Where There s Smoke There s Obstruction Stephen G. Basheda, D.O., F.C.C.P. 1 Disclosures Dr. Basheda is an independent contractor for AstraZeneca Pharmaceuticals, LP and GlaxoSmithKline and on the speaker s bureau for Boehringer-Ingelheim and AstraZeneca Pharmaceuticals, LP. 2 Outline Asthma update COPD update Smoking alternatives 3 January 31, 2019-February 3, 2019 1
Airway Obstruction 4 5 Airway Obstruction - Spirometry FEV1-Forced Expiratory Volume at 1 second FVC-Forced Vital Capacity FEV1/FVC < 0.7 6 January 31, 2019-February 3, 2019 2
7 8 Asthma-Definition Intermittent Persistent 9 January 31, 2019-February 3, 2019 3
Cough Asthma Triggers: talk/laughter, cold air, exercise, deep breath Spirometry-Normal Chest exam-no wheezing 10 Cough Asthma-Treatment Recognition Asthma medications (bronchodilators/steroids) 11 Asthma-Treatment Options Anti-inflammatory therapyinhaled steroids (ICS) 12 January 31, 2019-February 3, 2019 4
Asthma-Treatment (continued) LABA/ICS combination LABA=Long Acting Bronchodilators 13 14 Asthma Treatment-Monoclonal Antibodies Omalizumab (Xolair) anti-ige Mepolizumab (Nucala) -anti-interleukin-5 (IL-5/eosinophils) Benralizumab (Fasenra) 15 January 31, 2019-February 3, 2019 5
Asthma Management History and physical Asthma Control Test (ACT) Spirometry Nitric oxide 16 17 Fe No (Fractional Exhaled Nitric Oxide) Increased with eosinophilic airway inflammation 50 parts/billion (ppb) adults Monitoring (20% change/change 10 ppb) 18 January 31, 2019-February 3, 2019 6
Tobacco Induced Chronic Obstructive Pulmonary Disease (COPD) 19 20 COPD Management Smoking cessation Medications Pulmonary rehabilitation Interventional therapy 21 January 31, 2019-February 3, 2019 7
COPD Management Alphabet Soup LABA LAMA SABA SAMA LABA/LAMA SABA/SAMA LABA/LAMA/ICS ICS LABA/ICS 22 COPD - Dual Bronchodilator Therapy LABA=long acting bronchodilator agent LAMA=long acting muscarinic agent 23 24 January 31, 2019-February 3, 2019 8
COPD Therapy LABA/ICS 25 COPD Therapy-Triple Therapy LABA/LAMA/ICS 26 Phosphodiesterase-4-Inhibitor Rofumilast (Daliresp) Severe obstruction Exacerbations 27 January 31, 2019-February 3, 2019 9
COPD-Interventional Therapy Lung Volume Reduction Surgery (LVRS) Bullectomy Lung transplantation Bronchoscopic Intervention (valves/coils) 28 COPD-Treatment Oxygen (>15 hours/day) Nocturnal ventilation (hypercapneic respiratory failure) Hospice care 29 COPD Treatment-Delivery Dry powder inhalers Propellant inhalers (+spacer)/soft mist inhaler Nebulizer 30 January 31, 2019-February 3, 2019 10
Smoking Alternatives 31 32 Smoking Alternatives Vaping/electronic cigarettes Heated liquid vapor Flavoring (8000) +/- nicotine 1% toxic chemicals of cigarette smoke 33 January 31, 2019-February 3, 2019 11
E-Cigarettes-Usage Smoking cessation Recreational use Healthier than cigarettes Circumvent smoke-free laws Cost 34 E-Cigarettes-Problems Gateway to tobacco smoking Heavy metals/ toxicants Alternative use (marijuana/drugs) Persistent cardiovascular risks? Battery explosion 35 36 January 31, 2019-February 3, 2019 12
E-Cigarettes-Benefits Decreased carcinogens? Improving lung function Decreased respiratory symptoms 37 Lung Cancer Screening-Low Dose Chest CT Scan Age 55 74-80 Current smokers/quit within 15 years 30 pack-year smoking history?length/frequency of screening 38 39 January 31, 2019-February 3, 2019 13
Lung Cancer Screening-Chest CT Suggests decrease mortality Detection at earlier stage 40 Marijuana and Lung Health Toxins/carcinogens (similar to tobacco)?second-hand exposure risks Asthma/chronic bronchitis Blebs/bullae formation Immunosuppression (Aspergillus) 41 January 31, 2019-February 3, 2019 14