2024 CHEST Conference Highlights

Podcast Transcript

Raed Dweik, MD:

Hello and welcome to the Respiratory Exchange podcast. I'm Raed Dweik, chairman of the Respiratory Institute at Cleveland Clinic. This podcast series of short, digestible episodes is intended for healthcare providers, and covers topics related to respiratory health and disease. My colleagues and I will be interviewing experts about timely and timeless topics in the areas of pulmonary, critical care, sleep, infectious disease, and related disciplines. We will share information that will help you take better care of your patients today, as well as the patients of tomorrow. I hope you enjoy today's episode.

Angel Coz, MD:

Hello, welcome to the Respiratory Exchange podcast. My name is Angel Coz, and I am one of the staff in the pulmonary and critical care divisions at the IHI. And it is my pleasure to welcome today two of my colleagues, Dr. Priya Balakrishnan and Dr. Eduardo Mireles. And the topic today is going to be about CHEST 2024, and it was a very well-attended meeting. And I just wanted to introduce my guest, Priya.

Priya Balakrishnan, MD:

Thank you, Angel. I'm Priya Balakrishnan. I am a pulmonary specialist, focusing mainly on interstitial lung disease and sarcoidosis. Thank you very much for inviting me on the podcast today.

Angel Coz, MD:

Thank you. Eduardo?

Eduardo Mireles-Cabodevila, MD:

Hello, I'm Eduardo Mireles-Cabodevila, and I'm a pulmonary critical care physician here at the Cleveland Clinic. And my area is mainly critical care, and my pulmonary part neuromuscular disease. And thank you very much for inviting me, Angel.

Angel Coz, MD:

Excellent. Welcome, and thank you for joining us. And I just wanted to get your take on the meeting. I thought that it was a very good meeting. It was, from what I know, it has been the largest attendance recorded in CHEST history. It was very, very well attended. It was, the sessions were really great. But I wanted to get your take on what were your favorite sessions, Priya,

Priya Balakrishnan, MD:

So I think that, you know, CHEST this year was very meaningful to me because I saw most of my colleagues and, and friends, really, at the meeting. It felt almost as if it was mini–Cleveland Clinic over at Boston. And I think we were very well represented, not just from any particular subspecialty, but across the board. We had a full session on all three days, Monday, Tuesday, and Wednesday, which are the main conference days. Not just in terms of presentations, but also in scientific presentations in oral and poster forms.

You know, as a ILD specialist, my main interest was all on the ILD talks. I truly enjoyed Dr. Maeve MacMurdo's presentation on pneumoconiosis, because it spanned across the spectrum of all the different types of occupational lung disease that we see. And there was also a particular section just discussing pathological samples of these different disease conditions.

The second part I wanted to say was my highlight of the meeting was actually the Diffuse Lung Disease Network section meeting. I think it was important to have everyone in the same room promoting each other and also the field in terms of next year's conference. So I think those two were my personal highlights. Thank you.

Angel Coz, MD:

Excellent. Thank you. Yeah, and we'll talk a little bit more about the, the, the business meetings, because for those who want to get involved in the ins and outs of CHEST or maybe wanna get involved in, in the actual meeting for next year, I think those are great opportunities. So what about you, Eduardo? What was your favorite part of the meeting?

Eduardo Mireles-Cabodevila, MD:

Well, I would divide it into probably two or three items. The first one is getting to see a lot of our alumni, Cleveland Clinic alumni and the faculty. I mean, even though we work in the same place, many of us are in different buildings at different times, and it's always great to see each other outside, outside work. So that social environment, I find it really appealing and a great thing that, that CHEST does. Along that topic, I would say that they have created and facilitated a series of events that allow those clashes, right these areas where you can get to, to interact with different people. So that's one of my favorite things of going back to, to CHEST.

The second part that I enjoy a lot is that they have focused on a couple of things that really make this educational meeting. In one part, you have educational lectures that go to the basics and the state-of-the-art conversation. So within critical care, they visited a lot of high quality topics regarding things that are of interest, mechanical ventilation, ECMO, and whatnot. But also there was a lot of focus on neuromuscular disease and home ventilation. Actually, I would say that this is the CHEST meeting of all the meetings that I attend, I have seen such a high amount of focus on home mechanical ventilation. And I really wanted to applaud that item.

