Society News

Season 2 of Small Talk, Big Topics is here!

AGA’s podcast for trainees and early career GIs, Small Talk, Big Topics, is back for season two. To kick off the new season, hosts Drs. Matthew Whitson, Nina Nandy, and CS Tse sit down with AGA President Dr. John Carethers in a two-part special to chat about his career and how his involvement with AGA has impacted him.

In episode one, Drs. Whitson, Nandy and Tse take a deep dive with Dr. Carethers to reflect on how he first got involved with AGA, his experience with different committees, and how those roles paved the way to leadership positions.

Now, as president, he says, “I am having so much fun. AGA has been with me for my entire GI career. It’s really the voice of the science and practice of gastroenterology.”

In episode two, Dr. Carethers examines the career advice he’s received, how it shaped his leadership style and provides guidance to early career GIs.

“What’s important about some of these higher-level [decisions] is to set a vision. You can’t be a leader if you have no followers, and people have to believe in something, that they’re moving toward something.”

Listen to more of Dr. Carethers’ insight in the first two episodes of Small Talk, Big Topics wherever you listen to podcasts and subscribe to stay up to date on new episodes.
 

Maximize your first day at DDW^® 2023

Held during the first day of Digestive Disease Week^®, this year’s AGA Postgraduate Course will be held live on Saturday, May 6, from 8:30 a.m. to 5 p.m. CT. This year’s theme – Advances in Gastroenterology: News You Can Use – will help you cut through the noise surrounding best practices for GI physicians.

Pricing is the same for both in-person and virtual attendees, giving you the flexibility to experience the course in-person or from the comfort of your home. All registrants will have on-demand access to the course for three months and the opportunity to earn up to 17.5 total credits when you complete all on-demand content.
 

What’s new this year?

General session format
Presentations will be given in an engaging format that will feel less didactic and more akin to a discussion among faculty, or a conversation with the experts! It’s also an exciting opportunity to mix junior and senior lecturers on the same platform.

Recent clinical practices
Session panelists will work together to select the key papers in their topic areas for discussion. Only the newest — within one year — and most important papers, clinical guidelines and pathways in the field will be selected.

Register to attend DDW and the Postgraduate Course today.

And the winner of this year’s Shark Tank is …

The 13th annual AGA Tech Summit took place in San Francisco, Calif., recently, bringing together GI entrepreneurs, clinicians, medical technology companies, venture capitalists, and regulatory agencies working to improve patient care in the field. A highlight of the event is the annual Shark Tank competition, where forward-thinking companies showcase and pitch their innovations to a panel of expert judges. 

Congratulations to this year’s winner – Endiatx!
From devices providing rapid cancer detection to technology that makes endoscopy safer, the five companies selected for the 2023 AGA Shark Tank represented a glimpse of the future of GI patient care. 

While each team offered a creative solution to modern-day GI challenges, only one could be declared the winner. Congratulations to our 2023 winner, Endiatx! Endiatx will represent AGA in the upcoming Shark Tank competition at DDW^®. 
 

Endiatx has developed a vitamin-sized intrabody robot
PillBot is a miniature robotic capsule endoscopy. Shipped to a patient’s home or picked up from a pharmacy, the standard size capsule is swallowed and then controlled by an external joystick-like device or a phone app by a physician in a physically separate location. Using real-time video transmissions visible to both operator and patient, the capsule navigates the entire stomach in a few minutes without anesthesia and ultimately is excreted outside the body without the need for recapture.

Future GI physician innovators

This year the AGA Center for GI Innovation and Technology (CGIT) welcomed 22 first-year to advanced endoscopy fellows to the AGA Innovation Fellows Program. The program provides a unique opportunity for the fellows to learn from GI clinicians, innovators, entrepreneurs, and medical technology executives on how new technologies are developed and brought to market.

American Gastroenterological Association

The fellows received an exclusive behind-the-scenes tour of Medtronic’s R&D facility in Santa Clara, Calif., and got to experience hands-on demonstrations of GI Genius^TM, PillCam^TM, Endoflip^TM, Nexpowder^TM, Bravo^TM, Barrx^TM and ProdiGI^TM technologies. The group was also hosted by Boston Scientific Corporation, Castle Biosciences and PENTAX Medical at a dinner that included an innovators panel discussion. The program will continue throughout the year with monthly educational sessions moderated by members of the AGA CGIT committee. 

• Mohd Amer Alsamman, MD, Georgetown University
• Mohammad Arfeen, MD, Franciscan Health Olympia Fields
• Alexis Bayudan, MD, University of California, San Francisco
• Aileen Bui, MD, University of Southern California
• Divya Chalikonda, MD, Thomas Jefferson University Hospital
• Alec Faggen, MD, University of California, San Francisco
• Sweta Ghosh, PhD, University of Louisville School of Medicine
• Hemant Goyal, MD, University of Texas Houston
• Averill Guo, MD, Brown University
• Omar Jamil, MD, University of Chicago
• Christina Kratschmer, MD, Washington University in St. Louis
• Thi Khuc, MD, University of Maryland School of Medicine
• Anand Kumar, MD, Northwell Health – Lenox Hill Hospital
• Xing Li, MD, Massachusetts General Hospital
• Alana Persaud, MD, SUNY Downstate Medical Center
• Itegbemie Obaitan, MD, Indiana University School of Medicine
• Chethan Ramprasad, MD, University of Pennsylvania
• Abhishek Satishchandran, MD, University of Michigan
• Kevin Shah, MD, Emory University School of Medicine
• Shifa Umar, MD, University of Chicago
• Kornpong Vantanasiri, MD, Mayo Clinic Rochester
• Shaleen Vasavada, MD, Baylor College of Medicine

Highlights from social media

See what else attendees shared with #AGATech on Twitter.

The 2023 AGA Tech Summit was made possible by support from Castle Biosciences and Medtronic (Diamond Sponsors), AI Medical Services, Boston Scientific, Exact Sciences Corporation, FUJIFILM Medical Systems and Olympus Corporation (Gold Sponsors), Cook Medical Inc., and STERIS Endoscopy (Silver Sponsors), and Apollo Endosurgery and EvoEndo (Bronze Sponsors).
 

AGA takes CRC month to Capitol Hill

Participating in Colorectal Cancer Awareness Month in Washington, D.C., means one thing – taking the fight to save lives from CRC to Capitol Hill and advocating for increased access to screening and research to improve outcomes.

Austin Chiang, MD, MPH

In March, AGA joined the national advocacy organization Fight Colorectal Cancer (Fight CRC) and partners in the colorectal cancer community for events in our nation’s capital. The goal was to destigmatize talking about gut health and CRC and to collaboratively develop solutions that will improve and increase access to CRC screening.

Austin Chiang, MD, MPH

Fight CRC working lunch
Former AGA president Dr. David Lieberman and fellow AGA member and FORWARD graduate Dr. Fola May served as facilitators for the coalition of public and private leaders assembled by Fight CRC. The group is working to develop an action plan to further equitable CRC screening and lower the number of lives impacted by CRC. Among the participants were insurers, industry, federal agencies, healthcare providers, retail businesses, and patients.

White House Cancer Moonshot colorectal cancer forum
In partnership with President Biden’s reignited Cancer Moonshot initiative, we joined Fight CRC and other advocacy and industry leaders in the colorectal cancer community for the Cancer Moonshot Colorectal Cancer Forum, hosted by the White House.

Dr. May participated as a panelist during the forum and discussed how we should address disparities in CRC. “Research dollars are essential in [combating CRC inequity]. We do not know how to effectively deliver care and preventive services to these populations unless we do deep dives into these particular settings to understand how to best deliver that care. This is not a “pick a model and apply broadly” approach. We need to go to the people, and we need to go to the people with the methods that work for that particular setting, and that’s going to be different in every community.”

American Gastroenterological Association

Fight CRC United in Blue rally on the National Mall
It’s become an annual tradition for us to join Fight CRC’s United in Blue rally and blue flag installation on the National Mall, and this year was no different. We joined industry and patient advocacy groups in the CRC community to raise our voices about the need for screening, research, and advocacy to improve colon cancer outcomes.

The rally included inspiring calls to action and CRC testimonials from individuals who have been personally impacted by the disease, including Rep. Donald Payne Jr. (D-NJ), who lost his father to CRC and who personally underwent screening, which led to the discovery of 13 polyps.

Dr. Manish Singla from Capital Digestive Care spoke on behalf of AGA and provided encouragement and a reminder for patients and providers.

“What I keep hearing here is patients feel like they’re not being heard – so we’re listening. We’re trying and we’re here to fight the disease with you all. Everyone here knows somebody who is due for a colonoscopy and isn’t getting it, so use your persuasion – talk about it, convince, cajole, shame – use whatever you need so that everyone gets the screenings they need,” Dr. Singla said.

Our work is just beginning: Let’s work together to encourage screenings for colorectal cancer and save lives. Join us as we remind everyone that 45 is the new 50.

Season 2 of Small Talk, Big Topics is here!

AGA’s podcast for trainees and early career GIs, Small Talk, Big Topics, is back for season two. To kick off the new season, hosts Drs. Matthew Whitson, Nina Nandy, and CS Tse sit down with AGA President Dr. John Carethers in a two-part special to chat about his career and how his involvement with AGA has impacted him.

In episode one, Drs. Whitson, Nandy and Tse take a deep dive with Dr. Carethers to reflect on how he first got involved with AGA, his experience with different committees, and how those roles paved the way to leadership positions.

Now, as president, he says, “I am having so much fun. AGA has been with me for my entire GI career. It’s really the voice of the science and practice of gastroenterology.”

In episode two, Dr. Carethers examines the career advice he’s received, how it shaped his leadership style and provides guidance to early career GIs.

“What’s important about some of these higher-level [decisions] is to set a vision. You can’t be a leader if you have no followers, and people have to believe in something, that they’re moving toward something.”

Listen to more of Dr. Carethers’ insight in the first two episodes of Small Talk, Big Topics wherever you listen to podcasts and subscribe to stay up to date on new episodes.
 

Maximize your first day at DDW^® 2023

Held during the first day of Digestive Disease Week^®, this year’s AGA Postgraduate Course will be held live on Saturday, May 6, from 8:30 a.m. to 5 p.m. CT. This year’s theme – Advances in Gastroenterology: News You Can Use – will help you cut through the noise surrounding best practices for GI physicians.

Pricing is the same for both in-person and virtual attendees, giving you the flexibility to experience the course in-person or from the comfort of your home. All registrants will have on-demand access to the course for three months and the opportunity to earn up to 17.5 total credits when you complete all on-demand content.
 

What’s new this year?

General session format
Presentations will be given in an engaging format that will feel less didactic and more akin to a discussion among faculty, or a conversation with the experts! It’s also an exciting opportunity to mix junior and senior lecturers on the same platform.

Recent clinical practices
Session panelists will work together to select the key papers in their topic areas for discussion. Only the newest — within one year — and most important papers, clinical guidelines and pathways in the field will be selected.

Register to attend DDW and the Postgraduate Course today.

And the winner of this year’s Shark Tank is …

The 13th annual AGA Tech Summit took place in San Francisco, Calif., recently, bringing together GI entrepreneurs, clinicians, medical technology companies, venture capitalists, and regulatory agencies working to improve patient care in the field. A highlight of the event is the annual Shark Tank competition, where forward-thinking companies showcase and pitch their innovations to a panel of expert judges. 

Congratulations to this year’s winner – Endiatx!
From devices providing rapid cancer detection to technology that makes endoscopy safer, the five companies selected for the 2023 AGA Shark Tank represented a glimpse of the future of GI patient care. 

While each team offered a creative solution to modern-day GI challenges, only one could be declared the winner. Congratulations to our 2023 winner, Endiatx! Endiatx will represent AGA in the upcoming Shark Tank competition at DDW^®. 
 

Endiatx has developed a vitamin-sized intrabody robot
PillBot is a miniature robotic capsule endoscopy. Shipped to a patient’s home or picked up from a pharmacy, the standard size capsule is swallowed and then controlled by an external joystick-like device or a phone app by a physician in a physically separate location. Using real-time video transmissions visible to both operator and patient, the capsule navigates the entire stomach in a few minutes without anesthesia and ultimately is excreted outside the body without the need for recapture.

Future GI physician innovators

This year the AGA Center for GI Innovation and Technology (CGIT) welcomed 22 first-year to advanced endoscopy fellows to the AGA Innovation Fellows Program. The program provides a unique opportunity for the fellows to learn from GI clinicians, innovators, entrepreneurs, and medical technology executives on how new technologies are developed and brought to market.

