News From CHEST Physician®

Airways disorders

Updated guidelines on the use of home O2 in COPD: A much-needed respite

The use of long-term oxygen therapy (LTOT, oxygen prescribed for at least 15 h/day) in patients with COPD and chronic hypoxemia has been standard of care based on trials from the 1980s that conferred a survival benefit with the use of continuous oxygen (Ann Internal Med. 1980;93[3]:391-8). More recently, LTOT has not shown to improve survival or delay time to the hospitalization in patients with stable COPD and resting or exercise-induced moderate desaturation (N Engl J Med. 2016;375[17]:1617-27). Thus far, existing recommendations had been semi-inclusive in patient selection. A fundamental lack of evidence-based clinical practice guidelines prompted additional research into patient selection, portable oxygen technology, advocacy for improved oxygen therapy financing, and updating of policies (Jacobs et al., Ann Am Thorac Soc. 2018;15[12]:1369-81). With over a million patients in the United States being prescribed home oxygen and reported disconnect in-home oxygen needs/experiences across disease processes, lifestyles, and oxygen supply requirements, the 2020 American Thoracic Society (ATS) workshop on optimizing home oxygen therapy sought to answer critical questions in the use of LTOT for COPD patients (AlMutairi, et al. Respir Care. 2018;63[11]:1321-30; Jacobs, et al. Am J Respir Crit Care Med. 2020;202[10]:e121-e141).

Dharani Kumari Narendra, MBBS, FCCP
Steering Committee Member

Chest infections

Eradicating COVID-19 scourge: It is up to all of us— get vaccinated!

2021 brings hope, spurred by the availability of several effective COVID-19 vaccines – unprecedented scientific advances, considering that these vaccines were developed in record time. We have stark choices: while some individuals ignore scientific evidence and refuse to take the vaccine, we from the Chest Infections NetWork urge an alternative and imperative choice. As health providers caring for COVID-19 patients, we first-hand witness the horrors of dying alone in a hospital bed – far away from beloved ones. I have a sticker on my car that says: If you do not like your mask, you will not like my ventilator. With the advent of vaccines, I plan on replacing this sticker: If you do not want to get vaccinated, you will not like my ventilator. When the vaccine became available at my institution, I was the first to roll up my sleeve and feel the pinch in my upper arm. I urge you all to do the same. Make a difference, do your part – get vaccinated.

Marcos I. Restrepo, MD, MSc, PhD
Chair

Clinical pulmonary medicine

COVID-19 vaccines – mRNA and beyond

We currently have two COVID-19 mRNA vaccines with US FDA emergency use authorization (EUA) for use in individuals less than or equal to age 18 years – Pfizer and Moderna. They work by introducing mRNA into a muscle cell that instructs the host cell ribosomes to express Sars-CoV-2 spike proteins, thereby triggering a systemic immune response.

Shyam Subramanian, MD, FCCP
Chair

Clinical research and quality improvement
 

COVID-19 treatment, so far!

COVID-19 has turned rapidly into a fatal illness, causing over 1.8 million deaths worldwide so far. The pandemic has also showed us the power of adaptive trials, multi-arm trials, and the role for collaboration across the global scientific community. A few significant studies are worth mentioning.

Ankita Agarwal, MD
Fellows-in-Training Members
 

Critical care

Awake proning in COVID-19

Prone positioning has been shown to improve pulmonary mechanics in intubated patients with acute respiratory distress syndrome (ARDS). Proposed mechanisms for these benefits include shape matching, reversing the pleural pressure gradient, homogenizing distribution of pleural pressures, reducing the impact of the heart and abdomen on the lungs, and maintaining distribution of perfusion. Application of prone positioning has also been shown to reduce mortality in severe ARDS (Guérin, et al. N Engl J Med. 2013;368(23):2159-68). With the COVID-19 pandemic, clinicians have extrapolated that nonintubated patients with severe hypoxia may benefit from awake proning in the hopes of improving oxygenation and decreasing need for intubation. But, what’s the evidence so far?

Viren Kaul, MD
Steering Committee Members

Home-Based Mechanical Ventilation and Neuromuscular Disease

New horizons in home ventilation

Phasing out a particular ventilator (Philips Respironics Trilogy 100 ventilator) has everyone on a steep learning curve with the replacement (Trilogy EVO). Most features are replicated in the EVO, including volume/pressure control and pressure-supported modes, mouthpiece ventilation, active/passive circuit capability, and portability (11.5 lb). Upgrades include longer battery life (15 hours; 7.5 hours internal/7.5 hours detachable) and use in pediatric patients now greater than or equal to 2.5 kg.

Online resources
EVO e-learning curriculum

Interprofessional team

Interprofessional team approach to palliative extubation

The emotional burden of caring for patients at the end of life affects all members of the care team. Palliative (or compassionate) extubation consists of the withdrawal of mechanical ventilation when the absolute priority in care delivery is to afford comfort and allow for natural death to occur. Rapid withdrawal of ventilatory support may lead to significant respiratory distress, and the critical care team has an obligation to ensure patient comfort during the dying process (Truog RD, et al. Crit Care Med. 2008;36[3]:953). Registered nurses (RN) are primarily responsible for the titration of sedation/analgesia and should be included in discussions regarding medication selection. It is imperative that neuromuscular blockade is absent, and benzodiazepines and/or opioids should be initiated prior to palliative extubation (Lanken PN, et al. Am J Respir Crit Care Med. 2008;177:912). Respiratory therapists (RT) are responsible for endotracheal tube removal despite rare participation in end-of-life discussions (Grandhige AP, et al. Respir Care. 2016;61[7]:891). It is recommended that an experienced physician, RN, and RT be readily available to respond quickly to any signs of distress (Downar J, et al. Intensive Care Med. 2016;42:1003). Regular debriefing sessions exploring team actions and communication dynamics are advised following end-of-life care (Ho A, et al. J Interprof Care. 2016;30[6]:795-803). Palliative extubation demands meticulous planning and clear communication among all team members (physician, RN, RT) and the patient’s family. Poor planning may result in physical and emotional suffering for the patient and difficult bereavement for the family (Coradazi A, et al. Hos Pal Med Int J. 2019;3[1]:10-14). Interprofessional team-based care results from intentional teams that exhibit collective identity and shared responsibility for the patients they serve (Core Competencies for Interprofessional Education Collaborative Practice, 2016). An inclusive and interprofessional approach to withdrawal of mechanical ventilation is key to both quality patient care and provider wellbeing.

Rebecca Anna Gersten, MD
Steering Committee Member

Samantha Davis, MS, RRT
Steering Committee Member

Munish Luthra, MD, FCCP
Vice-Chair Committee

Airways disorders

Updated guidelines on the use of home O2 in COPD: A much-needed respite

The use of long-term oxygen therapy (LTOT, oxygen prescribed for at least 15 h/day) in patients with COPD and chronic hypoxemia has been standard of care based on trials from the 1980s that conferred a survival benefit with the use of continuous oxygen (Ann Internal Med. 1980;93[3]:391-8). More recently, LTOT has not shown to improve survival or delay time to the hospitalization in patients with stable COPD and resting or exercise-induced moderate desaturation (N Engl J Med. 2016;375[17]:1617-27). Thus far, existing recommendations had been semi-inclusive in patient selection. A fundamental lack of evidence-based clinical practice guidelines prompted additional research into patient selection, portable oxygen technology, advocacy for improved oxygen therapy financing, and updating of policies (Jacobs et al., Ann Am Thorac Soc. 2018;15[12]:1369-81). With over a million patients in the United States being prescribed home oxygen and reported disconnect in-home oxygen needs/experiences across disease processes, lifestyles, and oxygen supply requirements, the 2020 American Thoracic Society (ATS) workshop on optimizing home oxygen therapy sought to answer critical questions in the use of LTOT for COPD patients (AlMutairi, et al. Respir Care. 2018;63[11]:1321-30; Jacobs, et al. Am J Respir Crit Care Med. 2020;202[10]:e121-e141).

Dharani Kumari Narendra, MBBS, FCCP
Steering Committee Member

Chest infections

Eradicating COVID-19 scourge: It is up to all of us— get vaccinated!

2021 brings hope, spurred by the availability of several effective COVID-19 vaccines – unprecedented scientific advances, considering that these vaccines were developed in record time. We have stark choices: while some individuals ignore scientific evidence and refuse to take the vaccine, we from the Chest Infections NetWork urge an alternative and imperative choice. As health providers caring for COVID-19 patients, we first-hand witness the horrors of dying alone in a hospital bed – far away from beloved ones. I have a sticker on my car that says: If you do not like your mask, you will not like my ventilator. With the advent of vaccines, I plan on replacing this sticker: If you do not want to get vaccinated, you will not like my ventilator. When the vaccine became available at my institution, I was the first to roll up my sleeve and feel the pinch in my upper arm. I urge you all to do the same. Make a difference, do your part – get vaccinated.

Marcos I. Restrepo, MD, MSc, PhD
Chair

Clinical pulmonary medicine

COVID-19 vaccines – mRNA and beyond

We currently have two COVID-19 mRNA vaccines with US FDA emergency use authorization (EUA) for use in individuals less than or equal to age 18 years – Pfizer and Moderna. They work by introducing mRNA into a muscle cell that instructs the host cell ribosomes to express Sars-CoV-2 spike proteins, thereby triggering a systemic immune response.

Shyam Subramanian, MD, FCCP
Chair

Clinical research and quality improvement
 

COVID-19 treatment, so far!

COVID-19 has turned rapidly into a fatal illness, causing over 1.8 million deaths worldwide so far. The pandemic has also showed us the power of adaptive trials, multi-arm trials, and the role for collaboration across the global scientific community. A few significant studies are worth mentioning.

Ankita Agarwal, MD
Fellows-in-Training Members
 

Critical care

Awake proning in COVID-19

Prone positioning has been shown to improve pulmonary mechanics in intubated patients with acute respiratory distress syndrome (ARDS). Proposed mechanisms for these benefits include shape matching, reversing the pleural pressure gradient, homogenizing distribution of pleural pressures, reducing the impact of the heart and abdomen on the lungs, and maintaining distribution of perfusion. Application of prone positioning has also been shown to reduce mortality in severe ARDS (Guérin, et al. N Engl J Med. 2013;368(23):2159-68). With the COVID-19 pandemic, clinicians have extrapolated that nonintubated patients with severe hypoxia may benefit from awake proning in the hopes of improving oxygenation and decreasing need for intubation. But, what’s the evidence so far?

Viren Kaul, MD
Steering Committee Members

Home-Based Mechanical Ventilation and Neuromuscular Disease

New horizons in home ventilation

Phasing out a particular ventilator (Philips Respironics Trilogy 100 ventilator) has everyone on a steep learning curve with the replacement (Trilogy EVO). Most features are replicated in the EVO, including volume/pressure control and pressure-supported modes, mouthpiece ventilation, active/passive circuit capability, and portability (11.5 lb). Upgrades include longer battery life (15 hours; 7.5 hours internal/7.5 hours detachable) and use in pediatric patients now greater than or equal to 2.5 kg.

Online resources
EVO e-learning curriculum

Interprofessional team

Interprofessional team approach to palliative extubation

The emotional burden of caring for patients at the end of life affects all members of the care team. Palliative (or compassionate) extubation consists of the withdrawal of mechanical ventilation when the absolute priority in care delivery is to afford comfort and allow for natural death to occur. Rapid withdrawal of ventilatory support may lead to significant respiratory distress, and the critical care team has an obligation to ensure patient comfort during the dying process (Truog RD, et al. Crit Care Med. 2008;36[3]:953). Registered nurses (RN) are primarily responsible for the titration of sedation/analgesia and should be included in discussions regarding medication selection. It is imperative that neuromuscular blockade is absent, and benzodiazepines and/or opioids should be initiated prior to palliative extubation (Lanken PN, et al. Am J Respir Crit Care Med. 2008;177:912). Respiratory therapists (RT) are responsible for endotracheal tube removal despite rare participation in end-of-life discussions (Grandhige AP, et al. Respir Care. 2016;61[7]:891). It is recommended that an experienced physician, RN, and RT be readily available to respond quickly to any signs of distress (Downar J, et al. Intensive Care Med. 2016;42:1003). Regular debriefing sessions exploring team actions and communication dynamics are advised following end-of-life care (Ho A, et al. J Interprof Care. 2016;30[6]:795-803). Palliative extubation demands meticulous planning and clear communication among all team members (physician, RN, RT) and the patient’s family. Poor planning may result in physical and emotional suffering for the patient and difficult bereavement for the family (Coradazi A, et al. Hos Pal Med Int J. 2019;3[1]:10-14). Interprofessional team-based care results from intentional teams that exhibit collective identity and shared responsibility for the patients they serve (Core Competencies for Interprofessional Education Collaborative Practice, 2016). An inclusive and interprofessional approach to withdrawal of mechanical ventilation is key to both quality patient care and provider wellbeing.

