News From CHEST Physician®

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

We remember our colleagues and extend our sincere condolences.



Edward C. Rosenow III, MD, Master FCCP

Jack Stanko, MD, MS, FCCP

Arthur S. Turetsky, MD, FCCP

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

We remember our colleagues and extend our sincere condolences.



Edward C. Rosenow III, MD, Master FCCP

Jack Stanko, MD, MS, FCCP

Arthur S. Turetsky, MD, FCCP

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

We remember our colleagues and extend our sincere condolences.



Edward C. Rosenow III, MD, Master FCCP

Jack Stanko, MD, MS, FCCP

Arthur S. Turetsky, MD, FCCP

Receiving a chronic disease diagnosis can be paralyzing, with a wide range of associated emotions. A patient’s family, physicians, and other health care professionals can provide a source of support, but, often, the strongest support comes from those who can empathize.

Someone who has lived with a diagnosis can provide guidance and empathy at a more personal level because, to them, it is just that – personal. Fred Schick and Betsy Glaeser have done just that by taking their personal experiences and using them to help others navigate their diagnoses.

Improving patients’ lives is the core focus of the American College of Chest Physicians and the CHEST Foundation. Events like the Belmont Stakes Dinner and Auction provide an opportunity for us to recognize and celebrate powerful stories such as Fred and Betsy’s, while also raising funds to support important initiatives that will improve patient care. Please consider joining the fight against lung disease by making a donation to the CHEST Foundation today at chestfoundation.org/donate.
 

Patient Advocate – Fred Schick

Increasing awareness of pulmonary fibrosis

Fred Schick of the Chicagoland area was diagnosed with idiopathic pulmonary fibrosis (IPF) in 2017 after years of searching for the root cause of his worsening symptoms.

Fred started experiencing shortness of breath and labored breathing—once to the extent that he needed to be pulled out of the water on vacation despite being an active swimmer. Because Fred was a former cardiac patient, his doctors looked to his heart for a diagnosis.

It wasn’t until his primary care physician retired that he started seeing a new doctor who took a different look at his symptoms. In hearing about the strong changes in his exercise endurance, this particular doctor made the decision to refer Fred to a pulmonologist, which ultimately led Fred on the right path to his IPF diagnosis.
 

Helping others navigate the path

In his 5 years since being diagnosed with IPF, Fred uses his experience to advocate for others living with this illness. Active in support groups for those with IPF, he is especially focused on helping others navigate the first few months after receiving their diagnosis.

Fred knows from experience that receiving the IPF diagnosis is something to come to terms with but encourages others to look to him for an example of how to live with the illness.

“The first thing I say to someone who has been recently diagnosed with pulmonary fibrosis is, ‘Whatever you’ve read on the Internet, don’t believe it,’ because there are a lot of people who live well beyond the 3- to 5-year expectancy you’ll see in your Google search.”

“I also encourage everyone to be their own health advocate – tell your doctor if anything in your life is abnormal because you know your body better than anyone.”

Like Fred, many living with IPF wait years for a diagnosis because of the commonality in the way the symptoms present, including shortness of breath, fatigue, difficulty breathing, and others. To address this delay, the American College of Chest Physicians, supported by the CHEST Foundation, partnered with the Three Lakes Foundation to create an initiative led by a steering committee of pulmonologists and primary care physicians to join together to shorten the time to diagnosis for interstitial lung diseases like IPF. Among other activities, the steering committee will work to create tools for physicians to use during patient intake that can more quickly bring IPF into the conversation when it is pertinent.
 

Patient Advocate – Betsy Glaeser

Blazing the trail for NTM

Local to New York, Betsy Glaeser was diagnosed with pulmonary nontuberculous mycobacteria disease (NTM) more than 20 years ago.

Leading up to her diagnosis, Betsy was frequently short of breath with overwhelming fatigue and fevers. She was hospitalized multiple times for pneumonia and treated again and again with short-term standard antibiotics. At the time (1998), there were no clinical programs dedicated to NTM, and when her sputum was tested, it was only for pneumonia.

As a financial consultant required to travel 4 days per week for work, Betsy grew especially concerned about her illness when she developed hemoptysis and began coughing up blood. Lacking local resources, she sought care at the Mayo Clinic in Rochester, Minnesota, where she received her NTM diagnosis.

Based on the severity of her illness and her worsening symptoms, the recommendation of the Mayo Clinic was that she stop working. After 30 years of challenging jobs, quitting was very painful, but a Mayo doctor asked Betsy a very poignant question that resonated with her: “Are you planning to die for your employer?”

With that, she left her job and sought care for her illness. As her NTM developed a second, more resistant strain associated with her disease, requiring daily, constant treatment, Betsy was fortunate to be accepted into the National Institutes of Health NTM protocol, which has directed her care, coordinated with NYU-Langone.

Despite the challenges of having NTM, Betsy maintains an active and enriching life.
 

Leading with experience

Betsy uses her diagnosis and her experience with NTM to help others who are hearing their diagnoses for the first time. She serves as a charter member and co-leader of a New York NTM patient support group and serves as a member of the NTM Info & Research (NTMir) Board of Directors.

Her goal is to ensure that no one living with NTM feels alone or frightened.

“Not so long ago – and now, too, even – there were doctors who did not know how to treat NTM,” says Betsy. “But, it has really gotten better – as I’ve progressed through all of my medications and lived with this disease, NTM has progressed as well. I hope I helped expand NTM knowledge with my lived experiences, but I’ve been so fortunate to receive medical care from those doctors who knew the most about NTM.”

Receiving a chronic disease diagnosis can be paralyzing, with a wide range of associated emotions. A patient’s family, physicians, and other health care professionals can provide a source of support, but, often, the strongest support comes from those who can empathize.

Someone who has lived with a diagnosis can provide guidance and empathy at a more personal level because, to them, it is just that – personal. Fred Schick and Betsy Glaeser have done just that by taking their personal experiences and using them to help others navigate their diagnoses.

Improving patients’ lives is the core focus of the American College of Chest Physicians and the CHEST Foundation. Events like the Belmont Stakes Dinner and Auction provide an opportunity for us to recognize and celebrate powerful stories such as Fred and Betsy’s, while also raising funds to support important initiatives that will improve patient care. Please consider joining the fight against lung disease by making a donation to the CHEST Foundation today at chestfoundation.org/donate.
 

Patient Advocate – Fred Schick

Increasing awareness of pulmonary fibrosis

Fred Schick of the Chicagoland area was diagnosed with idiopathic pulmonary fibrosis (IPF) in 2017 after years of searching for the root cause of his worsening symptoms.

Fred started experiencing shortness of breath and labored breathing—once to the extent that he needed to be pulled out of the water on vacation despite being an active swimmer. Because Fred was a former cardiac patient, his doctors looked to his heart for a diagnosis.

It wasn’t until his primary care physician retired that he started seeing a new doctor who took a different look at his symptoms. In hearing about the strong changes in his exercise endurance, this particular doctor made the decision to refer Fred to a pulmonologist, which ultimately led Fred on the right path to his IPF diagnosis.
 

Helping others navigate the path

In his 5 years since being diagnosed with IPF, Fred uses his experience to advocate for others living with this illness. Active in support groups for those with IPF, he is especially focused on helping others navigate the first few months after receiving their diagnosis.

Fred knows from experience that receiving the IPF diagnosis is something to come to terms with but encourages others to look to him for an example of how to live with the illness.

“The first thing I say to someone who has been recently diagnosed with pulmonary fibrosis is, ‘Whatever you’ve read on the Internet, don’t believe it,’ because there are a lot of people who live well beyond the 3- to 5-year expectancy you’ll see in your Google search.”

“I also encourage everyone to be their own health advocate – tell your doctor if anything in your life is abnormal because you know your body better than anyone.”

Like Fred, many living with IPF wait years for a diagnosis because of the commonality in the way the symptoms present, including shortness of breath, fatigue, difficulty breathing, and others. To address this delay, the American College of Chest Physicians, supported by the CHEST Foundation, partnered with the Three Lakes Foundation to create an initiative led by a steering committee of pulmonologists and primary care physicians to join together to shorten the time to diagnosis for interstitial lung diseases like IPF. Among other activities, the steering committee will work to create tools for physicians to use during patient intake that can more quickly bring IPF into the conversation when it is pertinent.
 

Patient Advocate – Betsy Glaeser

Blazing the trail for NTM

Local to New York, Betsy Glaeser was diagnosed with pulmonary nontuberculous mycobacteria disease (NTM) more than 20 years ago.

Leading up to her diagnosis, Betsy was frequently short of breath with overwhelming fatigue and fevers. She was hospitalized multiple times for pneumonia and treated again and again with short-term standard antibiotics. At the time (1998), there were no clinical programs dedicated to NTM, and when her sputum was tested, it was only for pneumonia.

As a financial consultant required to travel 4 days per week for work, Betsy grew especially concerned about her illness when she developed hemoptysis and began coughing up blood. Lacking local resources, she sought care at the Mayo Clinic in Rochester, Minnesota, where she received her NTM diagnosis.

Based on the severity of her illness and her worsening symptoms, the recommendation of the Mayo Clinic was that she stop working. After 30 years of challenging jobs, quitting was very painful, but a Mayo doctor asked Betsy a very poignant question that resonated with her: “Are you planning to die for your employer?”

With that, she left her job and sought care for her illness. As her NTM developed a second, more resistant strain associated with her disease, requiring daily, constant treatment, Betsy was fortunate to be accepted into the National Institutes of Health NTM protocol, which has directed her care, coordinated with NYU-Langone.

Despite the challenges of having NTM, Betsy maintains an active and enriching life.
 

Leading with experience

Betsy uses her diagnosis and her experience with NTM to help others who are hearing their diagnoses for the first time. She serves as a charter member and co-leader of a New York NTM patient support group and serves as a member of the NTM Info & Research (NTMir) Board of Directors.

Her goal is to ensure that no one living with NTM feels alone or frightened.

“Not so long ago – and now, too, even – there were doctors who did not know how to treat NTM,” says Betsy. “But, it has really gotten better – as I’ve progressed through all of my medications and lived with this disease, NTM has progressed as well. I hope I helped expand NTM knowledge with my lived experiences, but I’ve been so fortunate to receive medical care from those doctors who knew the most about NTM.”

Receiving a chronic disease diagnosis can be paralyzing, with a wide range of associated emotions. A patient’s family, physicians, and other health care professionals can provide a source of support, but, often, the strongest support comes from those who can empathize.

Someone who has lived with a diagnosis can provide guidance and empathy at a more personal level because, to them, it is just that – personal. Fred Schick and Betsy Glaeser have done just that by taking their personal experiences and using them to help others navigate their diagnoses.

Improving patients’ lives is the core focus of the American College of Chest Physicians and the CHEST Foundation. Events like the Belmont Stakes Dinner and Auction provide an opportunity for us to recognize and celebrate powerful stories such as Fred and Betsy’s, while also raising funds to support important initiatives that will improve patient care. Please consider joining the fight against lung disease by making a donation to the CHEST Foundation today at chestfoundation.org/donate.
 

Patient Advocate – Fred Schick

Increasing awareness of pulmonary fibrosis

Fred Schick of the Chicagoland area was diagnosed with idiopathic pulmonary fibrosis (IPF) in 2017 after years of searching for the root cause of his worsening symptoms.

Fred started experiencing shortness of breath and labored breathing—once to the extent that he needed to be pulled out of the water on vacation despite being an active swimmer. Because Fred was a former cardiac patient, his doctors looked to his heart for a diagnosis.

It wasn’t until his primary care physician retired that he started seeing a new doctor who took a different look at his symptoms. In hearing about the strong changes in his exercise endurance, this particular doctor made the decision to refer Fred to a pulmonologist, which ultimately led Fred on the right path to his IPF diagnosis.
 

Helping others navigate the path

In his 5 years since being diagnosed with IPF, Fred uses his experience to advocate for others living with this illness. Active in support groups for those with IPF, he is especially focused on helping others navigate the first few months after receiving their diagnosis.

Fred knows from experience that receiving the IPF diagnosis is something to come to terms with but encourages others to look to him for an example of how to live with the illness.

“The first thing I say to someone who has been recently diagnosed with pulmonary fibrosis is, ‘Whatever you’ve read on the Internet, don’t believe it,’ because there are a lot of people who live well beyond the 3- to 5-year expectancy you’ll see in your Google search.”

“I also encourage everyone to be their own health advocate – tell your doctor if anything in your life is abnormal because you know your body better than anyone.”

Like Fred, many living with IPF wait years for a diagnosis because of the commonality in the way the symptoms present, including shortness of breath, fatigue, difficulty breathing, and others. To address this delay, the American College of Chest Physicians, supported by the CHEST Foundation, partnered with the Three Lakes Foundation to create an initiative led by a steering committee of pulmonologists and primary care physicians to join together to shorten the time to diagnosis for interstitial lung diseases like IPF. Among other activities, the steering committee will work to create tools for physicians to use during patient intake that can more quickly bring IPF into the conversation when it is pertinent.
 

Patient Advocate – Betsy Glaeser

Blazing the trail for NTM

Local to New York, Betsy Glaeser was diagnosed with pulmonary nontuberculous mycobacteria disease (NTM) more than 20 years ago.

Leading up to her diagnosis, Betsy was frequently short of breath with overwhelming fatigue and fevers. She was hospitalized multiple times for pneumonia and treated again and again with short-term standard antibiotics. At the time (1998), there were no clinical programs dedicated to NTM, and when her sputum was tested, it was only for pneumonia.

As a financial consultant required to travel 4 days per week for work, Betsy grew especially concerned about her illness when she developed hemoptysis and began coughing up blood. Lacking local resources, she sought care at the Mayo Clinic in Rochester, Minnesota, where she received her NTM diagnosis.

Based on the severity of her illness and her worsening symptoms, the recommendation of the Mayo Clinic was that she stop working. After 30 years of challenging jobs, quitting was very painful, but a Mayo doctor asked Betsy a very poignant question that resonated with her: “Are you planning to die for your employer?”

With that, she left her job and sought care for her illness. As her NTM developed a second, more resistant strain associated with her disease, requiring daily, constant treatment, Betsy was fortunate to be accepted into the National Institutes of Health NTM protocol, which has directed her care, coordinated with NYU-Langone.

Despite the challenges of having NTM, Betsy maintains an active and enriching life.
 

