Scientific Program

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Speaker: Alberto Papi, MD
Moderator: Girolamo Pelaia, MD

Session Description:
Management of mild asthma has been for a long time unsatisfactory and not tested in clinical trials. The use (overuse) of SABA in patients ``treated as`` mild asthmatics has become of concern, and the association with severe adverse events has become clear. Adherence to regular ICS treatment is a major issue in this population. The rationale and efficacy of the “as needed ICS” will be discussed in this session.
Learning Objectives:
• Review concerns associated with the use of rescue SABA in the absence of maintenance treatment.
• Discuss merits of as-needed ICS treatment strategies in mild asthma.

Speaker: Emiel Wouters, MD
Moderator: Alfredo Chetta, MD

Description:
Based on the seminal observations of Fletcher and Peto, modification of the accelerated decline in FEV1was considered the holy grail in initial clinical trials in COPD. Based on the concept of offering anti-inflammatory therapy, exacerbations and mortality were introduced as outcomes in large intervention studies. These studies have contributed to a tunnel perspective on COPD and a one size fits all approach to a complex heterogeneous syndrome.

Learning Objectives:
• A one size fits all approach is killing for profound understanding of underlying mechanisms of a disease condition.
• A personalized management strategy starts by understanding the heterogeneity of the COPD syndrome.

Speaker: Lisa Moores, MD, FCCP
Moderator: Clayton T. Cowl, MD

Description:
This session will review current prognostic scoring systems that can be utilized to more specifically inform the appropriate setting for treatment of acute pulmonary embolism.

Learning Objectives:
• Recall validated prognostic scores in patients with acute PE.
• Select appropriate patients for outpatient therapy of PE.
• Identify patients with PE most appropriate for ICU care.

Speaker: Septimiu D. Murgu, MD, FCCP
Moderator: Mangala Narasimhan, DO, FCCP

Description:
This session will review the indications, contraindications, outcomes, and potential adverse events related to fundamental bronchoscopic techniques.
Learning Objectives:
• 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.

Speaker: Prof. Giorgio Walter Canonica, MD
Moderator: Caterina Bucca, MD

Description:
Until the 1940s, the development of new treatments relied on NRS. After that time, there was increasing recognition that anecdotal reports based on clinical practice observations were often misleading. This led to a near-total replacement of the prior nonrandomized approach with the use of randomized, controlled clinical trials (RCT). Indeed, the history of medicine is rife with examples whereby observational data have been misleading even with established clinical practices, and which are only uncovered after the same hypothesis is tested in an RCT. This reinforces the widely held notion about NRS that no matter how large in scale or sophisticated in analysis, the risk of bias (including misspecification, selection, reporting, analysis, and confounding, among others) will limit certainty in causal inference. Conversely, proponents of NRS RWE advocate that mechanistic trials may often not be fully representative of real-life situations because they employ strict, protocol-defined inclusion criteria to identify eligible patients – that is to say, directness in the applicability of the studied intervention effects to the applied population. This could mean that some patients with the condition of interest may be excluded based on characteristics such as disease severity, age, comorbidities, or the use of concomitant medications. Since a few years, severe asthma is a great example of both bias in selection of population enrolled in registration trials for biologics and how the registries provided useful information about both diagnosis and management. Finally, they revealed how to better define more severe phenotypes and how oral corticosteroids (OCS) impact in severe asthma treatment in real life.

Speaker: Eugenio Baraldi, MD
Moderator: Francesco de Blasio, MD, FCCP

Description:
Bronchopulmonary dysplasia (BPD) is the most frequent respiratory complication of extremely premature birth. In most studies, survivors of BPD have airflow limitation and their FEV1 does not reach the normally-expected optimal peak at 24 years old. Poor lung function early in life tracks with a weaker lung function in adulthood and a higher risk of a COPD-like disease.

Speaker: Mangala Narasimhan, DO, FCCP
Moderator: Tommaso Tonetti, MD

Description:
The use of extracorporeal membrane oxygenation for severe respiratory failure has been increasing exponentially since the influenza epidemics of 2009/2010. The identification of patients most likely to benefit is a crucial step, as well as the timing of ECMO initiation. In this session, patient selection, severity assessment, benefits of ECMO, and timing will be discussed, based on guidelines and most recent clinical trials.
• Discuss the implementation of a high-quality lung cancer screening program.

Speaker: Deborah J. Levine, MD, FCCP
Moderator: Stephanie Levine, MD, FCCP

Description:
In 2017, more than 4,000 lung transplant procedures were reported to the International Society for Heart and Lung Transplantation.

Learning Objectives:
• Discuss current activity and outcomes following lung transplantation.
• Define indications for lung transplantation.
• Review guidelines for LT candidate selection.
• Understand management of the lung transplant recipient.
• Review complications following lung transplantation.
• Discuss the immunosuppressive and other medications used in lung transplantation.

Speaker: Maria Grabriela Matera, PhD
Moderator: Mario Cazzola, MD

Description:
Oxidative stress can be an important mechanism of ``amplification`` in
COPD, which is further increased during exacerbations. Oxidants are generated mainly in nonphysiologic conditions by both cigarette smoke and other particulates inhaled and released by activated inflammatory cells, such as macrophages and neutrophils.
Mucoregulatory drugs can both reduce the generation of ROS and neutralize oxidants, with the potential to indirectly influence inflammation in COPD and consequently have an impact on symptoms, as well as reduce exacerbations.

Speaker: John (Jack) Buckley, MD, MPH, FCCP
Moderator: Doreen Addrizzo-Harris, MD, FCCP

Description:
This session will provide an overview of tuberculosis epidemiology across the globe along with recent advances and insight into prevention, diagnosis and treatment.

Speaker: Clayton T. Cowl, MD, FCCP
Moderator: William F. Kelly, MD, FCCP

Description:
From smoke inhalation to exposure to common household and industrial chemicals, lung injury from acute toxic exposures is an important component of a respirologist’s clinical practice. This session will address common exposures and review strategies for assessment and treatment.

Learning Objectives:
1. Understand important medical history to obtain when source of a toxic exposure is unknown.
2. Distinguish common forms of toxic inhalations.
3. Discuss treatment strategies for acute toxic exposures.

Speaker: Septimiu D. Murgu, MD, FCCP

Session Description:
Rotation:
1. Bronschoscopic Management or Airway Bleeding.
2. Airway Foreign Body.
3. Airway and Mediastinal Anatomy
4. Cyroextraction for Central Airway Obstruction

Speaker: Frederico Lavorini
Moderator: Francesco de Blasio MD, FCCP

Description:
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.

Learning Objectives:
• 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.

Speaker: Nicolino Ambrosino, MD
Moderator: Alfredo Chetta, MD

Description:
It is altogether appropriate that we acknowledge the founders of the field of pulmonary rehabilitation, a highly effective therapy for patients with chronic lung disease. This lecture will review the evolution of pulmonary rehabilitation as its physiologic basis was elucidated. Recent developments will also be reviewed and linked to their historical context.

Learning Objectives:
• Recognize the early innovators who defied the common conception that exercise was to be avoided in dyspneic patients with chronic respiratory disease.
• Review how the physiologic benefits of rehabilitative exercise programs were established.
• Consider the implications of the growing scarcity of in-center rehabilitation programs.

