January 2018 Arizona Thoracic Society Notes

The January 2018 Arizona Thoracic Society meeting was held on Wednesday, January 24, 2018 at the HonorHealth Rehabilitation Hospital beginning at 6:30 PM. This was a dinner meeting with case presentations. There were 11 in attendance representing the pulmonary, critical care, sleep, and radiology communities.

At the beginning of the meeting several issues were discussed:

1. CME for Arizona Thoracic Society Meetings. Dr. Robbins will be going to Washington and will meet with the ATS concerning obtaining CME for the Arizona Thoracic Society meetings.
2. Tobacco 21. It was unclear if any action was occurring. Dr. Parides said he would check.
3. Council of Chapter Representatives (CCR) Meeting and “Hill Day”. Dr. Robbins will be attending the CCR meeting March 21-22 for Dr. Schwartzberg. This includes meeting with the Arizona Congressional representatives. Those that have issues they wish presented to either the ATS leadership or their legislators should contact Dr. Robbins at rickrobbins@cox.net. 

There were 4 case presentations:

1. Dr. Gerry Swartzberg presented a follow-up of a now 74-year-old who was presented in 2014 who was asymptomatic but with a CT scan showing cysts.  No diagnosis was made at that time. She has been followed for the last 3 years. She now has some shortness of breath with exertion. It was discovered that she had cockatiels. A complete “bird” hypersensitivity was recommended but the patient declined because of cost. A repeat CT in late 2017 showed that the cysts had enlarged. A pigeon serum serologic test was positive. Dr. Gotway pointed out that lung cysts can occur with hypersensitivity pneumonitis (1). A biopsy was performed which showed necrotizing granulomas without any organisms. Although she got rid of her cockatiels, further history reveals that the patient still feeds pigeons.  The consensus (although by no means unanimous) was this was likely hypersensitivity pneumonitis with an unusual presentation. It was thought that a trial of steroids might be beneficial.
2. Dr. Lewis Wesselius presented a 75-year-old woman with a thymic carcinoid tumor diagnosed in 2015. She was treated with resection and radiation therapy. CT scan showed changes consistent with radiation pneumonitis. Bronchoscopy with transbronchial biopsy showed “organizing pneumonitis”. She was treated with corticosteroids for 1 month. CT scan showed some improvement and the steroids were tapered. Her symptoms recurred and she was again started on corticosteroids with improvement but after tapering her steroids, her symptoms again recurred. CT scan showed marked worsening of the lung infiltrates. A bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial biopsy was performed. The BAL showed 12% eosinophils and the biopsy was consistent with chronic eosinophilic pneumonia.
3. Dr. Wesselius also presented a 79-year-old woman who had a right upper lobe resection for non-small cell lung cancer. A follow-up CT scan sometime later showed ground glass opacities (GGOs). A decision was made to follow the GGO’s but a year later CT scan showed worsening of the lesions. Navigational bronchoscopy was nondiagnostic. After a tumor board conference, she received radiation therapy for presumed carcinoma. She was followed but again had increasing shortness of breath. CT scan showed changes consistent with radiation pneumonitis. A long discussion ensued about empiric radiation therapy.
4. Dr. George Parides presented a woman with a clinical history consistent with idiopathic pulmonary fibrosis (IPF) and a CT scan which showed ground glass opacities. Most felt that this was IPF. Pirfenidone was started. A discussion about therapies, including experimental therapies for IPF ensued.

There being no further business, the meeting was adjourned about 8:30 PM. The next meeting will be in Phoenix on March 28 at 6:30 PM at HonorHealth Rehabilitation Hospital.

Richard A. Robbins MD

Editor, SWJPCC

Reference

1. Franquet T, Hansell DM, Senbanjo T, Remy-Jardin M, Müller NL. Lung cysts in subacute hypersensitivity pneumonitis. J Comput Assist Tomogr. 2003 Jul-Aug;27(4):475-8.[CrossRef] [PubMed]

Cite as: Robbins RA. January 2018 Arizona thoracic society notes. Southwest J Pulm Crit Care. 2018;16(1):51-2. doi: https://doi.org/10.13175/swjpcc018-18 PDF 

May 2013 Council of Chapter Representatives Notes

The Council of Chapter Representatives met in conjunction with the ATS meeting in Philadelphia on May 18, 2012.

