Interventional chest and diagnostic procedures

Risk stratification and management of pleural infections

Pleural infection carries a significant health care burden with an estimated mortality rate between 10% and 20% in adults. Standard of care for pleural infections has traditionally included antibiotics and tube thoracostomy, with select patients requiring a surgical intervention. The landmark MIST II trial demonstrated that combination intrapleural fibrinolytic and DNase therapy led to reduced length of stay and lower surgical referral rates compared with placebo.¹ While the use of combination intrapleural therapy has become common in the management of these patients, controversies still exist regarding nuances related to the various aspects of this therapy. A recent position paper published in Lancet Respiratory Medicine² addresses these knowledge gaps and provides recommendations to offer guidance in decision-making. The consensus statement by the authors addresses the topics of intrapleural monotherapy, dosing regimen, sequence of dosing, and cost considerations amongst other things. The authors also summarize evidence and discuss a surgery first vs. intrapleural enzyme therapy first approach based on stage of empyema and presence of surgical expertise and surgical candidacy. However, the debate between early surgical intervention vs early intrapleural enzyme therapy has not been settled yet. A large prospective randomized control trial is currently ongoing to help answer this question [https://doi.org/10.1186/ISRCTN18192121].

Meanwhile, there has been a lack of robust validated prediction methods for selecting high-risk patients at presentation with pleural infection for an early aggressive intervention. Based on previous studies, Rahman et al.³ had described the RAPID (Renal[urea], Age, fluid Purulence, Infection Source, Dietary [albumin]) score for risk stratification of these patients. Corcoran et al.⁴ recently conducted a prospective, observational study and validated that the RAPID risk category (Low-risk [0-2], Medium-risk [3-4], and High-risk [5-7]) can help predict mortality at 3 months. This score may prove to be a useful tool for future research directed at improving outcomes in patients with pleural infections.

Abhinav Agrawal, MD

Samaan Rafeq , MD

NetWork Members

References

1. Rahman NM, et al. N Engl J Med. 2011 Aug 11;365(6):518.

doi: 10.1056/NEJMoa1012740.

2. Chaddha U, et al. Lancet Respir Med. 2021. S2213-2600(20)30533-6. doi: 10.1016/S2213-2600(20)30533-6.

3. Rahman NM, et al. Chest. 2014 Apr;145(4):848. doi: 10.1378/chest.13-1558.

4. Corcoran JP, et al. Eur Respir J. 2020 Nov 26;56(5):2000130. doi: 10.1183/13993003.00130-2020.
 

Pediatric chest medicine

Appendicitis and COVID-19

During the 2020-21 year, there was an unprecedent amount of literature and studies released to the scientific and general public about the severe, acute respiratory Coronavirus 2 (SARS-CoV-2) syndrome, commonly referred to as COVID-19. The impressive focus on SARS-CoV-2 appeared appropriately featured given the public health concerns with contraction of the disease.

While it is important to understand the potential presentations, complications, and treatments in the adult population, clinicians must be aware of the impact of this disease on children. Contrary to reports early in the pandemic, SARS-CoV-2 infection can lead to serious complications in the pediatric population. One complication is a condition called multisystem inflammation syndrome in children (MIS-C) that can mimic Kawasaki disease or toxic shock syndrome. In addition to the expected common clinical presentation of respiratory symptoms and fever, gastrointestinal complaints were reported in up to 84% of the infected children. Gastrointestinal symptoms may be the only complaint in this population, typically presenting with nausea, emesis, abdominal pain, and diarrhea. The Pediatric Chest NetWork intends to highlight these gastrointestinal complaints and make clinicians aware of an appendicitis-like syndrome or even true acute appendicitis that seems to occur in association with SARS-CoV-2 infection. There is a handful of case reports and case series that discussed this phenomenon. Due to the overlap of presenting symptoms in SARS-CoV-2 infection and acute appendicitis, clinicians must astutely evaluate patients to prevent worsening complications of a missed diagnosed appendicitis.

Eric Mull, DO

NetWork Fellow-in-Training

Pulmonary physiology, function, and rehabilitation

Lung function testing during the COVID-19 pandemic

The COVID-19 pandemic poses unique challenges to caring for patients with established lung disease or new onset respiratory complaints. Although maneuvers differ across individual tests, most involve forced expiration or high ventilatory rates. They also tend to generate cough. Because the SARS-CoV-2 virus is predominantly spread via respiratory droplets, coughing, forced expiration, and high ventilatory rates will increase the risk for transmission.

Respiratory societies across the world have developed recommendations for operating a pulmonary function lab during the pandemic (Pulmonology. 2020 Aug 5;S2531-0437[20]30175-6; Ann Am Thorac Soc. 2020;17[11]:1343). In general, deferring all non-ssential testing and adjusting precautions and testing volume by local infection rates is recommended. Using proper personal protective equipment (PPE), including N95 respirators for staff, enhanced cleaning of rooms and PFT equipment (per manufacturer recommendations), and allowing time for adequate air exchange between tests are recommended practices. Screening for symptoms prior to testing is mandatory, with the recognition that for pulmonary patients, the specificity for COVID-19 will be poor. Finally, testing for SARS-CoV-2, generally within 72 hours, and using negative pressure rooms, has been encouraged by all, though there is variation by institution and resources.

It remains imperative that lung function labs provide a safe environment for patients and staff. However, delays related to deferrals and the increased turnover time required for cleaning and air circulation grow worse over time. As the pandemic persists, the mounting toll on our pulmonary patients looms large – so please, get vaccinated and use proper precautions.

Thomas Decato, MD, FCCP

Vice-Chair

Aaron Holley, MD, FCCP

NetWork Member

Pulmonary vascular disease

I screen, you screen, we all screen for ... PAH

Although rare in the general population, pulmonary arterial hypertension (PAH) occurs more frequently in connective tissue disease, congenital heart disease, HIV, portal hypertension, and in carriers of gene mutations of heritable PAH. Given the high morbidity and mortality, and improved outcomes with earlier diagnosis and treatment, guidelines recommend aggressive assessment and screening for PAH in these high-risk groups (Frost A, et al. Eur Respir J. 2019; 53:1801904).

Effective PAH screening algorithms have been developed in systemic sclerosis. The best validated screening tool is the DETECT algorithm (Coghlan JG, et al. Ann Rheum Dis. 2014;73:1340), which uses clinical, laboratory, and pulmonary function test parameters in conjunction with echocardiographic findings to recommend right heart catheterization (RHC) for PH diagnosis. Multimodal assessments are more sensitive than echocardiography alone in diagnosing PAH in systemic sclerosis (Hao Y, et al. Arthritis Res Ther. 2015;17:7) and should be developed in other at-risk cohorts.

Recently, the DELPHI-2 study prospectively screened 55 asymptomatic adult carriers of a BMPR2 mutation- the most common genetic mutation in heritable PAH- for minimum of 2 years (Montani D, et al. Eur Respir J. 2020 Dec 30;2004229. doi: 10.1183/13993003.04229-2020). Using predefined symptomatic, echocardiographic, and cardiopulmonary exercise testing criteria for referral for RHC, the incidence of PAH was 2.3% per year. This study lays the foundation for a multimodal approach to screening carriers of BMPR2 mutations and emphasizes the importance of genetic counseling for idiopathic and familial PAH patients to identify mutation carriers who stand to benefit from appropriate PAH screening.

Christopher J. Mullin, MD, MHS

Steering Committee Member

Interventional chest and diagnostic procedures

Risk stratification and management of pleural infections

Pleural infection carries a significant health care burden with an estimated mortality rate between 10% and 20% in adults. Standard of care for pleural infections has traditionally included antibiotics and tube thoracostomy, with select patients requiring a surgical intervention. The landmark MIST II trial demonstrated that combination intrapleural fibrinolytic and DNase therapy led to reduced length of stay and lower surgical referral rates compared with placebo.¹ While the use of combination intrapleural therapy has become common in the management of these patients, controversies still exist regarding nuances related to the various aspects of this therapy. A recent position paper published in Lancet Respiratory Medicine² addresses these knowledge gaps and provides recommendations to offer guidance in decision-making. The consensus statement by the authors addresses the topics of intrapleural monotherapy, dosing regimen, sequence of dosing, and cost considerations amongst other things. The authors also summarize evidence and discuss a surgery first vs. intrapleural enzyme therapy first approach based on stage of empyema and presence of surgical expertise and surgical candidacy. However, the debate between early surgical intervention vs early intrapleural enzyme therapy has not been settled yet. A large prospective randomized control trial is currently ongoing to help answer this question [https://doi.org/10.1186/ISRCTN18192121].

Meanwhile, there has been a lack of robust validated prediction methods for selecting high-risk patients at presentation with pleural infection for an early aggressive intervention. Based on previous studies, Rahman et al.³ had described the RAPID (Renal[urea], Age, fluid Purulence, Infection Source, Dietary [albumin]) score for risk stratification of these patients. Corcoran et al.⁴ recently conducted a prospective, observational study and validated that the RAPID risk category (Low-risk [0-2], Medium-risk [3-4], and High-risk [5-7]) can help predict mortality at 3 months. This score may prove to be a useful tool for future research directed at improving outcomes in patients with pleural infections.

Abhinav Agrawal, MD

Samaan Rafeq , MD

NetWork Members

References

1. Rahman NM, et al. N Engl J Med. 2011 Aug 11;365(6):518.

doi: 10.1056/NEJMoa1012740.

2. Chaddha U, et al. Lancet Respir Med. 2021. S2213-2600(20)30533-6. doi: 10.1016/S2213-2600(20)30533-6.

3. Rahman NM, et al. Chest. 2014 Apr;145(4):848. doi: 10.1378/chest.13-1558.

4. Corcoran JP, et al. Eur Respir J. 2020 Nov 26;56(5):2000130. doi: 10.1183/13993003.00130-2020.
 

Pediatric chest medicine

Appendicitis and COVID-19

During the 2020-21 year, there was an unprecedent amount of literature and studies released to the scientific and general public about the severe, acute respiratory Coronavirus 2 (SARS-CoV-2) syndrome, commonly referred to as COVID-19. The impressive focus on SARS-CoV-2 appeared appropriately featured given the public health concerns with contraction of the disease.

While it is important to understand the potential presentations, complications, and treatments in the adult population, clinicians must be aware of the impact of this disease on children. Contrary to reports early in the pandemic, SARS-CoV-2 infection can lead to serious complications in the pediatric population. One complication is a condition called multisystem inflammation syndrome in children (MIS-C) that can mimic Kawasaki disease or toxic shock syndrome. In addition to the expected common clinical presentation of respiratory symptoms and fever, gastrointestinal complaints were reported in up to 84% of the infected children. Gastrointestinal symptoms may be the only complaint in this population, typically presenting with nausea, emesis, abdominal pain, and diarrhea. The Pediatric Chest NetWork intends to highlight these gastrointestinal complaints and make clinicians aware of an appendicitis-like syndrome or even true acute appendicitis that seems to occur in association with SARS-CoV-2 infection. There is a handful of case reports and case series that discussed this phenomenon. Due to the overlap of presenting symptoms in SARS-CoV-2 infection and acute appendicitis, clinicians must astutely evaluate patients to prevent worsening complications of a missed diagnosed appendicitis.

