Society News

CHEST

Soon after moving to Pittsburgh for my pulmonary and critical care medicine fellowship in 2014, I began noticing a theme: So many of my patients expressed a sense that the air they breathed was harming them or was in some way responsible for the severity of their lung disease.

In this city, the legacy of the steel industry from the last century fostered economic prosperity but resulted in a profound legacy of pollution as well. Unfortunately, due to a combination of fossil fuel dependence for electricity generation and transportation, industrial particulate matter (PM) generation and greenhouse gas emissions, temperature inversions related to the topography of the region, and, most recently, smoke from Canadian wildfires in the summer of 2023, the air quality in Pittsburgh ranks among the 25 least healthy US cities. Our patients are bearing the burden of climate change.

My patients relay that because of the poor air quality in the neighborhood they live in, they feel sick. I remember a patient in clinic talking about how on the days he could see a film of particulate on all the cars and the street outside, he knew he would feel more shortness of breath. Patients share about how when they had lived in different neighborhoods in town or traveled outside of Pittsburgh, their breathing improved.

Patients tell me that their asthma or COPD that did not use to cause them frequent trouble is now less well controlled despite better therapies available. Patients who used to experience seasonal allergies in just the fall or the spring now are plagued by their allergy symptoms year-round because of a warming climate yielding excess pollen throughout all seasons.

A recent study of patients with pulmonary fibrosis demonstrated that exposure to excess PM_2.5 in this region resulted in more rapid clinical deterioration and premature death compared with patients with the same disease in other parts of North America with better air quality. The common denominator is human-generated climate change’s negative impact on health.

In particular, those who are already vulnerable because of underlying chronic disease or socioeconomic disparity are at greater risk and feel these repercussions disproportionately. Black and brown communities are more heavily exposed to air pollution due to the history of redlining and ongoing structural racism and, as a result, have worse health outcomes than other groups. There is an urgency and moral imperative for us as clinicians to address generations of environmental injustice.

While these themes floated around in the background during the early stage of my career as a pulmonologist, I didn’t have language or deep knowledge around these structural environmental issues. As a profession, we are gradually recognizing that the health impacts of climate change on which to advocate are within our wheelhouse as clinicians.

Our patients and our trainees are increasingly aware of these issues, and, as a result, we as currently practicing clinicians and educators must urgently learn about the lived experiences of our patients and how their diseases interplay with their exposures.

Nowadays, I think more about how to mitigate the impact of air pollution, which did not previously factor into my training or the early years of my clinical practice. We know that some patients, particularly those with underlying lung disease and young children, are at greater risk when exposed to more polluted air and may need to take different steps to limit their exposure. We now consider advising these patients with chronic respiratory disease to be aware of air quality advisories and limit their time outdoors on worse air quality days. We anticipate that when the air quality is worse, we will see more complications of cardiovascular and pulmonary disease.

As lifelong learners, we thirst for the latest data to incorporate into our clinical decision-making. Similarly, colleagues and I are now also voraciously reading and starting to have conversations with peers about the convergence of climate change and disease. But no matter how compelling and urgent these issues are, one clinician cannot tackle the massive threat of climate change and complexity of health care sustainability in isolation.

I am fortunate to work with several like-minded and highly motivated colleagues at my own institution. We have been able to organize effectively to spark local change toward reducing our system’s carbon emissions. Similarly, through professional organizations like CHEST, I have been able to collaborate with other pulmonary and critical care clinicians who share these passions and are doing similar advocacy work across the country. I am honored to serve as CHEST’s representative to the Medical Society Consortium on Climate and Health as another avenue to keep advancing this cause at scale in collaboration with advocates across all specialties.

While I worry every day for my patients, our communities, and my children as we face the accelerating threat of climate change, knowing that I am actively engaging in these efforts in pursuit of environmental justice and mitigating health care’s climate change contribution gives me a sense of empowerment and solidarity with others also striving to lessen our burden on the planet.

This article was adapted from the Winter 2024 online issue of CHEST Advocates. For the full article — and to engage with the other content from this issue — visit https://chestnet.org/chest-advocates.

CHEST

Soon after moving to Pittsburgh for my pulmonary and critical care medicine fellowship in 2014, I began noticing a theme: So many of my patients expressed a sense that the air they breathed was harming them or was in some way responsible for the severity of their lung disease.

In this city, the legacy of the steel industry from the last century fostered economic prosperity but resulted in a profound legacy of pollution as well. Unfortunately, due to a combination of fossil fuel dependence for electricity generation and transportation, industrial particulate matter (PM) generation and greenhouse gas emissions, temperature inversions related to the topography of the region, and, most recently, smoke from Canadian wildfires in the summer of 2023, the air quality in Pittsburgh ranks among the 25 least healthy US cities. Our patients are bearing the burden of climate change.

My patients relay that because of the poor air quality in the neighborhood they live in, they feel sick. I remember a patient in clinic talking about how on the days he could see a film of particulate on all the cars and the street outside, he knew he would feel more shortness of breath. Patients share about how when they had lived in different neighborhoods in town or traveled outside of Pittsburgh, their breathing improved.

Patients tell me that their asthma or COPD that did not use to cause them frequent trouble is now less well controlled despite better therapies available. Patients who used to experience seasonal allergies in just the fall or the spring now are plagued by their allergy symptoms year-round because of a warming climate yielding excess pollen throughout all seasons.

A recent study of patients with pulmonary fibrosis demonstrated that exposure to excess PM_2.5 in this region resulted in more rapid clinical deterioration and premature death compared with patients with the same disease in other parts of North America with better air quality. The common denominator is human-generated climate change’s negative impact on health.

In particular, those who are already vulnerable because of underlying chronic disease or socioeconomic disparity are at greater risk and feel these repercussions disproportionately. Black and brown communities are more heavily exposed to air pollution due to the history of redlining and ongoing structural racism and, as a result, have worse health outcomes than other groups. There is an urgency and moral imperative for us as clinicians to address generations of environmental injustice.

While these themes floated around in the background during the early stage of my career as a pulmonologist, I didn’t have language or deep knowledge around these structural environmental issues. As a profession, we are gradually recognizing that the health impacts of climate change on which to advocate are within our wheelhouse as clinicians.

Our patients and our trainees are increasingly aware of these issues, and, as a result, we as currently practicing clinicians and educators must urgently learn about the lived experiences of our patients and how their diseases interplay with their exposures.

Nowadays, I think more about how to mitigate the impact of air pollution, which did not previously factor into my training or the early years of my clinical practice. We know that some patients, particularly those with underlying lung disease and young children, are at greater risk when exposed to more polluted air and may need to take different steps to limit their exposure. We now consider advising these patients with chronic respiratory disease to be aware of air quality advisories and limit their time outdoors on worse air quality days. We anticipate that when the air quality is worse, we will see more complications of cardiovascular and pulmonary disease.

As lifelong learners, we thirst for the latest data to incorporate into our clinical decision-making. Similarly, colleagues and I are now also voraciously reading and starting to have conversations with peers about the convergence of climate change and disease. But no matter how compelling and urgent these issues are, one clinician cannot tackle the massive threat of climate change and complexity of health care sustainability in isolation.

I am fortunate to work with several like-minded and highly motivated colleagues at my own institution. We have been able to organize effectively to spark local change toward reducing our system’s carbon emissions. Similarly, through professional organizations like CHEST, I have been able to collaborate with other pulmonary and critical care clinicians who share these passions and are doing similar advocacy work across the country. I am honored to serve as CHEST’s representative to the Medical Society Consortium on Climate and Health as another avenue to keep advancing this cause at scale in collaboration with advocates across all specialties.

While I worry every day for my patients, our communities, and my children as we face the accelerating threat of climate change, knowing that I am actively engaging in these efforts in pursuit of environmental justice and mitigating health care’s climate change contribution gives me a sense of empowerment and solidarity with others also striving to lessen our burden on the planet.

This article was adapted from the Winter 2024 online issue of CHEST Advocates. For the full article — and to engage with the other content from this issue — visit https://chestnet.org/chest-advocates.

CHEST

Soon after moving to Pittsburgh for my pulmonary and critical care medicine fellowship in 2014, I began noticing a theme: So many of my patients expressed a sense that the air they breathed was harming them or was in some way responsible for the severity of their lung disease.

In this city, the legacy of the steel industry from the last century fostered economic prosperity but resulted in a profound legacy of pollution as well. Unfortunately, due to a combination of fossil fuel dependence for electricity generation and transportation, industrial particulate matter (PM) generation and greenhouse gas emissions, temperature inversions related to the topography of the region, and, most recently, smoke from Canadian wildfires in the summer of 2023, the air quality in Pittsburgh ranks among the 25 least healthy US cities. Our patients are bearing the burden of climate change.

My patients relay that because of the poor air quality in the neighborhood they live in, they feel sick. I remember a patient in clinic talking about how on the days he could see a film of particulate on all the cars and the street outside, he knew he would feel more shortness of breath. Patients share about how when they had lived in different neighborhoods in town or traveled outside of Pittsburgh, their breathing improved.

Patients tell me that their asthma or COPD that did not use to cause them frequent trouble is now less well controlled despite better therapies available. Patients who used to experience seasonal allergies in just the fall or the spring now are plagued by their allergy symptoms year-round because of a warming climate yielding excess pollen throughout all seasons.

A recent study of patients with pulmonary fibrosis demonstrated that exposure to excess PM_2.5 in this region resulted in more rapid clinical deterioration and premature death compared with patients with the same disease in other parts of North America with better air quality. The common denominator is human-generated climate change’s negative impact on health.

In particular, those who are already vulnerable because of underlying chronic disease or socioeconomic disparity are at greater risk and feel these repercussions disproportionately. Black and brown communities are more heavily exposed to air pollution due to the history of redlining and ongoing structural racism and, as a result, have worse health outcomes than other groups. There is an urgency and moral imperative for us as clinicians to address generations of environmental injustice.

While these themes floated around in the background during the early stage of my career as a pulmonologist, I didn’t have language or deep knowledge around these structural environmental issues. As a profession, we are gradually recognizing that the health impacts of climate change on which to advocate are within our wheelhouse as clinicians.

Our patients and our trainees are increasingly aware of these issues, and, as a result, we as currently practicing clinicians and educators must urgently learn about the lived experiences of our patients and how their diseases interplay with their exposures.

