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Occupational and environmental health
Destruction in the air
Building collapse, such as that of the Surfside condominiums in Miami, Florida, results not only in tragic loss of life but also leads to devastating effects on lung health. Following the World Trade Center collapse, a massive particle dust cloud of up to 11,000 tons of PM2.5 was dispersed, 90% of which was particles greater than 10 mcm (Rom et al. Proc Am Thorac Soc. 2010 May;7[2]:142-5).
Fine particulate matter has been associated with multiple lung conditions. Those who arrive on site in the first 24 hours may have immediate changes in FEV1 and FVC. Acute eosinophilic pneumonia has also been described in the initial aftermath (Rom et al. Am J Respir Crit Care Med. 2002;166(6):785).
Chronic lung diseases such as chronic obstructive pulmonary disease and asthma, may worsen with repeated exposure. One Swedish study demonstrated an increased incidence of chronic lower respiratory disease in cement and demolition workers compared with the general labor force (Purdue et al. Thorax. 2007 Jan;62[1]:51-6). Clean-up sites may contain a variety of materials associated with occupational lung diseases, like chrysolite asbestos, silica, and heavy metals.
Prevention remains key. In the United States, the Occupational Safety and Health Administration requires all construction and demolition sites to have a dust control plan. Primary prevention includes the use of N-95 masks and watering sites. N-95 masks protect against particulate matter PM2.5 and smaller (Zhou et al. J Thorac Dis. 2018 Mar;10[3]:2059-69. Watering sites, while useful, can be challenging depending on the size and temperature of the area. Workers in high-risk occupations should have prior screening with pulmonary function testing. After an exposure, it is recommended pulmonary function testing be repeated, with close interval monitoring.
Disclaimer: The views expressed in this article are those of the author(s) and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or U.S. Government.
Tyler Church, DO
Jason Unger, MD
Fellow-in-training Members
Bathmapriya Balakrishnan, MD
Steering Committee Member
Palliative care and end of life
Empathy in the ICU
The importance of empathetic patient care has never seemed so significant with patients isolated from the standard support systems in a pandemic that has pushed health care to its limits. While empathy can clearly impact patient outcomes (Rakel DP et al. Fam Med. 2009;41[7]:494-501), the practicality of delivering empathic care is less well defined. Into this void step Dr. Jessica Bunin and colleagues (Bunin J et al. J Crit Care. 2021;29;65:156-63), who present a scoping review of the limited literature in an effort to address gaps in the practice of empathy. Perhaps unsurprising but most critically, the authors found that far from being a dichotomous construct, empathy is a “complex phenomenon” that exists on a continuum. It is inconsistently defined in the existing literature, with the inclusion of cognitive, affective, and somatic processes variable. Equally important, they identified that practicing empathy carries risk in addition to its beneficial applications for both patients and intensivists.
Far from being easily identifiable, measured, and taught, this concept of empathy as a nuanced and contextually charged skill that requires practice and reflection aligns it with other skills and tools used in the care of our critically ill patients. This group has suggested that a clear definition of empathy, transparent discussion of the risks and benefits of using empathy, attention to developing environments that minimize barriers and facilitate the practice of empathy in clinical care, and the growth of educational practice to promote attention to self-care in the use of empathy will overall benefit both patient and physician well-being. At the very least, we need to allow ourselves grace to fail and learn as we strive to provide empathic care for our patients and ourselves.
Laura Johnson, MD, FCCP
NetWork Ex-Officio
Respiratory care network
National campaign to address respiratory therapist shortage
As our population grows, hospitals and physician practices face a rapidly growing need for more specialized, high-quality respiratory care; but the numbers of respiratory therapists are not keeping pace. (U.S. Bureau of Labor Statistics. Occupational Outlook Handbook. Respiratory Therapists).
To inspire a new generation of respiratory therapists and promote this lifesaving profession, the American Association for Respiratory Care (AARC), the Commission on Accreditation for Respiratory Care (CoARC), and The National Board for Respiratory Care (NBRC) are pursuing a multiyear, national campaign called The World Needs More RTs. This campaign has three primary goals:
1. Enhance the value of the respiratory care profession.
2. Recruit and retain more respiratory therapists.
3. Shape future leadership in respiratory care.
There are factors behind the current and impending future inadequate numbers of respiratory therapists:
- Decrease in undergraduate enrollment.
