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Disaster response and global health. Interstitial and diffuse lung disease. Practice operations. Transplant. Women’s lung health.
Disaster response and global health
One step forward, two back…
No adult alive today will live to see global gender parity. The 2020 World Economic Forum Global Gender Gap Report, published December 2019, assessed four dimensions of gender inequality – health, economic opportunities, educational advancement, and political empowerment.
The report stated that despite some advances, overall global gender parity would not be reached for 99 years. The gender gap is not solely a developing nation’s problem. The US standing as the 51st in gender parity fell to 53rd during the previous 2-year period. And these numbers were before Covid COVID-19.
Disasters, including pandemics, negatively affect female subjects disproportionately. Covid COVID-19 has unmasked and exacerbated both gender and minority disparity. Global health care workers (HCW) are overwhelmingly female, exposing them to a higher risk of contagion. This risk was exceptionally high among Black, Asian, and minority ethnic HCW (Nguyen et al. Lancet Public Health. 2020;5[9]:E475). The gender pay gap, where women are paid 80% of their male counterparts and women of color make 63%, has led to a greater financial burden among female HCW during Covid COVID-19. Women, including HCW, provide the majority of the unpaid work, i.e., childcare, elder care, and home care. 2020 saw an unprecedented loss of women in the workplace, including health care. Both clinical practice and research have been affected. The long- term effect on women HCW careers is unknown at present. Global gross domestic product growth loss due to this decline in the female workforce is estimated at 1 trillion USD over the next decade.
Disaster and gender parity are entwined. Covid COVID-19 has revealed the persistence of inequalities that nees to be considered in future disaster planning.
Mary Jane Reed, MD, FCCP
Steering Committee Ex-Officio
Interstitial and diffuse lung disease
Emergence and benefits of home monitoring and telemedicine for patients with ILD
Patients with interstitial lung disease (ILD) require regular monitoring with outpatient clinic visits and pulmonary function tests.
The emergence of COVID-19 forced an unprecedented transition to telemedicine and a new reliance on home monitoring. Home spirometry enables quick detection of rapidly progressive disease and is more sensitive than hospital-based spirometry in predicting prognosis (Russel, et al. Am J Respir Crit Care Med. 2016;194[8]:989). Patients with idiopathic pulmonary fibrosis randomized to a home monitoring program had improved psychological wellbeing and higher patient satisfaction with individually tailored treatment decisions (Moor, et al. Am J Respir Crit Care Med. 2020;202[3]:393). However, there are some inaccuracies in home monitoring. For instance, pulse oximetry is less reliable in African American patients receiving supplemental oxygen (Sjoding, et al. N Engl J Med. 2020;383:2477). It is critical to protect ILD patients from potential COVID-19 exposure given the high risk of serious complications. Telemedicine should be offered to all patients and may actually increase access to care in ILD patients, a population with disabling dyspnea and supplemental oxygen needs that requires specialist care unavailable in many geographic regions. African American patients, those older than 65, and patients with lower socioeconomic status are less willing to engage in videoconferencing (Fischer, et al. JAMA Netw Open. 2020;3[10]:e2022302). It is essential that telephone visits be offered to minimize disparities in access to care. Many telemedicine platforms enable caregivers and family members to attend visits from separate locations and provide a unique opportunity to address advance care planning. In-person visits should be arranged for patients with no access to internet or telephone or those with poor medical literacy or insufficient social support to conduct a productive remote visit. Telemedicine and home monitoring have proved invaluable during the COVID-19 pandemic and have the potential to continually increase access to and quality of care.
Rebecca Anna Gersten, MD
Steering Committee Member
Practice operations
Use of media platforms to eliminate the COVID-19 infodemic
We were shocked when we read a tweet in December 2020 from a health care worker stating, “My biggest concern is the lack of data and the quick development time. Feels like we are a bunch of guinea pigs” in reference to the new COVID-19 vaccine.
I reflected back on the last pandemic in 2009, H1N1, and remembered when the new vaccine developed in 174 days was first released to pregnant women and children after phase 3 trials. How did we get here? What do we do to fix it?
This misinformation is labeled as the “COVID-19 infodemic.” In the last year, we have seen the media, more specifically social platforms, quickly spread medical misinformation. In the book “Made to Stick: Why Some Ideas Survive and Some Die,” the authors described core elements that make an idea “sticky.” Use of those exact same sticky techniques can be used to circulate accurate information and to halt the spread of this infodemic. Although, numerous media companies, including Twitter, are making an effort to remove the false content from their platforms, their efforts require a lengthy process and are delayed. Therefore, it is crucial for the public health figures and community at large in partnership with various national organizations to establish a robust connection with the social platforms in a dynamic and timely fashion to help spread the verified information across social media, digital and traditional media outlets.
The UN has launched an initiate called “Verified.” This is a worldwide effort to help individuals spread reliable information regarding COVID-19 to their friends and families via social platforms as various media platforms and businesses have partnered with Verified. Also, we encourage our members to access the CHEST COVID-19 resource center and benefit from the various clinical and practice management tools along with validated patient information materials.
Roozera Khan, DO, FCCP
Steering Committee Member
Humayun Anjum, MD, FCCP
Chair
References
1. The Lancet Infectious Diseases-Editorial. The COVID-19 infodemic. Lancet Infect Dis. 2020;20(8):875.
2. Tangcharoensathien V, et al. Framework for managing the COVID-19 infodemic: methods and results of an online, crowdsourced WHO technical consultation. J Med Internet Res. 2020;22e19659.
3. Verified. https://shareverified.com/en/about. Accessed Feb 18, 2021.
Transplant
COVID-19 + lung transplant
The COVID-19 pandemic has created a dilemma for lung transplantation, with a new group of patients with refractory respiratory failure secondary to the viral illness. As transplant centers worldwide receive referrals for COVID-19 related respiratory failure, information regarding evaluation, listing, and posttransplant care continues to be published, but further research will be needed to care for this complex population.
The first lung transplant for COVID-19 in the United States occurred at Northwestern Hospital on June 5th, 2020,and was publicized for its innovativeness. Information from their three lung transplants completed thus far includes information regarding pathologic findings of the explanted lung tissue; pulmonary fibrosis was the dominant feature, suggesting COVID-19-induced acute respiratory distress syndrome with prolonged time supported by mechanical support may only be survivable with the use of lung transplant (Bharat, et al. Sci Transl Med. 2020;12(574):eabe4282).
Lung transplant in the setting of COVID-19 fibrosis increases surgical complexity as well, with case reports of dense adhesions and distortion of regular surgical planes (Bharat, et al. Sci. Transl. Med. 2020; Lang, et al. Lancet Respir Med. 2020;8:1057). Recognizing the difficulty with deciding to use transplantation after an infectious disease, The International Society for Heart and Lung Transplant (ISHLT) has created guidelines regarding indications for transplantation (ISHLT.org). Continued research will be necessary to identify those at the highest likelihood for success from transplantation, preparation for the increased complexity, and long-term outcomes. Further information is available in a CHEST webinar titled “Lung Transplantation in the Era of COVID-19” .
Clauden Louis, MD
Grant Turner, MD
Fellows-in-Training NetWork Members
Women’s lung health
Pregnancy in cystic fibrosis
The newest in the line of modulator therapy, Trikafta (elexacaftor/tezacaftor/ivacaftor and ivacaftor), is expected to improve life expectancy and quality of life for patients with cystic fibrosis (CF). This evolution in therapy will shape how providers care for their patients, particularly women of reproductive age. Conventionally, women with significantly impaired lung function due to CF have been advised to avoid pregnancy due to potential complications for mother and baby. It is likely that now, with improved lung function while receiving Trikafta, more women will feel better equipped to attempt pregnancy.
There are several considerations in this setting, including the need for careful drug safety and monitoring, creating a plan of action for possible decline in lung function while off certain CF-related medications, and counseling on drug interactions during lactation. In our experience with women becoming pregnant while receiving Trikafta or contemplating pregnancy, all have opted to discontinue modulator therapy with declines in lung function. Trikafta does not report teratogenicity based on animal studies of the individual components of the drug; however, ivacaftor is known to cause impairment in fertility and reproductive indices, including nonviable embryos and implantation failure in a rat model at five times the maximum recommended human dose, dosed prior to and during early embryogenesis. Small mammal models have decreased birth weight at high doses of elexacaftor, tezacaftor and ivacaftor administered individually. There is evidence of placental transfer of ivacaftor and breast milk concentrations of tezacaftor and ivacaftor are higher than plasma concentrations in rats. There are no human data in parturient or lactating women or infants. Three women became pregnant during the phase 3 clinical study of Trikafta, one with elective termination, one pregnancy was carried to full term with normal birth outcome, and one ended in a spontaneous abortion, which was deemed not to be related to the study drug. Translating this information into recommendations for patients has important implications.
Debasree Banerjee, MD, MS
Steering Committee Member
Disaster response and global health
One step forward, two back…
No adult alive today will live to see global gender parity. The 2020 World Economic Forum Global Gender Gap Report, published December 2019, assessed four dimensions of gender inequality – health, economic opportunities, educational advancement, and political empowerment.
The report stated that despite some advances, overall global gender parity would not be reached for 99 years. The gender gap is not solely a developing nation’s problem. The US standing as the 51st in gender parity fell to 53rd during the previous 2-year period. And these numbers were before Covid COVID-19.
Disasters, including pandemics, negatively affect female subjects disproportionately. Covid COVID-19 has unmasked and exacerbated both gender and minority disparity. Global health care workers (HCW) are overwhelmingly female, exposing them to a higher risk of contagion. This risk was exceptionally high among Black, Asian, and minority ethnic HCW (Nguyen et al. Lancet Public Health. 2020;5[9]:E475). The gender pay gap, where women are paid 80% of their male counterparts and women of color make 63%, has led to a greater financial burden among female HCW during Covid COVID-19. Women, including HCW, provide the majority of the unpaid work, i.e., childcare, elder care, and home care. 2020 saw an unprecedented loss of women in the workplace, including health care. Both clinical practice and research have been affected. The long- term effect on women HCW careers is unknown at present. Global gross domestic product growth loss due to this decline in the female workforce is estimated at 1 trillion USD over the next decade.
Disaster and gender parity are entwined. Covid COVID-19 has revealed the persistence of inequalities that nees to be considered in future disaster planning.
Mary Jane Reed, MD, FCCP
Steering Committee Ex-Officio
Interstitial and diffuse lung disease
Emergence and benefits of home monitoring and telemedicine for patients with ILD
Patients with interstitial lung disease (ILD) require regular monitoring with outpatient clinic visits and pulmonary function tests.
The emergence of COVID-19 forced an unprecedented transition to telemedicine and a new reliance on home monitoring. Home spirometry enables quick detection of rapidly progressive disease and is more sensitive than hospital-based spirometry in predicting prognosis (Russel, et al. Am J Respir Crit Care Med. 2016;194[8]:989). Patients with idiopathic pulmonary fibrosis randomized to a home monitoring program had improved psychological wellbeing and higher patient satisfaction with individually tailored treatment decisions (Moor, et al. Am J Respir Crit Care Med. 2020;202[3]:393). However, there are some inaccuracies in home monitoring. For instance, pulse oximetry is less reliable in African American patients receiving supplemental oxygen (Sjoding, et al. N Engl J Med. 2020;383:2477). It is critical to protect ILD patients from potential COVID-19 exposure given the high risk of serious complications. Telemedicine should be offered to all patients and may actually increase access to care in ILD patients, a population with disabling dyspnea and supplemental oxygen needs that requires specialist care unavailable in many geographic regions. African American patients, those older than 65, and patients with lower socioeconomic status are less willing to engage in videoconferencing (Fischer, et al. JAMA Netw Open. 2020;3[10]:e2022302). It is essential that telephone visits be offered to minimize disparities in access to care. Many telemedicine platforms enable caregivers and family members to attend visits from separate locations and provide a unique opportunity to address advance care planning. In-person visits should be arranged for patients with no access to internet or telephone or those with poor medical literacy or insufficient social support to conduct a productive remote visit. Telemedicine and home monitoring have proved invaluable during the COVID-19 pandemic and have the potential to continually increase access to and quality of care.
Rebecca Anna Gersten, MD
Steering Committee Member
Practice operations
Use of media platforms to eliminate the COVID-19 infodemic
We were shocked when we read a tweet in December 2020 from a health care worker stating, “My biggest concern is the lack of data and the quick development time. Feels like we are a bunch of guinea pigs” in reference to the new COVID-19 vaccine.
I reflected back on the last pandemic in 2009, H1N1, and remembered when the new vaccine developed in 174 days was first released to pregnant women and children after phase 3 trials. How did we get here? What do we do to fix it?
This misinformation is labeled as the “COVID-19 infodemic.” In the last year, we have seen the media, more specifically social platforms, quickly spread medical misinformation. In the book “Made to Stick: Why Some Ideas Survive and Some Die,” the authors described core elements that make an idea “sticky.” Use of those exact same sticky techniques can be used to circulate accurate information and to halt the spread of this infodemic. Although, numerous media companies, including Twitter, are making an effort to remove the false content from their platforms, their efforts require a lengthy process and are delayed. Therefore, it is crucial for the public health figures and community at large in partnership with various national organizations to establish a robust connection with the social platforms in a dynamic and timely fashion to help spread the verified information across social media, digital and traditional media outlets.
The UN has launched an initiate called “Verified.” This is a worldwide effort to help individuals spread reliable information regarding COVID-19 to their friends and families via social platforms as various media platforms and businesses have partnered with Verified. Also, we encourage our members to access the CHEST COVID-19 resource center and benefit from the various clinical and practice management tools along with validated patient information materials.
Roozera Khan, DO, FCCP
Steering Committee Member
Humayun Anjum, MD, FCCP
Chair
References
1. The Lancet Infectious Diseases-Editorial. The COVID-19 infodemic. Lancet Infect Dis. 2020;20(8):875.
2. Tangcharoensathien V, et al. Framework for managing the COVID-19 infodemic: methods and results of an online, crowdsourced WHO technical consultation. J Med Internet Res. 2020;22e19659.
