Obstructive Lung Disease

Questions discussed in this category

Which class of biologic agent do you use first in a patient with asthma who may qualify for multiple drugs?

1 Answer available

What is your preferred rescue inhaler for patients with asthma?

Do you favor albuterol PRN, albuterol/budesonide PRN, or SMART therapy with ICS/formoterol?

2 Answers available

How do you approach the use of benzodiazepines in patients with chronic medical illnesses that may be susceptible to respiratory compromise (e.g., CHF, COPD, ILD)?

Should you work to wean patients of benzodiazepines? Is your approach different for patients who have been on benzodiazepines for years? What would yo...

4 Answers available

Have you observed adverse mental health side effects in patients who start montelukast?

In light of the FDA warning about mental health side effects of the medication have you observed in particular any patients develop suicidal thoughts ...

3 Answers available

Do you use bronchodilator response to distinguish between asthma, COPD, or asthma-COPD overlap?

Do the findings of a recent large cohort study (Beasly et al., PMID 38029294) in which bronchodilator response did not distinguish between asthma and ...

1 Answer available

Is methacholine challenge on its way out?

1 Answer available

When would you recommend prescribing an asthmatic patient budesonide/salbutamol rather than budesonide/formoterol?

6 Answers available

What is your preferred biologic in children and adolescents with T2 high asthma?

1 Answer available

Do you feel high dose Symbicort or Dulera is appropriate to use for SMART despite these doses not being studied in clinical trials?

1 Answer available

What factors do you consider prior to offering a trial of ICS/LABA therapy versus a methacholine challenge test in patients with suspected asthma but normal pulmonary function testing?

1 Answer available

Should in-office oscillometry for lung function measurements be utilized in pediatric patients who are unable to reliably perform spirometry?

1 Answer available

What is your approach to de-escalation of asthma inhaler therapy in the setting of negative bronchoprovocation testing when patients are averse to deprescribing?

At times due to limited testing resources, inhaler therapy is started based on clinical suspicion of asthma and bronchoprovocation testing is done lat...

1 Answer available

What features on PFT or flow-volume loops do you look at to suspect small airway dysfunction?

Often distal flattening of expiratory limb or decreased Fev25-50/FVC is referred for small airway dysfunction but it is advised against using it give ...

1 Answer available

What is the rationale/evidence to support doing 4 puffs of albuterol vs. 2 puffs for a reversibility study?

3 Answers available

Will you incorporate ensifentrine in the treatment regimen of patients with COPD on baseline dual or triple inhaler therapy?

1 Answer available

What is your approach to de-escalation of asthma therapy if patients have remained clinically stable on triple inhaler therapy and a biologic agent?

1 Answer available

Is there a role for biologics to improve lung function in patients who have severe asthma with daily symptoms and reduced lung function but do not experience frequent exacerbations?

2 Answers available

How do you factor smoking history into biologic selection for asthma since the clinical trials generally excluded these patients?

1 Answer available

Do you diagnose obstruction by the criteria of FEV1/FVC < 70% or < LLN?

5 Answers available

Do you use hypercapnia as an exclusion criteria in all patients that are being assessed for bronchoscopic lung volume reduction?

1 Answer available

What is your approach to inhaler therapy in a patient with asthma who cannot be on an inhaled corticosteroid due to ocular disease?

1 Answer available

What is your threshold to start triple therapy in mild to moderate asthma/COPD overlap with minimal functional limitation?

1 Answer available

Will you use FeNO testing in all COPD patients to determine whether they are candidates for therapy with dupilumab?

If so, would this be a consideration in all patients regardless of active smoking status? FeNO in active smokers has been questioned, could this have ...

2 Answers available

Are the results of the BOREAS trial generalizable to non-white populations?

The cohort in the study was predominantly white. Do these results highlight significant disparities in COPD care?

2 Answers available

Did the low rate of COPD exacerbations in the BOREAS cohort overall confound the results of the study?

2 Answers available

What patient factors prompt you to consider starting dupilumab in patients with COPD?

Does active smoking status influence this decision?

2 Answers available

Do you prescribe bronchodilators to patients with radiographic emphysema and respiratory symptoms, but no spirometric obstruction?

1 Answer available

Is there a role for biologics to help patients with ABPA who are steroid responsive and have removed their allergen insult, but continue to have an elevated serum IgE and incomplete resolution of symptoms return to their baseline functional status?

1 Answer available

Do you consider dual biologic therapy in patients with ABPA that remain steroid dependent despite the use of omalizumab?