- Increase in retirements.
- Escalation of burnout in health care.
This campaign aims to address these factors, enhance interest in the profession, and prevent further decline in RT numbers.
Respiratory therapists make an invaluable impact on patient care, and simply put, the world needs more RTs. More RTs are needed to provide lifesaving care in the critical care units, emergency departments, and clinics (Shaw RC, Benavente JL. AARC Human Resources Survey of Acute Care Hospital Employers. NBRC 2020). More RTs are needed to educate the next RT generation (Shaw RC, Benavente JL. AARC Human Resources Survey of Education Programs. NBRC 2020). To see how you can champion the campaign, visit MoreRTs.com.
Lori Tinkler, MBA
CEO, NBRC
Steering Committee Member
De De Gardner, DrPH, RRT, FCCP
Vice-Chair
Sleep disorders
COPD and sleep-disordered breathing: Updates and steps forward
The presence of sleep breathing disorders in individuals with COPD, in the form of COPD and OSA overlap syndrome (OVS) or chronic hypercarbic respiratory failure (CHRF), portend poor outcomes when untreated. Treatment of OVS and CHRF are among few interventions that positively impact mortality, readmission rates, and quality of life in patients with COPD.
Higher mortality and readmission rates are seen in those admitted with COPD exacerbations who have OVS compared with COPD alone. Initiation and adherence to PAP therapy decreases mortality and COPD-related hospitalizations (Ioachimescu OC et al. J Clin Sleep Med. 2020;16[2]:267-77; Singh G et al. Sleep Breath. 2019;23[1]:193).
In CHRF, initiation of high intensity noninvasive ventilation (NIV) at least 2 weeks after resolution of acute respiratory failure reduces mortality and prolongs time to readmission (Murphy PB et al. JAMA. 2017;317[21]:2177-86; Kohnlein T et al. Lancet Respir Med. 2014;2:698-705). Initiating home NIV in individuals with acute hypercarbic respiratory failure does not improve readmission rates or time to readmission (Struik FM et al. Thorax. 2014;69:826-34). The new ATS guidelines, therefore, recommend NIV initiation for stable CHRF in COPD, screening for OVS prior to NIV initiation, and targeting PaCO2 normalization (Macrea M et al. Am J Respir Crit Care Med. 2020;202[4]:e74-e87).
Identification and treatment of OVS and CHRF pose unique challenges for clinicians, particularly when navigating current testing and reimbursement guidelines. A multisociety Technical Expert Panel, including members of CHEST, has recently published its recommendations for changes to CMS national coverage determinations for NIV to take the next steps forward (Gay PC et al. Chest. 2021;S0012-3692[21]01481-1).
Megan Lowery, MD
Sreelatha Naik, MD
Steering Committee Members
Thoracic oncology
CHEST releases its newest edition of the tobacco treatment toolkit
Tobacco remains the greatest single cause of morbidity and mortality. Left unaddressed, tobacco is projected to kill 1 billion people worldwide this century. Despite this, only 5% of all tobacco-dependent patients in the United States receive both a medication and even minimal counseling for their addiction.
Tobacco dependence is a severe chronic life-threatening disease. It is with this focus that CHEST released its latest iteration of the Tobacco Dependence Treatment Toolkit. This edition focuses on treating tobacco addiction as a chronic disease, titrating all seven FDA-approved medications toward tobacco abstinence, and medical practice/hospital reimbursement.
The CHEST toolkit is divided into eight sections: Motivational Interviewing, Testing/Diagnostics, Treatment Basics (pharmacologic and nonpharmacologic), Treatment Pearls, Clinical Vignettes and Studies, Special Populations, Treatment for e-Cigarettes and Other Tobacco Products, and Insurance Billing and Telehealth.