Speaker: Darcy D. Marciniuk, MD, FCCP
Moderator: Doreen Addrizzo-Harris, MD, FCCP

Learning Objectives:
• Discuss various techniques utilized to effectively report and disseminate research findings.
• Review factors that contribute to success in the reporting of research results, outcomes, and learning.
• Outline practical steps to help ensure your research is appreciated.

Speaker: Clayton T. Cowl, MD, FCCP
Moderator: Stephanie Levine, MD, FCCP

Description:
Occupational and environmental dust exposures such as asbestosis, silicosis, and hard metal lung disease continue to plague certain populations of workers, many who are years away from the initial exposure. This session offers a brief review of common interstitial lung diseases associated with inhalations of dust and other compounds resulting in interstitial lung disease and provides clinical updates on evaluation and management.

Triple Extrafine Therapy: New Evidences for COPD Patients
Speaker: Francesco De Blasio, MD, FCCP
Moderator: Claudio Micheletto, MD, FCCP
Supported by Chiesi

Product Theater- Supported by Intuitive Surgical

Advancing lung cancer care with robotic bronchoscopy technology
Dr. Erik Folch
Co-Director, Interventional Pulmonology,
Chief, Complex Chest Disease Center, Massachusetts General Hospital

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Speaker: Nicola Scichilone, MD
Moderator: Caterina Bucca, MD

Description:
Asthma affects older adults to the same extent as children and adolescents. However, one is led to imagine that asthma prevalence decreases with aging and becomes a rare entity in the elderly. From a clinical perspective, this misconception has not trivial consequences in that, the recognition of the disease is delayed and the treatment postponed. The overall management of asthma in the elderly populations is also complicated by specific features that the disease develops in the most advanced ages and by the difficulties that the physician encounters when approaching the older asthmatic subjects. Asthma in older-age patients presents with specific clinical presentations and may encounter gaps and pitfalls in the diagnostic and therapeutic approaches. A multidisciplinary and multidimensional management of asthma in the elderly is, therefore, strongly advocated.

Speaker: David Schulman, MD, FCCP
Moderator: Alfredo Chetta

Description:
Obesity hypoventilation syndrome is a relatively common cause of chronic hypercapnic respiratory failure and can occur with or without obstructive sleep apnea, yet the optimal approach to treatment is not well defined. This will be a case-based interactive session that will review current diagnostic criteria, recent literature and guidelines and various management strategies. During this session, the faculty and attendees will also review the role of CPAP and more advanced nocturnal ventilatory modalities on outcomes in patients with OHS.

Learning Objectives:
• Define obesity hypoventilation syndrome (OHS) and diagnostic approaches.
• Understand the most recent literature and guidelines related to the management of OHS.
• List different management strategies, including the use of various nocturnal ventilatory modes, that may improve outcomes in this patient population.

Speaker: Patricia Rocco, MD, PhD
Moderator: Antonio Sachetta

Description:
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.

Learning Objectives:
• 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.

Speaker: Sandhya Khurana, MD, FCCP
Moderator: Clayton T. Cowl, MD, FCCP

Description:
Fractional exhaled nitric oxide (FeNO) is the only currently available point-of-care biomarker of type 2 airway inflammation. FeNO is predominantly used as a predictor of response to inhaled corticosteroids, to monitor adherence and as a diagnostic tool in ICS-naïve patients. FeNO has also been shown to be a predictive factor for asthma exacerbations, with higher levels being associated with a greater number of exacerbations. Recent evidence suggests that FeNO may also be useful as a surrogate biomarker for the assessment and management of severe asthma and to predict responsiveness to some biological therapies. This session will review current evidence for clinical utility of measuring FeNO in asthma evaluation and management.

Learning objectives:
1. Discuss the utility of FeNO in diagnosing asthma
2. Describe the association between FeNO and asthma exacerbations
3. Understand how FeNO can guide asthma management

Speaker: Septimiu D. Murgu, MD, FCCP

Session Description:
Rotation:
1. Bronschoscopic Management or Airway Bleeding.
2. Airway Foreign Body.
3. Airway and Mediastinal Anatomy
4. Cyroextraction for Central Airway Obstruction

Moderator: Sandhya Khurana, MD, FCCP

- Targeted Biologics of Severe Asthma - Girolama Pelaia, MD, FCCP

- Comorbidities in Difficult Asthma - Sandhya Khurana, MD, FCCP
Description:
Using a case-based interactive format, this session will illustrate a systematic and multi-disciplinary approach to management of ‘difficult to treat’ and severe asthma. Discussion will include common challenges when caring for such patients, including comorbidities. The session will focus on currently available clinical, functional, and biological tools that can be used to characterize the various phenotypes and endotypes of asthma. Faculty will discuss a practical approach to application of targeted therapy.
Learning Objectives:
• Review a systematic and comprehensive evaluation of patients with severe asthma in order to properly personalize both standard and biological therapies.
• Recognize the impact of common comorbidities in asthma, and describe an evidence-based approach to their evaluation and management.
• Discuss strategies for selection of most appropriate add-on biological therapy for each patient with severe asthma.

- Selecting the Right Treatment for the Right Patient - Pierluigi Paggiaro, MD
Description:
Precision medicine is now considered the best approach to asthma treatment, taking into account the progress recently obtained in the assessment and management of asthma. The knowledge of the specific pathogenetic mechanisms underlying the same clinical characteristics in different groups of asthmatic subjects may allow personalization of the treatment on the basis of the different endotypes of the disease. Unfortunately, at the present time, only a single pathogenetic aspect (type 2 asthma vs non-type 2) may be considered in order to select specific treatments (from ICS to new biologics). In any case, the personalization of the treatment may allow consideration of other clinical aspects that may characterize single patients (attitude toward the disease, self-management ability, symptoms perception, presence of comorbidities, etc) may help to individualize the treatment, which may be better tailored to the single patient.

Learning Objectives:
• Know the characteristics of personalized vs precision medicine.
• Know the role of clinical and functional characteristics of asthma in the single patient.
• Realize which kinds of endotypes may be useful in the selection of potential new drugs.

Speaker: Stefano Nava, MD
Moderator: Nicolino Ambrosino, MD

Description:
A great variability in end-of-life practice is observed in the terminally ill mainly because physicians are not always able to correctly predict survival. There is a need for a clear discussion about decision making earlier than when acute respiratory failure ensues, especially in patients with chronic respiratory diseases. Indeed, a perceived poor quality of life does not necessarily correlate with a clear willingness to refuse invasive or noninvasive mechanical ventilation. The overall incidence of end-of-life practices in Europe is only partially known, but there are important differences between countries or regions, reflecting the absence of a common strategy even within the European community. Concerning the problem of patients affected by chronic pulmonary disorders, it was shown that only 13% of units provide information to patients with severe COPD when they are stable, and 25% of patients with oxygen dependence have discussed care with medical staff.

