Society News

Greetings. I hope that you are well and are enjoying the summer as best you can during these challenging times. Since the “CHEST year” has drawn to a close recently, I would like to offer my reflections, which were recently shared with the Board of Regents, as well as a glimpse of what is ahead for CHEST. There is just so much great work I want to share.

This past year has posed a number of challenges. COVID-19 has caused us to interact differently on both a social and a business level. CHEST Headquarters has been closed, and we have not had a live-learning course for more than 4 months. But our work has not faltered. We have been extremely productive during this period and have once again demonstrated our resiliency and innovative spirit; in our vernacular, we “Crushed It.”

While COVID-19 has presented us with a number of obstacles, it has presented us with a number of opportunities, and we have taken advantage of them. During this pandemic, CHEST has truly demonstrated its ability to provide a connection at a critical time, giving this phrase new meaning and urgency. We have created a new resource center for clinicians, developed patient education and awareness campaigns to support the public through this crisis, launched a webinar series, developed scientific guidance statements, and more. At the same time, we have invested in our technology and educational infrastructure to grow our capabilities and position CHEST for long-term success.

Prior to COVID-19, we spent a significant amount of time among the CHEST staff, Presidents, and Boards drafting and reviewing a concise strategy statement for CHEST to provide focus and clarity to its efforts and derive and tie together future strategies specific to learning, technology, and more. From this statement, we derived four key areas requiring our continued and explicit focus to achieve this goal:

• People: Ensure we attract, retain, and incentivize the right people (staff, leaders, and volunteers).

• Products: Foster an environment of innovation and product development resulting in overall revenue growth, as well as revenue from new products and services.

• Education: Ensure that CHEST education products and services are robust, differentiated, and scalable..

• Growth: Meet or exceed revenue and margin targets.

As long as the mission and strategy of the organization does not deviate, these goals should not change. However, how we go about executing on achieving these goals each year will depend on the context of our environment and be shaped by the specific initiatives planned affecting our People, Products, Education, and building toward Growth. This consistency is important to sustain a vibrant, aligned, and productive organization.

Beyond this groundwork, I also would like to list a series of things that, together, CHEST accomplished over the last year.

• Reviewed existing contracts and, where appropriate, renegotiated major contracts to ensure terms more favorable for CHEST.
• Hired and on-boarded a Chief Learning Officer to place greater emphasis on expanding CHEST educational programs. Analyzed current educational products and have begun repositioning our educational efforts to better serve our learners.
• Refined the one CHEST concept, realigned responsibilities throughout the organization in general, and the CHEST Foundation, in particular, to enhance resource readiness and productivity. Clarified relationship with industry by continuing to implement our Industry Partnership Guidelines and streamline efforts with our partners.
• Continued rollout and execution of our international event strategy. Successfully developed and held a program for CHEST Congress 2020 Italy with our CHEST Italian Delegation, in a virtual format, due to COVID, while enabling us to build momentum for a rescheduled meeting in 2021. We had over 2,000 virtual registrants from over 100 countries, and there was a thank you given to all attendees by Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, to start off the program – what a success!
• Accelerated our digital transformation with an educational focus on virtual Board Review, CHEST 2020 Annual Meeting, online simulation.
• Forecasting strong financial outlook and improving financial reporting for FY19-20. Successful 2019 annual meeting:

o Total attendance 8,593—the largest attendance to date.

o Simulation Session Registration 979

o Exhibiting companies 160 SOLD OUT

o CHEST Annual Meeting 2019 delivered largest number of APPs and fellows attending in the last 5 years.

• Reintroduced CHEST into the advocacy and health policy arena through the successful acquisition of NAMDRC.

CHEST’s operating financial performance is solid, and well thought out efforts have kept CHEST on a growth trajectory over the last 7 years. During this same period (since 2011/12), our staff headcount has grown from 85 to a projected 121 this year; the new expertise and capabilities we have brought on board, combined with our highly talented and committed staff team, have contributed to this tremendous growth.

Our future is bright. These 2 two years have been very exciting for me both professionally and personally. I am grateful for the opportunity to work with all of you and serve as your CEO/EVP because together, we truly are making a significant difference in moving CHEST forward and crushing lung disease.

I know you are as proud of CHEST’s efforts this year as I am.

Thank you.

Greetings. I hope that you are well and are enjoying the summer as best you can during these challenging times. Since the “CHEST year” has drawn to a close recently, I would like to offer my reflections, which were recently shared with the Board of Regents, as well as a glimpse of what is ahead for CHEST. There is just so much great work I want to share.

This past year has posed a number of challenges. COVID-19 has caused us to interact differently on both a social and a business level. CHEST Headquarters has been closed, and we have not had a live-learning course for more than 4 months. But our work has not faltered. We have been extremely productive during this period and have once again demonstrated our resiliency and innovative spirit; in our vernacular, we “Crushed It.”

While COVID-19 has presented us with a number of obstacles, it has presented us with a number of opportunities, and we have taken advantage of them. During this pandemic, CHEST has truly demonstrated its ability to provide a connection at a critical time, giving this phrase new meaning and urgency. We have created a new resource center for clinicians, developed patient education and awareness campaigns to support the public through this crisis, launched a webinar series, developed scientific guidance statements, and more. At the same time, we have invested in our technology and educational infrastructure to grow our capabilities and position CHEST for long-term success.

Prior to COVID-19, we spent a significant amount of time among the CHEST staff, Presidents, and Boards drafting and reviewing a concise strategy statement for CHEST to provide focus and clarity to its efforts and derive and tie together future strategies specific to learning, technology, and more. From this statement, we derived four key areas requiring our continued and explicit focus to achieve this goal:

• People: Ensure we attract, retain, and incentivize the right people (staff, leaders, and volunteers).

• Products: Foster an environment of innovation and product development resulting in overall revenue growth, as well as revenue from new products and services.

• Education: Ensure that CHEST education products and services are robust, differentiated, and scalable..

• Growth: Meet or exceed revenue and margin targets.

As long as the mission and strategy of the organization does not deviate, these goals should not change. However, how we go about executing on achieving these goals each year will depend on the context of our environment and be shaped by the specific initiatives planned affecting our People, Products, Education, and building toward Growth. This consistency is important to sustain a vibrant, aligned, and productive organization.

Beyond this groundwork, I also would like to list a series of things that, together, CHEST accomplished over the last year.

• Reviewed existing contracts and, where appropriate, renegotiated major contracts to ensure terms more favorable for CHEST.
• Hired and on-boarded a Chief Learning Officer to place greater emphasis on expanding CHEST educational programs. Analyzed current educational products and have begun repositioning our educational efforts to better serve our learners.
• Refined the one CHEST concept, realigned responsibilities throughout the organization in general, and the CHEST Foundation, in particular, to enhance resource readiness and productivity. Clarified relationship with industry by continuing to implement our Industry Partnership Guidelines and streamline efforts with our partners.
• Continued rollout and execution of our international event strategy. Successfully developed and held a program for CHEST Congress 2020 Italy with our CHEST Italian Delegation, in a virtual format, due to COVID, while enabling us to build momentum for a rescheduled meeting in 2021. We had over 2,000 virtual registrants from over 100 countries, and there was a thank you given to all attendees by Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, to start off the program – what a success!
• Accelerated our digital transformation with an educational focus on virtual Board Review, CHEST 2020 Annual Meeting, online simulation.
• Forecasting strong financial outlook and improving financial reporting for FY19-20. Successful 2019 annual meeting:

o Total attendance 8,593—the largest attendance to date.

o Simulation Session Registration 979

o Exhibiting companies 160 SOLD OUT

o CHEST Annual Meeting 2019 delivered largest number of APPs and fellows attending in the last 5 years.

• Reintroduced CHEST into the advocacy and health policy arena through the successful acquisition of NAMDRC.

CHEST’s operating financial performance is solid, and well thought out efforts have kept CHEST on a growth trajectory over the last 7 years. During this same period (since 2011/12), our staff headcount has grown from 85 to a projected 121 this year; the new expertise and capabilities we have brought on board, combined with our highly talented and committed staff team, have contributed to this tremendous growth.

Our future is bright. These 2 two years have been very exciting for me both professionally and personally. I am grateful for the opportunity to work with all of you and serve as your CEO/EVP because together, we truly are making a significant difference in moving CHEST forward and crushing lung disease.

I know you are as proud of CHEST’s efforts this year as I am.

Thank you.

Greetings. I hope that you are well and are enjoying the summer as best you can during these challenging times. Since the “CHEST year” has drawn to a close recently, I would like to offer my reflections, which were recently shared with the Board of Regents, as well as a glimpse of what is ahead for CHEST. There is just so much great work I want to share.

This past year has posed a number of challenges. COVID-19 has caused us to interact differently on both a social and a business level. CHEST Headquarters has been closed, and we have not had a live-learning course for more than 4 months. But our work has not faltered. We have been extremely productive during this period and have once again demonstrated our resiliency and innovative spirit; in our vernacular, we “Crushed It.”

While COVID-19 has presented us with a number of obstacles, it has presented us with a number of opportunities, and we have taken advantage of them. During this pandemic, CHEST has truly demonstrated its ability to provide a connection at a critical time, giving this phrase new meaning and urgency. We have created a new resource center for clinicians, developed patient education and awareness campaigns to support the public through this crisis, launched a webinar series, developed scientific guidance statements, and more. At the same time, we have invested in our technology and educational infrastructure to grow our capabilities and position CHEST for long-term success.

Prior to COVID-19, we spent a significant amount of time among the CHEST staff, Presidents, and Boards drafting and reviewing a concise strategy statement for CHEST to provide focus and clarity to its efforts and derive and tie together future strategies specific to learning, technology, and more. From this statement, we derived four key areas requiring our continued and explicit focus to achieve this goal:

• People: Ensure we attract, retain, and incentivize the right people (staff, leaders, and volunteers).

• Products: Foster an environment of innovation and product development resulting in overall revenue growth, as well as revenue from new products and services.

• Education: Ensure that CHEST education products and services are robust, differentiated, and scalable..

• Growth: Meet or exceed revenue and margin targets.

As long as the mission and strategy of the organization does not deviate, these goals should not change. However, how we go about executing on achieving these goals each year will depend on the context of our environment and be shaped by the specific initiatives planned affecting our People, Products, Education, and building toward Growth. This consistency is important to sustain a vibrant, aligned, and productive organization.

Beyond this groundwork, I also would like to list a series of things that, together, CHEST accomplished over the last year.

• Reviewed existing contracts and, where appropriate, renegotiated major contracts to ensure terms more favorable for CHEST.
• Hired and on-boarded a Chief Learning Officer to place greater emphasis on expanding CHEST educational programs. Analyzed current educational products and have begun repositioning our educational efforts to better serve our learners.
• Refined the one CHEST concept, realigned responsibilities throughout the organization in general, and the CHEST Foundation, in particular, to enhance resource readiness and productivity. Clarified relationship with industry by continuing to implement our Industry Partnership Guidelines and streamline efforts with our partners.
• Continued rollout and execution of our international event strategy. Successfully developed and held a program for CHEST Congress 2020 Italy with our CHEST Italian Delegation, in a virtual format, due to COVID, while enabling us to build momentum for a rescheduled meeting in 2021. We had over 2,000 virtual registrants from over 100 countries, and there was a thank you given to all attendees by Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, to start off the program – what a success!
• Accelerated our digital transformation with an educational focus on virtual Board Review, CHEST 2020 Annual Meeting, online simulation.
• Forecasting strong financial outlook and improving financial reporting for FY19-20. Successful 2019 annual meeting:

o Total attendance 8,593—the largest attendance to date.

o Simulation Session Registration 979

o Exhibiting companies 160 SOLD OUT

o CHEST Annual Meeting 2019 delivered largest number of APPs and fellows attending in the last 5 years.

• Reintroduced CHEST into the advocacy and health policy arena through the successful acquisition of NAMDRC.

CHEST’s operating financial performance is solid, and well thought out efforts have kept CHEST on a growth trajectory over the last 7 years. During this same period (since 2011/12), our staff headcount has grown from 85 to a projected 121 this year; the new expertise and capabilities we have brought on board, combined with our highly talented and committed staff team, have contributed to this tremendous growth.

Our future is bright. These 2 two years have been very exciting for me both professionally and personally. I am grateful for the opportunity to work with all of you and serve as your CEO/EVP because together, we truly are making a significant difference in moving CHEST forward and crushing lung disease.

I know you are as proud of CHEST’s efforts this year as I am.

Thank you.

Dear Colleagues,

We are now near 6 months into living with COVID-19. In Texas, we are experiencing the surge that much of the Northeast saw in March and April. The COVID-19 Task Force led by Dr. Steve Simpson (CHEST President-Elect) and with representation from the Critical Care, Chest Infections, and Disaster Response and Global Health NetWorks continues to meet regularly to keep our members updated on the latest research and rapidly changing clinical management of COVID-19 illness and the sequelae. COVID-19 has put our medical profession and our subspecialty under considerable stress, and CHEST has launched a new longitudinal Wellness Center led by Dr. Alex Niven, from Mayo Clinic, Rochester. These new resources will feature a wellness webinar series focused on mental health and wellness for clinicians during COVID-19 and beyond. CHEST received overwhelming positive feedback from members and attendees to the Women & Pulmonary Virtual Happy Hour that focused on sharing stories and building community. Many leaders have suggested other such topics and efforts that may be useful to the CHEST community. The CHEST Wellness Center will launch on July 15.

In addition to COVID-19 activities, our nation and the world have compelled a new powerful look at race relations, disparities, and diversity. I represented CHEST at a “White Coats for Black Lives” event in San Antonio. Following our nation’s call for racial equality, CHEST released a Statement of Equity that received overwhelmingly positive feedback and response from members via email and on social media. This statement clearly resonated with the CHEST community. We are asking our leadership and members to consider ways in which CHEST might continue to raise awareness and continue with efforts related to diversity and equity. CHEST also hosted an excellent webinar moderated by Dr. Demondes Haynes and Dr. Nneka Sederstrom in late June that offered a direct and meaningful dialogue on issues facing clinicians and patients of color, and the responsibility of those in leadership positions. CHEST leadership stand firm that racism and inequality are public health issues and are working to define how we further our efforts in this arena.

On June 17, CHEST held a 1-day Virtual CHEST Congress in conjunction with our the CHEST Italian Delegation, as COVID-19 prevented us from safely holding the live Congress in Bologna. We had 3,250 registered attendees. I was so impressed at what a virtual platform can deliver, complete with great educational sessions, including much on COVID-19, as well as capturing the CHEST experience with games, bocce, jeopardy etc! This gave CHEST an opportunity to explore further virtual-based education to reach our wider global audience. CHEST will still be holding an in-person Congress in Bologna, June 24-26, 2021.

CHEST will host three entirely virtual Board Review Courses this August in the areas of Pulmonary, Critical Care, and Pediatric Pulmonary Medicine. These courses will include a combination of pre-recorded lectures and live, interactive sessions. Audience response systems and SEEK questions will still be utilized. There’s still time to register, so don’t miss it! With time being a major commodity at present, all attendees will receive year-long access to all material!

