been given specifically to community service projects. “

Our physicians experience the limitations of our health care system first-hand – a system that isn’t built to assist the people who need help the most. Finding solutions requires a willingness to think and operate creatively. The funding the Foundation provides through our community service grants supplies the resources to do just that – implement real-world solutions that will help patients gain better access to care.
 

Cases in point

Marina Lima, MD, MSc, was seeing an inordinate number of children and teens with uncontrolled asthma symptoms in Brazil. She applied for and was awarded a grant to make Asthmaland, the first gamified pediatric asthma educational program in Portuguese.

Besides her “Aha!” moments, Dr. Roberta Kato revealed a way she knows her work is making a difference: the funding is helping to shift the nonprofit landscape in her community.

“Sometimes there is a rift between different organizations. When I ask them to collaborate or advertise together, I get resistance. However, when I’ve reached out and said that I’ve received funding for an initiative, all of a sudden, there is forward movement. That is how I am hoping to make the biggest difference,” explained Dr. Kato.

Dr. Joseph Huang, who received a grant to fund the East Africa Training Initiative (EATI), is faced with a different obstacle. “We’ve been awarded the grant many times, and I know the Foundation is focused on supporting new, up-and-coming programs. Therefore, I’m committed to ensuring that my program can continue even after we stop receiving funding.”

How is Dr. Huang going to do that? Besides procuring ICU equipment, EATI focuses on training pulmonology fellows in east Africa. The fellows who graduate will train other physicians and care team members across the continent, both in hospitals and rural clinics, safeguarding the future of his program.
 

A clear vision for the future

While the Foundation is ready to tackle new problems, community service grants will remain the constant thread woven throughout the work, and it’s obvious why. As Dr. Huang emphasized, his grant “will ensure that the people living in Africa have a better chance at getting access to the care they need.”

When you strip away everything else, community service grants boil down to one thing: helping people live healthier, more fulfilled lives. What can be more worthwhile?

Help us continue this important work

While we are privileged to award numerous grants over the past 2 decades, our community service grants have always held a special place in the hearts and minds of everyone involved with the CHEST Foundation. We hope they hold a special place in your heart too.

Please consider donating so that we can continue this work together.