Society News

Occupational and Environmental Health

Severe silicosis in engineered stone fabrication workers: An emerging epidemic

Silicosis is an irreversible fibrotic lung disease caused by inhalation of respirable forms of crystalline silica. Silica exposure is also associated with increased risk for mycobacterial infections, lung cancer, emphysema, autoimmune diseases, and kidney disease (Leung CC, et al. Lancet. 2012;379[9830]:2008; Bang KM, et al. MMWR. 2015;64[5]:117). Engineered stone is a manufactured quartz-based composite increasingly used for countertops in the United States where imports of engineered stone for this use have increased around 800% from 2010 to 2018. With this, reported silicosis cases among engineered stone fabrication workers have risen. Silica content in different stones varies from up to 45% in natural stones (granite) to >90% in engineered stone and quartz. The act of cutting, grinding, sanding, drilling, polishing, and installing this stone puts workers with direct and indirect contact with these tasks at risk for hazardous levels of inhaled silica exposure (OSHA et al. https://www.osha.gov/Publications/OSHA3768.pdf. 2015).

A growing number of cases associated with stone fabrication have been reported worldwide (Kramer MR, et al. Chest. 2012;142[2]:419; Kirby T. Lancet. 2019;393:861). The CDC recently published a report of 18 cases of accelerated silicosis over a two-year period among engineered stone fabrication workers. The majority of patients were aged <50 years, five patients had autoimmune disease, two patients had latent TB, and two died (Rose C, et al. MMWR. 2019;68[38]:813). Thus, the experience of engineered stone fabrication workers appears to parallel that of patient exposed to silica in other occupations.

Control measures (see resources below) for silica exposure, prevention, and medical surveillance have been updated since 2016 at the federal level prompting a recent revision of OSHA’s National Emphasis Program for respirable crystalline silica as of February 2020 (OSHA, https://www.osha.gov/news/newsreleases/trade/02052020, published February 5, 2020). Despite these measures, enforcement within the stone fabrication industry remains challenging. Small-scale operations with limited expertise in exposure control combined with high density of immigrant workers with limited health-care access and potential threat of retaliation have limited compliance with updated standards (Rose C, et al. MMWR. 2019;68[38]:813).

Silicosis is preventable, and efforts to minimize workplace exposure and enhance medical surveillance of stone fabrication workers should be prioritized.

Useful resources for silica workplace control measures:

https://www.cdph.ca.gov/silica-stonefabricators

https://www.cdc.gov/niosh/topics/silica/

https://www.osha.gov/sites/default/files/enforcement/directives/CPL_03-00-023.pdf

Sujith Cherian MD, FCCP

Haala Rokadia MD, FCCP

Steering Committee Members

Palliative and end-of-life care

Building primary palliative care competencies in the CHEST community

The CHEST community cares for many patients with serious illnesses characterized by a high risk of mortality, burdensome symptoms or treatments, and caregiver distress, which negatively impact quality of life (QOL) (Kelly, et al. J Palliat Med. 2018;21[S2]:S7). Specialist palliative care (PC) clinicians work in partnership with other specialties to optimize QOL and alleviate suffering for seriously ill patients (i.e., advanced or chronic respiratory disease and/or critical illness).

Referral for specialist PC integration should be based on the complex needs of patients and not prognosis. PC can and should be delivered alongside disease-directed and life-prolonging therapies. Early PC referral in serious illness has been associated with improved QOL, better prognostic awareness, and, in some instances, increased survival. Additionally, reductions in medical costs at the end-of-life have been observed with early PC integration (Parikh, et al. N Engl J Med. 2013;369[24]:2347). However, patients with chronic or advanced respiratory diseases often receive PC late, if at all (Brown, et al. Ann Am Thorac Soc. 2016;13[5]:684). This might be explained by significant shortages within the PC workforce, misconceptions that PC is only delivered at the end of life, and limited proficiency or comfort in primary PC delivery. Primary PC competencies have already been defined for pulmonary and critical care clinicians (Lanken, et al. Am J Respir Crit Care Med. 2008;177:912). The Palliative and End-of-Life Care NetWork is focused on promoting awareness of specialty PC while providing education and resources to support primary PC competencies within the CHEST community. Look for NetWork-sponsored sessions at the annual meeting and follow conversations on social media using the hashtag #CHESTPalCare.

Dina Khateeb, DO

Fellow-in-Training Member

Respiratory care

I am a new respiratory therapist and a team member

It’s 11:00 pm and relatively quiet in the ICU. Then, that all too familiar sound, Code Blue. I rush to the room and assess the situation. As a new grad, this is one of the skills I am still developing; balancing my adrenaline with critical thinking in order to help manage the situation. Whether it is an unplanned extubation, acute respiratory failure, or cardiac arrest, as the respiratory therapist, I am there to bring an expertise to the assessment and management of airway and breathing. Once the crisis is resolved, my work is not done. I remain at the bedside to ensure ventilator management, explain to the family the respiratory interventions, and work with the medical team to implement the best plan of care.

As the bedside RT, I have unique perspective and training. My education prepared me with the knowledge base to work in this arena, but I still have so much to learn. And, as a new grad, one of the biggest lessons I have learned so far is to speak up. Whether it is during rounds, a code situation, or just conversations with the team. I owe it to my patients to advocate for their care and provide the expertise that I bring to the team. To the doctor or nurse, I hope you will give me that opportunity to help care for our patients; to learn; and even teach to improve that care.

Bethlehem Markos

Fellow-in-Training Member

Sleep medicine

What’s new in the sleep apnea treatment pipeline?

While weight loss in obese patients with sleep apnea is an effective treatment strategy, researchers honed in on a particular site of impact – the tongue fat (Wang SH, et al. Am J Respir Crit Care Med.2020;201[6]:718). After a weight loss program, they studied the changes in the tongue, pterygoid, lateral pharyngeal wall, and abdominal fat volumes using MRI. It turned out that reduced tongue fat volume was the primary mediator associated with AHI improvement. The authors suggested a reduction in tongue fat volume may be a potential OSA treatment strategy. Future studies will tell whether this is feasible and effective.

Recently, the FDA approved a new medication to treat residual daytime sleepiness in patients with sleep apnea – solriamfetol. Like other wake-promoting agents, it acts on the central nervous system and improves the reuptake of dopamine and norepinephrine. We look forward to head-to-head studies with current agents (modafinil or armodafinil).

Though not entirely new, two devices have been gaining popularity for sleep apnea treatment. Both are nerve stimulators: one designed for obstructive sleep apnea, is a hypoglossal nerve stimulator; the other, a treatment for central sleep apnea, is a phrenic nerve stimulator. They are slowly gaining popularity, though their invasive nature, patient selection criteria, and cost may limit their widespread adaption. More importantly, data on long-term outcomes and impact on hard endpoints such as mortality and reduction in cardiovascular morbidity are sparse.

Ritwick Agrawal, MD, MS, FCCP

Steering Committee Member
 

Thoracic oncology

The long and winding treatment road of advanced lung cancer: Long-term outcomes with immunotherapy

Immune checkpoint inhibitors (ICIs) have transformed the landscape in advanced non-small cell lung cancer (NSCLC) treatment, extending progression-free survival (PFS) and overall survival (OS).

Pembrolizumab is approved in advanced NSCLC with ≥50% PD-L1 expression based on KEYNOTE-024 trial.¹ Recent updated analysis of KEYNOTE 024 trial² showed that patients with advanced NSCLC treated with pembrolizumab had a median OS of 30.0 months compared with 14.2 months for those treated with chemotherapy. More recently, 5-year outcomes of KEYNOTE-001 trial³ showed that OS was 23.2% for treatment-naive patients and 15.5% for previously treated patients with no grade 4 or 5 treatment-related adverse events.

Nivolumab is approved for the treatment of patients with advanced NSCLC with progression of disease after standard chemotherapy (regardless of PD-L1 expression) based on CHECKMATE 017/057 trials.^4,5 OS at 5 years in recently presented pooled analysis of these trials was 13.4% in nivolumab arm compared to 2.6% in docetaxel arm with a PFS of 8% and 0% respectively.^6,7 Median duration of response was 19.9 months vs 5.6 months. At 5 years, almost one-third of patients who responded to the nivolumab were without disease progression. Similarly, a recent 5-year analysis of patients with advanced NSCLC treated with nivolumab showed OS of 16%, identical for squamous and nonsquamous histology. 75% of 5-year survivors were without disease progression.⁸

Treatment with immunotherapy in advanced NSCLC has resulted in a dramatic change in outcomes with a small percent of patients able to achieve durable responses.