Nowadays, I think more about how to mitigate the impact of air pollution, which did not previously factor into my training or the early years of my clinical practice. We know that some patients, particularly those with underlying lung disease and young children, are at greater risk when exposed to more polluted air and may need to take different steps to limit their exposure. We now consider advising these patients with chronic respiratory disease to be aware of air quality advisories and limit their time outdoors on worse air quality days. We anticipate that when the air quality is worse, we will see more complications of cardiovascular and pulmonary disease.

As lifelong learners, we thirst for the latest data to incorporate into our clinical decision-making. Similarly, colleagues and I are now also voraciously reading and starting to have conversations with peers about the convergence of climate change and disease. But no matter how compelling and urgent these issues are, one clinician cannot tackle the massive threat of climate change and complexity of health care sustainability in isolation.

I am fortunate to work with several like-minded and highly motivated colleagues at my own institution. We have been able to organize effectively to spark local change toward reducing our system’s carbon emissions. Similarly, through professional organizations like CHEST, I have been able to collaborate with other pulmonary and critical care clinicians who share these passions and are doing similar advocacy work across the country. I am honored to serve as CHEST’s representative to the Medical Society Consortium on Climate and Health as another avenue to keep advancing this cause at scale in collaboration with advocates across all specialties.

While I worry every day for my patients, our communities, and my children as we face the accelerating threat of climate change, knowing that I am actively engaging in these efforts in pursuit of environmental justice and mitigating health care’s climate change contribution gives me a sense of empowerment and solidarity with others also striving to lessen our burden on the planet.

This article was adapted from the Winter 2024 online issue of CHEST Advocates. For the full article — and to engage with the other content from this issue — visit https://chestnet.org/chest-advocates.

CHEST

In his prior research, Chien-Ching Li, PhD, MPH, focused on promoting lung cancer screening in Chinese American men, a population that frequently smokes heavily. But last year, he applied for a CHEST grant that’s shifting his focus to another demographic: Chinese American women who do not smoke, especially those with limited English proficiency.

“They are developing lung cancer, and we don’t know why,” said Dr. Li, an associate professor of Health Systems Management at Rush University.

In the United States, Asian American women who don’t smoke, and never have, are twice as likely to be diagnosed with lung cancer as white women with similar nonsmoking habits. In fact, 57% of Asian American women diagnosed with lung cancer never smoked cigarettes.

What’s behind this rise in lung cancer in women who have never smoked compared with men, and particularly in Asian American women? One possibility: While Chinese American women may never smoke themselves, they frequently live with partners or family members who do. (About 28% of Chinese American men smoke heavily, Dr. Li said.)

“We think secondhand smoke might be one of the key risk factors, because they’re living with people who smoke,” Dr. Li said. His prior research shows that the majority of Chinese American men in greater Chicagoland—89%—are married, and many of them smoke or have a history of smoking.

With the CHEST grant Dr. Li received in October 2023, he’s working to increase awareness among Chinese American women about the risks of secondhand smoke and “reduce the health disparity in lung cancer among women,” Dr. Li said.
 

Developing culturally sensitive materials for a high-risk group

While many lung cancer reduction efforts focus on people who smoke, there are plenty of pamphlets designed to inform about the risks incurred when breathing in secondhand smoke.

These handouts, however, aren’t always available in languages spoken by Chinese Americans. Nor is it as simple as hiring a translator; doing so may make the pamphlets readable to the women, but it won’t necessarily make the text culturally appropriate.

This is what Dr. Li—along with his coinvestigators, Alicia Matthews, PhD, a professor of clinical psychology at Columbia University, and Hong Liu, PhD, of the Midwest Asian Health Association—seeks to change, with funding from the CHEST grant. Their goal is four-pronged:

1. Discovery: Dr. Li and his team are currently surveying Chinese American women who have never smoked but who live with people who smoke in greater Chicagoland. These surveys will help them learn more about what (if anything) this group knows about the health risks associated with secondhand smoke and other types of environmental smoke.

2. Identify: These surveys, along with focus group interviews with select participants, will help reveal barriers standing in the way of reducing the women’s exposure to secondhand smoke—as well as ways to encourage habits to reduce risk.

3. Develop: All the information gained through surveys and conversations will then be analyzed and used to craft targeted, translated, and culturally appropriate materials on secondhand smoke, conveying communication strategies the women can use to persuade their partners to quit smoking and ways to build a smoke-free household.

4. Evaluate: The effectiveness of the new materials will be tested to assess the change in the women’s knowledge, as well as any uptick in taking steps to reduce exposure or sign up for screening.
 

Using the CHEST grant as a building block to more grants—and more information

Dr. Li and his collaborators are still in the early stages of using the CHEST grant: gathering up participants and surveying them.

But there’s much ahead. With the CHEST grant in hand, Dr. Li plans to apply for grants from the National Institutes of Health (NIH): first, an NIH Exploratory/Developmental Research Grant Award (R21) to help achieve that fourth aim of evaluating how the intervention works. And next, they’ll apply for an NIH Research Project Grant Program (R01), which will fund an even larger trial.

“Not many studies focus on identifying the risk factors with lung cancer associated with Chinese American [women who have never smoked],” Dr. Li said. “This is why we want to focus on this area to provide more knowledge and make more contributions to research.”

Projects like this are made possible by generous contributions from CHEST donors. Support the future of chest medicine by visiting https://chestnet.org/donate.

CHEST

In his prior research, Chien-Ching Li, PhD, MPH, focused on promoting lung cancer screening in Chinese American men, a population that frequently smokes heavily. But last year, he applied for a CHEST grant that’s shifting his focus to another demographic: Chinese American women who do not smoke, especially those with limited English proficiency.

“They are developing lung cancer, and we don’t know why,” said Dr. Li, an associate professor of Health Systems Management at Rush University.

In the United States, Asian American women who don’t smoke, and never have, are twice as likely to be diagnosed with lung cancer as white women with similar nonsmoking habits. In fact, 57% of Asian American women diagnosed with lung cancer never smoked cigarettes.

What’s behind this rise in lung cancer in women who have never smoked compared with men, and particularly in Asian American women? One possibility: While Chinese American women may never smoke themselves, they frequently live with partners or family members who do. (About 28% of Chinese American men smoke heavily, Dr. Li said.)

“We think secondhand smoke might be one of the key risk factors, because they’re living with people who smoke,” Dr. Li said. His prior research shows that the majority of Chinese American men in greater Chicagoland—89%—are married, and many of them smoke or have a history of smoking.

With the CHEST grant Dr. Li received in October 2023, he’s working to increase awareness among Chinese American women about the risks of secondhand smoke and “reduce the health disparity in lung cancer among women,” Dr. Li said.
 

Developing culturally sensitive materials for a high-risk group

While many lung cancer reduction efforts focus on people who smoke, there are plenty of pamphlets designed to inform about the risks incurred when breathing in secondhand smoke.

These handouts, however, aren’t always available in languages spoken by Chinese Americans. Nor is it as simple as hiring a translator; doing so may make the pamphlets readable to the women, but it won’t necessarily make the text culturally appropriate.

This is what Dr. Li—along with his coinvestigators, Alicia Matthews, PhD, a professor of clinical psychology at Columbia University, and Hong Liu, PhD, of the Midwest Asian Health Association—seeks to change, with funding from the CHEST grant. Their goal is four-pronged:

1. Discovery: Dr. Li and his team are currently surveying Chinese American women who have never smoked but who live with people who smoke in greater Chicagoland. These surveys will help them learn more about what (if anything) this group knows about the health risks associated with secondhand smoke and other types of environmental smoke.

2. Identify: These surveys, along with focus group interviews with select participants, will help reveal barriers standing in the way of reducing the women’s exposure to secondhand smoke—as well as ways to encourage habits to reduce risk.

3. Develop: All the information gained through surveys and conversations will then be analyzed and used to craft targeted, translated, and culturally appropriate materials on secondhand smoke, conveying communication strategies the women can use to persuade their partners to quit smoking and ways to build a smoke-free household.

4. Evaluate: The effectiveness of the new materials will be tested to assess the change in the women’s knowledge, as well as any uptick in taking steps to reduce exposure or sign up for screening.
 

Using the CHEST grant as a building block to more grants—and more information

Dr. Li and his collaborators are still in the early stages of using the CHEST grant: gathering up participants and surveying them.

But there’s much ahead. With the CHEST grant in hand, Dr. Li plans to apply for grants from the National Institutes of Health (NIH): first, an NIH Exploratory/Developmental Research Grant Award (R21) to help achieve that fourth aim of evaluating how the intervention works. And next, they’ll apply for an NIH Research Project Grant Program (R01), which will fund an even larger trial.

“Not many studies focus on identifying the risk factors with lung cancer associated with Chinese American [women who have never smoked],” Dr. Li said. “This is why we want to focus on this area to provide more knowledge and make more contributions to research.”

Projects like this are made possible by generous contributions from CHEST donors. Support the future of chest medicine by visiting https://chestnet.org/donate.

CHEST

In his prior research, Chien-Ching Li, PhD, MPH, focused on promoting lung cancer screening in Chinese American men, a population that frequently smokes heavily. But last year, he applied for a CHEST grant that’s shifting his focus to another demographic: Chinese American women who do not smoke, especially those with limited English proficiency.

“They are developing lung cancer, and we don’t know why,” said Dr. Li, an associate professor of Health Systems Management at Rush University.

In the United States, Asian American women who don’t smoke, and never have, are twice as likely to be diagnosed with lung cancer as white women with similar nonsmoking habits. In fact, 57% of Asian American women diagnosed with lung cancer never smoked cigarettes.

What’s behind this rise in lung cancer in women who have never smoked compared with men, and particularly in Asian American women? One possibility: While Chinese American women may never smoke themselves, they frequently live with partners or family members who do. (About 28% of Chinese American men smoke heavily, Dr. Li said.)

“We think secondhand smoke might be one of the key risk factors, because they’re living with people who smoke,” Dr. Li said. His prior research shows that the majority of Chinese American men in greater Chicagoland—89%—are married, and many of them smoke or have a history of smoking.

