Home CHEST Thought Leaders Hot in CHEST® January 2018

Hot in CHEST® Journal January 2018

By: Dr. Chris Carroll

Dr. Chris CarrollEach month, we ask Drs. Chris Carroll and Deep Ramachandran, Social Media Co-Editors of CHEST®, to weigh in on the hot topics in CHEST®. It's January, so let's hear from Dr. Carroll as he outlines his highlights. After reviewing the issue, be sure to share your hot list on our Facebook wall, tweet with the hashtag #journalCHEST, or discuss in the CHEST LinkedIn group.

Higher Priced Older Pharmaceuticals; How Should We Respond?

H.P Acthar Gel, a depot corticotropin injection has been in the spotlight recently. The medication has a “grandfathered” FDA indication for sarcoidosis, meaning it was approved in the 1950s when it needed to meet standards of safety but not necessarily efficacy. The drug has been a source of great controversy due to its astronomical cost of $35,000 per vial and a lack of convincing data that it works better than prednisone. 

In this editorial, stakeholders representing pulmonologists, sarcoidosis specialists, pharma, medical societies, pharmacies, and ethics committees give a multipronged response to the phenomenon of higher priced older pharmaceuticals. While I would count myself as an Acthar skeptic, there are some compelling arguments for a potential role for this drug in a small group of patients with refractory sarcoidosis. Is the argument enough to convince you to prescribe this drug?

Introducing TEACH: CHEST’s Teaching, Education, and Career Hub

This new section in CHEST®, to quote their introductory article, “will bring increased visibility to the science and practice of teaching and provide prominent peer review publication opportunities to those carrying out educational research in our field”. The new section will be headed up by new Section Editors Gabriel Bosslet, MD, FCCP, and Matthew Miles, MD, FCCP. We look forward to seeing this unique feature to CHEST® in coming issues.

SIRS vs Sepsis-3

In 2016 the Society of Critical Care Medicine and the European Society of Intensive Care Medicine published new proposed sepsis guidelines; Sepsis-3, otherwise known as Third International Consensus Definition of Sepsis and Septic Shock. These guidelines proposed moving beyond the use of SIRS criteria, which were thought to provide inadequate specificity, in favor of new criteria, which instead concentrate on identifying sepsis via organ dysfunction using the SOFA score. The move has not been without controversy. 

As highlighted in this editorial by Steven Simpson, MD, FCCP, moving away from SIRS criteria surrenders a significant amount of early detection. Dr. Simpson provides a nice overview of the history of Sepsis-1, SIRS scores, and somehow masterfully manages to avoid any bad puns about the “uncomfortable SOFA.”

Classification of Cough

Is it coincidence that CHEST® just happens to publish this updated cough management algorithm at the junction of Fluvember and Coughuary? Of course it is, we’re doctors, not marketers! If we were marketers we would tell you that you need to purchase this CHEST-branded Ladies’ Port Authority Full Zip Fleece Jacket. But we’re not, telling you that. In fact we’re telling you NOT to buy it because it’s far too warm and comfy.

In any case, in this article, definitions for acute, subacute, and chronic cough are presented, which help classify patients in different management strata. Definitely not opportunistic at all.