Learning Objectives:
• Describe the terminology of end-of-life decision (E-o-L).
• Illustrate the different approach in different geographic locations (ie, EU vs US and within the EU).
• Discuss the potential timing to start speaking about E-o-L.
• Explore tricks and tips to improve patient/clinician communication about E-o-L issues.

Moderator: Darcy D. Marciniuk, MD, FCCP

- Important Clinical Outcomes in COPD - Pierachille Santus, MD, PhD

Description:
COPD represents one of the commonest noncommunicable diseases with a prevalence that is continuously increasing and is one of the major causes of chronic morbidity and mortality worldwide that bears a major social and economic burden on health-care systems. To understand the pathophysiologic modifications is essential and fundamental in order to better understand COPD, as this is the first point for every clinician. So, the COPD clinical presentation is related to morphologic, functional, and clinical characteristics, in terms of symptoms, exacerbations, and biological parameters. All these topics must be known and evaluated for good clinical management.
Learning Objectives:
• Understand the lung pathophysiologic modifications from early to severe stage in patients with COPD.
• Discuss the symptoms variability and their clinical relevance.
• Explain the clinical presentation of COPD exacerbations and their differences.
• Describe the importance of biological parameters with particular attention to the blood eosinophils.

- Non-Pharmacologic Therapies - Darcy D. Marciniuk, MD, FCCP

Learning Objectives:
• Recognize effective nonpharmacologic therapies and interventions for COPD management.
• Utilize valuable interventions and strategies that include pharmacologic, nonpharmacologic and health-care system practices that will improve the care and outcomes for patients suffering from COPD.

- Long-term Non-invasive Ventilation - Enrico Clini, MD, FCCP

Description:
Patients with advanced COPD often develop respiratory failure, which leads to progressive carbon dioxide (CO2) retention related to alveolar hypoventilation. Hypercapnia initially develops night-time but further increases symptoms day-time, furthermore it influences long-term morbidity and mortality. Therefore, application of long-term noninvasive ventilation (LTNIV) could represent a valid means to counteract the pathophysiologic and clinical consequences of chronic hypercapnia in these patients.
Learning Objectives:
• Discuss pathophyiologic mechanisms and the rationale to control and/or reduce hypercapnia in patients with COPD.
• Update the clinical effectiveness of LTNIV in hypercapnic patients with COPD.
• Discuss the most recent recommendations on when and how to apply LTNIV in these patients.

Description:
The lecture will review the latest evidence regarding endoscopic lung volume reduction and provide the most updated information about different devices available. Attendees will be able to improve candidate selection in order to maximize benefits.

Learning Objectives:
• Update the knowledge of the audience about BLVR approaches.
• Provide precise information to improve patient selection, which is the key factor for better outcomes.

Description:
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.

Learning Objectives:
• 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.

Learning Objectives:
• Review interesting complicated cases of lung cancer with an expert panel, including pulmonology, thoracic surgery, and interventional pulmonary medicine.
• Better understand, through case-based scenarios, how decisions are made with regards to the diagnosis, staging, and treatment of lung cancer.

- Update on Pneumonia Treatment - Stefano Marinari
Description:
The emergence of antibacterial resistance is one of the main causes that prevents the reduction of mortality and the general burden of pneumonia. Multidrug-resistant bacteria (MDR) are frequently the cause of hospital-acquired pneumonia but could be the cause of community-acquired pneumonia in subjects with specific risk factors or conditions, such as altered lung structure (eg, bronchiectasis), antibiotic selective pressure, and general conditions, such as chronic renal failure and liver cirrhosis reduce the physical and immune defense favoring the selection and the emergence of MDR. New molecules and alternative ways of administration are constantly being researched to find new methods to better manage pneumonia. Development of new molecules or new combination regimens are very important for patients with severe infections and in specific subgroups of patients. The development of new antibiotics with new targets could allow the overcome of the actual bacterial resistance. Moreover, it could be useful to evaluate and study different antibiotic combinations in order to reduce the future development of new bacterial-resistant strains. Research on new antibiotics and antiviral drugs must be continued to find new drugs able to overcome the progressive development of resistant strains. Prevention of difficult-to treat-infections and the development of methods to increase host immunodeficiencies could be new efficient strategies to fight infections and reduce the appearance of resistance strains.

Learning Objectives:
• Improve the knowledge on advances in care delivery and on the use of new antibiotics, vaccinations, and other measures to prevent pneumonia.

- Pneumonia in the Immunocompromised Host - Stefano Albertini, MD
Description:
The aging of the population, the increased number of subjects suffering from chronic diseases and/or undergoing immunosuppressive therapies will lead to a substantial increase of immunocompromised patients who will develop pneumonia. International guidelines on the management of both community-acquired and hospital-acquired pneumonia have not addressed this important immunosuppressed patient population. The spectrum of potential pathogens giving CAP might expand according to the type and severity of immunosuppression to include fungal infections, less common viral infections, and even parasitic infections.

Learning Objectives for Pneumonia in the Immunocompromised Host:
• To evaluate the epidemiology of CAP in immunocompromised patients
• To review clinical characteristics, disease severity, microbiology and outcomes of CAP in immunocompromised patients
• To discuss expert opinion-based strategies for the management of CAP in immunocompromised patients

- Non-resolving Pneumonia - Lisa K. Moores, MD, FCCP
Description:
This session will be a panel discussion consisting of three specific scenarios in the diagnosis and management of pneumonia.

Learning Objectives:
• Define non-resolving pneumonia
• Describe the diagnostic approach to patients with non-resolving pneumonia

Moderators: Francesco de Blasio, MD, FCCP
Darcy D. Marciniuk, MD, FCCP

- Optimal Pharmacotherapy in 2022 - Alessandro Vatrella, MD
Description:
Pharmacologic therapy of airflow obstruction. Patients with symptomatic COPD require pharmacologic therapy. This should be implemented according to the severity of symptoms, the degree of lung dysfunction, history of exacerbations, and the tolerance of the patient to specific drugs. A step-wise approach based on the integration of the medical findings is indicated because medications alleviate symptoms, improve exercise tolerance, decrease exacerbations, improve quality of life, and may even decrease mortality. Because most patients with COPD are elderly, care must be taken when prescribing drugs for this population.

Learning Objectives:
• Inform on the most recent studies with multiple pharmacologic agents for patients with COPD.
• Provide as practical approach to the integration of the medical information needed to initiate and modify pharmacotherapy in patients with different COPD phenotypes and severity.
• Remind health-care providers about side effects of medications and the need to ensure proper medication use.

- Challenges with the Use of Bronchodilators - Mario Cazzola, MD
Description:
At least nine potential new classes of bronchodilators that could better optimise bronchodilation have been identified, but they are mostly in a preclinical phase. Research is in progress also in the glucocorticoid field to identify ligands of the glucocorticoid receptor that preferentially induce transrepression with little or no transactivating activity, in order to have a potent anti-inflammatory action and a low side-effects profile. Furthermore, there are several new treatment for COPD beyond bronchodilators and glucocorticoids, such as small molecules (eg, CXCR2 antagonists, kinase inhibitors), biologics (eg, IFN-β1α, IL-17/IL-17R blockers, IL1β antagonists), licensed drugs used off label (eg, PPARy agonists, macrolides, statins, β-blockers, ACE inhibitors, and ARBS), and also other treatments such as drugs to aid smoking cessation, reversal of steroid resistance, vitamin D, and antioxidants/mucolytics.

