How To Treat COPD and Asthma (Updated 2023 Guidelines!)

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Is albuterol still the rescue inhaler of choice? What are the new 2023 GOLD guidelines? Should we start patients on roflumilast or chronic azithromycin as hospitalists? Should all patients with COPD be tested for alpha-1 antitrypsin deficiency? In this video we will discuss treatment, management, pathophysiology, and diagnosis of COPD/asthma - including many common questions and misconceptions you may encounter!
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1 июл 2024

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Комментарии : 38

@hind7593 2 месяца назад

I’m a IM intern and I really love yours videos! You make topics in an organized and simple way. Thank you.

@parkerjk11 2 месяца назад

Fantastic overview! New subscriber to the channel and I gotta say I’m such a big fan. I’m starting intern year this summer for IM residency and def gonna be referencing your vids!! Thanks for all the hard work you put into these 🙌🏼

@aaro96live 2 месяца назад

Just discovered this channel a few days ago and I love your videos!!! Keep up the great work! Subscribed!

@user-wq9jj7vg5f 2 месяца назад

great breakdown as usual 🎉🎉🎉

@hishamabbas9399 2 месяца назад

Great video. Thank you

@aaro96live 2 месяца назад

I think I remember an attending telling me that Formoterol is the only LABA that can be used as a reliever since the onset of action is short (2-3 min). Correct me if I'm wrong.

@bobbysantiago5783 2 месяца назад

Love these videos. Great information that gives me a little more knowledge as a Paramedic.

@praksori8238 Месяц назад

Thanks, Dr. Conan. Respecting for your hard work from a Cambodian.

@DS-nr9zc 2 месяца назад

these are amazing, I'm an M3 applying into IM and I love your videos! Could you do one on sickle cell disease in the future?

@Ann-pn9or Месяц назад

why do they always think people with COPD smoked cigarettes? It also occurs with those living with wood stoves.

@josephineria9208 2 месяца назад

Nice! Can you do rapid response series?!

@hassanfakhoury5304 2 месяца назад

Hi Dr. Liu, amazing video as always. I am an IM intern who is a big fan. I was wondering what your practice is when it comes to deciding to treat with steroids in COPD exacerbations specifically in the setting of an influenza infection. Some studies have shown increased mortality when giving steroids in influenza. Thank you!

@ConanLiuMD 2 месяца назад

Great question! I actually did not know about that data, so thank you for bringing that up. In general, my practice would have been to treat both the COPD exacerbation with steroids, as well as the influenza with Tamiflu. However, I’ll have to look that data up, and if there really are poor outcomes for giving steroids in this situation, I suppose I would hold off on them if the wheezing and COPD component of the patient symptoms seems to be contributing less to their overall presentation!

@earlkoh216 Месяц назад

Hi, loving your content. I think there is a small error at the start of the video regarding when to start abx The Anthonisen criteria is based on the presence of increased dyspnea, sputum production and sputum purulence (i believe you said dyspnoea, sputum and cough)

@jamesthorburn8118 Месяц назад

Are you not using Z-scores in your PFT results. Also we are now using GLI reference values under ATS/ERS 2019 and lower limit of normal.

@irrelephant0 2 месяца назад

In regards to the GINA recommendation for the preferred reliever as PRN ICS-formoterol, I think it’s interesting that the Symbicort package labeling still does not recommend use for sudden symptoms of asthma/COPD (aka reliever therapy) despite the newer data saying otherwise. Even the 2023 GINA guidelines still recommend PRN ICS-formoterol. (I believe GINA releases updates yearly, from what I could see.) Thanks for the content Conan!

@ConanLiuMD 2 месяца назад

Love that little factoid! I actually didn’t know that, so that really is very interesting they haven’t updated it themselves yet haha!

@nguyenpham7328 2 месяца назад

Thanks for sharing Dr. Liu. So recently, do you still classify asthma: intermittent, mild persistence, ect.. or we just treat them and escalate/de-escalated medications base on their symptoms? Also, when should we start IV Mg and how long do we keep them on IV Mg?

