News From CHEST Physician®

In 2013, CHEST began work with the Chinese Ministry of Health and the Chinese Medical Doctor Association to establish the specialty of Pulmonary and Critical Care Medicine in China. CHEST members, among them Drs. Renli Qiao, Jack Buckley, Darcy Marciniuk, Mark Rosen, and Stephanie Levine, helped to establish a curriculum and a board exam and have now seen the first class of fellows complete their training. At our October Board meeting, Dr. Buckley reported at this meeting that the Chinese PCCM program, the first medical subspecialty to be established in China, is prepared to stand on its own, without further support from CHEST. This is a huge accomplishment for both the Chinese Medical Doctor Association and for CHEST, and the Board heartily congratulated everyone who contributed to this impressive project.

Another important function at this October meeting is to approve the Governance Committee’s recommendations for a new slate of board members and a new President-Designate. The board bid farewell to four valued members at the end of their terms: Drs. Robert Aranson (Freeport, ME), Subhakar Kandi (Hyderabad, India), Janet Maurer (Desert Hills, AZ), and Hassan Bencheqroun (San Diego, CA). All contributed immensely to the success of CHEST, and the remaining board members expressed their gratitude. The Board also approved Drs. Vera De Palo (Providence, RI), Neil Freedman (Evanston, IL), Francesco DeBlasio (Napoli, Italy), and Lynn Tanoue (New Haven, CT) as at-large regents, and Dr. Steven Simpson (Kansas City, KS) as the new President-Designate. The Board is committed to ensuring that its makeup be representative of the entirety of our membership base. As CHEST continues to grow internationally and as we gain more members who are women and historically underrepresented minorities, we are dedicated to ensuring that there is no glass ceiling in our organization and that all have the opportunity to contribute to the full extent of their ability. We are, likewise, dedicated to providing mentorship and leadership opportunities for members of groups who are under-represented.

Following the resignation of CHEST’s CEO during the summer, the Chief Operating Officer, Dr. Robert Musacchio, became interim CEO. Dr. Musacchio is a PhD economist who joined CHEST in 2015 after a 35-year stint at the American Medical Association and who has broad and deep experience in the business of running a nonprofit medical organization. He brings an extraordinary skill set in both business and staff development to the role, and we very much look forward to working with him in this new position! Dr. Musacchio gave an update on educational efforts, domestic and international growth in membership, changes in the structure of the professional staff, and the state of our flagship journal, CHEST®.

In 2013, CHEST began work with the Chinese Ministry of Health and the Chinese Medical Doctor Association to establish the specialty of Pulmonary and Critical Care Medicine in China. CHEST members, among them Drs. Renli Qiao, Jack Buckley, Darcy Marciniuk, Mark Rosen, and Stephanie Levine, helped to establish a curriculum and a board exam and have now seen the first class of fellows complete their training. At our October Board meeting, Dr. Buckley reported at this meeting that the Chinese PCCM program, the first medical subspecialty to be established in China, is prepared to stand on its own, without further support from CHEST. This is a huge accomplishment for both the Chinese Medical Doctor Association and for CHEST, and the Board heartily congratulated everyone who contributed to this impressive project.

Another important function at this October meeting is to approve the Governance Committee’s recommendations for a new slate of board members and a new President-Designate. The board bid farewell to four valued members at the end of their terms: Drs. Robert Aranson (Freeport, ME), Subhakar Kandi (Hyderabad, India), Janet Maurer (Desert Hills, AZ), and Hassan Bencheqroun (San Diego, CA). All contributed immensely to the success of CHEST, and the remaining board members expressed their gratitude. The Board also approved Drs. Vera De Palo (Providence, RI), Neil Freedman (Evanston, IL), Francesco DeBlasio (Napoli, Italy), and Lynn Tanoue (New Haven, CT) as at-large regents, and Dr. Steven Simpson (Kansas City, KS) as the new President-Designate. The Board is committed to ensuring that its makeup be representative of the entirety of our membership base. As CHEST continues to grow internationally and as we gain more members who are women and historically underrepresented minorities, we are dedicated to ensuring that there is no glass ceiling in our organization and that all have the opportunity to contribute to the full extent of their ability. We are, likewise, dedicated to providing mentorship and leadership opportunities for members of groups who are under-represented.

Following the resignation of CHEST’s CEO during the summer, the Chief Operating Officer, Dr. Robert Musacchio, became interim CEO. Dr. Musacchio is a PhD economist who joined CHEST in 2015 after a 35-year stint at the American Medical Association and who has broad and deep experience in the business of running a nonprofit medical organization. He brings an extraordinary skill set in both business and staff development to the role, and we very much look forward to working with him in this new position! Dr. Musacchio gave an update on educational efforts, domestic and international growth in membership, changes in the structure of the professional staff, and the state of our flagship journal, CHEST®.

In 2013, CHEST began work with the Chinese Ministry of Health and the Chinese Medical Doctor Association to establish the specialty of Pulmonary and Critical Care Medicine in China. CHEST members, among them Drs. Renli Qiao, Jack Buckley, Darcy Marciniuk, Mark Rosen, and Stephanie Levine, helped to establish a curriculum and a board exam and have now seen the first class of fellows complete their training. At our October Board meeting, Dr. Buckley reported at this meeting that the Chinese PCCM program, the first medical subspecialty to be established in China, is prepared to stand on its own, without further support from CHEST. This is a huge accomplishment for both the Chinese Medical Doctor Association and for CHEST, and the Board heartily congratulated everyone who contributed to this impressive project.

Another important function at this October meeting is to approve the Governance Committee’s recommendations for a new slate of board members and a new President-Designate. The board bid farewell to four valued members at the end of their terms: Drs. Robert Aranson (Freeport, ME), Subhakar Kandi (Hyderabad, India), Janet Maurer (Desert Hills, AZ), and Hassan Bencheqroun (San Diego, CA). All contributed immensely to the success of CHEST, and the remaining board members expressed their gratitude. The Board also approved Drs. Vera De Palo (Providence, RI), Neil Freedman (Evanston, IL), Francesco DeBlasio (Napoli, Italy), and Lynn Tanoue (New Haven, CT) as at-large regents, and Dr. Steven Simpson (Kansas City, KS) as the new President-Designate. The Board is committed to ensuring that its makeup be representative of the entirety of our membership base. As CHEST continues to grow internationally and as we gain more members who are women and historically underrepresented minorities, we are dedicated to ensuring that there is no glass ceiling in our organization and that all have the opportunity to contribute to the full extent of their ability. We are, likewise, dedicated to providing mentorship and leadership opportunities for members of groups who are under-represented.

Following the resignation of CHEST’s CEO during the summer, the Chief Operating Officer, Dr. Robert Musacchio, became interim CEO. Dr. Musacchio is a PhD economist who joined CHEST in 2015 after a 35-year stint at the American Medical Association and who has broad and deep experience in the business of running a nonprofit medical organization. He brings an extraordinary skill set in both business and staff development to the role, and we very much look forward to working with him in this new position! Dr. Musacchio gave an update on educational efforts, domestic and international growth in membership, changes in the structure of the professional staff, and the state of our flagship journal, CHEST®.

NAMDRC focuses on keeping its members informed on legislative and regulatory issues impacting their practices

NAMDRC’s mission statement clearly signals its commitment to improve access to quality care for patients with respiratory disease by removing regulatory and legislative barriers to appropriate treatment. Adhering to that commitment presents challenges in the rapidly changing structure of the delivery of health care. For example, 10 years ago, the majority of NAMDRC members were private practitioners/group practices, many with contracts to provide a range of services to institutions. While those agreements varied, the underlying principles were relatively constant – structure your agreements that were mutually beneficial to physician and hospital.

Today, those agreements have been replaced by employment contracts or simply disappeared entirely, replaced by various business models that have invariably shifted the focus of coverage and payment issues away from the group practice into significantly different financial incentives. The challenge for NAMDRC is to keep its members informed about structural changes in coverage and payment rules that could impact their decision making. In November 2018, CMS published three distinctly separate sets of rules slated to take effect in 2019, all of which affect physicians in the pulmonary, critical care, and sleep landscapes. Through the monthly membership publication, the Washington Watchline, members get timely information that impact their practices. Excerpts from a recent Watchline include:

Physician fee schedule: As most physicians know, CMS had proposed dramatic changes to payment for Level 4 and Level % E&M codes, but due to strong reaction from man within the medical community, CMS is withdrawing that specific proposal, at least in the short term. Related provisions include:

• For CY 2019 and 2020, CMS will continue the current coding and payment structure for E/M office/outpatient visits,

• Effective January 1, 2019, for new and established patients for E/M office/outpatient visits, practitioners need not re-enter in the medical record information on the patient’s chief complaint and history that has already been entered by ancillary staff or the beneficiary. The practitioner may simply indicate in the medical record that he or she reviewed and verified this information.

• For 2021, CMS is finalizing a significant reduction in the current payment variation in office/outpatient E/M visit levels by paying a single rate for E/M office/outpatient visit levels 2, 3, and 4 (one for established and another for new patients) beginning in 2021. However, CMS is not finalizing the inclusion of E/M office/outpatient level 5 visits in the single payment rate, to better account for the care and needs of particularly complex patients.

• CMS policy for 2021 will adopt add-on codes that describe the additional resources inherent in visits for primary care and particular kinds of specialized medical care. As discussed further below, these codes will only be reportable with E/M office/outpatient level 2 through 4 visits, and their use generally will not impose new per-visit documentation requirements.



Hospital outpatient rules: There are two particularly relevant issues addressed in this final regulation. The payment rates for pulmonary rehab are:

• Pulmonary Rehab via G0424 – APC 5733, $55.90 with co-pay of $11.18

• Pulmonary Rehab via G0237, 38, 39 – APC 5732, $32.12 with co-pay of $6.43



This regulation is also the vehicle for CMS addressing issues related to Section 603/site of service payment issues. As physicians know, CMS enacted Section 603 of the 23015 Budget Act that puts notable restrictions on payment for certain hospital outpatient services provided off campus (more than 250 yards from main campus of the hospital). NAMDRC is most concerned about the impact on pulmonary rehab – under the rules, off-campus programs that are grandfathered (“excepted” is the CMS term) as long as they were billing for those services at that location November 2015. However, if a hospital chooses to open a new program, or relocate an existing program to a different location, the payment principles that apply are physician fee schedule rates rather than hospital outpatient rates. In the proposed rule posted this past July, CMS had proposed that even a new service provided in an excepted setting would be subject to PFS payment rates rather than hospital outpatient rates. CMS has withdrawn that proposal for the coming year, so new services in excepted settings will be covered.

DME: In its proposed rule this past summer, CMS actually acknowledged flaws in the structure of the competitive bidding system for DME (including oxygen, CPAP, and certain ventilators referred to by CMS as respiratory assist devices). Specifically, related to oxygen, there is also acknowledgement of reductions in liquid oxygen utilization, a story we have been pushing for years. The CMS proposed rule would have tied liquid portable payment rates to portable concentrator and transfill system payment rates, a genuine bump in actual $$. More than a dozen societies joined to respond to the proposed rule, including NAMDRC, CHEST, and ATS.

In the final rule, CMS is moving forward with its proposal, acknowledging that it will need to monitor shifts in the oxygen marketplace and adjust their payment policies accordingly.
 

NAMDRC focuses on keeping its members informed on legislative and regulatory issues impacting their practices

NAMDRC’s mission statement clearly signals its commitment to improve access to quality care for patients with respiratory disease by removing regulatory and legislative barriers to appropriate treatment. Adhering to that commitment presents challenges in the rapidly changing structure of the delivery of health care. For example, 10 years ago, the majority of NAMDRC members were private practitioners/group practices, many with contracts to provide a range of services to institutions. While those agreements varied, the underlying principles were relatively constant – structure your agreements that were mutually beneficial to physician and hospital.

Today, those agreements have been replaced by employment contracts or simply disappeared entirely, replaced by various business models that have invariably shifted the focus of coverage and payment issues away from the group practice into significantly different financial incentives. The challenge for NAMDRC is to keep its members informed about structural changes in coverage and payment rules that could impact their decision making. In November 2018, CMS published three distinctly separate sets of rules slated to take effect in 2019, all of which affect physicians in the pulmonary, critical care, and sleep landscapes. Through the monthly membership publication, the Washington Watchline, members get timely information that impact their practices. Excerpts from a recent Watchline include:

Physician fee schedule: As most physicians know, CMS had proposed dramatic changes to payment for Level 4 and Level % E&M codes, but due to strong reaction from man within the medical community, CMS is withdrawing that specific proposal, at least in the short term. Related provisions include:

• For CY 2019 and 2020, CMS will continue the current coding and payment structure for E/M office/outpatient visits,

• Effective January 1, 2019, for new and established patients for E/M office/outpatient visits, practitioners need not re-enter in the medical record information on the patient’s chief complaint and history that has already been entered by ancillary staff or the beneficiary. The practitioner may simply indicate in the medical record that he or she reviewed and verified this information.

• For 2021, CMS is finalizing a significant reduction in the current payment variation in office/outpatient E/M visit levels by paying a single rate for E/M office/outpatient visit levels 2, 3, and 4 (one for established and another for new patients) beginning in 2021. However, CMS is not finalizing the inclusion of E/M office/outpatient level 5 visits in the single payment rate, to better account for the care and needs of particularly complex patients.

• CMS policy for 2021 will adopt add-on codes that describe the additional resources inherent in visits for primary care and particular kinds of specialized medical care. As discussed further below, these codes will only be reportable with E/M office/outpatient level 2 through 4 visits, and their use generally will not impose new per-visit documentation requirements.



Hospital outpatient rules: There are two particularly relevant issues addressed in this final regulation. The payment rates for pulmonary rehab are:

• Pulmonary Rehab via G0424 – APC 5733, $55.90 with co-pay of $11.18

• Pulmonary Rehab via G0237, 38, 39 – APC 5732, $32.12 with co-pay of $6.43



This regulation is also the vehicle for CMS addressing issues related to Section 603/site of service payment issues. As physicians know, CMS enacted Section 603 of the 23015 Budget Act that puts notable restrictions on payment for certain hospital outpatient services provided off campus (more than 250 yards from main campus of the hospital). NAMDRC is most concerned about the impact on pulmonary rehab – under the rules, off-campus programs that are grandfathered (“excepted” is the CMS term) as long as they were billing for those services at that location November 2015. However, if a hospital chooses to open a new program, or relocate an existing program to a different location, the payment principles that apply are physician fee schedule rates rather than hospital outpatient rates. In the proposed rule posted this past July, CMS had proposed that even a new service provided in an excepted setting would be subject to PFS payment rates rather than hospital outpatient rates. CMS has withdrawn that proposal for the coming year, so new services in excepted settings will be covered.

DME: In its proposed rule this past summer, CMS actually acknowledged flaws in the structure of the competitive bidding system for DME (including oxygen, CPAP, and certain ventilators referred to by CMS as respiratory assist devices). Specifically, related to oxygen, there is also acknowledgement of reductions in liquid oxygen utilization, a story we have been pushing for years. The CMS proposed rule would have tied liquid portable payment rates to portable concentrator and transfill system payment rates, a genuine bump in actual $$. More than a dozen societies joined to respond to the proposed rule, including NAMDRC, CHEST, and ATS.

In the final rule, CMS is moving forward with its proposal, acknowledging that it will need to monitor shifts in the oxygen marketplace and adjust their payment policies accordingly.
 

NAMDRC focuses on keeping its members informed on legislative and regulatory issues impacting their practices

NAMDRC’s mission statement clearly signals its commitment to improve access to quality care for patients with respiratory disease by removing regulatory and legislative barriers to appropriate treatment. Adhering to that commitment presents challenges in the rapidly changing structure of the delivery of health care. For example, 10 years ago, the majority of NAMDRC members were private practitioners/group practices, many with contracts to provide a range of services to institutions. While those agreements varied, the underlying principles were relatively constant – structure your agreements that were mutually beneficial to physician and hospital.

Today, those agreements have been replaced by employment contracts or simply disappeared entirely, replaced by various business models that have invariably shifted the focus of coverage and payment issues away from the group practice into significantly different financial incentives. The challenge for NAMDRC is to keep its members informed about structural changes in coverage and payment rules that could impact their decision making. In November 2018, CMS published three distinctly separate sets of rules slated to take effect in 2019, all of which affect physicians in the pulmonary, critical care, and sleep landscapes. Through the monthly membership publication, the Washington Watchline, members get timely information that impact their practices. Excerpts from a recent Watchline include:

Physician fee schedule: As most physicians know, CMS had proposed dramatic changes to payment for Level 4 and Level % E&M codes, but due to strong reaction from man within the medical community, CMS is withdrawing that specific proposal, at least in the short term. Related provisions include:

• For CY 2019 and 2020, CMS will continue the current coding and payment structure for E/M office/outpatient visits,

• Effective January 1, 2019, for new and established patients for E/M office/outpatient visits, practitioners need not re-enter in the medical record information on the patient’s chief complaint and history that has already been entered by ancillary staff or the beneficiary. The practitioner may simply indicate in the medical record that he or she reviewed and verified this information.

• For 2021, CMS is finalizing a significant reduction in the current payment variation in office/outpatient E/M visit levels by paying a single rate for E/M office/outpatient visit levels 2, 3, and 4 (one for established and another for new patients) beginning in 2021. However, CMS is not finalizing the inclusion of E/M office/outpatient level 5 visits in the single payment rate, to better account for the care and needs of particularly complex patients.