With the CHEST grant Dr. Li received in October 2023, he’s working to increase awareness among Chinese American women about the risks of secondhand smoke and “reduce the health disparity in lung cancer among women,” Dr. Li said.
 

Developing culturally sensitive materials for a high-risk group

While many lung cancer reduction efforts focus on people who smoke, there are plenty of pamphlets designed to inform about the risks incurred when breathing in secondhand smoke.

These handouts, however, aren’t always available in languages spoken by Chinese Americans. Nor is it as simple as hiring a translator; doing so may make the pamphlets readable to the women, but it won’t necessarily make the text culturally appropriate.

This is what Dr. Li—along with his coinvestigators, Alicia Matthews, PhD, a professor of clinical psychology at Columbia University, and Hong Liu, PhD, of the Midwest Asian Health Association—seeks to change, with funding from the CHEST grant. Their goal is four-pronged:

1. Discovery: Dr. Li and his team are currently surveying Chinese American women who have never smoked but who live with people who smoke in greater Chicagoland. These surveys will help them learn more about what (if anything) this group knows about the health risks associated with secondhand smoke and other types of environmental smoke.

2. Identify: These surveys, along with focus group interviews with select participants, will help reveal barriers standing in the way of reducing the women’s exposure to secondhand smoke—as well as ways to encourage habits to reduce risk.

3. Develop: All the information gained through surveys and conversations will then be analyzed and used to craft targeted, translated, and culturally appropriate materials on secondhand smoke, conveying communication strategies the women can use to persuade their partners to quit smoking and ways to build a smoke-free household.

4. Evaluate: The effectiveness of the new materials will be tested to assess the change in the women’s knowledge, as well as any uptick in taking steps to reduce exposure or sign up for screening.
 

Using the CHEST grant as a building block to more grants—and more information

Dr. Li and his collaborators are still in the early stages of using the CHEST grant: gathering up participants and surveying them.

But there’s much ahead. With the CHEST grant in hand, Dr. Li plans to apply for grants from the National Institutes of Health (NIH): first, an NIH Exploratory/Developmental Research Grant Award (R21) to help achieve that fourth aim of evaluating how the intervention works. And next, they’ll apply for an NIH Research Project Grant Program (R01), which will fund an even larger trial.

“Not many studies focus on identifying the risk factors with lung cancer associated with Chinese American [women who have never smoked],” Dr. Li said. “This is why we want to focus on this area to provide more knowledge and make more contributions to research.”

Projects like this are made possible by generous contributions from CHEST donors. Support the future of chest medicine by visiting https://chestnet.org/donate.

Growing up in a household where GI issues dominated conversations, it’s no surprise that Shida Haghighat, MD, chose gastroenterology as her area of study in medicine.

She watched her father suffer from the complications of Crohn’s disease and her brother struggle with irritable bowel syndrome. “We always needed to know where the nearest bathroom was. I grew up with that around me, and I was always just fascinated by the gut and the digestive system,” said Dr. Haghighat, who just finished up her fellowship at the University of Miami and is now a gastroenterologist at University of California, Los Angeles. She also serves as social media editor for AGA’s Gastro Hep Advances.

University of Miami

As she got to know the personalities of the GI department in the first year of medical school, “I realized that our senses of humor and personalities kind of aligned, and I was like, ‘Oh yeah, this is where I’m supposed to be,’ ” said Dr. Haghighat, who can be found on X @DoctorShida.

Humor is something Dr. Haghighat has reached for throughout her life and career. She eventually channeled her gift for satire onto the stage and the internet, as a stand-up comedian. In an interview with GI & Hepatology News, she spoke about the connection between GI medicine and humor, and the creative ways she has helped promote cancer screening in underserved populations.
 

Q: What practice challenges have you faced in your career?

Dr. Haghighat: I trained in a county hospital, so I’ve always worked with underserved and vulnerable populations. One of the challenges has been just navigation of care, especially as it pertains to cancer diagnoses or cancer screening. A lot of the time, patients don’t understand why they have to do a test or something invasive like a colonoscopy for symptoms they don’t have. 

Q: A focus of yours has been improving uptake of screening in underserved communities. Please talk about the work you’ve done in this area.

Dr. Haghighat: I was at Los Angeles General Medical Center — a county hospital in Los Angeles — for residency, where we treated underserved, uninsured patients. I noticed in our primary care clinics a very low uptake of colon cancer screening. Patients didn’t want to bring the stool tests back or get colonoscopies. I surveyed a bunch of the patients and asked: How can we make colon cancer screening easier for you? About a third of the patients said, “If I can do it in the clinic before I go home, that would be great.”

So, I started this initiative called “Go Before You Go.” We would ask patients, “Hey, do you need to go to the bathroom right now, if you can?” Our nurses handed them the stool test to do in the bathroom before they left the clinic after their doctor visits.

We saw really good results with that. Surprisingly, a lot of people can go on demand. We saw increased screening rates, and that quality improvement project went on to win multiple first place awards in research competitions. So that’s what got me interested, and that’s where I had my beginnings of increasing preventative services in underserved communities on the ground.
 

Q: Can you discuss some health disparity studies you’ve done in this area?

Dr. Haghighat: As a GI at Jackson Memorial Hospital in Miami, I was seeing cancer disparities firsthand every day. I wanted to approach these disparities from a research funding standpoint on a federal level. I was particularly interested in gastric cancer because it’s not common enough in the United States to warrant universal screening, but it’s very common among certain racial and ethnic minorities, which would warrant targeted screening.

I evaluated cancer funding allocation from the National Cancer Institute among the most common cancers in the United States and found that cancer afflicting a higher proportion of racial and ethnic minorities was receiving lower funding. One of those cancers was stomach cancer. This study basically highlighted that, to decrease these disparities, a top-down policy approach is necessary to distribute cancer research funding equitably across these groups. 

A lot of stomach cancer comes from a bacteria called Helicobacter pylori, which can be more prevalent in certain countries. In another study, I looked at country of birth as a risk factor for stomach cancer, specifically for gastric intestinal metaplasia, which is a precursor for gastric cancer . 

We found that country of birth is a key risk factor for gastric intestinal metaplasia and that it should be incorporated into risk stratification for targeted screening. 
 

Q: Outside of medicine, you perform as a stand-up comedian. You have a popular satirical alias on social media. How did you get interested in stand-up comedy?

Dr. Haghighat: I gave my medical school’s commencement speech, and I had sprinkled a few jokes in there. Afterward, multiple people approached me and said, “You should really consider stand-up comedy. Your timing and delivery are great.” A few months later, I started my intern year in Los Angeles and simultaneously took stand-up comedy classes. I started performing at local clubs around town throughout residency, and I had two or three good sets that I could rely on. And so that’s how I got into stand-up comedy.

My intern year is also when I started this social media satire account. It was a way to cope with the anxieties and stress of residency. Before I knew it, the account gained multitudes of followers, doctors, and other medical professionals. And I joke that the more hours I work in a week, the more memes I make, the more posts I make. It’s kind of a creative outlet for me after a long day.
 

Q: What types of things do you talk about during your stand-up act?

Dr. Haghighat: A lot of it is about growing up in an immigrant household as a first-generation Iranian American. One of my favorite jokes is, my parents gave me so many options for a career. They said I could be a family doctor, a surgeon, a plastic surgeon, and if I worked hard, even a wife of a surgeon. But I talk a lot about being a woman in medicine. That always gets a lot of laughs. And now that I’ve graduated GI fellowship, I’m excited to incorporate some GI jokes because it turns out people love poop jokes.

Lightning Round

Texting or talking?

Text

Favorite city in U.S. besides the one you live in?

Denver

Cat or dog person

Dog

Best place you went on vacation

Patagonia

Favorite sport

Basketball

Favorite ice cream

Rocky Road

What song do you have to sing along with when you hear it?

Celine Dion’s My Heart Will Go On

Growing up in a household where GI issues dominated conversations, it’s no surprise that Shida Haghighat, MD, chose gastroenterology as her area of study in medicine.

She watched her father suffer from the complications of Crohn’s disease and her brother struggle with irritable bowel syndrome. “We always needed to know where the nearest bathroom was. I grew up with that around me, and I was always just fascinated by the gut and the digestive system,” said Dr. Haghighat, who just finished up her fellowship at the University of Miami and is now a gastroenterologist at University of California, Los Angeles. She also serves as social media editor for AGA’s Gastro Hep Advances.

University of Miami

As she got to know the personalities of the GI department in the first year of medical school, “I realized that our senses of humor and personalities kind of aligned, and I was like, ‘Oh yeah, this is where I’m supposed to be,’ ” said Dr. Haghighat, who can be found on X @DoctorShida.

Humor is something Dr. Haghighat has reached for throughout her life and career. She eventually channeled her gift for satire onto the stage and the internet, as a stand-up comedian. In an interview with GI & Hepatology News, she spoke about the connection between GI medicine and humor, and the creative ways she has helped promote cancer screening in underserved populations.
 

Q: What practice challenges have you faced in your career?

Dr. Haghighat: I trained in a county hospital, so I’ve always worked with underserved and vulnerable populations. One of the challenges has been just navigation of care, especially as it pertains to cancer diagnoses or cancer screening. A lot of the time, patients don’t understand why they have to do a test or something invasive like a colonoscopy for symptoms they don’t have. 

Q: A focus of yours has been improving uptake of screening in underserved communities. Please talk about the work you’ve done in this area.

Dr. Haghighat: I was at Los Angeles General Medical Center — a county hospital in Los Angeles — for residency, where we treated underserved, uninsured patients. I noticed in our primary care clinics a very low uptake of colon cancer screening. Patients didn’t want to bring the stool tests back or get colonoscopies. I surveyed a bunch of the patients and asked: How can we make colon cancer screening easier for you? About a third of the patients said, “If I can do it in the clinic before I go home, that would be great.”

So, I started this initiative called “Go Before You Go.” We would ask patients, “Hey, do you need to go to the bathroom right now, if you can?” Our nurses handed them the stool test to do in the bathroom before they left the clinic after their doctor visits.

We saw really good results with that. Surprisingly, a lot of people can go on demand. We saw increased screening rates, and that quality improvement project went on to win multiple first place awards in research competitions. So that’s what got me interested, and that’s where I had my beginnings of increasing preventative services in underserved communities on the ground.
 