Eric Mull, DO

NetWork Fellow-in-Training

Pulmonary physiology, function, and rehabilitation

Lung function testing during the COVID-19 pandemic

The COVID-19 pandemic poses unique challenges to caring for patients with established lung disease or new onset respiratory complaints. Although maneuvers differ across individual tests, most involve forced expiration or high ventilatory rates. They also tend to generate cough. Because the SARS-CoV-2 virus is predominantly spread via respiratory droplets, coughing, forced expiration, and high ventilatory rates will increase the risk for transmission.

Respiratory societies across the world have developed recommendations for operating a pulmonary function lab during the pandemic (Pulmonology. 2020 Aug 5;S2531-0437[20]30175-6; Ann Am Thorac Soc. 2020;17[11]:1343). In general, deferring all non-ssential testing and adjusting precautions and testing volume by local infection rates is recommended. Using proper personal protective equipment (PPE), including N95 respirators for staff, enhanced cleaning of rooms and PFT equipment (per manufacturer recommendations), and allowing time for adequate air exchange between tests are recommended practices. Screening for symptoms prior to testing is mandatory, with the recognition that for pulmonary patients, the specificity for COVID-19 will be poor. Finally, testing for SARS-CoV-2, generally within 72 hours, and using negative pressure rooms, has been encouraged by all, though there is variation by institution and resources.

It remains imperative that lung function labs provide a safe environment for patients and staff. However, delays related to deferrals and the increased turnover time required for cleaning and air circulation grow worse over time. As the pandemic persists, the mounting toll on our pulmonary patients looms large – so please, get vaccinated and use proper precautions.

Thomas Decato, MD, FCCP

Vice-Chair

Aaron Holley, MD, FCCP

NetWork Member

Pulmonary vascular disease

I screen, you screen, we all screen for ... PAH

Although rare in the general population, pulmonary arterial hypertension (PAH) occurs more frequently in connective tissue disease, congenital heart disease, HIV, portal hypertension, and in carriers of gene mutations of heritable PAH. Given the high morbidity and mortality, and improved outcomes with earlier diagnosis and treatment, guidelines recommend aggressive assessment and screening for PAH in these high-risk groups (Frost A, et al. Eur Respir J. 2019; 53:1801904).

Effective PAH screening algorithms have been developed in systemic sclerosis. The best validated screening tool is the DETECT algorithm (Coghlan JG, et al. Ann Rheum Dis. 2014;73:1340), which uses clinical, laboratory, and pulmonary function test parameters in conjunction with echocardiographic findings to recommend right heart catheterization (RHC) for PH diagnosis. Multimodal assessments are more sensitive than echocardiography alone in diagnosing PAH in systemic sclerosis (Hao Y, et al. Arthritis Res Ther. 2015;17:7) and should be developed in other at-risk cohorts.

Recently, the DELPHI-2 study prospectively screened 55 asymptomatic adult carriers of a BMPR2 mutation- the most common genetic mutation in heritable PAH- for minimum of 2 years (Montani D, et al. Eur Respir J. 2020 Dec 30;2004229. doi: 10.1183/13993003.04229-2020). Using predefined symptomatic, echocardiographic, and cardiopulmonary exercise testing criteria for referral for RHC, the incidence of PAH was 2.3% per year. This study lays the foundation for a multimodal approach to screening carriers of BMPR2 mutations and emphasizes the importance of genetic counseling for idiopathic and familial PAH patients to identify mutation carriers who stand to benefit from appropriate PAH screening.

Christopher J. Mullin, MD, MHS

Steering Committee Member

Interventional chest and diagnostic procedures

Risk stratification and management of pleural infections

Pleural infection carries a significant health care burden with an estimated mortality rate between 10% and 20% in adults. Standard of care for pleural infections has traditionally included antibiotics and tube thoracostomy, with select patients requiring a surgical intervention. The landmark MIST II trial demonstrated that combination intrapleural fibrinolytic and DNase therapy led to reduced length of stay and lower surgical referral rates compared with placebo.¹ While the use of combination intrapleural therapy has become common in the management of these patients, controversies still exist regarding nuances related to the various aspects of this therapy. A recent position paper published in Lancet Respiratory Medicine² addresses these knowledge gaps and provides recommendations to offer guidance in decision-making. The consensus statement by the authors addresses the topics of intrapleural monotherapy, dosing regimen, sequence of dosing, and cost considerations amongst other things. The authors also summarize evidence and discuss a surgery first vs. intrapleural enzyme therapy first approach based on stage of empyema and presence of surgical expertise and surgical candidacy. However, the debate between early surgical intervention vs early intrapleural enzyme therapy has not been settled yet. A large prospective randomized control trial is currently ongoing to help answer this question [https://doi.org/10.1186/ISRCTN18192121].

Meanwhile, there has been a lack of robust validated prediction methods for selecting high-risk patients at presentation with pleural infection for an early aggressive intervention. Based on previous studies, Rahman et al.³ had described the RAPID (Renal[urea], Age, fluid Purulence, Infection Source, Dietary [albumin]) score for risk stratification of these patients. Corcoran et al.⁴ recently conducted a prospective, observational study and validated that the RAPID risk category (Low-risk [0-2], Medium-risk [3-4], and High-risk [5-7]) can help predict mortality at 3 months. This score may prove to be a useful tool for future research directed at improving outcomes in patients with pleural infections.

Abhinav Agrawal, MD

Samaan Rafeq , MD

NetWork Members

References

1. Rahman NM, et al. N Engl J Med. 2011 Aug 11;365(6):518.

doi: 10.1056/NEJMoa1012740.

2. Chaddha U, et al. Lancet Respir Med. 2021. S2213-2600(20)30533-6. doi: 10.1016/S2213-2600(20)30533-6.

3. Rahman NM, et al. Chest. 2014 Apr;145(4):848. doi: 10.1378/chest.13-1558.

4. Corcoran JP, et al. Eur Respir J. 2020 Nov 26;56(5):2000130. doi: 10.1183/13993003.00130-2020.
 

Pediatric chest medicine

Appendicitis and COVID-19

During the 2020-21 year, there was an unprecedent amount of literature and studies released to the scientific and general public about the severe, acute respiratory Coronavirus 2 (SARS-CoV-2) syndrome, commonly referred to as COVID-19. The impressive focus on SARS-CoV-2 appeared appropriately featured given the public health concerns with contraction of the disease.

While it is important to understand the potential presentations, complications, and treatments in the adult population, clinicians must be aware of the impact of this disease on children. Contrary to reports early in the pandemic, SARS-CoV-2 infection can lead to serious complications in the pediatric population. One complication is a condition called multisystem inflammation syndrome in children (MIS-C) that can mimic Kawasaki disease or toxic shock syndrome. In addition to the expected common clinical presentation of respiratory symptoms and fever, gastrointestinal complaints were reported in up to 84% of the infected children. Gastrointestinal symptoms may be the only complaint in this population, typically presenting with nausea, emesis, abdominal pain, and diarrhea. The Pediatric Chest NetWork intends to highlight these gastrointestinal complaints and make clinicians aware of an appendicitis-like syndrome or even true acute appendicitis that seems to occur in association with SARS-CoV-2 infection. There is a handful of case reports and case series that discussed this phenomenon. Due to the overlap of presenting symptoms in SARS-CoV-2 infection and acute appendicitis, clinicians must astutely evaluate patients to prevent worsening complications of a missed diagnosed appendicitis.

Eric Mull, DO

NetWork Fellow-in-Training

Pulmonary physiology, function, and rehabilitation

Lung function testing during the COVID-19 pandemic

The COVID-19 pandemic poses unique challenges to caring for patients with established lung disease or new onset respiratory complaints. Although maneuvers differ across individual tests, most involve forced expiration or high ventilatory rates. They also tend to generate cough. Because the SARS-CoV-2 virus is predominantly spread via respiratory droplets, coughing, forced expiration, and high ventilatory rates will increase the risk for transmission.

Respiratory societies across the world have developed recommendations for operating a pulmonary function lab during the pandemic (Pulmonology. 2020 Aug 5;S2531-0437[20]30175-6; Ann Am Thorac Soc. 2020;17[11]:1343). In general, deferring all non-ssential testing and adjusting precautions and testing volume by local infection rates is recommended. Using proper personal protective equipment (PPE), including N95 respirators for staff, enhanced cleaning of rooms and PFT equipment (per manufacturer recommendations), and allowing time for adequate air exchange between tests are recommended practices. Screening for symptoms prior to testing is mandatory, with the recognition that for pulmonary patients, the specificity for COVID-19 will be poor. Finally, testing for SARS-CoV-2, generally within 72 hours, and using negative pressure rooms, has been encouraged by all, though there is variation by institution and resources.

It remains imperative that lung function labs provide a safe environment for patients and staff. However, delays related to deferrals and the increased turnover time required for cleaning and air circulation grow worse over time. As the pandemic persists, the mounting toll on our pulmonary patients looms large – so please, get vaccinated and use proper precautions.

Thomas Decato, MD, FCCP

Vice-Chair

Aaron Holley, MD, FCCP

NetWork Member

Pulmonary vascular disease

I screen, you screen, we all screen for ... PAH

Although rare in the general population, pulmonary arterial hypertension (PAH) occurs more frequently in connective tissue disease, congenital heart disease, HIV, portal hypertension, and in carriers of gene mutations of heritable PAH. Given the high morbidity and mortality, and improved outcomes with earlier diagnosis and treatment, guidelines recommend aggressive assessment and screening for PAH in these high-risk groups (Frost A, et al. Eur Respir J. 2019; 53:1801904).

Effective PAH screening algorithms have been developed in systemic sclerosis. The best validated screening tool is the DETECT algorithm (Coghlan JG, et al. Ann Rheum Dis. 2014;73:1340), which uses clinical, laboratory, and pulmonary function test parameters in conjunction with echocardiographic findings to recommend right heart catheterization (RHC) for PH diagnosis. Multimodal assessments are more sensitive than echocardiography alone in diagnosing PAH in systemic sclerosis (Hao Y, et al. Arthritis Res Ther. 2015;17:7) and should be developed in other at-risk cohorts.

Recently, the DELPHI-2 study prospectively screened 55 asymptomatic adult carriers of a BMPR2 mutation- the most common genetic mutation in heritable PAH- for minimum of 2 years (Montani D, et al. Eur Respir J. 2020 Dec 30;2004229. doi: 10.1183/13993003.04229-2020). Using predefined symptomatic, echocardiographic, and cardiopulmonary exercise testing criteria for referral for RHC, the incidence of PAH was 2.3% per year. This study lays the foundation for a multimodal approach to screening carriers of BMPR2 mutations and emphasizes the importance of genetic counseling for idiopathic and familial PAH patients to identify mutation carriers who stand to benefit from appropriate PAH screening.

Christopher J. Mullin, MD, MHS

Steering Committee Member

CHEST has been informed of the following deaths of CHEST members.

We extend our sincere condolences.

Noe Zamel, MD (2020)

Stuart Craig Lennox, MD (2018)

Teruo Hirose, MD, PhD, FCCP

Priscilla S. A Sarinas, MD, FCCP

Stephen Jenkinson, MD, FCCP (2021)

CHEST has been informed of the following deaths of CHEST members.

