60th RESPIRATORY CARE Journal Conference

8:00 a.m.–8:15 a.m.

Welcome

Dean Hess

Overview, Introductions, Ground Rules

Neil MacIntyre and Surya Bhatt

Introduction

8:15 a.m.–8:45 a.m.

Pulmonary Rehabilitation: History and Definitions

Neil MacIntyre

History of pulmonary rehabilitation and evolution of the rehabilitation concept for chronic lung disease over the past 60 years. What is the target population? What are the key components? What are the overarching goals?

8:45 a.m.–9:00 a.m.

Discussion of Dr. MacIntyre’s presentation.

Why Does Pulmonary Rehabilitation Work?

9:00 a.m.–9:30 a.m.

Pulmonary Rehabilitation: Mechanisms of Functional Loss and Benefits of Exercise

Linda Nici

What is the impact of impaired gas exchange on function? What are the effects of systemic inflammation due to chronic lung disease? What are the effects of skeletal muscle abnormalities (sarcomere injury) from systemic inflammation, hypoxemia, malnutrition, lung disease comorbidities (e.g., cardiac, metabolic, OSA)? What is the role of exercise in managing functional loss in CLD? Aerobic training? strength training? respiratory muscle focus? How much is needed?

9:30 a.m.–9:45 a.m.

Discussion of Dr. Nici’s presentation.

9:45 a.m.–10:00 a.m.

Break

10:00 a.m.–10:30 a.m.

Respiratory Assist Devices in Pulmonary Rehabilitation

Gerard Criner

What are the benefits of oxygen supplementation for exercise related hypoxemia (short- and long-term effects)? Is oxygen also helpful in the non-hypoxemic chronic lung disease patient? Are portable positive pressure assist devices (NIV and others) effective during exercise? Do they work? Are they beneficial? Does NIV at night in hypercapneic patients or those with OSA facilitate pulmonary rehabilitation exercise programs? Are inspiratory muscle training and PEP devices useful during pulmonary rehabilitation?

10:30 a.m.–10:45 a.m.

Discussion of Dr. Criner’s presentation.

10:45 a.m.–11:15 a.m.

Psychosocial Support in Pulmonary Rehabilitation

Abebaw Yohannes

How do anxiety and depression, which are common features in patients with chronic lung disease, impact functional status, quality of life, health care costs and outcomes? How best to assess anxiety and depression in patients with chronic lung disease? How aggressive should pharmacotherapy be to facilitate pulmonary rehabilitation? What are features of pulmonary rehabilitation that can mitigate anxiety and depression?

11:15 a.m.–11:30 a.m.

Discussion of Dr. Yohannes’ presentation.

11:30 a.m.–2:00 p.m.

Recess (On your own)

2:00 p.m.–2:30 p.m.

Self-management of Chronic Lung Disease

Roberto Benzo

Proper chronic lung disease management is complex — drugs, devices, O2, exercise plans, airway care, etc., can be overwhelming to patients. Are exacerbation action plans effective? Education is key and can be based in PR programs. However, reliable support structures (e.g., home visits, hot lines, ongoing education programs) are also needed. Can PR programs be the infrastructure to support these activities? The technology enabling home monitoring (spirometers, oximeters, respiratory pattern monitors, hemodynamic monitors, activity monitors, etc.) is growing rapidly. Which monitors provide real benefit? How might maintenance and/or telemedicine PR programs interact with these?

2:30 p.m.–2:45 p.m.

Discussion of Dr. Benzo’s presentation.

Patient Focused Clinical Benefits of Pulmonary Rehabilitation

2:45 p.m.–3:15 p.m.

The Evidence for Pulmonary Rehabilitation in COPD

Christopher Mosher

Beyond exercise capacity improvement — PR has effects on quality of life, health care utilization, mortality. What is the evidence for these benefits? What is the cost effectiveness of PR in COPD

3:15 p.m.–3:30 p.m.

Discussion of Dr. Mosher’s presentation.

3:30 p.m.–3:45 p.m.

Break

3:45 p.m.–4:15 p.m.

Pulmonary Rehabilitation in non-COPD Chronic Lung Diseases

Rachael Evans

Chronic lung disease is more than COPD and includes ILD, post COVID, PAH, transplant, and others. Like COPD, these chronic conditions can impact functional status, quality of life, health care utilization, mortality, and costs. Can pulmonary rehabilitation provide benefits like those seen in COPD to those with non-COPD CLD?

4:15 p.m.–4:30 p.m.

Discussion of Dr. Evans’ presentation.

Access and Maintenance

4:30 p.m.–5:00 p.m.

Barriers to Pulmonary Rehabilitation

Carolyn Rochester

How many patients with chronic lung disease utilize PR? What are the medical, societal, and geographic barriers? How does financial/insurance coverage serve as a barrier? What might be the health care costs benefits to increased access?

5:00 p.m.–5:15 p.m.

Discussion of Dr. Rochester’s presentation.

5:15 p.m.

Recess

6:00 p.m.–7:00 p.m.

Reception

In the Mezzanine. Families and friends are welcome.

8:00 a.m.–8:30 a.m.

Maintenance Rehabilitation

Marilyn Moy

PR is more than a specific interventional program—it is a lifetime commitment. What are the challenges of maintaining benefits or either facility or home-based programs? What are the challenges to translating rehabilitation to improvements in physical activity?

8:30 a.m.–8:45 a.m.

Discussion of Dr. Moy’s presentation.

Models of Pulmonary Rehabilitation Delivery — A Pro/Con

8:45 a.m.–9:15 a.m.

Center-based Pulmonary Rehabilitation is the standard: Pro

Richard Casaburi

What is the evidence for center-based pulmonary rehabilitation?

9:15 a.m.–9:45 a.m.

Center-based Pulmonary Rehabilitation is the gold standard: Con

Surya Bhatt

What is the Evidence for home and tele-pulmonary rehabilitation?

9:45 a.m.–10:00 a.m.

Break

10:00 a.m.–10:15 a.m.

Casaburi rebuttal

10:15 a.m.–10:30 a.m.

Bhatt rebuttal

10:30 a.m.–10:45 a.m.

Pro/con discussion

10:45 a.m.–11:15 a.m.

Pulmonary Rehabilitation: Reimbursement Challenges

Chris Garvey

What are the models for reimbursement? What drives payer decisions? Lifetime limits on coverage? Coverage for Non-COPD pulmonary rehabilitation? What about coverage for maintenance rehabilitation?

11:15 a.m.–11:30 a.m.

Discussion of Ms. Garvey’s presentation.

11:30 a.m.

Adjourn