• CMS policy for 2021 will adopt add-on codes that describe the additional resources inherent in visits for primary care and particular kinds of specialized medical care. As discussed further below, these codes will only be reportable with E/M office/outpatient level 2 through 4 visits, and their use generally will not impose new per-visit documentation requirements.



Hospital outpatient rules: There are two particularly relevant issues addressed in this final regulation. The payment rates for pulmonary rehab are:

• Pulmonary Rehab via G0424 – APC 5733, $55.90 with co-pay of $11.18

• Pulmonary Rehab via G0237, 38, 39 – APC 5732, $32.12 with co-pay of $6.43



This regulation is also the vehicle for CMS addressing issues related to Section 603/site of service payment issues. As physicians know, CMS enacted Section 603 of the 23015 Budget Act that puts notable restrictions on payment for certain hospital outpatient services provided off campus (more than 250 yards from main campus of the hospital). NAMDRC is most concerned about the impact on pulmonary rehab – under the rules, off-campus programs that are grandfathered (“excepted” is the CMS term) as long as they were billing for those services at that location November 2015. However, if a hospital chooses to open a new program, or relocate an existing program to a different location, the payment principles that apply are physician fee schedule rates rather than hospital outpatient rates. In the proposed rule posted this past July, CMS had proposed that even a new service provided in an excepted setting would be subject to PFS payment rates rather than hospital outpatient rates. CMS has withdrawn that proposal for the coming year, so new services in excepted settings will be covered.

DME: In its proposed rule this past summer, CMS actually acknowledged flaws in the structure of the competitive bidding system for DME (including oxygen, CPAP, and certain ventilators referred to by CMS as respiratory assist devices). Specifically, related to oxygen, there is also acknowledgement of reductions in liquid oxygen utilization, a story we have been pushing for years. The CMS proposed rule would have tied liquid portable payment rates to portable concentrator and transfill system payment rates, a genuine bump in actual $$. More than a dozen societies joined to respond to the proposed rule, including NAMDRC, CHEST, and ATS.

In the final rule, CMS is moving forward with its proposal, acknowledging that it will need to monitor shifts in the oxygen marketplace and adjust their payment policies accordingly.
 

As the CHEST Foundation continues to grow, so does our ability to impact the careers of early career clinicians. What began as a small travel grants program for the 2015 winners of the NetWorks Challenge to help offset their trainee members’ travel to CHEST 2015 in Montreal, was quickly identified as opportunity for the CHEST Foundation to deepen their engagement with early career clinicians. The CHEST Foundation travel grants program has grown immensely since then, but the core tenants of the program remain unchanged – to provide excellent trainees, medical students, and all other members of the care team with the fiscal support they need to become successful clinicians and faithfully treat their patients and community. Some of the ways our travel grants are put to good use is to attend the CHEST Annual Meeting and to further engage them as active members of CHEST. In addition to travel grant support to offset the costs of attending the annual meeting, recipients of these competitive grants receive free registration to the meeting; individualized mentorship from a CHEST member who is currently or has been part of CHEST leadership (ie, served on one of the boards, as faculty, on committees, as well as chairs and vice-chairs of the NetWorks); learn best practices for applying for research and community service grants from previous grant winners; invitations to exclusive receptions to network with peers and potential employers; and access to several sessions at the annual meeting intended to strengthen their clinical skill set. All of these programmatic pieces come together to help propel these young leaders’ careers and invest in the future of our discipline as CHEST clinicians.

Due to your overwhelming philanthropic support, CHEST Foundation’s travel grant programs continue to flourish. In 2017, the CHEST Foundation supported

a total of 43 early career clinicians’ travel to attend the CHEST Annual Meeting in Toronto. Through continued donor support, a successful NetWorks Challenge

fundraiser, and an overwhelming number of qualified early career applicants for the travel grants, that number swelled to 72 clinicians for the 2018 CHEST Annual Meeting in San Antonio. In total, the CHEST Foundation dispensed over $70,000 in travel grants for CHEST 2018. We can’t thank you enough for the impact you have made in these early career clinicians’ professional lives, and we urge you to increase your gifts, so we can advance these important professional development opportunities for clinicians by CHEST 2019!



“I’m so thankful to be a recipient of the CHEST travel grant! It enabled me to connect with such a wide array of health-care professionals and learn from my peers. It was wonderful to discover that there are many ways for me as a respiratory therapist to become involved in CHEST! Thank you to all the donors who made these awards a reality!”

- Maya Jenkins, RRT

“As an international medical graduate fellow, I experience challenges spanning from economic (inability to moonlight), professional (scarce funding and sponsorship opportunities, mentorship) to immigration-related difficulties. The CHEST Foundation grant is a superbly structured and implemented opportunity that allowed me a chance to address most of these challenges as I advance in my academic career. The grant itinerary permitted me to network with mentors and, subsequently, resulted in critical leads: A collaborative research project, offers to write letters in support of my visa situation, interest from a journal for one my manuscripts, plans to submit proposals for #CHEST2019, and, most importantly, support from leaders in our field who offered guidance and sponsorship (huge shout out to Dr. Chris Carroll)! I would like to thank the Foundation for awarding this grant as it isn’t just the grant but the slew of opportunities that came along with it that can, and, in my case, catapult fledgling careers in the field of pulmonary and critical care medicine.”

-Viren Kaul, MD

“CHEST education is the cornerstone of pulmonary medicine and delivering world-class health care. CHEST and the CHEST Foundation care about me and the importance of being the best practitioner I can be for my patients. Having impactful conversations with other clinicians, seeing new innovations, and learning through a diverse number of ways while at CHEST 2018 gave me meaningful lessons to apply in my daily practice. The travel grant made this possible!”

- Sarah Brundidge, MSc, RRT
 

As the CHEST Foundation continues to grow, so does our ability to impact the careers of early career clinicians. What began as a small travel grants program for the 2015 winners of the NetWorks Challenge to help offset their trainee members’ travel to CHEST 2015 in Montreal, was quickly identified as opportunity for the CHEST Foundation to deepen their engagement with early career clinicians. The CHEST Foundation travel grants program has grown immensely since then, but the core tenants of the program remain unchanged – to provide excellent trainees, medical students, and all other members of the care team with the fiscal support they need to become successful clinicians and faithfully treat their patients and community. Some of the ways our travel grants are put to good use is to attend the CHEST Annual Meeting and to further engage them as active members of CHEST. In addition to travel grant support to offset the costs of attending the annual meeting, recipients of these competitive grants receive free registration to the meeting; individualized mentorship from a CHEST member who is currently or has been part of CHEST leadership (ie, served on one of the boards, as faculty, on committees, as well as chairs and vice-chairs of the NetWorks); learn best practices for applying for research and community service grants from previous grant winners; invitations to exclusive receptions to network with peers and potential employers; and access to several sessions at the annual meeting intended to strengthen their clinical skill set. All of these programmatic pieces come together to help propel these young leaders’ careers and invest in the future of our discipline as CHEST clinicians.

Due to your overwhelming philanthropic support, CHEST Foundation’s travel grant programs continue to flourish. In 2017, the CHEST Foundation supported

a total of 43 early career clinicians’ travel to attend the CHEST Annual Meeting in Toronto. Through continued donor support, a successful NetWorks Challenge

fundraiser, and an overwhelming number of qualified early career applicants for the travel grants, that number swelled to 72 clinicians for the 2018 CHEST Annual Meeting in San Antonio. In total, the CHEST Foundation dispensed over $70,000 in travel grants for CHEST 2018. We can’t thank you enough for the impact you have made in these early career clinicians’ professional lives, and we urge you to increase your gifts, so we can advance these important professional development opportunities for clinicians by CHEST 2019!



“I’m so thankful to be a recipient of the CHEST travel grant! It enabled me to connect with such a wide array of health-care professionals and learn from my peers. It was wonderful to discover that there are many ways for me as a respiratory therapist to become involved in CHEST! Thank you to all the donors who made these awards a reality!”

- Maya Jenkins, RRT

“As an international medical graduate fellow, I experience challenges spanning from economic (inability to moonlight), professional (scarce funding and sponsorship opportunities, mentorship) to immigration-related difficulties. The CHEST Foundation grant is a superbly structured and implemented opportunity that allowed me a chance to address most of these challenges as I advance in my academic career. The grant itinerary permitted me to network with mentors and, subsequently, resulted in critical leads: A collaborative research project, offers to write letters in support of my visa situation, interest from a journal for one my manuscripts, plans to submit proposals for #CHEST2019, and, most importantly, support from leaders in our field who offered guidance and sponsorship (huge shout out to Dr. Chris Carroll)! I would like to thank the Foundation for awarding this grant as it isn’t just the grant but the slew of opportunities that came along with it that can, and, in my case, catapult fledgling careers in the field of pulmonary and critical care medicine.”

-Viren Kaul, MD

“CHEST education is the cornerstone of pulmonary medicine and delivering world-class health care. CHEST and the CHEST Foundation care about me and the importance of being the best practitioner I can be for my patients. Having impactful conversations with other clinicians, seeing new innovations, and learning through a diverse number of ways while at CHEST 2018 gave me meaningful lessons to apply in my daily practice. The travel grant made this possible!”

- Sarah Brundidge, MSc, RRT
 

As the CHEST Foundation continues to grow, so does our ability to impact the careers of early career clinicians. What began as a small travel grants program for the 2015 winners of the NetWorks Challenge to help offset their trainee members’ travel to CHEST 2015 in Montreal, was quickly identified as opportunity for the CHEST Foundation to deepen their engagement with early career clinicians. The CHEST Foundation travel grants program has grown immensely since then, but the core tenants of the program remain unchanged – to provide excellent trainees, medical students, and all other members of the care team with the fiscal support they need to become successful clinicians and faithfully treat their patients and community. Some of the ways our travel grants are put to good use is to attend the CHEST Annual Meeting and to further engage them as active members of CHEST. In addition to travel grant support to offset the costs of attending the annual meeting, recipients of these competitive grants receive free registration to the meeting; individualized mentorship from a CHEST member who is currently or has been part of CHEST leadership (ie, served on one of the boards, as faculty, on committees, as well as chairs and vice-chairs of the NetWorks); learn best practices for applying for research and community service grants from previous grant winners; invitations to exclusive receptions to network with peers and potential employers; and access to several sessions at the annual meeting intended to strengthen their clinical skill set. All of these programmatic pieces come together to help propel these young leaders’ careers and invest in the future of our discipline as CHEST clinicians.

Due to your overwhelming philanthropic support, CHEST Foundation’s travel grant programs continue to flourish. In 2017, the CHEST Foundation supported

a total of 43 early career clinicians’ travel to attend the CHEST Annual Meeting in Toronto. Through continued donor support, a successful NetWorks Challenge

fundraiser, and an overwhelming number of qualified early career applicants for the travel grants, that number swelled to 72 clinicians for the 2018 CHEST Annual Meeting in San Antonio. In total, the CHEST Foundation dispensed over $70,000 in travel grants for CHEST 2018. We can’t thank you enough for the impact you have made in these early career clinicians’ professional lives, and we urge you to increase your gifts, so we can advance these important professional development opportunities for clinicians by CHEST 2019!



“I’m so thankful to be a recipient of the CHEST travel grant! It enabled me to connect with such a wide array of health-care professionals and learn from my peers. It was wonderful to discover that there are many ways for me as a respiratory therapist to become involved in CHEST! Thank you to all the donors who made these awards a reality!”

- Maya Jenkins, RRT

“As an international medical graduate fellow, I experience challenges spanning from economic (inability to moonlight), professional (scarce funding and sponsorship opportunities, mentorship) to immigration-related difficulties. The CHEST Foundation grant is a superbly structured and implemented opportunity that allowed me a chance to address most of these challenges as I advance in my academic career. The grant itinerary permitted me to network with mentors and, subsequently, resulted in critical leads: A collaborative research project, offers to write letters in support of my visa situation, interest from a journal for one my manuscripts, plans to submit proposals for #CHEST2019, and, most importantly, support from leaders in our field who offered guidance and sponsorship (huge shout out to Dr. Chris Carroll)! I would like to thank the Foundation for awarding this grant as it isn’t just the grant but the slew of opportunities that came along with it that can, and, in my case, catapult fledgling careers in the field of pulmonary and critical care medicine.”

-Viren Kaul, MD

“CHEST education is the cornerstone of pulmonary medicine and delivering world-class health care. CHEST and the CHEST Foundation care about me and the importance of being the best practitioner I can be for my patients. Having impactful conversations with other clinicians, seeing new innovations, and learning through a diverse number of ways while at CHEST 2018 gave me meaningful lessons to apply in my daily practice. The travel grant made this possible!”

- Sarah Brundidge, MSc, RRT
 

Everyone who attended CHEST Annual Meeting 2018 is a winner, but we would like to call out the winners participating in CHEST’s special categories of awards and events. Congratulations to all!

ANNUAL CHEST AWARDS

Master FCCP
David Gutterman, MD, Master FCCP

Distinguished Service Award
David Gutterman, MD, Master FCCP

College Medalist Award
Ghada Bourjeily, MD, FCCP

Master Clinician Educator
Lisa Moores, MD, FCCP

Early Career Clinician Educator
Amy Morris, MD, FCCP

Alfred Soffer Award for Editorial Excellence
Jean Rice

Presidential Citation
Darcy Marciniuk, MD, FCCP

Presidential Citation
D. Robert McCaffree, MD, Master FCCP

HONOR LECTURES AND MEMORIAL AWARDS

Edward C. Rosenow III, MD, Master FCCP/Master Teacher Honor Lecture Accelerated Aging in COPD and Its Comorbidities: Novel Therapeutic Targets
Peter Barnes, MD, Master FCCP
The lecture is generously funded by the CHEST Foundation.

Distinguished Scientist Honor Lecture in Cardiopulmonary Physiology
Understanding Diaphragm Performance: The Role of Ultrasound
F. Dennis McCool, MD, FCCP
The lecture is generously funded by the CHEST Foundation.

Presidential Honor Lecture
Asthma: Past, Present, and Future
Jay Peters, MD, FCCP

Thomas L. Petty, MD, Master FCCP Memorial Lecture
Recent Developments in Pulmonary Rehabilitation and Long-Term Oxygen Therapy: Would Tom Petty be Pleased?
Richard Casaburi, MD, PhD, FCCP
The lecture is generously funded by the CHEST Foundation.

Margaret Pfrommer Memorial Lecture in Long-term Mechanical Ventilation
Saving Lives…One Ventilator at a Time - HMV in 2018 and Beyond
Douglas McKim, MD, FCCP
The Margaret Pfrommer Memorial Lecture in Long-term 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 Medicine
Evolution of Endobronchial Ultrasound: From Diagnostics to Therapeutics
Kazuhiro Yasufuku, MD, PhD, FCCP
The lecture is generously funded by the CHEST Foundation.

Roger C. Bone Memorial Lecture in Critical Care
Methylprednisolone in ARDS: A Highly Effective Treatment. How it Works, How to Use it
G. Umberto Meduri, MD
The lecture is generously funded by the CHEST Foundation.
 

CHEST FOUNDATION GRANT WINNERS

Distinguished Scholar
Robert C. Hyzy, MD, FCCP
Eli Lilly and Company Distinguished Scholar in Critical Care MedicineGrant Title: The Use of Electrical Impedance Tomography to Assess Mechanical Ventilation in Acute Respiratory Distress Syndrome
This grant is made possible due to the philanthropic support from Eli Lilly and Company.

Community Service Grantees
Deborah Haisch, MD
Columbia University Medical Center – New York, NY
CHEST Foundation Community Service Grant Honoring D. Robert McCaffree, MD, Master FCCP
Grant Title: East African Training Initiative in Pulmonary and Critical Care Medicine

Pamela Garrett, CCRN, MN
Gwinnett Medical Center – Lawrenceville, GA
CHEST Foundation Community Service Grant Honoring D. Robert McCaffree, MD, Master FCCP
Grant Title: Breathe Better Gwinnett

Phillip Sheridan
Mobile Care Chicago – Chicago, IL
CHEST Foundation Community Service Grant Honoring D. Robert McCaffree, MD, Master FCCP
Grant Title: Home Environment Education for Children with Asthma

These grants are supported in full by the CHEST Foundation.

Research Grant Winners
Ayodeji Adegunsoye, MD, MS
Research Grant in Pulmonary Fibrosis
Grant Title: Impact of Telomere Length on Pulmonary Fibrosis Clusters Across Diverse Racial Cohorts

Justin Oldham, MD, MS
Research Grant in Pulmonary Fibrosis
Grant Title: Plasma Biomarkers to Predict Outcomes and Treatment Response in Patients with Pulmonary Fibrosis

These grants above are supported by Boehringer Ingelheim Pharmaceuticals, Inc and Genentech.

Jacob Brenner, MD, PhD
Research Grant in Chronic Obstructive Pulmonary Disease
Grant Title: Ambulatory Cuirass Ventilation for Relief of Exertional Dyspnea in Severe COPD Patients

William Zhang, MD
Research Grant in Chronic Obstructive Pulmonary Disease
Grant Title: Pulmonary Iron Overload as a Novel COPD Endotype

These grants above are supported by AstraZeneca LP and Sunovion Pharmaceuticals Inc.

Margaret Bublitz, PhD
CHEST Foundation Research Grant in Women’s Lung Health
Grant Title: Sex as a Predictor of Sleep-Disordered Breathing and Its Consequences in Pregnancy
This grant is supported in full by the CHEST Foundation.