I know you have been wondering about CHEST 2020, and as you have heard by now, CHEST 2020 in Chicago will be a virtual meeting. I am sure that this announcement came as no big surprise, but is certainly disappointing. As you can imagine this was a difficult decision, but one that was necessary based upon our new reality. It was compounded by limitations on the convention center venue under the Illinois reopening plan, and the fact that a large number of our faculty, as well as our attendees, are under a travel ban for the remainder of 2020 that will not allow them to travel to Chicago. The abstract and case report deadline closed June 1, and despite these circumstances, we saw our highest number of submissions to date! Late abstracts were due on July 17. We will be presenting standalone and complementary online offerings to ensure seamless delivery of critical education in formats that cater easily to our newly formed habits.

Thanks to our dedicated Scientific Program Committee Chair, Dr. Victor Test, and staff, we had already begun preparing for virtual CHEST Annual Meeting 2020. Here’s what you can expect:

• A memorable experience

• A highly interactive education program that includes audience Q&A, discussion threads, and audience response systems

• Opportunities for one-on-one discussions, networking, and access to faculty

• Industry-sponsored programs and a virtual exhibit hall

• Access to hundreds of narrated poster presentations, case reports, and research abstracts

• Competitive educational gaming where attendees can participate, win, or watch

• Dedicated COVID-19 update sessions

• CME and MOC credits

If you have already registered for CHEST 2020, you will have the option to transfer your registration to this new model. Our main focus is delivering the virtual program with the highest level of service that you have come to expect from CHEST and respect for our member’s time and current situation. I know Dr. Victor Test and the program committee will deliver a superb educational experience in a virtual meeting setting. Thank you for your support and understanding as we continue to evolve our events to meet the needs of our members while adapting to the best delivery methods.

Since so many fellows were unable to hold their live graduation events, and celebrations, we decided to send them off with a virtual event! On June 30 we held a Joint CHEST/ATS Respiratory Community Graduation Ceremony–for graduating fellows, and to welcome new fellows to our profession. The ceremony consisted of a combination of live and recorded messages from key leaders from both organizations. In addition, there was a keynote address from Dr. Rana Awdish, a critical care physician at Henry Ford Hospital in Detroit, who authored the bestselling book “In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope.” I encourage you to watch the video on the Early Career Professionals page on our Chestnet.org website.

The National Association for Medical Direction of Respiratory Care (NAMDRC) merger with CHEST was finalized at the end of May. Look for more advocacy-related actions coming from CHEST. The newly formed Health Policy and Advocacy Committee is helping to set CHEST’s advocacy agendas in the legislative and regulatory arenas, engaging with policymakers and educating CHEST members on governmental affairs relevant to CHEST’s mission. Did you see the inaugural CHEST published, on-line issue of Washington Watchline, a newsletter that aims to keep CHEST members informed about governmental activities that affect physicians who provide clinical care in respiratory, critical care, and sleep medicine? Follow Washington Watchline to learn more about CHEST’s advocacy around regulatory, legislative, and payment issues that relate to the delivery of health care in support of CHEST’s mission. One of the features was Telemedicine, which many of us are now using and is likely to be a part of many of our practices going forward.

With new COVID-19 surges throughout many parts of the United States, CHEST has continued our volunteer matching program for areas of need, including to the Navaho Nations, where CHEST matched 20 volunteers and has had more than a half-dozen inquiries from our members. In addition, in conjunction with the Foundation, CHEST has partnered with American Mask Rally and started a campaign to distribute masks to frontline essential workers in underserved communities. CHEST received a generous donation from AstraZeneca and Glaxo Smith Kline to help in the global fight against COVID-19 to provide current and accurate information and education to frontline clinicians to allow them to provide the best patient outcomes. CHEST also partnered with the American Thoracic Society to launch a joint PSA/ media campaign entitled For My Lung Health Campaign, to provide credible resources for underserved Black and Latino communities, as these communities are disproportionally affected by COVID-19. At the time of this writing, over a million people have seen the related video, featuring tips for taking control of one’s health in these difficult and uncertain times.

So, in closing, thank you all for what you do in these challenging times. 2020 will certainly be a year to remember! Stay safe and stay well!

Stephanie




 

Dear Colleagues,

We are now near 6 months into living with COVID-19. In Texas, we are experiencing the surge that much of the Northeast saw in March and April. The COVID-19 Task Force led by Dr. Steve Simpson (CHEST President-Elect) and with representation from the Critical Care, Chest Infections, and Disaster Response and Global Health NetWorks continues to meet regularly to keep our members updated on the latest research and rapidly changing clinical management of COVID-19 illness and the sequelae. COVID-19 has put our medical profession and our subspecialty under considerable stress, and CHEST has launched a new longitudinal Wellness Center led by Dr. Alex Niven, from Mayo Clinic, Rochester. These new resources will feature a wellness webinar series focused on mental health and wellness for clinicians during COVID-19 and beyond. CHEST received overwhelming positive feedback from members and attendees to the Women & Pulmonary Virtual Happy Hour that focused on sharing stories and building community. Many leaders have suggested other such topics and efforts that may be useful to the CHEST community. The CHEST Wellness Center will launch on July 15.

In addition to COVID-19 activities, our nation and the world have compelled a new powerful look at race relations, disparities, and diversity. I represented CHEST at a “White Coats for Black Lives” event in San Antonio. Following our nation’s call for racial equality, CHEST released a Statement of Equity that received overwhelmingly positive feedback and response from members via email and on social media. This statement clearly resonated with the CHEST community. We are asking our leadership and members to consider ways in which CHEST might continue to raise awareness and continue with efforts related to diversity and equity. CHEST also hosted an excellent webinar moderated by Dr. Demondes Haynes and Dr. Nneka Sederstrom in late June that offered a direct and meaningful dialogue on issues facing clinicians and patients of color, and the responsibility of those in leadership positions. CHEST leadership stand firm that racism and inequality are public health issues and are working to define how we further our efforts in this arena.

On June 17, CHEST held a 1-day Virtual CHEST Congress in conjunction with our the CHEST Italian Delegation, as COVID-19 prevented us from safely holding the live Congress in Bologna. We had 3,250 registered attendees. I was so impressed at what a virtual platform can deliver, complete with great educational sessions, including much on COVID-19, as well as capturing the CHEST experience with games, bocce, jeopardy etc! This gave CHEST an opportunity to explore further virtual-based education to reach our wider global audience. CHEST will still be holding an in-person Congress in Bologna, June 24-26, 2021.

CHEST will host three entirely virtual Board Review Courses this August in the areas of Pulmonary, Critical Care, and Pediatric Pulmonary Medicine. These courses will include a combination of pre-recorded lectures and live, interactive sessions. Audience response systems and SEEK questions will still be utilized. There’s still time to register, so don’t miss it! With time being a major commodity at present, all attendees will receive year-long access to all material!

I know you have been wondering about CHEST 2020, and as you have heard by now, CHEST 2020 in Chicago will be a virtual meeting. I am sure that this announcement came as no big surprise, but is certainly disappointing. As you can imagine this was a difficult decision, but one that was necessary based upon our new reality. It was compounded by limitations on the convention center venue under the Illinois reopening plan, and the fact that a large number of our faculty, as well as our attendees, are under a travel ban for the remainder of 2020 that will not allow them to travel to Chicago. The abstract and case report deadline closed June 1, and despite these circumstances, we saw our highest number of submissions to date! Late abstracts were due on July 17. We will be presenting standalone and complementary online offerings to ensure seamless delivery of critical education in formats that cater easily to our newly formed habits.

Thanks to our dedicated Scientific Program Committee Chair, Dr. Victor Test, and staff, we had already begun preparing for virtual CHEST Annual Meeting 2020. Here’s what you can expect:

• A memorable experience

• A highly interactive education program that includes audience Q&A, discussion threads, and audience response systems

• Opportunities for one-on-one discussions, networking, and access to faculty

• Industry-sponsored programs and a virtual exhibit hall

• Access to hundreds of narrated poster presentations, case reports, and research abstracts

• Competitive educational gaming where attendees can participate, win, or watch

• Dedicated COVID-19 update sessions

• CME and MOC credits

If you have already registered for CHEST 2020, you will have the option to transfer your registration to this new model. Our main focus is delivering the virtual program with the highest level of service that you have come to expect from CHEST and respect for our member’s time and current situation. I know Dr. Victor Test and the program committee will deliver a superb educational experience in a virtual meeting setting. Thank you for your support and understanding as we continue to evolve our events to meet the needs of our members while adapting to the best delivery methods.

Since so many fellows were unable to hold their live graduation events, and celebrations, we decided to send them off with a virtual event! On June 30 we held a Joint CHEST/ATS Respiratory Community Graduation Ceremony–for graduating fellows, and to welcome new fellows to our profession. The ceremony consisted of a combination of live and recorded messages from key leaders from both organizations. In addition, there was a keynote address from Dr. Rana Awdish, a critical care physician at Henry Ford Hospital in Detroit, who authored the bestselling book “In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope.” I encourage you to watch the video on the Early Career Professionals page on our Chestnet.org website.

The National Association for Medical Direction of Respiratory Care (NAMDRC) merger with CHEST was finalized at the end of May. Look for more advocacy-related actions coming from CHEST. The newly formed Health Policy and Advocacy Committee is helping to set CHEST’s advocacy agendas in the legislative and regulatory arenas, engaging with policymakers and educating CHEST members on governmental affairs relevant to CHEST’s mission. Did you see the inaugural CHEST published, on-line issue of Washington Watchline, a newsletter that aims to keep CHEST members informed about governmental activities that affect physicians who provide clinical care in respiratory, critical care, and sleep medicine? Follow Washington Watchline to learn more about CHEST’s advocacy around regulatory, legislative, and payment issues that relate to the delivery of health care in support of CHEST’s mission. One of the features was Telemedicine, which many of us are now using and is likely to be a part of many of our practices going forward.

With new COVID-19 surges throughout many parts of the United States, CHEST has continued our volunteer matching program for areas of need, including to the Navaho Nations, where CHEST matched 20 volunteers and has had more than a half-dozen inquiries from our members. In addition, in conjunction with the Foundation, CHEST has partnered with American Mask Rally and started a campaign to distribute masks to frontline essential workers in underserved communities. CHEST received a generous donation from AstraZeneca and Glaxo Smith Kline to help in the global fight against COVID-19 to provide current and accurate information and education to frontline clinicians to allow them to provide the best patient outcomes. CHEST also partnered with the American Thoracic Society to launch a joint PSA/ media campaign entitled For My Lung Health Campaign, to provide credible resources for underserved Black and Latino communities, as these communities are disproportionally affected by COVID-19. At the time of this writing, over a million people have seen the related video, featuring tips for taking control of one’s health in these difficult and uncertain times.

So, in closing, thank you all for what you do in these challenging times. 2020 will certainly be a year to remember! Stay safe and stay well!

Stephanie




 

Dear Colleagues,

We are now near 6 months into living with COVID-19. In Texas, we are experiencing the surge that much of the Northeast saw in March and April. The COVID-19 Task Force led by Dr. Steve Simpson (CHEST President-Elect) and with representation from the Critical Care, Chest Infections, and Disaster Response and Global Health NetWorks continues to meet regularly to keep our members updated on the latest research and rapidly changing clinical management of COVID-19 illness and the sequelae. COVID-19 has put our medical profession and our subspecialty under considerable stress, and CHEST has launched a new longitudinal Wellness Center led by Dr. Alex Niven, from Mayo Clinic, Rochester. These new resources will feature a wellness webinar series focused on mental health and wellness for clinicians during COVID-19 and beyond. CHEST received overwhelming positive feedback from members and attendees to the Women & Pulmonary Virtual Happy Hour that focused on sharing stories and building community. Many leaders have suggested other such topics and efforts that may be useful to the CHEST community. The CHEST Wellness Center will launch on July 15.

In addition to COVID-19 activities, our nation and the world have compelled a new powerful look at race relations, disparities, and diversity. I represented CHEST at a “White Coats for Black Lives” event in San Antonio. Following our nation’s call for racial equality, CHEST released a Statement of Equity that received overwhelmingly positive feedback and response from members via email and on social media. This statement clearly resonated with the CHEST community. We are asking our leadership and members to consider ways in which CHEST might continue to raise awareness and continue with efforts related to diversity and equity. CHEST also hosted an excellent webinar moderated by Dr. Demondes Haynes and Dr. Nneka Sederstrom in late June that offered a direct and meaningful dialogue on issues facing clinicians and patients of color, and the responsibility of those in leadership positions. CHEST leadership stand firm that racism and inequality are public health issues and are working to define how we further our efforts in this arena.

On June 17, CHEST held a 1-day Virtual CHEST Congress in conjunction with our the CHEST Italian Delegation, as COVID-19 prevented us from safely holding the live Congress in Bologna. We had 3,250 registered attendees. I was so impressed at what a virtual platform can deliver, complete with great educational sessions, including much on COVID-19, as well as capturing the CHEST experience with games, bocce, jeopardy etc! This gave CHEST an opportunity to explore further virtual-based education to reach our wider global audience. CHEST will still be holding an in-person Congress in Bologna, June 24-26, 2021.

CHEST will host three entirely virtual Board Review Courses this August in the areas of Pulmonary, Critical Care, and Pediatric Pulmonary Medicine. These courses will include a combination of pre-recorded lectures and live, interactive sessions. Audience response systems and SEEK questions will still be utilized. There’s still time to register, so don’t miss it! With time being a major commodity at present, all attendees will receive year-long access to all material!

I know you have been wondering about CHEST 2020, and as you have heard by now, CHEST 2020 in Chicago will be a virtual meeting. I am sure that this announcement came as no big surprise, but is certainly disappointing. As you can imagine this was a difficult decision, but one that was necessary based upon our new reality. It was compounded by limitations on the convention center venue under the Illinois reopening plan, and the fact that a large number of our faculty, as well as our attendees, are under a travel ban for the remainder of 2020 that will not allow them to travel to Chicago. The abstract and case report deadline closed June 1, and despite these circumstances, we saw our highest number of submissions to date! Late abstracts were due on July 17. We will be presenting standalone and complementary online offerings to ensure seamless delivery of critical education in formats that cater easily to our newly formed habits.

Thanks to our dedicated Scientific Program Committee Chair, Dr. Victor Test, and staff, we had already begun preparing for virtual CHEST Annual Meeting 2020. Here’s what you can expect:

• A memorable experience

• A highly interactive education program that includes audience Q&A, discussion threads, and audience response systems

• Opportunities for one-on-one discussions, networking, and access to faculty

• Industry-sponsored programs and a virtual exhibit hall

• Access to hundreds of narrated poster presentations, case reports, and research abstracts

• Competitive educational gaming where attendees can participate, win, or watch

• Dedicated COVID-19 update sessions

• CME and MOC credits

If you have already registered for CHEST 2020, you will have the option to transfer your registration to this new model. Our main focus is delivering the virtual program with the highest level of service that you have come to expect from CHEST and respect for our member’s time and current situation. I know Dr. Victor Test and the program committee will deliver a superb educational experience in a virtual meeting setting. Thank you for your support and understanding as we continue to evolve our events to meet the needs of our members while adapting to the best delivery methods.