Roll Call. The meeting was called to order at 11 AM. Representatives from Arizona, California, DC Metro, Louisiana, Michigan, New Mexico, New York, Oregon, and Rhode Island were in attendance, and by telephone from Washington.

Chapter Updates. Information on chapter activities and a chapter brochure. There are currently 19 active chapters. Most are having annual meetings.

Advocacy. Gary Ewart from ATS Government Relations gave a presentation on Washington activities. Highlights included activities on the SGR, a number of air pollution regulations and a letter campaign advocating regulation of cigars.

ATS President 2013-14-vision for the coming year. Patrician Finn gave a summary of what she hopes to accomplish over the next year. The theme of her presidency will be health equality.

ATS Executive Director-update. Steve Crane gave a positive presentation on the financial status. Although not as well attended as last year’s ATS in San Francisco, this year’s Philadelphia meeting has better attendance than expected. The reserve has increased to nearly 75% of the yearly budget. The ATS is offering free maintenance of certification modules.

2013 Outstanding Clinician Award. The finalists for the ATS 2013 Outstanding Clinician Award; Allen Thomas (Arizona), Amine Temmar (New Mexico) and Steve Kirtland (Washington) will be recognized at the Clinician’s Center, Monday, 3:30-4:30 PM, Pennsylvania Convention Center, Hall C, 200 level.

Presentation of CCR Officers 2013-4

• Linda Nici-Immediate Past Chair
• Samya Nasr-Chair
• Robin Gross-Chair-elect
• Steve Kirtland-Secretary

ATS Foundation. Jim Donahue, Foundation president, gave a presentation of the activities of the ATS Foundation. Currently, all monies designated for research are used to support research. The ATS is also holding a meeting with the ALA to discuss joint grants.

Great Cases Symposium. The Great Cases Symposium organized by CCR will be held on Sunday, May 19, 2:00-4:30 PM.

A Look at the Coming Year. Samya Nasr, incoming CCR Chair, reviewed plans for the upcoming year.

Important Dates

• May 16-21, 2014-ATS International Conference, San Diego
• July 1, 2013-Call for input for 2014 International Conference
• November 6, 2013-Abstract deadline for the 2014 International Conference

CCR Committee Representatives 2013-4

• Clinicians Advisory: Robin Gross
• Education: Carol Welsh
• Ethics and Conflicts of Interest: Samya Nasr
• Health Policy: Dona Upson
• Planning and Evaluation: Linda Nici
• Quality Improvement: Rick Robbins
• Research Advocacy: Linda Nici
• Training: Samya Nasr

Adjournment. The meeting was adjourned at 1:00 PM.

Richard A. Robbins

Arizona Chapter Representative

Reference as: Robbins RA. May 2013 council of chapter representatives notes. Southwest J Pulm Crit Care. 2013:6(5):239-40. PDF

March 2013 Council of Chapter Representatives Meeting and “Hill Day” Notes

March 18, 2013

As part of “Hill Day” the Council of Chapter Representatives meant on March 18, 2012 in Washington, D.C. beginning at 2:00 PM.

1. Welcome/Open meeting: Dona Upson 2:00 PM

Roll call determined there were representatives present from Arizona, Colorado, DC-Metro, Louisiana, Michigan, Mississippi, New York, and Washington. Linda Nicci, CCR Chair from Rhode Island, was delayed by weather and attended by conference call.

2. ATS Leadership Update 2:15pm

Presentations were given by Monica Kraft, ATS president, and Steven Crane, ATS executive director. Highlights of their presentations included –

• A discussion of hospitalists eligibility for critical care boards
• The ATS bottom line 
  • Bottom line was positive beginning in 2010 and growing in 2011 and 2012
  • Reserves have also increased (about 2/3 of a year)
• Ken Adler will serve 3 more years as editor of the “Red Journal”
• Annals of the ATS will be published shortly. It is hoped to be clinician friendly.
• A 3 year core curriculum aligned to ABIM’s exam has been posted on the ATS website.
• 2013 International Meeting
  • Over 5000 abstracts (1500 more than ERS and 3-4000 more than ACCP
  • 40% of revenue comes from ATS meeting
  • Registration down about 12% compared to San Francisco
• Some drop in membership in 2013 attributed to the meeting not in San Francisco and Hurricane Sandy delayed processing applications-expect numbers to rise
• ATS webinars have had over 1200 participants
• 8000 are following ATS on Facebook and Twitter
• ATS developing bridge funding for NIH grantees because of sequestration
• ALL money given to the ATS Foundation goes for research-no administrative costs