@ConanLiuMD 2 месяца назад

Yes you still classify as intermittent, mild persistent, etc. per the 2019 GINA guidelines! I just didn't really discuss it too much as it's more of an outpatient thing so I don't do it too much in the hospital haha. Low threshold to give IV magnesium, usually just a dose for a day or two to help bronchodilation in the setting of an acute flare but otherwise no need to keep them on it after that!

@ricyha 2 месяца назад

hey doc, where can I read more about the reversal of hypoxic pulmonary vasoconstriction and oxygen therapy for COPD? I am not fully convinced.. I still believe that hypoxic drive, surely, must be the primary reason we hesitate to immediately provide O2 - not the reversal of hypoxic vasoconstriction.

@Valcreee 2 месяца назад

Great video! Question, in regards to antimicrobial selection when patient have 2 of the 3 cardinal symptoms did they mention antibiotics beyond Azithromycin? If patient has risk factor for pseudomonas should we be covering for that? Also is the Azithro purely used as an anti inflammatory agent in this setting or to treat COPD exacerbation 2/2 to suspected PNA? It seems like on up to date they recommend antibiotics if 2 of the 3 cardinal symptoms are met even without concurrent PNA but would like to hear your thoughts based on your experience and these recommendations. Long time viewer btw just switched my RU-vid name!

@ConanLiuMD 2 месяца назад

Great question! If it is just a COPD exacerbation without concern for superimposed bacterial pneumonia, and they meet 2 out of 3 criteria, then I would give azithromycin. If there is concern for a bacterial pneumonia such as a focal consolidation on imaging then I would treat as community acquired pneumonia with CTX/azithro, or for hospital acquired pneumonia with vanc/cefepime for MRSA and Pseudomonal coverage! Hope that helps :)

@vrishalipatki5466 2 месяца назад

What books/material you followed for medicine residency?

@ConanLiuMD 2 месяца назад

Uptodate, looking up guidelines, recently been getting back into podcasts as well!

@tarek6359 2 месяца назад

Why didnt you mention the oxygen goal of 94-98% in copd exacerbation that doesnt have hypercapnia/or never had hypercapnia?

@xjacky03x 2 месяца назад

do you have a copd dotphase????

@ConanLiuMD 2 месяца назад

Yes but I have to update it, perhaps I will post it once I’ve optimized it a bit more!

@cranberryeater7459 2 месяца назад

I want my boy to start an MD channel as well. For popularity and recognition. Helps with the resume. Any advice?

@ConanLiuMD 2 месяца назад

Great, just finish 4 years of undergrad, 4 years of medical school, 3-7 years of residency, and make sure to go in with the goal of educating future medical students and residents. Not for popularity and recognition! Hope that helps!

@cranberryeater7459 2 месяца назад

@@ConanLiuMD USMLE Step 1 no longer matters. Before 2022 it was a benchmark for knowledge and intelligence. Now you get a flood of mediocre doctors who just need to pass. How do you distinguish yourself from all the graduates who are labeled as “passed” instead of on a bell-curve. My wife did her Step 1 and was in the 90th percentile. It’s a shame that medicine is collapsing. CMS needs more cheap doctors and this certainly will help increase the supply of doctors.

@Gigadrane 2 месяца назад

@@cranberryeater7459I guess Step 2, 3 and specialty board exams don't exist ? If the mediocre doctors passed the same specialty board exams (which is post-residency) as your wife, then I wonder what that means. Hmm

@asong5328 2 месяца назад

Let your boy decide, that’s what I did😊

@a_hmd01 2 месяца назад

Wtf is this attitude @@cranberryeater7459

@jessicamillerr 2 месяца назад

Your thumbnail is very low. 👎👎👎 Please make the thumbnail nice. By the way, those who want the thumbnail to be good should write "Yes" in the comment.🍂

@ConanLiuMD 2 месяца назад

Thank you for the feedback. Yeah tbh I have been wanting to make better thumbnails but I don't really know what the best way to do it would be. Do you have any examples of something that might be more appealing?