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Update – CHEST clinical practice guidelines
CHEST has a long history of developing high quality clinical practice guidelines based on rigorous methodology, particularly in Thoracic Oncology, Pulmonary Vascular/Venous Thromboembolic Disease, and Clinical Pulmonary Medicine/Cough. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach, CHEST guidelines aim to optimize patient care by providing evidence-based recommendations that are transparent and free from bias.
Recently, CHEST invested in reassessing how we could further enhance the relevance, timeliness, and impact of guidelines on patient care and outcomes. We re-evaluated how we prioritize guideline topics to ensure we identify conditions in which patient care might be significantly improved by the application of evidence-based recommendations. In addition to re-committing to the rigorous GRADE approach, we also committed to timelier guideline development that would cover a broader scope of clinical topics, better mirroring the needs of our membership.
Since resuming our guideline process last year, we completed four Expert Panel Reports covering COVID-19–related topics, as well as several CHEST clinical practice guidelines. This includes publications on the management of cough in various conditions and populations – chronic bronchitis, acute bronchitis in the immunocompromised adult, asthma and nonasthmatic eosinophilic bronchitis, and in children. We also published Diagnosis and Evaluation of Hypersensitivity Pneumonitis earlier this year. This guideline outlines a patient-centered and interdisciplinary diagnostic approach to aid clinicians and patients in navigating many of the uncertainties in the evaluation of this condition.
Updates from two of our guidelines following our ‘living guideline’ model were also recently published – Screening for Lung Cancer and Antithrombic Therapy for VTE Disease. The Screening for Lung Cancer update provides guidance on patient selection for lung cancer screening, updating the age and smoking history criteria based on new evidence published since the original CHEST guideline. The updated guideline also provides recommendations for implementing high-quality lung cancer screening programs to optimize the overall benefits of screening.
In Antithrombotic Therapy for VTE, the structure of recommendations follows the chronology of VTE management: ‘Whether to treat,’ ‘Interventional and adjunctive treatments,’ ‘Initiation phase,’ ‘Treatment phase,’ ‘Extended phase,’ and ‘Complications of VTE.’ This guideline was designed to provide a comprehensive reference for VTE management in patients at any stage of the disease. Several recommendations are new from prior versions of the guideline, including whether patients with cerebral venous sinus thrombosis should be treated with anticoagulation and the choice of anticoagulant therapy for patients with antiphospholipid syndrome and thrombosis.
As we look toward the future of guideline development at CHEST, we are excited by the opportunity to expand the CHEST guideline portfolio. Starting in 2022, we will be broadening the scope of CHEST guidelines to include topics in nine clinical domains: Airway Disorders, Chest Infections, Clinical Pulmonary Medicine, Critical Care, Interstitial Lung Disease, Interventional Pulmonology, Pulmonary Vascular Disease (including venous thromboembolic disease), Thoracic Oncology, and Sleep. We anticipate issuing a Request for Proposals in select areas from these domains in the Spring of 2022, allowing CHEST members the opportunity to propose topics for which clinical guidance is needed.
As we recommit to the rigorous guideline methodology for which CHEST is known and broaden our impact across the spectrum of chest disease, we seek to ensure CHEST remains the leading resource for evidence-based guidelines in the field of chest medicine.
CHEST has a long history of developing high quality clinical practice guidelines based on rigorous methodology, particularly in Thoracic Oncology, Pulmonary Vascular/Venous Thromboembolic Disease, and Clinical Pulmonary Medicine/Cough. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach, CHEST guidelines aim to optimize patient care by providing evidence-based recommendations that are transparent and free from bias.
Recently, CHEST invested in reassessing how we could further enhance the relevance, timeliness, and impact of guidelines on patient care and outcomes. We re-evaluated how we prioritize guideline topics to ensure we identify conditions in which patient care might be significantly improved by the application of evidence-based recommendations. In addition to re-committing to the rigorous GRADE approach, we also committed to timelier guideline development that would cover a broader scope of clinical topics, better mirroring the needs of our membership.
Since resuming our guideline process last year, we completed four Expert Panel Reports covering COVID-19–related topics, as well as several CHEST clinical practice guidelines. This includes publications on the management of cough in various conditions and populations – chronic bronchitis, acute bronchitis in the immunocompromised adult, asthma and nonasthmatic eosinophilic bronchitis, and in children. We also published Diagnosis and Evaluation of Hypersensitivity Pneumonitis earlier this year. This guideline outlines a patient-centered and interdisciplinary diagnostic approach to aid clinicians and patients in navigating many of the uncertainties in the evaluation of this condition.
Updates from two of our guidelines following our ‘living guideline’ model were also recently published – Screening for Lung Cancer and Antithrombic Therapy for VTE Disease. The Screening for Lung Cancer update provides guidance on patient selection for lung cancer screening, updating the age and smoking history criteria based on new evidence published since the original CHEST guideline. The updated guideline also provides recommendations for implementing high-quality lung cancer screening programs to optimize the overall benefits of screening.
In Antithrombotic Therapy for VTE, the structure of recommendations follows the chronology of VTE management: ‘Whether to treat,’ ‘Interventional and adjunctive treatments,’ ‘Initiation phase,’ ‘Treatment phase,’ ‘Extended phase,’ and ‘Complications of VTE.’ This guideline was designed to provide a comprehensive reference for VTE management in patients at any stage of the disease. Several recommendations are new from prior versions of the guideline, including whether patients with cerebral venous sinus thrombosis should be treated with anticoagulation and the choice of anticoagulant therapy for patients with antiphospholipid syndrome and thrombosis.
As we look toward the future of guideline development at CHEST, we are excited by the opportunity to expand the CHEST guideline portfolio. Starting in 2022, we will be broadening the scope of CHEST guidelines to include topics in nine clinical domains: Airway Disorders, Chest Infections, Clinical Pulmonary Medicine, Critical Care, Interstitial Lung Disease, Interventional Pulmonology, Pulmonary Vascular Disease (including venous thromboembolic disease), Thoracic Oncology, and Sleep. We anticipate issuing a Request for Proposals in select areas from these domains in the Spring of 2022, allowing CHEST members the opportunity to propose topics for which clinical guidance is needed.
As we recommit to the rigorous guideline methodology for which CHEST is known and broaden our impact across the spectrum of chest disease, we seek to ensure CHEST remains the leading resource for evidence-based guidelines in the field of chest medicine.
CHEST has a long history of developing high quality clinical practice guidelines based on rigorous methodology, particularly in Thoracic Oncology, Pulmonary Vascular/Venous Thromboembolic Disease, and Clinical Pulmonary Medicine/Cough. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach, CHEST guidelines aim to optimize patient care by providing evidence-based recommendations that are transparent and free from bias.
Recently, CHEST invested in reassessing how we could further enhance the relevance, timeliness, and impact of guidelines on patient care and outcomes. We re-evaluated how we prioritize guideline topics to ensure we identify conditions in which patient care might be significantly improved by the application of evidence-based recommendations. In addition to re-committing to the rigorous GRADE approach, we also committed to timelier guideline development that would cover a broader scope of clinical topics, better mirroring the needs of our membership.
Since resuming our guideline process last year, we completed four Expert Panel Reports covering COVID-19–related topics, as well as several CHEST clinical practice guidelines. This includes publications on the management of cough in various conditions and populations – chronic bronchitis, acute bronchitis in the immunocompromised adult, asthma and nonasthmatic eosinophilic bronchitis, and in children. We also published Diagnosis and Evaluation of Hypersensitivity Pneumonitis earlier this year. This guideline outlines a patient-centered and interdisciplinary diagnostic approach to aid clinicians and patients in navigating many of the uncertainties in the evaluation of this condition.
