Society News

The AGA Community (https://community.gastro.org) received a makeover – the upgraded networking platform now features a newsfeed for difficult patient scenarios and regularly scheduled Roundtable discussions with experts in the field. In case you missed it, here are the most popular clinical discussions happening in the newsfeed:

• UC patient with new diagnosis of breast cancer (https://community.gastro.org/posts/20142)
• COVID testing before elective procedures (https://community.gastro.org/posts/21106)
• Remdesivir and hepatic failure (https://community.gastro.org/posts/21130)
• Doses of antibiotics for IBS-D patient (https://community.gastro.org/posts/19749)
• Vedolizumab and sinus migraines (https://community.gastro.org/posts/20204)

Follow and ask experts your questions in Roundtable:

• Resumption of elective endoscopy during COVID-19
• COVID-19 and GI: Caring for IBD
• Q&A with EoE guideline authors
• Q&A with the U.S. Multi-Society Task Force on Colorectal Cancer: follow-up after normal colonoscopy and polypectomy

View all upcoming Roundtables in the community at https://community.gastro.org/discussions.

The AGA Community (https://community.gastro.org) received a makeover – the upgraded networking platform now features a newsfeed for difficult patient scenarios and regularly scheduled Roundtable discussions with experts in the field. In case you missed it, here are the most popular clinical discussions happening in the newsfeed:

• UC patient with new diagnosis of breast cancer (https://community.gastro.org/posts/20142)
• COVID testing before elective procedures (https://community.gastro.org/posts/21106)
• Remdesivir and hepatic failure (https://community.gastro.org/posts/21130)
• Doses of antibiotics for IBS-D patient (https://community.gastro.org/posts/19749)
• Vedolizumab and sinus migraines (https://community.gastro.org/posts/20204)

Follow and ask experts your questions in Roundtable:

• Resumption of elective endoscopy during COVID-19
• COVID-19 and GI: Caring for IBD
• Q&A with EoE guideline authors
• Q&A with the U.S. Multi-Society Task Force on Colorectal Cancer: follow-up after normal colonoscopy and polypectomy

View all upcoming Roundtables in the community at https://community.gastro.org/discussions.

The AGA Community (https://community.gastro.org) received a makeover – the upgraded networking platform now features a newsfeed for difficult patient scenarios and regularly scheduled Roundtable discussions with experts in the field. In case you missed it, here are the most popular clinical discussions happening in the newsfeed:

• UC patient with new diagnosis of breast cancer (https://community.gastro.org/posts/20142)
• COVID testing before elective procedures (https://community.gastro.org/posts/21106)
• Remdesivir and hepatic failure (https://community.gastro.org/posts/21130)
• Doses of antibiotics for IBS-D patient (https://community.gastro.org/posts/19749)
• Vedolizumab and sinus migraines (https://community.gastro.org/posts/20204)

Follow and ask experts your questions in Roundtable:

• Resumption of elective endoscopy during COVID-19
• COVID-19 and GI: Caring for IBD
• Q&A with EoE guideline authors
• Q&A with the U.S. Multi-Society Task Force on Colorectal Cancer: follow-up after normal colonoscopy and polypectomy

View all upcoming Roundtables in the community at https://community.gastro.org/discussions.

This article is brought you by AGA PAC, a voluntary, non-partisan political organization affiliated with and supported by AGA and the only political action committee supported by a national gastroenterology society. Its mission is to give gastroenterologists a greater presence on Capitol Hill and a more effective voice in policy discussions.

The 116th Congress is well represented by the physician community, featuring a total of 17 physicians: 3 in the U.S. Senate and 14 in the House of Representatives. One of the physicians in the House, Rep. Roger Marshall, MD, R-KS, is an OBGYN by trade who is currently serving his second term in Congress. First elected in 2016, he arrived in Washington as one of only two physicians in his freshman class. He actively engaged in health care policy from the very beginning, working across party lines on a range of health care issues facing Capitol Hill. Upon entering Congress, he proactively reached out to AGA as well as other specialty physician organizations to learn our priority issues and expressed his desire to serve as a champion of the physician community.

In addition to the two committees he sits on, Dr. Marshall also serves as the chairman of the health task force for the Republican Study Committee. Additionally, Dr. Marshall is a member of the GOP Doctors Caucus, a coalition of 21 Republican medical providers with a mission statement “to utilize medical expertise to develop patient-centered health care reforms focused on quality, access, affordability, portability, and choice.” The GOP Doctors Caucus was instrumental in pushing for a permanent repeal of the sustainable growth rate (SGR) and helped to coalesce bipartisan, bicameral support for repeal legislation in the 113th Congress. The GOP Doctors Caucus continues to be active in the current Congress, advocating for policies that strengthen both the patient and provider communities.

As a member of the GOP Doctors Caucus and as a physician held in high regard by his House colleagues, Dr. Marshall is uniquely situated to advance agendas and legislative priorities that promote sound health care policy. He willingly works across the aisle with his Democratic counterparts on legislation of importance to the physician and patient community. Dr. Marshall recently worked with one of his Democratic, physician colleagues, Rep. Ami Bera, MD, D-CA, on the Improving Seniors Timely Access to Care Act, legislation addressing prior authorization burdens in Medicare Advantage plans. Dr. Marshall has vocalized the importance of physicians getting involved in the political process and to that effect, spoke to AGA members at AGA’s annual Advocacy Day about his experience as a physician running for Congress and the importance of physician advocacy.

Dr. Marshall is running for the open Senate seat in Kansas. Given that Dr. Marshall has reiterated his desire to continue to work with the physician community to ensure access to care for our patients, AGA looks forward to supporting Dr. Marshall’s Senate candidacy and continuing to work with him and his office on issues and initiatives to advance the science and practice of gastroenterology.

[email protected]

This article is brought you by AGA PAC, a voluntary, non-partisan political organization affiliated with and supported by AGA and the only political action committee supported by a national gastroenterology society. Its mission is to give gastroenterologists a greater presence on Capitol Hill and a more effective voice in policy discussions.

The 116th Congress is well represented by the physician community, featuring a total of 17 physicians: 3 in the U.S. Senate and 14 in the House of Representatives. One of the physicians in the House, Rep. Roger Marshall, MD, R-KS, is an OBGYN by trade who is currently serving his second term in Congress. First elected in 2016, he arrived in Washington as one of only two physicians in his freshman class. He actively engaged in health care policy from the very beginning, working across party lines on a range of health care issues facing Capitol Hill. Upon entering Congress, he proactively reached out to AGA as well as other specialty physician organizations to learn our priority issues and expressed his desire to serve as a champion of the physician community.

In addition to the two committees he sits on, Dr. Marshall also serves as the chairman of the health task force for the Republican Study Committee. Additionally, Dr. Marshall is a member of the GOP Doctors Caucus, a coalition of 21 Republican medical providers with a mission statement “to utilize medical expertise to develop patient-centered health care reforms focused on quality, access, affordability, portability, and choice.” The GOP Doctors Caucus was instrumental in pushing for a permanent repeal of the sustainable growth rate (SGR) and helped to coalesce bipartisan, bicameral support for repeal legislation in the 113th Congress. The GOP Doctors Caucus continues to be active in the current Congress, advocating for policies that strengthen both the patient and provider communities.

As a member of the GOP Doctors Caucus and as a physician held in high regard by his House colleagues, Dr. Marshall is uniquely situated to advance agendas and legislative priorities that promote sound health care policy. He willingly works across the aisle with his Democratic counterparts on legislation of importance to the physician and patient community. Dr. Marshall recently worked with one of his Democratic, physician colleagues, Rep. Ami Bera, MD, D-CA, on the Improving Seniors Timely Access to Care Act, legislation addressing prior authorization burdens in Medicare Advantage plans. Dr. Marshall has vocalized the importance of physicians getting involved in the political process and to that effect, spoke to AGA members at AGA’s annual Advocacy Day about his experience as a physician running for Congress and the importance of physician advocacy.

Dr. Marshall is running for the open Senate seat in Kansas. Given that Dr. Marshall has reiterated his desire to continue to work with the physician community to ensure access to care for our patients, AGA looks forward to supporting Dr. Marshall’s Senate candidacy and continuing to work with him and his office on issues and initiatives to advance the science and practice of gastroenterology.

