APSR Respiratory Structure and Function
Assembly Virtual Meeting (AVM)
"Exploring the Small Airway Disease"
Questions for panelists and their responses
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response(s)
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what the role of pharmacy in asthma?
Response
Dr Alberto Papi responds:
Not sure I undersood the question. Generally speaking, yes it has an imporant role
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Do you think extra fine formulations are more forgiving in terms of inhaler technique errors
Response
Dr Alberto Papi responds:
Thanks. Yes, you are right. The longer duration of the cloud generated by extrafine-devices and the reduced speed of the plume favor a better coordination betwen inahation manouver and actuation of the device. Thus it makes the coordination simpler and overall forgiving some degree of "suboptimal use" of the device
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Thank you for nice presentation Dr Pappi. What do you recommend to monitor SAD response to inhaler therapy in individual patients
Response
Dr Alberto Papi responds:
Any tool you can use. Preferentially Oscillomentry. But Mid Flows would do and other Lung functon parameters such as RV. All of the with give a piece of information on small airways. The combinnationnis best!
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Any evidence of usage for BDP/FF as regular + PRN therapy?
Response
Dr Alberto Papi responds:
Yes the MART study has tested BDP/FF maintenance and reliever in asthma. PapiA et al Lancet Resp Med 2013
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Would airway exercise regime help in SAD?
Response
Dr Alberto Papi responds:
Thanks. Good question. No specific data on this. The efficay of extrafine BDP/FF has been studied in prevention of methacholine induced bronchoconstriction (MART1 study). Which indirectly provided some responses. But it is something it should be studied. Good suggestion!!
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do we need to assess SAD for all our patients? or at certain point or patients?
Response
Dr Alberto Papi responds:
I wuold do at the initaition of the treatment/charaterization. And at follow up to see the changes in realtion to treatment effects/efficay
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There is a belief that the SAD is already destroyed in patient with advanced COPD and therefore there is no rationale in targeting it.
Response
Dr Alberto Papi responds:
Thanks. It is a belive. But edicence indicate that a proportion of alterations in peripheral airways is sensitive to antinflammatory treatmemt. Inlammation is presente in peripharal aiways in COPD (Hogg 2004) and its severity increases with the severity of the airflow limitation (Hogg NEJM). Clinical evidence indicate that with extrafine formulations we can improve lung function paramaters (eg reduced RV) and improve clinical outcomes (eg Dyspnea) more effectively than equipotent doses on non extarfine compounds.
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what are the Preventive measures/treatment guidelines if any, for Early Airways Remodelling?
Response
Dr Alberto Papi responds:
Early Diagnosis and early treatment. This is one of the reason why new GINA include ICS (though as needed) also in step 1
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Dr Papi, SYGMA studies showed benefit as needed usageBudesonide/Formoterol. Can we also implement this in Beclomethasone/Formoterol?
Response
Dr Alberto Papi responds:
live answered
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Can Oscillometry be the routine choice of investigation for lung function during this Covid scenarion?
Response
Dr Alberto Papi responds:
Thanks. Still sanification procedures should be taken.
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Do you think your findings can be applied to bronchiolitis obliterans after hematopoetic stem cell transplantation?
Response
Dr Alberto Papi responds:
Good point. It should be tested. But the rationale is there. Definitely something worth exploring in the future. But as of now, I wouldn't say my findings can be directly applied to this patient population.