Updates from two of our guidelines following our ‘living guideline’ model were also recently published – Screening for Lung Cancer and Antithrombic Therapy for VTE Disease. The Screening for Lung Cancer update provides guidance on patient selection for lung cancer screening, updating the age and smoking history criteria based on new evidence published since the original CHEST guideline. The updated guideline also provides recommendations for implementing high-quality lung cancer screening programs to optimize the overall benefits of screening.
In Antithrombotic Therapy for VTE, the structure of recommendations follows the chronology of VTE management: ‘Whether to treat,’ ‘Interventional and adjunctive treatments,’ ‘Initiation phase,’ ‘Treatment phase,’ ‘Extended phase,’ and ‘Complications of VTE.’ This guideline was designed to provide a comprehensive reference for VTE management in patients at any stage of the disease. Several recommendations are new from prior versions of the guideline, including whether patients with cerebral venous sinus thrombosis should be treated with anticoagulation and the choice of anticoagulant therapy for patients with antiphospholipid syndrome and thrombosis.
As we look toward the future of guideline development at CHEST, we are excited by the opportunity to expand the CHEST guideline portfolio. Starting in 2022, we will be broadening the scope of CHEST guidelines to include topics in nine clinical domains: Airway Disorders, Chest Infections, Clinical Pulmonary Medicine, Critical Care, Interstitial Lung Disease, Interventional Pulmonology, Pulmonary Vascular Disease (including venous thromboembolic disease), Thoracic Oncology, and Sleep. We anticipate issuing a Request for Proposals in select areas from these domains in the Spring of 2022, allowing CHEST members the opportunity to propose topics for which clinical guidance is needed.
As we recommit to the rigorous guideline methodology for which CHEST is known and broaden our impact across the spectrum of chest disease, we seek to ensure CHEST remains the leading resource for evidence-based guidelines in the field of chest medicine.
AGA Foundation: Gift options for your will
When life changes, so should your will. An old will can’t cover every change that may have occurred since it was first drawn. Ensure that this important document matches your current wishes by reviewing it every few years.
Use your will to give back!
Help support young investigators doing research.
- Gift us a share of what›s left in your estate after other obligations are met.
- Make a contingent bequest. That is, you give part of your estate to some individual if that person survives you; if not, then it goes to us.
- Create a charitable remainder trust to pay an income to your spouse or other loved one for life and designate the remaining principal for us.
- Create a charitable lead trust to pay income to us for a number of years, or for another person’s lifetime, with the trust assets eventually being distributed to your family.
- Donate a specific amount of cash or securities.
To make sure your will accomplishes all you intend, seek the help of an attorney who specializes in estate planning. If our organization fits into your plans, we can help you choose the method that best satisfies your wishes and our needs.
When life changes, so should your will. An old will can’t cover every change that may have occurred since it was first drawn. Ensure that this important document matches your current wishes by reviewing it every few years.
Use your will to give back!
Help support young investigators doing research.
- Gift us a share of what›s left in your estate after other obligations are met.
- Make a contingent bequest. That is, you give part of your estate to some individual if that person survives you; if not, then it goes to us.
- Create a charitable remainder trust to pay an income to your spouse or other loved one for life and designate the remaining principal for us.
- Create a charitable lead trust to pay income to us for a number of years, or for another person’s lifetime, with the trust assets eventually being distributed to your family.
- Donate a specific amount of cash or securities.
To make sure your will accomplishes all you intend, seek the help of an attorney who specializes in estate planning. If our organization fits into your plans, we can help you choose the method that best satisfies your wishes and our needs.
When life changes, so should your will. An old will can’t cover every change that may have occurred since it was first drawn. Ensure that this important document matches your current wishes by reviewing it every few years.
Use your will to give back!
Help support young investigators doing research.
- Gift us a share of what›s left in your estate after other obligations are met.
- Make a contingent bequest. That is, you give part of your estate to some individual if that person survives you; if not, then it goes to us.
- Create a charitable remainder trust to pay an income to your spouse or other loved one for life and designate the remaining principal for us.
- Create a charitable lead trust to pay income to us for a number of years, or for another person’s lifetime, with the trust assets eventually being distributed to your family.
- Donate a specific amount of cash or securities.
To make sure your will accomplishes all you intend, seek the help of an attorney who specializes in estate planning. If our organization fits into your plans, we can help you choose the method that best satisfies your wishes and our needs.
Dr. Tadataka “Tachi” Yamada dies at 76
Dr. Yamada had a storied career as a GI leader, educator, and mentor before his work as a biotech pharma research chief and a global health advocate with the Bill and Melinda Gates Foundation.
AGA President John Inadomi, MD, tweeted “We lost a mentor, sponsor, role model and true pioneer in gastroenterology – Honor his legacy.” You can share your remembrances on the AGA Community.
Over the years, Tachi made enormous contributions to AGA. He served on multiple committees, too numerous to list. He served on the AGA Governing Board multiple times and as president.
He was awarded the association’s highest honor, the Julius Friedenwald Medal, in 2003. At that time, Chung Owyang, MD, wrote a bio of Tachi and noted his critical role in shaping AGA and Digestive Disease Week® (DDW). He was the founding chair of the AGA Council working hard to reformat DDW into a major international event for our subspecialty. He was also among the group of AGA leaders who proposed the establishment of the AGA Foundation.
In 1996, Tachi assumed the presidency of AGA during a time of great turbulence in health care, where not only the practice but also the education and research missions of gastroenterology were threatened by change. Tachi took on the challenge with exemplary vision, energy, and intelligence.
Dan Podolsky, MD, a former AGA president commented at the time of Tachi’s Friedenwald Medal that “Tachi applied characteristic creativity and energy to all AGA activities. An inspirational leader, he was especially effective in promoting the AGA’s commitment to the career development of young gastroenterologists, promoting digestive diseases research, and as a tireless advocate for the field of gastroenterology.”
“Tachi has not only led our field, but he has been a global leader helping pharma rethink their role in global health, and helping the Gates Foundation save so many lives. He was soft-spoken but his worldwide contributions and vision will carry on. Heartfelt condolences to his family and friends,” said Bishr Omary, MD, PhD, past president of AGA Institute.
Dr. Yamada had a storied career as a GI leader, educator, and mentor before his work as a biotech pharma research chief and a global health advocate with the Bill and Melinda Gates Foundation.
AGA President John Inadomi, MD, tweeted “We lost a mentor, sponsor, role model and true pioneer in gastroenterology – Honor his legacy.” You can share your remembrances on the AGA Community.
Over the years, Tachi made enormous contributions to AGA. He served on multiple committees, too numerous to list. He served on the AGA Governing Board multiple times and as president.
He was awarded the association’s highest honor, the Julius Friedenwald Medal, in 2003. At that time, Chung Owyang, MD, wrote a bio of Tachi and noted his critical role in shaping AGA and Digestive Disease Week® (DDW). He was the founding chair of the AGA Council working hard to reformat DDW into a major international event for our subspecialty. He was also among the group of AGA leaders who proposed the establishment of the AGA Foundation.
In 1996, Tachi assumed the presidency of AGA during a time of great turbulence in health care, where not only the practice but also the education and research missions of gastroenterology were threatened by change. Tachi took on the challenge with exemplary vision, energy, and intelligence.
Dan Podolsky, MD, a former AGA president commented at the time of Tachi’s Friedenwald Medal that “Tachi applied characteristic creativity and energy to all AGA activities. An inspirational leader, he was especially effective in promoting the AGA’s commitment to the career development of young gastroenterologists, promoting digestive diseases research, and as a tireless advocate for the field of gastroenterology.”