[email protected]

This article is brought you by AGA PAC, a voluntary, non-partisan political organization affiliated with and supported by AGA and the only political action committee supported by a national gastroenterology society. Its mission is to give gastroenterologists a greater presence on Capitol Hill and a more effective voice in policy discussions.

The 116th Congress is well represented by the physician community, featuring a total of 17 physicians: 3 in the U.S. Senate and 14 in the House of Representatives. One of the physicians in the House, Rep. Roger Marshall, MD, R-KS, is an OBGYN by trade who is currently serving his second term in Congress. First elected in 2016, he arrived in Washington as one of only two physicians in his freshman class. He actively engaged in health care policy from the very beginning, working across party lines on a range of health care issues facing Capitol Hill. Upon entering Congress, he proactively reached out to AGA as well as other specialty physician organizations to learn our priority issues and expressed his desire to serve as a champion of the physician community.

In addition to the two committees he sits on, Dr. Marshall also serves as the chairman of the health task force for the Republican Study Committee. Additionally, Dr. Marshall is a member of the GOP Doctors Caucus, a coalition of 21 Republican medical providers with a mission statement “to utilize medical expertise to develop patient-centered health care reforms focused on quality, access, affordability, portability, and choice.” The GOP Doctors Caucus was instrumental in pushing for a permanent repeal of the sustainable growth rate (SGR) and helped to coalesce bipartisan, bicameral support for repeal legislation in the 113th Congress. The GOP Doctors Caucus continues to be active in the current Congress, advocating for policies that strengthen both the patient and provider communities.

As a member of the GOP Doctors Caucus and as a physician held in high regard by his House colleagues, Dr. Marshall is uniquely situated to advance agendas and legislative priorities that promote sound health care policy. He willingly works across the aisle with his Democratic counterparts on legislation of importance to the physician and patient community. Dr. Marshall recently worked with one of his Democratic, physician colleagues, Rep. Ami Bera, MD, D-CA, on the Improving Seniors Timely Access to Care Act, legislation addressing prior authorization burdens in Medicare Advantage plans. Dr. Marshall has vocalized the importance of physicians getting involved in the political process and to that effect, spoke to AGA members at AGA’s annual Advocacy Day about his experience as a physician running for Congress and the importance of physician advocacy.

Dr. Marshall is running for the open Senate seat in Kansas. Given that Dr. Marshall has reiterated his desire to continue to work with the physician community to ensure access to care for our patients, AGA looks forward to supporting Dr. Marshall’s Senate candidacy and continuing to work with him and his office on issues and initiatives to advance the science and practice of gastroenterology.

[email protected]

AGA just released GI Distance Learning, agau.gastro.org/diweb/catalog/q/GI-Distance-Learning, a new initiative providing AGA trainee members and medical residents a complementary set of curated education and career development resources available online. A part of AGA University, GI Distance Learning enables you to enhance your knowledge in a number of GI-related topics at your own pace from the comfort of home.

Through GI Distance Learning, you will have free access until Aug. 1 to the 800+ questions and answers included in the DDSEP^® 9 Question Bank. Assess your knowledge, identify gaps in learning, and stay current on the latest advances in GI and liver disease.

To access the Question Bank free of charge:

• Visit AGA University and sign in to your AGA account.
• Go to the DDSEP 9 Question Bank.
• Add the Question Bank to your Cart and Checkout.
• Type DDSEP9Distance in the Discount Code box.
• Apply the discount and submit your order.
• Use the My Courses link to access the Question Bank.

During the COVID-19 pandemic, many of us are struggling with the new normal and changes in our daily routines. Resiliency, emotional intelligence, and strategies for combatting burnout become increasingly important. The following on-demand resources from GI Distance Learning can help.

• Resilient Leadership
• Emotional Intelligence
• Strategies to Combat Burnout in GI and Maintaining Work/Life Balance

Continue to check back regularly at AGA University as we will continue to add resources to GI Distance Learning in the coming weeks.

[email protected]

AGA just released GI Distance Learning, agau.gastro.org/diweb/catalog/q/GI-Distance-Learning, a new initiative providing AGA trainee members and medical residents a complementary set of curated education and career development resources available online. A part of AGA University, GI Distance Learning enables you to enhance your knowledge in a number of GI-related topics at your own pace from the comfort of home.

Through GI Distance Learning, you will have free access until Aug. 1 to the 800+ questions and answers included in the DDSEP^® 9 Question Bank. Assess your knowledge, identify gaps in learning, and stay current on the latest advances in GI and liver disease.

To access the Question Bank free of charge:

• Visit AGA University and sign in to your AGA account.
• Go to the DDSEP 9 Question Bank.
• Add the Question Bank to your Cart and Checkout.
• Type DDSEP9Distance in the Discount Code box.
• Apply the discount and submit your order.
• Use the My Courses link to access the Question Bank.

During the COVID-19 pandemic, many of us are struggling with the new normal and changes in our daily routines. Resiliency, emotional intelligence, and strategies for combatting burnout become increasingly important. The following on-demand resources from GI Distance Learning can help.

• Resilient Leadership
• Emotional Intelligence
• Strategies to Combat Burnout in GI and Maintaining Work/Life Balance

Continue to check back regularly at AGA University as we will continue to add resources to GI Distance Learning in the coming weeks.

[email protected]

AGA just released GI Distance Learning, agau.gastro.org/diweb/catalog/q/GI-Distance-Learning, a new initiative providing AGA trainee members and medical residents a complementary set of curated education and career development resources available online. A part of AGA University, GI Distance Learning enables you to enhance your knowledge in a number of GI-related topics at your own pace from the comfort of home.

Through GI Distance Learning, you will have free access until Aug. 1 to the 800+ questions and answers included in the DDSEP^® 9 Question Bank. Assess your knowledge, identify gaps in learning, and stay current on the latest advances in GI and liver disease.

To access the Question Bank free of charge:

• Visit AGA University and sign in to your AGA account.
• Go to the DDSEP 9 Question Bank.
• Add the Question Bank to your Cart and Checkout.
• Type DDSEP9Distance in the Discount Code box.
• Apply the discount and submit your order.
• Use the My Courses link to access the Question Bank.

During the COVID-19 pandemic, many of us are struggling with the new normal and changes in our daily routines. Resiliency, emotional intelligence, and strategies for combatting burnout become increasingly important. The following on-demand resources from GI Distance Learning can help.

• Resilient Leadership
• Emotional Intelligence
• Strategies to Combat Burnout in GI and Maintaining Work/Life Balance

Continue to check back regularly at AGA University as we will continue to add resources to GI Distance Learning in the coming weeks.

[email protected]

Since the beginning of the pandemic, AGA has objected to the Centers for Medicare & Medicaid Services’ (CMS) low reimbursement rate for evaluation and management (E/M) services provided by telephone. Today, CMS fixed the problem. Retroactive to March 1, 2020, CMS will pay E/M services provided by telephone at the same rate as in-person, office/outpatient E/M services.

Thanks to everyone who helped us push CMS to address this issue. AGA worked together in coalition with other specialties and Congress on resolving this problem from the start of the pandemic.

Here are more details:

• Medicare’s updated guidance to physicians states, “Medicare payment for the telephone evaluation and management visits (CPT codes 99441-99443) is equivalent to the Medicare payment for office/outpatient visits with established patients effective March 1, 2020.
• The CMS press release outlined the new rates for telephone E/M:
• CMS is also increasing payments for these telephone visits to match payments for similar office and outpatient visits. This would increase payments for these services from a range of about $14-$41 to about $46-$110. The payments are retroactive to March 1, 2020.

We are pleased CMS listened to our message and has addressed this issue. Join the discussion on the AGA Community.

[email protected]

Since the beginning of the pandemic, AGA has objected to the Centers for Medicare & Medicaid Services’ (CMS) low reimbursement rate for evaluation and management (E/M) services provided by telephone. Today, CMS fixed the problem. Retroactive to March 1, 2020, CMS will pay E/M services provided by telephone at the same rate as in-person, office/outpatient E/M services.

Thanks to everyone who helped us push CMS to address this issue. AGA worked together in coalition with other specialties and Congress on resolving this problem from the start of the pandemic.

