Septimiu D. Murgu, MD, FCCP

This session will review the indications, contraindications, outcomes, and potential adverse events related to fundamental bronchoscopic techniques.

List the safety issues and techniques of bronchoscopy in special populations: pregnancy, severe asthma, COPD, OSA, and heart disease.
Enumerate four techniques for managing massive airway bleeding.
Mention the expected results and complications from BAL, brushings, and endobronchial and transbronchial biopsy.

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Peter Mazzone, MD, FCCP

During this session, we will review the evidence of benefit and harms from lung cancer screening and discuss how implementation could impact this balance. We will highlight some practical issues in establishing a lung cancer screening program.

Describe the benefits and harms of low-dose CT scan-based lung cancer screening.
Discuss the implementation of a high-quality lung cancer screening program.

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Francesco Blasi, MD

The epidemiology and natural history of cystic fibrosis (CF) is changing. In most western countries, the predicted median survival increased, over the past 5 decades, from less than 12 to more than 45 years with an estimated increase of the number of adult patients in the next decade of about 75%. Adults with CF major complications, from life-threatening respiratory infections to respiratory failure, lung transplantation and end-of-life management. New challenges include microbiology with a very high prevalence of multidrug-resistant pathogens, the use of CFTR modulators, including the role of these drugs in transplanted patients, and age-related complications (diabetes, osteoporosis, cancer, cardiovascular events). Considerable expertise is required to ensure all patients receive a high standard of care, with optimized drug and physical treatments and appropriate and holistic integration and management of the care of CF disease in other organ systems. These challenges generate new training needs and require renewed efforts in education and training to recruit and retain the next generation of CF specialists.

Improve the knowledge of advances in care delivery and on the use of new antibiotics, mucoactive drugs, correctors, and potentiators in the treatment of adult CF patients.

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Patricia Rocco, MD

Pharmacotherapy for ARDS has been tested in preclinical and clinical studies. However, to date, no pharmacologic interventions have proven effective. Personalized medicine targeting the different ARDS phenotypes has emerged as an option to improve survival.

ARDS pathophysiology and the main pharmacologic agents that may counteract certain pathophysiologic features will be discussed. Furthermore, the importance of personalized medicine in improving the therapeutic approach to ARDS will be addressed.

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Giulia Veronesi, MD

Understand indication to screening and selection of high risk individuals.
Learn risks and benefits of LC screening.
Understand the diagnostic algorithm to reduce false-positive cases.
Learn stage distribution of screening cancers and indication to lung-sparing minimally invasive surgery.

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Lung cancer still ranks first in Italy in terms of mortality, while it is the third in number of cases after colorectal and breast cancers. Survival at 5 years after diagnosis is just under 16% and is inexorably burdened by the fact that a large proportion of the diagnosis is made when the cancer is at an advanced stage. An examination such as spiral CT scan could capture millimeter lesions that a surgical operation could remove, definitely improving the prognosis of the disease. And, this is the exam that should become part of the screening programs according to a risk stratification approach. The spiral CT scan is the only method supported by scientific evidence for the early diagnosis of lung cancer associated with a reduction in mortality. In Europe, the time is ripe to start a lung cancer screening program. SMAC (Smokers health Multiple Actions) is a prevention program in Italy for smokers or ex-smokers whose objectives are testing a reliable method of recruiting a population at risk in collaboration with family doctors and integrate a prevention program of different smoking-related diseases of the respiratory system, primarily emphysema and COPD, but also those affecting the cardiovascular system, such as heart attack and stroke. The SMAC program involves the performance of some tests, including coronary calcium at low-dose CT scan and spirometry, antismoking activity. The program also plans to study molecules and blood cells in order to develop non-invasive methods for the early detection of tumors and to develop a computerized program for the automatic diagnosis of pulmonary nodules. The correct management of small nodules detected at screening is critical to avoid risk of overdiagnosis and reduce false-positive cases at surgery. In addition, surgical resection is becoming more and more conservative.

Bartolome R. Celli, MD, FCCP
Richard Casaburi, MD, PhD, FCCP
Francesca Polverino, MD, PhD

Italians have contributed significantly to the advancement of medicine in general and respiratory diseases in particular. The role of Italians of different migratory generations have enrichened the landscape of respiratory diseases in the United States. In particular, the personal experience and academic contribution of three current clinician-scientists of Italian origin attest to the constructive role played by this ethnic group in the context of the diverse society in which we live.

