Podcasts about copd

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Sly & The Family Stone's frontman Sly Stone (Sylvester Stewart), died 6/9 from COPD. Hulu premiered his Sly Lives documentary in February for Black History Month. Going from church, radio, producing, fame, and downfall, he innovated multiple genre's future sounds. I discuss Sly's bio and created a playlist for you to hear his influential sounds by other artists. Theme Song: "Dance Track", composed by Jessica Ann CatenaMusic Catalog / YouTube ChannelEpisode PlaylistMedia Mentioned: Uncle Buck Dance Scene (1989), Summer of Soul, 50 Years of SNL Music,Rock Talk StudioSongs Mentioned: "Laugh, Laugh" - The Beau Brummels (1965)"Somebody to Love" - Jefferson Airplane! (1967)"Hot Fun in the Summertime" - David T. Walker (1971), The Beach Boys (1992), The Manhattan Transfer & Chaka Khan (1995)"People Everyday" - Arrested Development (1992)"Stand" - Lenny Kravitz (2011) - live"Rhythm Nation" (1989-1990), "And On And On" (1993-1994) - Janet Jackson"Mama Said Knock You Out" - LL Cool J (1990-1991)"Fight the Power" - Public Enemy (1989)"Star/Pointro" - The Roots (2004)"Boogie Shoes" - KC and the Sunshine Band (1975)"Shadrach" - Beastie Boys (1989)"Weapon of Choice" - Fatboy Slim & Bootsy Collins (2000)"No One to Depend On" - Santana (1971)"Rocky Mountain Way" - Joe Walsh (1973)"X-tasy" - Missy Elliott (2001)"Love and Happiness" - Al Green (1972, 1977); BET Awards 2008Related Episodes: Ep. 37 - 20 Summer Songs CountdownEp. 120 - That's My Jam - Game ShowEp. 154 - Janet Jackson's Rhythm NationEp. 220 - Top 40 Songs of 2023 (Part 1)Ep. 241 - The Beach Boys Rare 10Ep. 272 - Top 40 Songs of 2024 (Part 1)

This week, join Kate, Mark and Henry as they discuss all in one triple inhalers for COPD, the best medication for pain management in children and suzetrigine, a new medicine for acute pain in adults. Gary is off this week, working on his French lessons. And we add intro music! Yay!

In de zomer van 2023 wordt de toen 76-jarige Ans bestolen door Hamse. Hij steelt haar handtas en wil wegrijden, maar Ans gaat voor zijn auto staan. Ze wordt aangereden door Hamse en raakt zwaargewond. Maanden later overlijdt ze, en dan is de grote vraag voor de rechter: is Hamse hiervoor verantwoordelijk? Nadat ze is aangereden, belandt Ans in het ziekenhuis. Daar viert ze haar 77ste verjaardag. Enkele maanden later overlijdt ze aan de gevolgen van een COPD-aanval. In de rechtbank vertelt haar familie over hun moeder: „Beste Hamse, dit is Ans na de aanrijding en maanden voor haar overlijden”, zegt haar schoonzoon, terwijl foto’s van haar verwondingen in de rechtbank worden getoond. De advocaten van Hamse D. vragen om vrijspraak van de verdachte: ,,Het is niet zo dat ze is overleden door de verwondingen van het ongeval, maar door een longziekte waar ze al jaren aan leed.’’ Verslaggever Michiel van Gruijthuijsen volgt de zaak namens AD Haagsche Courant en bezoekt haar in het ziekenhuis: ,,Dat was gewoon niet leuk om te zien natuurlijk. Ik zag er een vrouw liggen met heel veel energie, die bij wijze van spreken eigenlijk vastgeketend lag in een ziekenhuisbed.’’See omnystudio.com/listener for privacy information.