Here are more details:

• Medicare’s updated guidance to physicians states, “Medicare payment for the telephone evaluation and management visits (CPT codes 99441-99443) is equivalent to the Medicare payment for office/outpatient visits with established patients effective March 1, 2020.
• The CMS press release outlined the new rates for telephone E/M:
• CMS is also increasing payments for these telephone visits to match payments for similar office and outpatient visits. This would increase payments for these services from a range of about $14-$41 to about $46-$110. The payments are retroactive to March 1, 2020.

We are pleased CMS listened to our message and has addressed this issue. Join the discussion on the AGA Community.

[email protected]

Since the beginning of the pandemic, AGA has objected to the Centers for Medicare & Medicaid Services’ (CMS) low reimbursement rate for evaluation and management (E/M) services provided by telephone. Today, CMS fixed the problem. Retroactive to March 1, 2020, CMS will pay E/M services provided by telephone at the same rate as in-person, office/outpatient E/M services.

Thanks to everyone who helped us push CMS to address this issue. AGA worked together in coalition with other specialties and Congress on resolving this problem from the start of the pandemic.

Here are more details:

• Medicare’s updated guidance to physicians states, “Medicare payment for the telephone evaluation and management visits (CPT codes 99441-99443) is equivalent to the Medicare payment for office/outpatient visits with established patients effective March 1, 2020.
• The CMS press release outlined the new rates for telephone E/M:
• CMS is also increasing payments for these telephone visits to match payments for similar office and outpatient visits. This would increase payments for these services from a range of about $14-$41 to about $46-$110. The payments are retroactive to March 1, 2020.

We are pleased CMS listened to our message and has addressed this issue. Join the discussion on the AGA Community.

[email protected]

AGA has published new expert recommendations in Gastroenterology: AGA Institute Rapid Review of the GI and Liver Manifestations of COVID-19, Meta-Analysis of International Data, and Recommendations for the Consultative Management of Patients with COVID-19.

Key guidance for gastroenterologists:

• GI symptoms are not as common in COVID-19 as previously estimated: The overall prevalence was 7.7% (95% CI 7.4 to 8.6%) for diarrhea, 7.8% (95% CI: 7.1 to 8.5%) for nausea/vomiting, and 3.6% (95% CI 3.0 to 4.3%) for abdominal pain. Notably, in outpatients, the pooled prevalence of diarrhea is lower (4.0%).
• However, COVID-19 can present atypically, with GI symptoms: COVID-19 can present with diarrhea as an initial symptom, with a pooled prevalence of 7.9% across 35 studies, encompassing 9,717 patients. Most often, diarrhea is accompanied by other upper respiratory infection symptoms. However, in some cases, diarrhea can precede other symptoms by a few days, and COVID-19 may present as isolated GI symptoms prior to the development of upper respiratory infection symptoms.
• Monitor patients with new diarrhea, nausea, or vomiting for other COVID-19 symptoms: Patients should inform gastroenterologists if they begin to experience new fever, cough, shortness of breath, or other upper respiratory infection symptoms after the onset of GI symptoms. If this occurs, testing for COVID-19 should be considered.
• Abnormalities in liver function tests should prompt thorough evaluation: Liver test abnormalities can be seen in COVID-19 (in approximately 15% of patients); however, available data support that these abnormalities are more commonly attributable to secondary effects from severe disease, rather than primary virus-mediated liver injury. Therefore, it is important to consider alternative etiologies, such as viral hepatitis, when new elevations in aminotransferases are observed.

For all seven evidence-based recommendations and a detailed discussion, review the full publication in Gastroenterology.
 

Authors: Shahnaz Sultan, Osama Altayar, Shazia M. Siddique, Perica Davitkov, Joseph D. Feuerstein, Joseph K. Lim, Yngve Falck-Ytter, Hashem B. El-Serag on behalf of the AGA.

[email protected]

AGA has published new expert recommendations in Gastroenterology: AGA Institute Rapid Review of the GI and Liver Manifestations of COVID-19, Meta-Analysis of International Data, and Recommendations for the Consultative Management of Patients with COVID-19.

Key guidance for gastroenterologists:

• GI symptoms are not as common in COVID-19 as previously estimated: The overall prevalence was 7.7% (95% CI 7.4 to 8.6%) for diarrhea, 7.8% (95% CI: 7.1 to 8.5%) for nausea/vomiting, and 3.6% (95% CI 3.0 to 4.3%) for abdominal pain. Notably, in outpatients, the pooled prevalence of diarrhea is lower (4.0%).
• However, COVID-19 can present atypically, with GI symptoms: COVID-19 can present with diarrhea as an initial symptom, with a pooled prevalence of 7.9% across 35 studies, encompassing 9,717 patients. Most often, diarrhea is accompanied by other upper respiratory infection symptoms. However, in some cases, diarrhea can precede other symptoms by a few days, and COVID-19 may present as isolated GI symptoms prior to the development of upper respiratory infection symptoms.
• Monitor patients with new diarrhea, nausea, or vomiting for other COVID-19 symptoms: Patients should inform gastroenterologists if they begin to experience new fever, cough, shortness of breath, or other upper respiratory infection symptoms after the onset of GI symptoms. If this occurs, testing for COVID-19 should be considered.
• Abnormalities in liver function tests should prompt thorough evaluation: Liver test abnormalities can be seen in COVID-19 (in approximately 15% of patients); however, available data support that these abnormalities are more commonly attributable to secondary effects from severe disease, rather than primary virus-mediated liver injury. Therefore, it is important to consider alternative etiologies, such as viral hepatitis, when new elevations in aminotransferases are observed.

For all seven evidence-based recommendations and a detailed discussion, review the full publication in Gastroenterology.
 

Authors: Shahnaz Sultan, Osama Altayar, Shazia M. Siddique, Perica Davitkov, Joseph D. Feuerstein, Joseph K. Lim, Yngve Falck-Ytter, Hashem B. El-Serag on behalf of the AGA.

[email protected]

AGA has published new expert recommendations in Gastroenterology: AGA Institute Rapid Review of the GI and Liver Manifestations of COVID-19, Meta-Analysis of International Data, and Recommendations for the Consultative Management of Patients with COVID-19.

Key guidance for gastroenterologists:

• GI symptoms are not as common in COVID-19 as previously estimated: The overall prevalence was 7.7% (95% CI 7.4 to 8.6%) for diarrhea, 7.8% (95% CI: 7.1 to 8.5%) for nausea/vomiting, and 3.6% (95% CI 3.0 to 4.3%) for abdominal pain. Notably, in outpatients, the pooled prevalence of diarrhea is lower (4.0%).
• However, COVID-19 can present atypically, with GI symptoms: COVID-19 can present with diarrhea as an initial symptom, with a pooled prevalence of 7.9% across 35 studies, encompassing 9,717 patients. Most often, diarrhea is accompanied by other upper respiratory infection symptoms. However, in some cases, diarrhea can precede other symptoms by a few days, and COVID-19 may present as isolated GI symptoms prior to the development of upper respiratory infection symptoms.
• Monitor patients with new diarrhea, nausea, or vomiting for other COVID-19 symptoms: Patients should inform gastroenterologists if they begin to experience new fever, cough, shortness of breath, or other upper respiratory infection symptoms after the onset of GI symptoms. If this occurs, testing for COVID-19 should be considered.
• Abnormalities in liver function tests should prompt thorough evaluation: Liver test abnormalities can be seen in COVID-19 (in approximately 15% of patients); however, available data support that these abnormalities are more commonly attributable to secondary effects from severe disease, rather than primary virus-mediated liver injury. Therefore, it is important to consider alternative etiologies, such as viral hepatitis, when new elevations in aminotransferases are observed.

For all seven evidence-based recommendations and a detailed discussion, review the full publication in Gastroenterology.
 

Authors: Shahnaz Sultan, Osama Altayar, Shazia M. Siddique, Perica Davitkov, Joseph D. Feuerstein, Joseph K. Lim, Yngve Falck-Ytter, Hashem B. El-Serag on behalf of the AGA.

[email protected]

There is no denying that over the last few months, the world has become a very different and uncertain place. We all are slowly adjusting to our new “normal” and whether it has been through longer and more grueling hours, volunteering in areas of greater need, or switching your practice to function through an online platform, I commend you for the extra time, focus, and energy you have undoubtedly put into your everyday patient care routines throughout the pandemic.

There have been a lot of questions coming in about what the plan is for CHEST Annual Meeting 2020 in October. Will we be able to gather in large groups at that time? Will there be alternative education options if some are unable to travel to Chicago, Illinois, due to travel restrictions or an increased workload? What is our plan?