Leading with experience

Betsy uses her diagnosis and her experience with NTM to help others who are hearing their diagnoses for the first time. She serves as a charter member and co-leader of a New York NTM patient support group and serves as a member of the NTM Info & Research (NTMir) Board of Directors.

Her goal is to ensure that no one living with NTM feels alone or frightened.

“Not so long ago – and now, too, even – there were doctors who did not know how to treat NTM,” says Betsy. “But, it has really gotten better – as I’ve progressed through all of my medications and lived with this disease, NTM has progressed as well. I hope I helped expand NTM knowledge with my lived experiences, but I’ve been so fortunate to receive medical care from those doctors who knew the most about NTM.”

Affecting around 400,000 people in the United States, interstitial lung diseases (ILD), like pulmonary fibrosis (PF), present with symptoms that are similar to other more common lung diseases, frequently resulting in misdiagnosis or delayed diagnosis. Some studies show that reaching a proper diagnosis for rarer lung diseases can take upwards of several years.

Despite scientific advancements and increased information available, timely and accurate diagnosis for PF remains a challenge. The course of the disease varies from person to person and can progress rapidly in some cases, increasing the necessity to have the condition diagnosed in its earliest stages. By the time patients learn they have PF, the condition may require reliance on oxygen use and hospitalizations, and it can lead to poor quality of life and a significantly shortened lifespan.

To address this issue, Three Lakes Foundation (TLF) and the American College of Chest Physicians (CHEST) recently announced their collaboration on a multiphase educational initiative led by a steering committee of medical experts aiming to reduce the time it takes to diagnose patients with ILDs like PF. Composed of pulmonologists, primary care physicians, and a nursing professional, the steering committee will work to create materials that will aid in identifying and diagnosing complex lung diseases quicker.

“As a catalyst for change in the PF community, Three Lakes Foundation spoke with patients, health care professionals, physicians, and advocacy groups to advance an understanding of the PF diagnostic experience,” said Dana Ball, executive director for Three Lakes Foundation. “We approached CHEST when it became apparent that primary care physicians could use specific tools to identify high-risk patients with pulmonary conditions. This collaboration is the result of our common need to increase awareness among health care professionals and to improve patient outcomes.”

Members of the expert steering committee include individuals from leading medical institutions, health systems, and organizations across the country:

• Daniel F. Dilling, MD, FCCP, Professor of Medicine, Division of Pulmonary and Critical Care, Loyola University Chicago, Stritch School of Medicine, Maywood, IL.
• Andrew Duggan, MPH, Patient Engagement and Innovation Leader representing Three Lakes Foundation, Boston, MA.
• Jessica Glennie, APRN, MSN, Nurse Practitioner, Interstitial Lung Disease Clinic, Cleveland Clinic, Cleveland, OH.
• Timothy Hernandez, MD, Family Medicine Physician, Chief Executive Officer of Entira Family Clinics, San Antonio, TX.
• Corey D. Kershaw, MD, FCCP, Associate Professor of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
• Tejaswini Kulkarni, MD, MPH, FCCP, Assistant Professor, Director, Interstitial Lung Disease Program, Division of Pulmonary, Allergy and Critical Care Medicine, The University of Alabama at Birmingham, Birmingham, AL.
• William Lago, MD, Family Medicine Physician, Wooster Family Health Center, Cleveland Clinic Foundation, Wooster, OH.
• Andrew H. Limper, MD, FCCP, Annenberg Professor of Pulmonary Medicine, Professor of Biochemistry and Molecular Biology, Director – Thoracic Disease Research Unit, Mayo Clinic College of Medicine, Rochester, MN.
• Anoop M. Nambiar, MD, MS, FCCP, Professor of Medicine, Founding Director of the UT Health San Antonio Center for Interstitial Lung Diseases, Division of Pulmonary and Critical Care Medicine, Department of Medicine, The University of Texas Health Science Center at San Antonio and South Texas Veterans Health Care System, San Antonio, TX.
• Mary Beth Scholand, MD, Associate Professor of Internal Medicine, Division of Pulmonary Diseases, Director, Interstitial Lung Program, University of Utah, Salt Lake City, UT

“While interstitial lung diseases do not affect a substantial amount of the population, those touched by the disease are impacted tremendously,” says steering committee member and pulmonologist, Dr. Andrew H. Limper. “Any delay in receiving a diagnosis is time that could be dedicated to finding a treatment therapy that can improve their quality of life. I look forward to the work of this committee helping to shape how patients with ILDs are diagnosed and treated in the future.”

Starting with data-gathering surveys sent to both primary care physicians and pulmonologists, the committee will evaluate the findings to develop tools that can be used to aid in diagnosing complex lung diseases.

“Having experts from both pulmonary and primary care medicine as members of the steering committee is critical,” says steering committee member and family medicine physician, Dr. William Lago. “Patients first see their family medicine or primary care clinicians and, all too often, the most complex lung diseases present in ways that are indistinguishable from more common conditions like asthma and COPD. Bringing together experts in both fields will yield the best results in creating a path to diagnosis.”

Three Lakes Foundation is providing the initial funding for CHEST to begin designing an educational intervention that addresses the gaps in knowledge and practice and will play an active role in overseeing the development of the program.

For more information on the Bridging Specialties^™: Timely Diagnosis for Patients With ILD initiative and to sign up for updates, visit info.chestnet.org/bridging-specialties-timely-diagnosis-for-ild-patients.

Affecting around 400,000 people in the United States, interstitial lung diseases (ILD), like pulmonary fibrosis (PF), present with symptoms that are similar to other more common lung diseases, frequently resulting in misdiagnosis or delayed diagnosis. Some studies show that reaching a proper diagnosis for rarer lung diseases can take upwards of several years.

Despite scientific advancements and increased information available, timely and accurate diagnosis for PF remains a challenge. The course of the disease varies from person to person and can progress rapidly in some cases, increasing the necessity to have the condition diagnosed in its earliest stages. By the time patients learn they have PF, the condition may require reliance on oxygen use and hospitalizations, and it can lead to poor quality of life and a significantly shortened lifespan.

To address this issue, Three Lakes Foundation (TLF) and the American College of Chest Physicians (CHEST) recently announced their collaboration on a multiphase educational initiative led by a steering committee of medical experts aiming to reduce the time it takes to diagnose patients with ILDs like PF. Composed of pulmonologists, primary care physicians, and a nursing professional, the steering committee will work to create materials that will aid in identifying and diagnosing complex lung diseases quicker.

“As a catalyst for change in the PF community, Three Lakes Foundation spoke with patients, health care professionals, physicians, and advocacy groups to advance an understanding of the PF diagnostic experience,” said Dana Ball, executive director for Three Lakes Foundation. “We approached CHEST when it became apparent that primary care physicians could use specific tools to identify high-risk patients with pulmonary conditions. This collaboration is the result of our common need to increase awareness among health care professionals and to improve patient outcomes.”

Members of the expert steering committee include individuals from leading medical institutions, health systems, and organizations across the country:

• Daniel F. Dilling, MD, FCCP, Professor of Medicine, Division of Pulmonary and Critical Care, Loyola University Chicago, Stritch School of Medicine, Maywood, IL.
• Andrew Duggan, MPH, Patient Engagement and Innovation Leader representing Three Lakes Foundation, Boston, MA.
• Jessica Glennie, APRN, MSN, Nurse Practitioner, Interstitial Lung Disease Clinic, Cleveland Clinic, Cleveland, OH.
• Timothy Hernandez, MD, Family Medicine Physician, Chief Executive Officer of Entira Family Clinics, San Antonio, TX.
• Corey D. Kershaw, MD, FCCP, Associate Professor of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
• Tejaswini Kulkarni, MD, MPH, FCCP, Assistant Professor, Director, Interstitial Lung Disease Program, Division of Pulmonary, Allergy and Critical Care Medicine, The University of Alabama at Birmingham, Birmingham, AL.
• William Lago, MD, Family Medicine Physician, Wooster Family Health Center, Cleveland Clinic Foundation, Wooster, OH.
• Andrew H. Limper, MD, FCCP, Annenberg Professor of Pulmonary Medicine, Professor of Biochemistry and Molecular Biology, Director – Thoracic Disease Research Unit, Mayo Clinic College of Medicine, Rochester, MN.
• Anoop M. Nambiar, MD, MS, FCCP, Professor of Medicine, Founding Director of the UT Health San Antonio Center for Interstitial Lung Diseases, Division of Pulmonary and Critical Care Medicine, Department of Medicine, The University of Texas Health Science Center at San Antonio and South Texas Veterans Health Care System, San Antonio, TX.
• Mary Beth Scholand, MD, Associate Professor of Internal Medicine, Division of Pulmonary Diseases, Director, Interstitial Lung Program, University of Utah, Salt Lake City, UT

“While interstitial lung diseases do not affect a substantial amount of the population, those touched by the disease are impacted tremendously,” says steering committee member and pulmonologist, Dr. Andrew H. Limper. “Any delay in receiving a diagnosis is time that could be dedicated to finding a treatment therapy that can improve their quality of life. I look forward to the work of this committee helping to shape how patients with ILDs are diagnosed and treated in the future.”

Starting with data-gathering surveys sent to both primary care physicians and pulmonologists, the committee will evaluate the findings to develop tools that can be used to aid in diagnosing complex lung diseases.

“Having experts from both pulmonary and primary care medicine as members of the steering committee is critical,” says steering committee member and family medicine physician, Dr. William Lago. “Patients first see their family medicine or primary care clinicians and, all too often, the most complex lung diseases present in ways that are indistinguishable from more common conditions like asthma and COPD. Bringing together experts in both fields will yield the best results in creating a path to diagnosis.”

Three Lakes Foundation is providing the initial funding for CHEST to begin designing an educational intervention that addresses the gaps in knowledge and practice and will play an active role in overseeing the development of the program.

For more information on the Bridging Specialties^™: Timely Diagnosis for Patients With ILD initiative and to sign up for updates, visit info.chestnet.org/bridging-specialties-timely-diagnosis-for-ild-patients.

Affecting around 400,000 people in the United States, interstitial lung diseases (ILD), like pulmonary fibrosis (PF), present with symptoms that are similar to other more common lung diseases, frequently resulting in misdiagnosis or delayed diagnosis. Some studies show that reaching a proper diagnosis for rarer lung diseases can take upwards of several years.

Despite scientific advancements and increased information available, timely and accurate diagnosis for PF remains a challenge. The course of the disease varies from person to person and can progress rapidly in some cases, increasing the necessity to have the condition diagnosed in its earliest stages. By the time patients learn they have PF, the condition may require reliance on oxygen use and hospitalizations, and it can lead to poor quality of life and a significantly shortened lifespan.

To address this issue, Three Lakes Foundation (TLF) and the American College of Chest Physicians (CHEST) recently announced their collaboration on a multiphase educational initiative led by a steering committee of medical experts aiming to reduce the time it takes to diagnose patients with ILDs like PF. Composed of pulmonologists, primary care physicians, and a nursing professional, the steering committee will work to create materials that will aid in identifying and diagnosing complex lung diseases quicker.

“As a catalyst for change in the PF community, Three Lakes Foundation spoke with patients, health care professionals, physicians, and advocacy groups to advance an understanding of the PF diagnostic experience,” said Dana Ball, executive director for Three Lakes Foundation. “We approached CHEST when it became apparent that primary care physicians could use specific tools to identify high-risk patients with pulmonary conditions. This collaboration is the result of our common need to increase awareness among health care professionals and to improve patient outcomes.”

Members of the expert steering committee include individuals from leading medical institutions, health systems, and organizations across the country:

• Daniel F. Dilling, MD, FCCP, Professor of Medicine, Division of Pulmonary and Critical Care, Loyola University Chicago, Stritch School of Medicine, Maywood, IL.
• Andrew Duggan, MPH, Patient Engagement and Innovation Leader representing Three Lakes Foundation, Boston, MA.
• Jessica Glennie, APRN, MSN, Nurse Practitioner, Interstitial Lung Disease Clinic, Cleveland Clinic, Cleveland, OH.
• Timothy Hernandez, MD, Family Medicine Physician, Chief Executive Officer of Entira Family Clinics, San Antonio, TX.
• Corey D. Kershaw, MD, FCCP, Associate Professor of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
• Tejaswini Kulkarni, MD, MPH, FCCP, Assistant Professor, Director, Interstitial Lung Disease Program, Division of Pulmonary, Allergy and Critical Care Medicine, The University of Alabama at Birmingham, Birmingham, AL.
• William Lago, MD, Family Medicine Physician, Wooster Family Health Center, Cleveland Clinic Foundation, Wooster, OH.
• Andrew H. Limper, MD, FCCP, Annenberg Professor of Pulmonary Medicine, Professor of Biochemistry and Molecular Biology, Director – Thoracic Disease Research Unit, Mayo Clinic College of Medicine, Rochester, MN.
• Anoop M. Nambiar, MD, MS, FCCP, Professor of Medicine, Founding Director of the UT Health San Antonio Center for Interstitial Lung Diseases, Division of Pulmonary and Critical Care Medicine, Department of Medicine, The University of Texas Health Science Center at San Antonio and South Texas Veterans Health Care System, San Antonio, TX.
• Mary Beth Scholand, MD, Associate Professor of Internal Medicine, Division of Pulmonary Diseases, Director, Interstitial Lung Program, University of Utah, Salt Lake City, UT

“While interstitial lung diseases do not affect a substantial amount of the population, those touched by the disease are impacted tremendously,” says steering committee member and pulmonologist, Dr. Andrew H. Limper. “Any delay in receiving a diagnosis is time that could be dedicated to finding a treatment therapy that can improve their quality of life. I look forward to the work of this committee helping to shape how patients with ILDs are diagnosed and treated in the future.”

Starting with data-gathering surveys sent to both primary care physicians and pulmonologists, the committee will evaluate the findings to develop tools that can be used to aid in diagnosing complex lung diseases.

“Having experts from both pulmonary and primary care medicine as members of the steering committee is critical,” says steering committee member and family medicine physician, Dr. William Lago. “Patients first see their family medicine or primary care clinicians and, all too often, the most complex lung diseases present in ways that are indistinguishable from more common conditions like asthma and COPD. Bringing together experts in both fields will yield the best results in creating a path to diagnosis.”

Three Lakes Foundation is providing the initial funding for CHEST to begin designing an educational intervention that addresses the gaps in knowledge and practice and will play an active role in overseeing the development of the program.