Rebecca Anna Gersten, MD
Steering Committee Member

Samantha Davis, MS, RRT
Steering Committee Member

Munish Luthra, MD, FCCP
Vice-Chair Committee

Airways disorders

Updated guidelines on the use of home O2 in COPD: A much-needed respite

The use of long-term oxygen therapy (LTOT, oxygen prescribed for at least 15 h/day) in patients with COPD and chronic hypoxemia has been standard of care based on trials from the 1980s that conferred a survival benefit with the use of continuous oxygen (Ann Internal Med. 1980;93[3]:391-8). More recently, LTOT has not shown to improve survival or delay time to the hospitalization in patients with stable COPD and resting or exercise-induced moderate desaturation (N Engl J Med. 2016;375[17]:1617-27). Thus far, existing recommendations had been semi-inclusive in patient selection. A fundamental lack of evidence-based clinical practice guidelines prompted additional research into patient selection, portable oxygen technology, advocacy for improved oxygen therapy financing, and updating of policies (Jacobs et al., Ann Am Thorac Soc. 2018;15[12]:1369-81). With over a million patients in the United States being prescribed home oxygen and reported disconnect in-home oxygen needs/experiences across disease processes, lifestyles, and oxygen supply requirements, the 2020 American Thoracic Society (ATS) workshop on optimizing home oxygen therapy sought to answer critical questions in the use of LTOT for COPD patients (AlMutairi, et al. Respir Care. 2018;63[11]:1321-30; Jacobs, et al. Am J Respir Crit Care Med. 2020;202[10]:e121-e141).

Dharani Kumari Narendra, MBBS, FCCP
Steering Committee Member

Chest infections

Eradicating COVID-19 scourge: It is up to all of us— get vaccinated!

2021 brings hope, spurred by the availability of several effective COVID-19 vaccines – unprecedented scientific advances, considering that these vaccines were developed in record time. We have stark choices: while some individuals ignore scientific evidence and refuse to take the vaccine, we from the Chest Infections NetWork urge an alternative and imperative choice. As health providers caring for COVID-19 patients, we first-hand witness the horrors of dying alone in a hospital bed – far away from beloved ones. I have a sticker on my car that says: If you do not like your mask, you will not like my ventilator. With the advent of vaccines, I plan on replacing this sticker: If you do not want to get vaccinated, you will not like my ventilator. When the vaccine became available at my institution, I was the first to roll up my sleeve and feel the pinch in my upper arm. I urge you all to do the same. Make a difference, do your part – get vaccinated.

Marcos I. Restrepo, MD, MSc, PhD
Chair

Clinical pulmonary medicine

COVID-19 vaccines – mRNA and beyond

We currently have two COVID-19 mRNA vaccines with US FDA emergency use authorization (EUA) for use in individuals less than or equal to age 18 years – Pfizer and Moderna. They work by introducing mRNA into a muscle cell that instructs the host cell ribosomes to express Sars-CoV-2 spike proteins, thereby triggering a systemic immune response.

Shyam Subramanian, MD, FCCP
Chair

Clinical research and quality improvement
 

COVID-19 treatment, so far!

COVID-19 has turned rapidly into a fatal illness, causing over 1.8 million deaths worldwide so far. The pandemic has also showed us the power of adaptive trials, multi-arm trials, and the role for collaboration across the global scientific community. A few significant studies are worth mentioning.

Ankita Agarwal, MD
Fellows-in-Training Members
 

Critical care

Awake proning in COVID-19

Prone positioning has been shown to improve pulmonary mechanics in intubated patients with acute respiratory distress syndrome (ARDS). Proposed mechanisms for these benefits include shape matching, reversing the pleural pressure gradient, homogenizing distribution of pleural pressures, reducing the impact of the heart and abdomen on the lungs, and maintaining distribution of perfusion. Application of prone positioning has also been shown to reduce mortality in severe ARDS (Guérin, et al. N Engl J Med. 2013;368(23):2159-68). With the COVID-19 pandemic, clinicians have extrapolated that nonintubated patients with severe hypoxia may benefit from awake proning in the hopes of improving oxygenation and decreasing need for intubation. But, what’s the evidence so far?

Viren Kaul, MD
Steering Committee Members

Home-Based Mechanical Ventilation and Neuromuscular Disease

New horizons in home ventilation

Phasing out a particular ventilator (Philips Respironics Trilogy 100 ventilator) has everyone on a steep learning curve with the replacement (Trilogy EVO). Most features are replicated in the EVO, including volume/pressure control and pressure-supported modes, mouthpiece ventilation, active/passive circuit capability, and portability (11.5 lb). Upgrades include longer battery life (15 hours; 7.5 hours internal/7.5 hours detachable) and use in pediatric patients now greater than or equal to 2.5 kg.

Online resources
EVO e-learning curriculum

Interprofessional team

Interprofessional team approach to palliative extubation

The emotional burden of caring for patients at the end of life affects all members of the care team. Palliative (or compassionate) extubation consists of the withdrawal of mechanical ventilation when the absolute priority in care delivery is to afford comfort and allow for natural death to occur. Rapid withdrawal of ventilatory support may lead to significant respiratory distress, and the critical care team has an obligation to ensure patient comfort during the dying process (Truog RD, et al. Crit Care Med. 2008;36[3]:953). Registered nurses (RN) are primarily responsible for the titration of sedation/analgesia and should be included in discussions regarding medication selection. It is imperative that neuromuscular blockade is absent, and benzodiazepines and/or opioids should be initiated prior to palliative extubation (Lanken PN, et al. Am J Respir Crit Care Med. 2008;177:912). Respiratory therapists (RT) are responsible for endotracheal tube removal despite rare participation in end-of-life discussions (Grandhige AP, et al. Respir Care. 2016;61[7]:891). It is recommended that an experienced physician, RN, and RT be readily available to respond quickly to any signs of distress (Downar J, et al. Intensive Care Med. 2016;42:1003). Regular debriefing sessions exploring team actions and communication dynamics are advised following end-of-life care (Ho A, et al. J Interprof Care. 2016;30[6]:795-803). Palliative extubation demands meticulous planning and clear communication among all team members (physician, RN, RT) and the patient’s family. Poor planning may result in physical and emotional suffering for the patient and difficult bereavement for the family (Coradazi A, et al. Hos Pal Med Int J. 2019;3[1]:10-14). Interprofessional team-based care results from intentional teams that exhibit collective identity and shared responsibility for the patients they serve (Core Competencies for Interprofessional Education Collaborative Practice, 2016). An inclusive and interprofessional approach to withdrawal of mechanical ventilation is key to both quality patient care and provider wellbeing.

Rebecca Anna Gersten, MD
Steering Committee Member

Samantha Davis, MS, RRT
Steering Committee Member

Munish Luthra, MD, FCCP
Vice-Chair Committee

ANNUAL AWARDS

Master FCCP

Nancy A. Collop MD, Master FCCP



College Medalist Award

Neil R. MacIntyre, MD, FCCP



Distinguished Service Award

Lisa K. Moores, MD, FCCP



Master Clinician Educator

William F. Kelly, MD, FCCP

David A. Schulman, MD, MPH, FCCP



Early Career Clinician Educator

Subani Chandra, MD, FCCP



Alfred Soffer Award for Editorial Excellence

Barbara Anderson, CHEST Staff

Laura Lipsey, CHEST Staff



Presidential Citation

Mangala Narasimhan, DO, FCCP

Renli Qiao, MD, PhD, FCCP
 

HONOR LECTURE AND MEMORIAL AWARDS

Edward C. Rosenow III, MD, Master FCCP/Master Teacher Endowed Honor Lecture Evolving Therapies in ANCA-Associated Vasculitides

Joseph P. Lynch, III, MD, FCCP

The lecture is generously funded by the CHEST Foundation.Distinguished Scientist Honor Lecture in Cardiopulmonary PhysiologyHelping the Dyspneic Patient: Clinical Physiology Matters!

Denis E. O’Donnell, MD, MBBCh, FCCP

The lecture is generously funded by the CHEST Foundation.Presidential Honor LectureCOPD Management: We’ve Come So Far

Darcy D. Marciniuk, MD, Master FCCP



Thomas L. Petty, MD, Master FCCP Memorial LectureReal World Research - What Would Dr. Petty Say?

Mary Hart, RRT, MS, FCCP

The lecture is generously funded by the CHEST Foundation.Margaret Pfrommer Endowed Memorial Lecture in Home-Based Mechanical VentilationNavigating to Home NIV Nirvana: What Would Margaret Do?

Peter C. Gay, MD, MS, FCCP

The Margaret Pfrommer Endowed Memorial Lecture in Home-Based Mechanical Ventilation is generously supported by International Ventilator Users Network of Post-Polio Health International and the CHEST Foundation.Pasquale Ciaglia Memorial Lecture in Interventional MedicineRaising the Bar: The Interventional Pulmonary Outcomes Group

Lonny B. Yarmus, DO, MBA, FCCP

The lecture is generously funded by the CHEST Foundation.

Roger C. Bone Memorial Lecture in Critical CareTo SIRS with Love: Dr. Roger Bone’s Continued Influence on Early Sepsis Care

Emanuel P. Rivers, MD, MPH, FCCP

The lecture is generously funded by the CHEST Foundation.Murray Kornfeld Memorial Founders LectureOur Pneumonia Journey: The Lungs and Beyond

Marcos I. Restrepo, MD, PhD, FCCP

The lecture is generously funded by the CHEST Foundation.

CHEST FOUNDATION GRANT AWARDS

The GlaxoSmithKline Distinguished Scholar in Respiratory Health

Deepa Gotur, MD, FCCP

Cytokine Release in SARS COV2 Viral Illness and Trends of Inflammasome Expression in Acute Respiratory Distress Syndrome Manifestations and ManagementThis grant is supported by an endowed fund from GlaxoSmithKline.CHEST Foundation and the Alpha-1 Foundation Research Grant in Alpha-1 Antitrypsin Deficiency

Paul R. Ellis, MBChB

Cardiovascular Outcomes and Phenotypes in Pulmonary Exacerbations of Alpha-1 AntitrypsinThis grant is jointly supported by the CHEST Foundation and the Alpha-1 Foundation.CHEST Foundation Research Grant in Women’s Lung Health

Shannon E. Kay, MD

Sex-specific Gene Expression in AsthmaThis grant is supported by the CHEST Foundation.CHEST Foundation Research Grant in Chronic Obstructive Pulmonary Disease

Davide Biondini, MD, PhD

Role of the Immune Check Points (CTLA-4 and PD-1) in the Development or Evasion of Smoking-Induced Chronic Obstructive Pulmonary Disease



Andrew J. Gangemi, MD

Are Sleep Health, Nicotine Metabolism, and Airway Inflammation Mechanisms for Differences in Lung Function between African American and Non-Hispanic White Smokers? A Proof-of-Concept ExaminationThese grants are supported by AstraZeneca LP.CHEST Foundation Research Grant in Critical Care

Mounica Vallurupalli, MD

Evaluating the Impact of Clonal Hematopoiesis on Host Immune Response During Sepsis

This grant is supported by the CHEST Foundation.CHEST Foundation Research Grant in Lung Cancer

Stefanie Mason, MD

Implications of Longitudinal Muscle-Mass Trajectories in Lung CancerThis grant is supported by the CHEST Foundation.CHEST Foundation Research Grant in Venous Thromboembolism

Jansen N. Seheult, MD, MBBCh

Untangling the NET: Neutrophil Activation as the Driver of Venous Thromboembolism in Coronavirus Disease 2019This grant is supported by the CHEST Foundation.CHEST Foundation Research Grant in Nontuberculous Mycobacteria Diseases

Bryan A. Garcia, MD

Longitudinal Proteomic Endotyping of Patients with Nontuberculous Mycobacterial Lung InfectionsThis grant is supported by Insmed Incorporated.CHEST Foundation Research Grant in Cystic Fibrosis

Jeffrey Barry, MD

Eosinophilia as a Biomarker for Worse Outcomes in Cystic Fibrosis



Kristina Montemayor, MD

The Association of Sex Hormones and Respiratory Morbidity in Individuals with Cystic FibrosisThese grants are supported by Vertex Pharmaceuticals.John R. Addrizzo, MD, FCCP Research Grant in Sarcoidosis

Changwan Ryu, MD

Extracellular Matrix Proteins as a Biomarker for Stage IV SarcoidosisThis grant is in honor of John R. Addrizzo, MD, FCCP and is jointly supported by the Addrizzo family and the CHEST Foundation.CHEST Foundation Research Grant in Severe Asthma

Isaretta L. Riley, MD, MPH

Coping with Asthma through Life Management (CALM)This grant is funded by AstraZeneca LP.CHEST Foundation Research Grant in Pulmonary Fibrosis

Sarah Beshay, MD

COPA Syndrome-Associated Mutations in Lung Transplant Recipients for Pulmonary Fibrosis



Erica D. Farrand, MD

The Future of Telehealth in Interstitial Lung DiseaseThese grants are supported by Boehringer Ingelheim Pharmaceuticals and Genentech, Inc.CHEST Foundation Research Grant in Sleep Medicine

Tetyana Kendzerska, MD, PhD

The Role of Sleep and Circadian Disturbances in Cancer Development and Progression: A Historical Multicenter Clinical Cohort Study



Nancy Stewart, DO

Improving COPD/OSA Overlap Syndrome Pre-Discharge Care DeliveryThese grants are funded by Jazz Pharmaceuticals, Inc.CHEST Foundation and Association of Critical Care Medicine Program Directors Award Research Grant in Medical Education

Ilana R. Krumm, MD

What’s good about Soul Food? Discovering and Analyzing Elements of an ICU Team Group Discussion Which Improve Provider WellnessThis grant is jointly supported by the CHEST Foundation and APCCMPD.CHEST Foundation and American Thoracic Society Research Grant in Diversity

Thomas S. Valley, MD, MSc

Understanding Differences in Delivery of Care Processes for Respiratory Failure by Race/EthnicityThis grant is jointly supported by the CHEST Foundation and ATS.CHEST Foundation Research Grant in COVID-19

David Furfaro, MD

Subphenotypes, Inflammatory Profiles, and Antibody Response in COVID-19 ARDSThis grant is supported by the CHEST Foundation.CHEST Foundation and American Thoracic Society Grant in COVID-19 and Diversity

Peter D. Jackson, MD

The Effect of the COVID-19 Pandemic on Tuberculosis Care in UgandaThis grant is jointly supported by the CHEST Foundation and ATS.CHEST Foundation Research Grant in Ultrasonography and COVID-19

Marjan M. Islam, MD

Thoracic Ultrasound in COVID-19: A Prospective Study Using Lung and Diaphragm Ultrasound in Evaluating Dyspnea in ICU Survivors with COVID-19 in a Post-ICU Clinic



Siddharth Dugar, MBBS

Spontaneous Echo Contrast in Lower Extremity and Correlation with Venous Velocity and Subsequent Deep Venous Thrombosis in Critically Ill COVID-19 PatientsThis grant is jointly supported by the CHEST Foundation and FUJIFILM SonoSite.

