Management of mild asthma has been for a long time unsatisfactory and not tested in clinical trials. The use (overuse) of SABA in patients "treated as" mild asthmatics has become of concern, and the association with severe adverse events has become clear. Adherence to regular ICS treatment is a major issue in this population. The rationale and efficacy of the “as needed ICS” will be discussed in this session.
Learning Objectives:• Review concerns associated with the use of rescue SABA in the absence of maintenance treatment.
• Discuss merits of as-needed ICS treatment strategies in mild asthma.
Description:
Based on the seminal observations of Fletcher and Peto, modification of the accelerated decline in FEV1was considered the holy grail in initial clinical trials in COPD. Based on the concept of offering anti-inflammatory therapy, exacerbations and mortality were introduced as outcomes in large intervention studies. These studies have contributed to a tunnel perspective on COPD and a one size fits all approach to a complex heterogeneous syndrome.
Learning Objectives:
•A one size fits all approach is killing for profound understanding of underlying mechanisms of a disease condition.
•A personalized management strategy starts by understanding the heterogeneity of the COPD syndrome.
Description:
This session will review current prognostic scoring systems that can be utilized to more specifically inform the appropriate setting for treatment of acute pulmonary embolism.
Learning Objectives:
•Recall validated prognostic scores in patients with acute PE.
•Select appropriate patients for outpatient therapy of PE.
•Identify patients with PE most appropriate for ICU care.
Description:
This session will review the indications, contraindications, outcomes, and potential adverse events related to fundamental bronchoscopic techniques.
Learning Objectives:
•List the safety issues and techniques of bronchoscopy in special populations: pregnancy, severe asthma, COPD, OSA, and heart disease.
•Enumerate four techniques for managing massive airway bleeding.
•Mention the expected results and complications from BAL, brushings, and endobronchial and transbronchial biopsy.
Until the 1940s, the development of new treatments relied on NRS. After that time, there was increasing recognition that anecdotal reports based on clinical practice observations were often misleading. This led to a near-total replacement of the prior nonrandomized approach with the use of randomized, controlled clinical trials (RCT). Indeed, the history of medicine is rife with examples whereby observational data have been misleading even with established clinical practices, and which are only uncovered after the same hypothesis is tested in an RCT. This reinforces the widely held notion about NRS that no matter how large in scale or sophisticated in analysis, the risk of bias (including misspecification, selection, reporting, analysis, and confounding, among others) will limit certainty in causal inference. Conversely, proponents of NRS RWE advocate that mechanistic trials may often not be fully representative of real-life situations because they employ strict, protocol-defined inclusion criteria to identify eligible patients – that is to say, directness in the applicability of the studied intervention effects to the applied population. This could mean that some patients with the condition of interest may be excluded based on characteristics such as disease severity, age, comorbidities, or the use of concomitant medications. Since a few years, severe asthma is a great example of both bias in selection of population enrolled in registration trials for biologics and how the registries provided useful information about both diagnosis and management. Finally, they revealed how to better define more severe phenotypes and how oral corticosteroids (OCS) impact in severe asthma treatment in real life.
Description:
Bronchopulmonary dysplasia (BPD) is the most frequent respiratory complication of extremely premature birth. In most studies, survivors of BPD have airflow limitation and their FEV1 does not reach the normally-expected optimal peak at 24 years old. Poor lung function early in life tracks with a weaker lung function in adulthood and a higher risk of a COPD-like disease.
Description:
The use of extracorporeal membrane oxygenation for severe respiratory failure has been increasing exponentially since the influenza epidemics of 2009/2010. The identification of patients most likely to benefit is a crucial step, as well as the timing of ECMO initiation. In this session, patient selection, severity assessment, benefits of ECMO, and timing will be discussed, based on guidelines and most recent clinical trials.
•Discuss the implementation of a high-quality lung cancer screening program.
Description:
In 2017, more than 4,000 lung transplant procedures were reported to the International Society for Heart and Lung Transplantation.
Learning Objectives:
•Discuss current activity and outcomes following lung transplantation.
•Define indications for lung transplantation.
•Review guidelines for LT candidate selection.
•Understand management of the lung transplant recipient.
•Review complications following lung transplantation.
•Discuss the immunosuppressive and other medications used in lung transplantation.
Description:
This session will provide an overview of tuberculosis epidemiology across the globe along with recent advances and insight into prevention, diagnosis and treatment.