Q: Can you discuss some health disparity studies you’ve done in this area?

Dr. Haghighat: As a GI at Jackson Memorial Hospital in Miami, I was seeing cancer disparities firsthand every day. I wanted to approach these disparities from a research funding standpoint on a federal level. I was particularly interested in gastric cancer because it’s not common enough in the United States to warrant universal screening, but it’s very common among certain racial and ethnic minorities, which would warrant targeted screening.

I evaluated cancer funding allocation from the National Cancer Institute among the most common cancers in the United States and found that cancer afflicting a higher proportion of racial and ethnic minorities was receiving lower funding. One of those cancers was stomach cancer. This study basically highlighted that, to decrease these disparities, a top-down policy approach is necessary to distribute cancer research funding equitably across these groups. 

A lot of stomach cancer comes from a bacteria called Helicobacter pylori, which can be more prevalent in certain countries. In another study, I looked at country of birth as a risk factor for stomach cancer, specifically for gastric intestinal metaplasia, which is a precursor for gastric cancer . 

We found that country of birth is a key risk factor for gastric intestinal metaplasia and that it should be incorporated into risk stratification for targeted screening. 
 

Q: Outside of medicine, you perform as a stand-up comedian. You have a popular satirical alias on social media. How did you get interested in stand-up comedy?

Dr. Haghighat: I gave my medical school’s commencement speech, and I had sprinkled a few jokes in there. Afterward, multiple people approached me and said, “You should really consider stand-up comedy. Your timing and delivery are great.” A few months later, I started my intern year in Los Angeles and simultaneously took stand-up comedy classes. I started performing at local clubs around town throughout residency, and I had two or three good sets that I could rely on. And so that’s how I got into stand-up comedy.

My intern year is also when I started this social media satire account. It was a way to cope with the anxieties and stress of residency. Before I knew it, the account gained multitudes of followers, doctors, and other medical professionals. And I joke that the more hours I work in a week, the more memes I make, the more posts I make. It’s kind of a creative outlet for me after a long day.
 

Q: What types of things do you talk about during your stand-up act?

Dr. Haghighat: A lot of it is about growing up in an immigrant household as a first-generation Iranian American. One of my favorite jokes is, my parents gave me so many options for a career. They said I could be a family doctor, a surgeon, a plastic surgeon, and if I worked hard, even a wife of a surgeon. But I talk a lot about being a woman in medicine. That always gets a lot of laughs. And now that I’ve graduated GI fellowship, I’m excited to incorporate some GI jokes because it turns out people love poop jokes.

Lightning Round

Texting or talking?

Text

Favorite city in U.S. besides the one you live in?

Denver

Cat or dog person

Dog

Best place you went on vacation

Patagonia

Favorite sport

Basketball

Favorite ice cream

Rocky Road

What song do you have to sing along with when you hear it?

Celine Dion’s My Heart Will Go On

Growing up in a household where GI issues dominated conversations, it’s no surprise that Shida Haghighat, MD, chose gastroenterology as her area of study in medicine.

She watched her father suffer from the complications of Crohn’s disease and her brother struggle with irritable bowel syndrome. “We always needed to know where the nearest bathroom was. I grew up with that around me, and I was always just fascinated by the gut and the digestive system,” said Dr. Haghighat, who just finished up her fellowship at the University of Miami and is now a gastroenterologist at University of California, Los Angeles. She also serves as social media editor for AGA’s Gastro Hep Advances.

University of Miami

As she got to know the personalities of the GI department in the first year of medical school, “I realized that our senses of humor and personalities kind of aligned, and I was like, ‘Oh yeah, this is where I’m supposed to be,’ ” said Dr. Haghighat, who can be found on X @DoctorShida.

Humor is something Dr. Haghighat has reached for throughout her life and career. She eventually channeled her gift for satire onto the stage and the internet, as a stand-up comedian. In an interview with GI & Hepatology News, she spoke about the connection between GI medicine and humor, and the creative ways she has helped promote cancer screening in underserved populations.
 

Q: What practice challenges have you faced in your career?

Dr. Haghighat: I trained in a county hospital, so I’ve always worked with underserved and vulnerable populations. One of the challenges has been just navigation of care, especially as it pertains to cancer diagnoses or cancer screening. A lot of the time, patients don’t understand why they have to do a test or something invasive like a colonoscopy for symptoms they don’t have. 

Q: A focus of yours has been improving uptake of screening in underserved communities. Please talk about the work you’ve done in this area.

Dr. Haghighat: I was at Los Angeles General Medical Center — a county hospital in Los Angeles — for residency, where we treated underserved, uninsured patients. I noticed in our primary care clinics a very low uptake of colon cancer screening. Patients didn’t want to bring the stool tests back or get colonoscopies. I surveyed a bunch of the patients and asked: How can we make colon cancer screening easier for you? About a third of the patients said, “If I can do it in the clinic before I go home, that would be great.”

So, I started this initiative called “Go Before You Go.” We would ask patients, “Hey, do you need to go to the bathroom right now, if you can?” Our nurses handed them the stool test to do in the bathroom before they left the clinic after their doctor visits.

We saw really good results with that. Surprisingly, a lot of people can go on demand. We saw increased screening rates, and that quality improvement project went on to win multiple first place awards in research competitions. So that’s what got me interested, and that’s where I had my beginnings of increasing preventative services in underserved communities on the ground.
 

Q: Can you discuss some health disparity studies you’ve done in this area?

Dr. Haghighat: As a GI at Jackson Memorial Hospital in Miami, I was seeing cancer disparities firsthand every day. I wanted to approach these disparities from a research funding standpoint on a federal level. I was particularly interested in gastric cancer because it’s not common enough in the United States to warrant universal screening, but it’s very common among certain racial and ethnic minorities, which would warrant targeted screening.

I evaluated cancer funding allocation from the National Cancer Institute among the most common cancers in the United States and found that cancer afflicting a higher proportion of racial and ethnic minorities was receiving lower funding. One of those cancers was stomach cancer. This study basically highlighted that, to decrease these disparities, a top-down policy approach is necessary to distribute cancer research funding equitably across these groups. 

A lot of stomach cancer comes from a bacteria called Helicobacter pylori, which can be more prevalent in certain countries. In another study, I looked at country of birth as a risk factor for stomach cancer, specifically for gastric intestinal metaplasia, which is a precursor for gastric cancer . 

We found that country of birth is a key risk factor for gastric intestinal metaplasia and that it should be incorporated into risk stratification for targeted screening. 
 

Q: Outside of medicine, you perform as a stand-up comedian. You have a popular satirical alias on social media. How did you get interested in stand-up comedy?

Dr. Haghighat: I gave my medical school’s commencement speech, and I had sprinkled a few jokes in there. Afterward, multiple people approached me and said, “You should really consider stand-up comedy. Your timing and delivery are great.” A few months later, I started my intern year in Los Angeles and simultaneously took stand-up comedy classes. I started performing at local clubs around town throughout residency, and I had two or three good sets that I could rely on. And so that’s how I got into stand-up comedy.

My intern year is also when I started this social media satire account. It was a way to cope with the anxieties and stress of residency. Before I knew it, the account gained multitudes of followers, doctors, and other medical professionals. And I joke that the more hours I work in a week, the more memes I make, the more posts I make. It’s kind of a creative outlet for me after a long day.
 

Q: What types of things do you talk about during your stand-up act?

Dr. Haghighat: A lot of it is about growing up in an immigrant household as a first-generation Iranian American. One of my favorite jokes is, my parents gave me so many options for a career. They said I could be a family doctor, a surgeon, a plastic surgeon, and if I worked hard, even a wife of a surgeon. But I talk a lot about being a woman in medicine. That always gets a lot of laughs. And now that I’ve graduated GI fellowship, I’m excited to incorporate some GI jokes because it turns out people love poop jokes.

Lightning Round

Texting or talking?

Text

Favorite city in U.S. besides the one you live in?

Denver

Cat or dog person

Dog

Best place you went on vacation

Patagonia

Favorite sport

Basketball

Favorite ice cream

Rocky Road

What song do you have to sing along with when you hear it?

Celine Dion’s My Heart Will Go On

A new AGA white paper, published in Clinical Gastroenterology and Hepatology, highlights barriers to care and calls for collaboration among our healthcare community, insurers, pharmaceutical companies, and legislators to improve and optimize care for more than 3 million Americans living with inflammatory bowel disease (IBD).

Over the last two decades, there has been a revolution in therapeutics fueled by exciting research and development that continues to expand the treatment options for IBD, offering tools for better disease control. However, the most effective therapies are cost prohibitive and have largely become inaccessible due to insurer-mandated barriers to care, such as prior authorization and step therapy.

AGA has created a plan that addresses these barriers and proposes tangible solutions to provide patients with high quality, high value care.

1. The lived experiences and valuable insights from both patients and expert clinicians should be reflected in the data and research represented in the field.

2. AGA recognizes the powerful benefit of individually tailoring IBD therapy based on risk, comorbidities and response, and encourages all stakeholders to do the same.

3. As a field, we need to move beyond insurer-mandated step therapy and fail first policies.

4. AGA urges insurers to cover all necessary disease activity and drug level monitoring, which will ensure patients are able to achieve treat-to-target-driven outcomes.

5. Streamlined and expedited expert reviews should be guaranteed to all providers when they are mandated by an insurer.

6. To ensure transparency and accountability, AGA wants to require that payors publish their denial and appeals data.

7. AGA believes that holistic patient-centered multidisciplinary care, including psychosocial and dietary support, should be covered by insurance. Having access to such care contributes to improved patient resilience and well-being, which will lead to decreased health care utilization and better health outcomes.

8. AGA supports the creation and continuation of a variety of patient education programs to improve health literacy and awareness of complex health care systems.

9. AGA is committed to improving patients’ access to expert specialized clinical IBD care. This includes flexible delivery models to ensure that underserved populations are being reached. In addition, AGA supports training and educating specialty providers across the spectrum of medical care (advanced practice providers, nurse educators, etc.) to increase the number of qualified IBD providers.

10. Piloting innovative shared incentive partnerships between high value subspecialty care practices and payors will be a new shared goal.

11. AGA wants to engage pharmaceutical partners in developing equitable programs to address prohibitive drug costs while also expanding patient access and support.