CHEST Foundation Community Service Grant Honoring D. Robert McCaffree, MD, Master FCCP



Ivan Nemorin, MBA, MS, RRT

Healthier Homes for Children-Community Asthma Prevention Program



Joseph Huang, MD

East Africa Training Initiative (EATI)



Aninda Das, MD, MBBS

Screening for Childhood Tuberculosis in Children 0-4 years of Age with Moderate to Severe Malnutrition in a Rural District of West Bengal, India



Trishual Siddharthan, MD

Establishing a Pulmonary and Critical Care Training Program in Uganda



Marina Lima, MD, MSc

Asmaland: The First Gamified Pediatric Asthma Educational Program in Portuguese



Roberta M. Kato, MD

Lung Power



These grants are supported by the CHEST Foundation.Alfred Soffer Research Award Winners

Mazen O. Al-Qadi, MD: RESPIRATORY VARIATION IN RIGHT ATRIAL PRESSURE PREDICTS RIGHT VENTRICULAR DYSFUNCTION IN PATIENTS WITH PRE-CAPILLARY PULMONARY HYPERTENSION

Valerie G. Press, MD: COST SAVING SIMULATION FOR THE TRANSITION FROM NEBULIZER TO COMBINATION OF NEBULIZER AND METERED-DOSE INHALERS (MD)



Young Investigator Award Winners

Gabriel E. Ortiz Jaimes, MD: CORRELATION OF CARDIAC OUTPUT MEASUREMENT BY GOAL-DIRECTED ECHOCARDIOGRAPHY PERFORMED BY INTENSIVISTS VS PULMONARY ARTERY CATHETER

Palakkumar Patel, MD: IMPACT OF HAVING PULMONARY HYPERTENSION IN PATIENTS ADMITTED WITH ACUTE EXACERBATION OF COPD IN THEIR HEALTHCARE UTILIZATION AND READMISSION: A US POPULATION COHORT STUDY

Top 5 Abstract Posters

Winner: Amr Alwakeel, MD: IMPACT OF A PLEURAL CARE PROGRAM ON THE PATHWAY TO DEFINITIVE PALLIATION OF MALIGNANT PLEURAL EFFUSIONS: A PRE-AND POST STUDY

Winner: Konstantinos Zorbas, MD: A SIMPLE PREDICTION SCORE FOR POSTOPERATIVE DEATH AFTER DECORTICATION

Winner: Yichen Wang, MD, MSc: CORONAVIRUS-RELATED HOSPITAL ADMISSIONS IN THE UNITED STATES IN 2016-2017

Runner up: Daniel Ospina-Delgado, MD: CHARACTERIZATION OF LARYNGEAL DISORDERS IN PATIENTS WITH EXCESSIVE CENTRAL AIRWAY COLLAPSE

Runner up: Vishal Vashistha, MD: TREATMENT PATTERNS AMONG LOWER-INCOME INDIAN PATIENTS WITH METASTATIC NON-SMALL CELL LUNG CANCER HARBORING EGFR MUTATIONS OR ALK REARRANGEMENTS



Case Report Poster Winners

Faiza Khalid, MD: FORME FUSTE OF INTERMEDIATE SYNDROME (IMS) IN ORGANOPHOSPHATE POISOING (OPP): EXPERT OPINION GUIDELINE WITHOUT CLEAR END-POINT.

William Meng, MD: VINGT MILLE LIEUES SOUS LES MERS: A POISONOUS GUEST FROM THE BLUE SEA TOXIC INHALATION OF CORAL PALYTOXIN

Dhruv Amratia, MD: PULMONARY BLASTOMA: A RARE FORM OF LUNG CANCER

Melinda Becker, MD: ECMO-ASSISTED BRONCHOSCOPY FOR NEAR-COMPLETE TRACHEAL OBSTRUCTION

Brittany Blass, PA-C: A CASE OF AUTOIMMUNE PULMONARY ALVEOLAR PROTEINOSIS WITH UNDERLYING MONOCLONAL B-CELL LYMPHOCYTOSIS

Abigayle Sullivan, MD: BIRD FANCIER’S LUNG: AN UNDERDIAGNOSED CAUSE OF SHORTNESS OF BREATH

Nitin Gupta, DO: SUCCESSFUL EMERGENT CORONARY ARTERY BYPASS IN A WOMAN WITH POSTPARTUM SPONTANEOUS CORONARY ARTERY DISSECTION

Michelle Miles, DO: GI VARIANT OF LEMIERRE SYNDROME: COMPLETE OCCLUSION OF SUPERIOR MESENTERIC VEIN IN A 30-YEAR-OLD WITH APPENDICEAL ABSCESS

Adarsha Ojha, MD: BLEEDING LUNG AND BLOATING GUT: LANE HAMILTON SYNDROME

Abdul Siddiqui, MD: A CASE OF E-CIGARETTE OR VAPING PRODUCT USE-ASSOCIATED LUNG INJURY IN AN INFREQUENT VAPE USER

James Dugan, MD: EMPHYSEMA WITH PLACENTAL TRANSMOGRIFICATION AND LIPOMATOUS CHANGE

Daniel Condit, MD: DUPLICATE INFERIOR VENA CAVA AS A POTENTIAL PATHWAY FOR RECURRENT PULMONARY EMBOLISM


 

CHEST 2020 CHEST Challenge

1st Place



Case Western Reserve University (MetroHealth)



Enambir Josan, MD

Ishan Lalani, MD, MPH

Faisal Qadir, MD



Program Director: Ziad Shaman, MD, FCCP







2nd Place





SUNY Downstate



Suchit Khanijao, MD

Chetana Pendkar, MBBS

Ayla Zubair, MBBS



Program Director: Robert Foronjy, MD



3rd Place



NYP Brooklyn Methodist Hospital



John Gorski, MD

Sandi Khin, MD

Kinjal Patel, MD


 

Program Director: Anthony Saleh, MD, FCCP

ANNUAL AWARDS

Master FCCP

Nancy A. Collop MD, Master FCCP



College Medalist Award

Neil R. MacIntyre, MD, FCCP



Distinguished Service Award

Lisa K. Moores, MD, FCCP



Master Clinician Educator

William F. Kelly, MD, FCCP

David A. Schulman, MD, MPH, FCCP



Early Career Clinician Educator

Subani Chandra, MD, FCCP



Alfred Soffer Award for Editorial Excellence

Barbara Anderson, CHEST Staff

Laura Lipsey, CHEST Staff



Presidential Citation

Mangala Narasimhan, DO, FCCP

Renli Qiao, MD, PhD, FCCP
 

HONOR LECTURE AND MEMORIAL AWARDS

Edward C. Rosenow III, MD, Master FCCP/Master Teacher Endowed Honor Lecture Evolving Therapies in ANCA-Associated Vasculitides

Joseph P. Lynch, III, MD, FCCP

The lecture is generously funded by the CHEST Foundation.Distinguished Scientist Honor Lecture in Cardiopulmonary PhysiologyHelping the Dyspneic Patient: Clinical Physiology Matters!

Denis E. O’Donnell, MD, MBBCh, FCCP

The lecture is generously funded by the CHEST Foundation.Presidential Honor LectureCOPD Management: We’ve Come So Far

Darcy D. Marciniuk, MD, Master FCCP



Thomas L. Petty, MD, Master FCCP Memorial LectureReal World Research - What Would Dr. Petty Say?

Mary Hart, RRT, MS, FCCP

The lecture is generously funded by the CHEST Foundation.Margaret Pfrommer Endowed Memorial Lecture in Home-Based Mechanical VentilationNavigating to Home NIV Nirvana: What Would Margaret Do?

Peter C. Gay, MD, MS, FCCP

The Margaret Pfrommer Endowed Memorial Lecture in Home-Based Mechanical Ventilation is generously supported by International Ventilator Users Network of Post-Polio Health International and the CHEST Foundation.Pasquale Ciaglia Memorial Lecture in Interventional MedicineRaising the Bar: The Interventional Pulmonary Outcomes Group

Lonny B. Yarmus, DO, MBA, FCCP

The lecture is generously funded by the CHEST Foundation.

Roger C. Bone Memorial Lecture in Critical CareTo SIRS with Love: Dr. Roger Bone’s Continued Influence on Early Sepsis Care

Emanuel P. Rivers, MD, MPH, FCCP

The lecture is generously funded by the CHEST Foundation.Murray Kornfeld Memorial Founders LectureOur Pneumonia Journey: The Lungs and Beyond

Marcos I. Restrepo, MD, PhD, FCCP

The lecture is generously funded by the CHEST Foundation.

CHEST FOUNDATION GRANT AWARDS

The GlaxoSmithKline Distinguished Scholar in Respiratory Health

Deepa Gotur, MD, FCCP

Cytokine Release in SARS COV2 Viral Illness and Trends of Inflammasome Expression in Acute Respiratory Distress Syndrome Manifestations and ManagementThis grant is supported by an endowed fund from GlaxoSmithKline.CHEST Foundation and the Alpha-1 Foundation Research Grant in Alpha-1 Antitrypsin Deficiency

Paul R. Ellis, MBChB

Cardiovascular Outcomes and Phenotypes in Pulmonary Exacerbations of Alpha-1 AntitrypsinThis grant is jointly supported by the CHEST Foundation and the Alpha-1 Foundation.CHEST Foundation Research Grant in Women’s Lung Health

Shannon E. Kay, MD

Sex-specific Gene Expression in AsthmaThis grant is supported by the CHEST Foundation.CHEST Foundation Research Grant in Chronic Obstructive Pulmonary Disease

Davide Biondini, MD, PhD

Role of the Immune Check Points (CTLA-4 and PD-1) in the Development or Evasion of Smoking-Induced Chronic Obstructive Pulmonary Disease



Andrew J. Gangemi, MD

Are Sleep Health, Nicotine Metabolism, and Airway Inflammation Mechanisms for Differences in Lung Function between African American and Non-Hispanic White Smokers? A Proof-of-Concept ExaminationThese grants are supported by AstraZeneca LP.CHEST Foundation Research Grant in Critical Care

Mounica Vallurupalli, MD

Evaluating the Impact of Clonal Hematopoiesis on Host Immune Response During Sepsis

This grant is supported by the CHEST Foundation.CHEST Foundation Research Grant in Lung Cancer

Stefanie Mason, MD

Implications of Longitudinal Muscle-Mass Trajectories in Lung CancerThis grant is supported by the CHEST Foundation.CHEST Foundation Research Grant in Venous Thromboembolism

Jansen N. Seheult, MD, MBBCh

Untangling the NET: Neutrophil Activation as the Driver of Venous Thromboembolism in Coronavirus Disease 2019This grant is supported by the CHEST Foundation.CHEST Foundation Research Grant in Nontuberculous Mycobacteria Diseases

Bryan A. Garcia, MD

Longitudinal Proteomic Endotyping of Patients with Nontuberculous Mycobacterial Lung InfectionsThis grant is supported by Insmed Incorporated.CHEST Foundation Research Grant in Cystic Fibrosis

Jeffrey Barry, MD

Eosinophilia as a Biomarker for Worse Outcomes in Cystic Fibrosis



Kristina Montemayor, MD

The Association of Sex Hormones and Respiratory Morbidity in Individuals with Cystic FibrosisThese grants are supported by Vertex Pharmaceuticals.John R. Addrizzo, MD, FCCP Research Grant in Sarcoidosis

Changwan Ryu, MD

Extracellular Matrix Proteins as a Biomarker for Stage IV SarcoidosisThis grant is in honor of John R. Addrizzo, MD, FCCP and is jointly supported by the Addrizzo family and the CHEST Foundation.CHEST Foundation Research Grant in Severe Asthma

Isaretta L. Riley, MD, MPH

Coping with Asthma through Life Management (CALM)This grant is funded by AstraZeneca LP.CHEST Foundation Research Grant in Pulmonary Fibrosis

Sarah Beshay, MD

COPA Syndrome-Associated Mutations in Lung Transplant Recipients for Pulmonary Fibrosis



Erica D. Farrand, MD

The Future of Telehealth in Interstitial Lung DiseaseThese grants are supported by Boehringer Ingelheim Pharmaceuticals and Genentech, Inc.CHEST Foundation Research Grant in Sleep Medicine

Tetyana Kendzerska, MD, PhD

The Role of Sleep and Circadian Disturbances in Cancer Development and Progression: A Historical Multicenter Clinical Cohort Study



Nancy Stewart, DO

Improving COPD/OSA Overlap Syndrome Pre-Discharge Care DeliveryThese grants are funded by Jazz Pharmaceuticals, Inc.CHEST Foundation and Association of Critical Care Medicine Program Directors Award Research Grant in Medical Education

Ilana R. Krumm, MD

What’s good about Soul Food? Discovering and Analyzing Elements of an ICU Team Group Discussion Which Improve Provider WellnessThis grant is jointly supported by the CHEST Foundation and APCCMPD.CHEST Foundation and American Thoracic Society Research Grant in Diversity

Thomas S. Valley, MD, MSc

Understanding Differences in Delivery of Care Processes for Respiratory Failure by Race/EthnicityThis grant is jointly supported by the CHEST Foundation and ATS.CHEST Foundation Research Grant in COVID-19

David Furfaro, MD

Subphenotypes, Inflammatory Profiles, and Antibody Response in COVID-19 ARDSThis grant is supported by the CHEST Foundation.CHEST Foundation and American Thoracic Society Grant in COVID-19 and Diversity

Peter D. Jackson, MD

The Effect of the COVID-19 Pandemic on Tuberculosis Care in UgandaThis grant is jointly supported by the CHEST Foundation and ATS.CHEST Foundation Research Grant in Ultrasonography and COVID-19

Marjan M. Islam, MD

Thoracic Ultrasound in COVID-19: A Prospective Study Using Lung and Diaphragm Ultrasound in Evaluating Dyspnea in ICU Survivors with COVID-19 in a Post-ICU Clinic



Siddharth Dugar, MBBS

Spontaneous Echo Contrast in Lower Extremity and Correlation with Venous Velocity and Subsequent Deep Venous Thrombosis in Critically Ill COVID-19 PatientsThis grant is jointly supported by the CHEST Foundation and FUJIFILM SonoSite.