3. Verified. https://shareverified.com/en/about. Accessed Feb 18, 2021.
Transplant
COVID-19 + lung transplant
The COVID-19 pandemic has created a dilemma for lung transplantation, with a new group of patients with refractory respiratory failure secondary to the viral illness. As transplant centers worldwide receive referrals for COVID-19 related respiratory failure, information regarding evaluation, listing, and posttransplant care continues to be published, but further research will be needed to care for this complex population.
The first lung transplant for COVID-19 in the United States occurred at Northwestern Hospital on June 5th, 2020,and was publicized for its innovativeness. Information from their three lung transplants completed thus far includes information regarding pathologic findings of the explanted lung tissue; pulmonary fibrosis was the dominant feature, suggesting COVID-19-induced acute respiratory distress syndrome with prolonged time supported by mechanical support may only be survivable with the use of lung transplant (Bharat, et al. Sci Transl Med. 2020;12(574):eabe4282).
Lung transplant in the setting of COVID-19 fibrosis increases surgical complexity as well, with case reports of dense adhesions and distortion of regular surgical planes (Bharat, et al. Sci. Transl. Med. 2020; Lang, et al. Lancet Respir Med. 2020;8:1057). Recognizing the difficulty with deciding to use transplantation after an infectious disease, The International Society for Heart and Lung Transplant (ISHLT) has created guidelines regarding indications for transplantation (ISHLT.org). Continued research will be necessary to identify those at the highest likelihood for success from transplantation, preparation for the increased complexity, and long-term outcomes. Further information is available in a CHEST webinar titled “Lung Transplantation in the Era of COVID-19” .
Clauden Louis, MD
Grant Turner, MD
Fellows-in-Training NetWork Members
Women’s lung health
Pregnancy in cystic fibrosis
The newest in the line of modulator therapy, Trikafta (elexacaftor/tezacaftor/ivacaftor and ivacaftor), is expected to improve life expectancy and quality of life for patients with cystic fibrosis (CF). This evolution in therapy will shape how providers care for their patients, particularly women of reproductive age. Conventionally, women with significantly impaired lung function due to CF have been advised to avoid pregnancy due to potential complications for mother and baby. It is likely that now, with improved lung function while receiving Trikafta, more women will feel better equipped to attempt pregnancy.
There are several considerations in this setting, including the need for careful drug safety and monitoring, creating a plan of action for possible decline in lung function while off certain CF-related medications, and counseling on drug interactions during lactation. In our experience with women becoming pregnant while receiving Trikafta or contemplating pregnancy, all have opted to discontinue modulator therapy with declines in lung function. Trikafta does not report teratogenicity based on animal studies of the individual components of the drug; however, ivacaftor is known to cause impairment in fertility and reproductive indices, including nonviable embryos and implantation failure in a rat model at five times the maximum recommended human dose, dosed prior to and during early embryogenesis. Small mammal models have decreased birth weight at high doses of elexacaftor, tezacaftor and ivacaftor administered individually. There is evidence of placental transfer of ivacaftor and breast milk concentrations of tezacaftor and ivacaftor are higher than plasma concentrations in rats. There are no human data in parturient or lactating women or infants. Three women became pregnant during the phase 3 clinical study of Trikafta, one with elective termination, one pregnancy was carried to full term with normal birth outcome, and one ended in a spontaneous abortion, which was deemed not to be related to the study drug. Translating this information into recommendations for patients has important implications.
Debasree Banerjee, MD, MS
Steering Committee Member
Disaster response and global health
One step forward, two back…
No adult alive today will live to see global gender parity. The 2020 World Economic Forum Global Gender Gap Report, published December 2019, assessed four dimensions of gender inequality – health, economic opportunities, educational advancement, and political empowerment.
The report stated that despite some advances, overall global gender parity would not be reached for 99 years. The gender gap is not solely a developing nation’s problem. The US standing as the 51st in gender parity fell to 53rd during the previous 2-year period. And these numbers were before Covid COVID-19.
Disasters, including pandemics, negatively affect female subjects disproportionately. Covid COVID-19 has unmasked and exacerbated both gender and minority disparity. Global health care workers (HCW) are overwhelmingly female, exposing them to a higher risk of contagion. This risk was exceptionally high among Black, Asian, and minority ethnic HCW (Nguyen et al. Lancet Public Health. 2020;5[9]:E475). The gender pay gap, where women are paid 80% of their male counterparts and women of color make 63%, has led to a greater financial burden among female HCW during Covid COVID-19. Women, including HCW, provide the majority of the unpaid work, i.e., childcare, elder care, and home care. 2020 saw an unprecedented loss of women in the workplace, including health care. Both clinical practice and research have been affected. The long- term effect on women HCW careers is unknown at present. Global gross domestic product growth loss due to this decline in the female workforce is estimated at 1 trillion USD over the next decade.
Disaster and gender parity are entwined. Covid COVID-19 has revealed the persistence of inequalities that nees to be considered in future disaster planning.
Mary Jane Reed, MD, FCCP
Steering Committee Ex-Officio
Interstitial and diffuse lung disease
Emergence and benefits of home monitoring and telemedicine for patients with ILD
Patients with interstitial lung disease (ILD) require regular monitoring with outpatient clinic visits and pulmonary function tests.
The emergence of COVID-19 forced an unprecedented transition to telemedicine and a new reliance on home monitoring. Home spirometry enables quick detection of rapidly progressive disease and is more sensitive than hospital-based spirometry in predicting prognosis (Russel, et al. Am J Respir Crit Care Med. 2016;194[8]:989). Patients with idiopathic pulmonary fibrosis randomized to a home monitoring program had improved psychological wellbeing and higher patient satisfaction with individually tailored treatment decisions (Moor, et al. Am J Respir Crit Care Med. 2020;202[3]:393). However, there are some inaccuracies in home monitoring. For instance, pulse oximetry is less reliable in African American patients receiving supplemental oxygen (Sjoding, et al. N Engl J Med. 2020;383:2477). It is critical to protect ILD patients from potential COVID-19 exposure given the high risk of serious complications. Telemedicine should be offered to all patients and may actually increase access to care in ILD patients, a population with disabling dyspnea and supplemental oxygen needs that requires specialist care unavailable in many geographic regions. African American patients, those older than 65, and patients with lower socioeconomic status are less willing to engage in videoconferencing (Fischer, et al. JAMA Netw Open. 2020;3[10]:e2022302). It is essential that telephone visits be offered to minimize disparities in access to care. Many telemedicine platforms enable caregivers and family members to attend visits from separate locations and provide a unique opportunity to address advance care planning. In-person visits should be arranged for patients with no access to internet or telephone or those with poor medical literacy or insufficient social support to conduct a productive remote visit. Telemedicine and home monitoring have proved invaluable during the COVID-19 pandemic and have the potential to continually increase access to and quality of care.
Rebecca Anna Gersten, MD
Steering Committee Member
Practice operations
Use of media platforms to eliminate the COVID-19 infodemic
We were shocked when we read a tweet in December 2020 from a health care worker stating, “My biggest concern is the lack of data and the quick development time. Feels like we are a bunch of guinea pigs” in reference to the new COVID-19 vaccine.
I reflected back on the last pandemic in 2009, H1N1, and remembered when the new vaccine developed in 174 days was first released to pregnant women and children after phase 3 trials. How did we get here? What do we do to fix it?
This misinformation is labeled as the “COVID-19 infodemic.” In the last year, we have seen the media, more specifically social platforms, quickly spread medical misinformation. In the book “Made to Stick: Why Some Ideas Survive and Some Die,” the authors described core elements that make an idea “sticky.” Use of those exact same sticky techniques can be used to circulate accurate information and to halt the spread of this infodemic. Although, numerous media companies, including Twitter, are making an effort to remove the false content from their platforms, their efforts require a lengthy process and are delayed. Therefore, it is crucial for the public health figures and community at large in partnership with various national organizations to establish a robust connection with the social platforms in a dynamic and timely fashion to help spread the verified information across social media, digital and traditional media outlets.
The UN has launched an initiate called “Verified.” This is a worldwide effort to help individuals spread reliable information regarding COVID-19 to their friends and families via social platforms as various media platforms and businesses have partnered with Verified. Also, we encourage our members to access the CHEST COVID-19 resource center and benefit from the various clinical and practice management tools along with validated patient information materials.
Roozera Khan, DO, FCCP
Steering Committee Member
Humayun Anjum, MD, FCCP
Chair
References
1. The Lancet Infectious Diseases-Editorial. The COVID-19 infodemic. Lancet Infect Dis. 2020;20(8):875.
2. Tangcharoensathien V, et al. Framework for managing the COVID-19 infodemic: methods and results of an online, crowdsourced WHO technical consultation. J Med Internet Res. 2020;22e19659.
3. Verified. https://shareverified.com/en/about. Accessed Feb 18, 2021.
Transplant
COVID-19 + lung transplant
The COVID-19 pandemic has created a dilemma for lung transplantation, with a new group of patients with refractory respiratory failure secondary to the viral illness. As transplant centers worldwide receive referrals for COVID-19 related respiratory failure, information regarding evaluation, listing, and posttransplant care continues to be published, but further research will be needed to care for this complex population.
The first lung transplant for COVID-19 in the United States occurred at Northwestern Hospital on June 5th, 2020,and was publicized for its innovativeness. Information from their three lung transplants completed thus far includes information regarding pathologic findings of the explanted lung tissue; pulmonary fibrosis was the dominant feature, suggesting COVID-19-induced acute respiratory distress syndrome with prolonged time supported by mechanical support may only be survivable with the use of lung transplant (Bharat, et al. Sci Transl Med. 2020;12(574):eabe4282).
Lung transplant in the setting of COVID-19 fibrosis increases surgical complexity as well, with case reports of dense adhesions and distortion of regular surgical planes (Bharat, et al. Sci. Transl. Med. 2020; Lang, et al. Lancet Respir Med. 2020;8:1057). Recognizing the difficulty with deciding to use transplantation after an infectious disease, The International Society for Heart and Lung Transplant (ISHLT) has created guidelines regarding indications for transplantation (ISHLT.org). Continued research will be necessary to identify those at the highest likelihood for success from transplantation, preparation for the increased complexity, and long-term outcomes. Further information is available in a CHEST webinar titled “Lung Transplantation in the Era of COVID-19” .
Clauden Louis, MD
Grant Turner, MD
Fellows-in-Training NetWork Members
Women’s lung health
Pregnancy in cystic fibrosis
The newest in the line of modulator therapy, Trikafta (elexacaftor/tezacaftor/ivacaftor and ivacaftor), is expected to improve life expectancy and quality of life for patients with cystic fibrosis (CF). This evolution in therapy will shape how providers care for their patients, particularly women of reproductive age. Conventionally, women with significantly impaired lung function due to CF have been advised to avoid pregnancy due to potential complications for mother and baby. It is likely that now, with improved lung function while receiving Trikafta, more women will feel better equipped to attempt pregnancy.
There are several considerations in this setting, including the need for careful drug safety and monitoring, creating a plan of action for possible decline in lung function while off certain CF-related medications, and counseling on drug interactions during lactation. In our experience with women becoming pregnant while receiving Trikafta or contemplating pregnancy, all have opted to discontinue modulator therapy with declines in lung function. Trikafta does not report teratogenicity based on animal studies of the individual components of the drug; however, ivacaftor is known to cause impairment in fertility and reproductive indices, including nonviable embryos and implantation failure in a rat model at five times the maximum recommended human dose, dosed prior to and during early embryogenesis. Small mammal models have decreased birth weight at high doses of elexacaftor, tezacaftor and ivacaftor administered individually. There is evidence of placental transfer of ivacaftor and breast milk concentrations of tezacaftor and ivacaftor are higher than plasma concentrations in rats. There are no human data in parturient or lactating women or infants. Three women became pregnant during the phase 3 clinical study of Trikafta, one with elective termination, one pregnancy was carried to full term with normal birth outcome, and one ended in a spontaneous abortion, which was deemed not to be related to the study drug. Translating this information into recommendations for patients has important implications.
Debasree Banerjee, MD, MS
Steering Committee Member
President’s report
As I write, it is 1 degree Fahrenheit and dreary in Kansas City, where I live. That’s minus 17 degrees Celsius for many of you. I hope that it is cheerier and bordering on springtime when you’re reading. You’ll understand, though, why I say Happy 2021! 2020 was a humdinger in many ways.
One of those ways, of course, was the COVID-19 pandemic, which wrought so many things – face masks, social distancing, steep learning curves, over 300,000 excess deaths, and new vaccines. For CHEST, it meant that two of our most important educational opportunities of the year, board review and the annual meeting, were held virtually. Dr. Levine has already written about the board reviews, so I’ll focus on the annual meeting, held in late October.
In many ways, the meeting was a success. We had over 6,800 attendees. There were 88 live online sessions, 22 that were semi-live, and 160 prerecorded sessions. For presenters, this was simultaneously both easy and difficult. They had to ensure that their recording equipment and their Internet access were of sufficient quality, and if prerecorded, the sessions had to be finished weeks ahead of time. But the presentations could be given from presenters’ homes or from their normal work offices. For attendees, the ability for nonsimultaneous playback allowed for fitting the meeting into a work-life schedule. In fact, at least one friend related that he watched sessions with a grandchild on his lap. However, it meant a lack of opportunities to ask clarifying questions of the presenters, which is a common activity at the end of a session, and the opportunity to see and catch up with old friends and colleagues was missing. Simulations, of course, could not be hands-on, but virtual educational games matured significantly. The satisfaction scores from both attendees and faculty were good, if slightly below our usual scores for live meetings. They told us that we all prefer our in-person meetings, but that content is deliverable and receivable in an online format. Overall, we have to consider the CHEST 2020 online platform to be a successful endeavor.
Which brings me to our plans for future meetings. The Board of Regents discussed the alternatives for CHEST 2021. Should we hold a live meeting in Vancouver, as planned? Should we hold another online meeting like the one we just discussed? None of us has the crystal ball that tells us exactly how COVID-19 is going to develop. We don’t know exactly how many people will be vaccinated either north or south of the U.S.-Canada border. While those of us who care for patients in the United States have had the opportunity to be vaccinated, we don’t know if the professional staff from CHEST headquarters who travel to the annual meeting will be vaccinated, even though that prospect is currently looking very reasonable. We don’t know if the Canadian government will be allowing U.S. residents to visit Canada without quarantine. There are just quite a few things that we can’t know. However, convention centers need to know if we will be there, and we needed to decide.