Maria Artunduaga is the founder & CEO of Samay, the winner of the 2024 MedTech Innovator accelerator, as well as a groundbreaking physician, scientist, and inventor. Maria discusses her inspiring journey from a small town in Columbia to leading a top MedTech company in the US. After pivoting away from plastic surgery training, she channeled her efforts into creating Sylvee, an AI wearable sensor for COPD patients. Maria shares her relentless determination, innovative problem-solving strategies, and the creation of a company culture that emphasizes learning and diversity.    Guest links: https://www.samayhealth.com/home | https://www.linkedin.com/in/drartunduaga/  Charity supported: ASPCA Interested in being a guest on the show or have feedback to share? Email us at theleadingdifference@velentium.com.  PRODUCTION CREDITS Host: Lindsey Dinneen Editing: Marketing Wise Producer: Velentium   EPISODE TRANSCRIPT Episode 057 - Maria Artunduaga [00:00:00] Lindsey Dinneen: Hi, I'm Lindsey and I'm talking with MedTech industry leaders on how they change lives for a better world. [00:00:09] Diane Bouis: The inventions and technologies are fascinating and so are the people who work with them. [00:00:15] Frank Jaskulke: There was a period of time where I realized, fundamentally, my job was to go hang out with really smart people that are saving lives and then do work that would help them save more lives. [00:00:28] Diane Bouis: I got into the business to save lives and it is incredibly motivating to work with people who are in that same business, saving or improving lives. [00:00:38] Duane Mancini: What better industry than where I get to wake up every day and just save people's lives. [00:00:42] Lindsey Dinneen: These are extraordinary people doing extraordinary work, and this is The Leading Difference. Hello, and welcome back to another episode of The Leading Difference podcast. I'm your host Lindsey, and I am delighted to welcome as my guest today, Maria Artunduaga. Maria is a physician, scientist, and inventor with 60 plus prizes, including becoming the first woman to lead a US LATAM company to win MedTech Innovator, the world's most competitive accelerator for medical technology surpassing over 1300 global companies. A top 1% student in Columbia, her country of birth, she relocated to the US to pursue plastic surgery training, but abandoned it to dedicate herself to solve the problem that killed her grandmother-- a lack of home technologies that can detect COPD exasperations early. Maria has raised 5.2 million, almost 60% in non-dilutive capital from NSF and NIH to build Sylvee, an AI wearable sensor that can provide COPD patients with continuous data on pulmonary functions similar to what continuous glucose monitoring sensors do for diabetic patients. Her invention has been featured by a hundred plus media outlets, including Forbes, TechCrunch, Bloomberg, Fierce Healthcare, and more. Before Samay, Maria completed postdoctoral studies in human genetics at Harvard Medical School, started a plastic surgery residency at the University of Chicago, and completed two master's degrees, one in global public health at the University of Washington, and another in translational medicine at the University of California at Berkeley and San Francisco. She lives in Mountain View, California with her husband, 2-year-old daughter, and four pets. In her free time, she enjoys flamenco dancing, bolero singing, traveling the world, and fostering diversity in and outside the workplace by mentoring underrepresented scientists and entrepreneurs. All right. Well, thank you so much for being here, Maria. I'm so excited to finally get a chance to speak with you. I'd love if you would share a little bit about your background and your career trajectory. What led you to MedTech? [00:02:40] Maria Artunduaga: Sure. So it's gonna be a little long and I'm gonna tell you everything about my life because the personal history is very important to me and for my company too. So, as you have noticed, I have an accent. So, I grew up in Columbia in a very small town in the southern part of the country. My parents were both doctors and I'm the oldest of four kids and two of us followed their lead. So my life in my city was pretty chill. Everyone knew everyone. I spent most of my days at a Catholic school studying very hard on weekends where I usually spent tagging along my parents to doctor events. One of the things that I really like to tell, it's how my parents work as entrepreneurs really shaped my life. They were real pioneers. They built in my hometown the first big clinic back in the eighties and the nineties. And my mom was the only woman in that group, and she actually was the CEO for a while, which was a big deal. She was the only woman in a partnership of 10 people. And watching them build that clinic, that hospital really taught me a lot about dealing with uncertainty and finding solutions. Every day we'll have supper or lunch and I'll just hear all of these challenges and stories, their struggles and how they solve things. Something that was, that is definitely super helpful in what I do now, right? So, and then I was 16 and after high school I moved to Bogota, the capital, which is up in the mountains, it's very cold. I got a scholarship 'cause I was always a very good student. You know, career I spent my last year, I spent nine months in the US. Honestly, coming to the US blew my mind. The technology that I got to see, the speed, effects on science, it was nothing like I've ever seen before, and that was true inspiration for me. So I knew that I had to come to the US. I needed to come back to learn from the best, of course. And it's interesting because my parents didn't want me to relocate to the US. I was the oldest. I was supposed to follow into their footsteps and obviously, like inherited that clinic, right? That hospital, we call it clinic, it's actually a hospital. And I was a very contrarian. I didn't listen to them. I told them, you know, I really wanna be where the best people are. And what I did was that I, it took me three years to save the money to come to the US, to get Harvard to actually sponsor me my visa because they wouldn't pay me for the first year. So I remember I had to save $30,000, which in pesos is significant. So back in 2007, so many years ago, I made it to Boston, and the original idea was that I wanted to become a pediatric plastic surgeon and bring that level of care back to Columbia. I spent four years of researching a genetic ear condition that's called microtia. And with that work, I was able to land a plastic surgery residency spot or position at the University of Chicago. And I shared this with a lot of people. I actually had a really negative experience. Things didn't go as planned. I actually faced discrimination. I eventually, you know, had to leave and I made the top choice to never ever go back into clinical practice. And I changed paths. I was 32 years old and yeah I decided to switch gears. I retrained into public health and tech. And then in 2016, I moved to the Bay Area where I am right now. And I got another scholarship to finish master's in translational medicine at UC Berkeley and UCSF. And during the courses that I took, some of them with business class etc., etc., I decided to found Samay in 2018. I really wanted to build something that would really make a difference in respiratory medicine. And this is where my grandmother comes. So my, the grandmother, my abuela, her name was Sylvia and she had Chronic Obstruct Pulmonary Disease or COPD and she's the reason behind my company. So, she often couldn't tell when her symptoms were getting worse. That's a huge problem. Catching the respiratory attacks, exacerbations is definitely key to keeping people outside of the hospitals, and obviously feeling their best to have a better quality of life. So, that's what we are trying to solve with a company, right? If we are able to catch those exacerbations even with a day or two notice in advance, right, that we can all make a difference. And so by missing these exacerbations, we are having really high expenses in hospitalizations and ER visits and the problem we trying to solve is that today technologies that are adequate enough to be used outside of the hospital because the ones that are considered to be the gold standard, they are very expensive. They are confined to their hospitals and they are very difficult to complete for the patient, especially when they're exacerbating. They need to blow out forcefully for about 10 seconds, 21 times. So what we are doing is, we are developing a sensor that makes it super simple for people to use it at home to track their lung function without doing those forceful maneuvers and ideally in the future to warm them, right? Like to let them know when things are starting to go south or obviously, you know, not going very well, and that's what it's all about. I mean, that's what we do with Sylvee right here. And it's wearable sensor and we have done significantly well over the past couple of years. We actually just won MedTech Innovator. [00:08:04] Lindsey Dinneen: Yeah. Significantly well over the last few years. Yes. So congratulations on that, and I want to dive into all of those exciting milestones in just a second. But I am, first of all, so inspired by your story. Thank you for just sharing that your resilience and your grit and your determination are really admirable. So thank you for sticking with something that was not easy, not an easy path. [00:08:29] Maria Artunduaga: I know. I know. [00:08:31] Lindsey Dinneen: It continues not to be, ironically, as we've kind of touched on before, but just going backward a little bit in your story. So I, it sounds to me like getting the opportunity to watch your parents have this incredible impact on their community and the healthcare and the opportunity is just so valuable for you. And even just learning about how your mom was the CEO and those kinds of things, did that help shape the idea for you that not only is entrepreneurship possible, is innovation and healthcare possible, but you can also be this in incredible leader as a woman in whatever capacity? I would just love to dive into that. [00:09:13] Maria Artunduaga: Yeah, it's super interesting, right? My mom really taught me a lot about leadership. She's a surgeon, so you can imagine how good of a leader she is in the operating room at home, everywhere, right? I mean, she's definitely the general, that's how I call her. And I honestly, I try to replicate, so my leadership and styles pretty much shaped by her. So I always call her my best role model whenever somebody asks me about the question, right? So I'm just like her. I lead from the front. I like setting the pace by working the hardest. So I really like to lead by example and I also, just like she did, and obviously because of her surgical training, I hold myself to a really high standard, and I expect everyone on my team to do the same. So people in my company know that I'm very strict, I'm very disciplined, and they know that from the beginning. It's so funny because when I interview all of them, at the final interviews with me, and I actually do the anti sale to join Samay. It's like, this is, these are all the reasons why you shouldn't join. I start describing myself as a very intense, obsessed CEO with insomnia, which I still have, because I really wanna make this work, right? So, yeah, I, ask them, and most of them say yes. I really like, I attract people that like challenges, especially intellectual challenges. So, yeah, to this point, most of them say yes. Some of them have obviously, you know, because probably too much. But at the same time, I tell them, "Look, this is going to be very hard in terms of the deliverables, the things that we're expecting from you." But at the same time, my goal is to not only help people with respiratory problems, I try to sell the company as a company where everyone that gets hired can be themselves and thrive. So, so for example, I tell them," Look, I'm trying to be the boss that I never had." And this goes obviously very tied to the very negative experience that I had during my surgical residency and even before, right? So, I never had a boss that really supported me, who recognize my true self and those characteristics as good things, right? So they always try to tone me down. I'm very energetic, as you can notice, and I'm also super ambitious. I'm really ambitious. I wanna do all of these great things. And they always thought that I was aiming for too much, especially for a woman. It's like, " You need to lean in, Maria. You need to behave." So I remember my residency, they were criticizing like, "Why are you behaving like this, Maria? Why are you asking so many questions? You're asking too many questions. You look more as an internal medicine doctor. Why are you always smiling, Maria? Why are you so happy?" So now, with everyone that I hire, what I try to do is that I focus on understanding their dreams and I try to figure out how this job is gonna help them get there. So if they wanna become a top engineer, maybe they wanna learn managerial skills, or they wanna run operations, or they eventually wanna become a founder themselves. So I try to create a partnership with them where they obviously help me succeed with the company, build Samay, but at the same time they get to do this personal growth. So it's extremely important that they get to place where they wanna be. [00:12:32] Lindsey Dinneen: Yeah, that's wonderful. And such a gift to your employees. And I also honestly, that sort of anti interview or whatever technique is brilliant because you do want it to be a fit for everyone, and it's so much better to have aligned expectations from the start. So, oh my goodness, that's so interesting. So, okay, so then. Speaking into that, how do you develop a company culture for yourself? You've learned from some pretty negative experiences, so obviously that's what not to do, but you know, as you're crafting your own company culture now, what kinds of things are sort of your core values, other than of course, your hard work and your excellence and holding yourself and others to high standards, but what kinds of things do have you developed that make it special to be where you are? [00:13:19] Maria Artunduaga: Yeah, I mean, that's a really good question. I'm very true to myself, and one of the things that I wanna do with Samay, it's I wanna create legacy. If you go to my WhatsApp, that's exactly the little logo or the slogan that's below my name: I'm creating or building my life's legacy. That's how I pitch myself. So I really wanna be remembered as someone that made healthcare more accessible, especially for the people that get left behind. So growing up in Columbia, I saw firsthand how unfair things will be and I wanted to change that. So that's how the values of Samay go, people first. I think legacy, it's extremely important, right? It's about getting those life changing tools and opportunities into the hands of people who really need them. And again, it's not necessarily, the group that we're building. It's the own experience of building a company with me, learning from the company, from the people that are working with. I really wanna make it accessible for people. And I wanna also be obviously a source of inspiration. You don't necessarily need to be this perfect person to be a CEO. You know, life is a struggle and that's totally fine. Just be very passionate about building legacy, right, your work and how you're impacting other people. And especially for me, I do a lot of work with women and minorities. I really wanna empower them to chase their dreams in science and technology. I really care about people. I don't know, I'm selfless about me. It's all about the others and creating legacy and being remembered. So, yeah, that's how I, that's how I roll. [00:14:59] Lindsey Dinneen: I love that. I love that. So speaking of you embracing the CEO role, when you first started your company, did you feel ready to step into this kind of position? Or was it something where you just were like, "You know what? I see the need. I know I can make a difference in this field. I'm gonna do it and I'll learn along the way." [00:15:19] Maria Artunduaga: No, not at all. And let, so there's a very good anecdote that I'm sharing. Again, back to all of these life changing experiences. I got into medtech because of, I don't know, somehow the planets got aligned, right? So I was doing a master's in public health because I thought that was going to be my real call, working for Gates in Seattle, because that's where I actually lived for about two years. Then I came to realize that it was very bureaucratic. It's very, was very slow. I have a type A personality. I really like to fix things very quick. I like to implement stuff. So I decided to do a second master's degree, and as I mentioned, here in Berkeley, I decided to join one of Atma METs minority programs for students, right? It's called SMDP. And I remember that was back in 2016, and they sent me to Minneapolis for the big conference. And that's where I got my first real taste of MedTech. And I remember watching the MedTech Innovator finals with Paul Grand. He was introducing the program, the finalist. I remember clearly seeing all of his pitches and how Green Sun Medical CEO won, and it was a game changer to me because when I saw them pitch, it was very exciting. You know, all these technologies, the many millions of people they could definitely impact, I saw that, and it clicked. I could turn the scientific ideas into something that helps millions in a way, the way how I would practice medicine, but in a more impactful way. So interesting story though. So the other thing that was very inspiring or at least that motivated me, I was the only person in the room who looked like me and spoke with an accent from South America, from Latin America. So it was like two reasons behind it. For me, it was I wanna be a medtech entrepreneur, but at the same time I wanna be able to break the glass ceiling, right? The first Latina physician CEO building a company that has hardware, software, and AI, this is what we actually do. And yeah, so it, it's mainly that. I really like challenges and I'm very motivated to show people that I can do things that might seem impossible or too difficult. So I really like showing people that anything is possible with a lot of hard work and determination. So yeah, that's mainly it. [00:17:47] Lindsey Dinneen: I love that. Embracing those challenges, running full steam at them and having that, I don't know, that gumption is fantastic too. And the desire, like... [00:17:57] Maria Artunduaga: Thank you. [00:17:57] Lindsey Dinneen: ...you said, to break through those ceilings and to represent and say, "No, it is possible." It is, and I love that. So, excellent. Okay, so can you share a little bit about the journey that the company has gone under recently and some of the really exciting milestones? I know there have been bumps and whatnot, but maybe some of the exciting things that have been developing and what you're looking forward to as you continue down the road. [00:18:24] Maria Artunduaga: Sure. I mean, whew. There are so many things that have been happening for the last couple of months. So it's been a long journey. It's been six years so far. Initially, you know, I wanted to build a company with an idea that was inspired, obviously, by the fact that I lost my grandmother to exacerbation and also because, at the time, I didn't know what I wanted to build. When I was doing an interview with a pulmonologist, what I realized was that I could actually build a technology that could be inspired by consumer devices, so hearing aids for example. And funny story is that my husband who is also Columbian, and went to MIT, he's been working at Google for over a decade and he's an auto engineer. He does a lot of things. He's very smart and he's one of the main architects. What I decided to do back then was, let's repurpose hearing aid technology by sending signals through the chest, and let's use the physical principle of acoustic resonance to understand what's going on inside of the lungs. And that's exactly what we are doing. We have 10 granted patents so far. We have 20 more pending on pulmonary so far. So we've done a lot of things. So we've tested that device on 450 people almost. All of our numbers of accuracy are over 90. Sensitivities and specificities are also between 82 to 98. Right now we are starting to see changes a few days before an exacerbation is actually diagnosed by a physician, which is extremely exciting. We have data from two people. Obviously it's a small sample size. We are following eight of them, and we're aiming to finish at 60 to hundred people in the next year or so. So that's our main goal. We've raised 5.2 million, 60% of that money is coming from grants, federal grants, and we just submitted a breakthrough designation to the FDA about a week ago, so fingers crossed, though, we get it right? There are a lot of things in the pipeline, things that are very exciting. Right now I'm super excited 'cause those six years were very hard. I was running a science project with my nails, getting money from grants, help from people who have known me forever. It was very hard for me to recruit a full-time CTO. So my husband has been helping me with some hours here and there. And we have right now 12 people in Columbia. So for developers, designers, clinical researchers, we are running most of our operations in Latin America because it's extremely, well, obviously cost efficient, and more importantly, we have access to people that are patients especially that are, that exacerbate more often. So we are to leverage all the different angles that we can get. [00:21:04] Lindsey Dinneen: Yeah. Wow. So lots of exciting things in the works and in the future, and oh my goodness, I'm so excited, can't wait to continue to celebrate all those wonderful accomplishments. So I'm curious, as you've taken this journey and even before with your other health experiences and finding this path, are there any moments all along the journey that really stand out to you as affirming, "Yes, I am in the right place at the right time, in the right industry." [00:21:31] Maria Artunduaga: Yeah, beyond the MedTech Innovator, the experience eight years ago, I mean, every day I find that this is the perfect fit for me. I always tell people, "Look, entrepreneurship is not for everyone. It really needs to be a fit of personality." So when I talked to my parents, because at the beginning they weren't very agreeable with the idea of me becoming an entrepreneur 'cause physicians don't do this, right? I was sort of like a black sheep of a family, 'cause my sister, she's successful and she's a pediatric radiologist as she's working for an academic center in, in Dallas. So, my personality, I'm Type A. I'm very anxious. I really like doing things super fast. I really like to get things done, right? So, I dunno if I picked the wrong career, probably could have done a better job as an engineer, as a scientist myself. So at heart, I'm a true scientist. That's what I really enjoy. I like practicing medicine, sort of miss it a little bit, but I'm more in the quest of solving questions and discovering, right? That's what really excites me. And then, every day is a new day when you're building a company. And the challenges that I have every day, all of the problems I have to solve, I really enjoy the process of solving them. And this is a little crazy. Who gets excited with problems, right? So, I don't know, that's probably me. So I guess every day, the moment I go home or that I go to sleep, I say, "This is perfect. I don't think I'll be as happy as I am right now if I had stayed medicine. I don't think so." [00:23:10] Lindsey Dinneen: Wow. And that says a lot. And that just affirms to you on a daily basis, "Yeah. I am doing what I'm supposed to be doing. That's wonderful. [00:23:17] Maria Artunduaga: Exactly. Right. It's like, yeah, I'm good at this thing. You know? I like solving problems. I got, I really enjoy the fires. I really like them. I's like, I don't know. I'm, yeah. I'm addicted to them. [00:23:30] Lindsey Dinneen: I love that. Well, and that is unusual, and I'm curious, do you? But it's a great thing. No, it's a wonderful thing. Yeah, no, absolutely. I love that. So, so when you're at finding yourself up against a problem, do you start with any particular kind of established framework? Do you like to just brainstorm solutions? How do you approach problem solving? [00:23:53] Maria Artunduaga: Gosh, this is a really good question. It's like, you know, if I had to teach something, right? So I'm very good at solving problems, at connecting different disciplines, right, to solve those issues. So for example, the way how I go about them, first of all, I don't get frustrated or too anxious about it. I always try to think first, right? And then, yeah, I start brainstorming. I'm very quick at thinking, my mind goes super quick. I have a whiteboard right behind me. I do a lot brainstorming on my own. I ask a lot of questions too. So I rely on a lot of people, and I get a lot of feedback on the way, how I think a problem needs to be solved. And obviously with time and experience, the older that you get, the better you become, right? So yeah, honestly, every problem is different. I just like seeing it from different angles, right? I'm very good with social stuff. I'm very good with arts too. I really like doing science, learning a about engineering. I really like different ways of solving problems. For example, I remember that I we had this NIH grant and we were working collaboration with a big, famous academic center right here. And things weren't working very well. That was through during a pandemic and I was getting charged things that we actually didn't approve. So things were getting a little awkward. I decided to finalize that agreement. But then I got through this situation that I had no access to patients here in the States, and at the time, I didn't have my clinical site in Columbia opened up. So what I did was the craziest thing, which is what I did, was that I bought an $80,000 machine and I came into an agreement with a friend from medical school who has a pulmonary practice in South Florida, one of the largest pulmonary practices. He's a partner with nine other guys, and they see probably a hundred patients every day. Can you imagine that? So respiratory patients, and I told him, "Look, I don't have any money to pay your rent, but I'm gonna give you equity for that rent, and you're gonna use this machine from Monday through Thursday, and I'm going to test your patients from Friday to Saturday. And I'm going to bring people, I'm going to become my own CRO, right? So I'm gonna bring people, doctors, from Columbia on a J1 visa as a research scholar visa. I'm gonna train them and I'm gonna get them to do the recruitment, review everything, test the patients. We are going to become our own CROs, and we are going to do as many people as we can every single week." So we were able to do 430 people in a span of a probably a year and a half. Something that usually would cost us thousands of dollars. I dunno how much money I spend, probably just 300,000 to do everything. Can you imagine? I mean, that's significantly cheap compared to any other quote that I've been getting from an academic center. So, I sometimes go for the crazy idea, right? Like, what's the craziest thing that I could think of? I literally, I write it down, right? And then I just try to double check with my lawyer. "Am I doing something illegal here?" And I, yeah, I cross reference with other founders. " I'm thinking of doing this, how that's that sound?" And they're like, "This is pretty non-traditional, Maria, but I mean, if you can get it done..." I'm like, "Yeah, of course I can get it done." And I just get it done. I just don't take a no for an answer. I'm very good at also finding, convincing people to jump on board with the vision, the mission. This excitement, this energy, people really get very engaged with Samay and with me as a founder, and they love it. Most of these people either have invested in the company, they are helping me many more hours, pro bono, literally free, and we are building together. [00:27:43] Lindsey Dinneen: Wow, that is so cool. And what a fantastic story. Thank you for sharing that one as well. Oh my word. [00:27:50] Maria Artunduaga: I have way too many stories to share. This is the one I really like to, to tell people. [00:27:55] Lindsey Dinneen: I love that, and I love the willingness to come up with those crazy ideas. And it might be just so crazy that it works. So, hey, you never know until you try, and that's fantastic. Oh my gosh, I love that approach. Alright, so pivoting the conversation a little bit just for fun. Imagine you are to be offered a million dollars to teach a masterclass... I know! ...to teach a masterclass on anything you want. What would you choose to teach? [00:28:22] Maria Artunduaga: Yeah. So, good question. So, gosh, I, I tackle problem. So my, my brain again is very good at figuring stuff out. That plus the fact that I'm very stubborn. So if I'm into something, I don't give up easily. And now I'm gonna tell the story about our winning MedTech Innovator. We beat 65 companies globally, right? And I still like, sort of, I cannot process that we won. So the story goes like this, but a year ago, I tried to raise five millions, my very first institutional round, and I totally flopped. [00:28:55] Lindsey Dinneen: Oh. [00:28:56] Maria Artunduaga: I only got $200,000 because multiple funds that I was talking to, they wanted me to feel half of the round before weighing any money or signing anything. So you can imagine. So do I got, you know, chicken or the egg problem? I failed. And instead of crying or mopping, I thought, "Okay, wait. I got into Medtech Innovator. You know what? I'm just gonna win that competition, still $350,000." And why not? So obviously people, my advisors, my best friend, "Like, you're crazy. It's the most competitive thing ever. You're not established in the field. People know who you are, but it's not like you have exited a company or anything, right? You're not even an engineer, Maria." So what I did was, again I went back to my whiteboard. Again, I probably should have become an engineer before, I dunno. I'm really good at solving problems. So I was like, "You know, this is a problem. These are the different ways how I can tackle this." And more importantly, I'm very good at the studying stuff. I really like, again, knowing, wisdom, information. I just love that. I really love that. So what I did was, I treat it like a big project, and I talked to the past winners, anyone who had done or won any sort of like prize with MedTech Innovator, and I figure out their secret sauce. So I either talk to them, I studied every single video, every single pitch. I spend many hours studying everyone who had one or had done significantly well throughout the accelerator. So what I discovered was the accelerator was kind of a school, like a school. So the harder you work, the better you do. And one of the things that I realized was that mentors and reviewers were key players. So I focused on building those connections. I met with many of them. I probably spent about, I don't know, probably four to five hours meeting with mentors, anyone who I thought could help me somehow, obviously, for free, because a lot of the help that they give used for free. And I also spent a lot of time doing homework, the webinars, et cetera, et cetera. I ask a lot of people for advice. I really got people excited about Samay. I recruited my mentors and they got on board from day one. Because of that, I started building those relationships and it was authentic. I mean, don't get me wrong, this wasn't like, you know, I'm trying to play anybody. I really care about what they had to say, and I incorporate all that feedback into my company to this day. So the other thing is, I make sure to go to everywhere, every webinar, every event, everything. My camera was always on, because most people, when they do their webinars, they don't even turn on their cameras, right? So I was very engaged. I was asking questions, I was getting involved with everything. Same thing with the Slack channel that we have for MedTech Innovator. I was helping people, I was sharing stuff. I was even offering to make introductions. I really made sure that people knew who I was. And I obviously also asked the MedTech Innovator people, the staff, for help, feedback, right? Am I doing this right? What do you think I should do? Anything that you can share with me that you think. I was very clear with them. I wanna go to the, I wanna get to the finals. I told them, and I remember they telling me, "Oh, Maria, about getting to the finals, it's so hard. It depends on the strategics and the sponsors." And I was like, " I'm gonna get there. What do you think I should do?" So I literally ask a lot of people how I needed to get there. And with the finals, the way how they pick the finalist, it's actually the mentors who go in front of the strategics, and they sort of champion your company. And they really went to bat for us. They told them how committed I was, the many people that from my team were actually going for participating to the winner because I brought people from my team... [00:32:45] Lindsey Dinneen: Yeah. [00:32:46] Maria Artunduaga: You know, very few founders did that. I brought people from Colombia, obviously online, people who barely could understand English. But, I made them prepare questions. "You need to do this and that we need to be super engaged. We need to help other people." And they saw it was hard work. And at the end, we got into the finals and what I realized was, okay, so after the finals, I understood that the game was, obviously it changed. The way how the winner is chosen is that the audience votes, right, during The MedTech Conference. So what I did was, I went all in on social media. We made an awesome video for the best video competition. I remember that that was the first thing that I did back in June. I scheduled two weeks. I flew to Columbia. I hired right people. I made sure that I was perfect, so I was part of the creative team. I designed everything. Again, I really like arts, right? That's why, one of the reasons why I didn't, I was in pleasantry and that's why I really like dancing too, right? So I'm obsessive with everything that we do. I really am into the details and I supervise everything. And we also got into the finals for the best video competition. So I was going to this problem from every single angle. I didn't let anything up to chance. I, yeah, I'm a freak. I'm a control freak. That's what I did. I remember that even for the pitch, the four and a half minute pitch, I practiced, I don't know how many hours, but every single thing that I say that was obviously memorized, needed to be perfect. The way how I, let's go back to dancing since you're a dancer yourself, the way how I moved my hands, right? The way, how I walked on that stage, everything was rehearsed. So, yeah, I mean, I just I worked my ass off. I mean, everything was the way it needed to be and that's how we won. [00:34:39] Lindsey Dinneen: Yeah. Wow. That's great. What a fantastic story. Yeah. Amazing. Yes. I love how it's so choreographed. Yeah, that's [00:34:48] Maria Artunduaga: great. It was choreographed, [00:34:50] Lindsey Dinneen: I love that. Excellent. Well, I know you have touched on the importance of legacy and how much that means to you, but how do you wish to be remembered after you leave this world? [00:35:03] Maria Artunduaga: Oh gosh. Yeah. I mean, so I have a little daughter, I want to some somehow replicate the same experience that I had with my mom. Maybe she doesn't even realize how much of the inspiration and the impact that she had on me. And again, leading by example, I don't spend a lot of hours with my daughter, right? I have a nanny for 12 hours. So my salary goes to her payment, right? Yeah, I wanna be remembered as somebody who tried very hard, who literally, instead of saying things, I walked the talk. The things that I said I was going to say. For example, I'm very opinionated with anything diversity and inclusion because, as I've said, I've experienced discrimination myself. So I walk the talk, I build a product, I build the change. I worked really hard. I impacted a lot of people. And more importantly, the world has changed somehow because I existed. So that's that. It's as simple as that. I wanna help other people get to fulfillment of their lives and their dreams. And yeah, and I obviously wanna be happy while I do all of these things. And more importantly, I wanna feel that I learned a lot. I really like learning. The process of learning every single day, learning a new thing makes me super happy. So if I don't learn something new, I consider day as, you know, as like a flop or something. So yeah, it's very simple. I'm actually a very simple person, I'm not that complicated. [00:36:30] Lindsey Dinneen: Yeah. Okay. And then final question. What is one thing that makes you smile every time you see or think about it? [00:36:39] Maria Artunduaga: Oh, cute. I mean, obviously my daughter. So I'm a mom. I'm 44, well, almost 45, and I had her at 42. So just thinking about her makes me smile every single time. She's a miracle baby. She's, you know, after four years of IVF, eight retrievals, it finally happened. I finally had her, and having her in my life has turned my world upside down in the best way. She's determined, and she's only three. She's diving into doing all sorts of things. She's doing gymnastics, she's building Legos, she's doing engineering stuff. I really like that "I can do anything attitude" and obviously I'm sort of like reinforcing her to do anything she wants to try. So seeing her try all these new things, all this confidence that I, that she has. It's like, I don't know. I mean, that inspires me. That motivates me to be a better mom, a better CEO, and to do exactly the same thing with the people that I work with. So everyone in my company, I I tell them I'm a mom, right? So, remember that, and I try to do the same with them. It's like I tell them, what do you wanna do? What do you wanna learn this month? What do you need? Right? My work as a CEO is getting the resources and put out the fires. Just tell me, and this is your playground, so I'm trying to do exactly the same with my daughter too. But yeah, I'm very happy with her. [00:38:07] Lindsey Dinneen: Aw, that's wonderful. I'm so glad. Well, oh my goodness, this conversation has been amazing. I kind of wish it didn't have to end, but I also wanna respect your time 'cause obviously you have so much going on. But thank you so much for sharing about your story, your advice. You're so inspiring, and I know this is gonna inspire so many people to go for it, and not to have the fear, to have that problem solving mentality, and growth mindset and learning and, hey, look where curiosity got you. [00:38:37] Maria Artunduaga: Yeah, exactly. That's a perfect slogan. It's all about that curiosity and it gets you places. Look at me. [00:38:43] Lindsey Dinneen: Yeah, exactly. Yeah. And this is just the start. [00:38:47] Maria Artunduaga: Yes, of course. [00:38:48] Lindsey Dinneen: Indeed. So I just wanna say thank you again for your time today, and we just wish you the most continued success as you work to change lives for a better world. [00:38:58] Maria Artunduaga: Thank you so much and thank you again for invitation. I really enjoyed it. [00:39:02] Lindsey Dinneen: Yeah, absolutely. Me too. And we are honored to be making a donation on your behalf as a thank you for your time today to the American Society for the Prevention of Cruelty to Animals, which is dedicated to preventing animal cruelty in the United States. We really appreciate you choosing that organization to support and thank you just again, so very much for your time here today. Yeah, and holy cannoli, thank you so much to our listeners for tuning in, and if you're feeling as inspired as I am right now, I'd love it if you'd share this episode with a colleague or two, and we'll catch you next time. [00:39:44] Ben Trombold: The Leading Difference is brought to you by Velentium. Velentium is a full-service CDMO with 100% in-house capability to design, develop, and manufacture medical devices from class two wearables to class three active implantable medical devices. Velentium specializes in active implantables, leads, programmers, and accessories across a wide range of indications, such as neuromodulation, deep brain stimulation, cardiac management, and diabetes management. Velentium's core competencies include electrical, firmware, and mechanical design, mobile apps, embedded cybersecurity, human factors and usability, automated test systems, systems engineering, and contract manufacturing. Velentium works with clients worldwide, from startups seeking funding to established Fortune 100 companies. Visit velentium.com to explore your next step in medical device development.

