News From CHEST Physician®

The suggested Medicare Physician Fee Schedule for calendar year (CY) 2024 was announced by the Centers for Medicare & Medicaid Services (CMS) in July 2023. Physicians who specialize in pulmonary, critical care, and sleep medicine will be impacted by a number of policy and payment changes. Additionally, keep in mind that this is the proposed rule. Following are some of the key points for our readers:

1. The conversion factor that CMS is suggesting for 2024 is $32.75, which represents a $1.14 (–3.34%) reduction. The current conversion factor is $33.89. This is specifically meant to lower total Medicare spending.

2. It is forecast that pulmonary specialists will experience an estimated 1.09% reduction in Medicare reimbursements if the proposed changes are approved. Medicare reimbursements for critical care specialists will be reduced by 2.51%, and sleep medicine specialists will be seeing a 0.75% increase.

3. Interestingly, CMS is proposing a Healthcare Common Procedure Coding System (HCPCS) code G2211 that will have a distinct add-on payment starting on January 1, 2024. With the help of this add-on code, the resource costs of evaluation and management visits for primary care and long-term treatment of difficult patients will be more accurately recognized. In general, it will be used as an additional payment for outpatient office visits in recognition of the potential expenditures that doctors may face when treating a patient’s single, significant, or complex chronic condition over time. Payment for this add-on code would have a redistributive impact on all other CY 2024 payments, which are still lower than what was previously predicted for this policy in CY 2021 under the Medicare Physician Fee Schedule, which was not implemented at the request of various surgical specialties.

4. As you all are aware, split (or shared) E/M visits in hospitals and other institutional settings are those that are provided in part by doctors and in part by other practitioners of the same specialty but billed under a single provider. Thankfully CMS is recommending delaying the application of the “substantive portion” definition of more than 50% of the total period to at least December 31, 2024. Instead, they are going to keep the present definition of the “substantive portion” for CY 2024, which permits use of either more than half of the visit’s total time or one of the three major components (history, exam, or MDM) to determine who bills the visit. Please remember that Critical Care services (99291/99292) may also be shared or split; however, in this case, billing is based only on time.

5. According to CMS’s current regulatory stance, teaching physicians have to be physically present to charge for services involving residents at the end of the COVID-19 Public Health Emergency. Congress, on the other hand, stepped in and passed legislation to expand Medicare coverage of a number of telehealth services. In accordance with the expanded telehealth policies adopted by Congress, CMS is recommending that teaching physicians be permitted to employ audio/video real-time communications technology when the resident physician provides telehealth services to Medicare beneficiaries for CY 2024.

The CMS’s document is fairly comprehensive, so please visit this link for more information

The suggested Medicare Physician Fee Schedule for calendar year (CY) 2024 was announced by the Centers for Medicare & Medicaid Services (CMS) in July 2023. Physicians who specialize in pulmonary, critical care, and sleep medicine will be impacted by a number of policy and payment changes. Additionally, keep in mind that this is the proposed rule. Following are some of the key points for our readers:

1. The conversion factor that CMS is suggesting for 2024 is $32.75, which represents a $1.14 (–3.34%) reduction. The current conversion factor is $33.89. This is specifically meant to lower total Medicare spending.

2. It is forecast that pulmonary specialists will experience an estimated 1.09% reduction in Medicare reimbursements if the proposed changes are approved. Medicare reimbursements for critical care specialists will be reduced by 2.51%, and sleep medicine specialists will be seeing a 0.75% increase.

3. Interestingly, CMS is proposing a Healthcare Common Procedure Coding System (HCPCS) code G2211 that will have a distinct add-on payment starting on January 1, 2024. With the help of this add-on code, the resource costs of evaluation and management visits for primary care and long-term treatment of difficult patients will be more accurately recognized. In general, it will be used as an additional payment for outpatient office visits in recognition of the potential expenditures that doctors may face when treating a patient’s single, significant, or complex chronic condition over time. Payment for this add-on code would have a redistributive impact on all other CY 2024 payments, which are still lower than what was previously predicted for this policy in CY 2021 under the Medicare Physician Fee Schedule, which was not implemented at the request of various surgical specialties.

4. As you all are aware, split (or shared) E/M visits in hospitals and other institutional settings are those that are provided in part by doctors and in part by other practitioners of the same specialty but billed under a single provider. Thankfully CMS is recommending delaying the application of the “substantive portion” definition of more than 50% of the total period to at least December 31, 2024. Instead, they are going to keep the present definition of the “substantive portion” for CY 2024, which permits use of either more than half of the visit’s total time or one of the three major components (history, exam, or MDM) to determine who bills the visit. Please remember that Critical Care services (99291/99292) may also be shared or split; however, in this case, billing is based only on time.

5. According to CMS’s current regulatory stance, teaching physicians have to be physically present to charge for services involving residents at the end of the COVID-19 Public Health Emergency. Congress, on the other hand, stepped in and passed legislation to expand Medicare coverage of a number of telehealth services. In accordance with the expanded telehealth policies adopted by Congress, CMS is recommending that teaching physicians be permitted to employ audio/video real-time communications technology when the resident physician provides telehealth services to Medicare beneficiaries for CY 2024.

The CMS’s document is fairly comprehensive, so please visit this link for more information

The suggested Medicare Physician Fee Schedule for calendar year (CY) 2024 was announced by the Centers for Medicare & Medicaid Services (CMS) in July 2023. Physicians who specialize in pulmonary, critical care, and sleep medicine will be impacted by a number of policy and payment changes. Additionally, keep in mind that this is the proposed rule. Following are some of the key points for our readers:

1. The conversion factor that CMS is suggesting for 2024 is $32.75, which represents a $1.14 (–3.34%) reduction. The current conversion factor is $33.89. This is specifically meant to lower total Medicare spending.

2. It is forecast that pulmonary specialists will experience an estimated 1.09% reduction in Medicare reimbursements if the proposed changes are approved. Medicare reimbursements for critical care specialists will be reduced by 2.51%, and sleep medicine specialists will be seeing a 0.75% increase.

3. Interestingly, CMS is proposing a Healthcare Common Procedure Coding System (HCPCS) code G2211 that will have a distinct add-on payment starting on January 1, 2024. With the help of this add-on code, the resource costs of evaluation and management visits for primary care and long-term treatment of difficult patients will be more accurately recognized. In general, it will be used as an additional payment for outpatient office visits in recognition of the potential expenditures that doctors may face when treating a patient’s single, significant, or complex chronic condition over time. Payment for this add-on code would have a redistributive impact on all other CY 2024 payments, which are still lower than what was previously predicted for this policy in CY 2021 under the Medicare Physician Fee Schedule, which was not implemented at the request of various surgical specialties.

4. As you all are aware, split (or shared) E/M visits in hospitals and other institutional settings are those that are provided in part by doctors and in part by other practitioners of the same specialty but billed under a single provider. Thankfully CMS is recommending delaying the application of the “substantive portion” definition of more than 50% of the total period to at least December 31, 2024. Instead, they are going to keep the present definition of the “substantive portion” for CY 2024, which permits use of either more than half of the visit’s total time or one of the three major components (history, exam, or MDM) to determine who bills the visit. Please remember that Critical Care services (99291/99292) may also be shared or split; however, in this case, billing is based only on time.

5. According to CMS’s current regulatory stance, teaching physicians have to be physically present to charge for services involving residents at the end of the COVID-19 Public Health Emergency. Congress, on the other hand, stepped in and passed legislation to expand Medicare coverage of a number of telehealth services. In accordance with the expanded telehealth policies adopted by Congress, CMS is recommending that teaching physicians be permitted to employ audio/video real-time communications technology when the resident physician provides telehealth services to Medicare beneficiaries for CY 2024.

The CMS’s document is fairly comprehensive, so please visit this link for more information

Earlier this year, CHEST released new clinical resources on sepsis and antibiotic stewardship developed by the Sepsis Resources Steering Committee with grant support from the US Centers for Disease Control and Prevention (CDC).

The resources – including infographics, videos, podcasts, and research commentaries – aim to help clinicians increase their knowledge of sepsis prevention and treatment, especially when considering the use of antibiotics.

According to CHEST Past President, Steven Q. Simpson, MD, FCCP, who serves as Chair of the Sepsis Resources Steering Committee, sepsis is the number one cause of death in U.S. hospitals . It’s also the most expensive condition treated in those hospitals.

“Perhaps the single most important tool we have to fight sepsis is our array of antimicrobial therapies, including antibacterial, antifungal, and antiviral agents,” Dr. Simpson said. “It is vital that we use the antibiotics we have wisely and preserve them for future use.”

He pointed to the apparent tension between the need to administer broad-spectrum antimicrobials quickly to patients with sepsis and the need to limit the use of broad-spectrum agents as much as possible. But these concepts aren’t at odds with each another, he said. They’re allies in the sepsis war.