Learning Objectives:
• Review the emerging classes of drugs potentially useful in COPD.
• Suggest their possible inclusion in the COPD therapeutic scheme.

- Endobronchial Valve Therapy - Otis Rickman, MD, FCCP
Description:
Comprehensive review of lung volume reduction using endobronchial valves for emphysema. This will be accomplished using a case-based format. Spiration and Zephyr valves will be compared and contrasted. Cases will be used to allow participants to select appropriate patients for bronchoscopic lung volume reduction. Risks and benefits of the procedure will be discussed in detail.

Learning Objectives:
• Understand rationale for lung volume reduction in emphysema.
• Know types of valves available for use.
• Understand patient selection.
• Review recent clinical trial data and expected outcome.

Speakers:
Patricia Rocco, MD, PhD
John (Jack) Buckley, MD, FCCP
Mangala Narasimhan, DO, FCCP

Moderator: Jack Buckley, MD, MPH, FCCP

How To Minimize Ventilator Induced Lung Injury? - Patricia Rocco, MD, PhD
When to Extubate and How Aggressive Should We Be? - John (Jack) Buckley, MD, FCCP
Troubleshooting Common Problems in Mechanical Ventilation - Mangala Narasimhan, DO, FCCP

Otis Rickman, DO, FCCP
Septimiu D. Murgu, MD,FCCP
Mangala Narasimhan, DO, FCCP

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Speaker: Francesco de Blasio, MD, FCCP
Moderator: William Kelly, MD, FCCP

Description:
CHEST Italian Delegation (formerly called American College of Chest Physicians Italian Chapter) was founded in 1950 on the occasion of the World Meeting of ACCP that was held in Rome. It was Professor Eugenio Morelli who presided over the Chapter for the first 6-year mandate, inaugurating a life-long history of scientific as well as associative activities in our country. Since then, CHEST Italian Delegation has represented a solid landmark for health professionals who daily deal with the diseases of the chest. During his life, Dr. Mark J. Rosen, Master ACCP – who covered, among the others, the role of Chair of the Board of Regent and Director, Global Education and Development – intensively supported all International activities of the College, and of the Italian Delegation particularly. After over 70 years of continuous activity, CHEST Italian Delegation is proud to host all International attendees in our wonderful country.

David Schulman, MD

Moderator: Francesco de Blasio, MD, FCCP

Moderator: Girolamo Pelaia, MD, FCCP

Moderator: William F. Kelly, MD, FCCP

Moderator: Sandhya Khurana, MD, FCCP

- Defining Non-T2 Asthma: What are the Mechanisms? - Pierluigi Paggiaro, MD
Description:
Non-type 2 asthma represents about 20-30% of all severe asthmatics. At the present time, there is no specific biomaker that may identify this specific endotype, apart from the absence of type 2 eosinophilic inflammation.; probably, in the next future we would have different biomarkers able to distinguish different subgroups in this large cohort of asthmatic subjects. This endotype may be frequently associated with some comorbidities, like obesity, gastroesophageal reflux of smoking habit). Noneosinophilic severe asthmatics not adequately controlled with the best of the standard therapy may require the addition of other drugs (tiotropium as first additional option, oral theophylline, or long-term macrolide therapy or PDE4 inhibitors). These patients usually respond poorly to oral corticosteroids, but, in any case, this treatment is often used by the majority of the patients, for the lack of significant and effective alternatives.
Learning Objectives:
• Know how to diagnose this subgroup of severe asthmatics.
• Know the pathogenetic mechanisms of this specific endotype.
• Select the appropriate treatment and management of these “difficult-to-treat” patients.

- Best Management Strategy for Non-T2 Asthma - TBA
Description:
Most/all of the biologic approaches recently that have recently become available address T2 severe asthma. Until now, non-T2 is a major unmet need. Besides the identification of the patients with severe asthma, the optimization of inhaled treatment and of nonpharmacologica intervention, the available options and the interventions currently under development potentially effective for non-T2 severe asthma will be discussed.
Learning Objectives:
• Identification of severe asthma patients: clinical platform and optimization of management steps.
• Therapeutic options (current and under investigation) for no T2 asthma patients.

- Obesity & Asthma - Sandhya Khurana, MD, FCCP
Description:
Non-ype-2 asthma remains an area of great unmet need. Recent advances in asthma have focused on improved understanding of the pathobiology of, and targeted therapy for, type-2 asthma. The currently available biologics don’t work for the large subset of patients who have a predominance of non-T2 inflammation. This session will offer an update on mechanisms, evaluation and management of non-T2 asthma including obesity associated asthma.
Learning Objectives:
• Review mechanisms of non-T2 asthma
• Describe challenges specific to management of non-T2 asthma and discuss effective treatment options
• Understand the impact of obesity on non-T2 asthma and discuss best-evidence management of obesity-associated asthma

Speaker: Venerino Poletti, MD
Moderator: Francesco de Blasio, MD, FCCP

Description:
Transbronchial cryobiopsy is a new modality used to obtain valid lung tissue samples for a diagnosis of ILDs. Morphologic diagnosis of complex patterns such as usual interstitial pneumonia (UIP) may be done in samples so retrieved. Its safety profile appears good enough to suggest this approach as the first approach in cases in which histologic examination is deemed necessary.

Learning Objectives:
• Learn to perform transbronchial lung cryobiopsy and how to insert this approach into the diagnostic workup of patients with suspected ILD.

Speaker: Darcy D. Marciniuk, MD, FCCP
Moderator: Enrico Clini, MD

Session description:
Cardiopulmonary exercise testing (CPET) is increasingly used in clinical practice for functional and prognostic evaluation of patients with respiratory and cardiac diseases. Moreover, CPET quite useful in the evaluation of therapeutic interventions and in the evaluation of patients with unexplained dyspnea. This presentation will focus on the main indications of CPET in clinical practice. Also, exercise protocols and results interpretation of CPET will be discussed.

Speaker: Otis Rickman, DO, FCCP
Moderator: Septimiu D. Murgu, MD, FCCP

Description:
This interactive session is designed to provide and up to date review of best published evidence on interventional management of patients with pneumothorax, infection and malignant pleural disease. This will be accomplished using a case-based review format with an audience response system. Participants will develop a comprehensive knowledge of the indications, contraindications and associated complications of common pleural procedures including ultrasound guided thoracentesis, chest tube and indwelling pleural catheter placement, pleural biopsy and thoracoscopy.