American Gastroenterological Association

The fellows received an exclusive behind-the-scenes tour of Medtronic’s R&D facility in Santa Clara, Calif., and got to experience hands-on demonstrations of GI Genius^TM, PillCam^TM, Endoflip^TM, Nexpowder^TM, Bravo^TM, Barrx^TM and ProdiGI^TM technologies. The group was also hosted by Boston Scientific Corporation, Castle Biosciences and PENTAX Medical at a dinner that included an innovators panel discussion. The program will continue throughout the year with monthly educational sessions moderated by members of the AGA CGIT committee. 

• Mohd Amer Alsamman, MD, Georgetown University
• Mohammad Arfeen, MD, Franciscan Health Olympia Fields
• Alexis Bayudan, MD, University of California, San Francisco
• Aileen Bui, MD, University of Southern California
• Divya Chalikonda, MD, Thomas Jefferson University Hospital
• Alec Faggen, MD, University of California, San Francisco
• Sweta Ghosh, PhD, University of Louisville School of Medicine
• Hemant Goyal, MD, University of Texas Houston
• Averill Guo, MD, Brown University
• Omar Jamil, MD, University of Chicago
• Christina Kratschmer, MD, Washington University in St. Louis
• Thi Khuc, MD, University of Maryland School of Medicine
• Anand Kumar, MD, Northwell Health – Lenox Hill Hospital
• Xing Li, MD, Massachusetts General Hospital
• Alana Persaud, MD, SUNY Downstate Medical Center
• Itegbemie Obaitan, MD, Indiana University School of Medicine
• Chethan Ramprasad, MD, University of Pennsylvania
• Abhishek Satishchandran, MD, University of Michigan
• Kevin Shah, MD, Emory University School of Medicine
• Shifa Umar, MD, University of Chicago
• Kornpong Vantanasiri, MD, Mayo Clinic Rochester
• Shaleen Vasavada, MD, Baylor College of Medicine

Highlights from social media

See what else attendees shared with #AGATech on Twitter.

The 2023 AGA Tech Summit was made possible by support from Castle Biosciences and Medtronic (Diamond Sponsors), AI Medical Services, Boston Scientific, Exact Sciences Corporation, FUJIFILM Medical Systems and Olympus Corporation (Gold Sponsors), Cook Medical Inc., and STERIS Endoscopy (Silver Sponsors), and Apollo Endosurgery and EvoEndo (Bronze Sponsors).
 

AGA takes CRC month to Capitol Hill

Participating in Colorectal Cancer Awareness Month in Washington, D.C., means one thing – taking the fight to save lives from CRC to Capitol Hill and advocating for increased access to screening and research to improve outcomes.

Austin Chiang, MD, MPH

In March, AGA joined the national advocacy organization Fight Colorectal Cancer (Fight CRC) and partners in the colorectal cancer community for events in our nation’s capital. The goal was to destigmatize talking about gut health and CRC and to collaboratively develop solutions that will improve and increase access to CRC screening.

Austin Chiang, MD, MPH

Fight CRC working lunch
Former AGA president Dr. David Lieberman and fellow AGA member and FORWARD graduate Dr. Fola May served as facilitators for the coalition of public and private leaders assembled by Fight CRC. The group is working to develop an action plan to further equitable CRC screening and lower the number of lives impacted by CRC. Among the participants were insurers, industry, federal agencies, healthcare providers, retail businesses, and patients.

White House Cancer Moonshot colorectal cancer forum
In partnership with President Biden’s reignited Cancer Moonshot initiative, we joined Fight CRC and other advocacy and industry leaders in the colorectal cancer community for the Cancer Moonshot Colorectal Cancer Forum, hosted by the White House.

Dr. May participated as a panelist during the forum and discussed how we should address disparities in CRC. “Research dollars are essential in [combating CRC inequity]. We do not know how to effectively deliver care and preventive services to these populations unless we do deep dives into these particular settings to understand how to best deliver that care. This is not a “pick a model and apply broadly” approach. We need to go to the people, and we need to go to the people with the methods that work for that particular setting, and that’s going to be different in every community.”

American Gastroenterological Association

Fight CRC United in Blue rally on the National Mall
It’s become an annual tradition for us to join Fight CRC’s United in Blue rally and blue flag installation on the National Mall, and this year was no different. We joined industry and patient advocacy groups in the CRC community to raise our voices about the need for screening, research, and advocacy to improve colon cancer outcomes.

The rally included inspiring calls to action and CRC testimonials from individuals who have been personally impacted by the disease, including Rep. Donald Payne Jr. (D-NJ), who lost his father to CRC and who personally underwent screening, which led to the discovery of 13 polyps.

Dr. Manish Singla from Capital Digestive Care spoke on behalf of AGA and provided encouragement and a reminder for patients and providers.

“What I keep hearing here is patients feel like they’re not being heard – so we’re listening. We’re trying and we’re here to fight the disease with you all. Everyone here knows somebody who is due for a colonoscopy and isn’t getting it, so use your persuasion – talk about it, convince, cajole, shame – use whatever you need so that everyone gets the screenings they need,” Dr. Singla said.

Our work is just beginning: Let’s work together to encourage screenings for colorectal cancer and save lives. Join us as we remind everyone that 45 is the new 50.

Season 2 of Small Talk, Big Topics is here!

AGA’s podcast for trainees and early career GIs, Small Talk, Big Topics, is back for season two. To kick off the new season, hosts Drs. Matthew Whitson, Nina Nandy, and CS Tse sit down with AGA President Dr. John Carethers in a two-part special to chat about his career and how his involvement with AGA has impacted him.

In episode one, Drs. Whitson, Nandy and Tse take a deep dive with Dr. Carethers to reflect on how he first got involved with AGA, his experience with different committees, and how those roles paved the way to leadership positions.

Now, as president, he says, “I am having so much fun. AGA has been with me for my entire GI career. It’s really the voice of the science and practice of gastroenterology.”

In episode two, Dr. Carethers examines the career advice he’s received, how it shaped his leadership style and provides guidance to early career GIs.

“What’s important about some of these higher-level [decisions] is to set a vision. You can’t be a leader if you have no followers, and people have to believe in something, that they’re moving toward something.”

Listen to more of Dr. Carethers’ insight in the first two episodes of Small Talk, Big Topics wherever you listen to podcasts and subscribe to stay up to date on new episodes.
 

Maximize your first day at DDW^® 2023

Held during the first day of Digestive Disease Week^®, this year’s AGA Postgraduate Course will be held live on Saturday, May 6, from 8:30 a.m. to 5 p.m. CT. This year’s theme – Advances in Gastroenterology: News You Can Use – will help you cut through the noise surrounding best practices for GI physicians.

Pricing is the same for both in-person and virtual attendees, giving you the flexibility to experience the course in-person or from the comfort of your home. All registrants will have on-demand access to the course for three months and the opportunity to earn up to 17.5 total credits when you complete all on-demand content.
 

What’s new this year?

General session format
Presentations will be given in an engaging format that will feel less didactic and more akin to a discussion among faculty, or a conversation with the experts! It’s also an exciting opportunity to mix junior and senior lecturers on the same platform.

Recent clinical practices
Session panelists will work together to select the key papers in their topic areas for discussion. Only the newest — within one year — and most important papers, clinical guidelines and pathways in the field will be selected.

Register to attend DDW and the Postgraduate Course today.

And the winner of this year’s Shark Tank is …

The 13th annual AGA Tech Summit took place in San Francisco, Calif., recently, bringing together GI entrepreneurs, clinicians, medical technology companies, venture capitalists, and regulatory agencies working to improve patient care in the field. A highlight of the event is the annual Shark Tank competition, where forward-thinking companies showcase and pitch their innovations to a panel of expert judges. 

Congratulations to this year’s winner – Endiatx!
From devices providing rapid cancer detection to technology that makes endoscopy safer, the five companies selected for the 2023 AGA Shark Tank represented a glimpse of the future of GI patient care. 

While each team offered a creative solution to modern-day GI challenges, only one could be declared the winner. Congratulations to our 2023 winner, Endiatx! Endiatx will represent AGA in the upcoming Shark Tank competition at DDW^®. 
 

Endiatx has developed a vitamin-sized intrabody robot
PillBot is a miniature robotic capsule endoscopy. Shipped to a patient’s home or picked up from a pharmacy, the standard size capsule is swallowed and then controlled by an external joystick-like device or a phone app by a physician in a physically separate location. Using real-time video transmissions visible to both operator and patient, the capsule navigates the entire stomach in a few minutes without anesthesia and ultimately is excreted outside the body without the need for recapture.

Future GI physician innovators

This year the AGA Center for GI Innovation and Technology (CGIT) welcomed 22 first-year to advanced endoscopy fellows to the AGA Innovation Fellows Program. The program provides a unique opportunity for the fellows to learn from GI clinicians, innovators, entrepreneurs, and medical technology executives on how new technologies are developed and brought to market.

American Gastroenterological Association

The fellows received an exclusive behind-the-scenes tour of Medtronic’s R&D facility in Santa Clara, Calif., and got to experience hands-on demonstrations of GI Genius^TM, PillCam^TM, Endoflip^TM, Nexpowder^TM, Bravo^TM, Barrx^TM and ProdiGI^TM technologies. The group was also hosted by Boston Scientific Corporation, Castle Biosciences and PENTAX Medical at a dinner that included an innovators panel discussion. The program will continue throughout the year with monthly educational sessions moderated by members of the AGA CGIT committee. 

• Mohd Amer Alsamman, MD, Georgetown University
• Mohammad Arfeen, MD, Franciscan Health Olympia Fields
• Alexis Bayudan, MD, University of California, San Francisco
• Aileen Bui, MD, University of Southern California
• Divya Chalikonda, MD, Thomas Jefferson University Hospital
• Alec Faggen, MD, University of California, San Francisco
• Sweta Ghosh, PhD, University of Louisville School of Medicine
• Hemant Goyal, MD, University of Texas Houston
• Averill Guo, MD, Brown University
• Omar Jamil, MD, University of Chicago
• Christina Kratschmer, MD, Washington University in St. Louis
• Thi Khuc, MD, University of Maryland School of Medicine
• Anand Kumar, MD, Northwell Health – Lenox Hill Hospital
• Xing Li, MD, Massachusetts General Hospital
• Alana Persaud, MD, SUNY Downstate Medical Center
• Itegbemie Obaitan, MD, Indiana University School of Medicine
• Chethan Ramprasad, MD, University of Pennsylvania
• Abhishek Satishchandran, MD, University of Michigan
• Kevin Shah, MD, Emory University School of Medicine
• Shifa Umar, MD, University of Chicago
• Kornpong Vantanasiri, MD, Mayo Clinic Rochester
• Shaleen Vasavada, MD, Baylor College of Medicine

Highlights from social media

See what else attendees shared with #AGATech on Twitter.

The 2023 AGA Tech Summit was made possible by support from Castle Biosciences and Medtronic (Diamond Sponsors), AI Medical Services, Boston Scientific, Exact Sciences Corporation, FUJIFILM Medical Systems and Olympus Corporation (Gold Sponsors), Cook Medical Inc., and STERIS Endoscopy (Silver Sponsors), and Apollo Endosurgery and EvoEndo (Bronze Sponsors).
 

AGA takes CRC month to Capitol Hill

Participating in Colorectal Cancer Awareness Month in Washington, D.C., means one thing – taking the fight to save lives from CRC to Capitol Hill and advocating for increased access to screening and research to improve outcomes.

Austin Chiang, MD, MPH

In March, AGA joined the national advocacy organization Fight Colorectal Cancer (Fight CRC) and partners in the colorectal cancer community for events in our nation’s capital. The goal was to destigmatize talking about gut health and CRC and to collaboratively develop solutions that will improve and increase access to CRC screening.

Austin Chiang, MD, MPH

Fight CRC working lunch
Former AGA president Dr. David Lieberman and fellow AGA member and FORWARD graduate Dr. Fola May served as facilitators for the coalition of public and private leaders assembled by Fight CRC. The group is working to develop an action plan to further equitable CRC screening and lower the number of lives impacted by CRC. Among the participants were insurers, industry, federal agencies, healthcare providers, retail businesses, and patients.

White House Cancer Moonshot colorectal cancer forum
In partnership with President Biden’s reignited Cancer Moonshot initiative, we joined Fight CRC and other advocacy and industry leaders in the colorectal cancer community for the Cancer Moonshot Colorectal Cancer Forum, hosted by the White House.

Dr. May participated as a panelist during the forum and discussed how we should address disparities in CRC. “Research dollars are essential in [combating CRC inequity]. We do not know how to effectively deliver care and preventive services to these populations unless we do deep dives into these particular settings to understand how to best deliver that care. This is not a “pick a model and apply broadly” approach. We need to go to the people, and we need to go to the people with the methods that work for that particular setting, and that’s going to be different in every community.”

American Gastroenterological Association

Fight CRC United in Blue rally on the National Mall
It’s become an annual tradition for us to join Fight CRC’s United in Blue rally and blue flag installation on the National Mall, and this year was no different. We joined industry and patient advocacy groups in the CRC community to raise our voices about the need for screening, research, and advocacy to improve colon cancer outcomes.