CHEST’s new resources can help clinicians practice good antimicrobial stewardship as they balance these needs. Included in the collection is a two-part video discussion exploring conservative and aggressive approaches to antibiotic use in suspected sepsis. A series of podcasts delves into complex sepsis cases, and easy-reference infographics outline key components of an antimicrobial stewardship program, rapid diagnostics for infectious diseases in the ICU, and sepsis mimics.

Steering committee members were chosen from CHEST’s membership for their clinical expertise in sepsis, infectious diseases, and antimicrobial stewardship. The committee selected topics based on current practice and knowledge gaps where education is most needed.

Working with the CDC increases CHEST’s impact in this area. Much of the care of patients with sepsis happens before they reach the ICU. The CDC’s broad reach with general and specialty medical audiences allows CHEST to share these resources with a wide array of clinicians who practice inside and outside of the ICU.

“Cooperation with the CDC gives us an opportunity to spread CHEST’s knowledge and expertise to a much broader audience, making the CDC a powerful partner and allowing us to serve the nation and beyond in a way that we cannot do by ourselves,” Dr. Simpson said.

Access the full collection of sepsis resources at chestnet.org/topic-collections/sepsis.

Earlier this year, CHEST released new clinical resources on sepsis and antibiotic stewardship developed by the Sepsis Resources Steering Committee with grant support from the US Centers for Disease Control and Prevention (CDC).

The resources – including infographics, videos, podcasts, and research commentaries – aim to help clinicians increase their knowledge of sepsis prevention and treatment, especially when considering the use of antibiotics.

According to CHEST Past President, Steven Q. Simpson, MD, FCCP, who serves as Chair of the Sepsis Resources Steering Committee, sepsis is the number one cause of death in U.S. hospitals . It’s also the most expensive condition treated in those hospitals.

“Perhaps the single most important tool we have to fight sepsis is our array of antimicrobial therapies, including antibacterial, antifungal, and antiviral agents,” Dr. Simpson said. “It is vital that we use the antibiotics we have wisely and preserve them for future use.”

He pointed to the apparent tension between the need to administer broad-spectrum antimicrobials quickly to patients with sepsis and the need to limit the use of broad-spectrum agents as much as possible. But these concepts aren’t at odds with each another, he said. They’re allies in the sepsis war.

CHEST’s new resources can help clinicians practice good antimicrobial stewardship as they balance these needs. Included in the collection is a two-part video discussion exploring conservative and aggressive approaches to antibiotic use in suspected sepsis. A series of podcasts delves into complex sepsis cases, and easy-reference infographics outline key components of an antimicrobial stewardship program, rapid diagnostics for infectious diseases in the ICU, and sepsis mimics.

Steering committee members were chosen from CHEST’s membership for their clinical expertise in sepsis, infectious diseases, and antimicrobial stewardship. The committee selected topics based on current practice and knowledge gaps where education is most needed.

Working with the CDC increases CHEST’s impact in this area. Much of the care of patients with sepsis happens before they reach the ICU. The CDC’s broad reach with general and specialty medical audiences allows CHEST to share these resources with a wide array of clinicians who practice inside and outside of the ICU.

“Cooperation with the CDC gives us an opportunity to spread CHEST’s knowledge and expertise to a much broader audience, making the CDC a powerful partner and allowing us to serve the nation and beyond in a way that we cannot do by ourselves,” Dr. Simpson said.

Access the full collection of sepsis resources at chestnet.org/topic-collections/sepsis.

Earlier this year, CHEST released new clinical resources on sepsis and antibiotic stewardship developed by the Sepsis Resources Steering Committee with grant support from the US Centers for Disease Control and Prevention (CDC).

The resources – including infographics, videos, podcasts, and research commentaries – aim to help clinicians increase their knowledge of sepsis prevention and treatment, especially when considering the use of antibiotics.

According to CHEST Past President, Steven Q. Simpson, MD, FCCP, who serves as Chair of the Sepsis Resources Steering Committee, sepsis is the number one cause of death in U.S. hospitals . It’s also the most expensive condition treated in those hospitals.

“Perhaps the single most important tool we have to fight sepsis is our array of antimicrobial therapies, including antibacterial, antifungal, and antiviral agents,” Dr. Simpson said. “It is vital that we use the antibiotics we have wisely and preserve them for future use.”

He pointed to the apparent tension between the need to administer broad-spectrum antimicrobials quickly to patients with sepsis and the need to limit the use of broad-spectrum agents as much as possible. But these concepts aren’t at odds with each another, he said. They’re allies in the sepsis war.

CHEST’s new resources can help clinicians practice good antimicrobial stewardship as they balance these needs. Included in the collection is a two-part video discussion exploring conservative and aggressive approaches to antibiotic use in suspected sepsis. A series of podcasts delves into complex sepsis cases, and easy-reference infographics outline key components of an antimicrobial stewardship program, rapid diagnostics for infectious diseases in the ICU, and sepsis mimics.

Steering committee members were chosen from CHEST’s membership for their clinical expertise in sepsis, infectious diseases, and antimicrobial stewardship. The committee selected topics based on current practice and knowledge gaps where education is most needed.

Working with the CDC increases CHEST’s impact in this area. Much of the care of patients with sepsis happens before they reach the ICU. The CDC’s broad reach with general and specialty medical audiences allows CHEST to share these resources with a wide array of clinicians who practice inside and outside of the ICU.

“Cooperation with the CDC gives us an opportunity to spread CHEST’s knowledge and expertise to a much broader audience, making the CDC a powerful partner and allowing us to serve the nation and beyond in a way that we cannot do by ourselves,” Dr. Simpson said.

Access the full collection of sepsis resources at chestnet.org/topic-collections/sepsis.

In an ideal world, change would be progressive, the direction would be clear, and adoption would be easy. We learned in these past few years that sometimes change cannot wait. The vulnerabilities of the health care system were laid bare by the pandemic, including vast disparities in treatment and the urgent need to grow our profession.

In the light of these truths, CHEST looked within and asked a difficult question: Are we doing everything we can? This question probably sounds very familiar – one you ask every day, one you know the importance of asking. It was time we asked it of ourselves.

Milestones are a good time to reevaluate

Philanthropy is not new to CHEST. We celebrated 25 years of the CHEST Foundation in Nashville during CHEST 2022. Stories about community and clinical research grants were circulated in website blogs, emails, and newsletters and on social media for years. Our committee member volunteers worked hard developing accurate and credible patient education content for the CHEST Foundation website. Because of our faithful donors, communities around the world had access to better medical care and healthier environments.

This is amazing work, but it was time to ask:

• What can CHEST provide that others cannot?
• Where are the gaps we can fill?
• What is our community passionate about changing?

Working collectively, CHEST and CHEST Foundation leadership, along with staff, rigorously reviewed the success of our past fundraising efforts, areas of commitment our donors had specified, and the direction of interest our membership was leading us toward – like social accountability, growth and diversification of our profession, grassroots community impact, and partnerships to expand our reach. The process took nearly a year to complete – but, in the realm of big changes, that’s equal to the time needed for one good, deep breath.

Focusing on significant change means narrowing our scope

Meeting these goals would mean changing how we worked and letting go of areas better served elsewhere. CHEST needed to:

1. Align philanthropy with our mission to elevate the value placed on giving, making it a core priority and responsibility of CHEST as an organization.

2. Consolidate philanthropy under CHEST to reduce administrative costs and create efficiencies, allowing more funds to go directly to our philanthropic efforts.

3. Establish clear and transparent areas of giving that resonate with our members as a way to grow our impact and make real change.

With the full support of the CHEST Board of Regents, the CHEST Foundation Board of Advisors – under the guidance of Advisory Chair, Robert De Marco, MD, FCCP, and CHEST Foundation President, Ian Nathanson, MD, FCCP – approved a merger of the CHEST Foundation with CHEST.

In order to increase our impact and create greater awareness of CHEST philanthropic efforts, the Board of Advisors got to work defining a giving strategy that would meet the philanthropic goals and priorities of the CHEST membership. Four areas were defined and are referred to as our philanthropic pillars: clinical research, community impact, support of the profession, and dedication to education.

These pillars were approved by the Board of Regents at their spring leadership meeting.
 

Giving goals without support are just dreams

This transition puts the responsibility for funding the giving pillars in the hands of CHEST. The first step is ensuring the members see the impact of their donations.

“When you see your donation in action, you never doubt that you made a good decision,” said CHEST CEO, Robert A. Musacchio, PhD. “If we can show that to every member, the next 25 years of CHEST philanthropy are limitless.”

Helping connect donors to that experience is Meggie Cramer, the new Director of Philanthropy and Advancement , who has experience working directly with health care systems like Rush University Medical Center in Chicago and Hospital Sister Health System in Green Bay, Wisconsin.

“When you are giving to programs you are passionate about, you feel good about being a part of making a difference,” explained Cramer. “That’s my goal – to help our members find areas they care about and know their gift is part of creating real change.”

For frequently asked questions about the transition, please visit our website.

In an ideal world, change would be progressive, the direction would be clear, and adoption would be easy. We learned in these past few years that sometimes change cannot wait. The vulnerabilities of the health care system were laid bare by the pandemic, including vast disparities in treatment and the urgent need to grow our profession.