“Tachi has not only led our field, but he has been a global leader helping pharma rethink their role in global health, and helping the Gates Foundation save so many lives. He was soft-spoken but his worldwide contributions and vision will carry on. Heartfelt condolences to his family and friends,” said Bishr Omary, MD, PhD, past president of AGA Institute.
Dr. Yamada had a storied career as a GI leader, educator, and mentor before his work as a biotech pharma research chief and a global health advocate with the Bill and Melinda Gates Foundation.
AGA President John Inadomi, MD, tweeted “We lost a mentor, sponsor, role model and true pioneer in gastroenterology – Honor his legacy.” You can share your remembrances on the AGA Community.
Over the years, Tachi made enormous contributions to AGA. He served on multiple committees, too numerous to list. He served on the AGA Governing Board multiple times and as president.
He was awarded the association’s highest honor, the Julius Friedenwald Medal, in 2003. At that time, Chung Owyang, MD, wrote a bio of Tachi and noted his critical role in shaping AGA and Digestive Disease Week® (DDW). He was the founding chair of the AGA Council working hard to reformat DDW into a major international event for our subspecialty. He was also among the group of AGA leaders who proposed the establishment of the AGA Foundation.
In 1996, Tachi assumed the presidency of AGA during a time of great turbulence in health care, where not only the practice but also the education and research missions of gastroenterology were threatened by change. Tachi took on the challenge with exemplary vision, energy, and intelligence.
Dan Podolsky, MD, a former AGA president commented at the time of Tachi’s Friedenwald Medal that “Tachi applied characteristic creativity and energy to all AGA activities. An inspirational leader, he was especially effective in promoting the AGA’s commitment to the career development of young gastroenterologists, promoting digestive diseases research, and as a tireless advocate for the field of gastroenterology.”
“Tachi has not only led our field, but he has been a global leader helping pharma rethink their role in global health, and helping the Gates Foundation save so many lives. He was soft-spoken but his worldwide contributions and vision will carry on. Heartfelt condolences to his family and friends,” said Bishr Omary, MD, PhD, past president of AGA Institute.
AGA Advocacy Day
Whether you’re a clinician or researcher,
Help us elevate the GI perspective by participating in AGA Advocacy Day on Thursday, Sept. 23, 2021, from 9 a.m. to 4 p.m. EDT. This is a unique opportunity for you to virtually meet with federal legislators to share your experiences and show how supporting the needs of GIs and our patients impacts the community they represent.
No prior advocacy experience needed! AGA staff will supply key talking points on a variety of health care policies and provide plenty of training to help you tell your story in a way that inspires and influences policymakers.
Your participation on this day – no matter how long – is vital to our success. If you can’t attend meetings the entire day, then share your availability during registration and we’ll arrange meetings around your busy schedule.
Save your spot.
Whether you’re a clinician or researcher,
Help us elevate the GI perspective by participating in AGA Advocacy Day on Thursday, Sept. 23, 2021, from 9 a.m. to 4 p.m. EDT. This is a unique opportunity for you to virtually meet with federal legislators to share your experiences and show how supporting the needs of GIs and our patients impacts the community they represent.
No prior advocacy experience needed! AGA staff will supply key talking points on a variety of health care policies and provide plenty of training to help you tell your story in a way that inspires and influences policymakers.
Your participation on this day – no matter how long – is vital to our success. If you can’t attend meetings the entire day, then share your availability during registration and we’ll arrange meetings around your busy schedule.
Save your spot.
Whether you’re a clinician or researcher,
Help us elevate the GI perspective by participating in AGA Advocacy Day on Thursday, Sept. 23, 2021, from 9 a.m. to 4 p.m. EDT. This is a unique opportunity for you to virtually meet with federal legislators to share your experiences and show how supporting the needs of GIs and our patients impacts the community they represent.
No prior advocacy experience needed! AGA staff will supply key talking points on a variety of health care policies and provide plenty of training to help you tell your story in a way that inspires and influences policymakers.
Your participation on this day – no matter how long – is vital to our success. If you can’t attend meetings the entire day, then share your availability during registration and we’ll arrange meetings around your busy schedule.
Save your spot.
Confronting the NASH epidemic together
. The recommendations from this meeting have been copublished in Gastroenterology along with three other leading journals: Diabetes Care, Metabolism: Clinical and Experimental, and Obesity: The Journal of the Obesity Society.
Key findings from this special report include the following:
- Patients with obesity or type 2 diabetes are at a higher risk of developing NAFLD/NASH with diabetes being a major risk factor for worse disease severity and progression to cirrhosis (permanent damage to the liver).
- Primary care providers are critical to managing this growing epidemic. They should be the first line for screening patients at risk, stratifying patients based on their risk for advanced fibrosis, and providing effective management and referrals.
- The guiding principle for risk stratification is to rule out advanced fibrosis by simple, noninvasive fibrosis scores (such as NAFLD fibrosis score or Fibrosis-4 Index). Patients at intermediate or high risk may require further assessment with a second-line test – evaluation with elastography or by serum marker test with direct measures of fibrogenesis.
- Because NAFLD is not an isolated disease but a component of cardiometabolic abnormalities typically associated with obesity, insulin resistance, and type 2 diabetes, the cornerstone of therapy is lifestyle-based therapies (altered diet – such as reduced-calorie or Mediterranean diets – and regular, moderate physical activity), as well as replacing obesogenic medications, to decrease body weight and improve cardiometabolic health. Patients with diabetes who also have NASH may benefit from certain antidiabetic medications (such as pioglitazone and semaglutide) that treat not only their diabetes but also reverse steatohepatitis and improve cardiometabolic health.
- Optimal care of patients with NAFLD and NASH requires collaboration among primary care providers, endocrinologists, diabetologists, obesity medicine specialists, gastroenterologists, and hepatologists to tackle both the liver manifestations of the disease and the comorbid metabolic syndrome and cardiovascular risk, as well as screening and treating other comorbid conditions (such as obstructive sleep apnea).
. The recommendations from this meeting have been copublished in Gastroenterology along with three other leading journals: Diabetes Care, Metabolism: Clinical and Experimental, and Obesity: The Journal of the Obesity Society.
Key findings from this special report include the following:
- Patients with obesity or type 2 diabetes are at a higher risk of developing NAFLD/NASH with diabetes being a major risk factor for worse disease severity and progression to cirrhosis (permanent damage to the liver).
- Primary care providers are critical to managing this growing epidemic. They should be the first line for screening patients at risk, stratifying patients based on their risk for advanced fibrosis, and providing effective management and referrals.
- The guiding principle for risk stratification is to rule out advanced fibrosis by simple, noninvasive fibrosis scores (such as NAFLD fibrosis score or Fibrosis-4 Index). Patients at intermediate or high risk may require further assessment with a second-line test – evaluation with elastography or by serum marker test with direct measures of fibrogenesis.
- Because NAFLD is not an isolated disease but a component of cardiometabolic abnormalities typically associated with obesity, insulin resistance, and type 2 diabetes, the cornerstone of therapy is lifestyle-based therapies (altered diet – such as reduced-calorie or Mediterranean diets – and regular, moderate physical activity), as well as replacing obesogenic medications, to decrease body weight and improve cardiometabolic health. Patients with diabetes who also have NASH may benefit from certain antidiabetic medications (such as pioglitazone and semaglutide) that treat not only their diabetes but also reverse steatohepatitis and improve cardiometabolic health.
- Optimal care of patients with NAFLD and NASH requires collaboration among primary care providers, endocrinologists, diabetologists, obesity medicine specialists, gastroenterologists, and hepatologists to tackle both the liver manifestations of the disease and the comorbid metabolic syndrome and cardiovascular risk, as well as screening and treating other comorbid conditions (such as obstructive sleep apnea).
