2023 Recap: This Year in Medicine

Dr. Albert Rizzo:
Hello, I'm Dr. Albert Rizzo, Chief Medical Officer of the American Lung Association. Welcome to Lungcast. Before we dive into this episode, just a reminder of all the ways you can enjoy Lungcast. If you're watching this on YouTube, be sure to subscribe to our channel, @Lungcast, to get updates on new episodes and interview segments. If you're listening on your podcast player, you can do the same there. You can also get more Lungcast episodes and segments on hcp live.com and lung.org.

Since the American Lung Association and HCP Live launched Lungcast in the summer of 2020, the field of respiratory health has evolved in unprecedented ways. One doesn’t have to look further than our own episode library to appreciate the shifts in the field brought on by a global pandemic, numerous public health phenomena, and practice-changing innovations in screening, diagnostics, prevention, and therapy—from vaccination to late-stage lung cancer care. The world of respiratory health has irrevocably changed in just four years.

To reflect on this year's spectacular headlines, we bring you our annual recap episode, where we revisit our favorite Lungcast interview segments of 2023. We hope you enjoy the recap, and if you want, check out the episode notes below to interact with each interview you may have missed.

Back in February, we discussed the unique role of thoracic surgeons in lung cancer management with Dr. Thomas Cook, the founding Chief of the Division of General Thoracic Surgery at UC Davis. Among the many perspectives Dr. Cook shared was how he and his peers approach stage four lung cancer.

Dr. Thomas Cook:
Getting back to lung cancer screening a bit, we know the main driver of this procedure is to shift the stage of lung cancer to an earlier stage, which is potentially more curative. Unfortunately, many patients present with metastatic stage four disease. This stage-four group is heterogeneous. Despite all being stage four, some patients have a higher disease burden than others. In 2017, the updated TNM staging reclassified metastatic disease into three groups—M1a, M1b, and M1c—because of median survival differences.

Do you see this as changing the approach from a thoracic surgery standpoint?

Yes, because those changes were made to identify patients with what’s called oligometastatic disease—oligo meaning few—where the disease has metastasized to one site. For instance, someone with an isolated brain metastasis and otherwise early-stage lung cancer could have that single metastasis treated with focused radiation, while their lung cancer is treated surgically. Similarly, an isolated adrenal metastasis may be treated with radiation or laparoscopic adrenalectomy in collaboration with oncology colleagues. These decisions need to be part of a multidisciplinary tumor board; they shouldn’t be made in a vacuum.

Dr. Albert Rizzo:
Next, in March, Dr. Robbie Khan, Deputy Division Chief of Pulmonary Critical Care Medicine at Northwestern Feinberg School of Medicine, discussed the promising prospects of lung disease interception and the ALA Lung Health Cohort study.

Dr. Robbie Khan:
The Lung Health Cohort (AL LHC) is community-based, focusing on healthy adults aged 25–35. We want to understand peak respiratory health and how exposures, behaviors, and environment influence lung function. We conduct spirometry, lung CT scans, and biomarker analysis, including nasal epithelium and blood sampling. We also geocode addresses to estimate exposure to airborne pollutants and allergens.

We aim to follow participants long-term, similar to the Framingham study for cardiovascular disease, to identify ways to intercept chronic lung disease before it becomes clinically apparent. The idea is to find a “cholesterol for the lung” and develop interventions to prevent progression toward chronic disease.

Dr. Albert Rizzo:
In May, we discussed early-onset allergic asthma with New York-based allergist Dr. Pile Gupta, who explained the atopic or allergic march.

Dr. Pile Gupta:
The allergic march describes the progression of allergic diseases from infancy to adulthood—conditions like food allergies, allergic rhinitis, asthma, and atopic dermatitis. Children with a family history of allergies are at higher risk. From birth to one year, children may show skin irritation; ages one to three may develop food allergies; ages four to six, environmental allergies appear; and ages five to seven, asthma can emerge. This progression helps guide prevention and treatment strategies.

Dr. Albert Rizzo:
In May, we also took the show on the road with Dr. Ann Dixon, live from the ATS 2023 Annual Meeting in Washington, D.C., who discussed weight loss interventions for asthma care.