In the end, a couple of things swayed us—the unexpected availability of a U.S. convention center and uncertainty about travel to Canada. We are planning to hold CHEST 2021 in Orlando, Florida, during our usual late October time frame. CHEST 2021 is slated to be the first in-person pulmonary, critical care, and sleep conference to be held in the United States in 2 years. The Executive Program Committee has met, and program selections have been made. Very soon, invitations will go to our prospective faculty, and we will be underway. We are planning CHEST 2021 as what we call a “hybrid” meeting, a meeting that will provide an excellent experience whether one attends in person at the Orlando Convention Center or partakes of the meeting from home. Some sessions will be broadcast live and others will be prerecorded. Needless to say, the experience will not be equal for in-person and at-home learners, but it will be equitable. Regardless of how you choose to partake, CHEST 2021 will have excellent content to suit your needs. This plan also allows us the ability to convert to a fully online meeting, should the COVID-19 circumstances dictate that we must. Having sat in on the program committee meetings, I am excited about what we have to offer. So, dig around and find your old mouse ears or your red forehead scar. CHEST 2021 will be a dynamite experience for us all to share.
Our board review sessions, which are also among the most highly valued of CHEST activities, will be different out of necessity. Again, decisions had to be made many months ahead of time, and we have chosen to hold our board reviews online again this year. COVID-19 uncertainties certainly play into our decision to not put attendees in a room together. However, the ability to play and replay, slow down and speed up video content, and ability to watch any session any time are all well suited to reviewing for an examination. We think this is the appropriate decision for 2021, but we may be back together again for future sessions. Frankly, we are listening to hear which format our attendees like more. And, we are plotting how to make the online platform review even better.
The Board of Regents has been hard at work on a lot of fronts, but I want to focus on one of them, for now. It is important to the Board of Regents and to me, personally, that CHEST be the single most inclusive and diverse professional medical society, bar none. It is of utmost importance that we remove any barriers that might have inadvertently been put into place that would hamper the success of any of our members or their patients. In other words, we hope to find any implicit biases in attitude and behavior and to illuminate and remedy them. We have begun the process by focusing on what CHEST is all about – making a difference with our patients and corporate self and being an inclusive and diverse professional organization.
We believe that we must look at ourselves in three separate, but related, ways. We must examine our patient-facing side and the ways in which we help our members to serve their patients. We must examine our headquarters and our hiring, working, and promoting practices to ensure an inclusive and welcoming environment for the staff who do our day to day business. Finally, we must examine ourselves and our member-based organization, to ensure that all can participate freely in CHEST opportunities and, for those who aspire to lead our organization, to ensure that there are no implicit biases that hold them back.
We began the process with a series of regional listening sessions across the United States, sponsored by the CHEST Foundation, in which we heard from both patients and community leaders of color. We learned of challenges that our patients face in accessing care, communicating with their doctors, and obtaining the medications they need for their illness. Our professional staff has organized an anti-racism task force and is working to ensure that we can be proud of a diverse and inclusive work environment. For our members, we have held two board development sessions, so that our Board of Regents can examine us and our attitudes toward race and toward inclusiveness in our organization. We will soon be holding a listening session with CHEST members of color with the express purpose of allowing those of us who are not persons of color to better understand the challenges faced by our members and to understand where organizational changes could be necessary to help make their professional lives better. As a long time CHEST member, I believe that CHEST is not purposefully exclusive of anyone. We are, nevertheless, a part of the larger fabric of society, and because of that, we are subject to having implicit biases and practices as an organization. Our best path to be aware of them and to deal with them is to hear from our members who experience them, and we shall.
I will end on a note that is somber but important. In the past year, we have all lost friends and colleagues with whom we worked side by side, to COVID-19. Many of them have been CHEST members. Because of the pandemic, we have often not been able to mourn those we have cared about in the same ways that we normally would, in the company of friends and family. Yet, it is important for us to remember our colleagues and to share our memories. So, we established CHEST Remembers, a memorial wall on the CHEST website where we can post the news of our friends’ passing, along with our remembrances of them. If your friend or colleague has died of COVID-19, please feel free to share with the CHEST community. You can find the link to do that at www.chestnet.org.
As I write, it is 1 degree Fahrenheit and dreary in Kansas City, where I live. That’s minus 17 degrees Celsius for many of you. I hope that it is cheerier and bordering on springtime when you’re reading. You’ll understand, though, why I say Happy 2021! 2020 was a humdinger in many ways.
One of those ways, of course, was the COVID-19 pandemic, which wrought so many things – face masks, social distancing, steep learning curves, over 300,000 excess deaths, and new vaccines. For CHEST, it meant that two of our most important educational opportunities of the year, board review and the annual meeting, were held virtually. Dr. Levine has already written about the board reviews, so I’ll focus on the annual meeting, held in late October.
In many ways, the meeting was a success. We had over 6,800 attendees. There were 88 live online sessions, 22 that were semi-live, and 160 prerecorded sessions. For presenters, this was simultaneously both easy and difficult. They had to ensure that their recording equipment and their Internet access were of sufficient quality, and if prerecorded, the sessions had to be finished weeks ahead of time. But the presentations could be given from presenters’ homes or from their normal work offices. For attendees, the ability for nonsimultaneous playback allowed for fitting the meeting into a work-life schedule. In fact, at least one friend related that he watched sessions with a grandchild on his lap. However, it meant a lack of opportunities to ask clarifying questions of the presenters, which is a common activity at the end of a session, and the opportunity to see and catch up with old friends and colleagues was missing. Simulations, of course, could not be hands-on, but virtual educational games matured significantly. The satisfaction scores from both attendees and faculty were good, if slightly below our usual scores for live meetings. They told us that we all prefer our in-person meetings, but that content is deliverable and receivable in an online format. Overall, we have to consider the CHEST 2020 online platform to be a successful endeavor.
Which brings me to our plans for future meetings. The Board of Regents discussed the alternatives for CHEST 2021. Should we hold a live meeting in Vancouver, as planned? Should we hold another online meeting like the one we just discussed? None of us has the crystal ball that tells us exactly how COVID-19 is going to develop. We don’t know exactly how many people will be vaccinated either north or south of the U.S.-Canada border. While those of us who care for patients in the United States have had the opportunity to be vaccinated, we don’t know if the professional staff from CHEST headquarters who travel to the annual meeting will be vaccinated, even though that prospect is currently looking very reasonable. We don’t know if the Canadian government will be allowing U.S. residents to visit Canada without quarantine. There are just quite a few things that we can’t know. However, convention centers need to know if we will be there, and we needed to decide.
In the end, a couple of things swayed us—the unexpected availability of a U.S. convention center and uncertainty about travel to Canada. We are planning to hold CHEST 2021 in Orlando, Florida, during our usual late October time frame. CHEST 2021 is slated to be the first in-person pulmonary, critical care, and sleep conference to be held in the United States in 2 years. The Executive Program Committee has met, and program selections have been made. Very soon, invitations will go to our prospective faculty, and we will be underway. We are planning CHEST 2021 as what we call a “hybrid” meeting, a meeting that will provide an excellent experience whether one attends in person at the Orlando Convention Center or partakes of the meeting from home. Some sessions will be broadcast live and others will be prerecorded. Needless to say, the experience will not be equal for in-person and at-home learners, but it will be equitable. Regardless of how you choose to partake, CHEST 2021 will have excellent content to suit your needs. This plan also allows us the ability to convert to a fully online meeting, should the COVID-19 circumstances dictate that we must. Having sat in on the program committee meetings, I am excited about what we have to offer. So, dig around and find your old mouse ears or your red forehead scar. CHEST 2021 will be a dynamite experience for us all to share.
Our board review sessions, which are also among the most highly valued of CHEST activities, will be different out of necessity. Again, decisions had to be made many months ahead of time, and we have chosen to hold our board reviews online again this year. COVID-19 uncertainties certainly play into our decision to not put attendees in a room together. However, the ability to play and replay, slow down and speed up video content, and ability to watch any session any time are all well suited to reviewing for an examination. We think this is the appropriate decision for 2021, but we may be back together again for future sessions. Frankly, we are listening to hear which format our attendees like more. And, we are plotting how to make the online platform review even better.
The Board of Regents has been hard at work on a lot of fronts, but I want to focus on one of them, for now. It is important to the Board of Regents and to me, personally, that CHEST be the single most inclusive and diverse professional medical society, bar none. It is of utmost importance that we remove any barriers that might have inadvertently been put into place that would hamper the success of any of our members or their patients. In other words, we hope to find any implicit biases in attitude and behavior and to illuminate and remedy them. We have begun the process by focusing on what CHEST is all about – making a difference with our patients and corporate self and being an inclusive and diverse professional organization.
We believe that we must look at ourselves in three separate, but related, ways. We must examine our patient-facing side and the ways in which we help our members to serve their patients. We must examine our headquarters and our hiring, working, and promoting practices to ensure an inclusive and welcoming environment for the staff who do our day to day business. Finally, we must examine ourselves and our member-based organization, to ensure that all can participate freely in CHEST opportunities and, for those who aspire to lead our organization, to ensure that there are no implicit biases that hold them back.
We began the process with a series of regional listening sessions across the United States, sponsored by the CHEST Foundation, in which we heard from both patients and community leaders of color. We learned of challenges that our patients face in accessing care, communicating with their doctors, and obtaining the medications they need for their illness. Our professional staff has organized an anti-racism task force and is working to ensure that we can be proud of a diverse and inclusive work environment. For our members, we have held two board development sessions, so that our Board of Regents can examine us and our attitudes toward race and toward inclusiveness in our organization. We will soon be holding a listening session with CHEST members of color with the express purpose of allowing those of us who are not persons of color to better understand the challenges faced by our members and to understand where organizational changes could be necessary to help make their professional lives better. As a long time CHEST member, I believe that CHEST is not purposefully exclusive of anyone. We are, nevertheless, a part of the larger fabric of society, and because of that, we are subject to having implicit biases and practices as an organization. Our best path to be aware of them and to deal with them is to hear from our members who experience them, and we shall.
I will end on a note that is somber but important. In the past year, we have all lost friends and colleagues with whom we worked side by side, to COVID-19. Many of them have been CHEST members. Because of the pandemic, we have often not been able to mourn those we have cared about in the same ways that we normally would, in the company of friends and family. Yet, it is important for us to remember our colleagues and to share our memories. So, we established CHEST Remembers, a memorial wall on the CHEST website where we can post the news of our friends’ passing, along with our remembrances of them. If your friend or colleague has died of COVID-19, please feel free to share with the CHEST community. You can find the link to do that at www.chestnet.org.
As I write, it is 1 degree Fahrenheit and dreary in Kansas City, where I live. That’s minus 17 degrees Celsius for many of you. I hope that it is cheerier and bordering on springtime when you’re reading. You’ll understand, though, why I say Happy 2021! 2020 was a humdinger in many ways.
One of those ways, of course, was the COVID-19 pandemic, which wrought so many things – face masks, social distancing, steep learning curves, over 300,000 excess deaths, and new vaccines. For CHEST, it meant that two of our most important educational opportunities of the year, board review and the annual meeting, were held virtually. Dr. Levine has already written about the board reviews, so I’ll focus on the annual meeting, held in late October.
In many ways, the meeting was a success. We had over 6,800 attendees. There were 88 live online sessions, 22 that were semi-live, and 160 prerecorded sessions. For presenters, this was simultaneously both easy and difficult. They had to ensure that their recording equipment and their Internet access were of sufficient quality, and if prerecorded, the sessions had to be finished weeks ahead of time. But the presentations could be given from presenters’ homes or from their normal work offices. For attendees, the ability for nonsimultaneous playback allowed for fitting the meeting into a work-life schedule. In fact, at least one friend related that he watched sessions with a grandchild on his lap. However, it meant a lack of opportunities to ask clarifying questions of the presenters, which is a common activity at the end of a session, and the opportunity to see and catch up with old friends and colleagues was missing. Simulations, of course, could not be hands-on, but virtual educational games matured significantly. The satisfaction scores from both attendees and faculty were good, if slightly below our usual scores for live meetings. They told us that we all prefer our in-person meetings, but that content is deliverable and receivable in an online format. Overall, we have to consider the CHEST 2020 online platform to be a successful endeavor.
Which brings me to our plans for future meetings. The Board of Regents discussed the alternatives for CHEST 2021. Should we hold a live meeting in Vancouver, as planned? Should we hold another online meeting like the one we just discussed? None of us has the crystal ball that tells us exactly how COVID-19 is going to develop. We don’t know exactly how many people will be vaccinated either north or south of the U.S.-Canada border. While those of us who care for patients in the United States have had the opportunity to be vaccinated, we don’t know if the professional staff from CHEST headquarters who travel to the annual meeting will be vaccinated, even though that prospect is currently looking very reasonable. We don’t know if the Canadian government will be allowing U.S. residents to visit Canada without quarantine. There are just quite a few things that we can’t know. However, convention centers need to know if we will be there, and we needed to decide.
In the end, a couple of things swayed us—the unexpected availability of a U.S. convention center and uncertainty about travel to Canada. We are planning to hold CHEST 2021 in Orlando, Florida, during our usual late October time frame. CHEST 2021 is slated to be the first in-person pulmonary, critical care, and sleep conference to be held in the United States in 2 years. The Executive Program Committee has met, and program selections have been made. Very soon, invitations will go to our prospective faculty, and we will be underway. We are planning CHEST 2021 as what we call a “hybrid” meeting, a meeting that will provide an excellent experience whether one attends in person at the Orlando Convention Center or partakes of the meeting from home. Some sessions will be broadcast live and others will be prerecorded. Needless to say, the experience will not be equal for in-person and at-home learners, but it will be equitable. Regardless of how you choose to partake, CHEST 2021 will have excellent content to suit your needs. This plan also allows us the ability to convert to a fully online meeting, should the COVID-19 circumstances dictate that we must. Having sat in on the program committee meetings, I am excited about what we have to offer. So, dig around and find your old mouse ears or your red forehead scar. CHEST 2021 will be a dynamite experience for us all to share.