CHEST Foundation Community Service Grant Honoring D. Robert McCaffree, MD, Master FCCP



Ivan Nemorin, MBA, MS, RRT

Healthier Homes for Children-Community Asthma Prevention Program



Joseph Huang, MD

East Africa Training Initiative (EATI)



Aninda Das, MD, MBBS

Screening for Childhood Tuberculosis in Children 0-4 years of Age with Moderate to Severe Malnutrition in a Rural District of West Bengal, India



Trishual Siddharthan, MD

Establishing a Pulmonary and Critical Care Training Program in Uganda



Marina Lima, MD, MSc

Asmaland: The First Gamified Pediatric Asthma Educational Program in Portuguese



Roberta M. Kato, MD

Lung Power



These grants are supported by the CHEST Foundation.Alfred Soffer Research Award Winners

Mazen O. Al-Qadi, MD: RESPIRATORY VARIATION IN RIGHT ATRIAL PRESSURE PREDICTS RIGHT VENTRICULAR DYSFUNCTION IN PATIENTS WITH PRE-CAPILLARY PULMONARY HYPERTENSION

Valerie G. Press, MD: COST SAVING SIMULATION FOR THE TRANSITION FROM NEBULIZER TO COMBINATION OF NEBULIZER AND METERED-DOSE INHALERS (MD)



Young Investigator Award Winners

Gabriel E. Ortiz Jaimes, MD: CORRELATION OF CARDIAC OUTPUT MEASUREMENT BY GOAL-DIRECTED ECHOCARDIOGRAPHY PERFORMED BY INTENSIVISTS VS PULMONARY ARTERY CATHETER

Palakkumar Patel, MD: IMPACT OF HAVING PULMONARY HYPERTENSION IN PATIENTS ADMITTED WITH ACUTE EXACERBATION OF COPD IN THEIR HEALTHCARE UTILIZATION AND READMISSION: A US POPULATION COHORT STUDY

Top 5 Abstract Posters

Winner: Amr Alwakeel, MD: IMPACT OF A PLEURAL CARE PROGRAM ON THE PATHWAY TO DEFINITIVE PALLIATION OF MALIGNANT PLEURAL EFFUSIONS: A PRE-AND POST STUDY

Winner: Konstantinos Zorbas, MD: A SIMPLE PREDICTION SCORE FOR POSTOPERATIVE DEATH AFTER DECORTICATION

Winner: Yichen Wang, MD, MSc: CORONAVIRUS-RELATED HOSPITAL ADMISSIONS IN THE UNITED STATES IN 2016-2017

Runner up: Daniel Ospina-Delgado, MD: CHARACTERIZATION OF LARYNGEAL DISORDERS IN PATIENTS WITH EXCESSIVE CENTRAL AIRWAY COLLAPSE

Runner up: Vishal Vashistha, MD: TREATMENT PATTERNS AMONG LOWER-INCOME INDIAN PATIENTS WITH METASTATIC NON-SMALL CELL LUNG CANCER HARBORING EGFR MUTATIONS OR ALK REARRANGEMENTS



Case Report Poster Winners

Faiza Khalid, MD: FORME FUSTE OF INTERMEDIATE SYNDROME (IMS) IN ORGANOPHOSPHATE POISOING (OPP): EXPERT OPINION GUIDELINE WITHOUT CLEAR END-POINT.

William Meng, MD: VINGT MILLE LIEUES SOUS LES MERS: A POISONOUS GUEST FROM THE BLUE SEA TOXIC INHALATION OF CORAL PALYTOXIN

Dhruv Amratia, MD: PULMONARY BLASTOMA: A RARE FORM OF LUNG CANCER

Melinda Becker, MD: ECMO-ASSISTED BRONCHOSCOPY FOR NEAR-COMPLETE TRACHEAL OBSTRUCTION

Brittany Blass, PA-C: A CASE OF AUTOIMMUNE PULMONARY ALVEOLAR PROTEINOSIS WITH UNDERLYING MONOCLONAL B-CELL LYMPHOCYTOSIS

Abigayle Sullivan, MD: BIRD FANCIER’S LUNG: AN UNDERDIAGNOSED CAUSE OF SHORTNESS OF BREATH

Nitin Gupta, DO: SUCCESSFUL EMERGENT CORONARY ARTERY BYPASS IN A WOMAN WITH POSTPARTUM SPONTANEOUS CORONARY ARTERY DISSECTION

Michelle Miles, DO: GI VARIANT OF LEMIERRE SYNDROME: COMPLETE OCCLUSION OF SUPERIOR MESENTERIC VEIN IN A 30-YEAR-OLD WITH APPENDICEAL ABSCESS

Adarsha Ojha, MD: BLEEDING LUNG AND BLOATING GUT: LANE HAMILTON SYNDROME

Abdul Siddiqui, MD: A CASE OF E-CIGARETTE OR VAPING PRODUCT USE-ASSOCIATED LUNG INJURY IN AN INFREQUENT VAPE USER

James Dugan, MD: EMPHYSEMA WITH PLACENTAL TRANSMOGRIFICATION AND LIPOMATOUS CHANGE

Daniel Condit, MD: DUPLICATE INFERIOR VENA CAVA AS A POTENTIAL PATHWAY FOR RECURRENT PULMONARY EMBOLISM


 

CHEST 2020 CHEST Challenge

1st Place



Case Western Reserve University (MetroHealth)



Enambir Josan, MD

Ishan Lalani, MD, MPH

Faisal Qadir, MD



Program Director: Ziad Shaman, MD, FCCP







2nd Place





SUNY Downstate



Suchit Khanijao, MD

Chetana Pendkar, MBBS

Ayla Zubair, MBBS



Program Director: Robert Foronjy, MD



3rd Place



NYP Brooklyn Methodist Hospital



John Gorski, MD

Sandi Khin, MD

Kinjal Patel, MD


 

Program Director: Anthony Saleh, MD, FCCP

ANNUAL AWARDS

Master FCCP

Nancy A. Collop MD, Master FCCP



College Medalist Award

Neil R. MacIntyre, MD, FCCP



Distinguished Service Award

Lisa K. Moores, MD, FCCP



Master Clinician Educator

William F. Kelly, MD, FCCP

David A. Schulman, MD, MPH, FCCP



Early Career Clinician Educator

Subani Chandra, MD, FCCP



Alfred Soffer Award for Editorial Excellence

Barbara Anderson, CHEST Staff

Laura Lipsey, CHEST Staff



Presidential Citation

Mangala Narasimhan, DO, FCCP

Renli Qiao, MD, PhD, FCCP
 

HONOR LECTURE AND MEMORIAL AWARDS

Edward C. Rosenow III, MD, Master FCCP/Master Teacher Endowed Honor Lecture Evolving Therapies in ANCA-Associated Vasculitides

Joseph P. Lynch, III, MD, FCCP

The lecture is generously funded by the CHEST Foundation.Distinguished Scientist Honor Lecture in Cardiopulmonary PhysiologyHelping the Dyspneic Patient: Clinical Physiology Matters!

Denis E. O’Donnell, MD, MBBCh, FCCP

The lecture is generously funded by the CHEST Foundation.Presidential Honor LectureCOPD Management: We’ve Come So Far

Darcy D. Marciniuk, MD, Master FCCP



Thomas L. Petty, MD, Master FCCP Memorial LectureReal World Research - What Would Dr. Petty Say?

Mary Hart, RRT, MS, FCCP

The lecture is generously funded by the CHEST Foundation.Margaret Pfrommer Endowed Memorial Lecture in Home-Based Mechanical VentilationNavigating to Home NIV Nirvana: What Would Margaret Do?

Peter C. Gay, MD, MS, FCCP

The Margaret Pfrommer Endowed Memorial Lecture in Home-Based Mechanical Ventilation is generously supported by International Ventilator Users Network of Post-Polio Health International and the CHEST Foundation.Pasquale Ciaglia Memorial Lecture in Interventional MedicineRaising the Bar: The Interventional Pulmonary Outcomes Group

Lonny B. Yarmus, DO, MBA, FCCP

The lecture is generously funded by the CHEST Foundation.

Roger C. Bone Memorial Lecture in Critical CareTo SIRS with Love: Dr. Roger Bone’s Continued Influence on Early Sepsis Care

Emanuel P. Rivers, MD, MPH, FCCP

The lecture is generously funded by the CHEST Foundation.Murray Kornfeld Memorial Founders LectureOur Pneumonia Journey: The Lungs and Beyond

Marcos I. Restrepo, MD, PhD, FCCP

The lecture is generously funded by the CHEST Foundation.

CHEST FOUNDATION GRANT AWARDS

The GlaxoSmithKline Distinguished Scholar in Respiratory Health

Deepa Gotur, MD, FCCP

Cytokine Release in SARS COV2 Viral Illness and Trends of Inflammasome Expression in Acute Respiratory Distress Syndrome Manifestations and ManagementThis grant is supported by an endowed fund from GlaxoSmithKline.CHEST Foundation and the Alpha-1 Foundation Research Grant in Alpha-1 Antitrypsin Deficiency

Paul R. Ellis, MBChB

Cardiovascular Outcomes and Phenotypes in Pulmonary Exacerbations of Alpha-1 AntitrypsinThis grant is jointly supported by the CHEST Foundation and the Alpha-1 Foundation.CHEST Foundation Research Grant in Women’s Lung Health

Shannon E. Kay, MD

Sex-specific Gene Expression in AsthmaThis grant is supported by the CHEST Foundation.CHEST Foundation Research Grant in Chronic Obstructive Pulmonary Disease

Davide Biondini, MD, PhD

Role of the Immune Check Points (CTLA-4 and PD-1) in the Development or Evasion of Smoking-Induced Chronic Obstructive Pulmonary Disease



Andrew J. Gangemi, MD

Are Sleep Health, Nicotine Metabolism, and Airway Inflammation Mechanisms for Differences in Lung Function between African American and Non-Hispanic White Smokers? A Proof-of-Concept ExaminationThese grants are supported by AstraZeneca LP.CHEST Foundation Research Grant in Critical Care

Mounica Vallurupalli, MD

Evaluating the Impact of Clonal Hematopoiesis on Host Immune Response During Sepsis

This grant is supported by the CHEST Foundation.CHEST Foundation Research Grant in Lung Cancer

Stefanie Mason, MD

Implications of Longitudinal Muscle-Mass Trajectories in Lung CancerThis grant is supported by the CHEST Foundation.CHEST Foundation Research Grant in Venous Thromboembolism

Jansen N. Seheult, MD, MBBCh

Untangling the NET: Neutrophil Activation as the Driver of Venous Thromboembolism in Coronavirus Disease 2019This grant is supported by the CHEST Foundation.CHEST Foundation Research Grant in Nontuberculous Mycobacteria Diseases

Bryan A. Garcia, MD

Longitudinal Proteomic Endotyping of Patients with Nontuberculous Mycobacterial Lung InfectionsThis grant is supported by Insmed Incorporated.CHEST Foundation Research Grant in Cystic Fibrosis

Jeffrey Barry, MD

Eosinophilia as a Biomarker for Worse Outcomes in Cystic Fibrosis



Kristina Montemayor, MD

The Association of Sex Hormones and Respiratory Morbidity in Individuals with Cystic FibrosisThese grants are supported by Vertex Pharmaceuticals.John R. Addrizzo, MD, FCCP Research Grant in Sarcoidosis

Changwan Ryu, MD

Extracellular Matrix Proteins as a Biomarker for Stage IV SarcoidosisThis grant is in honor of John R. Addrizzo, MD, FCCP and is jointly supported by the Addrizzo family and the CHEST Foundation.CHEST Foundation Research Grant in Severe Asthma

Isaretta L. Riley, MD, MPH

Coping with Asthma through Life Management (CALM)This grant is funded by AstraZeneca LP.CHEST Foundation Research Grant in Pulmonary Fibrosis

Sarah Beshay, MD

COPA Syndrome-Associated Mutations in Lung Transplant Recipients for Pulmonary Fibrosis