We extend our sincere condolences.

Noe Zamel, MD (2020)

Stuart Craig Lennox, MD (2018)

Teruo Hirose, MD, PhD, FCCP

Priscilla S. A Sarinas, MD, FCCP

Stephen Jenkinson, MD, FCCP (2021)

CHEST has been informed of the following deaths of CHEST members.

We extend our sincere condolences.

Noe Zamel, MD (2020)

Stuart Craig Lennox, MD (2018)

Teruo Hirose, MD, PhD, FCCP

Priscilla S. A Sarinas, MD, FCCP

Stephen Jenkinson, MD, FCCP (2021)

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused by the novel coronavirus of the year 2019 (COVID-19) has had a major impact on global health and economy. United States reported a total caseload of 28,998,834 patients and total mortality of 525,031 as of March 2021 (NPR.org; worldometer. Accessed March 8, 2021). The beginning of 2021 ushered positivity with the development of multiple highly effective SARS-CoV-2 vaccines. Although the medical world has gained much knowledge about this deadly disease, there are many unknowns and still much to be learned.

Two early landmark studies from Italy (Lombardy) and United States (New York City area) provided initial insight on comorbid conditions associated with increased risk of severe COVID-19 infection (Richardson S, et al. JAMA. 2020;323[20]:2052; Grasselli G, et al. JAMA Intern Med. 2020;180[10]:1345). In the United States cohort, hypertension (HTN), obesity, and diabetes (DM) were independent risk factors for severe disease, while in the Italy cohort, older age, male, COPD, hypercholesterolemia, and diabetes were independent risk factors for increased mortality. Obstructive sleep apnea (OSA) was not mentioned as a comorbid risk factor.

There is much speculation regarding OSA as an independent risk factor for severe COVID-19 infection. OSA is a common sleep-related breathing disorder with increased prevalence in men, older age, and higher body mass index (BMI); and OSA is associated with hypertension, obesity, and diabetes, all of which are risk factors for severe COVID-19. Because of the shared similarities in pathophysiology between OSA and COVID-19 (Tufik S, et al. J Clin Sleep Med. 2020;16[8]:1425), and shared comorbid conditions associated with increased risk of severe COVID-19 disease, OSA has been suggested as an independent risk factor for unfavorable COVID-19-related outcomes.

SARS-CoV-2 triggers a severe inflammatory response involving type-II pneumocytes and angiotensin-converting enzyme 2 pathway. OSA is characterized by intermittent hypoxia and sleep fragmentation, leading to a cascade of systemic inflammatory response involving oxidative stress, pro-inflammatory cytokines, endothelial dysfunction, and consequent cardiovascular injury (Jose RJ, et al. Lancet Respir Med. 2020;8[6]:e46; Saxena K, et al. Sleep Medicine. 2021;79:223). In this regard, OSA may contribute to COVID-19 “cytokine storm” by causing or exacerbating endothelial dysfunction, inflammation, and oxidative stress.

Multiple studies have recently been published on the impact of OSA on COVID-19 outcomes. The Coronavirus SARS-CoV-2 and Diabetes Outcomes (CORONADO) study was one of the initial studies that analyzed the relationship between OSA and COVID-19-related outcomes. This was a multicenter observational study involving diabetic patients hospitalized with COVID-19. The primary outcome was mechanical ventilation and/or death within 7 days of admission. Multivariate adjustment showed that age, BMI, and OSA, among other factors, were independently associated with risk of death on day 7 (Cariou B, et al. Diabetologia. 2020;63[8]:1500). Strausz and colleagues also evaluated OSA as an independent risk factor for severe COVID-19 in a large registry of hospital discharge patients (FinnGen study). The authors reported that although the risk of contracting COVID-19 was the same for patients with or without OSA, after adjusting for age, sex, and BMI, OSA was associated with higher risk of hospitalization (Strausz S, et al. BMJ Open Resp Res. 2021;8:e000845). Similar findings were confirmed by the Maas et al. study, which utilized a large socioeconomically diverse database composed of 10 hospital systems. Diagnoses and outcomes were identified by ICD-10 coding and medical record data. After adjustments for diabetes, HTN, and BMI, OSA conferred an eight-fold risk for COVID-19 infection, was associated with increased risk of hospitalization, and doubled the risk of developing respiratory failure (Maas MB, et al. Sleep Breath. 2020 Sep; 29:1-3. doi: 10.1007/s11325-020-02203-0).

Peker and colleagues conducted a prospective multicenter observational study comparing clinical outcomes of severe COVID-19 infection in patients with low vs high pretest probability of having OSA based on the Berlin questionnaire. The authors reported a clinically significant risk of poorer clinical outcomes in the high pretest probability OSA group after adjustments for age, sex, and comorbidities (Peker Y, et al. Ann Am Thorac Soc. 2021. Feb 17. doi: 10.1513/AnnalsATS.202011-1409OC). A timely meta-analysis including 21 studies (19 with retrospective design) with 54,276 COVID-19 patients and 4,640 OSA patients concluded poor composite outcomes including severe COVID-19, intensive care unit admission, mechanical ventilatory support, and death in association with OSA (OR – 1.72 95% CI 1.55-1.91, P< .00001). In patients with obesity, OSA is a highly prevalent co-morbid condition. BMI, however, was not adjusted in this model (Hariyanto TI, et al. Sleep Med. 2021. doi: 10.1016/j.sleep.2021.03.029).

Other studies have concluded the opposite with OSA not being an independent risk factor for severe COVID-19 infection. Cade and colleagues conducted a retrospective analysis from a comprehensive electronic health dataset using ICD codes to identify OSA patients with severe COVID-19 infection. A significant association between OSA and COVID-19 death was noted after adjustment for demographics (ethnicity, age, sex). However, when fully adjusted for demographics, BMI, asthma, COPD, HTN, or DM, OSA was not an independent risk factor for COVID-19-related mortality and hospitalization (Cade BE, et al. Am J Respir Crit Care Med. 2020;202[10]:1462). The FinnGen study (Strausz et al.) was part of a meta-analysis examining the association between OSA and severe COVID-19 with and without adjustments for BMI. This meta-analysis consisted of 15,835 COVID-19 patients including 1,294 with OSA. The authors found that OSA was a risk factor with a two-fold increased risk of severe COVID-19 infection (OR = 2.37, P = .021). However, after adjustments were made for BMI, this finding lost statistical significance (OR=1.55, P=.13) (Strausz S, et al. BMJ Open Resp Res. 2021;8:e000845).

It is worth noting that a majority of studies identified OSA by indirect and imperfect methods through chart review, ICD codes, and databases. Confirmed OSA based on formal testing with a sleep study in COVID-19 patients remains a challenge. Perhaps well performed screening questionnaires, such as STOP-Bang, Berlin, or NoSAS, can be utilized as was the case in one study. It is also unclear if outcomes of COVID-19 infection differ in patients with treated or untreated OSA, as raised by the CORONADO study. A recent cross-sectional telephone interview survey of patients with confirmed OSA in Iran alluded to higher prevalence of COVID-19 in patients with severe OSA with suggestion of lower prevalence in patients who were currently receiving OSA treatment with positive airway pressure (PAP) therapy (Najafi A, et al. Sleep Health. 2021 Feb;7[1]:14). This is a crucial question as PAP therapy is considered an aerosol-generating procedure (Lance CG. Cleve Clin J Med. 2020 May 5. doi: 10.3949/ccjm.87a.ccc003). Studies have suggested continued use of PAP therapy with additional measures to mitigate the spread of virus, since failure to use PAP could be deleterious to the patient’s quality of life. Interestingly, PAP adherence seemed to have improved during the pandemic as evidenced by a telephonic survey done in New York City that showed 88% of patients with OSA used a PAP device consistently (Attias D, et al. Eur Respir J. 2020 Jul 30;56[1]:2001607. doi: 10.1183/13993003.01607-2020).

In summary, the jury is still out on whether OSA is a facilitator for viral replication, or an independent risk factor for poor prognosis related to COVID-19 infection, or has no clinical relevance to COVID-19. COVID-19 and OSA share comorbidities and pathways leading to a systemic inflammatory cascade. Theoretically, it would make sense that OSA is a risk factor for severe COVID-19 infection; however, it remains to be proven. The recent studies are limited by retrospective and observational nature, imprecise OSA classification/diagnostic criteria, and confounded by difficult to control variables. Further research is needed to expand our understanding of OSA -induced intermittent hypoxemia, inflammation, and endothelial dysfunction that may play a role in COVID-19 morbidity and mortality. Until we have more clarity, close monitoring of OSA patients infected with COVID-19 is recommended along with implementation of safe protocols for continuation of PAP usage during the infectious phase. Identifying underlying comorbid conditions that contribute to worsening of a COVID-19 infectious course is a crucial step in improving clinical outcomes.
 

Dr. Sahni is Assistant Professor of Clinical Medicine, Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago. Dr. Cao is Clinical Associate Professor, Division of Sleep Medicine and Division of Neuromuscular Medicine, Department of Psychiatry and Department of Neurology, Stanford (Calif.) University.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused by the novel coronavirus of the year 2019 (COVID-19) has had a major impact on global health and economy. United States reported a total caseload of 28,998,834 patients and total mortality of 525,031 as of March 2021 (NPR.org; worldometer. Accessed March 8, 2021). The beginning of 2021 ushered positivity with the development of multiple highly effective SARS-CoV-2 vaccines. Although the medical world has gained much knowledge about this deadly disease, there are many unknowns and still much to be learned.

Two early landmark studies from Italy (Lombardy) and United States (New York City area) provided initial insight on comorbid conditions associated with increased risk of severe COVID-19 infection (Richardson S, et al. JAMA. 2020;323[20]:2052; Grasselli G, et al. JAMA Intern Med. 2020;180[10]:1345). In the United States cohort, hypertension (HTN), obesity, and diabetes (DM) were independent risk factors for severe disease, while in the Italy cohort, older age, male, COPD, hypercholesterolemia, and diabetes were independent risk factors for increased mortality. Obstructive sleep apnea (OSA) was not mentioned as a comorbid risk factor.

There is much speculation regarding OSA as an independent risk factor for severe COVID-19 infection. OSA is a common sleep-related breathing disorder with increased prevalence in men, older age, and higher body mass index (BMI); and OSA is associated with hypertension, obesity, and diabetes, all of which are risk factors for severe COVID-19. Because of the shared similarities in pathophysiology between OSA and COVID-19 (Tufik S, et al. J Clin Sleep Med. 2020;16[8]:1425), and shared comorbid conditions associated with increased risk of severe COVID-19 disease, OSA has been suggested as an independent risk factor for unfavorable COVID-19-related outcomes.

SARS-CoV-2 triggers a severe inflammatory response involving type-II pneumocytes and angiotensin-converting enzyme 2 pathway. OSA is characterized by intermittent hypoxia and sleep fragmentation, leading to a cascade of systemic inflammatory response involving oxidative stress, pro-inflammatory cytokines, endothelial dysfunction, and consequent cardiovascular injury (Jose RJ, et al. Lancet Respir Med. 2020;8[6]:e46; Saxena K, et al. Sleep Medicine. 2021;79:223). In this regard, OSA may contribute to COVID-19 “cytokine storm” by causing or exacerbating endothelial dysfunction, inflammation, and oxidative stress.