Story at-a-glance People managing multiple chronic illnesses are nearly twice as likely to develop depression, even if they've never had mental health issues before, according to a decade-long study Living with both heart disease and diabetes drastically increases your future depression risk, making cardiometabolic combinations among the most dangerous for emotional health outcomes Chronic illnesses like asthma, chronic obstructive pulmonary disease (COPD), liver disease, and bowel disorders sharply increase your risk of depression by overwhelming your body's ability to regulate mood and energy Women with joint and bone issues like arthritis face a higher depression risk than men with the same diagnosis, revealing a serious and often ignored gender vulnerability Depression doesn't just follow disease — it drives it. Left untreated, it speeds up illness progression, weakens your immune system, and increases your chances of hospitalization

Story at-a-glance People managing multiple chronic illnesses are nearly twice as likely to develop depression, even if they've never had mental health issues before, according to a decade-long study Living with both heart disease and diabetes drastically increases your future depression risk, making cardiometabolic combinations among the most dangerous for emotional health outcomes Chronic illnesses like asthma, chronic obstructive pulmonary disease (COPD), liver disease, and bowel disorders sharply increase your risk of depression by overwhelming your body's ability to regulate mood and energy Women with joint and bone issues like arthritis face a higher depression risk than men with the same diagnosis, revealing a serious and often ignored gender vulnerability Depression doesn't just follow disease — it drives it. Left untreated, it speeds up illness progression, weakens your immune system, and increases your chances of hospitalization

As we age, our brains become more sensitive to stress and disease. A recent study sheds light on a lesser-known risk: reduced oxygen levels. The study, titled “Defining the hypoxic thresholds that trigger blood-brain barrier disruption: the effect of age” and recently published as the cover for Volume 17, Issue 5 of Aging (Aging-US), found that low oxygen—also called hypoxia—can harm the aging brain by disrupting the blood-brain barrier (BBB). This damage may contribute to cognitive decline, memory problems, and an increased risk of dementia. Understanding Hypoxia in the Brain The brain relies on a steady supply of oxygen to stay healthy. When oxygen levels fall—a condition known as hypoxia—the brain undergoes changes to adapt. These changes include the remodeling of blood vessels and, importantly, a weakening of the blood-brain barrier. The BBB acts as a filter, protecting brain tissue from harmful substances. When it breaks down, it can lead to inflammation, brain cell damage, and cognitive issues. Hypoxia is common in older adults, especially those with conditions like sleep apnea, chronic obstructive pulmonary disease (COPD), heart failure, and asthma. That is why understanding the connection between low oxygen and the aging brain is crucial for preventing long-term neurological damage. Full blog - https://aging-us.org/2025/06/oxygen-deprivation-and-the-aging-brain-a-hidden-trigger-for-cognitive-decline/ Paper DOI - https://doi.org/10.18632/aging.206241 Corresponding author - Richard Milner - rmilner@sdbri.org Video short - https://www.youtube.com/watch?v=Nr6rTm7aJRo Sign up for free Altmetric alerts about this article - https://aging.altmetric.com/details/email_updates?id=10.18632%2Faging.206241 Subscribe for free publication alerts from Aging - https://www.aging-us.com/subscribe-to-toc-alerts Keywords - aging, blood-brain barrier integrity, endothelial, proliferation, microglia, chronic mild hypoxia, hypoxic threshold To learn more about the journal, please visit our website at https://www.Aging-US.com​​ and connect with us: Facebook - https://www.facebook.com/AgingUS/ X - https://twitter.com/AgingJrnl Instagram - https://www.instagram.com/agingjrnl/ YouTube - https://www.youtube.com/@AgingJournal LinkedIn - https://www.linkedin.com/company/aging/ Bluesky - https://bsky.app/profile/aging-us.bsky.social Pinterest - https://www.pinterest.com/AgingUS/ Spotify - https://open.spotify.com/show/1X4HQQgegjReaf6Mozn6Mc MEDIA@IMPACTJOURNALS.COM

Dr. Jeffrey Kopin, Chief Medical Officer for Northwestern Medicine Lake Forest Hospital, joins John Williams to talk about Sly Stone dying after a prolonged battle with COPD, if he’s concerned about the ability to get flu shots this fall, and to share his thoughts on Robert F. Kennedy Jr. removing the 17 independent vaccine experts from the […]

Continuing our series on What You May Have Missed at ATS 2025, host Amy Attaway, MD, MS, of Cleveland Clinic, dives into key topics from the Clinical Year in Review with Sara Auld, MD, MSc, Emory University. Did you miss the ATS 2025 International Conference? Or were you unable to attend some key sessions? Go to conference.thoracic.org/program/conference-highlights/ to purchase your ATS Conference Highlight Package. 

一、【20250607間菩提】 慈濟將近六十年了，腳步是一步步地向前走，但方向不可以偏。所以面對著人間事相，慈濟都很謹慎在做，從沒想過能得到什麼。如何去為人間付出，對社會有益，我們該做，總是去做。 因為做慈善，看見了老、病、苦，所以開始義診，而且不只是治療，還要關心他們以後生活怎麼過，在因緣範圍裡，做得到的，盡量去做。但個人的力量有限，所以需要各行各業一起投入，利益人間。 空間、人間，合起來就是世間。人在這個大空間裡如何能和平相處，就是要人人和合。方向正確，就是永恆的和平，宗教就是希望這樣。輔導人、淨化人心，去除偏差的惡念，往善的方向去利益人間，所有的宗教總是止惡揚善，是共通的道理。 二、健康100分 花蓮慈濟醫院的「肺部守門員」劉迪塑醫師，深入探討慢性阻塞性肺病（COPD），這是國人十大死因之一，尤其抽菸族群為高風險群。劉醫師指出，肺阻塞屬於退化性疾病，肺功能一旦受損便無法逆轉，且退化速度可能為正常人的兩倍，因此強調「及早預防」的重要性。 他呼籲民眾戒菸與遠離空汙，包括二手菸與環境廢氣，同時建議每週至少進行150分鐘中等強度運動，如快走、慢跑、超慢跑、爬樓梯等皆可分段完成，達成提升心肺功能的目的。對於已有症狀者，劉醫師推薦「噘嘴式呼吸」與「腹式呼吸」兩種技巧，能減緩呼吸困難、強化自律神經、改善生活品質。 除了運動與呼吸訓練，劉醫師也提及疫苗施打的重要性，特別是65歲以上長者與慢性病患者應接種肺炎鏈球菌疫苗與流感疫苗，以減少肺部感染與急性發作風險。此外，營養攝取同樣關鍵，肺阻塞病人常因喘促而影響食慾，建議採少量多餐、軟質飲食、補充高蛋白，預防營養不良與肌少症。 最後他提醒，COPD患者常伴隨多重共病，如肺癌、憂鬱症與心血管疾病，故需全面照護。唯有從自身生活方式著手，包含戒菸、運動、飲食、疫苗與情緒管理，才能達到長期穩定控制與健康生活的目標。

Dr. Jeffrey Kopin, Chief Medical Officer for Northwestern Medicine Lake Forest Hospital, joins John Williams to talk about Sly Stone dying after a prolonged battle with COPD, if he’s concerned about the ability to get flu shots this fall, and to share his thoughts on Robert F. Kennedy Jr. removing the 17 independent vaccine experts from the […]

Dr. Jeffrey Kopin, Chief Medical Officer for Northwestern Medicine Lake Forest Hospital, joins John Williams to talk about Sly Stone dying after a prolonged battle with COPD, if he’s concerned about the ability to get flu shots this fall, and to share his thoughts on Robert F. Kennedy Jr. removing the 17 independent vaccine experts from the […]

After Roger Cook suggested a change to the date of WA Day, Clairsy & Lisa took calls and texts on the topic ‘What should we have another public holiday for? Elliot Yeo dropped in to chat about the Eagles loss to the kangaroos, their expectations for this weekend’s game against Carlton and most importantly.. . how fatherhood is going. Nicholas Hammond popped in to give the team the inside scoop on his latest role in the play ‘And Then There Were None’ as well the upcoming 60th anniversary of The Sound of Music and his keen interest in the ‘Mushroom Murder’ trial. Ahead of Clairsy & Lisa’s Perth Pub Crawl at Pinocchio’s this Friday, John Webster and Dave Cook (The Motors) came into the studio for a coffee and to talk about their Almost Famous style emergency plane landing, their first gig at The Herdsman and other rock n roll moments. On today’s The Shaw Report, Lisa reports that Sly Stone has passed away after a battle with COPD. Snoop Doogg’s exciting new biopic and Aussie actress Sarah Snook’s big win at The Tony Awards. See omnystudio.com/listener for privacy information.