For more information on the Bridging Specialties^™: Timely Diagnosis for Patients With ILD initiative and to sign up for updates, visit info.chestnet.org/bridging-specialties-timely-diagnosis-for-ild-patients.

Airways disorders network, bronchiectasis section

Phenotyping bronchiectasis: Focus on eosinophilic bronchiectasis

Bronchiectasis has been often linked to neutrophilic inflammation; however, 20% may have a predominantly eosinophilic inflammation.

Eosinophilic bronchiectasis has been associated with a distinct airway microbiome. Shoemark and colleagues showed in an analysis of 1,007 patients from five countries that 22.6% of patients had blood eosinophil counts (BEC) of >300 cells/μL. BEC of <100 cells/μL were associated with higher bronchiectasis severity and increased mortality (Shoemark et al. Am J Respir Crit Care Med. 2022;205[8]:894-902).

BEC of >300 cells/μL were correlated with Streptococcus- and Pseudomonas-dominated microbiome profiles. Compared with patients with BEC of <100 cells/μL, patients with 100-299 cells/μL (hazard ratio [HR], 2.38; 95% confidence interval, 1.33–4.25; P = .003) and those with >300 cells/μL (HR, 3.99; 95% confidence interval, 2.20–7.85; P = .0001) were associated with shorter time to exacerbation.

Eosinophilic inflammation is a risk factor for exacerbations in patients with P. aeruginosa infection and may be considered as a treatable trait. Shoemark and colleagues’ data show that quality of life was improved with inhaled corticosteroid treatment in patients with bronchiectasis who had blood eosinophil counts of >3%, and eosinophils contribute to bronchiectasis exacerbations.

Diffuse lung disease and lung transplant network, occupational and environmental health section

A ubiquitous invasion: The rise of microplastics

About 6.3 billion tons of plastic waste were produced between 1950 and 2015.¹ Their degradation into submillimeter fragments of 1 μm to 5 mm, is called microplastics (MP).² MP are vectors of pollutants, pathologic microorganisms, and chemical additives used in their fabrication.³ Exposure to MP is unavoidable as they are bio-persistent and ubiquitous, even indoors.⁴ MP have been detected in the snow of large metropolitan areas and in remote locations.⁵ Humans are exposed to MP via oral ingestion and inhalation. A Brazilian study of human lung autopsy specimens revealed the presence of MP in 13 of 20 subjects.³

In vitro studies have suggested a causal role of polystyrene-MP in the development of chronic pulmonary disease through the formation of reactive oxygen species, inhibition of cell proliferation, and cellular morphology aberration.⁶ MP can cause local effects due to macrophage-induced inflammation, or alternatively, be transported distantly to the pleura and the systemic circulation.

In addition, MP may disrupt the endocrine pathway due to its estrogenic effects.⁷ Larger MPs of 8 to 10 µm, like nylon, have been associated with interstitial lung disease.⁸ Lung biopsies from workers exposed to airborne synthetic fibers (acrylic, polyester, and terylene) have revealed different degrees of inflammation, granulomas, and interstitial fibrosis.⁹ Factory workers exposed to polyvinyl chloride dust have increased risk of exertional dyspnea and decreased pulmonary function.¹⁰ Due to the pervasive nature of MP, it is essential to establish the global burden of airborne MP and to determine its role in lung health.

Bathmapriya Balakrishnan, MD 
Member-at-Large
 

*Tyler Church, DO 
Fellow-in-Training Member

*Disclaimer: The views expressed in this article are those of the author(s) and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or U.S. Government.
 

References

1. Rhodes CJ. Plastic pollution and potential solutions. Sci Prog. 2018;101(3):207-60.

2. Danopoulos E et al. Microplastic contamination of drinking water: A systematic review. PLoS One. 2020;15(7):e0236838.

3. Amato-Lourenço LF et al. Presence of airborne microplastics in human lung tissue. J Hazard Mater. 2021;416:126.

4. Al Horr Y et al. Occupant productivity and office indoor environment quality: A review of the literature. Building and Environment. 2016;105:369-89.

5. Bergmann M et al. White and wonderful? Microplastics prevail in snow from the Alps to the Arctic. Sci Adv. 2019;5:eaax1157.

6. Dong CD et al. Polystyrene microplastic particles: In vitro pulmonary toxicity assessment. J Hazard Mater. 2020;385:121575.

7. Amato-Lourenço LF et al. An emerging class of air pollutants: Potential effects of microplastics to respiratory human health. Sci Total Environ. 2020;749:141676.

8. Kern DG et al. Flock worker’s lung: Chronic interstitial lung disease in the nylon flocking industry. Ann Intern Med. 1998;129[4]:261-72. Erratum in: Ann Intern Med. 1999;130[3]:246.

9. Pimentel JC et al. Respiratory disease caused by synthetic fibers: a new occupational disease. Thorax. 1975;30:204-19.

10. Soutar CA et al. Epidemiological study of respiratory disease in workers exposed to polyvinyl chloride dust. Thorax. 1980;35:644-52.
 

Critical care network, palliative and end-of-life section

Discussing code status with families of critically ill patients

Discussing code status with patients is complex and emotional, especially when critically ill.

The complexity further increases when these conversations have to take place with family members.

Here are some practical tips to help have these conversations in a concise and compassionate manner.  

Introduction  

• Introduce yourself, and make sure to identify the correct decision-maker.   
• Get to know the patient.  

–What kind of person are they?  

–What brings them joy?  

• Find out what the family knows about the current clinical condition of their family member.   

–What have you been hearing from the medical team?  

–What are you worried about?  

Update    

• Fill in the gaps – update them on the clinical condition and ongoing management.  
• Discuss how you think they will respond to current management and further management options.   
• Allow them to process the information.  

Provide a medical recommendation    

• Example: We are worried he might die, and if his heart stops, interventions like CPR or intubation would not work, and we would not recommend them.  
• Do not pressure for a decision right away. (You can say “We do not need a decision today, so please take time to process this information.”)  

Respond to emotions    

• I can’t image how hard this must be.  
• Offer chaplain services if that is important to them.  

Things to avoid 

• Avoid aggressive language.  

–We will have to pound on their chest, break ribs.   

–They would be suffering.  

• Blaming or judgmental language.  

While this complex discussion r equires individualization, these tips will help set a framework for goals of care conversations that lead to high quality care for patients that aligns with their goals.   

Reference

Goldfish and Rosielle. Language for Routine Code Status Discussions, Fast Facts and Concepts #365, Palliative Care Network of Wisconsin.

Syed Nazeer Mahmood, MD
Fellow-in-Training Member

Anne Kelemen, LCSW
Member-at-Large

Airways disorders network, bronchiectasis section

Phenotyping bronchiectasis: Focus on eosinophilic bronchiectasis

Bronchiectasis has been often linked to neutrophilic inflammation; however, 20% may have a predominantly eosinophilic inflammation.

Eosinophilic bronchiectasis has been associated with a distinct airway microbiome. Shoemark and colleagues showed in an analysis of 1,007 patients from five countries that 22.6% of patients had blood eosinophil counts (BEC) of >300 cells/μL. BEC of <100 cells/μL were associated with higher bronchiectasis severity and increased mortality (Shoemark et al. Am J Respir Crit Care Med. 2022;205[8]:894-902).

BEC of >300 cells/μL were correlated with Streptococcus- and Pseudomonas-dominated microbiome profiles. Compared with patients with BEC of <100 cells/μL, patients with 100-299 cells/μL (hazard ratio [HR], 2.38; 95% confidence interval, 1.33–4.25; P = .003) and those with >300 cells/μL (HR, 3.99; 95% confidence interval, 2.20–7.85; P = .0001) were associated with shorter time to exacerbation.

Eosinophilic inflammation is a risk factor for exacerbations in patients with P. aeruginosa infection and may be considered as a treatable trait. Shoemark and colleagues’ data show that quality of life was improved with inhaled corticosteroid treatment in patients with bronchiectasis who had blood eosinophil counts of >3%, and eosinophils contribute to bronchiectasis exacerbations.

Diffuse lung disease and lung transplant network, occupational and environmental health section

A ubiquitous invasion: The rise of microplastics

About 6.3 billion tons of plastic waste were produced between 1950 and 2015.¹ Their degradation into submillimeter fragments of 1 μm to 5 mm, is called microplastics (MP).² MP are vectors of pollutants, pathologic microorganisms, and chemical additives used in their fabrication.³ Exposure to MP is unavoidable as they are bio-persistent and ubiquitous, even indoors.⁴ MP have been detected in the snow of large metropolitan areas and in remote locations.⁵ Humans are exposed to MP via oral ingestion and inhalation. A Brazilian study of human lung autopsy specimens revealed the presence of MP in 13 of 20 subjects.³

In vitro studies have suggested a causal role of polystyrene-MP in the development of chronic pulmonary disease through the formation of reactive oxygen species, inhibition of cell proliferation, and cellular morphology aberration.⁶ MP can cause local effects due to macrophage-induced inflammation, or alternatively, be transported distantly to the pleura and the systemic circulation.

In addition, MP may disrupt the endocrine pathway due to its estrogenic effects.⁷ Larger MPs of 8 to 10 µm, like nylon, have been associated with interstitial lung disease.⁸ Lung biopsies from workers exposed to airborne synthetic fibers (acrylic, polyester, and terylene) have revealed different degrees of inflammation, granulomas, and interstitial fibrosis.⁹ Factory workers exposed to polyvinyl chloride dust have increased risk of exertional dyspnea and decreased pulmonary function.¹⁰ Due to the pervasive nature of MP, it is essential to establish the global burden of airborne MP and to determine its role in lung health.

Bathmapriya Balakrishnan, MD 
Member-at-Large
 

*Tyler Church, DO 
Fellow-in-Training Member

*Disclaimer: The views expressed in this article are those of the author(s) and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or U.S. Government.
 

References

1. Rhodes CJ. Plastic pollution and potential solutions. Sci Prog. 2018;101(3):207-60.

2. Danopoulos E et al. Microplastic contamination of drinking water: A systematic review. PLoS One. 2020;15(7):e0236838.

3. Amato-Lourenço LF et al. Presence of airborne microplastics in human lung tissue. J Hazard Mater. 2021;416:126.

4. Al Horr Y et al. Occupant productivity and office indoor environment quality: A review of the literature. Building and Environment. 2016;105:369-89.

5. Bergmann M et al. White and wonderful? Microplastics prevail in snow from the Alps to the Arctic. Sci Adv. 2019;5:eaax1157.

6. Dong CD et al. Polystyrene microplastic particles: In vitro pulmonary toxicity assessment. J Hazard Mater. 2020;385:121575.

7. Amato-Lourenço LF et al. An emerging class of air pollutants: Potential effects of microplastics to respiratory human health. Sci Total Environ. 2020;749:141676.

8. Kern DG et al. Flock worker’s lung: Chronic interstitial lung disease in the nylon flocking industry. Ann Intern Med. 1998;129[4]:261-72. Erratum in: Ann Intern Med. 1999;130[3]:246.

9. Pimentel JC et al. Respiratory disease caused by synthetic fibers: a new occupational disease. Thorax. 1975;30:204-19.

10. Soutar CA et al. Epidemiological study of respiratory disease in workers exposed to polyvinyl chloride dust. Thorax. 1980;35:644-52.
 

Critical care network, palliative and end-of-life section

Discussing code status with families of critically ill patients

Discussing code status with patients is complex and emotional, especially when critically ill.

The complexity further increases when these conversations have to take place with family members.

Here are some practical tips to help have these conversations in a concise and compassionate manner.  

Introduction  

• Introduce yourself, and make sure to identify the correct decision-maker.   
• Get to know the patient.  

–What kind of person are they?  

–What brings them joy?  

• Find out what the family knows about the current clinical condition of their family member.   

–What have you been hearing from the medical team?  

–What are you worried about?  

Update    

• Fill in the gaps – update them on the clinical condition and ongoing management.  
• Discuss how you think they will respond to current management and further management options.   
• Allow them to process the information.  

Provide a medical recommendation    

• Example: We are worried he might die, and if his heart stops, interventions like CPR or intubation would not work, and we would not recommend them.  
• Do not pressure for a decision right away. (You can say “We do not need a decision today, so please take time to process this information.”)  

Respond to emotions    

• I can’t image how hard this must be.  
• Offer chaplain services if that is important to them.  

Things to avoid 

• Avoid aggressive language.  

–We will have to pound on their chest, break ribs.   

–They would be suffering.  

• Blaming or judgmental language.  

While this complex discussion r equires individualization, these tips will help set a framework for goals of care conversations that lead to high quality care for patients that aligns with their goals.   

Reference

Goldfish and Rosielle. Language for Routine Code Status Discussions, Fast Facts and Concepts #365, Palliative Care Network of Wisconsin.

Syed Nazeer Mahmood, MD
Fellow-in-Training Member

Anne Kelemen, LCSW
Member-at-Large

Airways disorders network, bronchiectasis section

Phenotyping bronchiectasis: Focus on eosinophilic bronchiectasis

Bronchiectasis has been often linked to neutrophilic inflammation; however, 20% may have a predominantly eosinophilic inflammation.

Eosinophilic bronchiectasis has been associated with a distinct airway microbiome. Shoemark and colleagues showed in an analysis of 1,007 patients from five countries that 22.6% of patients had blood eosinophil counts (BEC) of >300 cells/μL. BEC of <100 cells/μL were associated with higher bronchiectasis severity and increased mortality (Shoemark et al. Am J Respir Crit Care Med. 2022;205[8]:894-902).

BEC of >300 cells/μL were correlated with Streptococcus- and Pseudomonas-dominated microbiome profiles. Compared with patients with BEC of <100 cells/μL, patients with 100-299 cells/μL (hazard ratio [HR], 2.38; 95% confidence interval, 1.33–4.25; P = .003) and those with >300 cells/μL (HR, 3.99; 95% confidence interval, 2.20–7.85; P = .0001) were associated with shorter time to exacerbation.

Eosinophilic inflammation is a risk factor for exacerbations in patients with P. aeruginosa infection and may be considered as a treatable trait. Shoemark and colleagues’ data show that quality of life was improved with inhaled corticosteroid treatment in patients with bronchiectasis who had blood eosinophil counts of >3%, and eosinophils contribute to bronchiectasis exacerbations.