Multiple studies have recently been published on the impact of OSA on COVID-19 outcomes. The Coronavirus SARS-CoV-2 and Diabetes Outcomes (CORONADO) study was one of the initial studies that analyzed the relationship between OSA and COVID-19-related outcomes. This was a multicenter observational study involving diabetic patients hospitalized with COVID-19. The primary outcome was mechanical ventilation and/or death within 7 days of admission. Multivariate adjustment showed that age, BMI, and OSA, among other factors, were independently associated with risk of death on day 7 (Cariou B, et al. Diabetologia. 2020;63[8]:1500). Strausz and colleagues also evaluated OSA as an independent risk factor for severe COVID-19 in a large registry of hospital discharge patients (FinnGen study). The authors reported that although the risk of contracting COVID-19 was the same for patients with or without OSA, after adjusting for age, sex, and BMI, OSA was associated with higher risk of hospitalization (Strausz S, et al. BMJ Open Resp Res. 2021;8:e000845). Similar findings were confirmed by the Maas et al. study, which utilized a large socioeconomically diverse database composed of 10 hospital systems. Diagnoses and outcomes were identified by ICD-10 coding and medical record data. After adjustments for diabetes, HTN, and BMI, OSA conferred an eight-fold risk for COVID-19 infection, was associated with increased risk of hospitalization, and doubled the risk of developing respiratory failure (Maas MB, et al. Sleep Breath. 2020 Sep; 29:1-3. doi: 10.1007/s11325-020-02203-0).

Peker and colleagues conducted a prospective multicenter observational study comparing clinical outcomes of severe COVID-19 infection in patients with low vs high pretest probability of having OSA based on the Berlin questionnaire. The authors reported a clinically significant risk of poorer clinical outcomes in the high pretest probability OSA group after adjustments for age, sex, and comorbidities (Peker Y, et al. Ann Am Thorac Soc. 2021. Feb 17. doi: 10.1513/AnnalsATS.202011-1409OC). A timely meta-analysis including 21 studies (19 with retrospective design) with 54,276 COVID-19 patients and 4,640 OSA patients concluded poor composite outcomes including severe COVID-19, intensive care unit admission, mechanical ventilatory support, and death in association with OSA (OR – 1.72 95% CI 1.55-1.91, P< .00001). In patients with obesity, OSA is a highly prevalent co-morbid condition. BMI, however, was not adjusted in this model (Hariyanto TI, et al. Sleep Med. 2021. doi: 10.1016/j.sleep.2021.03.029).

Other studies have concluded the opposite with OSA not being an independent risk factor for severe COVID-19 infection. Cade and colleagues conducted a retrospective analysis from a comprehensive electronic health dataset using ICD codes to identify OSA patients with severe COVID-19 infection. A significant association between OSA and COVID-19 death was noted after adjustment for demographics (ethnicity, age, sex). However, when fully adjusted for demographics, BMI, asthma, COPD, HTN, or DM, OSA was not an independent risk factor for COVID-19-related mortality and hospitalization (Cade BE, et al. Am J Respir Crit Care Med. 2020;202[10]:1462). The FinnGen study (Strausz et al.) was part of a meta-analysis examining the association between OSA and severe COVID-19 with and without adjustments for BMI. This meta-analysis consisted of 15,835 COVID-19 patients including 1,294 with OSA. The authors found that OSA was a risk factor with a two-fold increased risk of severe COVID-19 infection (OR = 2.37, P = .021). However, after adjustments were made for BMI, this finding lost statistical significance (OR=1.55, P=.13) (Strausz S, et al. BMJ Open Resp Res. 2021;8:e000845).

It is worth noting that a majority of studies identified OSA by indirect and imperfect methods through chart review, ICD codes, and databases. Confirmed OSA based on formal testing with a sleep study in COVID-19 patients remains a challenge. Perhaps well performed screening questionnaires, such as STOP-Bang, Berlin, or NoSAS, can be utilized as was the case in one study. It is also unclear if outcomes of COVID-19 infection differ in patients with treated or untreated OSA, as raised by the CORONADO study. A recent cross-sectional telephone interview survey of patients with confirmed OSA in Iran alluded to higher prevalence of COVID-19 in patients with severe OSA with suggestion of lower prevalence in patients who were currently receiving OSA treatment with positive airway pressure (PAP) therapy (Najafi A, et al. Sleep Health. 2021 Feb;7[1]:14). This is a crucial question as PAP therapy is considered an aerosol-generating procedure (Lance CG. Cleve Clin J Med. 2020 May 5. doi: 10.3949/ccjm.87a.ccc003). Studies have suggested continued use of PAP therapy with additional measures to mitigate the spread of virus, since failure to use PAP could be deleterious to the patient’s quality of life. Interestingly, PAP adherence seemed to have improved during the pandemic as evidenced by a telephonic survey done in New York City that showed 88% of patients with OSA used a PAP device consistently (Attias D, et al. Eur Respir J. 2020 Jul 30;56[1]:2001607. doi: 10.1183/13993003.01607-2020).

In summary, the jury is still out on whether OSA is a facilitator for viral replication, or an independent risk factor for poor prognosis related to COVID-19 infection, or has no clinical relevance to COVID-19. COVID-19 and OSA share comorbidities and pathways leading to a systemic inflammatory cascade. Theoretically, it would make sense that OSA is a risk factor for severe COVID-19 infection; however, it remains to be proven. The recent studies are limited by retrospective and observational nature, imprecise OSA classification/diagnostic criteria, and confounded by difficult to control variables. Further research is needed to expand our understanding of OSA -induced intermittent hypoxemia, inflammation, and endothelial dysfunction that may play a role in COVID-19 morbidity and mortality. Until we have more clarity, close monitoring of OSA patients infected with COVID-19 is recommended along with implementation of safe protocols for continuation of PAP usage during the infectious phase. Identifying underlying comorbid conditions that contribute to worsening of a COVID-19 infectious course is a crucial step in improving clinical outcomes.
 

Dr. Sahni is Assistant Professor of Clinical Medicine, Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago. Dr. Cao is Clinical Associate Professor, Division of Sleep Medicine and Division of Neuromuscular Medicine, Department of Psychiatry and Department of Neurology, Stanford (Calif.) University.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused by the novel coronavirus of the year 2019 (COVID-19) has had a major impact on global health and economy. United States reported a total caseload of 28,998,834 patients and total mortality of 525,031 as of March 2021 (NPR.org; worldometer. Accessed March 8, 2021). The beginning of 2021 ushered positivity with the development of multiple highly effective SARS-CoV-2 vaccines. Although the medical world has gained much knowledge about this deadly disease, there are many unknowns and still much to be learned.

Two early landmark studies from Italy (Lombardy) and United States (New York City area) provided initial insight on comorbid conditions associated with increased risk of severe COVID-19 infection (Richardson S, et al. JAMA. 2020;323[20]:2052; Grasselli G, et al. JAMA Intern Med. 2020;180[10]:1345). In the United States cohort, hypertension (HTN), obesity, and diabetes (DM) were independent risk factors for severe disease, while in the Italy cohort, older age, male, COPD, hypercholesterolemia, and diabetes were independent risk factors for increased mortality. Obstructive sleep apnea (OSA) was not mentioned as a comorbid risk factor.

There is much speculation regarding OSA as an independent risk factor for severe COVID-19 infection. OSA is a common sleep-related breathing disorder with increased prevalence in men, older age, and higher body mass index (BMI); and OSA is associated with hypertension, obesity, and diabetes, all of which are risk factors for severe COVID-19. Because of the shared similarities in pathophysiology between OSA and COVID-19 (Tufik S, et al. J Clin Sleep Med. 2020;16[8]:1425), and shared comorbid conditions associated with increased risk of severe COVID-19 disease, OSA has been suggested as an independent risk factor for unfavorable COVID-19-related outcomes.

SARS-CoV-2 triggers a severe inflammatory response involving type-II pneumocytes and angiotensin-converting enzyme 2 pathway. OSA is characterized by intermittent hypoxia and sleep fragmentation, leading to a cascade of systemic inflammatory response involving oxidative stress, pro-inflammatory cytokines, endothelial dysfunction, and consequent cardiovascular injury (Jose RJ, et al. Lancet Respir Med. 2020;8[6]:e46; Saxena K, et al. Sleep Medicine. 2021;79:223). In this regard, OSA may contribute to COVID-19 “cytokine storm” by causing or exacerbating endothelial dysfunction, inflammation, and oxidative stress.

Multiple studies have recently been published on the impact of OSA on COVID-19 outcomes. The Coronavirus SARS-CoV-2 and Diabetes Outcomes (CORONADO) study was one of the initial studies that analyzed the relationship between OSA and COVID-19-related outcomes. This was a multicenter observational study involving diabetic patients hospitalized with COVID-19. The primary outcome was mechanical ventilation and/or death within 7 days of admission. Multivariate adjustment showed that age, BMI, and OSA, among other factors, were independently associated with risk of death on day 7 (Cariou B, et al. Diabetologia. 2020;63[8]:1500). Strausz and colleagues also evaluated OSA as an independent risk factor for severe COVID-19 in a large registry of hospital discharge patients (FinnGen study). The authors reported that although the risk of contracting COVID-19 was the same for patients with or without OSA, after adjusting for age, sex, and BMI, OSA was associated with higher risk of hospitalization (Strausz S, et al. BMJ Open Resp Res. 2021;8:e000845). Similar findings were confirmed by the Maas et al. study, which utilized a large socioeconomically diverse database composed of 10 hospital systems. Diagnoses and outcomes were identified by ICD-10 coding and medical record data. After adjustments for diabetes, HTN, and BMI, OSA conferred an eight-fold risk for COVID-19 infection, was associated with increased risk of hospitalization, and doubled the risk of developing respiratory failure (Maas MB, et al. Sleep Breath. 2020 Sep; 29:1-3. doi: 10.1007/s11325-020-02203-0).

Peker and colleagues conducted a prospective multicenter observational study comparing clinical outcomes of severe COVID-19 infection in patients with low vs high pretest probability of having OSA based on the Berlin questionnaire. The authors reported a clinically significant risk of poorer clinical outcomes in the high pretest probability OSA group after adjustments for age, sex, and comorbidities (Peker Y, et al. Ann Am Thorac Soc. 2021. Feb 17. doi: 10.1513/AnnalsATS.202011-1409OC). A timely meta-analysis including 21 studies (19 with retrospective design) with 54,276 COVID-19 patients and 4,640 OSA patients concluded poor composite outcomes including severe COVID-19, intensive care unit admission, mechanical ventilatory support, and death in association with OSA (OR – 1.72 95% CI 1.55-1.91, P< .00001). In patients with obesity, OSA is a highly prevalent co-morbid condition. BMI, however, was not adjusted in this model (Hariyanto TI, et al. Sleep Med. 2021. doi: 10.1016/j.sleep.2021.03.029).