2 Answers available

Is there a role for the use of biologics as steroid sparing agents in treating patients with ABPA who are intolerant to prednisone?

1 Answer available

Do you use continuous or intermittent bronchodilator therapy in severe airway obstruction?

1 Answer available

What is your second line therapy for patients with EGPA with mainly pulmonary and sinonasal features who did not respond to mepolizumab 300 mg/month and still require high doses of steroid?

2 Answers available

Are you using NAC in lieu of hypertonic saline amidst the current shortage of hypertonic saline in patients with either CF or non-CF bronchiectasis?

1 Answer available

How do you choose between azithromycin and roflumilast in the management of a patient with severe COPD who remains symptomatic with frequent exacerbations despite maximal dose LABA/LAMA/ICS with demonstrated compliance and proper inhaler technique?

1 Answer available

Are there any concerns utilizing apremilast for psoriatic arthritis in patients who are also taking roflumilast for COPD?

1 Answer available

Is there a role for biologic therapies in asthma-COPD overlap syndrome with evidence of type 2 inflammation?

2 Answers available

Do you find that complete interlobar fissures on HRCT correlate well with decreased collateral ventilation on endoscopic balloon occlusion in the evaluation and placement of endobronchial valves for bronchoscopic lung volume reduction?

2 Answers available

Do you consider bronchoscopic lung volume reduction in patients with homogenous emphysema?

1 Answer available

Papers discussed in this category

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2000-04

Practice guidelines for diseases caused by Aspergillus. Infectious Diseases Society of America.

Chest, 2018 Jan 11

A Randomized Trial of Itraconazole vs Prednisolone in Acute-Stage Allergic Bronchopulmonary Aspergillosis Complicating Asthma.

J Allergy Clin Immunol Pract, 2021 Mar 06

Real-World Effectiveness of Anti-IL-5/5R Therapy in Severe Atopic Eosinophilic Asthma with Fungal Sensitization.

Chest, 2020 Aug 31

Real-World Effectiveness of Benralizumab in Severe Eosinophilic Asthma.

J Allergy Clin Immunol Pract, 2020 Jun 16

Omalizumab Is an Effective Intervention in Severe Asthma with Fungal Sensitization.

Cureus, 2020 Aug 12

Mepolizumab as Possible Treatment for Allergic Bronchopulmonary Aspergillosis: A Review of Eight Cases.

J Allergy Clin Immunol Pract, 2015 Jan 29

Clinical efficacy and immunologic effects of omalizumab in allergic bronchopulmonary aspergillosis.

American journal of respiratory and critical care medicine, 2013-04-01

Cystic fibrosis pulmonary guidelines. Chronic medications for maintenance of lung health.

American journal of respiratory and critical care medicine, 2018-11-01

A Multicenter Randomized Controlled Trial of Zephyr Endobronchial Valve Treatment in Heterogeneous Emphysema (LIBERATE).

Ann Am Thorac Soc,

The Clinical Significance of Collateral Ventilation.

Chest,

Rationale and design of The National Emphysema Treatment Trial: a prospective randomized trial of lung volume reduction surgery. The National Emphysema Treatment Trial Research Group.

Annals of the American Thoracic Society, 2015-05

The accuracy of computed tomography to predict completeness of pulmonary fissures. A prospective study.

Int J Chron Obstruct Pulmon Dis, 2020 Jun 09

An Integrative Approach of the Fissure Completeness Score and Chartis Assessment in Endobronchial Valve Treatment for Emphysema.

American journal of respiratory and critical care medicine, 2023 Aug 15

Ensifentrine, a Novel Phosphodiesterase 3 and 4 Inhibitor for the Treatment of Chronic Obstructive Pulmonary Disease: Randomized, Double-Blind, Placebo-controlled, Multicenter Phase III Trials (the ENHANCE Trials).

Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology, 2024 Sep 14

Airway oscillometry in asthma - present and future perspectives.

Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology, 2024 Nov 26

Oscillometry in the diagnosis, assessment, and monitoring of asthma in children and adults.

Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology, 2024 Nov 15

Oscillometry-defined small airways dysfunction as a treatable trait in asthma.

The Journal of allergy and clinical immunology, 2023 Jan 24

Biologics in the treatment of asthma in children and adolescents.

The journal of allergy and clinical immunology. In practice, 2023 Jul 29

Controversies in Allergy: Are Biologic Treatment Responses in Severe Asthma the Same in Adults and Children?

Journal of asthma and allergy, 2019

Two vs four puffs of albuterol: does dose change bronchodilator response?

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