Hiren Mehta, MD, FCCP

Steering Committee Member
 

References

1. N Engl J Med. 2016; 375:1823.

2. J Clin Oncol. 2019; 37:537.

3. J Clin Oncol. 2019; 37:2518.

4. N Engl J Med. 2015; 373:123.

5. N Engl J Med. 2015; 373:1627.6. J Clin Oncol 2017; 35:3924.

7. https://wclc2019.iaslc.org/wp-content/uploads/2019/08/WCLC2019-Abstract-Book_web-friendly.pdf

8. J Clin Oncol. 2018;36:1675.

Occupational and Environmental Health

Severe silicosis in engineered stone fabrication workers: An emerging epidemic

Silicosis is an irreversible fibrotic lung disease caused by inhalation of respirable forms of crystalline silica. Silica exposure is also associated with increased risk for mycobacterial infections, lung cancer, emphysema, autoimmune diseases, and kidney disease (Leung CC, et al. Lancet. 2012;379[9830]:2008; Bang KM, et al. MMWR. 2015;64[5]:117). Engineered stone is a manufactured quartz-based composite increasingly used for countertops in the United States where imports of engineered stone for this use have increased around 800% from 2010 to 2018. With this, reported silicosis cases among engineered stone fabrication workers have risen. Silica content in different stones varies from up to 45% in natural stones (granite) to >90% in engineered stone and quartz. The act of cutting, grinding, sanding, drilling, polishing, and installing this stone puts workers with direct and indirect contact with these tasks at risk for hazardous levels of inhaled silica exposure (OSHA et al. https://www.osha.gov/Publications/OSHA3768.pdf. 2015).

A growing number of cases associated with stone fabrication have been reported worldwide (Kramer MR, et al. Chest. 2012;142[2]:419; Kirby T. Lancet. 2019;393:861). The CDC recently published a report of 18 cases of accelerated silicosis over a two-year period among engineered stone fabrication workers. The majority of patients were aged <50 years, five patients had autoimmune disease, two patients had latent TB, and two died (Rose C, et al. MMWR. 2019;68[38]:813). Thus, the experience of engineered stone fabrication workers appears to parallel that of patient exposed to silica in other occupations.

Control measures (see resources below) for silica exposure, prevention, and medical surveillance have been updated since 2016 at the federal level prompting a recent revision of OSHA’s National Emphasis Program for respirable crystalline silica as of February 2020 (OSHA, https://www.osha.gov/news/newsreleases/trade/02052020, published February 5, 2020). Despite these measures, enforcement within the stone fabrication industry remains challenging. Small-scale operations with limited expertise in exposure control combined with high density of immigrant workers with limited health-care access and potential threat of retaliation have limited compliance with updated standards (Rose C, et al. MMWR. 2019;68[38]:813).

Silicosis is preventable, and efforts to minimize workplace exposure and enhance medical surveillance of stone fabrication workers should be prioritized.

Useful resources for silica workplace control measures:

https://www.cdph.ca.gov/silica-stonefabricators

https://www.cdc.gov/niosh/topics/silica/

https://www.osha.gov/sites/default/files/enforcement/directives/CPL_03-00-023.pdf

Sujith Cherian MD, FCCP

Haala Rokadia MD, FCCP

Steering Committee Members

Palliative and end-of-life care

Building primary palliative care competencies in the CHEST community

The CHEST community cares for many patients with serious illnesses characterized by a high risk of mortality, burdensome symptoms or treatments, and caregiver distress, which negatively impact quality of life (QOL) (Kelly, et al. J Palliat Med. 2018;21[S2]:S7). Specialist palliative care (PC) clinicians work in partnership with other specialties to optimize QOL and alleviate suffering for seriously ill patients (i.e., advanced or chronic respiratory disease and/or critical illness).

Referral for specialist PC integration should be based on the complex needs of patients and not prognosis. PC can and should be delivered alongside disease-directed and life-prolonging therapies. Early PC referral in serious illness has been associated with improved QOL, better prognostic awareness, and, in some instances, increased survival. Additionally, reductions in medical costs at the end-of-life have been observed with early PC integration (Parikh, et al. N Engl J Med. 2013;369[24]:2347). However, patients with chronic or advanced respiratory diseases often receive PC late, if at all (Brown, et al. Ann Am Thorac Soc. 2016;13[5]:684). This might be explained by significant shortages within the PC workforce, misconceptions that PC is only delivered at the end of life, and limited proficiency or comfort in primary PC delivery. Primary PC competencies have already been defined for pulmonary and critical care clinicians (Lanken, et al. Am J Respir Crit Care Med. 2008;177:912). The Palliative and End-of-Life Care NetWork is focused on promoting awareness of specialty PC while providing education and resources to support primary PC competencies within the CHEST community. Look for NetWork-sponsored sessions at the annual meeting and follow conversations on social media using the hashtag #CHESTPalCare.

Dina Khateeb, DO

Fellow-in-Training Member

Respiratory care

I am a new respiratory therapist and a team member

It’s 11:00 pm and relatively quiet in the ICU. Then, that all too familiar sound, Code Blue. I rush to the room and assess the situation. As a new grad, this is one of the skills I am still developing; balancing my adrenaline with critical thinking in order to help manage the situation. Whether it is an unplanned extubation, acute respiratory failure, or cardiac arrest, as the respiratory therapist, I am there to bring an expertise to the assessment and management of airway and breathing. Once the crisis is resolved, my work is not done. I remain at the bedside to ensure ventilator management, explain to the family the respiratory interventions, and work with the medical team to implement the best plan of care.

As the bedside RT, I have unique perspective and training. My education prepared me with the knowledge base to work in this arena, but I still have so much to learn. And, as a new grad, one of the biggest lessons I have learned so far is to speak up. Whether it is during rounds, a code situation, or just conversations with the team. I owe it to my patients to advocate for their care and provide the expertise that I bring to the team. To the doctor or nurse, I hope you will give me that opportunity to help care for our patients; to learn; and even teach to improve that care.

Bethlehem Markos

Fellow-in-Training Member

Sleep medicine

What’s new in the sleep apnea treatment pipeline?

While weight loss in obese patients with sleep apnea is an effective treatment strategy, researchers honed in on a particular site of impact – the tongue fat (Wang SH, et al. Am J Respir Crit Care Med.2020;201[6]:718). After a weight loss program, they studied the changes in the tongue, pterygoid, lateral pharyngeal wall, and abdominal fat volumes using MRI. It turned out that reduced tongue fat volume was the primary mediator associated with AHI improvement. The authors suggested a reduction in tongue fat volume may be a potential OSA treatment strategy. Future studies will tell whether this is feasible and effective.

Recently, the FDA approved a new medication to treat residual daytime sleepiness in patients with sleep apnea – solriamfetol. Like other wake-promoting agents, it acts on the central nervous system and improves the reuptake of dopamine and norepinephrine. We look forward to head-to-head studies with current agents (modafinil or armodafinil).

Though not entirely new, two devices have been gaining popularity for sleep apnea treatment. Both are nerve stimulators: one designed for obstructive sleep apnea, is a hypoglossal nerve stimulator; the other, a treatment for central sleep apnea, is a phrenic nerve stimulator. They are slowly gaining popularity, though their invasive nature, patient selection criteria, and cost may limit their widespread adaption. More importantly, data on long-term outcomes and impact on hard endpoints such as mortality and reduction in cardiovascular morbidity are sparse.

Ritwick Agrawal, MD, MS, FCCP

Steering Committee Member
 

Thoracic oncology

The long and winding treatment road of advanced lung cancer: Long-term outcomes with immunotherapy

Immune checkpoint inhibitors (ICIs) have transformed the landscape in advanced non-small cell lung cancer (NSCLC) treatment, extending progression-free survival (PFS) and overall survival (OS).