Special attention is given to tobacco addiction diagnostics and using these findings to treat the chronic disease of tobacco addiction just like any other chronic disease by aggressively and successfully titrating FDA-approved medications in various permutations and combinations, as needed. The therapeutic goal is assisting the patient to feel normal, minimizing withdrawal throughout the process, so that tobacco abstinence can ultimately be obtained and maintained.
Clinicians and medical centers can receive insurance reimbursement for these diagnostics and associated interventions. This includes both in-office procedures and via telehealth. The CHEST toolkit discusses both in-depth.
A new unique associated feature is our Clinician Interactive Toolkit. This multimedia interactive platform reviews clinician interactions with a tobacco-dependent patient via avatars and can be found here: Clinician Interactive Toolkit.
https://foundation.chestnet.org/lung-health-a-z/smoking-and-tobacco-use/?Item=For-Clinicians
The American College of Chest Physicians’ Tobacco Treatment Toolkit can be downloaded here.
The American College of Chest Physicians’ Tobacco Treatment Toolkit project also included the development of a new video game for tobacco users. Smoke Out: Tobacco Pirates is available for download for free to all at the Apple App Store for iPhones and iPads, and at Google Play (play.google.com/store/apps/details?id=com.gforcelearning.smokeout&hl=en_US&gl=US). The game is fun, the theme is immersive, and the educational content is specifically focused on tobacco users, although clinicians will enjoy it too.
Matthew Bars, MS
Steering Committee Member
Occupational and environmental health
Destruction in the air
Building collapse, such as that of the Surfside condominiums in Miami, Florida, results not only in tragic loss of life but also leads to devastating effects on lung health. Following the World Trade Center collapse, a massive particle dust cloud of up to 11,000 tons of PM2.5 was dispersed, 90% of which was particles greater than 10 mcm (Rom et al. Proc Am Thorac Soc. 2010 May;7[2]:142-5).
Fine particulate matter has been associated with multiple lung conditions. Those who arrive on site in the first 24 hours may have immediate changes in FEV1 and FVC. Acute eosinophilic pneumonia has also been described in the initial aftermath (Rom et al. Am J Respir Crit Care Med. 2002;166(6):785).
Chronic lung diseases such as chronic obstructive pulmonary disease and asthma, may worsen with repeated exposure. One Swedish study demonstrated an increased incidence of chronic lower respiratory disease in cement and demolition workers compared with the general labor force (Purdue et al. Thorax. 2007 Jan;62[1]:51-6). Clean-up sites may contain a variety of materials associated with occupational lung diseases, like chrysolite asbestos, silica, and heavy metals.
Prevention remains key. In the United States, the Occupational Safety and Health Administration requires all construction and demolition sites to have a dust control plan. Primary prevention includes the use of N-95 masks and watering sites. N-95 masks protect against particulate matter PM2.5 and smaller (Zhou et al. J Thorac Dis. 2018 Mar;10[3]:2059-69. Watering sites, while useful, can be challenging depending on the size and temperature of the area. Workers in high-risk occupations should have prior screening with pulmonary function testing. After an exposure, it is recommended pulmonary function testing be repeated, with close interval monitoring.
Disclaimer: The views expressed in this article are those of the author(s) and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or U.S. Government.
Tyler Church, DO
Jason Unger, MD
Fellow-in-training Members
Bathmapriya Balakrishnan, MD
Steering Committee Member
Palliative care and end of life
Empathy in the ICU
The importance of empathetic patient care has never seemed so significant with patients isolated from the standard support systems in a pandemic that has pushed health care to its limits. While empathy can clearly impact patient outcomes (Rakel DP et al. Fam Med. 2009;41[7]:494-501), the practicality of delivering empathic care is less well defined. Into this void step Dr. Jessica Bunin and colleagues (Bunin J et al. J Crit Care. 2021;29;65:156-63), who present a scoping review of the limited literature in an effort to address gaps in the practice of empathy. Perhaps unsurprising but most critically, the authors found that far from being a dichotomous construct, empathy is a “complex phenomenon” that exists on a continuum. It is inconsistently defined in the existing literature, with the inclusion of cognitive, affective, and somatic processes variable. Equally important, they identified that practicing empathy carries risk in addition to its beneficial applications for both patients and intensivists.