Diffuse lung disease and lung transplant network, occupational and environmental health section

A ubiquitous invasion: The rise of microplastics

About 6.3 billion tons of plastic waste were produced between 1950 and 2015.¹ Their degradation into submillimeter fragments of 1 μm to 5 mm, is called microplastics (MP).² MP are vectors of pollutants, pathologic microorganisms, and chemical additives used in their fabrication.³ Exposure to MP is unavoidable as they are bio-persistent and ubiquitous, even indoors.⁴ MP have been detected in the snow of large metropolitan areas and in remote locations.⁵ Humans are exposed to MP via oral ingestion and inhalation. A Brazilian study of human lung autopsy specimens revealed the presence of MP in 13 of 20 subjects.³

In vitro studies have suggested a causal role of polystyrene-MP in the development of chronic pulmonary disease through the formation of reactive oxygen species, inhibition of cell proliferation, and cellular morphology aberration.⁶ MP can cause local effects due to macrophage-induced inflammation, or alternatively, be transported distantly to the pleura and the systemic circulation.

In addition, MP may disrupt the endocrine pathway due to its estrogenic effects.⁷ Larger MPs of 8 to 10 µm, like nylon, have been associated with interstitial lung disease.⁸ Lung biopsies from workers exposed to airborne synthetic fibers (acrylic, polyester, and terylene) have revealed different degrees of inflammation, granulomas, and interstitial fibrosis.⁹ Factory workers exposed to polyvinyl chloride dust have increased risk of exertional dyspnea and decreased pulmonary function.¹⁰ Due to the pervasive nature of MP, it is essential to establish the global burden of airborne MP and to determine its role in lung health.

Bathmapriya Balakrishnan, MD 
Member-at-Large
 

*Tyler Church, DO 
Fellow-in-Training Member

*Disclaimer: The views expressed in this article are those of the author(s) and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or U.S. Government.
 

References

1. Rhodes CJ. Plastic pollution and potential solutions. Sci Prog. 2018;101(3):207-60.

2. Danopoulos E et al. Microplastic contamination of drinking water: A systematic review. PLoS One. 2020;15(7):e0236838.

3. Amato-Lourenço LF et al. Presence of airborne microplastics in human lung tissue. J Hazard Mater. 2021;416:126.

4. Al Horr Y et al. Occupant productivity and office indoor environment quality: A review of the literature. Building and Environment. 2016;105:369-89.

5. Bergmann M et al. White and wonderful? Microplastics prevail in snow from the Alps to the Arctic. Sci Adv. 2019;5:eaax1157.

6. Dong CD et al. Polystyrene microplastic particles: In vitro pulmonary toxicity assessment. J Hazard Mater. 2020;385:121575.

7. Amato-Lourenço LF et al. An emerging class of air pollutants: Potential effects of microplastics to respiratory human health. Sci Total Environ. 2020;749:141676.

8. Kern DG et al. Flock worker’s lung: Chronic interstitial lung disease in the nylon flocking industry. Ann Intern Med. 1998;129[4]:261-72. Erratum in: Ann Intern Med. 1999;130[3]:246.

9. Pimentel JC et al. Respiratory disease caused by synthetic fibers: a new occupational disease. Thorax. 1975;30:204-19.

10. Soutar CA et al. Epidemiological study of respiratory disease in workers exposed to polyvinyl chloride dust. Thorax. 1980;35:644-52.
 

Critical care network, palliative and end-of-life section

Discussing code status with families of critically ill patients

Discussing code status with patients is complex and emotional, especially when critically ill.

The complexity further increases when these conversations have to take place with family members.

Here are some practical tips to help have these conversations in a concise and compassionate manner.  

Introduction  

• Introduce yourself, and make sure to identify the correct decision-maker.   
• Get to know the patient.  

–What kind of person are they?  

–What brings them joy?  

• Find out what the family knows about the current clinical condition of their family member.   

–What have you been hearing from the medical team?  

–What are you worried about?  

Update    

• Fill in the gaps – update them on the clinical condition and ongoing management.  
• Discuss how you think they will respond to current management and further management options.   
• Allow them to process the information.  

Provide a medical recommendation    

• Example: We are worried he might die, and if his heart stops, interventions like CPR or intubation would not work, and we would not recommend them.  
• Do not pressure for a decision right away. (You can say “We do not need a decision today, so please take time to process this information.”)  

Respond to emotions    

• I can’t image how hard this must be.  
• Offer chaplain services if that is important to them.  

Things to avoid 

• Avoid aggressive language.  

–We will have to pound on their chest, break ribs.   

–They would be suffering.  

• Blaming or judgmental language.  

While this complex discussion r equires individualization, these tips will help set a framework for goals of care conversations that lead to high quality care for patients that aligns with their goals.   

Reference

Goldfish and Rosielle. Language for Routine Code Status Discussions, Fast Facts and Concepts #365, Palliative Care Network of Wisconsin.

Syed Nazeer Mahmood, MD
Fellow-in-Training Member

Anne Kelemen, LCSW
Member-at-Large

The Relationship Between Insurance Status and The Affordable Care Act on Asthma Outcomes Among Low-Income Us Adults. By Dr. Rajat Suri et al.

Characteristics and Outcomes of Intensive Care Unit Patients With Respiratory Syncytial Virus Compared to Those With Influenza Infection: A Multicentre Matched Cohort Study. By Dr. Julien Coussement et al

“Can Do, Do Do” Quadrants and 6-Year All-Cause Mortality in Patients with COPD. By Dr. Anouk W. Vaes et al.

Trends in Geriatric Conditions Among Older Adults Admitted to US ICUs Between 1998 and 2015. By Dr. Julien Cobert et al.

Setting and Titrating Positive End-Expiratory Pressure. By Dr. Scott J. Millington et al.

COVID-19 in Lymphangioleiomyomatosis: An International Study of Outcomes and Impact of Mechanistic Target of Rapamycin Inhibition. By Dr. Bruno Guedes Baldi et al.

Perceptions of Life Support and Advance Care Planning During the COVID-19 Pandemic: A Global Study of Twitter Users. By Vishal R. Patel et al.

Framework for Integrating Equity Into Machine Learning Models: A Case Study. By Dr. Juan C. Rojas et al.

Comparison of Guidelines for Evaluation of Suspected Pulmonary Embolism in Pregnancy: A Cost-Effectiveness Analysis. By John Austin McCandlish et al.

Relationship Between CPAP Termination and All-Cause Mortality: A French Nationwide Database Analysis. By Dr. Jean-Louis Pépin et al.

Clinical Outcomes of Immune Checkpoint Inhibitor Therapy in Patients With Advanced Non-small Cell Lung Cancer and Preexisting Interstitial Lung Diseases: A Systematic Review and Meta-Analysis. By Dr. Meng Zhang, et al.

The Impact of Persistent Smoking After Surgery on Long-Term Outcomes After Stage I Non–Small Cell Lung Cancer Resection. By Dr. Brendan T. Heiden et al.

The Relationship Between Insurance Status and The Affordable Care Act on Asthma Outcomes Among Low-Income Us Adults. By Dr. Rajat Suri et al.

Characteristics and Outcomes of Intensive Care Unit Patients With Respiratory Syncytial Virus Compared to Those With Influenza Infection: A Multicentre Matched Cohort Study. By Dr. Julien Coussement et al

“Can Do, Do Do” Quadrants and 6-Year All-Cause Mortality in Patients with COPD. By Dr. Anouk W. Vaes et al.

Trends in Geriatric Conditions Among Older Adults Admitted to US ICUs Between 1998 and 2015. By Dr. Julien Cobert et al.

Setting and Titrating Positive End-Expiratory Pressure. By Dr. Scott J. Millington et al.

COVID-19 in Lymphangioleiomyomatosis: An International Study of Outcomes and Impact of Mechanistic Target of Rapamycin Inhibition. By Dr. Bruno Guedes Baldi et al.

Perceptions of Life Support and Advance Care Planning During the COVID-19 Pandemic: A Global Study of Twitter Users. By Vishal R. Patel et al.

Framework for Integrating Equity Into Machine Learning Models: A Case Study. By Dr. Juan C. Rojas et al.

Comparison of Guidelines for Evaluation of Suspected Pulmonary Embolism in Pregnancy: A Cost-Effectiveness Analysis. By John Austin McCandlish et al.

Relationship Between CPAP Termination and All-Cause Mortality: A French Nationwide Database Analysis. By Dr. Jean-Louis Pépin et al.

Clinical Outcomes of Immune Checkpoint Inhibitor Therapy in Patients With Advanced Non-small Cell Lung Cancer and Preexisting Interstitial Lung Diseases: A Systematic Review and Meta-Analysis. By Dr. Meng Zhang, et al.

The Impact of Persistent Smoking After Surgery on Long-Term Outcomes After Stage I Non–Small Cell Lung Cancer Resection. By Dr. Brendan T. Heiden et al.

The Relationship Between Insurance Status and The Affordable Care Act on Asthma Outcomes Among Low-Income Us Adults. By Dr. Rajat Suri et al.

Characteristics and Outcomes of Intensive Care Unit Patients With Respiratory Syncytial Virus Compared to Those With Influenza Infection: A Multicentre Matched Cohort Study. By Dr. Julien Coussement et al

“Can Do, Do Do” Quadrants and 6-Year All-Cause Mortality in Patients with COPD. By Dr. Anouk W. Vaes et al.

Trends in Geriatric Conditions Among Older Adults Admitted to US ICUs Between 1998 and 2015. By Dr. Julien Cobert et al.

Setting and Titrating Positive End-Expiratory Pressure. By Dr. Scott J. Millington et al.

COVID-19 in Lymphangioleiomyomatosis: An International Study of Outcomes and Impact of Mechanistic Target of Rapamycin Inhibition. By Dr. Bruno Guedes Baldi et al.

Perceptions of Life Support and Advance Care Planning During the COVID-19 Pandemic: A Global Study of Twitter Users. By Vishal R. Patel et al.

Framework for Integrating Equity Into Machine Learning Models: A Case Study. By Dr. Juan C. Rojas et al.

Comparison of Guidelines for Evaluation of Suspected Pulmonary Embolism in Pregnancy: A Cost-Effectiveness Analysis. By John Austin McCandlish et al.

Relationship Between CPAP Termination and All-Cause Mortality: A French Nationwide Database Analysis. By Dr. Jean-Louis Pépin et al.

Clinical Outcomes of Immune Checkpoint Inhibitor Therapy in Patients With Advanced Non-small Cell Lung Cancer and Preexisting Interstitial Lung Diseases: A Systematic Review and Meta-Analysis. By Dr. Meng Zhang, et al.

The Impact of Persistent Smoking After Surgery on Long-Term Outcomes After Stage I Non–Small Cell Lung Cancer Resection. By Dr. Brendan T. Heiden et al.

Pulmonary vascular & cardiovascular network: Cardiovascular medicine & surgery section 

Targeted temperature management (TTM) after cardiac arrest: How cool?  

Recent randomized control trials, TTM2 (Dankiewicz J. N Engl J Med. 2021;384:2283) and HYPERION (Lascarrou J-B. N Engl J Med. 2019;381:2327), of therapeutic hypothermia, as opposed to normothermia, in patients who remain comatose after return of spontaneous circulation (ROSC) after cardiac arrest have produced conflicting results regarding survival and neurologic benefit. TTM2 reported no benefit to cooling to 33°C, while HYPERION found improved neurologic outcome at 90 days in patients cooled to 33°C.  The European Resuscitation Council (ERC) and European Society of Intensive Care Medicine (ESICM) recently released an evidence review and guideline for adults who remain comatose after cardiac arrest (Sandroni C. Intensive Care Med. 2022;48:261). These guidelines recommend continuous monitoring of core temperature in all patients who remain comatose after cardiac arrest, and preventing fever (>37.7°C) for 72 hours, but with no recommendation of target temperature of 32°C vs 36°C.  

Differences in patient populations, presenting rhythm during arrest, duration of CPR, and time to target temperature likely each contribute to the disparate conclusions of previous trials. For example, HYPERION enrolled patients with out of hospital cardiac arrest with initial nonshockable rhythms and found benefit to cooling to 33°C.  In comparison, TTM2 enrolled all patients with ROSC following arrest (regardless of rhythm), including patients with in-hospital cardiac arrest and found no benefit in therapeutic cooling. Differences in patient populations are underscored by the widely differing percentage of patients with good neurologic outcome in their respective control groups: approximately 30% in the TTM2 trial and 6% in HYPERION. The guidelines leave significant room for clinical judgment in employing therapeutic cooling but encourage the continuous monitoring of core temperature and active avoidance of fever.  

Fiore Mastroianna, MD

Section Member-at-Large 

Chest infections & disaster response network: Chest infections section

Update on LTBI treatment: Ensuring success by simplifying, shortening, and completing treatment

My patient has a positive IGRA test result – what’s next?

If TB disease is ruled out by clinical, radiographic, and microbiologic assessment (if indicated), then latent TB infection (LTBI) is established, and treatment should be offered, guided by shared-decision making between provider and patient.

Courtesy CHEST

What options are available?

While the former standard 9-month regimen of isoniazid-monotherapy can be shortened to 6 months, shorter rifamycin-based regimens are now preferred in most cases and include:

4 months rifampin daily, 3 months isoniazid plus rifampin daily, or 3 months isoniazid plus rifapentine weekly. In addition, 1 month of isoniazid plus rifapentine daily has recently been shown to be effective in people with HIV.

Courtesy CHEST

Sebastian Kurz, MD, FCCP

Amee Patrawalla, MD, MPH, FCCP

Section Members-at-Large

References

Testing and Treatment of Latent Tuberculosis Infection in the United States: Clinical Recommendations. A Guide for Health Care Providers and Public Health Programs. Copyright © 2021 by the National Society of Tuberculosis Clinicians and National Tuberculosis Controllers Association

1. Shah, D. Latent tuberculosis infection. N Engl J Med. 2021;385:2271-80.

2. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of tuberculosis in adults and children. Clin Infect Dis. 2017 Jan 15;64(2):111-115.

3. Swindells et. al. One month of rifapentine plus isoniazid to prevent HIV-related tuberculosis. N Engl J Med. 2019;380:1001-11.

