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CHEST in the news
CHEST works to provide opportunities for members to serve as expert sources for both mainstream and trade media to create a stronger voice for members in pulmonary, critical care, and sleep medicine.
Below are media coverage highlights from the past few months that work to expand awareness of CHEST and to promote the expertise of CHEST members in the media.
Improving NIV access for patients with COPD
In December, Pulmonology Advisor covered recommendations from the noninvasive ventilation Technical Expert Panel report published in the journal CHEST® by The American College of Chest Physicians, the American Association for Respiratory Care, the American Academy of Sleep Medicine, and the American Thoracic Society.
The article shares that, in the United States, patients with COPD are often prescribed home mechanical ventilators rather than more appropriate devices, due largely to current Centers for Medicare & Medicaid Services (CMS) policies that do not always take into account unique complexities of patients’ conditions.
In addition to the recommendations covered in Optimal NIV Medicare Access Promotion: Patients With COPD, the Technical Expert Panel also published reports on patients with Obstructive Sleep Apnea, patients with Central Sleep Apnea, patients with Hypoventilation Syndromes, and patients with Thoracic Restrictive Disorders in the journal CHEST.
The full article, Expert Panel Guidelines Promote Access to In-Home NIV for Patients With COPD, can be found on the Pulmonology Advisor website.
OSA and cardiovascular mortality
A journal CHEST® article, “A Validation Study of Four Different Cluster Analyses of OSA and the Incidence of Cardiovascular Mortality in a Hispanic Population,” by Gonzalo Labarca, MD, et al. was featured in a Healio Pulmonology article.
The research showed an association between excessive sleepiness and increased risk for cardiovascular mortality in Hispanic adults with moderate to severe Obstructive Sleep Apnea and, in the article, Dr. Labarca says, “The Latino population is underrepresented in the scientific literature. Therefore, validation data regarding novel approaches to better identify a subtype of OSA patients at high risk of CV mortality is strongly needed.”
The full article, Risk for CV Mortality Elevated in Hispanic Adults with OSA, Excessive Sleepiness, can be found on the Healio website.
Member in the news:
Chair of the CHEST COVID-19 Task Force, Ryan Maves, MD , joined New York Times podcast, “The Daily” to discuss how the omicron COVID-19 surge was different than previous surges because unvaccinated deaths are skewing younger. During the podcast, Dr. Maves said, “You know, many more [unvaccinated] people in their 40s and 50s are dying. And it’s a grim feeling, watching people who are your own age and maybe not that much older than you die of an entirely preventable illness.” The full podcast, This COVID Surge Feels Different can be found on the New York Times website.
CHEST news
CHEST regularly issues statements and press releases on a variety of topics, including closing the synthetic nicotine loophole and requests for Congress to extend telehealth services.
For all recent CHEST News, including these statements, visit the CHEST Newsroom at chestnet.org, and follow the hashtag #CHESTNews on Twitter.
If you have been included in a recent news article and would like it to be featured, send the coverage to media@chestnet.org.
CHEST works to provide opportunities for members to serve as expert sources for both mainstream and trade media to create a stronger voice for members in pulmonary, critical care, and sleep medicine.
Below are media coverage highlights from the past few months that work to expand awareness of CHEST and to promote the expertise of CHEST members in the media.
Improving NIV access for patients with COPD
In December, Pulmonology Advisor covered recommendations from the noninvasive ventilation Technical Expert Panel report published in the journal CHEST® by The American College of Chest Physicians, the American Association for Respiratory Care, the American Academy of Sleep Medicine, and the American Thoracic Society.
The article shares that, in the United States, patients with COPD are often prescribed home mechanical ventilators rather than more appropriate devices, due largely to current Centers for Medicare & Medicaid Services (CMS) policies that do not always take into account unique complexities of patients’ conditions.
In addition to the recommendations covered in Optimal NIV Medicare Access Promotion: Patients With COPD, the Technical Expert Panel also published reports on patients with Obstructive Sleep Apnea, patients with Central Sleep Apnea, patients with Hypoventilation Syndromes, and patients with Thoracic Restrictive Disorders in the journal CHEST.
The full article, Expert Panel Guidelines Promote Access to In-Home NIV for Patients With COPD, can be found on the Pulmonology Advisor website.
OSA and cardiovascular mortality
A journal CHEST® article, “A Validation Study of Four Different Cluster Analyses of OSA and the Incidence of Cardiovascular Mortality in a Hispanic Population,” by Gonzalo Labarca, MD, et al. was featured in a Healio Pulmonology article.
The research showed an association between excessive sleepiness and increased risk for cardiovascular mortality in Hispanic adults with moderate to severe Obstructive Sleep Apnea and, in the article, Dr. Labarca says, “The Latino population is underrepresented in the scientific literature. Therefore, validation data regarding novel approaches to better identify a subtype of OSA patients at high risk of CV mortality is strongly needed.”
The full article, Risk for CV Mortality Elevated in Hispanic Adults with OSA, Excessive Sleepiness, can be found on the Healio website.
Member in the news:
Chair of the CHEST COVID-19 Task Force, Ryan Maves, MD , joined New York Times podcast, “The Daily” to discuss how the omicron COVID-19 surge was different than previous surges because unvaccinated deaths are skewing younger. During the podcast, Dr. Maves said, “You know, many more [unvaccinated] people in their 40s and 50s are dying. And it’s a grim feeling, watching people who are your own age and maybe not that much older than you die of an entirely preventable illness.” The full podcast, This COVID Surge Feels Different can be found on the New York Times website.
CHEST news
CHEST regularly issues statements and press releases on a variety of topics, including closing the synthetic nicotine loophole and requests for Congress to extend telehealth services.
For all recent CHEST News, including these statements, visit the CHEST Newsroom at chestnet.org, and follow the hashtag #CHESTNews on Twitter.
If you have been included in a recent news article and would like it to be featured, send the coverage to media@chestnet.org.
CHEST works to provide opportunities for members to serve as expert sources for both mainstream and trade media to create a stronger voice for members in pulmonary, critical care, and sleep medicine.
Below are media coverage highlights from the past few months that work to expand awareness of CHEST and to promote the expertise of CHEST members in the media.
Improving NIV access for patients with COPD
In December, Pulmonology Advisor covered recommendations from the noninvasive ventilation Technical Expert Panel report published in the journal CHEST® by The American College of Chest Physicians, the American Association for Respiratory Care, the American Academy of Sleep Medicine, and the American Thoracic Society.
The article shares that, in the United States, patients with COPD are often prescribed home mechanical ventilators rather than more appropriate devices, due largely to current Centers for Medicare & Medicaid Services (CMS) policies that do not always take into account unique complexities of patients’ conditions.
In addition to the recommendations covered in Optimal NIV Medicare Access Promotion: Patients With COPD, the Technical Expert Panel also published reports on patients with Obstructive Sleep Apnea, patients with Central Sleep Apnea, patients with Hypoventilation Syndromes, and patients with Thoracic Restrictive Disorders in the journal CHEST.
The full article, Expert Panel Guidelines Promote Access to In-Home NIV for Patients With COPD, can be found on the Pulmonology Advisor website.
OSA and cardiovascular mortality
A journal CHEST® article, “A Validation Study of Four Different Cluster Analyses of OSA and the Incidence of Cardiovascular Mortality in a Hispanic Population,” by Gonzalo Labarca, MD, et al. was featured in a Healio Pulmonology article.
The research showed an association between excessive sleepiness and increased risk for cardiovascular mortality in Hispanic adults with moderate to severe Obstructive Sleep Apnea and, in the article, Dr. Labarca says, “The Latino population is underrepresented in the scientific literature. Therefore, validation data regarding novel approaches to better identify a subtype of OSA patients at high risk of CV mortality is strongly needed.”
The full article, Risk for CV Mortality Elevated in Hispanic Adults with OSA, Excessive Sleepiness, can be found on the Healio website.
Member in the news:
Chair of the CHEST COVID-19 Task Force, Ryan Maves, MD , joined New York Times podcast, “The Daily” to discuss how the omicron COVID-19 surge was different than previous surges because unvaccinated deaths are skewing younger. During the podcast, Dr. Maves said, “You know, many more [unvaccinated] people in their 40s and 50s are dying. And it’s a grim feeling, watching people who are your own age and maybe not that much older than you die of an entirely preventable illness.” The full podcast, This COVID Surge Feels Different can be found on the New York Times website.
CHEST news
CHEST regularly issues statements and press releases on a variety of topics, including closing the synthetic nicotine loophole and requests for Congress to extend telehealth services.
For all recent CHEST News, including these statements, visit the CHEST Newsroom at chestnet.org, and follow the hashtag #CHESTNews on Twitter.
If you have been included in a recent news article and would like it to be featured, send the coverage to media@chestnet.org.
Building trust together
During the fall of 2020, the CHEST Foundation launched a Listening Tour in areas of the United States that were experiencing disproportionate incidents and mortality from COVID-19. This program was initiated to gain insights in order toand identify solutions to combat lung health inequities among marginalized communities. The COVID-19 pandemic has exacerbated health disparities in America. Underserved communities, communities with higher rates of poverty, and communities of color have suffered disproportionate rates of illness and mortality due to COVID-19.
Even before the COVID-19 pandemic, underserved communities were impacted disproportionately by four of the most common lung diseases: asthma, chronic obstructive pulmonary diseaseCOPD, interstitial lung disease, and lung cancer. Inequities in care and health outcomes are well documented. Inequities are due to a multitude of factors, including socioeconomic status, environmental issues such as air populationpollution, and issues that impact access to care, such as individuals being uninsured or under insured, and a lack of specialists in underserved communities.
The CHEST Foundation selected Listening Tour cities based on a number of criteria, including documented inequities in lung health and prevalence of the predominant lung diseases. Listening Tour events were held virtually in Jackson, MS; New York, NY; Chicago, IL; South Texas; and the US Southwest. In each location, the CHEST Foundation approached community leaders, clinicians, patients, and families to participate. Individual interviews focused on lung health experiences, positive and negative; needs from clinicians, patients, families, and community leaders; and help actually received (or not) based on these needs.