Dr. Ann Dixon:
My research focuses on obesity, metabolic dysfunction, and lung disease. We found that obesity significantly affects asthma outcomes. A recent pilot study showed that losing just 5% of body weight improved asthma control scores, demonstrating that modest weight loss can meaningfully impact asthma management. This highlights the need to consider metabolic health alongside asthma treatment.

Dr. Albert Rizzo:
During the wildfire crisis in Canada, Kevin Kman and I recorded a special episode on air quality, discussing the Air Quality Index (AQI).

Kevin Kman:
The AQI, developed by the EPA, measures air pollutants like ozone, particulate matter, carbon monoxide, sulfur dioxide, and nitrogen oxides. Particle pollution is particularly concerning because fine particles (2.5 microns) can penetrate deep into the lungs and bloodstream, affecting both respiratory and cardiac health. Higher AQI values correlate with increased health risks, particularly for children, the elderly, and pregnant individuals.

Dr. Albert Rizzo:
In June, Dr. Carolyn Presley discussed age-related treatment equity in lung cancer.

Dr. Carolyn Presley:
There shouldn’t be an age cutoff for treatment discussions. Chronologic age isn’t equivalent to physiologic age. Geriatric assessment helps understand patient function and can decrease treatment-related toxicities. Shared decision-making is critical in lung cancer care, considering both functional status and individual preferences.

Dr. Albert Rizzo:
In July, Julia Movgle, a long COVID patient and researcher, provided an update on emerging treatments.

Julia Movgle:
Long COVID remains a long-term condition. Only about 8% of patients recover in the first two years. Current clinical trials are mostly small, which limits their impact. We need well-powered studies to address symptom heterogeneity and develop effective treatments. I estimate that it may still be five years before robust treatments are widely available.

Dr. Albert Rizzo:
In September, Dr. Parth Rali, Associate Professor at Temple University, reviewed pulmonary embolism diagnostics and treatments.

Dr. Parth Rali:
AI software now allows near-instant PE diagnosis and RV/LV ratio assessment, drastically reducing diagnostic delays. Additionally, multiple RCTs are underway comparing advanced treatment options, from catheter-directed thrombolysis to anticoagulation strategies. We expect evidence-based guidelines for both acute and post-PE care in the coming years.

Dr. Albert Rizzo:
Respiratory syncytial virus (RSV) also had major developments, including FDA approval of two vaccines and a monoclonal antibody. We spoke with Dr. Barbara Taylor in September about these new tools.

Dr. Barbara Taylor:
Shared decision-making is key for adults aged 60 or older. The vaccines, REXI (GlaxoSmithKline) and ABRISO (Pfizer), target the prefusion F protein and are highly effective against RSV-related lower respiratory tract disease. Post-marketing surveillance is ongoing, especially for older adults and those in long-term care. Vaccination timing should be before the start of RSV season.

Dr. Albert Rizzo:
In October, Dr. Mark Hernandez discussed indoor air pollution exposures, particularly in schools.

Dr. Mark Hernandez:
Signs of unhealthy air include fatigue and tiredness in children. We are studying absenteeism in conjunction with the University of Colorado Medical School to see if improved air quality lowers respiratory-related absences. Our approach is public health-focused, not individual or cluster-based.

Dr. Albert Rizzo:
Finally, in November, we shared the story of Christy Fiser, a four-time survivor of non-smoking stage four lung cancer.

Christy Fiser:
The most important thing is to maintain who you are and keep living your life. I treat lung cancer as a competition—I won’t let it take more of my time than necessary. Keep moving forward, find joy, and integrate treatment into life without letting the disease define you.

Dr. Albert Rizzo:
That concludes our 2023 recap. After more than 40 episodes over three years, we thank everyone who helped make Lungcast possible. We will continue producing monthly episodes into 2024 and beyond. Subscribe on your podcast platform or YouTube, and check out lung.org and hcp live.com for more content.

I’m Dr. Albert Rizzo, reminding you: Who can’t breathe? Nothing else matters. Have a happy and healthy holiday.