Learning Objectives:
• Discuss in detail the evaluation and management of patients with pleural effusion and pneumothorax.
• Develop a comprehensive knowledge of the indications, contraindications and associated complications of common pleural procedures

Speaker: Rocco Trisolini, MD
Moderator: Andrea Bianco, MD

Description:
Sarcoidosis is a multisystem granulomatous disease of unknown cause that is diagnosed more reliably in the presence of the following three criteria: a compatible clinical-radiological presentation; the demonstration of a nonnecrotizing granulomatous inflammation in at least one tissue sample; and the reliable exclusion of alternative causes of granulomatous disease. Because thoracic involvement is highly prevalent, bronchoscopy with its ancillary techniques of sampling the airways (endobronchial biopsy), lung parenchyma (transbronchial lung biopsy), or intrathoracic lymph nodes (conventional transbronchial needle aspiration, endosonography) has the highest diagnostic yield, unless more easily accessible sites (ie, superficial lymph nodes, conjunctiva, skin) are available. In the last decade, the possibility to sample under ultrasound guidance (endosonography) the intrathoracic lymph nodes through the airways (endobronchial ultrasound guided, EBUS-TBNA) or through the esophagus (endoscopic ultrasound-guided fine needle aspiration, EUS-FNA/EUS-b-FNA) has revolutionized the diagnostic approach to sarcoidosis.

Learning Objectives:
• Discuss the clinical reasons why endosonography (EBUS, EUS-B) has become the first-step method for the pathological confirmation of the clinical suspicion of sarcoidosis.
• Discuss the possible drawbacks associated with the use of endosonography in sarcoidosis.
• Discuss the main technical aspects (ie, needle size, airways vs esophageal route, number of needle passes, number of revolution within the target lymph node, processing of the samples, and the role of the pathologist) that influence the diagnostic success of EBUS-TBNA and EUS-B-FNA.

Speaker: Darcy D. Marciniuk, MD, FCCP
Moderator: Stefano Marinari, MD

Learning Objectives:
• Understand that COPD is a lung disease with systemic involvement and consequences.
• Appreciate that these systemic manifestations significantly affect the outcomes and prognosis of both COPD, as well as of associated co-existent conditions.
• Be familiar with emerging tools/indices intended to help us better understand, appreciate, and manage these systemic manifestations and interactions.

Moderator: Francesco de Blasio, MD, FCCP

- Classification and Diagnosis Guidelines - Carlo Vancheri, MD
Description:
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.

- Rare Interstitial Lung Diseases - Elena Bargagli, MD, PhD
Description:
This session will explain the novel approach to the diagnosis of chronic hypersensitivity pneumonitis; describe pleuroparenchymal fibroelastosis: a novel rare entity, and explain alveolar microlithiasis.

- Newest Therapeutic Approach - Alessandro Sanduzzi Zamparelli, MD
Description:
Nowadays, pharmacologic treatment of IPF is based on one among two available antifibrotic drugs (pirfenidone and nintedanib): increasing reports in the literature show that, in the future, there could be some possibilities to enlarge therapeutic scheme, ranging from the possible association between the two drugs in use, to the add -on use
of an old drug (NAC), finally to the utilization of new drugs, actually under investigation.

Speaker: Lisa K. Moores, MD, FCCP
Moderator: Jack Buckley, MD, FCCP

Description
This session will highlight the significant prothrombotic state that occurs in patients with moderate to severe COVID-19 infection, the rationale behind the initial set of guidelines, and the studies that have emerged since that time and how they have formed our current understanding and recommendations for prevention.

Objectives
• Discuss the underlying pathophysiology that leads to thrombotic events in COVID-19 and how this informed the first iteration of guidelines.
• Review randomized controlled trials regarding prevention.
• Discuss current recommendations based upon this recent data, including controversies surrounding these recommendations.

Speaker: Antonio Spanevello, MD
Moderator: Stefano Marinari, MD

Description:
No biologic treatments are currently available for type 2–low severe asthma, which is characterized by neutrophilic or paucigranulocytic airway inflammation and is associated with: older age, adult-onset asthma, obesity, metabolic syndrome, hypertension, and greater resistance to treatment with glucocorticoids.
Although the pathophysiologic features of type 2–low asthma still need to be elucidated, several molecular mechanisms have been implicated, including interleukin-6, CXCL8 (CXC motif chemokine ligand 8), interleukin-17A, interleukin-23, interferon-γ, tumor necrosis factor-α, interleukin-33, and TSLP.
Recently, the anti-TSLP antibody tezepelumab was shown to reduce exacerbation rates among patients with severe, uncontrolled asthma, irrespective of the blood eosinophil count at baseline, 51 whereas the anti–interleukin-23 monoclonal antibody risankizumab did not provide a clinical benefit in patients with severe asthma.

Speakers:
Nicola Scichilone, MD
Venerino Poletti, MD
Leonardo Fabbri, MD

Moderator: Girolamo Pelaia, MD, FCCP

Description:
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.

Learning Objectives:
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.

Session Description:
Rotation:
1. Ultrasound-Guided Thoracentesis 2. Tunneled Indwelling Pleural Catheters for Effusion
3. Small-Bore Pleural Catheters for Pneumothorax
4. Large-Bore Wire-Guided Tube Thoracostomy

Speaker: Eva Polverino, MD
Moderator: Simonetta Baraldo, MD

Learning Objectives:
• Understand the main limitations of antibiotic therapy.
• Learn what strategies can be invoked to fight infections before or beyond antibiotics.

Speaker: David A. Schulman, MD, FCCP
Moderator: Francesco Fanfulla, MD

Description
This session will cover the top articles relevant to sleep medicine between 2021 and 2022 in a rapid-fire fashion.

Speaker: Stephanie M. Levine, MD, FCCP
Moderator: William F. Kelly, MD, FCCP

Description:
These are a diverse group of disorders characterized by an increased number of eosinophils in one or more compartments of the lung and/or the peripheral blood stream, often associated with radiographic changes and PFT abnormalities.

Learning Objectives:
• Review the major eosinophilic pulmonary disorders.
• Distinguish acute and chronic eosinophilic pneumonia (AEP and CEP).
• Be familiar with common presentations of AEP, CEP, allergic bronchopulmonary aspergillosis (abpa), eosinophilic granulomatosis with polyangiitis (EGPA, Churg- Strauss Syndrome), hypereosinophilic syndrome.

Evolving COPD Paradigm: Early Treatment and Tailored Patient Management
Speaker: Andrea Bianco, MD, PhD
Moderator: Mario Del Donno, MD, FCCP
Sponsored by: GlaxoSmithKline

Therapeutic Appropriateness In COPD
Speaker: Marco Contoli, MD
Moderator: Enrico Clini, MD, FCCP
Sponsored by: Boehringer

Product Theater - Supported by Vathin Medical

Product Theater- Supported by Intuitive Surgical

Shape-sensing technology and how to integrate robotic bronchoscopy to your practice
Dr. Michael Pritchett
Director, Chest Center of the Carolinas at First Health
Past President of the Society for Advanced Bronchoscopy

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Speaker: Doreen Addrizzo-Harris, MD, FCCP
Moderator: Pier Anselmo Mori, MD

Description:
This session will cover the epidemiology of M abscessus pulmonary disease, its presentation and management. Several cases will be presented that will illustrate treatment strategies for dealing with this often complex and hard to treat disease.

Speaker: Stefano Gasparini, MD
Moderator: Antonio Sachetta

Description of the lecture
ROSE (rapid on-site cytological evaluation) is a process that can be done during bronchoscopic procedures to evaluate in real time the adequacy of the samples and to have an immediate feedback that can optimize the procedure. ROSE is underutilized mainly for the lack of pathologists available. This lecture will demonstrate how pulmonologists could evaluate ROSE by themselves, after a short training in cytopathology.