Tim Morris, MD, FCCP
CHEST Foundation Research Grant in Venous Thromboembolism
Grant Title: Long-term Follow-up of Acute Pulmonary Embolism
This grant is supported in full by the CHEST Foundation.

Monica Mukherjee, MD, MPH
CHEST Foundation Research Grant in Pulmonary Arterial Hypertension
Grant Title: Exercise Provocation in the Noninvasive Detection of Occult Right Ventricular Dysfunction and Emerging Pulmonary Hypertension in Systemic Sclerosis
This grant is supported in full by the CHEST Foundation.

Don Sanders, MD, MS
CHEST Foundation Research Grant in Cystic Fibrosis
Grant Title: Whole-genome Shotgun Sequencing of Oropharyngeal Swabs in Infants With CF
This grant is supported by Vertex Pharmaceuticals.

Imran Sulaiman, MD, PhD
CHEST Foundation Research Grant in Nontuberculosis Mycobacteria Diseases
Grant Title: Lower Airway Microbiota Signatures Associated W ith Impaired Immune Response in Non-Tuberculous Mycobacterium
This grant is supported by Insmed.

Samira Shojaee, MD, MPH, FCCP
CHEST Foundation Research Grant in Lung Cancer
Grant Title: Extracellular Vesicle miRNA as a Biomarker in Malignant Pleural Effusion
This grant is supported in full by the CHEST Foundation.

Anna Volerman, MD
CHEST Foundation Research Grant in Severe Asthma
Grant Title: A Randomized Clinical Trial Evaluating the Effectiveness of Virtual Teach-to-Goal(TM) Education versus Brief Intervention for Children with Severe Asthma
This grant is supported by AstraZeneca LP.


ABSTRACT AND CASE REPORT WINNERS

Alfred Soffer Research Award Winners
Clauden Louis, MD: Left ventricular assist devices in Intermacs 1 acute cardiogenic shock patients

Babith J. Mankidy, MBBS, FCCP: Reduction in in-hospital cardiac arrest with early interventions in the emergency department and non-ICU units by a novel approach of rapid response teams and mobile ICU management

Young Investigator Award Winners
Fayez Kheir, MD, MSc: Intrapleural tissue plasminogen activator and deoxyribonuclease therapy vs early medical thoracoscopy for treatment of pleural infection: a randomized clinical trial

Michael Rosman, MD: The utility of end tidal CO2 (ETCO2) monitoring during in-hospital cardiac arrest to predict return of spontaneous circulation

Top 5 Abstract Poster Winners
Neha Agarwal, MD: The 3 wishes project: a feasible intervention to improve end of life care in the ICU at UCLA

Hiroaki Harada, MD: Usefulness of comprehensive preoperative pulmonary rehabilitation program including intensive nutritional support concomitant with physical exercise through an interdisciplinary team approach

Joseph M. Carrington, DO, MHA: Targeting the trans-IL-6 signaling pathway to reduce agriculture organic dust exposure-induced airway inflammation in mice

Yu Kuang Lai, MBBCh: The utility of parametric response mapping in pulmonary graft vs host disease following hematopoietic stem cell transplant

Top Abstract Poster Finalists
Ligia M. Puiu, MD, PhD, FCCP: Association between echocardiographic and lipid parameters to workers in the metalliferous mines

Kush R. Dholakia, MD: Colloids vs crystalloids for postoperative resuscitation in patients undergoing off-pump coronary artery bypass surgery

Kulothungan Gunasekaran, MD, MBBS: Risk of VTE in idiopathic pulmonary fibrosis: a systematic review

Laura B. Sutton, PharmD: Ease and correct use of Ellipta by age in patients with asthma and COPD

Ankur Mogla, MD: To assess the utilization of pulmonary function testing for perioperative respiratory complications in bariatric surgery patients

Ali Ammar: Tracheostomy and admission diagnosis as predictors for an extended length of stay (ELOS)

Charlene Kalani, PharmD: Efficacy and safety of direct oral anticoagulants (DOACS) in morbidly obese patients

Jonghoo Lee, MD: Performances of modified CRB-65 score compared to SIRS and QSOFA as a rapid screening tool for sepsis among infected patients in initial emergency department: a propensity score matching study

Frank J. Trudo, MD, FCCP: Clinical burden of eosinophilic COPD

Elise L. Stephenson, MD: Vitamin C and point of care glucose measurements: a retrospective, observational study

Faisal Siddiqi, MD: Implementation of an early mobility program in the medical ICU

Eileen Harder, MD: Connective tissue disease-associated pulmonary arterial hypertension hospitalizations from 2001-2014

Sophie Korzan, MD: Exhaled nitric oxide and asthma-COPD overlap in patients hospitalized with exacerbations of airway disease: preliminary observations

Andreas Grove, MD: MicroRNA (MIRNA) and biological markers discriminate between normotensive and prehypertensive young men in hypobaric hypoxic environments

Snigdha Nutalapati, MBBS: Large cell neuroendocrine cancer of the lung: SEER 2004-2014 analysis

Anubhav Jain, MBBS: Survival benefit of beta-blockers in patients hospitalized for acute exacerbation of COPD

Case Report Slide Winners
Ze Ying Tan: All that wheezes is not asthma

Jason Lam: Pulmonary mucor mycetoma

Adam Young: Nonresolving pneumonia and cyclic fevers in an immunocompetent patient

Ritu Modi: Histopathological misdiagnosis of pulmonary coccidiodes

Argun Can: A rare inborn error of fatty acid oxidation presenting with severe hyperammonemia in the ICU

Morgan Gilani: A colorful cause of cardiovascular collapse

Katie Jeans: A sweet surprise

Anthony Mattox: Unusual case of interstitial lung disease

Andrew Berglund: Pulmonary light chain deposition disease in a 29-year-old army soldier

Cristia Maysol Morales: A case report of a primary malignant melanoma of anterior mediastinum

Anthony McClafferty: Fibrosing mediastinitis and rheumatoid arthritis: an autoimmune inflammatory connection

Ahmed Munir: HIV with disseminated tularemia: a rare presentation Benjamin Garren: Mycobacterium avium complex mediastinal lymphadenitis in an immunocompetent adolescent with erosion into the airway

Robert Hilton: Obtunded with a chest mass: a case of a rare neurologic paraneoplastic syndrome,

Audra Schwalk: Mucoepidermoid carcinoma: a rare malignancy treated endobronchially

Jessica Riggs: Successful transplantation defies genetics: a case of rapidly-progressive pulmonary fibrosis due to Hermansky-Pudlak syndrome

Meghan Cirulis: Acute vasodilator testing: an opportunity to refine study design and provide precision care in pulmonary hypertension

Patrick Chan: VATS lobectomy for bronchial atresia in an adult

Andrew Mehlman: Multivessel coronary artery aneurysms presenting as myocardial ischemia

Scott Maughan: Diagnosing milliary Mycobacterium bovis from the prostate of an immunocompetent host

Adam Austin: Survived ECMO, death by BLASTO: the first reported fatal case of disseminated blastomycosis in pregnancy

Tie: Donnie Carter: Subclinical polycythemia vera presenting as extensive thrombosis due to massive transfusion, and

Lindsay Hammons: Rare case of Serratia pneumonia causing transient aplastic anemia

Paola Baskin: Novel observations during point-of-care ultrasound (POCUS) in cardiopulmonary resuscitation: a case of ultrasound-guided probe pressure to reduce esophageal insufflation during bag-valve-mask ventilator

David Dennis: Pulmonary alveolar proteinosis presenting as intracerebral nocardiosis

Rakin Choudhury: Severe asthma caused by therapy-resistant asthmatic granulomatosis

Andrew Lytle: Lung adenocarcinoma in a patient with Turcot syndrome

Chelsea Leipold: Case of a granulomatous-lymphocytic interstitial lung disease in a patient with common variable immunodeficiency disorder

Galyna Ivashchuk: Double trouble: ANCA vasculitis with concomitant IGA nephropathy presenting as massive diffuse alveolar hemorrhage and fulminant renal failure

Case Report Poster Winners
Christine Zhou: Role of transbronchial lung cryobiopsy in the diagnosis of adenocarcinoma in situ

Parin Shah: A rare case of Erdheim-Chester disease masquerading as metastatic lung cancer

Avanthika Wynn : A rare asthma mimic

Muhammad S. Ali: Severe pancolitis: a rare adverse effect of nintedanib

Brian Foster: Don’t forget to breathe: a case of hypoxemia after carotid body resection

Kelly Pennington: Intra-cardiac embolization of an inferior vena cava filter resulting in cardiac arrest

George Elkomos-Botros: Acute generalized exanthematous pustulosis presenting as distributive shock with multi-organ failure

Ashley M. Scott: Avian occupational hypersensitivity pneumonitis in a restaurant employee

Andrew Polito: Pulmonary amyloidosis: an unusual presentation of a rare disease


CHEST B-I-N-G-O WINNERS
Stella Ogake, MD
Erin E. Peterson, APRN, CNP
Megan J. Castillo, PA-C
Gretchen R. Winter, MD
Jeanette P. Brown, MD, PhD
Yu Hong Chan, MBBS
Anita Naik, DO
Gary A. Aaronson, DO, FCCP
Allison S. Cowl, MD
Kyle Halligan, MD
Palaniappan Muthappan, MD
Faizullah S. Lokhandwala, MBBS, FCCP
Jamie R. Chua, MD
Francis L. Ervin, MD, FCCP
Robyn Luper

CHEST CHALLENGE WINNER (AND RUNNER’S-UP)

Emory University (First Place)
Mirza Haider Ali, MD
Mohleen Kang, MD
Matthew Schimmel, MD

University of Michigan (Second Place)
Patrick Bradley, MD
Matthew Hensley, MD
Bonnie Wang, MD

Cleveland Clinic (Third Place)
Jorge Mirales-Estrella, MD
Apostolos Perelas, MD
Gretchen Winter, MD

2018 DISTINGUISHED CHEST EDUCATORS
Michael H Ackerman, DNSc
Sandra G Adams, MD, MS, FCCP
Doreen J Addrizzo-Harris, MD, FCCP
Cara Lyn Agerstrand, MD, BS
Jason A Akulian, MD, FCCP
Raed H Alalawi, MD, FCCP
A. Christine Argento, MD, FCCP
Robert Arntfield, MD, FCCP
Alex A Balekian, MD
Meyer S Balter, MD, FCCP
Gisela I Banauch, MD, MS, FCCP
Robert P Baughman, MD, FCCP
David G Bell, MD, FCCP
Michel A Boivin, MD, FCCP
Gabriel T Bosslet, MD, FCCP
Jean Bourbeau, MD, MS, FCCP
Ghada R Bourjeily, MD, FCCP
David L Bowton, MD, FCCM
Jack D Buckley, MD, MPH, FCCP
Marie M Budev, DO, MPH, FCCP
Kristin M Burkart, MD, MS, FCCP
Brian Carlin, MD, FCCP
Christopher L Carroll, MD, FCCP
Roberto F Casal, MD
Kevin M Chan, MD, FCCP
Subani Chandra, MD, FCCP
Ching-Fei Chang, MD
Alexander C Chen, MD
Nancy A Collop, MD, FCCP
Clayton T Cowl, MD, MS, FCCP
Angel O Coz Yataco, MD, FCCP
Gerard J Criner, MD, FCCP
Carolyn M D’Ambrosio, MD, FCCP
Mauricio Danckers, MD, FCCP
Aneesa M Das, MD, FCCP
John Davies, RRT, MA, FCCP
Zachary S DePew, MD, FCCP
Frank C Detterbeck, MD, FCCP
Naresh A. Dewan, MBBS, FCCP
Kevin C Doerschug, MD, MS, FCCP
Meagan Dubosky, RRT-ACCS
Kevin M Dushay, MD, FCCP
Eric S Edell, MD, FCCP
Jean M Elwing, MD, FCCP
William Enfinger
Michael E Ezzie, MD, FCCP
Kevin J Felner, MD, FCCP
Mark E Fenton, MD, MSc, FCCP
Jason Filopei, MD
Neil S Freedman, MD, FCCP
Laura Kathleen Frye, MD
Thomas M Fuhrman, MD, MS, FCCP
John P Gaillard, MD, FCCP
Colin T Gillespie, MD
Yonatan Y Greenstein, MD
Maritza L Groth, MD, FCCP
Keith P Guevarra, DO, FCCP
Jesse B Hall, MD, FCCP
Nicola A Hanania, MD, MBBS, FCCP
D Kyle Hogarth, MD, FCCP
Steven M Hollenberg, MD, FCCP
David W Hsia, MD, FCCP
Candace A Huebert, MD, FCCP
Robert C Hyzy, MD, FCCP
Octavian C Ioachimescu, MD, PhD, FCCP
Richard S Irwin, MD, Master FCCP
Kirk D Jones, MD
Nader Kamangar, MD, MS, FCCP
Carl A Kaplan, MD, FCCP
Brian S Kaufman, MD, FCCP
William F Kelly, MD, FCCP
Marcus P Kennedy, MD, FCCP
Sandhya Khurana, MD, FCCP
James R Klinger, MD, FCCP
Seth J Koenig, MD, FCCP
Lindsey Kreisher, RRT
Karol Kremens, MD, FCCP
Patricia A Kritek, MD, FCCP
Sunita Kumar, MD, MBBS, FCCP
Rudy P Lackner, MD, FCCP
Viera Lakticova, MD
Carla R Lamb, MD, FCCP
Hans J Lee, MD, FCCP
Peter H Lenz, MD, MEd, FCCP
Stephanie M Levine, MD, FCCP
Deborah Jo Levine, MD, MS, FCCP
Andrea Loiselle, MD
Kenneth E Lyn-Kew, MD
Michael S Machuzak, MD, FCCP
Neil R MacIntyre, MD, FCCP
Donald A Mahler, MD, FCCP
Fabien Maldonado, MD, FCCP
Atul Malhotra, MD, FCCP
Darcy D Marciniuk, MD, FCCP
Diego J Maselli Caceres, MD, FCCP
Paul H Mayo, MD, FCCP
Peter J Mazzone, MD, MPH, FCCP
John K McIlwaine, DO, MBA, FCCP
Matthew C Miles, MD, FCCP
Scott Millington, MD
Taro Minami, MD, FCCP
Lisa K Moores, MD, FCCP
Amy E Morris, MD, FCCP
John J Mullon, MD, FCCP
Septimiu D Murgu, MD, FCCP
Mangala Narasimhan, DO, FCCP
Michael S Niederman, MD, FCCP
Alexander S Niven, MD, FCCP
Anne E O’Donnell, MD, FCCP
Erik C Osborn, MD
David E Ost, MD, MPH, FCCP
Ronald J Oudiz, MD, FCCP
Daniel R Ouellette, MD, MS, FCCP
Amit D Parulekar, MD, MS, FCCP
Nicholas J Pastis, MD, FCCP
Nina M Patel, MD, FCCP
Paru S Patrawalla, MD, FCCP
Jay I Peters, MD, FCCP
Barbara A Phillips, MD, MSPH, FCCP
Margaret A Pisani, MD, MS, FCCP
Janos Porszasz, MD, PhD
Whitney S Prince, MD, FCCP
Suhail Raoof, MBBS, Master FCCP
Ruben D Restrepo, RRT, FCCP
Marcos I Restrepo, MD, PhD, FCCP
Otis B Rickman, DO, FCCP
Roy D Ridgeway
Mary Ried, RN, CCRN
Linda Rogers, MD, FCCP
Mark J Rosen, MD, Master FCCP
Bernard J Roth, MD, FCCP
Ashutosh Sachdeva, MBBS, FCCP
Anthony G Saleh, MD, FCCP
Juan F Sanchez, MD, FCCP
Pralay K Sarkar, MBBS, FCCP
Lewis G Satterwhite, MD, BA, FCCP
Gregory A Schmidt, MD, FCCP
Mary Beth Scholand, MD, FCCP
David A Schulman, MD, MPH, FCCP
Brady Scott, RRT, MS, FCCP
Bernardo Selim, MD, FCCP
Curtis N Sessler, MD, FCCP
Rakesh D Shah, MD, FCCP
Ray Wes Shepherd, MD, FCCP
John H Sherner, MD, FCCP
Ariel L Shiloh, MD
Samira Shojaee, MD, FCCP
Marcos Silva Restrepo
Gerard A Silvestri, MD, MS, FCCP
Steven Q Simpson, MD, FCCP
James K Stoller, MD, MS, FCCP
Charlie Strange, MD, FCCP
Mary E Strek, MD, FCCP
William W Stringer, MD, FCCP
Eleanor M Summerhill, MD, FCCP
Maximiliano A Tamae Kakazu, MD, FCCP
Nichole T Tanner, MD, MS, FCCP
Lynn T Tanoue, MD, FCCP
Victor J Test, MD, FCCP
Arthur J Tokarczyk, MD, FCCP
Alain Tremblay, MD, FCCP
Adey Tsegaye, MD, FCCP
Anil Vachani, MD, FCCP
Momen M Wahidi, MD, MBA, FCCP
Keith M Wille, MD, FCCP
Lisa F Wolfe, MD
Richard G Wunderink, MD, FCCP
Lonny B Yarmus, DO, FCCP
Kazuhiro Yasufuku, MD, PhD, FCCP
Gulrukh Zaidi, MD, FCCP
David Zielinski, MD, FCCP

Everyone who attended CHEST Annual Meeting 2018 is a winner, but we would like to call out the winners participating in CHEST’s special categories of awards and events. Congratulations to all!