Erica D. Farrand, MD

The Future of Telehealth in Interstitial Lung DiseaseThese grants are supported by Boehringer Ingelheim Pharmaceuticals and Genentech, Inc.CHEST Foundation Research Grant in Sleep Medicine

Tetyana Kendzerska, MD, PhD

The Role of Sleep and Circadian Disturbances in Cancer Development and Progression: A Historical Multicenter Clinical Cohort Study



Nancy Stewart, DO

Improving COPD/OSA Overlap Syndrome Pre-Discharge Care DeliveryThese grants are funded by Jazz Pharmaceuticals, Inc.CHEST Foundation and Association of Critical Care Medicine Program Directors Award Research Grant in Medical Education

Ilana R. Krumm, MD

What’s good about Soul Food? Discovering and Analyzing Elements of an ICU Team Group Discussion Which Improve Provider WellnessThis grant is jointly supported by the CHEST Foundation and APCCMPD.CHEST Foundation and American Thoracic Society Research Grant in Diversity

Thomas S. Valley, MD, MSc

Understanding Differences in Delivery of Care Processes for Respiratory Failure by Race/EthnicityThis grant is jointly supported by the CHEST Foundation and ATS.CHEST Foundation Research Grant in COVID-19

David Furfaro, MD

Subphenotypes, Inflammatory Profiles, and Antibody Response in COVID-19 ARDSThis grant is supported by the CHEST Foundation.CHEST Foundation and American Thoracic Society Grant in COVID-19 and Diversity

Peter D. Jackson, MD

The Effect of the COVID-19 Pandemic on Tuberculosis Care in UgandaThis grant is jointly supported by the CHEST Foundation and ATS.CHEST Foundation Research Grant in Ultrasonography and COVID-19

Marjan M. Islam, MD

Thoracic Ultrasound in COVID-19: A Prospective Study Using Lung and Diaphragm Ultrasound in Evaluating Dyspnea in ICU Survivors with COVID-19 in a Post-ICU Clinic



Siddharth Dugar, MBBS

Spontaneous Echo Contrast in Lower Extremity and Correlation with Venous Velocity and Subsequent Deep Venous Thrombosis in Critically Ill COVID-19 PatientsThis grant is jointly supported by the CHEST Foundation and FUJIFILM SonoSite.

CHEST Foundation Community Service Grant Honoring D. Robert McCaffree, MD, Master FCCP



Ivan Nemorin, MBA, MS, RRT

Healthier Homes for Children-Community Asthma Prevention Program



Joseph Huang, MD

East Africa Training Initiative (EATI)



Aninda Das, MD, MBBS

Screening for Childhood Tuberculosis in Children 0-4 years of Age with Moderate to Severe Malnutrition in a Rural District of West Bengal, India



Trishual Siddharthan, MD

Establishing a Pulmonary and Critical Care Training Program in Uganda



Marina Lima, MD, MSc

Asmaland: The First Gamified Pediatric Asthma Educational Program in Portuguese



Roberta M. Kato, MD

Lung Power



These grants are supported by the CHEST Foundation.Alfred Soffer Research Award Winners

Mazen O. Al-Qadi, MD: RESPIRATORY VARIATION IN RIGHT ATRIAL PRESSURE PREDICTS RIGHT VENTRICULAR DYSFUNCTION IN PATIENTS WITH PRE-CAPILLARY PULMONARY HYPERTENSION

Valerie G. Press, MD: COST SAVING SIMULATION FOR THE TRANSITION FROM NEBULIZER TO COMBINATION OF NEBULIZER AND METERED-DOSE INHALERS (MD)



Young Investigator Award Winners

Gabriel E. Ortiz Jaimes, MD: CORRELATION OF CARDIAC OUTPUT MEASUREMENT BY GOAL-DIRECTED ECHOCARDIOGRAPHY PERFORMED BY INTENSIVISTS VS PULMONARY ARTERY CATHETER

Palakkumar Patel, MD: IMPACT OF HAVING PULMONARY HYPERTENSION IN PATIENTS ADMITTED WITH ACUTE EXACERBATION OF COPD IN THEIR HEALTHCARE UTILIZATION AND READMISSION: A US POPULATION COHORT STUDY

Top 5 Abstract Posters

Winner: Amr Alwakeel, MD: IMPACT OF A PLEURAL CARE PROGRAM ON THE PATHWAY TO DEFINITIVE PALLIATION OF MALIGNANT PLEURAL EFFUSIONS: A PRE-AND POST STUDY

Winner: Konstantinos Zorbas, MD: A SIMPLE PREDICTION SCORE FOR POSTOPERATIVE DEATH AFTER DECORTICATION

Winner: Yichen Wang, MD, MSc: CORONAVIRUS-RELATED HOSPITAL ADMISSIONS IN THE UNITED STATES IN 2016-2017

Runner up: Daniel Ospina-Delgado, MD: CHARACTERIZATION OF LARYNGEAL DISORDERS IN PATIENTS WITH EXCESSIVE CENTRAL AIRWAY COLLAPSE

Runner up: Vishal Vashistha, MD: TREATMENT PATTERNS AMONG LOWER-INCOME INDIAN PATIENTS WITH METASTATIC NON-SMALL CELL LUNG CANCER HARBORING EGFR MUTATIONS OR ALK REARRANGEMENTS



Case Report Poster Winners

Faiza Khalid, MD: FORME FUSTE OF INTERMEDIATE SYNDROME (IMS) IN ORGANOPHOSPHATE POISOING (OPP): EXPERT OPINION GUIDELINE WITHOUT CLEAR END-POINT.

William Meng, MD: VINGT MILLE LIEUES SOUS LES MERS: A POISONOUS GUEST FROM THE BLUE SEA TOXIC INHALATION OF CORAL PALYTOXIN

Dhruv Amratia, MD: PULMONARY BLASTOMA: A RARE FORM OF LUNG CANCER

Melinda Becker, MD: ECMO-ASSISTED BRONCHOSCOPY FOR NEAR-COMPLETE TRACHEAL OBSTRUCTION

Brittany Blass, PA-C: A CASE OF AUTOIMMUNE PULMONARY ALVEOLAR PROTEINOSIS WITH UNDERLYING MONOCLONAL B-CELL LYMPHOCYTOSIS

Abigayle Sullivan, MD: BIRD FANCIER’S LUNG: AN UNDERDIAGNOSED CAUSE OF SHORTNESS OF BREATH

Nitin Gupta, DO: SUCCESSFUL EMERGENT CORONARY ARTERY BYPASS IN A WOMAN WITH POSTPARTUM SPONTANEOUS CORONARY ARTERY DISSECTION

Michelle Miles, DO: GI VARIANT OF LEMIERRE SYNDROME: COMPLETE OCCLUSION OF SUPERIOR MESENTERIC VEIN IN A 30-YEAR-OLD WITH APPENDICEAL ABSCESS

Adarsha Ojha, MD: BLEEDING LUNG AND BLOATING GUT: LANE HAMILTON SYNDROME

Abdul Siddiqui, MD: A CASE OF E-CIGARETTE OR VAPING PRODUCT USE-ASSOCIATED LUNG INJURY IN AN INFREQUENT VAPE USER

James Dugan, MD: EMPHYSEMA WITH PLACENTAL TRANSMOGRIFICATION AND LIPOMATOUS CHANGE

Daniel Condit, MD: DUPLICATE INFERIOR VENA CAVA AS A POTENTIAL PATHWAY FOR RECURRENT PULMONARY EMBOLISM


 

CHEST 2020 CHEST Challenge

1st Place



Case Western Reserve University (MetroHealth)



Enambir Josan, MD

Ishan Lalani, MD, MPH

Faisal Qadir, MD



Program Director: Ziad Shaman, MD, FCCP







2nd Place





SUNY Downstate



Suchit Khanijao, MD

Chetana Pendkar, MBBS

Ayla Zubair, MBBS



Program Director: Robert Foronjy, MD



3rd Place



NYP Brooklyn Methodist Hospital



John Gorski, MD

Sandi Khin, MD

Kinjal Patel, MD


 

Program Director: Anthony Saleh, MD, FCCP

In the year of COVID-19, we saw unprecedented changes in our environment and social interactions. Almost nothing was as it should be—sports championships in a “bubble,” social distancing, limited travel, economic hardships, and, of course, the devastating effects on the health of people all over the world. CHEST did not shy away from the challenges of COVID-19. Instead, we accelerated our focus on education, patient care, research, and advocacy to assist clinicians caring for affected patients. The CHEST Foundation, the philanthropic arm of CHEST, contributed to this effort by funding research and community service grants and distributing over 14,000 pieces of PPE to health workers and the public.

Amid social protests, CHEST issued statements supporting inclusion and diversity and called for improving health care disparities. To better understand how these important issues interact, the CHEST Foundation began conducting listening tours across the country

to learn what is important to patients and what barriers they face. These lessons will influence how the foundation implements its current programs and designs future programs. Over the next few months, the CHEST Foundation will set in motion a course of action to support valuable programs in these areas. We will focus on three main themes.

First, we will utilize the strength of CHEST by inviting fellows to participate in CHEST Foundation activities and serve on our committees. By creating an atmosphere of inclusion and collegiality, we believe that fellows will better understand the CHEST Foundation’s goals and commit themselves to strengthening the foundation for years to come.

Second, we want to establish relationships with organizations outside of CHEST. Although our partnerships with health care industry organizations are strong, we have few robust alliances in the non-endemic space. Corporations espouse wellness, and we have experts all over the world who can address the needs and concerns of these companies. Preliminary exploration tells us that non-endemic corporations have an interest in what we can offer.

Third, we want to grow the corpus of the CHEST Foundation. Dreams without funding become only aspirations, but dreams with funding become reality. Without a solid corpus, we operate on a short-term plan. CHEST has some of the most influential leaders in the fields of pulmonary, critical care, and sleep medicine. Together, we can develop programs that can significantly impact the lives of the people we serve.

The CHEST Foundation looks forward to building on past successes and tackling new challenges. On behalf of CHEST’s Board of Trustees and the gifted staff, I invite you to join us to reach these goals.

In the year of COVID-19, we saw unprecedented changes in our environment and social interactions. Almost nothing was as it should be—sports championships in a “bubble,” social distancing, limited travel, economic hardships, and, of course, the devastating effects on the health of people all over the world. CHEST did not shy away from the challenges of COVID-19. Instead, we accelerated our focus on education, patient care, research, and advocacy to assist clinicians caring for affected patients. The CHEST Foundation, the philanthropic arm of CHEST, contributed to this effort by funding research and community service grants and distributing over 14,000 pieces of PPE to health workers and the public.

Amid social protests, CHEST issued statements supporting inclusion and diversity and called for improving health care disparities. To better understand how these important issues interact, the CHEST Foundation began conducting listening tours across the country

to learn what is important to patients and what barriers they face. These lessons will influence how the foundation implements its current programs and designs future programs. Over the next few months, the CHEST Foundation will set in motion a course of action to support valuable programs in these areas. We will focus on three main themes.

First, we will utilize the strength of CHEST by inviting fellows to participate in CHEST Foundation activities and serve on our committees. By creating an atmosphere of inclusion and collegiality, we believe that fellows will better understand the CHEST Foundation’s goals and commit themselves to strengthening the foundation for years to come.

Second, we want to establish relationships with organizations outside of CHEST. Although our partnerships with health care industry organizations are strong, we have few robust alliances in the non-endemic space. Corporations espouse wellness, and we have experts all over the world who can address the needs and concerns of these companies. Preliminary exploration tells us that non-endemic corporations have an interest in what we can offer.

Third, we want to grow the corpus of the CHEST Foundation. Dreams without funding become only aspirations, but dreams with funding become reality. Without a solid corpus, we operate on a short-term plan. CHEST has some of the most influential leaders in the fields of pulmonary, critical care, and sleep medicine. Together, we can develop programs that can significantly impact the lives of the people we serve.

The CHEST Foundation looks forward to building on past successes and tackling new challenges. On behalf of CHEST’s Board of Trustees and the gifted staff, I invite you to join us to reach these goals.

In the year of COVID-19, we saw unprecedented changes in our environment and social interactions. Almost nothing was as it should be—sports championships in a “bubble,” social distancing, limited travel, economic hardships, and, of course, the devastating effects on the health of people all over the world. CHEST did not shy away from the challenges of COVID-19. Instead, we accelerated our focus on education, patient care, research, and advocacy to assist clinicians caring for affected patients. The CHEST Foundation, the philanthropic arm of CHEST, contributed to this effort by funding research and community service grants and distributing over 14,000 pieces of PPE to health workers and the public.

Amid social protests, CHEST issued statements supporting inclusion and diversity and called for improving health care disparities. To better understand how these important issues interact, the CHEST Foundation began conducting listening tours across the country

to learn what is important to patients and what barriers they face. These lessons will influence how the foundation implements its current programs and designs future programs. Over the next few months, the CHEST Foundation will set in motion a course of action to support valuable programs in these areas. We will focus on three main themes.

First, we will utilize the strength of CHEST by inviting fellows to participate in CHEST Foundation activities and serve on our committees. By creating an atmosphere of inclusion and collegiality, we believe that fellows will better understand the CHEST Foundation’s goals and commit themselves to strengthening the foundation for years to come.

Second, we want to establish relationships with organizations outside of CHEST. Although our partnerships with health care industry organizations are strong, we have few robust alliances in the non-endemic space. Corporations espouse wellness, and we have experts all over the world who can address the needs and concerns of these companies. Preliminary exploration tells us that non-endemic corporations have an interest in what we can offer.