Learning Objectives
• Demonstrate the possible advantages of ROSE in needle aspiration techniques (transbronchial or percutaneous) for the diagnosis of pulmonary diseases.
• Stimulate pulmonologists to acquire knowledges and skill in performing ROSE.

Speakers:
Stephanie M. Levine, MD, FCCP
Deborah J. Levine, MD, FCCP
John (Jack) Buckley, MD, MPH, FCCP
Darcy D. Marciniuk, MD, FCCP

Moderator: Stephanie M. Levine, MD, FCCP

Moderator: Francesco de Blasio, MD, FCCP

- COPD Inflammatory Phenotyping - Antonio Spanevello, MD
Description:
Patients with COPD might present different clinical and inflammatory phenotypes. Therapeutic approach should take into consideration the heterogeneity of the disease and comorbidities that usually affect COPD patients.
Learning Objectives:
• Learn how a multidisciplinary approach can deal with the complexity of the disease.
• Explore how systemic and peripheral inflammation can impact on follow-up.

- Evaluation of Body Composition - Luca Scalfi, MD
Description:
The evaluation of body weight and body composition is essential and highly recommended in respiratory patients’ management in order to develop targeted and personalized nutritional interventions. For example, in COPD patients, unintentional weight loss and low BMI are associated with significantly worse clinical outcomes. In cystic fibrosis, a major area of recent progress has been the emphasis on the central role of undernutrition. On the other hand, clinical epidemiologic studies suggest a strong relationship between obesity and poor control of asthma. Beside BMI, muscle or fat-free mass measurements may be even better predictors of clinical outcomes in respiratory patients, being associated with impaired physical performance and worse lung function. In addition, a pivotal role of osteoporosis in disease progression has emerged, which places the assessment of body composition as integral part of disease management. Although there is no exact standard diagnostic procedure to evaluate body composition, different methods can be used in clinical practice: anthropometry (weight, height, skinfolds/circumferences measurements), bioelectric impedance analysis (BIA), dual-energy x-ray absorptiometry (DXA), as well as more advanced imaging technologies like computed tomography (CT) and nuclear magnetic resonance (NMR). The criteria for this choice will depend on the advantages and disadvantages offered by each one but also on the patient’s limitations, the conditions of the health system, and the purpose of the study.
Learning Objectives:
• Provide practical information in order to identify alterations of body composition and poor nutritional status in respiratory patients.

- Clinical Approach to Exercise Tolerance in Patients With Advanced COPD - Enrico Clini, MD, FCCP
Learning Objectives:
• Understand the patho-physiologic factors limiting exercise tolerance in patients with advanced COPD.
• Effectiveness of exercise training in COPD and methods on top to adopt in more advanced patients.
• Consider practical recommendations and different training for exercise training over a rehabilitation course.
Learning Objectives:
• Understand the patho-physiologic factors limiting exercise tolerance in patients with advanced COPD.
• Effectiveness of exercise training in COPD and methods on top to adopt in more advanced patients.
• Consider practical recommendations and different training for exercise training over a rehabilitation course.

Session Description:
Rotation:
1. Ultrasound-Guided Thoracentesis 2. Tunneled Indwelling Pleural Catheters for Effusion
3. Small-Bore Pleural Catheters for Pneumothorax
4. Large-Bore Wire-Guided Tube Thoracostomy

Speaker: Gerard A. Silvestri, MD
Moderator: Sergio Harari, MD

Learning Objectives:
• Define the epidemiology of this disorder.
• Review the diagnostic approach to distinguishing benign from malignant disease.
• Better understand when to use lung biopsy, PET scan, or surgery for the management of lung nodules.
• Introduce how blood biomarkers will potentially be used in this space.

Speaker: Giuseppe Insalaco, MD
Moderator: David Schulman, MD

Speaker: Gerard A. Silvestri, MD
Moderator: Gerolamo Pelaia, MD, FCCP

Description:
During this session we will review and discuss the clinical implications of recently published practice changing research.

Learning Objectives:
• Describe recently published clinical research likely to impact the detection, diagnosis, staging, or treatment of lung cancer.
• Discuss the clinical implications of the literature reviewed.

Speaker: John (Jack) Buckley, MD, MPH, FCCP
Moderator: Giuseppe Insalaco, MD

Learning Objectives:
• List clinical conditions where empiric antibiotic use is important.
• Identify antibiotic selection strategies.
• Outline strategies for antibiotic de-escalation.

Moderator: Sandhya Khurana, MD, FCCP

- Novel Insights in Pathobiology of Severe Asthma - Sandhya Khurana, MD, FCCP
Description:
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.

Learning Objectives:
• 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.

- Viral Infections and Asthma Exacerbations - Alberto Papi, MD
Description:
The session will coverdentification of respiratory viruses; epidemiology of viral infection during asthma acute episodes; mechanisms of asthma exacerbations; and mechanisms of viral-induced exacerbations.

Learning Objectives:
• Asthma exacerbations are frequently infective events of viral origin.
• Immunology of virus-associated exacerbations.
• Possible targets for prevention.

- Advances in Inhaled Pharmacotherapy - Pierluigi Paggiaro, MD
Description:
Inhaled therapies are the cornerstone for the treatment of asthma. Because no new drug categories have been developed in recent years, the novelty in this field is related to: a) different combinations of ICS/LABA/LAMA: triple therapy for the management of moderate-severe asthmatics has been studied after the first demonstration that adding tiotropium to ICS/LABA combinations resulted in a significant increase in FEV1 and a significant reduction of severe exacerbations; at the present time, some fixed ICS/LABA/LAMA combinations have been produced, some of them with recently published results, showing the additional value of this triple therapy vs ICS/LABA combinations; b) different strategies for management of mild asthma: according to the results of the two SYGMA studies and of the other two pragmatic trials, rescue use of budesonide/formoterol resulted in a similar or better effect in comparison with regular low-dose budesonide in preventing moderate-severe asthma exacerbations; c) different devices with new technology: recently a new breath-activated inhaler with fluticasone-formoterol combinations has been demonstrated able to improve lung deposition of the drug and to improve compliance with the treatment; in addition, new “intelligent” devices (able to monitor the inhalation performance) have been produced, always aiming to improve adherence and, therefore, asthma control.

Learning Objectives:
• Understand the results related to the efficacy of the different fixed triple combinations to be used in uncontrolled patients with moderate-severe asthma.
• Explain the rationale and the results of the rescue medication treatment strategy in mild asthma and also the potential problems in the application of this strategy in real life.
• Describe the novelty about technology of the new inhalers, which may improve the adherence in patients.

- New Therapies in Severe Asthma - Girolamo Pelaia, MD, FCCP
Description:
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:
• 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.

Panel:
Semra Bilaceroglu, MD
Stefano Gasparini, MD
Otis Rickman, DO, FCCP

Moderator: Septimiu D. Murgu, MD, FCCP

Description:
This session is designed for pulmonologists and thoracic surgeons interested in improving their knowledge pertinent to malignant airway obstruction, benign airway strictures and tracheobronchomalacia. This is an interactive panel discussion using case-based scenarios and an audience response system to enhance learning.

