What do you do with patients that have a negative methacoline but do way better with BALA when they exercice or when they are sick. Add CSI? Only when sick? Long-term?
Response: Metacholine is not a great test; however BALA or LABAs should never be used without ICS in asthma. I tell them to use Symbicort prn.
Eosinophil cut off again is 300 and %?
Response: 4%; 400 and 5% even better
Could we review which specific tests we should be checking off on pulmonary function testing requisition for asthma. Versus the ones in COPD. Did they restart metacholine testing since peak of COVID?
Response: Full pft and FeNO. Metacholine still hard to get.
Can you get less than 12% FEV1 change post BD in pts that are asymtpomatic upon testing when trying to establish the diagnosis - and when is diagnosis instead a combination of Asthma/COPD?
Response: COPD is seen in smokers (usually more than 30 pack years) and by definition have some fixed airflow obstruction.
Can Zenhale be used instead of Symbicort?
Response: Zenhale 100 yes with aerochamber.
What do you do with patients with a suggestive history but spirometry that is not diagnostic (ex: reversibility 8%m or fev1/fvc 74% etc)?
Response: More tests or trial of symbicort.
Canadian asthma guidelines differ from GINA in their use of Symbicort as first line for mild intermittent asthma. Why is that? Why does he favor GINA’s approach?
Response: Canadian guideline were led by pediatricians; usually more conservative and less data in children though this is changing.
What is your recommended prednisone dose for acute asthma exacerbation?
Response: Pred 30 for 7 days up to pred 40 for 10 days.
Pts with asthma and COPD, what are your thoughts about roflumilast? When should it be commenced?
Response: Available but of almost no use.
5 day a week azithro - generally just during cold season or could be any time of year?
Response: any time
Once a patient has been diagnosed with asthma, how often should we be doing PFTs?
Response: Yearly or with change in symptoms.
Is Symbicort covered by RAMQ as first lime treatment for asthma? Without first using Flovent and Ventolin?
Response: yes RE479
What are your thoughts on physicians prescribing inhalers for patients with a wheeze during a viral illness when they do not have asthma?
Response: useless
Can we say there is no more continuous corticotherapy used since bilologics are preferred with much less side effects?
Response: yes
Did you say symbicort 100 was a pediatric medication? So we should go directly to 200 for any adult?
Response: yes