The rally included inspiring calls to action and CRC testimonials from individuals who have been personally impacted by the disease, including Rep. Donald Payne Jr. (D-NJ), who lost his father to CRC and who personally underwent screening, which led to the discovery of 13 polyps.

Dr. Manish Singla from Capital Digestive Care spoke on behalf of AGA and provided encouragement and a reminder for patients and providers.

“What I keep hearing here is patients feel like they’re not being heard – so we’re listening. We’re trying and we’re here to fight the disease with you all. Everyone here knows somebody who is due for a colonoscopy and isn’t getting it, so use your persuasion – talk about it, convince, cajole, shame – use whatever you need so that everyone gets the screenings they need,” Dr. Singla said.

Our work is just beginning: Let’s work together to encourage screenings for colorectal cancer and save lives. Join us as we remind everyone that 45 is the new 50.

As a member of CHEST leadership for years, Bob De Marco, MD, FCCP, ruminated over new, exciting ways to increase support of the philanthropic efforts of the American College of Chest Physicians.

Dr. De Marco knows all too well that the percentage of CHEST members who donate to support CHEST’s philanthropic initiatives is – in a word - underwhelming. For those who are involved, they do so greatly and with their whole selves, but Dr. De Marco believed more could be done.

In the months leading up to the CHEST Annual Meeting 2022 in Nashville, Dr. De Marco discussed fundraising with CHEST staff and was already thinking ahead to CHEST 2023 in Hawai’i.

“That’s when it hit me – we could leverage Hawai’i to get donations and to expose people to CHEST philanthropy,” said Dr. De Marco. “Hawai’i is a dream destination, and that might be the exact motivation it would take to get that first donation from someone.”

Having a good idea is one thing, but making sure it happens requires individual commitment. Dr. DeMarco personally pledged to cover the cost of first-class airfare for two to Hawai’i, hotel accommodations, and registration to CHEST 2023 in Honolulu. For a minimum donation of $250 to CHEST between September and the end of 2022, each donor would be entered into a drawing for a chance to win this dream trip.

“I thought to myself, who wouldn’t want this prize?” said Dr. De Marco.

“You get to go to paradise for free – with a guest – and attend a top tier educational conference. Knowing your entry supported an organization as deserving as CHEST is the cherry on top,” he added.

In launching the Hawai’i trip fundraiser before and during CHEST 2022, attendees from around the world were introduced to CHEST’s philanthropic efforts and its mission to champion lung health. Over $180,000 was donated during this time period, in no small part because of the Hawai’i travel reward.

“I’m happy to say that the fundraiser did a lot better than I expected, and I was elated to see all of the new donors,” said Dr. De Marco.

“It’s my hope that those first-time donors continue their support for all that we do to provide grants – community, research, and diversity – and support CHEST initiatives that impact patient care and change lives.”

During CHEST 2022, Dr. De Marco and other donors reflected on the organization’s philanthropic accomplishments and impact over the past decades.

Former grant recipients were invited to celebrate with donors and speak to what they were able to accomplish because of the support they received.

The celebration also introduced new CHEST initiatives, the First 5 Minutes® program and Bridging Specialties™: Timely Diagnosis for ILD. The former improves patient care through strengthened patient/clinician relationships, and the latter aims to eliminate gaps in diagnosing complex lung diseases like pulmonary fibrosis.

To all who donated to CHEST in 2022, Dr. De Marco said, “A sincere thank you to each and every one of you for helping us fulfill our mission. To the first-time donors, hopefully this will inspire you and your friends to be an active part of the CHEST family.”

And, to the winner of the trip, Dr. De Marco said, “A sincere congratulations and I hope you enjoy beautiful Hawai’i and your time at the meeting.”

Those who are interested in getting involved and supporting the philanthropic work of CHEST can contact chestphilanthropy@chestnet.org.

Out of the 150+ donors who gave $250 or more to CHEST between September 2022 and the end of 2022, longtime friend of CHEST, Noah Dorsky, was the recipient of two first-class tickets to Hawai’i, hotel accommodations, and registration to CHEST 2023 in Honolulu.

Noah donated specifically to the Mark J. Rosen, MD, Master FCCP Endowment in honor of his late friend, Dr. Mark J. Rosen, who served as CHEST President from 2006 to 2007 and died in 2019.

"Mark was a remarkable doctor and valued life-long friend,” Noah said. “My continued support for CHEST is my way of honoring his memory and how much he meant to me and others."

Dr. Rosen’s distinguished career in pulmonary and critical care medicine spanned more than 4 decades, marked by his deep commitments to medical education and patient care. Before serving as President, Dr. Rosen served on the CHEST Board of Regents for many years. He held positions as Chair or member on numerous CHEST committees, including Education, Nominations, Membership, Marketing, and Finance.

Following his passing, Dr. Rosen’s wife, Ilene, stayed engaged with CHEST by creating the endowment in his name and attending the CHEST Annual Meeting every year to award the Rosen Cup to the winners of the annual CHEST Challenge.

Congratulations, Noah, and thank you for your faithful giving to support the work of CHEST.

As a member of CHEST leadership for years, Bob De Marco, MD, FCCP, ruminated over new, exciting ways to increase support of the philanthropic efforts of the American College of Chest Physicians.

Dr. De Marco knows all too well that the percentage of CHEST members who donate to support CHEST’s philanthropic initiatives is – in a word - underwhelming. For those who are involved, they do so greatly and with their whole selves, but Dr. De Marco believed more could be done.

In the months leading up to the CHEST Annual Meeting 2022 in Nashville, Dr. De Marco discussed fundraising with CHEST staff and was already thinking ahead to CHEST 2023 in Hawai’i.

“That’s when it hit me – we could leverage Hawai’i to get donations and to expose people to CHEST philanthropy,” said Dr. De Marco. “Hawai’i is a dream destination, and that might be the exact motivation it would take to get that first donation from someone.”

Having a good idea is one thing, but making sure it happens requires individual commitment. Dr. DeMarco personally pledged to cover the cost of first-class airfare for two to Hawai’i, hotel accommodations, and registration to CHEST 2023 in Honolulu. For a minimum donation of $250 to CHEST between September and the end of 2022, each donor would be entered into a drawing for a chance to win this dream trip.

“I thought to myself, who wouldn’t want this prize?” said Dr. De Marco.

“You get to go to paradise for free – with a guest – and attend a top tier educational conference. Knowing your entry supported an organization as deserving as CHEST is the cherry on top,” he added.

In launching the Hawai’i trip fundraiser before and during CHEST 2022, attendees from around the world were introduced to CHEST’s philanthropic efforts and its mission to champion lung health. Over $180,000 was donated during this time period, in no small part because of the Hawai’i travel reward.

“I’m happy to say that the fundraiser did a lot better than I expected, and I was elated to see all of the new donors,” said Dr. De Marco.

“It’s my hope that those first-time donors continue their support for all that we do to provide grants – community, research, and diversity – and support CHEST initiatives that impact patient care and change lives.”

During CHEST 2022, Dr. De Marco and other donors reflected on the organization’s philanthropic accomplishments and impact over the past decades.

Former grant recipients were invited to celebrate with donors and speak to what they were able to accomplish because of the support they received.

The celebration also introduced new CHEST initiatives, the First 5 Minutes® program and Bridging Specialties™: Timely Diagnosis for ILD. The former improves patient care through strengthened patient/clinician relationships, and the latter aims to eliminate gaps in diagnosing complex lung diseases like pulmonary fibrosis.

To all who donated to CHEST in 2022, Dr. De Marco said, “A sincere thank you to each and every one of you for helping us fulfill our mission. To the first-time donors, hopefully this will inspire you and your friends to be an active part of the CHEST family.”

And, to the winner of the trip, Dr. De Marco said, “A sincere congratulations and I hope you enjoy beautiful Hawai’i and your time at the meeting.”

Those who are interested in getting involved and supporting the philanthropic work of CHEST can contact chestphilanthropy@chestnet.org.

Out of the 150+ donors who gave $250 or more to CHEST between September 2022 and the end of 2022, longtime friend of CHEST, Noah Dorsky, was the recipient of two first-class tickets to Hawai’i, hotel accommodations, and registration to CHEST 2023 in Honolulu.

Noah donated specifically to the Mark J. Rosen, MD, Master FCCP Endowment in honor of his late friend, Dr. Mark J. Rosen, who served as CHEST President from 2006 to 2007 and died in 2019.

"Mark was a remarkable doctor and valued life-long friend,” Noah said. “My continued support for CHEST is my way of honoring his memory and how much he meant to me and others."

Dr. Rosen’s distinguished career in pulmonary and critical care medicine spanned more than 4 decades, marked by his deep commitments to medical education and patient care. Before serving as President, Dr. Rosen served on the CHEST Board of Regents for many years. He held positions as Chair or member on numerous CHEST committees, including Education, Nominations, Membership, Marketing, and Finance.

Following his passing, Dr. Rosen’s wife, Ilene, stayed engaged with CHEST by creating the endowment in his name and attending the CHEST Annual Meeting every year to award the Rosen Cup to the winners of the annual CHEST Challenge.

Congratulations, Noah, and thank you for your faithful giving to support the work of CHEST.

As a member of CHEST leadership for years, Bob De Marco, MD, FCCP, ruminated over new, exciting ways to increase support of the philanthropic efforts of the American College of Chest Physicians.

Dr. De Marco knows all too well that the percentage of CHEST members who donate to support CHEST’s philanthropic initiatives is – in a word - underwhelming. For those who are involved, they do so greatly and with their whole selves, but Dr. De Marco believed more could be done.

In the months leading up to the CHEST Annual Meeting 2022 in Nashville, Dr. De Marco discussed fundraising with CHEST staff and was already thinking ahead to CHEST 2023 in Hawai’i.

“That’s when it hit me – we could leverage Hawai’i to get donations and to expose people to CHEST philanthropy,” said Dr. De Marco. “Hawai’i is a dream destination, and that might be the exact motivation it would take to get that first donation from someone.”

Having a good idea is one thing, but making sure it happens requires individual commitment. Dr. DeMarco personally pledged to cover the cost of first-class airfare for two to Hawai’i, hotel accommodations, and registration to CHEST 2023 in Honolulu. For a minimum donation of $250 to CHEST between September and the end of 2022, each donor would be entered into a drawing for a chance to win this dream trip.

“I thought to myself, who wouldn’t want this prize?” said Dr. De Marco.

“You get to go to paradise for free – with a guest – and attend a top tier educational conference. Knowing your entry supported an organization as deserving as CHEST is the cherry on top,” he added.

In launching the Hawai’i trip fundraiser before and during CHEST 2022, attendees from around the world were introduced to CHEST’s philanthropic efforts and its mission to champion lung health. Over $180,000 was donated during this time period, in no small part because of the Hawai’i travel reward.

“I’m happy to say that the fundraiser did a lot better than I expected, and I was elated to see all of the new donors,” said Dr. De Marco.

“It’s my hope that those first-time donors continue their support for all that we do to provide grants – community, research, and diversity – and support CHEST initiatives that impact patient care and change lives.”

During CHEST 2022, Dr. De Marco and other donors reflected on the organization’s philanthropic accomplishments and impact over the past decades.

Former grant recipients were invited to celebrate with donors and speak to what they were able to accomplish because of the support they received.

The celebration also introduced new CHEST initiatives, the First 5 Minutes® program and Bridging Specialties™: Timely Diagnosis for ILD. The former improves patient care through strengthened patient/clinician relationships, and the latter aims to eliminate gaps in diagnosing complex lung diseases like pulmonary fibrosis.

To all who donated to CHEST in 2022, Dr. De Marco said, “A sincere thank you to each and every one of you for helping us fulfill our mission. To the first-time donors, hopefully this will inspire you and your friends to be an active part of the CHEST family.”

And, to the winner of the trip, Dr. De Marco said, “A sincere congratulations and I hope you enjoy beautiful Hawai’i and your time at the meeting.”

Those who are interested in getting involved and supporting the philanthropic work of CHEST can contact chestphilanthropy@chestnet.org.

Out of the 150+ donors who gave $250 or more to CHEST between September 2022 and the end of 2022, longtime friend of CHEST, Noah Dorsky, was the recipient of two first-class tickets to Hawai’i, hotel accommodations, and registration to CHEST 2023 in Honolulu.

Noah donated specifically to the Mark J. Rosen, MD, Master FCCP Endowment in honor of his late friend, Dr. Mark J. Rosen, who served as CHEST President from 2006 to 2007 and died in 2019.

"Mark was a remarkable doctor and valued life-long friend,” Noah said. “My continued support for CHEST is my way of honoring his memory and how much he meant to me and others."