ANNUAL CHEST AWARDS

Master FCCP
David Gutterman, MD, Master FCCP

Distinguished Service Award
David Gutterman, MD, Master FCCP

College Medalist Award
Ghada Bourjeily, MD, FCCP

Master Clinician Educator
Lisa Moores, MD, FCCP

Early Career Clinician Educator
Amy Morris, MD, FCCP

Alfred Soffer Award for Editorial Excellence
Jean Rice

Presidential Citation
Darcy Marciniuk, MD, FCCP

Presidential Citation
D. Robert McCaffree, MD, Master FCCP

HONOR LECTURES AND MEMORIAL AWARDS

Edward C. Rosenow III, MD, Master FCCP/Master Teacher Honor Lecture Accelerated Aging in COPD and Its Comorbidities: Novel Therapeutic Targets
Peter Barnes, MD, Master FCCP
The lecture is generously funded by the CHEST Foundation.

Distinguished Scientist Honor Lecture in Cardiopulmonary Physiology
Understanding Diaphragm Performance: The Role of Ultrasound
F. Dennis McCool, MD, FCCP
The lecture is generously funded by the CHEST Foundation.

Presidential Honor Lecture
Asthma: Past, Present, and Future
Jay Peters, MD, FCCP

Thomas L. Petty, MD, Master FCCP Memorial Lecture
Recent Developments in Pulmonary Rehabilitation and Long-Term Oxygen Therapy: Would Tom Petty be Pleased?
Richard Casaburi, MD, PhD, FCCP
The lecture is generously funded by the CHEST Foundation.

Margaret Pfrommer Memorial Lecture in Long-term Mechanical Ventilation
Saving Lives…One Ventilator at a Time - HMV in 2018 and Beyond
Douglas McKim, MD, FCCP
The Margaret Pfrommer Memorial Lecture in Long-term 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 Medicine
Evolution of Endobronchial Ultrasound: From Diagnostics to Therapeutics
Kazuhiro Yasufuku, MD, PhD, FCCP
The lecture is generously funded by the CHEST Foundation.

Roger C. Bone Memorial Lecture in Critical Care
Methylprednisolone in ARDS: A Highly Effective Treatment. How it Works, How to Use it
G. Umberto Meduri, MD
The lecture is generously funded by the CHEST Foundation.
 

CHEST FOUNDATION GRANT WINNERS

Distinguished Scholar
Robert C. Hyzy, MD, FCCP
Eli Lilly and Company Distinguished Scholar in Critical Care MedicineGrant Title: The Use of Electrical Impedance Tomography to Assess Mechanical Ventilation in Acute Respiratory Distress Syndrome
This grant is made possible due to the philanthropic support from Eli Lilly and Company.

Community Service Grantees
Deborah Haisch, MD
Columbia University Medical Center – New York, NY
CHEST Foundation Community Service Grant Honoring D. Robert McCaffree, MD, Master FCCP
Grant Title: East African Training Initiative in Pulmonary and Critical Care Medicine

Pamela Garrett, CCRN, MN
Gwinnett Medical Center – Lawrenceville, GA
CHEST Foundation Community Service Grant Honoring D. Robert McCaffree, MD, Master FCCP
Grant Title: Breathe Better Gwinnett

Phillip Sheridan
Mobile Care Chicago – Chicago, IL
CHEST Foundation Community Service Grant Honoring D. Robert McCaffree, MD, Master FCCP
Grant Title: Home Environment Education for Children with Asthma

These grants are supported in full by the CHEST Foundation.

Research Grant Winners
Ayodeji Adegunsoye, MD, MS
Research Grant in Pulmonary Fibrosis
Grant Title: Impact of Telomere Length on Pulmonary Fibrosis Clusters Across Diverse Racial Cohorts

Justin Oldham, MD, MS
Research Grant in Pulmonary Fibrosis
Grant Title: Plasma Biomarkers to Predict Outcomes and Treatment Response in Patients with Pulmonary Fibrosis

These grants above are supported by Boehringer Ingelheim Pharmaceuticals, Inc and Genentech.

Jacob Brenner, MD, PhD
Research Grant in Chronic Obstructive Pulmonary Disease
Grant Title: Ambulatory Cuirass Ventilation for Relief of Exertional Dyspnea in Severe COPD Patients

William Zhang, MD
Research Grant in Chronic Obstructive Pulmonary Disease
Grant Title: Pulmonary Iron Overload as a Novel COPD Endotype

These grants above are supported by AstraZeneca LP and Sunovion Pharmaceuticals Inc.

Margaret Bublitz, PhD
CHEST Foundation Research Grant in Women’s Lung Health
Grant Title: Sex as a Predictor of Sleep-Disordered Breathing and Its Consequences in Pregnancy
This grant is supported in full by the CHEST Foundation.

Tim Morris, MD, FCCP
CHEST Foundation Research Grant in Venous Thromboembolism
Grant Title: Long-term Follow-up of Acute Pulmonary Embolism
This grant is supported in full by the CHEST Foundation.

Monica Mukherjee, MD, MPH
CHEST Foundation Research Grant in Pulmonary Arterial Hypertension
Grant Title: Exercise Provocation in the Noninvasive Detection of Occult Right Ventricular Dysfunction and Emerging Pulmonary Hypertension in Systemic Sclerosis
This grant is supported in full by the CHEST Foundation.

Don Sanders, MD, MS
CHEST Foundation Research Grant in Cystic Fibrosis
Grant Title: Whole-genome Shotgun Sequencing of Oropharyngeal Swabs in Infants With CF
This grant is supported by Vertex Pharmaceuticals.

Imran Sulaiman, MD, PhD
CHEST Foundation Research Grant in Nontuberculosis Mycobacteria Diseases
Grant Title: Lower Airway Microbiota Signatures Associated W ith Impaired Immune Response in Non-Tuberculous Mycobacterium
This grant is supported by Insmed.

Samira Shojaee, MD, MPH, FCCP
CHEST Foundation Research Grant in Lung Cancer
Grant Title: Extracellular Vesicle miRNA as a Biomarker in Malignant Pleural Effusion
This grant is supported in full by the CHEST Foundation.

Anna Volerman, MD
CHEST Foundation Research Grant in Severe Asthma
Grant Title: A Randomized Clinical Trial Evaluating the Effectiveness of Virtual Teach-to-Goal(TM) Education versus Brief Intervention for Children with Severe Asthma
This grant is supported by AstraZeneca LP.


ABSTRACT AND CASE REPORT WINNERS

Alfred Soffer Research Award Winners
Clauden Louis, MD: Left ventricular assist devices in Intermacs 1 acute cardiogenic shock patients

Babith J. Mankidy, MBBS, FCCP: Reduction in in-hospital cardiac arrest with early interventions in the emergency department and non-ICU units by a novel approach of rapid response teams and mobile ICU management

Young Investigator Award Winners
Fayez Kheir, MD, MSc: Intrapleural tissue plasminogen activator and deoxyribonuclease therapy vs early medical thoracoscopy for treatment of pleural infection: a randomized clinical trial

Michael Rosman, MD: The utility of end tidal CO2 (ETCO2) monitoring during in-hospital cardiac arrest to predict return of spontaneous circulation

Top 5 Abstract Poster Winners
Neha Agarwal, MD: The 3 wishes project: a feasible intervention to improve end of life care in the ICU at UCLA

Hiroaki Harada, MD: Usefulness of comprehensive preoperative pulmonary rehabilitation program including intensive nutritional support concomitant with physical exercise through an interdisciplinary team approach

Joseph M. Carrington, DO, MHA: Targeting the trans-IL-6 signaling pathway to reduce agriculture organic dust exposure-induced airway inflammation in mice

Yu Kuang Lai, MBBCh: The utility of parametric response mapping in pulmonary graft vs host disease following hematopoietic stem cell transplant

Top Abstract Poster Finalists
Ligia M. Puiu, MD, PhD, FCCP: Association between echocardiographic and lipid parameters to workers in the metalliferous mines

Kush R. Dholakia, MD: Colloids vs crystalloids for postoperative resuscitation in patients undergoing off-pump coronary artery bypass surgery

Kulothungan Gunasekaran, MD, MBBS: Risk of VTE in idiopathic pulmonary fibrosis: a systematic review

Laura B. Sutton, PharmD: Ease and correct use of Ellipta by age in patients with asthma and COPD

Ankur Mogla, MD: To assess the utilization of pulmonary function testing for perioperative respiratory complications in bariatric surgery patients

Ali Ammar: Tracheostomy and admission diagnosis as predictors for an extended length of stay (ELOS)

Charlene Kalani, PharmD: Efficacy and safety of direct oral anticoagulants (DOACS) in morbidly obese patients

Jonghoo Lee, MD: Performances of modified CRB-65 score compared to SIRS and QSOFA as a rapid screening tool for sepsis among infected patients in initial emergency department: a propensity score matching study

Frank J. Trudo, MD, FCCP: Clinical burden of eosinophilic COPD

Elise L. Stephenson, MD: Vitamin C and point of care glucose measurements: a retrospective, observational study

Faisal Siddiqi, MD: Implementation of an early mobility program in the medical ICU

Eileen Harder, MD: Connective tissue disease-associated pulmonary arterial hypertension hospitalizations from 2001-2014

Sophie Korzan, MD: Exhaled nitric oxide and asthma-COPD overlap in patients hospitalized with exacerbations of airway disease: preliminary observations

Andreas Grove, MD: MicroRNA (MIRNA) and biological markers discriminate between normotensive and prehypertensive young men in hypobaric hypoxic environments

Snigdha Nutalapati, MBBS: Large cell neuroendocrine cancer of the lung: SEER 2004-2014 analysis

Anubhav Jain, MBBS: Survival benefit of beta-blockers in patients hospitalized for acute exacerbation of COPD

Case Report Slide Winners
Ze Ying Tan: All that wheezes is not asthma

Jason Lam: Pulmonary mucor mycetoma

Adam Young: Nonresolving pneumonia and cyclic fevers in an immunocompetent patient

Ritu Modi: Histopathological misdiagnosis of pulmonary coccidiodes

Argun Can: A rare inborn error of fatty acid oxidation presenting with severe hyperammonemia in the ICU

Morgan Gilani: A colorful cause of cardiovascular collapse

Katie Jeans: A sweet surprise

Anthony Mattox: Unusual case of interstitial lung disease

Andrew Berglund: Pulmonary light chain deposition disease in a 29-year-old army soldier

Cristia Maysol Morales: A case report of a primary malignant melanoma of anterior mediastinum

Anthony McClafferty: Fibrosing mediastinitis and rheumatoid arthritis: an autoimmune inflammatory connection

Ahmed Munir: HIV with disseminated tularemia: a rare presentation Benjamin Garren: Mycobacterium avium complex mediastinal lymphadenitis in an immunocompetent adolescent with erosion into the airway

Robert Hilton: Obtunded with a chest mass: a case of a rare neurologic paraneoplastic syndrome,

Audra Schwalk: Mucoepidermoid carcinoma: a rare malignancy treated endobronchially

Jessica Riggs: Successful transplantation defies genetics: a case of rapidly-progressive pulmonary fibrosis due to Hermansky-Pudlak syndrome

Meghan Cirulis: Acute vasodilator testing: an opportunity to refine study design and provide precision care in pulmonary hypertension

Patrick Chan: VATS lobectomy for bronchial atresia in an adult

Andrew Mehlman: Multivessel coronary artery aneurysms presenting as myocardial ischemia

Scott Maughan: Diagnosing milliary Mycobacterium bovis from the prostate of an immunocompetent host

Adam Austin: Survived ECMO, death by BLASTO: the first reported fatal case of disseminated blastomycosis in pregnancy

Tie: Donnie Carter: Subclinical polycythemia vera presenting as extensive thrombosis due to massive transfusion, and

Lindsay Hammons: Rare case of Serratia pneumonia causing transient aplastic anemia

Paola Baskin: Novel observations during point-of-care ultrasound (POCUS) in cardiopulmonary resuscitation: a case of ultrasound-guided probe pressure to reduce esophageal insufflation during bag-valve-mask ventilator

David Dennis: Pulmonary alveolar proteinosis presenting as intracerebral nocardiosis

Rakin Choudhury: Severe asthma caused by therapy-resistant asthmatic granulomatosis

Andrew Lytle: Lung adenocarcinoma in a patient with Turcot syndrome

Chelsea Leipold: Case of a granulomatous-lymphocytic interstitial lung disease in a patient with common variable immunodeficiency disorder

Galyna Ivashchuk: Double trouble: ANCA vasculitis with concomitant IGA nephropathy presenting as massive diffuse alveolar hemorrhage and fulminant renal failure

Case Report Poster Winners
Christine Zhou: Role of transbronchial lung cryobiopsy in the diagnosis of adenocarcinoma in situ

Parin Shah: A rare case of Erdheim-Chester disease masquerading as metastatic lung cancer

Avanthika Wynn : A rare asthma mimic

Muhammad S. Ali: Severe pancolitis: a rare adverse effect of nintedanib

Brian Foster: Don’t forget to breathe: a case of hypoxemia after carotid body resection

Kelly Pennington: Intra-cardiac embolization of an inferior vena cava filter resulting in cardiac arrest

George Elkomos-Botros: Acute generalized exanthematous pustulosis presenting as distributive shock with multi-organ failure

Ashley M. Scott: Avian occupational hypersensitivity pneumonitis in a restaurant employee

Andrew Polito: Pulmonary amyloidosis: an unusual presentation of a rare disease


CHEST B-I-N-G-O WINNERS
Stella Ogake, MD
Erin E. Peterson, APRN, CNP
Megan J. Castillo, PA-C
Gretchen R. Winter, MD
Jeanette P. Brown, MD, PhD
Yu Hong Chan, MBBS
Anita Naik, DO
Gary A. Aaronson, DO, FCCP
Allison S. Cowl, MD
Kyle Halligan, MD
Palaniappan Muthappan, MD
Faizullah S. Lokhandwala, MBBS, FCCP
Jamie R. Chua, MD
Francis L. Ervin, MD, FCCP
Robyn Luper

CHEST CHALLENGE WINNER (AND RUNNER’S-UP)

Emory University (First Place)
Mirza Haider Ali, MD
Mohleen Kang, MD
Matthew Schimmel, MD

University of Michigan (Second Place)
Patrick Bradley, MD
Matthew Hensley, MD
Bonnie Wang, MD

Cleveland Clinic (Third Place)
Jorge Mirales-Estrella, MD
Apostolos Perelas, MD
Gretchen Winter, MD