 3. Chapter Activity Update 2:40pm

• A handout was distributed with the 2012-13 Chapter Educational Meetings
• A brief discussion was held of the Chapter publications from Arizona and California
• Some inactive chapters showing renewed interest
• A brief discussion of ALA relationship and administration

4. Outstanding Clinician Award (OCA) 3:00pm

• The 2013 OCA finalists were from AZ, NM, WA
• The ATS OCA for 2013 is Allen Thomas, MD, Arizona

5. Committee Updates by CCR reps 3:15pm

• Verbal/written updates from CCR reps on committees they cover
  • Clinicians Advisory-Chris Fukui
  • Education-Linda Nici
  • Ethics and Conflict of Interest-Anthony Scardella
  • Health Policy-Dona Upson
  • Planning and Evaluation-Carol Welsh
  • Quality Improvement-Chris Fukui Wilhelm
  • Research Advocacy-Rajesh Bhagat
  • Training-Rajesh Bhagat

6. Advocacy Update - 3:45pm

Gary Ewart, ATS lobbyists, presented an advocacy update. Highlights included:

• Advocacy by CCR
• A review of the list of chapter ‘advocacy’ champions (CCR)
• An open discussion other (potential) advocacy initiatives

7. Future Activity/Additional Role of CCR 4:25pm

• Linda Nicci made a presentation.
• Highlights of the discussion included
  • Increased CCR presence at International Conference
  • Officers to commit to times in Clinicians Center and Fellows Center.
  • Review of CCR brochure
  • CCR/ATS Foundation Partnership
  • Report on CCR involvement with Better Breathing Alliance

8. Great Cases Symposium at International Conference – organized by CCR 4:50pm

A reminder and a brief discussion was held of the Great Cases Symposium Organized by CCR: Session A83: Great Cases: Clinical, Radiologic and Pathologic Correlations by Master Clinicians

9. CCR Meeting date in Philadelphia 4:55pm

A CCR meeting will be held in Philadelphia on Saturday, May 18 from 11:00 AM-1:00 PM.

10. There being no further business the meeting was adjourned 5:00pm

March 19, 2013

1. Presentations were made by James Kiley, Director of the Division of Lung Diseases, and several staff from Congressional including the Veterans Affairs and research related committees from 8 AM-10 AM.

2. Meetings with Congressional representatives were held throughout the day. The offices were presented with handouts advocating (Click on title to be directed to the handouts)

• Opposition to the “Cigar Bill” (H.R. 792)
• Repeal and replacement of the Medicare Sustainable Growth Rate Factor (SGR)
• Urging Congress to provide $32 billion for the National Institutes of Health for fiscal year 2014

Meetings with Arizona, New Mexico and Colorado representatives included:

 Arizona

• Michael Nelson from the Office of Senator Jeff Flake (R-AZ)
• Christopher Bowlin from the Office of Senator John McCain (R-AZ)
• Lliam Morrison from the Office of Representative Matt Salmon (R-AZ)
• Laurie Ellington from the Office of Representative Ed Pastor (D-AZ)

New Mexico 

• Sandra Wilkniss from the Office of Senator Martin Heinrich (D-NM)
• Representative Michelle Lujan Grisham (D-NM) and Kristin Palmer from her office
• Lauren Arias from the Office of Tom Udall (R-NM)

Colorado

• Representative Michael Coffman (R-CO and sponsor of the HR 792 tobacco bill) and legislative assistant Stephen Beck
• Jacquelyn White, health policy fellow from the office of representative Dianna DeGette (D-CO)
• Kristen Joyce legislative correspondent from the office of senator Mark Udall (D-CO)
• Rina Shah, legislative fellow from the office of senator Michael Bennet (D-CO)
• Morning coffee with Senator Michael Bennet (D-CO)

3. A dinner debriefing was held later that evening to discuss the advocacy efforts.

Richard A. Robbins, MD

Arizona CCR Representative

Reference as: Robbins RA. March 2013 council of chapter representatives meeting and "hill day" notes. Southwest J Pulm Crit Care. 2013;6(3):145-7. PDF