A theme that emerged centered on the importance trust plays in the patient/clinician relationship. Barriers to the establishment of trust as expressed by patients related to:
- Perceived dismissive attitudes among physicians
- Lack of understanding and/or appreciation about social determinants of health
- Overuse of highly technical/medical terminology that can be intimidating to patients
- General cultural and philosophical differences that may contribute to implicit biases
Gaining trust and building rapport among patients is not only limited to key findings from the Listening Tour but also corroborated through peer- reviewed studies. Many studies have documented that trust is the foundation on which patient/clinician relationshipss are built and without it, patients are less likely to maintain adherence to treatment plans, miss appointments, minimize sharing information about their symptoms, and suffer from poorer health and overall quality of life.
In response, the CHEST Foundation is proposing a project with the aim of broader replication based upon key findings. Building trust and developing rapport with patients areis key in creating an environment where they are active participants in their care. An empathetic care training model will provide clinicians with an understanding of the barriers that exist and the tools needed to establish trust with their patients.
The major components of the project include:
1. Development and standardization of a culturally competent toolkit for use during the first five 5 minutes of clinician/patient encounters
2. Creating Creation of education on the tool and training clinicians that who will pilot the tool in health care clinics/medical institutions and collect data on its impact
3. Implementation of the tool use during clinician/patient visits and data collection
4. Data analysis and synthesis of findings for use in refinement and scalability for broader impact
Future plans include scaling the project to additional sites and health care settings; disseminating the culturally competent tool along with education for its utilization to CHEST’s membership and to a larger audience of health care providers; and sharing results and lessons learned. The CHEST Foundation is hoping to build a national, sustainable program that helps achieve health equity, but in order to achieve this, we need your help. Make a donation, and join the CHEST Foundation as we embark on a bold new initiative to build trust, identify and remove barriers, and promote health care access for all in order to help fight lung disease. Together, we will build trust and understanding within communities, specifically between patients, their families, their caregivers, and their clinicians.
During the fall of 2020, the CHEST Foundation launched a Listening Tour in areas of the United States that were experiencing disproportionate incidents and mortality from COVID-19. This program was initiated to gain insights in order toand identify solutions to combat lung health inequities among marginalized communities. The COVID-19 pandemic has exacerbated health disparities in America. Underserved communities, communities with higher rates of poverty, and communities of color have suffered disproportionate rates of illness and mortality due to COVID-19.
Even before the COVID-19 pandemic, underserved communities were impacted disproportionately by four of the most common lung diseases: asthma, chronic obstructive pulmonary diseaseCOPD, interstitial lung disease, and lung cancer. Inequities in care and health outcomes are well documented. Inequities are due to a multitude of factors, including socioeconomic status, environmental issues such as air populationpollution, and issues that impact access to care, such as individuals being uninsured or under insured, and a lack of specialists in underserved communities.
The CHEST Foundation selected Listening Tour cities based on a number of criteria, including documented inequities in lung health and prevalence of the predominant lung diseases. Listening Tour events were held virtually in Jackson, MS; New York, NY; Chicago, IL; South Texas; and the US Southwest. In each location, the CHEST Foundation approached community leaders, clinicians, patients, and families to participate. Individual interviews focused on lung health experiences, positive and negative; needs from clinicians, patients, families, and community leaders; and help actually received (or not) based on these needs.
A theme that emerged centered on the importance trust plays in the patient/clinician relationship. Barriers to the establishment of trust as expressed by patients related to:
- Perceived dismissive attitudes among physicians
- Lack of understanding and/or appreciation about social determinants of health
- Overuse of highly technical/medical terminology that can be intimidating to patients
- General cultural and philosophical differences that may contribute to implicit biases
Gaining trust and building rapport among patients is not only limited to key findings from the Listening Tour but also corroborated through peer- reviewed studies. Many studies have documented that trust is the foundation on which patient/clinician relationshipss are built and without it, patients are less likely to maintain adherence to treatment plans, miss appointments, minimize sharing information about their symptoms, and suffer from poorer health and overall quality of life.
In response, the CHEST Foundation is proposing a project with the aim of broader replication based upon key findings. Building trust and developing rapport with patients areis key in creating an environment where they are active participants in their care. An empathetic care training model will provide clinicians with an understanding of the barriers that exist and the tools needed to establish trust with their patients.
The major components of the project include:
1. Development and standardization of a culturally competent toolkit for use during the first five 5 minutes of clinician/patient encounters
2. Creating Creation of education on the tool and training clinicians that who will pilot the tool in health care clinics/medical institutions and collect data on its impact
3. Implementation of the tool use during clinician/patient visits and data collection
4. Data analysis and synthesis of findings for use in refinement and scalability for broader impact
Future plans include scaling the project to additional sites and health care settings; disseminating the culturally competent tool along with education for its utilization to CHEST’s membership and to a larger audience of health care providers; and sharing results and lessons learned. The CHEST Foundation is hoping to build a national, sustainable program that helps achieve health equity, but in order to achieve this, we need your help. Make a donation, and join the CHEST Foundation as we embark on a bold new initiative to build trust, identify and remove barriers, and promote health care access for all in order to help fight lung disease. Together, we will build trust and understanding within communities, specifically between patients, their families, their caregivers, and their clinicians.
During the fall of 2020, the CHEST Foundation launched a Listening Tour in areas of the United States that were experiencing disproportionate incidents and mortality from COVID-19. This program was initiated to gain insights in order toand identify solutions to combat lung health inequities among marginalized communities. The COVID-19 pandemic has exacerbated health disparities in America. Underserved communities, communities with higher rates of poverty, and communities of color have suffered disproportionate rates of illness and mortality due to COVID-19.
Even before the COVID-19 pandemic, underserved communities were impacted disproportionately by four of the most common lung diseases: asthma, chronic obstructive pulmonary diseaseCOPD, interstitial lung disease, and lung cancer. Inequities in care and health outcomes are well documented. Inequities are due to a multitude of factors, including socioeconomic status, environmental issues such as air populationpollution, and issues that impact access to care, such as individuals being uninsured or under insured, and a lack of specialists in underserved communities.
The CHEST Foundation selected Listening Tour cities based on a number of criteria, including documented inequities in lung health and prevalence of the predominant lung diseases. Listening Tour events were held virtually in Jackson, MS; New York, NY; Chicago, IL; South Texas; and the US Southwest. In each location, the CHEST Foundation approached community leaders, clinicians, patients, and families to participate. Individual interviews focused on lung health experiences, positive and negative; needs from clinicians, patients, families, and community leaders; and help actually received (or not) based on these needs.
A theme that emerged centered on the importance trust plays in the patient/clinician relationship. Barriers to the establishment of trust as expressed by patients related to:
- Perceived dismissive attitudes among physicians
- Lack of understanding and/or appreciation about social determinants of health
- Overuse of highly technical/medical terminology that can be intimidating to patients
- General cultural and philosophical differences that may contribute to implicit biases
Gaining trust and building rapport among patients is not only limited to key findings from the Listening Tour but also corroborated through peer- reviewed studies. Many studies have documented that trust is the foundation on which patient/clinician relationshipss are built and without it, patients are less likely to maintain adherence to treatment plans, miss appointments, minimize sharing information about their symptoms, and suffer from poorer health and overall quality of life.
In response, the CHEST Foundation is proposing a project with the aim of broader replication based upon key findings. Building trust and developing rapport with patients areis key in creating an environment where they are active participants in their care. An empathetic care training model will provide clinicians with an understanding of the barriers that exist and the tools needed to establish trust with their patients.
The major components of the project include:
1. Development and standardization of a culturally competent toolkit for use during the first five 5 minutes of clinician/patient encounters
2. Creating Creation of education on the tool and training clinicians that who will pilot the tool in health care clinics/medical institutions and collect data on its impact
3. Implementation of the tool use during clinician/patient visits and data collection
4. Data analysis and synthesis of findings for use in refinement and scalability for broader impact
Future plans include scaling the project to additional sites and health care settings; disseminating the culturally competent tool along with education for its utilization to CHEST’s membership and to a larger audience of health care providers; and sharing results and lessons learned. The CHEST Foundation is hoping to build a national, sustainable program that helps achieve health equity, but in order to achieve this, we need your help. Make a donation, and join the CHEST Foundation as we embark on a bold new initiative to build trust, identify and remove barriers, and promote health care access for all in order to help fight lung disease. Together, we will build trust and understanding within communities, specifically between patients, their families, their caregivers, and their clinicians.
Asthma, IPF, mechanical ventilation and more...
Airway disorders network: Asthma and COPD section
Betting on asthma: The over and under of diagnosis
Asthma is one of the major chronic respiratory diseases worldwide (WHO 2020), yet it is a clinical syndrome that lacks a consensus on its definition, is comprised of nonspecific respiratory symptoms, and is without a gold standard diagnostic test or a set guideline on confirmation of bronchial hyperresponsiveness (Sá-Sousa A et al. Clin Transl Allergy. 2014 Aug 4;4:24). In addition, once adequately treated, there is an absence of an algorithm to diagnose disease remission (Aaron SD et al. Am J Respir Crit Care Med. 2018 Oct 15;198[8]:1012-20). It is estimated that 20%-70% of people with asthma worldwide across the spectrum of all ages remain undiagnosed.
Spirometry and bronchoprovocation challenges with fixed cut-off values demonstrate reduced sensitivity with day-to-day, diurnal, and long-term variation in airflow obstruction, inflammation, and bronchial hyperresponsiveness (Wang R et al. Thorax. 2021 Jun;76[6]:624-31). Inflammatory biomarkers like fractional exhaled nitric oxide (FeNO) have higher specificity but are subject to diurnal variation and confounding diagnoses.
Overdiagnosis of asthma can result in lost opportunity to diagnose significant cardiopulmonary diseases, unnecessary escalation of the asthma treatment regimen for poorly controlled respiratory symptoms, potential for medication adverse effects, and, increased cost burden to the patient and to the health care system (Aaron SD et al. JAMA. 2017;317:269-79; Shaw D et al. Prim Care Respir J. 2012;21:283-7). Among the newly physician-diagnosed asthmatics, <50% have spirometry performed within 1 year of diagnosis (Sokol KC et al. Am J Med. 2015 May;128[5]:502-8). Spirometry was further underutilized with limit on aerosol-generating procedures during COVID-19 pandemic (Kankaanranta H et al. J Allergy Clin Immunol Pract. 2021 Dec;9[12]:4252-3); 30%-35% obese and nonobese patients with physician-diagnosed asthma did not have current asthma when objectively assessed for airflow limitation (Aaron SD et al. JAMA. 2017;317:269-79; van Huisstede A, et al. Respir Med. 2013;107:1356-64).
