American College of Chest Physicians, Oct. 19-23

The 85th Annual Meeting of the American College of Chest Physicians

The annual meeting of the American College of Chest Physicians was held from Oct. 19 to 23 in New Orleans and attracted approximately 6,000 participants from around the world, including specialists and other health care professionals. The conference featured presentations focusing on clinical updates in chest medicine, including advances in pulmonary, critical care, and sleep medicine.

In one study, Srinadh Annangi, M.D., of the University of Kentucky School of Medicine in Lexington, and colleagues examined whether the underutilization of bronchodilator testing plays a role in the overdiagnosis of chronic obstructive pulmonary disease (COPD). Specifically, the investigators evaluated the role of bronchodilator testing in identifying COPD patients with possible asthma-COPD overlap syndrome, a phenotype of COPD that warrants different management strategies from COPD alone.

The researchers found that using the prebronchodilator forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) ratio in identifying COPD may lead to COPD overdiagnosis in 39 percent of patients.

"This will not only lead to inappropriately being treated for COPD and resource utilization but also delay in identifying alternate possible reasons for the patient's symptoms," Annangi said. "Bronchodilator testing along with other clinical findings will also enable physicians to identify COPD subjects with possible asthma-COPD overlap syndrome, found in 7 to 19 percent of subjects with COPD."

Furthermore, the investigators found that bronchodilator testing may identify 5 percent of patients with a possible asthma diagnosis who would otherwise be mislabeled as COPD if the prebronchodilator FEV1/FVC ratio is used to diagnose COPD.

"We acknowledge the retrospective nature of this study, but that does not undermine the clinical importance of our study findings," Annangi concluded. "Further studies should focus on two things -- identifying barriers among health care providers towards performing bronchodilator testing and to overcome those barriers. Second, prospectively follow subjects who were diagnosed as COPD based on the prebronchodilator FEV1/FVC ratio for clinical outcomes, including symptom improvement and possible delay in identifying an alternate diagnosis attributable to their initial symptoms."

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In another study, Scott Bickel, M.D., of the University of Louisville School of Medicine in Kentucky, and colleagues found that children who switched asthma inhaler types (standard metered dose inhalers to breath-actuated dry powder inhalers) due to changes in the insurance formulary were observed to have a significant decline in lung function.

The investigators found that patients who changed inhaler types saw an average 10 percent decline in their FEV1 compared with before the switch (99.3 to 89.3 percent), while those who stayed on a metered dose inhaler saw no significant change in their FEV1.

"Insurance formulary changes may result in a decline in asthma control, especially if it requires children to change inhaler device types. Our findings suggest that when considering formulary changes, insurance organizations should take into account the unique needs of pediatric patients with asthma, ensuring all children have access to the inhaler device that is most appropriate for their individualized care," Bickel said. "It is important that children with asthma be monitored closely if changing therapies secondary to insurance formulary changes to make sure they are using their new medication correctly and that it is effective for them."

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Kam Sing Ho, M.D., of Mount Sinai St. Luke's and Mount Sinai West in New York City, and colleagues found that active smokers hospitalized with a primary diagnosis of pulmonary embolism have a higher hospital readmission rate compared with nonsmokers.

"This is the first study to quantify the increased rate of hospital readmission due to smoking. Our data show that a significant number of patients (34.2 percent; 58,628 adults) were active smokers at the time of their hospitalization for pulmonary embolism. Hence, we questioned whether smoking was worth the risk," Ho said. "Given that smoking is a common phenomenon among patients admitted with pulmonary embolism, we suggest that more rigorous smoking cessation services are implemented prior to discharge for all active smokers. Future research will focus on implementing inpatient smoking cessation strategies at our hospital and its effect on local readmission rate, health resources utilization, and mortality."

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CHEST: Admissions, Deaths for COPD Vary by Season

FRIDAY, Oct. 25, 2019 (HealthDay News) -- There is dramatic seasonal variation in rates of admissions for chronic obstructive pulmonary disease exacerbation, according to a study presented at CHEST 2019, the annual meeting of the American College of Chest Physicians, held from Oct. 19 to 23 in New Orleans.

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CHEST: Blood Transfusion Practices Should Be Revisited

THURSDAY, Oct. 24, 2019 (HealthDay News) -- Restricting blood transfusion guidelines may save both lives and money, according to a study presented at CHEST 2019, the annual meeting of the American College of Chest Physicians, held from Oct. 19 to 23 in New Orleans.

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CHEST: Flu Shots Benefit Patients Hospitalized With Pneumonia

WEDNESDAY, Oct. 23, 2019 (HealthDay News) -- Routine, in-hospital influenza vaccinations for all adults hospitalized with pneumonia may save lives and reduce hospitalizations, according to a study presented at CHEST 2019, the annual meeting of the American College of Chest Physicians, held from Oct. 19 to 23 in New Orleans.

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CHEST: Metoprolol Does Not Cut Time to COPD Exacerbation

MONDAY, Oct. 21, 2019 (HealthDay News) -- For patients with chronic obstructive pulmonary disease, metoprolol does not reduce the time to first exacerbation versus placebo, according to a study published online Oct. 20 in the New England Journal of Medicine. The research was published to coincide with a presentation at CHEST 2019, the annual meeting of the American College of Chest Physicians, held from Oct. 19 to 23 in New Orleans.

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