Other studies have concluded the opposite with OSA not being an independent risk factor for severe COVID-19 infection. Cade and colleagues conducted a retrospective analysis from a comprehensive electronic health dataset using ICD codes to identify OSA patients with severe COVID-19 infection. A significant association between OSA and COVID-19 death was noted after adjustment for demographics (ethnicity, age, sex). However, when fully adjusted for demographics, BMI, asthma, COPD, HTN, or DM, OSA was not an independent risk factor for COVID-19-related mortality and hospitalization (Cade BE, et al. Am J Respir Crit Care Med. 2020;202[10]:1462). The FinnGen study (Strausz et al.) was part of a meta-analysis examining the association between OSA and severe COVID-19 with and without adjustments for BMI. This meta-analysis consisted of 15,835 COVID-19 patients including 1,294 with OSA. The authors found that OSA was a risk factor with a two-fold increased risk of severe COVID-19 infection (OR = 2.37, P = .021). However, after adjustments were made for BMI, this finding lost statistical significance (OR=1.55, P=.13) (Strausz S, et al. BMJ Open Resp Res. 2021;8:e000845).

It is worth noting that a majority of studies identified OSA by indirect and imperfect methods through chart review, ICD codes, and databases. Confirmed OSA based on formal testing with a sleep study in COVID-19 patients remains a challenge. Perhaps well performed screening questionnaires, such as STOP-Bang, Berlin, or NoSAS, can be utilized as was the case in one study. It is also unclear if outcomes of COVID-19 infection differ in patients with treated or untreated OSA, as raised by the CORONADO study. A recent cross-sectional telephone interview survey of patients with confirmed OSA in Iran alluded to higher prevalence of COVID-19 in patients with severe OSA with suggestion of lower prevalence in patients who were currently receiving OSA treatment with positive airway pressure (PAP) therapy (Najafi A, et al. Sleep Health. 2021 Feb;7[1]:14). This is a crucial question as PAP therapy is considered an aerosol-generating procedure (Lance CG. Cleve Clin J Med. 2020 May 5. doi: 10.3949/ccjm.87a.ccc003). Studies have suggested continued use of PAP therapy with additional measures to mitigate the spread of virus, since failure to use PAP could be deleterious to the patient’s quality of life. Interestingly, PAP adherence seemed to have improved during the pandemic as evidenced by a telephonic survey done in New York City that showed 88% of patients with OSA used a PAP device consistently (Attias D, et al. Eur Respir J. 2020 Jul 30;56[1]:2001607. doi: 10.1183/13993003.01607-2020).

In summary, the jury is still out on whether OSA is a facilitator for viral replication, or an independent risk factor for poor prognosis related to COVID-19 infection, or has no clinical relevance to COVID-19. COVID-19 and OSA share comorbidities and pathways leading to a systemic inflammatory cascade. Theoretically, it would make sense that OSA is a risk factor for severe COVID-19 infection; however, it remains to be proven. The recent studies are limited by retrospective and observational nature, imprecise OSA classification/diagnostic criteria, and confounded by difficult to control variables. Further research is needed to expand our understanding of OSA -induced intermittent hypoxemia, inflammation, and endothelial dysfunction that may play a role in COVID-19 morbidity and mortality. Until we have more clarity, close monitoring of OSA patients infected with COVID-19 is recommended along with implementation of safe protocols for continuation of PAP usage during the infectious phase. Identifying underlying comorbid conditions that contribute to worsening of a COVID-19 infectious course is a crucial step in improving clinical outcomes.
 

Dr. Sahni is Assistant Professor of Clinical Medicine, Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago. Dr. Cao is Clinical Associate Professor, Division of Sleep Medicine and Division of Neuromuscular Medicine, Department of Psychiatry and Department of Neurology, Stanford (Calif.) University.

Feeling lonely is one of the biggest challenges that we are faced with during this pandemic. It doesn’t matter who you are – a patient, a caregiver, or a physician – it affects us all.

Social distancing practices make it almost impossible to host in-person gatherings, which is hard on everyone, but as a philanthropic organization that focuses on community events, it’s down-right devastating. Not only does the Foundation look to events to help form a sense of camaraderie among our donors, we rely on them to help fund our projects.

That’s why we had to get creative last year and quickly reimagine our events in a totally new space ... cyberspace to be exact.
 

New takes on old favorites

We’re proud to say that we hosted seven online events in 2020, including Irv Feldman’s Poker Tournament, one of our most popular fundraisers. “We wanted to continue our traditions but knew we had to do it in a different format. We learned to pivot quickly and get everything online, but we then had to cross our fingers that our donors would get onboard,” said Angela Perillo, Director, Development & Foundation Operations. To the Foundation’s delight, the events not only piqued people’s interest, they brought in more than $150,000!

The impact of your ticket purchase

The Foundation has a new motto in 2021: “When you attend an event, you tend to our mission.” In other words, every event we host raises funds for our initiatives. “We want our donors to know that while they’re having a great time, they’re also doing their part in helping the Foundation enable more people to get access to the resources they need. A ticket sale today might help a patient get better care tomorrow, “ said Perillo.

Now’s the time to attend

Several events have been planned for this spring and summer. We hope you’ll join us by registering at chestfoundation.org and following #CHESTFoundation25 on social media:

• Irv’s Spring Splash Poker Tournament: Thursday, May 20 at 7 pm CT
• Belmont Stakes Reception & Auction: June 5 at 5 pm CT
• Irv’s Spring Splash Poker Tournament: June 18 at 7 pm CT
• Wine Tasting: June 24 at 7 pm CT
• Trivia Night: July 21 at 7 pm CT

Chestfoundation.org

Feeling lonely is one of the biggest challenges that we are faced with during this pandemic. It doesn’t matter who you are – a patient, a caregiver, or a physician – it affects us all.

Social distancing practices make it almost impossible to host in-person gatherings, which is hard on everyone, but as a philanthropic organization that focuses on community events, it’s down-right devastating. Not only does the Foundation look to events to help form a sense of camaraderie among our donors, we rely on them to help fund our projects.

That’s why we had to get creative last year and quickly reimagine our events in a totally new space ... cyberspace to be exact.
 

New takes on old favorites

We’re proud to say that we hosted seven online events in 2020, including Irv Feldman’s Poker Tournament, one of our most popular fundraisers. “We wanted to continue our traditions but knew we had to do it in a different format. We learned to pivot quickly and get everything online, but we then had to cross our fingers that our donors would get onboard,” said Angela Perillo, Director, Development & Foundation Operations. To the Foundation’s delight, the events not only piqued people’s interest, they brought in more than $150,000!

The impact of your ticket purchase

The Foundation has a new motto in 2021: “When you attend an event, you tend to our mission.” In other words, every event we host raises funds for our initiatives. “We want our donors to know that while they’re having a great time, they’re also doing their part in helping the Foundation enable more people to get access to the resources they need. A ticket sale today might help a patient get better care tomorrow, “ said Perillo.

Now’s the time to attend

Several events have been planned for this spring and summer. We hope you’ll join us by registering at chestfoundation.org and following #CHESTFoundation25 on social media:

• Irv’s Spring Splash Poker Tournament: Thursday, May 20 at 7 pm CT
• Belmont Stakes Reception & Auction: June 5 at 5 pm CT
• Irv’s Spring Splash Poker Tournament: June 18 at 7 pm CT
• Wine Tasting: June 24 at 7 pm CT
• Trivia Night: July 21 at 7 pm CT

Chestfoundation.org

Feeling lonely is one of the biggest challenges that we are faced with during this pandemic. It doesn’t matter who you are – a patient, a caregiver, or a physician – it affects us all.

Social distancing practices make it almost impossible to host in-person gatherings, which is hard on everyone, but as a philanthropic organization that focuses on community events, it’s down-right devastating. Not only does the Foundation look to events to help form a sense of camaraderie among our donors, we rely on them to help fund our projects.

That’s why we had to get creative last year and quickly reimagine our events in a totally new space ... cyberspace to be exact.
 

New takes on old favorites

We’re proud to say that we hosted seven online events in 2020, including Irv Feldman’s Poker Tournament, one of our most popular fundraisers. “We wanted to continue our traditions but knew we had to do it in a different format. We learned to pivot quickly and get everything online, but we then had to cross our fingers that our donors would get onboard,” said Angela Perillo, Director, Development & Foundation Operations. To the Foundation’s delight, the events not only piqued people’s interest, they brought in more than $150,000!

The impact of your ticket purchase

The Foundation has a new motto in 2021: “When you attend an event, you tend to our mission.” In other words, every event we host raises funds for our initiatives. “We want our donors to know that while they’re having a great time, they’re also doing their part in helping the Foundation enable more people to get access to the resources they need. A ticket sale today might help a patient get better care tomorrow, “ said Perillo.

Now’s the time to attend

Several events have been planned for this spring and summer. We hope you’ll join us by registering at chestfoundation.org and following #CHESTFoundation25 on social media:

• Irv’s Spring Splash Poker Tournament: Thursday, May 20 at 7 pm CT
• Belmont Stakes Reception & Auction: June 5 at 5 pm CT
• Irv’s Spring Splash Poker Tournament: June 18 at 7 pm CT
• Wine Tasting: June 24 at 7 pm CT
• Trivia Night: July 21 at 7 pm CT

Chestfoundation.org

COVID-19 vaccination efforts were initially restricted to health department control, and physician practices were not often included as vaccination sites. However, as vaccine availability improves ,physician offices will become a place where vaccines can be delivered conveniently and efficiently. It is important to understand the current and future coding and billing requirements for COVID-19 vaccination so that one’s practice may be appropriately reimbursed.

The provision of COVID-19 vaccination in an office setting is not as simple as influenza or pneumonia vaccination. One can find useful information about all vaccines and specifically about COVID-19 vaccines at https://www.cdc.gov/vaccines/ed/index.html. This site includes video training modules and downloadable resources for clinical use, as well as patient education. This information is important as providing vaccinations may require a change in infrastructure, equipment, and clinical flow. It may not be financially advantageous for one’s practice to provide COVID-19 vaccination.

If the decision is made to provide COVID-19 vaccinations, there are specific CPT codes for each vaccine and its administration (Table 1). These codes are valid for the vaccines with emergency use authorization (Pfizer, Moderna, Janssen) but not yet for as yet unauthorized vaccines (AstraZeneca). Should additional vaccines be authorized, it is expected that new CPT codes will be added.

When a patient is vaccinated, only the administration code is used at this time. The CPT codes for the vaccine (91300-3) should not be used because the cost of the vaccine is currently born by the federal government. When the vaccines are available for purchase by a practice, it will then be appropriate to use the vaccine CPT code. If an evaluation and management (E/M) service is performed, the appropriate E/M service code should be reported in addition to the vaccine administration code.

For payment of the vaccine administration by Medicare, either a single claim or roster claim can be submitted. When five or more patients are vaccinated using the same vaccine on the same day, one may submit a roster claim. Instructions on how to appropriately bill the various Medicare plans can be found at https://tinyurl.com/hfya8888. Guidelines for payment by private insurers should also be reviewed as well, as they will have their own requirements. If a vaccine is given to an individual who does not have any insurance coverage, reimbursement may be available through the Provider Relief Fund. These funds were made available by legislation, including the CARES act and information about claim submittal for the uninsured can be found at https://www.hrsa.gov/CovidUninsuredClaim.