Clinical remission is greater in early-onset asthma as compared with late-onset asthma (De Marco R et al. J Allergy Clin Immunol. 2002;110:228-35). If asthma is well controlled, a stepping down treatment regimen is suggested (Global Initiative for Asthma 2021;Usmani et al. J Allergy Clin Immunol Pract. 2017 Sep-Oct;5[5]:1378-87.e5; Hagan JB et al. Allergy. 2014 Apr;69[4]:510-6), and although a randomized trial is lacking, it may be feasible to “undiagnose” patients who don’t experience clinical worsening, airflow obstruction, or bronchial hyperresponsiveness after being tapered off all asthma medications with a low relapse rate (Aaron SD et al. JAMA. 2017;317:269-79; J Fam Pract. 2018;67(11):704-7).
Asthma over- and underdiagnosis is prevalent and has clinical and global health consequences. New standardized algorithms with improved biomarkers may help alter this oversight.
Richa Nahar, MD
Network Member-at-Large
Allen J. Blaivas, DO, FCCP
Network Steering Committee Chair
Diffuse lung disease and lung transplant network: Interstitial lung disease section
Future therapies for IPF
Idiopathic pulmonary fibrosis (IPF) is a chronic lung disease characterized by progressive fibrosis, respiratory failure, and a mortality rate of 80% at 5 years. Only two drugs are currently FDA-approved for IPF treatment.
The antifibrotics pirfenidone and nintedanib reduce the rate of forced vital capacity (FVC) decline and improve progression free survival (King TE et al. N Engl J Med. 2014;370:2083-92; King TE et al. N Engl J Med. 2014;370:2071-82). While considered revolutionary when introduced, these medications neither reverse disease progression nor improve symptoms. More recently, the Galapagos ISABELA Phase III clinical trial of ziritaxestat in IPF was discontinued due to an unfavorable risk-benefit profile. Despite this, several prospects for IPF therapy exist.
Post hoc analysis of the INCREASE Trial demonstrated a positive effect of inhaled treprostinil on FVC in patients with IPF and group 3 pulmonary hypertension (Waxman A et al. N Engl J Med. 2021;384:325-34). Consequently, a phase 3 randomized trial investigating its safety and efficacy in patients with IPF alone is ongoing. Additional targeted therapies for IPF are also emerging. Recombinant human pentraxin-2, an inhibitor of monocyte differentiation into proinflammatory macrophages, and pamrevlumab, a recombinant human monoclonal antibody against connective tissue growth factor, both demonstrated attenuation of FVC decline compared with placebo in phase 2 trials. Both are currently in phase 3 studies (Raghu G et al. JAMA. 2018 Jun 12;319[22]:2299-307; Sgalla G et al. Expert Opin Investig Drugs. 2020 Aug;29[8]:771-7) Lastly, in February the Food and Drug Administration granted breakthrough therapy designation to BI 1015550 for treatment of IPF based on a 12-week phase 2 randomized, double-blind, placebo-controlled trial. (Data will be presented at ATS). BI 1015550 is an oral, phosphodiesterase 4B (PDE4B) inhibitor with both antifibrotic and anti-inflammatory properties. These advances in drug development provide hope for a future where IPF is transformed from a fatal disease to one manageable over many years.
Adrian Shifren, MD
Network Member-at-Large
Gabriel Schroeder, MD
Network Member-at-Large
Sleep medicine network: Home-based mechanical ventilation and neuromuscular section
Role of airway clearance therapies in neuromuscular disease
Individuals with neuromuscular weakness have an impaired ability to cough and clear secretions from the airway, which can result in atelectasis and pneumonia. Proximal airway clearance therapies (ACT), including manual lung volume recruitment (LVR) and mechanical in-exsufflation (MI-E), mobilize secretions, improve cough efficacy, maintain chest wall compliance, and slow progression of restrictive lung impairment (Chatwin et al. Respir Med. 2018;136:98-110; Sheers et al. Respirology. 2019;24:512-520).
ACT are recommended in international care guidelines for respiratory management of individuals with neuromuscular disease. At a recent Home-based Mechanical Ventilation and Neuromuscular Disease Section “PEEPS Talking PAP” rounds, participants discussed their approach to ACT. Practices varied by country and between adult/pediatric care providers. MI-E is most often used in the United States, but elsewhere in the world, LVR with a self-inflating bag and one-way valve is first-line therapy. Clinical care guidelines suggest initiation of regular ACT when cough peak flow is < 270 L/minute, forced vital capacity < 40%-60% predicted, or with subjectively weak cough (Hull et al. Thorax. 2012;67(7):654-655; Amin et al. Can J Resp Crit Care Sleep Med. 2017;1(1):7-36; McKim et al. Can Resp J. 2011;18(4):197-215; Birnkrant et al. Lancet Neurol. 2018;17(4):347-361; Sheehan et al. Pediatrics. 2018;142(Suppl 2):S62-s71).
Optimal timing for initiation of routine ACT, however, is not clear. A newly published randomized controlled trial of twice daily LVR in boys with Duchenne muscular dystrophy with relatively normal baseline lung function did not demonstrate a significant slowing of decline in forced vital capacity over 2 years. In individuals with preserved lung function, the burden of regular therapy may outweigh benefit (Katz et al. Thorax. 2022; doi: 10.1136/thoraxjnl-2021-218196). (While we are still learning about how best to apply this therapy in less advanced neuromuscular disease, ACT has demonstrated benefits during respiratory exacerbations, and routine use plays a role in preservation of lung function in more advanced disease (Katz et al. Ann Am Thorac Soc. 2016;13(2):217-222; McKim et al. Arch Phys Med Rehab. 2012;93(7):1117-1122; O’Sullivan et al. Arch Phys Med Rehabil. 2021;102(5):976-983; Bach et al. Am J Phys Med Rehab. 2008;87(9):720-725).
Sherri Katz, MD, FCCP
Section Steering Committee Chair
Critical care network: Mechanical ventilation and airways management section
NIV following extubation: Which devices and which patients?
For those of us interested in studying mechanical ventilation, an interesting paradox exists: despite our interest and enthusiasm in studying it, our patients benefit from avoiding it! Patients who require re-intubation are at high risk of in-hospital mortality (Frutos-Vivar et al. J Crit Care. 2011;26:502-9).
Studies in high-risk patients receiving mechanical ventilation have demonstrated that patients treated with immediate noninvasive ventilation (NIV) following extubation had reduced risk of re-intubation. CHEST guidelines focused on ventilator liberation considered these studies in a metanalysis which led to recommendations to employ NIV immediately after extubation in high-risk patients to reduce re-intubation rates (Ouellette D et al. Chest. 2017;151:166-80).
In the years since the publication of the CHEST guidelines, more information has been forthcoming. Evidence has emerged that treatment with high-flow nasal cannula devices following extubation may mitigate against re-intubation. An interesting strategy from the High-Wean Study Group suggested that postextubation combination therapy with both a high-flow cannula and NIV leads to improved outcomes compared with high-flow alone (Thille AW et al. JAMA. 2019;322:1465-75).
Thille and coworkers recently broadened our concept of patients who may benefit from NIV post extubation. They examined a cohort of obese patients requiring mechanical ventilation, finding that when patients were treated with NIV and high-flow nasal cannula post extubation, that they had a reduced risk of re-intubation compared with a group receiving high flow alone (Thille AW, et al. Am J Respir Crit Care Med. 2022;205:440-9).
As the incoming chair of the Mechanical Ventilation and Airways Management Section of the CHEST Critical Care Network, I look forward during the next 2 years to having interesting conversations about topics like this one and working with section members to develop exciting new projects concerning mechanical ventilation.
Daniel Ouellette, MD, MS, FCCP
Section Steering Committee Chair
Thoracic oncology and chest procedures network: Pleural disease section
Management of recurrent transudative pleural effusions (REDUCE trial)
Nonmalignant pleural effusions contribute significantly to health care costs and mortality (Mummadi SR et al. CHEST. 2021 Oct;160[4]:1534-51; Walker SP et al. CHEST. 2017 May;151[5]:1099-105). Management of transudative effusions has traditionally been to treat the underlying etiology. However, despite maximal medical therapies, these recurrent effusions may add to patients’ symptom burden and often create a challenge for the clinician. In 2017, the FDA approved the use of indwelling pleural catheters (IPC) in patients with recurrent transudative effusions, but data are limited.
In a recent prospective multicenter randomized control trial, Walker and colleagues (Eur Respir J. 2022 Feb;59:2101362) aimed to compare IPCs to repeated therapeutic thoracentesis (TT) in the management of transudative effusions. Pleural fluid etiologies included heart (68%), liver (24%), and renal failure (8%). The primary outcome was mean dyspnea score (daily visual analog scales) over 12 weeks, and there was no significant difference noted (39.7 vs. 45.0, mean difference –2.9 mm, 95% confidence interval [CI] –16.1 to 10.3; P = .67). Secondary outcomes demonstrated increased overall drainage in the IPC vs. TT group (17,412 mL vs. 2,901 mL, difference 13,892 mL, 95% CI, 7,669-20,116 mL; P < .001) and fewer invasive procedures required in the IPC group. Adverse events were noted in 59% of the IPC group compared with 37% managed with TT (OR, 3.13, 95% CI, 1.07-9.13, P = .04).
The REDUCE trial offers valuable data, but failure to meet primary outcome, study size, and adverse events highlight limitations to a definitive change in practice. Further study with specific-disease processes (ie, cardiac) may be helpful in the future. As in malignant pleural effusions, the selection of definitive pleural intervention should be tailored for each patient.
