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Alopecia profoundly disrupts identity, emotional wellbeing, and social life, with many people struggling due to stigma, concealment pressures, and unmet psychological support needs.

Exploring Identity, Appearance Experiences Among Patients With Alopecia

Oral semaglutide (Wegovy; Novo Nordisk) expands GLP-1 weight-loss options, but pharmacy budgets and health care cost pressures persist.

5 Things to Know About the Oral GLP-1 Era

Mary Caffrey is the Executive Editor for The American Journal of Managed Care® (

®). She joined AJMC® in 2013 and is the primary staff editor for 

the multistakeholder publication that reaches 22,000+ oncology providers, policy makers and formulary decision makers. She is also part of the team that oversees speaker recruitment and panel preparations for 

®'s premier annual oncology meeting, Patient-Centered Oncology Care®. For more than a decade, Mary has covered ASCO, ASH, ACC and other leading scientific meetings for 

Mary has a BA in communications and philosophy from Loyola University New Orleans. You can connect with Mary on 

A study from Sweden, the largest of its kind, challenges the standard 24-month milestone as the key point when early relapse is a concern.

Even After 6 Years, Disease Progression Impacts Survival in Mantle Cell Lymphoma

Study links elevated serum haptoglobin to chronic spontaneous urticaria activity, suggesting it predicts treatment response and complete disease control.

Potential Predictor of Treatment Response in Chronic Spontaneous Urticaria Identified

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Mass spectrometry technology identified proteomic biomarkers of IPF, but more work will be needed to fully translate these findings to the clinic.

Proteomic Biomarkers Hold Promise in IPF

The approval was based on the pivotal phase 3 FIBRONEER-ILD trial, in which nerandomilast slowed lung function decline in PPF and had similar discontinuation rates to placebo.

FDA Approves Nerandomilast for Progressive Pulmonary Fibrosis

The 2025 American Thoracic Society International Conference brought advancements in pulmonary medicine and highlighted the need for health equity reforms.

ICYMI: Highlights From ATS 2025

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Study: People With PF Prefer “Blended” Patient Education Approach

Nerandomilast slowed disease progression at 2 doses compared with placebo among US participants in the trial.

Nerandomilast Shown Safe, Effective in IPF Among US FIBRONEER-IPF Subgroup 

CHEST Interview

Chronic obstructive pulmonary disease (COPD) presents a significant challenge for both patients and health care providers and discussions of effective management strategies took center stage at 

 in Boston. Daniel Howell, MBBS, MSc, clinical assistant professor at NYU Grossman School of Medicine, was one of 4 speakers discussing current therapies for COPD. In an interview, he shared what the session covered, including the latest evidence surrounding inhaler therapy, the optimization of management through home oxygen therapy, and respiratory muscle training, both of which play crucial roles in improving patient outcomes.

This transcript was lightly edited for clarity.

Can you provide an overview of the session you participated in "COPD: Making the Most Out of Current Therapies"?

Yeah, so this session was really trying to touch on various aspects of managing a patient with COPD. Firstly, we had a talk from Dr. [Sarah] Assaf from the University of New Mexico, and she touched on the data that go behind the use of triple therapy—that's with ICS [inhaled corticosteroid]/[long-acting β-agonist]/[long-acting muscarinic antagonist] combination inhalers.

This is an area that's been, I think, an area of focus because we have 2 bits of data to contend with. We have a reduction in moderate-to-severe exacerbations in those with COPD who have exacerbations. And then we also have an increased risk of pneumonia if you're using inhaled corticosteroids with COPD. So, for those patients not exacerbating, we tend to try to avoid the ICS. But in those who exacerbate, we tend to use it. But there's a little bit of uncertainty there: how do we look at the phenotype of the patient? Perhaps they have an inflammatory phenotype with high eosinophil counts in the blood. So, yes, she talked us through that. 

