Highlights 2016 American Thoracic Society Conference

American Thoracic Society Conference in San Francisco

The annual American Thoracic Society conference is one of the major respiratory meetings in the world. It was attended by over 17,000 health care workers and those working for pharmaceutical and medical device companies from 90 countries. The main focus in on research in lung disease. Reducing exacerbations (flare-ups) of COPD was a popular topic. One reason is that hospitals are being penalized by lower payments (reimbursement) for those readmitted to the hospital within 30 days of being discharged for an exacerbation of COPD as part of the Affordable Care Act.  Thus, most hospitals and health care systems have developed programs, or pathways, to try to prevent re-admissions to the hospital. Presentation on May 15 at the American Thoracic Society conference: Dr. Roberto Benzo from the Mayo Clinic reported on a study that
Dr., Roberto Benzo of the Mayo Clinic.

Dr., Roberto Benzo of the Mayo Clinic.

compared the use of health coaches versus usual care after discharge from the hospital after a COPD exacerbation. The goal was to provide better care and to prevent re-admissions to the hospital. There were two treatment groups of the 215 individuals hospitalized for a flare-up of their COPD. ♦ a written action plan plus weekly calls after discharge by a health coach  to check on how the person was doing ♦ usual care The results showed a reduction in re-admission to the hospital in the group who received weekly calls up to 9 months after discharge, but not at 12 months, compared to the usual care group. Scores for breathing difficulty and fatigue were better for those who received calls from health coaches. This study is published on-line in the American Journal of Respiratory and Critical Care Medicine.Am J Respir Crit Care Med. 2016 Mar 8. [Epub ahead of print] Another area of interest at the meeting was the use of coils placed into the breathing tubes of those with advanced emphysema. Presentation on May 16 at the American Thoracic Society conference: The results of the RENEW trial were presented by Dr. Frank Sciurba of the University of Pittsburg School of Medicine. All participants had
Dr. Frank Sciurba of the University of Pittsburgh School of Medicine

Dr. Frank Sciurba of the University of Pittsburgh School of Medicine

advanced emphysema with hyperinflation of the lungs (unable to exhale the normal amount of air out of the lungs). The two treatment groups were: ♦  10 – 14 Nitinol coils were placed through a tube passed into the mouth and then into breathing tubes (called bronchoscopy) into one lobe of the lung to compress or collapse parts of the lung. A second procedure was performed 4 months later into one lobe of the opposite lung (158 subjects) ♦ usual care (157 subjects) How do the coils work? The coils compress parts of the lung that are diseased and also help to keep breathing tubes open allowing better emptying of air during exhalation.
Xray of chest that shows several coils in the left lung

Xray of chest that shows several coils in the left lung

The main outcome was how far the subjects could walk in 6 minutes at 12 months after treatment. Results: In the coil treated group compared to usual care: there was a significant increase of an average of 14 meters (45 feet) in the walking distance and a significant improvement in quality of life by 8.9 units (a 4 unit change is considered significant). Complications: pneumonia requiring hospitalization – 35% in the coil group vs. 19% in the usual care group; pneumothorax (air in the lining of the lung) – 10% in the coil group and 1% in the usual care group. This study adds to our knowledge of the possible benefits and possible complications of bronchoscopic lung volume reduction for those with advanced emphysema. This study was published online in the Journal of the American Medical Association (JAMA) on May 15, 2016. doi:10.1001/jama.2016.6261    

Donald A. Mahler, M.D. is Emeritus Professor of Medicine at Geisel School of Medicine at Dartmouth in Hanover, New Hampshire. He works as a pulmonary physician at Valley Regional Hospital in Claremont, NH, where he is Director of Respiratory Services.