Since so many fellows were unable to hold their live graduation events, and celebrations, we decided to send them off with a virtual event! On June 30 we held a Joint CHEST/ATS Respiratory Community Graduation Ceremony–for graduating fellows, and to welcome new fellows to our profession. The ceremony consisted of a combination of live and recorded messages from key leaders from both organizations. In addition, there was a keynote address from Dr. Rana Awdish, a critical care physician at Henry Ford Hospital in Detroit, who authored the bestselling book “In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope.” I encourage you to watch the video on the Early Career Professionals page on our Chestnet.org website.

The National Association for Medical Direction of Respiratory Care (NAMDRC) merger with CHEST was finalized at the end of May. Look for more advocacy-related actions coming from CHEST. The newly formed Health Policy and Advocacy Committee is helping to set CHEST’s advocacy agendas in the legislative and regulatory arenas, engaging with policymakers and educating CHEST members on governmental affairs relevant to CHEST’s mission. Did you see the inaugural CHEST published, on-line issue of Washington Watchline, a newsletter that aims to keep CHEST members informed about governmental activities that affect physicians who provide clinical care in respiratory, critical care, and sleep medicine? Follow Washington Watchline to learn more about CHEST’s advocacy around regulatory, legislative, and payment issues that relate to the delivery of health care in support of CHEST’s mission. One of the features was Telemedicine, which many of us are now using and is likely to be a part of many of our practices going forward.

With new COVID-19 surges throughout many parts of the United States, CHEST has continued our volunteer matching program for areas of need, including to the Navaho Nations, where CHEST matched 20 volunteers and has had more than a half-dozen inquiries from our members. In addition, in conjunction with the Foundation, CHEST has partnered with American Mask Rally and started a campaign to distribute masks to frontline essential workers in underserved communities. CHEST received a generous donation from AstraZeneca and Glaxo Smith Kline to help in the global fight against COVID-19 to provide current and accurate information and education to frontline clinicians to allow them to provide the best patient outcomes. CHEST also partnered with the American Thoracic Society to launch a joint PSA/ media campaign entitled For My Lung Health Campaign, to provide credible resources for underserved Black and Latino communities, as these communities are disproportionally affected by COVID-19. At the time of this writing, over a million people have seen the related video, featuring tips for taking control of one’s health in these difficult and uncertain times.

So, in closing, thank you all for what you do in these challenging times. 2020 will certainly be a year to remember! Stay safe and stay well!

Stephanie




 

Obstructive sleep apnea (OSA) has been recognized to increase the risk of adverse cardiopulmonary perioperative outcomes for some time now.¹ An ever growing body of literature supports this finding,2 including a large prospective study published in 2019 highlighting the significant risk of poor cardiac-related postoperative outcomes in patients with unrecognized OSA.³ As the majority of patients presenting for elective surgery with OSA will not be diagnosed at the time of presentation,^3,4 many centers have developed preoperative screening programs to identify these patients, though the practice is not universal and a desire for better guidance is needed.⁵ In addition, best practices for patients with suspected or known OSA undergoing surgery have been a matter of debate. Out of these concerns, the Society of Anesthesia and Sleep Medicine (SASM) was formed over 10 years ago to promote interdisciplinary communication, education, and research into matters common to anesthesia and sleep.

Pulmonary and sleep medicine providers are often asked to provide preoperative clearance and recommendations for patients with suspected or known OSA. Recognizing the need for guidance in this area, a task force assembled by SASM obtained input from experts in anesthesiology, sleep medicine, and perioperative medicine to develop and publish an evidence-based / expert consensus guideline on the preoperative assessment and best practices for patients with suspected or known OSA.⁶ While specifics regarding logistics of preoperative screening and optimization of patients will vary based on each medical center’s infrastructure and organization, the recommendations presented should be able to be adapted by most, if not all, institutions. Preoperative evaluation and management is only part of the overall perioperative journey however, and SASM thus followed this document with guidelines for the intraoperative management of patients with OSA.⁷ To complete this set of recommendations, guidelines for the postoperative care of these patients are being planned. Guidelines for pediatric and obstetric perioperative OSA management are also currently being developed by SASM task forces to address these unique areas.

OSA is not the only sleep disorder where the perioperative environment may pose problems for our patients. Sleep disorders such as the hypersomnias and sleep-related movement disorders (including restless legs syndrome) may both impact and be impacted by the perioperative environment and may create safety concerns for some patients.^8,9 These issues are also under active investigation by SASM. In addition, understanding the basic mechanisms determining unconsciousness in both anesthesia and sleep, as well as examination of the interrelationships between sleep disturbance, sedation and their effects on clinical outcomes, are areas of interest that have implications beyond the perioperative arena.

SASM is currently planning to host its 10th anniversary conference in Washington DC on October 1-2, public health issues permitting. The meeting has consistently enlisted expert speakers from anesthesia, sleep medicine, and other relevant fields, and this year will be no different. Given the host city, discussions on important healthcare policy issues will be included, as well. Registration for the meeting, as well as meeting updates, are on the SASM website (sasmhq.org).
 

Dr. Auckley is with the Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth Medical Center, Professor of Medicine, Case Western Reserve University, Cleveland, OH. He is the current president of the Society of Anesthesia and Sleep Medicine.

References

1. Gupta RM, et al. Postoperative complications in patients with obstructive sleep apnea syndrome undergoing hip or knee replacement: A case-control study. Mayo Clin Proc. 2001;76(9):897.

2. Opperer M, et al. Does obstructive sleep apnea influence perioperative outcome? A qualitative systematic review for the Society of Anesthesia and Sleep Medicine Task Force on Preoperative Preparation of Patients with Sleep-Disordered Breathing. Anesth Analg. 2016;122(5):1321.

3. Chan MTV, et al. Association of unrecognized obstructive sleep apnea with postoperative cardiovascular events in patients undergoing major noncardiac surgery. JAMA. 2019;321(18):1788.

4. Finkel KJ, et al. Prevalence of undiagnosed obstructive sleep apnea among adult surgical patients in an academic center. Sleep Med. 2009;10(7):753.

5. Auckley D, et al. Attitudes regarding perioperative care of patients with OSA: a survey study of four specialties in the United States. Sleep Breath. 2015;19(1):315.

6. Chung F, et al. Society of Anesthesia and Sleep Medicine Guidelines (SASM) on Preoperative Screening and Assessment of Adult Patients with Obstructive Sleep Apnea. Anesth Analg. 2016;123(2):452.

7. Memtsoudis SG, et al. Society of Anesthesia and Sleep Medicine Guideline (SASM) on Intraoperative Management of Adult Patients with Obstructive Sleep Apnea. Anesth Analg. 2018;127(4):967.

8. Hershner S, et al. Knowledge gaps in the perioperative management of adults with narcolepsy: A call for further research. Anesth Analg. 2019 Jul;129(1):204.

9. Goldstein C. Management of restless legs syndrome / Willis-Ekbom disease in hospitalized and perioperative patients. Sleep Med Clin. 2015;10(3):303.

Obstructive sleep apnea (OSA) has been recognized to increase the risk of adverse cardiopulmonary perioperative outcomes for some time now.¹ An ever growing body of literature supports this finding,2 including a large prospective study published in 2019 highlighting the significant risk of poor cardiac-related postoperative outcomes in patients with unrecognized OSA.³ As the majority of patients presenting for elective surgery with OSA will not be diagnosed at the time of presentation,^3,4 many centers have developed preoperative screening programs to identify these patients, though the practice is not universal and a desire for better guidance is needed.⁵ In addition, best practices for patients with suspected or known OSA undergoing surgery have been a matter of debate. Out of these concerns, the Society of Anesthesia and Sleep Medicine (SASM) was formed over 10 years ago to promote interdisciplinary communication, education, and research into matters common to anesthesia and sleep.

Pulmonary and sleep medicine providers are often asked to provide preoperative clearance and recommendations for patients with suspected or known OSA. Recognizing the need for guidance in this area, a task force assembled by SASM obtained input from experts in anesthesiology, sleep medicine, and perioperative medicine to develop and publish an evidence-based / expert consensus guideline on the preoperative assessment and best practices for patients with suspected or known OSA.⁶ While specifics regarding logistics of preoperative screening and optimization of patients will vary based on each medical center’s infrastructure and organization, the recommendations presented should be able to be adapted by most, if not all, institutions. Preoperative evaluation and management is only part of the overall perioperative journey however, and SASM thus followed this document with guidelines for the intraoperative management of patients with OSA.⁷ To complete this set of recommendations, guidelines for the postoperative care of these patients are being planned. Guidelines for pediatric and obstetric perioperative OSA management are also currently being developed by SASM task forces to address these unique areas.

OSA is not the only sleep disorder where the perioperative environment may pose problems for our patients. Sleep disorders such as the hypersomnias and sleep-related movement disorders (including restless legs syndrome) may both impact and be impacted by the perioperative environment and may create safety concerns for some patients.^8,9 These issues are also under active investigation by SASM. In addition, understanding the basic mechanisms determining unconsciousness in both anesthesia and sleep, as well as examination of the interrelationships between sleep disturbance, sedation and their effects on clinical outcomes, are areas of interest that have implications beyond the perioperative arena.

SASM is currently planning to host its 10th anniversary conference in Washington DC on October 1-2, public health issues permitting. The meeting has consistently enlisted expert speakers from anesthesia, sleep medicine, and other relevant fields, and this year will be no different. Given the host city, discussions on important healthcare policy issues will be included, as well. Registration for the meeting, as well as meeting updates, are on the SASM website (sasmhq.org).
 

Dr. Auckley is with the Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth Medical Center, Professor of Medicine, Case Western Reserve University, Cleveland, OH. He is the current president of the Society of Anesthesia and Sleep Medicine.

References

1. Gupta RM, et al. Postoperative complications in patients with obstructive sleep apnea syndrome undergoing hip or knee replacement: A case-control study. Mayo Clin Proc. 2001;76(9):897.

2. Opperer M, et al. Does obstructive sleep apnea influence perioperative outcome? A qualitative systematic review for the Society of Anesthesia and Sleep Medicine Task Force on Preoperative Preparation of Patients with Sleep-Disordered Breathing. Anesth Analg. 2016;122(5):1321.

3. Chan MTV, et al. Association of unrecognized obstructive sleep apnea with postoperative cardiovascular events in patients undergoing major noncardiac surgery. JAMA. 2019;321(18):1788.

4. Finkel KJ, et al. Prevalence of undiagnosed obstructive sleep apnea among adult surgical patients in an academic center. Sleep Med. 2009;10(7):753.

5. Auckley D, et al. Attitudes regarding perioperative care of patients with OSA: a survey study of four specialties in the United States. Sleep Breath. 2015;19(1):315.

6. Chung F, et al. Society of Anesthesia and Sleep Medicine Guidelines (SASM) on Preoperative Screening and Assessment of Adult Patients with Obstructive Sleep Apnea. Anesth Analg. 2016;123(2):452.

7. Memtsoudis SG, et al. Society of Anesthesia and Sleep Medicine Guideline (SASM) on Intraoperative Management of Adult Patients with Obstructive Sleep Apnea. Anesth Analg. 2018;127(4):967.

8. Hershner S, et al. Knowledge gaps in the perioperative management of adults with narcolepsy: A call for further research. Anesth Analg. 2019 Jul;129(1):204.

9. Goldstein C. Management of restless legs syndrome / Willis-Ekbom disease in hospitalized and perioperative patients. Sleep Med Clin. 2015;10(3):303.

Obstructive sleep apnea (OSA) has been recognized to increase the risk of adverse cardiopulmonary perioperative outcomes for some time now.¹ An ever growing body of literature supports this finding,2 including a large prospective study published in 2019 highlighting the significant risk of poor cardiac-related postoperative outcomes in patients with unrecognized OSA.³ As the majority of patients presenting for elective surgery with OSA will not be diagnosed at the time of presentation,^3,4 many centers have developed preoperative screening programs to identify these patients, though the practice is not universal and a desire for better guidance is needed.⁵ In addition, best practices for patients with suspected or known OSA undergoing surgery have been a matter of debate. Out of these concerns, the Society of Anesthesia and Sleep Medicine (SASM) was formed over 10 years ago to promote interdisciplinary communication, education, and research into matters common to anesthesia and sleep.

Pulmonary and sleep medicine providers are often asked to provide preoperative clearance and recommendations for patients with suspected or known OSA. Recognizing the need for guidance in this area, a task force assembled by SASM obtained input from experts in anesthesiology, sleep medicine, and perioperative medicine to develop and publish an evidence-based / expert consensus guideline on the preoperative assessment and best practices for patients with suspected or known OSA.⁶ While specifics regarding logistics of preoperative screening and optimization of patients will vary based on each medical center’s infrastructure and organization, the recommendations presented should be able to be adapted by most, if not all, institutions. Preoperative evaluation and management is only part of the overall perioperative journey however, and SASM thus followed this document with guidelines for the intraoperative management of patients with OSA.⁷ To complete this set of recommendations, guidelines for the postoperative care of these patients are being planned. Guidelines for pediatric and obstetric perioperative OSA management are also currently being developed by SASM task forces to address these unique areas.

OSA is not the only sleep disorder where the perioperative environment may pose problems for our patients. Sleep disorders such as the hypersomnias and sleep-related movement disorders (including restless legs syndrome) may both impact and be impacted by the perioperative environment and may create safety concerns for some patients.^8,9 These issues are also under active investigation by SASM. In addition, understanding the basic mechanisms determining unconsciousness in both anesthesia and sleep, as well as examination of the interrelationships between sleep disturbance, sedation and their effects on clinical outcomes, are areas of interest that have implications beyond the perioperative arena.

SASM is currently planning to host its 10th anniversary conference in Washington DC on October 1-2, public health issues permitting. The meeting has consistently enlisted expert speakers from anesthesia, sleep medicine, and other relevant fields, and this year will be no different. Given the host city, discussions on important healthcare policy issues will be included, as well. Registration for the meeting, as well as meeting updates, are on the SASM website (sasmhq.org).
 

Dr. Auckley is with the Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth Medical Center, Professor of Medicine, Case Western Reserve University, Cleveland, OH. He is the current president of the Society of Anesthesia and Sleep Medicine.

References

1. Gupta RM, et al. Postoperative complications in patients with obstructive sleep apnea syndrome undergoing hip or knee replacement: A case-control study. Mayo Clin Proc. 2001;76(9):897.

2. Opperer M, et al. Does obstructive sleep apnea influence perioperative outcome? A qualitative systematic review for the Society of Anesthesia and Sleep Medicine Task Force on Preoperative Preparation of Patients with Sleep-Disordered Breathing. Anesth Analg. 2016;122(5):1321.

3. Chan MTV, et al. Association of unrecognized obstructive sleep apnea with postoperative cardiovascular events in patients undergoing major noncardiac surgery. JAMA. 2019;321(18):1788.

4. Finkel KJ, et al. Prevalence of undiagnosed obstructive sleep apnea among adult surgical patients in an academic center. Sleep Med. 2009;10(7):753.