As the Program Chair of this year’s meeting, and as a practicing pulmonary and critical care physician, I will be honest with you. There is still a lot of unknown. We cannot confidently say what the world will look like come October. We do not know what travel restrictions will still be in place, or if any new ones will have been implemented. We do not know what the volume of COVID-19 cases will be at that point in time. But, we do know that the community of clinical professionals that has grown at previous CHEST Annual Meetings, and at other live CHEST education courses, is eager for an opportunity to once again connect with their peers, make new connections, and learn in new ways at the premier event in clinical pulmonary, critical care, and sleep medicine. Not forgetting, that now, more than ever, colleagues outside of our specialties are looking for the education that CHEST has to offer in management of coagulation and ARDS, and more.

I do not have all of the answers, but I do know that the staff at CHEST Global Headquarters are working tirelessly to build a meeting that is at present, still planned to take place in Chicago, but that also will be translated onto an online platform that will allow for anyone and everyone to participate, either in person or online. The CHEST team is working closely with our Scientific Program Committee to produce an innovative meeting with live interactive education, networking events, CHEST Games, and so much more.

Here at CHEST, the hope is to create a “light at the end of the tunnel,” to give you and your colleagues something to look forward to – an opportunity to relax, learn, explore, and reconnect with your peers in the chest medicine field. CHEST leadership and staff are continually monitoring the pandemic, weighing the shifting trajectory of the infection and infection control measures implemented nationally and locally, while ensuring that we have flexible offerings available to meet your short- and long-term educational needs.

There will be more updates available in the coming months, so I encourage you to visit chestmeeting.chestnet.org to stay up to date. I am looking forward to seeing the great community of clinical professionals at CHEST Annual Meeting 2020, this October 17-21, whether it is in-person, or online.

Best,

Victor Test, MD, FCCP

There is no denying that over the last few months, the world has become a very different and uncertain place. We all are slowly adjusting to our new “normal” and whether it has been through longer and more grueling hours, volunteering in areas of greater need, or switching your practice to function through an online platform, I commend you for the extra time, focus, and energy you have undoubtedly put into your everyday patient care routines throughout the pandemic.

There have been a lot of questions coming in about what the plan is for CHEST Annual Meeting 2020 in October. Will we be able to gather in large groups at that time? Will there be alternative education options if some are unable to travel to Chicago, Illinois, due to travel restrictions or an increased workload? What is our plan?

As the Program Chair of this year’s meeting, and as a practicing pulmonary and critical care physician, I will be honest with you. There is still a lot of unknown. We cannot confidently say what the world will look like come October. We do not know what travel restrictions will still be in place, or if any new ones will have been implemented. We do not know what the volume of COVID-19 cases will be at that point in time. But, we do know that the community of clinical professionals that has grown at previous CHEST Annual Meetings, and at other live CHEST education courses, is eager for an opportunity to once again connect with their peers, make new connections, and learn in new ways at the premier event in clinical pulmonary, critical care, and sleep medicine. Not forgetting, that now, more than ever, colleagues outside of our specialties are looking for the education that CHEST has to offer in management of coagulation and ARDS, and more.

I do not have all of the answers, but I do know that the staff at CHEST Global Headquarters are working tirelessly to build a meeting that is at present, still planned to take place in Chicago, but that also will be translated onto an online platform that will allow for anyone and everyone to participate, either in person or online. The CHEST team is working closely with our Scientific Program Committee to produce an innovative meeting with live interactive education, networking events, CHEST Games, and so much more.

Here at CHEST, the hope is to create a “light at the end of the tunnel,” to give you and your colleagues something to look forward to – an opportunity to relax, learn, explore, and reconnect with your peers in the chest medicine field. CHEST leadership and staff are continually monitoring the pandemic, weighing the shifting trajectory of the infection and infection control measures implemented nationally and locally, while ensuring that we have flexible offerings available to meet your short- and long-term educational needs.

There will be more updates available in the coming months, so I encourage you to visit chestmeeting.chestnet.org to stay up to date. I am looking forward to seeing the great community of clinical professionals at CHEST Annual Meeting 2020, this October 17-21, whether it is in-person, or online.

Best,

Victor Test, MD, FCCP

There is no denying that over the last few months, the world has become a very different and uncertain place. We all are slowly adjusting to our new “normal” and whether it has been through longer and more grueling hours, volunteering in areas of greater need, or switching your practice to function through an online platform, I commend you for the extra time, focus, and energy you have undoubtedly put into your everyday patient care routines throughout the pandemic.

There have been a lot of questions coming in about what the plan is for CHEST Annual Meeting 2020 in October. Will we be able to gather in large groups at that time? Will there be alternative education options if some are unable to travel to Chicago, Illinois, due to travel restrictions or an increased workload? What is our plan?

As the Program Chair of this year’s meeting, and as a practicing pulmonary and critical care physician, I will be honest with you. There is still a lot of unknown. We cannot confidently say what the world will look like come October. We do not know what travel restrictions will still be in place, or if any new ones will have been implemented. We do not know what the volume of COVID-19 cases will be at that point in time. But, we do know that the community of clinical professionals that has grown at previous CHEST Annual Meetings, and at other live CHEST education courses, is eager for an opportunity to once again connect with their peers, make new connections, and learn in new ways at the premier event in clinical pulmonary, critical care, and sleep medicine. Not forgetting, that now, more than ever, colleagues outside of our specialties are looking for the education that CHEST has to offer in management of coagulation and ARDS, and more.

I do not have all of the answers, but I do know that the staff at CHEST Global Headquarters are working tirelessly to build a meeting that is at present, still planned to take place in Chicago, but that also will be translated onto an online platform that will allow for anyone and everyone to participate, either in person or online. The CHEST team is working closely with our Scientific Program Committee to produce an innovative meeting with live interactive education, networking events, CHEST Games, and so much more.

Here at CHEST, the hope is to create a “light at the end of the tunnel,” to give you and your colleagues something to look forward to – an opportunity to relax, learn, explore, and reconnect with your peers in the chest medicine field. CHEST leadership and staff are continually monitoring the pandemic, weighing the shifting trajectory of the infection and infection control measures implemented nationally and locally, while ensuring that we have flexible offerings available to meet your short- and long-term educational needs.

There will be more updates available in the coming months, so I encourage you to visit chestmeeting.chestnet.org to stay up to date. I am looking forward to seeing the great community of clinical professionals at CHEST Annual Meeting 2020, this October 17-21, whether it is in-person, or online.

Best,

Victor Test, MD, FCCP

CHEST is known for innovative learning. This stems from an appetite for experimentation, a highly engaged membership, strong volunteer leaders, and a responsive staff. We are leaders in gaming, simulation, and hands-on and applied learning, and we’re best in class in key areas – namely our annual conference – that demonstrate organizational responsiveness.

I serve as Chief Learning Officer and Senior Vice President of Education and have been with CHEST for nearly a year. I was drawn to CHEST for its strong mission and look forward to sharing ideas for how we can develop and deliver learning in a changed world.

The charge for developing an organization-wide learning strategy comes from the CHEST Board and Robert Musacchio, PhD, CHEST CEO and Executive Vice President, and it is reflected in an ambitious strategic statement that links our shared direction to broad-based growth through expansion of our clinical audience and reach, resulting in an increased ability to improve the lives of patients.

CHEST will crush lung disease by creating exceptional educational experiences relevant to clinicians, patients, caregivers, and industry, applying our trusted brand and data and employing our highly respected staff and volunteers with clinical expertise.

To meet this challenge, we gathered insights from across the membership and identified that our learning strategy should be built on the three anchors of choice:

• Choice – Emphasizes easy-to-find learning that adapts to learner need through engagement, pathways, and social interaction. This is known as personalized learning.
• Responsiveness – Combines our ability to understand and respond to learners with new and enhanced programs, products, and learning experiences.
• Connection – Provides learners with immediate, longitudinal, and engaging communities to maximize their connection to CHEST over the length of their career.

The coronavirus pandemic requires us to come together as a community and further our focus. Our values remain unchanged: to meet our learners where they are. Now, more than ever, that means we need to deliver CHEST learning with an emphasis on digital. Three areas make up CHEST digital learning: virtual programming, e-learning, and game-based learning. Some concrete examples of what you can expect:

• We are currently preparing and will be prepared to deliver virtual versions of our Annual Conference and Board Review (should either event not run in-person).
• We will release a game hub called Arcades this summer, which will allow for you to access our games online.
• We continue to enhance the offerings available in our e-learning subscription.
• We continue to release fresh educational content on the CHEST COVID-19 site.

