CHEST: American College of Chest Physicians Annual Meeting

Chronic cough is a problem that can have a major impact on quality of life for patients. In many cases, no cause can be found, but there are emerging therapies that could change treatment for these patients.

Chronic cough is frustrating for patients and their families, especially during the pandemic, explained Krishna M. Sundar, MD, FCCP, clinical professor, Pulmonary Division, Department of Medicine, and medical director, Sleep-Wake Center, University of Utah.

Clinician handoff is critical and can help reduce medical errors in the intensive care unit (ICU), according to a series of presentations on planning and communicating around ICU transitions.

We are still working to figure out why low levels of vitamin D are associated with worse outcomes in critical illness, noted Todd W. Rice, MD, FCCP, associate professor of medicine at Vanderbilt University Medical Center in Nashville, Tennessee.

Tele–intensive care units (ICUs) address coverage gaps and improve quality outcomes, noted John Kazianis, MD, clinical associate professor, Yale School of Medicine, and medical director, InSight Tele-ICU, Yale New Haven Hospital.

Coronavirus disease 2019 (COVID-19) is unlike any pandemic the world has experienced in the last 100 years, said Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, during his keynote.

The era of accountable care and pay for performance is here, and physicians will have to embrace these novel reimbursement models. In a plenary session, Rubin Cohen, MD, FCCP, a member of the American College of Chest Physician's quality improvement committee, discussed the relationship between quality improvement and outcomes.

During a plenary session at the American College of Chest Physicians' CHEST meeting in Austin, Texas, Edgar Jimenez, MD, FCCM, vice president of critical care integration at Baylor Scott and White Health in Central Texas, discussed how to prepare for Ebola in the Intensive Care Unit (ICU) setting. Dr Jimenez began by introducing the session as a way to answer questions and to provide hospital ICU staff with key considerations for Ebola preparation in the United States.

A symposium on idiopathic pulmonary fibrosis (IPF), which was presented on behalf of InterMune, Inc, highlighted clinical data supporting the use of pirfenidone in patients with IPF. Leading the panel discussion was Steven Nathan, MD, FCCP, a principal investigator involved in studies of pirfenidone. Dr Nathan was joined by IPF experts Lisa Lancaster, MD, of Vanderbilt University Medical Center and Marilyn Glassberg, MD, of the University of Miami Health System.

The categorization of lung allograft dysfunction is changing, David Nunley, MD, clinical director of lung transplant at the University of Louisville Health Care Outpatient Center, said at the 2014 CHEST meeting in Austin, Texas.

Fear is the biggest barrier preventing providers from using social media to its fullest potential, according to Christopher Carroll, MD, social media editor at CHEST and research director for the Division of Critical Care at the Connecticut Children's Medical Center.

Dan Heath, a senior fellow at the Center for Advancement of Social Entrepreneurship at Duke University, outlined strategies for implementing change within an organization, including looking for solutions that are already present within an organization, as a solution to a large problem may already have been implemented on a small scale.

During a panel discussion, Darren Taichman, MD, PhD, executive deputy editor of the Annals of Internal Medicine and adjunct associate professor of medicine, Perelman School of Medicine, University of Pennsylvania, presented updates to pulmonary hypertension treatment guidelines, and Daniel Oulette, MD, FCCP, leader of the American College of Chest Physicians guideline oversight committee, discussed the move toward evidence-based guidelines that allow for continuous updates.

The molecular heterogeneity of idiopathic pulmonary fibrosis (IPF) may be important when selecting treatment strategies, including 2 new medications for delaying the progression of IPF-pirfenidone and nintedanib. In a featured lecture, Steven K. Huang, MD, an expert in IPF and an assistant professor of internal medicine at the University of Michigan, discussed characterization of the disease from the perspective of genetics.

The big news at the 2014 CHEST meeting in Austin, TX, was that 2 new drugs - pirfenidone and nintedanib - were approved to treat idiopathic pulmonary fibrosis, according to Steven Nathan, MD, medical director of the Lung Transplant Program at Inova Fairfax Hospital in Falls Church, VA.

Guidelines for the treatment of healthcare-associated pneumonia recommend the use of broad-spectrum therapy. But based on current evidence, use of broad-spectrum therapy may not be warranted, according to Marcos I. Restrepo, MD, MSc, of the University of Texas Health Science Center at San Antonio.

In this session, Gerard A. Silvestri MD, MS, a professor at the Medical University of South Carolina, discussed the evolution of therapy for non-small cell lung cancer (NSCLC). The use of targeted therapies has led to a dramatic improvement in survival for a certain subset of patients with NSCLC whose cancers have specific driver mutations.

Lung cancer is a good candidate for broad, population-based screening because it is a common disease with a high mortality rate that is often more successfully treated when a diagnosis is established early in the disease process. In an educational session, Gerard A. Silvestri, MD, MS, a professor at the Medical University of South Carolina, discussed the state of the art in lung cancer screening.

Check out photos from this year's conference in Atlanta, GA, which took place from October 20-25. The meeting was held at the Georgia World Congress Center, which sits between CNN headquarters and the Georgia Dome.

Robert De Marco, MD, FCCP, Intensivist, Orlando Health, Dr. Phillips Hospital, says that a concern for reimbursement in the ICU is that many private physicians are becoming hospital employed. He says that convincing the hospital they need full-time critical care coverage is a difficult task even though it saves cost and cuts down length of stay and mortalities.

Brian Carlin, MD, FCCP, Allegheny General Hospital, states that there are many challenges in providing pulmonary rehabilitation to patients with chronic lung diseases.

Although there has been a concentrated focus on pulmonary vascular diseases at this year's CHEST conference, there have also been a number of studies released that pertain to cardiovascular events, such as congestive heart failure, atrial fibrillation, and chronic obstructive pulmonary disease. Here are some of the highlights in these areas.

As one might expect, lung cancer is one of the major focuses at each CHEST conference. The following are highlights from this year's recently released abstracts and late-breaking studies.

Although there have been a wide variety of disease states covered at this year's CHEST conference, much of the focus has been on those under the umbrella of pulmonary vascular disease, such as pulmonary arterial hypertension and deep vein thrombosis. Here are some of the new study highlights related to pulmonary vascular disease.

Jun Chiong, MD, MPH, FACC, FCCP, Associate Professor of Medicine, Loma Linda University Medical Center, states the US healthcare system does not utilize a team-based approach.

Robert Frantz, MD, FACC, Director, Pulmonary Hypertension Clinic, Mayo Clinic, says that the issue of cost is an important factor in treating patients with pulmonary arterial hypertension.

The following are highlights of abstracts that focus on readmission rates, an increasingly important subject for hospitals that are subject to evolving rules and regulations as they relate to reimbursement.

Craig Lilly, MD, Professor of Medicine, Anesthesiology and Surgery, Director, UMass Memorial eICU Program, says that technologies must be integrated as well as embraced by the workforce.

The CHEST 2012 meeting features a number of newly published studies for a wide variety of disease states ranging from tuberculosis to lung disease. The following are highlights of hypertension abstracts.

Edward Zawada, MD, MACP, Vice President of Scientific Affairs, Medical Director, Intensivist Program, Medical Director, eICU Program, Avera Medical Group Nephrology, says that the Tele-Intensive Care Program provides the skill set required to care for critically ill patients.