And, the last part that I really enjoy, I like getting lost in the hallways with all the posters. I think that that's a great service to the medical students, the residents, the fellows that are presenting for the first time. And sometimes there's people that see some colleagues presenting their posters and their work, and I really like that because it's kind of ... It's impossible for you to read everything, and then you're walking, and then some, you see this title, you stop by, you ask them to explain, and you learned a fair amount about a topic that you never thought that you were gonna, or that would be improbable for you to see otherwise. So those are my three favorite things.

Angel Coz, MD:

Excellent. I echo what you said about the neuromuscular disease emphasis. I think part of that is because there were recently guidelines published on that, so they wanted to highlight some of the guideline work and also kind of how to implement those, which sometimes is the difficult part when guidelines are written, is, "Yeah, this sounds really nice in practice, but then how does that translate to the bedside, to my patient?" And I think that emphasis was, was really well received.

So one thing that I wanted to highlight is the, the degree of involvement that our current fellows, former fellows, current faculty have had. It has been really, really refreshing to see how in the last few years the engagement in the leadership roles has increased significantly. I was doing some kind of review of the membership rosters on the, on the sections and networks leadership, and there were very few sections, I think it was only a couple, in which there was not at least someone who was or is part of our family, either as a fellow or as a faculty member. And I think that's really great, but I think it also opens an opportunity to kind of be ambassadors of our institution and kind of promote and encourage other people who want to be involved, to encourage them to apply when the time comes in the spring for leadership roles.

And there are different opportunities in, basically in every flavor. In pulmonary, you have airways, you have pulmonary vascular disease, ILD, neuromuscular disease. And then you have sleep and, and all the different categories in sleep, non-respiratory. And in critical care, there's sepsis, mechanical ventilation, non-respiratory critical care. So there's basically any flavor you have interest in, there is an option. And if you wanna be involved, I mean you can talk to Priya, myself, Eduardo, it's not something that... At the beginning can seem something very daunting because it's hard to navigate a society that you don't know. But it's just basically showing you where the right door is. And after that, it's really, really easy, once you start doing a good job, to kind of get more and more opportunities. And Priya can probably attest to that. You wanna tell us a little bit about your role-

Priya Balakrishnan, MD:

Thank you. (laughs)

Angel Coz, MD:

... and how things have been going until the fact that you became a rising star?

Priya Balakrishnan, MD:

(laughs) Thank you very much, Angel. Actually, I have to thank you 'cause you were instrumental in a lot of my achievements, so to speak, within CHEST. But you know, I have a soft spot for CHEST in my heart. I think a lot of my professional development and also enjoyment in my professional career actually comes from CHEST. I tried very hard to get into CHEST as a fellow and had a lot of doors closed, so to speak. But once I got in, you know, you're absolutely right. You get what you put in. So the more heart and soul you pour, they actually promote you more and more. So it's like a goodwill circle that goes around.

I can say that within the Diffuse Lung Disease and Transplant Network, we are very well represented. We have an incoming faculty, Dr. Sameep Sehgal, under the lung transplant umbrella or section of the Diffuse Lung Disease Network. The occupational health section, very well represented by myself, where I'm vice chair there, but also Dr. MacMurdo is a vital member of that section. And, you know, beyond the networks, we also have a major footprint in the leadership positions within CHEST as a whole. A lot of alumni, as well as current faculty, hold leadership positions. Myself, I'm part of the guideline oversight committee, which you were an outgoing member for, Angel.

Angel Coz, MD:

I got fired.

Priya Balakrishnan, MD:

(laughs) No, it was just a turnover. (laughs)

Angel Coz, MD:

(laughs)

Priya Balakrishnan, MD:

But, you know, the other things that I'm proud of is also, I'm part of the Scientific Presentation and Awards Committee, so I'm part of the committee that evaluates all these great posters and podium presentations that you mentioned, Eduardo. And then there's a lot of ways that we can get involved, not just in leadership roles, but also just volunteering your time to, um, moderate all these sessions, podium, posters, rapid-fires, and also just judging and scoring these, these sessions for awards and presentations during the annual conference. I'll let Eduardo take over here.

Eduardo Mireles-Cabodevila, MD:

From my standpoint, the opportunities to get engaged are wide open. I think that one of those things that you, that CHEST did that I liked was, one, these network mixers that they generate, and then the sessions that essentially are social sessions in which you go in, and some of them ended up in circles, some of them ended up in people in between chairs, just chatting amongst themselves, but getting to know each other. From these are those type of interactions that breed different items. They breed clinical collaboration in which you have people that you have heard of or read of, and you want to learn a little bit more from them. And so that's awesome. The other one is to do actually networking in terms of research activities and how to, to grow and, and to join some efforts, which sometimes it's hard to achieve just by email or by requests going out in an email that says, "We're looking for people for this event." And you, by having these situations in which you could put a face, a name, a voice makes it much better.

