Sessions focus on pulmonary, critical care, sleep medicine

One of the great strengths of the ATS International Conference is that it’s multidisciplinary. Throughout ATS 2012, you can immerse yourself in a wealth of offerings within the Society’s three pillars—pulmonary, critical care and sleep medicine. Whether you choose topics in all three pillars or focus on just one pillar, ATS 2012 offers the latest trends in treatment, leading to improved patient care. What follows is a selection of today’s programming in pulmonary, critical care and sleep medicine. Additional suggestions for each day’s offerings will be included in the Monday and Tuesday issues of the ATS Daily Bulletin.

Pulmonary sessions
8:15 to 10:45 a.m.
A7 Airway Remodeling and Hyperresponsiveness in Asthma: What Are They and What Can We Do About Them?
Rooms 2005-2007, West Building  (Level 2), Moscone Center
Leaders in the field of airway disease will present the rapidly evolving new data on the underlying mechanisms of airway remodeling and airway hyperresponsiveness in asthma. They will describe how to identify and measure hyperresponsiveness, remodeling and airway hyperresponsiveness after an allergen challenge in asthma, ventilation heterogeneity as a major determinant of airway hyperresponsiveness in asthma independent of airway inflammation, remodeling of airway smooth muscle, the interaction of the airways and parenchyma during bronchoconstriction and the effect of bronchoconstriction on airway remodeling in asthma.

8:15 to 10:45 a.m.
A9 Epigenetics at the Crossroads: The Intersection Between the Lung and the Environment
Rooms 3020-3022, West Building (Level 3), Moscone Center
This course is a timely presentation of pulmonary epigenetics. The introduction will provide an overview of supporting evidence for the investigation of epigenetic modifications in understanding the environmental impact on the plasticity of the human genome. The course will highlight the epigenomic impact of air pollution, allergens and tobacco smoke in the context of large epidemiology studies. DNA methylation data from asthma, chronic obstructive pulmonary disease (COPD) and interstitial lung disease studies will be presented, together with a summary of the statistical challenges of large-scale epigenomics. Lastly, data from the Lung Genome Research Consortium will be presented, including details about public access for interested investigators.

8:15 to 10:45 a.m.
A11 Adult Cystic Fibrosis: The Essentials
Room 2005-2007, West Building (Level 2), Moscone Center
Over the past decade, there have been substantial changes in our understanding of the pathophysiology of cystic fibrosis (CF). This symposium will provide an in-depth review of managing adults with cystic fibrosis. Discussions will focus on the recognizing and diagnosing late presentations of late CF, maintenance treatments for CF lung disease, diagnosis and management of CF pulmonary exacerbations, management of end-stage CF lung disease, management of non-pulmonary CF and the future of genotype-specific cystic fibrosis transmembrane conductance regulator modulation therapy. This will be of particular interest to pulmonologists who look after patients with cystic fibrosis outside of specialized CF centers.

2 to 4:30 p.m.
A89 Novel Inflammatory and Repair Pathways in Chronic Obstructive Pulmonary Disease (COPD)
Room 2006-2008, West Building (Level 2), Moscone Center
COPD is a condition with significant morbidity and mortality worldwide. A large burden of this mortality stems from ongoing inflammation and dysregulated repair. Recent evidence suggests unique mechanisms regulating these responses in the COPD lung disease. This session will focus on the delineation of these pathways and their potential for therapeutic targeting in COPD. Speakers will tackle inflammation and fibrosis, mTOR signaling as a novel pathway of lung injury and emphysema, regulation of the novel matrikine—PGP—in lung disease, proteases regulating extracellular matrix turnover in COPD, Alpha Nu Beta 8 integrin-mediated immune and fibrotic response in COPD, targeting repair in emphysema via Wnt/Beta-catenin signaling pathway, the importance of molecular pathways and subgroup phenotyping in therapeutics and COPD.

Critical care sessions 
8:15 to 10:45 a.m. 
A4 What Do You Do Now? Clinical Challenges at the Edge of the Evidence
Rooms 303-305-307, South Building (Esplanade Level), Moscone Center
Most sessions on clinical practice focus on reviewing the evidence base for different areas. But what should be done when there is no more evidence? This session will examine five common clinical scenarios, with a review of available evidence and expert opinion on how to approach the problem when the patient is failing despite best evidence-based practice. Master clinicians will propose criteria for deciding when to stop standard therapy. They will also discuss how to communicate and resolve a disagreement with family members about care.

12 to 1 p.m.
MP408 Role of Pulmonary Intensivist in the Paradigm of Accountable Care Organizations
Room 224, South Building (Mezzanine Level), Moscone Center
Healthcare administration and finance is under tremendous upheaval with many imminent changes in the air. The idea of accountable care organizations as gatekeeper structures is receiving much attention. However, how a pulmonary intensivist subspecialist might fit into this paradigm is entirely unknown. This meet the professor session will offer a platform for review of key imperatives and concepts that will affect the specialty.  In addition, it will offer an opportunity to generate discussion within ATS advocacy groups. Pre-registration is required, and attendance is limited. The course fee is $70.

12 to 1 p.m.
MP410 Achieving Zero CLABSI Rates in Your ICU
Room 236, South Building (Mezzanine Level), Moscone Center
This meet the professor session will describe the success of Michigan’s Keystone ICU project in decreasing and keeping low the rate of catheter-associated bloodstream infections. The emphasis will be on how the lessons learned from Keystone ICU may best be implemented in the ICU. Pre-registration is required, and attendance is limited. The course fee is $70.

Sleep sessions
8:15 to 10:45 a.m.
A18 Obstructive Sleep Apnea: Interventions and New Associations
Rooms 3001-3003, West Building (Level 3), Moscone Center
This mini-symposium will highlight the latest findings in sleep-disordered breathing as a role in cancer mortality, including results from the Wisconsin Sleep Cohort Study, in which researchers found that cancer mortality rates were directly related to the severity of the disorder. Patients with untreated severe obstructive sleep apnea were nearly four times more likely to die of cancer than those who did not have sleep apnea. These findings are supported by a murine model of sleep apnea that found that intermittent hypoxia increased tumor growth in lean mice, which will also be presented during ATS 2012. In addition to seven other abstracts, a featured talk will highlight “OSA and Cardiometabolic Function: Challenges From the Maternofetal Model.”

2 to 4: 30 p.m.
A87 Arrhythmogenesis and Cardiac Disease in Sleep-Disordered Breathing: Mechanisms and Clinical Implications
Rooms 2009-2011, West Building (Level 2), Moscone Center
This symposium will provide an overview of recent developments in exploring the relationship between sleep-disordered breathing and cardiac risk, particularly arrhythmias. Discussion will include novel data on electrophysiologic markers and an update on the influences of the autonomic nervous system. Alterations in subclinical electrocardiophysiologic markers, atrial/ventricular arrhythmias and structural heart disease and their relationship to sleep disordered breathing will be discussed. The translation of such findings to the bedside will be discussed, as emerging data influence treatment decisions in the care of patients with sleep apnea. Two abstracts are based on the ongoing German study—Sleep-Disordered Breathing in Patients with Stable Chronic Heart Failure, or SchlaHF. Among other conclusions, the studies found that heart failure is linked to the severity of sleep-disordered breathing and that age, obesity, severity of heart failure and being male are clinical predictors of sleep-disordered breathing.