Commentary by Laura Evans MD, NYU Division of Pulmonary and Critical Care Medicine
The 2008 American Thoracic Society (ATS) meeting took place from May 16-21 in Toronto, Ontario. Over 16,000 physicians, nurses and respiratory therapists attended the meeting. There were more than 400 sessions, 800 speakers and 5,500 original research abstracts focusing on pulmonary, critical care and sleep medicine.
The NYU Division of Pulmonary and Critical Care medicine was well represented. The division presented more than 20 original research abstracts and symposia in areas such as tuberculosis, asthma, lung cancer, WTC exposure, sleep medicine, interventional bronchoscopy, and end of life care. NYU fellow Sherry Goldyn, under the mentorship of Dr. Doreen Addrizzo-Harris, was chosen to present “a case of rapidly progressive cystic lung disease in an ex-smoker” at the fellow symposium, and she succeeded in “stumping the experts!”
It’s not possible to summarize the whole meeting here due to the breadth and depth of the research presented, but here are some of the highlights:
COPD– Dr. Karen Rice from the University of Minnesota reported the results of a randomized study of a simplified case management plan for VA patients with COPD. Patients in the case management arm of the trial had a one hour visit with a respiratory therapist, reviewed inhaler technique, received a written action plan about how to recognize a COPD exacerbation, and received a monthly telephone call from a case manager.
Compared to the usual care arm, patients in the case management arm had a 41% reduction in a combined endpoint of ER visits and hospitalizations (p<0.0001). The results of this study have spurred a larger confirmatory study, which if successful will potentially have a large impact on how COPD is managed.
Lung Cancer– Researchers from the University of Pennsylvania identified a 24 gene signature that is expressed at a higher rate by peripheral blood mononuclear cells in patients with early stage lung adenocarcinoma than in normal controls. In their study of 228 patients, the 24 gene signature had a sensitivity and specificity of 85% and 87% respectively, with an area under the curve of 0.92 on the ROC analysis. If confirmed in larger studies, this gene signature may allow a blood test to help diagnose lung cancer. In a related study, Dr. Bill Bulman from Columbia University presented a 42 gene signature in patients with non-small cell lung cancer that predicted relapse after surgery with curative intent.
Critical Care– Results from the VA/NIH Acute Renal Failure Trial Network were released the same day the results of the study were published online in the New England Journal of Medicine. 1,124 critically ill patients with acute renal failure were randomized to high-intensity or low-intensity renal replacement therapy. There was no difference in 60 day mortality, in-hospital mortality, or recovery of renal function. Mortality in the study population was high, confirming the results of multiple previous studies demonstrating the poor prognosis of patients with acute renal failure in the ICU, but in this largest trial to date of renal replacement therapy, the intensity of renal replacement therapy provided did not affect mortality.
Medical Education– An analysis by Dr. Meeta Prasad from the University of Pennsylvania found that resident work hour restrictions implemented by the ACGME in 2003 did not affect ICU mortality. Using the APACHE IV database, she examined mortality data from 160,787 patients in 21 teaching hospitals and 84,863 patients in non-teaching hospitals. Mortality decreased slightly overall in the post-work hours reform period (OR 0.89 (95%CI 0.87-0.92)), but there was no difference in this observation between teaching and non-teaching hospitals. She suggested that teaching hospitals have found multiple effective methods to compensate for fewer hours worked by residents.
The next ATS International Conference will take place in San Diego, California in May 2009.