In the light of these truths, CHEST looked within and asked a difficult question: Are we doing everything we can? This question probably sounds very familiar – one you ask every day, one you know the importance of asking. It was time we asked it of ourselves.

Milestones are a good time to reevaluate

Philanthropy is not new to CHEST. We celebrated 25 years of the CHEST Foundation in Nashville during CHEST 2022. Stories about community and clinical research grants were circulated in website blogs, emails, and newsletters and on social media for years. Our committee member volunteers worked hard developing accurate and credible patient education content for the CHEST Foundation website. Because of our faithful donors, communities around the world had access to better medical care and healthier environments.

This is amazing work, but it was time to ask:

• What can CHEST provide that others cannot?
• Where are the gaps we can fill?
• What is our community passionate about changing?

Working collectively, CHEST and CHEST Foundation leadership, along with staff, rigorously reviewed the success of our past fundraising efforts, areas of commitment our donors had specified, and the direction of interest our membership was leading us toward – like social accountability, growth and diversification of our profession, grassroots community impact, and partnerships to expand our reach. The process took nearly a year to complete – but, in the realm of big changes, that’s equal to the time needed for one good, deep breath.

Focusing on significant change means narrowing our scope

Meeting these goals would mean changing how we worked and letting go of areas better served elsewhere. CHEST needed to:

1. Align philanthropy with our mission to elevate the value placed on giving, making it a core priority and responsibility of CHEST as an organization.

2. Consolidate philanthropy under CHEST to reduce administrative costs and create efficiencies, allowing more funds to go directly to our philanthropic efforts.

3. Establish clear and transparent areas of giving that resonate with our members as a way to grow our impact and make real change.

With the full support of the CHEST Board of Regents, the CHEST Foundation Board of Advisors – under the guidance of Advisory Chair, Robert De Marco, MD, FCCP, and CHEST Foundation President, Ian Nathanson, MD, FCCP – approved a merger of the CHEST Foundation with CHEST.

In order to increase our impact and create greater awareness of CHEST philanthropic efforts, the Board of Advisors got to work defining a giving strategy that would meet the philanthropic goals and priorities of the CHEST membership. Four areas were defined and are referred to as our philanthropic pillars: clinical research, community impact, support of the profession, and dedication to education.

These pillars were approved by the Board of Regents at their spring leadership meeting.
 

Giving goals without support are just dreams

This transition puts the responsibility for funding the giving pillars in the hands of CHEST. The first step is ensuring the members see the impact of their donations.

“When you see your donation in action, you never doubt that you made a good decision,” said CHEST CEO, Robert A. Musacchio, PhD. “If we can show that to every member, the next 25 years of CHEST philanthropy are limitless.”

Helping connect donors to that experience is Meggie Cramer, the new Director of Philanthropy and Advancement , who has experience working directly with health care systems like Rush University Medical Center in Chicago and Hospital Sister Health System in Green Bay, Wisconsin.

“When you are giving to programs you are passionate about, you feel good about being a part of making a difference,” explained Cramer. “That’s my goal – to help our members find areas they care about and know their gift is part of creating real change.”

For frequently asked questions about the transition, please visit our website.

In an ideal world, change would be progressive, the direction would be clear, and adoption would be easy. We learned in these past few years that sometimes change cannot wait. The vulnerabilities of the health care system were laid bare by the pandemic, including vast disparities in treatment and the urgent need to grow our profession.

In the light of these truths, CHEST looked within and asked a difficult question: Are we doing everything we can? This question probably sounds very familiar – one you ask every day, one you know the importance of asking. It was time we asked it of ourselves.

Milestones are a good time to reevaluate

Philanthropy is not new to CHEST. We celebrated 25 years of the CHEST Foundation in Nashville during CHEST 2022. Stories about community and clinical research grants were circulated in website blogs, emails, and newsletters and on social media for years. Our committee member volunteers worked hard developing accurate and credible patient education content for the CHEST Foundation website. Because of our faithful donors, communities around the world had access to better medical care and healthier environments.

This is amazing work, but it was time to ask:

• What can CHEST provide that others cannot?
• Where are the gaps we can fill?
• What is our community passionate about changing?

Working collectively, CHEST and CHEST Foundation leadership, along with staff, rigorously reviewed the success of our past fundraising efforts, areas of commitment our donors had specified, and the direction of interest our membership was leading us toward – like social accountability, growth and diversification of our profession, grassroots community impact, and partnerships to expand our reach. The process took nearly a year to complete – but, in the realm of big changes, that’s equal to the time needed for one good, deep breath.

Focusing on significant change means narrowing our scope

Meeting these goals would mean changing how we worked and letting go of areas better served elsewhere. CHEST needed to:

1. Align philanthropy with our mission to elevate the value placed on giving, making it a core priority and responsibility of CHEST as an organization.

2. Consolidate philanthropy under CHEST to reduce administrative costs and create efficiencies, allowing more funds to go directly to our philanthropic efforts.

3. Establish clear and transparent areas of giving that resonate with our members as a way to grow our impact and make real change.

With the full support of the CHEST Board of Regents, the CHEST Foundation Board of Advisors – under the guidance of Advisory Chair, Robert De Marco, MD, FCCP, and CHEST Foundation President, Ian Nathanson, MD, FCCP – approved a merger of the CHEST Foundation with CHEST.

In order to increase our impact and create greater awareness of CHEST philanthropic efforts, the Board of Advisors got to work defining a giving strategy that would meet the philanthropic goals and priorities of the CHEST membership. Four areas were defined and are referred to as our philanthropic pillars: clinical research, community impact, support of the profession, and dedication to education.

These pillars were approved by the Board of Regents at their spring leadership meeting.
 

Giving goals without support are just dreams

This transition puts the responsibility for funding the giving pillars in the hands of CHEST. The first step is ensuring the members see the impact of their donations.

“When you see your donation in action, you never doubt that you made a good decision,” said CHEST CEO, Robert A. Musacchio, PhD. “If we can show that to every member, the next 25 years of CHEST philanthropy are limitless.”

Helping connect donors to that experience is Meggie Cramer, the new Director of Philanthropy and Advancement , who has experience working directly with health care systems like Rush University Medical Center in Chicago and Hospital Sister Health System in Green Bay, Wisconsin.

“When you are giving to programs you are passionate about, you feel good about being a part of making a difference,” explained Cramer. “That’s my goal – to help our members find areas they care about and know their gift is part of creating real change.”

For frequently asked questions about the transition, please visit our website.

“Ew, gross.”

“Um, no way.”

“Of course not.”

Earlier this summer, I partnered with Dr. Melissa Keene, the medical director of a federally qualified health center in southwest Virginia, to talk about tobacco with middle school students. A few minutes after our arrival, it was clear to us that cigarettes weren’t cool anymore.

We asked hundreds of kids if they or their friends smoked cigarettes. The above quoted responses were repeated over and over.

Tobacco health advocates have spent decades working on public health messaging surrounding cigarette use, which is clearly working in this Virginian middle school.

But our patients, friends, and family who are already dependent on tobacco products still face addiction, morbidity, and premature mortality. And the ever-changing forms of tobacco delivery pose new challenges for our collective cessation efforts.

The Summer 2023 issue of CHEST Advocates features parents, lawyers, doctors, and nonprofit leaders who all share their inspiring stories of action in the fight against tobacco use.

Learn from tobacco experts, Dr. Susan Walley and Dr. Evan Stepp, about evidence-based approaches to tobacco cessation in young people –including why we should start having conversations by age 11 about smoking or vaping and why it’s important to inform youth about big tobacco marketing strategies.

Read an interview with Dr. Anne Melzer, who shares lessons from her career in tobacco advocacy centered in a US veteran population. Dr. Melzer suggests free resources that are available to all clinicians who sometimes struggle to help patients find the best way to quit.

Watch a video of Dr. Iyaad Hasan and Dr. Roy St. John, who run The Breathing Association, a nonprofit in Ohio serving individuals who are underinsured or uninsured. This organization offers a mobile medical unit that provides a free, evidenced-based program to help with smoking cessation via education, counseling, and personalized quit plans.

Learn from Natasha Phelps, JD, the Director of Equity-Centered Policies at The Center for Black Health & Equity. For more than 2 decades, this organization has focused on building community capacity to give local constituents the tools needed for sustainable health improvements, including tobacco cessation.

Hear from Dr. Panagiotis Behrakis, who – after decades of advocacy against tobacco use—the World Health Organization recognized in May for his Smoke Free Greece program. He explains why his work focuses on a two-pronged approach that places equal emphasis on both cessation and prevention.

Listen to a podcast featuring an amazing organization called Parents Against Vaping e-cigarettes, which started in response to a predatory marketing strategy by a tobacco company in a school system.

See how CHEST is fighting the battle against smoking and vaping, as told by Dr. Frank Leone, Chair of the Tobacco/Vaping Work Group for the CHEST Health Policy and Advocacy Committee. And, lastly, interact with a timeline of CHEST’s advocacy work in tobacco cessation and regulation through the decades.

