Hot in Journal CHEST® April 2019
Dr. Deep Ramachandran (@Caduceusblogger)
April 16, 2019
Each month, we ask our Social Media Co-Editors of CHEST to weigh in on the hot topics in CHEST. It's April, so let's hear from Dr. Ramachandran 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.
Social Media Initiatives by Medical Societies
I’m a proud member of the Social Media Work Group here at the American College of Chest Physicians® (CHEST). We’ve been a part of a larger group of health-care providers who have felt that it’s important that providers take the lead in using social media to help educate the public and each other. In this issue, the Social Media Collaboration of Critical Care Practitioners and Researchers (otherwise known as the SoMe-CCCPR group) published findings on engagement at yearly conferences of the Society of Critical Care Medicine, CHEST, and the American Thoracic Society.
They found large and statistically significant increases in several different metrics measuring social media participation. They also found that, contrary to conventional wisdom, the use of multiple Twitter feeds improved engagement. As such, the article goes on to make several best practice suggestions that medical organizations can use to enhance their reach.
Should pirfenedone be continued despite progression of IPF?
Patients with idiopathic pulmonary fibrois (IPF) can survive their disease longer if placed on pirfenidone. However, side effects can be difficult to tolerate. As such patients who experience continued progression of their disease may be inclined to ask, “Hey doc, is this stuff doing anything?” only to be met with “Maybe, yes.” In this post-hoc analysis (that’s Latin for “after hoc”) researchers looked at progression events, defined as reduction in FVC, decline in 6-min walk distance, hospitalization, and death during the ASCEND and CAPACITY studies.
They found that not only did IPF patients treated with pirfenidone have a reduced chance of experiencing one of the events, but they also had a reduced chance of experiencing a second event in comparison with placebo. Doctors who treat IPF can now answer the question “Is this stuff doing anything?” with a definitive “Probably, yes!”
What proportion of patients with COPD are seen by pulmonologists?
Chris is nice guy; his office sits on the other side of the wall that separates our two clinics. Chris is also immensely smart, which is good, since Chris is a cardiologist. We send each other patients in the way that cardiologists and pulmonologists often do. However, this study tells me that Chris has a secret that he probably doesn’t even know about. According to this study, Chris sees more COPD patients than I do. In this population-based study conducted in Ontario, nearly 900 thousand patients were identified with COPD. While about 10% saw a pulmonologist, patients with COPD were more likely to see a cardiologist and several other nonpulmonary specialists.
While not every patient with COPD needs to see a pulmonologist, the study also showed that even among patients with severe COPD, only about 50% saw a pulmonologist. It’s hard to know if the data can be generalized to other practice locations, but this certainly provides us with opportunities to do better. Earlier referral to pulmonologists might improve outcomes. Furthermore, primary care physicians and nonpulmonary specialists may benefit from training on how to identify and treat COPD as well as when a referral to a pulmonologist is appropriate.