Random Pearls in Pulmonary Medicine and Critical Care from #CHEST2019 in New Orleans
Recap of random pearls and highlights from #CHEST2019 including: A pop quiz on inhaler use, interstitial lung disease, pulmonary fibrosis (IPF), limitations of supplemental oxygen, lung cancer screening, imposter syndrome, and is it safe to use beta blockers in COPD. Special thanks to Dr. Bill Kelly and his team at CHEST (@accpchest) for their hospitality.
Clear SpO2 targets have not been defined, but there is risk of harm without proven by artificially raising oxygen levels (Hofmann, 2017).
Siemieniuk et al in BMJ 2018 recommend targeting a range of 90-94% for most acutely ill patients and 88-92% for patients at risk of hypercapnia (Siemieniuk, 2018).
15:07 Dr Erin Narewski discusses the brand new BLOCK trial.
Beta blockers (BB) should not be used in patients with COPD unless they have another indication e.g. atrial fibrillation or heart failure (Dransfield, 2019).
Patients with moderate to severe COPD without an indication for BB had no increase in time to exacerbation, BUT hospitalization for exacerbation was more common.
18:11 Dr Chidinma Chima-Melton @LABritishLady (UCLA) discusses the latest in interstitial lung disease (ILD) treatment and gives a rapid overview of ILD.
Interstitial Pulmonary Fibrosis (IPF) is a chronic and progressive form of ILD.
Patients with both IPF and severe GERD (despite medical therapy) have a reduction in cough and improvement in FEV1 after Nissen fundoplication (from session “Update in IPF Treatment with speakers Patel N, Robbins H, Scholand MB, Strek M). The following review Ghebre, 2017 and original research also address this topic Raghu, 2018.
ILD should be treated in centers of excellence by a multidisciplinary team, but we must try to improve delivery models (e.g. telemedicine visits) –expert opinion.
The family of patients with IPF should be screened with low dose CT because about 1/3 of IPF cases have a genetic mutation that is hereditary (Lawson, 2011; Krauss, 2019).
The life expectancy of IPF is 3-5 years from the time of diagnosis.
IPF treatments include pirfenidone and nintedanib. Major side effects include GI upset (diarrhea, nausea and vomiting) and may limit use. They can be safely used in combination (Vancheri, 2018) with the caveats: combination therapy is expensive and not yet FDA approved).
29:15 Dr Nina Maouelainin discusses lung cancer screening
Key points from session “Updates in Lung Cancer Screening: 8 Years Beyond the NLST by Rivera MP, Silvestri G, Tanner N
Lung cancer screening programs are concentrated outside the areas that need them most like the Southeastern US.
For family of patients with IPF, should we use low dose CT or high resolution CT to screen ?