Pembrolizumab is approved in advanced NSCLC with ≥50% PD-L1 expression based on KEYNOTE-024 trial.¹ Recent updated analysis of KEYNOTE 024 trial² showed that patients with advanced NSCLC treated with pembrolizumab had a median OS of 30.0 months compared with 14.2 months for those treated with chemotherapy. More recently, 5-year outcomes of KEYNOTE-001 trial³ showed that OS was 23.2% for treatment-naive patients and 15.5% for previously treated patients with no grade 4 or 5 treatment-related adverse events.

Nivolumab is approved for the treatment of patients with advanced NSCLC with progression of disease after standard chemotherapy (regardless of PD-L1 expression) based on CHECKMATE 017/057 trials.^4,5 OS at 5 years in recently presented pooled analysis of these trials was 13.4% in nivolumab arm compared to 2.6% in docetaxel arm with a PFS of 8% and 0% respectively.^6,7 Median duration of response was 19.9 months vs 5.6 months. At 5 years, almost one-third of patients who responded to the nivolumab were without disease progression. Similarly, a recent 5-year analysis of patients with advanced NSCLC treated with nivolumab showed OS of 16%, identical for squamous and nonsquamous histology. 75% of 5-year survivors were without disease progression.⁸

Treatment with immunotherapy in advanced NSCLC has resulted in a dramatic change in outcomes with a small percent of patients able to achieve durable responses.

Hiren Mehta, MD, FCCP

Steering Committee Member
 

References

1. N Engl J Med. 2016; 375:1823.

2. J Clin Oncol. 2019; 37:537.

3. J Clin Oncol. 2019; 37:2518.

4. N Engl J Med. 2015; 373:123.

5. N Engl J Med. 2015; 373:1627.6. J Clin Oncol 2017; 35:3924.

7. https://wclc2019.iaslc.org/wp-content/uploads/2019/08/WCLC2019-Abstract-Book_web-friendly.pdf

8. J Clin Oncol. 2018;36:1675.

Occupational and Environmental Health

Severe silicosis in engineered stone fabrication workers: An emerging epidemic

Silicosis is an irreversible fibrotic lung disease caused by inhalation of respirable forms of crystalline silica. Silica exposure is also associated with increased risk for mycobacterial infections, lung cancer, emphysema, autoimmune diseases, and kidney disease (Leung CC, et al. Lancet. 2012;379[9830]:2008; Bang KM, et al. MMWR. 2015;64[5]:117). Engineered stone is a manufactured quartz-based composite increasingly used for countertops in the United States where imports of engineered stone for this use have increased around 800% from 2010 to 2018. With this, reported silicosis cases among engineered stone fabrication workers have risen. Silica content in different stones varies from up to 45% in natural stones (granite) to >90% in engineered stone and quartz. The act of cutting, grinding, sanding, drilling, polishing, and installing this stone puts workers with direct and indirect contact with these tasks at risk for hazardous levels of inhaled silica exposure (OSHA et al. https://www.osha.gov/Publications/OSHA3768.pdf. 2015).

A growing number of cases associated with stone fabrication have been reported worldwide (Kramer MR, et al. Chest. 2012;142[2]:419; Kirby T. Lancet. 2019;393:861). The CDC recently published a report of 18 cases of accelerated silicosis over a two-year period among engineered stone fabrication workers. The majority of patients were aged <50 years, five patients had autoimmune disease, two patients had latent TB, and two died (Rose C, et al. MMWR. 2019;68[38]:813). Thus, the experience of engineered stone fabrication workers appears to parallel that of patient exposed to silica in other occupations.

Control measures (see resources below) for silica exposure, prevention, and medical surveillance have been updated since 2016 at the federal level prompting a recent revision of OSHA’s National Emphasis Program for respirable crystalline silica as of February 2020 (OSHA, https://www.osha.gov/news/newsreleases/trade/02052020, published February 5, 2020). Despite these measures, enforcement within the stone fabrication industry remains challenging. Small-scale operations with limited expertise in exposure control combined with high density of immigrant workers with limited health-care access and potential threat of retaliation have limited compliance with updated standards (Rose C, et al. MMWR. 2019;68[38]:813).

Silicosis is preventable, and efforts to minimize workplace exposure and enhance medical surveillance of stone fabrication workers should be prioritized.

Useful resources for silica workplace control measures:

https://www.cdph.ca.gov/silica-stonefabricators

https://www.cdc.gov/niosh/topics/silica/

https://www.osha.gov/sites/default/files/enforcement/directives/CPL_03-00-023.pdf

Sujith Cherian MD, FCCP

Haala Rokadia MD, FCCP

Steering Committee Members

Palliative and end-of-life care

Building primary palliative care competencies in the CHEST community

The CHEST community cares for many patients with serious illnesses characterized by a high risk of mortality, burdensome symptoms or treatments, and caregiver distress, which negatively impact quality of life (QOL) (Kelly, et al. J Palliat Med. 2018;21[S2]:S7). Specialist palliative care (PC) clinicians work in partnership with other specialties to optimize QOL and alleviate suffering for seriously ill patients (i.e., advanced or chronic respiratory disease and/or critical illness).

Referral for specialist PC integration should be based on the complex needs of patients and not prognosis. PC can and should be delivered alongside disease-directed and life-prolonging therapies. Early PC referral in serious illness has been associated with improved QOL, better prognostic awareness, and, in some instances, increased survival. Additionally, reductions in medical costs at the end-of-life have been observed with early PC integration (Parikh, et al. N Engl J Med. 2013;369[24]:2347). However, patients with chronic or advanced respiratory diseases often receive PC late, if at all (Brown, et al. Ann Am Thorac Soc. 2016;13[5]:684). This might be explained by significant shortages within the PC workforce, misconceptions that PC is only delivered at the end of life, and limited proficiency or comfort in primary PC delivery. Primary PC competencies have already been defined for pulmonary and critical care clinicians (Lanken, et al. Am J Respir Crit Care Med. 2008;177:912). The Palliative and End-of-Life Care NetWork is focused on promoting awareness of specialty PC while providing education and resources to support primary PC competencies within the CHEST community. Look for NetWork-sponsored sessions at the annual meeting and follow conversations on social media using the hashtag #CHESTPalCare.

Dina Khateeb, DO

Fellow-in-Training Member

Respiratory care

I am a new respiratory therapist and a team member

It’s 11:00 pm and relatively quiet in the ICU. Then, that all too familiar sound, Code Blue. I rush to the room and assess the situation. As a new grad, this is one of the skills I am still developing; balancing my adrenaline with critical thinking in order to help manage the situation. Whether it is an unplanned extubation, acute respiratory failure, or cardiac arrest, as the respiratory therapist, I am there to bring an expertise to the assessment and management of airway and breathing. Once the crisis is resolved, my work is not done. I remain at the bedside to ensure ventilator management, explain to the family the respiratory interventions, and work with the medical team to implement the best plan of care.

As the bedside RT, I have unique perspective and training. My education prepared me with the knowledge base to work in this arena, but I still have so much to learn. And, as a new grad, one of the biggest lessons I have learned so far is to speak up. Whether it is during rounds, a code situation, or just conversations with the team. I owe it to my patients to advocate for their care and provide the expertise that I bring to the team. To the doctor or nurse, I hope you will give me that opportunity to help care for our patients; to learn; and even teach to improve that care.

Bethlehem Markos

Fellow-in-Training Member

Sleep medicine

What’s new in the sleep apnea treatment pipeline?

While weight loss in obese patients with sleep apnea is an effective treatment strategy, researchers honed in on a particular site of impact – the tongue fat (Wang SH, et al. Am J Respir Crit Care Med.2020;201[6]:718). After a weight loss program, they studied the changes in the tongue, pterygoid, lateral pharyngeal wall, and abdominal fat volumes using MRI. It turned out that reduced tongue fat volume was the primary mediator associated with AHI improvement. The authors suggested a reduction in tongue fat volume may be a potential OSA treatment strategy. Future studies will tell whether this is feasible and effective.

Recently, the FDA approved a new medication to treat residual daytime sleepiness in patients with sleep apnea – solriamfetol. Like other wake-promoting agents, it acts on the central nervous system and improves the reuptake of dopamine and norepinephrine. We look forward to head-to-head studies with current agents (modafinil or armodafinil).