COVID-19 vaccination efforts were initially restricted to health department control, and physician practices were not often included as vaccination sites. However, as vaccine availability improves ,physician offices will become a place where vaccines can be delivered conveniently and efficiently. It is important to understand the current and future coding and billing requirements for COVID-19 vaccination so that one’s practice may be appropriately reimbursed.

The provision of COVID-19 vaccination in an office setting is not as simple as influenza or pneumonia vaccination. One can find useful information about all vaccines and specifically about COVID-19 vaccines at https://www.cdc.gov/vaccines/ed/index.html. This site includes video training modules and downloadable resources for clinical use, as well as patient education. This information is important as providing vaccinations may require a change in infrastructure, equipment, and clinical flow. It may not be financially advantageous for one’s practice to provide COVID-19 vaccination.

If the decision is made to provide COVID-19 vaccinations, there are specific CPT codes for each vaccine and its administration (Table 1). These codes are valid for the vaccines with emergency use authorization (Pfizer, Moderna, Janssen) but not yet for as yet unauthorized vaccines (AstraZeneca). Should additional vaccines be authorized, it is expected that new CPT codes will be added.

When a patient is vaccinated, only the administration code is used at this time. The CPT codes for the vaccine (91300-3) should not be used because the cost of the vaccine is currently born by the federal government. When the vaccines are available for purchase by a practice, it will then be appropriate to use the vaccine CPT code. If an evaluation and management (E/M) service is performed, the appropriate E/M service code should be reported in addition to the vaccine administration code.

For payment of the vaccine administration by Medicare, either a single claim or roster claim can be submitted. When five or more patients are vaccinated using the same vaccine on the same day, one may submit a roster claim. Instructions on how to appropriately bill the various Medicare plans can be found at https://tinyurl.com/hfya8888. Guidelines for payment by private insurers should also be reviewed as well, as they will have their own requirements. If a vaccine is given to an individual who does not have any insurance coverage, reimbursement may be available through the Provider Relief Fund. These funds were made available by legislation, including the CARES act and information about claim submittal for the uninsured can be found at https://www.hrsa.gov/CovidUninsuredClaim.

COVID-19 vaccination efforts were initially restricted to health department control, and physician practices were not often included as vaccination sites. However, as vaccine availability improves ,physician offices will become a place where vaccines can be delivered conveniently and efficiently. It is important to understand the current and future coding and billing requirements for COVID-19 vaccination so that one’s practice may be appropriately reimbursed.

The provision of COVID-19 vaccination in an office setting is not as simple as influenza or pneumonia vaccination. One can find useful information about all vaccines and specifically about COVID-19 vaccines at https://www.cdc.gov/vaccines/ed/index.html. This site includes video training modules and downloadable resources for clinical use, as well as patient education. This information is important as providing vaccinations may require a change in infrastructure, equipment, and clinical flow. It may not be financially advantageous for one’s practice to provide COVID-19 vaccination.

If the decision is made to provide COVID-19 vaccinations, there are specific CPT codes for each vaccine and its administration (Table 1). These codes are valid for the vaccines with emergency use authorization (Pfizer, Moderna, Janssen) but not yet for as yet unauthorized vaccines (AstraZeneca). Should additional vaccines be authorized, it is expected that new CPT codes will be added.

When a patient is vaccinated, only the administration code is used at this time. The CPT codes for the vaccine (91300-3) should not be used because the cost of the vaccine is currently born by the federal government. When the vaccines are available for purchase by a practice, it will then be appropriate to use the vaccine CPT code. If an evaluation and management (E/M) service is performed, the appropriate E/M service code should be reported in addition to the vaccine administration code.

For payment of the vaccine administration by Medicare, either a single claim or roster claim can be submitted. When five or more patients are vaccinated using the same vaccine on the same day, one may submit a roster claim. Instructions on how to appropriately bill the various Medicare plans can be found at https://tinyurl.com/hfya8888. Guidelines for payment by private insurers should also be reviewed as well, as they will have their own requirements. If a vaccine is given to an individual who does not have any insurance coverage, reimbursement may be available through the Provider Relief Fund. These funds were made available by legislation, including the CARES act and information about claim submittal for the uninsured can be found at https://www.hrsa.gov/CovidUninsuredClaim.

Recognizing that caring for patients with COVID continues to be the focus of many physicians, in March, the American Board of Internal Medicine (ABIM) announced that it extended all MOC requirement deadlines until 12/31/22. For those ABIM Board Certified in Critical Care Medicine, Hospital Medicine, Infectious Disease, or Pulmonary Disease, MOC requirements have been extended until the end of 2023.

In a letter to the internal medicine community, Richard J. Baron, MD, MACP, ABIM President and CEO; and Marianne M. Green, MD, Chair of the ABIM Board of Directors, said, “We know internists and internal medicine subspecialists have been on the front lines meeting the country’s needs, many experiencing the tragedy of COVID in deeply personal ways…We also recognize the high levels of stress you may have faced over the last 12 months, and that it will likely be some time until it subsides…We hope this gives you one less thing to worry about.”

The decision means that nobody will lose ABIM certification if they are unable to complete MOC requirements this year. Recognizing every physician’s situation is different, all ABIM MOC exams will be administered as scheduled in 2021 for those who wish to take one.

In January 2022, ABIM will launch a new Longitudinal Knowledge Assessment (LKATM) (www.abim.org/lka/), a more flexible and convenient way to maintain certification. Physicians who decide to delay their 2021 assessment will be able to enroll in the LKA when it rolls out (pending availability), or can choose to take the traditional, 10-year MOC exam if they prefer.

The LKA for Critical Care, Hospital Medicine, Infectious Disease, and Pulmonary Disease will launch in January 2023. As these were among the disciplines most impacted by COVID, additional time is needed to create the requisite content for a high-quality assessment and is why MOC requirement deadlines for these specialties is extended an additional year to provide a transition pathway to the LKA.

Through the LKA, questions can be answered on almost any internet-connected device at any time, and physicians can access all the resources used in practice (except another person). ABIM will release 30 questions each quarter that can be answered a few at a time, or all at once. Immediate feedback with rationale and reference will be provided. As long as at least 500 of the 600 questions are answered over the 5-year cycle, the LKA Participation Requirement will be met.

ABIM is in the process of updating the Physician Portal in light of the MOC requirements deadline extension. If you have any questions about your requirements, call 1-800-441-ABIM or email [email protected]. For further information about the LKA, visit abim.org/lka/.

Recognizing that caring for patients with COVID continues to be the focus of many physicians, in March, the American Board of Internal Medicine (ABIM) announced that it extended all MOC requirement deadlines until 12/31/22. For those ABIM Board Certified in Critical Care Medicine, Hospital Medicine, Infectious Disease, or Pulmonary Disease, MOC requirements have been extended until the end of 2023.

In a letter to the internal medicine community, Richard J. Baron, MD, MACP, ABIM President and CEO; and Marianne M. Green, MD, Chair of the ABIM Board of Directors, said, “We know internists and internal medicine subspecialists have been on the front lines meeting the country’s needs, many experiencing the tragedy of COVID in deeply personal ways…We also recognize the high levels of stress you may have faced over the last 12 months, and that it will likely be some time until it subsides…We hope this gives you one less thing to worry about.”

The decision means that nobody will lose ABIM certification if they are unable to complete MOC requirements this year. Recognizing every physician’s situation is different, all ABIM MOC exams will be administered as scheduled in 2021 for those who wish to take one.

In January 2022, ABIM will launch a new Longitudinal Knowledge Assessment (LKATM) (www.abim.org/lka/), a more flexible and convenient way to maintain certification. Physicians who decide to delay their 2021 assessment will be able to enroll in the LKA when it rolls out (pending availability), or can choose to take the traditional, 10-year MOC exam if they prefer.

The LKA for Critical Care, Hospital Medicine, Infectious Disease, and Pulmonary Disease will launch in January 2023. As these were among the disciplines most impacted by COVID, additional time is needed to create the requisite content for a high-quality assessment and is why MOC requirement deadlines for these specialties is extended an additional year to provide a transition pathway to the LKA.

Through the LKA, questions can be answered on almost any internet-connected device at any time, and physicians can access all the resources used in practice (except another person). ABIM will release 30 questions each quarter that can be answered a few at a time, or all at once. Immediate feedback with rationale and reference will be provided. As long as at least 500 of the 600 questions are answered over the 5-year cycle, the LKA Participation Requirement will be met.

ABIM is in the process of updating the Physician Portal in light of the MOC requirements deadline extension. If you have any questions about your requirements, call 1-800-441-ABIM or email [email protected]. For further information about the LKA, visit abim.org/lka/.

Recognizing that caring for patients with COVID continues to be the focus of many physicians, in March, the American Board of Internal Medicine (ABIM) announced that it extended all MOC requirement deadlines until 12/31/22. For those ABIM Board Certified in Critical Care Medicine, Hospital Medicine, Infectious Disease, or Pulmonary Disease, MOC requirements have been extended until the end of 2023.

In a letter to the internal medicine community, Richard J. Baron, MD, MACP, ABIM President and CEO; and Marianne M. Green, MD, Chair of the ABIM Board of Directors, said, “We know internists and internal medicine subspecialists have been on the front lines meeting the country’s needs, many experiencing the tragedy of COVID in deeply personal ways…We also recognize the high levels of stress you may have faced over the last 12 months, and that it will likely be some time until it subsides…We hope this gives you one less thing to worry about.”

The decision means that nobody will lose ABIM certification if they are unable to complete MOC requirements this year. Recognizing every physician’s situation is different, all ABIM MOC exams will be administered as scheduled in 2021 for those who wish to take one.

In January 2022, ABIM will launch a new Longitudinal Knowledge Assessment (LKATM) (www.abim.org/lka/), a more flexible and convenient way to maintain certification. Physicians who decide to delay their 2021 assessment will be able to enroll in the LKA when it rolls out (pending availability), or can choose to take the traditional, 10-year MOC exam if they prefer.

The LKA for Critical Care, Hospital Medicine, Infectious Disease, and Pulmonary Disease will launch in January 2023. As these were among the disciplines most impacted by COVID, additional time is needed to create the requisite content for a high-quality assessment and is why MOC requirement deadlines for these specialties is extended an additional year to provide a transition pathway to the LKA.

Through the LKA, questions can be answered on almost any internet-connected device at any time, and physicians can access all the resources used in practice (except another person). ABIM will release 30 questions each quarter that can be answered a few at a time, or all at once. Immediate feedback with rationale and reference will be provided. As long as at least 500 of the 600 questions are answered over the 5-year cycle, the LKA Participation Requirement will be met.

ABIM is in the process of updating the Physician Portal in light of the MOC requirements deadline extension. If you have any questions about your requirements, call 1-800-441-ABIM or email [email protected]. For further information about the LKA, visit abim.org/lka/.

A little over a year ago, none of us imagined we’d be where we are right now. The pandemic has deeply affected us all, and there have been so many losses, both professional and personal. I’m proud of how our CHEST community responded to the pandemic. The incredibly rapid pace of knowledge acquisition and the speed at which we disseminated that knowledge took a lot of combined effort, but that’s nothing new to our CHEST community.

