Jack D. Buckley, MD, MPH, FCCP -- President CHEST 2024, Western Michigan University Stryker School of Medicine

My name is Jack Buckley. I am a pulmonary and critical care physician and have the distinct honor of being president of Chest for 2024. My home is in Kalamazoo, Michigan, where I'm on faculty as a professor at the Western Michigan University Stryker School of Medicine.

The main themes of our meeting this year were our traditional themes of an expanded focus on education and having a variety of educational sessions and tools for an extremely diverse group of learners.

But this year, we put a greater emphasis on a very important theme centered around health equity, part of our mission of social responsibility. And that was apparent in a number of and a variety of activities and sessions that we hosted this year.

We had a couple of terrific sessions. They were actually hosted by the editors of our journals. So, for example, we had a terrific session hosted by Dr. Matt Miles, who is the editor of Chest Pulmonary, and he was able to interview the lead author of a fantastic research study that explored using invasive cardiopulmonary exercise testing and identifying distinct subgroups of independent types for people who've had long Covid.

The researchers used these invasive cardiopulmonary exercise tests that actually measure metabolism and oxygen use and production and durability and their anaerobic thresholds to help identify these very different groups surprisingly. And it helps help us distinguish. Long Covid is not just one thing we're discovering, it's multiple things. And this can help differentiate these patients into very specific groups based on physiology, not just their symptoms.

Then probably our other big research session that really kind of popped for the audience was when our editor in chief of our flagship journal Chest Dr. Peter Mazzone and I had a chance to review the results of a fascinating study on a treatment using a newer medication in the treatment of pulmonary sarcoidosis.

The study sheds some light on the efficacy of the medication (Efzofitimod) and balances that against the side effect profile so that the clinicians can make some more informed decisions about when and how to use this medication as it becomes available for the treatment of the patients with sarcoid.

I think the advances that we've had and the discovery of various new biologic agents and biomarker testing is just getting started, I'm convinced. And so, we've already had some spectacular discoveries around the roles and treatments around different types of asthma and different types of COPD. You don't lump them all together in the same group. They have very distinct groups within them and some patients can really respond to very specific new therapies that can make a dramatic impact in a patient's life

And then the other big area, I think what's going to be an exciting year is going to be in the area of lung cancer. So, with lung cancer, not only have we made some terrific advances in the treatment of lung cancer and using newer targeted therapies for these folks with these newer medications, but we also have a slew of research going on in the area of biomarkers to help us diagnose lung cancer at a much earlier stage. And you add that on to some of the advances we've had in an earlier diagnosis with better lung cancer screening ad we can use some of these newer biomarkers to help us identify these diseases at an earlier stage. And obviously, when you can identify lung cancer early, you have a much better chance of cure and treatment.

Environmental, Social and Health Disparities between Rural and Urban Women with COPD in a National Cohort

Arianne Baldomero, MD -- Minneapolis VA, Asst. Professor University of Minnesota School of Medicine and Public Health

My name is Arianne Baldomero. I am a staff physician at the Minneapolis VA and assistant professor at the University of Minnesota in the Department of Pulmonary Allergy, Critical Care and Sleep Medicine.

Our research is particularly motivated by a report from the CDC Morbidity and Mortality Weekly report showing rising mortality rates for rural women with COPD between 1999 to 2019. And this is in stark contrast to the declining rates for men and urban women.

The reasons behind this is unclear, so we aim to explore whether environmental, social and health disparities are driving these worsening outcomes among these rural women with COPD.

Our study was conducted using retrospective analysis, using real world health care data from the National Veterans Health Administration, including over 50,000 women with a diagnosis of COPD between 2016 and 2019. And then we applied the CDC Environmental Justice Index, which evaluates the impact of 36 environmental, social and health factors, providing a comprehensive view of the burden faced by these women with COPD in different geographic locations.

It was most striking, the difference between rural versus urban women with COPD with regards to social vulnerability index. And particularly these rural women with COPD lived in areas with higher poverty, fewer diplomas, high school diplomas, lower broadband Internet access, and lived in more mobile homes compared to their urban counterparts.

In addition to this, the rural women with COPD lived in neighborhoods where there's higher burden of other health care conditions compared to urban Women with COPD. And what I mean by that is they live in areas where there's more individuals with asthma, high blood pressure, cancer, diabetes and mental health issues.

Policy policymakers should think about health care infrastructures in these communities. So particularly what we find here is that there is a significant contrast in terms of broadband access, Internet access. And in the world in this time where telemedicine is such a vital part of our care, everyone should have access to this. and then increasing provider ability, availability and in being able to go to services that you need, for example, pulmonary rehab and of course enhancing insurance coverage. Those are among the most important things that we need to think about as community policy makers.

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