Then Dr. Jerry Krishnan from the University of Illinois spoke to us regarding roflumilast and azithromycin. These are 2 medications that reduce the risk of exacerbations in COPD. And he talked a little bit about the data behind those 2 medications and drug selection. This is something that he's studying in his RELIANCE trial, which he told us all about. 

Thirdly, Dr. [Nicola] Hanania from the Baylor School of Medicine spoke to us regarding home oxygen therapy and the data behind that. There is uncertainty with regard to the use in patients with exercise-only hypoxemia and some of the practical aspects around that. 

Then lastly, I spoke regarding respiratory muscle training in COPD. This was something that I wanted to focus on because I think, as pulmonologists, we think a lot about the lungs, and we don't think about what's just outside them. And actually, the mechanics of breathing, so how we breathe, is something that I think we need to focus a little bit more on. You know, not all dyspnea is just impairment of lung function. So dyspnea is something that's felt in the brain, and therefore there are central mechanisms that drive dyspnea. We have afferent fibers from the rib cage projecting into our sensory cortex that can drive dysthymia, the carbon dioxide chemoreceptors in the brain.

But also, if we think about the rib cage itself, and what happens with the COPD patient, both at rest and then worsens during exercise is that, because they have an increased expiratory lung volume, as they exercise, they are breathing closer and closer to their total lung capacity within a reduced inspiratory reserve volume, and that means that they have to work harder, right? So, the amount of pressure that they have to generate in order to get their desired tidal volume is a greater amount of pressure, a greater workload that the muscles are having to do, and this can therefore drive dyspnea. 

So, respiratory muscle training is a way that can help improve that mismatch between the ventilator requirements and the strength of the muscles to meet those requirements, given the physiology that I just described. We have respiratory muscle training as a group, and then we have inspiratory muscle training and expiratory muscle training. In the COPD space, inspiratory muscle training is what's been studied most, and we have a number of different devices available for that.

A threshold device requires a patient to overcome the load that you set a certain pressure in order to generate flow. It's able to precisely determine what the load is of the patient that they're having to overcome like this are setting the pressure resistive training devices. They basically work by having a smaller and smaller orifice through which you have to generate your flow that does depend on the work of the patient, right? And how much effort they put into it, their inspiratory flow, which is related to resistance. That can be a little bit more difficult...when something's effort-dependent, it can be a little bit harder to know what the patient is doing. But still, certainly something that there is a role for and you know, the isocapnic hyperpnea device is there something that we don't really tend to use just because it's a lot more effort for the patient.

Videos

Chronic obstructive pulmonary disease (COPD) management strategies were a focal point at CHEST 2024, with experts discussing current therapies. Key topics included the use of triple therapy inhalers, balancing exacerbation reduction with pneumonia risk, and the role of roflumilast and azithromycin in reducing exacerbations. Home oxygen therapy's efficacy, particularly for exercise-induced hypoxemia, was also examined. Additionally, respiratory muscle training was highlighted as a crucial component in addressing dyspnea, emphasizing the importance of inspiratory muscle training and the use of various training devices to improve patient outcomes.

Chronic obstructive pulmonary disease (COPD) presents a significant challenge for both patients and health care providers and discussions of effective management strategies took center stage at CHEST 2024 in Boston.

Conference

Providers

Dr Daniel Howell Details the Current Types of Therapies for Effective COPD Management

CHEST 2024

Hope is on the horizon for patients living with chronic obstructive pulmonary disease (COPD). 

 in Boston featured a session highlighting emerging bronchoscopic therapies. Traditionally, COPD management has relied on bronchodilators, pulmonary rehabilitation, steroids, and invasive options like lung transplantation or lung volume reduction surgery, leaving a gap in minimally invasive treatments.

Jonathan Kurman, MD, assistant professor of medicine at the Medical College of Wisconsin and the director of Interventional Pulmonology at Froedtert Hospital, presented on the topic and is an investigator in 4 of the ongoing clinical trials in their initiation stage. 

This transcript has been lightly edited for clarity.

What was the focus of your presentation on emerging bronchoscopic management of COPD at CHEST?