. The recommendations from this meeting have been copublished in Gastroenterology along with three other leading journals: Diabetes Care, Metabolism: Clinical and Experimental, and Obesity: The Journal of the Obesity Society.
Key findings from this special report include the following:
- Patients with obesity or type 2 diabetes are at a higher risk of developing NAFLD/NASH with diabetes being a major risk factor for worse disease severity and progression to cirrhosis (permanent damage to the liver).
- Primary care providers are critical to managing this growing epidemic. They should be the first line for screening patients at risk, stratifying patients based on their risk for advanced fibrosis, and providing effective management and referrals.
- The guiding principle for risk stratification is to rule out advanced fibrosis by simple, noninvasive fibrosis scores (such as NAFLD fibrosis score or Fibrosis-4 Index). Patients at intermediate or high risk may require further assessment with a second-line test – evaluation with elastography or by serum marker test with direct measures of fibrogenesis.
- Because NAFLD is not an isolated disease but a component of cardiometabolic abnormalities typically associated with obesity, insulin resistance, and type 2 diabetes, the cornerstone of therapy is lifestyle-based therapies (altered diet – such as reduced-calorie or Mediterranean diets – and regular, moderate physical activity), as well as replacing obesogenic medications, to decrease body weight and improve cardiometabolic health. Patients with diabetes who also have NASH may benefit from certain antidiabetic medications (such as pioglitazone and semaglutide) that treat not only their diabetes but also reverse steatohepatitis and improve cardiometabolic health.
- Optimal care of patients with NAFLD and NASH requires collaboration among primary care providers, endocrinologists, diabetologists, obesity medicine specialists, gastroenterologists, and hepatologists to tackle both the liver manifestations of the disease and the comorbid metabolic syndrome and cardiovascular risk, as well as screening and treating other comorbid conditions (such as obstructive sleep apnea).
CHEST 2021 transitions from hybrid meeting to fully online
After an extensive review of the present and potential conditions affecting in-person participation, CHEST 2021 will be fully online again this year. Our goal is to make attending CHEST 2021 as accessible as possible for the entire chest medicine community. Make sure to join your colleagues online for the most exciting event in chest medicine, October 17-20.
After an extensive review of the present and potential conditions affecting in-person participation, CHEST 2021 will be fully online again this year. Our goal is to make attending CHEST 2021 as accessible as possible for the entire chest medicine community. Make sure to join your colleagues online for the most exciting event in chest medicine, October 17-20.
After an extensive review of the present and potential conditions affecting in-person participation, CHEST 2021 will be fully online again this year. Our goal is to make attending CHEST 2021 as accessible as possible for the entire chest medicine community. Make sure to join your colleagues online for the most exciting event in chest medicine, October 17-20.
NetWorks Compete to Combat Health Disparities
One way members get involved in CHEST’s philanthropic efforts takes place each year with the start of the NetWorks Challenge. CHEST members compete through their NetWorks – special interest groups that focus on particular areas of chest medicine – to raise funds that support Foundation microgrants.
NetWorks Challenge 2021 kicked off in June with a special twist to celebrate the Foundation’s 25th anniversary. Each NetWork is asked to complete a 25k virtual physical challenge. This can be done by walking, running, biking, swimming—or any other physical activity.
Through the challenge, members engage in friendly competition while supporting the goals of the Foundation. This year, money raised will directly help the Foundation in addressing health disparities through our microgrants program. In addition, the funds will support travel grants for doctors in training looking to attend CHEST 2021.
By participating in the NetWorks Challenge, members help fund grants that aim to lend a hand to those who need it the most. Expanding research capabilities, improving patient care, and giving access to medical equipment are just a few ways microgrants from the CHEST Foundation have been used in the past.
Inspired by the Listening Tour and the struggles experienced by underserved communities, money raised through the Network Challenge will go to a new pilot microgrant program called Rita’s Fund. The grants aim to supplement community-based projects that provide resources to individuals to help drastically change their quality of life. Funding will assist with coverage for medical equipment, transportation, and access to technology for those living with lung disease and other medical complications.
NetWork members are asked to encourage one another to join in this summer’s race to 25k.
To learn more about this initiative and this year’s NetWorks Challenge, visit chestfoundation.org/nwc21. And, don’t miss the summer issue of Donor Spotlight.
One way members get involved in CHEST’s philanthropic efforts takes place each year with the start of the NetWorks Challenge. CHEST members compete through their NetWorks – special interest groups that focus on particular areas of chest medicine – to raise funds that support Foundation microgrants.
NetWorks Challenge 2021 kicked off in June with a special twist to celebrate the Foundation’s 25th anniversary. Each NetWork is asked to complete a 25k virtual physical challenge. This can be done by walking, running, biking, swimming—or any other physical activity.
Through the challenge, members engage in friendly competition while supporting the goals of the Foundation. This year, money raised will directly help the Foundation in addressing health disparities through our microgrants program. In addition, the funds will support travel grants for doctors in training looking to attend CHEST 2021.
By participating in the NetWorks Challenge, members help fund grants that aim to lend a hand to those who need it the most. Expanding research capabilities, improving patient care, and giving access to medical equipment are just a few ways microgrants from the CHEST Foundation have been used in the past.
Inspired by the Listening Tour and the struggles experienced by underserved communities, money raised through the Network Challenge will go to a new pilot microgrant program called Rita’s Fund. The grants aim to supplement community-based projects that provide resources to individuals to help drastically change their quality of life. Funding will assist with coverage for medical equipment, transportation, and access to technology for those living with lung disease and other medical complications.
NetWork members are asked to encourage one another to join in this summer’s race to 25k.
To learn more about this initiative and this year’s NetWorks Challenge, visit chestfoundation.org/nwc21. And, don’t miss the summer issue of Donor Spotlight.
One way members get involved in CHEST’s philanthropic efforts takes place each year with the start of the NetWorks Challenge. CHEST members compete through their NetWorks – special interest groups that focus on particular areas of chest medicine – to raise funds that support Foundation microgrants.
NetWorks Challenge 2021 kicked off in June with a special twist to celebrate the Foundation’s 25th anniversary. Each NetWork is asked to complete a 25k virtual physical challenge. This can be done by walking, running, biking, swimming—or any other physical activity.
Through the challenge, members engage in friendly competition while supporting the goals of the Foundation. This year, money raised will directly help the Foundation in addressing health disparities through our microgrants program. In addition, the funds will support travel grants for doctors in training looking to attend CHEST 2021.
By participating in the NetWorks Challenge, members help fund grants that aim to lend a hand to those who need it the most. Expanding research capabilities, improving patient care, and giving access to medical equipment are just a few ways microgrants from the CHEST Foundation have been used in the past.
Inspired by the Listening Tour and the struggles experienced by underserved communities, money raised through the Network Challenge will go to a new pilot microgrant program called Rita’s Fund. The grants aim to supplement community-based projects that provide resources to individuals to help drastically change their quality of life. Funding will assist with coverage for medical equipment, transportation, and access to technology for those living with lung disease and other medical complications.
NetWork members are asked to encourage one another to join in this summer’s race to 25k.
To learn more about this initiative and this year’s NetWorks Challenge, visit chestfoundation.org/nwc21. And, don’t miss the summer issue of Donor Spotlight.
This month in the journal CHEST®Editor’s Picks
Peak inspiratory flow as a predictive therapeutic biomarker in COPD. By Drs. D. Mahler and D. Halpin.Family presence for critically ill patients during a pandemic. By Drs. J. Hart and S. Taylor.