Our board review sessions, which are also among the most highly valued of CHEST activities, will be different out of necessity. Again, decisions had to be made many months ahead of time, and we have chosen to hold our board reviews online again this year. COVID-19 uncertainties certainly play into our decision to not put attendees in a room together. However, the ability to play and replay, slow down and speed up video content, and ability to watch any session any time are all well suited to reviewing for an examination. We think this is the appropriate decision for 2021, but we may be back together again for future sessions. Frankly, we are listening to hear which format our attendees like more. And, we are plotting how to make the online platform review even better.
The Board of Regents has been hard at work on a lot of fronts, but I want to focus on one of them, for now. It is important to the Board of Regents and to me, personally, that CHEST be the single most inclusive and diverse professional medical society, bar none. It is of utmost importance that we remove any barriers that might have inadvertently been put into place that would hamper the success of any of our members or their patients. In other words, we hope to find any implicit biases in attitude and behavior and to illuminate and remedy them. We have begun the process by focusing on what CHEST is all about – making a difference with our patients and corporate self and being an inclusive and diverse professional organization.
We believe that we must look at ourselves in three separate, but related, ways. We must examine our patient-facing side and the ways in which we help our members to serve their patients. We must examine our headquarters and our hiring, working, and promoting practices to ensure an inclusive and welcoming environment for the staff who do our day to day business. Finally, we must examine ourselves and our member-based organization, to ensure that all can participate freely in CHEST opportunities and, for those who aspire to lead our organization, to ensure that there are no implicit biases that hold them back.
We began the process with a series of regional listening sessions across the United States, sponsored by the CHEST Foundation, in which we heard from both patients and community leaders of color. We learned of challenges that our patients face in accessing care, communicating with their doctors, and obtaining the medications they need for their illness. Our professional staff has organized an anti-racism task force and is working to ensure that we can be proud of a diverse and inclusive work environment. For our members, we have held two board development sessions, so that our Board of Regents can examine us and our attitudes toward race and toward inclusiveness in our organization. We will soon be holding a listening session with CHEST members of color with the express purpose of allowing those of us who are not persons of color to better understand the challenges faced by our members and to understand where organizational changes could be necessary to help make their professional lives better. As a long time CHEST member, I believe that CHEST is not purposefully exclusive of anyone. We are, nevertheless, a part of the larger fabric of society, and because of that, we are subject to having implicit biases and practices as an organization. Our best path to be aware of them and to deal with them is to hear from our members who experience them, and we shall.
I will end on a note that is somber but important. In the past year, we have all lost friends and colleagues with whom we worked side by side, to COVID-19. Many of them have been CHEST members. Because of the pandemic, we have often not been able to mourn those we have cared about in the same ways that we normally would, in the company of friends and family. Yet, it is important for us to remember our colleagues and to share our memories. So, we established CHEST Remembers, a memorial wall on the CHEST website where we can post the news of our friends’ passing, along with our remembrances of them. If your friend or colleague has died of COVID-19, please feel free to share with the CHEST community. You can find the link to do that at www.chestnet.org.
CHEST to offer research matching service
CHEST Analytics has announced its new resource for members interested in serving as investigators in industry-sponsored clinical trials.
The new program, CHEST Clinical Trials Solutions, will pair members who have indicated their interest in specific research topics with companies seeking investigators. According to CHEST President Steven Q. Simpson, MD, FCCP: “For members who would like to be involved in research and for companies that have defined distinct criteria for their studies, CHEST Analytics can pair qualifying parties to facilitate communication between researcher and sponsor. It’s a great way for young investigators to get started or accomplished members to share their experience while helping industry expedite introducing new products that improve patient care.” More information regarding enrollment will be available at info.chestnet.org/clinical-trials.
CHEST Analytics has announced its new resource for members interested in serving as investigators in industry-sponsored clinical trials.
The new program, CHEST Clinical Trials Solutions, will pair members who have indicated their interest in specific research topics with companies seeking investigators. According to CHEST President Steven Q. Simpson, MD, FCCP: “For members who would like to be involved in research and for companies that have defined distinct criteria for their studies, CHEST Analytics can pair qualifying parties to facilitate communication between researcher and sponsor. It’s a great way for young investigators to get started or accomplished members to share their experience while helping industry expedite introducing new products that improve patient care.” More information regarding enrollment will be available at info.chestnet.org/clinical-trials.
CHEST Analytics has announced its new resource for members interested in serving as investigators in industry-sponsored clinical trials.
The new program, CHEST Clinical Trials Solutions, will pair members who have indicated their interest in specific research topics with companies seeking investigators. According to CHEST President Steven Q. Simpson, MD, FCCP: “For members who would like to be involved in research and for companies that have defined distinct criteria for their studies, CHEST Analytics can pair qualifying parties to facilitate communication between researcher and sponsor. It’s a great way for young investigators to get started or accomplished members to share their experience while helping industry expedite introducing new products that improve patient care.” More information regarding enrollment will be available at info.chestnet.org/clinical-trials.
President-Designate: Doreen J. Addrizzo-Harris, MD, FCCP
Doreen J. Addrizzo-Harris, MD, FCCP, is a pulmonary/critical care physician with an extensive background in bronchiectasis and non-tuberculous mycobacterial infection and medical education.
Dr. Addrizzo-Harris is currently a Professor of Medicine at the NYU Grossman School of Medicine. She serves as the Associate Division Director for Clinical and Faculty Affairs, is the Director of the NYU Bronchiectasis and NTM Program, and is Co-Director of the NYU Pulmonary Faculty Practice. She is now serving in her 20th year as the Program Director of NYU's Pulmonary and Critical Care Medicine Fellowship. Dr. Addrizzo-Harris received her medical degree and completed her residency and fellowship training at New York University School of Medicine. Since completing her training, she was recruited to stay as a faculty member at NYU, where she has been a critical presence over the past 25 years. She has been instrumental in educating the next generation of pulmonary/critical care physicians and has won a number of awards for her teaching skills, most recently, the 2021 Outstanding Educator Award from the APCCMPD. Dr. Addrizzo-Harris has served on the board of the Association of Pulmonary and Critical Care Medicine Program Directors (APCCMPD), including serving as President from 2006-2007. Academically, she authored 44 peer-reviewed publications and 57 scientific abstracts presented at international conferences. She has participated in numerous clinical trials, many as PI. Dr. Addrizzo-Harris has been recognized as a Distinguished CHEST Educator each year since its inception in 2017 and received the Distinguished Service Award in 2019.
During her leadership tenure with CHEST, Dr. Addrizzo-Harris has served on the Marketing Committee, the Health and Science Policy Committee (Chair from 2007-2009), Government Relations Committee, Scientific Program Committee, Education Committee, Governance Committee, Editorial Board for CHEST Physician, Professional Standards Committee (Chair 2016-2018), Board of Regents, and CHEST Foundation Board of Trustees. Most recently, Dr. Addrizzo-Harris served as the President of the CHEST Foundation from 2018-2019 and Co-Chair of the Foundation Awards Committee from 2015-2020. She will serve as the sixth woman to lead the American College of Chest Physicians.
Doreen J. Addrizzo-Harris, MD, FCCP, is a pulmonary/critical care physician with an extensive background in bronchiectasis and non-tuberculous mycobacterial infection and medical education.
Dr. Addrizzo-Harris is currently a Professor of Medicine at the NYU Grossman School of Medicine. She serves as the Associate Division Director for Clinical and Faculty Affairs, is the Director of the NYU Bronchiectasis and NTM Program, and is Co-Director of the NYU Pulmonary Faculty Practice. She is now serving in her 20th year as the Program Director of NYU's Pulmonary and Critical Care Medicine Fellowship. Dr. Addrizzo-Harris received her medical degree and completed her residency and fellowship training at New York University School of Medicine. Since completing her training, she was recruited to stay as a faculty member at NYU, where she has been a critical presence over the past 25 years. She has been instrumental in educating the next generation of pulmonary/critical care physicians and has won a number of awards for her teaching skills, most recently, the 2021 Outstanding Educator Award from the APCCMPD. Dr. Addrizzo-Harris has served on the board of the Association of Pulmonary and Critical Care Medicine Program Directors (APCCMPD), including serving as President from 2006-2007. Academically, she authored 44 peer-reviewed publications and 57 scientific abstracts presented at international conferences. She has participated in numerous clinical trials, many as PI. Dr. Addrizzo-Harris has been recognized as a Distinguished CHEST Educator each year since its inception in 2017 and received the Distinguished Service Award in 2019.
During her leadership tenure with CHEST, Dr. Addrizzo-Harris has served on the Marketing Committee, the Health and Science Policy Committee (Chair from 2007-2009), Government Relations Committee, Scientific Program Committee, Education Committee, Governance Committee, Editorial Board for CHEST Physician, Professional Standards Committee (Chair 2016-2018), Board of Regents, and CHEST Foundation Board of Trustees. Most recently, Dr. Addrizzo-Harris served as the President of the CHEST Foundation from 2018-2019 and Co-Chair of the Foundation Awards Committee from 2015-2020. She will serve as the sixth woman to lead the American College of Chest Physicians.
Doreen J. Addrizzo-Harris, MD, FCCP, is a pulmonary/critical care physician with an extensive background in bronchiectasis and non-tuberculous mycobacterial infection and medical education.
Dr. Addrizzo-Harris is currently a Professor of Medicine at the NYU Grossman School of Medicine. She serves as the Associate Division Director for Clinical and Faculty Affairs, is the Director of the NYU Bronchiectasis and NTM Program, and is Co-Director of the NYU Pulmonary Faculty Practice. She is now serving in her 20th year as the Program Director of NYU's Pulmonary and Critical Care Medicine Fellowship. Dr. Addrizzo-Harris received her medical degree and completed her residency and fellowship training at New York University School of Medicine. Since completing her training, she was recruited to stay as a faculty member at NYU, where she has been a critical presence over the past 25 years. She has been instrumental in educating the next generation of pulmonary/critical care physicians and has won a number of awards for her teaching skills, most recently, the 2021 Outstanding Educator Award from the APCCMPD. Dr. Addrizzo-Harris has served on the board of the Association of Pulmonary and Critical Care Medicine Program Directors (APCCMPD), including serving as President from 2006-2007. Academically, she authored 44 peer-reviewed publications and 57 scientific abstracts presented at international conferences. She has participated in numerous clinical trials, many as PI. Dr. Addrizzo-Harris has been recognized as a Distinguished CHEST Educator each year since its inception in 2017 and received the Distinguished Service Award in 2019.
During her leadership tenure with CHEST, Dr. Addrizzo-Harris has served on the Marketing Committee, the Health and Science Policy Committee (Chair from 2007-2009), Government Relations Committee, Scientific Program Committee, Education Committee, Governance Committee, Editorial Board for CHEST Physician, Professional Standards Committee (Chair 2016-2018), Board of Regents, and CHEST Foundation Board of Trustees. Most recently, Dr. Addrizzo-Harris served as the President of the CHEST Foundation from 2018-2019 and Co-Chair of the Foundation Awards Committee from 2015-2020. She will serve as the sixth woman to lead the American College of Chest Physicians.
Introducing this year’s Recognition Prize recipients
“AGA Recognition Prizes allow members to honor their contemporaries for their exceptional contributions to the field of gastroenterology and hepatology,” said Hashem B. El-Serag, MD, MPH, AGAF, chair of AGA. “The 2021 AGA Recognition Prize winners represent only a small group of our widely distinguished and exceptional members who help make AGA such an accomplished organization. We are honored that such esteemed individuals are representatives of AGA.”
This year the AGA Recognition Prizes will be presented virtually in May 2021.
- Michael Camilleri, MD, AGAF, Julius Friedenwald Medal
- Byron Cryer, MD, Distinguished Service Award in Diversity, Equity and Inclusion
- Sandra Quezada, MD, MS, Distinguished Service Award in Diversity, Equity and Inclusion
- Kim Barrett, Distinguished Achievement Award in Basic Science
- David Y. Graham, William Beaumont Prize
- Griffin Rodgers, MD, MACP, Research Service Award
- Lin Chang, Distinguished Educator Award
- Nimish Vakil, MD, AGAF, FASGE, Distinguished Clinician Award in Private Practice
- Peter H.R. Green, Distinguished Clinician Award in Academic Practice
- Vay Liang “Bill” Go, MD, AGAF, Distinguished Mentor Award
- Shahnaz Sultan, MD, MHSc, AGAF, Outstanding Service Award
- Osama Altayar, MD, Outstanding Service Award
- Perica Davitkov, MD, Outstanding Service Award
- Joseph D. Feuerstein, MD, Outstanding Service Award
- Shazia M. Siddique, MD, MSHP, Outstanding Service Award
- Yngve T. Falck-Ytter, MD, AGAF, Outstanding Service Award
- Joseph K. Lim, MD, AGAF, Outstanding Service Award
To learn more about our 2021 AGA recognition prize recipients, visit https://gastro.org/2021awards.
“AGA Recognition Prizes allow members to honor their contemporaries for their exceptional contributions to the field of gastroenterology and hepatology,” said Hashem B. El-Serag, MD, MPH, AGAF, chair of AGA. “The 2021 AGA Recognition Prize winners represent only a small group of our widely distinguished and exceptional members who help make AGA such an accomplished organization. We are honored that such esteemed individuals are representatives of AGA.”
This year the AGA Recognition Prizes will be presented virtually in May 2021.
- Michael Camilleri, MD, AGAF, Julius Friedenwald Medal
- Byron Cryer, MD, Distinguished Service Award in Diversity, Equity and Inclusion
- Sandra Quezada, MD, MS, Distinguished Service Award in Diversity, Equity and Inclusion
- Kim Barrett, Distinguished Achievement Award in Basic Science
- David Y. Graham, William Beaumont Prize
- Griffin Rodgers, MD, MACP, Research Service Award
- Lin Chang, Distinguished Educator Award
- Nimish Vakil, MD, AGAF, FASGE, Distinguished Clinician Award in Private Practice
- Peter H.R. Green, Distinguished Clinician Award in Academic Practice
- Vay Liang “Bill” Go, MD, AGAF, Distinguished Mentor Award
- Shahnaz Sultan, MD, MHSc, AGAF, Outstanding Service Award
- Osama Altayar, MD, Outstanding Service Award
- Perica Davitkov, MD, Outstanding Service Award
- Joseph D. Feuerstein, MD, Outstanding Service Award
- Shazia M. Siddique, MD, MSHP, Outstanding Service Award
- Yngve T. Falck-Ytter, MD, AGAF, Outstanding Service Award
- Joseph K. Lim, MD, AGAF, Outstanding Service Award
To learn more about our 2021 AGA recognition prize recipients, visit https://gastro.org/2021awards.