Thoracic oncology & chest procedures network: Lung cancer section

Adjuvant and neoadjuvant therapies in early stage lung cancer

Since the discovery of the epidermal growth factor receptor (EGFR) mutation in 2004 and the development of checkpoint blockade in 2006, personalized treatment options for non–small cell lung cancer (NSCLC) have exploded, but targeted systemic therapy medications were only recommended among patients with metastatic or locally advanced disease (Rivera MP, Matthay RA. Clin Chest Med. 2020;41[1]:ix-xi). However, in November 2020, the National Comprehensive Cancer Network (NCCN) updated guidelines to recommend EGFR testing in surgically resected stage IB-IIIA adenocarcinoma, and to consider adjuvant osimerintib in those who were mutation-positive (NCCN. Nov 2020). Interim analysis of an ongoing phase-3 trial showed 89% of patients in the osimertinib group were alive and disease-free at 24 months compared with 52% in the placebo group (hazard ratio 0.20, P < .001) (Wu YL, et al. N Engl J Med. 2020;383[18]:1711-23).   

Courtesy CHEST

The FDA has also recently approved the use of neoadjuvant and adjuvant immunotherapy in combination with platinum-based chemotherapy. Nivolumab is now approved as neoadjuvant therapy in patients with resectable IB-IIIA NSCLC regardless of PDL-1 status. The Checkmate-816 trial showed increased median event-free survival in the immunotherapy plus chemotherapy group of 31.6 months vs 20.8 months in the chemotherapy-only group (FDA.gov. 2022, Mar 4). Atezolizumab is also now approved for adjuvant treatment following resection and platinum-based chemotherapy in patients with stage II to IIIA NSCLC whose tumors have PD-L1 expression on ≥ 1% of tumor cells. Median disease-free survival was not reached in patients in the atezolizumab groups vs 35.3 months in the best supportive care group (FDA.gov. 2021, Oct 15). With so many advances in the personalized treatment among all stages of NSCLC, this is a hopeful new chapter in the care of patients with NSCLC. 

More information: https://www.nccn.org/guidelines/guidelines-process/transparency-process-and-recommendations/GetFileFromFileManager?fileManagerId=11259 
 

Sohini Ghosh, MD

Section Member-at-Large

Diffuse lung disease and lung transplant network: Lung transplant section 

Continuous distribution for lung transplant: Overhauling the wait list 

Determining how to allocate the scarce resource of donor lungs to patients is a difficult task and evaluated continuously for potential improvement. Since 2005, in the United States, lung transplant recipients have been selected based primarily on location within a Donor Service Area and by lung allocation score (LAS), a composite score of urgency for transplant. This was updated in 2017 to an allocation by highest LAS within 250 nautical miles from the donor hospital. Factors such as blood type compatibility and height are also considered. Implementation of the LAS improved the sickest patients’ access to transplants while not worsening 1-year mortality (Egan TM. Semin Respir Crit Care Med. 2018;39[02]:126-37). Unfortunately, geographic hard boundaries mean a high proportion of low LAS (<50) patients receive local donors while high LAS patients receive national offers or die while on the waitlist (Iribarne A, et al. Clin Transplant. 2016:30:688-93). 

Courtesy CHEST

A new model that employs continuous distribution has been developed based on concerns regarding equity and improving allocation. This model would prioritize patients based on factors including medical priority, efficient management of organ placement (distance), expected posttransplant outcomes, and patient access (equity). By creating a composite of these without a geographic boundary, patients would be considered more on urgency within realistic constraints of distance and outcomes.   

Courtesy CHEST

The Organ Procurement and Transplantation Network has officially approved continuous distribution, with implementation planned for 2022; details regarding the new scoring system are to be published and further research will need to be undertaken to determine if it meets the goal of overall improvement in patient access, equity, and outcomes.

Grant A. Turner, MD, MHA

Laura Frye, MD

Section Members-at-Large

Critical care network: Non-respiratory critical care section

Update from the non-respiratory critical care section

As you’ve probably noticed, there have been some changes here at CHEST involving the Networks. Leadership here at CHEST has been hard at work restructuring the networks to make them more closely aligned with relevant clinical disciplines, and, ultimately, allow for greater participation. I am proud to have been given stewardship of the new Non-Respiratory Critical Care Section of the Critical Care Network.

Courtesy CHEST

So, what exactly is Non-Respiratory Critical Care? Well, that’s where I need your help. You see this network is meant to reflect the needs and wants of CHEST members like you. We need you, dear readers, to join in this venture and help us guide the content that this section will ultimately create for our members.

If you’re interested in critical care, but you don’t see your particular area of interest anywhere else in the current structure ... guess what? You’ve found the right place!

My Infectious Diseases and Nephro peeps? Welcome! Are you a surgical or anesthesia intensivist? Don’t be shy. ECMO people, let’s hear some chatter!Is therapeutic hypothermia your thing? Come on in. The water’s freezing. 33 degrees just like you folks like it. Or is it 36? Not sure. Anyway, see what I’m talking about? We really need your help!You can get involved by clicking on the Membership & Community tab at the CHEST website. Once you’re a member, you can even nominate yourself to run for the Steering Committee elections which are held periodically. Hope to see you soon!

Deep Ramachandran, MD, FCCP

Section Chair

Sleep medicine network: Non-respiratory sleep section

Unusual suspects? Breakthrough in the treatment of idiopathic hypersomnia

Idiopathic hypersomnia (IH) is a rare and debilitating disorder defined by its excessive daytime sleepiness, sleep inertia, prolonged nighttime sleep, and long, unrefreshing naps (AASM. ICSD 3rd ed. 2014). Gamma-aminobutyric acid (GABA) is one of the main inhibitory neurotransmitters in the nervous system. It is through the potentiation of GABA that substances such as alcohol and benzodiazepines yield their effects. It is also hypothesized that the “brain fog” experienced in IH may be a consequence of either higher levels of an endogenous benzodiazepines in the cerebral spinal fluid or the presence of a GABA-enhancing peptide (Rye DB. Science Transl Med. 2012;Med 4:161ra151).

Sodium oxybate (SXB), a compound that likely has its therapeutic effect through the potentiation of GABA receptors, is an effective treatment option for cataplexy and sleepiness in narcolepsy. Although there may be some overlap between narcolepsy and IH in both diagnosis and treatment (Bassetti C, et al. Brain. 1997;120:1423), it would perhaps be entirely counterintuitive (given SXB’s pharmacology) to imagine using SXB as a plausible treatment option in IH. It was, however, investigated in the treatment of refractory hypersomnia and IH. In the retrospective study looking at 46 subjects treated with SXB, 71% experienced improvement of their severe sleep inertia, 55% had a decrease in their excessive daytime sleepiness, and 52% reported a shortened nighttime sleep time (Leu-Semenescu S, et al. Sleep Med. 2016;17:38).

In a recent double-blind, randomized control trial, the lower-sodium oxybate (LXB) was trialed in 154 patients with IH. It demonstrated statistically significant and clinically meaningful improvements (compared with placebo) in the Epworth Sleepiness Scale score (P <.0001) and in the Idiopathic Hypersomnia Severity Scale (P <.0001). The effects were seen both during the up titration of LXB and the benefits were maintained during the stable phase of the intervention (Dauvilliers Y, et al. Lancet Neurol. 2022;21(1):53). In August 2021, LXB (initially launched in 2020 for the treatment of narcolepsy) is now the first FDA-approved medication to treat IH in adults. It is curious, however, that LXB’s understood therapeutic effects are secondary to the “potentiation” of the very GABA receptor we have believed to be the root cause of the debilitating symptoms in IH. Could this discovery lend to further insights into the origins of this condition?

Ruckshanda Majid, MD, FCCP

Pulmonary vascular & cardiovascular network: Cardiovascular medicine & surgery section 

Targeted temperature management (TTM) after cardiac arrest: How cool?  

Recent randomized control trials, TTM2 (Dankiewicz J. N Engl J Med. 2021;384:2283) and HYPERION (Lascarrou J-B. N Engl J Med. 2019;381:2327), of therapeutic hypothermia, as opposed to normothermia, in patients who remain comatose after return of spontaneous circulation (ROSC) after cardiac arrest have produced conflicting results regarding survival and neurologic benefit. TTM2 reported no benefit to cooling to 33°C, while HYPERION found improved neurologic outcome at 90 days in patients cooled to 33°C.  The European Resuscitation Council (ERC) and European Society of Intensive Care Medicine (ESICM) recently released an evidence review and guideline for adults who remain comatose after cardiac arrest (Sandroni C. Intensive Care Med. 2022;48:261). These guidelines recommend continuous monitoring of core temperature in all patients who remain comatose after cardiac arrest, and preventing fever (>37.7°C) for 72 hours, but with no recommendation of target temperature of 32°C vs 36°C.  

Differences in patient populations, presenting rhythm during arrest, duration of CPR, and time to target temperature likely each contribute to the disparate conclusions of previous trials. For example, HYPERION enrolled patients with out of hospital cardiac arrest with initial nonshockable rhythms and found benefit to cooling to 33°C.  In comparison, TTM2 enrolled all patients with ROSC following arrest (regardless of rhythm), including patients with in-hospital cardiac arrest and found no benefit in therapeutic cooling. Differences in patient populations are underscored by the widely differing percentage of patients with good neurologic outcome in their respective control groups: approximately 30% in the TTM2 trial and 6% in HYPERION. The guidelines leave significant room for clinical judgment in employing therapeutic cooling but encourage the continuous monitoring of core temperature and active avoidance of fever.  

Fiore Mastroianna, MD

Section Member-at-Large 

Chest infections & disaster response network: Chest infections section

Update on LTBI treatment: Ensuring success by simplifying, shortening, and completing treatment

My patient has a positive IGRA test result – what’s next?

If TB disease is ruled out by clinical, radiographic, and microbiologic assessment (if indicated), then latent TB infection (LTBI) is established, and treatment should be offered, guided by shared-decision making between provider and patient.

Courtesy CHEST

What options are available?

While the former standard 9-month regimen of isoniazid-monotherapy can be shortened to 6 months, shorter rifamycin-based regimens are now preferred in most cases and include:

4 months rifampin daily, 3 months isoniazid plus rifampin daily, or 3 months isoniazid plus rifapentine weekly. In addition, 1 month of isoniazid plus rifapentine daily has recently been shown to be effective in people with HIV.

Courtesy CHEST

Sebastian Kurz, MD, FCCP

Amee Patrawalla, MD, MPH, FCCP

Section Members-at-Large

References

Testing and Treatment of Latent Tuberculosis Infection in the United States: Clinical Recommendations. A Guide for Health Care Providers and Public Health Programs. Copyright © 2021 by the National Society of Tuberculosis Clinicians and National Tuberculosis Controllers Association

1. Shah, D. Latent tuberculosis infection. N Engl J Med. 2021;385:2271-80.

2. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of tuberculosis in adults and children. Clin Infect Dis. 2017 Jan 15;64(2):111-115.

3. Swindells et. al. One month of rifapentine plus isoniazid to prevent HIV-related tuberculosis. N Engl J Med. 2019;380:1001-11.

Thoracic oncology & chest procedures network: Lung cancer section

Adjuvant and neoadjuvant therapies in early stage lung cancer

Since the discovery of the epidermal growth factor receptor (EGFR) mutation in 2004 and the development of checkpoint blockade in 2006, personalized treatment options for non–small cell lung cancer (NSCLC) have exploded, but targeted systemic therapy medications were only recommended among patients with metastatic or locally advanced disease (Rivera MP, Matthay RA. Clin Chest Med. 2020;41[1]:ix-xi). However, in November 2020, the National Comprehensive Cancer Network (NCCN) updated guidelines to recommend EGFR testing in surgically resected stage IB-IIIA adenocarcinoma, and to consider adjuvant osimerintib in those who were mutation-positive (NCCN. Nov 2020). Interim analysis of an ongoing phase-3 trial showed 89% of patients in the osimertinib group were alive and disease-free at 24 months compared with 52% in the placebo group (hazard ratio 0.20, P < .001) (Wu YL, et al. N Engl J Med. 2020;383[18]:1711-23).   

Courtesy CHEST

The FDA has also recently approved the use of neoadjuvant and adjuvant immunotherapy in combination with platinum-based chemotherapy. Nivolumab is now approved as neoadjuvant therapy in patients with resectable IB-IIIA NSCLC regardless of PDL-1 status. The Checkmate-816 trial showed increased median event-free survival in the immunotherapy plus chemotherapy group of 31.6 months vs 20.8 months in the chemotherapy-only group (FDA.gov. 2022, Mar 4). Atezolizumab is also now approved for adjuvant treatment following resection and platinum-based chemotherapy in patients with stage II to IIIA NSCLC whose tumors have PD-L1 expression on ≥ 1% of tumor cells. Median disease-free survival was not reached in patients in the atezolizumab groups vs 35.3 months in the best supportive care group (FDA.gov. 2021, Oct 15). With so many advances in the personalized treatment among all stages of NSCLC, this is a hopeful new chapter in the care of patients with NSCLC. 

More information: https://www.nccn.org/guidelines/guidelines-process/transparency-process-and-recommendations/GetFileFromFileManager?fileManagerId=11259 
 

Sohini Ghosh, MD

Section Member-at-Large

Diffuse lung disease and lung transplant network: Lung transplant section 

Continuous distribution for lung transplant: Overhauling the wait list 

Determining how to allocate the scarce resource of donor lungs to patients is a difficult task and evaluated continuously for potential improvement. Since 2005, in the United States, lung transplant recipients have been selected based primarily on location within a Donor Service Area and by lung allocation score (LAS), a composite score of urgency for transplant. This was updated in 2017 to an allocation by highest LAS within 250 nautical miles from the donor hospital. Factors such as blood type compatibility and height are also considered. Implementation of the LAS improved the sickest patients’ access to transplants while not worsening 1-year mortality (Egan TM. Semin Respir Crit Care Med. 2018;39[02]:126-37). Unfortunately, geographic hard boundaries mean a high proportion of low LAS (<50) patients receive local donors while high LAS patients receive national offers or die while on the waitlist (Iribarne A, et al. Clin Transplant. 2016:30:688-93). 

Courtesy CHEST

A new model that employs continuous distribution has been developed based on concerns regarding equity and improving allocation. This model would prioritize patients based on factors including medical priority, efficient management of organ placement (distance), expected posttransplant outcomes, and patient access (equity). By creating a composite of these without a geographic boundary, patients would be considered more on urgency within realistic constraints of distance and outcomes.   

Courtesy CHEST

The Organ Procurement and Transplantation Network has officially approved continuous distribution, with implementation planned for 2022; details regarding the new scoring system are to be published and further research will need to be undertaken to determine if it meets the goal of overall improvement in patient access, equity, and outcomes.

