BB&T Contributing Writer

SAN DIEGO – With more than 13,000 members, the American Thoracic Society (ATS; New York) is the leading medical association dedicated to advancing lung, critical care and sleep medicine. Founded in 1905 to find a cure for tuberculosis, the society has expanded its work to help prevent and fight respiratory diseases around the world. Some 14,500 persons attended the society’s annual conference here in mid-May, an international gathering that included booths set up specifically to serve attendees from the UK and France.

Among the meeting’s features were a discussion of this country’s critical care crisis and a presentation highlighting the increasing costs associated with chronic obstructive pulmonary disease.

Looming shortage of intensivists

Intensivists are specialists in the care of patients in intensive care units (ICUs) of hospitals. Even tho-ugh it is a relatively new medical specialty, a critical lack of intensivists is looming in the U.S. During a press conference, the Critical Care Workforce Partnership discussed the Health Resources and Services Administration’s May report to Congress, The Critical Care Workforce: A Study of the Supply and Demand for Critical Care Physicians. The study estimates a 129% increase in the demand for critical care specialists by the year 2020 due to the rapid growth in the U.S.’s aging population and the resulting escalating demand for critical care services. Because intensivists are more likely to provide care in large hospitals, the partnership said the shortage is likely to be worse in some regions of the country and for populations that already have limited access to physicians.

Of the 18 million days spent in the ICU annually, more than half are used by patients over age 65. By 2020, the population aged 65 and older will increase by 50% and by 100% in 2030. As a result, the aging population will increase the demand for intensivists by 38%. The Critical Care Workforce Partnership includes the American College of Chest Physicians, the American Association of Critical Care Nurses, the Society of Critical Care Medicine and the American Thoracic Society. Their report urged Congress to address this imminent critical care workforce shortage in order to avoid a national healthcare crisis.

The partnership is working with Sen. Richard Durbin (D-Illinois) to develop solutions to alleviate the current and future burden imposed by the predicted workforce shortage. Specific steps recommended include increasing the efficiency of the critical care workforce through research on optimal delivery models, developing incentives to better distribute pro-viders and simplifying the currently cumbersome reimbursement system. Increased medical and nursing school capacities also were recommended. The partnership also proposed expanding the J-1 visa waiver program in the U.S. to allow more U.S.-trained international medical graduates to practice in the U.S. in designated underserved areas.

In one of the more interesting scientific presentations, lead researcher Todd Lee, PharmD, PhD, rese-arch assistant professor at Northwestern University (Evanston, Illinois), presented a study which used a mathematical model to estimate future costs related to chronic obstructive pulmonary disease (COPD). Over the next 20 years, medical costs related to the disease will total some $832.9 billion in the U.S., Lee said.

COPD is the fourth-leading cause of death in the U.S., claiming the lives of 120,000 Americans in 2002. Lee estimated 10.7 million U.S. adults have COPD, but there may be many more undiagnosed cases. Smoking is the primary risk factor for COPD – between 80% and 90% of COPD deaths are estimated to be caused by smoking. “As the prevalence of COPD continues to grow, the costs associated with the disease will continue to rise and are projected to consume a significant portion of the healthcare budget over the next two decades,” he said.

On the exhibit floor

ATS attendees were drawn to several new and innovative products while visiting the 609 booths at the trade show. Among these were a product for vibration response imaging, one for guided lymph node analysis, another for treating asthma and stents for non-vascular therapies.

Deep Breeze’s (OrAkiva, Israel) vibration response imaging (VRI) methodology extends a physician’s ability to visualize the lungs. VRI uses an array of sensors (V-Array) placed on a patient’s back to record the vibration energy created by air flow traveling through the bronchial tree. The vibrations propagate through the lung tissue, where the vibration response is modified by different structures along its propagation path. The vibration energy is then collected by the sensor array units. Proprietary software processes this vibration energy and converts it into a dynamic image reflecting the structural and functional abnormalities within the lung.

The company believes VRI offers a view of the lungs not previously attainable from other technologies. The procedure requires neither special facilities nor unique technical expertise. On average, the entire procedure takes less than 10 minutes. The VRI consists of three elements: two sensor array units that are attached by vacuum to the patient’s back, the VRI hardware and a dedicated work station with VRI software (for operation, display and image analysis). U.S. clinical studies are ongoing but the device is not yet FDA-approved.

The diagnosis and staging of intrathoracic disease often requires a tissue diagnosis from lymph nodes adjacent to the tracheobronchial tree. Flexible bronchoscopy with transbronchial needle aspiration is currently the least-invasive method for sampling tissue in the area.

The superDimension/Bronchus (Minneapolis) system’s Guided Lymph Node Approach enables a physician to navigate dedicated tools in real time, overlaid on a roadmap constructed of preoperative computed tomography (CT) images. The procedure is performed in the bronchoscopy suite.

Clinical studies have shown a 95% success rate in reaching mediastinal lymph nodes. The system includes a locatable guide containing a location sensor; a 3-D CT roadmap and a localization system. The Location Board generates a very low frequency electromagnetic field. It is placed under the mattress of the procedure bed. A passive location sensor at the tip of the Locatable Guide is activated and detected when it enters the electromagnetic field above the Location Board. The sensor’s location is shown in real time on the 3-D CT roadmap.

Asthmatx (Mountain View, California) is focused on helping patients with asthma breathe easier. The company is developing an interventional medical device, called the Alair System, for the bronchoscopic treatment of patients with moderate to severe asthma. Multiple clinical studies are under way to evaluate the safety and efficacy of this device in potentially improving the lives of patients with asthma. One of these studies, the Air2 Trial, is enrolling patients.

The Alair System is a catheter-based device with a distal expandable wire basket. Placed through a standard flexible bronchoscope, the physician performs controlled bronchial thermoplasty (heating of the lining of the airways). The company believes the procedure will keep airways from narrowing by preventing the airway’s smooth muscle from contracting.

An emerging leader in the development of non-vascular interventional stent technology, Alveolus (Charlotte, North Carolina) demonstrated its Aero Tracheobronchial stent. The product is an investigational device for sale only in select European countries at this time. The Maxxwire endoscopic guidewire and Alimaxx-E esophageal stents are available in the U.S. and Europe. Stenting has been used by vascular specialists for years. Now Alveolus is bringing the same techniques to the interventional pulmonologist, gastroenterologist and interventional radiologist.