Maria Azhar, MD
Network Member-at-Large
Saadia A. Faiz, MD FCCP
Section Steering Committee Chair
Airway disorders network: Asthma and COPD section
Betting on asthma: The over and under of diagnosis
Asthma is one of the major chronic respiratory diseases worldwide (WHO 2020), yet it is a clinical syndrome that lacks a consensus on its definition, is comprised of nonspecific respiratory symptoms, and is without a gold standard diagnostic test or a set guideline on confirmation of bronchial hyperresponsiveness (Sá-Sousa A et al. Clin Transl Allergy. 2014 Aug 4;4:24). In addition, once adequately treated, there is an absence of an algorithm to diagnose disease remission (Aaron SD et al. Am J Respir Crit Care Med. 2018 Oct 15;198[8]:1012-20). It is estimated that 20%-70% of people with asthma worldwide across the spectrum of all ages remain undiagnosed.
Spirometry and bronchoprovocation challenges with fixed cut-off values demonstrate reduced sensitivity with day-to-day, diurnal, and long-term variation in airflow obstruction, inflammation, and bronchial hyperresponsiveness (Wang R et al. Thorax. 2021 Jun;76[6]:624-31). Inflammatory biomarkers like fractional exhaled nitric oxide (FeNO) have higher specificity but are subject to diurnal variation and confounding diagnoses.
Overdiagnosis of asthma can result in lost opportunity to diagnose significant cardiopulmonary diseases, unnecessary escalation of the asthma treatment regimen for poorly controlled respiratory symptoms, potential for medication adverse effects, and, increased cost burden to the patient and to the health care system (Aaron SD et al. JAMA. 2017;317:269-79; Shaw D et al. Prim Care Respir J. 2012;21:283-7). Among the newly physician-diagnosed asthmatics, <50% have spirometry performed within 1 year of diagnosis (Sokol KC et al. Am J Med. 2015 May;128[5]:502-8). Spirometry was further underutilized with limit on aerosol-generating procedures during COVID-19 pandemic (Kankaanranta H et al. J Allergy Clin Immunol Pract. 2021 Dec;9[12]:4252-3); 30%-35% obese and nonobese patients with physician-diagnosed asthma did not have current asthma when objectively assessed for airflow limitation (Aaron SD et al. JAMA. 2017;317:269-79; van Huisstede A, et al. Respir Med. 2013;107:1356-64).
Clinical remission is greater in early-onset asthma as compared with late-onset asthma (De Marco R et al. J Allergy Clin Immunol. 2002;110:228-35). If asthma is well controlled, a stepping down treatment regimen is suggested (Global Initiative for Asthma 2021;Usmani et al. J Allergy Clin Immunol Pract. 2017 Sep-Oct;5[5]:1378-87.e5; Hagan JB et al. Allergy. 2014 Apr;69[4]:510-6), and although a randomized trial is lacking, it may be feasible to “undiagnose” patients who don’t experience clinical worsening, airflow obstruction, or bronchial hyperresponsiveness after being tapered off all asthma medications with a low relapse rate (Aaron SD et al. JAMA. 2017;317:269-79; J Fam Pract. 2018;67(11):704-7).
Asthma over- and underdiagnosis is prevalent and has clinical and global health consequences. New standardized algorithms with improved biomarkers may help alter this oversight.
Richa Nahar, MD
Network Member-at-Large
Allen J. Blaivas, DO, FCCP
Network Steering Committee Chair
Diffuse lung disease and lung transplant network: Interstitial lung disease section
Future therapies for IPF
Idiopathic pulmonary fibrosis (IPF) is a chronic lung disease characterized by progressive fibrosis, respiratory failure, and a mortality rate of 80% at 5 years. Only two drugs are currently FDA-approved for IPF treatment.
The antifibrotics pirfenidone and nintedanib reduce the rate of forced vital capacity (FVC) decline and improve progression free survival (King TE et al. N Engl J Med. 2014;370:2083-92; King TE et al. N Engl J Med. 2014;370:2071-82). While considered revolutionary when introduced, these medications neither reverse disease progression nor improve symptoms. More recently, the Galapagos ISABELA Phase III clinical trial of ziritaxestat in IPF was discontinued due to an unfavorable risk-benefit profile. Despite this, several prospects for IPF therapy exist.
Post hoc analysis of the INCREASE Trial demonstrated a positive effect of inhaled treprostinil on FVC in patients with IPF and group 3 pulmonary hypertension (Waxman A et al. N Engl J Med. 2021;384:325-34). Consequently, a phase 3 randomized trial investigating its safety and efficacy in patients with IPF alone is ongoing. Additional targeted therapies for IPF are also emerging. Recombinant human pentraxin-2, an inhibitor of monocyte differentiation into proinflammatory macrophages, and pamrevlumab, a recombinant human monoclonal antibody against connective tissue growth factor, both demonstrated attenuation of FVC decline compared with placebo in phase 2 trials. Both are currently in phase 3 studies (Raghu G et al. JAMA. 2018 Jun 12;319[22]:2299-307; Sgalla G et al. Expert Opin Investig Drugs. 2020 Aug;29[8]:771-7) Lastly, in February the Food and Drug Administration granted breakthrough therapy designation to BI 1015550 for treatment of IPF based on a 12-week phase 2 randomized, double-blind, placebo-controlled trial. (Data will be presented at ATS). BI 1015550 is an oral, phosphodiesterase 4B (PDE4B) inhibitor with both antifibrotic and anti-inflammatory properties. These advances in drug development provide hope for a future where IPF is transformed from a fatal disease to one manageable over many years.
Adrian Shifren, MD
Network Member-at-Large
Gabriel Schroeder, MD
Network Member-at-Large
Sleep medicine network: Home-based mechanical ventilation and neuromuscular section
Role of airway clearance therapies in neuromuscular disease
Individuals with neuromuscular weakness have an impaired ability to cough and clear secretions from the airway, which can result in atelectasis and pneumonia. Proximal airway clearance therapies (ACT), including manual lung volume recruitment (LVR) and mechanical in-exsufflation (MI-E), mobilize secretions, improve cough efficacy, maintain chest wall compliance, and slow progression of restrictive lung impairment (Chatwin et al. Respir Med. 2018;136:98-110; Sheers et al. Respirology. 2019;24:512-520).
ACT are recommended in international care guidelines for respiratory management of individuals with neuromuscular disease. At a recent Home-based Mechanical Ventilation and Neuromuscular Disease Section “PEEPS Talking PAP” rounds, participants discussed their approach to ACT. Practices varied by country and between adult/pediatric care providers. MI-E is most often used in the United States, but elsewhere in the world, LVR with a self-inflating bag and one-way valve is first-line therapy. Clinical care guidelines suggest initiation of regular ACT when cough peak flow is < 270 L/minute, forced vital capacity < 40%-60% predicted, or with subjectively weak cough (Hull et al. Thorax. 2012;67(7):654-655; Amin et al. Can J Resp Crit Care Sleep Med. 2017;1(1):7-36; McKim et al. Can Resp J. 2011;18(4):197-215; Birnkrant et al. Lancet Neurol. 2018;17(4):347-361; Sheehan et al. Pediatrics. 2018;142(Suppl 2):S62-s71).
Optimal timing for initiation of routine ACT, however, is not clear. A newly published randomized controlled trial of twice daily LVR in boys with Duchenne muscular dystrophy with relatively normal baseline lung function did not demonstrate a significant slowing of decline in forced vital capacity over 2 years. In individuals with preserved lung function, the burden of regular therapy may outweigh benefit (Katz et al. Thorax. 2022; doi: 10.1136/thoraxjnl-2021-218196). (While we are still learning about how best to apply this therapy in less advanced neuromuscular disease, ACT has demonstrated benefits during respiratory exacerbations, and routine use plays a role in preservation of lung function in more advanced disease (Katz et al. Ann Am Thorac Soc. 2016;13(2):217-222; McKim et al. Arch Phys Med Rehab. 2012;93(7):1117-1122; O’Sullivan et al. Arch Phys Med Rehabil. 2021;102(5):976-983; Bach et al. Am J Phys Med Rehab. 2008;87(9):720-725).
Sherri Katz, MD, FCCP
Section Steering Committee Chair
Critical care network: Mechanical ventilation and airways management section
NIV following extubation: Which devices and which patients?
For those of us interested in studying mechanical ventilation, an interesting paradox exists: despite our interest and enthusiasm in studying it, our patients benefit from avoiding it! Patients who require re-intubation are at high risk of in-hospital mortality (Frutos-Vivar et al. J Crit Care. 2011;26:502-9).
Studies in high-risk patients receiving mechanical ventilation have demonstrated that patients treated with immediate noninvasive ventilation (NIV) following extubation had reduced risk of re-intubation. CHEST guidelines focused on ventilator liberation considered these studies in a metanalysis which led to recommendations to employ NIV immediately after extubation in high-risk patients to reduce re-intubation rates (Ouellette D et al. Chest. 2017;151:166-80).
In the years since the publication of the CHEST guidelines, more information has been forthcoming. Evidence has emerged that treatment with high-flow nasal cannula devices following extubation may mitigate against re-intubation. An interesting strategy from the High-Wean Study Group suggested that postextubation combination therapy with both a high-flow cannula and NIV leads to improved outcomes compared with high-flow alone (Thille AW et al. JAMA. 2019;322:1465-75).
Thille and coworkers recently broadened our concept of patients who may benefit from NIV post extubation. They examined a cohort of obese patients requiring mechanical ventilation, finding that when patients were treated with NIV and high-flow nasal cannula post extubation, that they had a reduced risk of re-intubation compared with a group receiving high flow alone (Thille AW, et al. Am J Respir Crit Care Med. 2022;205:440-9).
As the incoming chair of the Mechanical Ventilation and Airways Management Section of the CHEST Critical Care Network, I look forward during the next 2 years to having interesting conversations about topics like this one and working with section members to develop exciting new projects concerning mechanical ventilation.
Daniel Ouellette, MD, MS, FCCP
Section Steering Committee Chair
Thoracic oncology and chest procedures network: Pleural disease section
Management of recurrent transudative pleural effusions (REDUCE trial)
Nonmalignant pleural effusions contribute significantly to health care costs and mortality (Mummadi SR et al. CHEST. 2021 Oct;160[4]:1534-51; Walker SP et al. CHEST. 2017 May;151[5]:1099-105). Management of transudative effusions has traditionally been to treat the underlying etiology. However, despite maximal medical therapies, these recurrent effusions may add to patients’ symptom burden and often create a challenge for the clinician. In 2017, the FDA approved the use of indwelling pleural catheters (IPC) in patients with recurrent transudative effusions, but data are limited.