Throughout the pandemic, CHEST pushed digital education with an array of webinars, podcasts, bite-sized educational modules, and infographics. We held a highly successful, well-received CHEST 2020 online conference with just a few months of planning. I’m so excited to take what we learned about offering high-quality, digital education and turn that into a hybrid meeting for CHEST 2021 that meets the educational needs of every participant!

At CHEST 2021, you will be presented with the latest in pulmonary, critical care, and sleep medicine for clinicians at all levels. Whether you are a trainee or an experienced clinician, there is something to learn at CHEST 2021. We are packing the agenda with experiences from live learning and simulation to high-quality education sessions and smaller problem-based learning classes.

On top of this, you have an amazing opportunity to network and reconnect with colleagues you haven’t seen in months! Whether at Experience CHEST, in the gaming area, the Trainee and Transition Lounge, and more, CHEST 2021, as always, is the best at providing top-tier education, team-based learning, and community connections.

This will be the first hybrid meeting put on by CHEST. We came to the decision knowing that while some people are hungry to get back to having an in-person experience, others found that an online conference better fits their needs. I strongly encourage you to join us October 17-20 in Orlando, Florida, to experience the networking and growth opportunities that come from attending in person. We are following strict protocols, as recommended by the CDC, and will be requiring all attendees to attest to being vaccinated. However, if travel isn’t possible, join us for livestreamed, immersive digital learning from wherever you are in the world. Regardless of your choice, both options will allow you to engage in fun experiences, learn, and connect.

As Co-Chair of CHEST 2021, I’d like to personally invite you to participate, whether this is your first time or you’ve lost count how many times you’ve attended our annual meeting. The community at CHEST is what makes the CHEST conference special, and we are proud to be able to keep you all connected despite geographic restrictions.

Looking forward to seeing you there and connecting on Twitter at #CHEST2021.

Chris Carroll, MD

Co-Chair, CHEST 2021

A little over a year ago, none of us imagined we’d be where we are right now. The pandemic has deeply affected us all, and there have been so many losses, both professional and personal. I’m proud of how our CHEST community responded to the pandemic. The incredibly rapid pace of knowledge acquisition and the speed at which we disseminated that knowledge took a lot of combined effort, but that’s nothing new to our CHEST community.

Throughout the pandemic, CHEST pushed digital education with an array of webinars, podcasts, bite-sized educational modules, and infographics. We held a highly successful, well-received CHEST 2020 online conference with just a few months of planning. I’m so excited to take what we learned about offering high-quality, digital education and turn that into a hybrid meeting for CHEST 2021 that meets the educational needs of every participant!

At CHEST 2021, you will be presented with the latest in pulmonary, critical care, and sleep medicine for clinicians at all levels. Whether you are a trainee or an experienced clinician, there is something to learn at CHEST 2021. We are packing the agenda with experiences from live learning and simulation to high-quality education sessions and smaller problem-based learning classes.

On top of this, you have an amazing opportunity to network and reconnect with colleagues you haven’t seen in months! Whether at Experience CHEST, in the gaming area, the Trainee and Transition Lounge, and more, CHEST 2021, as always, is the best at providing top-tier education, team-based learning, and community connections.

This will be the first hybrid meeting put on by CHEST. We came to the decision knowing that while some people are hungry to get back to having an in-person experience, others found that an online conference better fits their needs. I strongly encourage you to join us October 17-20 in Orlando, Florida, to experience the networking and growth opportunities that come from attending in person. We are following strict protocols, as recommended by the CDC, and will be requiring all attendees to attest to being vaccinated. However, if travel isn’t possible, join us for livestreamed, immersive digital learning from wherever you are in the world. Regardless of your choice, both options will allow you to engage in fun experiences, learn, and connect.

As Co-Chair of CHEST 2021, I’d like to personally invite you to participate, whether this is your first time or you’ve lost count how many times you’ve attended our annual meeting. The community at CHEST is what makes the CHEST conference special, and we are proud to be able to keep you all connected despite geographic restrictions.

Looking forward to seeing you there and connecting on Twitter at #CHEST2021.

Chris Carroll, MD

Co-Chair, CHEST 2021

A little over a year ago, none of us imagined we’d be where we are right now. The pandemic has deeply affected us all, and there have been so many losses, both professional and personal. I’m proud of how our CHEST community responded to the pandemic. The incredibly rapid pace of knowledge acquisition and the speed at which we disseminated that knowledge took a lot of combined effort, but that’s nothing new to our CHEST community.

Throughout the pandemic, CHEST pushed digital education with an array of webinars, podcasts, bite-sized educational modules, and infographics. We held a highly successful, well-received CHEST 2020 online conference with just a few months of planning. I’m so excited to take what we learned about offering high-quality, digital education and turn that into a hybrid meeting for CHEST 2021 that meets the educational needs of every participant!

At CHEST 2021, you will be presented with the latest in pulmonary, critical care, and sleep medicine for clinicians at all levels. Whether you are a trainee or an experienced clinician, there is something to learn at CHEST 2021. We are packing the agenda with experiences from live learning and simulation to high-quality education sessions and smaller problem-based learning classes.

On top of this, you have an amazing opportunity to network and reconnect with colleagues you haven’t seen in months! Whether at Experience CHEST, in the gaming area, the Trainee and Transition Lounge, and more, CHEST 2021, as always, is the best at providing top-tier education, team-based learning, and community connections.

This will be the first hybrid meeting put on by CHEST. We came to the decision knowing that while some people are hungry to get back to having an in-person experience, others found that an online conference better fits their needs. I strongly encourage you to join us October 17-20 in Orlando, Florida, to experience the networking and growth opportunities that come from attending in person. We are following strict protocols, as recommended by the CDC, and will be requiring all attendees to attest to being vaccinated. However, if travel isn’t possible, join us for livestreamed, immersive digital learning from wherever you are in the world. Regardless of your choice, both options will allow you to engage in fun experiences, learn, and connect.

As Co-Chair of CHEST 2021, I’d like to personally invite you to participate, whether this is your first time or you’ve lost count how many times you’ve attended our annual meeting. The community at CHEST is what makes the CHEST conference special, and we are proud to be able to keep you all connected despite geographic restrictions.

Looking forward to seeing you there and connecting on Twitter at #CHEST2021.

Chris Carroll, MD

Co-Chair, CHEST 2021

Mitzi Joi Williams, MD, Medical Director and CEO of Joi Life Wellness Group in Atlanta, GA, discusses treatment data and other timely updates in multiple sclerosis (MS) coming out of the American Academy of Neurology (AAN) 2021 Annual Meeting.

Dr. Williams introduces the new National African Americans with Multiple Sclerosis Registry, an important initiative aimed at expanding evidence-based knowledge of MS in African American patients, increasing clinical trial participation, and engaging in research that will benefit this community.

In a review of a long-term analysis of evobrutinib, Dr. Williams shares the positive efficacy and safety outcomes that were observed and maintained in patients receiving evobrutinib 75 mg twice daily throughout the duration of the 48-week double-blind, randomized, phase 2 trial and the 60-week open-label extension portions of the study.

Next, Dr. Williams highlights a study of patients taking disease-modifying therapies (DMTs) at the NYU MS Care Center. The analysis found factors such as public insurance status, younger age, and Hispanic ethnicity to be larger predictors of COVID-19 infection in this patient population than any of the DMTs that were studied.

Lastly, Dr. Williams discusses an analysis of racial and ethnic differences in patients receiving ofatumumab in the ASCLEPIOS I/II and APOLITOS trials. The study revealed no clinically relevant differences in annualized relapse rate, pharmacokinetics, B-cell depletion, or safety profile between the study populations.

--

Mitzi Joi Williams, MD, Medical Director, CEO; Department of Neurology, Joi Life Wellness Group, Atlanta, Georgia

Mitzi Joi Williams, MD, has disclosed the following relevant financial relationships:

Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Biogen Idec; EMD Serono; Genentech; Novartis; Bristol-Myers Squibb; AbbVie; Alexion; Novartis.

Serve(d) as a speaker or a member of a speakers bureau for: Biogen Idec; EMD Serono; Genentech Roche; Novartis; Bristol-Myers Squibb.

Mitzi Joi Williams, MD, Medical Director and CEO of Joi Life Wellness Group in Atlanta, GA, discusses treatment data and other timely updates in multiple sclerosis (MS) coming out of the American Academy of Neurology (AAN) 2021 Annual Meeting.

Dr. Williams introduces the new National African Americans with Multiple Sclerosis Registry, an important initiative aimed at expanding evidence-based knowledge of MS in African American patients, increasing clinical trial participation, and engaging in research that will benefit this community.

In a review of a long-term analysis of evobrutinib, Dr. Williams shares the positive efficacy and safety outcomes that were observed and maintained in patients receiving evobrutinib 75 mg twice daily throughout the duration of the 48-week double-blind, randomized, phase 2 trial and the 60-week open-label extension portions of the study.

Next, Dr. Williams highlights a study of patients taking disease-modifying therapies (DMTs) at the NYU MS Care Center. The analysis found factors such as public insurance status, younger age, and Hispanic ethnicity to be larger predictors of COVID-19 infection in this patient population than any of the DMTs that were studied.

Lastly, Dr. Williams discusses an analysis of racial and ethnic differences in patients receiving ofatumumab in the ASCLEPIOS I/II and APOLITOS trials. The study revealed no clinically relevant differences in annualized relapse rate, pharmacokinetics, B-cell depletion, or safety profile between the study populations.

--

Mitzi Joi Williams, MD, Medical Director, CEO; Department of Neurology, Joi Life Wellness Group, Atlanta, Georgia

Mitzi Joi Williams, MD, has disclosed the following relevant financial relationships:

Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Biogen Idec; EMD Serono; Genentech; Novartis; Bristol-Myers Squibb; AbbVie; Alexion; Novartis.

Serve(d) as a speaker or a member of a speakers bureau for: Biogen Idec; EMD Serono; Genentech Roche; Novartis; Bristol-Myers Squibb.

Mitzi Joi Williams, MD, Medical Director and CEO of Joi Life Wellness Group in Atlanta, GA, discusses treatment data and other timely updates in multiple sclerosis (MS) coming out of the American Academy of Neurology (AAN) 2021 Annual Meeting.

Dr. Williams introduces the new National African Americans with Multiple Sclerosis Registry, an important initiative aimed at expanding evidence-based knowledge of MS in African American patients, increasing clinical trial participation, and engaging in research that will benefit this community.

In a review of a long-term analysis of evobrutinib, Dr. Williams shares the positive efficacy and safety outcomes that were observed and maintained in patients receiving evobrutinib 75 mg twice daily throughout the duration of the 48-week double-blind, randomized, phase 2 trial and the 60-week open-label extension portions of the study.

Next, Dr. Williams highlights a study of patients taking disease-modifying therapies (DMTs) at the NYU MS Care Center. The analysis found factors such as public insurance status, younger age, and Hispanic ethnicity to be larger predictors of COVID-19 infection in this patient population than any of the DMTs that were studied.

Lastly, Dr. Williams discusses an analysis of racial and ethnic differences in patients receiving ofatumumab in the ASCLEPIOS I/II and APOLITOS trials. The study revealed no clinically relevant differences in annualized relapse rate, pharmacokinetics, B-cell depletion, or safety profile between the study populations.