Executive summary: diagnosis and evaluation of hypersensitivity pneumonitis: CHEST guideline and expert panel report. By Dr. L. Fernandez Perez et al.
The usefulness of chest CT imaging in patients with suspected or diagnosed COVID-19: A review of literature. By Dr. S. Machnicki et al.
Oxygen therapy in sleep-disordered breathing. By Dr. S. Zeineddine et al.
Peak inspiratory flow as a predictive therapeutic biomarker in COPD. By Drs. D. Mahler and D. Halpin.Family presence for critically ill patients during a pandemic. By Drs. J. Hart and S. Taylor.
Executive summary: diagnosis and evaluation of hypersensitivity pneumonitis: CHEST guideline and expert panel report. By Dr. L. Fernandez Perez et al.
The usefulness of chest CT imaging in patients with suspected or diagnosed COVID-19: A review of literature. By Dr. S. Machnicki et al.
Oxygen therapy in sleep-disordered breathing. By Dr. S. Zeineddine et al.
Peak inspiratory flow as a predictive therapeutic biomarker in COPD. By Drs. D. Mahler and D. Halpin.Family presence for critically ill patients during a pandemic. By Drs. J. Hart and S. Taylor.
Executive summary: diagnosis and evaluation of hypersensitivity pneumonitis: CHEST guideline and expert panel report. By Dr. L. Fernandez Perez et al.
The usefulness of chest CT imaging in patients with suspected or diagnosed COVID-19: A review of literature. By Dr. S. Machnicki et al.
Oxygen therapy in sleep-disordered breathing. By Dr. S. Zeineddine et al.
CHEST website redesign puts the user first
You’ve probably noticed that we recently rolled out a new website – one that is updated, streamlined, and user-friendly (and if you haven’t, go check it out!). Our goal for this project was to ensure that chestnet.org remains your go-to resource when it comes to pulmonary, critical care, and sleep medicine, and to accomplish that, we recognized that some major changes were needed. In short, while we were on the cutting-edge of chest medicine, our website definitely was not.
That’s why we’ve redesigned everything from the ground up. Our very best tools, resources, and offerings are now front and center, which means that you’ll be able to find everything you’re looking for, plus some extras you aren’t, with a few simple clicks.
While there are a lot of new features on the site that we can’t wait for you to discover, here are the upgrades that we’re most excited about.
Mobile responsiveness
One of the biggest changes to the site is that it is now mobile responsive. That means you’ll have a seamless experience regardless of what device you’re on. Whether that’s a phone or a tablet, you’ll be able to log in to your account, view any of our resources, and purchase products – functions that used to be only accessible from a desktop.
Intuitive navigation
We have so much content to offer that finding a place for everything can be difficult, and, in the past, resources often got buried within the navigation. That’s why we spent months taking an inventory of our entire site so that we could reorganize all of our resources in a way that would make more sense to you – our users.
Community-centered
We know that you joined CHEST for more than our top-tier resources; you joined to be part of a community. That’s why the new site includes more community-based hubs and opportunities for peer-to-peer interaction. We’ll continue to add more features like blog commenting and Twitter feeds so that you can continue to engage with your colleagues, let your voice be heard, and expand your circle of peers.
User-focused design
What are you hoping to find when coming to our site? What do you want to accomplish? What features would make that easier? By asking these questions, employing a succinct set of design principles, and completing several rounds of member prototype testing, we believe that we redesigned the site not only for you, but with you.
While we’ve made some major upgrades, we’re not done yet. We’ll continue to enhance the site in the upcoming month with one goal in mind – to ensure you’re getting more out of your membership than ever before.
You’ve probably noticed that we recently rolled out a new website – one that is updated, streamlined, and user-friendly (and if you haven’t, go check it out!). Our goal for this project was to ensure that chestnet.org remains your go-to resource when it comes to pulmonary, critical care, and sleep medicine, and to accomplish that, we recognized that some major changes were needed. In short, while we were on the cutting-edge of chest medicine, our website definitely was not.
That’s why we’ve redesigned everything from the ground up. Our very best tools, resources, and offerings are now front and center, which means that you’ll be able to find everything you’re looking for, plus some extras you aren’t, with a few simple clicks.
While there are a lot of new features on the site that we can’t wait for you to discover, here are the upgrades that we’re most excited about.
Mobile responsiveness
One of the biggest changes to the site is that it is now mobile responsive. That means you’ll have a seamless experience regardless of what device you’re on. Whether that’s a phone or a tablet, you’ll be able to log in to your account, view any of our resources, and purchase products – functions that used to be only accessible from a desktop.
Intuitive navigation
We have so much content to offer that finding a place for everything can be difficult, and, in the past, resources often got buried within the navigation. That’s why we spent months taking an inventory of our entire site so that we could reorganize all of our resources in a way that would make more sense to you – our users.
Community-centered
We know that you joined CHEST for more than our top-tier resources; you joined to be part of a community. That’s why the new site includes more community-based hubs and opportunities for peer-to-peer interaction. We’ll continue to add more features like blog commenting and Twitter feeds so that you can continue to engage with your colleagues, let your voice be heard, and expand your circle of peers.
User-focused design
What are you hoping to find when coming to our site? What do you want to accomplish? What features would make that easier? By asking these questions, employing a succinct set of design principles, and completing several rounds of member prototype testing, we believe that we redesigned the site not only for you, but with you.
While we’ve made some major upgrades, we’re not done yet. We’ll continue to enhance the site in the upcoming month with one goal in mind – to ensure you’re getting more out of your membership than ever before.
You’ve probably noticed that we recently rolled out a new website – one that is updated, streamlined, and user-friendly (and if you haven’t, go check it out!). Our goal for this project was to ensure that chestnet.org remains your go-to resource when it comes to pulmonary, critical care, and sleep medicine, and to accomplish that, we recognized that some major changes were needed. In short, while we were on the cutting-edge of chest medicine, our website definitely was not.
That’s why we’ve redesigned everything from the ground up. Our very best tools, resources, and offerings are now front and center, which means that you’ll be able to find everything you’re looking for, plus some extras you aren’t, with a few simple clicks.
While there are a lot of new features on the site that we can’t wait for you to discover, here are the upgrades that we’re most excited about.
Mobile responsiveness
One of the biggest changes to the site is that it is now mobile responsive. That means you’ll have a seamless experience regardless of what device you’re on. Whether that’s a phone or a tablet, you’ll be able to log in to your account, view any of our resources, and purchase products – functions that used to be only accessible from a desktop.
Intuitive navigation
We have so much content to offer that finding a place for everything can be difficult, and, in the past, resources often got buried within the navigation. That’s why we spent months taking an inventory of our entire site so that we could reorganize all of our resources in a way that would make more sense to you – our users.
Community-centered
We know that you joined CHEST for more than our top-tier resources; you joined to be part of a community. That’s why the new site includes more community-based hubs and opportunities for peer-to-peer interaction. We’ll continue to add more features like blog commenting and Twitter feeds so that you can continue to engage with your colleagues, let your voice be heard, and expand your circle of peers.
User-focused design
What are you hoping to find when coming to our site? What do you want to accomplish? What features would make that easier? By asking these questions, employing a succinct set of design principles, and completing several rounds of member prototype testing, we believe that we redesigned the site not only for you, but with you.
While we’ve made some major upgrades, we’re not done yet. We’ll continue to enhance the site in the upcoming month with one goal in mind – to ensure you’re getting more out of your membership than ever before.
Disaster medicine in the pandemic; telehealth; rise in lung transplants for older patients; women’s lung health; and more
Disaster response
Advancing disaster medicine and global health in times of pandemic
Worldwide hardships due to COVID-19 have revealed opportunities for improvement. Disaster education, telemedicine, knowledge sharing, and resource allocation have been highlighted as such areas. In an August 2020 publication, Hart et al. argue, “Every hospital needs a Disaster Medicine physician now” (Hart et al. “Why Every US Hospital Needs a Disaster Medicine Physician Now”).