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-436 Overview: Many patients with chronic obstructive pulmonary disease (COPD) are improperly treated with inhaled corticosteroids (ICS), increasing their risk of harm. This episode explores the latest evidence on long-term ICS risks and provides practical guidance to help you align COPD care with current guidelines—improving outcomes while minimizing adverse effects like pneumonia, cataracts, type 2 diabetes mellitus, and osteoporosis. Episode resource links: Pace WD, Callen E, Gaona-Villarreal G, Shaikh A, Yawn BP. Adverse outcomes associated with inhaled corticosteroid use in individuals with chronic obstructive pulmonary disease. Ann Fam Med. 2025;23(2):127-135. doi:10.1370/afm.240030 Pocket Guide to COPD Diagnosis, Management, and Prevention: A Guide for Healthcare Professionals. 2025 Edition. Global Initiative for Chronic Obstructive Lung Disease. https://goldcopd.org/2025-gold-report/ Guest: Jillian Joseph, PA-C   Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com   

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-436 Overview: Many patients with chronic obstructive pulmonary disease (COPD) are improperly treated with inhaled corticosteroids (ICS), increasing their risk of harm. This episode explores the latest evidence on long-term ICS risks and provides practical guidance to help you align COPD care with current guidelines—improving outcomes while minimizing adverse effects like pneumonia, cataracts, type 2 diabetes mellitus, and osteoporosis. Episode resource links: Pace WD, Callen E, Gaona-Villarreal G, Shaikh A, Yawn BP. Adverse outcomes associated with inhaled corticosteroid use in individuals with chronic obstructive pulmonary disease. Ann Fam Med. 2025;23(2):127-135. doi:10.1370/afm.240030 Pocket Guide to COPD Diagnosis, Management, and Prevention: A Guide for Healthcare Professionals. 2025 Edition. Global Initiative for Chronic Obstructive Lung Disease. https://goldcopd.org/2025-gold-report/ Guest: Jillian Joseph, PA-C   Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com   

Dr. Nathan Pennell and Dr. Cheryl Czerlanis discuss challenges in lung cancer screening and potential solutions to increase screening rates, including the use of AI to enhance risk prediction and screening processes. Transcript Dr. Nate Pennell: Hello, and welcome to By the Book, a monthly podcast series for ASCO Education that features engaging discussions between editors and authors from the ASCO Educational Book. I'm Dr. Nate Pennell, the co-director of the Cleveland Clinic Lung Cancer Program and vice chair of clinical research for the Taussig Cancer Center. I'm also the editor-in-chief for the ASCO Educational Book.  Lung cancer is one of the leading causes of cancer-related mortality worldwide, and most cases are diagnosed at advanced stages where curative treatment options are limited. On the opposite end, early-stage lung cancers are very curable. If only we could find more patients at that early stage, an approach that has revolutionized survival for other cancer types such as colorectal and breast cancer.  On today's episode, I'm delighted to be joined by Dr. Cheryl Czerlanis, a professor of medicine and thoracic medical oncologist at the University of Wisconsin Carbone Cancer Center, to discuss her article titled, "Broadening the Net: Overcoming Challenges and Embracing Novel Technologies in Lung Cancer Screening." The article was recently published in the ASCO Educational Book and featured in an Education Session at the 2025 ASCO Annual Meeting. Our full disclosures are available in the transcript of this episode.  Cheryl, it's great to have you on the podcast today. Thanks for being here. Dr. Cheryl Czerlanis: Thanks, Nate. It's great to be here with you. Dr. Nate Pennell: So, I'd like to just start by asking you a little bit about the importance of lung cancer screening and what evidence is there that lung cancer screening is beneficial. Dr. Cheryl Czerlanis: Thank you. Lung cancer screening is extremely important because we know that lung cancer survival is closely tied to stage at diagnosis. We have made significant progress in the treatment of lung cancer, especially over the past decade, with the introduction of immunotherapies and targeted therapies based on personalized evaluation of genomic alterations. But the reality is that outside of a lung screening program, most patients with lung cancer present with symptoms related to advanced cancer, where our ability to cure the disease is more limited.  While lung cancer screening has been studied for years, the National Lung Screening Trial, or the NLST, first reported in 2011 a significant reduction in lung cancer deaths through screening. Annual low-dose CT scans were performed in a high-risk population for lung cancer in comparison to chest X-ray. The study population was comprised of asymptomatic persons aged 55 to 74 with a 30-pack-year history of smoking who were either active smokers or had quit within 15 years. The low-dose CT screening was associated with a 20% relative risk reduction in lung cancer-related mortality. A similar magnitude of benefit was also reported in the NELSON trial, which was a large European randomized trial comparing low-dose CT with a control group receiving no screening. Dr. Nate Pennell: So, this led, of course, to approval from CMS (Centers for Medicare and Medicaid Services) for lung cancer screening in the Medicare population, probably about 10 years ago now, I think. And there are now two major trials showing an unequivocal reduction in lung cancer-related mortality and even evidence that it reduces overall mortality with lung cancer screening. But despite this, lung cancer screening rates are very low in the United States. So, first of all, what's going on? Why are we not seeing the kinds of screening rates that we see with mammography and colonoscopy? And what are the barriers to that here? Dr. Cheryl Czerlanis: That's a great question. Thank you, Nate. In the United States, recruitment for lung cancer screening programs has faced numerous challenges, including those related to socioeconomic, cultural, logistical, and even racial disparities. Our current lung cancer screening guidelines are somewhat imprecise and often fail to address differences that we know exist in sex, smoking history, socioeconomic status, and ethnicity. We also see underrepresentation in certain groups, including African Americans and other minorities, and special populations, including individuals with HIV. And even where lung cancer screening is readily available and we have evidence of its efficacy, uptake can be low due to both provider and patient factors. On the provider side, barriers include having insufficient time in a clinic visit for shared decision-making, fear of missed test results, lack of awareness about current guidelines, concerns about cost, potential harms, and evaluating both true and false-positive test results.  And then on the patient side, barriers include concerns about cost, fear of getting a cancer diagnosis, stigma associated with tobacco smoking, and misconceptions about the treatability of lung cancer. Dr. Nate Pennell: I think those last two are really what make lung cancer unique compared to, say, for example, breast cancer, where there really is a public acceptance of the value of mammography and that breast cancer is no one's fault and that it really is embraced as an active way you can take care of yourself by getting your breast cancer screening. Whereas in lung cancer, between the stigma of smoking and the concern that, you know, it's a death sentence, I think we really have some work to be made up, which we'll talk about in a minute about what we can do to help improve this.  Now, that's in the U.S. I think things are probably, I would imagine, even worse when we leave the U.S. and look outside, especially at low- and middle-income countries. Dr. Cheryl Czerlanis: Yes, globally, this issue is even more complex than it is in the United States. Widespread implementation of low-dose CT imaging for lung cancer screening is limited by manpower, infrastructure, and economic constraints. Many low- and middle-income countries even lack sufficient CT machines, trained personnel, and specialized facilities for accurate and timely screenings. Even in urban centers with advanced diagnostic facilities, the high screening and follow-up care costs can limit access. Rural populations face additional barriers, such as geographic inaccessibility of urban centers, transportation costs, language barriers, and mistrust of healthcare systems. In addition, healthcare systems in these regions often prioritize infectious diseases and maternal health, leaving limited room for investments in noncommunicable disease prevention like lung cancer screening. Policymakers often struggle to justify allocating resources to lung cancer screening when immediate healthcare needs remain unmet. Urban-rural disparities exacerbate these challenges, with rural regions frequently lacking the infrastructure and resources to sustain screening programs. Dr. Nate Pennell: Well, it's certainly an intimidating problem to try to reduce these disparities, especially between the U.S. and low- and middle-income countries. So, what are some of the potential solutions, both here in the U.S. and internationally, that we can do to try to increase the rates of lung cancer screening? Dr. Cheryl Czerlanis: The good news is that we can take steps to address these challenges, but a multifaceted approach is needed. Public awareness campaigns focused on the benefits of early detection and dispelling myths about lung cancer screening are essential to improving participation rates. Using risk-prediction models to identify high-risk individuals can increase the efficiency of lung cancer screening programs. Automated follow-up reminders and screening navigators can also ensure timely referrals and reduce delays in diagnosis and treatment. Reducing or subsidizing the cost of low-dose CT scans, especially in low- or middle-income countries, can improve accessibility. Deploying mobile CT scanners can expand access to rural and underserved areas.  On a global scale, integrating lung cancer screening with existing healthcare programs, such as TB or noncommunicable disease initiatives, can enhance resource utilization and program scalability. Implementing lung cancer screening in resource-limited settings requires strategic investment, capacity building, and policy interventions that prioritize equity. Addressing financial constraints, infrastructure gaps, and sociocultural barriers can help overcome existing challenges. By focusing on cost-effective strategies, public awareness, and risk-based eligibility criteria, global efforts can promote equitable access to lung cancer screening and improve outcomes.  Lastly, as part of the medical community, we play an important role in a patient's decision to pursue lung cancer screening. Being up to date with current lung cancer screening recommendations, identifying eligible patients, and encouraging a patient to undergo screening often is the difference-maker. Electronic medical record (EMR) systems and reminders are helpful in this regard, but relationship building and a recommendation from a trusted provider are really essential here. Dr. Nate Pennell: I think that makes a lot of sense. I mean, there are technology improvements. For example, our lung cancer screening program at The Cleveland Clinic, a few years back, we finally started an automated best practice alert in our EMR for patients who met the age and smoking requirements, and it led to a six-fold increase in people referred for screening. But at the same time, there's a difference between just getting this alert and putting in an order for lung cancer screening and actually getting those patients to go and actually do the screening and then follow up on it. And that, of course, requires having that relationship and discussion with the patient so that they trust that you have their best interests. Dr. Cheryl Czerlanis: Exactly. I think that's important. You know, certainly, while technology can aid in bringing patients in, there really is no substitute for trust-building and a personal relationship with a provider. Dr. Nate Pennell: I know that there are probably multiple examples within the U.S. where health systems or programs have put together, I would say, quality improvement projects to try to increase lung cancer screening and working with their community. There's one in particular that you discuss in your paper called the "End Lung Cancer Now" initiative. I wonder if you could take us through that. Dr. Cheryl Czerlanis: Absolutely. "End Lung Cancer Now" is an initiative at the Indiana University Simon Comprehensive Cancer Center that has the vision to end suffering and death from lung cancer in Indiana through education and community empowerment. We discuss this as a paradigm for how community engagement is important in building and scaling a lung cancer screening program.  In 2023, the "End Lung Cancer Now" team decided to focus its efforts on scaling and transforming lung cancer screening rates in Indiana. They developed a task force with 26 experts in various fields, including radiology, pulmonary medicine, thoracic surgery, public health, and advocacy groups. The result of this work is an 85-page blueprint with key recommendations that any system and community can use to scale lung cancer screening efforts. After building strong infrastructure for lung cancer screening at Indiana University, they sought to understand what the priorities, resources, and challenges in their communities were. To do this, they forged strong partnerships with both local and national organizations, including the American Lung Association, American Cancer Society, and others. In the first year, they actually tripled the number of screening low-dose CTs performed in their academic center and saw a 40% increase system-wide. One thing that I think is the most striking is that through their community outreach, they learned that most people prefer to get medical care close to home within their own communities. Establishing a way to support the local infrastructure to provide care became far more important than recruiting patients to their larger system.  In exciting news, "End Lung Cancer Now" has partnered with the IU Simon Comprehensive Cancer Center and IU Health to launch Indiana's first and only mobile lung screening program in March of 2025. This mobile program travels around the state to counties where the highest incidence of lung cancer exists and there is limited access to screening. The mobile unit parks at trusted sites within communities and works in partnership, not competition, with local health clinics and facilities to screen high-risk populations. Dr. Nate Pennell: I think that sounds like a great idea. Screening is such an important thing that it doesn't necessarily have to be owned by any one particular health system for their patients. I think. And I love the idea of bringing the screening to patients where they are. I can speak to working in a regional healthcare system with a main campus in the downtown that patients absolutely hate having to come here from even 30 or 40 minutes away, and they'd much rather get their care locally. So that makes perfect sense.  So, under the current guidelines, there are certainly things that we can do to try to improve capturing the people that meet those. But are those guidelines actually capturing enough patients with lung cancer to make a difference? There certainly are proposals within patient advocacy communities and even other countries where there's a large percentage of non-smokers who perhaps get lung cancer. Can we expand beyond just older, current and heavy smokers to identify at-risk populations who could benefit from screening? Dr. Cheryl Czerlanis: Yes, I think we can, and it's certainly an active area of research interest. We know that tobacco is the leading cause of lung cancer worldwide. However, other risk factors include secondhand smoke, family history, exposure to environmental carcinogens, and pulmonary diseases like COPD and interstitial lung disease. Despite these known associations, the benefit of lung cancer screening is less well elucidated in never-smokers and those at risk of developing lung cancer because of family history or other risk factors. We know that the eligibility criteria associated with our current screening guidelines focus on age and smoking history and may miss more than 50% of lung cancers. Globally, 10% to 25% of lung cancer cases occur in never-smokers. And in certain parts of the world, like you mentioned, Nate, such as East Asia, many lung cancers are diagnosed in never-smokers, especially in women. Risk-prediction models use specific risk factors for lung cancer to enhance individual selection for screening, although they have historically focused on current or former smokers.  We know that individuals with family members affected by lung cancer have an increased risk of developing the disease. To this end, several large-scale, single-arm prospective studies in Asia have evaluated broadening screening criteria to never-smokers, with or without additional risk factors. One such study, the Taiwan Lung Cancer Screening in Never-Smoker Trial, was a multicenter prospective cohort study at 17 medical centers in Taiwan. The primary outcome of the TALENT trial was lung cancer detection rate. Eligible patients aged 55 to 75 had either never smoked or had a light and remote smoking history. In addition, inclusion required one or more of the following risk factors: family history of lung cancer, passive smoke exposure, history of TB or COPD, a high cooking index, which is a metric that quantifies exposure to cooking fumes, or a history of cooking without ventilation. Participants underwent low-dose CT screening at baseline, then annually for 2 years, and then every 2 years for up to 6 years. The lung cancer detection rate was 2.6%, which was higher than that reported in the NLST and NELSON trials, and most were stage 0 or I cancers. Subsequently, this led to the Taiwan Early Detection Program for Lung Cancer, a national screening program that was launched in 2022, targeting 2 screening populations: individuals with a heavy history of smoking and individuals with a family history of lung cancer.  We really need randomized controlled trials to determine the true rates of overdiagnosis or finding cancers that would not lead to morbidity or mortality in persons who are diagnosed, and to establish whether the high lung detection rates are associated with a decrease in lung cancer-related mortality in these populations. However, the implementation of randomized controlled low-dose CT screening trials in never-smokers has been limited by the need for large sample sizes, lengthy follow-up, and cost.  In another group potentially at higher risk for developing lung cancer, the role of lung cancer screening in individuals who harbor germline pathogenic variants associated with lung cancer also needs to be explored further. Dr. Nate Pennell: We had this discussion when the first criteria came out because there have always been risk-based calculators for lung cancer that certainly incorporate smoking but other factors as well and have discussion about whether we should be screening people based on their risk and not just based on discrete criteria such as smoking. But of course, the insurance coverage for screening, you have to fit the actual criteria, which is very constrained by age and smoking history. Do you think in the U.S. there's hope for broadening our screening beyond NLST and NELSON criteria? Dr. Cheryl Czerlanis: I do think at some point there is hope for broadening the criteria beyond smoking history and age, beyond the criteria that we have typically used and that is covered by insurance. I do think it will take some work to perhaps make the prediction models more precise or to really understand who can benefit. We certainly know that there are many patients who develop lung cancer without a history of smoking or without family history, and it would be great if we could diagnose more patients with lung cancer at an earlier stage. I think this will really count on there being some work towards trying to figure out what would be the best population for screening, what risk factors to look for, perhaps using some new technologies that may help us to predict who is at risk for developing lung cancer, and trying to increase the group that we study to try and find these early-stage lung cancers that can be cured. Dr. Nate Pennell: Part of the reason we, of course, try to enrich our population is screening works better when you have a higher pretest probability of actually having cancer. And part of that also is that our technology is not that great. You know, even in high-risk patients who have CT scans that are positive for a screen, we know that the vast majority of those patients with lung nodules actually don't have lung cancer. And so you have to follow them, you have to use various models to see, you know, what the risk, even in the setting of a positive screen, is of having lung cancer.  So, why don't we talk about some newer tools that we might use to help improve lung cancer screening? And one of the things that everyone is super excited about, of course, is artificial intelligence. Are there AI technologies that are helping out in early detection in lung cancer screening? Dr. Cheryl Czerlanis: Yes, that's a great question. We know that predicting who's at risk for lung cancer is challenging for the reasons that we talked about, knowing that there are many risk factors beyond smoking and age that are hard to quantify. Artificial intelligence is a tool that can help refine screening criteria and really expand screening access. Machine learning is a form of AI technology that is adept at recognizing patterns in large datasets and then applying the learning to new datasets. Several machine learning models have been developed for risk stratification and early detection of lung cancer on imaging, both with and without blood-based biomarkers. This type of technology is very promising and can serve as a tool that helps to select individuals for screening by predicting who is likely to develop lung cancer in the future.  A group at Massachusetts General Hospital, represented in our group for this paper by my co-authors, Drs. Fintelmann and Chang, developed Sybil, which is an open-access 3D convolutional neural network that predicts an individual's future risk of lung cancer based on the analysis of a single low-dose CT without the need for human annotation or other clinical inputs. Sybil and other machine learning models have tremendous potential for precision lung cancer screening, even, and perhaps especially, in settings where expert image interpretation is unavailable. They could support risk-adapted screening schedules, such as varying the frequency and interval of low-dose CT scans according to individual risk and potentially expand lung cancer screening eligibility beyond age and smoking history. Their group predicts that AI tools like Sybil will play a major role in decoding the complex landscape of lung cancer risk factors, enabling us to extend life-saving lung cancer screening to all who are at risk. Dr. Nate Pennell: I think that that would certainly be welcome. And as AI is working its way into pretty much every aspect of life, including medical care, I think it's certainly promising that it can improve on our existing technology.  We don't have to spend a lot of time on this because I know it's a little out of scope for what you covered in your paper, but I'm sure our listeners are curious about your thoughts on the use of other types of testing beyond CT screening for detecting lung cancer. I know that there are a number of investigational and even commercially available blood tests, for example, for detection of lung cancer, or even the so-called multi-cancer detection blood tests that are now being offered, although not necessarily being covered by insurance, for multiple types of cancer, but lung cancer being a common cancer is included in that. So, what do you think? Dr. Cheryl Czerlanis: Yes, like you mentioned, there are novel bioassays such as blood-based biomarker testing that evaluate for DNA, RNA, and circulating tumor cells that are both promising and under active investigation for lung cancer and multi-cancer detection. We know that such biomarker assays may be useful in both identifying lung cancers but also in identifying patients with a high-risk result who should undergo lung cancer screening by conventional methods. Dr. Nate Pennell: Anything that will improve on our rate of screening, I think, will be welcome. I think probably in the future, it will be some combination of better risk prediction and better interpretation of screening results, whether those be imaging or some combination of imaging and biomarkers, breath-based, blood-based. There's so much going on that it is pretty exciting, but we're still going to have to overcome the stigma and lack of public support for lung cancer screening if we're going to move the needle. Dr. Cheryl Czerlanis: Yes, I think moving the needle is so important because we know lung cancer is still a very morbid disease, and our ability to cure patients is not where we would like it to be. But I do believe there's hope. There are a lot of motivated individuals and groups who are passionate about lung cancer screening, like myself and my co-authors, and we're just happy to be able to share some ways that we can overcome the challenges and really try and make an impact in the lives of our patients. Dr. Nate Pennell: Well, thank you, Dr. Czerlanis, for joining me on the By the Book Podcast today and for all of your work to advance care for patients with lung cancer. Dr. Cheryl Czerlanis: Thank you, Dr. Pennell. It's such a pleasure to be with you today. Thank you. Dr. Nate Pennell: And thank you to our listeners for joining us today. You'll find a link to Dr. Czerlanis' article in the transcript of this episode.  Please join us again next month for By the Book's next episode and more insightful views on topics you'll be hearing at the education sessions from ASCO meetings throughout the year, and our deep dives on approaches that are shaping modern oncology. Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Follow today's speakers:     Dr. Nathan Pennell    @n8pennell   @n8pennell.bsky.social Dr. Cheryl Czerlanis Follow ASCO on social media:     @ASCO on X (formerly Twitter)     ASCO on Bluesky    ASCO on Facebook     ASCO on LinkedIn     Disclosures:    Dr. Nate Pennell:        Consulting or Advisory Role: AstraZeneca, Lilly, Cota Healthcare, Merck, Bristol-Myers Squibb, Genentech, Amgen, G1 Therapeutics, Pfizer, Boehringer Ingelheim, Viosera, Xencor, Mirati Therapeutics, Janssen Oncology, Sanofi/Regeneron       Research Funding (Institution): Genentech, AstraZeneca, Merck, Loxo, Altor BioScience, Spectrum Pharmaceuticals, Bristol-Myers Squibb, Jounce Therapeutics, Mirati Therapeutics, Heat Biologics, WindMIL, Sanofi    Dr. Cheryl Czerlanis: Research Funding (Institution): LungLife AI, AstraZeneca, Summit Therapeutics