As Dr. Melzer so eloquently stated in her interview featured in this issue, “tobacco cessation is a process that belongs to everybody, and, therefore, sometimes to nobody.” We hope this issue will inspire you to advocate for your patients and partner with your communities in our shared mission to improve education, awareness, and action against tobacco use.

“Ew, gross.”

“Um, no way.”

“Of course not.”

Earlier this summer, I partnered with Dr. Melissa Keene, the medical director of a federally qualified health center in southwest Virginia, to talk about tobacco with middle school students. A few minutes after our arrival, it was clear to us that cigarettes weren’t cool anymore.

We asked hundreds of kids if they or their friends smoked cigarettes. The above quoted responses were repeated over and over.

Tobacco health advocates have spent decades working on public health messaging surrounding cigarette use, which is clearly working in this Virginian middle school.

But our patients, friends, and family who are already dependent on tobacco products still face addiction, morbidity, and premature mortality. And the ever-changing forms of tobacco delivery pose new challenges for our collective cessation efforts.

The Summer 2023 issue of CHEST Advocates features parents, lawyers, doctors, and nonprofit leaders who all share their inspiring stories of action in the fight against tobacco use.

Learn from tobacco experts, Dr. Susan Walley and Dr. Evan Stepp, about evidence-based approaches to tobacco cessation in young people –including why we should start having conversations by age 11 about smoking or vaping and why it’s important to inform youth about big tobacco marketing strategies.

Read an interview with Dr. Anne Melzer, who shares lessons from her career in tobacco advocacy centered in a US veteran population. Dr. Melzer suggests free resources that are available to all clinicians who sometimes struggle to help patients find the best way to quit.

Watch a video of Dr. Iyaad Hasan and Dr. Roy St. John, who run The Breathing Association, a nonprofit in Ohio serving individuals who are underinsured or uninsured. This organization offers a mobile medical unit that provides a free, evidenced-based program to help with smoking cessation via education, counseling, and personalized quit plans.

Learn from Natasha Phelps, JD, the Director of Equity-Centered Policies at The Center for Black Health & Equity. For more than 2 decades, this organization has focused on building community capacity to give local constituents the tools needed for sustainable health improvements, including tobacco cessation.

Hear from Dr. Panagiotis Behrakis, who – after decades of advocacy against tobacco use—the World Health Organization recognized in May for his Smoke Free Greece program. He explains why his work focuses on a two-pronged approach that places equal emphasis on both cessation and prevention.

Listen to a podcast featuring an amazing organization called Parents Against Vaping e-cigarettes, which started in response to a predatory marketing strategy by a tobacco company in a school system.

See how CHEST is fighting the battle against smoking and vaping, as told by Dr. Frank Leone, Chair of the Tobacco/Vaping Work Group for the CHEST Health Policy and Advocacy Committee. And, lastly, interact with a timeline of CHEST’s advocacy work in tobacco cessation and regulation through the decades.

As Dr. Melzer so eloquently stated in her interview featured in this issue, “tobacco cessation is a process that belongs to everybody, and, therefore, sometimes to nobody.” We hope this issue will inspire you to advocate for your patients and partner with your communities in our shared mission to improve education, awareness, and action against tobacco use.

“Ew, gross.”

“Um, no way.”

“Of course not.”

Earlier this summer, I partnered with Dr. Melissa Keene, the medical director of a federally qualified health center in southwest Virginia, to talk about tobacco with middle school students. A few minutes after our arrival, it was clear to us that cigarettes weren’t cool anymore.

We asked hundreds of kids if they or their friends smoked cigarettes. The above quoted responses were repeated over and over.

Tobacco health advocates have spent decades working on public health messaging surrounding cigarette use, which is clearly working in this Virginian middle school.

But our patients, friends, and family who are already dependent on tobacco products still face addiction, morbidity, and premature mortality. And the ever-changing forms of tobacco delivery pose new challenges for our collective cessation efforts.

The Summer 2023 issue of CHEST Advocates features parents, lawyers, doctors, and nonprofit leaders who all share their inspiring stories of action in the fight against tobacco use.

Learn from tobacco experts, Dr. Susan Walley and Dr. Evan Stepp, about evidence-based approaches to tobacco cessation in young people –including why we should start having conversations by age 11 about smoking or vaping and why it’s important to inform youth about big tobacco marketing strategies.

Read an interview with Dr. Anne Melzer, who shares lessons from her career in tobacco advocacy centered in a US veteran population. Dr. Melzer suggests free resources that are available to all clinicians who sometimes struggle to help patients find the best way to quit.

Watch a video of Dr. Iyaad Hasan and Dr. Roy St. John, who run The Breathing Association, a nonprofit in Ohio serving individuals who are underinsured or uninsured. This organization offers a mobile medical unit that provides a free, evidenced-based program to help with smoking cessation via education, counseling, and personalized quit plans.

Learn from Natasha Phelps, JD, the Director of Equity-Centered Policies at The Center for Black Health & Equity. For more than 2 decades, this organization has focused on building community capacity to give local constituents the tools needed for sustainable health improvements, including tobacco cessation.

Hear from Dr. Panagiotis Behrakis, who – after decades of advocacy against tobacco use—the World Health Organization recognized in May for his Smoke Free Greece program. He explains why his work focuses on a two-pronged approach that places equal emphasis on both cessation and prevention.

Listen to a podcast featuring an amazing organization called Parents Against Vaping e-cigarettes, which started in response to a predatory marketing strategy by a tobacco company in a school system.

See how CHEST is fighting the battle against smoking and vaping, as told by Dr. Frank Leone, Chair of the Tobacco/Vaping Work Group for the CHEST Health Policy and Advocacy Committee. And, lastly, interact with a timeline of CHEST’s advocacy work in tobacco cessation and regulation through the decades.

As Dr. Melzer so eloquently stated in her interview featured in this issue, “tobacco cessation is a process that belongs to everybody, and, therefore, sometimes to nobody.” We hope this issue will inspire you to advocate for your patients and partner with your communities in our shared mission to improve education, awareness, and action against tobacco use.

Two exciting updates have come to the CHEST SEEK^™ portfolio this summer.

The latest book, CHEST SEEK^™ Pulmonary Medicine: 33rd Edition, was released in August. And in this newest book and certain CHEST SEEK Library collections, a feature called key points is included in the recently published 150 pulmonary medicine questions.

Key points are concise summaries of the most important takeaways of SEEK questions. Knowing the key point can help learners focus their studies.

“SEEK questions can be quite robust and intentionally detailed in their response as to why the answer options are correct or incorrect. But because of the level of detail, it can be difficult at times for the learner to correctly hone in on the author’s teaching point,” said CHEST Director, Product Strategy and Evaluation, Martha Zaborowski Pascale, CPM.

“Key points concisely summarize each question’s most important details, potentially saving the learner study time.”

CHEST SEEK^™ Pulmonary Medicine: 33rd Edition was developed from the pulmonary medicine board subspecialty examination content blueprints. It tests recall, interpretation, and problem-solving skills.

Rationales provide thorough explanations and reasoning for the correct and incorrect answers. Key points are easy to find at the bottom of the pages and in a tab within SEEK Library questions.

For 3 decades, SEEK has been a trusted resource for chest medicine clinicians. From a printed booklet to the classic book and subscription-based library, learners have engaged with case-based questions in multiple ways. As SEEK has transformed through the years, it’s continued to be a timeless, reliable study partner.

“SEEK has evolved in many ways over its 30-year history. As technologic involvement has permitted greater advances in imaging and data presentation, SEEK has sought to make such advances from the bedside as part of the SEEK experience,” said Pascale.

“The strength of peer-reviewed, expert-written content has remained the same, but modalities such as digital flash cards and behind-the-scenes peer review discussions have enhanced this enduring product in ways that help it stand the test of time.”

Based on CHEST evaluation data, more than 90% of SEEK learners said their practice will change based on content found in the library. Plus, more than 95% of SEEK learners agreed that SEEK question authors are effective instructors.

“The success of SEEK in the past and the ability of this tool to be adapted to the changing needs of learners makes one excited about the editions to come,” said Jesse B. Hall, MD, FCCP, SEEK Editor-in-Chief and Chair of CHEST SEEK^™ Pulmonary Medicine: 33rd Edition.

Looking toward the future, SEEK will continue to develop and serve the needs of chest medicine clinicians.

“One of the joys of our professional lives is the constant new discoveries and trials that change the way we practice,” said SEEK Pulmonary Medicine Vice-Chair and Deputy Editor, Jess Mandel, MD.

“However, with this comes the challenge of keeping up and staying current as the field evolves. SEEK is a terrific resource for keeping up with changes in practice and the underlying data that justify them.”

Subscribe to the SEEK Library and find CHEST SEEK^™ Pulmonary Medicine: 33rd Edition at chestnet.org/Learning-and-Events/Learning/Seek-App.

Two exciting updates have come to the CHEST SEEK^™ portfolio this summer.