Our session was entitled "COPD Beyond Bronchodilators." The focus of our session was on bronchoscopic management of COPD, and this is an entirely new area. Historically, we've been reliant upon bronchodilators, pulmonary rehab, steroids, and then we've had much more invasive management strategies like lung transplantation or lung volume reduction surgery for patients who have severe emphysema. But we really haven't had anything in the middle, and with bronchoscopic interventions for COPD, now you have an entirely new category of treatment options that are minimally invasive. 

There is one that's currently available commercially in the US, that's bronchoscopic lung volume reduction, abbreviated BLVR most commonly, and that's implanting 1-way valves for patients who have emphysema with hyperinflation. That laid the groundwork for what's coming next. 

Now, for patients who wanted to pursue bronchoscopic lung volume reduction but were ineligible due to what's called collateral ventilation, which is simply airflow between the target lobe and the adjacent lobe or lobes, you're going to have bronchoscopic fissure completion, in which we instill a polymer sealant into the airway to remedy any visual defects. That's for emphysema. 

For our chronic bronchitis patients, we're studying bronchial rheoplasty and metered spray cryotherapy. These are both bronchoscopic treatment modalities that target goblet cell hyperplasia, which is the main pathology present in folks who have chronic bronchitis, and this helps decrease mucus hypersecretion—the primary driver of their chronic cough. 

The other big area of interest is reducing COPD exacerbation frequency. For this, we're studying targeted lung denervation, in which we use radio frequency energy to ablate the vagal nerve plexus in the bilateral main stem bronchi. This reduces some of the inappropriate feedback between the brain and the lungs that can precipitate bronchoconstriction inappropriately. 

All of the things I've talked about, except for bronchoscopic lung volume reduction, are currently in the clinical trial phase. But I'm hopeful that the trial data will be positive and that these treatment modalities will become part of standard commercial care in the near future. 

I know patients are very interested in this, and so they are learning about it. They're being proactive, and I imagine that they'll be inquiring about these modalities as they become more widely known. So, I just want providers to be aware of what's coming down the pike, both for their own knowledge and so that they can accurately respond to patient-driven inquiries.

Emerging bronchoscopic therapies offer new hope for COPD patients, bridging the gap between traditional treatments and invasive procedures. These minimally invasive options include bronchoscopic lung volume reduction (BLVR) using one-way valves, bronchoscopic fissure completion for emphysema, and bronchial rheoplasty and metered spray cryotherapy for chronic bronchitis. Additionally, targeted lung denervation aims to reduce COPD exacerbation frequency. While most are in clinical trials, these therapies could soon become standard care, prompting increased patient interest and necessitating provider awareness of these advancements.

Hope is on the horizon for patients living with chronic obstructive pulmonary disease (COPD). CHEST 2024 in Boston featured a session highlighting emerging bronchoscopic therapies.

Dr Jonathan Kurman Outlines Emerging Bronchoscopic Therapies for COPD

CHEST interview

 conference, a session on navigating pulmonary embolism (PE) highlighted research results regarding the timing of mechanical thrombectomy for acute pulmonary embolism. The team of investigators, which included Krunal Patel, MD, a pulmonary critical care fellow at Temple University Hospital, and Parth Rali, MD, FCCP, director of fellowship wellness and social media, Pulmonary and Critical Care Fellowship, and associate professor of thoracic medicine and surgery, Lewis Katz School of Medicine at Temple University, reviewed data from the FLASH registry, focusing on the efficacy and safety of thrombectomy devices. 

Patel explained that their research aimed to explore whether performing a thrombectomy within 12 hours of symptom onset yielded better outcomes than later interventions. The findings suggested that earlier intervention could significantly improve patient hemodynamics, hinting at the potential for new guidelines in the treatment of PE.

What were the highlights from your CHEST session focusing on navigating pulmonary embolism (PE)?