Every physician must be prepared to be the expert in times of disaster. A survey of U.S. medical students showed that despite few respondents (<27%) feeling adequately educated, >90% are willing to respond to a natural disaster or a pandemic (Kaiser et al. Disaster Med Pub Health Prep. 2009;3[4]:210-16). While natural disasters have increased by almost 35% since the 1990s, a robust approach to disaster education is not routinely implemented across the fields of medicine, nursing, allied health, and health administration (Freebairn. World Disasters Report 2020: Executive Summary. 2020 ed. IFRC. ). Notably, disaster education provides opportunities for multidisciplinary team-building where learners build a foundation of knowledge together. While no ideal educational model has been fully adopted, high-quality educational opportunities include National Disaster Life Support Foundation courses, SALT triage, and ATLS (Homer et al. Prehospital and Disaster Medicine).
Telemedicine has emerged as a very effective means of disaster support through both direct patient encounters and provider education. Tele-triage used to delineate patients requiring urgent hospitalization from those who can be managed at home has proven effective in areas with limited health care facilities (World Health Organization. Coronavirus disease.). Knowledge sharing opportunities from organizations like Project ECHO have allowed for >368,000 learners from 146 countries to exchange information during >8,000 learning sessions (Project ECHO COVID-19 response.).
Physicians of all specialties should continue to develop skills in triage, surge capacity management, ethical/legal issues surrounding disasters, organizational interoperability, and telemedicine, and emphasize skills to ensure their own personal protection.
Christopher Miller, DO, MPH
Steering Committee Fellow-in-Training Member
Sarang Patil, MD
Steering Committee Member
Practice operations
Telehealth and postpandemic care
Telehealth is the use of electronic information and telecommunication technologies to provide care when the physician and the patient are not in the same place. Telehealth has been available for 40 years. The COVID-19 pandemic forced health care providers, systems, and patients to quickly adapt to virtual audio and visual visits, new documentation parameters, billing, and reimbursement structures. Emergency rules have removed the barriers to adoption of home-based diagnostics and virtual visits. It is expected that 20% to 30% post-pandemic care will be provided via telehealth.
Telehealth is particularly beneficial in providing counseling services or managing chronic illnesses, such as COPD and heart failure. There has been an explosion of monitoring devices both wearable and implantable. Some devices, which monitor PA pressure, have been shown to reduce heart failure hospitalizations and all-cause hospitalizations (Shavelle DM, et al. Circ Heart Fail. 2020;13: e006863). Studies have been conducted on home spirometry and oximetry devices in post-lung transplant, ILD (Russell AM et al. Am J Respir Crit Care Med. 2016 Oct 15; 194[8]:989-997), and CF patients (Compton M et al. Telemed J E Health . 2020 Aug;26[8]:978-84). As we move forward, we will have to ascertain what data acquisition is relevant and develop processes to address it in real time.
In this changing landscape of health care delivery, we can anticipate an increase in virtual visits and a trend toward e-consults, which will necessitate further advancements in remote monitoring and assessment and will require us to adopt new practice models.
Caitlin Baxter, MBBS
Steering Committee Fellow-in-Training
Namita Sood, MBBCh, FCCP
Steering Committee Member
Transplant network
The rise in lung transplant for older patients
Over the past 20 years, there has been a dramatic increase in lung transplantation in elderly patients, with wide variability in age limit amongst transplant centers. The number of recipients over the age of 65 has risen from 6.9% in 2004 to 29.6% in 2016 in the United States, and 2.6% to 17% internationally. There is a number of factors driving this increase; the prevalence of advanced lung disease with increasing age, advances in targeted therapies to treat cystic fibrosis, an increased willingness of centers to perform transplants in older patients, and the 2005 revision of the Lung Allocation Scoring System (Courtwright A, Cantu E. J Thoracic Dis. 2017:9[9]:3346-51).
In the past, outcomes posttransplant for elderly patients have been conflicting in single-center studies. More recently, Hayanga et al. found no difference in survival up to 1 year between individuals 60-69 and those over 70 (J Heart Lung Transplant. 2015;34[2]:182-88). Mosher et al., however, found the median survival dropped from 4.64 years for patients aged 65-69 to 3.07 years for patients ≥74 (J Heart Lung Transplant. 2021;40[1]:42-55). Notably, older recipients were more likely to be readmitted at 30 and 90 days, and more likely to be discharged to an inpatient rehabilitation facility following transplant (McCarthy et al. J Heart Lung Transplant. 2017;36:S115; Tang et al. Clin Transplant. 2015;29:581-587).
The use of transplant in elderly patients comes with many concerns regarding neurocognitive status, frailty, and other comorbidities, all of which must be rigorously tested prior to consideration(Biswas R et al. Ann Thorac Surg. 2015;100:443-51). Recipient age, creatinine level, bilirubin level, steroid use at the time of transplant, and hospitalization at the time of transplant were associated with increased mortality (Mosher et al. J Heart Lung Transplant. 2021;40[1]:42-55). Further research is warranted in this evolving area.
Melissa B. Lesko, DO
Grant Turner, MD, MHA
Steering Committee Members
Women’s lung health
Will the new pulmonary hypertension hemodynamic classification temper the PH ‘sex-paradox’?
Older and contemporary PH registries have consistently shown that PH predominantly affects women ~2 to 3.5 times than men, with female patients having better survival compared with men (Kozu K et al. Heart Vessels. 2018;33[8]:93), a fact attributed to better RV function in female than male subjects. This PH sex-paradox denotes that while estrogen leads to increased susceptibility to PH, it appears to confer better outcomes after PH develops due to improved RV function, since RV dysfunction is a strong predictor of poor outcomes in PH. Multiple preclinical studies have described how estrogen provides protective effects on the RV (Cheng TC et al. Am J Physiol Heart Circ Physiol. 2020;319:H1459; Frump AL et al. Am J Physiol Lung Cell Mol Physiol. 2015;308:L873).
The recent recommended updates to the hemodynamic definition reflect acknowledgment of irrefutable evidence that even mildly elevated mPAP (between 19 and 24 mm Hg) is associated with increased morbidity and mortality based on consistent data from pulmonary arterial hypertension (PAH) as well as from other forms of PH [Simonneau G et al. Eur Respir J. 2019;(Jan 24);53(1):1801913). With incorporation of the updated definition that more accurately captures the disease state and its progression, an unaddressed question still remains as to how the new classification will change PH treatment algorithm and outcomes in women compared with men. Setting the definition of PH at a mPAP of 20 mm Hg not only better represents the typical patients with PH in practice, such as those with PH due to left-sided heart disease (Group 2) or PH associated with chronic lung disease (Group 3), but incorporates the preclinical pathologic disease state of PH, in which symptoms may not be evident (Maron BA, et al. Circulation. 2016;133:1240). In adhering to the new PH definition, will earlier diagnosis across the spectrum of all individuals with PH before RV dysfunction has developed improve outcomes for all those afflicted with PH and equalize outcomes between men and women? As future studies continue to investigate the direct effects of sex hormones on the RV and dissect the mechanisms leading to the sex differences in RV function in PH, a pre-clinical diagnosis in all PH patients, particularly male patients with Group 2/3 disease, may mitigate some of the previously observed advantages of estrogen on outcomes in PH.