In a recent prospective multicenter randomized control trial, Walker and colleagues (Eur Respir J. 2022 Feb;59:2101362) aimed to compare IPCs to repeated therapeutic thoracentesis (TT) in the management of transudative effusions. Pleural fluid etiologies included heart (68%), liver (24%), and renal failure (8%). The primary outcome was mean dyspnea score (daily visual analog scales) over 12 weeks, and there was no significant difference noted (39.7 vs. 45.0, mean difference –2.9 mm, 95% confidence interval [CI] –16.1 to 10.3; P = .67). Secondary outcomes demonstrated increased overall drainage in the IPC vs. TT group (17,412 mL vs. 2,901 mL, difference 13,892 mL, 95% CI, 7,669-20,116 mL; P < .001) and fewer invasive procedures required in the IPC group. Adverse events were noted in 59% of the IPC group compared with 37% managed with TT (OR, 3.13, 95% CI, 1.07-9.13, P = .04).
The REDUCE trial offers valuable data, but failure to meet primary outcome, study size, and adverse events highlight limitations to a definitive change in practice. Further study with specific-disease processes (ie, cardiac) may be helpful in the future. As in malignant pleural effusions, the selection of definitive pleural intervention should be tailored for each patient.
Maria Azhar, MD
Network Member-at-Large
Saadia A. Faiz, MD FCCP
Section Steering Committee Chair
Airway disorders network: Asthma and COPD section
Betting on asthma: The over and under of diagnosis
Asthma is one of the major chronic respiratory diseases worldwide (WHO 2020), yet it is a clinical syndrome that lacks a consensus on its definition, is comprised of nonspecific respiratory symptoms, and is without a gold standard diagnostic test or a set guideline on confirmation of bronchial hyperresponsiveness (Sá-Sousa A et al. Clin Transl Allergy. 2014 Aug 4;4:24). In addition, once adequately treated, there is an absence of an algorithm to diagnose disease remission (Aaron SD et al. Am J Respir Crit Care Med. 2018 Oct 15;198[8]:1012-20). It is estimated that 20%-70% of people with asthma worldwide across the spectrum of all ages remain undiagnosed.
Spirometry and bronchoprovocation challenges with fixed cut-off values demonstrate reduced sensitivity with day-to-day, diurnal, and long-term variation in airflow obstruction, inflammation, and bronchial hyperresponsiveness (Wang R et al. Thorax. 2021 Jun;76[6]:624-31). Inflammatory biomarkers like fractional exhaled nitric oxide (FeNO) have higher specificity but are subject to diurnal variation and confounding diagnoses.
Overdiagnosis of asthma can result in lost opportunity to diagnose significant cardiopulmonary diseases, unnecessary escalation of the asthma treatment regimen for poorly controlled respiratory symptoms, potential for medication adverse effects, and, increased cost burden to the patient and to the health care system (Aaron SD et al. JAMA. 2017;317:269-79; Shaw D et al. Prim Care Respir J. 2012;21:283-7). Among the newly physician-diagnosed asthmatics, <50% have spirometry performed within 1 year of diagnosis (Sokol KC et al. Am J Med. 2015 May;128[5]:502-8). Spirometry was further underutilized with limit on aerosol-generating procedures during COVID-19 pandemic (Kankaanranta H et al. J Allergy Clin Immunol Pract. 2021 Dec;9[12]:4252-3); 30%-35% obese and nonobese patients with physician-diagnosed asthma did not have current asthma when objectively assessed for airflow limitation (Aaron SD et al. JAMA. 2017;317:269-79; van Huisstede A, et al. Respir Med. 2013;107:1356-64).
Clinical remission is greater in early-onset asthma as compared with late-onset asthma (De Marco R et al. J Allergy Clin Immunol. 2002;110:228-35). If asthma is well controlled, a stepping down treatment regimen is suggested (Global Initiative for Asthma 2021;Usmani et al. J Allergy Clin Immunol Pract. 2017 Sep-Oct;5[5]:1378-87.e5; Hagan JB et al. Allergy. 2014 Apr;69[4]:510-6), and although a randomized trial is lacking, it may be feasible to “undiagnose” patients who don’t experience clinical worsening, airflow obstruction, or bronchial hyperresponsiveness after being tapered off all asthma medications with a low relapse rate (Aaron SD et al. JAMA. 2017;317:269-79; J Fam Pract. 2018;67(11):704-7).
Asthma over- and underdiagnosis is prevalent and has clinical and global health consequences. New standardized algorithms with improved biomarkers may help alter this oversight.
Richa Nahar, MD
Network Member-at-Large
Allen J. Blaivas, DO, FCCP
Network Steering Committee Chair
Diffuse lung disease and lung transplant network: Interstitial lung disease section
Future therapies for IPF
Idiopathic pulmonary fibrosis (IPF) is a chronic lung disease characterized by progressive fibrosis, respiratory failure, and a mortality rate of 80% at 5 years. Only two drugs are currently FDA-approved for IPF treatment.
The antifibrotics pirfenidone and nintedanib reduce the rate of forced vital capacity (FVC) decline and improve progression free survival (King TE et al. N Engl J Med. 2014;370:2083-92; King TE et al. N Engl J Med. 2014;370:2071-82). While considered revolutionary when introduced, these medications neither reverse disease progression nor improve symptoms. More recently, the Galapagos ISABELA Phase III clinical trial of ziritaxestat in IPF was discontinued due to an unfavorable risk-benefit profile. Despite this, several prospects for IPF therapy exist.
Post hoc analysis of the INCREASE Trial demonstrated a positive effect of inhaled treprostinil on FVC in patients with IPF and group 3 pulmonary hypertension (Waxman A et al. N Engl J Med. 2021;384:325-34). Consequently, a phase 3 randomized trial investigating its safety and efficacy in patients with IPF alone is ongoing. Additional targeted therapies for IPF are also emerging. Recombinant human pentraxin-2, an inhibitor of monocyte differentiation into proinflammatory macrophages, and pamrevlumab, a recombinant human monoclonal antibody against connective tissue growth factor, both demonstrated attenuation of FVC decline compared with placebo in phase 2 trials. Both are currently in phase 3 studies (Raghu G et al. JAMA. 2018 Jun 12;319[22]:2299-307; Sgalla G et al. Expert Opin Investig Drugs. 2020 Aug;29[8]:771-7) Lastly, in February the Food and Drug Administration granted breakthrough therapy designation to BI 1015550 for treatment of IPF based on a 12-week phase 2 randomized, double-blind, placebo-controlled trial. (Data will be presented at ATS). BI 1015550 is an oral, phosphodiesterase 4B (PDE4B) inhibitor with both antifibrotic and anti-inflammatory properties. These advances in drug development provide hope for a future where IPF is transformed from a fatal disease to one manageable over many years.
Adrian Shifren, MD
Network Member-at-Large
Gabriel Schroeder, MD
Network Member-at-Large
Sleep medicine network: Home-based mechanical ventilation and neuromuscular section
Role of airway clearance therapies in neuromuscular disease
Individuals with neuromuscular weakness have an impaired ability to cough and clear secretions from the airway, which can result in atelectasis and pneumonia. Proximal airway clearance therapies (ACT), including manual lung volume recruitment (LVR) and mechanical in-exsufflation (MI-E), mobilize secretions, improve cough efficacy, maintain chest wall compliance, and slow progression of restrictive lung impairment (Chatwin et al. Respir Med. 2018;136:98-110; Sheers et al. Respirology. 2019;24:512-520).
ACT are recommended in international care guidelines for respiratory management of individuals with neuromuscular disease. At a recent Home-based Mechanical Ventilation and Neuromuscular Disease Section “PEEPS Talking PAP” rounds, participants discussed their approach to ACT. Practices varied by country and between adult/pediatric care providers. MI-E is most often used in the United States, but elsewhere in the world, LVR with a self-inflating bag and one-way valve is first-line therapy. Clinical care guidelines suggest initiation of regular ACT when cough peak flow is < 270 L/minute, forced vital capacity < 40%-60% predicted, or with subjectively weak cough (Hull et al. Thorax. 2012;67(7):654-655; Amin et al. Can J Resp Crit Care Sleep Med. 2017;1(1):7-36; McKim et al. Can Resp J. 2011;18(4):197-215; Birnkrant et al. Lancet Neurol. 2018;17(4):347-361; Sheehan et al. Pediatrics. 2018;142(Suppl 2):S62-s71).
Optimal timing for initiation of routine ACT, however, is not clear. A newly published randomized controlled trial of twice daily LVR in boys with Duchenne muscular dystrophy with relatively normal baseline lung function did not demonstrate a significant slowing of decline in forced vital capacity over 2 years. In individuals with preserved lung function, the burden of regular therapy may outweigh benefit (Katz et al. Thorax. 2022; doi: 10.1136/thoraxjnl-2021-218196). (While we are still learning about how best to apply this therapy in less advanced neuromuscular disease, ACT has demonstrated benefits during respiratory exacerbations, and routine use plays a role in preservation of lung function in more advanced disease (Katz et al. Ann Am Thorac Soc. 2016;13(2):217-222; McKim et al. Arch Phys Med Rehab. 2012;93(7):1117-1122; O’Sullivan et al. Arch Phys Med Rehabil. 2021;102(5):976-983; Bach et al. Am J Phys Med Rehab. 2008;87(9):720-725).
Sherri Katz, MD, FCCP
Section Steering Committee Chair
Critical care network: Mechanical ventilation and airways management section
NIV following extubation: Which devices and which patients?
For those of us interested in studying mechanical ventilation, an interesting paradox exists: despite our interest and enthusiasm in studying it, our patients benefit from avoiding it! Patients who require re-intubation are at high risk of in-hospital mortality (Frutos-Vivar et al. J Crit Care. 2011;26:502-9).