2018 DISTINGUISHED CHEST EDUCATORS
Michael H Ackerman, DNSc
Sandra G Adams, MD, MS, FCCP
Doreen J Addrizzo-Harris, MD, FCCP
Cara Lyn Agerstrand, MD, BS
Jason A Akulian, MD, FCCP
Raed H Alalawi, MD, FCCP
A. Christine Argento, MD, FCCP
Robert Arntfield, MD, FCCP
Alex A Balekian, MD
Meyer S Balter, MD, FCCP
Gisela I Banauch, MD, MS, FCCP
Robert P Baughman, MD, FCCP
David G Bell, MD, FCCP
Michel A Boivin, MD, FCCP
Gabriel T Bosslet, MD, FCCP
Jean Bourbeau, MD, MS, FCCP
Ghada R Bourjeily, MD, FCCP
David L Bowton, MD, FCCM
Jack D Buckley, MD, MPH, FCCP
Marie M Budev, DO, MPH, FCCP
Kristin M Burkart, MD, MS, FCCP
Brian Carlin, MD, FCCP
Christopher L Carroll, MD, FCCP
Roberto F Casal, MD
Kevin M Chan, MD, FCCP
Subani Chandra, MD, FCCP
Ching-Fei Chang, MD
Alexander C Chen, MD
Nancy A Collop, MD, FCCP
Clayton T Cowl, MD, MS, FCCP
Angel O Coz Yataco, MD, FCCP
Gerard J Criner, MD, FCCP
Carolyn M D’Ambrosio, MD, FCCP
Mauricio Danckers, MD, FCCP
Aneesa M Das, MD, FCCP
John Davies, RRT, MA, FCCP
Zachary S DePew, MD, FCCP
Frank C Detterbeck, MD, FCCP
Naresh A. Dewan, MBBS, FCCP
Kevin C Doerschug, MD, MS, FCCP
Meagan Dubosky, RRT-ACCS
Kevin M Dushay, MD, FCCP
Eric S Edell, MD, FCCP
Jean M Elwing, MD, FCCP
William Enfinger
Michael E Ezzie, MD, FCCP
Kevin J Felner, MD, FCCP
Mark E Fenton, MD, MSc, FCCP
Jason Filopei, MD
Neil S Freedman, MD, FCCP
Laura Kathleen Frye, MD
Thomas M Fuhrman, MD, MS, FCCP
John P Gaillard, MD, FCCP
Colin T Gillespie, MD
Yonatan Y Greenstein, MD
Maritza L Groth, MD, FCCP
Keith P Guevarra, DO, FCCP
Jesse B Hall, MD, FCCP
Nicola A Hanania, MD, MBBS, FCCP
D Kyle Hogarth, MD, FCCP
Steven M Hollenberg, MD, FCCP
David W Hsia, MD, FCCP
Candace A Huebert, MD, FCCP
Robert C Hyzy, MD, FCCP
Octavian C Ioachimescu, MD, PhD, FCCP
Richard S Irwin, MD, Master FCCP
Kirk D Jones, MD
Nader Kamangar, MD, MS, FCCP
Carl A Kaplan, MD, FCCP
Brian S Kaufman, MD, FCCP
William F Kelly, MD, FCCP
Marcus P Kennedy, MD, FCCP
Sandhya Khurana, MD, FCCP
James R Klinger, MD, FCCP
Seth J Koenig, MD, FCCP
Lindsey Kreisher, RRT
Karol Kremens, MD, FCCP
Patricia A Kritek, MD, FCCP
Sunita Kumar, MD, MBBS, FCCP
Rudy P Lackner, MD, FCCP
Viera Lakticova, MD
Carla R Lamb, MD, FCCP
Hans J Lee, MD, FCCP
Peter H Lenz, MD, MEd, FCCP
Stephanie M Levine, MD, FCCP
Deborah Jo Levine, MD, MS, FCCP
Andrea Loiselle, MD
Kenneth E Lyn-Kew, MD
Michael S Machuzak, MD, FCCP
Neil R MacIntyre, MD, FCCP
Donald A Mahler, MD, FCCP
Fabien Maldonado, MD, FCCP
Atul Malhotra, MD, FCCP
Darcy D Marciniuk, MD, FCCP
Diego J Maselli Caceres, MD, FCCP
Paul H Mayo, MD, FCCP
Peter J Mazzone, MD, MPH, FCCP
John K McIlwaine, DO, MBA, FCCP
Matthew C Miles, MD, FCCP
Scott Millington, MD
Taro Minami, MD, FCCP
Lisa K Moores, MD, FCCP
Amy E Morris, MD, FCCP
John J Mullon, MD, FCCP
Septimiu D Murgu, MD, FCCP
Mangala Narasimhan, DO, FCCP
Michael S Niederman, MD, FCCP
Alexander S Niven, MD, FCCP
Anne E O’Donnell, MD, FCCP
Erik C Osborn, MD
David E Ost, MD, MPH, FCCP
Ronald J Oudiz, MD, FCCP
Daniel R Ouellette, MD, MS, FCCP
Amit D Parulekar, MD, MS, FCCP
Nicholas J Pastis, MD, FCCP
Nina M Patel, MD, FCCP
Paru S Patrawalla, MD, FCCP
Jay I Peters, MD, FCCP
Barbara A Phillips, MD, MSPH, FCCP
Margaret A Pisani, MD, MS, FCCP
Janos Porszasz, MD, PhD
Whitney S Prince, MD, FCCP
Suhail Raoof, MBBS, Master FCCP
Ruben D Restrepo, RRT, FCCP
Marcos I Restrepo, MD, PhD, FCCP
Otis B Rickman, DO, FCCP
Roy D Ridgeway
Mary Ried, RN, CCRN
Linda Rogers, MD, FCCP
Mark J Rosen, MD, Master FCCP
Bernard J Roth, MD, FCCP
Ashutosh Sachdeva, MBBS, FCCP
Anthony G Saleh, MD, FCCP
Juan F Sanchez, MD, FCCP
Pralay K Sarkar, MBBS, FCCP
Lewis G Satterwhite, MD, BA, FCCP
Gregory A Schmidt, MD, FCCP
Mary Beth Scholand, MD, FCCP
David A Schulman, MD, MPH, FCCP
Brady Scott, RRT, MS, FCCP
Bernardo Selim, MD, FCCP
Curtis N Sessler, MD, FCCP
Rakesh D Shah, MD, FCCP
Ray Wes Shepherd, MD, FCCP
John H Sherner, MD, FCCP
Ariel L Shiloh, MD
Samira Shojaee, MD, FCCP
Marcos Silva Restrepo
Gerard A Silvestri, MD, MS, FCCP
Steven Q Simpson, MD, FCCP
James K Stoller, MD, MS, FCCP
Charlie Strange, MD, FCCP
Mary E Strek, MD, FCCP
William W Stringer, MD, FCCP
Eleanor M Summerhill, MD, FCCP
Maximiliano A Tamae Kakazu, MD, FCCP
Nichole T Tanner, MD, MS, FCCP
Lynn T Tanoue, MD, FCCP
Victor J Test, MD, FCCP
Arthur J Tokarczyk, MD, FCCP
Alain Tremblay, MD, FCCP
Adey Tsegaye, MD, FCCP
Anil Vachani, MD, FCCP
Momen M Wahidi, MD, MBA, FCCP
Keith M Wille, MD, FCCP
Lisa F Wolfe, MD
Richard G Wunderink, MD, FCCP
Lonny B Yarmus, DO, FCCP
Kazuhiro Yasufuku, MD, PhD, FCCP
Gulrukh Zaidi, MD, FCCP
David Zielinski, MD, FCCP

Everyone who attended CHEST Annual Meeting 2018 is a winner, but we would like to call out the winners participating in CHEST’s special categories of awards and events. Congratulations to all!

ANNUAL CHEST AWARDS

Master FCCP
David Gutterman, MD, Master FCCP

Distinguished Service Award
David Gutterman, MD, Master FCCP

College Medalist Award
Ghada Bourjeily, MD, FCCP

Master Clinician Educator
Lisa Moores, MD, FCCP

Early Career Clinician Educator
Amy Morris, MD, FCCP

Alfred Soffer Award for Editorial Excellence
Jean Rice

Presidential Citation
Darcy Marciniuk, MD, FCCP

Presidential Citation
D. Robert McCaffree, MD, Master FCCP

HONOR LECTURES AND MEMORIAL AWARDS

Edward C. Rosenow III, MD, Master FCCP/Master Teacher Honor Lecture Accelerated Aging in COPD and Its Comorbidities: Novel Therapeutic Targets
Peter Barnes, MD, Master FCCP
The lecture is generously funded by the CHEST Foundation.

Distinguished Scientist Honor Lecture in Cardiopulmonary Physiology
Understanding Diaphragm Performance: The Role of Ultrasound
F. Dennis McCool, MD, FCCP
The lecture is generously funded by the CHEST Foundation.

Presidential Honor Lecture
Asthma: Past, Present, and Future
Jay Peters, MD, FCCP

Thomas L. Petty, MD, Master FCCP Memorial Lecture
Recent Developments in Pulmonary Rehabilitation and Long-Term Oxygen Therapy: Would Tom Petty be Pleased?
Richard Casaburi, MD, PhD, FCCP
The lecture is generously funded by the CHEST Foundation.

Margaret Pfrommer Memorial Lecture in Long-term Mechanical Ventilation
Saving Lives…One Ventilator at a Time - HMV in 2018 and Beyond
Douglas McKim, MD, FCCP
The Margaret Pfrommer Memorial Lecture in Long-term 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 Medicine
Evolution of Endobronchial Ultrasound: From Diagnostics to Therapeutics
Kazuhiro Yasufuku, MD, PhD, FCCP
The lecture is generously funded by the CHEST Foundation.

Roger C. Bone Memorial Lecture in Critical Care
Methylprednisolone in ARDS: A Highly Effective Treatment. How it Works, How to Use it
G. Umberto Meduri, MD
The lecture is generously funded by the CHEST Foundation.
 

CHEST FOUNDATION GRANT WINNERS

Distinguished Scholar
Robert C. Hyzy, MD, FCCP
Eli Lilly and Company Distinguished Scholar in Critical Care MedicineGrant Title: The Use of Electrical Impedance Tomography to Assess Mechanical Ventilation in Acute Respiratory Distress Syndrome
This grant is made possible due to the philanthropic support from Eli Lilly and Company.

Community Service Grantees
Deborah Haisch, MD
Columbia University Medical Center – New York, NY
CHEST Foundation Community Service Grant Honoring D. Robert McCaffree, MD, Master FCCP
Grant Title: East African Training Initiative in Pulmonary and Critical Care Medicine

Pamela Garrett, CCRN, MN
Gwinnett Medical Center – Lawrenceville, GA
CHEST Foundation Community Service Grant Honoring D. Robert McCaffree, MD, Master FCCP
Grant Title: Breathe Better Gwinnett

Phillip Sheridan
Mobile Care Chicago – Chicago, IL
CHEST Foundation Community Service Grant Honoring D. Robert McCaffree, MD, Master FCCP
Grant Title: Home Environment Education for Children with Asthma

These grants are supported in full by the CHEST Foundation.

Research Grant Winners
Ayodeji Adegunsoye, MD, MS
Research Grant in Pulmonary Fibrosis
Grant Title: Impact of Telomere Length on Pulmonary Fibrosis Clusters Across Diverse Racial Cohorts

Justin Oldham, MD, MS
Research Grant in Pulmonary Fibrosis
Grant Title: Plasma Biomarkers to Predict Outcomes and Treatment Response in Patients with Pulmonary Fibrosis

These grants above are supported by Boehringer Ingelheim Pharmaceuticals, Inc and Genentech.

Jacob Brenner, MD, PhD
Research Grant in Chronic Obstructive Pulmonary Disease
Grant Title: Ambulatory Cuirass Ventilation for Relief of Exertional Dyspnea in Severe COPD Patients

William Zhang, MD
Research Grant in Chronic Obstructive Pulmonary Disease
Grant Title: Pulmonary Iron Overload as a Novel COPD Endotype

These grants above are supported by AstraZeneca LP and Sunovion Pharmaceuticals Inc.

Margaret Bublitz, PhD
CHEST Foundation Research Grant in Women’s Lung Health
Grant Title: Sex as a Predictor of Sleep-Disordered Breathing and Its Consequences in Pregnancy
This grant is supported in full by the CHEST Foundation.

Tim Morris, MD, FCCP
CHEST Foundation Research Grant in Venous Thromboembolism
Grant Title: Long-term Follow-up of Acute Pulmonary Embolism
This grant is supported in full by the CHEST Foundation.

Monica Mukherjee, MD, MPH
CHEST Foundation Research Grant in Pulmonary Arterial Hypertension
Grant Title: Exercise Provocation in the Noninvasive Detection of Occult Right Ventricular Dysfunction and Emerging Pulmonary Hypertension in Systemic Sclerosis
This grant is supported in full by the CHEST Foundation.

Don Sanders, MD, MS
CHEST Foundation Research Grant in Cystic Fibrosis
Grant Title: Whole-genome Shotgun Sequencing of Oropharyngeal Swabs in Infants With CF
This grant is supported by Vertex Pharmaceuticals.

Imran Sulaiman, MD, PhD
CHEST Foundation Research Grant in Nontuberculosis Mycobacteria Diseases
Grant Title: Lower Airway Microbiota Signatures Associated W ith Impaired Immune Response in Non-Tuberculous Mycobacterium
This grant is supported by Insmed.

Samira Shojaee, MD, MPH, FCCP
CHEST Foundation Research Grant in Lung Cancer
Grant Title: Extracellular Vesicle miRNA as a Biomarker in Malignant Pleural Effusion
This grant is supported in full by the CHEST Foundation.

Anna Volerman, MD
CHEST Foundation Research Grant in Severe Asthma
Grant Title: A Randomized Clinical Trial Evaluating the Effectiveness of Virtual Teach-to-Goal(TM) Education versus Brief Intervention for Children with Severe Asthma
This grant is supported by AstraZeneca LP.


ABSTRACT AND CASE REPORT WINNERS

Alfred Soffer Research Award Winners
Clauden Louis, MD: Left ventricular assist devices in Intermacs 1 acute cardiogenic shock patients

Babith J. Mankidy, MBBS, FCCP: Reduction in in-hospital cardiac arrest with early interventions in the emergency department and non-ICU units by a novel approach of rapid response teams and mobile ICU management

Young Investigator Award Winners
Fayez Kheir, MD, MSc: Intrapleural tissue plasminogen activator and deoxyribonuclease therapy vs early medical thoracoscopy for treatment of pleural infection: a randomized clinical trial

Michael Rosman, MD: The utility of end tidal CO2 (ETCO2) monitoring during in-hospital cardiac arrest to predict return of spontaneous circulation

Top 5 Abstract Poster Winners
Neha Agarwal, MD: The 3 wishes project: a feasible intervention to improve end of life care in the ICU at UCLA

Hiroaki Harada, MD: Usefulness of comprehensive preoperative pulmonary rehabilitation program including intensive nutritional support concomitant with physical exercise through an interdisciplinary team approach

Joseph M. Carrington, DO, MHA: Targeting the trans-IL-6 signaling pathway to reduce agriculture organic dust exposure-induced airway inflammation in mice

Yu Kuang Lai, MBBCh: The utility of parametric response mapping in pulmonary graft vs host disease following hematopoietic stem cell transplant

Top Abstract Poster Finalists
Ligia M. Puiu, MD, PhD, FCCP: Association between echocardiographic and lipid parameters to workers in the metalliferous mines

Kush R. Dholakia, MD: Colloids vs crystalloids for postoperative resuscitation in patients undergoing off-pump coronary artery bypass surgery

Kulothungan Gunasekaran, MD, MBBS: Risk of VTE in idiopathic pulmonary fibrosis: a systematic review

Laura B. Sutton, PharmD: Ease and correct use of Ellipta by age in patients with asthma and COPD

Ankur Mogla, MD: To assess the utilization of pulmonary function testing for perioperative respiratory complications in bariatric surgery patients

Ali Ammar: Tracheostomy and admission diagnosis as predictors for an extended length of stay (ELOS)

Charlene Kalani, PharmD: Efficacy and safety of direct oral anticoagulants (DOACS) in morbidly obese patients

Jonghoo Lee, MD: Performances of modified CRB-65 score compared to SIRS and QSOFA as a rapid screening tool for sepsis among infected patients in initial emergency department: a propensity score matching study

Frank J. Trudo, MD, FCCP: Clinical burden of eosinophilic COPD

Elise L. Stephenson, MD: Vitamin C and point of care glucose measurements: a retrospective, observational study

Faisal Siddiqi, MD: Implementation of an early mobility program in the medical ICU

Eileen Harder, MD: Connective tissue disease-associated pulmonary arterial hypertension hospitalizations from 2001-2014

Sophie Korzan, MD: Exhaled nitric oxide and asthma-COPD overlap in patients hospitalized with exacerbations of airway disease: preliminary observations

Andreas Grove, MD: MicroRNA (MIRNA) and biological markers discriminate between normotensive and prehypertensive young men in hypobaric hypoxic environments

Snigdha Nutalapati, MBBS: Large cell neuroendocrine cancer of the lung: SEER 2004-2014 analysis

Anubhav Jain, MBBS: Survival benefit of beta-blockers in patients hospitalized for acute exacerbation of COPD

Case Report Slide Winners
Ze Ying Tan: All that wheezes is not asthma

Jason Lam: Pulmonary mucor mycetoma

Adam Young: Nonresolving pneumonia and cyclic fevers in an immunocompetent patient

Ritu Modi: Histopathological misdiagnosis of pulmonary coccidiodes

Argun Can: A rare inborn error of fatty acid oxidation presenting with severe hyperammonemia in the ICU

Morgan Gilani: A colorful cause of cardiovascular collapse

Katie Jeans: A sweet surprise

Anthony Mattox: Unusual case of interstitial lung disease

Andrew Berglund: Pulmonary light chain deposition disease in a 29-year-old army soldier

Cristia Maysol Morales: A case report of a primary malignant melanoma of anterior mediastinum

Anthony McClafferty: Fibrosing mediastinitis and rheumatoid arthritis: an autoimmune inflammatory connection

Ahmed Munir: HIV with disseminated tularemia: a rare presentation Benjamin Garren: Mycobacterium avium complex mediastinal lymphadenitis in an immunocompetent adolescent with erosion into the airway

Robert Hilton: Obtunded with a chest mass: a case of a rare neurologic paraneoplastic syndrome,

Audra Schwalk: Mucoepidermoid carcinoma: a rare malignancy treated endobronchially

Jessica Riggs: Successful transplantation defies genetics: a case of rapidly-progressive pulmonary fibrosis due to Hermansky-Pudlak syndrome

Meghan Cirulis: Acute vasodilator testing: an opportunity to refine study design and provide precision care in pulmonary hypertension

Patrick Chan: VATS lobectomy for bronchial atresia in an adult

Andrew Mehlman: Multivessel coronary artery aneurysms presenting as myocardial ischemia

Scott Maughan: Diagnosing milliary Mycobacterium bovis from the prostate of an immunocompetent host

Adam Austin: Survived ECMO, death by BLASTO: the first reported fatal case of disseminated blastomycosis in pregnancy

Tie: Donnie Carter: Subclinical polycythemia vera presenting as extensive thrombosis due to massive transfusion, and

Lindsay Hammons: Rare case of Serratia pneumonia causing transient aplastic anemia

Paola Baskin: Novel observations during point-of-care ultrasound (POCUS) in cardiopulmonary resuscitation: a case of ultrasound-guided probe pressure to reduce esophageal insufflation during bag-valve-mask ventilator

David Dennis: Pulmonary alveolar proteinosis presenting as intracerebral nocardiosis

Rakin Choudhury: Severe asthma caused by therapy-resistant asthmatic granulomatosis

Andrew Lytle: Lung adenocarcinoma in a patient with Turcot syndrome

Chelsea Leipold: Case of a granulomatous-lymphocytic interstitial lung disease in a patient with common variable immunodeficiency disorder

Galyna Ivashchuk: Double trouble: ANCA vasculitis with concomitant IGA nephropathy presenting as massive diffuse alveolar hemorrhage and fulminant renal failure

Case Report Poster Winners
Christine Zhou: Role of transbronchial lung cryobiopsy in the diagnosis of adenocarcinoma in situ

Parin Shah: A rare case of Erdheim-Chester disease masquerading as metastatic lung cancer