Lavannya Pandit, MD, FCCP
Disaster response
Advancing disaster medicine and global health in times of pandemic
Worldwide hardships due to COVID-19 have revealed opportunities for improvement. Disaster education, telemedicine, knowledge sharing, and resource allocation have been highlighted as such areas. In an August 2020 publication, Hart et al. argue, “Every hospital needs a Disaster Medicine physician now” (Hart et al. “Why Every US Hospital Needs a Disaster Medicine Physician Now”).
Every physician must be prepared to be the expert in times of disaster. A survey of U.S. medical students showed that despite few respondents (<27%) feeling adequately educated, >90% are willing to respond to a natural disaster or a pandemic (Kaiser et al. Disaster Med Pub Health Prep. 2009;3[4]:210-16). While natural disasters have increased by almost 35% since the 1990s, a robust approach to disaster education is not routinely implemented across the fields of medicine, nursing, allied health, and health administration (Freebairn. World Disasters Report 2020: Executive Summary. 2020 ed. IFRC. ). Notably, disaster education provides opportunities for multidisciplinary team-building where learners build a foundation of knowledge together. While no ideal educational model has been fully adopted, high-quality educational opportunities include National Disaster Life Support Foundation courses, SALT triage, and ATLS (Homer et al. Prehospital and Disaster Medicine).
Telemedicine has emerged as a very effective means of disaster support through both direct patient encounters and provider education. Tele-triage used to delineate patients requiring urgent hospitalization from those who can be managed at home has proven effective in areas with limited health care facilities (World Health Organization. Coronavirus disease.). Knowledge sharing opportunities from organizations like Project ECHO have allowed for >368,000 learners from 146 countries to exchange information during >8,000 learning sessions (Project ECHO COVID-19 response.).
Physicians of all specialties should continue to develop skills in triage, surge capacity management, ethical/legal issues surrounding disasters, organizational interoperability, and telemedicine, and emphasize skills to ensure their own personal protection.
Christopher Miller, DO, MPH
Steering Committee Fellow-in-Training Member
Sarang Patil, MD
Steering Committee Member
Practice operations
Telehealth and postpandemic care
Telehealth is the use of electronic information and telecommunication technologies to provide care when the physician and the patient are not in the same place. Telehealth has been available for 40 years. The COVID-19 pandemic forced health care providers, systems, and patients to quickly adapt to virtual audio and visual visits, new documentation parameters, billing, and reimbursement structures. Emergency rules have removed the barriers to adoption of home-based diagnostics and virtual visits. It is expected that 20% to 30% post-pandemic care will be provided via telehealth.
Telehealth is particularly beneficial in providing counseling services or managing chronic illnesses, such as COPD and heart failure. There has been an explosion of monitoring devices both wearable and implantable. Some devices, which monitor PA pressure, have been shown to reduce heart failure hospitalizations and all-cause hospitalizations (Shavelle DM, et al. Circ Heart Fail. 2020;13: e006863). Studies have been conducted on home spirometry and oximetry devices in post-lung transplant, ILD (Russell AM et al. Am J Respir Crit Care Med. 2016 Oct 15; 194[8]:989-997), and CF patients (Compton M et al. Telemed J E Health . 2020 Aug;26[8]:978-84). As we move forward, we will have to ascertain what data acquisition is relevant and develop processes to address it in real time.
In this changing landscape of health care delivery, we can anticipate an increase in virtual visits and a trend toward e-consults, which will necessitate further advancements in remote monitoring and assessment and will require us to adopt new practice models.
Caitlin Baxter, MBBS
Steering Committee Fellow-in-Training
Namita Sood, MBBCh, FCCP
Steering Committee Member
Transplant network
The rise in lung transplant for older patients
Over the past 20 years, there has been a dramatic increase in lung transplantation in elderly patients, with wide variability in age limit amongst transplant centers. The number of recipients over the age of 65 has risen from 6.9% in 2004 to 29.6% in 2016 in the United States, and 2.6% to 17% internationally. There is a number of factors driving this increase; the prevalence of advanced lung disease with increasing age, advances in targeted therapies to treat cystic fibrosis, an increased willingness of centers to perform transplants in older patients, and the 2005 revision of the Lung Allocation Scoring System (Courtwright A, Cantu E. J Thoracic Dis. 2017:9[9]:3346-51).
In the past, outcomes posttransplant for elderly patients have been conflicting in single-center studies. More recently, Hayanga et al. found no difference in survival up to 1 year between individuals 60-69 and those over 70 (J Heart Lung Transplant. 2015;34[2]:182-88). Mosher et al., however, found the median survival dropped from 4.64 years for patients aged 65-69 to 3.07 years for patients ≥74 (J Heart Lung Transplant. 2021;40[1]:42-55). Notably, older recipients were more likely to be readmitted at 30 and 90 days, and more likely to be discharged to an inpatient rehabilitation facility following transplant (McCarthy et al. J Heart Lung Transplant. 2017;36:S115; Tang et al. Clin Transplant. 2015;29:581-587).
The use of transplant in elderly patients comes with many concerns regarding neurocognitive status, frailty, and other comorbidities, all of which must be rigorously tested prior to consideration(Biswas R et al. Ann Thorac Surg. 2015;100:443-51). Recipient age, creatinine level, bilirubin level, steroid use at the time of transplant, and hospitalization at the time of transplant were associated with increased mortality (Mosher et al. J Heart Lung Transplant. 2021;40[1]:42-55). Further research is warranted in this evolving area.
Melissa B. Lesko, DO
Grant Turner, MD, MHA
Steering Committee Members
Women’s lung health
Will the new pulmonary hypertension hemodynamic classification temper the PH ‘sex-paradox’?
Older and contemporary PH registries have consistently shown that PH predominantly affects women ~2 to 3.5 times than men, with female patients having better survival compared with men (Kozu K et al. Heart Vessels. 2018;33[8]:93), a fact attributed to better RV function in female than male subjects. This PH sex-paradox denotes that while estrogen leads to increased susceptibility to PH, it appears to confer better outcomes after PH develops due to improved RV function, since RV dysfunction is a strong predictor of poor outcomes in PH. Multiple preclinical studies have described how estrogen provides protective effects on the RV (Cheng TC et al. Am J Physiol Heart Circ Physiol. 2020;319:H1459; Frump AL et al. Am J Physiol Lung Cell Mol Physiol. 2015;308:L873).
The recent recommended updates to the hemodynamic definition reflect acknowledgment of irrefutable evidence that even mildly elevated mPAP (between 19 and 24 mm Hg) is associated with increased morbidity and mortality based on consistent data from pulmonary arterial hypertension (PAH) as well as from other forms of PH [Simonneau G et al. Eur Respir J. 2019;(Jan 24);53(1):1801913). With incorporation of the updated definition that more accurately captures the disease state and its progression, an unaddressed question still remains as to how the new classification will change PH treatment algorithm and outcomes in women compared with men. Setting the definition of PH at a mPAP of 20 mm Hg not only better represents the typical patients with PH in practice, such as those with PH due to left-sided heart disease (Group 2) or PH associated with chronic lung disease (Group 3), but incorporates the preclinical pathologic disease state of PH, in which symptoms may not be evident (Maron BA, et al. Circulation. 2016;133:1240). In adhering to the new PH definition, will earlier diagnosis across the spectrum of all individuals with PH before RV dysfunction has developed improve outcomes for all those afflicted with PH and equalize outcomes between men and women? As future studies continue to investigate the direct effects of sex hormones on the RV and dissect the mechanisms leading to the sex differences in RV function in PH, a pre-clinical diagnosis in all PH patients, particularly male patients with Group 2/3 disease, may mitigate some of the previously observed advantages of estrogen on outcomes in PH.