Studies in high-risk patients receiving mechanical ventilation have demonstrated that patients treated with immediate noninvasive ventilation (NIV) following extubation had reduced risk of re-intubation. CHEST guidelines focused on ventilator liberation considered these studies in a metanalysis which led to recommendations to employ NIV immediately after extubation in high-risk patients to reduce re-intubation rates (Ouellette D et al. Chest. 2017;151:166-80).
In the years since the publication of the CHEST guidelines, more information has been forthcoming. Evidence has emerged that treatment with high-flow nasal cannula devices following extubation may mitigate against re-intubation. An interesting strategy from the High-Wean Study Group suggested that postextubation combination therapy with both a high-flow cannula and NIV leads to improved outcomes compared with high-flow alone (Thille AW et al. JAMA. 2019;322:1465-75).
Thille and coworkers recently broadened our concept of patients who may benefit from NIV post extubation. They examined a cohort of obese patients requiring mechanical ventilation, finding that when patients were treated with NIV and high-flow nasal cannula post extubation, that they had a reduced risk of re-intubation compared with a group receiving high flow alone (Thille AW, et al. Am J Respir Crit Care Med. 2022;205:440-9).
As the incoming chair of the Mechanical Ventilation and Airways Management Section of the CHEST Critical Care Network, I look forward during the next 2 years to having interesting conversations about topics like this one and working with section members to develop exciting new projects concerning mechanical ventilation.
Daniel Ouellette, MD, MS, FCCP
Section Steering Committee Chair
Thoracic oncology and chest procedures network: Pleural disease section
Management of recurrent transudative pleural effusions (REDUCE trial)
Nonmalignant pleural effusions contribute significantly to health care costs and mortality (Mummadi SR et al. CHEST. 2021 Oct;160[4]:1534-51; Walker SP et al. CHEST. 2017 May;151[5]:1099-105). Management of transudative effusions has traditionally been to treat the underlying etiology. However, despite maximal medical therapies, these recurrent effusions may add to patients’ symptom burden and often create a challenge for the clinician. In 2017, the FDA approved the use of indwelling pleural catheters (IPC) in patients with recurrent transudative effusions, but data are limited.
In a recent prospective multicenter randomized control trial, Walker and colleagues (Eur Respir J. 2022 Feb;59:2101362) aimed to compare IPCs to repeated therapeutic thoracentesis (TT) in the management of transudative effusions. Pleural fluid etiologies included heart (68%), liver (24%), and renal failure (8%). The primary outcome was mean dyspnea score (daily visual analog scales) over 12 weeks, and there was no significant difference noted (39.7 vs. 45.0, mean difference –2.9 mm, 95% confidence interval [CI] –16.1 to 10.3; P = .67). Secondary outcomes demonstrated increased overall drainage in the IPC vs. TT group (17,412 mL vs. 2,901 mL, difference 13,892 mL, 95% CI, 7,669-20,116 mL; P < .001) and fewer invasive procedures required in the IPC group. Adverse events were noted in 59% of the IPC group compared with 37% managed with TT (OR, 3.13, 95% CI, 1.07-9.13, P = .04).
The REDUCE trial offers valuable data, but failure to meet primary outcome, study size, and adverse events highlight limitations to a definitive change in practice. Further study with specific-disease processes (ie, cardiac) may be helpful in the future. As in malignant pleural effusions, the selection of definitive pleural intervention should be tailored for each patient.
Maria Azhar, MD
Network Member-at-Large
Saadia A. Faiz, MD FCCP
Section Steering Committee Chair
This month in the journal CHEST®
Editor’s picks
Barriers and Enablers to Objective Testing for Asthma and COPD in Primary Care: A Systematic Review Using the Theoretical Domains Framework
By Dr. Janet Yamada et al.
COVID Complications: Diagnostic and Therapeutic Considerations for Critical Covid
By Dr. David M. Maslove et al.
Interstitial Lung Abnormalities, Emphysema, and Spirometry in Smokers
By Dr. Aravind A. Menon et al.
Sleep-Disordered Breathing in Hospitalized Patients: A Game Changer?
By Dr. Sunil Sharma and Dr. Robert Stansbury.
Distribution, Risk Factors, and Temporal Trends for Lung Cancer Incidence and Mortality: A Global Analysis
By Dr. Junjie Huang et al.
Editor’s picks
Editor’s picks
Barriers and Enablers to Objective Testing for Asthma and COPD in Primary Care: A Systematic Review Using the Theoretical Domains Framework
By Dr. Janet Yamada et al.
COVID Complications: Diagnostic and Therapeutic Considerations for Critical Covid
By Dr. David M. Maslove et al.
Interstitial Lung Abnormalities, Emphysema, and Spirometry in Smokers
By Dr. Aravind A. Menon et al.
Sleep-Disordered Breathing in Hospitalized Patients: A Game Changer?
By Dr. Sunil Sharma and Dr. Robert Stansbury.
Distribution, Risk Factors, and Temporal Trends for Lung Cancer Incidence and Mortality: A Global Analysis
By Dr. Junjie Huang et al.
Barriers and Enablers to Objective Testing for Asthma and COPD in Primary Care: A Systematic Review Using the Theoretical Domains Framework
By Dr. Janet Yamada et al.
COVID Complications: Diagnostic and Therapeutic Considerations for Critical Covid
By Dr. David M. Maslove et al.
Interstitial Lung Abnormalities, Emphysema, and Spirometry in Smokers
By Dr. Aravind A. Menon et al.
Sleep-Disordered Breathing in Hospitalized Patients: A Game Changer?
By Dr. Sunil Sharma and Dr. Robert Stansbury.
Distribution, Risk Factors, and Temporal Trends for Lung Cancer Incidence and Mortality: A Global Analysis
By Dr. Junjie Huang et al.
Take action: Turn up the heat on prior auth
In our recent member survey, 99% of respondents expressed that prior authorization has a negative impact on patients’ access to clinically appropriate treatments. We need to continue to put pressure on legislators to eliminate prior authorization burdens.
AGA endorses the Improving Seniors Timely Access to Care Act, which would streamline the prior authorization process in Medicare Advantage by approving in real-time commonly approved services and implementing a standardized electronic prior authorization process.
Despite large bipartisan support, we need your help getting this bill across the finish line! Please take five minutes to ask your Representative to cosponsor this necessary bill by participating in our campaign.
Go to the AGA action center to contact your lawmakers!
In our recent member survey, 99% of respondents expressed that prior authorization has a negative impact on patients’ access to clinically appropriate treatments. We need to continue to put pressure on legislators to eliminate prior authorization burdens.
AGA endorses the Improving Seniors Timely Access to Care Act, which would streamline the prior authorization process in Medicare Advantage by approving in real-time commonly approved services and implementing a standardized electronic prior authorization process.
Despite large bipartisan support, we need your help getting this bill across the finish line! Please take five minutes to ask your Representative to cosponsor this necessary bill by participating in our campaign.
Go to the AGA action center to contact your lawmakers!
In our recent member survey, 99% of respondents expressed that prior authorization has a negative impact on patients’ access to clinically appropriate treatments. We need to continue to put pressure on legislators to eliminate prior authorization burdens.
AGA endorses the Improving Seniors Timely Access to Care Act, which would streamline the prior authorization process in Medicare Advantage by approving in real-time commonly approved services and implementing a standardized electronic prior authorization process.
Despite large bipartisan support, we need your help getting this bill across the finish line! Please take five minutes to ask your Representative to cosponsor this necessary bill by participating in our campaign.
Go to the AGA action center to contact your lawmakers!
2022 AGA recognition prize award recipients
“AGA is proud to officially announce the exceptional individuals selected for 2022 AGA Recognition Prizes. I wish to thank all the nominators and those who provided nomination letters, and the selection committees for the tough task they had to select among the many superb nominees,” said Bishr Omary, MD, PhD, AGAF, chair of the AGA. “Please join us in congratulating this year’s distinguished awardees and applauding their contributions to the field of gastroenterology that advance our profession and the patients we serve.”
AGA looks forward to celebrating the recipients during Digestive Disease Week® 2022, May 21-24, in San Diego, Calif.
Meet and learn more about our award recipients here.
“AGA is proud to officially announce the exceptional individuals selected for 2022 AGA Recognition Prizes. I wish to thank all the nominators and those who provided nomination letters, and the selection committees for the tough task they had to select among the many superb nominees,” said Bishr Omary, MD, PhD, AGAF, chair of the AGA. “Please join us in congratulating this year’s distinguished awardees and applauding their contributions to the field of gastroenterology that advance our profession and the patients we serve.”
AGA looks forward to celebrating the recipients during Digestive Disease Week® 2022, May 21-24, in San Diego, Calif.
Meet and learn more about our award recipients here.
“AGA is proud to officially announce the exceptional individuals selected for 2022 AGA Recognition Prizes. I wish to thank all the nominators and those who provided nomination letters, and the selection committees for the tough task they had to select among the many superb nominees,” said Bishr Omary, MD, PhD, AGAF, chair of the AGA. “Please join us in congratulating this year’s distinguished awardees and applauding their contributions to the field of gastroenterology that advance our profession and the patients we serve.”
AGA looks forward to celebrating the recipients during Digestive Disease Week® 2022, May 21-24, in San Diego, Calif.
Meet and learn more about our award recipients here.
New governing board members
M. Bishr Omary, MD, PhD, AGAF, chair of the AGA Nominating Committee, is pleased to announce that Maria T. Abreu, MD, AGAF, joins the presidential line-up for AGA.
Vice President
Maria T. Abreu, MD, AGAF
Director, Crohn’s and Colitis Center
University of Miami
Maria T. Abreu, MD, AGAF, has more than 20 years of leadership experience in basic, translational, and clinical research and mentoring. She is AGA’s current councillor at-large, past chair of the AGA Institute Council, and an AGA Institute Council Section Research Mentor Award recipient (2020) for the IMIBD section. Dr. Abreu is also a recipient of the 2019 Sherman Prize by The Bruce and Cynthia Sherman Charitable Foundation that recognizes outstanding achievements in intestinal bowel disease.
Read her bio from the University of Miami.
The nominating committee also appointed the following slate of councillors which is subject to membership vote.