Though not entirely new, two devices have been gaining popularity for sleep apnea treatment. Both are nerve stimulators: one designed for obstructive sleep apnea, is a hypoglossal nerve stimulator; the other, a treatment for central sleep apnea, is a phrenic nerve stimulator. They are slowly gaining popularity, though their invasive nature, patient selection criteria, and cost may limit their widespread adaption. More importantly, data on long-term outcomes and impact on hard endpoints such as mortality and reduction in cardiovascular morbidity are sparse.

Ritwick Agrawal, MD, MS, FCCP

Steering Committee Member
 

Thoracic oncology

The long and winding treatment road of advanced lung cancer: Long-term outcomes with immunotherapy

Immune checkpoint inhibitors (ICIs) have transformed the landscape in advanced non-small cell lung cancer (NSCLC) treatment, extending progression-free survival (PFS) and overall survival (OS).

Pembrolizumab is approved in advanced NSCLC with ≥50% PD-L1 expression based on KEYNOTE-024 trial.¹ Recent updated analysis of KEYNOTE 024 trial² showed that patients with advanced NSCLC treated with pembrolizumab had a median OS of 30.0 months compared with 14.2 months for those treated with chemotherapy. More recently, 5-year outcomes of KEYNOTE-001 trial³ showed that OS was 23.2% for treatment-naive patients and 15.5% for previously treated patients with no grade 4 or 5 treatment-related adverse events.

Nivolumab is approved for the treatment of patients with advanced NSCLC with progression of disease after standard chemotherapy (regardless of PD-L1 expression) based on CHECKMATE 017/057 trials.^4,5 OS at 5 years in recently presented pooled analysis of these trials was 13.4% in nivolumab arm compared to 2.6% in docetaxel arm with a PFS of 8% and 0% respectively.^6,7 Median duration of response was 19.9 months vs 5.6 months. At 5 years, almost one-third of patients who responded to the nivolumab were without disease progression. Similarly, a recent 5-year analysis of patients with advanced NSCLC treated with nivolumab showed OS of 16%, identical for squamous and nonsquamous histology. 75% of 5-year survivors were without disease progression.⁸

Treatment with immunotherapy in advanced NSCLC has resulted in a dramatic change in outcomes with a small percent of patients able to achieve durable responses.

Hiren Mehta, MD, FCCP

Steering Committee Member
 

References

1. N Engl J Med. 2016; 375:1823.

2. J Clin Oncol. 2019; 37:537.

3. J Clin Oncol. 2019; 37:2518.

4. N Engl J Med. 2015; 373:123.

5. N Engl J Med. 2015; 373:1627.6. J Clin Oncol 2017; 35:3924.

7. https://wclc2019.iaslc.org/wp-content/uploads/2019/08/WCLC2019-Abstract-Book_web-friendly.pdf

8. J Clin Oncol. 2018;36:1675.

CHEST 2019 marked the inaugural FISH Bowl competition for attendees. Inspired by Shark Tank, our kinder, gentler, yet still competitive and cutting-edge FISH Bowl (Furthering Innovation and Science for Health) featured CHEST members disrupting our beliefs about how clinical care and education are performed. As health-care providers, they presented innovative ideas pertaining to education and clinical disease for pulmonary, critical care, and sleep medicine. Six finalists were chosen from dozens of submissions, and three emerged winners. In this new Meet the FISH Bowl Finalists series, CHEST introduces you to many of them – including Education Category Finalist Dr. Cota.

Name: Donna Cota, DO

Institutional Affiliation: Baystate Medical Center, PGY5 Critical Care

Position: 2nd Year Fellow in PGY5 Critical Care



Title: Time to Vent: A Blended Learning Experience

Brief Summary of Submission: Time to Vent is a blended learning experience focused on ventilator management that incorporates modalities for all learning types. It includes a handout, audio/visual presentation, and practice case scenarios.



1. What inspired your innovation? I remembered that as a resident, I had a very difficult time understanding ventilators and worked hard to try to understand them on my own. When I started fellowship, I thought I understood ventilator management and then realized I was still wrong. I have focused my training on education, and I wanted to create a concise resource geared toward the fundamentals of ventilators for the benefit of educational levels.

2. Who do you think can benefit most from it, and why? Right now, I have focused the project on teaching residents of varying specialties, such as internal medicine and emergency medicine. They are still in training and rotate through ICUs, needing to understand ventilators for effective patient care and questions are present on their board examinations.

3. What do you see as challenges to your innovation gaining widespread acceptance? How can they be overcome? The biggest challenge is making the website able to be found on Google. This is a work in progress. However, right now, the link is sent via email to interested parties.

4. Why was it meaningful for you to emerge as a finalist in FISH Bowl 2019? It built confidence that my lifelong project is important and has merit to it. And, it ended up becoming a way for people to learn about the project and ask me for the link.

5. What future do you envision for your innovation beyond FISH Bowl 2019? I am still going to continue to improve the project with current endeavors to include a piece on waveforms and dyssynchrony of the ventilator. My ultimate goal is to create a free virtual ventilator simulator with practice cases.

CHEST 2019 marked the inaugural FISH Bowl competition for attendees. Inspired by Shark Tank, our kinder, gentler, yet still competitive and cutting-edge FISH Bowl (Furthering Innovation and Science for Health) featured CHEST members disrupting our beliefs about how clinical care and education are performed. As health-care providers, they presented innovative ideas pertaining to education and clinical disease for pulmonary, critical care, and sleep medicine. Six finalists were chosen from dozens of submissions, and three emerged winners. In this new Meet the FISH Bowl Finalists series, CHEST introduces you to many of them – including Education Category Finalist Dr. Cota.

Name: Donna Cota, DO

Institutional Affiliation: Baystate Medical Center, PGY5 Critical Care

Position: 2nd Year Fellow in PGY5 Critical Care



Title: Time to Vent: A Blended Learning Experience

Brief Summary of Submission: Time to Vent is a blended learning experience focused on ventilator management that incorporates modalities for all learning types. It includes a handout, audio/visual presentation, and practice case scenarios.



1. What inspired your innovation? I remembered that as a resident, I had a very difficult time understanding ventilators and worked hard to try to understand them on my own. When I started fellowship, I thought I understood ventilator management and then realized I was still wrong. I have focused my training on education, and I wanted to create a concise resource geared toward the fundamentals of ventilators for the benefit of educational levels.

2. Who do you think can benefit most from it, and why? Right now, I have focused the project on teaching residents of varying specialties, such as internal medicine and emergency medicine. They are still in training and rotate through ICUs, needing to understand ventilators for effective patient care and questions are present on their board examinations.

3. What do you see as challenges to your innovation gaining widespread acceptance? How can they be overcome? The biggest challenge is making the website able to be found on Google. This is a work in progress. However, right now, the link is sent via email to interested parties.

4. Why was it meaningful for you to emerge as a finalist in FISH Bowl 2019? It built confidence that my lifelong project is important and has merit to it. And, it ended up becoming a way for people to learn about the project and ask me for the link.

5. What future do you envision for your innovation beyond FISH Bowl 2019? I am still going to continue to improve the project with current endeavors to include a piece on waveforms and dyssynchrony of the ventilator. My ultimate goal is to create a free virtual ventilator simulator with practice cases.

CHEST 2019 marked the inaugural FISH Bowl competition for attendees. Inspired by Shark Tank, our kinder, gentler, yet still competitive and cutting-edge FISH Bowl (Furthering Innovation and Science for Health) featured CHEST members disrupting our beliefs about how clinical care and education are performed. As health-care providers, they presented innovative ideas pertaining to education and clinical disease for pulmonary, critical care, and sleep medicine. Six finalists were chosen from dozens of submissions, and three emerged winners. In this new Meet the FISH Bowl Finalists series, CHEST introduces you to many of them – including Education Category Finalist Dr. Cota.

Name: Donna Cota, DO

Institutional Affiliation: Baystate Medical Center, PGY5 Critical Care

Position: 2nd Year Fellow in PGY5 Critical Care



Title: Time to Vent: A Blended Learning Experience

Brief Summary of Submission: Time to Vent is a blended learning experience focused on ventilator management that incorporates modalities for all learning types. It includes a handout, audio/visual presentation, and practice case scenarios.