It was an interesting presentation. We were really talking about the FLASH registry database; there had already been recently published data called the FLASH registry. So, just doing a high-level review—it really looked at the efficacy of their mechanical thrombectomy catheter devices. It showed that it's a relatively safe product, had adverse effects of less than 2%, and had high-level mortality benefits. What we really wanted to check, Dr. [Parth] Rali—who's also one of my mentors and colleagues at Temple University—and I wanted to see whether early vs late mechanical thrombectomy had any sort of signal. 

We know mechanical thrombectomy works. I think now the next question is not whether it works or not or if it's safe—those answers have relatively been answered—it's more so timing. We know for cardiac, for MIs [myrocardial infarctions], the door-to-balloon time is about 90 minutes. So our kind of thought-provoking study was to determine if we can maybe figure out a signal to determine whether early, less than 12 hours, intervention vs slightly delayed, greater than 12 hours had any sort of positive signal. 

Were there any interesting findings from your research examining the influence of expedited mechanical thrombectomy on outcomes in acute pulmonary embolism?

Yeah, so you imagine the short [interval] group was slightly sicker. The average time in the short interval [intervention], which was 12 hours or less, was about 6 hours to intervention. Then, the longer group was about 24 hours to intervention. Even though we had stratified the 2 groups into short—from less than 12 hours and greater than 12 hours—the average was about 6 hours vs about 24 hours. And you can imagine that the shorter group was slightly sicker. 

But even when we kind of accounted for their level of acuity and level of sickness, still they had greater benefit in their hemodynamics; so their mean pulmonary artery pressures, their systolic pulmonary artery pressures, their 6-minute walk tests were all a lot better, even when we kind of calculated for these confounders. So, that was very interesting. It begs the question of whether we should be intervening on these patients at an earlier timeframe rather than slightly delayed.

Patel KH, Rali P. Influence of expedited mechanical thrombectomy on outcomes in acute pulmonary embolism: FLASH registry insights. 

Research presented at the CHEST 2024 conference examined the timing of mechanical thrombectomy for acute pulmonary embolism (PE) using data from the FLASH registry. The study, led by Dr. Krunal Patel and Dr. Parth Rali, focused on whether performing thrombectomy within 12 hours of symptom onset improved outcomes. Findings indicated that earlier intervention significantly enhanced patient hemodynamics, suggesting potential updates to PE treatment guidelines. The study confirmed the safety and efficacy of thrombectomy devices, with adverse effects reported in less than 2% of cases.

Krunal Patel, MD, Temple University Hospital, highlights CHEST 2024 data revealing why timing matters with acute pulmonary embolism (PE) intervention.

Dr Krunal Patel: New Research Explains the Impact of Early Mechanical Thrombectomy in Acute PE

 in Boston looked at the future of physician compensation, which highlighted the consolidation of physician practices, unionization of physicians, the future role of Current Procedural Terminology codes and fee-for-service payment in value-based care, and the impacts of facility 

Session chair Scott Manaker, MD, is a pulmonary critical care physician and the vice chair for Regulatory Affairs of the Department of Medicine at University of Pennsylvania Health System. In this interview, he discusses the critical junction of physician compensation amid shifting health care dynamics. Rising practice costs, inflation, and Medicare fee-for-service cuts over the past 4 years have reshaped the traditional practice model. Nearly 80% of physicians now work in employed settings, reducing their ability to negotiate contracts.

As more beneficiaries move to Medicare Advantage plans, the effectiveness of existing reimbursement models is increasingly questioned, especially as compensation has steadily declined—by 3% in recent years, with another 2.8% cut expected in 2025. These pressures are driving changes such as growing physician unionization and the decline of independent practices, signaling significant shifts ahead for the health care industry.

Can you discuss your CHEST 2024 session "The Future of Physician Compensation"?