--

Mitzi Joi Williams, MD, Medical Director, CEO; Department of Neurology, Joi Life Wellness Group, Atlanta, Georgia

Mitzi Joi Williams, MD, has disclosed the following relevant financial relationships:

Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Biogen Idec; EMD Serono; Genentech; Novartis; Bristol-Myers Squibb; AbbVie; Alexion; Novartis.

Serve(d) as a speaker or a member of a speakers bureau for: Biogen Idec; EMD Serono; Genentech Roche; Novartis; Bristol-Myers Squibb.

Numerous advances in diagnosis, staging, and treatment have evolved over the past several years for non-small cell lung cancer (NSCLC) patients. Because of the new developments, input from a team of specialists is required to treat each patient. Many hospitals have implemented a multidisciplinary team approach to treat these complex cases.

In this ReCAP, Dr Nicole Tanner, a pulmonary critical care specialist from the Medical University of South Carolina, hosts thoracic oncologist Dr Carrie Lee and thoracic surgeon Dr Jason Long, colleagues from the UNC Lineberger Comprehensive Cancer Center, in a discussion of the advantages of multidisciplinary teams in the treatment of NSCLC patients.

Their discussion ranges from identifying key multidisciplinary team members, individual practitioner responsibilities, benefits of multidisciplinary teams to patients and clinicians alike, and the advantages of incorporating telehealth visits into standard practice after the pandemic.

--

Jason M. Long, MD, MPH, FCCP, Associate Professor, Department of Surgery, University of North Carolina School of Medicine; Staff Physician, Department of Surgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina

Jason M. Long, MD, MPH, FCCP, has disclosed no relevant financial relationships.

Carrie B. Lee, MD, MPH, Associate Professor, Department of Medicine, University of North Carolina, Chapel Hill; Medical Director, Clinical Protocol Office, UNC Lineberger Comprehensive Cancer Center, North Carolina Cancer Hospital, Chapel Hill, North Carolina

Carrie B. Lee, MD, MPH, has disclosed the following relevant financial relationships:
Serve(d) as the chair of the Data and Safety Monitoring Board for: Delcath, Inc.

Nichole T. Tanner, MD, MSCR, FCCP, Associate Professor, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina

Nichole T. Tanner, MD, MSCR, FCCP, has disclosed no relevant financial relationships.

Numerous advances in diagnosis, staging, and treatment have evolved over the past several years for non-small cell lung cancer (NSCLC) patients. Because of the new developments, input from a team of specialists is required to treat each patient. Many hospitals have implemented a multidisciplinary team approach to treat these complex cases.

In this ReCAP, Dr Nicole Tanner, a pulmonary critical care specialist from the Medical University of South Carolina, hosts thoracic oncologist Dr Carrie Lee and thoracic surgeon Dr Jason Long, colleagues from the UNC Lineberger Comprehensive Cancer Center, in a discussion of the advantages of multidisciplinary teams in the treatment of NSCLC patients.

Their discussion ranges from identifying key multidisciplinary team members, individual practitioner responsibilities, benefits of multidisciplinary teams to patients and clinicians alike, and the advantages of incorporating telehealth visits into standard practice after the pandemic.

--

Jason M. Long, MD, MPH, FCCP, Associate Professor, Department of Surgery, University of North Carolina School of Medicine; Staff Physician, Department of Surgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina

Jason M. Long, MD, MPH, FCCP, has disclosed no relevant financial relationships.

Carrie B. Lee, MD, MPH, Associate Professor, Department of Medicine, University of North Carolina, Chapel Hill; Medical Director, Clinical Protocol Office, UNC Lineberger Comprehensive Cancer Center, North Carolina Cancer Hospital, Chapel Hill, North Carolina

Carrie B. Lee, MD, MPH, has disclosed the following relevant financial relationships:
Serve(d) as the chair of the Data and Safety Monitoring Board for: Delcath, Inc.

Nichole T. Tanner, MD, MSCR, FCCP, Associate Professor, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina

Nichole T. Tanner, MD, MSCR, FCCP, has disclosed no relevant financial relationships.

Numerous advances in diagnosis, staging, and treatment have evolved over the past several years for non-small cell lung cancer (NSCLC) patients. Because of the new developments, input from a team of specialists is required to treat each patient. Many hospitals have implemented a multidisciplinary team approach to treat these complex cases.

In this ReCAP, Dr Nicole Tanner, a pulmonary critical care specialist from the Medical University of South Carolina, hosts thoracic oncologist Dr Carrie Lee and thoracic surgeon Dr Jason Long, colleagues from the UNC Lineberger Comprehensive Cancer Center, in a discussion of the advantages of multidisciplinary teams in the treatment of NSCLC patients.

Their discussion ranges from identifying key multidisciplinary team members, individual practitioner responsibilities, benefits of multidisciplinary teams to patients and clinicians alike, and the advantages of incorporating telehealth visits into standard practice after the pandemic.

--

Jason M. Long, MD, MPH, FCCP, Associate Professor, Department of Surgery, University of North Carolina School of Medicine; Staff Physician, Department of Surgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina

Jason M. Long, MD, MPH, FCCP, has disclosed no relevant financial relationships.

Carrie B. Lee, MD, MPH, Associate Professor, Department of Medicine, University of North Carolina, Chapel Hill; Medical Director, Clinical Protocol Office, UNC Lineberger Comprehensive Cancer Center, North Carolina Cancer Hospital, Chapel Hill, North Carolina

Carrie B. Lee, MD, MPH, has disclosed the following relevant financial relationships:
Serve(d) as the chair of the Data and Safety Monitoring Board for: Delcath, Inc.

Nichole T. Tanner, MD, MSCR, FCCP, Associate Professor, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina

Nichole T. Tanner, MD, MSCR, FCCP, has disclosed no relevant financial relationships.

The patient is probably having a delayed allergenic response to an indoor mold allergen. Early reactions can occur immediately following allergen inhalation but can also manifest 4-10 hours after exposure to wet and damp areas, such as bathrooms and basements.

Allergic asthma represents the most common asthma phenotype. The average age of onset is younger than that of nonallergic asthma, with allergens triggering exacerbations in 60%-90% of children compared with 50% of adults.Triggers can include mold spores, seasonal pollen, dust mites, and animal allergens. There is also an increased incidence of co-occurring allergic rhinoconjunctivitis and atopic dermatitis in patients with allergic asthma.

During an acute asthma exacerbation, lung examination findings may include wheezing, rhonchi, hyperinflation, or a prolonged expiratory phase. In children, supraclavicular and intercostal retractions and nasal flaring, as well as abdominal breathing, are particularly telling. Total serum immunoglobulin E levels are usually higher in allergic vs nonallergic asthma (> 100 IU), although this marker is not specific to asthma.

The allergic asthma phenotype usually responds to inhaled corticosteroid therapy. Although evidence suggests that allergic vs nonallergic asthma is less severe in many cases, compelling data point to a causal relationship between mold allergy and asthma severity in a subgroup of younger asthma patients; specifically, mold sensitization may be associated with asthma attacks requiring hospital admission in this population.

Although spirometry assessments should be obtained as the primary test to establish the asthma diagnosis, to test for allergic sensitivity to specific allergens in the environment, allergy skin tests and blood radioallergosorbent tests may be used. Up to 85% of patients with asthma demonstrate positive skin test results, and in children, this sensitization is reflective of disease activity. Such testing for allergen-specific immunoglobulin E is critical in prescribing allergen avoidance techniques and allergen immunotherapy regimens, although the method shows a relatively high false positive rate and should not be performed during an exacerbation.

The patient is probably having a delayed allergenic response to an indoor mold allergen. Early reactions can occur immediately following allergen inhalation but can also manifest 4-10 hours after exposure to wet and damp areas, such as bathrooms and basements.

Allergic asthma represents the most common asthma phenotype. The average age of onset is younger than that of nonallergic asthma, with allergens triggering exacerbations in 60%-90% of children compared with 50% of adults.Triggers can include mold spores, seasonal pollen, dust mites, and animal allergens. There is also an increased incidence of co-occurring allergic rhinoconjunctivitis and atopic dermatitis in patients with allergic asthma.

During an acute asthma exacerbation, lung examination findings may include wheezing, rhonchi, hyperinflation, or a prolonged expiratory phase. In children, supraclavicular and intercostal retractions and nasal flaring, as well as abdominal breathing, are particularly telling. Total serum immunoglobulin E levels are usually higher in allergic vs nonallergic asthma (> 100 IU), although this marker is not specific to asthma.

The allergic asthma phenotype usually responds to inhaled corticosteroid therapy. Although evidence suggests that allergic vs nonallergic asthma is less severe in many cases, compelling data point to a causal relationship between mold allergy and asthma severity in a subgroup of younger asthma patients; specifically, mold sensitization may be associated with asthma attacks requiring hospital admission in this population.

Although spirometry assessments should be obtained as the primary test to establish the asthma diagnosis, to test for allergic sensitivity to specific allergens in the environment, allergy skin tests and blood radioallergosorbent tests may be used. Up to 85% of patients with asthma demonstrate positive skin test results, and in children, this sensitization is reflective of disease activity. Such testing for allergen-specific immunoglobulin E is critical in prescribing allergen avoidance techniques and allergen immunotherapy regimens, although the method shows a relatively high false positive rate and should not be performed during an exacerbation.

The patient is probably having a delayed allergenic response to an indoor mold allergen. Early reactions can occur immediately following allergen inhalation but can also manifest 4-10 hours after exposure to wet and damp areas, such as bathrooms and basements.

Allergic asthma represents the most common asthma phenotype. The average age of onset is younger than that of nonallergic asthma, with allergens triggering exacerbations in 60%-90% of children compared with 50% of adults.Triggers can include mold spores, seasonal pollen, dust mites, and animal allergens. There is also an increased incidence of co-occurring allergic rhinoconjunctivitis and atopic dermatitis in patients with allergic asthma.

During an acute asthma exacerbation, lung examination findings may include wheezing, rhonchi, hyperinflation, or a prolonged expiratory phase. In children, supraclavicular and intercostal retractions and nasal flaring, as well as abdominal breathing, are particularly telling. Total serum immunoglobulin E levels are usually higher in allergic vs nonallergic asthma (> 100 IU), although this marker is not specific to asthma.

The allergic asthma phenotype usually responds to inhaled corticosteroid therapy. Although evidence suggests that allergic vs nonallergic asthma is less severe in many cases, compelling data point to a causal relationship between mold allergy and asthma severity in a subgroup of younger asthma patients; specifically, mold sensitization may be associated with asthma attacks requiring hospital admission in this population.

Although spirometry assessments should be obtained as the primary test to establish the asthma diagnosis, to test for allergic sensitivity to specific allergens in the environment, allergy skin tests and blood radioallergosorbent tests may be used. Up to 85% of patients with asthma demonstrate positive skin test results, and in children, this sensitization is reflective of disease activity. Such testing for allergen-specific immunoglobulin E is critical in prescribing allergen avoidance techniques and allergen immunotherapy regimens, although the method shows a relatively high false positive rate and should not be performed during an exacerbation.