Raed A. Dweik

This year’s ATS Clinical Practice Guidelines will spotlight the latest evidence-based clinical recommendations on idiopathic pulmonary fibrosis, malignant pleural effusions, obesity in OSA, fungal infections, and pediatric supplemental oxygen.

Now in its fifth year, this annual scientific symposium comprises recently approved or published clinical guidelines formulated by a panel of experts. Session Co-Chair Raed A. Dweik, MD, ATSF, chair of the ATS Documents Development and Implementation Committee and chair of the Respiratory Institute at Cleveland Clinic, will lead panelists in a discussion about the guidelines’ foundation for improving care, the rationale for each, and review the evidence supporting each recommendation.

“All guideline recommendations are intended to improve patient outcomes. This is because a recommendation indicates that the benefits to patients exceed the potential harms, burdens, and costs,” Dr. Dweik said. “ATS Guidelines use a rigorous, systematic, scientific approach to synthesize evidence. The evidence is then used to inform recommendations that are intended to address true clinical uncertainties and help patients and clinicians.”

The session’s guidelines will cover four basic areas, including which population to treat, treatment type, which population to test, and test type. Randomized trials, observational studies, and accuracy studies provide the details to these discussion points. Occasionally, there is no study, and recommendations are made based upon uncontrolled studies and/or non-systematic clinical observations.

Judgments about interventions are based upon the body of evidence, not individual studies, according to Kevin C. Wilson, MD, ATSF, ATS document editor and featured speaker at the session. The ATS uses the Grading, Recommendations, Assessment, Development, and Evaluation (GRADE) approach to rate the quality of evidence as high, moderate, low, or very low. The quality of evidence indicates the confidence that the committee has in the estimated effects.

Panelists will discuss:

• Diagnosing idiopathic pulmonary fibrosis: Guidelines recommend bronchoalveolar lavage and surgical lung biopsy for patients, whose high-resolution CT scan of the chest and multidisciplinary decision-making is consistent with probable usual interstitial pneumonitis, indeterminate for UIP, or suggestive of an alternative diagnosis.
• Treating malignant pleural effusion: Guidelines recommend the use of ultrasound-guided interventions, using talc poudrage or talc slurry for chemical pleurodesis, using an intrapleural catheter instead of chemical pleurodesis in patients with non-expandable lung or failed chemical pleurodesis, and treating intrapleural catheter-associated infections with antibiotics while not removing the catheter.
• Treating obesity in OSA: Guidelines recommend a comprehensive behavioral intervention consisting of diet, exercise, and behavioral therapy.
• Pediatric home oxygen therapy: Guidelines recommend oxygen for hypoxemic children with cystic fibrosis, bronchopulmonary dysplasia, pulmonary hypertension without congenital heart disease, interstitial lung disease, and some patients with sickle cell disease or sleep-disordered breathing.