CHEST is known for innovative learning. This stems from an appetite for experimentation, a highly engaged membership, strong volunteer leaders, and a responsive staff. We are leaders in gaming, simulation, and hands-on and applied learning, and we’re best in class in key areas – namely our annual conference – that demonstrate organizational responsiveness.

I serve as Chief Learning Officer and Senior Vice President of Education and have been with CHEST for nearly a year. I was drawn to CHEST for its strong mission and look forward to sharing ideas for how we can develop and deliver learning in a changed world.

The charge for developing an organization-wide learning strategy comes from the CHEST Board and Robert Musacchio, PhD, CHEST CEO and Executive Vice President, and it is reflected in an ambitious strategic statement that links our shared direction to broad-based growth through expansion of our clinical audience and reach, resulting in an increased ability to improve the lives of patients.

CHEST will crush lung disease by creating exceptional educational experiences relevant to clinicians, patients, caregivers, and industry, applying our trusted brand and data and employing our highly respected staff and volunteers with clinical expertise.

To meet this challenge, we gathered insights from across the membership and identified that our learning strategy should be built on the three anchors of choice:

• Choice – Emphasizes easy-to-find learning that adapts to learner need through engagement, pathways, and social interaction. This is known as personalized learning.
• Responsiveness – Combines our ability to understand and respond to learners with new and enhanced programs, products, and learning experiences.
• Connection – Provides learners with immediate, longitudinal, and engaging communities to maximize their connection to CHEST over the length of their career.

The coronavirus pandemic requires us to come together as a community and further our focus. Our values remain unchanged: to meet our learners where they are. Now, more than ever, that means we need to deliver CHEST learning with an emphasis on digital. Three areas make up CHEST digital learning: virtual programming, e-learning, and game-based learning. Some concrete examples of what you can expect:

• We are currently preparing and will be prepared to deliver virtual versions of our Annual Conference and Board Review (should either event not run in-person).
• We will release a game hub called Arcades this summer, which will allow for you to access our games online.
• We continue to enhance the offerings available in our e-learning subscription.
• We continue to release fresh educational content on the CHEST COVID-19 site.

CHEST is known for innovative learning. This stems from an appetite for experimentation, a highly engaged membership, strong volunteer leaders, and a responsive staff. We are leaders in gaming, simulation, and hands-on and applied learning, and we’re best in class in key areas – namely our annual conference – that demonstrate organizational responsiveness.

I serve as Chief Learning Officer and Senior Vice President of Education and have been with CHEST for nearly a year. I was drawn to CHEST for its strong mission and look forward to sharing ideas for how we can develop and deliver learning in a changed world.

The charge for developing an organization-wide learning strategy comes from the CHEST Board and Robert Musacchio, PhD, CHEST CEO and Executive Vice President, and it is reflected in an ambitious strategic statement that links our shared direction to broad-based growth through expansion of our clinical audience and reach, resulting in an increased ability to improve the lives of patients.

CHEST will crush lung disease by creating exceptional educational experiences relevant to clinicians, patients, caregivers, and industry, applying our trusted brand and data and employing our highly respected staff and volunteers with clinical expertise.

To meet this challenge, we gathered insights from across the membership and identified that our learning strategy should be built on the three anchors of choice:

• Choice – Emphasizes easy-to-find learning that adapts to learner need through engagement, pathways, and social interaction. This is known as personalized learning.
• Responsiveness – Combines our ability to understand and respond to learners with new and enhanced programs, products, and learning experiences.
• Connection – Provides learners with immediate, longitudinal, and engaging communities to maximize their connection to CHEST over the length of their career.

The coronavirus pandemic requires us to come together as a community and further our focus. Our values remain unchanged: to meet our learners where they are. Now, more than ever, that means we need to deliver CHEST learning with an emphasis on digital. Three areas make up CHEST digital learning: virtual programming, e-learning, and game-based learning. Some concrete examples of what you can expect:

• We are currently preparing and will be prepared to deliver virtual versions of our Annual Conference and Board Review (should either event not run in-person).
• We will release a game hub called Arcades this summer, which will allow for you to access our games online.
• We continue to enhance the offerings available in our e-learning subscription.
• We continue to release fresh educational content on the CHEST COVID-19 site.

Registration for CHEST Annual Meeting 2020 has opened! It is important now, more than ever, to stay up to date in clinical chest education. CHEST Annual Meeting is prepared to equip attendees with the latest education and original research in the field that can be taken back home and implemented into practices.

While CHEST is excited to bring the premier event in clinical chest medicine to their Second City Home of Chicago, Illinois, this October 17-21, it is understood that now may not be the best time to be planning for a conference that is 6 months down the road. Currently, your full attention is likely on your patients, your families, your health, and your safety, and it should be! Here at CHEST, the hope is to create a “light at the end of the tunnel” to give you and your colleagues something to look forward to – an opportunity to relax, learn, explore, and reconnect with your peers in the chest medicine field.

This year’s annual meeting will be filled with both new and returning educational opportunities, including CHEST Games; virtual patient tours; hands-on simulation courses; problem-based learning; and the return of FISH Bowl, an innovation competition. Along with the advanced education, there will be countless opportunities to network at after-hour events, such as the CHEST Challenge final competition, the Young Professionals Reception, and the CHEST Foundation Casino Night. Our hope is that you will be able to look ahead to October and be excited about the chance to experience everything that will be offered at CHEST 2020.

Before the meeting in October, don’t forget to submit your abstracts and case reports for consideration to be presented at CHEST 2020. CHEST is excited to give you and your colleagues the opportunity to present new and original research at this year’s meeting, which is why the deadline for submissions has been extended to June 1, 2020.

CHEST acknowledges that your workload is becoming increasingly heavier each day, and we are also making the safety of attendees the top priority.

That is why CHEST will be granting full refunds to any registrant who finds that they can no longer attend CHEST 2020 as the meeting approaches. Any hotel reservation that is made through CHEST’s official housing site, onPeak, will be able to be changed or canceled up to 24 hours in advance of the reservation date. Visit chestmeeting.chestnet.org/hotel-accommodations for more information.

CHEST 2020 meeting chair, Victor Test, MD, FCCP, hopes to leave CHEST learners with a beacon of hope, saying, “Signing up to come to the meeting and participating may seem impossible to think about right now. We are working hard to provide a high-quality experience and are encouraging everyone to look forward to the future, which will be a lot brighter.”

For all of the latest information on CHEST 2020, visit chestmeeting.chestnet.org.

Registration for CHEST Annual Meeting 2020 has opened! It is important now, more than ever, to stay up to date in clinical chest education. CHEST Annual Meeting is prepared to equip attendees with the latest education and original research in the field that can be taken back home and implemented into practices.

While CHEST is excited to bring the premier event in clinical chest medicine to their Second City Home of Chicago, Illinois, this October 17-21, it is understood that now may not be the best time to be planning for a conference that is 6 months down the road. Currently, your full attention is likely on your patients, your families, your health, and your safety, and it should be! Here at CHEST, the hope is to create a “light at the end of the tunnel” to give you and your colleagues something to look forward to – an opportunity to relax, learn, explore, and reconnect with your peers in the chest medicine field.

This year’s annual meeting will be filled with both new and returning educational opportunities, including CHEST Games; virtual patient tours; hands-on simulation courses; problem-based learning; and the return of FISH Bowl, an innovation competition. Along with the advanced education, there will be countless opportunities to network at after-hour events, such as the CHEST Challenge final competition, the Young Professionals Reception, and the CHEST Foundation Casino Night. Our hope is that you will be able to look ahead to October and be excited about the chance to experience everything that will be offered at CHEST 2020.

Before the meeting in October, don’t forget to submit your abstracts and case reports for consideration to be presented at CHEST 2020. CHEST is excited to give you and your colleagues the opportunity to present new and original research at this year’s meeting, which is why the deadline for submissions has been extended to June 1, 2020.

CHEST acknowledges that your workload is becoming increasingly heavier each day, and we are also making the safety of attendees the top priority.