12. AGA plans to continue to advocate for legislation to make access to therapy equitable for Medicare and Medicaid patients.

“Unaffordable drug costs, step therapy, and other insurer-mandated barriers are fixable problems,” said M. Anthony Sofia, MD, a coauthor of the AGA white paper and an IBD specialist at Oregon Health and Science University, Portland.

Oregon Health and Science University

“Every day, we see people that have been harmed by delayed and inadequate care. Solving these barriers would lift an unimaginable weight off our patient’s shoulders and allow them to lead healthier lives. We must work together to collaborate on solutions to strengthen and advance the care for all people with IBD.”

View the full white paper here.

A new AGA white paper, published in Clinical Gastroenterology and Hepatology, highlights barriers to care and calls for collaboration among our healthcare community, insurers, pharmaceutical companies, and legislators to improve and optimize care for more than 3 million Americans living with inflammatory bowel disease (IBD).

Over the last two decades, there has been a revolution in therapeutics fueled by exciting research and development that continues to expand the treatment options for IBD, offering tools for better disease control. However, the most effective therapies are cost prohibitive and have largely become inaccessible due to insurer-mandated barriers to care, such as prior authorization and step therapy.

AGA has created a plan that addresses these barriers and proposes tangible solutions to provide patients with high quality, high value care.

1. The lived experiences and valuable insights from both patients and expert clinicians should be reflected in the data and research represented in the field.

2. AGA recognizes the powerful benefit of individually tailoring IBD therapy based on risk, comorbidities and response, and encourages all stakeholders to do the same.

3. As a field, we need to move beyond insurer-mandated step therapy and fail first policies.

4. AGA urges insurers to cover all necessary disease activity and drug level monitoring, which will ensure patients are able to achieve treat-to-target-driven outcomes.

5. Streamlined and expedited expert reviews should be guaranteed to all providers when they are mandated by an insurer.

6. To ensure transparency and accountability, AGA wants to require that payors publish their denial and appeals data.

7. AGA believes that holistic patient-centered multidisciplinary care, including psychosocial and dietary support, should be covered by insurance. Having access to such care contributes to improved patient resilience and well-being, which will lead to decreased health care utilization and better health outcomes.

8. AGA supports the creation and continuation of a variety of patient education programs to improve health literacy and awareness of complex health care systems.

9. AGA is committed to improving patients’ access to expert specialized clinical IBD care. This includes flexible delivery models to ensure that underserved populations are being reached. In addition, AGA supports training and educating specialty providers across the spectrum of medical care (advanced practice providers, nurse educators, etc.) to increase the number of qualified IBD providers.

10. Piloting innovative shared incentive partnerships between high value subspecialty care practices and payors will be a new shared goal.

11. AGA wants to engage pharmaceutical partners in developing equitable programs to address prohibitive drug costs while also expanding patient access and support.

12. AGA plans to continue to advocate for legislation to make access to therapy equitable for Medicare and Medicaid patients.

“Unaffordable drug costs, step therapy, and other insurer-mandated barriers are fixable problems,” said M. Anthony Sofia, MD, a coauthor of the AGA white paper and an IBD specialist at Oregon Health and Science University, Portland.

Oregon Health and Science University

“Every day, we see people that have been harmed by delayed and inadequate care. Solving these barriers would lift an unimaginable weight off our patient’s shoulders and allow them to lead healthier lives. We must work together to collaborate on solutions to strengthen and advance the care for all people with IBD.”

View the full white paper here.

A new AGA white paper, published in Clinical Gastroenterology and Hepatology, highlights barriers to care and calls for collaboration among our healthcare community, insurers, pharmaceutical companies, and legislators to improve and optimize care for more than 3 million Americans living with inflammatory bowel disease (IBD).

Over the last two decades, there has been a revolution in therapeutics fueled by exciting research and development that continues to expand the treatment options for IBD, offering tools for better disease control. However, the most effective therapies are cost prohibitive and have largely become inaccessible due to insurer-mandated barriers to care, such as prior authorization and step therapy.

AGA has created a plan that addresses these barriers and proposes tangible solutions to provide patients with high quality, high value care.

1. The lived experiences and valuable insights from both patients and expert clinicians should be reflected in the data and research represented in the field.

2. AGA recognizes the powerful benefit of individually tailoring IBD therapy based on risk, comorbidities and response, and encourages all stakeholders to do the same.

3. As a field, we need to move beyond insurer-mandated step therapy and fail first policies.

4. AGA urges insurers to cover all necessary disease activity and drug level monitoring, which will ensure patients are able to achieve treat-to-target-driven outcomes.

5. Streamlined and expedited expert reviews should be guaranteed to all providers when they are mandated by an insurer.

6. To ensure transparency and accountability, AGA wants to require that payors publish their denial and appeals data.

7. AGA believes that holistic patient-centered multidisciplinary care, including psychosocial and dietary support, should be covered by insurance. Having access to such care contributes to improved patient resilience and well-being, which will lead to decreased health care utilization and better health outcomes.

8. AGA supports the creation and continuation of a variety of patient education programs to improve health literacy and awareness of complex health care systems.

9. AGA is committed to improving patients’ access to expert specialized clinical IBD care. This includes flexible delivery models to ensure that underserved populations are being reached. In addition, AGA supports training and educating specialty providers across the spectrum of medical care (advanced practice providers, nurse educators, etc.) to increase the number of qualified IBD providers.

10. Piloting innovative shared incentive partnerships between high value subspecialty care practices and payors will be a new shared goal.

11. AGA wants to engage pharmaceutical partners in developing equitable programs to address prohibitive drug costs while also expanding patient access and support.

12. AGA plans to continue to advocate for legislation to make access to therapy equitable for Medicare and Medicaid patients.

“Unaffordable drug costs, step therapy, and other insurer-mandated barriers are fixable problems,” said M. Anthony Sofia, MD, a coauthor of the AGA white paper and an IBD specialist at Oregon Health and Science University, Portland.

Oregon Health and Science University

“Every day, we see people that have been harmed by delayed and inadequate care. Solving these barriers would lift an unimaginable weight off our patient’s shoulders and allow them to lead healthier lives. We must work together to collaborate on solutions to strengthen and advance the care for all people with IBD.”

View the full white paper here.

Did you know you can honor a family member, friend, or colleague whose life has been touched by GI research through a gift to the AGA Research Foundation? Your gift will honor a loved one or yourself and support the AGA Research Awards Program, while giving you a tax benefit.

• Giving now or later. Any charitable gift can be made in honor or memory of someone.
• A gift today. An outright gift will help fund the AGA Research Awards Program. Your gift will assist in furthering basic digestive disease research which can ultimately advance research into all digestive diseases. The financial benefits include an income tax deduction and possible elimination of capital gains tax. A cash gift of $5,000 or more qualifies for membership in the AGA Supporter Circle.
• A gift through your will or living trust. You can include a bequest in your will or living trust stating that a specific asset, certain dollar amount, or more commonly a percentage of your estate will pass to the AGA Research Foundation in honor of your loved one. A gift in your will of $50,000 or more qualifies for membership in the AGA Legacy Society, which recognizes the foundation’s most generous individual donors.
• Named commentary section funds. You can support a commentary section in a specific AGA journal to honor or memorialize a loved one. This can be established with a gift of $100,000 over the course of 5 years or through an estate gift. The AGA Institute Publications Committee will work with you to provide name recognition for the commentary section in a specific AGA journal for five years. All content and editing will be conducted by the editorial board of the journal.

Your Next Step

An honorary gift is a wonderful way to acknowledge someone’s vision for the future. To learn more about ways to recognize your honoree, visit our website at www.foundation.gastro.org.

Did you know you can honor a family member, friend, or colleague whose life has been touched by GI research through a gift to the AGA Research Foundation? Your gift will honor a loved one or yourself and support the AGA Research Awards Program, while giving you a tax benefit.

• Giving now or later. Any charitable gift can be made in honor or memory of someone.
• A gift today. An outright gift will help fund the AGA Research Awards Program. Your gift will assist in furthering basic digestive disease research which can ultimately advance research into all digestive diseases. The financial benefits include an income tax deduction and possible elimination of capital gains tax. A cash gift of $5,000 or more qualifies for membership in the AGA Supporter Circle.
• A gift through your will or living trust. You can include a bequest in your will or living trust stating that a specific asset, certain dollar amount, or more commonly a percentage of your estate will pass to the AGA Research Foundation in honor of your loved one. A gift in your will of $50,000 or more qualifies for membership in the AGA Legacy Society, which recognizes the foundation’s most generous individual donors.
• Named commentary section funds. You can support a commentary section in a specific AGA journal to honor or memorialize a loved one. This can be established with a gift of $100,000 over the course of 5 years or through an estate gift. The AGA Institute Publications Committee will work with you to provide name recognition for the commentary section in a specific AGA journal for five years. All content and editing will be conducted by the editorial board of the journal.

Your Next Step

An honorary gift is a wonderful way to acknowledge someone’s vision for the future. To learn more about ways to recognize your honoree, visit our website at www.foundation.gastro.org.

Did you know you can honor a family member, friend, or colleague whose life has been touched by GI research through a gift to the AGA Research Foundation? Your gift will honor a loved one or yourself and support the AGA Research Awards Program, while giving you a tax benefit.

• Giving now or later. Any charitable gift can be made in honor or memory of someone.
• A gift today. An outright gift will help fund the AGA Research Awards Program. Your gift will assist in furthering basic digestive disease research which can ultimately advance research into all digestive diseases. The financial benefits include an income tax deduction and possible elimination of capital gains tax. A cash gift of $5,000 or more qualifies for membership in the AGA Supporter Circle.
• A gift through your will or living trust. You can include a bequest in your will or living trust stating that a specific asset, certain dollar amount, or more commonly a percentage of your estate will pass to the AGA Research Foundation in honor of your loved one. A gift in your will of $50,000 or more qualifies for membership in the AGA Legacy Society, which recognizes the foundation’s most generous individual donors.
• Named commentary section funds. You can support a commentary section in a specific AGA journal to honor or memorialize a loved one. This can be established with a gift of $100,000 over the course of 5 years or through an estate gift. The AGA Institute Publications Committee will work with you to provide name recognition for the commentary section in a specific AGA journal for five years. All content and editing will be conducted by the editorial board of the journal.

