Gretchen Winter, MD 🌼 (Warning: Feral) Profile picture
I believe in loving others. Animal rescuer. Life explorer. Bibliophile. PCCM. Passions =🎼/💃/✈️/📸/MedEd/Bronchiectasis/Communication/Wellness. #BLM🌈

Oct 20, 2021, 58 tweets

Next up for some tweet-ucation is "Inhaled Medications in COPD: Contemporary Strategies to Manage an Old Disease"! #CHEST2021 1/

Dr. Arzu Ari speaks on "Aerosol Drug Delivery in Patients with COPD." #CHEST2021 2/

There are many devices available and the goal is to choose the most appropriate device to meet the patient's needs. #CHEST2021 3/

Unfortunately, only 35-37% of HCPs actually consider the device type to be highly important when prescribing. #CHEST2021 4/

Choose a device and medicine based on these factors. #CHEST2021 5/

Age is an important factor as inspiratory flow rate decreases with age and noneffective inhalations increase with age. #CHEST2021 6/

As the degree of obstruction worsens there is an increase in the error rate of ineffective inhalations. #CHEST2021 7/

Physical and cognitive abilities should also be considered. #CHEST2021 8/

For instance, impairments in some of these physical abilities can make it hard to use certain devices. #CHEST2021 9/

Also consider the cognitive ability of your patient and whether they can understand how and when to use a device. Of course also consider patient preference and cost of the medication. #CHEST2021 10/

Device selection flow chart. #CHEST2021 11/

Algorithm for device selection. #CHEST2021 12/

Main considerations in device selections #CHEST2021 13/

There are a number of factors that can contribute to incorrect inhalation technique. #CHEST2021 14/

Patients are concerned with medication effectiveness, but not with proper technique. #CHEST2021 15/

Lung dose can be increased with breath holding. #CHEST2021 16/

Each DPI required a different inspiratory flow rate. #CHEST2021 17/

There are tools that can be used to assess inhalation techniques. #CHEST2021 18/

Prepare effective educational sessions for your patients. #CHEST2021 19/

Reasons for poor patient adherence to aerosol therapy #CHEST2021 20/

Monitor patient adherence to therapy because it does contribute to their outcomes. #CHEST2021 21/

Algorithm for disease monitoring #CHEST2021 22/

Summary #CHEST2021 23/

Next up Dr. Nicola Hanania (@Hananianick) talks on "Update on Optimizing Therapy for COPD." #CHEST2021 24/

COPD today and tomorrow #CHEST2021 25/

Components and progression of COPD  #CHEST2021 26/

COPD is underdiagnosed.  #CHEST2021 27/

COPD is a heterogenous disease  #CHEST2021 28/

COPD has multiple phenotypes  #CHEST2021 29/

There are also comorbidities and coexistent conditions that have to be considered.  #CHEST2021 30/

Goals of COPD management  #CHEST2021 31/

GOLD COPD assessment tool  #CHEST2021 32/

Non-pharmacological interventions are also important, and COPD management is multidisciplinary.  #CHEST2021 33/

Current therapies for COPD  #CHEST2021 34/

Individual patient characteristics need to be considered in the medication plan.  #CHEST2021 35/

Choose initial medications based on GOLD group.  #CHEST2021 36/

Dual LABA/LAMA is superior to either alone in patients with symptomatic COPD. #CHEST2021 37/

Consider adding an ICS if they have high eosinophils. #CHEST2021 38/

Triple therapy has been shown to be superior to dual therapy in patients with severe COPD, and there is even a mortality benefit. #CHEST2021  39/

ATS guidelines for COPD pharmacologic management #CHEST2021 40/

Roflumilast can help patients with chronic bronchitis and a history of exacerbations. #CHEST2021 41/

Azithromycin decreases COPD exacerbations. #CHEST2021 42/

This loop needs to be continued in follow-up of patients with COPD. #CHEST2021 43/

Strategies to ensure adherence #CHEST2021 44/

Unmet needs with current therapies. #CHEST2021 45/

The future lies in targeting therapy to COPD phenotypes and endotypes. #CHEST2021 46/

Summary #CHEST2021 47/

Sanjay Sethi talks about "Problem-Based Clinical Case to Optimize Interprofessional COPD Care." #CHEST2021 48/

Interprofessional care in COPD #CHEST2021 49/

Management cycle #CHEST2021 50/

De-escalation of ICS #CHEST2021 51/

This study showed that adding Budesonide to Formoterol reduced daily COPD symptoms. #CHEST2021 52/

Pulmonary rehab improved a number of interventions, and it is underutilized. #CHEST2021 53/

Repeat pulmonary rehab helps, and home pulmonary rehab also has a benefit. #CHEST2021 54/

Methods of bronchoscopic lung volume reduction #CHEST2021 55/

This study showed improvement in CAT score with use of SR Morphine for refractory breathlessness (shameless plug to check out my on demand session on the management of chronic dyspnea!!!). #CHEST2021 56/

Mucus plugging is associated with worse outcomes. Consider airway clearance. #CHEST2021 57/

Summary #CHEST2021 58/58

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