“AGA Recognition Prizes allow members to honor their contemporaries for their exceptional contributions to the field of gastroenterology and hepatology,” said Hashem B. El-Serag, MD, MPH, AGAF, chair of AGA. “The 2021 AGA Recognition Prize winners represent only a small group of our widely distinguished and exceptional members who help make AGA such an accomplished organization. We are honored that such esteemed individuals are representatives of AGA.”
This year the AGA Recognition Prizes will be presented virtually in May 2021.
- Michael Camilleri, MD, AGAF, Julius Friedenwald Medal
- Byron Cryer, MD, Distinguished Service Award in Diversity, Equity and Inclusion
- Sandra Quezada, MD, MS, Distinguished Service Award in Diversity, Equity and Inclusion
- Kim Barrett, Distinguished Achievement Award in Basic Science
- David Y. Graham, William Beaumont Prize
- Griffin Rodgers, MD, MACP, Research Service Award
- Lin Chang, Distinguished Educator Award
- Nimish Vakil, MD, AGAF, FASGE, Distinguished Clinician Award in Private Practice
- Peter H.R. Green, Distinguished Clinician Award in Academic Practice
- Vay Liang “Bill” Go, MD, AGAF, Distinguished Mentor Award
- Shahnaz Sultan, MD, MHSc, AGAF, Outstanding Service Award
- Osama Altayar, MD, Outstanding Service Award
- Perica Davitkov, MD, Outstanding Service Award
- Joseph D. Feuerstein, MD, Outstanding Service Award
- Shazia M. Siddique, MD, MSHP, Outstanding Service Award
- Yngve T. Falck-Ytter, MD, AGAF, Outstanding Service Award
- Joseph K. Lim, MD, AGAF, Outstanding Service Award
To learn more about our 2021 AGA recognition prize recipients, visit https://gastro.org/2021awards.
How a gift of stock to the AGA Research Foundation can be a win-win
If you own stock that’s increased in value since you purchased it (and you’ve owned it for at least 1 year), you have a unique opportunity for philanthropy. When you donate securities to the AGA Research Foundation, you receive the same income tax savings (if you itemize) that you would if you wrote the AGA Research Foundation a check, but with the added benefit of eliminating capital gains taxes on the transfer, which can be as high as 20%.
Making a gift of securities to support the AGA Research Foundation’s mission to raise funds to support young researchers in gastroenterology and hepatology is as easy as instructing your broker to transfer the shares. Using assets other than cash also allows you more flexibility when planning your gift.
Benefits:
- Receive an income tax deduction for gifts of securities if you itemize.
- Provide relief from capital gains tax with gifts of securities.
- Help fulfill our mission with your contribution.
Take the next step:
The AGA Research Foundation can help clarify and document the steps to donate stock to us. Contact us at [email protected] to make your donation.
If you own stock that’s increased in value since you purchased it (and you’ve owned it for at least 1 year), you have a unique opportunity for philanthropy. When you donate securities to the AGA Research Foundation, you receive the same income tax savings (if you itemize) that you would if you wrote the AGA Research Foundation a check, but with the added benefit of eliminating capital gains taxes on the transfer, which can be as high as 20%.
Making a gift of securities to support the AGA Research Foundation’s mission to raise funds to support young researchers in gastroenterology and hepatology is as easy as instructing your broker to transfer the shares. Using assets other than cash also allows you more flexibility when planning your gift.
Benefits:
- Receive an income tax deduction for gifts of securities if you itemize.
- Provide relief from capital gains tax with gifts of securities.
- Help fulfill our mission with your contribution.
Take the next step:
The AGA Research Foundation can help clarify and document the steps to donate stock to us. Contact us at [email protected] to make your donation.
If you own stock that’s increased in value since you purchased it (and you’ve owned it for at least 1 year), you have a unique opportunity for philanthropy. When you donate securities to the AGA Research Foundation, you receive the same income tax savings (if you itemize) that you would if you wrote the AGA Research Foundation a check, but with the added benefit of eliminating capital gains taxes on the transfer, which can be as high as 20%.
Making a gift of securities to support the AGA Research Foundation’s mission to raise funds to support young researchers in gastroenterology and hepatology is as easy as instructing your broker to transfer the shares. Using assets other than cash also allows you more flexibility when planning your gift.
Benefits:
- Receive an income tax deduction for gifts of securities if you itemize.
- Provide relief from capital gains tax with gifts of securities.
- Help fulfill our mission with your contribution.
Take the next step:
The AGA Research Foundation can help clarify and document the steps to donate stock to us. Contact us at [email protected] to make your donation.
Registration for DDW® 2021 is now open
Join your colleagues in the digestive disease community at the most prestigious meeting for GI professionals. Registration for Digestive Disease Week® (DDW) 2021 is now open. Register on or before March 31 to receive a discounted rate. AGA member trainees, postdoctoral fellows, medical residents and students also receive complimentary registration during this early bird period.
In 2021, DDW moves online as a fully virtual meeting, taking place May 21–23, 2021. While DDW Virtual™ will look a little different, we’re excited by opportunities the new format provides to learn, share, and connect, such as the following:
- Explore today’s most pressing topics and new developments, shared in oral abstract and ePoster presentations.
- Gain the kind of insight that you can’t get out of a textbook, presented in sessions led by top GI and hepatology experts.
- Network and build connections with your colleagues in an engaging, interactive setting.
Learn more and register at ddw.org.
Join your colleagues in the digestive disease community at the most prestigious meeting for GI professionals. Registration for Digestive Disease Week® (DDW) 2021 is now open. Register on or before March 31 to receive a discounted rate. AGA member trainees, postdoctoral fellows, medical residents and students also receive complimentary registration during this early bird period.
In 2021, DDW moves online as a fully virtual meeting, taking place May 21–23, 2021. While DDW Virtual™ will look a little different, we’re excited by opportunities the new format provides to learn, share, and connect, such as the following:
- Explore today’s most pressing topics and new developments, shared in oral abstract and ePoster presentations.
- Gain the kind of insight that you can’t get out of a textbook, presented in sessions led by top GI and hepatology experts.
- Network and build connections with your colleagues in an engaging, interactive setting.
Learn more and register at ddw.org.
Join your colleagues in the digestive disease community at the most prestigious meeting for GI professionals. Registration for Digestive Disease Week® (DDW) 2021 is now open. Register on or before March 31 to receive a discounted rate. AGA member trainees, postdoctoral fellows, medical residents and students also receive complimentary registration during this early bird period.
In 2021, DDW moves online as a fully virtual meeting, taking place May 21–23, 2021. While DDW Virtual™ will look a little different, we’re excited by opportunities the new format provides to learn, share, and connect, such as the following:
- Explore today’s most pressing topics and new developments, shared in oral abstract and ePoster presentations.
- Gain the kind of insight that you can’t get out of a textbook, presented in sessions led by top GI and hepatology experts.
- Network and build connections with your colleagues in an engaging, interactive setting.
Learn more and register at ddw.org.
Meet the 2021 AGA Fellowship inductees
Join the GI community in a round of applause for the 120 members adding the designation “AGAF” in their professional activities. Along with a recognition pin and certificate of acceptance, American Gastroenterological Association President Bishr Omary commends the group in the AGA Community for their superior professional achievements and contributions to the field of gastroenterology. See the full list and join the discussion at https://community.gastro.org.
Join the GI community in a round of applause for the 120 members adding the designation “AGAF” in their professional activities. Along with a recognition pin and certificate of acceptance, American Gastroenterological Association President Bishr Omary commends the group in the AGA Community for their superior professional achievements and contributions to the field of gastroenterology. See the full list and join the discussion at https://community.gastro.org.
Join the GI community in a round of applause for the 120 members adding the designation “AGAF” in their professional activities. Along with a recognition pin and certificate of acceptance, American Gastroenterological Association President Bishr Omary commends the group in the AGA Community for their superior professional achievements and contributions to the field of gastroenterology. See the full list and join the discussion at https://community.gastro.org.
Advocacy in gastroenterology: Advancing health policies for our patients and our profession
Physician advocacy is an important tool for health care professionals to protect patients and the vitality of the profession. Medical associations across the spectrum participate in advocacy because of its value in preserving the beneficial role of physicians in health care policy decision making. This is especially true for specialty physician associations, like the American Gastroenterological Association, which represents more than 9,000 U.S. GI physicians and researchers. Advocacy allows for the voice of GIs and their patients to be heard on Capitol Hill, in the White House, and among various regulatory agencies. When we advocate as a profession, we help ensure good policies gain momentum and halt harmful legislative or regulatory efforts from enactment.
What is physician advocacy?
Physicians are advocating every day for their patients by helping patients make the right decisions about their care. This naturally translates into advocacy at the health policy level. Advocacy is lobbying. While that word may take on a negative meaning for some, it also means being a persuasive communicator, passionate educator, and a leader. National associations, like AGA, often call on members to do just that: educate lawmakers on policies affecting GI, communicate how policies could affect lawmakers’ constituencies back in their respective districts, and lead others to support GI policy agendas.
Physician advocacy works. AGA had its busiest year for policy work, but this was coupled with a large uptick in GI advocacy engagement. The public health emergency placed many burdens on the health care community and our profession. However, through our advocacy work, we also saw many changes, including increased federal research funding for digestive diseases and GI cancers, passage of legislation to remove patients’ barriers to colorectal cancer screening, increased regulatory and reimbursement flexibilities incorporated to ensure physicians could continue to deliver timely care, and creation of federal financial and small business relief programs to support gastroenterology practices.
Physician advocacy in GI is especially critical because specialty care is often viewed as having a smaller voice when compared with those of the larger bodies, such as primary care, surgery, or emergency physicians. As a health care specialty with a known shortage across the United States, we need all the help we can get to inform policy makers of our position on controversial policies. In many cases, non–health care professionals are informing policy makers on how to address issues that impact our profession. Additionally, there is a lack of knowledge about health care complexities and needs among decision makers who are ultimately determining how health care is delivered. As health care experts, we are best suited to educate lawmakers on the true impact of health policies. If we do not engage and educate policy makers, our profession and patients will suffer the consequences.
GI policy priorities for 2021
AGA will continue its advocacy work in 2021 on the following issues and encourage you and your colleagues to get involved:
Administrative burden relief
Utilization management protocols, like prior authorizations and step therapy, continue to increase and force physicians and their staff to spend hours of extra work time each week to process the paperwork. Prior authorizations are especially troublesome because they have increased for upper GI procedures and other common procedures. Step therapy protocols have also increased for IBD patients on biologics or other high-cost therapies, resulting in patients not receiving effective therapies as determined by their physician in a timely manner.
Patient access and protections
Coverage
Coverage for patients includes the following two areas:
COVID-19 relief: The public health emergency has weakened the health care workforce with physician practices and researchers facing financial instability and threatened patient access to specialty care. To support the health care community and to combat the pandemic, the following is necessary: Increased access to personal protective equipment and medical supplies for testing and vaccination distribution and increased rapid tests, testing sites, and health care workers. The public health emergency response also requires a stronger emphasis on health equity given the disproportionate impact it has had on communities of color.
- Preserving Affordable Care Act patient protections: The Supreme Court will rule on the Affordable Care Act, a decision which threatens to dismantle the law, including provisions that require insurers to cover preexisting conditions and preventive services. With patients delaying screenings because of the COVID-19 pandemic and the increased incidence among minority and younger populations, it is imperative that preventative screening services – like colorectal cancer screenings – remain fully covered by payers. Moreover, because of the nature of GI diseases, patients often develop multiple conditions throughout their lifetime. The preexisting conditions protections in the ACA ensure that GI patients can gain the insurance coverage they need to obtain quality treatment.
Choice
Health plans and pharmacy benefit managers are using burdensome practices, such as step therapy, to limit patient access to drugs and biologics. These practices disrupt treatment and restrict individuals with digestive diseases from the medicines that work best for them.
Affordability
High out-of-pocket drug and biologics costs limit access to necessary therapies for people with digestive diseases, such as Crohn’s disease and ulcerative colitis. High out-of-pocket costs contribute to noncompliance, which in turn results in disease progression and complications and increases in overall health care costs.
Research funding
Sustainable long-term funding for federal research is critical to ensure the United States remains a leading contributor to innovative research breakthroughs. Under the current appropriations process in Congress, federal research funding can vary dramatically from year to year. Often enough, research funding for the next fiscal year is delayed by politics in Congress that result in continuing resolutions to fund the government and U.S. research institutions. Unstable funding causes a turbulent environment for investigators and is a deterrent for new investigators entering the field.
Member engagement
GIs need to engage in the policymaking process as there are too many threats and opportunities in today’s policy arena. The effectiveness of AGA’s advocacy work in the federal government is contingent upon members’ engagement in public policy. To increase physician advocacy and AGA member engagement, AGA offers the following avenues for members:
AGA political action committee
Political engagement is a powerful tool physician advocates can use to increase the visibility of GI on Capitol Hill. Political action committees (PACs) help provide access to lawmakers and their staff so that our advocates can educate them on the rationale for supporting our clinical and research priorities. Although PACs do not guarantee successes in Congress, it is important to note that contributions to legislators’ campaigns help them to be run more smoothly and effectively and allow the legislators to continue to serve their constituents. AGA PAC is a bipartisan political arm of AGA and is the only PAC dedicated to gastroenterology. Learn more at gastro.org/AGA-PAC.
Grassroots engagement
Build a relationship with your elected officials and their health policy staff by communicating with them often and offering to serve as a resource to the office on issues related to specialty medicine. AGA makes this easy with its online advocacy action center: gastro.quorum.us. Find out who your lawmakers are and research their background, engage them by email or Twitter on priority policy issues, and share stories with AGA staff about your interactions with congressional offices.