Third, we want to grow the corpus of the CHEST Foundation. Dreams without funding become only aspirations, but dreams with funding become reality. Without a solid corpus, we operate on a short-term plan. CHEST has some of the most influential leaders in the fields of pulmonary, critical care, and sleep medicine. Together, we can develop programs that can significantly impact the lives of the people we serve.

The CHEST Foundation looks forward to building on past successes and tackling new challenges. On behalf of CHEST’s Board of Trustees and the gifted staff, I invite you to join us to reach these goals.

The American Medical Association (AMA) had its November 2020 AMA Special Meeting of the AMA House of Delegates (HOD) from November 13-17.

Delegates from over 170 societies (state societies, specialties, subspecialties, and uniformed services), including physicians, residents, and students, gathered virtually for the meeting(https://tinyurl.com/y7494mwa) to consider a wide array of proposals to help fulfill the AMA’s core mission of promoting medicine and improving public health. The AMA House of Delegates, also known as the “House” or the “HOD,” is the principal policy-making body of the AMA. This democratic forum represents the views and interests of a diverse group of member physicians from more than 170 societies. These delegates meet twice per year to establish policies on health; medical, professional, and governance matters; and the principles within which the AMA’s business activities are conducted.

During the COVID-19 pandemic, the AMA has been the leading physician and patient ally—voicing recommendations to key Congressional leaders and agency staff, state policymakers, and private sector stakeholders. Acting on both federal and state levels, examples of AMA’s recent efforts include actions in financial relief, telehealth, testing and vaccine development, health equity, and more.

CHEST is an active member, and through the HOD and Specialty and Service Society (SSS), CHEST can partner with AMA other societies to support each other on important regulatory issues. CHEST/Allergy Section Council (participants at this meeting were from the AAAAI, AAOA, AASM, ACAAI, ATS, CHEST, and SCCM) met before voting in the House to discuss pending business. The meeting was hosted by the current CHEST/Allergy council chair Dr. Wesley Vander Ark (AMA Delegate AAOA) and Jami Lucas, CEO AAOA.
 

Policy and resolutions

Overview of the process

Policies originate via resolutions submitted by individuals or societies. These resolutions then go to one of several Reference Committees for open discussion. These committees then report their recommendations back to the HOD, which then discusses and votes on the recommendations. In some instances, the question is referred for further studies by one of several Councils, which reports go to the Board of Trustees or back to the House. Details can be found in the April 2018 CHEST Physician® article on the process. (https://tinyurl.com/yacysxar).

This year, due to the virtual nature, prioritization matrix was utilized and based on urgency. Resolutions were divided into top priority, priority, medium priority, low priority, and not a priority.

The following reference committees convened at this Special Meeting Constitution & Bylaws, Medical Service, Legislation Medical Education, Public Health, Science and Technology, Finance and Medical Practice.

Some of the issues discussed at the House of Delegates are as follows:


 

Medical education

Continuing board certification (Adapted as a new policy)

The policy states that American Medical Association (AMA), through its Council on Medical Education, continue to work with the American Board of Medical Specialties (ABMS) and ABMS member boards to implement key recommendations outlined by the Continuing Board Certification: Vision for the Future Commission in its final report, including the development of new, integrated standards for continuing certification programs by 2020 that will address the Commission’s recommendations for flexibility in knowledge assessment and advancing practice, feedback to diplomates, and consistency.

Graduate medical education and the corporate practice of medicine (modified existing policy)

The existing policy was amended to urge AMA to continue to monitor issues, including waiver of due process requirements, created by corporate-owned graduate medical education sites.
 

Public health

Bullying in the Practice of Medicine

Health-care organizations, including academic medical centers, should establish policies to prevent and address bullying in their workplaces. An effective workplace policy should:

• Describe the management’s commitment to providing a safe and healthy workplace.

• Show the staff that their leaders are concerned about bullying and unprofessional behavior and that they take it seriously.

• Clearly define workplace violence, harassment, and bullying, specifically including intimidation, threats, and other forms of aggressive behavior.

• Specify to whom the policy applies (ie, medical staff, students, administration, patients, employees, contractors, vendors, etc).

• Define both expected and prohibited behaviors.

• Outline steps for individuals to take when they feel they are a victim of workplace bullying.

• Provide contact information for a confidential means for documenting and reporting incidents.

• Prohibit retaliation and ensure privacy and confidentiality.

• Document training requirements and establish clear expectations about the training objectives.



Availability of personal protective equipment (PPE)

That our American Medical Association actively support that physicians and health-care professionals are empowered to use workplace modifications to continue professional patient care when they determine such action to be appropriate and in the best interest of patient and physician wellbeing. Physicians and health-care professionals must be permitted to use their professional judgment and augment institution-provided PPE with additional, appropriately decontaminated, personally provided personal protective equipment (PPE) without penalty (Directive to Take Action); and be it further that AMA affirm that the medical staff of each healt-care institution should integrally be involved in disaster planning, strategy, and tactical management of ongoing crises (New HOD Policy).


 

AMA governance and finance

The establishment of private practice physicians’ section was approved.
 

Medical practice

Merit-based incentive payment system (MIPS)

That our American Medical Association (AMA) support legislation that ensures Medicare physician payment is sufficient to safeguard beneficiary access to care, replaces or supplements budget neutrality in MIPS with incentive payments, or implements positive annual physician payment updates. (Directive to Take Action).

Establishing professional services claims-based payment enhancement for activities associated with the COVID-19 pandemic

American Medical Association work with other interested parties to advocate for regulatory action on the part of the Centers for Medicare & Medicaid Services to implement a professional services claims-based payment enhancement to help recognize the enhanced, nonseparately reimbursable work performed by physicians during the COVID-19 Public Health Emergency. (Directive to Take Action).

This is just a small sampling of the activities and more information, including reports from the various Councils, are available on the AMA website, http://ama-assn.org.

CHEST members interested in the AMA policy-making process may observe any AMA-HOD meeting or participate in the AMA’s democratic processes. Attendees will also be able to increase their knowledge and skills at no cost. They will also be able to connect with more than 1,500 peers and other meeting attendees from across the country. CHEST members with the time (there are two 5-day meetings each year) and interest are invited to apply to be an official CHEST delegate to the AMA. Contact Jennifer Nemkovich at [email protected] for details.
 

Dr. Desai is with the Chicago Chest Center and AMITA Health Suburban Lung Associates; and the Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago. He is also the CHEST Delegate to the AMA House of Delegates.

The American Medical Association (AMA) had its November 2020 AMA Special Meeting of the AMA House of Delegates (HOD) from November 13-17.

Delegates from over 170 societies (state societies, specialties, subspecialties, and uniformed services), including physicians, residents, and students, gathered virtually for the meeting(https://tinyurl.com/y7494mwa) to consider a wide array of proposals to help fulfill the AMA’s core mission of promoting medicine and improving public health. The AMA House of Delegates, also known as the “House” or the “HOD,” is the principal policy-making body of the AMA. This democratic forum represents the views and interests of a diverse group of member physicians from more than 170 societies. These delegates meet twice per year to establish policies on health; medical, professional, and governance matters; and the principles within which the AMA’s business activities are conducted.

During the COVID-19 pandemic, the AMA has been the leading physician and patient ally—voicing recommendations to key Congressional leaders and agency staff, state policymakers, and private sector stakeholders. Acting on both federal and state levels, examples of AMA’s recent efforts include actions in financial relief, telehealth, testing and vaccine development, health equity, and more.

CHEST is an active member, and through the HOD and Specialty and Service Society (SSS), CHEST can partner with AMA other societies to support each other on important regulatory issues. CHEST/Allergy Section Council (participants at this meeting were from the AAAAI, AAOA, AASM, ACAAI, ATS, CHEST, and SCCM) met before voting in the House to discuss pending business. The meeting was hosted by the current CHEST/Allergy council chair Dr. Wesley Vander Ark (AMA Delegate AAOA) and Jami Lucas, CEO AAOA.
 

Policy and resolutions

Overview of the process

Policies originate via resolutions submitted by individuals or societies. These resolutions then go to one of several Reference Committees for open discussion. These committees then report their recommendations back to the HOD, which then discusses and votes on the recommendations. In some instances, the question is referred for further studies by one of several Councils, which reports go to the Board of Trustees or back to the House. Details can be found in the April 2018 CHEST Physician® article on the process. (https://tinyurl.com/yacysxar).

This year, due to the virtual nature, prioritization matrix was utilized and based on urgency. Resolutions were divided into top priority, priority, medium priority, low priority, and not a priority.

The following reference committees convened at this Special Meeting Constitution & Bylaws, Medical Service, Legislation Medical Education, Public Health, Science and Technology, Finance and Medical Practice.

Some of the issues discussed at the House of Delegates are as follows:


 

Medical education

Continuing board certification (Adapted as a new policy)

The policy states that American Medical Association (AMA), through its Council on Medical Education, continue to work with the American Board of Medical Specialties (ABMS) and ABMS member boards to implement key recommendations outlined by the Continuing Board Certification: Vision for the Future Commission in its final report, including the development of new, integrated standards for continuing certification programs by 2020 that will address the Commission’s recommendations for flexibility in knowledge assessment and advancing practice, feedback to diplomates, and consistency.

Graduate medical education and the corporate practice of medicine (modified existing policy)

The existing policy was amended to urge AMA to continue to monitor issues, including waiver of due process requirements, created by corporate-owned graduate medical education sites.
 

Public health

Bullying in the Practice of Medicine

Health-care organizations, including academic medical centers, should establish policies to prevent and address bullying in their workplaces. An effective workplace policy should:

• Describe the management’s commitment to providing a safe and healthy workplace.

• Show the staff that their leaders are concerned about bullying and unprofessional behavior and that they take it seriously.

• Clearly define workplace violence, harassment, and bullying, specifically including intimidation, threats, and other forms of aggressive behavior.

• Specify to whom the policy applies (ie, medical staff, students, administration, patients, employees, contractors, vendors, etc).

• Define both expected and prohibited behaviors.

• Outline steps for individuals to take when they feel they are a victim of workplace bullying.

• Provide contact information for a confidential means for documenting and reporting incidents.

• Prohibit retaliation and ensure privacy and confidentiality.

• Document training requirements and establish clear expectations about the training objectives.



Availability of personal protective equipment (PPE)

That our American Medical Association actively support that physicians and health-care professionals are empowered to use workplace modifications to continue professional patient care when they determine such action to be appropriate and in the best interest of patient and physician wellbeing. Physicians and health-care professionals must be permitted to use their professional judgment and augment institution-provided PPE with additional, appropriately decontaminated, personally provided personal protective equipment (PPE) without penalty (Directive to Take Action); and be it further that AMA affirm that the medical staff of each healt-care institution should integrally be involved in disaster planning, strategy, and tactical management of ongoing crises (New HOD Policy).


 

AMA governance and finance

The establishment of private practice physicians’ section was approved.
 

Medical practice

Merit-based incentive payment system (MIPS)

That our American Medical Association (AMA) support legislation that ensures Medicare physician payment is sufficient to safeguard beneficiary access to care, replaces or supplements budget neutrality in MIPS with incentive payments, or implements positive annual physician payment updates. (Directive to Take Action).

Establishing professional services claims-based payment enhancement for activities associated with the COVID-19 pandemic

American Medical Association work with other interested parties to advocate for regulatory action on the part of the Centers for Medicare & Medicaid Services to implement a professional services claims-based payment enhancement to help recognize the enhanced, nonseparately reimbursable work performed by physicians during the COVID-19 Public Health Emergency. (Directive to Take Action).

This is just a small sampling of the activities and more information, including reports from the various Councils, are available on the AMA website, http://ama-assn.org.

CHEST members interested in the AMA policy-making process may observe any AMA-HOD meeting or participate in the AMA’s democratic processes. Attendees will also be able to increase their knowledge and skills at no cost. They will also be able to connect with more than 1,500 peers and other meeting attendees from across the country. CHEST members with the time (there are two 5-day meetings each year) and interest are invited to apply to be an official CHEST delegate to the AMA. Contact Jennifer Nemkovich at [email protected] for details.
 

Dr. Desai is with the Chicago Chest Center and AMITA Health Suburban Lung Associates; and the Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago. He is also the CHEST Delegate to the AMA House of Delegates.

The American Medical Association (AMA) had its November 2020 AMA Special Meeting of the AMA House of Delegates (HOD) from November 13-17.

Delegates from over 170 societies (state societies, specialties, subspecialties, and uniformed services), including physicians, residents, and students, gathered virtually for the meeting(https://tinyurl.com/y7494mwa) to consider a wide array of proposals to help fulfill the AMA’s core mission of promoting medicine and improving public health. The AMA House of Delegates, also known as the “House” or the “HOD,” is the principal policy-making body of the AMA. This democratic forum represents the views and interests of a diverse group of member physicians from more than 170 societies. These delegates meet twice per year to establish policies on health; medical, professional, and governance matters; and the principles within which the AMA’s business activities are conducted.

During the COVID-19 pandemic, the AMA has been the leading physician and patient ally—voicing recommendations to key Congressional leaders and agency staff, state policymakers, and private sector stakeholders. Acting on both federal and state levels, examples of AMA’s recent efforts include actions in financial relief, telehealth, testing and vaccine development, health equity, and more.

CHEST is an active member, and through the HOD and Specialty and Service Society (SSS), CHEST can partner with AMA other societies to support each other on important regulatory issues. CHEST/Allergy Section Council (participants at this meeting were from the AAAAI, AAOA, AASM, ACAAI, ATS, CHEST, and SCCM) met before voting in the House to discuss pending business. The meeting was hosted by the current CHEST/Allergy council chair Dr. Wesley Vander Ark (AMA Delegate AAOA) and Jami Lucas, CEO AAOA.
 