Far from being easily identifiable, measured, and taught, this concept of empathy as a nuanced and contextually charged skill that requires practice and reflection aligns it with other skills and tools used in the care of our critically ill patients. This group has suggested that a clear definition of empathy, transparent discussion of the risks and benefits of using empathy, attention to developing environments that minimize barriers and facilitate the practice of empathy in clinical care, and the growth of educational practice to promote attention to self-care in the use of empathy will overall benefit both patient and physician well-being. At the very least, we need to allow ourselves grace to fail and learn as we strive to provide empathic care for our patients and ourselves.
Laura Johnson, MD, FCCP
NetWork Ex-Officio
Respiratory care network
National campaign to address respiratory therapist shortage
As our population grows, hospitals and physician practices face a rapidly growing need for more specialized, high-quality respiratory care; but the numbers of respiratory therapists are not keeping pace. (U.S. Bureau of Labor Statistics. Occupational Outlook Handbook. Respiratory Therapists).
To inspire a new generation of respiratory therapists and promote this lifesaving profession, the American Association for Respiratory Care (AARC), the Commission on Accreditation for Respiratory Care (CoARC), and The National Board for Respiratory Care (NBRC) are pursuing a multiyear, national campaign called The World Needs More RTs. This campaign has three primary goals:
1. Enhance the value of the respiratory care profession.
2. Recruit and retain more respiratory therapists.
3. Shape future leadership in respiratory care.
There are factors behind the current and impending future inadequate numbers of respiratory therapists:
- Decrease in undergraduate enrollment.
- Increase in retirements.
- Escalation of burnout in health care.
This campaign aims to address these factors, enhance interest in the profession, and prevent further decline in RT numbers.
Respiratory therapists make an invaluable impact on patient care, and simply put, the world needs more RTs. More RTs are needed to provide lifesaving care in the critical care units, emergency departments, and clinics (Shaw RC, Benavente JL. AARC Human Resources Survey of Acute Care Hospital Employers. NBRC 2020). More RTs are needed to educate the next RT generation (Shaw RC, Benavente JL. AARC Human Resources Survey of Education Programs. NBRC 2020). To see how you can champion the campaign, visit MoreRTs.com.
Lori Tinkler, MBA
CEO, NBRC
Steering Committee Member
De De Gardner, DrPH, RRT, FCCP
Vice-Chair
Sleep disorders
COPD and sleep-disordered breathing: Updates and steps forward
The presence of sleep breathing disorders in individuals with COPD, in the form of COPD and OSA overlap syndrome (OVS) or chronic hypercarbic respiratory failure (CHRF), portend poor outcomes when untreated. Treatment of OVS and CHRF are among few interventions that positively impact mortality, readmission rates, and quality of life in patients with COPD.
Higher mortality and readmission rates are seen in those admitted with COPD exacerbations who have OVS compared with COPD alone. Initiation and adherence to PAP therapy decreases mortality and COPD-related hospitalizations (Ioachimescu OC et al. J Clin Sleep Med. 2020;16[2]:267-77; Singh G et al. Sleep Breath. 2019;23[1]:193).
In CHRF, initiation of high intensity noninvasive ventilation (NIV) at least 2 weeks after resolution of acute respiratory failure reduces mortality and prolongs time to readmission (Murphy PB et al. JAMA. 2017;317[21]:2177-86; Kohnlein T et al. Lancet Respir Med. 2014;2:698-705). Initiating home NIV in individuals with acute hypercarbic respiratory failure does not improve readmission rates or time to readmission (Struik FM et al. Thorax. 2014;69:826-34). The new ATS guidelines, therefore, recommend NIV initiation for stable CHRF in COPD, screening for OVS prior to NIV initiation, and targeting PaCO2 normalization (Macrea M et al. Am J Respir Crit Care Med. 2020;202[4]:e74-e87).
