The 2021 Annual Congress of the American Thoracic Society (ATS) was held between May 14^th and 19^th and showcased the latest advances and breakthrough discoveries that will reshape the future of respiratory science, patient care and global respiratory health. A robust scientific, educational and networking programme was delivered via the virtual ATS platform, which included clinical and scientific sessions, keynote series, postgraduate courses and meet the expert sessions.

Juan Celedón, ATS President

ATS 2021 got underway with the opening ceremony and an address by current President Juan Celedón, who highlighted the extreme challenges of the past year which ATS has addressed with advocacy and a renewed focus on its over-arching mission to advance research and careers, clinical care and public health. Incoming President-Elect Lynn Schnapp then outlined key priorities and opportunities for the year ahead which include infrastructure upgrades, the leveraging of new learning methods and technologies and an increased focus on collaboration and knowledge-sharing.

“This past year, a once-in-a-century catastrophe has revealed the character and commitment of our ATS members who confronted the COVID-19 pandemic with selfless devotion to prevent further suffering and help those afflicted.”

ATS President, Juan Celedón

Anja Frei, Zurich, Switzerland, showcased results from a randomised controlled trial assessing the effectiveness of a 1-year home-based maintenance exercise training programme (HOMEX) versus usual care in 123 patients with chronic obstructive pulmonary disease (COPD) after pulmonary rehabilitation (PR). Although there was no significant difference in the primary outcome of change in conventional interviewer led dyspnoea, HOMEX training did provide benefit in functional exercise capacity assessed by the 1-minute-sit-to-stand test.

Two fifths of Medicare beneficiaries with COPD in the US have poor access to PR according to research presented by Gargya Malla, Birmingham, USA, with the deficit more prominent in rural areas and the south. It is therefore important to consider other cost-effective methods of tele-, home- and web-based PR, Dr Malla concluded.

Research by Enya Daynes, Leicester, UK, explored the need for PR following a COVID-19 hospitalisation in 938 patients admitted to University Hospitals of Leicester (UHL). Up to 30% of patients self-identified rehabilitation needs, as did 61% of those contacted. This equates to a large volume of patients requiring intervention and may place an increased burden on existing PR programmes as lockdowns ease, Dr Daynes cautioned.

Abebaw Yohannes, Azusa, USA, analysed predictors of premature discontinuation in 993 patients with COPD participating in an 8-week PR programme. Over a quarter of patients discontinued the PR course early, with younger age, elevated symptoms of dyspnoea and anxiety, and reduced exercise tolerance being significant predictive factors.

Proportion of patients with COPD who experienced premature discontinuation in an 8-week PR programme

Lower limb muscle ultrasound using two muscles can be used to predict low appendicular lean mass according to findings from a cross-sectional study of 61 adult lung transplant candidates. Manoela de Paula Ferreira, Montreal, Canada, suggested that this method may offer a simple, low-cost approach to evaluate muscle size and screen for the presence of sarcopenia. Secondary analysis of data from two RCTs involving 209 patients with COPD showed that baseline functional status was strongly associated with response to a web-based physical activity intervention. Discordance between what patients can do and what they actually do may be related to age, dyspnoea, forced expiratory volume in one second (FEV1%) predicted and exercise confidence, concluded Stephanie Robison, Boston, USA.

“Network analyses identified meaningful clinical symptom connections that highlight the complex interaction between physical and psychological features in COPD patients.”

Abebaw Yohannes, Azusa, USA

Closing Remarks