Provide an overview of the contribution of Italians to medicine in general and respiratory medicine in particular.
Provide a first-hand experience of three clinical-scientists of Italian origins in the respiratory medicine landscape in the United States.

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Interstitial Lung Diseases: An Update
Classification and Diagnosis Guidelines

Carlo Vancheri, MD

Idiopathic pulmonary fibrosis (IPF) is a specific form of chronic, progressive, fibrosing interstitial pneumonia of unknown cause. The disease is characterized by progressive morphologic changes of the lung architecture, causing cough and worsening dyspnea and, ultimately, leading to lung failure and death. It is defined by the histopathologic and/or high-resolution CT scan (HRCT) pattern of usual interstitial pneumonia (UIP). In all cases, exclusion of other known causes of lung fibrosis, in particular those linked to the environment, occupational exposures, drug toxicity, or systemic diseases, is required to establish the diagnosis of IPF. The disease is not readily recognized because of the lack of specific symptoms and, in general, for the poor awareness of the disease. On average, 2 years are necessary before receiving a correct diagnosis, often preceded by one or more misdiagnoses. Indeed, the diagnostic approach may be challenging, and a multidisciplinary approach, possibly in an expert center, is needed to obtain an accurate diagnosis.

Severe Asthma: State of the Art
Novel Insights in Pathobiology of Severe Asthma

Sandhya Khurana, MD, FCCP

This interactive session will provide the audience with an update on immunopathologic mechanisms of severe asthma and the role of viral infections in asthma exacerbations. The audience will hear about practical approaches to phenotyping and endotyping in severe asthma. This session will focus on current knowledge regarding the add-on biological therapies of severe asthma, including the humanized monoclonal anti-IgE antibody omalizumab, anti-IL-5 monoclonal antibodies mepolizumab and reslizumab, the IL-5 receptor blocker benralizumab, and the dual IL-4/IL-13 receptor antagonist dupilumab. Future biological approaches will be also considered, as well as nonbiological strategies, such as pharmacologic antagonism of CRTH2 receptor of prostaglandin D2.

Recognize the recent advances in the understanding of pathobiology of asthma.
Understand the role of viral infections in asthma exacerbations.
Review available therapeutic options, current and novel, in severe asthma.

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Girolamo Pelaia, MD, FCCP

This session will focus on current knowledge regarding the add-on biological therapies of severe asthma, including the humanized monoclonal anti-IgE antibody omalizumab, anti-IL-5 monoclonal antibodies mepolizumab and reslizumab, the IL-5 receptor blocker benralizumab, and the dual IL-4/IL-13 receptor antagonist dupilumab. Future biological approaches will be also considered, as well as nonbiological strategies such as pharmacologic antagonism of CRTH2 receptor of prostaglandin D2.

Learning objectives include the ability to make a correct choice of the most appropriate add-on biological therapy for each patient with severe asthma, as well as the acquisition of the main knowledge regarding the perspectives of biological and non-biological treatments currently under investigation for future management of severe asthma.

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Stephanie M. Levine, MD, FCCP
Deborah J. Levine, MD, FCCP
Jack D. Buckley MD, MPH, FCCP
Darcy D. Marciniuk, MD, FCCP

This session will be based on select questions from the well-known SEEK library used for continuing medical education and board preparation. The session will be conducted using an Audience Response System.

Gerard A. Silvestri, MD, FCCP
Peter J. Mazzone, MD, FCCP

During this session, we will discuss key elements of reach design and manuscript preparation that help to improve the chances that your manuscript will be published and impact clinical care.

Discuss elements of research design that impact the fidelity and importance of your research findings.
Discuss the preparation of a high-quality manuscript.
Provide general tips on what makes a medical manuscript attractive to reviewers.
Introduce a systematic approach to each aspect of the manuscript process, including the abstract, introduction, methods, results, and discussion.
Learn how to utilize your tables and figures to maximal effect.
Review of the submission and review process from the journals perspective.