Policy and resolutions

Overview of the process

Policies originate via resolutions submitted by individuals or societies. These resolutions then go to one of several Reference Committees for open discussion. These committees then report their recommendations back to the HOD, which then discusses and votes on the recommendations. In some instances, the question is referred for further studies by one of several Councils, which reports go to the Board of Trustees or back to the House. Details can be found in the April 2018 CHEST Physician® article on the process. (https://tinyurl.com/yacysxar).

This year, due to the virtual nature, prioritization matrix was utilized and based on urgency. Resolutions were divided into top priority, priority, medium priority, low priority, and not a priority.

The following reference committees convened at this Special Meeting Constitution & Bylaws, Medical Service, Legislation Medical Education, Public Health, Science and Technology, Finance and Medical Practice.

Some of the issues discussed at the House of Delegates are as follows:


 

Medical education

Continuing board certification (Adapted as a new policy)

The policy states that American Medical Association (AMA), through its Council on Medical Education, continue to work with the American Board of Medical Specialties (ABMS) and ABMS member boards to implement key recommendations outlined by the Continuing Board Certification: Vision for the Future Commission in its final report, including the development of new, integrated standards for continuing certification programs by 2020 that will address the Commission’s recommendations for flexibility in knowledge assessment and advancing practice, feedback to diplomates, and consistency.

Graduate medical education and the corporate practice of medicine (modified existing policy)

The existing policy was amended to urge AMA to continue to monitor issues, including waiver of due process requirements, created by corporate-owned graduate medical education sites.
 

Public health

Bullying in the Practice of Medicine

Health-care organizations, including academic medical centers, should establish policies to prevent and address bullying in their workplaces. An effective workplace policy should:

• Describe the management’s commitment to providing a safe and healthy workplace.

• Show the staff that their leaders are concerned about bullying and unprofessional behavior and that they take it seriously.

• Clearly define workplace violence, harassment, and bullying, specifically including intimidation, threats, and other forms of aggressive behavior.

• Specify to whom the policy applies (ie, medical staff, students, administration, patients, employees, contractors, vendors, etc).

• Define both expected and prohibited behaviors.

• Outline steps for individuals to take when they feel they are a victim of workplace bullying.

• Provide contact information for a confidential means for documenting and reporting incidents.

• Prohibit retaliation and ensure privacy and confidentiality.

• Document training requirements and establish clear expectations about the training objectives.



Availability of personal protective equipment (PPE)

That our American Medical Association actively support that physicians and health-care professionals are empowered to use workplace modifications to continue professional patient care when they determine such action to be appropriate and in the best interest of patient and physician wellbeing. Physicians and health-care professionals must be permitted to use their professional judgment and augment institution-provided PPE with additional, appropriately decontaminated, personally provided personal protective equipment (PPE) without penalty (Directive to Take Action); and be it further that AMA affirm that the medical staff of each healt-care institution should integrally be involved in disaster planning, strategy, and tactical management of ongoing crises (New HOD Policy).


 

AMA governance and finance

The establishment of private practice physicians’ section was approved.
 

Medical practice

Merit-based incentive payment system (MIPS)

That our American Medical Association (AMA) support legislation that ensures Medicare physician payment is sufficient to safeguard beneficiary access to care, replaces or supplements budget neutrality in MIPS with incentive payments, or implements positive annual physician payment updates. (Directive to Take Action).

Establishing professional services claims-based payment enhancement for activities associated with the COVID-19 pandemic

American Medical Association work with other interested parties to advocate for regulatory action on the part of the Centers for Medicare & Medicaid Services to implement a professional services claims-based payment enhancement to help recognize the enhanced, nonseparately reimbursable work performed by physicians during the COVID-19 Public Health Emergency. (Directive to Take Action).

This is just a small sampling of the activities and more information, including reports from the various Councils, are available on the AMA website, http://ama-assn.org.

CHEST members interested in the AMA policy-making process may observe any AMA-HOD meeting or participate in the AMA’s democratic processes. Attendees will also be able to increase their knowledge and skills at no cost. They will also be able to connect with more than 1,500 peers and other meeting attendees from across the country. CHEST members with the time (there are two 5-day meetings each year) and interest are invited to apply to be an official CHEST delegate to the AMA. Contact Jennifer Nemkovich at [email protected] for details.
 

Dr. Desai is with the Chicago Chest Center and AMITA Health Suburban Lung Associates; and the Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago. He is also the CHEST Delegate to the AMA House of Delegates.

We’re happy to introduce these new board members whose primary responsibility is the active review each month of potential articles for publication that could have an impact on or be of interest to our health-care professional readership.

We’re happy to introduce these new board members whose primary responsibility is the active review each month of potential articles for publication that could have an impact on or be of interest to our health-care professional readership.

We’re happy to introduce these new board members whose primary responsibility is the active review each month of potential articles for publication that could have an impact on or be of interest to our health-care professional readership.

Constance Baker was juggling the dual stresses of mothering a newborn and raising a teenager when she noticed a skin patch on her father looked discolored. His breathing soon became labored, and the skin on his hands turned calloused. Then he passed out. Initially, doctors thought his problems were cardiovascular.

Since James didn’t have a primary doctor, Constance repeatedly took him to the emergency room to receive care. His frequent visits attracted the attention of a medical intern who ordered tests and asked James to see a specialist. More than half a year later, Constance and James met pulmonologist Dr. Demondes Haynes and learned the cause of James’ troubled breathing. James has a rare disease called scleroderma, which hardens patches of skin and created scarring of his lung tissue. He also had pulmonary hypertension. James needed rapid intervention with a complicated regimen of medication.

At first, James didn’t want to go along with the program, but Dr. Haynes’ attentive and gentle nature changed his mind. “Dr. Haynes always made us comfortable, taking the time to listen and show us his concern. He even explained that we wouldn’t have to worry about paying for anything, which was a huge relief.”

Before Dr. Haynes, James and Constance had never met a doctor who didn’t treat them like a case file. “He actually acknowledged our circumstances, which meant he acknowledged us.”

As a native Mississippian, Dr. Haynes knows the plight of many of his patients. “Not everyone with lung disease can access a pulmonologist, like me, and not everyone can afford appropriate treatment. You have to recognize these disparities in order to build a relationship of trust with your patients.”

James was ready to start treatment with Dr. Haynes’ guidance, but since he couldn’t read, he couldn’t understand how to put the medication together. That’s when Constance had to step up. They worked together to change and clean the tubing to the port by his heart and make his medication. “We leaned on each other a lot during that time, and you know what? We made it through.”

Even though James’ disease can be debilitating at times, and his care can seem completely overwhelming, Constance wouldn’t have it any other way. “It’s always been my father and I, just us two. He’s always taken care of me, and now it’s my turn to take care of him.”

Unfortunately, Constance and James’ story is not unique. So many patients don’t have access to doctors, specialists, and caregivers, and many aren’t empowered enough to take

their medications. These stories don’t get posted on Instagram and they don’t make the evening news. Underprivileged and underserved patients have been left behind – left without a voice.

That’s why the foundation launched its virtual listening tours across America in September. Our tours give patients, caregivers, and physicians the opportunity to raise issues that they believe are impacting health care in their communities.

How can physicians work to understand their patients better? How can patients learn to trust their providers? These are all the questions we aim to answer.

James is doing as well as he is because of his relationship with Dr. Haynes. What can we do with that information? We can listen, we can learn, and we can spread the word.

Read more about the work of the CHEST Foundation in its 2020 Impact Report at chestfoundation.org.




 

Constance Baker was juggling the dual stresses of mothering a newborn and raising a teenager when she noticed a skin patch on her father looked discolored. His breathing soon became labored, and the skin on his hands turned calloused. Then he passed out. Initially, doctors thought his problems were cardiovascular.

Since James didn’t have a primary doctor, Constance repeatedly took him to the emergency room to receive care. His frequent visits attracted the attention of a medical intern who ordered tests and asked James to see a specialist. More than half a year later, Constance and James met pulmonologist Dr. Demondes Haynes and learned the cause of James’ troubled breathing. James has a rare disease called scleroderma, which hardens patches of skin and created scarring of his lung tissue. He also had pulmonary hypertension. James needed rapid intervention with a complicated regimen of medication.

At first, James didn’t want to go along with the program, but Dr. Haynes’ attentive and gentle nature changed his mind. “Dr. Haynes always made us comfortable, taking the time to listen and show us his concern. He even explained that we wouldn’t have to worry about paying for anything, which was a huge relief.”

Before Dr. Haynes, James and Constance had never met a doctor who didn’t treat them like a case file. “He actually acknowledged our circumstances, which meant he acknowledged us.”

As a native Mississippian, Dr. Haynes knows the plight of many of his patients. “Not everyone with lung disease can access a pulmonologist, like me, and not everyone can afford appropriate treatment. You have to recognize these disparities in order to build a relationship of trust with your patients.”

James was ready to start treatment with Dr. Haynes’ guidance, but since he couldn’t read, he couldn’t understand how to put the medication together. That’s when Constance had to step up. They worked together to change and clean the tubing to the port by his heart and make his medication. “We leaned on each other a lot during that time, and you know what? We made it through.”

Even though James’ disease can be debilitating at times, and his care can seem completely overwhelming, Constance wouldn’t have it any other way. “It’s always been my father and I, just us two. He’s always taken care of me, and now it’s my turn to take care of him.”

Unfortunately, Constance and James’ story is not unique. So many patients don’t have access to doctors, specialists, and caregivers, and many aren’t empowered enough to take

their medications. These stories don’t get posted on Instagram and they don’t make the evening news. Underprivileged and underserved patients have been left behind – left without a voice.

That’s why the foundation launched its virtual listening tours across America in September. Our tours give patients, caregivers, and physicians the opportunity to raise issues that they believe are impacting health care in their communities.

How can physicians work to understand their patients better? How can patients learn to trust their providers? These are all the questions we aim to answer.

James is doing as well as he is because of his relationship with Dr. Haynes. What can we do with that information? We can listen, we can learn, and we can spread the word.

Read more about the work of the CHEST Foundation in its 2020 Impact Report at chestfoundation.org.




 

Constance Baker was juggling the dual stresses of mothering a newborn and raising a teenager when she noticed a skin patch on her father looked discolored. His breathing soon became labored, and the skin on his hands turned calloused. Then he passed out. Initially, doctors thought his problems were cardiovascular.

Since James didn’t have a primary doctor, Constance repeatedly took him to the emergency room to receive care. His frequent visits attracted the attention of a medical intern who ordered tests and asked James to see a specialist. More than half a year later, Constance and James met pulmonologist Dr. Demondes Haynes and learned the cause of James’ troubled breathing. James has a rare disease called scleroderma, which hardens patches of skin and created scarring of his lung tissue. He also had pulmonary hypertension. James needed rapid intervention with a complicated regimen of medication.

At first, James didn’t want to go along with the program, but Dr. Haynes’ attentive and gentle nature changed his mind. “Dr. Haynes always made us comfortable, taking the time to listen and show us his concern. He even explained that we wouldn’t have to worry about paying for anything, which was a huge relief.”

Before Dr. Haynes, James and Constance had never met a doctor who didn’t treat them like a case file. “He actually acknowledged our circumstances, which meant he acknowledged us.”

As a native Mississippian, Dr. Haynes knows the plight of many of his patients. “Not everyone with lung disease can access a pulmonologist, like me, and not everyone can afford appropriate treatment. You have to recognize these disparities in order to build a relationship of trust with your patients.”

James was ready to start treatment with Dr. Haynes’ guidance, but since he couldn’t read, he couldn’t understand how to put the medication together. That’s when Constance had to step up. They worked together to change and clean the tubing to the port by his heart and make his medication. “We leaned on each other a lot during that time, and you know what? We made it through.”

Even though James’ disease can be debilitating at times, and his care can seem completely overwhelming, Constance wouldn’t have it any other way. “It’s always been my father and I, just us two. He’s always taken care of me, and now it’s my turn to take care of him.”

Unfortunately, Constance and James’ story is not unique. So many patients don’t have access to doctors, specialists, and caregivers, and many aren’t empowered enough to take

their medications. These stories don’t get posted on Instagram and they don’t make the evening news. Underprivileged and underserved patients have been left behind – left without a voice.

That’s why the foundation launched its virtual listening tours across America in September. Our tours give patients, caregivers, and physicians the opportunity to raise issues that they believe are impacting health care in their communities.

How can physicians work to understand their patients better? How can patients learn to trust their providers? These are all the questions we aim to answer.

James is doing as well as he is because of his relationship with Dr. Haynes. What can we do with that information? We can listen, we can learn, and we can spread the word.

Read more about the work of the CHEST Foundation in its 2020 Impact Report at chestfoundation.org.




 

Original Research

A behaviour change intervention aimed at increasing physical activity improves clinical control in adults with asthma: a randomised controlled trial. By Dr. C. Carvalho, et al.



Critically ill adults with COVID-19 in New Orleans and care with an evidence-based protocol. By Dr. D. Janz, et al.



Mortality trends of idiopathic pulmonary fibrosis in the United States from 2004 to 2017.By Dr. N. Jeganathan, et al.



United States Pulmonary Hypertension Scientific Registry (USPHSR): Baseline characteristics. By Dr. J. Badlam, et al.



CHEST Review

Pulmonary exacerbations in adults with cystic fibrosis: A grown-up issue in a changing CF landscape. By Dr. G. Stanford, et al.