Actually, I was talking to one of the, a resident that came, and actually this resident had approached me at one of the other meetings at SCCM and said, "You know, I want to become a fellow in critical care. What do you recommend?" And so, I mean, and this was a conversation that happens on one of these mixers, right, in that there's the chance that you have to do that. And I said, "Well, why don't we make some time, and chat a little bit more, and go from there?" And I will highlight this, Angel, because I was part of a sit-down in which we were talking, there were people from Latin America, from Ecuador and Venezuela in one of those mixers. And I make the effort. I mean, I, there's a lot of people that I know, but there's a lot that I don't. And so I went and sat at this table just to chat and hear what was going on. And out of there comes this person, said, "Oh, you work then with Angel?" I said, "Yeah. Oh yeah, he's my mentor." And he goes on to describe an interaction, a series of interactions that had occurred with you that had guided this physician into the pathway to becoming and how to get into the critical care and pulmonary world.

So I think that's a value added to all of this. And I would invite the listeners to, in any stage of your career that you are, that these are the moments in which you want to just say, "Well, I mean, let's lose some of that uncomfortable feeling of, I don't know anybody," and just walk in and extend your hand. And you'll see that everybody extends their hands the same way. And I still have to find the day that I, that that doesn't happen in one of these meetings. And it's always a very rich conversation, and it has led to interactions, to people coming here to rotate with us or just simply building up networks of knowledge. So that's, that's my experience with these network mixers and, and desires of CHEST to grow that.

Angel Coz, MD:

I totally agree. I think those are really, really important networking parts of the meeting that you cannot replace with a Zoom call or with an email. And I think those lead to kind of building relationships that may last for a long time. And it can be a mentorship relationship or a collaboration relationship in research or clinical development, et cetera. So... But I wanted to go back a little bit to the rising star part because I think Priya was being a little humble here.

Priya Balakrishnan, MD:

(laughs)

Angel Coz, MD:

I wanted to highlight because I think it was noteworthy that two of our members of our institute, one, a former fellow who just graduated graduated in July, he was awarded the Rising Star Award from the Pulmonary Vascular Disease Network. And then Priya, who is here with us, she was awarded the Rising Star Award as for the diffuse lung disease. I'm blanking on the whole name because I think it has, like, three parts to the name, but on that network. So those are really, really... And that's a new award, it was just last year, but it's to recognizing people who have great potential and who have done work for the network that is giving them that award. So I think congratulations to you. That is a good testament of how much involvement you've had over the last few years and of the quality of the work you're doing at CHEST. 

And I think that's one thing that is very important to stress, because when one gets involved in a professional society, it can be the unknown, meaning, "Who do I go? Who do I approach?" But at least my experience with CHEST is, you volunteer to do something, you do a good job, you do it on time, and just the opportunities will keep coming. And I mean, and you can kind of attest to that, Priya, it's, like, just happens and it keeps happening. And at some point you have to start saying no, because it might be more than you can, than you can handle. But it is really, really that.

And to Eduardo, I think he was also being humble because I think he was gonna talk about the 5K in which he ran. And I think he was, like, number seven for the whole race.

Eduardo Mireles-Cabodevila, MD:

(laughs)

Priya Balakrishnan, MD:

Wow. (laughs)

Eduardo Mireles-Cabodevila, MD:

12th, 12th, 12th.

Angel Coz, MD:

I mean, when I saw him running, because I run too-

Priya Balakrishnan, MD:

Congrats. (laughs)

Angel Coz, MD:

... but I mean, I'm not nearly as fast as he is, and he was, I think he was running, like, a six-minute mile, and it's like, "Oh my God."

Priya Balakrishnan, MD:

Wow. (laughs)

Eduardo Mireles-Cabodevila, MD:

No, no, no. (laughs) But, I would highlight this, Angel, and thank you for decreasing my minute mile, but it's... I really like the fact that the, these social events... So Gabriel organized this, Gabriel Bosslet, at this race, 5K, and you realize that we are so multiple dimensions in there, right? And there's this group that wants to do exercise, and this actually fulfills... Going to a meeting, to me is it's a lot of work. I mean, I come back more tired as, as I go there because it's from one place to the other, blah, blah, blah, eat, meet, meet, meet, meet, and then you get to the room, go to sleep, and wake up early and, and, and go again and repeat. And so having the ability to have these exercise events in which we went, run... And actually there was a lot of our friends there, right? You're running-

Angel Coz, MD:

Yeah.