I was asked to put together a session on the future of physician compensation. As you can imagine, the problem with predicting the future is it's difficult. So I gave a talk really looking at some of the macroeconomic and current trends that are going on that are adversely affecting physician reimbursement. That would include rising practice costs and inflation compared to, for the last 4 years, cuts in physician reimbursement in the Medicare fee-for-service program, the loss of independence by physicians who might have been in a private practice group and able to negotiate, whereas now, some estimates are as many as almost 80% of physicians are in a variety of employed models, whether they are for academic medical systems, venture capital and private equity, who are buying practices in a variety of medical specialties.  And even insurers, like Optum is the largest single employer of physicians in the United States, with I believe about 30,000 physicians in their direct employment. 

Other adverse economic trends are the shrinking of Medicare fee-for-service beneficiaries, where now more beneficiaries in Medicare are enrolled in the Medicare Advantage plans, rather than the fee-for-service program that winds up being largely negotiated contracts with a variety of payers. As you're well aware, payers will trigger off the Medicare fee-for-service system and pay a percentage, perhaps 80%, perhaps 120%, perhaps 220%, of the Medicare fee-for-service program, but it represents a different patient population with different outcomes as more and more articles are coming out and demonstrating. So the applicability of the reimbursement structure in the Medicare fee-for-service program may be increasingly disparate from the types of care that need to be delivered, both for Medicare Advantage patients, as well as in the variety of other insurance or health care coverages that are out there. 

I think the last point I would make is the Medicare fee-for-service program has reduced physicians’ compensation by about 3% for the last several years, with another 2.8% cut predicted for 2025. I don't think anyone can name a single industry where the workforce is paid less 4 years in a row, and you still have a stable workforce, which is leading to a variety of consequences, such as the extermination of physician private practices, physicians having a variety of employment models, physician unionization, which is burgeoning all across the country, not just for trainees, but for large physician groups. As an example, at Christiana Medical Center in Delaware, a 500-physician group recently just voted to unionize. And trends like that are increasing all across the country. I believe currently, only about 7% of physicians are in unions, but there's a rapid increase over the past year or two.

The future of physician compensation is being reshaped by economic pressures, including rising practice costs, inflation, and Medicare Fee-for-Service cuts. These factors have led to a decline in independent practices, with nearly 80% of physicians now in employed settings, limiting their contract negotiation power. The shift towards Medicare Advantage plans further complicates reimbursement models. Declining compensation has spurred physician unionization and the consolidation of practices. These trends indicate significant changes in the healthcare industry, with potential impacts on care delivery and physician workforce stability.

One of the first sessions to kick off CHEST 2024 in Boston looked at the future of physician compensation, which highlighted the consolidation of physician practices, unionization, the role of coding and fee-for-service payment, and the impacts of facility reimbursement, inflation, and market conditions.

Dr Scott Manaker Looks to the Future of Physician Compensation at CHEST 2024

Dr. Parth Rali 

There are multiple topics to be excited about participating in at CHEST 2024, according to Parth Rali, MD, FCCP, associate professor of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, director of Fellowship Wellness and Social Media, Pulmonary and Critical Care Fellowship, and director of the Pulmonary Embolism Response Team (PERT) Program, Temple University Hospital.

Rali is also an integral part of Temple Lung Center’s newly launched Pulmonary Vascular Disease Program, which provides comprehensive, expedited care for high-risk pulmonary hypertension and embolism cases, including mechanical support and lung transplant evaluations while extending outpatient services across multiple locations. With 11 active clinical trials and a strong focus on clinical research, the program serves as a leading resource for both complex patient care and advancing pulmonary vascular disease treatment.

In this interview, he highlights how the meeting's sessions focus on the spectrum of pulmonary vascular diseases, including pulmonary embolism and pulmonary hypertension, and emphasizes how this approach aligns with the practice at Temple University Hospital, viewing these conditions as interconnected rather than separate entities.

Are there any data, sessions, or trending topics that you're looking forward to at CHEST 2024?

Absolutely; I mean, CHEST is kind of our go-to conference for a lot of physicians like myself who are interested in pulmonary vascular disease. And what I mean by that is that people oftentimes group different diseases like pulmonary embolism and pulmonary hypertension and try to have specialization or expertise in one versus the other.