There's been a lot of discussion and concerns about the long-term effects of vaping of late, especially regarding young people. New research has started to uncover potential long-term problems with vaping. What is the problem with vaping? It was introduced as a “quit smoking” tool and was accepted to be less harmful than smoking. Useful as a quit smoking tool, as a substitute for cigarettes . However, the growing issue in NZ is young people taking up vaping who would otherwise not smoke. Surveys indicate that 26.5% of 18–24-year-olds and 10% of 14–18-year-olds vape daily. Concerns if there would be long-term effects on these young people. Is it addictive? Many vapes have nicotine which is highly addictive. Increasing reports of people not being able to get off vapes. We know nicotine can cause concerns over brain development, increased risk of anxiety, raise blood pressure, and increased heartrates. Vapes can irritate the lungs, causing coughs and even some concerns over increased risk of collapsed lungs. A new study has started to shed light A new study out of Oxford University has identified long term harm from vaping alone. It followed nearly 250,000 individuals who vaped, over four years. Major finding: vapers are 2.29 times more likely to develop Chronic Obstructive Airways Disease – COPD. COPD is often referred to as emphysema: lungs stiffen, lots of mucous, recurrent infections, and reduced ability to get oxygen into the blood stream due to lung damage. Permanent damage. Among 30-70-year-olds, they're 1.39 times more likely to have high blood pressure. Implications of this? Obviously, it's an issue for the number of young teenagers taking up vaping and an emerging health issue overall. We need to think hard about our approach to vaping – Australia has made vaping prescription only. Restrictions have been put in place in New Zealand. LISTEN ABOVE See omnystudio.com/listener for privacy information.

Barry Quart, CEO of Connect Biopharma, is developing the next generation of monoclonal antibodies targeting inflammatory respiratory diseases such as COPD and asthma. Administered subcutaneously, their lead program targets IL-4 and has demonstrated the ability to rapidly improve airway function and reduce the incidence of acute exacerbations in these patients. Current treatments rely on steroids and bronchodilators, which do not address the underlying inflammatory causes, an area that has largely been under-addressed by other biologic developers. Barry explains, "Connect has been dedicated for quite a few years to designing next-generation monoclonal antibodies targeting inflammatory diseases. I joined the company last year and really kind of turned the ship towards a sole focus on our lead program, which is rademikibart, a second-generation Dupixent, a monoclonal antibody targeting IL-4, a really important target for certain inflammatory diseases." "IL-4 can be used as a monoclonal antibody targeting IL-4 for diseases such as atopic dermatitis, asthma, and COPD, as well as several other conditions. We're focused on asthma and COPD. So, inflammatory respiratory disease, because our product has some unique characteristics that are going to allow us to focus on an area that's really been completely ignored by other developers of biologics in the respiratory space, and specifically on patients having acute exacerbations."  #ConnectBiopharma #MonoclonalAntibody #IL4 #COPD #Asthma #AtopicDermatitis #InflammatoryDiseases #RespiratoryDiseases connectbiopharm.com Listen to the podcast here

Barry Quart, CEO of Connect Biopharma, is developing the next generation of monoclonal antibodies targeting inflammatory respiratory diseases such as COPD and asthma. Administered subcutaneously, their lead program targets IL-4 and has demonstrated the ability to rapidly improve airway function and reduce the incidence of acute exacerbations in these patients. Current treatments rely on steroids and bronchodilators, which do not address the underlying inflammatory causes, an area that has largely been under-addressed by other biologic developers. Barry explains, "Connect has been dedicated for quite a few years to designing next-generation monoclonal antibodies targeting inflammatory diseases. I joined the company last year and really kind of turned the ship towards a sole focus on our lead program, which is rademikibart, a second-generation Dupixent, a monoclonal antibody targeting IL-4, a really important target for certain inflammatory diseases." "IL-4 can be used as a monoclonal antibody targeting IL-4 for diseases such as atopic dermatitis, asthma, and COPD, as well as several other conditions. We're focused on asthma and COPD. So, inflammatory respiratory disease, because our product has some unique characteristics that are going to allow us to focus on an area that's really been completely ignored by other developers of biologics in the respiratory space, and specifically on patients having acute exacerbations."  #ConnectBiopharma #MonoclonalAntibody #IL4 #COPD #Asthma #AtopicDermatitis #InflammatoryDiseases #RespiratoryDiseases connectbiopharm.com Download the transcript here

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For more information regarding this CME/CE activity and to complete the CME/CE requirements and claim credit for this activity, visit:https://www.mycme.com/courses/copd-inflammation-exacerbations-your-questions-answered-10143SummaryRejoin the conversation on COPD, inflammation, and new and emerging agents as two of our expert faculty come together to answer your top questions. Questions submitted from the recent Conversations in Primary Care live virtual symposia guide the discussion as we dig a bit deeper on type 2 inflammation, changes in COPD management, and new and emerging agents – including recently approved biologic agents – for COPD.Learning ObjectivesAt the conclusion of this activity, participants should be better able to:Review the relationship between inflammation, exacerbation, and disease progression in COPD, noting different inflammatory endotypes of patients with COPDDiscuss recent evidence surrounding the use of biologic agents in the management of patients with COPD and type 2 inflammationIntegrate current guidelines with clinical data on new and emerging agents for the management of COPD, distinguishing patients with and without markers of type 2 inflammationThis activity is accredited for CME/CE CreditThe National Association for Continuing Education is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.The National Association for Continuing Education designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.The National Association for Continuing Education is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education. Provider number: 121222. This activity is approved for 0.25 contact hours (which includes 0.25 hours of pharmacology).For additional information about the accreditation of this program, please contact NACE at info@naceonline.com.Summary of Individual DisclosuresPlease review faculty and planner disclosures here.Disclosure of Commercial SupportThis activity is supported by an independent medical education grant from Regeneron Pharmaceuticals, Inc and Sanofi.Please visit http://naceonline.com to engage in more live and on demand CME/CE content.

COPD is a leading and largely preventable cause of morbidity among First Nations Australians Smoking cessation must be addressed with cultural sensitivity and clinical nuance Spirometry is essential for accurate diagnosis yet remains severely limited and underutilised Inhaler technique and adherence are critical and frequently overlooked Community-driven, multidisciplinary models are key to delivering culturally care Host: Dr David Lim | Total Time: 44 mins Experts: Philippa Cotter, Physiotherapist & Michael Hewson, Pharmacist Register for our fortnightly FREE WEBCASTSEvery second Tuesday | 7:00pm-9:00pm AEST Click here to register for the next oneSee omnystudio.com/listener for privacy information.

In this podcast accompanying the June issue of DTB, David Phizackerley (DTB Editor) is joined by Julian Treadwell (DTB Associate Editor) and Laurence Leaver (GP). David and Julian start by discussing the editorial - https://dtb.bmj.com/content/63/6/82 - which highlights some of the challenges in preventing VTE in early pregnancy. They also talk about a cohort study - https://dtb.bmj.com/content/63/6/84 - that assessed whether gabapentinoid use was associated with severe exacerbations among patients aged >55 years with chronic obstructive pulmonary disease (COPD). In the second half of the podcast, Julian talks to Laurence about two articles - https://dtb.bmj.com/content/63/5/74 and https://dtb.bmj.com/content/63/6/85 - he wrote on managing ADHD in adults.   Their discussion includes issues relating to diagnosis, effectiveness of medication, starting and titrating medication and some of the common adverse effects associated with medication. Both articles are currently free to access on the DTB website.   Please subscribe to the DTB podcast to get episodes automatically downloaded to your mobile device and computer. Also, please consider leaving us a review or a comment on the DTB Podcast iTunes podcast page. If you want to contact us please email dtb@bmj.com. Thank you for listening.