Dr. Rosen’s distinguished career in pulmonary and critical care medicine spanned more than 4 decades, marked by his deep commitments to medical education and patient care. Before serving as President, Dr. Rosen served on the CHEST Board of Regents for many years. He held positions as Chair or member on numerous CHEST committees, including Education, Nominations, Membership, Marketing, and Finance.

Following his passing, Dr. Rosen’s wife, Ilene, stayed engaged with CHEST by creating the endowment in his name and attending the CHEST Annual Meeting every year to award the Rosen Cup to the winners of the annual CHEST Challenge.

Congratulations, Noah, and thank you for your faithful giving to support the work of CHEST.

Thoracic Oncology Network

Interventional Procedures Section

The management of recurrent pleural effusions is challenging. Indwelling tunneled pleural catheters (IPCs) have been shown to reduce the need for additional pleural procedures, admissions, and health care costs. These devices have become an important treatment option in patients with malignant pleural effusions (MPE), particularly those with a nonexpandable lung (Feller-Kopman DJ, et al. Am J Respir Crit Care Med. 2018;198[7]:839) and when talc pleurodesis is unsuccessful in patients with an expandable lung (Dresler CM, et al. Chest. 2005;127[3]:909).

Over the last 5 years, studies evaluating the use of IPCs in treating nonmalignant pleural disease have proliferated. These studies have included and shown the successful treatment of pleural effusions due to end-stage renal disease, advanced heart failure (Walker SP, et al. Eur Respir J. 2022;59[2]:2101362), and cirrhosis, especially when a transjugular intrahepatic portosystemic shunt or liver transplant is not an option (Shojaee S, et al., Chest. 2019;155[3]:546). Compared with MPE, the rate of pleurodesis is generally lower and takes longer when an IPC is used to manage a nonmalignant pleural disease. Infection is the most common complication; most cases can be managed without catheter removal.

With many cited advantages, the IPC is an essential tool in the armamentarium of the chest physician and interventional radiologist. Indwelling pleural catheters have proven applications beyond MPE. When applied in a multidisciplinary fashion involving subspecialists and considering the patient’s goals, using an IPC can help achieve a crucial patient-centric goal in managing a recurrent nonmalignant pleural effusion.

Samiksha Gupta, MD

2nd Year Fellow

Sameer Kaushik Avasarala, MD

Section Member-at-Large

Thoracic Oncology Network

Interventional Procedures Section

The management of recurrent pleural effusions is challenging. Indwelling tunneled pleural catheters (IPCs) have been shown to reduce the need for additional pleural procedures, admissions, and health care costs. These devices have become an important treatment option in patients with malignant pleural effusions (MPE), particularly those with a nonexpandable lung (Feller-Kopman DJ, et al. Am J Respir Crit Care Med. 2018;198[7]:839) and when talc pleurodesis is unsuccessful in patients with an expandable lung (Dresler CM, et al. Chest. 2005;127[3]:909).

Over the last 5 years, studies evaluating the use of IPCs in treating nonmalignant pleural disease have proliferated. These studies have included and shown the successful treatment of pleural effusions due to end-stage renal disease, advanced heart failure (Walker SP, et al. Eur Respir J. 2022;59[2]:2101362), and cirrhosis, especially when a transjugular intrahepatic portosystemic shunt or liver transplant is not an option (Shojaee S, et al., Chest. 2019;155[3]:546). Compared with MPE, the rate of pleurodesis is generally lower and takes longer when an IPC is used to manage a nonmalignant pleural disease. Infection is the most common complication; most cases can be managed without catheter removal.

With many cited advantages, the IPC is an essential tool in the armamentarium of the chest physician and interventional radiologist. Indwelling pleural catheters have proven applications beyond MPE. When applied in a multidisciplinary fashion involving subspecialists and considering the patient’s goals, using an IPC can help achieve a crucial patient-centric goal in managing a recurrent nonmalignant pleural effusion.

Samiksha Gupta, MD

2nd Year Fellow

Sameer Kaushik Avasarala, MD

Section Member-at-Large

Thoracic Oncology Network

Interventional Procedures Section

The management of recurrent pleural effusions is challenging. Indwelling tunneled pleural catheters (IPCs) have been shown to reduce the need for additional pleural procedures, admissions, and health care costs. These devices have become an important treatment option in patients with malignant pleural effusions (MPE), particularly those with a nonexpandable lung (Feller-Kopman DJ, et al. Am J Respir Crit Care Med. 2018;198[7]:839) and when talc pleurodesis is unsuccessful in patients with an expandable lung (Dresler CM, et al. Chest. 2005;127[3]:909).

Over the last 5 years, studies evaluating the use of IPCs in treating nonmalignant pleural disease have proliferated. These studies have included and shown the successful treatment of pleural effusions due to end-stage renal disease, advanced heart failure (Walker SP, et al. Eur Respir J. 2022;59[2]:2101362), and cirrhosis, especially when a transjugular intrahepatic portosystemic shunt or liver transplant is not an option (Shojaee S, et al., Chest. 2019;155[3]:546). Compared with MPE, the rate of pleurodesis is generally lower and takes longer when an IPC is used to manage a nonmalignant pleural disease. Infection is the most common complication; most cases can be managed without catheter removal.

With many cited advantages, the IPC is an essential tool in the armamentarium of the chest physician and interventional radiologist. Indwelling pleural catheters have proven applications beyond MPE. When applied in a multidisciplinary fashion involving subspecialists and considering the patient’s goals, using an IPC can help achieve a crucial patient-centric goal in managing a recurrent nonmalignant pleural effusion.

Samiksha Gupta, MD

2nd Year Fellow

Sameer Kaushik Avasarala, MD

Section Member-at-Large

Critical Care Network

Nonrespiratory Critical Care Section

Advocating for early mobility for patients in the ICU seems like a no-brainer. This is especially true for critically ill patients, in which weakness is more common and can result in worse outcomes (Kress JP, et al. N Engl J Med. 2014;370:1626). This advocacy is endorsed by major societies and guidelines, like the ABCDEF bundle (Balas MC, et al. Crit Care Med. 2013;41:S116), in which “E” stands for Early mobility and exercise. In fact, the PADIS guidelines, addressing Pain, Agitation, Delirium, Immobility, and Sleep in the ICU, added Immobility and Sleep (the “I” and “S” in PADIS) to the prior PAD guidelines in the latest update in 2018, to stress the importance of early mobility in the ICU (Devlin JW, et al. Crit Care Med. 2018;46[9]:e825). Multiple studies have shown a positive impact of early mobility in the ICU on patients’ outcomes (Tipping CJ, et al. Intensive Care Med. 2017;43:171).

The recent TEAM study examined an early mobility approach in mechanically ventilated patients and found no difference in the primary outcome of alive and out-of-hospital at 180 days (N Engl J Med. 2022;387:1747).

Before concluding, it is worth realizing that the usual care arm included mobilization that was otherwise normally provided. The intervention arm protocolized the early mobility to be done simultaneously with the minimization of sedation. Patients’ assessment occurred in 81% in the usual care arm vs 94% in the intervention arm; both numbers are much higher than reported data in the ICU (Jolley SE, et al. Crit Care Med. 2017;45:205).

Revisiting the question of early mobility in the ICU, more data are needed to clarify the best methodology, sedation, timing, amount, and type of patients who will benefit the most. Until then, it should remain a goal for ICUs and part of the daily discussion when caring for critically ill patients.

Mohammed J. Al-Jaghbeer, MBBS, FCCP

Section Member-at-Large

Salim Surani, MD, MPH, FCCP

Critical Care Network

Nonrespiratory Critical Care Section

Advocating for early mobility for patients in the ICU seems like a no-brainer. This is especially true for critically ill patients, in which weakness is more common and can result in worse outcomes (Kress JP, et al. N Engl J Med. 2014;370:1626). This advocacy is endorsed by major societies and guidelines, like the ABCDEF bundle (Balas MC, et al. Crit Care Med. 2013;41:S116), in which “E” stands for Early mobility and exercise. In fact, the PADIS guidelines, addressing Pain, Agitation, Delirium, Immobility, and Sleep in the ICU, added Immobility and Sleep (the “I” and “S” in PADIS) to the prior PAD guidelines in the latest update in 2018, to stress the importance of early mobility in the ICU (Devlin JW, et al. Crit Care Med. 2018;46[9]:e825). Multiple studies have shown a positive impact of early mobility in the ICU on patients’ outcomes (Tipping CJ, et al. Intensive Care Med. 2017;43:171).

The recent TEAM study examined an early mobility approach in mechanically ventilated patients and found no difference in the primary outcome of alive and out-of-hospital at 180 days (N Engl J Med. 2022;387:1747).

Before concluding, it is worth realizing that the usual care arm included mobilization that was otherwise normally provided. The intervention arm protocolized the early mobility to be done simultaneously with the minimization of sedation. Patients’ assessment occurred in 81% in the usual care arm vs 94% in the intervention arm; both numbers are much higher than reported data in the ICU (Jolley SE, et al. Crit Care Med. 2017;45:205).

Revisiting the question of early mobility in the ICU, more data are needed to clarify the best methodology, sedation, timing, amount, and type of patients who will benefit the most. Until then, it should remain a goal for ICUs and part of the daily discussion when caring for critically ill patients.

Mohammed J. Al-Jaghbeer, MBBS, FCCP

Section Member-at-Large

Salim Surani, MD, MPH, FCCP

Critical Care Network

Nonrespiratory Critical Care Section

Advocating for early mobility for patients in the ICU seems like a no-brainer. This is especially true for critically ill patients, in which weakness is more common and can result in worse outcomes (Kress JP, et al. N Engl J Med. 2014;370:1626). This advocacy is endorsed by major societies and guidelines, like the ABCDEF bundle (Balas MC, et al. Crit Care Med. 2013;41:S116), in which “E” stands for Early mobility and exercise. In fact, the PADIS guidelines, addressing Pain, Agitation, Delirium, Immobility, and Sleep in the ICU, added Immobility and Sleep (the “I” and “S” in PADIS) to the prior PAD guidelines in the latest update in 2018, to stress the importance of early mobility in the ICU (Devlin JW, et al. Crit Care Med. 2018;46[9]:e825). Multiple studies have shown a positive impact of early mobility in the ICU on patients’ outcomes (Tipping CJ, et al. Intensive Care Med. 2017;43:171).

The recent TEAM study examined an early mobility approach in mechanically ventilated patients and found no difference in the primary outcome of alive and out-of-hospital at 180 days (N Engl J Med. 2022;387:1747).

Before concluding, it is worth realizing that the usual care arm included mobilization that was otherwise normally provided. The intervention arm protocolized the early mobility to be done simultaneously with the minimization of sedation. Patients’ assessment occurred in 81% in the usual care arm vs 94% in the intervention arm; both numbers are much higher than reported data in the ICU (Jolley SE, et al. Crit Care Med. 2017;45:205).

Revisiting the question of early mobility in the ICU, more data are needed to clarify the best methodology, sedation, timing, amount, and type of patients who will benefit the most. Until then, it should remain a goal for ICUs and part of the daily discussion when caring for critically ill patients.

Mohammed J. Al-Jaghbeer, MBBS, FCCP

Section Member-at-Large

Salim Surani, MD, MPH, FCCP

In new evidence-based guidelines, the American Gastroenterological Association recommends noninvasive biomarkers as a first-line strategy for monitoring many patients with ulcerative colitis (UC). These guidelines were published in Gastroenterology.

The AGA guidelines outline use cases for three biomarkers that provide accurate insights into UC disease activity: serum C-reactive protein (CRP) (blood), fecal calprotectin (stool), and fecal lactoferrin (stool). AGA recommends a monitoring strategy that integrates noninvasive biomarkers for patients with UC in remission (no current symptoms) as well as those with current symptoms.
 

Patients with UC in symptomatic remission

• Perform interval biomarker monitoring every 6-12 months.
• AGA recommends stool-based biomarkers over blood testing.
• If biomarkers are normal, AGA suggests continuing biomarker monitoring and avoiding routine endoscopic assessment.
• If biomarkers are elevated, AGA suggests endoscopic assessment by a gastroenterologist.
• Listen to your body! Talk to your doctor about any new symptoms.

Patients with symptomatically active UC

• Biomarker testing should be the first step to determine the need for endoscopic assessment.
• For patients with mild symptoms who have normal or elevated biomarkers, AGA suggests endoscopic assessment by a gastroenterologist.
• For patients with moderate to severe symptoms who have normal biomarkers, AGA suggests endoscopic assessment by a gastroenterologist.
• For patients with moderate to severe symptoms and elevated biomarkers, AGA suggests treatment adjustment and avoiding endoscopic assessment.

With AGA guidelines guiding the use of noninvasive biomarkers, physicians can confidently offer a more convenient and closer monitoring option for their patients.

AGA will advocate for all insurers to cover the cost of biomarker testing in UC.

