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News — What: Experts from the American Thoracic Society will speak and answer questions from the media on two abstracts being presented at the society's annual conference: RSV Risk, and Undertreated Asthma.

When: May 8, 2024, 9:15 AM - 10:00 AM ET

Where: 麻豆传媒 Live Zoom Room (address will be included in follow-up email)

Details: 

The ATS 2024 International Conference starts May 17. Get a sneak peek at what’s coming up when you join us for discussions with the authors of two of the more than 6500 scientific abstracts, case reports and clinical trials selected by the international conference committee.

Identifying Newborns at Highest Risk for RSV: Ferdinand Cacho, MD

Inhaler Regimen for Severe Asthma Underprescribed: Sandra Zaeh, MD, and Zoe Zimmerman

Transcript:

Thom Canalichio: Hello and welcome to this news wise expert panel. Today we have two doctors with us presenting their studies at the American Thoracic Society International Conference that starts May 17th. The contents of today's discussion are under embargo until May 21st, at 2:15pm. Dr. Zaeh, please introduce yourself.

Dr. Sandra Zaeh: My name is Sandra Zaeh, I'm a pulmonary critical care physician at Yale School of Medicine.

Thom: Tell us why the study that you've done about implementing the updated asthma guidelines is so important for patients and doctors to know about?

Zaeh: Absolutely. So, recently, there have been changes in asthma management practice guidelines, and we use those guidelines to optimize clinical outcomes for patients with asthma. And so, you know, we wanted to see how frequently those updated guidelines were being implemented in our patients with moderate to severe asthma.

Thom: And there are a lot of patients that are being therefore undertreated that could be finding out from the doctor that there's new combinations of therapy available, is that basically the takeaway?

Zaeh: Absolutely. So for the last several decades, the core of asthma management has relied on having a controller and separate reliever therapy for care, typically termed albuterol, which lots of patients have taken for many years. And the updated guidelines suggest that for moderate to severe asthma, there is one inhaler that should be used for both maintenance and relief. So it's pretty different than what had been done previously.

Thom:Thanks, Dr. Zaeh. Let's also introduce your colleague, Dr. Cacho. Dr. Cacho. Please tell us your name and your job and where you work. 

Dr. Ferdinand Cacho: My name is Ferdinand Cacho. I am a pediatric pulmonology Fellow at Vanderbilt University Medical Center. 

Thom: And you've recently put out a study about identifying infants at high risk for RSV. 

Cacho: So our tool predicted infants at highest risk of severe infection and so those are infants that were at risk for death and needed an ICU admission. Our tool is important because it helps us prioritize new RSV medications and vaccines.

Thom :And RSV has been in the news for outbreaks and warnings to seniors, older Americans. This is also serious for infants.

Cacho: More than half of RSV hospitalizations are in healthy term infants. And so we really need a tool to help identify those who are at increased risk for hospitalization.

Thom: And the primary intervention vaccination by the parent and the infant after it's born. 

Cacho: Yeah. And so that in the last year, there have been two new products that were approved. And so that is a maternal vaccination that a mom would receive during pregnancy. And then there's a new monoclonal antibody called Nirsevimab that can be given shortly after birth, and that would protect them from a severe RSV infection.

Thom: Excellent. Dr. Cacho. Thank you, you are available to answer questions from media. And so we will share along with this the contact information for how to reach you. And do any of those follow up questions that there might be Dr. Zaeh if you would tell us in as general terms as you can, how would you explain this f for members of the media and their readers? Or viewers? What are the important takeaways here? 

Zaeh: Absolutely. So essentially, we found that only 14.5% of people with moderate to severe asthma were being prescribed the updated guideline recommended management for single, which is single maintenance and reliever therapy for asthma. So it really suggests that we have a long way to go in terms of implementing these new guidelines and optimizing asthma care. The single maintenance and reliever therapy that I'm talking about basically has been shown to reduce asthma exacerbations by over 30%. So this has the potential to impact a large number of people and have an impact on clinical outcomes.

Thom: Are there a lot of cases where you think it may be people who have been under this treatment for a long period of time, and they don't know that there are new therapies available? And so they're not asking their doctor?

Zaeh: Absolutely. I think albuterol has been the reliever of choice for, as I said previously, decades at this point in time. So I think, you know, there's a lack of knowledge, in part and there's also additional challenges such as insurance coverage, you know, adopting new guidelines, all of these things that come into play, and all things that I think this study supports that we need to address further to improve implementation.