5. Auckley D, et al. Attitudes regarding perioperative care of patients with OSA: a survey study of four specialties in the United States. Sleep Breath. 2015;19(1):315.

6. Chung F, et al. Society of Anesthesia and Sleep Medicine Guidelines (SASM) on Preoperative Screening and Assessment of Adult Patients with Obstructive Sleep Apnea. Anesth Analg. 2016;123(2):452.

7. Memtsoudis SG, et al. Society of Anesthesia and Sleep Medicine Guideline (SASM) on Intraoperative Management of Adult Patients with Obstructive Sleep Apnea. Anesth Analg. 2018;127(4):967.

8. Hershner S, et al. Knowledge gaps in the perioperative management of adults with narcolepsy: A call for further research. Anesth Analg. 2019 Jul;129(1):204.

9. Goldstein C. Management of restless legs syndrome / Willis-Ekbom disease in hospitalized and perioperative patients. Sleep Med Clin. 2015;10(3):303.

Risk factors of fatal outcome in hospitalized subjects with coronavirus disease 2019 from a nationwide analysis in China.By Dr. L. Shiyue, et al.

Effect of intermittent or continuous feed on muscle wasting in critical illness a phase II clinical trial. By Dr. A. McNelly, et al.

Triage of scarce critical care resources in COVID-19: An implementation guide for regional allocation: A CHEST and Task Force for Mass Critical Care Expert Panel Report.By Dr. J. Dichter, et al.

Managing Chronic Cough as a Symptom in Children and Management Algorithms: CHEST Guideline and Expert Panel Report. By Dr. A. Chang, et al.

Risk factors of fatal outcome in hospitalized subjects with coronavirus disease 2019 from a nationwide analysis in China.By Dr. L. Shiyue, et al.

Effect of intermittent or continuous feed on muscle wasting in critical illness a phase II clinical trial. By Dr. A. McNelly, et al.

Triage of scarce critical care resources in COVID-19: An implementation guide for regional allocation: A CHEST and Task Force for Mass Critical Care Expert Panel Report.By Dr. J. Dichter, et al.

Managing Chronic Cough as a Symptom in Children and Management Algorithms: CHEST Guideline and Expert Panel Report. By Dr. A. Chang, et al.

Risk factors of fatal outcome in hospitalized subjects with coronavirus disease 2019 from a nationwide analysis in China.By Dr. L. Shiyue, et al.

Effect of intermittent or continuous feed on muscle wasting in critical illness a phase II clinical trial. By Dr. A. McNelly, et al.

Triage of scarce critical care resources in COVID-19: An implementation guide for regional allocation: A CHEST and Task Force for Mass Critical Care Expert Panel Report.By Dr. J. Dichter, et al.

Managing Chronic Cough as a Symptom in Children and Management Algorithms: CHEST Guideline and Expert Panel Report. By Dr. A. Chang, et al.

On a Wednesday night in April, CHEST Women and Pulmonary Advisory Board hosted a virtual happy hour that was not just a webinar but also on Facebook Live, entitled Wellness Wednesday. During the 2-hour event, the hosts of the happy hour exchanged experiences during the pandemic, thoughts, hopes, and some very practical ideas on how to stay well in the midst of the pandemic. I was thrilled to co-host this event with Drs. Aneesa Das, Doreen Addrizzo-Harris, Margaret Pisani, Michele Cao, and Rachel Quaney.

We started off toasting with whatever drink people chose to have and each member shared what she was doing during the pandemic. There were many amazing stories of how these women adapted to the changing environment. Dr. Addrizzo-Harris told us how she and her husband literally split their apartment in half since they work in different hospitals and did not want to risk infecting not just one another but also their respective patients. Both she and her husband were working long shifts and most days of the week in the hospital and had not really seen each other since the lockdown started in New York. She also gave us an update on the pandemic and response in New York and reiterated her appreciation for health-care providers who came from elsewhere to help. Drs. Das and Quaney made a point to say that Ohio had done a great job planning for and preventing an onslaught of infected patients and that they were quite thankful to be able to do virtual visits and keep up with their patients.

With regards to work, a few panelists described not only the change in the hospital census and environment but also the impact on education for everyone. We shared ideas for keeping up with pulmonary and critical care that were not related to COVID-19 and ways to not feel overwhelmed by it. I mentioned that we kept our weekly clinical case conference for non-COVID cases and that our fellows and faculty found it refreshing and reinvigorating. Dr. Quaney, who is still in training, mentioned the impact the pandemic had on her education but was also thankful for all that was being done to mitigate that.

While several of us were going into the hospitals and working with COVID-19 patients, others were working from home. It may seem like that would be low stress but think about the challenges of doing virtual visits from home while young children are running around! Dr. Cao gave us a few stories about this and made us all laugh.

So much has changed in our lives and what we must do to care for ourselves, our families, and our patients. On this topic, many of the panelists mentioned that self-care is imperative, as well as all the other things we do. Many shared what they do to remain calm and to relieve stress, such as yoga, hiking, calls with friends and family, etc. Dr. Pisani in particular mentioned the importance of self-care while also lamenting that we have gone backwards with regard to delirium prevention in the ICU due to the isolation needed for COVID 19 patients.

The laughter and camaraderie amongst the panelist extended to the online participants. We had over 2,400 viewers either on Facebook live or via the webinar link! Many people who joined us asked questions or shared stories of how they were coping and what they miss about the pre-pandemic life. Most agreed that the lack of interpersonal interaction, especially with friends and family, has been difficult and that something as simple as this virtual happy hour was a welcome addition to all the other online meetings and patient visits. After the event, many online participants reached out personally and via social media to express how much they enjoyed it and hopes that we continue something like this going forward. I believe we all agreed at least a quarterly Wednesday Wellness event would be great, so I hope you will join us next time!

On a Wednesday night in April, CHEST Women and Pulmonary Advisory Board hosted a virtual happy hour that was not just a webinar but also on Facebook Live, entitled Wellness Wednesday. During the 2-hour event, the hosts of the happy hour exchanged experiences during the pandemic, thoughts, hopes, and some very practical ideas on how to stay well in the midst of the pandemic. I was thrilled to co-host this event with Drs. Aneesa Das, Doreen Addrizzo-Harris, Margaret Pisani, Michele Cao, and Rachel Quaney.

We started off toasting with whatever drink people chose to have and each member shared what she was doing during the pandemic. There were many amazing stories of how these women adapted to the changing environment. Dr. Addrizzo-Harris told us how she and her husband literally split their apartment in half since they work in different hospitals and did not want to risk infecting not just one another but also their respective patients. Both she and her husband were working long shifts and most days of the week in the hospital and had not really seen each other since the lockdown started in New York. She also gave us an update on the pandemic and response in New York and reiterated her appreciation for health-care providers who came from elsewhere to help. Drs. Das and Quaney made a point to say that Ohio had done a great job planning for and preventing an onslaught of infected patients and that they were quite thankful to be able to do virtual visits and keep up with their patients.

With regards to work, a few panelists described not only the change in the hospital census and environment but also the impact on education for everyone. We shared ideas for keeping up with pulmonary and critical care that were not related to COVID-19 and ways to not feel overwhelmed by it. I mentioned that we kept our weekly clinical case conference for non-COVID cases and that our fellows and faculty found it refreshing and reinvigorating. Dr. Quaney, who is still in training, mentioned the impact the pandemic had on her education but was also thankful for all that was being done to mitigate that.

While several of us were going into the hospitals and working with COVID-19 patients, others were working from home. It may seem like that would be low stress but think about the challenges of doing virtual visits from home while young children are running around! Dr. Cao gave us a few stories about this and made us all laugh.

So much has changed in our lives and what we must do to care for ourselves, our families, and our patients. On this topic, many of the panelists mentioned that self-care is imperative, as well as all the other things we do. Many shared what they do to remain calm and to relieve stress, such as yoga, hiking, calls with friends and family, etc. Dr. Pisani in particular mentioned the importance of self-care while also lamenting that we have gone backwards with regard to delirium prevention in the ICU due to the isolation needed for COVID 19 patients.

The laughter and camaraderie amongst the panelist extended to the online participants. We had over 2,400 viewers either on Facebook live or via the webinar link! Many people who joined us asked questions or shared stories of how they were coping and what they miss about the pre-pandemic life. Most agreed that the lack of interpersonal interaction, especially with friends and family, has been difficult and that something as simple as this virtual happy hour was a welcome addition to all the other online meetings and patient visits. After the event, many online participants reached out personally and via social media to express how much they enjoyed it and hopes that we continue something like this going forward. I believe we all agreed at least a quarterly Wednesday Wellness event would be great, so I hope you will join us next time!

On a Wednesday night in April, CHEST Women and Pulmonary Advisory Board hosted a virtual happy hour that was not just a webinar but also on Facebook Live, entitled Wellness Wednesday. During the 2-hour event, the hosts of the happy hour exchanged experiences during the pandemic, thoughts, hopes, and some very practical ideas on how to stay well in the midst of the pandemic. I was thrilled to co-host this event with Drs. Aneesa Das, Doreen Addrizzo-Harris, Margaret Pisani, Michele Cao, and Rachel Quaney.

We started off toasting with whatever drink people chose to have and each member shared what she was doing during the pandemic. There were many amazing stories of how these women adapted to the changing environment. Dr. Addrizzo-Harris told us how she and her husband literally split their apartment in half since they work in different hospitals and did not want to risk infecting not just one another but also their respective patients. Both she and her husband were working long shifts and most days of the week in the hospital and had not really seen each other since the lockdown started in New York. She also gave us an update on the pandemic and response in New York and reiterated her appreciation for health-care providers who came from elsewhere to help. Drs. Das and Quaney made a point to say that Ohio had done a great job planning for and preventing an onslaught of infected patients and that they were quite thankful to be able to do virtual visits and keep up with their patients.

With regards to work, a few panelists described not only the change in the hospital census and environment but also the impact on education for everyone. We shared ideas for keeping up with pulmonary and critical care that were not related to COVID-19 and ways to not feel overwhelmed by it. I mentioned that we kept our weekly clinical case conference for non-COVID cases and that our fellows and faculty found it refreshing and reinvigorating. Dr. Quaney, who is still in training, mentioned the impact the pandemic had on her education but was also thankful for all that was being done to mitigate that.

While several of us were going into the hospitals and working with COVID-19 patients, others were working from home. It may seem like that would be low stress but think about the challenges of doing virtual visits from home while young children are running around! Dr. Cao gave us a few stories about this and made us all laugh.

So much has changed in our lives and what we must do to care for ourselves, our families, and our patients. On this topic, many of the panelists mentioned that self-care is imperative, as well as all the other things we do. Many shared what they do to remain calm and to relieve stress, such as yoga, hiking, calls with friends and family, etc. Dr. Pisani in particular mentioned the importance of self-care while also lamenting that we have gone backwards with regard to delirium prevention in the ICU due to the isolation needed for COVID 19 patients.

The laughter and camaraderie amongst the panelist extended to the online participants. We had over 2,400 viewers either on Facebook live or via the webinar link! Many people who joined us asked questions or shared stories of how they were coping and what they miss about the pre-pandemic life. Most agreed that the lack of interpersonal interaction, especially with friends and family, has been difficult and that something as simple as this virtual happy hour was a welcome addition to all the other online meetings and patient visits. After the event, many online participants reached out personally and via social media to express how much they enjoyed it and hopes that we continue something like this going forward. I believe we all agreed at least a quarterly Wednesday Wellness event would be great, so I hope you will join us next time!

Airways

COVID-19 and asthma: Much remains unknown

Viral-induced asthma exacerbations are common, but there has yet to be a published data set showing worse outcomes among asthmatics with COVID-19.

It is possible that inhaled corticosteroids (ICS) may provide some protection from viral infection. A 2014 study showed that ICS may reduce exacerbations by modulating inflammation and reducing airway viral receptors (Yamaya, et al. Respir Investig. 2014;52[4]:251). Analysis from the SARP-3 database showed ICS use associated with reduced expression of both ACE2 and transmembrane protease serine 2 (TMPRSS2), two receptors used by SARS-CoV-2 (Peters, et al. Am J Respir Crit Care Med. 2020. Online ahead of print). Another study showed a similar effect of ICS on the seasonal coronavirus strain HCoV-229E (Yamaya M, et al. Respir Investig. 2020;58[3]:155), and one study reported decreased ACE2 expression in allergic asthma (Jackson, et al. J Allergy Clin Immunol. Article in press, 2020). While these findings could support a hypothesis of reduced risk for COVID-19 infection among asthmatics using ICS, one would generally expect those with underlying lung disease, such as asthma, to be at higher risk for more severe infection.

Despite physiologic hypotheses of protective mechanisms, clinical outcomes may suffer as clinical operations and the American economy are impacted by this pandemic. Reduced access to or utilization of outpatient care, loss of employment, loss of health insurance, or a new difficulty in affording or accessing medications may all result in worsening asthma control for patients. Poorly controlled asthmatics are at higher risk for a more severe exacerbation of disease triggered by viral infection. Current recommendations are for patients to continue all controller medications; the use of systemic corticosteroids in treatment of COVID pneumonia is controversial, but their use in treating a COVID-associated asthma exacerbation should be based on individual assessment. As we care for asthma patients through this pandemic, much remains unknown but may be elucidated by further study.

Megan Conroy, MD
Fellow-in-Training Member

Muhammad Adrish, MD, FCCP
Steering Committee Member

Clinical Research and Quality Improvement

Remdesivir for COVID-19: A ray of hope?

The year 2020 witnessed a pandemic of unprecedented proportions, caused by a novel corona virus strain (SARS-CoV2). Across the globe, there have been more than 6.5 million positive cases of COVID-19 and more than 380,000 deaths. (WHO COVID-19 Dashboard [https://covid19.who.int]). Multiple therapeutic agents are currently being studied as potential treatment options for this novel disease. With negative trials so far on lopinavir-ritonavir and hydroxychloroquine, the only candidate drug showing benefit is remdesivir.

Results of the randomized double-blind placebo controlled Adaptive COVID-19 Treatment Trial (ACTT-1) trial (Beigel, J et al. N Engl J Med. 2020; e-pub ahead of print) shows remdesivir improved recovery time in COVID -19 patients as compared with control subjects. Remdesivir is an inhibitor of viral RNA polymerase that has been shown to inhibit coronaviruses in animal models and SARS-CoV2 in-vitro. The ACTT-1 trial enrolled 1,063 patients with 541 assigned to the remdesivir arm and 522 to the placebo group. Primary outcome measure was time to recovery. Mortality at 14 and 28 days and incidence of adverse events were also evaluated.

As interim analysis showed positive results, the data safety and monitoring board recommended early termination of the trial. Patients in the remdesivir group had a shorter time to recovery, with median recovery time of 11 days as compared with 15 days in placebo group (95% CI:1.12-1.55; P < .001). Hospitalized patients requiring supplemental oxygen (but not high-flow, mechanical ventilation or ECMO) derived the maximum benefit with a rate ratio of recovery being 1.47(95% CI:1.17-1.84). Thus, early drug administration may be beneficial. The difference in mortality at 14 days was not statistically significant and data on mortality difference at 28 days were not available at the time of publication.

