"Exploring the Small Airway Disease"
Dr Alberto Papi responds:
Not sure I undersood the question. Generally speaking, yes it has an imporant role
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
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!
Dr Alberto Papi responds:
Yes the MART study has tested BDP/FF maintenance and reliever in asthma. PapiA et al Lancet Resp Med 2013
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!!
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
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.
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
Dr Alberto Papi responds:
live answered
Dr Alberto Papi responds:
Thanks. Still sanification procedures should be taken.
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.