Optimizing Home Oxygen Therapy. An Official American Thoracic Society Workshop Report.

More than 1.5 million adults in the United States use supplemental oxygen for a variety of respiratory disorders to improve their quality of life and prolong survival. This document describes recommendations from a multidisciplinary workshop convened at the ATS International Conference in 2017 with the goal of optimizing home oxygen therapy for adults. Ideal supplemental oxygen therapy is patient-specific, provided by a qualified clinician, includes an individualized prescription and therapeutic education program, and offers oxygen systems that are safe, promote mobility, and treat hypoxemia. Recently, patients and clinicians report a growing number of problems with home oxygen in the United States. Oxygen users experience significant functional, mechanical, and financial problems and a lack of education related to their oxygen equipment-problems that impact their quality of life. Health care providers report a lack of readily accessible resources needed to prescribe oxygen systems correctly and efficiently. Patients with certain lung diseases are affected more than others because of physically unmanageable or inadequate portable systems. Analysis is needed to quantify the unintended impact that the Centers for Medicare and Medicaid Services Competitive Bidding Program has had on patients receiving supplemental oxygen from durable medical equipment providers. Studies using effectiveness and implementation research designs are needed to develop and evaluate new models for patient education, identify effective ways for stakeholders to interface, determine the economic benefit of having respiratory therapists perform in-home education and follow-up testing, and collaborate with technology companies to improve portable oxygen devices. Generation of additional evidence of the benefit of supplemental oxygen across the spectrum of advanced lung diseases and the development of clinical practice guidelines should both be prioritized.

American Thoracic Society and Marron Institute Report. Estimated Excess Morbidity and Mortality Caused by Air Pollution above American Thoracic Society-Recommended Standards, 2011-2013.

Estimates of the health impacts of air pollution are needed to make informed air quality management decisions at both the national and local levels. Using design values of ambient pollution concentrations from 2011-2013 as a baseline, the American Thoracic Society (ATS) and the Marron Institute of Urban Management estimated excess morbidity and mortality in the United States attributable to exposure to ambient ozone (O3) and fine particulate matter (PM2.5) at levels above the American Thoracic Society-recommended standards. Within the subset of counties with valid design values for each pollutant, 14% had PM2.5 concentrations greater than the ATS recommendation, whereas 91% had O3 concentrations greater than the ATS recommendation. Approximately 9,320 excess deaths (69% from O3; 31% from PM2.5), 21,400 excess morbidities (74% from O3; 26% from PM2.5), and 19,300,000 adversely impacted days (88% from O3; 12% from PM2.5) in the United States each year are attributable to pollution exceeding the ATS-recommended standards. California alone is responsible for 37% of the total estimated health impacts, and the next three states (Pennsylvania, Texas, and Ohio) together contributed to 20% of the total estimates. City-specific health estimates are provided in this report and through an accompanying online tool to help inform air quality management decisions made at the local level. Riverside and Los Angeles, California have the most to gain by attaining the ATS recommendations for O3 and PM2.5. This report will be revised and updated regularly to help cities track their progress.

From closing the atmospheric ozone hole to reducing climate change. Lessons learned.

Global warming presents U.S. and transnational leaders with enormous political and policy challenges. World leadership addressed a similar worldwide environmental challenge in the 1980s and 1990s when scientists advised that accelerating emission of man-made chlorofluorocarbons was depleting the ozone layer of the earth's atmosphere. The process that led to global agreement on reducing depletion of the ozone layer holds valuable lessons, and some ironies, for scientists and policy makers seeking now to address global climate change. By understanding the international treaty process, how science informed that process, and how the physician community played a constructive role in the transition away from commercial use of ozone-depleting gases three decades ago, environmental activists can better understand the challenges, opportunities, and potential solutions under current consideration in affecting global climate change.

The critical care medicine crisis: a call for federal action: a white paper from the critical care professional societies.

In the United States, shortages of qualified health-care professionals have created a major threat to the availability and quality of critical care services for seriously ill patients. An unprecedented, and largely unrecognized, shortage of physician intensivists in the near future will deny standard critical care services for large populations of patients with serious illnesses. If the current trend persists, shortages of these specialists, combined with the current shortages of critical care nurses, pharmacists, and respiratory therapists, will become severe by 2007 and will worsen through 2030. Numerous studies demonstrate that critical care services directed by physicians who are formally trained in critical care medicine reduce mortality in the ICU and reduce health-care costs. While people of all ages, from low-birth-weight newborns to senior citizens, benefit from treatment in the ICU, older Americans receive a disproportionate share of ICU services. The demand for ICU services, therefore, will continue to grow as the baby boom generation ages. To address the shortage, the critical care professional societies recommend that steps be taken to improve the efficiency of critical care providers, to increase the number of critical care providers, and to address the demand for critical care services.