In new evidence-based guidelines, the American Gastroenterological Association recommends noninvasive biomarkers as a first-line strategy for monitoring many patients with ulcerative colitis (UC). These guidelines were published in Gastroenterology.

The AGA guidelines outline use cases for three biomarkers that provide accurate insights into UC disease activity: serum C-reactive protein (CRP) (blood), fecal calprotectin (stool), and fecal lactoferrin (stool). AGA recommends a monitoring strategy that integrates noninvasive biomarkers for patients with UC in remission (no current symptoms) as well as those with current symptoms.
 

Patients with UC in symptomatic remission

• Perform interval biomarker monitoring every 6-12 months.
• AGA recommends stool-based biomarkers over blood testing.
• If biomarkers are normal, AGA suggests continuing biomarker monitoring and avoiding routine endoscopic assessment.
• If biomarkers are elevated, AGA suggests endoscopic assessment by a gastroenterologist.
• Listen to your body! Talk to your doctor about any new symptoms.

Patients with symptomatically active UC

• Biomarker testing should be the first step to determine the need for endoscopic assessment.
• For patients with mild symptoms who have normal or elevated biomarkers, AGA suggests endoscopic assessment by a gastroenterologist.
• For patients with moderate to severe symptoms who have normal biomarkers, AGA suggests endoscopic assessment by a gastroenterologist.
• For patients with moderate to severe symptoms and elevated biomarkers, AGA suggests treatment adjustment and avoiding endoscopic assessment.

With AGA guidelines guiding the use of noninvasive biomarkers, physicians can confidently offer a more convenient and closer monitoring option for their patients.

AGA will advocate for all insurers to cover the cost of biomarker testing in UC.

In new evidence-based guidelines, the American Gastroenterological Association recommends noninvasive biomarkers as a first-line strategy for monitoring many patients with ulcerative colitis (UC). These guidelines were published in Gastroenterology.

The AGA guidelines outline use cases for three biomarkers that provide accurate insights into UC disease activity: serum C-reactive protein (CRP) (blood), fecal calprotectin (stool), and fecal lactoferrin (stool). AGA recommends a monitoring strategy that integrates noninvasive biomarkers for patients with UC in remission (no current symptoms) as well as those with current symptoms.
 

Patients with UC in symptomatic remission

• Perform interval biomarker monitoring every 6-12 months.
• AGA recommends stool-based biomarkers over blood testing.
• If biomarkers are normal, AGA suggests continuing biomarker monitoring and avoiding routine endoscopic assessment.
• If biomarkers are elevated, AGA suggests endoscopic assessment by a gastroenterologist.
• Listen to your body! Talk to your doctor about any new symptoms.

Patients with symptomatically active UC

• Biomarker testing should be the first step to determine the need for endoscopic assessment.
• For patients with mild symptoms who have normal or elevated biomarkers, AGA suggests endoscopic assessment by a gastroenterologist.
• For patients with moderate to severe symptoms who have normal biomarkers, AGA suggests endoscopic assessment by a gastroenterologist.
• For patients with moderate to severe symptoms and elevated biomarkers, AGA suggests treatment adjustment and avoiding endoscopic assessment.

With AGA guidelines guiding the use of noninvasive biomarkers, physicians can confidently offer a more convenient and closer monitoring option for their patients.

AGA will advocate for all insurers to cover the cost of biomarker testing in UC.

Medicare beneficiary cost sharing will no longer apply to the screening colonoscopy following a positive noninvasive stool-based screening test. To unlock this free benefit, providers must properly apply modifier KX.

What codes does this apply to?

Providers must append modifier KX (“requirements specified in the medical policy have been met”) to HCPCS codes G0105 and G0121 when the screening colonoscopy follows a positive result from one of the following noninvasive stool-based CRC screening tests:

• Screening Guaiac-based Fecal Occult Blood Test (gFOBT) (CPT 82270).
• Screening Immunoassay-based Fecal Occult Blood Test (iFOBT) (HCPCS G0328).
• Cologuard™ – Multi-target Stool DNA (sDNA) Test (CPT 81528).

What happens if I don’t use the KX modifier?

Medicare will return the screening colonoscopy claim as “unprocessable” and you will receive one of following messages:

CARC 16: “Claim/service lacks information or has submission billing error(s)” and RARC N822: “Missing Procedure Modifier(s)”

or

RARC N823: “Incomplete/Invalid Procedure Modifier”

Attach modifier KX and resubmit the claim to Medicare.
 

Should I use modifier KX if I remove polyps?

No. If you remove polyps during a screening colonoscopy following a positive noninvasive stool-based test, report the appropriate CPT code (for example, 45380, 45384, 45385, or 45388) and add modifier PT (colorectal cancer screening test; converted to diagnostic test or other procedure) to each CPT code for Medicare.

Some Medicare beneficiaries are not aware that Medicare has not fully eliminated the coinsurance responsibility yet when polypectomy is needed during a screening colonoscopy. Medicare beneficiary coinsurance responsibility is 15% of the cost of the procedure from 2023 to 2026. The coinsurance responsibility falls to 10% from 2027 to 2029 and by 2030 it will be covered 100% by Medicare.
 

Where can I find more information?

See the MLN Matters notice and the CMS Manual System.

Medicare beneficiary cost sharing will no longer apply to the screening colonoscopy following a positive noninvasive stool-based screening test. To unlock this free benefit, providers must properly apply modifier KX.

What codes does this apply to?

Providers must append modifier KX (“requirements specified in the medical policy have been met”) to HCPCS codes G0105 and G0121 when the screening colonoscopy follows a positive result from one of the following noninvasive stool-based CRC screening tests:

• Screening Guaiac-based Fecal Occult Blood Test (gFOBT) (CPT 82270).
• Screening Immunoassay-based Fecal Occult Blood Test (iFOBT) (HCPCS G0328).
• Cologuard™ – Multi-target Stool DNA (sDNA) Test (CPT 81528).

What happens if I don’t use the KX modifier?

Medicare will return the screening colonoscopy claim as “unprocessable” and you will receive one of following messages:

CARC 16: “Claim/service lacks information or has submission billing error(s)” and RARC N822: “Missing Procedure Modifier(s)”

or

RARC N823: “Incomplete/Invalid Procedure Modifier”

Attach modifier KX and resubmit the claim to Medicare.
 

Should I use modifier KX if I remove polyps?

No. If you remove polyps during a screening colonoscopy following a positive noninvasive stool-based test, report the appropriate CPT code (for example, 45380, 45384, 45385, or 45388) and add modifier PT (colorectal cancer screening test; converted to diagnostic test or other procedure) to each CPT code for Medicare.

Some Medicare beneficiaries are not aware that Medicare has not fully eliminated the coinsurance responsibility yet when polypectomy is needed during a screening colonoscopy. Medicare beneficiary coinsurance responsibility is 15% of the cost of the procedure from 2023 to 2026. The coinsurance responsibility falls to 10% from 2027 to 2029 and by 2030 it will be covered 100% by Medicare.
 

Where can I find more information?

See the MLN Matters notice and the CMS Manual System.

Medicare beneficiary cost sharing will no longer apply to the screening colonoscopy following a positive noninvasive stool-based screening test. To unlock this free benefit, providers must properly apply modifier KX.

What codes does this apply to?

Providers must append modifier KX (“requirements specified in the medical policy have been met”) to HCPCS codes G0105 and G0121 when the screening colonoscopy follows a positive result from one of the following noninvasive stool-based CRC screening tests:

• Screening Guaiac-based Fecal Occult Blood Test (gFOBT) (CPT 82270).
• Screening Immunoassay-based Fecal Occult Blood Test (iFOBT) (HCPCS G0328).
• Cologuard™ – Multi-target Stool DNA (sDNA) Test (CPT 81528).

What happens if I don’t use the KX modifier?

Medicare will return the screening colonoscopy claim as “unprocessable” and you will receive one of following messages:

CARC 16: “Claim/service lacks information or has submission billing error(s)” and RARC N822: “Missing Procedure Modifier(s)”

or

RARC N823: “Incomplete/Invalid Procedure Modifier”

Attach modifier KX and resubmit the claim to Medicare.
 

Should I use modifier KX if I remove polyps?

No. If you remove polyps during a screening colonoscopy following a positive noninvasive stool-based test, report the appropriate CPT code (for example, 45380, 45384, 45385, or 45388) and add modifier PT (colorectal cancer screening test; converted to diagnostic test or other procedure) to each CPT code for Medicare.

Some Medicare beneficiaries are not aware that Medicare has not fully eliminated the coinsurance responsibility yet when polypectomy is needed during a screening colonoscopy. Medicare beneficiary coinsurance responsibility is 15% of the cost of the procedure from 2023 to 2026. The coinsurance responsibility falls to 10% from 2027 to 2029 and by 2030 it will be covered 100% by Medicare.
 

Where can I find more information?

See the MLN Matters notice and the CMS Manual System.

Sleep Medicine Network

Home-Based Mechanical Ventilation & Neuromuscular Disease Section

Novel therapies for neuromuscular disease: What are the respiratory and sleep implications?

The natural history of respiratory impairment in children and adults with progressive neuromuscular disease (NMD) often follows a predictable progression. Muscle weakness leads to sleep-disordered breathing and sleep-related hypoventilation, followed by diurnal hypoventilation, and, ultimately leads to respiratory failure. A number of disease-specific and society guidelines provide protocols for anticipatory respiratory monitoring, such as the role of polysomnography, pulmonary function testing, and respiratory muscle strength testing. They also guide the treatment of respiratory symptoms, such as when to initiate cough augmentation and assisted ventilation.

The emergence of disease-modifying therapies over the last decade has changed the landscape of a number of neuromuscular diseases, including spinal muscular atrophy (SMA) and Duchenne muscular dystrophy. There are now cases of children with SMA type 1, who subsequent to treatment, are walking independently. Studies examining the impact of these therapies on motor function use standardized assessments, but there are limited studies assessing pulmonary and sleep outcomes (Gurbani N, et al. Pediatr Pulmonol. 2021;56[4]:700).

Researchers are also assessing the role of home testing to diagnose hypoventilation (Shi J, et al. Sleep Med. 2023;101:221-7) and using tools like positive airway pressure device data to guide treatment with noninvasive ventilation (Perrem L et al. Pediatr Pulmonol. 2020;55[1]:58-67). While these advances in therapy are exciting, we still do not know what the long-term respiratory function, prognosis, or disease progression may be. Questions remain regarding how to best monitor, and at what frequency to assess, the respiratory status in these patients.

Moshe Y. Prero, MD
Section Member-at-Large

Sleep Medicine Network

Home-Based Mechanical Ventilation & Neuromuscular Disease Section

Novel therapies for neuromuscular disease: What are the respiratory and sleep implications?

The natural history of respiratory impairment in children and adults with progressive neuromuscular disease (NMD) often follows a predictable progression. Muscle weakness leads to sleep-disordered breathing and sleep-related hypoventilation, followed by diurnal hypoventilation, and, ultimately leads to respiratory failure. A number of disease-specific and society guidelines provide protocols for anticipatory respiratory monitoring, such as the role of polysomnography, pulmonary function testing, and respiratory muscle strength testing. They also guide the treatment of respiratory symptoms, such as when to initiate cough augmentation and assisted ventilation.

The emergence of disease-modifying therapies over the last decade has changed the landscape of a number of neuromuscular diseases, including spinal muscular atrophy (SMA) and Duchenne muscular dystrophy. There are now cases of children with SMA type 1, who subsequent to treatment, are walking independently. Studies examining the impact of these therapies on motor function use standardized assessments, but there are limited studies assessing pulmonary and sleep outcomes (Gurbani N, et al. Pediatr Pulmonol. 2021;56[4]:700).

Researchers are also assessing the role of home testing to diagnose hypoventilation (Shi J, et al. Sleep Med. 2023;101:221-7) and using tools like positive airway pressure device data to guide treatment with noninvasive ventilation (Perrem L et al. Pediatr Pulmonol. 2020;55[1]:58-67). While these advances in therapy are exciting, we still do not know what the long-term respiratory function, prognosis, or disease progression may be. Questions remain regarding how to best monitor, and at what frequency to assess, the respiratory status in these patients.

Moshe Y. Prero, MD
Section Member-at-Large

Sleep Medicine Network

Home-Based Mechanical Ventilation & Neuromuscular Disease Section

Novel therapies for neuromuscular disease: What are the respiratory and sleep implications?

The natural history of respiratory impairment in children and adults with progressive neuromuscular disease (NMD) often follows a predictable progression. Muscle weakness leads to sleep-disordered breathing and sleep-related hypoventilation, followed by diurnal hypoventilation, and, ultimately leads to respiratory failure. A number of disease-specific and society guidelines provide protocols for anticipatory respiratory monitoring, such as the role of polysomnography, pulmonary function testing, and respiratory muscle strength testing. They also guide the treatment of respiratory symptoms, such as when to initiate cough augmentation and assisted ventilation.