That is why CHEST will be granting full refunds to any registrant who finds that they can no longer attend CHEST 2020 as the meeting approaches. Any hotel reservation that is made through CHEST’s official housing site, onPeak, will be able to be changed or canceled up to 24 hours in advance of the reservation date. Visit chestmeeting.chestnet.org/hotel-accommodations for more information.

CHEST 2020 meeting chair, Victor Test, MD, FCCP, hopes to leave CHEST learners with a beacon of hope, saying, “Signing up to come to the meeting and participating may seem impossible to think about right now. We are working hard to provide a high-quality experience and are encouraging everyone to look forward to the future, which will be a lot brighter.”

For all of the latest information on CHEST 2020, visit chestmeeting.chestnet.org.

Registration for CHEST Annual Meeting 2020 has opened! It is important now, more than ever, to stay up to date in clinical chest education. CHEST Annual Meeting is prepared to equip attendees with the latest education and original research in the field that can be taken back home and implemented into practices.

While CHEST is excited to bring the premier event in clinical chest medicine to their Second City Home of Chicago, Illinois, this October 17-21, it is understood that now may not be the best time to be planning for a conference that is 6 months down the road. Currently, your full attention is likely on your patients, your families, your health, and your safety, and it should be! Here at CHEST, the hope is to create a “light at the end of the tunnel” to give you and your colleagues something to look forward to – an opportunity to relax, learn, explore, and reconnect with your peers in the chest medicine field.

This year’s annual meeting will be filled with both new and returning educational opportunities, including CHEST Games; virtual patient tours; hands-on simulation courses; problem-based learning; and the return of FISH Bowl, an innovation competition. Along with the advanced education, there will be countless opportunities to network at after-hour events, such as the CHEST Challenge final competition, the Young Professionals Reception, and the CHEST Foundation Casino Night. Our hope is that you will be able to look ahead to October and be excited about the chance to experience everything that will be offered at CHEST 2020.

Before the meeting in October, don’t forget to submit your abstracts and case reports for consideration to be presented at CHEST 2020. CHEST is excited to give you and your colleagues the opportunity to present new and original research at this year’s meeting, which is why the deadline for submissions has been extended to June 1, 2020.

CHEST acknowledges that your workload is becoming increasingly heavier each day, and we are also making the safety of attendees the top priority.

That is why CHEST will be granting full refunds to any registrant who finds that they can no longer attend CHEST 2020 as the meeting approaches. Any hotel reservation that is made through CHEST’s official housing site, onPeak, will be able to be changed or canceled up to 24 hours in advance of the reservation date. Visit chestmeeting.chestnet.org/hotel-accommodations for more information.

CHEST 2020 meeting chair, Victor Test, MD, FCCP, hopes to leave CHEST learners with a beacon of hope, saying, “Signing up to come to the meeting and participating may seem impossible to think about right now. We are working hard to provide a high-quality experience and are encouraging everyone to look forward to the future, which will be a lot brighter.”

For all of the latest information on CHEST 2020, visit chestmeeting.chestnet.org.

Fighting the novel coronavirus together with you. By Dr. J. Li. 
 
Comparative Safety and Effectiveness of Inhaled Corticosteroid and Long-Acting Beta2-AgonistCombinations in Patients With COPD.By Dr. T-U Chang, et al. 
 
The Evolving Landscape of e-Cigarettes: A Systematic Review of Recent Evidence. By Dr. J. Bozier, et al.

Fighting the novel coronavirus together with you. By Dr. J. Li. 
 
Comparative Safety and Effectiveness of Inhaled Corticosteroid and Long-Acting Beta2-AgonistCombinations in Patients With COPD.By Dr. T-U Chang, et al. 
 
The Evolving Landscape of e-Cigarettes: A Systematic Review of Recent Evidence. By Dr. J. Bozier, et al.

Fighting the novel coronavirus together with you. By Dr. J. Li. 
 
Comparative Safety and Effectiveness of Inhaled Corticosteroid and Long-Acting Beta2-AgonistCombinations in Patients With COPD.By Dr. T-U Chang, et al. 
 
The Evolving Landscape of e-Cigarettes: A Systematic Review of Recent Evidence. By Dr. J. Bozier, et al.

Interventional and Chest Diagnostic Procedures

3D printing and pulmonology

Recent advances in 3D printing has enabled physicians to apply this technology in medical education, procedural planning, tissue modeling, and implantable device manufacturing. This is especially true in the field of pulmonology. Advancements in 3D printing have made personalized airway stents a reality, both by 3D printing-assisted injection molding or direct 3D printing.

Airway stents have significantly evolved over the last half century. With use of silicone, bare metallic, and hybrid stents, pulmonologists have an ever-expanding option to address airway stenosis due to both benign and malignancy etiologies. Personalized airway stents hold the potential for advance customization, minimizing pressure points, and improving airflow dynamics to increase mucus clearance. In January 2020, the US Food and Drug Administration (FDA) cleared patient-specific airway stents developed by Dr. Thomas Gildea of Cleveland Clinic. The patient-specific silicone stents are created using CT scans and 3D visualization software to generate a 3D-printed mold that was subsequently used to inject with medical-grade silicone. Two years earlier, a Duke University startup known as restor3D created the first direct 3D printed airway stent using a compressible biocompatible material with properties similar to that of silicone. Both of these stents have been used in patients with promising response.

As we look into the future, the field of pulmonology will experience significant changes with more adoption of 3D printing (ie, additive manufacturing). We may soon be able to create personalized airway prosthesis of any type (stents, spigots, valves, tracheostomies, t-tubes) for the benefit of our patients.

Pediatric Chest Medicine

COVID-19: Pediatric story of a new pandemic

In December 2019, an outbreak of pneumonia identified to be caused by 2019 novel coronavirus (2019-nCoV) emerged in Wuhan, China, possibly originating from the local wet market selling many species of live animals. A novel member of enveloped RNA coronavirus was identified in samples of BAL fluid from a patient in Wuhan.

It has since rapidly spread globally to countries across six continents. As of early April, 1,286,409 cases have been reported worldwide with 337,933 cases (9,600 deaths) in the US (https://coronavirus.jhu.edu/map.html) with more cases and deaths every day. Most of these initial reports of COVID-19 (COronaVIrusDisease) in children are from China. Fever (60%) and cough (65%) were the most common symptoms. Procalcitonin elevation (80% and co-infection (80%) were prominent clinical findings. Consolidation with surrounding halo sign (50%) and ground-glass opacities (60%) on CT scan were typical radiologic findings. Almost all children recovered without needing intensive care support.

Increased IgM COVID-19 antibody levels observed in three neonates raise questions of potential in-utero transmission (Kimberlin et al. JAMA 2020 Mar 26. doi: 10.1001/jama.2020.4868). One study provided evidence for persistent fecal shedding and possibility of fecal-oral transmission (Xu et al. Nat Med 2020 Mar 13. doi: 10.1038/s41591-020-0817-4).

Initial reports show that children appear to be at similar risk of infection as adults, though less likely to have severe symptoms. Young children, particularly infants, are more vulnerable to infection (Dong et al. Pediatrics. 2020 Apr. doi: 10.1542/peds.2020-0702); (Bi et al. medRxiv 2020 Mar 27. doi: 10.1101/2020.03.03.20028423v3). Thus far, few deaths have been reported in the pediatric age group. Trials are being conducted on a war footing to find a cure and a vaccine.

Harish Rao, MD, MBBS

Steering Committee Member
 

Pulmonary Physiology, Function, and Rehabilitation

Controversies and the clinical value of lung volume measurements

Lung volumes are often measured by body plethysmography or gas dilution. Their clinic importance in decision making is unclear. Though measured differently, predicted sets obtained by plethysmography from Caucasian populations are often used for gas dilution measurements (Ruppel GL. Respir Care. 2012 Jan;57[1]:26). Recently the GLI felt lung volume data were insufficient to develop universal reference equations (Cooper B, et al. Breathe (Sheff). 2017 Sep;13[3]:e56-e64). ERS/ATS guidelines recommend adjusting Caucasian predicted values depending on race, without advising how to adjust the confidence limits. Their algorithms show if the VC is normal, lung volumes are unnecessary, though it is not unusual to see a normal VC with reduced TLC. Does this suggest the VC is more important than the TLC, even if lacking predicted volume equations for non-Caucasians? Because combined obstructive and restrictive abnormalities occur simultaneously, recommendations state severity of impairment be determined by the FEV1 percent of predicted rather than TLC (Pellegrino R, et al. Eur Respir J. 2005;26:948). The value of quantifying other volumes such as FRC and ERV in conditions such as obesity and musculoskeletal defects is also not clear. In obstruction, volumes can indicate air trapping or hyperinflation measuring RV and RV/TLC. Though cutoffs of <80% and >120% of predicted are often used, guidelines discourage this practice, recommending using predicted equations based on age, race, height, and sex, with statistical limits of normal (Ruppel GL. Respir Care. 2012 Jan;57(1):26).

