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CHEST 2008, Oct. 25-30, 2008

American College of Chest Physicians Annual Meeting

CHEST 2008, the annual meeting of the American College of Chest Physicians, took place Oct. 25 to 30 in Philadelphia, featured more than 500 prominent national and international speakers, and attracted attendees from its international membership of 17,000. Highlights included sessions on disparities in medical care and the controversy over the use of anticholinergic medications in chronic obstructive pulmonary disease.

"We had several sessions that addressed disparities in medicine, which are most pronounced in conditions such as asthma, chronic obstructive pulmonary disease, lung cancer and sleep apnea," said scientific program chair Suhail Raoof, of New York Methodist Hospital in Brooklyn, N.Y.

Among them was "Overcoming Health Disparities: The Philadelphia Experience," which addressed the importance of providing information that is culturally sensitive, health literacy-appropriate, and language-specific to help patients in different racial, ethnic, and socioeconomic groups manage their health and access health care resources. "Philadelphia is a model city because of its high poverty rate," Raoof said.

One of the meeting's best-attended sessions -- a late-breaker entitled "Are Heart Attacks a Side Effect of Anticholinergic Inhalers?" -- featured the authors of two recent studies published in the Annals of Internal Medicine and the Journal of the American Medical Association, which showed that the use of medications such as ipratropium and tiopropium is associated with an increased risk of cardiovascular death. The session also included an author of a recent industry-sponsored study published in the New England Journal of Medicine which disputed these findings.

R. Graham Barr, M.D., of the Columbia University Medical Center in New York City, moderated a discussion aimed at comparing these discrepant studies. "The possible explanations for the conflicting results that we are seeing include study design differences, patient differences, outcome assessment, drug differences, different hypotheses, and even chance," Barr said in a statement. "Anticholinergics have predictable beneficial and adverse effects. Risk-benefit decisions are best informed by randomized controlled trial data. So, further objective evaluation of the safety of anticholinergics in randomized controlled trials is necessary."

"It was a herculean effort to put this session together," Raoof said. "It allowed the membership to hear the data, see the biases and discrepancies, and come up with their own conclusions about this contentious issue. Some clinicians who have been using these medications for long periods of time and have not seen any significant side effects may continue their practices unchanged. Others who are treating patients with mild chronic obstructive pulmonary disease who also have significant heart disease may reassess the use of anticholinergic medications. But we didn't want to reach a consensus because it's too early. The college has not taken any position on this hotly debated issue."

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Among the new features at this year's meeting was an expanded literature review covering 16 topics in pulmonary critical care medicine, sleep, and related subjects that was moderated by editors and associate editors of medical journals. "For each topic, leading experts selected the year's 10 most important articles, discussed five of them at length, and provided brief excerpts and references for the other five," Raoof said.

Other popular features included six medical simulation sessions that allowed participants to gain hands-on experience in situations involving complex airways, critical care, and polysomnography. "The college is a leader in medical simulation," Raoof said. "This is where medicine is headed for the purpose of accreditation and competency assessment."

The meeting also introduced new sessions called "Clinical Case Puzzlers," which included eight topics such as solitary pulmonary nodules. "Each session put into perspective the clinical, radiographic and pathological features," Raoof said. "The sessions were very close to what clinicians have to deal with on a day-to-day basis. We had anywhere between 100 and 140 clinicians attending each session."

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