In summary, this trial along with previous publications shows that remdesivir is a potential therapeutic option for COVID -19. The Food and Drug Administration (FDA) approved remdesivir under Emergency Use Authorization (EUA) for COVID-19 and larger trials are currently underway to study the full effect of this agent.

Aravind Menon, MD
Fellow-in-Training Member

Critical Care

Burnout in unprecedented times

Even in typical times, intensivists have a significantly higher rate of burnout compared with other medical specialties. We fight for lives, dealing with death, dying, and tragedy on a daily basis. Regrettably, we are no longer in ‘typical’ times. This is a prodigious and uncharted era.

The COVID-19 pandemic has created all new hardships. Added to the complex world of critical care, we undertake lack of appropriate medical equipment and PPE, the possibility of becoming ill or infecting our families, potential financial struggles, and the unpredictability of the future. Additionally, in our efforts to care for patients, we face increasing moral distress when placed in situations in which we cannot do what we feel is right. And we carry the burdens and guilt of patients’ families who cannot be with loved ones during this process, even during death.

What does burnout look like in this new era? Burnout is a continuum and can manifest differently depending on the individual. Even a typical day in the ICU may be cause for the symptoms of burnout including frustration, anger, anxiety, or sadness which can progress to feelings of powerlessness, self-doubt or depersonalization.

This crisis is a test of endurance. But we don’t have to face it alone. The ICU is a team environment, and we can help each other make it to the end. Consider beginning the shift with a group morale boosting activity. Perhaps debrief after the end of each shift to discuss ways of combatting these stressful times. Have a virtual happy hour with colleagues after work. Call on leadership for support. Watch each other’s back. Together we will get through these unprecedented times.

John P. Gaillard, MD
Steering Committee Member

Resources for confronting burnout:

http://ccsconline.org/optimizing-the-workforce/burnout

https://www.ama-assn.org/topics/physician-burnout

https://www.ahrq.gov/prevention/clinician/ahrq-works/burnout/index.html

Home-Based Mechanical Ventilation and Neuromuscular Disease

Use of modified RADs

Investigators have begun exploring ways to convert devices typically used to treat sleep-disordered breathing (respiratory assist device, RAD), with modifications to minimize risk of aerosolization of pathogen in the COVID-19 pandemic. These devices are presently not considered an effective means of treating acute respiratory distress syndrome (ARDS). In an emergency, however, it is reasonable to consider all the options available with a healthy respect for inherent device limitations.

A RAD could be converted from an open ventilation single-limb respiratory circuit to a closed ventilation circuit with a passive exhalation valve. This circuit could provide adequate minute ventilation and allow for adequate exhalation of CO2 to prevent rebreathing. Strategic placement of the passive exhalation valve proximal to a viricidal filter would allow the device to be used with either an endotracheal tube or a nonvented oronasal mask (Figure). These devices by design are pressure-regulated, and a backup rate would be necessary to control minute ventilation. Close monitoring would be necessary given lack of alarm capability for a critically ill patient and the need to ensure adequate oxygen bleed-in.

The primary limitation to these devices is the inability to achieve adequate mean airway pressure for ARDS. While such a converted device is not ready for prime time, it could be considered for patients who are close to weaning from conventional mechanical ventilation (i.e., freeing up a ventilator for a sicker patient) or temporizing a patient early in disease to stave off invasive ventilation.

MAJ Brian E. Foster, DO, USA
Fellow Member

COL Jacob F. Collen MD, FCCP, USA
Steering Committee Member
 

Interstitial and Diffuse Lung Disease NetWork

Advances in molecular imaging in pulmonary fibrosis

Fibrotic interstitial lung diseases (ILD), including idiopathic pulmonary fibrosis (IPF), have poor prognosis with marked heterogeneity in the clinical course. Treatment options, including antfibrotic drugs and immunosuppressants, are fairly limited for either conditions, and there is wide variability in drug responsiveness. Biomarkers that predict disease course and enable patient stratification to assess responsiveness to specific therapies play a crucial role in management of this fatal disease.

Molecular imaging has the ability to noninvasively provide both structural details, as well as functional/molecular information at the cellular level; it has thus developed into a powerful tool for several inflammatory and malignant disease processes. Probes that specifically target fibrosis-specific pathways utilizing positron emission tomography (PET) or magnetic resonance (MR) imaging have gained traction recently.

The most commonly used radiopharmaceutical for PET, 18F-FDG, is significantly increased in areas of established fibrosis in patients with IPF and autoimmune ILDs (Win, et al. Eur J Nucl Med Mol Imaging. 2018 May;45[5]:806; Uehara, et al. Mod Rheumatol. 2016;26[1]:121-7), as well as areas with seemingly normal morphologic appearance on HRCT scan (Win, et al. Eur J Nucl Med Mol Imaging. 2014 Feb;41[2]:337). While this probe was shown to have some potential for prognostication, there has been concern regarding the specificity of FDG uptake in fibrotic lung diseases. Hence, other probes that target specific fibrosis-related cellular mechanisms such as macrophages (Withana, et al. Nature Scientific Reports. 2016;6 [Jan 22):19755], and John, et al. J Nucl Med. 2013;54[12]:2146) and matrix proteins (Montesi, et al. Am J Respir Crit Care Med. 2019 Jul 15;200[2]:258) have been developed in preclinical fibrosis/lung injury models and are being translated to human subjects.

With the ability to capture early fibrogenesis and target engagement, molecular imaging has the potential to prognosticate patients, provide earlier evaluation of treatment responsiveness and have a promising application in clinical trial design for fibrotic lung diseases.

Tejaswini Kulkarni, MD
Steering Committee Member
 

Airways

COVID-19 and asthma: Much remains unknown

Viral-induced asthma exacerbations are common, but there has yet to be a published data set showing worse outcomes among asthmatics with COVID-19.

It is possible that inhaled corticosteroids (ICS) may provide some protection from viral infection. A 2014 study showed that ICS may reduce exacerbations by modulating inflammation and reducing airway viral receptors (Yamaya, et al. Respir Investig. 2014;52[4]:251). Analysis from the SARP-3 database showed ICS use associated with reduced expression of both ACE2 and transmembrane protease serine 2 (TMPRSS2), two receptors used by SARS-CoV-2 (Peters, et al. Am J Respir Crit Care Med. 2020. Online ahead of print). Another study showed a similar effect of ICS on the seasonal coronavirus strain HCoV-229E (Yamaya M, et al. Respir Investig. 2020;58[3]:155), and one study reported decreased ACE2 expression in allergic asthma (Jackson, et al. J Allergy Clin Immunol. Article in press, 2020). While these findings could support a hypothesis of reduced risk for COVID-19 infection among asthmatics using ICS, one would generally expect those with underlying lung disease, such as asthma, to be at higher risk for more severe infection.

Despite physiologic hypotheses of protective mechanisms, clinical outcomes may suffer as clinical operations and the American economy are impacted by this pandemic. Reduced access to or utilization of outpatient care, loss of employment, loss of health insurance, or a new difficulty in affording or accessing medications may all result in worsening asthma control for patients. Poorly controlled asthmatics are at higher risk for a more severe exacerbation of disease triggered by viral infection. Current recommendations are for patients to continue all controller medications; the use of systemic corticosteroids in treatment of COVID pneumonia is controversial, but their use in treating a COVID-associated asthma exacerbation should be based on individual assessment. As we care for asthma patients through this pandemic, much remains unknown but may be elucidated by further study.

Megan Conroy, MD
Fellow-in-Training Member

Muhammad Adrish, MD, FCCP
Steering Committee Member

Clinical Research and Quality Improvement

Remdesivir for COVID-19: A ray of hope?

The year 2020 witnessed a pandemic of unprecedented proportions, caused by a novel corona virus strain (SARS-CoV2). Across the globe, there have been more than 6.5 million positive cases of COVID-19 and more than 380,000 deaths. (WHO COVID-19 Dashboard [https://covid19.who.int]). Multiple therapeutic agents are currently being studied as potential treatment options for this novel disease. With negative trials so far on lopinavir-ritonavir and hydroxychloroquine, the only candidate drug showing benefit is remdesivir.

Results of the randomized double-blind placebo controlled Adaptive COVID-19 Treatment Trial (ACTT-1) trial (Beigel, J et al. N Engl J Med. 2020; e-pub ahead of print) shows remdesivir improved recovery time in COVID -19 patients as compared with control subjects. Remdesivir is an inhibitor of viral RNA polymerase that has been shown to inhibit coronaviruses in animal models and SARS-CoV2 in-vitro. The ACTT-1 trial enrolled 1,063 patients with 541 assigned to the remdesivir arm and 522 to the placebo group. Primary outcome measure was time to recovery. Mortality at 14 and 28 days and incidence of adverse events were also evaluated.

As interim analysis showed positive results, the data safety and monitoring board recommended early termination of the trial. Patients in the remdesivir group had a shorter time to recovery, with median recovery time of 11 days as compared with 15 days in placebo group (95% CI:1.12-1.55; P < .001). Hospitalized patients requiring supplemental oxygen (but not high-flow, mechanical ventilation or ECMO) derived the maximum benefit with a rate ratio of recovery being 1.47(95% CI:1.17-1.84). Thus, early drug administration may be beneficial. The difference in mortality at 14 days was not statistically significant and data on mortality difference at 28 days were not available at the time of publication.

In summary, this trial along with previous publications shows that remdesivir is a potential therapeutic option for COVID -19. The Food and Drug Administration (FDA) approved remdesivir under Emergency Use Authorization (EUA) for COVID-19 and larger trials are currently underway to study the full effect of this agent.

Aravind Menon, MD
Fellow-in-Training Member

Critical Care

Burnout in unprecedented times

Even in typical times, intensivists have a significantly higher rate of burnout compared with other medical specialties. We fight for lives, dealing with death, dying, and tragedy on a daily basis. Regrettably, we are no longer in ‘typical’ times. This is a prodigious and uncharted era.

The COVID-19 pandemic has created all new hardships. Added to the complex world of critical care, we undertake lack of appropriate medical equipment and PPE, the possibility of becoming ill or infecting our families, potential financial struggles, and the unpredictability of the future. Additionally, in our efforts to care for patients, we face increasing moral distress when placed in situations in which we cannot do what we feel is right. And we carry the burdens and guilt of patients’ families who cannot be with loved ones during this process, even during death.

What does burnout look like in this new era? Burnout is a continuum and can manifest differently depending on the individual. Even a typical day in the ICU may be cause for the symptoms of burnout including frustration, anger, anxiety, or sadness which can progress to feelings of powerlessness, self-doubt or depersonalization.

This crisis is a test of endurance. But we don’t have to face it alone. The ICU is a team environment, and we can help each other make it to the end. Consider beginning the shift with a group morale boosting activity. Perhaps debrief after the end of each shift to discuss ways of combatting these stressful times. Have a virtual happy hour with colleagues after work. Call on leadership for support. Watch each other’s back. Together we will get through these unprecedented times.

John P. Gaillard, MD
Steering Committee Member

Resources for confronting burnout:

http://ccsconline.org/optimizing-the-workforce/burnout

https://www.ama-assn.org/topics/physician-burnout

https://www.ahrq.gov/prevention/clinician/ahrq-works/burnout/index.html

Home-Based Mechanical Ventilation and Neuromuscular Disease

Use of modified RADs

Investigators have begun exploring ways to convert devices typically used to treat sleep-disordered breathing (respiratory assist device, RAD), with modifications to minimize risk of aerosolization of pathogen in the COVID-19 pandemic. These devices are presently not considered an effective means of treating acute respiratory distress syndrome (ARDS). In an emergency, however, it is reasonable to consider all the options available with a healthy respect for inherent device limitations.

A RAD could be converted from an open ventilation single-limb respiratory circuit to a closed ventilation circuit with a passive exhalation valve. This circuit could provide adequate minute ventilation and allow for adequate exhalation of CO2 to prevent rebreathing. Strategic placement of the passive exhalation valve proximal to a viricidal filter would allow the device to be used with either an endotracheal tube or a nonvented oronasal mask (Figure). These devices by design are pressure-regulated, and a backup rate would be necessary to control minute ventilation. Close monitoring would be necessary given lack of alarm capability for a critically ill patient and the need to ensure adequate oxygen bleed-in.

The primary limitation to these devices is the inability to achieve adequate mean airway pressure for ARDS. While such a converted device is not ready for prime time, it could be considered for patients who are close to weaning from conventional mechanical ventilation (i.e., freeing up a ventilator for a sicker patient) or temporizing a patient early in disease to stave off invasive ventilation.

MAJ Brian E. Foster, DO, USA
Fellow Member

COL Jacob F. Collen MD, FCCP, USA
Steering Committee Member
 

Interstitial and Diffuse Lung Disease NetWork

Advances in molecular imaging in pulmonary fibrosis

Fibrotic interstitial lung diseases (ILD), including idiopathic pulmonary fibrosis (IPF), have poor prognosis with marked heterogeneity in the clinical course. Treatment options, including antfibrotic drugs and immunosuppressants, are fairly limited for either conditions, and there is wide variability in drug responsiveness. Biomarkers that predict disease course and enable patient stratification to assess responsiveness to specific therapies play a crucial role in management of this fatal disease.

Molecular imaging has the ability to noninvasively provide both structural details, as well as functional/molecular information at the cellular level; it has thus developed into a powerful tool for several inflammatory and malignant disease processes. Probes that specifically target fibrosis-specific pathways utilizing positron emission tomography (PET) or magnetic resonance (MR) imaging have gained traction recently.

The most commonly used radiopharmaceutical for PET, 18F-FDG, is significantly increased in areas of established fibrosis in patients with IPF and autoimmune ILDs (Win, et al. Eur J Nucl Med Mol Imaging. 2018 May;45[5]:806; Uehara, et al. Mod Rheumatol. 2016;26[1]:121-7), as well as areas with seemingly normal morphologic appearance on HRCT scan (Win, et al. Eur J Nucl Med Mol Imaging. 2014 Feb;41[2]:337). While this probe was shown to have some potential for prognostication, there has been concern regarding the specificity of FDG uptake in fibrotic lung diseases. Hence, other probes that target specific fibrosis-related cellular mechanisms such as macrophages (Withana, et al. Nature Scientific Reports. 2016;6 [Jan 22):19755], and John, et al. J Nucl Med. 2013;54[12]:2146) and matrix proteins (Montesi, et al. Am J Respir Crit Care Med. 2019 Jul 15;200[2]:258) have been developed in preclinical fibrosis/lung injury models and are being translated to human subjects.

With the ability to capture early fibrogenesis and target engagement, molecular imaging has the potential to prognosticate patients, provide earlier evaluation of treatment responsiveness and have a promising application in clinical trial design for fibrotic lung diseases.

Tejaswini Kulkarni, MD
Steering Committee Member
 

Airways

COVID-19 and asthma: Much remains unknown

Viral-induced asthma exacerbations are common, but there has yet to be a published data set showing worse outcomes among asthmatics with COVID-19.