The emergence of disease-modifying therapies over the last decade has changed the landscape of a number of neuromuscular diseases, including spinal muscular atrophy (SMA) and Duchenne muscular dystrophy. There are now cases of children with SMA type 1, who subsequent to treatment, are walking independently. Studies examining the impact of these therapies on motor function use standardized assessments, but there are limited studies assessing pulmonary and sleep outcomes (Gurbani N, et al. Pediatr Pulmonol. 2021;56[4]:700).

Researchers are also assessing the role of home testing to diagnose hypoventilation (Shi J, et al. Sleep Med. 2023;101:221-7) and using tools like positive airway pressure device data to guide treatment with noninvasive ventilation (Perrem L et al. Pediatr Pulmonol. 2020;55[1]:58-67). While these advances in therapy are exciting, we still do not know what the long-term respiratory function, prognosis, or disease progression may be. Questions remain regarding how to best monitor, and at what frequency to assess, the respiratory status in these patients.

Moshe Y. Prero, MD
Section Member-at-Large

Airway Disorders Network

Bronchiectasis Section

Bronchiectasis is a condition of dilated, inflamed airways and mucous production caused by a myriad of diseases. Bronchiectasis entails chronic productive cough and an increased risk of infections leading to exacerbations. Chronic bacterial infections are often a hallmark of severe disease, especially with Pseudomonas aeruginosa (O’Donnell AE. N Engl J Med. 2022;387[6]:533). Prophylactic inhaled antibiotics have been used as off-label therapies with mixed evidence, particularly in non-cystic fibrosis bronchiectasis (Rubin BK, et al. Respiration. 2014;88[3]:177). As the incidence of bronchiectasis increases worldwide, the need for evidence-based therapies to reduce symptom burden is increasing.

In a recent publication, Guan and colleagues evaluated the efficacy and safety of tobramycin inhaled solution (TIS) for bronchiectasis with chronic P. aeruginosa in a phase 3, 16-week, multicenter, double-blind randomized, controlled trial (Guan W-J, et al. Chest. 2023;163[1]:64). A regimen of twice-daily TIS, compared with nebulized normal saline, demonstrated a more significant reduction in P. aeruginosa sputum density after two cycles of 28 days on-treatment and 28 days off-treatment (adjusted mean difference, 1.74 log10 colony-forming units/g; 95% CI, 1.12-2.35; (P < .001), and more patients became culture-negative for P. aeruginosa in the TIS group than in the placebo group on day 29 (29.3% vs 10.6%). Adverse events were similar in both groups. Importantly, there was an improvement in quality-of-life bronchiectasis respiratory symptom score by 7.91 points at day 29 and 6.72 points at day 85; all three were statistically significant but just below the minimal clinically important difference of 8 points.

Dr. Conroy Wong and Dr. Miguel Angel Martinez-Garcia (Chest. 2023 Jan;163[1]:3) highlighted in their accompanying editorial that use of health-related quality of life score was a “distinguishing feature” of the trial as “most studies have used the change in microbial density as the primary outcome measure alone.”

Future studies evaluating cyclical vs continuous antibiotic administration, treatment duration, and impact on exacerbations continue to be needed.

Alicia Mirza, MD
Section Member-at-Large

Airway Disorders Network

Bronchiectasis Section

Bronchiectasis is a condition of dilated, inflamed airways and mucous production caused by a myriad of diseases. Bronchiectasis entails chronic productive cough and an increased risk of infections leading to exacerbations. Chronic bacterial infections are often a hallmark of severe disease, especially with Pseudomonas aeruginosa (O’Donnell AE. N Engl J Med. 2022;387[6]:533). Prophylactic inhaled antibiotics have been used as off-label therapies with mixed evidence, particularly in non-cystic fibrosis bronchiectasis (Rubin BK, et al. Respiration. 2014;88[3]:177). As the incidence of bronchiectasis increases worldwide, the need for evidence-based therapies to reduce symptom burden is increasing.

In a recent publication, Guan and colleagues evaluated the efficacy and safety of tobramycin inhaled solution (TIS) for bronchiectasis with chronic P. aeruginosa in a phase 3, 16-week, multicenter, double-blind randomized, controlled trial (Guan W-J, et al. Chest. 2023;163[1]:64). A regimen of twice-daily TIS, compared with nebulized normal saline, demonstrated a more significant reduction in P. aeruginosa sputum density after two cycles of 28 days on-treatment and 28 days off-treatment (adjusted mean difference, 1.74 log10 colony-forming units/g; 95% CI, 1.12-2.35; (P < .001), and more patients became culture-negative for P. aeruginosa in the TIS group than in the placebo group on day 29 (29.3% vs 10.6%). Adverse events were similar in both groups. Importantly, there was an improvement in quality-of-life bronchiectasis respiratory symptom score by 7.91 points at day 29 and 6.72 points at day 85; all three were statistically significant but just below the minimal clinically important difference of 8 points.

Dr. Conroy Wong and Dr. Miguel Angel Martinez-Garcia (Chest. 2023 Jan;163[1]:3) highlighted in their accompanying editorial that use of health-related quality of life score was a “distinguishing feature” of the trial as “most studies have used the change in microbial density as the primary outcome measure alone.”

Future studies evaluating cyclical vs continuous antibiotic administration, treatment duration, and impact on exacerbations continue to be needed.

Alicia Mirza, MD
Section Member-at-Large

Airway Disorders Network

Bronchiectasis Section

Bronchiectasis is a condition of dilated, inflamed airways and mucous production caused by a myriad of diseases. Bronchiectasis entails chronic productive cough and an increased risk of infections leading to exacerbations. Chronic bacterial infections are often a hallmark of severe disease, especially with Pseudomonas aeruginosa (O’Donnell AE. N Engl J Med. 2022;387[6]:533). Prophylactic inhaled antibiotics have been used as off-label therapies with mixed evidence, particularly in non-cystic fibrosis bronchiectasis (Rubin BK, et al. Respiration. 2014;88[3]:177). As the incidence of bronchiectasis increases worldwide, the need for evidence-based therapies to reduce symptom burden is increasing.

In a recent publication, Guan and colleagues evaluated the efficacy and safety of tobramycin inhaled solution (TIS) for bronchiectasis with chronic P. aeruginosa in a phase 3, 16-week, multicenter, double-blind randomized, controlled trial (Guan W-J, et al. Chest. 2023;163[1]:64). A regimen of twice-daily TIS, compared with nebulized normal saline, demonstrated a more significant reduction in P. aeruginosa sputum density after two cycles of 28 days on-treatment and 28 days off-treatment (adjusted mean difference, 1.74 log10 colony-forming units/g; 95% CI, 1.12-2.35; (P < .001), and more patients became culture-negative for P. aeruginosa in the TIS group than in the placebo group on day 29 (29.3% vs 10.6%). Adverse events were similar in both groups. Importantly, there was an improvement in quality-of-life bronchiectasis respiratory symptom score by 7.91 points at day 29 and 6.72 points at day 85; all three were statistically significant but just below the minimal clinically important difference of 8 points.

Dr. Conroy Wong and Dr. Miguel Angel Martinez-Garcia (Chest. 2023 Jan;163[1]:3) highlighted in their accompanying editorial that use of health-related quality of life score was a “distinguishing feature” of the trial as “most studies have used the change in microbial density as the primary outcome measure alone.”

Future studies evaluating cyclical vs continuous antibiotic administration, treatment duration, and impact on exacerbations continue to be needed.

Alicia Mirza, MD
Section Member-at-Large

In our current society, it is likely that the “skinny patient with COPD” who walks into your clinic is less and less your “traditional” patient with COPD. We are seeing in our health care systems more of the “blue bloaters” – patients with COPD and significant obesity. This phenotype is representing what we are seeing worldwide as a consequence of the rising obesity prevalence. In the United States, the prepandemic (2017-2020) estimated percentage of adults over the age of 40 with obesity, defined as a body mass index (BMI) of at least 30 kg/m², was over 40%. Moreover, the estimated percentage of adults with morbid obesity (BMI at least 40 kg/m₂) is close to 10% (Akinbami, LJ et al. Vital Health Stat. 2022:190:1-36) and trending up. These patients with the “triple overlap” of morbid obesity, COPD, and awake daytime hypercapnia are being seen in clinics and in-hospital settings with increasing frequency, often presenting with complicating comorbidities such as acute respiratory failure, acute heart failure, kidney disease, or pulmonary hypertension. We are now faced with managing these patients with complex disease.

The obesity paradox does not seem applicable in the triple overlap phenotype. Patients with COPD who are overweight, defined as “mild obesity,” have lower mortality when compared with normal weight and underweight patients with COPD; however, this effect diminishes when BMI increases beyond 32 kg/m². With increasing obesity severity and aging, the risk of both obstructive sleep apnea (OSA) and hypoventilation increases. It is well documented that COPD-OSA overlap is linked to worse outcomes and that continuous positive airway pressure (CPAP) as first-line therapy decreases readmission rates and mortality. The triple overlap phenotypic patients, however, are presenting with chronic hypercapnic respiratory failure in a backdrop of morbid obesity, unlike the stable COPD-OSA overlap. The pathophysiology of hypoventilation in obesity is complex and multifactorial, and, although significant overlaps likely exist with comorbid COPD, by current definitions, to establish a diagnosis of obesity hypoventilation syndrome (OHS), one must have excluded other causes of hypoventilation, such as COPD.

These patients with the triple overlap of morbid obesity, awake daytime hypercapnia, and COPD are the subset of patients that providers struggle to fit in a diagnosis or in clinical research trials.
 

The triple overlap is a distinct syndrome

Different labels have been used in the medical literature: hypercapnic OSA-COPD overlap, morbid obesity and OSA-COPD overlap, hypercapnic morbidly obese COPD and OHS-COPD overlap. A better characterization of this distinctive phenotype is much needed. Patients with OSA-COPD overlap, for example, have an increased propensity to develop hypercapnia at higher FEV₁ when compared with COPD without OSA – but this is thought to be a consequence of prolonged and frequent apneas and hypopneas compounded with obesity-related central hypoventilation. We found that morbidly obese patients with OSA-COPD overlap have a higher hypoxia burden, more severe OSA, and are frequently prescribed noninvasive ventilation after a failed titration polysomnogram (Htun ZM, et al. Am J Respir Crit Care Med. 2019;199:A1382), perhaps signaling a distinctive phenotype with worse outcomes, but the study had the inherent limitations of a single-center, retrospective design lacking data on awake hypercapnia. On the other side, the term OHS-COPD is contradictory and confusing based on current OHS diagnostic criteria.

In standardizing diagnostic criteria for patients with this triple overlap syndrome, challenges remain: would the patient with a BMI of 70 kg/m² and fixed chronic airflow obstruction with FEV₁ 72% fall under the category of hypercapnic COPD vs OHS? Do these patients have worse outcomes regardless of their predominant feature? Would outcomes change if the apnea hypopnea index (AHI) is 10/h vs 65/h? More importantly, do patients with the triple overlap of COPD, morbid obesity, and daytime hypercapnia have worse outcomes when compared with hypercapnic COPD, or OHS with/without OSA? These questions can be better addressed once we agree on a definition. The patients with triple overlap syndrome have been traditionally excluded from clinical trials: the patient with morbid obesity has been excluded from chronic hypercapnic COPD clinical trials, and the patient with COPD has been excluded from OHS trials.

There are no specific clinical guidelines for this triple overlap phenotype. Positive airway pressure is the mainstay of treatment. CPAP is recommended as first-line therapy for patients with OSA-COPD overlap syndrome, while noninvasive ventilation (NIV) with bilevel positive airway pressure (BPAP) is recommended as first-line for the stable ambulatory hypercapnic patient with COPD. It is unclear if NIV is superior to CPAP in patients with triple overlap syndrome, although recently published data showed greater efficacy in reducing carbon dioxide (PaCO₂) and improving quality of life in a small group of subjects (Zheng et al. J Clin Sleep Med. 2022;18[1]:99-107). To take a step further, the subtleties of NIV set up, such as rise time and minimum inspiratory time, are contradictory: the goal in ventilating patients with COPD is to shorten inspiratory time, prolonging expiratory time, therefore allowing a shortened inspiratory cycle. In obesity, ventilation strategies aim to prolong and sustain inspiratory time to improve ventilation and dependent atelectasis. Another area of uncertainty is device selection. Should we aim to provide a respiratory assist device (RAD): the traditional, rent to own bilevel PAP without auto-expiratory positive airway pressure (EPAP) capabilities and lower maximum inspiratory pressure delivery capacity, vs a home mechanical ventilator at a higher expense, life-time rental, and one-way only data monitoring, which limits remote prescription adjustments, but allow auto-EPAP settings for patients with comorbid OSA? More importantly, how do we get these patients, who do not fit in any of the specified insurance criteria for PAP therapy approved for treatment?