Your Next Step

An honorary gift is a wonderful way to acknowledge someone’s vision for the future. To learn more about ways to recognize your honoree, visit our website at www.foundation.gastro.org.

Thoracic Oncology And Chest Procedures Network

Lung Cancer Section

Lung cancer stands as the leading cause of cancer-­related deaths globally, with its prevalence casting a long and challenging shadow. The most important risk factor for lung cancer is tobacco use, a relationship strongly substantiated by data. The impact of smoking cessation to reduce lung cancer incidence is underscored by the US Preventive Services Task Force, which mandates that smoking cessation services be an integral component of lung cancer screening programs.

However, beneath the surface of this overarching concern lies a web of factors contributing to racial and ethnic disparities in smoking cessation. Cultural intricacies play a pivotal role in shaping these disparities. Despite higher instances of light or intermediate smoking, racially ethnic minority groups in the general population often face greater challenges in achieving smoking cessation, as highlighted by Bacio, et al. Adding another layer to this complex scenario is the profound impact of sustained smoking during cancer treatment. Research suggests that for individuals diagnosed with lung cancer, smoking cessation can markedly boost treatment efficacy, reduce the risk of secondary tumors, and even double the chances of survival.¹

A study by Harris, et al. delving into the preferences of current smokers within a lung cancer screening setting uncovered noteworthy insights.² White participants exhibited a fourfold greater likelihood of favoring a digital format for receiving smoking cessation information, while their Black counterparts expressed a preference for face-to-face support, phone assistance, or printed materials.

Moreover, a meta-analysis conducted by Jabari, et al. sheds light on the efficacy of culturally targeted smoking interventions.³ This comprehensive review describes a dual-level approach to tailoring smoking cessation health interventions: surface and deep. Surface adaptations encompass elements like language and imagery, which aim to enhance the acceptability of interventions within specific communities. Simultaneously, deep-tailored elements identify culturally significant factors that can fundamentally influence the behavior of the target population. The findings of this meta-analysis reveal that the integration of culturally tailored components into standard interventions significantly enhances their efficacy in facilitating smoking cessation.

In conclusion, sustained smoking cessation is a crucial element in combating the global burden of lung cancer. Recognizing the importance of individualized approaches in health care, it is imperative to tailor smoking cessation communications and interventions to diverse cultural influences and socioeconomic factors. Culturally tailored smoking cessation programs that account for nuances specific to each community have the potential to significantly enhance their effectiveness. This necessitates a shift towards individualized smoking cessation care, with a targeted focus on increasing cessation rates among racial and ethnic minority groups. In doing so, we take a step closer to a more equitable landscape in the battle against lung cancer.

References

1. Dresler et al. Lung Cancer. 2003.

2. J Cancer Educ. 2018;33[5].

3. Addiction. 2023.

Thoracic Oncology And Chest Procedures Network

Lung Cancer Section

Lung cancer stands as the leading cause of cancer-­related deaths globally, with its prevalence casting a long and challenging shadow. The most important risk factor for lung cancer is tobacco use, a relationship strongly substantiated by data. The impact of smoking cessation to reduce lung cancer incidence is underscored by the US Preventive Services Task Force, which mandates that smoking cessation services be an integral component of lung cancer screening programs.

However, beneath the surface of this overarching concern lies a web of factors contributing to racial and ethnic disparities in smoking cessation. Cultural intricacies play a pivotal role in shaping these disparities. Despite higher instances of light or intermediate smoking, racially ethnic minority groups in the general population often face greater challenges in achieving smoking cessation, as highlighted by Bacio, et al. Adding another layer to this complex scenario is the profound impact of sustained smoking during cancer treatment. Research suggests that for individuals diagnosed with lung cancer, smoking cessation can markedly boost treatment efficacy, reduce the risk of secondary tumors, and even double the chances of survival.¹

A study by Harris, et al. delving into the preferences of current smokers within a lung cancer screening setting uncovered noteworthy insights.² White participants exhibited a fourfold greater likelihood of favoring a digital format for receiving smoking cessation information, while their Black counterparts expressed a preference for face-to-face support, phone assistance, or printed materials.

Moreover, a meta-analysis conducted by Jabari, et al. sheds light on the efficacy of culturally targeted smoking interventions.³ This comprehensive review describes a dual-level approach to tailoring smoking cessation health interventions: surface and deep. Surface adaptations encompass elements like language and imagery, which aim to enhance the acceptability of interventions within specific communities. Simultaneously, deep-tailored elements identify culturally significant factors that can fundamentally influence the behavior of the target population. The findings of this meta-analysis reveal that the integration of culturally tailored components into standard interventions significantly enhances their efficacy in facilitating smoking cessation.

In conclusion, sustained smoking cessation is a crucial element in combating the global burden of lung cancer. Recognizing the importance of individualized approaches in health care, it is imperative to tailor smoking cessation communications and interventions to diverse cultural influences and socioeconomic factors. Culturally tailored smoking cessation programs that account for nuances specific to each community have the potential to significantly enhance their effectiveness. This necessitates a shift towards individualized smoking cessation care, with a targeted focus on increasing cessation rates among racial and ethnic minority groups. In doing so, we take a step closer to a more equitable landscape in the battle against lung cancer.

References

1. Dresler et al. Lung Cancer. 2003.

2. J Cancer Educ. 2018;33[5].

3. Addiction. 2023.

Thoracic Oncology And Chest Procedures Network

Lung Cancer Section

Lung cancer stands as the leading cause of cancer-­related deaths globally, with its prevalence casting a long and challenging shadow. The most important risk factor for lung cancer is tobacco use, a relationship strongly substantiated by data. The impact of smoking cessation to reduce lung cancer incidence is underscored by the US Preventive Services Task Force, which mandates that smoking cessation services be an integral component of lung cancer screening programs.

However, beneath the surface of this overarching concern lies a web of factors contributing to racial and ethnic disparities in smoking cessation. Cultural intricacies play a pivotal role in shaping these disparities. Despite higher instances of light or intermediate smoking, racially ethnic minority groups in the general population often face greater challenges in achieving smoking cessation, as highlighted by Bacio, et al. Adding another layer to this complex scenario is the profound impact of sustained smoking during cancer treatment. Research suggests that for individuals diagnosed with lung cancer, smoking cessation can markedly boost treatment efficacy, reduce the risk of secondary tumors, and even double the chances of survival.¹

A study by Harris, et al. delving into the preferences of current smokers within a lung cancer screening setting uncovered noteworthy insights.² White participants exhibited a fourfold greater likelihood of favoring a digital format for receiving smoking cessation information, while their Black counterparts expressed a preference for face-to-face support, phone assistance, or printed materials.

Moreover, a meta-analysis conducted by Jabari, et al. sheds light on the efficacy of culturally targeted smoking interventions.³ This comprehensive review describes a dual-level approach to tailoring smoking cessation health interventions: surface and deep. Surface adaptations encompass elements like language and imagery, which aim to enhance the acceptability of interventions within specific communities. Simultaneously, deep-tailored elements identify culturally significant factors that can fundamentally influence the behavior of the target population. The findings of this meta-analysis reveal that the integration of culturally tailored components into standard interventions significantly enhances their efficacy in facilitating smoking cessation.

In conclusion, sustained smoking cessation is a crucial element in combating the global burden of lung cancer. Recognizing the importance of individualized approaches in health care, it is imperative to tailor smoking cessation communications and interventions to diverse cultural influences and socioeconomic factors. Culturally tailored smoking cessation programs that account for nuances specific to each community have the potential to significantly enhance their effectiveness. This necessitates a shift towards individualized smoking cessation care, with a targeted focus on increasing cessation rates among racial and ethnic minority groups. In doing so, we take a step closer to a more equitable landscape in the battle against lung cancer.

References

1. Dresler et al. Lung Cancer. 2003.

2. J Cancer Educ. 2018;33[5].

3. Addiction. 2023.

Sleep Medicine Network

Nonrespiratory Sleep Section

Q: Are there interventions that can be readily implemented to improve sleep quality for hospitalized patients?

Dr. Arora: A patient’s first night in the hospital is probably not the night to liberalize sleep; you’re still figuring out whether they’re stable. But by the second or third day, you should be questioning—do you need vitals at night? Do you need a 4 AM blood draw?

We did an intervention called SIESTA that included both staff education about batching care and system-wide, electronic health record-based interventions to remind clinicians that as patients get better, you can deintensify their care. And we’re currently doing a randomized controlled trial of educating and empowering patients to ask their teams to help them get better sleep.

Q: Does hospital sleep deprivation affect patients after discharge?

Dr. Arora: Absolutely. “Posthospital syndrome” is the idea that 30 days after discharge, you’re vulnerable to getting readmitted – not because of the disease you came in with, but something else. And people who report sleep complaints in the hospital are more likely to be readmitted.

When people are acutely sleep deprived, their blood pressure is higher. Their blood sugar is higher. Their cytokine response and immune function are blunted. And our work shows that sleep deficits from the hospital continue even when you go home. Fatigue becomes a very real issue. And when you’re super fatigued, are you going to want to do your physical therapy? Will you be able to take care of yourself? Will you be able to learn and understand your discharge instructions?

We have such a huge gap to improve sleep. It’s of interest to people, but they are struggling with how to do it. And that’s where I think empowering frontline clinicians to take the lead is a great project for people to take on.

Vineet Arora, MD, MAPP, is the Dean for Medical Education at the University of Chicago and an academic hospitalist who specializes in the quality, safety, and experience of care delivered to hospitalized adults.

Sleep Medicine Network

Nonrespiratory Sleep Section

Q: Are there interventions that can be readily implemented to improve sleep quality for hospitalized patients?

Dr. Arora: A patient’s first night in the hospital is probably not the night to liberalize sleep; you’re still figuring out whether they’re stable. But by the second or third day, you should be questioning—do you need vitals at night? Do you need a 4 AM blood draw?

We did an intervention called SIESTA that included both staff education about batching care and system-wide, electronic health record-based interventions to remind clinicians that as patients get better, you can deintensify their care. And we’re currently doing a randomized controlled trial of educating and empowering patients to ask their teams to help them get better sleep.

Q: Does hospital sleep deprivation affect patients after discharge?