Eduardo Mireles-Cabodevila, MD:

... and, yeah, yeah, yeah, you... I think that's a winner and they should keep that. Bravo to Gabriel and to the CHEST for doing that.

Angel Coz, MD:

Yeah. That was something that at least from what I know, it was done in the past, but then it kind of phased off and then Covid came and, but now it was Boston. And Gabe is a, he's a runner, so he being the chair of the committee, kind of, they proposed to bring it back, and I think it was very well attended. And it's for a good cause because all the proceeds go to the CHEST Foundation, which awards some of the travel grants that one of the members of our group also was awarded a travel grant and was also paired with a mentor, going back to the mentor relationship that you mentioned earlier. And this, it's more kind of building a relationship with somebody who does things outside our system and kind of can give you a different perspective on how things are done, and sometimes nice collaborations for research or, or whatnot come from that. So I was also aware of a specific session, I think, Eduardo, you can speak more about that, on sarcoidosis, that you attended that you wanted to mention.

Eduardo Mireles-Cabodevila, MD:

Yeah.

Angel Coz, MD:

Dan Culver, the chair of our pulmonary division. That was very well attended and was, was very well reviewed, my understanding.

Eduardo Mireles-Cabodevila, MD:

Yes. I mean, this was, as you know, they presented... They wanted to highlight publications from each one of the journals that the ACCP has. So they had the CHEST pulmonary and critical care, and then the regular CHEST journal. And in the regular CHEST journal, there was-

Angel Coz, MD:

We call it the flagship journal.

Eduardo Mireles-Cabodevila, MD:

The flagship journal, sorry.

Priya Balakrishnan, MD:

(laughs)

Angel Coz, MD:

(laughs)

Eduardo Mireles-Cabodevila, MD:

Thank you. The flagship journal, there was the person that was presenting was actually Dan Culver, the chair of our pulmonary division. And so this was... I actually have to tell you the sarcoidosis has been... I mean, we all have heard and treated patients with sarcoidosis. Well, the way that Dan presented this new medication and how it affected, and where it acted, and actually reorganizing where the focus is now in terms of research and how this medication, which is unpronounceable, fit. And probably, Priya, you're better at pronouncing this. Can you say it?

Priya Balakrishnan, MD:

Efzofitimod, I think.

Eduardo Mireles-Cabodevila, MD:

There you go.

Priya Balakrishnan, MD:

But I might be wrong. (laughs).

Eduardo Mireles-Cabodevila, MD:

No, you, no, that was perfect. Thank you very much. Sorry for putting you on the spot.

Priya Balakrishnan, MD:

(laughs)

Eduardo Mireles-Cabodevila, MD:

But, he framed it in a way that was very easy for me, a non ILD expert, and even though I'm a pulmonologist and I understand this, it was a real good review and putting it into frame. And after that, there were a series of other articles that came up, one for critical care and for the pulmonary, but the way that they, that these put when they do this type of article and the actual author presenting to frame it is worth a lot. And I would think that these are things that they need to continue to do to put people to speak about their, their articles and then expose them to questions from the audience. Because although you can do it and there's mechanisms to do it by typing, and sending letters, and, or calling the people, when you are there, it kind of puts another perspective and exposes you to hearing from other people that are questioning the same thing.

So first of all, I would just want to applaud our Dan Culver for an outstanding presentation. Number two, applaud CHEST for doing this type of sessions that really make us win.

Angel Coz, MD:

Yeah. And I wanted to stress that I think that is one thing that, at least makes CHEST appealing to me, that diverse type of sessions. Like you have these sessions in which you can meet the lead author of a big study and kind of get their perspective on, but there are also other type of sessions, like, very interactive, like if you had had a chance to attend the Pardon the Interruption, they are a lot of fun. And it is like a quickfire pro/con debate on a number of topics. And you also have gamification of different topics. So there's really a flavor for everyone. Like for those who like the more traditional lecture type, those are available. For those who like a little bit more short bite session type of format, that is available. For those who want it in a kind of more of a game type of format, those are available as well. So I think that is great.

And I think one part that I think, Priya, you may also want to comment on this, is to stress on how to get involved. One, for the annual meeting, you don't have to be an expert on how to submit a session and-

Priya Balakrishnan, MD:

Mm-hmm.