It is possible that inhaled corticosteroids (ICS) may provide some protection from viral infection. A 2014 study showed that ICS may reduce exacerbations by modulating inflammation and reducing airway viral receptors (Yamaya, et al. Respir Investig. 2014;52[4]:251). Analysis from the SARP-3 database showed ICS use associated with reduced expression of both ACE2 and transmembrane protease serine 2 (TMPRSS2), two receptors used by SARS-CoV-2 (Peters, et al. Am J Respir Crit Care Med. 2020. Online ahead of print). Another study showed a similar effect of ICS on the seasonal coronavirus strain HCoV-229E (Yamaya M, et al. Respir Investig. 2020;58[3]:155), and one study reported decreased ACE2 expression in allergic asthma (Jackson, et al. J Allergy Clin Immunol. Article in press, 2020). While these findings could support a hypothesis of reduced risk for COVID-19 infection among asthmatics using ICS, one would generally expect those with underlying lung disease, such as asthma, to be at higher risk for more severe infection.

Despite physiologic hypotheses of protective mechanisms, clinical outcomes may suffer as clinical operations and the American economy are impacted by this pandemic. Reduced access to or utilization of outpatient care, loss of employment, loss of health insurance, or a new difficulty in affording or accessing medications may all result in worsening asthma control for patients. Poorly controlled asthmatics are at higher risk for a more severe exacerbation of disease triggered by viral infection. Current recommendations are for patients to continue all controller medications; the use of systemic corticosteroids in treatment of COVID pneumonia is controversial, but their use in treating a COVID-associated asthma exacerbation should be based on individual assessment. As we care for asthma patients through this pandemic, much remains unknown but may be elucidated by further study.

Megan Conroy, MD
Fellow-in-Training Member

Muhammad Adrish, MD, FCCP
Steering Committee Member

Clinical Research and Quality Improvement

Remdesivir for COVID-19: A ray of hope?

The year 2020 witnessed a pandemic of unprecedented proportions, caused by a novel corona virus strain (SARS-CoV2). Across the globe, there have been more than 6.5 million positive cases of COVID-19 and more than 380,000 deaths. (WHO COVID-19 Dashboard [https://covid19.who.int]). Multiple therapeutic agents are currently being studied as potential treatment options for this novel disease. With negative trials so far on lopinavir-ritonavir and hydroxychloroquine, the only candidate drug showing benefit is remdesivir.

Results of the randomized double-blind placebo controlled Adaptive COVID-19 Treatment Trial (ACTT-1) trial (Beigel, J et al. N Engl J Med. 2020; e-pub ahead of print) shows remdesivir improved recovery time in COVID -19 patients as compared with control subjects. Remdesivir is an inhibitor of viral RNA polymerase that has been shown to inhibit coronaviruses in animal models and SARS-CoV2 in-vitro. The ACTT-1 trial enrolled 1,063 patients with 541 assigned to the remdesivir arm and 522 to the placebo group. Primary outcome measure was time to recovery. Mortality at 14 and 28 days and incidence of adverse events were also evaluated.

As interim analysis showed positive results, the data safety and monitoring board recommended early termination of the trial. Patients in the remdesivir group had a shorter time to recovery, with median recovery time of 11 days as compared with 15 days in placebo group (95% CI:1.12-1.55; P < .001). Hospitalized patients requiring supplemental oxygen (but not high-flow, mechanical ventilation or ECMO) derived the maximum benefit with a rate ratio of recovery being 1.47(95% CI:1.17-1.84). Thus, early drug administration may be beneficial. The difference in mortality at 14 days was not statistically significant and data on mortality difference at 28 days were not available at the time of publication.

In summary, this trial along with previous publications shows that remdesivir is a potential therapeutic option for COVID -19. The Food and Drug Administration (FDA) approved remdesivir under Emergency Use Authorization (EUA) for COVID-19 and larger trials are currently underway to study the full effect of this agent.

Aravind Menon, MD
Fellow-in-Training Member

Critical Care

Burnout in unprecedented times

Even in typical times, intensivists have a significantly higher rate of burnout compared with other medical specialties. We fight for lives, dealing with death, dying, and tragedy on a daily basis. Regrettably, we are no longer in ‘typical’ times. This is a prodigious and uncharted era.

The COVID-19 pandemic has created all new hardships. Added to the complex world of critical care, we undertake lack of appropriate medical equipment and PPE, the possibility of becoming ill or infecting our families, potential financial struggles, and the unpredictability of the future. Additionally, in our efforts to care for patients, we face increasing moral distress when placed in situations in which we cannot do what we feel is right. And we carry the burdens and guilt of patients’ families who cannot be with loved ones during this process, even during death.

What does burnout look like in this new era? Burnout is a continuum and can manifest differently depending on the individual. Even a typical day in the ICU may be cause for the symptoms of burnout including frustration, anger, anxiety, or sadness which can progress to feelings of powerlessness, self-doubt or depersonalization.

This crisis is a test of endurance. But we don’t have to face it alone. The ICU is a team environment, and we can help each other make it to the end. Consider beginning the shift with a group morale boosting activity. Perhaps debrief after the end of each shift to discuss ways of combatting these stressful times. Have a virtual happy hour with colleagues after work. Call on leadership for support. Watch each other’s back. Together we will get through these unprecedented times.

John P. Gaillard, MD
Steering Committee Member

Resources for confronting burnout:

http://ccsconline.org/optimizing-the-workforce/burnout

https://www.ama-assn.org/topics/physician-burnout

https://www.ahrq.gov/prevention/clinician/ahrq-works/burnout/index.html

Home-Based Mechanical Ventilation and Neuromuscular Disease

Use of modified RADs

Investigators have begun exploring ways to convert devices typically used to treat sleep-disordered breathing (respiratory assist device, RAD), with modifications to minimize risk of aerosolization of pathogen in the COVID-19 pandemic. These devices are presently not considered an effective means of treating acute respiratory distress syndrome (ARDS). In an emergency, however, it is reasonable to consider all the options available with a healthy respect for inherent device limitations.

A RAD could be converted from an open ventilation single-limb respiratory circuit to a closed ventilation circuit with a passive exhalation valve. This circuit could provide adequate minute ventilation and allow for adequate exhalation of CO2 to prevent rebreathing. Strategic placement of the passive exhalation valve proximal to a viricidal filter would allow the device to be used with either an endotracheal tube or a nonvented oronasal mask (Figure). These devices by design are pressure-regulated, and a backup rate would be necessary to control minute ventilation. Close monitoring would be necessary given lack of alarm capability for a critically ill patient and the need to ensure adequate oxygen bleed-in.

The primary limitation to these devices is the inability to achieve adequate mean airway pressure for ARDS. While such a converted device is not ready for prime time, it could be considered for patients who are close to weaning from conventional mechanical ventilation (i.e., freeing up a ventilator for a sicker patient) or temporizing a patient early in disease to stave off invasive ventilation.

MAJ Brian E. Foster, DO, USA
Fellow Member

COL Jacob F. Collen MD, FCCP, USA
Steering Committee Member
 

Interstitial and Diffuse Lung Disease NetWork

Advances in molecular imaging in pulmonary fibrosis

Fibrotic interstitial lung diseases (ILD), including idiopathic pulmonary fibrosis (IPF), have poor prognosis with marked heterogeneity in the clinical course. Treatment options, including antfibrotic drugs and immunosuppressants, are fairly limited for either conditions, and there is wide variability in drug responsiveness. Biomarkers that predict disease course and enable patient stratification to assess responsiveness to specific therapies play a crucial role in management of this fatal disease.

Molecular imaging has the ability to noninvasively provide both structural details, as well as functional/molecular information at the cellular level; it has thus developed into a powerful tool for several inflammatory and malignant disease processes. Probes that specifically target fibrosis-specific pathways utilizing positron emission tomography (PET) or magnetic resonance (MR) imaging have gained traction recently.

The most commonly used radiopharmaceutical for PET, 18F-FDG, is significantly increased in areas of established fibrosis in patients with IPF and autoimmune ILDs (Win, et al. Eur J Nucl Med Mol Imaging. 2018 May;45[5]:806; Uehara, et al. Mod Rheumatol. 2016;26[1]:121-7), as well as areas with seemingly normal morphologic appearance on HRCT scan (Win, et al. Eur J Nucl Med Mol Imaging. 2014 Feb;41[2]:337). While this probe was shown to have some potential for prognostication, there has been concern regarding the specificity of FDG uptake in fibrotic lung diseases. Hence, other probes that target specific fibrosis-related cellular mechanisms such as macrophages (Withana, et al. Nature Scientific Reports. 2016;6 [Jan 22):19755], and John, et al. J Nucl Med. 2013;54[12]:2146) and matrix proteins (Montesi, et al. Am J Respir Crit Care Med. 2019 Jul 15;200[2]:258) have been developed in preclinical fibrosis/lung injury models and are being translated to human subjects.

With the ability to capture early fibrogenesis and target engagement, molecular imaging has the potential to prognosticate patients, provide earlier evaluation of treatment responsiveness and have a promising application in clinical trial design for fibrotic lung diseases.

Tejaswini Kulkarni, MD
Steering Committee Member
 

These last few months have been something that none of us has ever experienced. As many of you have witnessed firsthand, life is full of uncertainty and, as many of us try to get back to the “new normal,” we know that much of this uncertainty will persist. We are now not only dealing with a pandemic and caring for our patients but also addressing civil unrest and taking the time to grow and understand the importance of human life, no matter what race, ethnicity, or gender. In response, the CHEST Foundation has made efforts to further research in COVID-19 and increase our efforts in diversity and inclusion.

While we all race for solutions, we cannot overlook the immediate need in our local communities. The CHEST Foundation, along with partners across the nation, is taking a stand to deliver new resources and support now.

I proudly support the CHEST Foundation and am asking for your support, as well. Give a gift today, and together we can effect change for the better in our communities.

Warmest regards,

Doreen J. Addrizzo-Harris, MD, FCCP

Immediate Past President & Trustee

These last few months have been something that none of us has ever experienced. As many of you have witnessed firsthand, life is full of uncertainty and, as many of us try to get back to the “new normal,” we know that much of this uncertainty will persist. We are now not only dealing with a pandemic and caring for our patients but also addressing civil unrest and taking the time to grow and understand the importance of human life, no matter what race, ethnicity, or gender. In response, the CHEST Foundation has made efforts to further research in COVID-19 and increase our efforts in diversity and inclusion.

While we all race for solutions, we cannot overlook the immediate need in our local communities. The CHEST Foundation, along with partners across the nation, is taking a stand to deliver new resources and support now.

I proudly support the CHEST Foundation and am asking for your support, as well. Give a gift today, and together we can effect change for the better in our communities.

Warmest regards,

Doreen J. Addrizzo-Harris, MD, FCCP

Immediate Past President & Trustee

These last few months have been something that none of us has ever experienced. As many of you have witnessed firsthand, life is full of uncertainty and, as many of us try to get back to the “new normal,” we know that much of this uncertainty will persist. We are now not only dealing with a pandemic and caring for our patients but also addressing civil unrest and taking the time to grow and understand the importance of human life, no matter what race, ethnicity, or gender. In response, the CHEST Foundation has made efforts to further research in COVID-19 and increase our efforts in diversity and inclusion.

While we all race for solutions, we cannot overlook the immediate need in our local communities. The CHEST Foundation, along with partners across the nation, is taking a stand to deliver new resources and support now.

I proudly support the CHEST Foundation and am asking for your support, as well. Give a gift today, and together we can effect change for the better in our communities.

Warmest regards,

Doreen J. Addrizzo-Harris, MD, FCCP

Immediate Past President & Trustee

What a privilege it has been over the last several months to participate as staff support along with Jenny Nemkovich and Michelle Kosobucki to CHEST’s new Health Policy and Advocacy Committee (HPAC). The opportunity to serve on a committee of CHEST from the perspective of staff rather than in a volunteer/leadership role has been very enlightening and clearly a learning experience.

Background

As most know, CHEST in the summer of 2019 made the decision to proactively strengthen our position in the areas of public policy, both advocacy and the regulatory space.

This decision will provide CHEST with the mechanism to have greater control over determining and influencing the pulmonary, critical care, and sleep agenda that directly impacts our members and our patients. Adding this piece to the CHEST portfolio is particularly fortuitous in light of the increased advocacy needs in this COVID-19 environment. Having recently completed the acquisition of NAMDRC, CHEST has jump-started our return to this space. While this acquisition does not represent a single source solution, it does represent a key component to a comprehensive approach to policy and advocacy. The rich experience of our new colleagues from NAMDRC brings incredible value and insights to our efforts.
 

Health policy and advocacy committee

The initial composition of the HPAC is made up of equal numbers of members drawn from the NAMDRC leadership pool, as well as members of both the CHEST Foundation Board of Trustees and the Board of Regents of the College. This group represents a very energetic, talented, and diverse group. Experience in the space of policy and advocacy in areas such as home ventilation, oxygen issues, telemedicine, and pulmonary rehab reimbursement is blended with presidential leadership of both the CHEST Foundation and CHEST, as well as talent in areas such as coding and reimbursement, social media applications, and also leadership representing our NetWorks.

Policy priorities

Having had three virtual meetings, the HPAC has initially been focusing on developing and discussing an initial group of policy priorities. These topics are being vetted and held to a rigorous discussion, including what success looks like in these areas, potential barriers or obstacles to making an impact, and who could represent important collaborative partners in these areas. These priorities will be coupled with an effort to define short-term and longer term performance indicators to help try to assess meaningful impact. Once these are better defined, we plan to reach out to our CHEST NetWorks, partners in Industry, sister societies, and friends in patient advocacy groups to get their input and, when appropriate, their collaboration. The BOR will be kept informed and eventually comment and hopefully endorse these policy priorities.

Member engagement

In my opinion, our approach in this area of policy and advocacy is somewhat unique in the associational arena. Rather than policy staff driving the agenda, we are following the example of other committees at CHEST in having volunteers and leadership developing the “what” and staff creating the “how.” At that point, a team of leadership/staff will deliver the product. I feel that this somewhat “bottom up” approach will lead to much more productive and effective member engagement and a growing group of advocacy aware and committed members.

Washington watchline

To complement the work of HPAC and better communicate important issues related to policy and advocacy, our Publications team, led by Nicki Augustyn, has taken over the production of what was NAMDRC’s valuable periodical, the Washington Watchline. Under the editorship for many years of past CHEST President, Jim Mathers, MD, FCCP, this resource has been a valuable and respected source of information for NAMDRC membership. The June edition has recently been published.

Spring meeting, 2021

The HPAC’s Chair and Vice-Chair, Drs. Neil Freedman and Jim Lamberti, are serving as the Program Directors for our first meeting that will blend the NAMDRC perspective and experience in a program around policy and advocacy with the traditional expertise in education delivery of CHEST. This meeting will be in conjunction with our Spring Leadership meetings in Sonoma, California. Save the date, as this promises to be a great meeting, with unique educational opportunities and policy and advocacy insights.

Thanks again to the members of HPAC and to Bob Musacchio for giving me an opportunity to provide staff assistance in this exciting new endeavor for CHEST.