1. What inspired your innovation? I remembered that as a resident, I had a very difficult time understanding ventilators and worked hard to try to understand them on my own. When I started fellowship, I thought I understood ventilator management and then realized I was still wrong. I have focused my training on education, and I wanted to create a concise resource geared toward the fundamentals of ventilators for the benefit of educational levels.

2. Who do you think can benefit most from it, and why? Right now, I have focused the project on teaching residents of varying specialties, such as internal medicine and emergency medicine. They are still in training and rotate through ICUs, needing to understand ventilators for effective patient care and questions are present on their board examinations.

3. What do you see as challenges to your innovation gaining widespread acceptance? How can they be overcome? The biggest challenge is making the website able to be found on Google. This is a work in progress. However, right now, the link is sent via email to interested parties.

4. Why was it meaningful for you to emerge as a finalist in FISH Bowl 2019? It built confidence that my lifelong project is important and has merit to it. And, it ended up becoming a way for people to learn about the project and ask me for the link.

5. What future do you envision for your innovation beyond FISH Bowl 2019? I am still going to continue to improve the project with current endeavors to include a piece on waveforms and dyssynchrony of the ventilator. My ultimate goal is to create a free virtual ventilator simulator with practice cases.

CHEST Annual Meeting 2020 will be here before you know it and we’re here to guide you through our Second City home, Chicago, Illinois. We’re so excited to be hosting CHEST 2020 in our backyard this year and want to help you experience everything that the city has to offer when you aren’t taking in the latest education in clinical chest medicine.

Whether you’re looking to embrace the culture, discover new shops, seeking entertainment, or just looking for a photo opportunity, we’ve got you covered. There’s something for everyone! Here are a few suggestions to keep you busy after your courses and sessions end.

Millennium Park Campus

Located in the heart of the city, Millennium Park is home to the Art Institute of Chicago, Cloud Gate (“The Bean”), Maggie Daley Park, Crown Fountain, Park Grill restaurant, and more. This is the perfect place to take a fall stroll this October. 

Cloud Gate (the bean)

Undoubtedly, one of Chicago’s most popular attractions, this reflective sculpture opposite of Millennium Park is a must for the perfect selfie. Don’t forget to bring your selfie stick to optimize your angles!

Field Museum

One of the largest history museums in the world, this space is filled with an extensive collection of artifacts and scientific-specimens, along with educational programs. Whether you’re interested in browsing through photo archives, taking a public tour, or strolling through the library of over 275,000 books, it would be easy to spend a few hours here during your breaks. (Kids will love it too!)

Wrigley Field Tours

The World Series is set to start during the meeting, fingers crossed the Cubs will be making a return to Wrigley Field. Regardless, you can still attend an off-season tour allowing you to visit the Visitors’ clubhouse, Cubs’ dugout, field, American Airlines 1914 Club, Maker’s Mark Barrel Room, and The W Club at the home of the Chicago Cubs.

Starbucks Reserve Roastery

While you’re strolling on Michigan Avenue, be sure to stop by the world’s largest Starbucks. Enjoy a latte while you take a tour of the roastery or even experience a master tasting.

Take a river boat tour

Embrace the outdoors by taking a scenic cruise on the Chicago River during a boat tour. Choose from tours that highlight architecture, classic Chicago spots, a dinner cruise, and more.

Skydeck Chicago

Take a step out on the Ledge during your stay in Chicago. Test your limits on the 103rd floor of the Willis Tower by stepping onto a glass platform 1,353 feet in the air. Skydeck Chicago also features museum-quality exhibits and theater presentation, Reaching For The Sky.

Navy Pier

Stretching more than 3,000 feet along the shoreline of Lake Michigan, Navy Pier offers access to parks, gardens, shops, dining experiences, live entertainment, and more. If you’re looking for an engaging experience for kids, Navy Pier is also home to the Chicago Children’s Museum.

Frank Lloyd Wright Tours

Wrap up your time in Chicago with the Wright Along the Lake tour, a half-day guided bus tour featuring some of Wright’s most iconic sites in Chicago. Tours are also available for select sites including the Frederick C. Robie House and the Rookery Light Court.

The Magnificent Mile

One of the most iconic shopping centers in the world, The Magnificent Mile stretches across downtown Michigan Avenue and features historic landmarks, more than 460 retailers, and more than 275 restaurants.

Don’t forget to bring your jacket for outdoor activities! They don’t call Chicago the Windy City for nothing.

We look forward to exploring clinical chest medicine and the city of Chicago with you at CHEST Annual Meeting 2020 in October. See you there!

CHEST Annual Meeting 2020 will be here before you know it and we’re here to guide you through our Second City home, Chicago, Illinois. We’re so excited to be hosting CHEST 2020 in our backyard this year and want to help you experience everything that the city has to offer when you aren’t taking in the latest education in clinical chest medicine.

Whether you’re looking to embrace the culture, discover new shops, seeking entertainment, or just looking for a photo opportunity, we’ve got you covered. There’s something for everyone! Here are a few suggestions to keep you busy after your courses and sessions end.

Millennium Park Campus

Located in the heart of the city, Millennium Park is home to the Art Institute of Chicago, Cloud Gate (“The Bean”), Maggie Daley Park, Crown Fountain, Park Grill restaurant, and more. This is the perfect place to take a fall stroll this October. 

Cloud Gate (the bean)

Undoubtedly, one of Chicago’s most popular attractions, this reflective sculpture opposite of Millennium Park is a must for the perfect selfie. Don’t forget to bring your selfie stick to optimize your angles!

Field Museum

One of the largest history museums in the world, this space is filled with an extensive collection of artifacts and scientific-specimens, along with educational programs. Whether you’re interested in browsing through photo archives, taking a public tour, or strolling through the library of over 275,000 books, it would be easy to spend a few hours here during your breaks. (Kids will love it too!)

Wrigley Field Tours

The World Series is set to start during the meeting, fingers crossed the Cubs will be making a return to Wrigley Field. Regardless, you can still attend an off-season tour allowing you to visit the Visitors’ clubhouse, Cubs’ dugout, field, American Airlines 1914 Club, Maker’s Mark Barrel Room, and The W Club at the home of the Chicago Cubs.

Starbucks Reserve Roastery

While you’re strolling on Michigan Avenue, be sure to stop by the world’s largest Starbucks. Enjoy a latte while you take a tour of the roastery or even experience a master tasting.

Take a river boat tour

Embrace the outdoors by taking a scenic cruise on the Chicago River during a boat tour. Choose from tours that highlight architecture, classic Chicago spots, a dinner cruise, and more.

Skydeck Chicago

Take a step out on the Ledge during your stay in Chicago. Test your limits on the 103rd floor of the Willis Tower by stepping onto a glass platform 1,353 feet in the air. Skydeck Chicago also features museum-quality exhibits and theater presentation, Reaching For The Sky.

Navy Pier

Stretching more than 3,000 feet along the shoreline of Lake Michigan, Navy Pier offers access to parks, gardens, shops, dining experiences, live entertainment, and more. If you’re looking for an engaging experience for kids, Navy Pier is also home to the Chicago Children’s Museum.

Frank Lloyd Wright Tours

Wrap up your time in Chicago with the Wright Along the Lake tour, a half-day guided bus tour featuring some of Wright’s most iconic sites in Chicago. Tours are also available for select sites including the Frederick C. Robie House and the Rookery Light Court.

The Magnificent Mile

One of the most iconic shopping centers in the world, The Magnificent Mile stretches across downtown Michigan Avenue and features historic landmarks, more than 460 retailers, and more than 275 restaurants.

Don’t forget to bring your jacket for outdoor activities! They don’t call Chicago the Windy City for nothing.

We look forward to exploring clinical chest medicine and the city of Chicago with you at CHEST Annual Meeting 2020 in October. See you there!

CHEST Annual Meeting 2020 will be here before you know it and we’re here to guide you through our Second City home, Chicago, Illinois. We’re so excited to be hosting CHEST 2020 in our backyard this year and want to help you experience everything that the city has to offer when you aren’t taking in the latest education in clinical chest medicine.

Whether you’re looking to embrace the culture, discover new shops, seeking entertainment, or just looking for a photo opportunity, we’ve got you covered. There’s something for everyone! Here are a few suggestions to keep you busy after your courses and sessions end.