Congressional Advocates Program
This program creates a national grassroots network of engaged gastroenterologists interested in advocating for our profession and patients. Congressional Advocates are mentored and receive year-round advocacy training by AGA leadership and staff. Learn more at gastro.org/advocacy-and-policy/congressional-advocates-program.
Start advocating for gastroenterology
A new session of Congress has just begun, a new administration with a heavy health care agenda was elected into office, and gastroenterology needs your voice more than ever as we advocate for what really matters to us and our patients.
Join your colleagues at AGA’s spring virtual Advocacy Day on April 22, 2021. The event allows AGA members to meet with lawmakers and health policy staff virtually to educate them on the priority issues affecting our profession.
AGA staff makes it easy for you to participate. Webinar trainings, meeting schedules, and talking points will be provided to you ahead of time. For this event, we will speak to lawmakers about increasing federal research funding, addressing regulatory burdens like prior authorizations and step therapy protocols, and ensuring gastroenterologists and investigators have continued support during the COVID-19 pandemic.
For more information, visit gastro.org/aga-advocacy-day or contact AGA’s senior public policy coordinator, Jonathan Sollish, at [email protected].
Physician advocacy is an important tool for health care professionals to protect patients and the vitality of the profession. Medical associations across the spectrum participate in advocacy because of its value in preserving the beneficial role of physicians in health care policy decision making. This is especially true for specialty physician associations, like the American Gastroenterological Association, which represents more than 9,000 U.S. GI physicians and researchers. Advocacy allows for the voice of GIs and their patients to be heard on Capitol Hill, in the White House, and among various regulatory agencies. When we advocate as a profession, we help ensure good policies gain momentum and halt harmful legislative or regulatory efforts from enactment.
What is physician advocacy?
Physicians are advocating every day for their patients by helping patients make the right decisions about their care. This naturally translates into advocacy at the health policy level. Advocacy is lobbying. While that word may take on a negative meaning for some, it also means being a persuasive communicator, passionate educator, and a leader. National associations, like AGA, often call on members to do just that: educate lawmakers on policies affecting GI, communicate how policies could affect lawmakers’ constituencies back in their respective districts, and lead others to support GI policy agendas.
Physician advocacy works. AGA had its busiest year for policy work, but this was coupled with a large uptick in GI advocacy engagement. The public health emergency placed many burdens on the health care community and our profession. However, through our advocacy work, we also saw many changes, including increased federal research funding for digestive diseases and GI cancers, passage of legislation to remove patients’ barriers to colorectal cancer screening, increased regulatory and reimbursement flexibilities incorporated to ensure physicians could continue to deliver timely care, and creation of federal financial and small business relief programs to support gastroenterology practices.
Physician advocacy in GI is especially critical because specialty care is often viewed as having a smaller voice when compared with those of the larger bodies, such as primary care, surgery, or emergency physicians. As a health care specialty with a known shortage across the United States, we need all the help we can get to inform policy makers of our position on controversial policies. In many cases, non–health care professionals are informing policy makers on how to address issues that impact our profession. Additionally, there is a lack of knowledge about health care complexities and needs among decision makers who are ultimately determining how health care is delivered. As health care experts, we are best suited to educate lawmakers on the true impact of health policies. If we do not engage and educate policy makers, our profession and patients will suffer the consequences.
GI policy priorities for 2021
AGA will continue its advocacy work in 2021 on the following issues and encourage you and your colleagues to get involved:
Administrative burden relief
Utilization management protocols, like prior authorizations and step therapy, continue to increase and force physicians and their staff to spend hours of extra work time each week to process the paperwork. Prior authorizations are especially troublesome because they have increased for upper GI procedures and other common procedures. Step therapy protocols have also increased for IBD patients on biologics or other high-cost therapies, resulting in patients not receiving effective therapies as determined by their physician in a timely manner.
Patient access and protections
Coverage
Coverage for patients includes the following two areas:
COVID-19 relief: The public health emergency has weakened the health care workforce with physician practices and researchers facing financial instability and threatened patient access to specialty care. To support the health care community and to combat the pandemic, the following is necessary: Increased access to personal protective equipment and medical supplies for testing and vaccination distribution and increased rapid tests, testing sites, and health care workers. The public health emergency response also requires a stronger emphasis on health equity given the disproportionate impact it has had on communities of color.
- Preserving Affordable Care Act patient protections: The Supreme Court will rule on the Affordable Care Act, a decision which threatens to dismantle the law, including provisions that require insurers to cover preexisting conditions and preventive services. With patients delaying screenings because of the COVID-19 pandemic and the increased incidence among minority and younger populations, it is imperative that preventative screening services – like colorectal cancer screenings – remain fully covered by payers. Moreover, because of the nature of GI diseases, patients often develop multiple conditions throughout their lifetime. The preexisting conditions protections in the ACA ensure that GI patients can gain the insurance coverage they need to obtain quality treatment.
Choice
Health plans and pharmacy benefit managers are using burdensome practices, such as step therapy, to limit patient access to drugs and biologics. These practices disrupt treatment and restrict individuals with digestive diseases from the medicines that work best for them.
Affordability
High out-of-pocket drug and biologics costs limit access to necessary therapies for people with digestive diseases, such as Crohn’s disease and ulcerative colitis. High out-of-pocket costs contribute to noncompliance, which in turn results in disease progression and complications and increases in overall health care costs.
Research funding
Sustainable long-term funding for federal research is critical to ensure the United States remains a leading contributor to innovative research breakthroughs. Under the current appropriations process in Congress, federal research funding can vary dramatically from year to year. Often enough, research funding for the next fiscal year is delayed by politics in Congress that result in continuing resolutions to fund the government and U.S. research institutions. Unstable funding causes a turbulent environment for investigators and is a deterrent for new investigators entering the field.
Member engagement
GIs need to engage in the policymaking process as there are too many threats and opportunities in today’s policy arena. The effectiveness of AGA’s advocacy work in the federal government is contingent upon members’ engagement in public policy. To increase physician advocacy and AGA member engagement, AGA offers the following avenues for members:
AGA political action committee
Political engagement is a powerful tool physician advocates can use to increase the visibility of GI on Capitol Hill. Political action committees (PACs) help provide access to lawmakers and their staff so that our advocates can educate them on the rationale for supporting our clinical and research priorities. Although PACs do not guarantee successes in Congress, it is important to note that contributions to legislators’ campaigns help them to be run more smoothly and effectively and allow the legislators to continue to serve their constituents. AGA PAC is a bipartisan political arm of AGA and is the only PAC dedicated to gastroenterology. Learn more at gastro.org/AGA-PAC.
Grassroots engagement
Build a relationship with your elected officials and their health policy staff by communicating with them often and offering to serve as a resource to the office on issues related to specialty medicine. AGA makes this easy with its online advocacy action center: gastro.quorum.us. Find out who your lawmakers are and research their background, engage them by email or Twitter on priority policy issues, and share stories with AGA staff about your interactions with congressional offices.
Congressional Advocates Program
This program creates a national grassroots network of engaged gastroenterologists interested in advocating for our profession and patients. Congressional Advocates are mentored and receive year-round advocacy training by AGA leadership and staff. Learn more at gastro.org/advocacy-and-policy/congressional-advocates-program.
Start advocating for gastroenterology
A new session of Congress has just begun, a new administration with a heavy health care agenda was elected into office, and gastroenterology needs your voice more than ever as we advocate for what really matters to us and our patients.
Join your colleagues at AGA’s spring virtual Advocacy Day on April 22, 2021. The event allows AGA members to meet with lawmakers and health policy staff virtually to educate them on the priority issues affecting our profession.
AGA staff makes it easy for you to participate. Webinar trainings, meeting schedules, and talking points will be provided to you ahead of time. For this event, we will speak to lawmakers about increasing federal research funding, addressing regulatory burdens like prior authorizations and step therapy protocols, and ensuring gastroenterologists and investigators have continued support during the COVID-19 pandemic.
For more information, visit gastro.org/aga-advocacy-day or contact AGA’s senior public policy coordinator, Jonathan Sollish, at [email protected].
Physician advocacy is an important tool for health care professionals to protect patients and the vitality of the profession. Medical associations across the spectrum participate in advocacy because of its value in preserving the beneficial role of physicians in health care policy decision making. This is especially true for specialty physician associations, like the American Gastroenterological Association, which represents more than 9,000 U.S. GI physicians and researchers. Advocacy allows for the voice of GIs and their patients to be heard on Capitol Hill, in the White House, and among various regulatory agencies. When we advocate as a profession, we help ensure good policies gain momentum and halt harmful legislative or regulatory efforts from enactment.
What is physician advocacy?
Physicians are advocating every day for their patients by helping patients make the right decisions about their care. This naturally translates into advocacy at the health policy level. Advocacy is lobbying. While that word may take on a negative meaning for some, it also means being a persuasive communicator, passionate educator, and a leader. National associations, like AGA, often call on members to do just that: educate lawmakers on policies affecting GI, communicate how policies could affect lawmakers’ constituencies back in their respective districts, and lead others to support GI policy agendas.
Physician advocacy works. AGA had its busiest year for policy work, but this was coupled with a large uptick in GI advocacy engagement. The public health emergency placed many burdens on the health care community and our profession. However, through our advocacy work, we also saw many changes, including increased federal research funding for digestive diseases and GI cancers, passage of legislation to remove patients’ barriers to colorectal cancer screening, increased regulatory and reimbursement flexibilities incorporated to ensure physicians could continue to deliver timely care, and creation of federal financial and small business relief programs to support gastroenterology practices.
Physician advocacy in GI is especially critical because specialty care is often viewed as having a smaller voice when compared with those of the larger bodies, such as primary care, surgery, or emergency physicians. As a health care specialty with a known shortage across the United States, we need all the help we can get to inform policy makers of our position on controversial policies. In many cases, non–health care professionals are informing policy makers on how to address issues that impact our profession. Additionally, there is a lack of knowledge about health care complexities and needs among decision makers who are ultimately determining how health care is delivered. As health care experts, we are best suited to educate lawmakers on the true impact of health policies. If we do not engage and educate policy makers, our profession and patients will suffer the consequences.
GI policy priorities for 2021
AGA will continue its advocacy work in 2021 on the following issues and encourage you and your colleagues to get involved:
Administrative burden relief
Utilization management protocols, like prior authorizations and step therapy, continue to increase and force physicians and their staff to spend hours of extra work time each week to process the paperwork. Prior authorizations are especially troublesome because they have increased for upper GI procedures and other common procedures. Step therapy protocols have also increased for IBD patients on biologics or other high-cost therapies, resulting in patients not receiving effective therapies as determined by their physician in a timely manner.
Patient access and protections
Coverage
Coverage for patients includes the following two areas:
COVID-19 relief: The public health emergency has weakened the health care workforce with physician practices and researchers facing financial instability and threatened patient access to specialty care. To support the health care community and to combat the pandemic, the following is necessary: Increased access to personal protective equipment and medical supplies for testing and vaccination distribution and increased rapid tests, testing sites, and health care workers. The public health emergency response also requires a stronger emphasis on health equity given the disproportionate impact it has had on communities of color.
- Preserving Affordable Care Act patient protections: The Supreme Court will rule on the Affordable Care Act, a decision which threatens to dismantle the law, including provisions that require insurers to cover preexisting conditions and preventive services. With patients delaying screenings because of the COVID-19 pandemic and the increased incidence among minority and younger populations, it is imperative that preventative screening services – like colorectal cancer screenings – remain fully covered by payers. Moreover, because of the nature of GI diseases, patients often develop multiple conditions throughout their lifetime. The preexisting conditions protections in the ACA ensure that GI patients can gain the insurance coverage they need to obtain quality treatment.
Choice
Health plans and pharmacy benefit managers are using burdensome practices, such as step therapy, to limit patient access to drugs and biologics. These practices disrupt treatment and restrict individuals with digestive diseases from the medicines that work best for them.
Affordability
High out-of-pocket drug and biologics costs limit access to necessary therapies for people with digestive diseases, such as Crohn’s disease and ulcerative colitis. High out-of-pocket costs contribute to noncompliance, which in turn results in disease progression and complications and increases in overall health care costs.
Research funding
Sustainable long-term funding for federal research is critical to ensure the United States remains a leading contributor to innovative research breakthroughs. Under the current appropriations process in Congress, federal research funding can vary dramatically from year to year. Often enough, research funding for the next fiscal year is delayed by politics in Congress that result in continuing resolutions to fund the government and U.S. research institutions. Unstable funding causes a turbulent environment for investigators and is a deterrent for new investigators entering the field.
Member engagement
GIs need to engage in the policymaking process as there are too many threats and opportunities in today’s policy arena. The effectiveness of AGA’s advocacy work in the federal government is contingent upon members’ engagement in public policy. To increase physician advocacy and AGA member engagement, AGA offers the following avenues for members:
AGA political action committee
Political engagement is a powerful tool physician advocates can use to increase the visibility of GI on Capitol Hill. Political action committees (PACs) help provide access to lawmakers and their staff so that our advocates can educate them on the rationale for supporting our clinical and research priorities. Although PACs do not guarantee successes in Congress, it is important to note that contributions to legislators’ campaigns help them to be run more smoothly and effectively and allow the legislators to continue to serve their constituents. AGA PAC is a bipartisan political arm of AGA and is the only PAC dedicated to gastroenterology. Learn more at gastro.org/AGA-PAC.
Grassroots engagement
Build a relationship with your elected officials and their health policy staff by communicating with them often and offering to serve as a resource to the office on issues related to specialty medicine. AGA makes this easy with its online advocacy action center: gastro.quorum.us. Find out who your lawmakers are and research their background, engage them by email or Twitter on priority policy issues, and share stories with AGA staff about your interactions with congressional offices.
Congressional Advocates Program
This program creates a national grassroots network of engaged gastroenterologists interested in advocating for our profession and patients. Congressional Advocates are mentored and receive year-round advocacy training by AGA leadership and staff. Learn more at gastro.org/advocacy-and-policy/congressional-advocates-program.
Start advocating for gastroenterology
A new session of Congress has just begun, a new administration with a heavy health care agenda was elected into office, and gastroenterology needs your voice more than ever as we advocate for what really matters to us and our patients.
