Ask The Experts – Doreen J. Addrizzo-Harris, MD

Expert Perspective
2018 CHEST Conference
Doreen J. Addrizzo-Harris, MD
Practice Community New York City, NY Hospital and Institute Affiliations NYU Langone Health Practice Niche Pulmonary Medicine, Critical Care, and Sleep Medicine
Question 1. What are some top-level takeaways for clinicians from this year’s CHEST 2018 conference?
Answer The theme of this year’s conference in San Antonio was “learn by doing.” Many of the sessions were hands-on or in a small group format with a rapid turnover time. None of the sessions were longer than 60 minutes so clinicians could get up-to-date experience either on procedures, such as ultrasound and simulations, methods they are using at their own sites, or up-to-date and personal updates on common disease states such as critical care, pneumonia, chest infections, airway diseases, etc.

There were also many small-group problem-based learning and case-based sessions that updated clinicians on radiology, lung cancer, and sleep medicine.
Question 2. There was a presentation on the importance of a team-based approach to pulmonary medicine given at CHEST 2018. Can you speak to the value and importance of a multidisciplinary management team in pulmonary medicine?
Answer Multidisciplinary management teams are extremely important in critical care. In the intensive care unit (ICU), these teams — made up of not only attending physicians but nurse practitioners, physician assistants, resident physicians, respiratory therapists, and pharmacists — are something most of us have been part of.

It is important to expand this process to other fields of pulmonary medicine; multidisciplinary approaches to pulmonary diseases are essential. For example, in lung cancer management, the pulmonologist should not be the only clinician managing the patient. Those patients are managed by a multidisciplinary team at many institutions that include radiologists, thoracic surgeons, and thoracic oncologists, as well to the pulmonologist. Often, there are other clinicians, such as pathologists and sometimes palliative care, involved as well.

So it is extremely important in order to provide the best care for our patients that we work with multidisciplinary teams, not only in the ICU but also in pulmonary medicine.
Question 3. Were there any practice-changing updates in bronchiectasis or nontuberculous mycobacteria (NTM) infection highlighted at CHEST 2018?
Answer A number of case presentations highlighted some of the new findings that have come out from the US Bronchiectasis Research Registry, a 13-site consortium that is looking at research questions in patients with bronchiectasis. Also, the first FDA-approved medication for NTM pulmonary disease came out prior to this conference — liposomal amikacin — and there were some presentations on the use of liposomal amikacin in patients with refractory mycobacterium avium disease.

We are hopeful that with this new therapy and some of the research being done through the US Bronchiectasis Research Registry, as well as the European consortium, that we will be able to care for these patients better than we have in the past.
Question 4. Can you discuss your high-level priorities for research initiatives as the incoming CHEST Foundation President for the American College of Chest Physicians?
Answer I am happy to be the president of the CHEST Foundation this year. One of the main pillars of the organization is awarding research grants either through the foundation itself or coupled with support from industry for fellows and junior attending physicians who are starting their careers in a number of important areas.

Our research initiatives are to provide as many of research grants as we can every year. We have provided grants for research in lung cancer, pulmonary fibrosis, nontuberculous mycobacteria disease, asthma, and a number of other areas.

We would like to try to increase our funding in 3 specific areas this year: critical care, sleep medicine, and pneumonia. So we are hopeful that we will get funding and lot of grant applications from fellows and faculty in these areas so that we can award not one but multiple grants for research in some of these areas.
Question 5. How can practicing pulmonologists take advantage of resources provided by CHEST or CHEST Foundation to improve their daily practice?
Answer Much of what CHEST and the foundation are about is patient-focused care. CHEST has many, many resources patients can access and that can provide physicians with information on ways to better treat their patients.

The second pillar the foundation is focused on is patient education on many, many disease states, and there is a wide array of these materials available on our website.

This information is not only for patients who can access these sites to find information about diseases and resources and links they can go to. A lot of these materials are accessible to physicians so they can have them in their offices in printed form, and when they are discussing a disease state — for example, bronchiectasis — with a patient, they have readily-available links to patient education materials. In addition, we work with other foundations and societies to make some of these materials available, so we can make them as robust as possible.
Disclosures: Dr Addrizzo-Harris had disclosed the following industry relationships:

Principal investigator trials sponsored by Insmed, Aradigm, Chiltern, and Novartis. Consultant for AIT Therapeutics and Insmed.