Millennium Park Campus

Located in the heart of the city, Millennium Park is home to the Art Institute of Chicago, Cloud Gate (“The Bean”), Maggie Daley Park, Crown Fountain, Park Grill restaurant, and more. This is the perfect place to take a fall stroll this October. 

Cloud Gate (the bean)

Undoubtedly, one of Chicago’s most popular attractions, this reflective sculpture opposite of Millennium Park is a must for the perfect selfie. Don’t forget to bring your selfie stick to optimize your angles!

Field Museum

One of the largest history museums in the world, this space is filled with an extensive collection of artifacts and scientific-specimens, along with educational programs. Whether you’re interested in browsing through photo archives, taking a public tour, or strolling through the library of over 275,000 books, it would be easy to spend a few hours here during your breaks. (Kids will love it too!)

Wrigley Field Tours

The World Series is set to start during the meeting, fingers crossed the Cubs will be making a return to Wrigley Field. Regardless, you can still attend an off-season tour allowing you to visit the Visitors’ clubhouse, Cubs’ dugout, field, American Airlines 1914 Club, Maker’s Mark Barrel Room, and The W Club at the home of the Chicago Cubs.

Starbucks Reserve Roastery

While you’re strolling on Michigan Avenue, be sure to stop by the world’s largest Starbucks. Enjoy a latte while you take a tour of the roastery or even experience a master tasting.

Take a river boat tour

Embrace the outdoors by taking a scenic cruise on the Chicago River during a boat tour. Choose from tours that highlight architecture, classic Chicago spots, a dinner cruise, and more.

Skydeck Chicago

Take a step out on the Ledge during your stay in Chicago. Test your limits on the 103rd floor of the Willis Tower by stepping onto a glass platform 1,353 feet in the air. Skydeck Chicago also features museum-quality exhibits and theater presentation, Reaching For The Sky.

Navy Pier

Stretching more than 3,000 feet along the shoreline of Lake Michigan, Navy Pier offers access to parks, gardens, shops, dining experiences, live entertainment, and more. If you’re looking for an engaging experience for kids, Navy Pier is also home to the Chicago Children’s Museum.

Frank Lloyd Wright Tours

Wrap up your time in Chicago with the Wright Along the Lake tour, a half-day guided bus tour featuring some of Wright’s most iconic sites in Chicago. Tours are also available for select sites including the Frederick C. Robie House and the Rookery Light Court.

The Magnificent Mile

One of the most iconic shopping centers in the world, The Magnificent Mile stretches across downtown Michigan Avenue and features historic landmarks, more than 460 retailers, and more than 275 restaurants.

Don’t forget to bring your jacket for outdoor activities! They don’t call Chicago the Windy City for nothing.

We look forward to exploring clinical chest medicine and the city of Chicago with you at CHEST Annual Meeting 2020 in October. See you there!

On Thursday, March 12, The American College of Chest Physicians (CHEST) and the National Association for Medical Direction of Respiratory Care (NAMDRC) announced publicly our official intent to come together as one association, integrating all NAMDRC activities and operations into CHEST.

This integration launch followed months of discussion between CHEST and NAMDRC leadership. Our respective Boards agreed that united efforts will amplify our individual involvement in patient advocacy and policy.

CHEST and NAMDRC have an intertwined purpose of delivering the highest standard of care for our patients. For this reason, our likeminded advocacy agendas can be even better fulfilled when we can leverage strengths from both associations.

CHEST and NAMDRC have shared an overlapping membership and collaborative history of empowering patients through the advancement of public policy and clinical education for decades. In additional to our individual efforts, our associations historically leveraged a combined advocacy presence in Washington D.C. to advance legislation against major tobacco corporations.

Coming together as a joint advocacy-focused organization, the initiation of CHEST’s Health Policy and Advocacy Committee, which will be comprised of an equal selection of CHEST and NAMDRC leadership, will drive CHEST’s advocacy agenda. The committee will work directly with policymakers, and target legislative and regulatory issues impacting pulmonary, critical care, and sleep medicine.

A committee of this kind, dedicated strictly to advocacy efforts, will be absolutely invaluable to our united organization. This group will be a true asset for membership to turn, to voice concerns within our practice, and to direct action on policies that matter to our patients.

Members of both organizations were notified of the integration by email on Wednesday, March 11. Along with email notification, NAMDRC members also received a voting ballot, as the dissolution of a nonprofit organization for Virginia-based organizations requires a vote of approval by membership within a 25-day waiting period.

NAMDRC’s long regarded monthly publication, Washington Watchline, will continue through CHEST, as will the NAMDRC Annual Meeting, slated for next March 18-20, 2021 in Sonoma, California, in conjunction with the CHEST Spring Leadership Meeting.

Concentrating our efforts under one organization allows us offer the best possible opportunities to our membership, patients, and far-reaching network. This is an exciting time for everyone involved, and we are looking forward to seeing all we can accomplish together.

On Thursday, March 12, The American College of Chest Physicians (CHEST) and the National Association for Medical Direction of Respiratory Care (NAMDRC) announced publicly our official intent to come together as one association, integrating all NAMDRC activities and operations into CHEST.

This integration launch followed months of discussion between CHEST and NAMDRC leadership. Our respective Boards agreed that united efforts will amplify our individual involvement in patient advocacy and policy.

CHEST and NAMDRC have an intertwined purpose of delivering the highest standard of care for our patients. For this reason, our likeminded advocacy agendas can be even better fulfilled when we can leverage strengths from both associations.

CHEST and NAMDRC have shared an overlapping membership and collaborative history of empowering patients through the advancement of public policy and clinical education for decades. In additional to our individual efforts, our associations historically leveraged a combined advocacy presence in Washington D.C. to advance legislation against major tobacco corporations.

Coming together as a joint advocacy-focused organization, the initiation of CHEST’s Health Policy and Advocacy Committee, which will be comprised of an equal selection of CHEST and NAMDRC leadership, will drive CHEST’s advocacy agenda. The committee will work directly with policymakers, and target legislative and regulatory issues impacting pulmonary, critical care, and sleep medicine.

A committee of this kind, dedicated strictly to advocacy efforts, will be absolutely invaluable to our united organization. This group will be a true asset for membership to turn, to voice concerns within our practice, and to direct action on policies that matter to our patients.

Members of both organizations were notified of the integration by email on Wednesday, March 11. Along with email notification, NAMDRC members also received a voting ballot, as the dissolution of a nonprofit organization for Virginia-based organizations requires a vote of approval by membership within a 25-day waiting period.

NAMDRC’s long regarded monthly publication, Washington Watchline, will continue through CHEST, as will the NAMDRC Annual Meeting, slated for next March 18-20, 2021 in Sonoma, California, in conjunction with the CHEST Spring Leadership Meeting.

Concentrating our efforts under one organization allows us offer the best possible opportunities to our membership, patients, and far-reaching network. This is an exciting time for everyone involved, and we are looking forward to seeing all we can accomplish together.

On Thursday, March 12, The American College of Chest Physicians (CHEST) and the National Association for Medical Direction of Respiratory Care (NAMDRC) announced publicly our official intent to come together as one association, integrating all NAMDRC activities and operations into CHEST.

This integration launch followed months of discussion between CHEST and NAMDRC leadership. Our respective Boards agreed that united efforts will amplify our individual involvement in patient advocacy and policy.

CHEST and NAMDRC have an intertwined purpose of delivering the highest standard of care for our patients. For this reason, our likeminded advocacy agendas can be even better fulfilled when we can leverage strengths from both associations.

CHEST and NAMDRC have shared an overlapping membership and collaborative history of empowering patients through the advancement of public policy and clinical education for decades. In additional to our individual efforts, our associations historically leveraged a combined advocacy presence in Washington D.C. to advance legislation against major tobacco corporations.

Coming together as a joint advocacy-focused organization, the initiation of CHEST’s Health Policy and Advocacy Committee, which will be comprised of an equal selection of CHEST and NAMDRC leadership, will drive CHEST’s advocacy agenda. The committee will work directly with policymakers, and target legislative and regulatory issues impacting pulmonary, critical care, and sleep medicine.

A committee of this kind, dedicated strictly to advocacy efforts, will be absolutely invaluable to our united organization. This group will be a true asset for membership to turn, to voice concerns within our practice, and to direct action on policies that matter to our patients.