Learning Objectives:
• Distinguish the different treatment alternatives for benign and malignant airway obstruction, including thermal and nonthermal ablation.
• Outline the indications for airway stenting, and list stent-related adverse events and the methods to prevent and manage them.
• Outline the optimal treatment nonsurgical strategies for tracheobronchomalacia and excessive dynamic airway collapse.
• List the indications for tracheal resection and tracheoplasty in patients with benign tracheal strictures and tracheobronchomalacia, respectively.

Speaker: Simonetta Baraldo, PhD
Moderator: Alessandro Sanduzzi Zamparelli, MD

Description:
COPD is a heterogeneous disease either at the clinical and biological level. The focus of research is shifting from the phenotype of the disease (e.g. emphysema or chronic bronchitis), to the endotypes, i.e. the pathobiological changes underlying a phenotype. In order to aim at a precision treatment for COPD, we need to understand what the endotypes are and how to target them before COPD is established and advanced.

Learning Objectives:
• Understand the COPD endotypes and why they are more informative than the phenotypes.
• Learn how to assess and target endotypes with recently developed technologies.
• Learn how basic researchers and clinicians can interact to advance the understanding of the COPD endotypes and their therapeutic implications.

Speaker: Fabio G. Numis, MD
Moderator: Francesco de Blasio, MD, FCCP

Description:
This session will cover the basics on the interpretation of hypoxia and hypoxemia, and the differences between these two conditions in terms of pathophysiological point of view. Two case reports will show the possible interpretation of lactatemia in blood gas analysis in patients with COVID-19.

Moderator: Stefano Nava

COVID - Where Are We Today - William F. Kelly, MD, FCCP
Post COVID Rehab - Francesco de Blasio, MD, FCCP

Speaker: Mario Cazzola, MD
Moderator: Maria Del Donno, MD

Description:
COPD has a high impact in elderly patients that use multiple pharmacies because often it is associated with different comorbidities such as cardiovascular diseases, depression, and diabetes mellitus. Bronchodilators are important in the management of COPD, but solid information on the role that age can play on their responses is still lacking. Furthermore, they can impact sometimes in a positive but often negative way on comorbidities. Age and comorbidities should affect bronchodilator selection with the need to minimize the risk of potential adverse effects and drug interactions.

Learning Objectives:
1. Examine the potential effects of bronchodilators on comorbidities of COPD.
2. Determine whether comorbidities are just comorbidities or are the consequence of concomitant pharmacologic treatments.
3. Describe the potential interactions between bronchodilators and drugs used to treat comorbidities.

Speaker: Doreen Addrizzo-Harris, MD, FCCP
Moderator: Pier Anselmo Mori, MD

Learning Objectives:
• Discuss and review the recent advances in pharmacologic treatment for NTM pulmonary disease.
• Summarize the newest guideline recommendations for NTM pulmonary disease.

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William F. Kelly, MD, FCCPs

Pulmonary Trivia Game show

Moderator: Francesco de Blasio, MD, FCCP

Moderator: Girolamo Pelaia, MD, FCCP

- The Evolution of World Symposium of Pulmonary Hypertension: Diagnostics and Treatment - Nazzareno Galiè, MD
Learning Objectives:
• Discuss and review the recent advances in pharmacologic treatment for NTM pulmonary disease.
• Summarize the newest guideline recommendations for NTM pulmonary disease.

- Pulmonary Hypertension and Lung Transplantation: Group 1 and Beyond - Deborah J. Levine, MD, FCCP
Description:
This session will review the indications for lung transplantation for patients with PAH, as well as the consequences in patients undergoing lung transplant who have coexistent PH. We will also discuss outcomes of both.

Learning Objectives:
• Identify the referral and selection of patients with PAH for lung transplantation.
• Understand the consequences of coexistent PH in patients undergoing lung transplantation.
• Review the management and outcomes of patients with PH undergoing lung transplantation.

Speaker: Gerard A. Silvestri, MD, FCCP
Moderator: Claudio Micheletto, MD

Learning Objectives:
• Review current literature on diagnostic yield of bronchoscopy using differing technologies.
• Review guided and navigation bronchoscopy.
• Introduce robotic bronchoscopy and its potential in diagnosing and treating lung cancer.

Speaker: Mauro Contini
Moderator: Francesco de Blasio, MD, FCCP

Description:
Dyspnea and fatigue are cardinal symptoms of both cardiac and lung diseases. Frequently, these pathologies coexist, worsening clinical condition and making it difficult for physicians to correctly identify the cause of dyspnea and reduced exercise capacity. A wide amount of evidence suggests that CPET, in conjunction with PFT, is a useful clinical tool to identify cardiac and/or pulmonary causes of dyspnea of unclear or multifactorial origin. In fact, lung function evaluation is pivotal in the diagnostic assessment of heart failure, as lung disease comorbidities influence both prognosis and therapy.

The close relationship between cardiac and pulmonary pathophysiology was first described in 1785 by Withering and in 1883 by Hope, who coined the term “cardiac asthma.” Moreover, several studies showed a reduction in FEV1, FVC and DLCO in heart failure. Several factors may be responsible for restrictive lung pattern in heart failure, such as increased lung stiffness due to alveolar effusion, reduction of working alveolar–capillary units, respiratory muscle fatigue, cardiac enlargement, and constriction of under-perfused alveoli leading to reduced lung compliance in a low cardiac output state. However, evidence in this field is not extensive and pathophysiology regulating heart-lung interactions is complex and not completely cleared.

Learning Objectives:
• Mechanisms in heart failure that can induce a restrictive lung pattern
• Which variables of the CPET are important to evaluate a lung-restrictive pattern
• Clinical strategies in the treatment of lung/heart pathological interactions

Speaker: Mangala Narasimhan, DO, FCCP
Moderator: Otis Rickman, DO, FCCP

Description:
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.

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

Speaker: Raffaele Scala, MD
Moderator: Mario Polverino, MD

Speaker: Francesco Fanfulla, MD
Moderator: David Schulman, MD, FCCP

Description:
The correlation between OSA and motor vehicle accidents or work injuries is confirmed in several studies. Motor vehicle crashes are more frequent in untreated patients, and they’re usually associated with more severe injuries. Regular CPAP treatment relieves excessive daytime sleepiness and reduces the crash risk.
However, it is a matter of discussion (15) if the driving risk in OSA is more closely related to the degree of daytime sleepiness, objective severity of sleep-disordered breathing, or to the presence of concomitant behavioral factors, like sleep restriction and work schedules.

Learning Objectives:
• Prevalence of sleepiness at wheel or sleepiness at work in patients with OSA and comparison with general population.
• Determinants of sleepiness at wheel, sleepiness at work, and determinant of accidents in patients with OSA.
• How to assess individual risk of accidents

Speaker: Jack Buckley, MD, FCCP
Moderator: Alessandro Zanasi, MD

Learning Objectives:
• List clinical options for monitoring shock.
• Describe approach to monitoring response to treatment interventions.
• Recognize pitfalls and limitations of currently available monitoring systems.