CHEST June 2025, Volume 167, Issue 6  CHEST journal's Editor in Chief, Peter Mazzone, MD, MPH, FCCP, highlights key research published in the journal CHEST June 2025 issue, including an investigation of the effects of low-dose morphine on sleep and breathlessness in COPD, an exploration into the impact of pulmonary rehabilitation on survival in people with interstitial lung disease, and more. 

Story at-a-glance Research shows perceived stress significantly worsens COPD symptoms, with high stress levels quadrupling the risk of serious flare-ups requiring medical intervention Stress triggers biological changes in COPD patients, increasing inflammation markers and oxidative stress that directly damage lung tissue and impair breathing People with COPD who experience high stress levels report greater death anxiety, especially women, unemployed individuals and those lacking education about their condition Understanding your condition and building confidence in managing symptoms (self-efficacy) significantly reduces both stress levels and physical complications of COPD Simple interventions like focused breathing, symptom tracking and establishing daily routines help interrupt the stress-symptom cycle and improve quality of life

Nucala gains new indication; the FDA are set to require placebo-controlled trials to evaluate COVID-19 vaccines; pruritus reported following discontinuation of antihistamines; oral carbapenem antibiotic looks promising for cUTIs; investigational celiac disease Tx gets Fast Tracked

Earlier this year, the Global Initiative for Obstructive Lung Disease (GOLD) guidelines were updated to include a new emphasis on cardiovascular disease and pulmonary hypertension in COPD, among much more. Rejoining us for an episode exploring these revisions is Gerard Criner, MD, of Temple University, a foremost COPD expert who serves on the GOLD Board of Directors and GOLD Science Committee. He spells out the improvements, from interventions like smoking cessation and pulmonary rehabilitation to the heightened importance of spirometry for diagnosis.

This week, Dr. Kahn dives into a packed lineup of new research and hot topics in heart health. He breaks down two major U.S. government reports—one on vaccines and another on the #MAHA movement—before covering a wide range of updates, including: plant-based diets and fasting-mimicking diets for liver health, high-fiber diets and PFAS, vitamin D and aging, CoQ10 and Fosamax, creatine for brain health, conflicts of interest in meat studies, HRT and heart markers, Type 1 diabetes and plant diets, homocysteine in hypertension, mouth taping, niacin in COPD, and aspirin use based on coronary calcium scores. The featured segment tackles the controversy around seed oils—often labeled the “Hateful 8.” Are these oils really harming your health, or is the fear overblown? Dr. Kahn breaks it all down in this must-hear episode.  Thanks to endur.com – use the code KahnMD10 for a discount.

Leah breaks down everything veterans need to know about getting VA disability benefits for COPD (Chronic Obstructive Pulmonary Disease). She explains how COPD includes conditions like chronic bronchitis and emphysema, outlines symptoms, and dives into medical literature showing a strong connection between toxic military exposures (like burn pits or Agent Orange) and COPD—even in non-smokers. Leah details the VA rating system, diagnostic codes, necessary medical documentation (like pulmonary function tests), and strategies for building a strong claim. She also clarifies how COPD can be service-connected directly, secondarily, or presumptively, and encourages veterans to seek help from VSOs or accredited representatives if they've been denied.

This week's episode dives into COPD treatment. When considering inhaler devices, what is the best strategy for COPD patients? Host Amy Attaway, MD, MS, associate director of the COPD Center at  Cleveland Clinic welcomes Anthony Anzueto, MD, professor of medicine at the University of Texas Health Science Center and chief of the pulmonary section for the South Texas Veterans Healthcare System in San Antonio.Support for this podcast is brought to you by Viatris and Theravance BioPharma.

In this episode, we talk with Dr. Peter DeBlieux about the management of COPD and a tool to help EM docs get the patients where they need to be. Episode supported by AstraZeneca.

Editor's Summary by Kirsten Bibbins-Domingo, PhD, MD, MAS, Editor in Chief, Preeti Malani, MD, MSJ, Deputy Editor, and Christopher W. Seymour, MD, MSc, Associate Editor of JAMA, the Journal of the American Medical Association, for articles published from May 17-23, 2025.

