By Anna Horner | News & Views
As respiratory medications are continuously updated and older medications are used in new ways or for new diseases, it’s important for pulmonary rehabilitation professionals to keep up with the latest medication information and updates to the Global Initiative for Chronic Obstructive Lung Disease and Global Initiative for Asthma guidelines. Even without major updates to the documents for this year, PR professionals should be aware of the year-to-year changes in management and new biologic medications for asthma, chronic obstructive pulmonary disease, interstitial lung diseases and cystic fibrosis.
The GINA recommendations, for instance, offer some leeway in shifting away from albuterol, which isn’t entirely new, but there is a new pathway for that, according to AACVPR Board member Katherine Menson, DO, pulmonary and critical care medicine physician at the University of Vermont Medical Center and assistant professor at the Larner College of Medicine at the University of Vermont. Meanwhile, the GOLD guidelines have not changed much, but there is now an emphasis on assessing eosinophilia. Menson explains, “Typically, we think of it as elevated and asthma. In addition to some new medications, a recent journal article focused on the use of an old asthma biologic for COPD patients. So, there is some emphasis on making sure that COPD patients who have those high eosinophil counts have new therapeutic options.”
In her AACVPR live webinar on June 29, Menson discussed new options for asthma management based on SMART therapy, how new pulmonary hypertension therapies may improve exercise capacity and how biologics are being used in COPD. Menson points out that there aren’t as many asthma patients in PR programs compared to the COPD population, and PR providers likely will begin to see more biologic therapies used. Local injection site reactions are a main concern for these patients, but most are doing the injections at home with an auto injector. However, it is important for PR professionals to be aware of the frequency and length of use of these medications for the patients in their care.
According to Menson, there generally are no limitations in terms of exercise for patients on these drugs. “The nice thing is that these biologic therapies are really helpful in liberating people from chronic steroid use or for people who are frequently needing steroids to control their lung disease,” she says. “Getting patients into PR as they’re starting biologics might be a really nice avenue to begin addressing things like steroid myopathy. It would be a good window of opportunity to have them participating in PR; you might be able to get significantly more gains because they're not having as many exacerbations.”
Menson also emphasizes the importance of keeping an eye on important developments in PR. “The bread and butter of most of our pulmonary rehab patients are COPD, ILD and, maybe to a lesser extent, pre-transplant patients, but there are exciting developments for other diseases as well,” she says. “There's always new molecular therapy for the CF population. And then there's some new and exciting developments in pulmonary hypertension, which are really important for PR professionals to know.”
The livestream event has ended; however, the recorded webinar is available to AACVPR members at no cost.