What a privilege it has been over the last several months to participate as staff support along with Jenny Nemkovich and Michelle Kosobucki to CHEST’s new Health Policy and Advocacy Committee (HPAC). The opportunity to serve on a committee of CHEST from the perspective of staff rather than in a volunteer/leadership role has been very enlightening and clearly a learning experience.

Background

As most know, CHEST in the summer of 2019 made the decision to proactively strengthen our position in the areas of public policy, both advocacy and the regulatory space.

This decision will provide CHEST with the mechanism to have greater control over determining and influencing the pulmonary, critical care, and sleep agenda that directly impacts our members and our patients. Adding this piece to the CHEST portfolio is particularly fortuitous in light of the increased advocacy needs in this COVID-19 environment. Having recently completed the acquisition of NAMDRC, CHEST has jump-started our return to this space. While this acquisition does not represent a single source solution, it does represent a key component to a comprehensive approach to policy and advocacy. The rich experience of our new colleagues from NAMDRC brings incredible value and insights to our efforts.
 

Health policy and advocacy committee

The initial composition of the HPAC is made up of equal numbers of members drawn from the NAMDRC leadership pool, as well as members of both the CHEST Foundation Board of Trustees and the Board of Regents of the College. This group represents a very energetic, talented, and diverse group. Experience in the space of policy and advocacy in areas such as home ventilation, oxygen issues, telemedicine, and pulmonary rehab reimbursement is blended with presidential leadership of both the CHEST Foundation and CHEST, as well as talent in areas such as coding and reimbursement, social media applications, and also leadership representing our NetWorks.

Policy priorities

Having had three virtual meetings, the HPAC has initially been focusing on developing and discussing an initial group of policy priorities. These topics are being vetted and held to a rigorous discussion, including what success looks like in these areas, potential barriers or obstacles to making an impact, and who could represent important collaborative partners in these areas. These priorities will be coupled with an effort to define short-term and longer term performance indicators to help try to assess meaningful impact. Once these are better defined, we plan to reach out to our CHEST NetWorks, partners in Industry, sister societies, and friends in patient advocacy groups to get their input and, when appropriate, their collaboration. The BOR will be kept informed and eventually comment and hopefully endorse these policy priorities.

Member engagement

In my opinion, our approach in this area of policy and advocacy is somewhat unique in the associational arena. Rather than policy staff driving the agenda, we are following the example of other committees at CHEST in having volunteers and leadership developing the “what” and staff creating the “how.” At that point, a team of leadership/staff will deliver the product. I feel that this somewhat “bottom up” approach will lead to much more productive and effective member engagement and a growing group of advocacy aware and committed members.

Washington watchline

To complement the work of HPAC and better communicate important issues related to policy and advocacy, our Publications team, led by Nicki Augustyn, has taken over the production of what was NAMDRC’s valuable periodical, the Washington Watchline. Under the editorship for many years of past CHEST President, Jim Mathers, MD, FCCP, this resource has been a valuable and respected source of information for NAMDRC membership. The June edition has recently been published.

Spring meeting, 2021

The HPAC’s Chair and Vice-Chair, Drs. Neil Freedman and Jim Lamberti, are serving as the Program Directors for our first meeting that will blend the NAMDRC perspective and experience in a program around policy and advocacy with the traditional expertise in education delivery of CHEST. This meeting will be in conjunction with our Spring Leadership meetings in Sonoma, California. Save the date, as this promises to be a great meeting, with unique educational opportunities and policy and advocacy insights.

Thanks again to the members of HPAC and to Bob Musacchio for giving me an opportunity to provide staff assistance in this exciting new endeavor for CHEST.

What a privilege it has been over the last several months to participate as staff support along with Jenny Nemkovich and Michelle Kosobucki to CHEST’s new Health Policy and Advocacy Committee (HPAC). The opportunity to serve on a committee of CHEST from the perspective of staff rather than in a volunteer/leadership role has been very enlightening and clearly a learning experience.

Background

As most know, CHEST in the summer of 2019 made the decision to proactively strengthen our position in the areas of public policy, both advocacy and the regulatory space.

This decision will provide CHEST with the mechanism to have greater control over determining and influencing the pulmonary, critical care, and sleep agenda that directly impacts our members and our patients. Adding this piece to the CHEST portfolio is particularly fortuitous in light of the increased advocacy needs in this COVID-19 environment. Having recently completed the acquisition of NAMDRC, CHEST has jump-started our return to this space. While this acquisition does not represent a single source solution, it does represent a key component to a comprehensive approach to policy and advocacy. The rich experience of our new colleagues from NAMDRC brings incredible value and insights to our efforts.
 

Health policy and advocacy committee

The initial composition of the HPAC is made up of equal numbers of members drawn from the NAMDRC leadership pool, as well as members of both the CHEST Foundation Board of Trustees and the Board of Regents of the College. This group represents a very energetic, talented, and diverse group. Experience in the space of policy and advocacy in areas such as home ventilation, oxygen issues, telemedicine, and pulmonary rehab reimbursement is blended with presidential leadership of both the CHEST Foundation and CHEST, as well as talent in areas such as coding and reimbursement, social media applications, and also leadership representing our NetWorks.

Policy priorities

Having had three virtual meetings, the HPAC has initially been focusing on developing and discussing an initial group of policy priorities. These topics are being vetted and held to a rigorous discussion, including what success looks like in these areas, potential barriers or obstacles to making an impact, and who could represent important collaborative partners in these areas. These priorities will be coupled with an effort to define short-term and longer term performance indicators to help try to assess meaningful impact. Once these are better defined, we plan to reach out to our CHEST NetWorks, partners in Industry, sister societies, and friends in patient advocacy groups to get their input and, when appropriate, their collaboration. The BOR will be kept informed and eventually comment and hopefully endorse these policy priorities.

Member engagement

In my opinion, our approach in this area of policy and advocacy is somewhat unique in the associational arena. Rather than policy staff driving the agenda, we are following the example of other committees at CHEST in having volunteers and leadership developing the “what” and staff creating the “how.” At that point, a team of leadership/staff will deliver the product. I feel that this somewhat “bottom up” approach will lead to much more productive and effective member engagement and a growing group of advocacy aware and committed members.

Washington watchline

To complement the work of HPAC and better communicate important issues related to policy and advocacy, our Publications team, led by Nicki Augustyn, has taken over the production of what was NAMDRC’s valuable periodical, the Washington Watchline. Under the editorship for many years of past CHEST President, Jim Mathers, MD, FCCP, this resource has been a valuable and respected source of information for NAMDRC membership. The June edition has recently been published.

Spring meeting, 2021

The HPAC’s Chair and Vice-Chair, Drs. Neil Freedman and Jim Lamberti, are serving as the Program Directors for our first meeting that will blend the NAMDRC perspective and experience in a program around policy and advocacy with the traditional expertise in education delivery of CHEST. This meeting will be in conjunction with our Spring Leadership meetings in Sonoma, California. Save the date, as this promises to be a great meeting, with unique educational opportunities and policy and advocacy insights.

Thanks again to the members of HPAC and to Bob Musacchio for giving me an opportunity to provide staff assistance in this exciting new endeavor for CHEST.

On March 17, 2020, I entered my patients electronic medical record and hit the “Connect with Zoom” button in her Epic (Epic Systems Corporation) chart. About 20 seconds later, the face of my 28-year-old patient with advanced spinal muscular atrophy type 2 (SMA-2) appeared virtually and not live for the first time since I had met her some 10 years previously. She appeared well and her history supported that. We spent most of the time reviewing recent events and surveying her home ventilation equipment. She felt well and sleep was of good quality. She was performing her normal activities without dyspnea. Her mechanical insufflator-exsufflator was working fine, although she used it only as needed, and she was performing lung volume recruitment maneuvers with a resuscitator bag three times a day with assistance. Her mask for nocturnal NPPV was getting old, and she showed me where the straps were fraying. We noted that her bilevel device was now 8 years old and that she needed a new one. We concluded our conversation in 20 minutes and she blurted out: “Wow, that was easy. Thanks, Dr. Benditt.” I got off the phone and put in the order for a new mask and bilevel device with our clinic respiratory therapist. She received the equipment 48 hours later and sent an electronic message through her chart to let me know it had arrived. A total of five in-person visits including me and other providers had been cancelled and replaced by virtual visits. She has made one visit to the hospital in the last 3 months for an intrathecal nusinersen (Spinraza) injection that was done with a COVID-19 prescreening and full PPE.

One week prior to our virtual visit, my university hospital had reduced in-person clinic visits to those deemed absolutely necessary due to the COVID-19 pandemic. Visits considered absolutely necessary included such patients as postoperative transplant visits and preoperative evaluations for urgent surgeries. All other patient visits were canceled with plans to reschedule them once the COVID-19 pandemic was controlled. As the breadth and depth of the pandemic became apparent, a very rapid ramp-up of “virtual visits” via telemedicine capacity was rolled out. I had not previously used telemedicine, and the learning curve was steep, although once in place, the technology was straightforward from the provider perspective. The telemedicine visits for our hospital for the entire year of 2019 totaled about 800. In the month of April of 2020 we engaged in 40,000 telemedicine visits. This explosive growth of telemedicine implementation has occurred around the country and world during the COVID-19 pandemic (Olayiwola JN, et al. JMIR Public Health Surveill. 2020, May 29. doi: 10.2196/19045). This recent growth of telemedicine in the US has been fueled by the need for social distancing and quarantine, the lack of universal testing and COVID-19 case tracking, and the realization by CMS that coverage of telemedicine services had to be expanded rapidly to allow for continued patient care in the setting of stay-at-home orders. A rapid role out of application technology support and online training classes for health-care providers was undertaken. Privileges for telemedicine virtual visits were approved when providers completed the informational online modules and set up their HIPPA compliant Zoom accounts (Zoom Video Communications, San Jose, CA). All of us had minor stumbles initially with the equipment, software, and getting the patients connected online. After four or five visits, the process started to click and has become rather routine. Many providers and patients found this quite a positive development in terms of patient-provider visits but a question arose almost immediately: “Will this continue to be supported by insurers and allow us to integrate this practice into our outpatient clinic setting once the pandemic was controlled?” Time with tell, but an opportunity has presented itself.

For patients with neuromuscular disease and respiratory failure, telemedicine is a technology that may be particularly attractive for a number of reasons. First, patients with neuromuscular respiratory failure are likely at a particularly high risk of death if they develop full-blown COVID-19 infection. Development of acute respiratory distress syndrome (ARDS) on top of underlying neuromuscular respiratory failure is likely to be particularly deadly, although, very fortunately, there are no published reports of widespread infections in patients with neuromuscular respiratory disease. We have known for many decades that pneumonia is the leading cause of death for these patients. Second, patients with neuromuscular respiratory failure often find it quite difficult to come to the hospital for clinic visits. Mobilizing equipment, caregivers, and transportation can take days to arrange. For this reason, many neuromuscular clinics provide a multidisciplinary/multi-provider half-day visit to reduce the need to come into the hospital for multiple separate visits. Lastly, there are relatively few respiratory health-care providers in the United States and around the world who focus on patients with neuromuscular respiratory disease. Many neuromuscular clinics and providers will, therefore, have a very wide patient catchment area. For instance, my practice, based in Seattle, Washington, includes patients from Alaska, Montana, Idaho, and Wyoming. In-person hospital visits more than once per year may be virtually impossible.

Telemedicine is a methodology that has long been considered helpful in the arena of home ventilation and, in fact, we have been using some telemedicine technologies for some time (Casavant DW, et al. J Telemed Telecare. 2014;20[8]:441). Telemedicine (telehealth) includes the use of electronic information and communications technologies to provide and support health care when distance separates the participants. For instance, monitoring of nocturnal ventilation via downloads from Internet-connected noninvasive or invasive ventilation devices, overnight oximetry, and even phone calls from durable medical equipment providers during a home visit would be considered telemedicine. Many of us have been using these methods for many years. It is really the face-to-face “virtual visit” frequency that the COVID-19 pandemic has accelerated. This is a crucial advance in the process of telehealth because we may be able to reduce visits to our clinics from once every 3 to 6 months to perhaps once per year if support for virtual visits by insurers continues and if home monitoring can expand to include accurate home measurement of patient CO₂ levels by either end-tidal CO₂, transcutaneous CO₂, or point of care arterial or capillary blood gases, as well as home pulmonary function monitoring. Measurement of CO² levels and pulmonary function has generally been done at the hospital or in the clinic although there is no reason that with home visit support from appropriate services (that might even include durable medical equipment companies) that this could not be accomplished. This is not to say that there are not hurdles to the application of telehealth in the neuromuscular disease and home ventilation population. Not all patients have the equipment or technology savvy to participate in virtual visits, and not all insurers cover these visits even now during COVID-19. However, I imagine a future where a significant number of visits for patients with neuromuscular respiratory disease and home ventilation needs could be performed virtually. I envision that this would reduce patient and home caregiver travel burdens, make more efficient use of health-care provider time, expand the number of patients that a neuromuscular respiratory disease practitioner could serve, and perhaps reduce health-care expenditures per patient. This may be a real health-care bright spot in the huge difficulties of COVID-19. Fingers crossed.
 

Dr. Benditt is Medical Director of Respiratory Care Services and Professor of Medicine, University of Washington Medical Center, Seattle, Washington.

On March 17, 2020, I entered my patients electronic medical record and hit the “Connect with Zoom” button in her Epic (Epic Systems Corporation) chart. About 20 seconds later, the face of my 28-year-old patient with advanced spinal muscular atrophy type 2 (SMA-2) appeared virtually and not live for the first time since I had met her some 10 years previously. She appeared well and her history supported that. We spent most of the time reviewing recent events and surveying her home ventilation equipment. She felt well and sleep was of good quality. She was performing her normal activities without dyspnea. Her mechanical insufflator-exsufflator was working fine, although she used it only as needed, and she was performing lung volume recruitment maneuvers with a resuscitator bag three times a day with assistance. Her mask for nocturnal NPPV was getting old, and she showed me where the straps were fraying. We noted that her bilevel device was now 8 years old and that she needed a new one. We concluded our conversation in 20 minutes and she blurted out: “Wow, that was easy. Thanks, Dr. Benditt.” I got off the phone and put in the order for a new mask and bilevel device with our clinic respiratory therapist. She received the equipment 48 hours later and sent an electronic message through her chart to let me know it had arrived. A total of five in-person visits including me and other providers had been cancelled and replaced by virtual visits. She has made one visit to the hospital in the last 3 months for an intrathecal nusinersen (Spinraza) injection that was done with a COVID-19 prescreening and full PPE.