Join your colleagues at AGA’s spring virtual Advocacy Day on April 22, 2021. The event allows AGA members to meet with lawmakers and health policy staff virtually to educate them on the priority issues affecting our profession.
AGA staff makes it easy for you to participate. Webinar trainings, meeting schedules, and talking points will be provided to you ahead of time. For this event, we will speak to lawmakers about increasing federal research funding, addressing regulatory burdens like prior authorizations and step therapy protocols, and ensuring gastroenterologists and investigators have continued support during the COVID-19 pandemic.
For more information, visit gastro.org/aga-advocacy-day or contact AGA’s senior public policy coordinator, Jonathan Sollish, at [email protected].
Home O2 in COPD. Eradicating COVID-19. mRNA and beyond. COVID-19 treatment, so far. Awake proning in COVID-19. Home ventilation. Interprofessional team approach to palliative extubation.
Airways disorders
Updated guidelines on the use of home O2 in COPD: A much-needed respite
The use of long-term oxygen therapy (LTOT, oxygen prescribed for at least 15 h/day) in patients with COPD and chronic hypoxemia has been standard of care based on trials from the 1980s that conferred a survival benefit with the use of continuous oxygen (Ann Internal Med. 1980;93[3]:391-8). More recently, LTOT has not shown to improve survival or delay time to the hospitalization in patients with stable COPD and resting or exercise-induced moderate desaturation (N Engl J Med. 2016;375[17]:1617-27). Thus far, existing recommendations had been semi-inclusive in patient selection. A fundamental lack of evidence-based clinical practice guidelines prompted additional research into patient selection, portable oxygen technology, advocacy for improved oxygen therapy financing, and updating of policies (Jacobs et al., Ann Am Thorac Soc. 2018;15[12]:1369-81). With over a million patients in the United States being prescribed home oxygen and reported disconnect in-home oxygen needs/experiences across disease processes, lifestyles, and oxygen supply requirements, the 2020 American Thoracic Society (ATS) workshop on optimizing home oxygen therapy sought to answer critical questions in the use of LTOT for COPD patients (AlMutairi, et al. Respir Care. 2018;63[11]:1321-30; Jacobs, et al. Am J Respir Crit Care Med. 2020;202[10]:e121-e141).
Kadambari Vijaykumar, MD
Fellow-in-Training Member
Dharani Kumari Narendra, MBBS, FCCP
Steering Committee Member
Chest infections
Eradicating COVID-19 scourge: It is up to all of us— get vaccinated!
2021 brings hope, spurred by the availability of several effective COVID-19 vaccines – unprecedented scientific advances, considering that these vaccines were developed in record time. We have stark choices: while some individuals ignore scientific evidence and refuse to take the vaccine, we from the Chest Infections NetWork urge an alternative and imperative choice. As health providers caring for COVID-19 patients, we first-hand witness the horrors of dying alone in a hospital bed – far away from beloved ones. I have a sticker on my car that says: If you do not like your mask, you will not like my ventilator. With the advent of vaccines, I plan on replacing this sticker: If you do not want to get vaccinated, you will not like my ventilator. When the vaccine became available at my institution, I was the first to roll up my sleeve and feel the pinch in my upper arm. I urge you all to do the same. Make a difference, do your part – get vaccinated.
Marcos I. Restrepo, MD, MSc, PhD
Chair
Clinical pulmonary medicine
COVID-19 vaccines – mRNA and beyond
We currently have two COVID-19 mRNA vaccines with US FDA emergency use authorization (EUA) for use in individuals less than or equal to age 18 years – Pfizer and Moderna. They work by introducing mRNA into a muscle cell that instructs the host cell ribosomes to express Sars-CoV-2 spike proteins, thereby triggering a systemic immune response.
Both are two-dose regimens, with Pfizer’s 21 days apart and requires storage at -75 C, and Moderna’s 28 days apart, requiring storage at -20 C.
Presently in development are three more vaccines. AstraZeneca (AZ) and Johnson & Johnson (JnJ) use an adenovirus vector. Both vaccines are stable at standard refrigerator temperatures. AZ’s results were mixed – with two, full-size doses efficacy at 62% effective, but with a half-dose followed by a full dose, efficacy was 90%. Novavax candidate works differently - it’s a protein subunit vaccine and uses a lab-made version of the SARS-CoV-2 spike protein, mixed with an adjuvant to help trigger the immune system. Results from all trials are eagerly awaited.
Mary Jo S. Farmer, MD, PhD, FCCP
Steering Committee Member
Shyam Subramanian, MD, FCCP
Chair
Clinical research and quality improvement
COVID-19 treatment, so far!
COVID-19 has turned rapidly into a fatal illness, causing over 1.8 million deaths worldwide so far. The pandemic has also showed us the power of adaptive trials, multi-arm trials, and the role for collaboration across the global scientific community. A few significant studies are worth mentioning.
Possible future therapies include antiviral monoclonal antibodies, bamlanivimab (Chen P, et al. N Engl J Med. 2020; online ahead of print); early convalescent plasma (Libster R, et al. N Engl J Med. 2021 Jan 6. doi: 10.1056/NEJMoa2033700); and casirivimab-imdevimab (Baum A, et al. Science. 2020 Nov 27 doi: 10.1126/science.abe2402). Development of mRNA COVID-19 vaccines can help with primary prevention and herd immunity (Polack FP, et al. N Engl J Med. 2020;383[27]:2603; Baden LR, et al. N Engl J Med. 2020; Dec 30; doi: 10.1056/NEJMoa2035389).
We are starting to understand why COVID-19 infection is more pathogenic in some, how to predict development of severe disease, and how to best treat respiratory failure. Defeating the pandemic will require ongoing international collaboration in research, development, and resource allocation.
Muhammad Hayat Syed, MBBS
Ankita Agarwal, MD
Fellows-in-Training Members
Critical care
Awake proning in COVID-19
Prone positioning has been shown to improve pulmonary mechanics in intubated patients with acute respiratory distress syndrome (ARDS). Proposed mechanisms for these benefits include shape matching, reversing the pleural pressure gradient, homogenizing distribution of pleural pressures, reducing the impact of the heart and abdomen on the lungs, and maintaining distribution of perfusion. Application of prone positioning has also been shown to reduce mortality in severe ARDS (Guérin, et al. N Engl J Med. 2013;368(23):2159-68). With the COVID-19 pandemic, clinicians have extrapolated that nonintubated patients with severe hypoxia may benefit from awake proning in the hopes of improving oxygenation and decreasing need for intubation. But, what’s the evidence so far?
Kathryn Pendleton, MD
Viren Kaul, MD
Steering Committee Members
Home-Based Mechanical Ventilation and Neuromuscular Disease
New horizons in home ventilation
Phasing out a particular ventilator (Philips Respironics Trilogy 100 ventilator) has everyone on a steep learning curve with the replacement (Trilogy EVO). Most features are replicated in the EVO, including volume/pressure control and pressure-supported modes, mouthpiece ventilation, active/passive circuit capability, and portability (11.5 lb). Upgrades include longer battery life (15 hours; 7.5 hours internal/7.5 hours detachable) and use in pediatric patients now greater than or equal to 2.5 kg.
Other significant improvements include lower flow trigger sensitivity to accommodate patients with severe respiratory muscle weakness, a fast start AVAPS with rapid breath-to-breath 3 cm H20 increases for the first minute to rapidly reach target tidal volume, and breath-to-breath auto-EPAP sensing of upper airway resistance to maintain airway patency for patients with upper airway obstruction.
Internal bluetooth transmission to cloud-based monitoring (Care OrchestratorTM) expands access to patients without wi-fi or cellular service. New monitoring modules, SpO2 and EtCO2, and transcutaneous CO2 monitoring (Sentec), transmit to cloud-based monitoring (EVO EtCs2 spring 2021).
These welcome improvements allow clinicians to better match ventilator settings to the patients’ evolving physiology and provide flexibility and connectivity to optimize long-term care.
Karin Provost, DO, PhD
Steering Committee Member
Janet Hilbert, MD
NetWork Member
Online resources
EVO e-learning curriculum
Interprofessional team
Interprofessional team approach to palliative extubation
The emotional burden of caring for patients at the end of life affects all members of the care team. Palliative (or compassionate) extubation consists of the withdrawal of mechanical ventilation when the absolute priority in care delivery is to afford comfort and allow for natural death to occur. Rapid withdrawal of ventilatory support may lead to significant respiratory distress, and the critical care team has an obligation to ensure patient comfort during the dying process (Truog RD, et al. Crit Care Med. 2008;36[3]:953). Registered nurses (RN) are primarily responsible for the titration of sedation/analgesia and should be included in discussions regarding medication selection. It is imperative that neuromuscular blockade is absent, and benzodiazepines and/or opioids should be initiated prior to palliative extubation (Lanken PN, et al. Am J Respir Crit Care Med. 2008;177:912). Respiratory therapists (RT) are responsible for endotracheal tube removal despite rare participation in end-of-life discussions (Grandhige AP, et al. Respir Care. 2016;61[7]:891). It is recommended that an experienced physician, RN, and RT be readily available to respond quickly to any signs of distress (Downar J, et al. Intensive Care Med. 2016;42:1003). Regular debriefing sessions exploring team actions and communication dynamics are advised following end-of-life care (Ho A, et al. J Interprof Care. 2016;30[6]:795-803). Palliative extubation demands meticulous planning and clear communication among all team members (physician, RN, RT) and the patient’s family. Poor planning may result in physical and emotional suffering for the patient and difficult bereavement for the family (Coradazi A, et al. Hos Pal Med Int J. 2019;3[1]:10-14). Interprofessional team-based care results from intentional teams that exhibit collective identity and shared responsibility for the patients they serve (Core Competencies for Interprofessional Education Collaborative Practice, 2016). An inclusive and interprofessional approach to withdrawal of mechanical ventilation is key to both quality patient care and provider wellbeing.
Rebecca Anna Gersten, MD
Steering Committee Member
Samantha Davis, MS, RRT
Steering Committee Member
Munish Luthra, MD, FCCP
Vice-Chair Committee
Airways disorders
Updated guidelines on the use of home O2 in COPD: A much-needed respite
The use of long-term oxygen therapy (LTOT, oxygen prescribed for at least 15 h/day) in patients with COPD and chronic hypoxemia has been standard of care based on trials from the 1980s that conferred a survival benefit with the use of continuous oxygen (Ann Internal Med. 1980;93[3]:391-8). More recently, LTOT has not shown to improve survival or delay time to the hospitalization in patients with stable COPD and resting or exercise-induced moderate desaturation (N Engl J Med. 2016;375[17]:1617-27). Thus far, existing recommendations had been semi-inclusive in patient selection. A fundamental lack of evidence-based clinical practice guidelines prompted additional research into patient selection, portable oxygen technology, advocacy for improved oxygen therapy financing, and updating of policies (Jacobs et al., Ann Am Thorac Soc. 2018;15[12]:1369-81). With over a million patients in the United States being prescribed home oxygen and reported disconnect in-home oxygen needs/experiences across disease processes, lifestyles, and oxygen supply requirements, the 2020 American Thoracic Society (ATS) workshop on optimizing home oxygen therapy sought to answer critical questions in the use of LTOT for COPD patients (AlMutairi, et al. Respir Care. 2018;63[11]:1321-30; Jacobs, et al. Am J Respir Crit Care Med. 2020;202[10]:e121-e141).
Kadambari Vijaykumar, MD
Fellow-in-Training Member
Dharani Kumari Narendra, MBBS, FCCP
Steering Committee Member
Chest infections
Eradicating COVID-19 scourge: It is up to all of us— get vaccinated!
2021 brings hope, spurred by the availability of several effective COVID-19 vaccines – unprecedented scientific advances, considering that these vaccines were developed in record time. We have stark choices: while some individuals ignore scientific evidence and refuse to take the vaccine, we from the Chest Infections NetWork urge an alternative and imperative choice. As health providers caring for COVID-19 patients, we first-hand witness the horrors of dying alone in a hospital bed – far away from beloved ones. I have a sticker on my car that says: If you do not like your mask, you will not like my ventilator. With the advent of vaccines, I plan on replacing this sticker: If you do not want to get vaccinated, you will not like my ventilator. When the vaccine became available at my institution, I was the first to roll up my sleeve and feel the pinch in my upper arm. I urge you all to do the same. Make a difference, do your part – get vaccinated.
Marcos I. Restrepo, MD, MSc, PhD
Chair
Clinical pulmonary medicine
COVID-19 vaccines – mRNA and beyond
We currently have two COVID-19 mRNA vaccines with US FDA emergency use authorization (EUA) for use in individuals less than or equal to age 18 years – Pfizer and Moderna. They work by introducing mRNA into a muscle cell that instructs the host cell ribosomes to express Sars-CoV-2 spike proteins, thereby triggering a systemic immune response.
Both are two-dose regimens, with Pfizer’s 21 days apart and requires storage at -75 C, and Moderna’s 28 days apart, requiring storage at -20 C.
Presently in development are three more vaccines. AstraZeneca (AZ) and Johnson & Johnson (JnJ) use an adenovirus vector. Both vaccines are stable at standard refrigerator temperatures. AZ’s results were mixed – with two, full-size doses efficacy at 62% effective, but with a half-dose followed by a full dose, efficacy was 90%. Novavax candidate works differently - it’s a protein subunit vaccine and uses a lab-made version of the SARS-CoV-2 spike protein, mixed with an adjuvant to help trigger the immune system. Results from all trials are eagerly awaited.
Mary Jo S. Farmer, MD, PhD, FCCP
Steering Committee Member
Shyam Subramanian, MD, FCCP
Chair
Clinical research and quality improvement
COVID-19 treatment, so far!
COVID-19 has turned rapidly into a fatal illness, causing over 1.8 million deaths worldwide so far. The pandemic has also showed us the power of adaptive trials, multi-arm trials, and the role for collaboration across the global scientific community. A few significant studies are worth mentioning.