Thom: And new people, new cases of asthma are likely to be prescribed this the first intervention. Correct?

Zaeh: Correct,. I mean, if a patient has what we would say moderate to severe asthma when they first present, Absolutely, they should be prescribed this therapy.

Thom: And would you recommend, what would you recommend patients ask their doctors about their asthma, if that's the case? 

Zaeh: Yeah. I think that when patients present, you know, they should ask about single maintenance and reliever therapy, what that looks like, is it appropriate for them? Whether they will qualify? And you know, is it a possibility for them to try it?

Thom: Thanks, Dr. Zaeh. Dr. Cacho, about the RSV, if an infant is not vaccinated, what tell us about what treatment options are available and the severity and prognosis in that situation? It's quite serious, isn't it?

Cacho: Yeah, it is. And so, unfortunately, we don't have a lot of treatments for RSV. And so it's a lot of what we call supportive care, and requires hospitalization, and to really help support their breathing. So they might require oxygen, they might require IV fluids, but there's no like dedicated treatment for RSV. And so that's why it's really important to get these immunizations to these babies before they develop a severe infection. Especially in the last year, during the RSV season, because these products were new, there was a shortage. And so a lot of babies are not able to receive this. And in other countries where, you know, these aren't available yet, these can be very, very helpful to healthcare providers, health care institutions, and policymakers help prioritize the most vulnerable babies.

Thom: And your tool, your model looks at how many different parameters 

Cacho: Yeah, so it uses 19 predictors that you can easily get from a healthcare record, or a birth certificate. And we put those 19 predictors in a formula or an equation, what we call our tool, and it helps calculate a risk. The most recent concerns about, you know, new medications and vaccines, I think there are a lot of families that are hesitant to get these for their kids. And I think having a tool and communicating to them that your baby is at increased risk of needing an ICU admission, I think that can help families get their children immunized. These 19 predictors that you can get from the medical chart or a birth certificate, a doctor or healthcare provider can put it in our tool and calculate a risk. And then depending on that number, they can really help promote the immunization to the family.

Thom: Dr. Zaeh about communicating about your work, obviously publishing a journal, presenting at a conference, you're doing things to put it out there. What would you like to see happen?

Zaeh:  Yeah, I really feel like I'm hoping that the word gets out both clinicians, patients, you know, and sort of prompts more people to prescribe this therapy, ask about this therapy get started on this therapy. And asthma is the most common chronic pulmonary disease in United States that impacts millions of people annually with like inpatient visits in the hospital, E.D. visits, but also like poor quality of life, like Miss days of school missed days of work. So I think if we can reduce asthma exacerbations, we can really have a positive impact on patients with asthma and their quality of life. Well, I being someone who takes care of patients with asthma primarily, I would always like to see more attention. Of course, you know, I think it is an issue that has been in the media and address, but it's really, it's really a common problem that a lot of people have, that is relevant to a lot of patients, which is why I think this is so, so important.

Thom: There's a lot of research about certain demographics…

Zaeh:  Absolutely. Yeah.

Thom: …vulnerable to this. 

Zaeh: Yeah, I would say that. Lots of research has shown that black Latina patients, and folks who have low socio economic status often have worse asthma outcomes than other patients, for a whole host of factors, including, you know, the various environmental factors, some folks like living in an urban environment and being more predisposed to certain things that trigger their asthma. But I think that and that is actually in part why I got interested in asthma care, I'm really interested in caring for vulnerable patient populations. I think that smart therapy and like, you know, use of updated asthma guidelines is so important, especially for that patient population to get the word out, optimized prescription of these medications for patients, and really, you know, with the potential of improving outcomes in those patients, and all patients with ALS But thinking about our vulnerable communities specifically.

Thom: Excellent. Thank you, Dr. Zaeh. Dr. Cacho, I think one final question. RSV, being in the news a little bit, as we've seen, but probably not enough attention. And what do you think is maybe they're getting right about or what there needs to be more coverage.

Cacho: I think more coverage is needed to promote that these new products as they're, again, they're very new, and they just came out last year. And so I think, really showing that they are safe and effective, and that infants would really benefit from this, to prevent them from going to the ICU, from getting so sick from RSV.

Thom: Thank you for sharing about your work today and best of luck, presenting it at the conference for members of the media. The studies are under embargo until 2:15pm. On May 21. After they're presented at the conference, they can be published about and we will provide contact information if you'd like to follow up with Dr. Cacho or Dr. Zaeh about their work. Thank you again very much for joining us, and have a great rest of your day.