Speaker: Mangala Narasimhan, DO, FCCP

Speaker: Semra Bilaceroglu, MD
Moderator: Maria Del Donno, MD

Description:
This presentation will focus on how to perform procedures in interventional pulmonology (mainly bronchoscopic and transthoracic) by rational medical approach and good clinical practice (ethical and scientific quality standards).

Learning Objectives:
• Teach patient-centered practical approach in interventional pulmonology by ethical and scientific standards.
• Teach principles for rational performance of procedures in interventional pulmonology regarding procedure effectiveness, patient safety, cost-effectiveness, quality and validation of outcomes.

Speaker: David Schulman, MD, FCCP
Moderator: Stephanie Levine, MD, FCCP

Description:
CPAP remains the most effective therapy for the treatment of obstructive sleep apnea, yet adherence to PAP therapy is suboptimal for many patients. This will be a case-based interactive session focusing on approaches that improve adherence to PAP therapy. The session will address patient and clinician barriers to instituting PAP therapy, predictors of PAP nonadherence and interventions that have been shown to enhance PAP therapy. The session will also review the role of various PAP modalities on PAP adherence and outcomes.
Learning Objectives:
• List predictors of CPAP adherence.
• Understand why patients don’t utilize PAP therapy as prescribed.
• Define strategies that may improve PAP adherence.

Speaker: Giuseppe Boriani, MD
Moderator: Francesco de Blasio, MD, FCCP

Session description:
This session will present the epidemiologic and clinical importance of atrial fibrillation, which is commonly associated with many other diseases, including diseases of the chest. The relationship between atrial fibrillation and stroke is clear, but the mechanism underlying this association appears nowadays more complex than in the past. Risk stratification for stroke is the basis for instituting oral anticoagulation, which has a major impact on the risk of stroke, with great value for the patients.

Speaker: Stefano Aliberti, MD
Moderator: Alessandro Zanasi, MD

Description:
Bronchiectasis is a chronic respiratory disease that includes a heterogeneous group of disorders that differ significantly in terms of etiological, clinical, radiological, functional, and microbial features. A personalized approach to each patient with bronchiectasis is needed in order to properly formulate an optimal management plan. A treatable traits approach represents a useful strategy to help clinicians consider the many different aspects that must be addressed for the appropriate clinical management of patients with bronchiectasis. This multimodality approach to treatment results in better clinical outcomes.

Learning Objectives:
• Explore the heterogeneity of bronchiectasis as chronic respiratory disease.
• Discuss clinical phenotypes and endotypes in bronchiectasis.
• Discuss targetable and treatable traits.
• Suggest a personalized approach in the management of bronchiectasis.

Speaker: Sandhya Khurana, MD, FCCP
Moderator: Antonio Sacchetta

Description:
This session will review the most clinically relevant literature published over the past year in the field of asthma.
Learning Objectives:
• Review findings from, and strengths/limitations of recent significant publications in asthma.
• Discuss how these findings may impact daily clinical practice when caring for patients with asthma.

Speaker: Stephanie M. Levine, MD, FCCP
Moderator: Girolamo Pelaia, MD, FCCP

Description:
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.

Learning Objectives:
• 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.

Speaker: Mangala Narasimhan, DO, FCCP
Moderator: Otis Rickman, DO, FCCP

Description:
This ultrasonography session will provide an opportunity to perform hands-on skill-building opportunities in the three critical components of echocardiography: image acquisition, image interpretation, and clinical applications. Specifically, it is designed to focus on the patient with an unknown cause of hemodynamic failure. Image acquisition will be practiced during small-group hands-on workshops, while training in image interpretation utilizing clinical case review. Practice your skills using high-quality ultrasonography technology on live patient models, supervised by experienced faculty who will guide and maximize your training.

Learning Objectives:
• Understand the knowledge base required to perform critical care echocardiography and interpret cases.
• Integrate general critical care ultrasonography with bedside echocardiography.
• Incorporate interpretation skills required for critical care ultrasonography and echocardiography.
• Demonstrate appropriate image acquisition techniques required for critical care echocardiography.

Moderators: Francesco de Blasio, MD
Antonio Sacchetta, MD

- The Modern Pulmonologist Facing the Study of Small Airways - Andrea Bianco, MD
Description:
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.

- Peculiarities of Respiratory Pattern During Sleep and Exercise in Normal Subjects - Claudio Micheletto, MD, FCCP
Description:
Physiology has played a crucial role in our understanding of common respiratory diseases, particularly asthma and COPD. Actually, interest is swinging back toward physiology, as the field integrates advances in cell and molecular biology with functional changes in whole organisms. It is recognized that physiology is of vital importance in making sense of all the advances in basic science, and the field is now re-emerging as functional genomics and system biology.

Learning Objectives:
• Review the respiratory pattern during exercise in normal subjects to better understand the flow limitation of chronic obstructive respiratory disease.
• Review the peculiarities of respiratory pattern during sleep in normal subjects.

- Airflow Limitation: How to Assess and Prevent It in Patients With Chronic Obstructive Diseases
Claudio Tantucci, MD
Learning Objectives:
• Learn the differences between airflow obstruction and airflow limitation in the obstructive lung diseases.
• Explore methods to assess tidal expiratory flow limitation at rest and during exercise.
• Learn patho-physiologic significance of tidal expiration flow limitation in clinical practice.

Moderator: Lisa K. Moores, MD, FCCP

- VTE: Lisa K. Moores, MD, FCCP
Description:
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.

Learning Objectives:
• 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.

- Pulmonary Hypertension Secondary to Lung Disease: Sergio Harari, MD
Learning Objectives:
• Learn the interaction between parenchymal and vascular changes in the pathogenesis of PH.
• Learn the role of medical treatment for PH associated to parenchymal lung disease.
• Discuss the area of future research in this field.

- PAH: Deborah J. Levine, MD, FCCP
Learning Objectives:
• Understand the outcomes of pregnancy in patients with PAH.
• Review evaluation and therapy for patients with pulmonary veno-occlusive disease (PVOD).

Speakers:
David A. Schulman, MD, FCCP
Giuseppe Insalaco, MD
Francesco Fanfulla, MD

Moderator: David A. Schulman, MD, FCCP

Description:
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:
• Should we be treating patients with mild obstructive sleep apnea?
• Managing nonsleepy patients with obstructive sleep apnea: Does it make a difference?
• Cardiovascular outcomes and OSA treatment: What are realistic expectations?
• Should we be treating central sleep apnea?
• What is the role of nocturnal ventilation in patients with COPD?

Learning Objectives:
• 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.

Speakers:
David Mannino, MD, FCCP
Michelle Vitacca, MD
Valerie Press, MD, MPH
Frank Sciurba, MD
Darcy Marciniuk, MD, Master FCCP
Alberto Papi, MD

Moderators: Michel Stickland MD
Enrico M. Clini, MD, FCCP

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

Learning Objectives:
• 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

Speaker: Mangala Narasimhan, DO, FCCP

Moderators: Francesco de Blasio, MD, FCCP
Girolamo Pelaia, MD, FCCP