JCO PO author Dr. Dean A. Regier at the Academy of Translational Medicine, University of British Columbia (UBC), and the School of Population and Public Health, BC Cancer Research Institute shares insights into his JCO PO article, “Clinical Effectiveness and Cost-Effectiveness of Multigene Panel Sequencing in Advanced Melanoma: A Population-Level Real-World Target Trial Emulation.” Host Dr. Rafeh Naqash and Dr. Regier discuss the real-world clinical effectiveness and cost-effectiveness of multigene panels compared with single-gene BRAF testing to guide therapeutic decisions in advanced melanoma. Transcript Dr. Rafeh Naqash:Hello and welcome to JCO Precision Oncology Conversations, where we bring you engaging conversations with authors of clinically relevant and highly significant JCO PO articles. I'm your host, Dr. Rafeh Naqash, Podcast Editor for JCO Precision Oncology and Assistant Professor at the OU Health Stephenson Cancer Center in the University of Oklahoma. Today, we are excited to be joined by Dr. Dean A. Regier, Director at the Academy of Translational Medicine, Associate Professor at the School of Population and Public Health, UBC Senior Scientist at the British Columbia Cancer Research Institute, and also the senior author of the JCO Precision Oncology article entitled "Clinical Effectiveness and Cost-Effectiveness of Multigene Panel Sequencing in Advanced Melanoma: A Population-Level Real-World Target Trial Emulation." At the time of this recording, our guest's disclosures will be linked in the transcript. Dean, welcome to our podcast and thank you for joining us today. Dr. Dean Regier:Thank you. I'm delighted to be here. Dr. Rafeh Naqash:So, obviously, you are from Canada, and medicine, or approvals of drugs to some extent, and in fact approvals of gene testing to some extent is slightly different, which we'll come to learn about more today, compared to what we do in the US—and in fact, similarly, Europe versus North America to a large extent as well. Most of the time, we end up talking about gene testing in lung cancer. There is a lot of data, a lot of papers around single-gene panel testing in non-small cell lung cancer versus multigene testing. In fact, a couple of those papers have been published in JCO PO, and it has shown significant cost-effectiveness and benefit and outcomes benefit in terms of multigene testing. So this is slightly, you know, on a similar approach, but in a different tumor type. So, could you tell us first why you wanted to investigate this question? What was the background to investigating this question? And given your expertise in health economics and policy, what are some of the aspects that one tends or should tend to understand in terms of cost-effectiveness before we go into the results for this very interesting manuscript? Dr. Dean Regier:Yeah, of course, delighted to. So, one of the reasons why we're deeply interested in looking at comparative outcomes with respect to single- versus multigene testing— whether that's in a public payer system like Canada or an insurer system, a private system in the United States— is that the question around does multigene versus single-gene testing work, has not typically tested in randomized controlled trials. You don't have people randomized to multigene versus single-gene testing. And what that does, it makes the resulting evidence base, whether it's efficacy, safety, or comparative cost-effectiveness, highly uncertain. So, the consequence of that has been uneven uptake around the world of next-generation sequencing panels. And so if we believe that next-gen sequencing panels are indeed effective for our patients, we really need to generate that comparative evidence around effectiveness and cost-effectiveness. So we can go to payers, whether it be single payer or a private insurer, to say, "Here are the comparative outcomes." And when I say that uptake has been uneven, uptake there's been actually plenty, as you know, publications around that uneven uptake, whether it be in Europe, in the United States, in Canada. And so we're really interested in trying to produce that evidence to create the type of deliberations that are needed to have these types of technologies accessible to patients. And part of those deliberations, of course, is the clinical, but also in some contexts, cost-effectiveness. And so, we really start from the perspective of, can we use our healthcare system data, our learning healthcare system, to generate that evidence in a way that emulates a randomized controlled trial? We won't be able to do these randomized controlled trials for various, like really important and and reasons that make sense, quite frankly. So how can we mimic or emulate randomized controlled trials in a way that allows us to make inference around those outcomes? And for my research lab, we usually think through how do we do causal inference to address some of those biases that are inherent in observational data. So in terms of advanced melanoma, we were really interested in this question because first of all, there have been no randomized controlled trials around next-gen sequencing versus single-gene testing. And secondly, these products, these ICIs, immune checkpoint inhibitors, and BRAF and MEK inhibitors, they are quite expensive. And so the question really becomes: are they effective? And if so, to what extent are they cost-effective? Do they provide a good reason to have information around value for money? Dr. Rafeh Naqash:So now going to the biology of melanoma, so we know that BRAF is one of the tumor-agnostic therapies, it has approvals for melanoma as well as several other tumor types. And in fact, I do trials with different RAF-RAS kinase inhibitors. Now, one of the things that I do know is, and I'm sure some of the listeners know, is the DREAMseq trial, which was a melanoma study that was an NCI Cooperative Group trial that was led by Dr. Mike Atkins from Georgetown a couple of years back, that did show survival benefit of first-line immunotherapy sequencing. It was a sequencing study of whether to do first-line BRAF in BRAF-mutant melanoma followed by checkpoint inhibitors, or vice versa. And the immune checkpoint inhibitors followed by BRAF was actually the one that showed benefit, and the trial had to stop early, was stopped early because of the significant benefit seen. So in that context, before we approach the question of single-gene versus multigene testing in melanoma, one would imagine that it's already established that upfront nivolumab plus ipilimumab, for that matter, doublet checkpoint inhibitor therapy is better for BRAF-mutant melanoma. And then there's no significant other approvals for melanoma for NRAS or KIT, you know, mucosal melanomas tend to have KIT mutations, for example, or uveal melanomas, for that matter, have GNAQ, and there's no targeted therapies. So, what is the actual need of doing a broader testing versus just testing for BRAF? So just trying to understand when you started looking into this question, I'm sure you kind of thought about some of these concepts before you delved into that. Dr. Dean Regier:I think that is an excellent question, and it is a question that we asked ourselves: did we really expect any differences in outcomes between the testing strategies? And what did the real-world implementation, physician-guided, physician-led implementation look like? And so, that was kind of one of the other reasons that we really were interested is, why would we go to expanded multigene panel sequencing at all? We didn't really expect or I didn't expect an overall survival a priori. But what we saw in our healthcare system, what happened in our healthcare system was the implementation in 2016 of this multigene panel. And this panel covered advanced melanoma, and this panel cost quite a bit more than what they were doing in terms of the single-gene BRAF testing. And so when you're a healthcare system, you have to ask yourself those questions of what is the additional value associated with that? And indeed, I think in a healthcare system, we have to be really aware that we do not actually follow to the ideal extent randomized controlled trials or trial settings. And so that's the other thing that we have to keep in mind is when these, whether it's an ICI or a BRAF MEK inhibitor, when these are implemented, they do not look like randomized controlled trials. And so, we really wanted to emulate not just a randomized controlled trial, but a pragmatic randomized controlled trial to really answer those real-world questions around implementation that are so important to decision making. Dr. Rafeh Naqash:Sure. And just to understand this a little better: for us in the United States, when we talk about multigene testing, we generally refer to, these days, whole-exome sequencing with whole-transcriptome sequencing, which is like the nuclear option of of the testings, which is not necessarily cheap. So, when you talk about multigene testing in your healthcare system, what does that look like? Is it a 16-gene panel? Is it a 52-gene panel? What is the actual makeup of that platform? Dr. Dean Regier:Excellent question. Yeah, so at the time that this study is looking at, it was 2016, when we, as BC Cancer—so British Columbia is a population right now of 5.7 million people, and we have data on all those individuals. We are one healthcare system providing health care to 5.7 million people. In 2016, we had what I call our "home-brew" multigene panel, which was a 53-gene panel that was reimbursed as standard of care across advanced cancers, one of them being advanced melanoma. We have evolved since then. I believe in 2022, we are using one of the Illumina panels, the Focus panel. And so things have changed; it's an evolving landscape. But we're specifically focused on the 53-gene panel. It was called OncoPanel. And that was produced in British Columbia through the Genome Sciences Centre, and it was validated in a single-arm trial mostly around validity, etc. Dr. Rafeh Naqash:Thank you for explaining that. So now, onto the actual meat and the science of this project. So, what are some of the metrics from a health economy standpoint that you did look at? And then, methodology-wise, I understand, in the United States, we have a fragmented healthcare system. I have data only from my institution, for that matter. So we have to reach out to outside collaborators and email them to get the data. And that is different for you where you have access to all the data under one umbrella. So could you speak to that a little bit and how that's an advantage for this kind of research especially? Dr. Dean Regier:Yeah. In health economics, we look at the comparative incremental costs against the incremental effectiveness. And when we think about incremental costs, we think not just about systemic therapy or whether you see a physician, but also about hospitalizations, about all the healthcare interactions related to oncology or not that a patient might experience during their time or interactions with the healthcare system. You can imagine with oncology, there are multiple interactions over a prolonged time period depending on survival. And so what we try to do is we try to—and the benefit of the single-payer healthcare system is what we do is we link all those resource utilization patterns that each patient encounters, and we know the price of that encounter. And we compare those incremental costs of, in this case, it's the multigene panel versus the single-gene panel. So it's not just the cost of the panel, not just the cost of systemic therapy, but hospitalizations, physician encounters, etc. And then similarly, we look at, in this case, we looked at overall survival - we can also look at progression-free survival - and ask the simple question, you know, what is the incremental cost per life-year gained? And in that way, we get a metric or an understanding of value for money. And how we evaluate that within a deliberative priority setting context is we look at safety and efficacy first. So a regulatory package that you might get from, in our case, Health Canada or the FDA, so we look at that package, and we deliberate on, okay, is it safe and is it effective? How many patients are affected, etc. And then separately, what is the cost-effectiveness? And at what price, if it's not cost-effective, at what price would it be cost-effective? Okay, so for example, we have this metric called the incremental cost-effectiveness ratio, which is incremental cost in the numerator, and in this case, life-years gained in the denominator. And if it is around $50,000 or $100,000 per life-year gained—so if it's in that range, this ratio—then we might say it's cost-effective. If it's above this range, which is common in oncology, especially when we talk about ICIs, etc., then you might want to negotiate a price. And indeed, when we negotiate that price, we use the economic evaluation, that incremental cost-effectiveness ratio, as a way to understand at what price should we negotiate to in order to get value for money for the healthcare system. Dr. Rafeh Naqash:Thank you for explaining those very interesting terminologies. Now, one question I have in the context of what you just mentioned is, you know, like the drug development space, you talked about efficacy and safety, but then on the safety side, we talk about all-grade adverse events or treatment-related adverse events—two different terminologies. From a healthcare utilization perspective, how do you untangle if a patient on a BRAF therapy got admitted for a hypoxic respiratory failure due to COPD, resulting in a hospitalization from the cost, overall cost utilization, or does it not matter? Dr. Dean Regier:We try to do as much digging into those questions as possible. And so, this is real-world data, right? Real-world data is not exactly as clean as you'd get from a well-conducted clinical trial. And so what we do is we look at potential adverse event, whether it's hospitalization, and the types of therapies around that hospitalization to try- and then engage with clinicians to try to understand or tease out the different grades of the adverse event. Whether it's successful or not, I think that is a real question that we grapple with in terms of are we accurate in delineating different levels of adverse events? But we try to take the data around the event to try to understand the context in which it happens. Dr. Rafeh Naqash:Thank you for explaining that, Dean. So, again to the results of this manuscript, could you go into the methodology briefly? Believe you had 147 patients, 147 patients in one arm, 147 in the other. How did you split that cohort, and what were some of the characteristics of this cohort? Dr. Dean Regier:So, the idea, of course, is that we have selection criteria, study inclusion criteria, which included in our case 364 patients. And these were patients who had advanced melanoma within our study time period. So that was 2016 to 2018. And we had one additional year follow. So we had three total years. And what we did is that we linked our data, our healthcare system data. During this time, because the policy change was in 2016, we had patients both go on the multigene panel and on the single-gene BRAF testing. So, the idea was to emulate a pragmatic randomized controlled trial where we looked at contemporaneous patients who had multigene panel testing versus single-gene BRAF testing. And then we did a matching procedure—we call it genetic matching. And that is a type of matching that allows us to balance covariates across the patient groups, across the multigene versus BRAF testing cohorts. The idea again is, as you get in a randomized controlled trial, you have these baseline characteristics that look the same. And then the hope is that you address any source selection or confounding biases that prohibit you to have a clean answer to the question: Is it effective or cost-effective? So you address all those biases that may prohibit you to find a signal if indeed a signal is there. And so, what we did is we created—we did this genetic matching to balance covariates across the two cohorts, and we matched them one-to-one. And so what we were able to do is we were able to find, of those 364 patients in our pool, 147 in the multigene versus 147 in the single-gene BRAF testing that were very, very similar. In fact, we created what's called a directed acyclic graph or a DAG, together with clinicians to say, “Hey, what biases would you expect to have in these two cohorts that might limit our ability to find a signal of effectiveness?” And so we worked with clinicians, with health economists, with epidemiologists to really understand those different biases at play. And the genetic matching was able to match the cohorts on the covariates of interest. Dr. Rafeh Naqash:And then could you speak on some of the highlights from the results? I know you did survival analysis, cost-effectiveness, could you explain that in terms of what you found? Dr. Dean Regier:We did two analyses. The intention-to-treat analysis is meant to emulate the pragmatic randomized controlled trial. And what that does is it answers the question, for all those eligible for multigene or single-gene testing: What is the cost-effectiveness in terms of incremental life-years gained and incremental cost per life-years gained? And the second one was around a protocol analysis, which really answered the question of: For those patients who were actually treated, what was the incremental effectiveness and cost-effectiveness? Now, they're different in two very important ways. For the intention-to-treat, it's around population questions. If we gave single-gene or multigene to the entire population of advanced melanoma patients, what is the cost-effectiveness? The per-protocol is really around that clinical question of those who actually received treatment, what was the incremental cost and effectiveness? So very different questions in terms of population versus clinical cost and effectiveness. So, for the intention-to-treat, what we found is that in terms of life-years gained is around 0.22, which is around 2.5 months of additional life that is afforded to patients who went through the multigene panel testing versus the single-gene testing. That was non-statistically significant from zero at the 5% level. But on average, you would expect this additional 2.5 months of life. The incremental costs were again non-statistically significant, but they're around $20,000. And so when we look at incremental cost-effectiveness, we can also look at the uncertainty around that question, meaning what percentage of incremental cost-effectiveness estimates are likely to be cost-effective at different willingness-to-pay thresholds? Okay? So if you are willing to pay $100,000 to get one gain of life-years, around 52.8% of our estimates, in terms of when we looked at the entire uncertainty, would be cost-effective. So actually that meets the threshold of implementation in our healthcare system. So it's quite uncertain, just over 50%. But what we see is that decision-makers actually have a high tolerance for uncertainty around cost-effectiveness. And so, while it is uncertain, we would say that, well, the cost-effectiveness is finely balanced. Now, when we looked at the population, the per-protocol population, those folks who just got treatment, we actually have a different story. We have all of a sudden around 4.5 or just under 5 months of life gained that is statistically significantly different from zero, meaning that this is a strong signal of benefit in terms of life-years gained. In terms of the changes in costs or the incremental costs, they are larger again, but statistically insignificant. So the question now is, to what extent is it cost-effective? What is the probability of it being cost-effective? And at the $100,000 per life-year gained willingness-to-pay, there was a 73% chance that multigene panel testing versus single-gene testing is cost-effective. Dr. Rafeh Naqash:So one of the questions I have here, this is a clarification both for myself and maybe the listeners also. So protocol treatment is basically if you had gene testing and you have a BRAF in the multigene panel, then the patient went on a BRAF treatment. Is that correct? Dr. Dean Regier:It's still physician choice. And I think that's important to say that. So typically what we saw in both in our pre- and post-matching data is that we saw around 50% of patients, irrespective of BRAF status, get an ICI, which is appropriate, right? And so the idea here is that you get physician-guided care, but if the patient no longer performs on the ICI, then it gives them a little bit more information on what to do next. Even during that time when we thought it wasn't going to be common to do an ICI, but it was actually quite common. Dr. Rafeh Naqash:Now, did you have any patients in this study who had the multigene testing done and had an NRAS or a KIT mutation and then went on to those therapies, which were not captured obviously in the single-gene testing, which would have just tried to look at BRAF? Dr. Dean Regier:So I did look at the data this morning because I thought that might come up in terms of my own questions that I had. I couldn't find it, but what we did see is that some patients went on to clinical trials. So, meaning that this multigene panel testing allowed, as you would hope in a learning healthcare system, patients to move on to clinical trials to have a better chance at more appropriate care if a target therapy was available. Dr. Rafeh Naqash:And the other question in that context, which is not necessarily related to the gene platform, but more on the variant allele frequency, so if you had a multigene panel that captured something that was present at a high VAF, with suspicion that this could be germline, did you have any of those patients? I'm guessing if you did, probably very low number, but I'm just thinking from a cost-effective standpoint, if you identify somebody with germline, their, you know, first-degree relative gets tested, that ends up, you know, prevention, etc. rather than somebody actually developing cancer subsequently. That's a lot of financial gains to the system if you capture something early. So did you look at that or maybe you're planning to look at that? Dr. Dean Regier:We did not look at that, but that is a really important question that typically goes unanswered in economic evaluations. And so, the short answer is yes, that result, if there was a germline finding, would be returned to the patient, and then the family would be able to be eligible for screening in the appropriate context. What we have found in economic evaluations, and we've recently published this research, is that that scope of analysis is rarely incorporated into the economic evaluation. So those downstream costs and those downstream benefits are ignored. And when you- especially also when you think about things like secondary or incidental findings, right? So it could be a germline finding for cancer, but what about all those other findings that we might have if you go with an exome or if you go with a genome, which by the way, we do have in British Columbia—we do whole-genome and transcriptome sequencing through something called the Personalized OncoGenomics program. That scope of evaluation, because it's very hard to get the right types of data, because it requires a decision model over the lifetime of both the patients and potentially their family, it becomes very complicated or complex to model over patients' and families' lifetime. That doesn't mean that we should not do it, however. Dr. Rafeh Naqash:So, in summary Dean, could you summarize some of the known and unknowns of what you learned and what you're planning in subsequent steps to this project? Dr. Dean Regier:Our North Star, if you will, is to really understand the entire system effect of next-generation sequencing panels, exome sequencing, whole genomes, or whole genomes and transcriptome analysis, which we think should be the future of precision oncology. The next steps in our research is to provide a nice base around multigene panels in terms of multigene versus single-gene testing, whether that be colorectal cancer, lung cancer, melanoma, etc., and to map out the entire system implications of implementing next-generation sequencing panels. And then we want to answer the questions around, “Well, what if we do exomes for all patients? What if we do whole genomes and transcriptomes for all patients? What are the comparative outcomes for a true tumor-agnostic precision oncology approach, accounting for, as you say, things like return of results with respect to hereditary cancers?” I think the challenge that's going to be encountered is really around the persistent high costs of something like a whole-genome and transcriptome sequencing approach. Although we do see the technology prices going down—the "$1,000 genome" or “$6,000 genome" on whatever Illumina machine you might have—that bioinformatics is continuing to be expensive. And so, there are pipelines that are automated, of course, and you can create a targeted gene report really rapidly within a reasonable turnaround time. But of course, for secondary or what I call level two analysis, that bioinformatics is going to continue to be expensive. And so, we're just continually asking that question is: In our healthcare system and in other healthcare systems, if you want to take a precision oncology approach, how do you create the pipelines? And what types of technologies really lend themselves to benefits over and above next-generation sequencing or multigene panels, allowing for access to off-label therapies? What does that look like? Does that actually improve patients? I think some of the challenges, of course, is because of heterogeneity, small benefiting populations, finding a signal if a signal is indeed there is really challenging. And so, what we are thinking through is, with respect to real-world evidence methods and emulating randomized controlled trials, what types of evidence methods actually allow us to find those signals if indeed those signals are there in the context of small benefiting populations? Dr. Rafeh Naqash:Thank you so much, Dean. Sounds like a very exciting field, especially in the current day and age where cost-effectiveness, financial toxicity is an important aspect of how we improve upon what is existing in oncology. And then lots more to be explored, as you mentioned. The last minute and a half I want to ask about you as an individual, as a researcher. There's very few people who have expertise in oncology, biomarkers, and health economics. So could you tell us for the sake of our trainees and early career physicians who might be listening, what was your trajectory briefly? How did you end up doing what you're doing? And maybe some advice for people who are interested in the cost of care, the cost of oncology drugs - what would your advice be for them very briefly? Dr. Dean Regier:Sure. So I'm an economist by training, and indeed I knew very little about the healthcare system and how it works. But I was recruited at one point to BC Cancer, to British Columbia, to really try to understand some of those questions around costs, and then I learned also around cost-effectiveness. And so, I did training in Scotland to understand patient preferences and patient values around quality of care, not just quantity of life, but also their quality of life and how that care was provided to them. And then after that, I was at Oxford University at the Nuffield Department of Population Health to understand how that can be incorporated into randomized control trials in children. And so, I did a little bit of learning about RCTs. Of course, during the way I picked up some epidemiology with deep understanding of what I call econometrics, what others might call biostatistics or just statistics. And from there, it was about working with clinicians, working with epidemiologists, working with clinical trialists, working with economists to understand the different approaches or ways of thinking of how to estimate efficacy, effectiveness, safety, and cost-effectiveness. I think this is really important to think through is that we have clinical trialists, we have people with deep understanding of biostatistics, we have genome scientists, we have clinicians, and then you add economists into the mix. What I've really benefited from is that interdisciplinary experience, meaning that when I talk to some of the world's leading genome scientists, I understand where they're coming from, what their hope and vision is. And they start to understand where I'm coming from and some of the tools that I use to understand comparative effectiveness and cost-effectiveness. And then we work together to actually change our methods in order to answer those questions that we're passionate about and curious about better for the benefit of patients. So, the short answer is it's been actually quite a trajectory between Canada, the UK. I spent some time at the University of Washington looking at the Fred Hutch Cancer Research Center, looking at precision oncology. And along the way, it's been an experience about interdisciplinary research approaches to evaluating comparative outcomes. And also really thinking through not just at one point in time on-off decisions—is this effective? Is it safe? Is it cost-effective?—not those on-off decisions, but those decisions across the lifecycle of a health product. What do those look like at each point in time? Because we gain new evidence, new information at each point in time as patients have more and more experience around it. And so what really is kind of driving our research is really thinking about interdisciplinary approaches to lifecycle evaluation of promising new drugs with the goal of having these promising technologies to patients sooner in a way that is sustainable for the healthcare system. Dr. Rafeh Naqash:Awesome. Thank you so much for those insights and also giving us a sneak peek of your very successful career. Thank you for listening to JCO Precision Oncology Conversations. Don't forget to give us a rating or review, and be sure to subscribe so you never miss an episode. You can find all ASCO shows at asco.org/podcast. Thank you. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.      

Emphasise pulmonary rehabilitation in the routine management of COPD, as it improves exercise capacity, reduces exacerbations, and enhances quality of life Prioritise vaccinations and ensure patients with COPD are up to date with critical vaccinations, including influenza, pneumococcal, and COVID-19, as these significantly reduce the risk of exacerbations and hospitalisations Focus on self-management and action plans, empowering patients with COPD to monitor symptoms and manage exacerbations early Involve a multidisciplinary team in COPD care, including physiotherapists, pharmacists, and social workers. Regularly check inhaler technique and ensure patients have access to the necessary resources for comprehensive care Host: Dr David Lim | Total Time: 32 mins Expert: Prof Ian Yang, Director of Thoracic Medicine Register for our fortnightly FREE WEBCASTSEvery second Tuesday | 7:00pm-9:00pm AEST Click here to register for the next oneSee omnystudio.com/listener for privacy information.

Contributor: Travis Barlock, MD Educational Pearls: Wheezing is classically heard in asthma and COPD, but it can be the result of a wide range of processes that cause airflow limitation Narrowed bronchioles lead to turbulent airflow → creates the wheezing Crackles (rales) suggest pulmonary edema which is often due to heart failure Approximately 35% of heart failure patients have bronchial edema, which can also produce wheezing COPD and heart failure can coexist in a patient, and both of these diseases can cause wheezing It's vital to differentiate whether the wheezing is due to the patient's COPD or their heart failure because the treatment differs Diagnosing wheezing due to heart failure (cardiac asthma): Symptoms: orthopnea, paroxysmal nocturnal dyspnea Diagnostic tools: bedside ultrasound Treatment: diuresis and BiPAP for respiratory support Not all wheezing is asthma Consider heart failure in the differential and tailor treatment accordingly References 1. Buckner K. Cardiac asthma. Immunol Allergy Clin North Am. 2013 Feb;33(1):35-44. doi: 10.1016/j.iac.2012.10.012. Epub 2012 Dec 23. PMID: 23337063. 2. Hollingsworth HM. Wheezing and stridor. Clin Chest Med. 1987 Jun;8(2):231-40. PMID: 3304813. Summarized by Meg Joyce, MS1 | Edited by Meg Joyce & Jorge Chalit, OMS3 Donate: https://emergencymedicalminute.org/donate/  

Send us a textIn dieser Podcast-Folge sprechen wir über ein oft unterschätztes Thema: Zahnschäden wie Karies, Mundtrockenheit und Schleimhautreizungen, die bei inhalativer Therapie von Asthma und COPD auftreten können. Viele Patient:innen wissen nicht, dass ihre Inhalationsmedikamente die Mundgesundheit beeinträchtigen können – besonders bei langfristiger Anwendung von Kortison-Sprays oder bronchienerweiternden Medikamenten.Wir erklären:Warum inhalative Medikamente das Kariesrisiko erhöhen könnenWie richtige Anwendung und Mundhygiene Schäden verhindern könnenWelche Rolle Speichel, Zuckeranteile und pH-Wert spielenWas Zahnärzt:innen und Lungenärzt:innen gemeinsam beachten solltenDiese Folge richtet sich an Patient:innen mit Asthma oder COPD, an Angehörige sowie an medizinisches Fachpersonal, das eine interdisziplinäre Perspektive auf Lungen- und Zahngesundheit schätzt.

