Commentary by Kristy Bauer MD and Nishay Chitkara MD, NYU Division of Pulmonary and Critical Care Medicine
The 2009 meeting of the American Thoracic Society took place in sunny San Diego, California from May 15-20. The ATS meeting is the largest gathering of pulmonologists, thoracic surgeons, nurses, respiratory therapists and other healthcare professionals, and features over 5300 original research studies and scientific presentations. San Diego has long been a frequent host to the ATS meeting, with its ideal location. The large convention center in downtown San Diego is located very close to the beach, and just blocks away from the historic Gaslamp Quarter, an area of many Victorian Era buildings which are home to a variety of restaurants, shops, and nightclubs.Each year the ATS meeting features a series of major seminars, among them the Clinical Year in Review and Clinical Topics in Pulmonary Medicine. This year the topics included interstitial lung disease, clinical problems in sarcoidosis, sex and gender in COPD, and clinical issues in lung cancer. Of course, symposia were also held on the latest information and data regarding the H1N1 influenza virus outbreak, just now named a global pandemic by the World Health Organization.
The NYU Division of Pulmonary and Critical Care Medicine contributed a great deal to the conference, with over 20 abstracts based on original research, numerous poster presentations, and a few oral presentations as well. Topics included the health consequences of World Trade Center dust exposure, asthma, tuberculosis, palliative care in the ICU, sleep medicine, pulmonary physiology and lung cancer.
Some highlights of the conference included the following:
Interstitial Lung Disease – An overview was given on the CAPACITY trials, which have evaluated pirfenidone, an oral anti-fibrotic agent, for potential use in patients with idiopathic pulmonary fibrosis (IPF). This medication has been shown to stabilize the forced vital capacity (FVC) measured at one year as compared to placebo, and to improve progression-free survival time. Pirfenidone works by inhibiting collagen synthesis, down-regulating profibrotic cytokines, and decreasing fibroblast proliferation. Its benefit in slowing the progression of IPF and the usual decline in lung function could mean better quality of life and improved exercise capacity for patients. The drug is awaiting FDA approval for treatment of IPF.
Lung Cancer – A symposium was held to discuss the new international classification of non small cell lung cancer. The histologic and radiologic differences in the new classification system were explained. The revision of the staging system now allows for a better correlation of a patient’s prognosis with the lung cancer stage. Once a tissue diagnosis of lung cancer has been made, consideration of the disease stage takes precedence since further management hinges on this determination. A significant dividing line exists, differentiating patients who are candidates for surgical resection from those who have inoperable disease but may benefit from chemotherapy and/or radiation therapy. In the past, primary surgical resection played a significant role in the treatment of nonbulky stage IIIA disease. The role of surgery has lessened more recently, due to routine pathologic staging of the mediastinum and a recognition of the poorer outcomes or prognosis in some clinical stage IIIA patients treated surgically, such as those with N2 nodal involvement. The advent of PET scanning has helped to refine noninvasive staging of lung cancer in recent years, and has thus assisted in the selection of patients with operable disease.
Critical Care – Dr. Deborah Cook summarized the NICE SUGAR study, an international, randomized trial which evaluated the effect of intensive glucose control on mortality among adults in the ICU. The study was published in the March 26, 2009 issue of the New England Journal of Medicine. It showed that a blood glucose target of 180 mg/dL or less resulted in a lower mortality compared to a blood glucose target of 81 to 108 mg/dL. The two groups showed no significant difference in the number of days in the ICU, median number of days of mechanical ventilation, or the requirement for renal-replacement therapy.
COPD – Pulmonary rehabilitation has gained increasing attention lately for its utility in treating patients with advanced COPD. A recent two-year trial from the Netherlands (published as an abstract and presented at the ATS meeting) randomized 199 newly diagnosed patients with moderate COPD to usual care or to an intensive rehab program consisting of exercise training, smoking cessation, nutritional advice, and other support. The intervention group demonstrated significant improvements in the St. George’s Respiratory Questionnaire (a measure of quality of life), stationary bicycle endurance time (a measure of exercise capacity), and in shortness of breath. The cost effectiveness of early pulmonary rehab may be subject for debate, but it holds promise for patients with moderate COPD.
As with every conference, the 2009 ATS meeting offered an opportunity to enjoy its locale – in southern California. In 2010, the international conference will return to New Orleans for the first time since 1996. It’s little doubt that the sound of a saxophone along the banks of the Mississippi River, the lively French Quarter, and the unbroken charm of the recovering city will form a wonderful backdrop to the meeting.