Identification and treatment of OVS and CHRF pose unique challenges for clinicians, particularly when navigating current testing and reimbursement guidelines. A multisociety Technical Expert Panel, including members of CHEST, has recently published its recommendations for changes to CMS national coverage determinations for NIV to take the next steps forward (Gay PC et al. Chest. 2021;S0012-3692[21]01481-1).
Megan Lowery, MD
Sreelatha Naik, MD
Steering Committee Members
Thoracic oncology
CHEST releases its newest edition of the tobacco treatment toolkit
Tobacco remains the greatest single cause of morbidity and mortality. Left unaddressed, tobacco is projected to kill 1 billion people worldwide this century. Despite this, only 5% of all tobacco-dependent patients in the United States receive both a medication and even minimal counseling for their addiction.
Tobacco dependence is a severe chronic life-threatening disease. It is with this focus that CHEST released its latest iteration of the Tobacco Dependence Treatment Toolkit. This edition focuses on treating tobacco addiction as a chronic disease, titrating all seven FDA-approved medications toward tobacco abstinence, and medical practice/hospital reimbursement.
The CHEST toolkit is divided into eight sections: Motivational Interviewing, Testing/Diagnostics, Treatment Basics (pharmacologic and nonpharmacologic), Treatment Pearls, Clinical Vignettes and Studies, Special Populations, Treatment for e-Cigarettes and Other Tobacco Products, and Insurance Billing and Telehealth.
Special attention is given to tobacco addiction diagnostics and using these findings to treat the chronic disease of tobacco addiction just like any other chronic disease by aggressively and successfully titrating FDA-approved medications in various permutations and combinations, as needed. The therapeutic goal is assisting the patient to feel normal, minimizing withdrawal throughout the process, so that tobacco abstinence can ultimately be obtained and maintained.
Clinicians and medical centers can receive insurance reimbursement for these diagnostics and associated interventions. This includes both in-office procedures and via telehealth. The CHEST toolkit discusses both in-depth.
A new unique associated feature is our Clinician Interactive Toolkit. This multimedia interactive platform reviews clinician interactions with a tobacco-dependent patient via avatars and can be found here: Clinician Interactive Toolkit.
https://foundation.chestnet.org/lung-health-a-z/smoking-and-tobacco-use/?Item=For-Clinicians
The American College of Chest Physicians’ Tobacco Treatment Toolkit can be downloaded here.
The American College of Chest Physicians’ Tobacco Treatment Toolkit project also included the development of a new video game for tobacco users. Smoke Out: Tobacco Pirates is available for download for free to all at the Apple App Store for iPhones and iPads, and at Google Play (play.google.com/store/apps/details?id=com.gforcelearning.smokeout&hl=en_US&gl=US). The game is fun, the theme is immersive, and the educational content is specifically focused on tobacco users, although clinicians will enjoy it too.
Matthew Bars, MS
Steering Committee Member
Occupational and environmental health
Destruction in the air
Building collapse, such as that of the Surfside condominiums in Miami, Florida, results not only in tragic loss of life but also leads to devastating effects on lung health. Following the World Trade Center collapse, a massive particle dust cloud of up to 11,000 tons of PM2.5 was dispersed, 90% of which was particles greater than 10 mcm (Rom et al. Proc Am Thorac Soc. 2010 May;7[2]:142-5).
Fine particulate matter has been associated with multiple lung conditions. Those who arrive on site in the first 24 hours may have immediate changes in FEV1 and FVC. Acute eosinophilic pneumonia has also been described in the initial aftermath (Rom et al. Am J Respir Crit Care Med. 2002;166(6):785).
Chronic lung diseases such as chronic obstructive pulmonary disease and asthma, may worsen with repeated exposure. One Swedish study demonstrated an increased incidence of chronic lower respiratory disease in cement and demolition workers compared with the general labor force (Purdue et al. Thorax. 2007 Jan;62[1]:51-6). Clean-up sites may contain a variety of materials associated with occupational lung diseases, like chrysolite asbestos, silica, and heavy metals.