The latest book, CHEST SEEK^™ Pulmonary Medicine: 33rd Edition, was released in August. And in this newest book and certain CHEST SEEK Library collections, a feature called key points is included in the recently published 150 pulmonary medicine questions.

Key points are concise summaries of the most important takeaways of SEEK questions. Knowing the key point can help learners focus their studies.

“SEEK questions can be quite robust and intentionally detailed in their response as to why the answer options are correct or incorrect. But because of the level of detail, it can be difficult at times for the learner to correctly hone in on the author’s teaching point,” said CHEST Director, Product Strategy and Evaluation, Martha Zaborowski Pascale, CPM.

“Key points concisely summarize each question’s most important details, potentially saving the learner study time.”

CHEST SEEK^™ Pulmonary Medicine: 33rd Edition was developed from the pulmonary medicine board subspecialty examination content blueprints. It tests recall, interpretation, and problem-solving skills.

Rationales provide thorough explanations and reasoning for the correct and incorrect answers. Key points are easy to find at the bottom of the pages and in a tab within SEEK Library questions.

For 3 decades, SEEK has been a trusted resource for chest medicine clinicians. From a printed booklet to the classic book and subscription-based library, learners have engaged with case-based questions in multiple ways. As SEEK has transformed through the years, it’s continued to be a timeless, reliable study partner.

“SEEK has evolved in many ways over its 30-year history. As technologic involvement has permitted greater advances in imaging and data presentation, SEEK has sought to make such advances from the bedside as part of the SEEK experience,” said Pascale.

“The strength of peer-reviewed, expert-written content has remained the same, but modalities such as digital flash cards and behind-the-scenes peer review discussions have enhanced this enduring product in ways that help it stand the test of time.”

Based on CHEST evaluation data, more than 90% of SEEK learners said their practice will change based on content found in the library. Plus, more than 95% of SEEK learners agreed that SEEK question authors are effective instructors.

“The success of SEEK in the past and the ability of this tool to be adapted to the changing needs of learners makes one excited about the editions to come,” said Jesse B. Hall, MD, FCCP, SEEK Editor-in-Chief and Chair of CHEST SEEK^™ Pulmonary Medicine: 33rd Edition.

Looking toward the future, SEEK will continue to develop and serve the needs of chest medicine clinicians.

“One of the joys of our professional lives is the constant new discoveries and trials that change the way we practice,” said SEEK Pulmonary Medicine Vice-Chair and Deputy Editor, Jess Mandel, MD.

“However, with this comes the challenge of keeping up and staying current as the field evolves. SEEK is a terrific resource for keeping up with changes in practice and the underlying data that justify them.”

Subscribe to the SEEK Library and find CHEST SEEK^™ Pulmonary Medicine: 33rd Edition at chestnet.org/Learning-and-Events/Learning/Seek-App.

Two exciting updates have come to the CHEST SEEK^™ portfolio this summer.

The latest book, CHEST SEEK^™ Pulmonary Medicine: 33rd Edition, was released in August. And in this newest book and certain CHEST SEEK Library collections, a feature called key points is included in the recently published 150 pulmonary medicine questions.

Key points are concise summaries of the most important takeaways of SEEK questions. Knowing the key point can help learners focus their studies.

“SEEK questions can be quite robust and intentionally detailed in their response as to why the answer options are correct or incorrect. But because of the level of detail, it can be difficult at times for the learner to correctly hone in on the author’s teaching point,” said CHEST Director, Product Strategy and Evaluation, Martha Zaborowski Pascale, CPM.

“Key points concisely summarize each question’s most important details, potentially saving the learner study time.”

CHEST SEEK^™ Pulmonary Medicine: 33rd Edition was developed from the pulmonary medicine board subspecialty examination content blueprints. It tests recall, interpretation, and problem-solving skills.

Rationales provide thorough explanations and reasoning for the correct and incorrect answers. Key points are easy to find at the bottom of the pages and in a tab within SEEK Library questions.

For 3 decades, SEEK has been a trusted resource for chest medicine clinicians. From a printed booklet to the classic book and subscription-based library, learners have engaged with case-based questions in multiple ways. As SEEK has transformed through the years, it’s continued to be a timeless, reliable study partner.

“SEEK has evolved in many ways over its 30-year history. As technologic involvement has permitted greater advances in imaging and data presentation, SEEK has sought to make such advances from the bedside as part of the SEEK experience,” said Pascale.

“The strength of peer-reviewed, expert-written content has remained the same, but modalities such as digital flash cards and behind-the-scenes peer review discussions have enhanced this enduring product in ways that help it stand the test of time.”

Based on CHEST evaluation data, more than 90% of SEEK learners said their practice will change based on content found in the library. Plus, more than 95% of SEEK learners agreed that SEEK question authors are effective instructors.

“The success of SEEK in the past and the ability of this tool to be adapted to the changing needs of learners makes one excited about the editions to come,” said Jesse B. Hall, MD, FCCP, SEEK Editor-in-Chief and Chair of CHEST SEEK^™ Pulmonary Medicine: 33rd Edition.

Looking toward the future, SEEK will continue to develop and serve the needs of chest medicine clinicians.

“One of the joys of our professional lives is the constant new discoveries and trials that change the way we practice,” said SEEK Pulmonary Medicine Vice-Chair and Deputy Editor, Jess Mandel, MD.

“However, with this comes the challenge of keeping up and staying current as the field evolves. SEEK is a terrific resource for keeping up with changes in practice and the underlying data that justify them.”

Subscribe to the SEEK Library and find CHEST SEEK^™ Pulmonary Medicine: 33rd Edition at chestnet.org/Learning-and-Events/Learning/Seek-App.

Just a few weeks ahead of CHEST 2023, we’re sharing the can’t-miss opportunities available on site at the meeting.

With double the abstract submissions of previous meetings, CHEST 2023 – taking place October 8 to 11 in Honolulu – will offer the highest caliber of educational content covering pulmonary, critical care, and sleep medicine. Beyond the top-tier education, CHEST 2023 has a lot to offer attendees in the way of networking, development, and unique experiences that will all make for a memorable meeting.

We’re sharing a preview of the many opportunities that will be available over the 4 days of the meeting. For more specifics on these events, including locations, visit the CHEST 2023 website. You can also download the CHEST 2023 mobile app, which will be available in mid-September.

 

Networking and development

• For those who want to get more involved with the CHEST community, the Networks Mixer (Monday, October 9, 4 PM HST) is open to all who’d like to learn more about the seven CHEST Networks and the 21 clinically-focused Sections within them.

• The annual Women in Chest Medicine Luncheon (Monday, October 9, 12:45 PM HST) will feature a panel of three women speaking about their experiences, their advice, how to support other women in the field, and more. This event is free, but preregistration is required. Scan the QR code to sign up.

• The first-ever Ohana Mixer (Tuesday, October 10, 6 PM HST) is an opportunity for CHEST attendees to celebrate the spirit of community that unites us across our differences. Attendees can network with each other, meet the members of our newly formed Interest Groups – including the leaders of our Women in Chest Medicine Interest Group and Respiratory Care Interest Group – and socialize with presenters from our three local CHEST Community Connections organizations.

• The Trainee Lounge will feature activities like speed mentoring, a lunch and learn with the Keynote Speaker, Dr. Cedric “Jamie” Rutland, financial wellness presentations, and more.
 

CHEST experiences

• The Opening Session (Sunday, October 8, 3:15 PM HST) will showcase traditional Hawaiian performances and the Keynote Address from Dr. Rutland. Immediately following, the CHEST Welcome Reception will feature live music and a traditional Hawaiian luau.

• For the second year, CHEST After Hours (Monday, October 9, 3 PM HST) will feature clinicians sharing stories of their personal triumphs, tribulations, and more experiences within medicine.

• Each year, the CHEST Challenge Championship (Tuesday, October 10, 7 PM HST) gives pulmonary and critical care medicine fellows-in-training an opportunity to compete in a live Jeopardy-style game – with bragging rights and cash prizes on the line.

• The Wellness Zone has a packed schedule of events, including beachy workouts, food demonstrations, meditation, and more.
 

Exhibit hall activities

• Opportunities to network with and hear presentations from local Hawaiian organizations, such as the Waianae Coast Comprehensive Health Center

• Hands-on, experiential education escape rooms

• Live educational games, including Hocus POCUS Diagnosis, PulmMemory, Peer Pressure, and more

• Simulation experiences, including Aspirated and Need for Speed – Airway Bleed



Mark your calendars now to participate in all that CHEST 2023 has to offer. We’ll see you in Hawai’i!

Just a few weeks ahead of CHEST 2023, we’re sharing the can’t-miss opportunities available on site at the meeting.

With double the abstract submissions of previous meetings, CHEST 2023 – taking place October 8 to 11 in Honolulu – will offer the highest caliber of educational content covering pulmonary, critical care, and sleep medicine. Beyond the top-tier education, CHEST 2023 has a lot to offer attendees in the way of networking, development, and unique experiences that will all make for a memorable meeting.

We’re sharing a preview of the many opportunities that will be available over the 4 days of the meeting. For more specifics on these events, including locations, visit the CHEST 2023 website. You can also download the CHEST 2023 mobile app, which will be available in mid-September.