I think more and more we are realizing that both fall under the umbrella of pulmonary vascular disease. It's important because that's how we approach our patients locally at Temple Lung Center. And I think that's exactly how CHEST views pulmonary disease: as a spectrum. It starts with pulmonary embolism, which is more on acute RV [right ventricular] failure, and then you have advanced pulmonary hypertension [and] different vascular diseases that can get involved in the patients with lung center and lung diseases. And there are a lot of sessions happening on the spectrum. So, I think I'm super excited for those looking at the full spectrum of the journey of different sessions that will be covering this essential topic of pulmonary vascular disease in general.

One of the other things I'm excited about is that at Temple Lung Center we believe in training the next generation. I mean, that's what we do at an academic center; we want that. Yes, I'm good, or I may be doing great, but how do I reproduce [that knowledge]? How do we create a task force of pulmonology intensivists who will go out into the community and take the leap forward? And I think that's something that we take very seriously here at Temple Lung Center in our fellowship training program. 

Nothing makes me happier when my fellows go out to the conferences, work on the research data, and present that data. So, one of our fellows, Dr. [Krunal] Patel, will be attending the conference. Actually, we have 3 of our fellows were invited to attend a fellows course, which is always by invitation and selection—3 fellows have the opportunity to attend CHEST's fellows courses, where I'll also be teaching about pulmonary artery waveforms and pulmonary vascular disease states. But they'll be attending that course, and one of my fellows will be taking a scientific approach and has an oral presentation for his scientific abstract, where he has looked into the timing of a large board mechanical thrombectomy in patients with pulmonary embolism because sometimes we know that patient needs to be treated, but sometimes we don't know when we should treat that patient. Should we treat that patient right away? Should we treat that patient a few hours later? Is there any benefit? There's no guidance on that. 

It's the tip of the iceberg that we are scratching, but I think as we have more options and we have more teams involved, we also need to figure out when we should be doing those interventions: who can wait and who cannot wait? So, he's looking into some further details about benefits versus risks of doing intervention early versus waiting a few hours, and is there a difference? I'm excited to see what he has to present, but that's something that we have been working on for the last 6 months, that we will be presenting just this year.

Parth Rali, MD, Temple University Hospital, is looking forward to approaching pulmonary vascular diseases as a spectrum, especially when assessing pulmonary embolism and pulmonary hypertension, at CHEST 2024.

The Spectrum of Pulmonary Disease: Dr Parth Rali Highlights CHEST 2024 Agenda

Dupilumab Improves Lung Function, Type 2 Inflammation in COPD

, Klaus Rabe, MD, PhD, chest physician and professor of medicine at the University of Kiel, discusses the potential of dupilumab as a therapeutic option for patients with 

 (COPD) characterized by type 2 inflammation. He provides insight into the findings from the 

, where patients experienced improvements in lung function, and explores the mechanisms that may have contributed to this outcome, including changes in mucus production and airway smooth muscle.

The results of the BOREAS trial were presented at 

The European Respiratory Society (ERS) International Congress

, held September 7-11, 2024, in Vienna, Austria.

"The disease COPD is frequently characterized or described as being a disease where lung function is irreversibly damaged," Rabe explained in an interview with 

. "Irreversibility is a relative term, and for some individuals who are very much impaired, even small changes in the lung volumes would probably make a difference."

In the BOREAS trial, the primary end point—reducing exacerbations in patients treated with dupilumab—was successfully achieved. According to Rabe, what stood out was the rapid improvement in lung function that occurred within 2 to 4 weeks, which was both surprising and clinically meaningful. He further emphasizes that the underlying mechanisms behind this rapid improvement, such as mucus plugging or smooth muscle reversibility, still require more investigation.

Klaus Rabe, MD, PhD, chest physician and professor of medicine, University of Kiel, discusses improvements in lung function observed in patients enrolled in the BOREAS trial. 

Pulmonology

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