Prevention remains key. In the United States, the Occupational Safety and Health Administration requires all construction and demolition sites to have a dust control plan. Primary prevention includes the use of N-95 masks and watering sites. N-95 masks protect against particulate matter PM2.5 and smaller (Zhou et al. J Thorac Dis. 2018 Mar;10[3]:2059-69. Watering sites, while useful, can be challenging depending on the size and temperature of the area. Workers in high-risk occupations should have prior screening with pulmonary function testing. After an exposure, it is recommended pulmonary function testing be repeated, with close interval monitoring.
Disclaimer: The views expressed in this article are those of the author(s) and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or U.S. Government.
Tyler Church, DO
Jason Unger, MD
Fellow-in-training Members
Bathmapriya Balakrishnan, MD
Steering Committee Member
Palliative care and end of life
Empathy in the ICU
The importance of empathetic patient care has never seemed so significant with patients isolated from the standard support systems in a pandemic that has pushed health care to its limits. While empathy can clearly impact patient outcomes (Rakel DP et al. Fam Med. 2009;41[7]:494-501), the practicality of delivering empathic care is less well defined. Into this void step Dr. Jessica Bunin and colleagues (Bunin J et al. J Crit Care. 2021;29;65:156-63), who present a scoping review of the limited literature in an effort to address gaps in the practice of empathy. Perhaps unsurprising but most critically, the authors found that far from being a dichotomous construct, empathy is a “complex phenomenon” that exists on a continuum. It is inconsistently defined in the existing literature, with the inclusion of cognitive, affective, and somatic processes variable. Equally important, they identified that practicing empathy carries risk in addition to its beneficial applications for both patients and intensivists.
Far from being easily identifiable, measured, and taught, this concept of empathy as a nuanced and contextually charged skill that requires practice and reflection aligns it with other skills and tools used in the care of our critically ill patients. This group has suggested that a clear definition of empathy, transparent discussion of the risks and benefits of using empathy, attention to developing environments that minimize barriers and facilitate the practice of empathy in clinical care, and the growth of educational practice to promote attention to self-care in the use of empathy will overall benefit both patient and physician well-being. At the very least, we need to allow ourselves grace to fail and learn as we strive to provide empathic care for our patients and ourselves.
Laura Johnson, MD, FCCP
NetWork Ex-Officio
Respiratory care network
National campaign to address respiratory therapist shortage
As our population grows, hospitals and physician practices face a rapidly growing need for more specialized, high-quality respiratory care; but the numbers of respiratory therapists are not keeping pace. (U.S. Bureau of Labor Statistics. Occupational Outlook Handbook. Respiratory Therapists).
To inspire a new generation of respiratory therapists and promote this lifesaving profession, the American Association for Respiratory Care (AARC), the Commission on Accreditation for Respiratory Care (CoARC), and The National Board for Respiratory Care (NBRC) are pursuing a multiyear, national campaign called The World Needs More RTs. This campaign has three primary goals:
1. Enhance the value of the respiratory care profession.
2. Recruit and retain more respiratory therapists.
3. Shape future leadership in respiratory care.
There are factors behind the current and impending future inadequate numbers of respiratory therapists:
- Decrease in undergraduate enrollment.
- Increase in retirements.
- Escalation of burnout in health care.
This campaign aims to address these factors, enhance interest in the profession, and prevent further decline in RT numbers.
Respiratory therapists make an invaluable impact on patient care, and simply put, the world needs more RTs. More RTs are needed to provide lifesaving care in the critical care units, emergency departments, and clinics (Shaw RC, Benavente JL. AARC Human Resources Survey of Acute Care Hospital Employers. NBRC 2020). More RTs are needed to educate the next RT generation (Shaw RC, Benavente JL. AARC Human Resources Survey of Education Programs. NBRC 2020). To see how you can champion the campaign, visit MoreRTs.com.
Lori Tinkler, MBA
CEO, NBRC
Steering Committee Member
De De Gardner, DrPH, RRT, FCCP
Vice-Chair
Sleep disorders
COPD and sleep-disordered breathing: Updates and steps forward
The presence of sleep breathing disorders in individuals with COPD, in the form of COPD and OSA overlap syndrome (OVS) or chronic hypercarbic respiratory failure (CHRF), portend poor outcomes when untreated. Treatment of OVS and CHRF are among few interventions that positively impact mortality, readmission rates, and quality of life in patients with COPD.