Grant A. Turner, MD, MHA

Laura Frye, MD

Section Members-at-Large

Critical care network: Non-respiratory critical care section

Update from the non-respiratory critical care section

As you’ve probably noticed, there have been some changes here at CHEST involving the Networks. Leadership here at CHEST has been hard at work restructuring the networks to make them more closely aligned with relevant clinical disciplines, and, ultimately, allow for greater participation. I am proud to have been given stewardship of the new Non-Respiratory Critical Care Section of the Critical Care Network.

Courtesy CHEST

So, what exactly is Non-Respiratory Critical Care? Well, that’s where I need your help. You see this network is meant to reflect the needs and wants of CHEST members like you. We need you, dear readers, to join in this venture and help us guide the content that this section will ultimately create for our members.

If you’re interested in critical care, but you don’t see your particular area of interest anywhere else in the current structure ... guess what? You’ve found the right place!

My Infectious Diseases and Nephro peeps? Welcome! Are you a surgical or anesthesia intensivist? Don’t be shy. ECMO people, let’s hear some chatter!Is therapeutic hypothermia your thing? Come on in. The water’s freezing. 33 degrees just like you folks like it. Or is it 36? Not sure. Anyway, see what I’m talking about? We really need your help!You can get involved by clicking on the Membership & Community tab at the CHEST website. Once you’re a member, you can even nominate yourself to run for the Steering Committee elections which are held periodically. Hope to see you soon!

Deep Ramachandran, MD, FCCP

Section Chair

Sleep medicine network: Non-respiratory sleep section

Unusual suspects? Breakthrough in the treatment of idiopathic hypersomnia

Idiopathic hypersomnia (IH) is a rare and debilitating disorder defined by its excessive daytime sleepiness, sleep inertia, prolonged nighttime sleep, and long, unrefreshing naps (AASM. ICSD 3rd ed. 2014). Gamma-aminobutyric acid (GABA) is one of the main inhibitory neurotransmitters in the nervous system. It is through the potentiation of GABA that substances such as alcohol and benzodiazepines yield their effects. It is also hypothesized that the “brain fog” experienced in IH may be a consequence of either higher levels of an endogenous benzodiazepines in the cerebral spinal fluid or the presence of a GABA-enhancing peptide (Rye DB. Science Transl Med. 2012;Med 4:161ra151).

Sodium oxybate (SXB), a compound that likely has its therapeutic effect through the potentiation of GABA receptors, is an effective treatment option for cataplexy and sleepiness in narcolepsy. Although there may be some overlap between narcolepsy and IH in both diagnosis and treatment (Bassetti C, et al. Brain. 1997;120:1423), it would perhaps be entirely counterintuitive (given SXB’s pharmacology) to imagine using SXB as a plausible treatment option in IH. It was, however, investigated in the treatment of refractory hypersomnia and IH. In the retrospective study looking at 46 subjects treated with SXB, 71% experienced improvement of their severe sleep inertia, 55% had a decrease in their excessive daytime sleepiness, and 52% reported a shortened nighttime sleep time (Leu-Semenescu S, et al. Sleep Med. 2016;17:38).

In a recent double-blind, randomized control trial, the lower-sodium oxybate (LXB) was trialed in 154 patients with IH. It demonstrated statistically significant and clinically meaningful improvements (compared with placebo) in the Epworth Sleepiness Scale score (P <.0001) and in the Idiopathic Hypersomnia Severity Scale (P <.0001). The effects were seen both during the up titration of LXB and the benefits were maintained during the stable phase of the intervention (Dauvilliers Y, et al. Lancet Neurol. 2022;21(1):53). In August 2021, LXB (initially launched in 2020 for the treatment of narcolepsy) is now the first FDA-approved medication to treat IH in adults. It is curious, however, that LXB’s understood therapeutic effects are secondary to the “potentiation” of the very GABA receptor we have believed to be the root cause of the debilitating symptoms in IH. Could this discovery lend to further insights into the origins of this condition?

Ruckshanda Majid, MD, FCCP

Pulmonary vascular & cardiovascular network: Cardiovascular medicine & surgery section 

Targeted temperature management (TTM) after cardiac arrest: How cool?  

Recent randomized control trials, TTM2 (Dankiewicz J. N Engl J Med. 2021;384:2283) and HYPERION (Lascarrou J-B. N Engl J Med. 2019;381:2327), of therapeutic hypothermia, as opposed to normothermia, in patients who remain comatose after return of spontaneous circulation (ROSC) after cardiac arrest have produced conflicting results regarding survival and neurologic benefit. TTM2 reported no benefit to cooling to 33°C, while HYPERION found improved neurologic outcome at 90 days in patients cooled to 33°C.  The European Resuscitation Council (ERC) and European Society of Intensive Care Medicine (ESICM) recently released an evidence review and guideline for adults who remain comatose after cardiac arrest (Sandroni C. Intensive Care Med. 2022;48:261). These guidelines recommend continuous monitoring of core temperature in all patients who remain comatose after cardiac arrest, and preventing fever (>37.7°C) for 72 hours, but with no recommendation of target temperature of 32°C vs 36°C.  

Differences in patient populations, presenting rhythm during arrest, duration of CPR, and time to target temperature likely each contribute to the disparate conclusions of previous trials. For example, HYPERION enrolled patients with out of hospital cardiac arrest with initial nonshockable rhythms and found benefit to cooling to 33°C.  In comparison, TTM2 enrolled all patients with ROSC following arrest (regardless of rhythm), including patients with in-hospital cardiac arrest and found no benefit in therapeutic cooling. Differences in patient populations are underscored by the widely differing percentage of patients with good neurologic outcome in their respective control groups: approximately 30% in the TTM2 trial and 6% in HYPERION. The guidelines leave significant room for clinical judgment in employing therapeutic cooling but encourage the continuous monitoring of core temperature and active avoidance of fever.  

Fiore Mastroianna, MD

Section Member-at-Large 

Chest infections & disaster response network: Chest infections section

Update on LTBI treatment: Ensuring success by simplifying, shortening, and completing treatment

My patient has a positive IGRA test result – what’s next?

If TB disease is ruled out by clinical, radiographic, and microbiologic assessment (if indicated), then latent TB infection (LTBI) is established, and treatment should be offered, guided by shared-decision making between provider and patient.

Courtesy CHEST

What options are available?

While the former standard 9-month regimen of isoniazid-monotherapy can be shortened to 6 months, shorter rifamycin-based regimens are now preferred in most cases and include:

4 months rifampin daily, 3 months isoniazid plus rifampin daily, or 3 months isoniazid plus rifapentine weekly. In addition, 1 month of isoniazid plus rifapentine daily has recently been shown to be effective in people with HIV.

Courtesy CHEST

Sebastian Kurz, MD, FCCP

Amee Patrawalla, MD, MPH, FCCP

Section Members-at-Large

References

Testing and Treatment of Latent Tuberculosis Infection in the United States: Clinical Recommendations. A Guide for Health Care Providers and Public Health Programs. Copyright © 2021 by the National Society of Tuberculosis Clinicians and National Tuberculosis Controllers Association

1. Shah, D. Latent tuberculosis infection. N Engl J Med. 2021;385:2271-80.

2. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of tuberculosis in adults and children. Clin Infect Dis. 2017 Jan 15;64(2):111-115.

3. Swindells et. al. One month of rifapentine plus isoniazid to prevent HIV-related tuberculosis. N Engl J Med. 2019;380:1001-11.

Thoracic oncology & chest procedures network: Lung cancer section

Adjuvant and neoadjuvant therapies in early stage lung cancer

Since the discovery of the epidermal growth factor receptor (EGFR) mutation in 2004 and the development of checkpoint blockade in 2006, personalized treatment options for non–small cell lung cancer (NSCLC) have exploded, but targeted systemic therapy medications were only recommended among patients with metastatic or locally advanced disease (Rivera MP, Matthay RA. Clin Chest Med. 2020;41[1]:ix-xi). However, in November 2020, the National Comprehensive Cancer Network (NCCN) updated guidelines to recommend EGFR testing in surgically resected stage IB-IIIA adenocarcinoma, and to consider adjuvant osimerintib in those who were mutation-positive (NCCN. Nov 2020). Interim analysis of an ongoing phase-3 trial showed 89% of patients in the osimertinib group were alive and disease-free at 24 months compared with 52% in the placebo group (hazard ratio 0.20, P < .001) (Wu YL, et al. N Engl J Med. 2020;383[18]:1711-23).   

Courtesy CHEST

The FDA has also recently approved the use of neoadjuvant and adjuvant immunotherapy in combination with platinum-based chemotherapy. Nivolumab is now approved as neoadjuvant therapy in patients with resectable IB-IIIA NSCLC regardless of PDL-1 status. The Checkmate-816 trial showed increased median event-free survival in the immunotherapy plus chemotherapy group of 31.6 months vs 20.8 months in the chemotherapy-only group (FDA.gov. 2022, Mar 4). Atezolizumab is also now approved for adjuvant treatment following resection and platinum-based chemotherapy in patients with stage II to IIIA NSCLC whose tumors have PD-L1 expression on ≥ 1% of tumor cells. Median disease-free survival was not reached in patients in the atezolizumab groups vs 35.3 months in the best supportive care group (FDA.gov. 2021, Oct 15). With so many advances in the personalized treatment among all stages of NSCLC, this is a hopeful new chapter in the care of patients with NSCLC. 

More information: https://www.nccn.org/guidelines/guidelines-process/transparency-process-and-recommendations/GetFileFromFileManager?fileManagerId=11259 
 

Sohini Ghosh, MD

Section Member-at-Large

Diffuse lung disease and lung transplant network: Lung transplant section 

Continuous distribution for lung transplant: Overhauling the wait list 

Determining how to allocate the scarce resource of donor lungs to patients is a difficult task and evaluated continuously for potential improvement. Since 2005, in the United States, lung transplant recipients have been selected based primarily on location within a Donor Service Area and by lung allocation score (LAS), a composite score of urgency for transplant. This was updated in 2017 to an allocation by highest LAS within 250 nautical miles from the donor hospital. Factors such as blood type compatibility and height are also considered. Implementation of the LAS improved the sickest patients’ access to transplants while not worsening 1-year mortality (Egan TM. Semin Respir Crit Care Med. 2018;39[02]:126-37). Unfortunately, geographic hard boundaries mean a high proportion of low LAS (<50) patients receive local donors while high LAS patients receive national offers or die while on the waitlist (Iribarne A, et al. Clin Transplant. 2016:30:688-93). 

Courtesy CHEST

A new model that employs continuous distribution has been developed based on concerns regarding equity and improving allocation. This model would prioritize patients based on factors including medical priority, efficient management of organ placement (distance), expected posttransplant outcomes, and patient access (equity). By creating a composite of these without a geographic boundary, patients would be considered more on urgency within realistic constraints of distance and outcomes.   

Courtesy CHEST

The Organ Procurement and Transplantation Network has officially approved continuous distribution, with implementation planned for 2022; details regarding the new scoring system are to be published and further research will need to be undertaken to determine if it meets the goal of overall improvement in patient access, equity, and outcomes.

Grant A. Turner, MD, MHA

Laura Frye, MD

Section Members-at-Large

Critical care network: Non-respiratory critical care section

Update from the non-respiratory critical care section

As you’ve probably noticed, there have been some changes here at CHEST involving the Networks. Leadership here at CHEST has been hard at work restructuring the networks to make them more closely aligned with relevant clinical disciplines, and, ultimately, allow for greater participation. I am proud to have been given stewardship of the new Non-Respiratory Critical Care Section of the Critical Care Network.

Courtesy CHEST

So, what exactly is Non-Respiratory Critical Care? Well, that’s where I need your help. You see this network is meant to reflect the needs and wants of CHEST members like you. We need you, dear readers, to join in this venture and help us guide the content that this section will ultimately create for our members.

If you’re interested in critical care, but you don’t see your particular area of interest anywhere else in the current structure ... guess what? You’ve found the right place!

My Infectious Diseases and Nephro peeps? Welcome! Are you a surgical or anesthesia intensivist? Don’t be shy. ECMO people, let’s hear some chatter!Is therapeutic hypothermia your thing? Come on in. The water’s freezing. 33 degrees just like you folks like it. Or is it 36? Not sure. Anyway, see what I’m talking about? We really need your help!You can get involved by clicking on the Membership & Community tab at the CHEST website. Once you’re a member, you can even nominate yourself to run for the Steering Committee elections which are held periodically. Hope to see you soon!

Deep Ramachandran, MD, FCCP

Section Chair

Sleep medicine network: Non-respiratory sleep section

Unusual suspects? Breakthrough in the treatment of idiopathic hypersomnia

Idiopathic hypersomnia (IH) is a rare and debilitating disorder defined by its excessive daytime sleepiness, sleep inertia, prolonged nighttime sleep, and long, unrefreshing naps (AASM. ICSD 3rd ed. 2014). Gamma-aminobutyric acid (GABA) is one of the main inhibitory neurotransmitters in the nervous system. It is through the potentiation of GABA that substances such as alcohol and benzodiazepines yield their effects. It is also hypothesized that the “brain fog” experienced in IH may be a consequence of either higher levels of an endogenous benzodiazepines in the cerebral spinal fluid or the presence of a GABA-enhancing peptide (Rye DB. Science Transl Med. 2012;Med 4:161ra151).

Sodium oxybate (SXB), a compound that likely has its therapeutic effect through the potentiation of GABA receptors, is an effective treatment option for cataplexy and sleepiness in narcolepsy. Although there may be some overlap between narcolepsy and IH in both diagnosis and treatment (Bassetti C, et al. Brain. 1997;120:1423), it would perhaps be entirely counterintuitive (given SXB’s pharmacology) to imagine using SXB as a plausible treatment option in IH. It was, however, investigated in the treatment of refractory hypersomnia and IH. In the retrospective study looking at 46 subjects treated with SXB, 71% experienced improvement of their severe sleep inertia, 55% had a decrease in their excessive daytime sleepiness, and 52% reported a shortened nighttime sleep time (Leu-Semenescu S, et al. Sleep Med. 2016;17:38).