Angel Coz, MD:

And I think you can certainly ask Priya, or myself, or Eduardo for help kind of putting a session together. But not only that, it's also regarding the involvement in sections or networks or committees. 

Priya Balakrishnan, MD:

Yeah. Oh thank you for that, Angel. I think, you know, to answer your question in part, CHEST 2025, the chance to shape the program in terms of topic presentations is open and it's actually closing in early December. So it's time to, you know, get hold of your colleagues from different institutions and come up together with a topic that you all can submit through the website available on the networks of CHEST. So this is a chance for you to be a chair of the session or even a faculty.

This is a lot of fun. You know, in terms of experience, when I was first year faculty, I think I submitted two. And, you know, it's hard to get in, but over time you do get the feel of what CHEST is looking for because you do get feedback whenever your sessions are not accepted. So, you know, in terms of your experience and your chance to succeed, goes up with time as you keep submitting. And, you know, in terms of how quickly you can get involved over a four-year period, I went from no sessions to three separate sessions as chair. So I think there's a high chance, even if you're an early career faculty member, trying to get more involved and having a presence at CHEST.

And then in terms of just networking, like Angel, you mentioned a lot of the mentorship programs, and CHEST has definitely formalized this. You can apply to be a mentee and you can apply to be a mentor. Again, the links are available on the CHEST website. So those things are definitely accessible for people that are interested.

And then finally about getting involved in CHEST, whether in a leadership position, in a committee, or even in the networks. The CHEST website is a good resource for that. They post calls for nominations regularly. So I think, you know, if you pay attention to the CHEST email bites that you get through your emails, you can definitely get involved if you're interested. So a lot of plugins there for CHEST next year.

Angel Coz, MD:

Yes. Also involving other committees like you, for example, in the Guidelines Oversight Committee, and there are other committees of different types, like Education Committee there is also the Scientific Presentations Committee, and those are really great opportunities to get involved if that's something that interests you, but also to network, and just kind of like a different perspective of how things are done outside our walls. And although our walls are pretty big walls and we have a huge faculty, I think it's always nice to kind of see how things are done outside our walls.

But overall, I think it's really refreshing to see how the representation of our institute has improved significantly, increased significantly over the last few years. And I think it's just a testament of, I mean, the quality of individuals we have in our group, because it started increasing slowly and now it's more, and I'm confident that we'll continue to, to increase over years. And I think that those are mainly the things that I wanted to cover about the meeting. Do you have any additional thoughts, Eduardo or Priya, that you wanted to share?

Eduardo Mireles-Cabodevila, MD:

First of all, thank you, Angel, because you have been a very strong force to help us grow within CHEST and the ACCP. So we appreciate that, because it always helps to have somebody that understands the language and how to start. And, and you walk the walk, right? Walk the talk. And I appreciate that.

Number two, please get involved. Actually this is even more important day after day as we are trying to educate and learn how to educate our physicians of the future. Having us engaged in these societies makes us stronger. So engagement and involvement is essential for us to advance the field and actually have a representative organization of what we believe and what we want to do. So if you are not part of it, I highly suggest that you become part of any of the societies that we have and become vocal there. Even by just attending, it makes us stronger and it makes the voice and you get represented by a group. So that's how, how I put it, it's a duty of, of citizenship and civility of being part of these societies. And so I'm proud to be part of this one.

Priya Balakrishnan, MD:

Yeah, thank you, Angel. You know, I strongly agree with what both of you have just highlighted. I think, you know, it's very important as part of your career development, and also medical education longitudinally, to get involved with societies. CHEST has a special place in my heart because it has allowed me to grow professionally as well as, you know, in general confidence when you're working with more senior people. So I think it has potential to enhance anyone's career. And CHEST is also very much more accessible compared to other societies, I find. So it's easy to get involved as a platform for greater things in the future. Thank you very much.

Angel Coz, MD:

Excellent. And thank you both for just taking the time to chat and kind of debrief about our experience at CHEST. And thanks to our listeners for tolerating us for 20-plus minutes and hopefully you get something out of this. But more importantly, if you have any questions, anything that you wanna know more about CHEST specifically you can feel free to reach out to me or... Priya, I wanna put you on the spot here too, because you are involved in leadership. So feel free to reach out to us and we can show you, I mean, how to get involved if that's what you're interested in.

Raed Dweik, MD:

Thank you for listening to this episode of the Respiratory Exchange Podcast. For more stories and information from the Cleveland Clinic Respiratory Institute, you can follow me on Twitter at RaedDweikMD.