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Mangala Narasimhan, DO, FCCP

Thoracic ultrasonography is a noninvasive and readily available imaging modality that has important applications in pulmonary medicine outside of the ICU. It allows the clinician to diagnose a variety of thoracic disorders at the point of care. This session will provide the learner both hands-on practice to acquire the ultrasound images with real models and image interpretation skills needed to integrate the image acquisitions with image interpretations.

Understand the knowledge base required to perform and interpret thoracic ultrasonography.
Acquire image acquisition skills required for thoracic ultrasonography.

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Panagiotis Behrakis, MD, PhD, FCCP

This lecture will be focused on two broad topics; health-related effects and regulation.

Learning Objectives:
Health-related effects

Immediate inflammatory reactions of the respiratory system.
Results of human studies will be presented showing immediate respiratory effects of active e-cigarette smoking and passive exposure to vaping emissions.
Poisoning, accidents, and other nonrespiratory effects
Presentation will refer to the occurrence of numerous adverse events associated with the use of electronic cigarettes, with special emphasis on nicotine effect and poisoning.
E-cigarette or vaping product use-associated lung injury (EVALI).
Presentation will include diagnostic criteria for EVALI and update on number of events (cases and deaths).

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Regulation

Update on regulatory status in the USA and Europe.
With the emerging research and case reports regulation on the electronic cigarettes, use is likely to be updated.

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Stephanie M. Levine, MD, FCCP

The management of common and less common pulmonary and critical care disorders may require modification when caring for the pregnant patient. This session will review some of these topics.

Review the normal respiratory and cardiovascular physiology of pregnancy.
Review the management of asthma, venous thromboembolism, and tuberculosis in pregnancy.
Review the causes and management of acute respiratory failure in pregnancy.

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Respiratory Pathophysiology in the Third Millennium
The Modern Pulmonologist Facing the Study of Small Airways

Stefano Centanni, MD

The small airways, ie, the bronchi with an internal diameter of less than 3 mm and with the absence of a supporting cartilaginous skeleton and in which the bronchial secretions are produced alone by cells and no longer by the mucosecretory glands of the submucosa. They have an important relevance both from the physiopathologic and clinical-therapeutic point of view, since they are the portion of the airways where obstruction develops primarily. The purpose of the presentation will be to deepen these aspects and the techniques and parameters set relating to the investigation of the small airways and to the objective measurement difficulties.

Difficult Cases in Pulmonary Vascular Disease: A Case-Based Discussion
VTE

Lisa K. Moores, MD, FCCP

Speakers will present the audience with cases that highlight difficult diagnostic or therapeutic issues in patients with pulmonary vascular disease. Audience response will be used to guide the discussion.

Describe the optimal use of D-dimer in diagnostic algorithms for PE.
Identify intermediate-high and intermediate-low risk patients with acute PE.
Discuss the potential role for low-dose thrombolysis.

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Neil S. Freedman, MD, FCCP
Giuseppe Insalaco, MD, FCCP
Francesco Fanfulla, MD

This will be a case-based interactive panel discussion that will cover several common, but controversial, diagnostic and treatment decisions related to the management of sleep-disordered breathing. Topics that will be covered include:
1. Should we be treating patients with mild obstructive sleep apnea?
2. Managing nonsleepy patients with obstructive sleep apnea: Does it make a difference?
3. Cardiovascular outcomes and OSA treatment: What are realistic expectations?
4. Should we be treating central sleep apnea?
5. What is the role of nocturnal ventilation in patients with COPD?

Determine which obstructive sleep apnea phenotypes are most likely to benefit from therapy.
Understand outcomes associated with the diagnosis and treatment of central sleep apnea.
Define which patients with COPD may benefit from nocturnal noninvasive ventilation.

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Moderators: Linda Nici, MD; Richard ZuWallack, MD; Enrico M. Clini, MD, FCCP Speakers: David Mannino, MD, FCCP; Bartolome Celli, MD; Valerie Press, MD, MPH; Frank Sciurba, MD; Michael Stickland, PhD

Provide clinicians new science in the clinical management of the complex patient with COPD.

Integrating care of the patient with COPD
Screening for COPD: Arguments for and against
Tailoring therapy to COPD phenotype
Preventing COPD hospitalization and rehospitalization
Precision bronchoscopic interventions in the management of COPD
Extending pulmonary rehabilitation to a wider audience

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