Avanthika Wynn : A rare asthma mimic

Muhammad S. Ali: Severe pancolitis: a rare adverse effect of nintedanib

Brian Foster: Don’t forget to breathe: a case of hypoxemia after carotid body resection

Kelly Pennington: Intra-cardiac embolization of an inferior vena cava filter resulting in cardiac arrest

George Elkomos-Botros: Acute generalized exanthematous pustulosis presenting as distributive shock with multi-organ failure

Ashley M. Scott: Avian occupational hypersensitivity pneumonitis in a restaurant employee

Andrew Polito: Pulmonary amyloidosis: an unusual presentation of a rare disease


CHEST B-I-N-G-O WINNERS
Stella Ogake, MD
Erin E. Peterson, APRN, CNP
Megan J. Castillo, PA-C
Gretchen R. Winter, MD
Jeanette P. Brown, MD, PhD
Yu Hong Chan, MBBS
Anita Naik, DO
Gary A. Aaronson, DO, FCCP
Allison S. Cowl, MD
Kyle Halligan, MD
Palaniappan Muthappan, MD
Faizullah S. Lokhandwala, MBBS, FCCP
Jamie R. Chua, MD
Francis L. Ervin, MD, FCCP
Robyn Luper

CHEST CHALLENGE WINNER (AND RUNNER’S-UP)

Emory University (First Place)
Mirza Haider Ali, MD
Mohleen Kang, MD
Matthew Schimmel, MD

University of Michigan (Second Place)
Patrick Bradley, MD
Matthew Hensley, MD
Bonnie Wang, MD

Cleveland Clinic (Third Place)
Jorge Mirales-Estrella, MD
Apostolos Perelas, MD
Gretchen Winter, MD

2018 DISTINGUISHED CHEST EDUCATORS
Michael H Ackerman, DNSc
Sandra G Adams, MD, MS, FCCP
Doreen J Addrizzo-Harris, MD, FCCP
Cara Lyn Agerstrand, MD, BS
Jason A Akulian, MD, FCCP
Raed H Alalawi, MD, FCCP
A. Christine Argento, MD, FCCP
Robert Arntfield, MD, FCCP
Alex A Balekian, MD
Meyer S Balter, MD, FCCP
Gisela I Banauch, MD, MS, FCCP
Robert P Baughman, MD, FCCP
David G Bell, MD, FCCP
Michel A Boivin, MD, FCCP
Gabriel T Bosslet, MD, FCCP
Jean Bourbeau, MD, MS, FCCP
Ghada R Bourjeily, MD, FCCP
David L Bowton, MD, FCCM
Jack D Buckley, MD, MPH, FCCP
Marie M Budev, DO, MPH, FCCP
Kristin M Burkart, MD, MS, FCCP
Brian Carlin, MD, FCCP
Christopher L Carroll, MD, FCCP
Roberto F Casal, MD
Kevin M Chan, MD, FCCP
Subani Chandra, MD, FCCP
Ching-Fei Chang, MD
Alexander C Chen, MD
Nancy A Collop, MD, FCCP
Clayton T Cowl, MD, MS, FCCP
Angel O Coz Yataco, MD, FCCP
Gerard J Criner, MD, FCCP
Carolyn M D’Ambrosio, MD, FCCP
Mauricio Danckers, MD, FCCP
Aneesa M Das, MD, FCCP
John Davies, RRT, MA, FCCP
Zachary S DePew, MD, FCCP
Frank C Detterbeck, MD, FCCP
Naresh A. Dewan, MBBS, FCCP
Kevin C Doerschug, MD, MS, FCCP
Meagan Dubosky, RRT-ACCS
Kevin M Dushay, MD, FCCP
Eric S Edell, MD, FCCP
Jean M Elwing, MD, FCCP
William Enfinger
Michael E Ezzie, MD, FCCP
Kevin J Felner, MD, FCCP
Mark E Fenton, MD, MSc, FCCP
Jason Filopei, MD
Neil S Freedman, MD, FCCP
Laura Kathleen Frye, MD
Thomas M Fuhrman, MD, MS, FCCP
John P Gaillard, MD, FCCP
Colin T Gillespie, MD
Yonatan Y Greenstein, MD
Maritza L Groth, MD, FCCP
Keith P Guevarra, DO, FCCP
Jesse B Hall, MD, FCCP
Nicola A Hanania, MD, MBBS, FCCP
D Kyle Hogarth, MD, FCCP
Steven M Hollenberg, MD, FCCP
David W Hsia, MD, FCCP
Candace A Huebert, MD, FCCP
Robert C Hyzy, MD, FCCP
Octavian C Ioachimescu, MD, PhD, FCCP
Richard S Irwin, MD, Master FCCP
Kirk D Jones, MD
Nader Kamangar, MD, MS, FCCP
Carl A Kaplan, MD, FCCP
Brian S Kaufman, MD, FCCP
William F Kelly, MD, FCCP
Marcus P Kennedy, MD, FCCP
Sandhya Khurana, MD, FCCP
James R Klinger, MD, FCCP
Seth J Koenig, MD, FCCP
Lindsey Kreisher, RRT
Karol Kremens, MD, FCCP
Patricia A Kritek, MD, FCCP
Sunita Kumar, MD, MBBS, FCCP
Rudy P Lackner, MD, FCCP
Viera Lakticova, MD
Carla R Lamb, MD, FCCP
Hans J Lee, MD, FCCP
Peter H Lenz, MD, MEd, FCCP
Stephanie M Levine, MD, FCCP
Deborah Jo Levine, MD, MS, FCCP
Andrea Loiselle, MD
Kenneth E Lyn-Kew, MD
Michael S Machuzak, MD, FCCP
Neil R MacIntyre, MD, FCCP
Donald A Mahler, MD, FCCP
Fabien Maldonado, MD, FCCP
Atul Malhotra, MD, FCCP
Darcy D Marciniuk, MD, FCCP
Diego J Maselli Caceres, MD, FCCP
Paul H Mayo, MD, FCCP
Peter J Mazzone, MD, MPH, FCCP
John K McIlwaine, DO, MBA, FCCP
Matthew C Miles, MD, FCCP
Scott Millington, MD
Taro Minami, MD, FCCP
Lisa K Moores, MD, FCCP
Amy E Morris, MD, FCCP
John J Mullon, MD, FCCP
Septimiu D Murgu, MD, FCCP
Mangala Narasimhan, DO, FCCP
Michael S Niederman, MD, FCCP
Alexander S Niven, MD, FCCP
Anne E O’Donnell, MD, FCCP
Erik C Osborn, MD
David E Ost, MD, MPH, FCCP
Ronald J Oudiz, MD, FCCP
Daniel R Ouellette, MD, MS, FCCP
Amit D Parulekar, MD, MS, FCCP
Nicholas J Pastis, MD, FCCP
Nina M Patel, MD, FCCP
Paru S Patrawalla, MD, FCCP
Jay I Peters, MD, FCCP
Barbara A Phillips, MD, MSPH, FCCP
Margaret A Pisani, MD, MS, FCCP
Janos Porszasz, MD, PhD
Whitney S Prince, MD, FCCP
Suhail Raoof, MBBS, Master FCCP
Ruben D Restrepo, RRT, FCCP
Marcos I Restrepo, MD, PhD, FCCP
Otis B Rickman, DO, FCCP
Roy D Ridgeway
Mary Ried, RN, CCRN
Linda Rogers, MD, FCCP
Mark J Rosen, MD, Master FCCP
Bernard J Roth, MD, FCCP
Ashutosh Sachdeva, MBBS, FCCP
Anthony G Saleh, MD, FCCP
Juan F Sanchez, MD, FCCP
Pralay K Sarkar, MBBS, FCCP
Lewis G Satterwhite, MD, BA, FCCP
Gregory A Schmidt, MD, FCCP
Mary Beth Scholand, MD, FCCP
David A Schulman, MD, MPH, FCCP
Brady Scott, RRT, MS, FCCP
Bernardo Selim, MD, FCCP
Curtis N Sessler, MD, FCCP
Rakesh D Shah, MD, FCCP
Ray Wes Shepherd, MD, FCCP
John H Sherner, MD, FCCP
Ariel L Shiloh, MD
Samira Shojaee, MD, FCCP
Marcos Silva Restrepo
Gerard A Silvestri, MD, MS, FCCP
Steven Q Simpson, MD, FCCP
James K Stoller, MD, MS, FCCP
Charlie Strange, MD, FCCP
Mary E Strek, MD, FCCP
William W Stringer, MD, FCCP
Eleanor M Summerhill, MD, FCCP
Maximiliano A Tamae Kakazu, MD, FCCP
Nichole T Tanner, MD, MS, FCCP
Lynn T Tanoue, MD, FCCP
Victor J Test, MD, FCCP
Arthur J Tokarczyk, MD, FCCP
Alain Tremblay, MD, FCCP
Adey Tsegaye, MD, FCCP
Anil Vachani, MD, FCCP
Momen M Wahidi, MD, MBA, FCCP
Keith M Wille, MD, FCCP
Lisa F Wolfe, MD
Richard G Wunderink, MD, FCCP
Lonny B Yarmus, DO, FCCP
Kazuhiro Yasufuku, MD, PhD, FCCP
Gulrukh Zaidi, MD, FCCP
David Zielinski, MD, FCCP

Greetings! My name is Robert Musacchio; I am proud to introduce myself as the new Chief Executive Officer and Executive Vice President of CHEST. I am honored to join this team of distinguished clinicians as we spearhead progress in the fight against lung disease.

I have had the pleasure of working at CHEST for the last 4 years, first joining CHEST Enterprises as Senior Vice President of Business Development. In that role, I focused on revenue growth and product diversification before becoming COO of CHEST. As COO, I dedicated myself to strengthening our team by mentoring staff and collaborating with senior leadership, a challenge that I have deeply enjoyed.

Before joining CHEST, I worked at the American Medical Association for 35 years in roles encompassing research, advocacy, membership, and publishing. I also worked with boards and membership groups as a member of the AMA’s CPT® Editorial Panel and as a publisher for JAMA.

As CEO, I hope to leverage those experiences to support CHEST in its mission, which is to improve lung health not just for 1 year but for the next 25 years. For that reason, our leadership team has outlined an organizational culture that fosters short-term success and long-term innovation, focusing on four key areas:



People: How do we attract and retain the right people?

Strategy: How do we create a truly differentiated strategy?

Execution: How do we improve our process to drive flawless execution?

Resources: How do we ensure that we have sufficient resources to invest in our mission?



Those questions in mind, we have established several standards that guide the way we work. We are focusing on leading with integrity, cultivating passion and innovation, honoring our team, and having fun while we deliver cutting-edge education and create community for our members. With these norms, we can continue to foster an environment that generates results. This, in turn, will enable CHEST to fulfill its core purpose of crushing lung disease.

We can crush lung disease by arming our members with industry-leading education offerings—including simulation experiences and live lab courses—and expanding them worldwide to Thailand and Greece in 2019. We can crush lung disease by using cutting-edge technologies—including interactive gaming platforms—to glean further insights. We can crush lung disease by connecting our membership of nearly 20,000 pulmonary, critical care, and sleep medicine professionals to innovative education tools, along with a network of prestigious colleagues to deliver the highest quality patient care.

Most importantly, we can crush lung disease by empowering our members in their work—if you care about lung disease, we care about you!

And, if you care about lung disease, I am excited to partner with you in this cause. I am thankful for this opportunity to lead CHEST and the CHEST Foundation into the future and look forward to working with you.

Greetings! My name is Robert Musacchio; I am proud to introduce myself as the new Chief Executive Officer and Executive Vice President of CHEST. I am honored to join this team of distinguished clinicians as we spearhead progress in the fight against lung disease.

I have had the pleasure of working at CHEST for the last 4 years, first joining CHEST Enterprises as Senior Vice President of Business Development. In that role, I focused on revenue growth and product diversification before becoming COO of CHEST. As COO, I dedicated myself to strengthening our team by mentoring staff and collaborating with senior leadership, a challenge that I have deeply enjoyed.

Before joining CHEST, I worked at the American Medical Association for 35 years in roles encompassing research, advocacy, membership, and publishing. I also worked with boards and membership groups as a member of the AMA’s CPT® Editorial Panel and as a publisher for JAMA.

As CEO, I hope to leverage those experiences to support CHEST in its mission, which is to improve lung health not just for 1 year but for the next 25 years. For that reason, our leadership team has outlined an organizational culture that fosters short-term success and long-term innovation, focusing on four key areas:



People: How do we attract and retain the right people?

Strategy: How do we create a truly differentiated strategy?

Execution: How do we improve our process to drive flawless execution?

Resources: How do we ensure that we have sufficient resources to invest in our mission?



Those questions in mind, we have established several standards that guide the way we work. We are focusing on leading with integrity, cultivating passion and innovation, honoring our team, and having fun while we deliver cutting-edge education and create community for our members. With these norms, we can continue to foster an environment that generates results. This, in turn, will enable CHEST to fulfill its core purpose of crushing lung disease.

We can crush lung disease by arming our members with industry-leading education offerings—including simulation experiences and live lab courses—and expanding them worldwide to Thailand and Greece in 2019. We can crush lung disease by using cutting-edge technologies—including interactive gaming platforms—to glean further insights. We can crush lung disease by connecting our membership of nearly 20,000 pulmonary, critical care, and sleep medicine professionals to innovative education tools, along with a network of prestigious colleagues to deliver the highest quality patient care.

Most importantly, we can crush lung disease by empowering our members in their work—if you care about lung disease, we care about you!

And, if you care about lung disease, I am excited to partner with you in this cause. I am thankful for this opportunity to lead CHEST and the CHEST Foundation into the future and look forward to working with you.

Greetings! My name is Robert Musacchio; I am proud to introduce myself as the new Chief Executive Officer and Executive Vice President of CHEST. I am honored to join this team of distinguished clinicians as we spearhead progress in the fight against lung disease.

I have had the pleasure of working at CHEST for the last 4 years, first joining CHEST Enterprises as Senior Vice President of Business Development. In that role, I focused on revenue growth and product diversification before becoming COO of CHEST. As COO, I dedicated myself to strengthening our team by mentoring staff and collaborating with senior leadership, a challenge that I have deeply enjoyed.

Before joining CHEST, I worked at the American Medical Association for 35 years in roles encompassing research, advocacy, membership, and publishing. I also worked with boards and membership groups as a member of the AMA’s CPT® Editorial Panel and as a publisher for JAMA.

As CEO, I hope to leverage those experiences to support CHEST in its mission, which is to improve lung health not just for 1 year but for the next 25 years. For that reason, our leadership team has outlined an organizational culture that fosters short-term success and long-term innovation, focusing on four key areas:



People: How do we attract and retain the right people?

Strategy: How do we create a truly differentiated strategy?

Execution: How do we improve our process to drive flawless execution?

Resources: How do we ensure that we have sufficient resources to invest in our mission?



Those questions in mind, we have established several standards that guide the way we work. We are focusing on leading with integrity, cultivating passion and innovation, honoring our team, and having fun while we deliver cutting-edge education and create community for our members. With these norms, we can continue to foster an environment that generates results. This, in turn, will enable CHEST to fulfill its core purpose of crushing lung disease.

We can crush lung disease by arming our members with industry-leading education offerings—including simulation experiences and live lab courses—and expanding them worldwide to Thailand and Greece in 2019. We can crush lung disease by using cutting-edge technologies—including interactive gaming platforms—to glean further insights. We can crush lung disease by connecting our membership of nearly 20,000 pulmonary, critical care, and sleep medicine professionals to innovative education tools, along with a network of prestigious colleagues to deliver the highest quality patient care.

Most importantly, we can crush lung disease by empowering our members in their work—if you care about lung disease, we care about you!

And, if you care about lung disease, I am excited to partner with you in this cause. I am thankful for this opportunity to lead CHEST and the CHEST Foundation into the future and look forward to working with you.

https://www.medscape.com/viewarticle/902668?src=par_chest_stm_mscpedt&faf=1

https://www.medscape.com/viewarticle/902668?src=par_chest_stm_mscpedt&faf=1

https://www.medscape.com/viewarticle/902668?src=par_chest_stm_mscpedt&faf=1

The American College of Chest Physicians® announced updates to the evidence-based guidelines on antithrombotic therapy for atrial fibrillation. The guideline panel submitted the manuscript, Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report, for publication in the journal CHEST®.

Key recommendations and shifts from previous guidelines include:

• For patients with atrial fibrillation without valvular heart disease, including those with paroxysmal atrial fibrillation who are at low risk of stroke (eg, CHA2DS2VASc score of 0 in males or 1 in females), we suggest no antithrombotic therapy.

• For patients with a single non-sex CHA2DS2VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin or combination therapy with aspirin and clopidogrel.

• For those at high risk of stroke, we recommend oral anticoagulation rather than no therapy, aspirin or combination therapy with aspirin and clopidogrel.

• Where we recommend or suggest in favor of oral anticoagulation, we suggest using a novel oral anticoagulant (NOAC) rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range (TTR) >70%.

• Attention to modifiable bleeding risk factors should be made at each patient contact, and HAS-BLED score should be used to assess the risk of bleeding where high-risk patients (>=3) can be identified for earlier review and follow-up visits.

The complete guideline article is free to view in the Online First section of the journal CHEST.

The American College of Chest Physicians® announced updates to the evidence-based guidelines on antithrombotic therapy for atrial fibrillation. The guideline panel submitted the manuscript, Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report, for publication in the journal CHEST®.