A uniform diagnostic definition and clear taxonomy allows for resource allocation, from government funded grants for clinical trials to a better-informed distribution of health care systems resources and support health care policy changes to improve patient-centric outcomes. Here, we propose that the morbidly obese patient (BMI >40 kg/m2) with chronic airflow obstruction and a forced expiratory ratio (FEV₁/FVC) <0.7 with awake daytime hypercapnia (PaCO₂ > 45 mm Hg) represents a different entity/phenotype and fits best under the triple overlap syndrome taxonomy.

We suspect that these patients have worse outcomes, including comorbidity burden, quality of life, exacerbation rates, longer hospital length-of-stay, and respiratory and all-cause mortality. Large, multicenter, controlled trials comparing the long-term effectiveness of NIV and CPAP: measurements of respiratory function, gas exchange, blood pressure, and health related quality of life are needed. This is a group of patients that may specifically benefit from volume-targeted pressure support mode ventilation with auto-EPAP capabilities upon discharge from the hospital after an acute exacerbation.
 

Inpatient (sleep medicine) and outpatient transitions

In patients hospitalized with the triple overlap syndrome, there are certain considerations that are of special interest. Given comorbid hypercapnia and limited data on NIV superiority over CPAP, a sleep study should not be needed for NIV qualification. In addition, the medical team may consider the following (Figure 1):

1. Noninvasive Ventilation:

a. Maintaining a high-pressure support differential between inspiratory positive airway pressure (IPAP) and EPAP. This can usually be achieved at 8-10 cm H₂O, further adjusting to target a tidal volume (Vt) of 8 mL/kg of ideal body weight (IBW).

b. Higher EPAP: To overcome dependent atelectasis, improve ventilation-perfusion (VQ) matching, and better treat upper airway resistance both during wakefulness and sleep. Also, adjustments of EPAP at bedside should be considered to counteract auto-PEEP-related ineffective triggering if observed.

c. OSA screening and EPAP adjustment: for high residual obstructive apneas or hypopneas if data are available on the NIV device, or with the use of peripheral arterial tonometry sleep testing devices with NIV on overnight before discharge.

d. Does the patient meet criteria for oxygen supplementation at home? Wean oxygen off, if possible.

2. Case-managers can help establish services with a durable medical equipment provider with expertise in advanced PAP devices.3. Obesity management, Consider referral to an obesity management program for lifestyle/dietary modifications along with pharmacotherapy or bariatric surgery interventions.

4. Close follow-up, track exacerbations. Device download data are crucial to monitor adherence/tolerance and treatment effectiveness with particular interest in AHI, oximetry, and CO₂ trends monitoring. Some patients may need dedicated titration polysomnograms to adjust ventilation settings, for optimization of residual OSA or for oxygen addition or discontinuation.
 

Conclusion

Patients with the triple overlap phenotype have not been systematically defined, studied, or included in clinical trials. We anticipate that these patients have worse outcomes: quality of life, symptom and comorbidity burden, exacerbation rates, in-hospital mortality, longer hospital stay and ICU stay, and respiratory and all-cause mortality. This is a group of patients that may specifically benefit from domiciliary NIV set-up upon discharge from the hospital with close follow-up. Properly identifying these patients will help pulmonologists and health care systems direct resources to optimally manage this complex group of patients. Funding of research trials to support clinical guidelines development should be prioritized. Triple overlap syndrome is different from COPD-OSA overlap, OHS with moderate to severe OSA, or OHS without significant OSA.

In our current society, it is likely that the “skinny patient with COPD” who walks into your clinic is less and less your “traditional” patient with COPD. We are seeing in our health care systems more of the “blue bloaters” – patients with COPD and significant obesity. This phenotype is representing what we are seeing worldwide as a consequence of the rising obesity prevalence. In the United States, the prepandemic (2017-2020) estimated percentage of adults over the age of 40 with obesity, defined as a body mass index (BMI) of at least 30 kg/m², was over 40%. Moreover, the estimated percentage of adults with morbid obesity (BMI at least 40 kg/m₂) is close to 10% (Akinbami, LJ et al. Vital Health Stat. 2022:190:1-36) and trending up. These patients with the “triple overlap” of morbid obesity, COPD, and awake daytime hypercapnia are being seen in clinics and in-hospital settings with increasing frequency, often presenting with complicating comorbidities such as acute respiratory failure, acute heart failure, kidney disease, or pulmonary hypertension. We are now faced with managing these patients with complex disease.

The obesity paradox does not seem applicable in the triple overlap phenotype. Patients with COPD who are overweight, defined as “mild obesity,” have lower mortality when compared with normal weight and underweight patients with COPD; however, this effect diminishes when BMI increases beyond 32 kg/m². With increasing obesity severity and aging, the risk of both obstructive sleep apnea (OSA) and hypoventilation increases. It is well documented that COPD-OSA overlap is linked to worse outcomes and that continuous positive airway pressure (CPAP) as first-line therapy decreases readmission rates and mortality. The triple overlap phenotypic patients, however, are presenting with chronic hypercapnic respiratory failure in a backdrop of morbid obesity, unlike the stable COPD-OSA overlap. The pathophysiology of hypoventilation in obesity is complex and multifactorial, and, although significant overlaps likely exist with comorbid COPD, by current definitions, to establish a diagnosis of obesity hypoventilation syndrome (OHS), one must have excluded other causes of hypoventilation, such as COPD.

These patients with the triple overlap of morbid obesity, awake daytime hypercapnia, and COPD are the subset of patients that providers struggle to fit in a diagnosis or in clinical research trials.
 

The triple overlap is a distinct syndrome

Different labels have been used in the medical literature: hypercapnic OSA-COPD overlap, morbid obesity and OSA-COPD overlap, hypercapnic morbidly obese COPD and OHS-COPD overlap. A better characterization of this distinctive phenotype is much needed. Patients with OSA-COPD overlap, for example, have an increased propensity to develop hypercapnia at higher FEV₁ when compared with COPD without OSA – but this is thought to be a consequence of prolonged and frequent apneas and hypopneas compounded with obesity-related central hypoventilation. We found that morbidly obese patients with OSA-COPD overlap have a higher hypoxia burden, more severe OSA, and are frequently prescribed noninvasive ventilation after a failed titration polysomnogram (Htun ZM, et al. Am J Respir Crit Care Med. 2019;199:A1382), perhaps signaling a distinctive phenotype with worse outcomes, but the study had the inherent limitations of a single-center, retrospective design lacking data on awake hypercapnia. On the other side, the term OHS-COPD is contradictory and confusing based on current OHS diagnostic criteria.

In standardizing diagnostic criteria for patients with this triple overlap syndrome, challenges remain: would the patient with a BMI of 70 kg/m² and fixed chronic airflow obstruction with FEV₁ 72% fall under the category of hypercapnic COPD vs OHS? Do these patients have worse outcomes regardless of their predominant feature? Would outcomes change if the apnea hypopnea index (AHI) is 10/h vs 65/h? More importantly, do patients with the triple overlap of COPD, morbid obesity, and daytime hypercapnia have worse outcomes when compared with hypercapnic COPD, or OHS with/without OSA? These questions can be better addressed once we agree on a definition. The patients with triple overlap syndrome have been traditionally excluded from clinical trials: the patient with morbid obesity has been excluded from chronic hypercapnic COPD clinical trials, and the patient with COPD has been excluded from OHS trials.

There are no specific clinical guidelines for this triple overlap phenotype. Positive airway pressure is the mainstay of treatment. CPAP is recommended as first-line therapy for patients with OSA-COPD overlap syndrome, while noninvasive ventilation (NIV) with bilevel positive airway pressure (BPAP) is recommended as first-line for the stable ambulatory hypercapnic patient with COPD. It is unclear if NIV is superior to CPAP in patients with triple overlap syndrome, although recently published data showed greater efficacy in reducing carbon dioxide (PaCO₂) and improving quality of life in a small group of subjects (Zheng et al. J Clin Sleep Med. 2022;18[1]:99-107). To take a step further, the subtleties of NIV set up, such as rise time and minimum inspiratory time, are contradictory: the goal in ventilating patients with COPD is to shorten inspiratory time, prolonging expiratory time, therefore allowing a shortened inspiratory cycle. In obesity, ventilation strategies aim to prolong and sustain inspiratory time to improve ventilation and dependent atelectasis. Another area of uncertainty is device selection. Should we aim to provide a respiratory assist device (RAD): the traditional, rent to own bilevel PAP without auto-expiratory positive airway pressure (EPAP) capabilities and lower maximum inspiratory pressure delivery capacity, vs a home mechanical ventilator at a higher expense, life-time rental, and one-way only data monitoring, which limits remote prescription adjustments, but allow auto-EPAP settings for patients with comorbid OSA? More importantly, how do we get these patients, who do not fit in any of the specified insurance criteria for PAP therapy approved for treatment?

A uniform diagnostic definition and clear taxonomy allows for resource allocation, from government funded grants for clinical trials to a better-informed distribution of health care systems resources and support health care policy changes to improve patient-centric outcomes. Here, we propose that the morbidly obese patient (BMI >40 kg/m2) with chronic airflow obstruction and a forced expiratory ratio (FEV₁/FVC) <0.7 with awake daytime hypercapnia (PaCO₂ > 45 mm Hg) represents a different entity/phenotype and fits best under the triple overlap syndrome taxonomy.

We suspect that these patients have worse outcomes, including comorbidity burden, quality of life, exacerbation rates, longer hospital length-of-stay, and respiratory and all-cause mortality. Large, multicenter, controlled trials comparing the long-term effectiveness of NIV and CPAP: measurements of respiratory function, gas exchange, blood pressure, and health related quality of life are needed. This is a group of patients that may specifically benefit from volume-targeted pressure support mode ventilation with auto-EPAP capabilities upon discharge from the hospital after an acute exacerbation.
 

Inpatient (sleep medicine) and outpatient transitions

In patients hospitalized with the triple overlap syndrome, there are certain considerations that are of special interest. Given comorbid hypercapnia and limited data on NIV superiority over CPAP, a sleep study should not be needed for NIV qualification. In addition, the medical team may consider the following (Figure 1):

1. Noninvasive Ventilation:

a. Maintaining a high-pressure support differential between inspiratory positive airway pressure (IPAP) and EPAP. This can usually be achieved at 8-10 cm H₂O, further adjusting to target a tidal volume (Vt) of 8 mL/kg of ideal body weight (IBW).

b. Higher EPAP: To overcome dependent atelectasis, improve ventilation-perfusion (VQ) matching, and better treat upper airway resistance both during wakefulness and sleep. Also, adjustments of EPAP at bedside should be considered to counteract auto-PEEP-related ineffective triggering if observed.

c. OSA screening and EPAP adjustment: for high residual obstructive apneas or hypopneas if data are available on the NIV device, or with the use of peripheral arterial tonometry sleep testing devices with NIV on overnight before discharge.

d. Does the patient meet criteria for oxygen supplementation at home? Wean oxygen off, if possible.

2. Case-managers can help establish services with a durable medical equipment provider with expertise in advanced PAP devices.3. Obesity management, Consider referral to an obesity management program for lifestyle/dietary modifications along with pharmacotherapy or bariatric surgery interventions.

4. Close follow-up, track exacerbations. Device download data are crucial to monitor adherence/tolerance and treatment effectiveness with particular interest in AHI, oximetry, and CO₂ trends monitoring. Some patients may need dedicated titration polysomnograms to adjust ventilation settings, for optimization of residual OSA or for oxygen addition or discontinuation.
 

Conclusion

Patients with the triple overlap phenotype have not been systematically defined, studied, or included in clinical trials. We anticipate that these patients have worse outcomes: quality of life, symptom and comorbidity burden, exacerbation rates, in-hospital mortality, longer hospital stay and ICU stay, and respiratory and all-cause mortality. This is a group of patients that may specifically benefit from domiciliary NIV set-up upon discharge from the hospital with close follow-up. Properly identifying these patients will help pulmonologists and health care systems direct resources to optimally manage this complex group of patients. Funding of research trials to support clinical guidelines development should be prioritized. Triple overlap syndrome is different from COPD-OSA overlap, OHS with moderate to severe OSA, or OHS without significant OSA.