Dr. Arora: Absolutely. “Posthospital syndrome” is the idea that 30 days after discharge, you’re vulnerable to getting readmitted – not because of the disease you came in with, but something else. And people who report sleep complaints in the hospital are more likely to be readmitted.

When people are acutely sleep deprived, their blood pressure is higher. Their blood sugar is higher. Their cytokine response and immune function are blunted. And our work shows that sleep deficits from the hospital continue even when you go home. Fatigue becomes a very real issue. And when you’re super fatigued, are you going to want to do your physical therapy? Will you be able to take care of yourself? Will you be able to learn and understand your discharge instructions?

We have such a huge gap to improve sleep. It’s of interest to people, but they are struggling with how to do it. And that’s where I think empowering frontline clinicians to take the lead is a great project for people to take on.

Vineet Arora, MD, MAPP, is the Dean for Medical Education at the University of Chicago and an academic hospitalist who specializes in the quality, safety, and experience of care delivered to hospitalized adults.

Sleep Medicine Network

Nonrespiratory Sleep Section

Q: Are there interventions that can be readily implemented to improve sleep quality for hospitalized patients?

Dr. Arora: A patient’s first night in the hospital is probably not the night to liberalize sleep; you’re still figuring out whether they’re stable. But by the second or third day, you should be questioning—do you need vitals at night? Do you need a 4 AM blood draw?

We did an intervention called SIESTA that included both staff education about batching care and system-wide, electronic health record-based interventions to remind clinicians that as patients get better, you can deintensify their care. And we’re currently doing a randomized controlled trial of educating and empowering patients to ask their teams to help them get better sleep.

Q: Does hospital sleep deprivation affect patients after discharge?

Dr. Arora: Absolutely. “Posthospital syndrome” is the idea that 30 days after discharge, you’re vulnerable to getting readmitted – not because of the disease you came in with, but something else. And people who report sleep complaints in the hospital are more likely to be readmitted.

When people are acutely sleep deprived, their blood pressure is higher. Their blood sugar is higher. Their cytokine response and immune function are blunted. And our work shows that sleep deficits from the hospital continue even when you go home. Fatigue becomes a very real issue. And when you’re super fatigued, are you going to want to do your physical therapy? Will you be able to take care of yourself? Will you be able to learn and understand your discharge instructions?

We have such a huge gap to improve sleep. It’s of interest to people, but they are struggling with how to do it. And that’s where I think empowering frontline clinicians to take the lead is a great project for people to take on.

Vineet Arora, MD, MAPP, is the Dean for Medical Education at the University of Chicago and an academic hospitalist who specializes in the quality, safety, and experience of care delivered to hospitalized adults.

Critical Care Network

Palliative and End-of-Life Care Section

For providers caring for critically ill patients, navigating death and dying in the intensive care unit (ICU) with proficiency and empathy is essential. Approximately 20% of deaths in the United States occur during or shortly after a stay in the ICU and approximately 40% of ICU deaths involve withdrawal of artificial life support (WOALS) or compassionate extubation.

This is a complex process that may involve advanced communication with family, expertise in mechanical ventilation, vasopressors, dialysis, and complex symptom management. Importantly, surrogate medical decision-making for a critically ill patient can be a challenging experience associated with anxiety and depression. How the team approaches WOALS can make a difference to both patients and decision-makers. Unfortunately, there is striking variation in practice and lack of guidance in navigating issues that arise at end-of-life in the ICU. One study of 2,814 hospitals in the US with ICU beds found that 52% had intensivists while 48% did not.² This highlights the importance of developing resources focusing on end-of-life care in the ICU setting regardless of the providers’ educational training.

Important elements could include the role for protocol-based WOALS, use of oxygen, selection and dosing strategy of comfort-focused medications, establishing expectations, and addressing uncertainties. This would be meaningful in providing effective, ethical end-of-life care based on evidence-based strategies. While death may be unavoidable, a thoughtful approach can allow providers to bring dignity to the dying process and lessen the burden of an already difficult experience for patients and families alike.

References

1. Curtis JR, et al. Am J Respir Crit Care Med. 2012;186[7]:587-592.

2. Halpern NA, et al. Crit Care Med. 2019;47[4]:517-525.

 

Critical Care Network

Palliative and End-of-Life Care Section

For providers caring for critically ill patients, navigating death and dying in the intensive care unit (ICU) with proficiency and empathy is essential. Approximately 20% of deaths in the United States occur during or shortly after a stay in the ICU and approximately 40% of ICU deaths involve withdrawal of artificial life support (WOALS) or compassionate extubation.

This is a complex process that may involve advanced communication with family, expertise in mechanical ventilation, vasopressors, dialysis, and complex symptom management. Importantly, surrogate medical decision-making for a critically ill patient can be a challenging experience associated with anxiety and depression. How the team approaches WOALS can make a difference to both patients and decision-makers. Unfortunately, there is striking variation in practice and lack of guidance in navigating issues that arise at end-of-life in the ICU. One study of 2,814 hospitals in the US with ICU beds found that 52% had intensivists while 48% did not.² This highlights the importance of developing resources focusing on end-of-life care in the ICU setting regardless of the providers’ educational training.

Important elements could include the role for protocol-based WOALS, use of oxygen, selection and dosing strategy of comfort-focused medications, establishing expectations, and addressing uncertainties. This would be meaningful in providing effective, ethical end-of-life care based on evidence-based strategies. While death may be unavoidable, a thoughtful approach can allow providers to bring dignity to the dying process and lessen the burden of an already difficult experience for patients and families alike.

References

1. Curtis JR, et al. Am J Respir Crit Care Med. 2012;186[7]:587-592.

2. Halpern NA, et al. Crit Care Med. 2019;47[4]:517-525.

 

Critical Care Network

Palliative and End-of-Life Care Section

For providers caring for critically ill patients, navigating death and dying in the intensive care unit (ICU) with proficiency and empathy is essential. Approximately 20% of deaths in the United States occur during or shortly after a stay in the ICU and approximately 40% of ICU deaths involve withdrawal of artificial life support (WOALS) or compassionate extubation.

This is a complex process that may involve advanced communication with family, expertise in mechanical ventilation, vasopressors, dialysis, and complex symptom management. Importantly, surrogate medical decision-making for a critically ill patient can be a challenging experience associated with anxiety and depression. How the team approaches WOALS can make a difference to both patients and decision-makers. Unfortunately, there is striking variation in practice and lack of guidance in navigating issues that arise at end-of-life in the ICU. One study of 2,814 hospitals in the US with ICU beds found that 52% had intensivists while 48% did not.² This highlights the importance of developing resources focusing on end-of-life care in the ICU setting regardless of the providers’ educational training.

Important elements could include the role for protocol-based WOALS, use of oxygen, selection and dosing strategy of comfort-focused medications, establishing expectations, and addressing uncertainties. This would be meaningful in providing effective, ethical end-of-life care based on evidence-based strategies. While death may be unavoidable, a thoughtful approach can allow providers to bring dignity to the dying process and lessen the burden of an already difficult experience for patients and families alike.

References

1. Curtis JR, et al. Am J Respir Crit Care Med. 2012;186[7]:587-592.

2. Halpern NA, et al. Crit Care Med. 2019;47[4]:517-525.

 

Chest Infections and Disaster Response Network

Disaster Response and Global Health Section    

Viral infections frequently cause acute respiratory failure requiring ICU admission. In the United States, influenza causes over 50,000 deaths annually and SARS-CoV2 resulted in 170,000 hospitalizations in December 2023 alone.^{1 2} RSV lacks precise incidence data due to inconsistent testing but is increasingly implicated in respiratory failure. 

Patients with underlying pulmonary comorbidities are at increased risk of severe infection. RSV induces bronchospasm and increases the risk for severe infection in patients with obstructive lung disease.³ Additionally, COPD patients with viral respiratory infections have higher rates of ICU admission, mechanical ventilation, and death compared with similar patients admitted for other etiologies.⁴

Diagnosis typically is achieved with nasopharyngeal PCR swabs. Positive viral swabs correlate with higher ICU admission and ventilation rates in patients with COPD.⁴ Coinfection with multiple respiratory viruses leads to higher mortality rates and bacterial and fungal coinfection further increases morbidity and mortality.⁵

Treatment includes respiratory support with noninvasive ventilation and high-flow nasal cannula, reducing the need for mechanical ventilation.⁶ Inhaled bronchodilators are particularly beneficial in patients with RSV infection.⁵ Oseltamivir reduces mortality in severe influenza cases, while remdesivir shows efficacy in SARS-CoV2 infection not requiring invasive ventilation.⁷ Severe SARS-CoV2 infection can be treated with immunomodulators. However, their availability is limited. Corticosteroids reduce mortality and mechanical ventilation in patients with SARS-CoV2; however, their use is associated with worse outcomes in influenza and RSV.^{7 8}

Vaccination remains crucial for prevention of severe disease. RSV vaccination, in addition to influenza and SARS-CoV2 immunization, presents an opportunity to reduce morbidity and mortality.

References

1. Troeger C, et al. Lancet Infect Dis. 2018;18[11]:1191-1210.

2. WHO COVID-19 Epidemiological Update, 2024.

3. Coussement J, et al. Chest. 2022;161[6]:1475-1484.

4. Mulpuru S, et al. Influenza Other Respir Viruses. 2022;16[6]:1172-1182.

5. Saura O, et al. Expert Rev Anti Infect Ther. 2022;20[12]:1537-1550.

6. Inglis R, Ayebale E, Schultz MJ. Curr Opin Crit Care. 2019;25[1]:45-53.

7. O’Driscoll LS, Martin-Loeches I. Semin Respir Crit Care Med. 2021;42[6]:771-787.

8. Bhimraj, A et al. Clin Inf Dis. 2022.

Chest Infections and Disaster Response Network

Disaster Response and Global Health Section    

Viral infections frequently cause acute respiratory failure requiring ICU admission. In the United States, influenza causes over 50,000 deaths annually and SARS-CoV2 resulted in 170,000 hospitalizations in December 2023 alone.^{1 2} RSV lacks precise incidence data due to inconsistent testing but is increasingly implicated in respiratory failure. 