 

Networking and development

• For those who want to get more involved with the CHEST community, the Networks Mixer (Monday, October 9, 4 PM HST) is open to all who’d like to learn more about the seven CHEST Networks and the 21 clinically-focused Sections within them.

• The annual Women in Chest Medicine Luncheon (Monday, October 9, 12:45 PM HST) will feature a panel of three women speaking about their experiences, their advice, how to support other women in the field, and more. This event is free, but preregistration is required. Scan the QR code to sign up.

• The first-ever Ohana Mixer (Tuesday, October 10, 6 PM HST) is an opportunity for CHEST attendees to celebrate the spirit of community that unites us across our differences. Attendees can network with each other, meet the members of our newly formed Interest Groups – including the leaders of our Women in Chest Medicine Interest Group and Respiratory Care Interest Group – and socialize with presenters from our three local CHEST Community Connections organizations.

• The Trainee Lounge will feature activities like speed mentoring, a lunch and learn with the Keynote Speaker, Dr. Cedric “Jamie” Rutland, financial wellness presentations, and more.
 

CHEST experiences

• The Opening Session (Sunday, October 8, 3:15 PM HST) will showcase traditional Hawaiian performances and the Keynote Address from Dr. Rutland. Immediately following, the CHEST Welcome Reception will feature live music and a traditional Hawaiian luau.

• For the second year, CHEST After Hours (Monday, October 9, 3 PM HST) will feature clinicians sharing stories of their personal triumphs, tribulations, and more experiences within medicine.

• Each year, the CHEST Challenge Championship (Tuesday, October 10, 7 PM HST) gives pulmonary and critical care medicine fellows-in-training an opportunity to compete in a live Jeopardy-style game – with bragging rights and cash prizes on the line.

• The Wellness Zone has a packed schedule of events, including beachy workouts, food demonstrations, meditation, and more.
 

Exhibit hall activities

• Opportunities to network with and hear presentations from local Hawaiian organizations, such as the Waianae Coast Comprehensive Health Center

• Hands-on, experiential education escape rooms

• Live educational games, including Hocus POCUS Diagnosis, PulmMemory, Peer Pressure, and more

• Simulation experiences, including Aspirated and Need for Speed – Airway Bleed



Mark your calendars now to participate in all that CHEST 2023 has to offer. We’ll see you in Hawai’i!

Just a few weeks ahead of CHEST 2023, we’re sharing the can’t-miss opportunities available on site at the meeting.

With double the abstract submissions of previous meetings, CHEST 2023 – taking place October 8 to 11 in Honolulu – will offer the highest caliber of educational content covering pulmonary, critical care, and sleep medicine. Beyond the top-tier education, CHEST 2023 has a lot to offer attendees in the way of networking, development, and unique experiences that will all make for a memorable meeting.

We’re sharing a preview of the many opportunities that will be available over the 4 days of the meeting. For more specifics on these events, including locations, visit the CHEST 2023 website. You can also download the CHEST 2023 mobile app, which will be available in mid-September.

 

Networking and development

• For those who want to get more involved with the CHEST community, the Networks Mixer (Monday, October 9, 4 PM HST) is open to all who’d like to learn more about the seven CHEST Networks and the 21 clinically-focused Sections within them.

• The annual Women in Chest Medicine Luncheon (Monday, October 9, 12:45 PM HST) will feature a panel of three women speaking about their experiences, their advice, how to support other women in the field, and more. This event is free, but preregistration is required. Scan the QR code to sign up.

• The first-ever Ohana Mixer (Tuesday, October 10, 6 PM HST) is an opportunity for CHEST attendees to celebrate the spirit of community that unites us across our differences. Attendees can network with each other, meet the members of our newly formed Interest Groups – including the leaders of our Women in Chest Medicine Interest Group and Respiratory Care Interest Group – and socialize with presenters from our three local CHEST Community Connections organizations.

• The Trainee Lounge will feature activities like speed mentoring, a lunch and learn with the Keynote Speaker, Dr. Cedric “Jamie” Rutland, financial wellness presentations, and more.
 

CHEST experiences

• The Opening Session (Sunday, October 8, 3:15 PM HST) will showcase traditional Hawaiian performances and the Keynote Address from Dr. Rutland. Immediately following, the CHEST Welcome Reception will feature live music and a traditional Hawaiian luau.

• For the second year, CHEST After Hours (Monday, October 9, 3 PM HST) will feature clinicians sharing stories of their personal triumphs, tribulations, and more experiences within medicine.

• Each year, the CHEST Challenge Championship (Tuesday, October 10, 7 PM HST) gives pulmonary and critical care medicine fellows-in-training an opportunity to compete in a live Jeopardy-style game – with bragging rights and cash prizes on the line.

• The Wellness Zone has a packed schedule of events, including beachy workouts, food demonstrations, meditation, and more.
 

Exhibit hall activities

• Opportunities to network with and hear presentations from local Hawaiian organizations, such as the Waianae Coast Comprehensive Health Center

• Hands-on, experiential education escape rooms

• Live educational games, including Hocus POCUS Diagnosis, PulmMemory, Peer Pressure, and more

• Simulation experiences, including Aspirated and Need for Speed – Airway Bleed



Mark your calendars now to participate in all that CHEST 2023 has to offer. We’ll see you in Hawai’i!

Thoracic Oncology & Chest Procedures Network

Ultrasound & Chest Imaging Section

Point-of-care ultrasound (POCUS) is integral to the delivery of high-quality patient care. The benefits of POCUS for timely diagnosis and procedural assistance are well documented. With continued innovation, its novel benefits can extend to the upper airway evaluation in both inpatient and outpatient settings.

Adi et al notes that POCUS can serve as an adjunct to traditional airway checklists and help intensivists/anesthesiologists identify potentially difficult laryngoscopies, choose the correct endotracheal tube size to reduce the risk of subglottic stenosis, and help confirm appropriate endotracheal tube placement (Adi, et al. J Emerg Crit Care Med. 2019;3:31).

The prediction of a difficult airway is a potentially lifesaving use for this technology. The authors note that smaller studies demonstrate promising results in four techniques: the inability to visualize the hyoid bone using the sublingual approach, a shorter hyomental distance in morbidly obese patients, anterior neck thickness at different anatomical levels (vocal cords, hyoid bone, and thyroid membrane), and a tongue thickness of more than 6.1 cm from the submental approach were all capable of predicting difficult tracheal intubation with varying degrees of sensitivity and specificity.

In the outpatient setting, an understanding of the upper airway anatomy can help with sleep apnea screenings. Korotun, et al. demonstrated in a small sample that ultrasound evaluation of hyoid bone excursion during hypoglossal nerve stimulation may be a useful tool to predict response to therapy and guide hypoglossal nerve stimulator settings (Korotun, et al. Sleep. 2020;43[Suppl_1]:A247-A248).Upper airway ultrasound is easy to learn. The anatomical landmarks are similar in most patients. This convenient tool can be added to your patient care repertoire in a variety of clinical settings.

Sameer Khanijo, MD, FCCP
Section Member-at-Large

Navitha Ramesh, MD, FCCP
Section Vice-Chair

Thoracic Oncology & Chest Procedures Network

Ultrasound & Chest Imaging Section

Point-of-care ultrasound (POCUS) is integral to the delivery of high-quality patient care. The benefits of POCUS for timely diagnosis and procedural assistance are well documented. With continued innovation, its novel benefits can extend to the upper airway evaluation in both inpatient and outpatient settings.

Adi et al notes that POCUS can serve as an adjunct to traditional airway checklists and help intensivists/anesthesiologists identify potentially difficult laryngoscopies, choose the correct endotracheal tube size to reduce the risk of subglottic stenosis, and help confirm appropriate endotracheal tube placement (Adi, et al. J Emerg Crit Care Med. 2019;3:31).

The prediction of a difficult airway is a potentially lifesaving use for this technology. The authors note that smaller studies demonstrate promising results in four techniques: the inability to visualize the hyoid bone using the sublingual approach, a shorter hyomental distance in morbidly obese patients, anterior neck thickness at different anatomical levels (vocal cords, hyoid bone, and thyroid membrane), and a tongue thickness of more than 6.1 cm from the submental approach were all capable of predicting difficult tracheal intubation with varying degrees of sensitivity and specificity.

In the outpatient setting, an understanding of the upper airway anatomy can help with sleep apnea screenings. Korotun, et al. demonstrated in a small sample that ultrasound evaluation of hyoid bone excursion during hypoglossal nerve stimulation may be a useful tool to predict response to therapy and guide hypoglossal nerve stimulator settings (Korotun, et al. Sleep. 2020;43[Suppl_1]:A247-A248).Upper airway ultrasound is easy to learn. The anatomical landmarks are similar in most patients. This convenient tool can be added to your patient care repertoire in a variety of clinical settings.