Said A. Chaaban, MD

Steering Committee Member

Zachary Q. Morris, MD

NetWork Member
 

Pulmonary Vascular Disease

Pulmonary hypertension associated with atrial septal defect in adults: closing time?

Up to 10% of adults with atrial septal defects (ASDs) can develop pulmonary arterial hypertension (PAH) according to European Guidelines on pulmonary hypertension (PH) (Galie, et al. Eur Heart J. 2016;37[1]:67). If ASD closure is considered, they propose a pulmonary vascular resistance index (PVRi) <4 Wood units (WU) m² as a safe cutoff. Higher PVRi carries a higher operative risk, warranting evaluation in specialized PH centers.

American guidelines (Stout, et al. Circulation. 2019 Apr 2;139[14]:e698) recommend closure in symptomatic patients with a net shunt (Qp/Qs) of >1.5:1. Closure appears safe if pulmonary artery (PA) systolic pressure is <1/2 systemic blood pressure, and PVR / systemic vascular resistance is <0.3. They recommend specialized evaluation for higher pressures and to avoid closure once a net right to left shunt is present (Qp/Qs <1.0).

However, in severe cases, experienced centers have reported some success with a “treat-and-close” approach if post-therapy PVR reaches <6.5 WU (Bradley, et al. Int J Cardiol. 2019;291:127).

Finally, consider the following when evaluating ASD-associated PAH: 1. A thermodilution cardiac output method should not be used to calculate PVR/PVRi because of confounding recirculation from the intracardiac shunt (Kwan, et al. Clin Cardiol. 2019;42[3]:334). Qp is used instead and is calculated using Fick equation, requiring accurate oxygen saturation measurements. 2. Mixed venous saturation (MvO2) is needed to determine Qs, and PA saturation cannot be used as MvO2 surrogate. MvO2 must be calculated using superior and inferior vena cava saturations. 3. Some patients with idiopathic PAH may have a small coexisting ASD that is not responsible for the abnormal hemodynamics. Closing the ASD in those cases would be contraindicated. 4. Patients may have more than one type of coexistent congenital heart defect.

Francisco J. Soto, MD, MS, FCCP

Steering Committee Member

Interventional and Chest Diagnostic Procedures

3D printing and pulmonology

Recent advances in 3D printing has enabled physicians to apply this technology in medical education, procedural planning, tissue modeling, and implantable device manufacturing. This is especially true in the field of pulmonology. Advancements in 3D printing have made personalized airway stents a reality, both by 3D printing-assisted injection molding or direct 3D printing.

Airway stents have significantly evolved over the last half century. With use of silicone, bare metallic, and hybrid stents, pulmonologists have an ever-expanding option to address airway stenosis due to both benign and malignancy etiologies. Personalized airway stents hold the potential for advance customization, minimizing pressure points, and improving airflow dynamics to increase mucus clearance. In January 2020, the US Food and Drug Administration (FDA) cleared patient-specific airway stents developed by Dr. Thomas Gildea of Cleveland Clinic. The patient-specific silicone stents are created using CT scans and 3D visualization software to generate a 3D-printed mold that was subsequently used to inject with medical-grade silicone. Two years earlier, a Duke University startup known as restor3D created the first direct 3D printed airway stent using a compressible biocompatible material with properties similar to that of silicone. Both of these stents have been used in patients with promising response.

As we look into the future, the field of pulmonology will experience significant changes with more adoption of 3D printing (ie, additive manufacturing). We may soon be able to create personalized airway prosthesis of any type (stents, spigots, valves, tracheostomies, t-tubes) for the benefit of our patients.

Pediatric Chest Medicine

COVID-19: Pediatric story of a new pandemic

In December 2019, an outbreak of pneumonia identified to be caused by 2019 novel coronavirus (2019-nCoV) emerged in Wuhan, China, possibly originating from the local wet market selling many species of live animals. A novel member of enveloped RNA coronavirus was identified in samples of BAL fluid from a patient in Wuhan.

It has since rapidly spread globally to countries across six continents. As of early April, 1,286,409 cases have been reported worldwide with 337,933 cases (9,600 deaths) in the US (https://coronavirus.jhu.edu/map.html) with more cases and deaths every day. Most of these initial reports of COVID-19 (COronaVIrusDisease) in children are from China. Fever (60%) and cough (65%) were the most common symptoms. Procalcitonin elevation (80% and co-infection (80%) were prominent clinical findings. Consolidation with surrounding halo sign (50%) and ground-glass opacities (60%) on CT scan were typical radiologic findings. Almost all children recovered without needing intensive care support.

Increased IgM COVID-19 antibody levels observed in three neonates raise questions of potential in-utero transmission (Kimberlin et al. JAMA 2020 Mar 26. doi: 10.1001/jama.2020.4868). One study provided evidence for persistent fecal shedding and possibility of fecal-oral transmission (Xu et al. Nat Med 2020 Mar 13. doi: 10.1038/s41591-020-0817-4).

Initial reports show that children appear to be at similar risk of infection as adults, though less likely to have severe symptoms. Young children, particularly infants, are more vulnerable to infection (Dong et al. Pediatrics. 2020 Apr. doi: 10.1542/peds.2020-0702); (Bi et al. medRxiv 2020 Mar 27. doi: 10.1101/2020.03.03.20028423v3). Thus far, few deaths have been reported in the pediatric age group. Trials are being conducted on a war footing to find a cure and a vaccine.

Harish Rao, MD, MBBS

Steering Committee Member
 

Pulmonary Physiology, Function, and Rehabilitation

Controversies and the clinical value of lung volume measurements

Lung volumes are often measured by body plethysmography or gas dilution. Their clinic importance in decision making is unclear. Though measured differently, predicted sets obtained by plethysmography from Caucasian populations are often used for gas dilution measurements (Ruppel GL. Respir Care. 2012 Jan;57[1]:26). Recently the GLI felt lung volume data were insufficient to develop universal reference equations (Cooper B, et al. Breathe (Sheff). 2017 Sep;13[3]:e56-e64). ERS/ATS guidelines recommend adjusting Caucasian predicted values depending on race, without advising how to adjust the confidence limits. Their algorithms show if the VC is normal, lung volumes are unnecessary, though it is not unusual to see a normal VC with reduced TLC. Does this suggest the VC is more important than the TLC, even if lacking predicted volume equations for non-Caucasians? Because combined obstructive and restrictive abnormalities occur simultaneously, recommendations state severity of impairment be determined by the FEV1 percent of predicted rather than TLC (Pellegrino R, et al. Eur Respir J. 2005;26:948). The value of quantifying other volumes such as FRC and ERV in conditions such as obesity and musculoskeletal defects is also not clear. In obstruction, volumes can indicate air trapping or hyperinflation measuring RV and RV/TLC. Though cutoffs of <80% and >120% of predicted are often used, guidelines discourage this practice, recommending using predicted equations based on age, race, height, and sex, with statistical limits of normal (Ruppel GL. Respir Care. 2012 Jan;57(1):26).

Said A. Chaaban, MD

Steering Committee Member

Zachary Q. Morris, MD

NetWork Member
 

Pulmonary Vascular Disease

Pulmonary hypertension associated with atrial septal defect in adults: closing time?

Up to 10% of adults with atrial septal defects (ASDs) can develop pulmonary arterial hypertension (PAH) according to European Guidelines on pulmonary hypertension (PH) (Galie, et al. Eur Heart J. 2016;37[1]:67). If ASD closure is considered, they propose a pulmonary vascular resistance index (PVRi) <4 Wood units (WU) m² as a safe cutoff. Higher PVRi carries a higher operative risk, warranting evaluation in specialized PH centers.