In a recent double-blind, randomized control trial, the lower-sodium oxybate (LXB) was trialed in 154 patients with IH. It demonstrated statistically significant and clinically meaningful improvements (compared with placebo) in the Epworth Sleepiness Scale score (P <.0001) and in the Idiopathic Hypersomnia Severity Scale (P <.0001). The effects were seen both during the up titration of LXB and the benefits were maintained during the stable phase of the intervention (Dauvilliers Y, et al. Lancet Neurol. 2022;21(1):53). In August 2021, LXB (initially launched in 2020 for the treatment of narcolepsy) is now the first FDA-approved medication to treat IH in adults. It is curious, however, that LXB’s understood therapeutic effects are secondary to the “potentiation” of the very GABA receptor we have believed to be the root cause of the debilitating symptoms in IH. Could this discovery lend to further insights into the origins of this condition?

Ruckshanda Majid, MD, FCCP

There is little I enjoy more than an opportunity to get together with old friends.

I write this missive on the return trip from a week of CHEST leadership meetings held last month, and I find myself filled with joy, awe, and great appreciation for the hard work our volunteers contribute to making the American College of Chest Physicians an extraordinarily productive and successful organization. This year’s meetings meant more than any I can ever recall from the past, in the context of a return to in-person gatherings that let our members share laughs, stories, and even a game or two of laser tag in the context of celebrating good times and friendship. And while some great works were accomplished by our committees, some of which I will enumerate below, the highlight of the week was definitely the esprit de corps that was on broad display.

Courtesy ACCP

Our Membership Committee meeting was led by Vice-Chair Marie Budev, DO, FCCP. While this committee is tasked with the critical duty of reviewing applications for the prestigious FCCP designation, they are just as importantly tasked with promoting membership, to our domestic and international colleagues. This is a challenging task, because different members prioritize the variety of benefits from CHEST differently; some focus on access to our educational offerings, both throughout the year and at our annual meeting, while others find greater value in the chance to network with colleagues from around the world and to participate in leadership in an international society. Making sure that we are helping our members realize these benefits, while also identifying (and potentially enhancing) those opportunities in which members are most interested is a challenging task, and I very much enjoyed watching these folks brainstorm ways that we could further increase the value of joining CHEST for current and potential future members.

The Guidelines Oversight Committee, chaired by Lisa Moores, MD, FCCP, is responsible for the oversight of CHEST’s evidence-based guidelines. As our clinical guidelines are among the most highly regarded of all of the things we publish, the members of this committee take special care to ensure that the subjects selected for review as part of the guideline process meet strict criteria. They receive dozens of proposals for new guidelines each year and carefully examine each one to identify the potential public health impact, to ensure the availability of literature in the space worthy of review, and to provide the opportunity to illuminate areas where there are significant clinical uncertainties, often due to new treatments or diagnostic tests. Watching committee members meticulously debate the merits of the many good ideas received to finalize a short list of topics for guideline development in the coming year was incredibly informative and validated my longstanding perception that our members are some of the best clinical minds in the pulmonary, critical care, and sleep fields in the world.

The Professional Standards Committee (PSC), chaired by Scott Manaker, MD, PhD, FCCP, has the important duty of developing CHEST’s conflict of interest (COI) policy, as well as reviewing all potential COI among CHEST leaders and members of our guideline panels. While this may sound a little dry, the fascinating part of this meeting was the ongoing discussion of what constitutes a meaningful COI. As one would expect, many of the best medical experts in the world have relationships with pharmaceutical and medical device companies, who often seek the counsel and participation of high-performing, high-volume clinicians for research trials. CHEST has extremely strict rules with regard to COI among its many levels of leadership, but the question of what constitutes a potentially problematic COI for the large number of folks who volunteer their time and energy to teach at one of our many courses is an interesting (albeit possibly philosophical) question. Since PSC members cannot observe every CHEST faculty interaction, we rely on our members to let us know if they perceive any potential bias in faculty teaching (and we so very much appreciate those of you who bring the extremely rare concerns to our attention!), but this is an area that we continue to watch very closely, as we continue to ensure that all CHEST education is accurate, unbiased, and the best available throughout the world.

The reformulated Council of Networks met under the leadership of Angel Coz Yataco, MD, FCCP, and Cassie Kennedy, MD, FCCP, to discuss how to best engage our members in the new structure, which comprises seven Networks and 22 component Sections. The Council’s primary charges are to develop educational content, to review project applications from Sections, and to serve as expert consultants to the President in their specific clinical domains. While the new configuration provides a significant increase in leadership positions for our members, as well as more formal opportunities to cultivate relationships across different Sections, I have received a few emails from colleagues who were concerned about elimination of certain former Networks, or the placement of a specific Section under a specific Network. Some of these concerns were discussed at the April meeting. While there will be some growing pains, listening to the thoughtful discussion that ensued validated my belief that Drs. Coz and Kennedy are the right folks to be leading the Council as it matures into this new and stronger structure.

While I also had the opportunity to hear reports from the Training and Transitions Committee, the Education Committee, and the Council of Global Governors, I wanted to briefly mention the Scientific Program Committee and its Innovations Group. While we are looking forward to seeing everyone in Nashville this October, I cannot tell you how excited I am about some of the new things we have in store for our first in-person annual meeting in 3 years. (Literally ... I am absolutely sworn to secrecy!) But under the leadership of Program Chair Subani Chandra, MD, FCCP, and my two other “Chief Fun Officers” Aneesa Das, MD, FCCP, and William Kelly, MD, FCCP, I can say that attendees are going to be in for a heck of a lot of fun. Oh, and there’s going to be some education there, also.

In closing, I want to reiterate how much of a pleasure and privilege it has been to sit in the President’s chair over the first few months of 2022. If any of the committees I’ve described above sound interesting to you, please strongly consider throwing your hat into the ring when nominations open up in the coming months. Getting involved at CHEST has been one of the best experiences of my career, and I expect you’ll feel the same way after you join in the fun. As always, I remain available to you, either by emailing me at [email protected] or messaging me on Twitter @ChestPrez. And, please come find me in Nashville in October, either to say hello, or to challenge me to a game of laser tag. ... I’m not very hard to beat.

Until next time,

David

There is little I enjoy more than an opportunity to get together with old friends.

I write this missive on the return trip from a week of CHEST leadership meetings held last month, and I find myself filled with joy, awe, and great appreciation for the hard work our volunteers contribute to making the American College of Chest Physicians an extraordinarily productive and successful organization. This year’s meetings meant more than any I can ever recall from the past, in the context of a return to in-person gatherings that let our members share laughs, stories, and even a game or two of laser tag in the context of celebrating good times and friendship. And while some great works were accomplished by our committees, some of which I will enumerate below, the highlight of the week was definitely the esprit de corps that was on broad display.

Courtesy ACCP

Our Membership Committee meeting was led by Vice-Chair Marie Budev, DO, FCCP. While this committee is tasked with the critical duty of reviewing applications for the prestigious FCCP designation, they are just as importantly tasked with promoting membership, to our domestic and international colleagues. This is a challenging task, because different members prioritize the variety of benefits from CHEST differently; some focus on access to our educational offerings, both throughout the year and at our annual meeting, while others find greater value in the chance to network with colleagues from around the world and to participate in leadership in an international society. Making sure that we are helping our members realize these benefits, while also identifying (and potentially enhancing) those opportunities in which members are most interested is a challenging task, and I very much enjoyed watching these folks brainstorm ways that we could further increase the value of joining CHEST for current and potential future members.

The Guidelines Oversight Committee, chaired by Lisa Moores, MD, FCCP, is responsible for the oversight of CHEST’s evidence-based guidelines. As our clinical guidelines are among the most highly regarded of all of the things we publish, the members of this committee take special care to ensure that the subjects selected for review as part of the guideline process meet strict criteria. They receive dozens of proposals for new guidelines each year and carefully examine each one to identify the potential public health impact, to ensure the availability of literature in the space worthy of review, and to provide the opportunity to illuminate areas where there are significant clinical uncertainties, often due to new treatments or diagnostic tests. Watching committee members meticulously debate the merits of the many good ideas received to finalize a short list of topics for guideline development in the coming year was incredibly informative and validated my longstanding perception that our members are some of the best clinical minds in the pulmonary, critical care, and sleep fields in the world.

The Professional Standards Committee (PSC), chaired by Scott Manaker, MD, PhD, FCCP, has the important duty of developing CHEST’s conflict of interest (COI) policy, as well as reviewing all potential COI among CHEST leaders and members of our guideline panels. While this may sound a little dry, the fascinating part of this meeting was the ongoing discussion of what constitutes a meaningful COI. As one would expect, many of the best medical experts in the world have relationships with pharmaceutical and medical device companies, who often seek the counsel and participation of high-performing, high-volume clinicians for research trials. CHEST has extremely strict rules with regard to COI among its many levels of leadership, but the question of what constitutes a potentially problematic COI for the large number of folks who volunteer their time and energy to teach at one of our many courses is an interesting (albeit possibly philosophical) question. Since PSC members cannot observe every CHEST faculty interaction, we rely on our members to let us know if they perceive any potential bias in faculty teaching (and we so very much appreciate those of you who bring the extremely rare concerns to our attention!), but this is an area that we continue to watch very closely, as we continue to ensure that all CHEST education is accurate, unbiased, and the best available throughout the world.

The reformulated Council of Networks met under the leadership of Angel Coz Yataco, MD, FCCP, and Cassie Kennedy, MD, FCCP, to discuss how to best engage our members in the new structure, which comprises seven Networks and 22 component Sections. The Council’s primary charges are to develop educational content, to review project applications from Sections, and to serve as expert consultants to the President in their specific clinical domains. While the new configuration provides a significant increase in leadership positions for our members, as well as more formal opportunities to cultivate relationships across different Sections, I have received a few emails from colleagues who were concerned about elimination of certain former Networks, or the placement of a specific Section under a specific Network. Some of these concerns were discussed at the April meeting. While there will be some growing pains, listening to the thoughtful discussion that ensued validated my belief that Drs. Coz and Kennedy are the right folks to be leading the Council as it matures into this new and stronger structure.

While I also had the opportunity to hear reports from the Training and Transitions Committee, the Education Committee, and the Council of Global Governors, I wanted to briefly mention the Scientific Program Committee and its Innovations Group. While we are looking forward to seeing everyone in Nashville this October, I cannot tell you how excited I am about some of the new things we have in store for our first in-person annual meeting in 3 years. (Literally ... I am absolutely sworn to secrecy!) But under the leadership of Program Chair Subani Chandra, MD, FCCP, and my two other “Chief Fun Officers” Aneesa Das, MD, FCCP, and William Kelly, MD, FCCP, I can say that attendees are going to be in for a heck of a lot of fun. Oh, and there’s going to be some education there, also.

In closing, I want to reiterate how much of a pleasure and privilege it has been to sit in the President’s chair over the first few months of 2022. If any of the committees I’ve described above sound interesting to you, please strongly consider throwing your hat into the ring when nominations open up in the coming months. Getting involved at CHEST has been one of the best experiences of my career, and I expect you’ll feel the same way after you join in the fun. As always, I remain available to you, either by emailing me at [email protected] or messaging me on Twitter @ChestPrez. And, please come find me in Nashville in October, either to say hello, or to challenge me to a game of laser tag. ... I’m not very hard to beat.

Until next time,

David

There is little I enjoy more than an opportunity to get together with old friends.

I write this missive on the return trip from a week of CHEST leadership meetings held last month, and I find myself filled with joy, awe, and great appreciation for the hard work our volunteers contribute to making the American College of Chest Physicians an extraordinarily productive and successful organization. This year’s meetings meant more than any I can ever recall from the past, in the context of a return to in-person gatherings that let our members share laughs, stories, and even a game or two of laser tag in the context of celebrating good times and friendship. And while some great works were accomplished by our committees, some of which I will enumerate below, the highlight of the week was definitely the esprit de corps that was on broad display.

Courtesy ACCP

Our Membership Committee meeting was led by Vice-Chair Marie Budev, DO, FCCP. While this committee is tasked with the critical duty of reviewing applications for the prestigious FCCP designation, they are just as importantly tasked with promoting membership, to our domestic and international colleagues. This is a challenging task, because different members prioritize the variety of benefits from CHEST differently; some focus on access to our educational offerings, both throughout the year and at our annual meeting, while others find greater value in the chance to network with colleagues from around the world and to participate in leadership in an international society. Making sure that we are helping our members realize these benefits, while also identifying (and potentially enhancing) those opportunities in which members are most interested is a challenging task, and I very much enjoyed watching these folks brainstorm ways that we could further increase the value of joining CHEST for current and potential future members.

The Guidelines Oversight Committee, chaired by Lisa Moores, MD, FCCP, is responsible for the oversight of CHEST’s evidence-based guidelines. As our clinical guidelines are among the most highly regarded of all of the things we publish, the members of this committee take special care to ensure that the subjects selected for review as part of the guideline process meet strict criteria. They receive dozens of proposals for new guidelines each year and carefully examine each one to identify the potential public health impact, to ensure the availability of literature in the space worthy of review, and to provide the opportunity to illuminate areas where there are significant clinical uncertainties, often due to new treatments or diagnostic tests. Watching committee members meticulously debate the merits of the many good ideas received to finalize a short list of topics for guideline development in the coming year was incredibly informative and validated my longstanding perception that our members are some of the best clinical minds in the pulmonary, critical care, and sleep fields in the world.

The Professional Standards Committee (PSC), chaired by Scott Manaker, MD, PhD, FCCP, has the important duty of developing CHEST’s conflict of interest (COI) policy, as well as reviewing all potential COI among CHEST leaders and members of our guideline panels. While this may sound a little dry, the fascinating part of this meeting was the ongoing discussion of what constitutes a meaningful COI. As one would expect, many of the best medical experts in the world have relationships with pharmaceutical and medical device companies, who often seek the counsel and participation of high-performing, high-volume clinicians for research trials. CHEST has extremely strict rules with regard to COI among its many levels of leadership, but the question of what constitutes a potentially problematic COI for the large number of folks who volunteer their time and energy to teach at one of our many courses is an interesting (albeit possibly philosophical) question. Since PSC members cannot observe every CHEST faculty interaction, we rely on our members to let us know if they perceive any potential bias in faculty teaching (and we so very much appreciate those of you who bring the extremely rare concerns to our attention!), but this is an area that we continue to watch very closely, as we continue to ensure that all CHEST education is accurate, unbiased, and the best available throughout the world.