At-Large Councillor
Kim Barrett, PhD, AGAF
Vice dean for research
University of California, Davis
Kim Barrett, PhD, AGAF, is the current chair of the AGA Publications Committee, former chair of the AGA Ethics And Audit Committees, and served twice as director of the Academic Skills Workshop. She was recognized with AGA’s top research award, the AGA Distinguished Achievement Award in Basic Science (2021).
Her research interests have centered on the physiology and pathophysiology of the intestinal epithelium and their relevance to inflammatory bowel diseases and diarrheal diseases and have resulted in more than 300 publications.
Read her bio from UC Davis.
Councillor For Development And Growth
Lawrence Kosinski, MD, MBA, AGAF
Chief medical officer
SonarMD
A serial entrepreneur and thought leader in the world of value-based payment, Larry Kosinski, MD, MBA, AGAF, currently serves as chief medical officer of SonarMD, the leading value-based care coordination solution for complex chronic diseases. He founded SonarMD in 2014 to make it easier for specialists and patients to work together to manage symptomatic chronic illness and prevent clinical deterioration, improving health outcomes, and lowering the cost of care.
In 2021, Dr. Kosinski was selected for his expertise in value-based payment to serve on the Centers for Medicare & Medicaid Services’ Physician-Focused Payment Model Technical Advisory Committee and help develop bold, new Medicare payment models.
Read his bio from the SonarMD website.
Education & Training Councillor
Sheryl Pfeil, MD, AGAF
Medical director and professor of clinical medicine, Clinical Skills Education and Assessment Center
The Ohio State University Wexner Medical Center
Sheryl Pfeil, MD, AGAF, has been an AGA member for 30 years, serving on the Education And Training Committee, as past chair of the Academy of Educators, as cochair of the AGA future leaders program, and on the editorial board for Gastro Hep Advances. Dr. Pfeil has 30 years of experience in medical education, leading medical students, residents, and fellow education.
Her educational research interests include professional development, training and assessment methods, and virtual education.
Read her bio from The Ohio State University.
Pending approval by the voting membership, all board members begin their terms after DDW 2022. The voting membership will be sent a ballot to approve the slate of councillors on or before March 28, 2022, with a response date of no later than April 29, 2022. Results will be announced at the AGA Annual Business Meeting on June 1, 2022.
M. Bishr Omary, MD, PhD, AGAF, chair of the AGA Nominating Committee, is pleased to announce that Maria T. Abreu, MD, AGAF, joins the presidential line-up for AGA.
Vice President
Maria T. Abreu, MD, AGAF
Director, Crohn’s and Colitis Center
University of Miami
Maria T. Abreu, MD, AGAF, has more than 20 years of leadership experience in basic, translational, and clinical research and mentoring. She is AGA’s current councillor at-large, past chair of the AGA Institute Council, and an AGA Institute Council Section Research Mentor Award recipient (2020) for the IMIBD section. Dr. Abreu is also a recipient of the 2019 Sherman Prize by The Bruce and Cynthia Sherman Charitable Foundation that recognizes outstanding achievements in intestinal bowel disease.
Read her bio from the University of Miami.
The nominating committee also appointed the following slate of councillors which is subject to membership vote.
At-Large Councillor
Kim Barrett, PhD, AGAF
Vice dean for research
University of California, Davis
Kim Barrett, PhD, AGAF, is the current chair of the AGA Publications Committee, former chair of the AGA Ethics And Audit Committees, and served twice as director of the Academic Skills Workshop. She was recognized with AGA’s top research award, the AGA Distinguished Achievement Award in Basic Science (2021).
Her research interests have centered on the physiology and pathophysiology of the intestinal epithelium and their relevance to inflammatory bowel diseases and diarrheal diseases and have resulted in more than 300 publications.
Read her bio from UC Davis.
Councillor For Development And Growth
Lawrence Kosinski, MD, MBA, AGAF
Chief medical officer
SonarMD
A serial entrepreneur and thought leader in the world of value-based payment, Larry Kosinski, MD, MBA, AGAF, currently serves as chief medical officer of SonarMD, the leading value-based care coordination solution for complex chronic diseases. He founded SonarMD in 2014 to make it easier for specialists and patients to work together to manage symptomatic chronic illness and prevent clinical deterioration, improving health outcomes, and lowering the cost of care.
In 2021, Dr. Kosinski was selected for his expertise in value-based payment to serve on the Centers for Medicare & Medicaid Services’ Physician-Focused Payment Model Technical Advisory Committee and help develop bold, new Medicare payment models.
Read his bio from the SonarMD website.
Education & Training Councillor
Sheryl Pfeil, MD, AGAF
Medical director and professor of clinical medicine, Clinical Skills Education and Assessment Center
The Ohio State University Wexner Medical Center
Sheryl Pfeil, MD, AGAF, has been an AGA member for 30 years, serving on the Education And Training Committee, as past chair of the Academy of Educators, as cochair of the AGA future leaders program, and on the editorial board for Gastro Hep Advances. Dr. Pfeil has 30 years of experience in medical education, leading medical students, residents, and fellow education.
Her educational research interests include professional development, training and assessment methods, and virtual education.
Read her bio from The Ohio State University.
Pending approval by the voting membership, all board members begin their terms after DDW 2022. The voting membership will be sent a ballot to approve the slate of councillors on or before March 28, 2022, with a response date of no later than April 29, 2022. Results will be announced at the AGA Annual Business Meeting on June 1, 2022.
M. Bishr Omary, MD, PhD, AGAF, chair of the AGA Nominating Committee, is pleased to announce that Maria T. Abreu, MD, AGAF, joins the presidential line-up for AGA.
Vice President
Maria T. Abreu, MD, AGAF
Director, Crohn’s and Colitis Center
University of Miami
Maria T. Abreu, MD, AGAF, has more than 20 years of leadership experience in basic, translational, and clinical research and mentoring. She is AGA’s current councillor at-large, past chair of the AGA Institute Council, and an AGA Institute Council Section Research Mentor Award recipient (2020) for the IMIBD section. Dr. Abreu is also a recipient of the 2019 Sherman Prize by The Bruce and Cynthia Sherman Charitable Foundation that recognizes outstanding achievements in intestinal bowel disease.
Read her bio from the University of Miami.
The nominating committee also appointed the following slate of councillors which is subject to membership vote.
At-Large Councillor
Kim Barrett, PhD, AGAF
Vice dean for research
University of California, Davis
Kim Barrett, PhD, AGAF, is the current chair of the AGA Publications Committee, former chair of the AGA Ethics And Audit Committees, and served twice as director of the Academic Skills Workshop. She was recognized with AGA’s top research award, the AGA Distinguished Achievement Award in Basic Science (2021).
Her research interests have centered on the physiology and pathophysiology of the intestinal epithelium and their relevance to inflammatory bowel diseases and diarrheal diseases and have resulted in more than 300 publications.
Read her bio from UC Davis.
Councillor For Development And Growth
Lawrence Kosinski, MD, MBA, AGAF
Chief medical officer
SonarMD
A serial entrepreneur and thought leader in the world of value-based payment, Larry Kosinski, MD, MBA, AGAF, currently serves as chief medical officer of SonarMD, the leading value-based care coordination solution for complex chronic diseases. He founded SonarMD in 2014 to make it easier for specialists and patients to work together to manage symptomatic chronic illness and prevent clinical deterioration, improving health outcomes, and lowering the cost of care.
In 2021, Dr. Kosinski was selected for his expertise in value-based payment to serve on the Centers for Medicare & Medicaid Services’ Physician-Focused Payment Model Technical Advisory Committee and help develop bold, new Medicare payment models.
Read his bio from the SonarMD website.
Education & Training Councillor
Sheryl Pfeil, MD, AGAF
Medical director and professor of clinical medicine, Clinical Skills Education and Assessment Center
The Ohio State University Wexner Medical Center
Sheryl Pfeil, MD, AGAF, has been an AGA member for 30 years, serving on the Education And Training Committee, as past chair of the Academy of Educators, as cochair of the AGA future leaders program, and on the editorial board for Gastro Hep Advances. Dr. Pfeil has 30 years of experience in medical education, leading medical students, residents, and fellow education.
Her educational research interests include professional development, training and assessment methods, and virtual education.
Read her bio from The Ohio State University.
Pending approval by the voting membership, all board members begin their terms after DDW 2022. The voting membership will be sent a ballot to approve the slate of councillors on or before March 28, 2022, with a response date of no later than April 29, 2022. Results will be announced at the AGA Annual Business Meeting on June 1, 2022.
Five reasons to update your will
You have a will, so you can rest easy, right? Not necessarily. Even though it can provide for some contingencies, an old will can’t cover every change that may have occurred since it was first drawn. Professionals advise that you review your will every few years and more often if situations such as the following five have occurred since you last updated your will.
#1. Family changes
If you’ve had any changes in your family situation, you will probably need to update your will. Events such as marriage, divorce, death, birth, adoption, or a falling out with a loved one may affect how your estate will be distributed, who should act as guardian for your dependents, and who should be named as executor of your estate.
#2. Relocating to a new state
The laws among the states vary. Moving to a new state or purchasing property in another state can affect your estate plan and how property in that state will be taxed and distributed.
#3. Tax law changes
Federal and state legislatures are continually tinkering with federal estate and state inheritance tax laws. An old will may fail to take advantage of strategies that will minimize estate taxes.
#4. You want to support a favorite cause
If you have developed a connection to a cause, you may want to benefit a particular charity with a gift in your estate. Contact us for sample language you can share with your attorney to include a gift to us in your will.
#5. Changes in your estate’s value
When you made your will, your assets may have been relatively modest. Now the value may be larger and your will no longer reflects how you would like your estate divided.
Consider including a gift to the AGA Research Foundation in your will. You will help spark future discoveries in GI. Visit our website at https://gastro.planmylegacy.org or contact us at foundation@gastro.org.
You have a will, so you can rest easy, right? Not necessarily. Even though it can provide for some contingencies, an old will can’t cover every change that may have occurred since it was first drawn. Professionals advise that you review your will every few years and more often if situations such as the following five have occurred since you last updated your will.