Lavannya Pandit, MD, FCCP
Disaster response
Advancing disaster medicine and global health in times of pandemic
Worldwide hardships due to COVID-19 have revealed opportunities for improvement. Disaster education, telemedicine, knowledge sharing, and resource allocation have been highlighted as such areas. In an August 2020 publication, Hart et al. argue, “Every hospital needs a Disaster Medicine physician now” (Hart et al. “Why Every US Hospital Needs a Disaster Medicine Physician Now”).
Every physician must be prepared to be the expert in times of disaster. A survey of U.S. medical students showed that despite few respondents (<27%) feeling adequately educated, >90% are willing to respond to a natural disaster or a pandemic (Kaiser et al. Disaster Med Pub Health Prep. 2009;3[4]:210-16). While natural disasters have increased by almost 35% since the 1990s, a robust approach to disaster education is not routinely implemented across the fields of medicine, nursing, allied health, and health administration (Freebairn. World Disasters Report 2020: Executive Summary. 2020 ed. IFRC. ). Notably, disaster education provides opportunities for multidisciplinary team-building where learners build a foundation of knowledge together. While no ideal educational model has been fully adopted, high-quality educational opportunities include National Disaster Life Support Foundation courses, SALT triage, and ATLS (Homer et al. Prehospital and Disaster Medicine).
Telemedicine has emerged as a very effective means of disaster support through both direct patient encounters and provider education. Tele-triage used to delineate patients requiring urgent hospitalization from those who can be managed at home has proven effective in areas with limited health care facilities (World Health Organization. Coronavirus disease.). Knowledge sharing opportunities from organizations like Project ECHO have allowed for >368,000 learners from 146 countries to exchange information during >8,000 learning sessions (Project ECHO COVID-19 response.).
Physicians of all specialties should continue to develop skills in triage, surge capacity management, ethical/legal issues surrounding disasters, organizational interoperability, and telemedicine, and emphasize skills to ensure their own personal protection.
Christopher Miller, DO, MPH
Steering Committee Fellow-in-Training Member
Sarang Patil, MD
Steering Committee Member
Practice operations
Telehealth and postpandemic care
Telehealth is the use of electronic information and telecommunication technologies to provide care when the physician and the patient are not in the same place. Telehealth has been available for 40 years. The COVID-19 pandemic forced health care providers, systems, and patients to quickly adapt to virtual audio and visual visits, new documentation parameters, billing, and reimbursement structures. Emergency rules have removed the barriers to adoption of home-based diagnostics and virtual visits. It is expected that 20% to 30% post-pandemic care will be provided via telehealth.
Telehealth is particularly beneficial in providing counseling services or managing chronic illnesses, such as COPD and heart failure. There has been an explosion of monitoring devices both wearable and implantable. Some devices, which monitor PA pressure, have been shown to reduce heart failure hospitalizations and all-cause hospitalizations (Shavelle DM, et al. Circ Heart Fail. 2020;13: e006863). Studies have been conducted on home spirometry and oximetry devices in post-lung transplant, ILD (Russell AM et al. Am J Respir Crit Care Med. 2016 Oct 15; 194[8]:989-997), and CF patients (Compton M et al. Telemed J E Health . 2020 Aug;26[8]:978-84). As we move forward, we will have to ascertain what data acquisition is relevant and develop processes to address it in real time.
In this changing landscape of health care delivery, we can anticipate an increase in virtual visits and a trend toward e-consults, which will necessitate further advancements in remote monitoring and assessment and will require us to adopt new practice models.
Caitlin Baxter, MBBS
Steering Committee Fellow-in-Training
Namita Sood, MBBCh, FCCP
Steering Committee Member
Transplant network
The rise in lung transplant for older patients
Over the past 20 years, there has been a dramatic increase in lung transplantation in elderly patients, with wide variability in age limit amongst transplant centers. The number of recipients over the age of 65 has risen from 6.9% in 2004 to 29.6% in 2016 in the United States, and 2.6% to 17% internationally. There is a number of factors driving this increase; the prevalence of advanced lung disease with increasing age, advances in targeted therapies to treat cystic fibrosis, an increased willingness of centers to perform transplants in older patients, and the 2005 revision of the Lung Allocation Scoring System (Courtwright A, Cantu E. J Thoracic Dis. 2017:9[9]:3346-51).
In the past, outcomes posttransplant for elderly patients have been conflicting in single-center studies. More recently, Hayanga et al. found no difference in survival up to 1 year between individuals 60-69 and those over 70 (J Heart Lung Transplant. 2015;34[2]:182-88). Mosher et al., however, found the median survival dropped from 4.64 years for patients aged 65-69 to 3.07 years for patients ≥74 (J Heart Lung Transplant. 2021;40[1]:42-55). Notably, older recipients were more likely to be readmitted at 30 and 90 days, and more likely to be discharged to an inpatient rehabilitation facility following transplant (McCarthy et al. J Heart Lung Transplant. 2017;36:S115; Tang et al. Clin Transplant. 2015;29:581-587).
The use of transplant in elderly patients comes with many concerns regarding neurocognitive status, frailty, and other comorbidities, all of which must be rigorously tested prior to consideration(Biswas R et al. Ann Thorac Surg. 2015;100:443-51). Recipient age, creatinine level, bilirubin level, steroid use at the time of transplant, and hospitalization at the time of transplant were associated with increased mortality (Mosher et al. J Heart Lung Transplant. 2021;40[1]:42-55). Further research is warranted in this evolving area.
Melissa B. Lesko, DO
Grant Turner, MD, MHA
Steering Committee Members
Women’s lung health
Will the new pulmonary hypertension hemodynamic classification temper the PH ‘sex-paradox’?
Older and contemporary PH registries have consistently shown that PH predominantly affects women ~2 to 3.5 times than men, with female patients having better survival compared with men (Kozu K et al. Heart Vessels. 2018;33[8]:93), a fact attributed to better RV function in female than male subjects. This PH sex-paradox denotes that while estrogen leads to increased susceptibility to PH, it appears to confer better outcomes after PH develops due to improved RV function, since RV dysfunction is a strong predictor of poor outcomes in PH. Multiple preclinical studies have described how estrogen provides protective effects on the RV (Cheng TC et al. Am J Physiol Heart Circ Physiol. 2020;319:H1459; Frump AL et al. Am J Physiol Lung Cell Mol Physiol. 2015;308:L873).
The recent recommended updates to the hemodynamic definition reflect acknowledgment of irrefutable evidence that even mildly elevated mPAP (between 19 and 24 mm Hg) is associated with increased morbidity and mortality based on consistent data from pulmonary arterial hypertension (PAH) as well as from other forms of PH [Simonneau G et al. Eur Respir J. 2019;(Jan 24);53(1):1801913). With incorporation of the updated definition that more accurately captures the disease state and its progression, an unaddressed question still remains as to how the new classification will change PH treatment algorithm and outcomes in women compared with men. Setting the definition of PH at a mPAP of 20 mm Hg not only better represents the typical patients with PH in practice, such as those with PH due to left-sided heart disease (Group 2) or PH associated with chronic lung disease (Group 3), but incorporates the preclinical pathologic disease state of PH, in which symptoms may not be evident (Maron BA, et al. Circulation. 2016;133:1240). In adhering to the new PH definition, will earlier diagnosis across the spectrum of all individuals with PH before RV dysfunction has developed improve outcomes for all those afflicted with PH and equalize outcomes between men and women? As future studies continue to investigate the direct effects of sex hormones on the RV and dissect the mechanisms leading to the sex differences in RV function in PH, a pre-clinical diagnosis in all PH patients, particularly male patients with Group 2/3 disease, may mitigate some of the previously observed advantages of estrogen on outcomes in PH.
Lavannya Pandit, MD, FCCP