The reformulated Council of Networks met under the leadership of Angel Coz Yataco, MD, FCCP, and Cassie Kennedy, MD, FCCP, to discuss how to best engage our members in the new structure, which comprises seven Networks and 22 component Sections. The Council’s primary charges are to develop educational content, to review project applications from Sections, and to serve as expert consultants to the President in their specific clinical domains. While the new configuration provides a significant increase in leadership positions for our members, as well as more formal opportunities to cultivate relationships across different Sections, I have received a few emails from colleagues who were concerned about elimination of certain former Networks, or the placement of a specific Section under a specific Network. Some of these concerns were discussed at the April meeting. While there will be some growing pains, listening to the thoughtful discussion that ensued validated my belief that Drs. Coz and Kennedy are the right folks to be leading the Council as it matures into this new and stronger structure.

While I also had the opportunity to hear reports from the Training and Transitions Committee, the Education Committee, and the Council of Global Governors, I wanted to briefly mention the Scientific Program Committee and its Innovations Group. While we are looking forward to seeing everyone in Nashville this October, I cannot tell you how excited I am about some of the new things we have in store for our first in-person annual meeting in 3 years. (Literally ... I am absolutely sworn to secrecy!) But under the leadership of Program Chair Subani Chandra, MD, FCCP, and my two other “Chief Fun Officers” Aneesa Das, MD, FCCP, and William Kelly, MD, FCCP, I can say that attendees are going to be in for a heck of a lot of fun. Oh, and there’s going to be some education there, also.

In closing, I want to reiterate how much of a pleasure and privilege it has been to sit in the President’s chair over the first few months of 2022. If any of the committees I’ve described above sound interesting to you, please strongly consider throwing your hat into the ring when nominations open up in the coming months. Getting involved at CHEST has been one of the best experiences of my career, and I expect you’ll feel the same way after you join in the fun. As always, I remain available to you, either by emailing me at [email protected] or messaging me on Twitter @ChestPrez. And, please come find me in Nashville in October, either to say hello, or to challenge me to a game of laser tag. ... I’m not very hard to beat.

Until next time,

David

Welcome to Corinne Young, MSN, FNP-C, FCCP, who recently joined the CHEST Physician editorial board to represent and advocate for the perspective of advanced practice providers on the interdisciplinary team.

Young is a nurse practitioner and director of APP and Clinical Services for Colorado Springs Pulmonary Consultants in Colorado. She also is the founder and president of the Association of Pulmonary Advanced Practice Providers, which she created with support from CHEST staff and leaders, who encouraged her to create a community around advocating for and developing credentialing opportunities for this population.

Courtesy ACCP

The idea began early in Young’s career, when, after joining CHEST and attending educational events, she was struck by the lack of standardization in practice she saw among APPs.

“Every time I would be at the CHEST meeting, if I happened to bump into another APP, I would assault them with questions because I didn’t know what the norm was—and come to find out, nobody did,” she said. “Our organization came out of that, and our goal is to eventually standardize the education and knowledge base of APPs.”

Because there is not an option for a national certification specifically for pulmonary medicine for APPs, Young instead attained the FCCP to demonstrate her clinical competency and knowledge. She also immersed herself in the education and community of CHEST, working on the former Clinical Research & Quality Improvement NetWork Committee and Interprofessional Team NetWork Committee, serving on the Scientific Program Committee, and developing patient education on asthma, among other projects.

Now, as a member of the CHEST Physician Editorial Board, Young hopes to build awareness among clinicians of the importance of APPs on the care team and to support another option for APPs to access high-quality education and content to help them build their knowledge and enhance the care they deliver.

“It’s important that CHEST Physician is interested in an APP perspective being included,” she said. “It’s validation that we’re part of the team, that we’re included in all aspects of care including areas outside of direct care: in education, in the literature. ... That they feel our contributions are important.”

When she isn’t working with CHEST or caring for patients, Young and her husband competitively team rope, a rodeo event in which two people work together to rope a steer. Although they were unable to attend, they qualified for the world series in the sport last year, and hope to qualify again this year.

Please join us in welcoming Corinne Young to the CHEST Physician editorial board.

Welcome to Corinne Young, MSN, FNP-C, FCCP, who recently joined the CHEST Physician editorial board to represent and advocate for the perspective of advanced practice providers on the interdisciplinary team.

Young is a nurse practitioner and director of APP and Clinical Services for Colorado Springs Pulmonary Consultants in Colorado. She also is the founder and president of the Association of Pulmonary Advanced Practice Providers, which she created with support from CHEST staff and leaders, who encouraged her to create a community around advocating for and developing credentialing opportunities for this population.

Courtesy ACCP

The idea began early in Young’s career, when, after joining CHEST and attending educational events, she was struck by the lack of standardization in practice she saw among APPs.

“Every time I would be at the CHEST meeting, if I happened to bump into another APP, I would assault them with questions because I didn’t know what the norm was—and come to find out, nobody did,” she said. “Our organization came out of that, and our goal is to eventually standardize the education and knowledge base of APPs.”

Because there is not an option for a national certification specifically for pulmonary medicine for APPs, Young instead attained the FCCP to demonstrate her clinical competency and knowledge. She also immersed herself in the education and community of CHEST, working on the former Clinical Research & Quality Improvement NetWork Committee and Interprofessional Team NetWork Committee, serving on the Scientific Program Committee, and developing patient education on asthma, among other projects.

Now, as a member of the CHEST Physician Editorial Board, Young hopes to build awareness among clinicians of the importance of APPs on the care team and to support another option for APPs to access high-quality education and content to help them build their knowledge and enhance the care they deliver.

“It’s important that CHEST Physician is interested in an APP perspective being included,” she said. “It’s validation that we’re part of the team, that we’re included in all aspects of care including areas outside of direct care: in education, in the literature. ... That they feel our contributions are important.”

When she isn’t working with CHEST or caring for patients, Young and her husband competitively team rope, a rodeo event in which two people work together to rope a steer. Although they were unable to attend, they qualified for the world series in the sport last year, and hope to qualify again this year.

Please join us in welcoming Corinne Young to the CHEST Physician editorial board.

Welcome to Corinne Young, MSN, FNP-C, FCCP, who recently joined the CHEST Physician editorial board to represent and advocate for the perspective of advanced practice providers on the interdisciplinary team.

Young is a nurse practitioner and director of APP and Clinical Services for Colorado Springs Pulmonary Consultants in Colorado. She also is the founder and president of the Association of Pulmonary Advanced Practice Providers, which she created with support from CHEST staff and leaders, who encouraged her to create a community around advocating for and developing credentialing opportunities for this population.

Courtesy ACCP

The idea began early in Young’s career, when, after joining CHEST and attending educational events, she was struck by the lack of standardization in practice she saw among APPs.

“Every time I would be at the CHEST meeting, if I happened to bump into another APP, I would assault them with questions because I didn’t know what the norm was—and come to find out, nobody did,” she said. “Our organization came out of that, and our goal is to eventually standardize the education and knowledge base of APPs.”

Because there is not an option for a national certification specifically for pulmonary medicine for APPs, Young instead attained the FCCP to demonstrate her clinical competency and knowledge. She also immersed herself in the education and community of CHEST, working on the former Clinical Research & Quality Improvement NetWork Committee and Interprofessional Team NetWork Committee, serving on the Scientific Program Committee, and developing patient education on asthma, among other projects.

Now, as a member of the CHEST Physician Editorial Board, Young hopes to build awareness among clinicians of the importance of APPs on the care team and to support another option for APPs to access high-quality education and content to help them build their knowledge and enhance the care they deliver.

“It’s important that CHEST Physician is interested in an APP perspective being included,” she said. “It’s validation that we’re part of the team, that we’re included in all aspects of care including areas outside of direct care: in education, in the literature. ... That they feel our contributions are important.”

When she isn’t working with CHEST or caring for patients, Young and her husband competitively team rope, a rodeo event in which two people work together to rope a steer. Although they were unable to attend, they qualified for the world series in the sport last year, and hope to qualify again this year.

Please join us in welcoming Corinne Young to the CHEST Physician editorial board.

Genetic Associations and Architecture of Asthma-COPD Overlap. By Catherine John, et al.

Emerging Nonpulmonary Complications for Adults With Cystic Fibrosis. By Dr. Melanie Chin, et al.

Aspirin as a Treatment for ARDS: A Randomized, Placebo-Controlled Clinical Trial. By Dr. Philip Toner, et al.

PICU in the MICU: How Adult ICUs Can Support Pediatric Care in Public Health Emergencies. By Dr. Mary A. King, et al.

Association of BMI and Change in Weight With Mortality in Patients With Fibrotic Interstitial Lung Disease. By Dr. Alessia Comes, et al.

Off-Label Use and Inappropriate Dosing of Direct Oral Anticoagulants in Cardiopulmonary Disease. By Dr. Ayman A. Hussein, et al.

Genetic Associations and Architecture of Asthma-COPD Overlap. By Catherine John, et al.

Emerging Nonpulmonary Complications for Adults With Cystic Fibrosis. By Dr. Melanie Chin, et al.

Aspirin as a Treatment for ARDS: A Randomized, Placebo-Controlled Clinical Trial. By Dr. Philip Toner, et al.

PICU in the MICU: How Adult ICUs Can Support Pediatric Care in Public Health Emergencies. By Dr. Mary A. King, et al.

Association of BMI and Change in Weight With Mortality in Patients With Fibrotic Interstitial Lung Disease. By Dr. Alessia Comes, et al.

Off-Label Use and Inappropriate Dosing of Direct Oral Anticoagulants in Cardiopulmonary Disease. By Dr. Ayman A. Hussein, et al.

Genetic Associations and Architecture of Asthma-COPD Overlap. By Catherine John, et al.

Emerging Nonpulmonary Complications for Adults With Cystic Fibrosis. By Dr. Melanie Chin, et al.

Aspirin as a Treatment for ARDS: A Randomized, Placebo-Controlled Clinical Trial. By Dr. Philip Toner, et al.

PICU in the MICU: How Adult ICUs Can Support Pediatric Care in Public Health Emergencies. By Dr. Mary A. King, et al.

Association of BMI and Change in Weight With Mortality in Patients With Fibrotic Interstitial Lung Disease. By Dr. Alessia Comes, et al.

Off-Label Use and Inappropriate Dosing of Direct Oral Anticoagulants in Cardiopulmonary Disease. By Dr. Ayman A. Hussein, et al.

Although attendees will be watching “The Test of the Champion” with bated breath, the upcoming Belmont Stakes Dinner and Auction on June 11 in New York City is about much more than a famous horse race. It’s about community – the vibrant community of clinicians, patients, advocates, and more who support the mission to crush lung disease.

The event started small with a Sunday brunch at the home of CHEST President-Elect Doreen Addrizzo-Harris, MD, FCCP, where attendees gathered to learn more from their host about the CHEST Foundation’s many initiatives. However, over the years, Dr. Addrizzo-Harris leaned on her own community of colleagues, family, friends, and patients to build an event that now boasts hundreds of attendees. But despite all that has changed, the Belmont Stakes Dinner and Auction is still dedicated to raising awareness about the CHEST Foundation and fundraising for initiatives to develop patient education and improve care.

In addition to a plated dinner, silent auction, cocktail reception, and rooftop after-party, this year’s event will feature speeches from two long-time patient advocates living with chronic lung conditions, Fred Schick and Betsy Glaeser.

For Dr. Addrizzo-Harris, spotlighting that unique patient perspective is particularly meaningful because the core focus of CHEST and the CHEST Foundation is to improve care and, by extension, patients’ lives.

Visit foundation.chestnet.org to read a blog post with more information about Schick and Glaeser’s work advocating for others with lung disease, find more details about the Belmont Stakes Dinner and Auction, and reserve your seat for this night of philanthropy and fun.

Although attendees will be watching “The Test of the Champion” with bated breath, the upcoming Belmont Stakes Dinner and Auction on June 11 in New York City is about much more than a famous horse race. It’s about community – the vibrant community of clinicians, patients, advocates, and more who support the mission to crush lung disease.

The event started small with a Sunday brunch at the home of CHEST President-Elect Doreen Addrizzo-Harris, MD, FCCP, where attendees gathered to learn more from their host about the CHEST Foundation’s many initiatives. However, over the years, Dr. Addrizzo-Harris leaned on her own community of colleagues, family, friends, and patients to build an event that now boasts hundreds of attendees. But despite all that has changed, the Belmont Stakes Dinner and Auction is still dedicated to raising awareness about the CHEST Foundation and fundraising for initiatives to develop patient education and improve care.

In addition to a plated dinner, silent auction, cocktail reception, and rooftop after-party, this year’s event will feature speeches from two long-time patient advocates living with chronic lung conditions, Fred Schick and Betsy Glaeser.

For Dr. Addrizzo-Harris, spotlighting that unique patient perspective is particularly meaningful because the core focus of CHEST and the CHEST Foundation is to improve care and, by extension, patients’ lives.

Visit foundation.chestnet.org to read a blog post with more information about Schick and Glaeser’s work advocating for others with lung disease, find more details about the Belmont Stakes Dinner and Auction, and reserve your seat for this night of philanthropy and fun.

Although attendees will be watching “The Test of the Champion” with bated breath, the upcoming Belmont Stakes Dinner and Auction on June 11 in New York City is about much more than a famous horse race. It’s about community – the vibrant community of clinicians, patients, advocates, and more who support the mission to crush lung disease.

The event started small with a Sunday brunch at the home of CHEST President-Elect Doreen Addrizzo-Harris, MD, FCCP, where attendees gathered to learn more from their host about the CHEST Foundation’s many initiatives. However, over the years, Dr. Addrizzo-Harris leaned on her own community of colleagues, family, friends, and patients to build an event that now boasts hundreds of attendees. But despite all that has changed, the Belmont Stakes Dinner and Auction is still dedicated to raising awareness about the CHEST Foundation and fundraising for initiatives to develop patient education and improve care.

In addition to a plated dinner, silent auction, cocktail reception, and rooftop after-party, this year’s event will feature speeches from two long-time patient advocates living with chronic lung conditions, Fred Schick and Betsy Glaeser.

For Dr. Addrizzo-Harris, spotlighting that unique patient perspective is particularly meaningful because the core focus of CHEST and the CHEST Foundation is to improve care and, by extension, patients’ lives.

Visit foundation.chestnet.org to read a blog post with more information about Schick and Glaeser’s work advocating for others with lung disease, find more details about the Belmont Stakes Dinner and Auction, and reserve your seat for this night of philanthropy and fun.