Sameer Khanijo, MD, FCCP
Section Member-at-Large

Navitha Ramesh, MD, FCCP
Section Vice-Chair

Thoracic Oncology & Chest Procedures Network

Ultrasound & Chest Imaging Section

Point-of-care ultrasound (POCUS) is integral to the delivery of high-quality patient care. The benefits of POCUS for timely diagnosis and procedural assistance are well documented. With continued innovation, its novel benefits can extend to the upper airway evaluation in both inpatient and outpatient settings.

Adi et al notes that POCUS can serve as an adjunct to traditional airway checklists and help intensivists/anesthesiologists identify potentially difficult laryngoscopies, choose the correct endotracheal tube size to reduce the risk of subglottic stenosis, and help confirm appropriate endotracheal tube placement (Adi, et al. J Emerg Crit Care Med. 2019;3:31).

The prediction of a difficult airway is a potentially lifesaving use for this technology. The authors note that smaller studies demonstrate promising results in four techniques: the inability to visualize the hyoid bone using the sublingual approach, a shorter hyomental distance in morbidly obese patients, anterior neck thickness at different anatomical levels (vocal cords, hyoid bone, and thyroid membrane), and a tongue thickness of more than 6.1 cm from the submental approach were all capable of predicting difficult tracheal intubation with varying degrees of sensitivity and specificity.

In the outpatient setting, an understanding of the upper airway anatomy can help with sleep apnea screenings. Korotun, et al. demonstrated in a small sample that ultrasound evaluation of hyoid bone excursion during hypoglossal nerve stimulation may be a useful tool to predict response to therapy and guide hypoglossal nerve stimulator settings (Korotun, et al. Sleep. 2020;43[Suppl_1]:A247-A248).Upper airway ultrasound is easy to learn. The anatomical landmarks are similar in most patients. This convenient tool can be added to your patient care repertoire in a variety of clinical settings.

Sameer Khanijo, MD, FCCP
Section Member-at-Large

Navitha Ramesh, MD, FCCP
Section Vice-Chair

Critical Care Network

Nonrespiratory Critical Care Section

Goals-of-care discussions are essential to management of the intensive care unit (ICU) patient. Racial inequities in end-of-life decision making have been documented for many years, with literature demonstrating that marginalized populations are less likely to have EHR-documented goals-of-care discussions and more likely to have concerns regarding clinician communication.

A recently published randomized control trial in JAMA highlights an intervention that offers promise in addressing disparities in goals-of-care conversations. Curtis, et al. studied whether priming physicians with a communication guide advising on discussion prompts and language for goals-of-care could improve the rate of documented goals-of-care discussions among hospitalized older adults with serious illness. The study found that for patients in the intervention arm, there was a significant increase in proportion of goals-of-care discussions within 30 days. Notably, the difference in documented goals-of-care discussions between arms was greater in the subgroup of patients from underserved groups (Curtis JR, et al. JAMA. 2023;329[23]:2028-37).

Nevertheless, while interventions may help increase the rate of goals-of-care discussions, it is also important to address the content of discussions themselves. You and colleagues recently published a mixed-methods study assessing the impact of race on shared decision-making behaviors during family/caregiver meetings. The authors found that while ICU physicians approached shared decision making with White and Black families similarly, Black families felt their physicians provided less validation of the family role in decision making than White families did (You H, et al. Ann Am Thorac Soc. 2023 May;20[5]:759-62). These findings highlight the importance of ongoing work that focuses not only on quantity but also on quality of communication regarding goals-of-care for patients from diverse backgrounds.

Divya Shankar MD
Section Fellow-in-Training

Muhammad Hayat-Syed MD
Section Vice Chair

Critical Care Network

Nonrespiratory Critical Care Section

Goals-of-care discussions are essential to management of the intensive care unit (ICU) patient. Racial inequities in end-of-life decision making have been documented for many years, with literature demonstrating that marginalized populations are less likely to have EHR-documented goals-of-care discussions and more likely to have concerns regarding clinician communication.

A recently published randomized control trial in JAMA highlights an intervention that offers promise in addressing disparities in goals-of-care conversations. Curtis, et al. studied whether priming physicians with a communication guide advising on discussion prompts and language for goals-of-care could improve the rate of documented goals-of-care discussions among hospitalized older adults with serious illness. The study found that for patients in the intervention arm, there was a significant increase in proportion of goals-of-care discussions within 30 days. Notably, the difference in documented goals-of-care discussions between arms was greater in the subgroup of patients from underserved groups (Curtis JR, et al. JAMA. 2023;329[23]:2028-37).

Nevertheless, while interventions may help increase the rate of goals-of-care discussions, it is also important to address the content of discussions themselves. You and colleagues recently published a mixed-methods study assessing the impact of race on shared decision-making behaviors during family/caregiver meetings. The authors found that while ICU physicians approached shared decision making with White and Black families similarly, Black families felt their physicians provided less validation of the family role in decision making than White families did (You H, et al. Ann Am Thorac Soc. 2023 May;20[5]:759-62). These findings highlight the importance of ongoing work that focuses not only on quantity but also on quality of communication regarding goals-of-care for patients from diverse backgrounds.

Divya Shankar MD
Section Fellow-in-Training

Muhammad Hayat-Syed MD
Section Vice Chair

Critical Care Network

Nonrespiratory Critical Care Section

Goals-of-care discussions are essential to management of the intensive care unit (ICU) patient. Racial inequities in end-of-life decision making have been documented for many years, with literature demonstrating that marginalized populations are less likely to have EHR-documented goals-of-care discussions and more likely to have concerns regarding clinician communication.

A recently published randomized control trial in JAMA highlights an intervention that offers promise in addressing disparities in goals-of-care conversations. Curtis, et al. studied whether priming physicians with a communication guide advising on discussion prompts and language for goals-of-care could improve the rate of documented goals-of-care discussions among hospitalized older adults with serious illness. The study found that for patients in the intervention arm, there was a significant increase in proportion of goals-of-care discussions within 30 days. Notably, the difference in documented goals-of-care discussions between arms was greater in the subgroup of patients from underserved groups (Curtis JR, et al. JAMA. 2023;329[23]:2028-37).

Nevertheless, while interventions may help increase the rate of goals-of-care discussions, it is also important to address the content of discussions themselves. You and colleagues recently published a mixed-methods study assessing the impact of race on shared decision-making behaviors during family/caregiver meetings. The authors found that while ICU physicians approached shared decision making with White and Black families similarly, Black families felt their physicians provided less validation of the family role in decision making than White families did (You H, et al. Ann Am Thorac Soc. 2023 May;20[5]:759-62). These findings highlight the importance of ongoing work that focuses not only on quantity but also on quality of communication regarding goals-of-care for patients from diverse backgrounds.

Divya Shankar MD
Section Fellow-in-Training

Muhammad Hayat-Syed MD
Section Vice Chair

Diffuse Lung Disease & Transplant Network

Lung Transplant Section

Frailty, a concept that originated in the geriatric population, is a state of vulnerability resulting from a decline in reserve and function across physiological systems. While it is more commonly observed in older adults, some aging-associated syndromes, such as sarcopenia, impaired cognition, inflammation, and malnutrition, may be present in younger patients with end-stage organ disease. These syndromes can be associated with biological age, as opposed to chronological age, which explains why younger patients with end-stage organ disease can develop frailty (Schaenman JM, et al. Am J Transplant. 2021 Jun;21[6]:2018-24). Frailty in the lung transplant population is associated with increased morbidity and mortality while on the waitlist and post-transplant (Montgomery E, et al. J Transplant. 2020 Aug 7:3239495). In 2021, the International Society of Heart and Lung Transplantation recommended including a frailty assessment to complete a patient’s transplant evaluation. The committee cautioned using current assessment tools, as they are not yet accepted as the standard of care (Leard, et al. J Heart Lung Transplant. 2021 Nov;40[11]:1349-79). Existing tools being used evolved from studies of community-dwelling older adults with no predilection for distinct organ disease, which include the Fried Physical Frailty Phenotype (FPFP) and the Short Physical Performance Battery (SPPB). Along with physical limitations, frail patients tend to have abnormal biomarkers including higher inflammatory cytokines, such as plasma IL-6 and tumor necrosis factor receptor 1, and lower insulin-like growth factor I and leptin (Singer JP, et al. Am J Respir Crit Care Med. 2015;192[11]1325-34). The concept of a lung-focused approach to frailty, which considers biomarkers and body composition, is currently being researched (Singer JP, et al. J Heart Lung Transplant. 2023;S1053-S2498[23]00049-9). This disease-specific frailty scale would identify lung transplant candidates who may benefit from targeted interventions, and such frailty would also be expected to improve after transplant.