Members of both organizations were notified of the integration by email on Wednesday, March 11. Along with email notification, NAMDRC members also received a voting ballot, as the dissolution of a nonprofit organization for Virginia-based organizations requires a vote of approval by membership within a 25-day waiting period.

NAMDRC’s long regarded monthly publication, Washington Watchline, will continue through CHEST, as will the NAMDRC Annual Meeting, slated for next March 18-20, 2021 in Sonoma, California, in conjunction with the CHEST Spring Leadership Meeting.

Concentrating our efforts under one organization allows us offer the best possible opportunities to our membership, patients, and far-reaching network. This is an exciting time for everyone involved, and we are looking forward to seeing all we can accomplish together.

Editor’s Picks

Characterization of severe asthma worldwide: data from the International Severe Asthma Registry (ISAR). By Dr. D. B. Price, et al.

Validation of the COPD Assessment Test (CAT) as an outcome measure in bronchiectasis. By Dr. J. D. Chalmers, et al.

Comparative effects of LAMA-LABA-ICS versus LAMA-LABA for COPD: Cohort study in real world clinical practice. By Dr. S. Suissa, et al.

Airway Management in Critical Illness: An Update. By Dr. J. Scott, et al.

Extremes of age decrease survival in adults after lung transplant. By Dr. M. Valapour, et al.

Editor’s Picks

Characterization of severe asthma worldwide: data from the International Severe Asthma Registry (ISAR). By Dr. D. B. Price, et al.

Validation of the COPD Assessment Test (CAT) as an outcome measure in bronchiectasis. By Dr. J. D. Chalmers, et al.

Comparative effects of LAMA-LABA-ICS versus LAMA-LABA for COPD: Cohort study in real world clinical practice. By Dr. S. Suissa, et al.

Airway Management in Critical Illness: An Update. By Dr. J. Scott, et al.

Extremes of age decrease survival in adults after lung transplant. By Dr. M. Valapour, et al.

Editor’s Picks

Characterization of severe asthma worldwide: data from the International Severe Asthma Registry (ISAR). By Dr. D. B. Price, et al.

Validation of the COPD Assessment Test (CAT) as an outcome measure in bronchiectasis. By Dr. J. D. Chalmers, et al.

Comparative effects of LAMA-LABA-ICS versus LAMA-LABA for COPD: Cohort study in real world clinical practice. By Dr. S. Suissa, et al.

Airway Management in Critical Illness: An Update. By Dr. J. Scott, et al.

Extremes of age decrease survival in adults after lung transplant. By Dr. M. Valapour, et al.

Disregard what is currently accepted as state of the art, reimagine the present as an imperfect stepping stone, and envision a future in which colorectal cancer (CRC) screening and surveillance are optimized. This was the direction for attendees of AGA’s consensus conference — Colorectal Cancer Screening and Surveillance: Role of Emerging Technology and Innovation to Improve Outcomes.

The AGA Center for GI Innovation and Technology invited leading academic and industry experts to a working meeting to identify barriers to the optimization of CRC screening and surveillance, and to define a roadmap for overcoming these barriers.
 

Meeting conclusions

Although colonoscopy is widely considered to be an excellent tool for CRC screening and surveillance, barriers to optimal effectiveness exist. Barriers include lack of access to health care, financial cost, suboptimal uptake even among individuals with health insurance and financial resources, imperfect adherence to guidelines, and development of early-age, and interval cancers despite adherence to guidelines.

Novel cost-effective, sensitive, specific, and personalized strategies are needed to address these barriers.

To read about the emerging technologies discussed at the meeting, review the meeting summary in Gastroenterology.
 

[email protected]

Disregard what is currently accepted as state of the art, reimagine the present as an imperfect stepping stone, and envision a future in which colorectal cancer (CRC) screening and surveillance are optimized. This was the direction for attendees of AGA’s consensus conference — Colorectal Cancer Screening and Surveillance: Role of Emerging Technology and Innovation to Improve Outcomes.

The AGA Center for GI Innovation and Technology invited leading academic and industry experts to a working meeting to identify barriers to the optimization of CRC screening and surveillance, and to define a roadmap for overcoming these barriers.
 

Meeting conclusions

Although colonoscopy is widely considered to be an excellent tool for CRC screening and surveillance, barriers to optimal effectiveness exist. Barriers include lack of access to health care, financial cost, suboptimal uptake even among individuals with health insurance and financial resources, imperfect adherence to guidelines, and development of early-age, and interval cancers despite adherence to guidelines.

Novel cost-effective, sensitive, specific, and personalized strategies are needed to address these barriers.

To read about the emerging technologies discussed at the meeting, review the meeting summary in Gastroenterology.
 

[email protected]

Disregard what is currently accepted as state of the art, reimagine the present as an imperfect stepping stone, and envision a future in which colorectal cancer (CRC) screening and surveillance are optimized. This was the direction for attendees of AGA’s consensus conference — Colorectal Cancer Screening and Surveillance: Role of Emerging Technology and Innovation to Improve Outcomes.

The AGA Center for GI Innovation and Technology invited leading academic and industry experts to a working meeting to identify barriers to the optimization of CRC screening and surveillance, and to define a roadmap for overcoming these barriers.
 

Meeting conclusions

Although colonoscopy is widely considered to be an excellent tool for CRC screening and surveillance, barriers to optimal effectiveness exist. Barriers include lack of access to health care, financial cost, suboptimal uptake even among individuals with health insurance and financial resources, imperfect adherence to guidelines, and development of early-age, and interval cancers despite adherence to guidelines.

Novel cost-effective, sensitive, specific, and personalized strategies are needed to address these barriers.

To read about the emerging technologies discussed at the meeting, review the meeting summary in Gastroenterology.
 

[email protected]

Physicians with difficult patient scenarios regularly bring their questions to the AGA Community (https://community.gastro.org) to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses.

Here are some recent clinical discussions in the forum regarding the coronavirus and your patients:

1. Biologic treatment for IBD in the COVID-19 era (http://ow.ly/9akD50yKW8E)

A GI colleague from Italy asks how others are managing IBD patients on ongoing biologic treatment during the coronavirus pandemic.

2. COVID-19 and colonoscopy (http://ow.ly/uYUD50yKWfS)

AGA members discuss recommendations for infection control in endoscopy centers.

3. IBD patients concerned about visiting infusion centers (http://ow.ly/gKED50yKWVZ)

How would you address patient concerns about picking up coronavirus from asymptomatic carriers at bustling infusion centers?



Join these discussions and more at https://community.gastro.org/discussions.

Physicians with difficult patient scenarios regularly bring their questions to the AGA Community (https://community.gastro.org) to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses.

Here are some recent clinical discussions in the forum regarding the coronavirus and your patients:

1. Biologic treatment for IBD in the COVID-19 era (http://ow.ly/9akD50yKW8E)

A GI colleague from Italy asks how others are managing IBD patients on ongoing biologic treatment during the coronavirus pandemic.

2. COVID-19 and colonoscopy (http://ow.ly/uYUD50yKWfS)

AGA members discuss recommendations for infection control in endoscopy centers.

3. IBD patients concerned about visiting infusion centers (http://ow.ly/gKED50yKWVZ)

How would you address patient concerns about picking up coronavirus from asymptomatic carriers at bustling infusion centers?



Join these discussions and more at https://community.gastro.org/discussions.

Physicians with difficult patient scenarios regularly bring their questions to the AGA Community (https://community.gastro.org) to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses.

Here are some recent clinical discussions in the forum regarding the coronavirus and your patients:

1. Biologic treatment for IBD in the COVID-19 era (http://ow.ly/9akD50yKW8E)

A GI colleague from Italy asks how others are managing IBD patients on ongoing biologic treatment during the coronavirus pandemic.

2. COVID-19 and colonoscopy (http://ow.ly/uYUD50yKWfS)

AGA members discuss recommendations for infection control in endoscopy centers.

3. IBD patients concerned about visiting infusion centers (http://ow.ly/gKED50yKWVZ)

How would you address patient concerns about picking up coronavirus from asymptomatic carriers at bustling infusion centers?



Join these discussions and more at https://community.gastro.org/discussions.