Possible future therapies include antiviral monoclonal antibodies, bamlanivimab (Chen P, et al. N Engl J Med. 2020; online ahead of print); early convalescent plasma (Libster R, et al. N Engl J Med. 2021 Jan 6. doi: 10.1056/NEJMoa2033700); and casirivimab-imdevimab (Baum A, et al. Science. 2020 Nov 27 doi: 10.1126/science.abe2402). Development of mRNA COVID-19 vaccines can help with primary prevention and herd immunity (Polack FP, et al. N Engl J Med. 2020;383[27]:2603; Baden LR, et al. N Engl J Med. 2020; Dec 30; doi: 10.1056/NEJMoa2035389).
We are starting to understand why COVID-19 infection is more pathogenic in some, how to predict development of severe disease, and how to best treat respiratory failure. Defeating the pandemic will require ongoing international collaboration in research, development, and resource allocation.
Muhammad Hayat Syed, MBBS
Ankita Agarwal, MD
Fellows-in-Training Members
Critical care
Awake proning in COVID-19
Prone positioning has been shown to improve pulmonary mechanics in intubated patients with acute respiratory distress syndrome (ARDS). Proposed mechanisms for these benefits include shape matching, reversing the pleural pressure gradient, homogenizing distribution of pleural pressures, reducing the impact of the heart and abdomen on the lungs, and maintaining distribution of perfusion. Application of prone positioning has also been shown to reduce mortality in severe ARDS (Guérin, et al. N Engl J Med. 2013;368(23):2159-68). With the COVID-19 pandemic, clinicians have extrapolated that nonintubated patients with severe hypoxia may benefit from awake proning in the hopes of improving oxygenation and decreasing need for intubation. But, what’s the evidence so far?
Kathryn Pendleton, MD
Viren Kaul, MD
Steering Committee Members
Home-Based Mechanical Ventilation and Neuromuscular Disease
New horizons in home ventilation
Phasing out a particular ventilator (Philips Respironics Trilogy 100 ventilator) has everyone on a steep learning curve with the replacement (Trilogy EVO). Most features are replicated in the EVO, including volume/pressure control and pressure-supported modes, mouthpiece ventilation, active/passive circuit capability, and portability (11.5 lb). Upgrades include longer battery life (15 hours; 7.5 hours internal/7.5 hours detachable) and use in pediatric patients now greater than or equal to 2.5 kg.
Other significant improvements include lower flow trigger sensitivity to accommodate patients with severe respiratory muscle weakness, a fast start AVAPS with rapid breath-to-breath 3 cm H20 increases for the first minute to rapidly reach target tidal volume, and breath-to-breath auto-EPAP sensing of upper airway resistance to maintain airway patency for patients with upper airway obstruction.
Internal bluetooth transmission to cloud-based monitoring (Care OrchestratorTM) expands access to patients without wi-fi or cellular service. New monitoring modules, SpO2 and EtCO2, and transcutaneous CO2 monitoring (Sentec), transmit to cloud-based monitoring (EVO EtCs2 spring 2021).
These welcome improvements allow clinicians to better match ventilator settings to the patients’ evolving physiology and provide flexibility and connectivity to optimize long-term care.
Karin Provost, DO, PhD
Steering Committee Member
Janet Hilbert, MD
NetWork Member
Online resources
EVO e-learning curriculum
Interprofessional team
Interprofessional team approach to palliative extubation
The emotional burden of caring for patients at the end of life affects all members of the care team. Palliative (or compassionate) extubation consists of the withdrawal of mechanical ventilation when the absolute priority in care delivery is to afford comfort and allow for natural death to occur. Rapid withdrawal of ventilatory support may lead to significant respiratory distress, and the critical care team has an obligation to ensure patient comfort during the dying process (Truog RD, et al. Crit Care Med. 2008;36[3]:953). Registered nurses (RN) are primarily responsible for the titration of sedation/analgesia and should be included in discussions regarding medication selection. It is imperative that neuromuscular blockade is absent, and benzodiazepines and/or opioids should be initiated prior to palliative extubation (Lanken PN, et al. Am J Respir Crit Care Med. 2008;177:912). Respiratory therapists (RT) are responsible for endotracheal tube removal despite rare participation in end-of-life discussions (Grandhige AP, et al. Respir Care. 2016;61[7]:891). It is recommended that an experienced physician, RN, and RT be readily available to respond quickly to any signs of distress (Downar J, et al. Intensive Care Med. 2016;42:1003). Regular debriefing sessions exploring team actions and communication dynamics are advised following end-of-life care (Ho A, et al. J Interprof Care. 2016;30[6]:795-803). Palliative extubation demands meticulous planning and clear communication among all team members (physician, RN, RT) and the patient’s family. Poor planning may result in physical and emotional suffering for the patient and difficult bereavement for the family (Coradazi A, et al. Hos Pal Med Int J. 2019;3[1]:10-14). Interprofessional team-based care results from intentional teams that exhibit collective identity and shared responsibility for the patients they serve (Core Competencies for Interprofessional Education Collaborative Practice, 2016). An inclusive and interprofessional approach to withdrawal of mechanical ventilation is key to both quality patient care and provider wellbeing.
Rebecca Anna Gersten, MD
Steering Committee Member
Samantha Davis, MS, RRT
Steering Committee Member
Munish Luthra, MD, FCCP
Vice-Chair Committee
Airways disorders
Updated guidelines on the use of home O2 in COPD: A much-needed respite
The use of long-term oxygen therapy (LTOT, oxygen prescribed for at least 15 h/day) in patients with COPD and chronic hypoxemia has been standard of care based on trials from the 1980s that conferred a survival benefit with the use of continuous oxygen (Ann Internal Med. 1980;93[3]:391-8). More recently, LTOT has not shown to improve survival or delay time to the hospitalization in patients with stable COPD and resting or exercise-induced moderate desaturation (N Engl J Med. 2016;375[17]:1617-27). Thus far, existing recommendations had been semi-inclusive in patient selection. A fundamental lack of evidence-based clinical practice guidelines prompted additional research into patient selection, portable oxygen technology, advocacy for improved oxygen therapy financing, and updating of policies (Jacobs et al., Ann Am Thorac Soc. 2018;15[12]:1369-81). With over a million patients in the United States being prescribed home oxygen and reported disconnect in-home oxygen needs/experiences across disease processes, lifestyles, and oxygen supply requirements, the 2020 American Thoracic Society (ATS) workshop on optimizing home oxygen therapy sought to answer critical questions in the use of LTOT for COPD patients (AlMutairi, et al. Respir Care. 2018;63[11]:1321-30; Jacobs, et al. Am J Respir Crit Care Med. 2020;202[10]:e121-e141).
Kadambari Vijaykumar, MD
Fellow-in-Training Member
Dharani Kumari Narendra, MBBS, FCCP
Steering Committee Member
Chest infections
Eradicating COVID-19 scourge: It is up to all of us— get vaccinated!
2021 brings hope, spurred by the availability of several effective COVID-19 vaccines – unprecedented scientific advances, considering that these vaccines were developed in record time. We have stark choices: while some individuals ignore scientific evidence and refuse to take the vaccine, we from the Chest Infections NetWork urge an alternative and imperative choice. As health providers caring for COVID-19 patients, we first-hand witness the horrors of dying alone in a hospital bed – far away from beloved ones. I have a sticker on my car that says: If you do not like your mask, you will not like my ventilator. With the advent of vaccines, I plan on replacing this sticker: If you do not want to get vaccinated, you will not like my ventilator. When the vaccine became available at my institution, I was the first to roll up my sleeve and feel the pinch in my upper arm. I urge you all to do the same. Make a difference, do your part – get vaccinated.
Marcos I. Restrepo, MD, MSc, PhD
Chair
Clinical pulmonary medicine
COVID-19 vaccines – mRNA and beyond
We currently have two COVID-19 mRNA vaccines with US FDA emergency use authorization (EUA) for use in individuals less than or equal to age 18 years – Pfizer and Moderna. They work by introducing mRNA into a muscle cell that instructs the host cell ribosomes to express Sars-CoV-2 spike proteins, thereby triggering a systemic immune response.
Both are two-dose regimens, with Pfizer’s 21 days apart and requires storage at -75 C, and Moderna’s 28 days apart, requiring storage at -20 C.
Presently in development are three more vaccines. AstraZeneca (AZ) and Johnson & Johnson (JnJ) use an adenovirus vector. Both vaccines are stable at standard refrigerator temperatures. AZ’s results were mixed – with two, full-size doses efficacy at 62% effective, but with a half-dose followed by a full dose, efficacy was 90%. Novavax candidate works differently - it’s a protein subunit vaccine and uses a lab-made version of the SARS-CoV-2 spike protein, mixed with an adjuvant to help trigger the immune system. Results from all trials are eagerly awaited.
Mary Jo S. Farmer, MD, PhD, FCCP
Steering Committee Member
Shyam Subramanian, MD, FCCP
Chair
Clinical research and quality improvement
COVID-19 treatment, so far!
COVID-19 has turned rapidly into a fatal illness, causing over 1.8 million deaths worldwide so far. The pandemic has also showed us the power of adaptive trials, multi-arm trials, and the role for collaboration across the global scientific community. A few significant studies are worth mentioning.
Possible future therapies include antiviral monoclonal antibodies, bamlanivimab (Chen P, et al. N Engl J Med. 2020; online ahead of print); early convalescent plasma (Libster R, et al. N Engl J Med. 2021 Jan 6. doi: 10.1056/NEJMoa2033700); and casirivimab-imdevimab (Baum A, et al. Science. 2020 Nov 27 doi: 10.1126/science.abe2402). Development of mRNA COVID-19 vaccines can help with primary prevention and herd immunity (Polack FP, et al. N Engl J Med. 2020;383[27]:2603; Baden LR, et al. N Engl J Med. 2020; Dec 30; doi: 10.1056/NEJMoa2035389).
We are starting to understand why COVID-19 infection is more pathogenic in some, how to predict development of severe disease, and how to best treat respiratory failure. Defeating the pandemic will require ongoing international collaboration in research, development, and resource allocation.
Muhammad Hayat Syed, MBBS
Ankita Agarwal, MD
Fellows-in-Training Members
Critical care
Awake proning in COVID-19
Prone positioning has been shown to improve pulmonary mechanics in intubated patients with acute respiratory distress syndrome (ARDS). Proposed mechanisms for these benefits include shape matching, reversing the pleural pressure gradient, homogenizing distribution of pleural pressures, reducing the impact of the heart and abdomen on the lungs, and maintaining distribution of perfusion. Application of prone positioning has also been shown to reduce mortality in severe ARDS (Guérin, et al. N Engl J Med. 2013;368(23):2159-68). With the COVID-19 pandemic, clinicians have extrapolated that nonintubated patients with severe hypoxia may benefit from awake proning in the hopes of improving oxygenation and decreasing need for intubation. But, what’s the evidence so far?
Kathryn Pendleton, MD
Viren Kaul, MD
Steering Committee Members
Home-Based Mechanical Ventilation and Neuromuscular Disease
New horizons in home ventilation
Phasing out a particular ventilator (Philips Respironics Trilogy 100 ventilator) has everyone on a steep learning curve with the replacement (Trilogy EVO). Most features are replicated in the EVO, including volume/pressure control and pressure-supported modes, mouthpiece ventilation, active/passive circuit capability, and portability (11.5 lb). Upgrades include longer battery life (15 hours; 7.5 hours internal/7.5 hours detachable) and use in pediatric patients now greater than or equal to 2.5 kg.
Other significant improvements include lower flow trigger sensitivity to accommodate patients with severe respiratory muscle weakness, a fast start AVAPS with rapid breath-to-breath 3 cm H20 increases for the first minute to rapidly reach target tidal volume, and breath-to-breath auto-EPAP sensing of upper airway resistance to maintain airway patency for patients with upper airway obstruction.
Internal bluetooth transmission to cloud-based monitoring (Care OrchestratorTM) expands access to patients without wi-fi or cellular service. New monitoring modules, SpO2 and EtCO2, and transcutaneous CO2 monitoring (Sentec), transmit to cloud-based monitoring (EVO EtCs2 spring 2021).
These welcome improvements allow clinicians to better match ventilator settings to the patients’ evolving physiology and provide flexibility and connectivity to optimize long-term care.
Karin Provost, DO, PhD
Steering Committee Member
Janet Hilbert, MD
NetWork Member
Online resources
EVO e-learning curriculum
Interprofessional team
Interprofessional team approach to palliative extubation
The emotional burden of caring for patients at the end of life affects all members of the care team. Palliative (or compassionate) extubation consists of the withdrawal of mechanical ventilation when the absolute priority in care delivery is to afford comfort and allow for natural death to occur. Rapid withdrawal of ventilatory support may lead to significant respiratory distress, and the critical care team has an obligation to ensure patient comfort during the dying process (Truog RD, et al. Crit Care Med. 2008;36[3]:953). Registered nurses (RN) are primarily responsible for the titration of sedation/analgesia and should be included in discussions regarding medication selection. It is imperative that neuromuscular blockade is absent, and benzodiazepines and/or opioids should be initiated prior to palliative extubation (Lanken PN, et al. Am J Respir Crit Care Med. 2008;177:912). Respiratory therapists (RT) are responsible for endotracheal tube removal despite rare participation in end-of-life discussions (Grandhige AP, et al. Respir Care. 2016;61[7]:891). It is recommended that an experienced physician, RN, and RT be readily available to respond quickly to any signs of distress (Downar J, et al. Intensive Care Med. 2016;42:1003). Regular debriefing sessions exploring team actions and communication dynamics are advised following end-of-life care (Ho A, et al. J Interprof Care. 2016;30[6]:795-803). Palliative extubation demands meticulous planning and clear communication among all team members (physician, RN, RT) and the patient’s family. Poor planning may result in physical and emotional suffering for the patient and difficult bereavement for the family (Coradazi A, et al. Hos Pal Med Int J. 2019;3[1]:10-14). Interprofessional team-based care results from intentional teams that exhibit collective identity and shared responsibility for the patients they serve (Core Competencies for Interprofessional Education Collaborative Practice, 2016). An inclusive and interprofessional approach to withdrawal of mechanical ventilation is key to both quality patient care and provider wellbeing.
Rebecca Anna Gersten, MD
Steering Committee Member
Samantha Davis, MS, RRT
Steering Committee Member
Munish Luthra, MD, FCCP
Vice-Chair Committee