One week prior to our virtual visit, my university hospital had reduced in-person clinic visits to those deemed absolutely necessary due to the COVID-19 pandemic. Visits considered absolutely necessary included such patients as postoperative transplant visits and preoperative evaluations for urgent surgeries. All other patient visits were canceled with plans to reschedule them once the COVID-19 pandemic was controlled. As the breadth and depth of the pandemic became apparent, a very rapid ramp-up of “virtual visits” via telemedicine capacity was rolled out. I had not previously used telemedicine, and the learning curve was steep, although once in place, the technology was straightforward from the provider perspective. The telemedicine visits for our hospital for the entire year of 2019 totaled about 800. In the month of April of 2020 we engaged in 40,000 telemedicine visits. This explosive growth of telemedicine implementation has occurred around the country and world during the COVID-19 pandemic (Olayiwola JN, et al. JMIR Public Health Surveill. 2020, May 29. doi: 10.2196/19045). This recent growth of telemedicine in the US has been fueled by the need for social distancing and quarantine, the lack of universal testing and COVID-19 case tracking, and the realization by CMS that coverage of telemedicine services had to be expanded rapidly to allow for continued patient care in the setting of stay-at-home orders. A rapid role out of application technology support and online training classes for health-care providers was undertaken. Privileges for telemedicine virtual visits were approved when providers completed the informational online modules and set up their HIPPA compliant Zoom accounts (Zoom Video Communications, San Jose, CA). All of us had minor stumbles initially with the equipment, software, and getting the patients connected online. After four or five visits, the process started to click and has become rather routine. Many providers and patients found this quite a positive development in terms of patient-provider visits but a question arose almost immediately: “Will this continue to be supported by insurers and allow us to integrate this practice into our outpatient clinic setting once the pandemic was controlled?” Time with tell, but an opportunity has presented itself.

For patients with neuromuscular disease and respiratory failure, telemedicine is a technology that may be particularly attractive for a number of reasons. First, patients with neuromuscular respiratory failure are likely at a particularly high risk of death if they develop full-blown COVID-19 infection. Development of acute respiratory distress syndrome (ARDS) on top of underlying neuromuscular respiratory failure is likely to be particularly deadly, although, very fortunately, there are no published reports of widespread infections in patients with neuromuscular respiratory disease. We have known for many decades that pneumonia is the leading cause of death for these patients. Second, patients with neuromuscular respiratory failure often find it quite difficult to come to the hospital for clinic visits. Mobilizing equipment, caregivers, and transportation can take days to arrange. For this reason, many neuromuscular clinics provide a multidisciplinary/multi-provider half-day visit to reduce the need to come into the hospital for multiple separate visits. Lastly, there are relatively few respiratory health-care providers in the United States and around the world who focus on patients with neuromuscular respiratory disease. Many neuromuscular clinics and providers will, therefore, have a very wide patient catchment area. For instance, my practice, based in Seattle, Washington, includes patients from Alaska, Montana, Idaho, and Wyoming. In-person hospital visits more than once per year may be virtually impossible.

Telemedicine is a methodology that has long been considered helpful in the arena of home ventilation and, in fact, we have been using some telemedicine technologies for some time (Casavant DW, et al. J Telemed Telecare. 2014;20[8]:441). Telemedicine (telehealth) includes the use of electronic information and communications technologies to provide and support health care when distance separates the participants. For instance, monitoring of nocturnal ventilation via downloads from Internet-connected noninvasive or invasive ventilation devices, overnight oximetry, and even phone calls from durable medical equipment providers during a home visit would be considered telemedicine. Many of us have been using these methods for many years. It is really the face-to-face “virtual visit” frequency that the COVID-19 pandemic has accelerated. This is a crucial advance in the process of telehealth because we may be able to reduce visits to our clinics from once every 3 to 6 months to perhaps once per year if support for virtual visits by insurers continues and if home monitoring can expand to include accurate home measurement of patient CO₂ levels by either end-tidal CO₂, transcutaneous CO₂, or point of care arterial or capillary blood gases, as well as home pulmonary function monitoring. Measurement of CO² levels and pulmonary function has generally been done at the hospital or in the clinic although there is no reason that with home visit support from appropriate services (that might even include durable medical equipment companies) that this could not be accomplished. This is not to say that there are not hurdles to the application of telehealth in the neuromuscular disease and home ventilation population. Not all patients have the equipment or technology savvy to participate in virtual visits, and not all insurers cover these visits even now during COVID-19. However, I imagine a future where a significant number of visits for patients with neuromuscular respiratory disease and home ventilation needs could be performed virtually. I envision that this would reduce patient and home caregiver travel burdens, make more efficient use of health-care provider time, expand the number of patients that a neuromuscular respiratory disease practitioner could serve, and perhaps reduce health-care expenditures per patient. This may be a real health-care bright spot in the huge difficulties of COVID-19. Fingers crossed.
 

Dr. Benditt is Medical Director of Respiratory Care Services and Professor of Medicine, University of Washington Medical Center, Seattle, Washington.

On March 17, 2020, I entered my patients electronic medical record and hit the “Connect with Zoom” button in her Epic (Epic Systems Corporation) chart. About 20 seconds later, the face of my 28-year-old patient with advanced spinal muscular atrophy type 2 (SMA-2) appeared virtually and not live for the first time since I had met her some 10 years previously. She appeared well and her history supported that. We spent most of the time reviewing recent events and surveying her home ventilation equipment. She felt well and sleep was of good quality. She was performing her normal activities without dyspnea. Her mechanical insufflator-exsufflator was working fine, although she used it only as needed, and she was performing lung volume recruitment maneuvers with a resuscitator bag three times a day with assistance. Her mask for nocturnal NPPV was getting old, and she showed me where the straps were fraying. We noted that her bilevel device was now 8 years old and that she needed a new one. We concluded our conversation in 20 minutes and she blurted out: “Wow, that was easy. Thanks, Dr. Benditt.” I got off the phone and put in the order for a new mask and bilevel device with our clinic respiratory therapist. She received the equipment 48 hours later and sent an electronic message through her chart to let me know it had arrived. A total of five in-person visits including me and other providers had been cancelled and replaced by virtual visits. She has made one visit to the hospital in the last 3 months for an intrathecal nusinersen (Spinraza) injection that was done with a COVID-19 prescreening and full PPE.

One week prior to our virtual visit, my university hospital had reduced in-person clinic visits to those deemed absolutely necessary due to the COVID-19 pandemic. Visits considered absolutely necessary included such patients as postoperative transplant visits and preoperative evaluations for urgent surgeries. All other patient visits were canceled with plans to reschedule them once the COVID-19 pandemic was controlled. As the breadth and depth of the pandemic became apparent, a very rapid ramp-up of “virtual visits” via telemedicine capacity was rolled out. I had not previously used telemedicine, and the learning curve was steep, although once in place, the technology was straightforward from the provider perspective. The telemedicine visits for our hospital for the entire year of 2019 totaled about 800. In the month of April of 2020 we engaged in 40,000 telemedicine visits. This explosive growth of telemedicine implementation has occurred around the country and world during the COVID-19 pandemic (Olayiwola JN, et al. JMIR Public Health Surveill. 2020, May 29. doi: 10.2196/19045). This recent growth of telemedicine in the US has been fueled by the need for social distancing and quarantine, the lack of universal testing and COVID-19 case tracking, and the realization by CMS that coverage of telemedicine services had to be expanded rapidly to allow for continued patient care in the setting of stay-at-home orders. A rapid role out of application technology support and online training classes for health-care providers was undertaken. Privileges for telemedicine virtual visits were approved when providers completed the informational online modules and set up their HIPPA compliant Zoom accounts (Zoom Video Communications, San Jose, CA). All of us had minor stumbles initially with the equipment, software, and getting the patients connected online. After four or five visits, the process started to click and has become rather routine. Many providers and patients found this quite a positive development in terms of patient-provider visits but a question arose almost immediately: “Will this continue to be supported by insurers and allow us to integrate this practice into our outpatient clinic setting once the pandemic was controlled?” Time with tell, but an opportunity has presented itself.

For patients with neuromuscular disease and respiratory failure, telemedicine is a technology that may be particularly attractive for a number of reasons. First, patients with neuromuscular respiratory failure are likely at a particularly high risk of death if they develop full-blown COVID-19 infection. Development of acute respiratory distress syndrome (ARDS) on top of underlying neuromuscular respiratory failure is likely to be particularly deadly, although, very fortunately, there are no published reports of widespread infections in patients with neuromuscular respiratory disease. We have known for many decades that pneumonia is the leading cause of death for these patients. Second, patients with neuromuscular respiratory failure often find it quite difficult to come to the hospital for clinic visits. Mobilizing equipment, caregivers, and transportation can take days to arrange. For this reason, many neuromuscular clinics provide a multidisciplinary/multi-provider half-day visit to reduce the need to come into the hospital for multiple separate visits. Lastly, there are relatively few respiratory health-care providers in the United States and around the world who focus on patients with neuromuscular respiratory disease. Many neuromuscular clinics and providers will, therefore, have a very wide patient catchment area. For instance, my practice, based in Seattle, Washington, includes patients from Alaska, Montana, Idaho, and Wyoming. In-person hospital visits more than once per year may be virtually impossible.

Telemedicine is a methodology that has long been considered helpful in the arena of home ventilation and, in fact, we have been using some telemedicine technologies for some time (Casavant DW, et al. J Telemed Telecare. 2014;20[8]:441). Telemedicine (telehealth) includes the use of electronic information and communications technologies to provide and support health care when distance separates the participants. For instance, monitoring of nocturnal ventilation via downloads from Internet-connected noninvasive or invasive ventilation devices, overnight oximetry, and even phone calls from durable medical equipment providers during a home visit would be considered telemedicine. Many of us have been using these methods for many years. It is really the face-to-face “virtual visit” frequency that the COVID-19 pandemic has accelerated. This is a crucial advance in the process of telehealth because we may be able to reduce visits to our clinics from once every 3 to 6 months to perhaps once per year if support for virtual visits by insurers continues and if home monitoring can expand to include accurate home measurement of patient CO₂ levels by either end-tidal CO₂, transcutaneous CO₂, or point of care arterial or capillary blood gases, as well as home pulmonary function monitoring. Measurement of CO² levels and pulmonary function has generally been done at the hospital or in the clinic although there is no reason that with home visit support from appropriate services (that might even include durable medical equipment companies) that this could not be accomplished. This is not to say that there are not hurdles to the application of telehealth in the neuromuscular disease and home ventilation population. Not all patients have the equipment or technology savvy to participate in virtual visits, and not all insurers cover these visits even now during COVID-19. However, I imagine a future where a significant number of visits for patients with neuromuscular respiratory disease and home ventilation needs could be performed virtually. I envision that this would reduce patient and home caregiver travel burdens, make more efficient use of health-care provider time, expand the number of patients that a neuromuscular respiratory disease practitioner could serve, and perhaps reduce health-care expenditures per patient. This may be a real health-care bright spot in the huge difficulties of COVID-19. Fingers crossed.
 

Dr. Benditt is Medical Director of Respiratory Care Services and Professor of Medicine, University of Washington Medical Center, Seattle, Washington.

On Thursday, April 30, 2020, CMS released a new interim final rule. During the COVID-19 Public Health Emergency, the Interim Final Rule makes several new, important temporary changes to Medicare regulations and payments. One important change retroactively (to March 1, 2020) increased payments for telephone-only visits to established patients:

• CPT 99441: a 5- to 10-minute telephone visit, in lieu of a face-to-face office visit, will be reimbursed at a similar rate to a 99212, about $46 (99441 is usually reimbursed at about $14).
• CPT 99442: an 11- to 20-minute telephone visit, in lieu of a face-to-face office visit, will be reimbursed at a similar rate to a 99213, about $76 (99442 is usually reimbursed at about $28).
• CPT 99443: a 21- to 30-minute telephone visit, in lieu of a face-to-face office visit, will be reimbursed at a similar rate to a 99212, about $110 (99443 is usually reimbursed at about $41).

These telephone codes may be used when addressing a new or old problem for established patients. Choose the code to reflect only the billing provider time communicating with the patient. There should not be another patient encounter for 7 calendar days before or after the telephone visit.

In addition, the new Interim Final Rule now allows attending physicians at teaching institutions providing supervision under the Primary Care Exception to report for telephone (using 99441-99443) or video (using 99212-99215) telemedicine encounters by residents, when the supervision is provided immediately after the resident encounter, rather than during the telephone or video visit. However, most chest physicians at teaching institutions do not supervise residents or fellows under the Primary Care Exception.

A CMS press release about the rule is available at cms.gov.

On Thursday, April 30, 2020, CMS released a new interim final rule. During the COVID-19 Public Health Emergency, the Interim Final Rule makes several new, important temporary changes to Medicare regulations and payments. One important change retroactively (to March 1, 2020) increased payments for telephone-only visits to established patients:

• CPT 99441: a 5- to 10-minute telephone visit, in lieu of a face-to-face office visit, will be reimbursed at a similar rate to a 99212, about $46 (99441 is usually reimbursed at about $14).
• CPT 99442: an 11- to 20-minute telephone visit, in lieu of a face-to-face office visit, will be reimbursed at a similar rate to a 99213, about $76 (99442 is usually reimbursed at about $28).
• CPT 99443: a 21- to 30-minute telephone visit, in lieu of a face-to-face office visit, will be reimbursed at a similar rate to a 99212, about $110 (99443 is usually reimbursed at about $41).

These telephone codes may be used when addressing a new or old problem for established patients. Choose the code to reflect only the billing provider time communicating with the patient. There should not be another patient encounter for 7 calendar days before or after the telephone visit.

In addition, the new Interim Final Rule now allows attending physicians at teaching institutions providing supervision under the Primary Care Exception to report for telephone (using 99441-99443) or video (using 99212-99215) telemedicine encounters by residents, when the supervision is provided immediately after the resident encounter, rather than during the telephone or video visit. However, most chest physicians at teaching institutions do not supervise residents or fellows under the Primary Care Exception.

A CMS press release about the rule is available at cms.gov.

On Thursday, April 30, 2020, CMS released a new interim final rule. During the COVID-19 Public Health Emergency, the Interim Final Rule makes several new, important temporary changes to Medicare regulations and payments. One important change retroactively (to March 1, 2020) increased payments for telephone-only visits to established patients:

• CPT 99441: a 5- to 10-minute telephone visit, in lieu of a face-to-face office visit, will be reimbursed at a similar rate to a 99212, about $46 (99441 is usually reimbursed at about $14).
• CPT 99442: an 11- to 20-minute telephone visit, in lieu of a face-to-face office visit, will be reimbursed at a similar rate to a 99213, about $76 (99442 is usually reimbursed at about $28).
• CPT 99443: a 21- to 30-minute telephone visit, in lieu of a face-to-face office visit, will be reimbursed at a similar rate to a 99212, about $110 (99443 is usually reimbursed at about $41).

These telephone codes may be used when addressing a new or old problem for established patients. Choose the code to reflect only the billing provider time communicating with the patient. There should not be another patient encounter for 7 calendar days before or after the telephone visit.

In addition, the new Interim Final Rule now allows attending physicians at teaching institutions providing supervision under the Primary Care Exception to report for telephone (using 99441-99443) or video (using 99212-99215) telemedicine encounters by residents, when the supervision is provided immediately after the resident encounter, rather than during the telephone or video visit. However, most chest physicians at teaching institutions do not supervise residents or fellows under the Primary Care Exception.

A CMS press release about the rule is available at cms.gov.