AGA has partnered with Rx.Health, a digital health company, to create a colorectal cancer (CRC) preparatory app.

You want to find ways to improve your patient outcomes and reduce your practice costs? Now, there is an app for that. The CRC preparatory app can reduce expenses you lose from aborted or incomplete colonoscopies.

Launched in 2019, the CRC app is already generating remarkable results. The Arizona Center for Digestive Health used the CRC app and recorded a 24% improvement in bowel preparation by colonoscopy patients, a 50% reduction in aborted procedures and a 93% patient satisfaction rate. Research conducted by Rx.Health also determined patients were using the CRC app two to four times longer than competing apps, and the CRC app was saving gastroenterologists between $20,000 and $40,000 annually.

Plans are underway between AGA and Rx.Health to expand the partnership to build apps for colorectal cancer surveillance, an inflammatory bowel disease (IBD) registry, fecal microbiota transplantation (FMT), and other GI disorders.

Interested in learning more? Visit rx.health/gi.

[email protected]

AGA has partnered with Rx.Health, a digital health company, to create a colorectal cancer (CRC) preparatory app.

You want to find ways to improve your patient outcomes and reduce your practice costs? Now, there is an app for that. The CRC preparatory app can reduce expenses you lose from aborted or incomplete colonoscopies.

Launched in 2019, the CRC app is already generating remarkable results. The Arizona Center for Digestive Health used the CRC app and recorded a 24% improvement in bowel preparation by colonoscopy patients, a 50% reduction in aborted procedures and a 93% patient satisfaction rate. Research conducted by Rx.Health also determined patients were using the CRC app two to four times longer than competing apps, and the CRC app was saving gastroenterologists between $20,000 and $40,000 annually.

Plans are underway between AGA and Rx.Health to expand the partnership to build apps for colorectal cancer surveillance, an inflammatory bowel disease (IBD) registry, fecal microbiota transplantation (FMT), and other GI disorders.

Interested in learning more? Visit rx.health/gi.

[email protected]

AGA has partnered with Rx.Health, a digital health company, to create a colorectal cancer (CRC) preparatory app.

You want to find ways to improve your patient outcomes and reduce your practice costs? Now, there is an app for that. The CRC preparatory app can reduce expenses you lose from aborted or incomplete colonoscopies.

Launched in 2019, the CRC app is already generating remarkable results. The Arizona Center for Digestive Health used the CRC app and recorded a 24% improvement in bowel preparation by colonoscopy patients, a 50% reduction in aborted procedures and a 93% patient satisfaction rate. Research conducted by Rx.Health also determined patients were using the CRC app two to four times longer than competing apps, and the CRC app was saving gastroenterologists between $20,000 and $40,000 annually.

Plans are underway between AGA and Rx.Health to expand the partnership to build apps for colorectal cancer surveillance, an inflammatory bowel disease (IBD) registry, fecal microbiota transplantation (FMT), and other GI disorders.

Interested in learning more? Visit rx.health/gi.

[email protected]

The recent explosion of innovations for the diagnosis and treatment of GI diseases makes it difficult to identify what will affect you today and what has implications for tomorrow.

Techniques and Innovations in Gastrointestinal Endoscopy (TIGE) cuts through the noise with quarterly updates featuring groundbreaking advances in GI endoscopy. Previously known as Techniques in Gastrointestinal Endoscopy, TIGE is the newest member of the AGA journal family and illuminates the next generation of technologies in an easily accessible, online-only format. TIGE will continue to be led by Co-Editors-in-Chief Vinay Chandrasekhara, MD, Mayo Clinic, Rochester, Minn., and Michael Kochman, MD, AGAF, University of Pennsylvania School of Medicine, Philadelphia, and a hand-selected editorial board of leaders in GI endoscopy.

Check out the current issue of TIGE focused on how lumen apposing metal stents (LAMS) are changing GI endoscopy. The issue provides a comprehensive review on the current state of LAMS and best practices for using LAMS to optimize patient outcomes.

Discover TIGE at tigejournal.org.
 

[email protected]

The recent explosion of innovations for the diagnosis and treatment of GI diseases makes it difficult to identify what will affect you today and what has implications for tomorrow.

Techniques and Innovations in Gastrointestinal Endoscopy (TIGE) cuts through the noise with quarterly updates featuring groundbreaking advances in GI endoscopy. Previously known as Techniques in Gastrointestinal Endoscopy, TIGE is the newest member of the AGA journal family and illuminates the next generation of technologies in an easily accessible, online-only format. TIGE will continue to be led by Co-Editors-in-Chief Vinay Chandrasekhara, MD, Mayo Clinic, Rochester, Minn., and Michael Kochman, MD, AGAF, University of Pennsylvania School of Medicine, Philadelphia, and a hand-selected editorial board of leaders in GI endoscopy.

Check out the current issue of TIGE focused on how lumen apposing metal stents (LAMS) are changing GI endoscopy. The issue provides a comprehensive review on the current state of LAMS and best practices for using LAMS to optimize patient outcomes.

Discover TIGE at tigejournal.org.
 

[email protected]

The recent explosion of innovations for the diagnosis and treatment of GI diseases makes it difficult to identify what will affect you today and what has implications for tomorrow.

Techniques and Innovations in Gastrointestinal Endoscopy (TIGE) cuts through the noise with quarterly updates featuring groundbreaking advances in GI endoscopy. Previously known as Techniques in Gastrointestinal Endoscopy, TIGE is the newest member of the AGA journal family and illuminates the next generation of technologies in an easily accessible, online-only format. TIGE will continue to be led by Co-Editors-in-Chief Vinay Chandrasekhara, MD, Mayo Clinic, Rochester, Minn., and Michael Kochman, MD, AGAF, University of Pennsylvania School of Medicine, Philadelphia, and a hand-selected editorial board of leaders in GI endoscopy.

Check out the current issue of TIGE focused on how lumen apposing metal stents (LAMS) are changing GI endoscopy. The issue provides a comprehensive review on the current state of LAMS and best practices for using LAMS to optimize patient outcomes.

Discover TIGE at tigejournal.org.
 

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The AGA Governing Board recognizes and shares the extreme uncertainty faced by the GI community regarding the rapidly evolving coronavirus situation. Priority #1 is, as always, keeping our patients and families safe, but we also would like to ensure the safety of our GI health care providers.

COVID-19 is an emerging disease and there is more to learn about its transmission, severity, and how it will take shape in the U.S. We have asked our clinical guidance experts to determine what, if any, GI-specific scientifically valid recommendations can be made. In fact, Gastroenterology has just published papers on GI symptoms and potential fecal transmission in coronavirus patients. You can see this work at www.gastrojournal.org/inpress.

Stay tuned to www.gastro.org and your email for continued updates on coronavirus, as well as information on AGA live events and DDW given the current circumstances.
 

[email protected]

The AGA Governing Board recognizes and shares the extreme uncertainty faced by the GI community regarding the rapidly evolving coronavirus situation. Priority #1 is, as always, keeping our patients and families safe, but we also would like to ensure the safety of our GI health care providers.

COVID-19 is an emerging disease and there is more to learn about its transmission, severity, and how it will take shape in the U.S. We have asked our clinical guidance experts to determine what, if any, GI-specific scientifically valid recommendations can be made. In fact, Gastroenterology has just published papers on GI symptoms and potential fecal transmission in coronavirus patients. You can see this work at www.gastrojournal.org/inpress.

Stay tuned to www.gastro.org and your email for continued updates on coronavirus, as well as information on AGA live events and DDW given the current circumstances.
 

[email protected]

The AGA Governing Board recognizes and shares the extreme uncertainty faced by the GI community regarding the rapidly evolving coronavirus situation. Priority #1 is, as always, keeping our patients and families safe, but we also would like to ensure the safety of our GI health care providers.

COVID-19 is an emerging disease and there is more to learn about its transmission, severity, and how it will take shape in the U.S. We have asked our clinical guidance experts to determine what, if any, GI-specific scientifically valid recommendations can be made. In fact, Gastroenterology has just published papers on GI symptoms and potential fecal transmission in coronavirus patients. You can see this work at www.gastrojournal.org/inpress.

Stay tuned to www.gastro.org and your email for continued updates on coronavirus, as well as information on AGA live events and DDW given the current circumstances.
 

[email protected]