Day 1 :
The University of Texas MD Anderson Cancer Center, USA
Time : 9:50-10:20
Vickie R Shannon holds MD from Washington University and is triple certified by the American Board of Internal Medicine in Internal Medicine, Pulmonology and Critical Care. Her research and clinical works in the area of pulmonary rehabilitation in cancer patients has made her a much-sought-after speaker and mentor to students interested in pursuing careers in medicine. In 2006, she launched an innovative pulmonary rehabilitation program at MD Anderson Cancer Center for cancer patients who suffer from compromised pulmonary function and performance status. Her primary clinical interests include chemotherapy and radiation-induced lung injury, lung injury in the immunocompromised host and pulmonary rehabilitation.
Statement of the Problem: Evidence-based support for pulmonary rehabilitation (PR) in the management of patients with chronic lung disease has grown tremendously. A beneficial role has been largely shown among patients with chronic obstructive pulmonary disease (COPD) and patients with pulmonary emphysema enlisted for lung volume reduction surgery. In these settings, significant reductions in dyspnea and improvements in exercise performance and health-related quality of life have been demonstrated following a program of PR. PR is often advocated as an adjunctive intervention in patients with cancer. Recent small studies suggest that PR may favorably impact lung cancer management by improving a variety of clinically meaningful outcomes, such as performance status, chemotherapy-related fatigue, oxygen consumption, exercise tolerance, and health-related quality of life. However, the true benefits and safety of this intervention in the cancer setting remain in question.
Purpose of the Study: To determine the role and safety of PR in improving chronic symptoms of dyspnea, fatigue and/or exercise intolerance in patients with hematologic and solid malignancies.
Methods: Patients with active hematologic or solid malignancies who were referred to the pulmonary service for evaluation of chronic dyspnea and/or decreased functional status were placed in our outpatient PR program and prospectively studied. Baseline clinical evaluation and functional status, including 6-minute walk distance (6 MWD), cardiopulmonary exercise testing (CPET) and self-reports of perceived exertion and dyspnea were used to develop an individualized exercise prescription and PR program for each patient. All studies were repeated upon program completion. The 12-week program encompassed thrice weekly progressive aerobic and resistance training sessions and weekly didactic educational and psychosocial components.
Results: PR program participation significantly increased the mean 6MWD distance (23%, P<.05) and oxygen consumption, as assessed by VO2 (18.6%, P<0.05). Dyspnea and perceived exertion scores were similar at pre- and post-rehabilitation despite greater post-rehabilitation physiologic work. Significant improvements were seen among patients with liquid and solid malignancies. No adverse events occurred during the study.
Conclusion: Pulmonary rehabilitation appears safe and shows promise as a therapeutic intervention in the management of a heterogeneous population of oncology patients with debilitating pulmonary symptoms.
Florida International University, USA
Keynote: The use of surrogate end points in pulmonary arterial hypertension: Enhancing clinical decision making by improving time to clinical worsening observations
Time : 10:20-10:50
Keith J Robinson is an Associate Clinical Professor with Florida International University practicing with Pulmonary Physicians of South Florida, LLC. He has completed his Medical training from Indiana University, his Residency in Internal Medicine from The University of Florida, Jacksonville, FL, and his Fellowship in Pulmonary/Critical Care Medicine from the University of California, CA.
Pulmonary Arterial Hypertension (PAH) is defined as a mean pulmonary artery pressure (mPAP)>25 mmHg at rest and >30 mmHg during exercise. Available pharmacologic therapies target pre-capillary disease by reducing pulmonary artery (PA) pressures. The effects of relaxing the PA, mitigates right heart failure caused by prolonged elevation in PA pressures. Early recognition and intervention in clinical deterioration is paramount towards maintaining exercise capacity, quality of life (QOL) and survival in PAH, but current clinical end points are limited in their predictive ability to reduce the latency in time to clinical worsening (TTCW). Field tests such as the 6 minute walk test (6 mwt), cardiopulmonary exercise testing (CPET) and the incremental shuttle walk test (ISWT) are simple to perform, validated means to measure response to intervention and correlate with invasive right heart catheterization data, which is the gold standard measure of PAH. However, clinically significant changes in these field tests, after intervention, have not demonstrated improved morbidity, hospitalization or need for the initiation of rescue therapy. Newer surrogate markers of disease, such as the tricuspid annular plane systolic excursion (TAPSE) and cardiac MRI, allow noninvasive measurement right ventricular (RV) function and demonstrate prognostic ability in PAH. However, imaging studies lack the ability to predict time to worsening heart function, due to lack of correlation with exercise capacity information. Physical activity, assessed by steps taken per day, is a cost effective therapy improving QOL and correlates with exercise capacity measurements obtained during field testing. Unfortunately, measuring physical activity is limited due to concerns exercise training may increase the risk of adverse clinical events. Optimum management of PAH, centers on preservation of RV function by early treatment of PA elevation and early detection of changes to PA pressure, prior to patient report. This goal requires movement away from outdated clinical trial designs and combining surrogate end points that detect changes in physical activity, which may predate loss of RV function.
Ohio State University College of Medicine, USA
Time : 10:50-11:20
Shahid Sheikh is currently working as an Associate Professor of Pediatrics at Ohio State University College of Medicine in the Divisions of Pulmonary Medicine and Allergy and Immunology. He is also working in the Department of Pediatrics in the Nationwide Children’s Hospital, USA.
Asthma is a common chronic disease of childhood. In the United States alone, asthma affects about 5 million children, with an estimated annual cost of more than $4 billion and prevalence of asthma is rising. Adoption and adherence to asthma guidelines is still less than optimal. Strategies to improve clinical outcomes depend heavily on educating primary care physicians. In busy primary care practices, physicians lack time educate parents on preventive asthma management plans. Thus it is important that, in addition to physicians, other medical personnel such as nurses and nurse practitioners be a part of patient/family education to improve self-management of asthma. Once trained, they can help implement preventive clinical management plans, educate patients and families, and ensure that patients are on appropriate therapies to achieve adequate asthma control. We are working on this model for last four years at our Institution and I can share results and outcomes.