Key recommendations and shifts from previous guidelines include:

• For patients with atrial fibrillation without valvular heart disease, including those with paroxysmal atrial fibrillation who are at low risk of stroke (eg, CHA2DS2VASc score of 0 in males or 1 in females), we suggest no antithrombotic therapy.

• For patients with a single non-sex CHA2DS2VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin or combination therapy with aspirin and clopidogrel.

• For those at high risk of stroke, we recommend oral anticoagulation rather than no therapy, aspirin or combination therapy with aspirin and clopidogrel.

• Where we recommend or suggest in favor of oral anticoagulation, we suggest using a novel oral anticoagulant (NOAC) rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range (TTR) >70%.

• Attention to modifiable bleeding risk factors should be made at each patient contact, and HAS-BLED score should be used to assess the risk of bleeding where high-risk patients (>=3) can be identified for earlier review and follow-up visits.

The complete guideline article is free to view in the Online First section of the journal CHEST.

The American College of Chest Physicians® announced updates to the evidence-based guidelines on antithrombotic therapy for atrial fibrillation. The guideline panel submitted the manuscript, Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report, for publication in the journal CHEST®.

Key recommendations and shifts from previous guidelines include:

• For patients with atrial fibrillation without valvular heart disease, including those with paroxysmal atrial fibrillation who are at low risk of stroke (eg, CHA2DS2VASc score of 0 in males or 1 in females), we suggest no antithrombotic therapy.

• For patients with a single non-sex CHA2DS2VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin or combination therapy with aspirin and clopidogrel.

• For those at high risk of stroke, we recommend oral anticoagulation rather than no therapy, aspirin or combination therapy with aspirin and clopidogrel.

• Where we recommend or suggest in favor of oral anticoagulation, we suggest using a novel oral anticoagulant (NOAC) rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range (TTR) >70%.

• Attention to modifiable bleeding risk factors should be made at each patient contact, and HAS-BLED score should be used to assess the risk of bleeding where high-risk patients (>=3) can be identified for earlier review and follow-up visits.

The complete guideline article is free to view in the Online First section of the journal CHEST.

Due to significant interest in the pulmonary/critical care community, the National Board of Echocardiography (NBE) has opened registration for a board examination as a requirement for national level certification in advanced critical care echocardiography (ACCE). The examination has been developed by the National Board of Medical Examiners; CHEST and the other professional societies are well represented on the writing committee. The first examination is scheduled to be given on January 15, 2019.

The board of the NBE will be the final arbiter for other requirements for certification. We anticipate that these will be available in 2019.

A few essential questions about the certification:

1. Who will be eligible for certification in ACCE?

The policy of the NBE is that any licensed physician may take the examination. Passing the examination confers testamur status, which is only one of several requirements for certification. The board of the NBE will make the final decision as to how to define the clinical background of the candidate that will be required for certification.

2. What will be the requirements for demonstration of competence at image acquisition for ACCE?

Competence at ACCE requires that the intensivist be expert at image acquisition of a comprehensive image set. The board of the NBE will make the final decision as to what constitutes a full ACCE image set, how many studies must be performed by the candidate, and how the studies will be documented. Regarding the latter question, it is likely that there will be a need for identification of qualified mentors to guide the candidate through the process of demonstrating competence in image acquisition.

3. What resources exist to learn more about the examination?

For some suggestions regarding mastery of the cognitive base, Dr. Yonatan Greenstein has set up an independent website that has recommendations about study material and an example of the full ACCE image set (advancedcriticalcareecho.org). The NBE website has a list of subjects that will be covered in the examination. In addition to passing the examination, there will be other elements required for ACCE certification. The NBE has not yet made final decision on the additional requirements. As soon as they are available, they will be posted on the NBE website (echoboards.org).

There is keen interest amongst fellows and junior attendings in the NBE certification who are already competent in whole body ultrasonography. They see ACCE as a natural and necessary extension of their scope of practice, as a means of better helping their critically ill patients, and as a means of acquiring a unique skill that defines them as having a special skill compared with other intensivists. A smaller group of senior attending intensivists are primarily motivated by a well-defined practice-related need of skill at ACCE and/or a strong perception that knowledge of ACCE may directly improve their ability to care for the critically ill patient. Interest in certification extends across the various specialties that provide critical care services. The NBE has indicated that there has been a strong showing of registrations for the examination thus far.

We recommend that candidates for certification consider that passing the examination should be the priority. Collection of the image set may occur in parallel, as the two will complement each other. Preparation for the examination requires intensive study of the cognitive base of ACCE and mastery of image interpretation.

To aid in preparation for the ACCE examination, CHEST is offering a comprehensive review course, Advanced Critical Care Echocardiography Board Review Exam Course, being held at the CHEST Innovation, Simulation, and Training Center, December 7-8, 2018, in Glenview, Illinois.




 

Due to significant interest in the pulmonary/critical care community, the National Board of Echocardiography (NBE) has opened registration for a board examination as a requirement for national level certification in advanced critical care echocardiography (ACCE). The examination has been developed by the National Board of Medical Examiners; CHEST and the other professional societies are well represented on the writing committee. The first examination is scheduled to be given on January 15, 2019.

The board of the NBE will be the final arbiter for other requirements for certification. We anticipate that these will be available in 2019.

A few essential questions about the certification:

1. Who will be eligible for certification in ACCE?

The policy of the NBE is that any licensed physician may take the examination. Passing the examination confers testamur status, which is only one of several requirements for certification. The board of the NBE will make the final decision as to how to define the clinical background of the candidate that will be required for certification.

2. What will be the requirements for demonstration of competence at image acquisition for ACCE?

Competence at ACCE requires that the intensivist be expert at image acquisition of a comprehensive image set. The board of the NBE will make the final decision as to what constitutes a full ACCE image set, how many studies must be performed by the candidate, and how the studies will be documented. Regarding the latter question, it is likely that there will be a need for identification of qualified mentors to guide the candidate through the process of demonstrating competence in image acquisition.

3. What resources exist to learn more about the examination?

For some suggestions regarding mastery of the cognitive base, Dr. Yonatan Greenstein has set up an independent website that has recommendations about study material and an example of the full ACCE image set (advancedcriticalcareecho.org). The NBE website has a list of subjects that will be covered in the examination. In addition to passing the examination, there will be other elements required for ACCE certification. The NBE has not yet made final decision on the additional requirements. As soon as they are available, they will be posted on the NBE website (echoboards.org).

There is keen interest amongst fellows and junior attendings in the NBE certification who are already competent in whole body ultrasonography. They see ACCE as a natural and necessary extension of their scope of practice, as a means of better helping their critically ill patients, and as a means of acquiring a unique skill that defines them as having a special skill compared with other intensivists. A smaller group of senior attending intensivists are primarily motivated by a well-defined practice-related need of skill at ACCE and/or a strong perception that knowledge of ACCE may directly improve their ability to care for the critically ill patient. Interest in certification extends across the various specialties that provide critical care services. The NBE has indicated that there has been a strong showing of registrations for the examination thus far.

We recommend that candidates for certification consider that passing the examination should be the priority. Collection of the image set may occur in parallel, as the two will complement each other. Preparation for the examination requires intensive study of the cognitive base of ACCE and mastery of image interpretation.

To aid in preparation for the ACCE examination, CHEST is offering a comprehensive review course, Advanced Critical Care Echocardiography Board Review Exam Course, being held at the CHEST Innovation, Simulation, and Training Center, December 7-8, 2018, in Glenview, Illinois.




 

Due to significant interest in the pulmonary/critical care community, the National Board of Echocardiography (NBE) has opened registration for a board examination as a requirement for national level certification in advanced critical care echocardiography (ACCE). The examination has been developed by the National Board of Medical Examiners; CHEST and the other professional societies are well represented on the writing committee. The first examination is scheduled to be given on January 15, 2019.

The board of the NBE will be the final arbiter for other requirements for certification. We anticipate that these will be available in 2019.

A few essential questions about the certification:

1. Who will be eligible for certification in ACCE?

The policy of the NBE is that any licensed physician may take the examination. Passing the examination confers testamur status, which is only one of several requirements for certification. The board of the NBE will make the final decision as to how to define the clinical background of the candidate that will be required for certification.

2. What will be the requirements for demonstration of competence at image acquisition for ACCE?

Competence at ACCE requires that the intensivist be expert at image acquisition of a comprehensive image set. The board of the NBE will make the final decision as to what constitutes a full ACCE image set, how many studies must be performed by the candidate, and how the studies will be documented. Regarding the latter question, it is likely that there will be a need for identification of qualified mentors to guide the candidate through the process of demonstrating competence in image acquisition.

3. What resources exist to learn more about the examination?

For some suggestions regarding mastery of the cognitive base, Dr. Yonatan Greenstein has set up an independent website that has recommendations about study material and an example of the full ACCE image set (advancedcriticalcareecho.org). The NBE website has a list of subjects that will be covered in the examination. In addition to passing the examination, there will be other elements required for ACCE certification. The NBE has not yet made final decision on the additional requirements. As soon as they are available, they will be posted on the NBE website (echoboards.org).

There is keen interest amongst fellows and junior attendings in the NBE certification who are already competent in whole body ultrasonography. They see ACCE as a natural and necessary extension of their scope of practice, as a means of better helping their critically ill patients, and as a means of acquiring a unique skill that defines them as having a special skill compared with other intensivists. A smaller group of senior attending intensivists are primarily motivated by a well-defined practice-related need of skill at ACCE and/or a strong perception that knowledge of ACCE may directly improve their ability to care for the critically ill patient. Interest in certification extends across the various specialties that provide critical care services. The NBE has indicated that there has been a strong showing of registrations for the examination thus far.

We recommend that candidates for certification consider that passing the examination should be the priority. Collection of the image set may occur in parallel, as the two will complement each other. Preparation for the examination requires intensive study of the cognitive base of ACCE and mastery of image interpretation.

To aid in preparation for the ACCE examination, CHEST is offering a comprehensive review course, Advanced Critical Care Echocardiography Board Review Exam Course, being held at the CHEST Innovation, Simulation, and Training Center, December 7-8, 2018, in Glenview, Illinois.




 

Interventional Chest/Diagnostic Procedures

Endobronchial valve therapy receives FDA approval for bronchoscopic LVR

Lung volume reduction surgery (LVRS) is an established approach to improve exercise capacity and lung function in patients with heterogeneous emphysema and may confer survival benefit in patients with apical-predominant disease (Fishman, et al. N Engl J Med. 2003;348[21]:2059). Despite this, LVRS case numbers remain low due to patient and procedural morbidity. Bronchoscopic alternatives for LVRS have advanced considerably over the last decade with endobronchial valve (EBV) therapy emerging as a viable option for select subsets of patients with heterogeneous emphysema. Endobronchial valves are removable devices placed in segmental/subsegmental airways, which allow efflux of air during exhalation but close during inspiration, resulting in distal atelectasis in the absence of collateral ventilation.

The LIBERATE study, a multicenter randomized controlled trial demonstrated improvement in FEV1 ≥15% in 48% of patients after EBV placement compared with 17% of patients receiving standard medical therapy has resulted in FDA approval (Criner G, et al. Am J Respir Crit Care Med. 2018 May 22. doi: 10.1164/rccm.201803-0590OC. [Epub ahead of print]). Patients with EBV had improved subjective dyspnea scores, residual volume, and 6-minute walk distance; however, the pneumothorax rate was 27%.

All study patients with EBV underwent bronchoscopic evaluation for collateral ventilation using a proprietary digital system, which measures expiratory airflow in target airways to establish the presence of collateral ventilation. Previous data have demonstrated improved transplant-free survival when implanted EBVs result in atelectasis of the target lobe, which requires intact interlobar fissures (Garner, et al. Am J Respir Crit Care Med. 2016;194[4]:519). Ongoing clinical trials are attempting to clarify the role of EBV therapy in different phenotypes of COPD, including patients with homogenous emphysema. Long-term follow-up data will be important in determining the broader implementation of bronchoscopic lung volume reduction moving forward.

Vivek Murthy, MD
Jason A. Akulian, MD, FCCP
Steering Committee Members
 

Pediatric Chest Medicine

CFTR modulators

Cystic fibrosis (CF) is a progressive genetic disorder resulting in multiorgan disease with progressive respiratory decline. CF is caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. This codes for the CFTR anion channel and contributes to the movement of salt in and out of the cell. CFTR dysfunction leads to thickened secretions in the lungs and other organs, such as the gut and pancreas. This leads to more lung infections and other organ dysfunction that ultimately leads to premature death.

Pulmonary Physiology, Function, and Rehabilitation

Wildfires, particulate matter, and lung function

In the last 3 decades, human-caused climate change contributed to wildfires in an additional 4.2 million hectares of land across the western US alone. Human impact on climate is responsible for nearly doubling the expected wildfire area (Abatzoglou, et al. PNAS. 2016;113:11770). Year 2017 saw the most destructive wildfires in California recorded to date, and over $2 billion dollars was spent by the US Forest Service, the most-expensive on record. Besides the devastating effects on the forestry and nearby communities, wildfires also generate a large amount of particulate matter (PM). In western US, wildfires contributed to 71.3% of total PM2.5 on days exceeding regulatory PM2.5 standards during 2004-2009 (Liu et al. Clim Change. 2016;138:655). Acute PM exposure is associated with respiratory health effects, such as exacerbation of asthma and COPD, increased ED visits and hospitalization for pneumonia, and increased mortality. Chronic PM2.5 exposure may also affect lung function. Cross-shift and cross-season FEV1 declined by 0.150 L and 0.104 L, respectively in forest firefighters (Betchley, et al. Am. J Ind Med. 1997;31:503). The Children’s Health Study conducted in California found that subjects who were exposed to the highest level of exposure to PM2.5 were five times more likely to have an FEV1 less than 80% of expected FEV1 when they reached 18 years of age than subjects exposed to the lowest level of PM2.5 (Gauderman et al. N Engl J Med. 2004;351:1057). Clinicians should educate patients and the public how to protect our environment and, when wildfires occur, how to protect themselves from exposure to PM.

Thomas W. DeCato, MD
Fellow-in-Training Committee Member

Yuh-Chin T. Huang, MD, FCCP
Steering Committee Member
 

Pulmonary Vascular Disease

Small increases in pulmonary pressures—big impact

Pulmonary hypertension (PH) is a progressive, life-limiting pulmonary vascular disease that is diagnosed hemodynamically by right-sided heart catheterization (RHC) and defined by a mean pulmonary artery pressure (mPAP) >25 mm Hg (Hoeper MM, et al. JACC. 2013;62(25 Suppl):D42).

The impact of PH on survival both in its “pure” form, pulmonary arterial hypertension, and in the setting of underlying cardiopulmonary disease, is well established. However, the clinical relevance of mildly elevated mPAP, defined as mPAP between 18 and 24 mm Hg, has been unclear until recently. Two large cohort studies have suggested that mild increases in mPAP are clinically relevant. A large retrospective analysis of hemodynamic data from 21,727 US veterans found mildly increased mPAP (19-24 mm Hg) was associated with increased hospitalization and decreased survival (Maron, et al. Circulation. 2016;133:1240).

While this population was skewed toward elderly men, a study from Vanderbilt University that included equal numbers of men and women showed similar results. Patients with mPAP 19-24 mm Hg experienced incrementally increased mortality (HR:1.31, P=.001). Importantly, in the subset of patients who underwent a repeat RHC in follow-up, 61% developed progressive increases of pulmonary pressures (>25 mm Hg) on follow-up RHC suggesting that the disease process may progress in a substantial proportion of patients (Assad, et al. JAMA Cardiol. 2017;2[1]):1361). Combined with prior data from smaller cohorts, these studies highlight the impact of mildly increased pulmonary pressures on outcomes. Given the dearth of available data regarding interventions for these patients, there is an urgent need to study to role of specific therapy for mildly elevated pulmonary pressures.

Vijay Balasubramanian, MD, FCCP
Steering Committee Member

Jean Elwing, MD, FCCP
Steering Committee Vice-Chair

Thoracic Oncology

Multiple tumor nodules in lung cancer diagnosis

Low dose CT (LDCT) scan screening for lung cancer is a recommended preventative modality for adults with a significant smoking history (Mayer et al. Ann Int Med. 2014;160(5):330). The screening approach aims to identify adults at significant risk for lung cancer. The goal is to discover lung cancers at low stage with benign mediastinal nodes for optimal treatment and potential for cure. In a minority, but significant number of cases, the LDCT demonstrates multiple lung nodules or masses confounding the attempt to adequately stage the tumor. Two tumors representing a primary cancer and separate malignant spread, namely, intra-pulmonary metastases, in the same lobe, different ipsilateral lobe, or contralateral lobe would be staged, respectively, as T3, T4, or M1a (Detterbeck et al. Chest. 2013;143(5):e191S). Clearly, if the two tumors are separate unique primary cancers, independent of one another, then at best they would be considered as multiple T1 tumors. The treatment modalities of and clinical survival outcomes for these multiple conditions would be markedly different.

The identification of additional tumors may be synchronous (at the same time of the primary discovery) or metachronous (at a later time than the primary discovery). The approach is basically the same. Two tumors with different histologic types, or having separate in-situ squamous cell carcinoma patterns, or disparate immunohistochemical or molecular expressions, or different genomic profiles or driver mutations may be considered as separate distinct primary malignancies (Detterbeck et al. J Thorac Oncol. 2016;11:639; Nicholson et al. J Thorac Oncol. 2017;13:205). Separate foci of ground-glass opacities with small solid central component indicative of minimally invasive adenocarcinoma may be designated as the highest T-stage. These cited and more challenging cases should be presented to a lung cancer tumor board with multiple specialties represented for analysis and judgment. The approach to diagnostic decision-making and clinical management should involve the expertise of all specialties in the lung cancer patient care team.