#1. Family changes
If you’ve had any changes in your family situation, you will probably need to update your will. Events such as marriage, divorce, death, birth, adoption, or a falling out with a loved one may affect how your estate will be distributed, who should act as guardian for your dependents, and who should be named as executor of your estate.
#2. Relocating to a new state
The laws among the states vary. Moving to a new state or purchasing property in another state can affect your estate plan and how property in that state will be taxed and distributed.
#3. Tax law changes
Federal and state legislatures are continually tinkering with federal estate and state inheritance tax laws. An old will may fail to take advantage of strategies that will minimize estate taxes.
#4. You want to support a favorite cause
If you have developed a connection to a cause, you may want to benefit a particular charity with a gift in your estate. Contact us for sample language you can share with your attorney to include a gift to us in your will.
#5. Changes in your estate’s value
When you made your will, your assets may have been relatively modest. Now the value may be larger and your will no longer reflects how you would like your estate divided.
Consider including a gift to the AGA Research Foundation in your will. You will help spark future discoveries in GI. Visit our website at https://gastro.planmylegacy.org or contact us at foundation@gastro.org.
You have a will, so you can rest easy, right? Not necessarily. Even though it can provide for some contingencies, an old will can’t cover every change that may have occurred since it was first drawn. Professionals advise that you review your will every few years and more often if situations such as the following five have occurred since you last updated your will.
#1. Family changes
If you’ve had any changes in your family situation, you will probably need to update your will. Events such as marriage, divorce, death, birth, adoption, or a falling out with a loved one may affect how your estate will be distributed, who should act as guardian for your dependents, and who should be named as executor of your estate.
#2. Relocating to a new state
The laws among the states vary. Moving to a new state or purchasing property in another state can affect your estate plan and how property in that state will be taxed and distributed.
#3. Tax law changes
Federal and state legislatures are continually tinkering with federal estate and state inheritance tax laws. An old will may fail to take advantage of strategies that will minimize estate taxes.
#4. You want to support a favorite cause
If you have developed a connection to a cause, you may want to benefit a particular charity with a gift in your estate. Contact us for sample language you can share with your attorney to include a gift to us in your will.
#5. Changes in your estate’s value
When you made your will, your assets may have been relatively modest. Now the value may be larger and your will no longer reflects how you would like your estate divided.
Consider including a gift to the AGA Research Foundation in your will. You will help spark future discoveries in GI. Visit our website at https://gastro.planmylegacy.org or contact us at foundation@gastro.org.
Victor Test, MD, FCCP, receives Medal of Valor from AMA
The American Medical Association (AMA) honored CHEST Board Member Victor J. Test, MD, FCCP, with the AMA Medal of Valor for his work on behalf of patients and his community during the COVID-19 pandemic.
The award, which recognizes physicians who demonstrate courage under extraordinary circumstances, was presented to Dr. Test because of his quick decisive actions during the onset of the pandemic, including personally securing personal protective equipment to supply the critical care faculty and fellows at the Texas Tech University hospital in Lubbock and building plexiglass and PVC chambers for the physicians and nursing staff caring for patients with COVID-19.
Read more here.
The American Medical Association (AMA) honored CHEST Board Member Victor J. Test, MD, FCCP, with the AMA Medal of Valor for his work on behalf of patients and his community during the COVID-19 pandemic.
The award, which recognizes physicians who demonstrate courage under extraordinary circumstances, was presented to Dr. Test because of his quick decisive actions during the onset of the pandemic, including personally securing personal protective equipment to supply the critical care faculty and fellows at the Texas Tech University hospital in Lubbock and building plexiglass and PVC chambers for the physicians and nursing staff caring for patients with COVID-19.
Read more here.
The American Medical Association (AMA) honored CHEST Board Member Victor J. Test, MD, FCCP, with the AMA Medal of Valor for his work on behalf of patients and his community during the COVID-19 pandemic.
The award, which recognizes physicians who demonstrate courage under extraordinary circumstances, was presented to Dr. Test because of his quick decisive actions during the onset of the pandemic, including personally securing personal protective equipment to supply the critical care faculty and fellows at the Texas Tech University hospital in Lubbock and building plexiglass and PVC chambers for the physicians and nursing staff caring for patients with COVID-19.
Read more here.
Off to the races with The CHEST Foundation
The CHEST Foundation cordially invites CHEST members and colleagues, health care professionals, and others to champion lung health and attend the annual Belmont Stakes Dinner and Auction, Saturday, June 11, in New York at the beautiful Water Club overlooking the East River.
Hosted by CHEST President-Elect Doreen Addrizzo-Harris, MD, FCCP, this year’s celebration will include a lively cocktail reception, a silent and live auction, dinner, and a rooftop after-party for young professionals to network with colleagues and CHEST leadership and take the challenge for a chance to win great prizes, including a Peloton, ultrasound machine, and access to CHEST courses and events. Fully immerse yourself in the event, and wear your race-day best!
This year, we are honoring two outstanding patients and advocates, Betsy Glaeser and Fred Schick, for their remarkable achievements in patient empowerment and access. Glaeser, who was diagnosed with nontuberculous mycobacteria (disease NTM) more than 20 years ago, pioneered opportunities for NTM-specific research funding and runs a hundreds-strong support group for people with NTM and bronchiectasis. Schick, who has pulmonary fibrosis, is an active ambassador in the patient community in Chicago and also leads local support groups for others with the disease.
All proceeds from the evening’s events will benefit the CHEST Foundation’s continued work toward bringing impactful, informative resources to patients.
As the patient-focused philanthropic arm of the American College of Chest Physicians, the CHEST Foundation is on a mission to champion lung health and strives to give health care professionals, patients, and caregivers opportunities to come together, give back, and advocate for change.
Since its inception, the Foundation has provided more than $8 million in research grants and $3 million in community grants, created free patient education resources for more than 80 disease states, and provided thousands of units of personal protective equipment and $1 million for pandemic relief efforts through COVID-19 Reaction Microgrants.
Support the continued work of the Foundation – and watch some of the most exciting few minutes in sports among colleagues and friends – at this year’s Belmont Stakes Dinner and Auction. To purchase a ticket, or to learn more about sponsorship benefits or underwriting opportunities, contact Angela Perillo at aperillo@chestnet.org or +1 (224) 521-9520.
The CHEST Foundation cordially invites CHEST members and colleagues, health care professionals, and others to champion lung health and attend the annual Belmont Stakes Dinner and Auction, Saturday, June 11, in New York at the beautiful Water Club overlooking the East River.
Hosted by CHEST President-Elect Doreen Addrizzo-Harris, MD, FCCP, this year’s celebration will include a lively cocktail reception, a silent and live auction, dinner, and a rooftop after-party for young professionals to network with colleagues and CHEST leadership and take the challenge for a chance to win great prizes, including a Peloton, ultrasound machine, and access to CHEST courses and events. Fully immerse yourself in the event, and wear your race-day best!
This year, we are honoring two outstanding patients and advocates, Betsy Glaeser and Fred Schick, for their remarkable achievements in patient empowerment and access. Glaeser, who was diagnosed with nontuberculous mycobacteria (disease NTM) more than 20 years ago, pioneered opportunities for NTM-specific research funding and runs a hundreds-strong support group for people with NTM and bronchiectasis. Schick, who has pulmonary fibrosis, is an active ambassador in the patient community in Chicago and also leads local support groups for others with the disease.
All proceeds from the evening’s events will benefit the CHEST Foundation’s continued work toward bringing impactful, informative resources to patients.
As the patient-focused philanthropic arm of the American College of Chest Physicians, the CHEST Foundation is on a mission to champion lung health and strives to give health care professionals, patients, and caregivers opportunities to come together, give back, and advocate for change.
Since its inception, the Foundation has provided more than $8 million in research grants and $3 million in community grants, created free patient education resources for more than 80 disease states, and provided thousands of units of personal protective equipment and $1 million for pandemic relief efforts through COVID-19 Reaction Microgrants.
Support the continued work of the Foundation – and watch some of the most exciting few minutes in sports among colleagues and friends – at this year’s Belmont Stakes Dinner and Auction. To purchase a ticket, or to learn more about sponsorship benefits or underwriting opportunities, contact Angela Perillo at aperillo@chestnet.org or +1 (224) 521-9520.
The CHEST Foundation cordially invites CHEST members and colleagues, health care professionals, and others to champion lung health and attend the annual Belmont Stakes Dinner and Auction, Saturday, June 11, in New York at the beautiful Water Club overlooking the East River.
Hosted by CHEST President-Elect Doreen Addrizzo-Harris, MD, FCCP, this year’s celebration will include a lively cocktail reception, a silent and live auction, dinner, and a rooftop after-party for young professionals to network with colleagues and CHEST leadership and take the challenge for a chance to win great prizes, including a Peloton, ultrasound machine, and access to CHEST courses and events. Fully immerse yourself in the event, and wear your race-day best!
This year, we are honoring two outstanding patients and advocates, Betsy Glaeser and Fred Schick, for their remarkable achievements in patient empowerment and access. Glaeser, who was diagnosed with nontuberculous mycobacteria (disease NTM) more than 20 years ago, pioneered opportunities for NTM-specific research funding and runs a hundreds-strong support group for people with NTM and bronchiectasis. Schick, who has pulmonary fibrosis, is an active ambassador in the patient community in Chicago and also leads local support groups for others with the disease.
All proceeds from the evening’s events will benefit the CHEST Foundation’s continued work toward bringing impactful, informative resources to patients.
As the patient-focused philanthropic arm of the American College of Chest Physicians, the CHEST Foundation is on a mission to champion lung health and strives to give health care professionals, patients, and caregivers opportunities to come together, give back, and advocate for change.
Since its inception, the Foundation has provided more than $8 million in research grants and $3 million in community grants, created free patient education resources for more than 80 disease states, and provided thousands of units of personal protective equipment and $1 million for pandemic relief efforts through COVID-19 Reaction Microgrants.
Support the continued work of the Foundation – and watch some of the most exciting few minutes in sports among colleagues and friends – at this year’s Belmont Stakes Dinner and Auction. To purchase a ticket, or to learn more about sponsorship benefits or underwriting opportunities, contact Angela Perillo at aperillo@chestnet.org or +1 (224) 521-9520.