American guidelines (Stout, et al. Circulation. 2019 Apr 2;139[14]:e698) recommend closure in symptomatic patients with a net shunt (Qp/Qs) of >1.5:1. Closure appears safe if pulmonary artery (PA) systolic pressure is <1/2 systemic blood pressure, and PVR / systemic vascular resistance is <0.3. They recommend specialized evaluation for higher pressures and to avoid closure once a net right to left shunt is present (Qp/Qs <1.0).

However, in severe cases, experienced centers have reported some success with a “treat-and-close” approach if post-therapy PVR reaches <6.5 WU (Bradley, et al. Int J Cardiol. 2019;291:127).

Finally, consider the following when evaluating ASD-associated PAH: 1. A thermodilution cardiac output method should not be used to calculate PVR/PVRi because of confounding recirculation from the intracardiac shunt (Kwan, et al. Clin Cardiol. 2019;42[3]:334). Qp is used instead and is calculated using Fick equation, requiring accurate oxygen saturation measurements. 2. Mixed venous saturation (MvO2) is needed to determine Qs, and PA saturation cannot be used as MvO2 surrogate. MvO2 must be calculated using superior and inferior vena cava saturations. 3. Some patients with idiopathic PAH may have a small coexisting ASD that is not responsible for the abnormal hemodynamics. Closing the ASD in those cases would be contraindicated. 4. Patients may have more than one type of coexistent congenital heart defect.

Francisco J. Soto, MD, MS, FCCP

Steering Committee Member

Interventional and Chest Diagnostic Procedures

3D printing and pulmonology

Recent advances in 3D printing has enabled physicians to apply this technology in medical education, procedural planning, tissue modeling, and implantable device manufacturing. This is especially true in the field of pulmonology. Advancements in 3D printing have made personalized airway stents a reality, both by 3D printing-assisted injection molding or direct 3D printing.

Airway stents have significantly evolved over the last half century. With use of silicone, bare metallic, and hybrid stents, pulmonologists have an ever-expanding option to address airway stenosis due to both benign and malignancy etiologies. Personalized airway stents hold the potential for advance customization, minimizing pressure points, and improving airflow dynamics to increase mucus clearance. In January 2020, the US Food and Drug Administration (FDA) cleared patient-specific airway stents developed by Dr. Thomas Gildea of Cleveland Clinic. The patient-specific silicone stents are created using CT scans and 3D visualization software to generate a 3D-printed mold that was subsequently used to inject with medical-grade silicone. Two years earlier, a Duke University startup known as restor3D created the first direct 3D printed airway stent using a compressible biocompatible material with properties similar to that of silicone. Both of these stents have been used in patients with promising response.

As we look into the future, the field of pulmonology will experience significant changes with more adoption of 3D printing (ie, additive manufacturing). We may soon be able to create personalized airway prosthesis of any type (stents, spigots, valves, tracheostomies, t-tubes) for the benefit of our patients.

Pediatric Chest Medicine

COVID-19: Pediatric story of a new pandemic

In December 2019, an outbreak of pneumonia identified to be caused by 2019 novel coronavirus (2019-nCoV) emerged in Wuhan, China, possibly originating from the local wet market selling many species of live animals. A novel member of enveloped RNA coronavirus was identified in samples of BAL fluid from a patient in Wuhan.

It has since rapidly spread globally to countries across six continents. As of early April, 1,286,409 cases have been reported worldwide with 337,933 cases (9,600 deaths) in the US (https://coronavirus.jhu.edu/map.html) with more cases and deaths every day. Most of these initial reports of COVID-19 (COronaVIrusDisease) in children are from China. Fever (60%) and cough (65%) were the most common symptoms. Procalcitonin elevation (80% and co-infection (80%) were prominent clinical findings. Consolidation with surrounding halo sign (50%) and ground-glass opacities (60%) on CT scan were typical radiologic findings. Almost all children recovered without needing intensive care support.

Increased IgM COVID-19 antibody levels observed in three neonates raise questions of potential in-utero transmission (Kimberlin et al. JAMA 2020 Mar 26. doi: 10.1001/jama.2020.4868). One study provided evidence for persistent fecal shedding and possibility of fecal-oral transmission (Xu et al. Nat Med 2020 Mar 13. doi: 10.1038/s41591-020-0817-4).

Initial reports show that children appear to be at similar risk of infection as adults, though less likely to have severe symptoms. Young children, particularly infants, are more vulnerable to infection (Dong et al. Pediatrics. 2020 Apr. doi: 10.1542/peds.2020-0702); (Bi et al. medRxiv 2020 Mar 27. doi: 10.1101/2020.03.03.20028423v3). Thus far, few deaths have been reported in the pediatric age group. Trials are being conducted on a war footing to find a cure and a vaccine.

Harish Rao, MD, MBBS

Steering Committee Member
 

Pulmonary Physiology, Function, and Rehabilitation

Controversies and the clinical value of lung volume measurements

Lung volumes are often measured by body plethysmography or gas dilution. Their clinic importance in decision making is unclear. Though measured differently, predicted sets obtained by plethysmography from Caucasian populations are often used for gas dilution measurements (Ruppel GL. Respir Care. 2012 Jan;57[1]:26). Recently the GLI felt lung volume data were insufficient to develop universal reference equations (Cooper B, et al. Breathe (Sheff). 2017 Sep;13[3]:e56-e64). ERS/ATS guidelines recommend adjusting Caucasian predicted values depending on race, without advising how to adjust the confidence limits. Their algorithms show if the VC is normal, lung volumes are unnecessary, though it is not unusual to see a normal VC with reduced TLC. Does this suggest the VC is more important than the TLC, even if lacking predicted volume equations for non-Caucasians? Because combined obstructive and restrictive abnormalities occur simultaneously, recommendations state severity of impairment be determined by the FEV1 percent of predicted rather than TLC (Pellegrino R, et al. Eur Respir J. 2005;26:948). The value of quantifying other volumes such as FRC and ERV in conditions such as obesity and musculoskeletal defects is also not clear. In obstruction, volumes can indicate air trapping or hyperinflation measuring RV and RV/TLC. Though cutoffs of <80% and >120% of predicted are often used, guidelines discourage this practice, recommending using predicted equations based on age, race, height, and sex, with statistical limits of normal (Ruppel GL. Respir Care. 2012 Jan;57(1):26).

Said A. Chaaban, MD

Steering Committee Member

Zachary Q. Morris, MD

NetWork Member
 

Pulmonary Vascular Disease

Pulmonary hypertension associated with atrial septal defect in adults: closing time?

Up to 10% of adults with atrial septal defects (ASDs) can develop pulmonary arterial hypertension (PAH) according to European Guidelines on pulmonary hypertension (PH) (Galie, et al. Eur Heart J. 2016;37[1]:67). If ASD closure is considered, they propose a pulmonary vascular resistance index (PVRi) <4 Wood units (WU) m² as a safe cutoff. Higher PVRi carries a higher operative risk, warranting evaluation in specialized PH centers.

American guidelines (Stout, et al. Circulation. 2019 Apr 2;139[14]:e698) recommend closure in symptomatic patients with a net shunt (Qp/Qs) of >1.5:1. Closure appears safe if pulmonary artery (PA) systolic pressure is <1/2 systemic blood pressure, and PVR / systemic vascular resistance is <0.3. They recommend specialized evaluation for higher pressures and to avoid closure once a net right to left shunt is present (Qp/Qs <1.0).

However, in severe cases, experienced centers have reported some success with a “treat-and-close” approach if post-therapy PVR reaches <6.5 WU (Bradley, et al. Int J Cardiol. 2019;291:127).

Finally, consider the following when evaluating ASD-associated PAH: 1. A thermodilution cardiac output method should not be used to calculate PVR/PVRi because of confounding recirculation from the intracardiac shunt (Kwan, et al. Clin Cardiol. 2019;42[3]:334). Qp is used instead and is calculated using Fick equation, requiring accurate oxygen saturation measurements. 2. Mixed venous saturation (MvO2) is needed to determine Qs, and PA saturation cannot be used as MvO2 surrogate. MvO2 must be calculated using superior and inferior vena cava saturations. 3. Some patients with idiopathic PAH may have a small coexisting ASD that is not responsible for the abnormal hemodynamics. Closing the ASD in those cases would be contraindicated. 4. Patients may have more than one type of coexistent congenital heart defect.

Francisco J. Soto, MD, MS, FCCP

Steering Committee Member