Erin Meier, MD
Section Fellow-in-Training

Anupam Kumar, MD, FCCP
Section Member-at-Large

Diffuse Lung Disease & Transplant Network

Lung Transplant Section

Frailty, a concept that originated in the geriatric population, is a state of vulnerability resulting from a decline in reserve and function across physiological systems. While it is more commonly observed in older adults, some aging-associated syndromes, such as sarcopenia, impaired cognition, inflammation, and malnutrition, may be present in younger patients with end-stage organ disease. These syndromes can be associated with biological age, as opposed to chronological age, which explains why younger patients with end-stage organ disease can develop frailty (Schaenman JM, et al. Am J Transplant. 2021 Jun;21[6]:2018-24). Frailty in the lung transplant population is associated with increased morbidity and mortality while on the waitlist and post-transplant (Montgomery E, et al. J Transplant. 2020 Aug 7:3239495). In 2021, the International Society of Heart and Lung Transplantation recommended including a frailty assessment to complete a patient’s transplant evaluation. The committee cautioned using current assessment tools, as they are not yet accepted as the standard of care (Leard, et al. J Heart Lung Transplant. 2021 Nov;40[11]:1349-79). Existing tools being used evolved from studies of community-dwelling older adults with no predilection for distinct organ disease, which include the Fried Physical Frailty Phenotype (FPFP) and the Short Physical Performance Battery (SPPB). Along with physical limitations, frail patients tend to have abnormal biomarkers including higher inflammatory cytokines, such as plasma IL-6 and tumor necrosis factor receptor 1, and lower insulin-like growth factor I and leptin (Singer JP, et al. Am J Respir Crit Care Med. 2015;192[11]1325-34). The concept of a lung-focused approach to frailty, which considers biomarkers and body composition, is currently being researched (Singer JP, et al. J Heart Lung Transplant. 2023;S1053-S2498[23]00049-9). This disease-specific frailty scale would identify lung transplant candidates who may benefit from targeted interventions, and such frailty would also be expected to improve after transplant.

Erin Meier, MD
Section Fellow-in-Training

Anupam Kumar, MD, FCCP
Section Member-at-Large

Diffuse Lung Disease & Transplant Network

Lung Transplant Section

Frailty, a concept that originated in the geriatric population, is a state of vulnerability resulting from a decline in reserve and function across physiological systems. While it is more commonly observed in older adults, some aging-associated syndromes, such as sarcopenia, impaired cognition, inflammation, and malnutrition, may be present in younger patients with end-stage organ disease. These syndromes can be associated with biological age, as opposed to chronological age, which explains why younger patients with end-stage organ disease can develop frailty (Schaenman JM, et al. Am J Transplant. 2021 Jun;21[6]:2018-24). Frailty in the lung transplant population is associated with increased morbidity and mortality while on the waitlist and post-transplant (Montgomery E, et al. J Transplant. 2020 Aug 7:3239495). In 2021, the International Society of Heart and Lung Transplantation recommended including a frailty assessment to complete a patient’s transplant evaluation. The committee cautioned using current assessment tools, as they are not yet accepted as the standard of care (Leard, et al. J Heart Lung Transplant. 2021 Nov;40[11]:1349-79). Existing tools being used evolved from studies of community-dwelling older adults with no predilection for distinct organ disease, which include the Fried Physical Frailty Phenotype (FPFP) and the Short Physical Performance Battery (SPPB). Along with physical limitations, frail patients tend to have abnormal biomarkers including higher inflammatory cytokines, such as plasma IL-6 and tumor necrosis factor receptor 1, and lower insulin-like growth factor I and leptin (Singer JP, et al. Am J Respir Crit Care Med. 2015;192[11]1325-34). The concept of a lung-focused approach to frailty, which considers biomarkers and body composition, is currently being researched (Singer JP, et al. J Heart Lung Transplant. 2023;S1053-S2498[23]00049-9). This disease-specific frailty scale would identify lung transplant candidates who may benefit from targeted interventions, and such frailty would also be expected to improve after transplant.

Erin Meier, MD
Section Fellow-in-Training

Anupam Kumar, MD, FCCP
Section Member-at-Large

Airway Disorders Network

Bronchiectasis Section

Bronchiectasis is a chronic inflammatory lung disease characterized by the progressive destruction of the airways and persistent inflammation. In bronchiectasis, excessive neutrophil accumulation in the airways leads to release of neutrophil serine proteases (NSPs), which contributes to tissue damage and perpetuates the inflammatory process in the lungs. The three main NSPs include neutrophil elastase (NE), proteinase3, and cathepsin G. Elevations in NE activity in sputum in NCFBE are associated with increased exacerbations and declines in lung function. Dipeptidyl peptidase 1 (DPP1), an enzyme primarily found in neutrophils, is responsible for activating NSPs during neutrophil maturation. In bronchiectasis, increased DPP1 activity results in an augmented production of active NSPs, exacerbating lung damage and inflammation.

Brensocatib, an oral, reversible inhibitor of DPP1 is currently being developed as a novel approach to managing bronchiectasis. Brensocatib was evaluated in a phase 2 clinical trial (WILLOW), a randomized, double-blind, placebo-controlled trial involving adults with non–cystic fibrosis bronchiectasis (NCFBE). Treatment with brensocatib for 24 weeks significantly prolonged the time to the first exacerbation at both the 10 mg and 25 mg doses and lowered the risk of exacerbation by 40% relative to placebo. The treatment was well tolerated, with no significant safety concerns. Results of a recent post hoc analysis from the WILLOW study show that brensocatib effectively reduces exacerbations and slows lung function decline across different severities of bronchiectasis. These findings suggest that brensocatib holds potential as the 1st new therapeutic option for patients with NCFBE, with currently no FDA-approved drugs. Results of a larger-scale phase 3 trial are awaited later this year, which will hopefully confirm these results and ascertain the long-term safety.

Shyamsunder Subramanian, MD, MBBS, FCCP
Section Chair

Airway Disorders Network

Bronchiectasis Section

Bronchiectasis is a chronic inflammatory lung disease characterized by the progressive destruction of the airways and persistent inflammation. In bronchiectasis, excessive neutrophil accumulation in the airways leads to release of neutrophil serine proteases (NSPs), which contributes to tissue damage and perpetuates the inflammatory process in the lungs. The three main NSPs include neutrophil elastase (NE), proteinase3, and cathepsin G. Elevations in NE activity in sputum in NCFBE are associated with increased exacerbations and declines in lung function. Dipeptidyl peptidase 1 (DPP1), an enzyme primarily found in neutrophils, is responsible for activating NSPs during neutrophil maturation. In bronchiectasis, increased DPP1 activity results in an augmented production of active NSPs, exacerbating lung damage and inflammation.

Brensocatib, an oral, reversible inhibitor of DPP1 is currently being developed as a novel approach to managing bronchiectasis. Brensocatib was evaluated in a phase 2 clinical trial (WILLOW), a randomized, double-blind, placebo-controlled trial involving adults with non–cystic fibrosis bronchiectasis (NCFBE). Treatment with brensocatib for 24 weeks significantly prolonged the time to the first exacerbation at both the 10 mg and 25 mg doses and lowered the risk of exacerbation by 40% relative to placebo. The treatment was well tolerated, with no significant safety concerns. Results of a recent post hoc analysis from the WILLOW study show that brensocatib effectively reduces exacerbations and slows lung function decline across different severities of bronchiectasis. These findings suggest that brensocatib holds potential as the 1st new therapeutic option for patients with NCFBE, with currently no FDA-approved drugs. Results of a larger-scale phase 3 trial are awaited later this year, which will hopefully confirm these results and ascertain the long-term safety.

Shyamsunder Subramanian, MD, MBBS, FCCP
Section Chair

Airway Disorders Network

Bronchiectasis Section

Bronchiectasis is a chronic inflammatory lung disease characterized by the progressive destruction of the airways and persistent inflammation. In bronchiectasis, excessive neutrophil accumulation in the airways leads to release of neutrophil serine proteases (NSPs), which contributes to tissue damage and perpetuates the inflammatory process in the lungs. The three main NSPs include neutrophil elastase (NE), proteinase3, and cathepsin G. Elevations in NE activity in sputum in NCFBE are associated with increased exacerbations and declines in lung function. Dipeptidyl peptidase 1 (DPP1), an enzyme primarily found in neutrophils, is responsible for activating NSPs during neutrophil maturation. In bronchiectasis, increased DPP1 activity results in an augmented production of active NSPs, exacerbating lung damage and inflammation.

Brensocatib, an oral, reversible inhibitor of DPP1 is currently being developed as a novel approach to managing bronchiectasis. Brensocatib was evaluated in a phase 2 clinical trial (WILLOW), a randomized, double-blind, placebo-controlled trial involving adults with non–cystic fibrosis bronchiectasis (NCFBE). Treatment with brensocatib for 24 weeks significantly prolonged the time to the first exacerbation at both the 10 mg and 25 mg doses and lowered the risk of exacerbation by 40% relative to placebo. The treatment was well tolerated, with no significant safety concerns. Results of a recent post hoc analysis from the WILLOW study show that brensocatib effectively reduces exacerbations and slows lung function decline across different severities of bronchiectasis. These findings suggest that brensocatib holds potential as the 1st new therapeutic option for patients with NCFBE, with currently no FDA-approved drugs. Results of a larger-scale phase 3 trial are awaited later this year, which will hopefully confirm these results and ascertain the long-term safety.

Shyamsunder Subramanian, MD, MBBS, FCCP
Section Chair