Computed tomography imaging and comorbidities in chronic obstructive pulmonary disease: Beyond lung cancer screening. By Dr. J. Bon, et al.



How I Do It

The PERT concept: A step-by-step approach to managing PE. By Dr. B. Rivera-Lebron, et al.



Special Feature

A brief overview of the national outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) and the primary causes. By Dr. E. Kiernan, et al.




 

Original Research

A behaviour change intervention aimed at increasing physical activity improves clinical control in adults with asthma: a randomised controlled trial. By Dr. C. Carvalho, et al.



Critically ill adults with COVID-19 in New Orleans and care with an evidence-based protocol. By Dr. D. Janz, et al.



Mortality trends of idiopathic pulmonary fibrosis in the United States from 2004 to 2017.By Dr. N. Jeganathan, et al.



United States Pulmonary Hypertension Scientific Registry (USPHSR): Baseline characteristics. By Dr. J. Badlam, et al.



CHEST Review

Pulmonary exacerbations in adults with cystic fibrosis: A grown-up issue in a changing CF landscape. By Dr. G. Stanford, et al.



Computed tomography imaging and comorbidities in chronic obstructive pulmonary disease: Beyond lung cancer screening. By Dr. J. Bon, et al.



How I Do It

The PERT concept: A step-by-step approach to managing PE. By Dr. B. Rivera-Lebron, et al.



Special Feature

A brief overview of the national outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) and the primary causes. By Dr. E. Kiernan, et al.




 

Original Research

A behaviour change intervention aimed at increasing physical activity improves clinical control in adults with asthma: a randomised controlled trial. By Dr. C. Carvalho, et al.



Critically ill adults with COVID-19 in New Orleans and care with an evidence-based protocol. By Dr. D. Janz, et al.



Mortality trends of idiopathic pulmonary fibrosis in the United States from 2004 to 2017.By Dr. N. Jeganathan, et al.



United States Pulmonary Hypertension Scientific Registry (USPHSR): Baseline characteristics. By Dr. J. Badlam, et al.



CHEST Review

Pulmonary exacerbations in adults with cystic fibrosis: A grown-up issue in a changing CF landscape. By Dr. G. Stanford, et al.



Computed tomography imaging and comorbidities in chronic obstructive pulmonary disease: Beyond lung cancer screening. By Dr. J. Bon, et al.



How I Do It

The PERT concept: A step-by-step approach to managing PE. By Dr. B. Rivera-Lebron, et al.



Special Feature

A brief overview of the national outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) and the primary causes. By Dr. E. Kiernan, et al.




 

Cardiovascular Medicine and Surgery

Use of hepatitis C donors in thoracic organ transplantation: Reportedly associated with increased risk of rejection

Mark Jay Zucker, MD, JD, FCCP

Vice-Chair

Transplanting organs from hepatitis C (HCV) antibody and/or antigen-positive donors is associated with a greater than 8%-90% likelihood that the recipient will acquire the infection. Several studies reported that if HCV conversion happened, the outcomes in both heart and lung recipients were worse, even if treated with interferon/ribavirin (Haji SA, et al J Heart Lung Transplant. 2004;23:277; Wang BY, et al. Ann Thorac Surg. 2010 May;89[5]:1645; Carreno MC, et al. J Heart Lung Transplant. 2001;20(2):224). Thus, despite the shortage of thoracic organ donors and high wait-list mortality, the practice was strongly discouraged.

In 2016, the successful use of a direct-acting antiviral (DAA) for 12 weeks to eliminate HCV in a lung transplant recipient of a seropositive organ was published (Khan B, et al. Am J Transplant. 2017;17:1129). Two years later, the outcomes of seronegative heart (n=8) or lung (n=36) transplant recipients receiving organs from seropositive donors were presented (Woolley AE, et al. N Engl J Med. 2019;380:1606). Forty-two of the patients had viremia within days of the operation. All patients were treated with 4 weeks of a DAA and, of the 35 patients available for 6-month analysis, viral load was undetectable in all. Of concern, however—more cellular rejection requiring treatment was seen in the lung recipients of HCV+ donors compared with recipients of HCV- donors. The difference was not statistically significant.

The largest analysis of the safety of HCV+ donors in HCV- thoracic organ transplant recipients involved 343 heart transplant recipients (Kilic A, et al. J Am Heart Assoc. 2020;9(2):e014495). No differences were noted in outcomes, strokes, need for dialysis, or incidence of treated rejection during the first year. However, the observation regarding rejection was not subsequently confirmed by the NYU team (Gidea CG, et al. J Heart Lung Transplant. 2020;39:1199). Of 22 HCV- recipients of an HCV donor with viremia, the rate of rejection was 64% vs 18% in 28 patients receiving a donor without viremia (through day 180 (P=.001)).

In summary, the ability of DAAs to render 97%-99% of immunosuppressed transplant recipients HCV seronegative has transformed the landscape and HCV viremia in the donor (or recipient) and is no longer an absolute contraindication to transplantation. However, more information is needed as to whether there is an increased incidence of rejection.


 

Cardiovascular Medicine and Surgery

Use of hepatitis C donors in thoracic organ transplantation: Reportedly associated with increased risk of rejection

Mark Jay Zucker, MD, JD, FCCP

Vice-Chair

Transplanting organs from hepatitis C (HCV) antibody and/or antigen-positive donors is associated with a greater than 8%-90% likelihood that the recipient will acquire the infection. Several studies reported that if HCV conversion happened, the outcomes in both heart and lung recipients were worse, even if treated with interferon/ribavirin (Haji SA, et al J Heart Lung Transplant. 2004;23:277; Wang BY, et al. Ann Thorac Surg. 2010 May;89[5]:1645; Carreno MC, et al. J Heart Lung Transplant. 2001;20(2):224). Thus, despite the shortage of thoracic organ donors and high wait-list mortality, the practice was strongly discouraged.

In 2016, the successful use of a direct-acting antiviral (DAA) for 12 weeks to eliminate HCV in a lung transplant recipient of a seropositive organ was published (Khan B, et al. Am J Transplant. 2017;17:1129). Two years later, the outcomes of seronegative heart (n=8) or lung (n=36) transplant recipients receiving organs from seropositive donors were presented (Woolley AE, et al. N Engl J Med. 2019;380:1606). Forty-two of the patients had viremia within days of the operation. All patients were treated with 4 weeks of a DAA and, of the 35 patients available for 6-month analysis, viral load was undetectable in all. Of concern, however—more cellular rejection requiring treatment was seen in the lung recipients of HCV+ donors compared with recipients of HCV- donors. The difference was not statistically significant.

The largest analysis of the safety of HCV+ donors in HCV- thoracic organ transplant recipients involved 343 heart transplant recipients (Kilic A, et al. J Am Heart Assoc. 2020;9(2):e014495). No differences were noted in outcomes, strokes, need for dialysis, or incidence of treated rejection during the first year. However, the observation regarding rejection was not subsequently confirmed by the NYU team (Gidea CG, et al. J Heart Lung Transplant. 2020;39:1199). Of 22 HCV- recipients of an HCV donor with viremia, the rate of rejection was 64% vs 18% in 28 patients receiving a donor without viremia (through day 180 (P=.001)).

In summary, the ability of DAAs to render 97%-99% of immunosuppressed transplant recipients HCV seronegative has transformed the landscape and HCV viremia in the donor (or recipient) and is no longer an absolute contraindication to transplantation. However, more information is needed as to whether there is an increased incidence of rejection.


 

Cardiovascular Medicine and Surgery

Use of hepatitis C donors in thoracic organ transplantation: Reportedly associated with increased risk of rejection

Mark Jay Zucker, MD, JD, FCCP

Vice-Chair

Transplanting organs from hepatitis C (HCV) antibody and/or antigen-positive donors is associated with a greater than 8%-90% likelihood that the recipient will acquire the infection. Several studies reported that if HCV conversion happened, the outcomes in both heart and lung recipients were worse, even if treated with interferon/ribavirin (Haji SA, et al J Heart Lung Transplant. 2004;23:277; Wang BY, et al. Ann Thorac Surg. 2010 May;89[5]:1645; Carreno MC, et al. J Heart Lung Transplant. 2001;20(2):224). Thus, despite the shortage of thoracic organ donors and high wait-list mortality, the practice was strongly discouraged.

In 2016, the successful use of a direct-acting antiviral (DAA) for 12 weeks to eliminate HCV in a lung transplant recipient of a seropositive organ was published (Khan B, et al. Am J Transplant. 2017;17:1129). Two years later, the outcomes of seronegative heart (n=8) or lung (n=36) transplant recipients receiving organs from seropositive donors were presented (Woolley AE, et al. N Engl J Med. 2019;380:1606). Forty-two of the patients had viremia within days of the operation. All patients were treated with 4 weeks of a DAA and, of the 35 patients available for 6-month analysis, viral load was undetectable in all. Of concern, however—more cellular rejection requiring treatment was seen in the lung recipients of HCV+ donors compared with recipients of HCV- donors. The difference was not statistically significant.

The largest analysis of the safety of HCV+ donors in HCV- thoracic organ transplant recipients involved 343 heart transplant recipients (Kilic A, et al. J Am Heart Assoc. 2020;9(2):e014495). No differences were noted in outcomes, strokes, need for dialysis, or incidence of treated rejection during the first year. However, the observation regarding rejection was not subsequently confirmed by the NYU team (Gidea CG, et al. J Heart Lung Transplant. 2020;39:1199). Of 22 HCV- recipients of an HCV donor with viremia, the rate of rejection was 64% vs 18% in 28 patients receiving a donor without viremia (through day 180 (P=.001)).

In summary, the ability of DAAs to render 97%-99% of immunosuppressed transplant recipients HCV seronegative has transformed the landscape and HCV viremia in the donor (or recipient) and is no longer an absolute contraindication to transplantation. However, more information is needed as to whether there is an increased incidence of rejection.


 

Power Outage: An Ignored Risk Factor for Chronic Obstructive Pulmonary Disease ExacerbationsBy Dr. Wangjian Zhang, et al.



PROPHETIC: Prospective Identification of Pneumonia in Hospitalized Patients in the ICU By Dr. Stephen P. Bergin, et al.



Chronic Beryllium Disease: Update on a Moving Target By Dr. Maeve MacMurdo, et al.



Development of Learning Curves for Bronchoscopy: Results of a Multicenter Study of Pulmonary Trainees By Dr. Nha Voduc, et al.



Bias and Racism Teaching Rounds at an Academic Medical Center By Dr. Quinn Capers, IV, et al.

Power Outage: An Ignored Risk Factor for Chronic Obstructive Pulmonary Disease ExacerbationsBy Dr. Wangjian Zhang, et al.



PROPHETIC: Prospective Identification of Pneumonia in Hospitalized Patients in the ICU By Dr. Stephen P. Bergin, et al.



Chronic Beryllium Disease: Update on a Moving Target By Dr. Maeve MacMurdo, et al.



Development of Learning Curves for Bronchoscopy: Results of a Multicenter Study of Pulmonary Trainees By Dr. Nha Voduc, et al.



Bias and Racism Teaching Rounds at an Academic Medical Center By Dr. Quinn Capers, IV, et al.

Power Outage: An Ignored Risk Factor for Chronic Obstructive Pulmonary Disease ExacerbationsBy Dr. Wangjian Zhang, et al.



PROPHETIC: Prospective Identification of Pneumonia in Hospitalized Patients in the ICU By Dr. Stephen P. Bergin, et al.



Chronic Beryllium Disease: Update on a Moving Target By Dr. Maeve MacMurdo, et al.



Development of Learning Curves for Bronchoscopy: Results of a Multicenter Study of Pulmonary Trainees By Dr. Nha Voduc, et al.



Bias and Racism Teaching Rounds at an Academic Medical Center By Dr. Quinn Capers, IV, et al.

How do we discuss race and lung health issues that impact our most deserving, underserved communities? Continuously and uncomfortably. As the Executive Director of the CHEST Foundation and as a young Black man, I am hopeful that we, as CHEST, can lead these uncomfortable conversations to better our communities. Our ability to listen and deliver support to our most-deserving communities is critical in how we fulfill our mission. CHEST continues to be a leader in lung health because we choose to give a voice and a platform in support of better lung health – especially to those who are disproportionately affected by lung disease, specifically addressing the quality of care they receive and bringing to light the fact that too often these patients are forgotten by the rest of society.

How do we discuss race and lung health issues that impact our most deserving, underserved communities? Continuously and uncomfortably. As the Executive Director of the CHEST Foundation and as a young Black man, I am hopeful that we, as CHEST, can lead these uncomfortable conversations to better our communities. Our ability to listen and deliver support to our most-deserving communities is critical in how we fulfill our mission. CHEST continues to be a leader in lung health because we choose to give a voice and a platform in support of better lung health – especially to those who are disproportionately affected by lung disease, specifically addressing the quality of care they receive and bringing to light the fact that too often these patients are forgotten by the rest of society.

How do we discuss race and lung health issues that impact our most deserving, underserved communities? Continuously and uncomfortably. As the Executive Director of the CHEST Foundation and as a young Black man, I am hopeful that we, as CHEST, can lead these uncomfortable conversations to better our communities. Our ability to listen and deliver support to our most-deserving communities is critical in how we fulfill our mission. CHEST continues to be a leader in lung health because we choose to give a voice and a platform in support of better lung health – especially to those who are disproportionately affected by lung disease, specifically addressing the quality of care they receive and bringing to light the fact that too often these patients are forgotten by the rest of society.