Every other week I'm republishing one of my most popular or impactful episodes and adding an update, new insight, or context that will help you benefit from it even more. This week I'm highlighting Episode 287, which is one of my all-time favorite episodes. And that's because it completely debunks some things I (and many students) are taught in nursing school. I learned a ton creating this episode, still re-listen to it on occasion, and hope you find it just as valuable, too! In nursing school, I learned that digital clubbing was a key sign of COPD and I accepted this as gospel and moved on with my life. I used this information to answer exam questions on the topic and I always included assessing for it in my care plans for patients with COPD. But, like all things in nursing, there's so much more to this story. In this episode you'll learn why much of what you've been taught about digital clubbing is wrong, and what's actually going on (spoiler alert…we don't fully know!) In this episode, you'll get answers to your burning questions: What is digital clubbing? What disease conditions are associated with digital clubbing? How is digital clubbing evaluated, measured and categorized? What is the pathophysiology of digital clubbing? ___________________ Full Transcript - Read the article and view references FREE CLASS - If all you've heard are nursing school horror stories, then you need this class! Join me in this on-demand session where I dispel all those nursing school myths and show you that YES...you can thrive in nursing school without it taking over your life! Study Sesh - Change the way you study with this private podcast that includes dynamic audio formats including podquizzes, case studies and drills that help you review and test your recall of important nursing concepts on-the-go. Free yourself from your desk with Study Sesh!  Med Surg Solution - Are you looking for a more effective way to learn Med Surg? Enroll in Med Surg Solution and get lessons on 57 key topics and out-of-this-world study guides.  Clinical Success Pack - One of the best ways to fast-track your clinical learning is having the right tools. This pack includes report sheets, sheets to help you plan your day, a clinical debrief form, and a patient safety cheat sheet.

Tamsin Chislett, CEO of Hyfe, highlights the importance of understanding coughs for healthcare providers, the lack of information about coughs, and Hyfe's advancements in building a database and developing biomarkers based on different kinds of coughs. Hyfe's AI technology, which can integrate with other devices and platforms for remote patient monitoring, enables passive, continuous tracking of cough patterns that can be used in research and clinical trials. Opportunities for digital therapeutics include chronic cough, COPD, lung cancer, respiratory infections, and cardiovascular diseases.  Tamsin elaborates, "Hyfe is the global leader in AI power. The problem we're trying to solve is that you have this really common symptom cough, which has been experienced by every human alive and is experienced daily by many people, yet to discuss it, measure it, monitor it, or even manage it, we're entirely reliant on subjective data. Everyone's had the experience of going into a primary care doctor, and saying I've got a really bad cough. The doctor says How bad is it, and is it getting worse?  We don't even have the proper language to describe it." "We want to get to the point where, in those situations, the doctor can start to get objective data about the patient's cough patterns and use that instead. The way we see it is that there was a time when to measure fever, we put a hand on a patient's forehead. We hope that within a few years, thanks to Hyfe's technology, we should not be in the same position with cough. So we're always looking to have objective data." "I think the interesting thing about cough is that because it's never been measurable, it hasn't been studied anywhere near as much as it probably should have. And even in the first five years of Hyfe's life, we've seen an explosion in cough-related science now that it's possible to monitor coughs with a smartphone, a smart watch, or anything with a microphone running Hyfe's technology. We've seen exciting science across a whole range, many of which are intuitive when you start thinking about cough, acute cough is a big one and respiratory infections, but there's also chronic cough."  "There's also COPD, there's IPF, there's lung cancer, there are so many respiratory and even cardiology diseases where cough is a cardinal symptom, a really clear sign of exacerbation of disease or worsening. However, to date, it has not been able to be measured, and cough monitoring with Hyfe allows you to monitor cough over time, see patterns, and use those patterns to optimize patient care in the future." #HyfeAI #ChronicCough #HyfeDTx #DigitalHealth #AIinHealthcare #DigitalTherapeutics #MedAI #CoughMonitoring #RemotePatientMonitoring #HealthInnovation #RespiratoryAwareness #CoughAwareness #CoughScience #PatientCentricCare hyfe.com Download the transcript here

Tamsin Chislett, CEO of Hyfe, highlights the importance of understanding coughs for healthcare providers, the lack of information about coughs, and Hyfe's advancements in building a database and developing biomarkers based on different kinds of coughs. Hyfe's AI technology, which can integrate with other devices and platforms for remote patient monitoring, enables passive, continuous tracking of cough patterns that can be used in research and clinical trials. Opportunities for digital therapeutics include chronic cough, COPD, lung cancer, respiratory infections, and cardiovascular diseases.  Tamsin elaborates, "Hyfe is the global leader in AI power. The problem we're trying to solve is that you have this really common symptom cough, which has been experienced by every human alive and is experienced daily by many people, yet to discuss it, measure it, monitor it, or even manage it, we're entirely reliant on subjective data. Everyone's had the experience of going into a primary care doctor, and saying I've got a really bad cough. The doctor says How bad is it, and is it getting worse?  We don't even have the proper language to describe it." "We want to get to the point where, in those situations, the doctor can start to get objective data about the patient's cough patterns and use that instead. The way we see it is that there was a time when to measure fever, we put a hand on a patient's forehead. We hope that within a few years, thanks to Hyfe's technology, we should not be in the same position with cough. So we're always looking to have objective data." "I think the interesting thing about cough is that because it's never been measurable, it hasn't been studied anywhere near as much as it probably should have. And even in the first five years of Hyfe's life, we've seen an explosion in cough-related science now that it's possible to monitor coughs with a smartphone, a smart watch, or anything with a microphone running Hyfe's technology. We've seen exciting science across a whole range, many of which are intuitive when you start thinking about cough, acute cough is a big one and respiratory infections, but there's also chronic cough."  "There's also COPD, there's IPF, there's lung cancer, there are so many respiratory and even cardiology diseases where cough is a cardinal symptom, a really clear sign of exacerbation of disease or worsening. However, to date, it has not been able to be measured, and cough monitoring with Hyfe allows you to monitor cough over time, see patterns, and use those patterns to optimize patient care in the future." #HyfeAI #ChronicCough #HyfeDTx #DigitalHealth #AIinHealthcare #DigitalTherapeutics #MedAI #CoughMonitoring #RemotePatientMonitoring #HealthInnovation #RespiratoryAwareness #CoughAwareness #CoughScience #PatientCentricCare hyfe.com Listen to the podcast here

Roger Seheult, MD of MedCram explains a new FDA approved medication for COPD and the ENHANCE trials. See all Dr. Seheult's videos at: https://www.medcram.com/ (This video was recorded on April 28th, 2025) Roger Seheult, MD is the co-founder and lead professor at https://www.medcram.com He is Board Certified in Internal Medicine, Pulmonary Disease, Critical Care, and Sleep Medicine and an Associate Professor at the University of California, Riverside School of Medicine. MEDCRAM WORKS WITH MEDICAL PROGRAMS AND HOSPITALS: MedCram offers group discounts for students and medical programs, hospitals, and other institutions. Contact us at customers@medcram.com if you are interested. MEDIA CONTACT:  Media Contact: customers@medcram.com Media contact info: https://www.medcram.com/pages/media-c... Video Produced by Kyle Allred FOLLOW US ON SOCIAL MEDIA: https://www.facebook.com/MedCram https://twitter.com/MedCramVideos https://www.instagram.com/medcram DISCLAIMER: MedCram medical videos are for medical education and exam preparation, and NOT intended to replace recommendations from your doctor. #COPD #FDA #Ensifentrine

CHEST May 2025, Volume 167, Issue 5  CHEST journal's Editor in Chief, Peter Mazzone, MD, MPH, FCCP, highlights key research published in the journal CHEST May 2025 issue, including an exploration into associations between socioeconomic status and frailty in patients with COPD, trends in all-cause mortality among US veterans with sarcoidosis, and much more. 

I am excited to have Leo Tonkin joining us today. Leo is a passionate advocate for Halotherapy. He believes the respiratory system is the key to longevity and quality of life because those who cannot breathe properly cannot live well. Even though we take around 20,000 breaths daily, we often take our breath for granted. Unfortunately, our respiratory system degenerates as we age, and the air quality around us keeps deteriorating. So if we fail to care for our lungs, we can lose the ability to sleep, work, and live well, and that's where Halotherapy, or salt therapy, can help us. Benefits of Salt Therapy: Clears mucus and reduces inflammation in the airways It is antibacterial, anti-inflammatory, and anti-fungal Eases symptoms of asthma, bronchitis, COPD, and allergies Helps prevent and relieve colds, flu, and sinus infections Strengthens immune function, increases lung capacity, and improves breathing Promotes deep and restful sleep Safe for pets and people of all ages Leo Tonkin's Bio: Leo Tonkin has been a pioneer in many industries, and in 2012, he revolutionized the salt therapy industry with his innovative approach and tireless dedication to transforming the way people think about their skin, respiratory, and mental wellness.  With a deep understanding of the science behind salt therapy and its benefits, Leo started SALT Chamber, the world's leading salt therapy design, equipment, and decor company.  Over a decade ago, he created a global industry for providing a safe, drug-free, evidence-based modality that is ‘hacking' into our respiratory and skin systems to enhance performance and recovery while improving quality of life.  In 2014, Leo was the Founding Chairman of the Salt Therapy Association, which now has over 3600+ members in 62 countries.  Understanding that air quality and climate change are major contributors to our well-being, he launched the Respiratory Wellness Initiative for the Global Wellness Institute.  He has a passion for making a difference in every breath we take, especially since being a Stage 4 cancer survivor. He lives in Delray Beach Florida, with his wife Lori. He has 4 grandchildren. In this episode: How Halotherapy originated and what it involves Why salt particles are effective for overcoming respiratory issues How does salt therapy work? How the halo generator functions in salt rooms The benefits of salt therapy for pets How salt therapy can help respiratory conditions like COPD, asthma, and cystic fibrosis When should salt therapy be avoided? Why we must keep on moving our bodies Links and Resources: Use code GRAY15 on ⁠Airdoctorpro⁠ website for discounts ⁠Sinus Support Use code TURMRIC to get 10% off ⁠TURMERIC Relative Links for This Show:

Featuring articles on lipoprotein(a), familial polycythemia, leukocyte adhesion deficiency, COPD, and on policies on reducing alcohol consumption; a review article on addressing alcohol use; a Clinical Problem-Solving on gazing into a crystal ball; and Perspectives on death and taxes, on cancer metastases, and on a good innings.

Join The First Lady of Nutrition as she sits down with Leo Tonkin, one of the nation's leading voices on the science and benefits of salt therapy—also known as halotherapy. From its origins in the healing salt mines of Eastern Europe to its modern-day use in thousands of wellness centers across the U.S., this ancient remedy is making a powerful comeback. Ann Louise and Leo get right to the heart of the matter, exploring how dry salt therapy—more absorbent and potent than ocean air or nebulizers—can help improve respiratory health, skin conditions, and immunity. Safe for daily use (even for infants), it has become a go-to for athletes looking to boost lung function and for anyone dealing with asthma, COPD, eczema, acne, or allergies. Tune in to learn the truth about Himalayan salt lamps, what kind of salt is really therapeutic, and how you can create your own pop-up salt booth at home. As Leo explains, breathing clean air isn't just refreshing, it could be the single most important marker of longevity and quality of life. To find a salt therapy location near you, visit www.salttherapyassociation.org/ and check out Leo's innovations at https://salttherapyhome.com/. The post Could Salt Be The Secret to Better Breathing? – Episode 192: Leo Tonkin first appeared on Ann Louise Gittleman, PhD, CNS.

Uncover the toxic scars of burn pits with Talking Lead as we confront a hidden threat haunting our veterans. From Iraq and Afghanistan's massive burn pits—loaded with jet-fueled trash like plastics, tires, and dioxins—to cancers and lung diseases striking heroes like Sergeant Major Alberto A. Toscano and Master Chief Hospital Corpsman (ret) Steve Flemming , we reveal the brutal cost. Learn how the PACT Act is helping our vets, why vets still fight for care, and the lawsuits targeting burn pit contractors. With science tying benzene and particulates to leukemia and COPD, we probe what's next—advocacy, VA registries, and public action. Stand with us to honor vets and demand justice.

Understanding Hospice Care: An Interview with Scott Zimmerman   In episode 144 of 'Hospice Explained,' host Marie Betcher BSN, RN a former hospice nurse, interviews Scott Zimmerman, a trusted advisor in life insurance and long-term care. Scott shares his personal experience with hospice care for his father, who had COPD, and discusses the importance of hospice in providing comfort during the end-of-life season. The episode delves into Scott's background, his professional insights, and his positive views on the significance of hospice care. Scott also shares his mother's perspective and talks about his work in life insurance and long-term care, offering his contact information for those interested.   00:00 Introduction to Hospice Explained 00:49 Meet Scott Zimmerman: Life Insurance and Long-Term Care Expert 02:32 Scott's Personal Hospice Experience 06:46 Understanding Hospice Care and Medications 08:20 Reflections on Hospice and End-of-Life Care 15:33 Scott's Professional Insights and Contact Information 19:39 Conclusion and Call to Action   https://linktr.ee/scottzimmerman   Finding a Hospice Agency 1. You can use Medicare.gov to help find a hospice agency, 2. choose Find provider 3. Choose Hospice 4. then add your zip code This should be a list of Hospice Agencies local to you or your loved one.  Hospice Explained Affiliates & Contact Information Buying from these Affilite links will help support this Podcast.   In addition you can donate to help support Hospice Explained at the Buy me a Coffee link  https://www.buymeacoffee.com/Hospice Kacie Gikonyo's Death Doula School https://hospiceexplained--deathdoulaschool.thrivecart.com/death-doula-school/ Affilitate for the Caregiving Years Training Academy:  https://www.careyearsacademy.com/ref/1096/  Affiliate for DNA is Love listeners also get a 5% discount!! https://dnaislove.com/?coupon=hospiceexplained5  The Death Deck and the E*O*L deck:  https://thedeathdeck.goaffpro.com/  Marie's Contact Marie@HospiceExplained.com www.HospiceExplained.com