In our current society, it is likely that the “skinny patient with COPD” who walks into your clinic is less and less your “traditional” patient with COPD. We are seeing in our health care systems more of the “blue bloaters” – patients with COPD and significant obesity. This phenotype is representing what we are seeing worldwide as a consequence of the rising obesity prevalence. In the United States, the prepandemic (2017-2020) estimated percentage of adults over the age of 40 with obesity, defined as a body mass index (BMI) of at least 30 kg/m², was over 40%. Moreover, the estimated percentage of adults with morbid obesity (BMI at least 40 kg/m₂) is close to 10% (Akinbami, LJ et al. Vital Health Stat. 2022:190:1-36) and trending up. These patients with the “triple overlap” of morbid obesity, COPD, and awake daytime hypercapnia are being seen in clinics and in-hospital settings with increasing frequency, often presenting with complicating comorbidities such as acute respiratory failure, acute heart failure, kidney disease, or pulmonary hypertension. We are now faced with managing these patients with complex disease.

The obesity paradox does not seem applicable in the triple overlap phenotype. Patients with COPD who are overweight, defined as “mild obesity,” have lower mortality when compared with normal weight and underweight patients with COPD; however, this effect diminishes when BMI increases beyond 32 kg/m². With increasing obesity severity and aging, the risk of both obstructive sleep apnea (OSA) and hypoventilation increases. It is well documented that COPD-OSA overlap is linked to worse outcomes and that continuous positive airway pressure (CPAP) as first-line therapy decreases readmission rates and mortality. The triple overlap phenotypic patients, however, are presenting with chronic hypercapnic respiratory failure in a backdrop of morbid obesity, unlike the stable COPD-OSA overlap. The pathophysiology of hypoventilation in obesity is complex and multifactorial, and, although significant overlaps likely exist with comorbid COPD, by current definitions, to establish a diagnosis of obesity hypoventilation syndrome (OHS), one must have excluded other causes of hypoventilation, such as COPD.

These patients with the triple overlap of morbid obesity, awake daytime hypercapnia, and COPD are the subset of patients that providers struggle to fit in a diagnosis or in clinical research trials.
 

The triple overlap is a distinct syndrome

Different labels have been used in the medical literature: hypercapnic OSA-COPD overlap, morbid obesity and OSA-COPD overlap, hypercapnic morbidly obese COPD and OHS-COPD overlap. A better characterization of this distinctive phenotype is much needed. Patients with OSA-COPD overlap, for example, have an increased propensity to develop hypercapnia at higher FEV₁ when compared with COPD without OSA – but this is thought to be a consequence of prolonged and frequent apneas and hypopneas compounded with obesity-related central hypoventilation. We found that morbidly obese patients with OSA-COPD overlap have a higher hypoxia burden, more severe OSA, and are frequently prescribed noninvasive ventilation after a failed titration polysomnogram (Htun ZM, et al. Am J Respir Crit Care Med. 2019;199:A1382), perhaps signaling a distinctive phenotype with worse outcomes, but the study had the inherent limitations of a single-center, retrospective design lacking data on awake hypercapnia. On the other side, the term OHS-COPD is contradictory and confusing based on current OHS diagnostic criteria.

In standardizing diagnostic criteria for patients with this triple overlap syndrome, challenges remain: would the patient with a BMI of 70 kg/m² and fixed chronic airflow obstruction with FEV₁ 72% fall under the category of hypercapnic COPD vs OHS? Do these patients have worse outcomes regardless of their predominant feature? Would outcomes change if the apnea hypopnea index (AHI) is 10/h vs 65/h? More importantly, do patients with the triple overlap of COPD, morbid obesity, and daytime hypercapnia have worse outcomes when compared with hypercapnic COPD, or OHS with/without OSA? These questions can be better addressed once we agree on a definition. The patients with triple overlap syndrome have been traditionally excluded from clinical trials: the patient with morbid obesity has been excluded from chronic hypercapnic COPD clinical trials, and the patient with COPD has been excluded from OHS trials.

There are no specific clinical guidelines for this triple overlap phenotype. Positive airway pressure is the mainstay of treatment. CPAP is recommended as first-line therapy for patients with OSA-COPD overlap syndrome, while noninvasive ventilation (NIV) with bilevel positive airway pressure (BPAP) is recommended as first-line for the stable ambulatory hypercapnic patient with COPD. It is unclear if NIV is superior to CPAP in patients with triple overlap syndrome, although recently published data showed greater efficacy in reducing carbon dioxide (PaCO₂) and improving quality of life in a small group of subjects (Zheng et al. J Clin Sleep Med. 2022;18[1]:99-107). To take a step further, the subtleties of NIV set up, such as rise time and minimum inspiratory time, are contradictory: the goal in ventilating patients with COPD is to shorten inspiratory time, prolonging expiratory time, therefore allowing a shortened inspiratory cycle. In obesity, ventilation strategies aim to prolong and sustain inspiratory time to improve ventilation and dependent atelectasis. Another area of uncertainty is device selection. Should we aim to provide a respiratory assist device (RAD): the traditional, rent to own bilevel PAP without auto-expiratory positive airway pressure (EPAP) capabilities and lower maximum inspiratory pressure delivery capacity, vs a home mechanical ventilator at a higher expense, life-time rental, and one-way only data monitoring, which limits remote prescription adjustments, but allow auto-EPAP settings for patients with comorbid OSA? More importantly, how do we get these patients, who do not fit in any of the specified insurance criteria for PAP therapy approved for treatment?

A uniform diagnostic definition and clear taxonomy allows for resource allocation, from government funded grants for clinical trials to a better-informed distribution of health care systems resources and support health care policy changes to improve patient-centric outcomes. Here, we propose that the morbidly obese patient (BMI >40 kg/m2) with chronic airflow obstruction and a forced expiratory ratio (FEV₁/FVC) <0.7 with awake daytime hypercapnia (PaCO₂ > 45 mm Hg) represents a different entity/phenotype and fits best under the triple overlap syndrome taxonomy.

We suspect that these patients have worse outcomes, including comorbidity burden, quality of life, exacerbation rates, longer hospital length-of-stay, and respiratory and all-cause mortality. Large, multicenter, controlled trials comparing the long-term effectiveness of NIV and CPAP: measurements of respiratory function, gas exchange, blood pressure, and health related quality of life are needed. This is a group of patients that may specifically benefit from volume-targeted pressure support mode ventilation with auto-EPAP capabilities upon discharge from the hospital after an acute exacerbation.
 

Inpatient (sleep medicine) and outpatient transitions

In patients hospitalized with the triple overlap syndrome, there are certain considerations that are of special interest. Given comorbid hypercapnia and limited data on NIV superiority over CPAP, a sleep study should not be needed for NIV qualification. In addition, the medical team may consider the following (Figure 1):

1. Noninvasive Ventilation:

a. Maintaining a high-pressure support differential between inspiratory positive airway pressure (IPAP) and EPAP. This can usually be achieved at 8-10 cm H₂O, further adjusting to target a tidal volume (Vt) of 8 mL/kg of ideal body weight (IBW).

b. Higher EPAP: To overcome dependent atelectasis, improve ventilation-perfusion (VQ) matching, and better treat upper airway resistance both during wakefulness and sleep. Also, adjustments of EPAP at bedside should be considered to counteract auto-PEEP-related ineffective triggering if observed.

c. OSA screening and EPAP adjustment: for high residual obstructive apneas or hypopneas if data are available on the NIV device, or with the use of peripheral arterial tonometry sleep testing devices with NIV on overnight before discharge.

d. Does the patient meet criteria for oxygen supplementation at home? Wean oxygen off, if possible.

2. Case-managers can help establish services with a durable medical equipment provider with expertise in advanced PAP devices.3. Obesity management, Consider referral to an obesity management program for lifestyle/dietary modifications along with pharmacotherapy or bariatric surgery interventions.

4. Close follow-up, track exacerbations. Device download data are crucial to monitor adherence/tolerance and treatment effectiveness with particular interest in AHI, oximetry, and CO₂ trends monitoring. Some patients may need dedicated titration polysomnograms to adjust ventilation settings, for optimization of residual OSA or for oxygen addition or discontinuation.
 

Conclusion

Patients with the triple overlap phenotype have not been systematically defined, studied, or included in clinical trials. We anticipate that these patients have worse outcomes: quality of life, symptom and comorbidity burden, exacerbation rates, in-hospital mortality, longer hospital stay and ICU stay, and respiratory and all-cause mortality. This is a group of patients that may specifically benefit from domiciliary NIV set-up upon discharge from the hospital with close follow-up. Properly identifying these patients will help pulmonologists and health care systems direct resources to optimally manage this complex group of patients. Funding of research trials to support clinical guidelines development should be prioritized. Triple overlap syndrome is different from COPD-OSA overlap, OHS with moderate to severe OSA, or OHS without significant OSA.

John A. Howington, MD, MBA, FCCP, is a cardiothoracic surgeon currently serving as Chief of Oncology Services and Chair of Thoracic Surgery at Ascension Saint Thomas Health and a professor at the University of Tennessee Health Sciences Center in Nashville, Tennessee.

Dr. Howington received his undergraduate degree from Tennessee Technological University and medical degree from the University of Tennessee. He completed his general surgery residency at the University of Missouri, Kansas City and thoracic surgery residency at Vanderbilt University Medical Center.

Most recently, he received his Physician Executive MBA from the University of Tennessee.

Dr. Howington has participated in and published more than 46 research publications and guidelines, numerous book chapters, and has presented hundreds of lectures internationally.

As a passionate thoracic surgeon, he has lent his knowledge to the extensive CHEST lung cancer guideline portfolio for more than a decade. He offers regular leadership in multidisciplinary and executive forums and has spearheaded a series of quality improvement initiatives at Ascension. He has served in a variety of leadership roles with CHEST and with other national thoracic surgery societies.

Dr. Howington began his CHEST leadership journey with the Networks, as a member of the Interventional Chest Medicine Steering Committee and then as the Thoracic Oncology Network Chair (2008-2010).

Other leadership positions include serving as the President of the CHEST Foundation (2014-2016), member of the Scientific Program Committee and Membership Committee, and, recently, as the Chair of the Finance Committee from 2018-2021.

Since 2017, he has served on the Board of Regents as a Member at Large. Dr. Howington will serve as the 87th CHEST President in 2025.

John A. Howington, MD, MBA, FCCP, is a cardiothoracic surgeon currently serving as Chief of Oncology Services and Chair of Thoracic Surgery at Ascension Saint Thomas Health and a professor at the University of Tennessee Health Sciences Center in Nashville, Tennessee.

Dr. Howington received his undergraduate degree from Tennessee Technological University and medical degree from the University of Tennessee. He completed his general surgery residency at the University of Missouri, Kansas City and thoracic surgery residency at Vanderbilt University Medical Center.

Most recently, he received his Physician Executive MBA from the University of Tennessee.

Dr. Howington has participated in and published more than 46 research publications and guidelines, numerous book chapters, and has presented hundreds of lectures internationally.

As a passionate thoracic surgeon, he has lent his knowledge to the extensive CHEST lung cancer guideline portfolio for more than a decade. He offers regular leadership in multidisciplinary and executive forums and has spearheaded a series of quality improvement initiatives at Ascension. He has served in a variety of leadership roles with CHEST and with other national thoracic surgery societies.

Dr. Howington began his CHEST leadership journey with the Networks, as a member of the Interventional Chest Medicine Steering Committee and then as the Thoracic Oncology Network Chair (2008-2010).

Other leadership positions include serving as the President of the CHEST Foundation (2014-2016), member of the Scientific Program Committee and Membership Committee, and, recently, as the Chair of the Finance Committee from 2018-2021.

Since 2017, he has served on the Board of Regents as a Member at Large. Dr. Howington will serve as the 87th CHEST President in 2025.

John A. Howington, MD, MBA, FCCP, is a cardiothoracic surgeon currently serving as Chief of Oncology Services and Chair of Thoracic Surgery at Ascension Saint Thomas Health and a professor at the University of Tennessee Health Sciences Center in Nashville, Tennessee.

Dr. Howington received his undergraduate degree from Tennessee Technological University and medical degree from the University of Tennessee. He completed his general surgery residency at the University of Missouri, Kansas City and thoracic surgery residency at Vanderbilt University Medical Center.

Most recently, he received his Physician Executive MBA from the University of Tennessee.

Dr. Howington has participated in and published more than 46 research publications and guidelines, numerous book chapters, and has presented hundreds of lectures internationally.

As a passionate thoracic surgeon, he has lent his knowledge to the extensive CHEST lung cancer guideline portfolio for more than a decade. He offers regular leadership in multidisciplinary and executive forums and has spearheaded a series of quality improvement initiatives at Ascension. He has served in a variety of leadership roles with CHEST and with other national thoracic surgery societies.

Dr. Howington began his CHEST leadership journey with the Networks, as a member of the Interventional Chest Medicine Steering Committee and then as the Thoracic Oncology Network Chair (2008-2010).

Other leadership positions include serving as the President of the CHEST Foundation (2014-2016), member of the Scientific Program Committee and Membership Committee, and, recently, as the Chair of the Finance Committee from 2018-2021.

Since 2017, he has served on the Board of Regents as a Member at Large. Dr. Howington will serve as the 87th CHEST President in 2025.