Patients with underlying pulmonary comorbidities are at increased risk of severe infection. RSV induces bronchospasm and increases the risk for severe infection in patients with obstructive lung disease.³ Additionally, COPD patients with viral respiratory infections have higher rates of ICU admission, mechanical ventilation, and death compared with similar patients admitted for other etiologies.⁴

Diagnosis typically is achieved with nasopharyngeal PCR swabs. Positive viral swabs correlate with higher ICU admission and ventilation rates in patients with COPD.⁴ Coinfection with multiple respiratory viruses leads to higher mortality rates and bacterial and fungal coinfection further increases morbidity and mortality.⁵

Treatment includes respiratory support with noninvasive ventilation and high-flow nasal cannula, reducing the need for mechanical ventilation.⁶ Inhaled bronchodilators are particularly beneficial in patients with RSV infection.⁵ Oseltamivir reduces mortality in severe influenza cases, while remdesivir shows efficacy in SARS-CoV2 infection not requiring invasive ventilation.⁷ Severe SARS-CoV2 infection can be treated with immunomodulators. However, their availability is limited. Corticosteroids reduce mortality and mechanical ventilation in patients with SARS-CoV2; however, their use is associated with worse outcomes in influenza and RSV.^{7 8}

Vaccination remains crucial for prevention of severe disease. RSV vaccination, in addition to influenza and SARS-CoV2 immunization, presents an opportunity to reduce morbidity and mortality.

References

1. Troeger C, et al. Lancet Infect Dis. 2018;18[11]:1191-1210.

2. WHO COVID-19 Epidemiological Update, 2024.

3. Coussement J, et al. Chest. 2022;161[6]:1475-1484.

4. Mulpuru S, et al. Influenza Other Respir Viruses. 2022;16[6]:1172-1182.

5. Saura O, et al. Expert Rev Anti Infect Ther. 2022;20[12]:1537-1550.

6. Inglis R, Ayebale E, Schultz MJ. Curr Opin Crit Care. 2019;25[1]:45-53.

7. O’Driscoll LS, Martin-Loeches I. Semin Respir Crit Care Med. 2021;42[6]:771-787.

8. Bhimraj, A et al. Clin Inf Dis. 2022.

Chest Infections and Disaster Response Network

Disaster Response and Global Health Section    

Viral infections frequently cause acute respiratory failure requiring ICU admission. In the United States, influenza causes over 50,000 deaths annually and SARS-CoV2 resulted in 170,000 hospitalizations in December 2023 alone.^{1 2} RSV lacks precise incidence data due to inconsistent testing but is increasingly implicated in respiratory failure. 

Patients with underlying pulmonary comorbidities are at increased risk of severe infection. RSV induces bronchospasm and increases the risk for severe infection in patients with obstructive lung disease.³ Additionally, COPD patients with viral respiratory infections have higher rates of ICU admission, mechanical ventilation, and death compared with similar patients admitted for other etiologies.⁴

Diagnosis typically is achieved with nasopharyngeal PCR swabs. Positive viral swabs correlate with higher ICU admission and ventilation rates in patients with COPD.⁴ Coinfection with multiple respiratory viruses leads to higher mortality rates and bacterial and fungal coinfection further increases morbidity and mortality.⁵

Treatment includes respiratory support with noninvasive ventilation and high-flow nasal cannula, reducing the need for mechanical ventilation.⁶ Inhaled bronchodilators are particularly beneficial in patients with RSV infection.⁵ Oseltamivir reduces mortality in severe influenza cases, while remdesivir shows efficacy in SARS-CoV2 infection not requiring invasive ventilation.⁷ Severe SARS-CoV2 infection can be treated with immunomodulators. However, their availability is limited. Corticosteroids reduce mortality and mechanical ventilation in patients with SARS-CoV2; however, their use is associated with worse outcomes in influenza and RSV.^{7 8}

Vaccination remains crucial for prevention of severe disease. RSV vaccination, in addition to influenza and SARS-CoV2 immunization, presents an opportunity to reduce morbidity and mortality.

References

1. Troeger C, et al. Lancet Infect Dis. 2018;18[11]:1191-1210.

2. WHO COVID-19 Epidemiological Update, 2024.

3. Coussement J, et al. Chest. 2022;161[6]:1475-1484.

4. Mulpuru S, et al. Influenza Other Respir Viruses. 2022;16[6]:1172-1182.

5. Saura O, et al. Expert Rev Anti Infect Ther. 2022;20[12]:1537-1550.

6. Inglis R, Ayebale E, Schultz MJ. Curr Opin Crit Care. 2019;25[1]:45-53.

7. O’Driscoll LS, Martin-Loeches I. Semin Respir Crit Care Med. 2021;42[6]:771-787.

8. Bhimraj, A et al. Clin Inf Dis. 2022.

Airways Disorders Network

Asthma and COPD Section  

Remodeling of airways and destruction of parenchyma by immune and inflammatory mechanisms are the leading cause of lung function decline in patients with COPD. Type 2 inflammation has been recognized as an important phenotypic pathway in asthma. However, its role in COPD has been much less clear, which had been largely associated with innate immune response.¹

Activation of Interleukin (IL)-25, IL-33, thymic stromal lymphopoietin (TSLP) produces type 2 cytokines IL-4, IL-5, and IL-13, either by binding to ILC2 or by direct Th2 cells resulting in elevated eosinophils in sputum, lungs, and blood, as well as fractional exhaled nitric oxide.² The combined inflammation from this pathway underpins the pathological changes seen in airway mucosa, causing mucous hypersecretion and hyperresponsiveness.

Prior trials delineating the role of biologics, such as mepolizumab and benralizumab, showed variable results with possible benefit of add-on biologics on the annual COPD exacerbations among patients with eosinophilic phenotype of COPD.³

More recently, the BOREAS trial evaluated the role of dupilumab as an add-on therapy for patients with type 2 inflammation-driven COPD established using blood eosinophil count of at least 300/mL at initial screening.⁴ Dupilumab is a human monoclonal antibody that blocks combined IL-4 and IL-13 pathways with a broader effect on the type 2 inflammation. It included patients with moderate to severe exacerbations despite maximal triple inhaler therapy with blood eosinophilia. Patients with asthma were excluded. This 52-week trial showed reduction in annual moderate to severe COPD exacerbations, sustained lung function improvement as measured by prebronchodilator FEV₁, and improvement in patient-reported respiratory symptoms.⁴ Evaluation of sustainability of these results with therapy step-down approaches should be explored.

References

1. Scanlon & McKenzie, 2012.

2. Brusselle et al, 2013.

3. Pavord et al, 2017.

4. Bhatt et al, 2023.

Airways Disorders Network

Asthma and COPD Section  

Remodeling of airways and destruction of parenchyma by immune and inflammatory mechanisms are the leading cause of lung function decline in patients with COPD. Type 2 inflammation has been recognized as an important phenotypic pathway in asthma. However, its role in COPD has been much less clear, which had been largely associated with innate immune response.¹

Activation of Interleukin (IL)-25, IL-33, thymic stromal lymphopoietin (TSLP) produces type 2 cytokines IL-4, IL-5, and IL-13, either by binding to ILC2 or by direct Th2 cells resulting in elevated eosinophils in sputum, lungs, and blood, as well as fractional exhaled nitric oxide.² The combined inflammation from this pathway underpins the pathological changes seen in airway mucosa, causing mucous hypersecretion and hyperresponsiveness.

Prior trials delineating the role of biologics, such as mepolizumab and benralizumab, showed variable results with possible benefit of add-on biologics on the annual COPD exacerbations among patients with eosinophilic phenotype of COPD.³

More recently, the BOREAS trial evaluated the role of dupilumab as an add-on therapy for patients with type 2 inflammation-driven COPD established using blood eosinophil count of at least 300/mL at initial screening.⁴ Dupilumab is a human monoclonal antibody that blocks combined IL-4 and IL-13 pathways with a broader effect on the type 2 inflammation. It included patients with moderate to severe exacerbations despite maximal triple inhaler therapy with blood eosinophilia. Patients with asthma were excluded. This 52-week trial showed reduction in annual moderate to severe COPD exacerbations, sustained lung function improvement as measured by prebronchodilator FEV₁, and improvement in patient-reported respiratory symptoms.⁴ Evaluation of sustainability of these results with therapy step-down approaches should be explored.

References

1. Scanlon & McKenzie, 2012.

2. Brusselle et al, 2013.

3. Pavord et al, 2017.

4. Bhatt et al, 2023.

Airways Disorders Network

Asthma and COPD Section  

Remodeling of airways and destruction of parenchyma by immune and inflammatory mechanisms are the leading cause of lung function decline in patients with COPD. Type 2 inflammation has been recognized as an important phenotypic pathway in asthma. However, its role in COPD has been much less clear, which had been largely associated with innate immune response.¹

Activation of Interleukin (IL)-25, IL-33, thymic stromal lymphopoietin (TSLP) produces type 2 cytokines IL-4, IL-5, and IL-13, either by binding to ILC2 or by direct Th2 cells resulting in elevated eosinophils in sputum, lungs, and blood, as well as fractional exhaled nitric oxide.² The combined inflammation from this pathway underpins the pathological changes seen in airway mucosa, causing mucous hypersecretion and hyperresponsiveness.

Prior trials delineating the role of biologics, such as mepolizumab and benralizumab, showed variable results with possible benefit of add-on biologics on the annual COPD exacerbations among patients with eosinophilic phenotype of COPD.³

More recently, the BOREAS trial evaluated the role of dupilumab as an add-on therapy for patients with type 2 inflammation-driven COPD established using blood eosinophil count of at least 300/mL at initial screening.⁴ Dupilumab is a human monoclonal antibody that blocks combined IL-4 and IL-13 pathways with a broader effect on the type 2 inflammation. It included patients with moderate to severe exacerbations despite maximal triple inhaler therapy with blood eosinophilia. Patients with asthma were excluded. This 52-week trial showed reduction in annual moderate to severe COPD exacerbations, sustained lung function improvement as measured by prebronchodilator FEV₁, and improvement in patient-reported respiratory symptoms.⁴ Evaluation of sustainability of these results with therapy step-down approaches should be explored.

References

1. Scanlon & McKenzie, 2012.

2. Brusselle et al, 2013.

3. Pavord et al, 2017.

4. Bhatt et al, 2023.