Higher mortality and readmission rates are seen in those admitted with COPD exacerbations who have OVS compared with COPD alone. Initiation and adherence to PAP therapy decreases mortality and COPD-related hospitalizations (Ioachimescu OC et al. J Clin Sleep Med. 2020;16[2]:267-77; Singh G et al. Sleep Breath. 2019;23[1]:193).
In CHRF, initiation of high intensity noninvasive ventilation (NIV) at least 2 weeks after resolution of acute respiratory failure reduces mortality and prolongs time to readmission (Murphy PB et al. JAMA. 2017;317[21]:2177-86; Kohnlein T et al. Lancet Respir Med. 2014;2:698-705). Initiating home NIV in individuals with acute hypercarbic respiratory failure does not improve readmission rates or time to readmission (Struik FM et al. Thorax. 2014;69:826-34). The new ATS guidelines, therefore, recommend NIV initiation for stable CHRF in COPD, screening for OVS prior to NIV initiation, and targeting PaCO2 normalization (Macrea M et al. Am J Respir Crit Care Med. 2020;202[4]:e74-e87).
Identification and treatment of OVS and CHRF pose unique challenges for clinicians, particularly when navigating current testing and reimbursement guidelines. A multisociety Technical Expert Panel, including members of CHEST, has recently published its recommendations for changes to CMS national coverage determinations for NIV to take the next steps forward (Gay PC et al. Chest. 2021;S0012-3692[21]01481-1).
Megan Lowery, MD
Sreelatha Naik, MD
Steering Committee Members
Thoracic oncology
CHEST releases its newest edition of the tobacco treatment toolkit
Tobacco remains the greatest single cause of morbidity and mortality. Left unaddressed, tobacco is projected to kill 1 billion people worldwide this century. Despite this, only 5% of all tobacco-dependent patients in the United States receive both a medication and even minimal counseling for their addiction.
Tobacco dependence is a severe chronic life-threatening disease. It is with this focus that CHEST released its latest iteration of the Tobacco Dependence Treatment Toolkit. This edition focuses on treating tobacco addiction as a chronic disease, titrating all seven FDA-approved medications toward tobacco abstinence, and medical practice/hospital reimbursement.
The CHEST toolkit is divided into eight sections: Motivational Interviewing, Testing/Diagnostics, Treatment Basics (pharmacologic and nonpharmacologic), Treatment Pearls, Clinical Vignettes and Studies, Special Populations, Treatment for e-Cigarettes and Other Tobacco Products, and Insurance Billing and Telehealth.
Special attention is given to tobacco addiction diagnostics and using these findings to treat the chronic disease of tobacco addiction just like any other chronic disease by aggressively and successfully titrating FDA-approved medications in various permutations and combinations, as needed. The therapeutic goal is assisting the patient to feel normal, minimizing withdrawal throughout the process, so that tobacco abstinence can ultimately be obtained and maintained.
Clinicians and medical centers can receive insurance reimbursement for these diagnostics and associated interventions. This includes both in-office procedures and via telehealth. The CHEST toolkit discusses both in-depth.
A new unique associated feature is our Clinician Interactive Toolkit. This multimedia interactive platform reviews clinician interactions with a tobacco-dependent patient via avatars and can be found here: Clinician Interactive Toolkit.
https://foundation.chestnet.org/lung-health-a-z/smoking-and-tobacco-use/?Item=For-Clinicians
The American College of Chest Physicians’ Tobacco Treatment Toolkit can be downloaded here.
The American College of Chest Physicians’ Tobacco Treatment Toolkit project also included the development of a new video game for tobacco users. Smoke Out: Tobacco Pirates is available for download for free to all at the Apple App Store for iPhones and iPads, and at Google Play (play.google.com/store/apps/details?id=com.gforcelearning.smokeout&hl=en_US&gl=US). The game is fun, the theme is immersive, and the educational content is specifically focused on tobacco users, although clinicians will enjoy it too.
Matthew Bars, MS
Steering Committee Member