Arnold M. Schwartz, MD, PhD, FCCP
Steering Committee Member


















 

Interventional Chest/Diagnostic Procedures

Endobronchial valve therapy receives FDA approval for bronchoscopic LVR

Lung volume reduction surgery (LVRS) is an established approach to improve exercise capacity and lung function in patients with heterogeneous emphysema and may confer survival benefit in patients with apical-predominant disease (Fishman, et al. N Engl J Med. 2003;348[21]:2059). Despite this, LVRS case numbers remain low due to patient and procedural morbidity. Bronchoscopic alternatives for LVRS have advanced considerably over the last decade with endobronchial valve (EBV) therapy emerging as a viable option for select subsets of patients with heterogeneous emphysema. Endobronchial valves are removable devices placed in segmental/subsegmental airways, which allow efflux of air during exhalation but close during inspiration, resulting in distal atelectasis in the absence of collateral ventilation.

The LIBERATE study, a multicenter randomized controlled trial demonstrated improvement in FEV1 ≥15% in 48% of patients after EBV placement compared with 17% of patients receiving standard medical therapy has resulted in FDA approval (Criner G, et al. Am J Respir Crit Care Med. 2018 May 22. doi: 10.1164/rccm.201803-0590OC. [Epub ahead of print]). Patients with EBV had improved subjective dyspnea scores, residual volume, and 6-minute walk distance; however, the pneumothorax rate was 27%.

All study patients with EBV underwent bronchoscopic evaluation for collateral ventilation using a proprietary digital system, which measures expiratory airflow in target airways to establish the presence of collateral ventilation. Previous data have demonstrated improved transplant-free survival when implanted EBVs result in atelectasis of the target lobe, which requires intact interlobar fissures (Garner, et al. Am J Respir Crit Care Med. 2016;194[4]:519). Ongoing clinical trials are attempting to clarify the role of EBV therapy in different phenotypes of COPD, including patients with homogenous emphysema. Long-term follow-up data will be important in determining the broader implementation of bronchoscopic lung volume reduction moving forward.

Vivek Murthy, MD
Jason A. Akulian, MD, FCCP
Steering Committee Members
 

Pediatric Chest Medicine

CFTR modulators

Cystic fibrosis (CF) is a progressive genetic disorder resulting in multiorgan disease with progressive respiratory decline. CF is caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. This codes for the CFTR anion channel and contributes to the movement of salt in and out of the cell. CFTR dysfunction leads to thickened secretions in the lungs and other organs, such as the gut and pancreas. This leads to more lung infections and other organ dysfunction that ultimately leads to premature death.

Pulmonary Physiology, Function, and Rehabilitation

Wildfires, particulate matter, and lung function

In the last 3 decades, human-caused climate change contributed to wildfires in an additional 4.2 million hectares of land across the western US alone. Human impact on climate is responsible for nearly doubling the expected wildfire area (Abatzoglou, et al. PNAS. 2016;113:11770). Year 2017 saw the most destructive wildfires in California recorded to date, and over $2 billion dollars was spent by the US Forest Service, the most-expensive on record. Besides the devastating effects on the forestry and nearby communities, wildfires also generate a large amount of particulate matter (PM). In western US, wildfires contributed to 71.3% of total PM2.5 on days exceeding regulatory PM2.5 standards during 2004-2009 (Liu et al. Clim Change. 2016;138:655). Acute PM exposure is associated with respiratory health effects, such as exacerbation of asthma and COPD, increased ED visits and hospitalization for pneumonia, and increased mortality. Chronic PM2.5 exposure may also affect lung function. Cross-shift and cross-season FEV1 declined by 0.150 L and 0.104 L, respectively in forest firefighters (Betchley, et al. Am. J Ind Med. 1997;31:503). The Children’s Health Study conducted in California found that subjects who were exposed to the highest level of exposure to PM2.5 were five times more likely to have an FEV1 less than 80% of expected FEV1 when they reached 18 years of age than subjects exposed to the lowest level of PM2.5 (Gauderman et al. N Engl J Med. 2004;351:1057). Clinicians should educate patients and the public how to protect our environment and, when wildfires occur, how to protect themselves from exposure to PM.

Thomas W. DeCato, MD
Fellow-in-Training Committee Member

Yuh-Chin T. Huang, MD, FCCP
Steering Committee Member
 

Pulmonary Vascular Disease

Small increases in pulmonary pressures—big impact

Pulmonary hypertension (PH) is a progressive, life-limiting pulmonary vascular disease that is diagnosed hemodynamically by right-sided heart catheterization (RHC) and defined by a mean pulmonary artery pressure (mPAP) >25 mm Hg (Hoeper MM, et al. JACC. 2013;62(25 Suppl):D42).

The impact of PH on survival both in its “pure” form, pulmonary arterial hypertension, and in the setting of underlying cardiopulmonary disease, is well established. However, the clinical relevance of mildly elevated mPAP, defined as mPAP between 18 and 24 mm Hg, has been unclear until recently. Two large cohort studies have suggested that mild increases in mPAP are clinically relevant. A large retrospective analysis of hemodynamic data from 21,727 US veterans found mildly increased mPAP (19-24 mm Hg) was associated with increased hospitalization and decreased survival (Maron, et al. Circulation. 2016;133:1240).

While this population was skewed toward elderly men, a study from Vanderbilt University that included equal numbers of men and women showed similar results. Patients with mPAP 19-24 mm Hg experienced incrementally increased mortality (HR:1.31, P=.001). Importantly, in the subset of patients who underwent a repeat RHC in follow-up, 61% developed progressive increases of pulmonary pressures (>25 mm Hg) on follow-up RHC suggesting that the disease process may progress in a substantial proportion of patients (Assad, et al. JAMA Cardiol. 2017;2[1]):1361). Combined with prior data from smaller cohorts, these studies highlight the impact of mildly increased pulmonary pressures on outcomes. Given the dearth of available data regarding interventions for these patients, there is an urgent need to study to role of specific therapy for mildly elevated pulmonary pressures.

Vijay Balasubramanian, MD, FCCP
Steering Committee Member

Jean Elwing, MD, FCCP
Steering Committee Vice-Chair

Thoracic Oncology

Multiple tumor nodules in lung cancer diagnosis

Low dose CT (LDCT) scan screening for lung cancer is a recommended preventative modality for adults with a significant smoking history (Mayer et al. Ann Int Med. 2014;160(5):330). The screening approach aims to identify adults at significant risk for lung cancer. The goal is to discover lung cancers at low stage with benign mediastinal nodes for optimal treatment and potential for cure. In a minority, but significant number of cases, the LDCT demonstrates multiple lung nodules or masses confounding the attempt to adequately stage the tumor. Two tumors representing a primary cancer and separate malignant spread, namely, intra-pulmonary metastases, in the same lobe, different ipsilateral lobe, or contralateral lobe would be staged, respectively, as T3, T4, or M1a (Detterbeck et al. Chest. 2013;143(5):e191S). Clearly, if the two tumors are separate unique primary cancers, independent of one another, then at best they would be considered as multiple T1 tumors. The treatment modalities of and clinical survival outcomes for these multiple conditions would be markedly different.

The identification of additional tumors may be synchronous (at the same time of the primary discovery) or metachronous (at a later time than the primary discovery). The approach is basically the same. Two tumors with different histologic types, or having separate in-situ squamous cell carcinoma patterns, or disparate immunohistochemical or molecular expressions, or different genomic profiles or driver mutations may be considered as separate distinct primary malignancies (Detterbeck et al. J Thorac Oncol. 2016;11:639; Nicholson et al. J Thorac Oncol. 2017;13:205). Separate foci of ground-glass opacities with small solid central component indicative of minimally invasive adenocarcinoma may be designated as the highest T-stage. These cited and more challenging cases should be presented to a lung cancer tumor board with multiple specialties represented for analysis and judgment. The approach to diagnostic decision-making and clinical management should involve the expertise of all specialties in the lung cancer patient care team.

Arnold M. Schwartz, MD, PhD, FCCP
Steering Committee Member


















 

Interventional Chest/Diagnostic Procedures

Endobronchial valve therapy receives FDA approval for bronchoscopic LVR

Lung volume reduction surgery (LVRS) is an established approach to improve exercise capacity and lung function in patients with heterogeneous emphysema and may confer survival benefit in patients with apical-predominant disease (Fishman, et al. N Engl J Med. 2003;348[21]:2059). Despite this, LVRS case numbers remain low due to patient and procedural morbidity. Bronchoscopic alternatives for LVRS have advanced considerably over the last decade with endobronchial valve (EBV) therapy emerging as a viable option for select subsets of patients with heterogeneous emphysema. Endobronchial valves are removable devices placed in segmental/subsegmental airways, which allow efflux of air during exhalation but close during inspiration, resulting in distal atelectasis in the absence of collateral ventilation.

The LIBERATE study, a multicenter randomized controlled trial demonstrated improvement in FEV1 ≥15% in 48% of patients after EBV placement compared with 17% of patients receiving standard medical therapy has resulted in FDA approval (Criner G, et al. Am J Respir Crit Care Med. 2018 May 22. doi: 10.1164/rccm.201803-0590OC. [Epub ahead of print]). Patients with EBV had improved subjective dyspnea scores, residual volume, and 6-minute walk distance; however, the pneumothorax rate was 27%.

All study patients with EBV underwent bronchoscopic evaluation for collateral ventilation using a proprietary digital system, which measures expiratory airflow in target airways to establish the presence of collateral ventilation. Previous data have demonstrated improved transplant-free survival when implanted EBVs result in atelectasis of the target lobe, which requires intact interlobar fissures (Garner, et al. Am J Respir Crit Care Med. 2016;194[4]:519). Ongoing clinical trials are attempting to clarify the role of EBV therapy in different phenotypes of COPD, including patients with homogenous emphysema. Long-term follow-up data will be important in determining the broader implementation of bronchoscopic lung volume reduction moving forward.

Vivek Murthy, MD
Jason A. Akulian, MD, FCCP
Steering Committee Members
 

Pediatric Chest Medicine

CFTR modulators

Cystic fibrosis (CF) is a progressive genetic disorder resulting in multiorgan disease with progressive respiratory decline. CF is caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. This codes for the CFTR anion channel and contributes to the movement of salt in and out of the cell. CFTR dysfunction leads to thickened secretions in the lungs and other organs, such as the gut and pancreas. This leads to more lung infections and other organ dysfunction that ultimately leads to premature death.

Pulmonary Physiology, Function, and Rehabilitation

Wildfires, particulate matter, and lung function

In the last 3 decades, human-caused climate change contributed to wildfires in an additional 4.2 million hectares of land across the western US alone. Human impact on climate is responsible for nearly doubling the expected wildfire area (Abatzoglou, et al. PNAS. 2016;113:11770). Year 2017 saw the most destructive wildfires in California recorded to date, and over $2 billion dollars was spent by the US Forest Service, the most-expensive on record. Besides the devastating effects on the forestry and nearby communities, wildfires also generate a large amount of particulate matter (PM). In western US, wildfires contributed to 71.3% of total PM2.5 on days exceeding regulatory PM2.5 standards during 2004-2009 (Liu et al. Clim Change. 2016;138:655). Acute PM exposure is associated with respiratory health effects, such as exacerbation of asthma and COPD, increased ED visits and hospitalization for pneumonia, and increased mortality. Chronic PM2.5 exposure may also affect lung function. Cross-shift and cross-season FEV1 declined by 0.150 L and 0.104 L, respectively in forest firefighters (Betchley, et al. Am. J Ind Med. 1997;31:503). The Children’s Health Study conducted in California found that subjects who were exposed to the highest level of exposure to PM2.5 were five times more likely to have an FEV1 less than 80% of expected FEV1 when they reached 18 years of age than subjects exposed to the lowest level of PM2.5 (Gauderman et al. N Engl J Med. 2004;351:1057). Clinicians should educate patients and the public how to protect our environment and, when wildfires occur, how to protect themselves from exposure to PM.

Thomas W. DeCato, MD
Fellow-in-Training Committee Member

Yuh-Chin T. Huang, MD, FCCP
Steering Committee Member
 

Pulmonary Vascular Disease

Small increases in pulmonary pressures—big impact

Pulmonary hypertension (PH) is a progressive, life-limiting pulmonary vascular disease that is diagnosed hemodynamically by right-sided heart catheterization (RHC) and defined by a mean pulmonary artery pressure (mPAP) >25 mm Hg (Hoeper MM, et al. JACC. 2013;62(25 Suppl):D42).

The impact of PH on survival both in its “pure” form, pulmonary arterial hypertension, and in the setting of underlying cardiopulmonary disease, is well established. However, the clinical relevance of mildly elevated mPAP, defined as mPAP between 18 and 24 mm Hg, has been unclear until recently. Two large cohort studies have suggested that mild increases in mPAP are clinically relevant. A large retrospective analysis of hemodynamic data from 21,727 US veterans found mildly increased mPAP (19-24 mm Hg) was associated with increased hospitalization and decreased survival (Maron, et al. Circulation. 2016;133:1240).

While this population was skewed toward elderly men, a study from Vanderbilt University that included equal numbers of men and women showed similar results. Patients with mPAP 19-24 mm Hg experienced incrementally increased mortality (HR:1.31, P=.001). Importantly, in the subset of patients who underwent a repeat RHC in follow-up, 61% developed progressive increases of pulmonary pressures (>25 mm Hg) on follow-up RHC suggesting that the disease process may progress in a substantial proportion of patients (Assad, et al. JAMA Cardiol. 2017;2[1]):1361). Combined with prior data from smaller cohorts, these studies highlight the impact of mildly increased pulmonary pressures on outcomes. Given the dearth of available data regarding interventions for these patients, there is an urgent need to study to role of specific therapy for mildly elevated pulmonary pressures.

Vijay Balasubramanian, MD, FCCP
Steering Committee Member

Jean Elwing, MD, FCCP
Steering Committee Vice-Chair

Thoracic Oncology

Multiple tumor nodules in lung cancer diagnosis

Low dose CT (LDCT) scan screening for lung cancer is a recommended preventative modality for adults with a significant smoking history (Mayer et al. Ann Int Med. 2014;160(5):330). The screening approach aims to identify adults at significant risk for lung cancer. The goal is to discover lung cancers at low stage with benign mediastinal nodes for optimal treatment and potential for cure. In a minority, but significant number of cases, the LDCT demonstrates multiple lung nodules or masses confounding the attempt to adequately stage the tumor. Two tumors representing a primary cancer and separate malignant spread, namely, intra-pulmonary metastases, in the same lobe, different ipsilateral lobe, or contralateral lobe would be staged, respectively, as T3, T4, or M1a (Detterbeck et al. Chest. 2013;143(5):e191S). Clearly, if the two tumors are separate unique primary cancers, independent of one another, then at best they would be considered as multiple T1 tumors. The treatment modalities of and clinical survival outcomes for these multiple conditions would be markedly different.

The identification of additional tumors may be synchronous (at the same time of the primary discovery) or metachronous (at a later time than the primary discovery). The approach is basically the same. Two tumors with different histologic types, or having separate in-situ squamous cell carcinoma patterns, or disparate immunohistochemical or molecular expressions, or different genomic profiles or driver mutations may be considered as separate distinct primary malignancies (Detterbeck et al. J Thorac Oncol. 2016;11:639; Nicholson et al. J Thorac Oncol. 2017;13:205). Separate foci of ground-glass opacities with small solid central component indicative of minimally invasive adenocarcinoma may be designated as the highest T-stage. These cited and more challenging cases should be presented to a lung cancer tumor board with multiple specialties represented for analysis and judgment. The approach to diagnostic decision-making and clinical management should involve the expertise of all specialties in the lung cancer patient care team.

Arnold M. Schwartz, MD, PhD, FCCP
Steering Committee Member


















 

Editor’s picks

Original Research
Pilot Feasibility Study in Establishing the Role of Ultrasound-Guided Pleural Biopsies in Pleural Infection (The AUDIO Study). By Dr. I. Psallidas, et al.


Commentary
Sleep Apnea Morbidity: A Consequence of Microbial-Immune Cross-Talk? By Dr. N. Farre, et al.


Evidence-Based Medicine
Treatment of Interstitial Lung Disease-Associated Cough: CHEST guideline and expert panel report. By Dr. S. S. Birring, et al.

Editor’s picks

Original Research
Pilot Feasibility Study in Establishing the Role of Ultrasound-Guided Pleural Biopsies in Pleural Infection (The AUDIO Study). By Dr. I. Psallidas, et al.


Commentary
Sleep Apnea Morbidity: A Consequence of Microbial-Immune Cross-Talk? By Dr. N. Farre, et al.


Evidence-Based Medicine
Treatment of Interstitial Lung Disease-Associated Cough: CHEST guideline and expert panel report. By Dr. S. S. Birring, et al.

Editor’s picks

Original Research
Pilot Feasibility Study in Establishing the Role of Ultrasound-Guided Pleural Biopsies in Pleural Infection (The AUDIO Study). By Dr. I. Psallidas, et al.


Commentary
Sleep Apnea Morbidity: A Consequence of Microbial-Immune Cross-Talk? By Dr. N. Farre, et al.


Evidence-Based Medicine
Treatment of Interstitial Lung Disease-Associated Cough: CHEST guideline and expert panel report. By Dr. S. S. Birring, et al.