American Thoracic Society

Can you answer the latest Wednesday Checkup? Post your answer in the comments then check back in on Thursday for the correct answer. A 3-month-old was born at 26 weeks gestation and required mechanical ventilation for the first 21 days of life. During her NICU stay, a moderate-sized patent ductus arteriosus (PDA) was discovered and treated with a course of indomethacin. After being liberated from mechanical ventilation, she required 0.25 LPM supplemental oxygen. She is being ...fed a 27-calorie formula by nasogastric tube every 3 hours. She has not had coughing or wheezing, but she demonstrates subcostal retractions on physical examination. Furosemide was added to her regimen because of intermittent crackles on auscultation accompanied by an increased supplemental oxygen requirement. You have been asked to monitor her diuretic regimen as she is discharged from the hospital. Which of the following is a complication that should be monitored in this patient? A. Persistence of patent ductus arteriosus B. Hypercalcemia C. Ocular toxicity D. Bronchoconstriction E. Hypoglycemia

Don’t miss the free webinar: The COVID-19 Pandemic and A Treatment Approach for Hospitalized Patients on 1/27 at 6:30pm ET. This program will cover the epidemiology of the current COVID-19 pandemic and show where demographic disparities exist. Information on the clinical trials, efficacy and safety data, and FDA labeling of a treatment option will also be presented. Register here: https://www.pathlms.com/american-thoracic-so/webinars/17786

True peace is not merely the absence of tension; it is the presence of justice.Martin Luther King Jr.

New podcast: COVID-19: Creating Safer Hospital Environments. IDSA Board member John Lynch, M.D., FIDSA, & SHEA/IDSA member Erica Shenoy, M.D., FIDSA discuss how to create safe environments across medical facility departments while treating COVID-19 patients. This episode was produced in partnership with the Society for Healthcare Epidemiology of America. Listen here: https://www.idsociety.org//covid19-creating-safer-hospita/

An ECMO machine can help save a person’s life, but it does not treat the disease or injury that led to the heart and lung failure. Learn more: https://www.thoracic.org//patie/resources/what-is-ecmo.pdf #ATSLungFact

Try to answer this ATS Quick Hits! A 3-year-old female initially presented with systemic onset juvenile idiopathic arthritis and macrophage activation syndrome, refractory to many biological agents. At age seven she developed exercise intolerance, chronic cough, nocturnal hypoxemia and marked digital clubbing. Along with her underlying disease that was poorly controlled, her respiratory symptoms gradually worsenedSee more: https://www.thoracic.org//clini/quick-hits/going-crazy.php

ATS 2020 registration is now open! Get access to all sessions and ePosters through November 10. Only $50 for members; $150 for non-members! Register now: https://conference.thoracic.org/attendees/index.php

Join the ATS on Wednesday November 18 at 12 pm ET for a Career Development Core Training webinar: Balance During COVID-19: Personal & Professional Development During the Pandemic. This webinar will review strategies for maintaining personal and professional balance during this global crisis. Register here: https://thoracic.zoom.us//tJAkdOqurD8vGtZeTeGbTu0HfB0UtKBo

There are several different categories of pulmonary hypertension (PH). These categories are important because they can determine which treatments may be the most effective for a PH patient. It is important for newly-diagnosed patients to find a PH specialist who can accurately find what is causing their PH and develop a treatment plan that is right for that specific type of PH as soon as possible.

Earn CME! Join the ATS on Tuesday, November 10, 89 pm ET for the next COVID-19 Critical Care Training Forum: Vaccine Development and Immune Responses in COVID-19. Register here: https://thoracic.zoom.us//tJYqdOytpzsjEtxiSbIjYO_IpT-LPiQ4

Can you solve this ATS Quick Hits? A 71-year-old female presents for evaluation of abnormal CT chest obtained as part of routine pre-transplant evaluation for end-stage renal disease secondary to isolated pauci-immune glomerulonephritis. See more: https://www.thoracic.org//not-all-that-glitters-is-bird.php

Visit the COVID-19 Real-Time Learning Network, an ATS collaboration with the Infectious Diseases Society of America and the CDC, for the latest information on fighting COVID-19, such as clinical guidance, institutional protocols, clinical trials data, and more: https://www.idsociety.org/covid-19-real-time-learning-netw/

Did you post an answer to the Wednesday Checkup? The correct answer is: B. Advise removal of the parakeet from the home and thorough cleaning of the environment Avoidance of further exposure to an identified antigen trigger is a top priority in devising a treatment regimen for hypersensitivity pneumonia. There are no prospective randomized controlled studies assessing the efficacy of appropriate drug treatment in fibrotic hypersensitivity pneumonia. A single randomized contro...lled trial in patient with acute hypersensitivity pneumonia showed a short-term benefit of corticosteroids with faster improvement of pulmonary gas exchange capacity (DLCO) in treated patients, but no differences in lung function at the end of the study. Low-quality retrospective data suggests that immunosuppression may benefit patients with progressive fibrotic hypersensitivity pneumonia. Antigen avoidance should be the first step in treatment of any patient with hypersensitivity pneumonia. References 1. Fernandez Perez ER, Swigris JJ, Forssen AV, Tourin O, Solomon JJ, Huie TJ, Olson AL, Brown KK. Identifying an inciting antigen is associated with improved survival in patients with chronic hypersensitivity pneumonitis. Chest 2013; 144: 1644-1651 2. Kokkarinen JI, Tukiainen HO, Terho EO. Effect of corticosteroid treatment on the recovery of pulmonary function in farmer’s lung. The American review of respiratory disease 1992; 145: 3-5 3. Morisset J, Johannson KA, Vittinghoff E, Aravena C, Elicker BM, Jones KD, Fell CD, Manganas H, Dube BP, Wolters PJ, Collard HR, Ryerson CJ, Ley B. Use of mycophenolate mofetil or azathioprine for the management of chronic hypersensitivity pneumonitis. Chest 2016.

Try to answer the latest Wednesday Checkup! Post your answer in the comments then check back in on Thursday for the correct answer. A 66 year old female has returned to the pulmonary clinic for follow up after undergoing a surgical lung biopsy for undifferentiated fibrotic interstitial lung disease. She originally presented for evaluation of 12 months of progressive dyspnea on exertion. The histopathology showed UIP-like fibrosis, along with patchy areas of cellular NSIP patt...ern, lymphocytic bronchiolitis, and loosely formed granulomas. She has received a tentative diagnosis of hypersensitivity pneumonia. Upon further questioning, she reveals that she has kept a parakeet in her home for the last 10 years. What is the first step in treatment? A. Initiate prednisone at a tapering dose B. Advise removal of the parakeet from the home and thorough cleaning of the environment C. Initiate azathioprine and prednisone at a tapering dose D. Recommend pulmonary rehabilitation exercise program E. Recommend close follow up and monitoring of pulmonary function every 3 months, with reconsideration of treatment strategy if she declines physiologically

Join the National Institutes of Health on Nov. 6 at 11am ET, for the Virtual SARS-CoV-2 Antiviral Therapeutics Summit, to discuss the progress and remaining challenges in developing antiviral treatments for COVID-19: Register and submit a question here: https://web.cvent.com//websitePage:4a9f1ae7-fd5e-40ea-a47b