CHEST 2023 On Demand Pass-Updates to the Asthma Diagnostic Toolbox: Bronchodilator Reversibility, FENO, and Oscillometry

Video Transcription

Video Summary

The panel discussion focused on updates to the asthma diagnostic toolbox with a special focus on oscillometry, bronchodilator reversibility, pheno, and bronchoscopy. Oscillometry is a non-invasive technique that measures lung mechanics by analyzing pressure and flow. It can be a useful alternative to spirometry in patients with difficulty performing the test. Oscillometry has been shown to be sensitive in detecting abnormal airway pathology, particularly in patients with preserved spirometry who have asthma. Bronchodilator reversibility, on the other hand, refers to the response of the airways to bronchodilator medication. The 2005 ATS guidelines recommend a 12% or 200 ml increase in FEV1 as positive bronchodilator reversibility. However, the guidelines have recently been updated to use a 10% change in FEV1 relative to the predicted value. This change was made to address the limitations of the absolute change in FEV1, such as its dependence on baseline lung function and height, age, and sex. The new guidelines also aim to incorporate a survival advantage by using predicted values and have been shown to be more accurate in predicting exacerbation risk. Pheno, or exhaled nitric oxide, was also discussed as a biomarker for asthma. It has been used to diagnose and monitor asthma, as well as predict lung function decline and guide treatment decisions. Lastly, the panel discussed the utility of bronchoscopy in asthma. While there is limited data on its use, it can be considered in patients with refractory asthma, when there are concerns of an alternative diagnosis, or when there is a mechanical component such as tracheobronchomalacia or mucus plugging. It is important to note that bronchoscopy carries some risks, such as adverse effects and hospital admissions, but the overall risks are relatively low.

Meta Tag

Category Pulmonary Physiology

Session ID 1051

Speaker Patrick Donohue

Speaker Malik Khurram Khan

Speaker Sumita Khatri

Speaker Erika Moses√≥n

Track Pulmonary Physiology

Keywords

asthma diagnostic toolbox

oscillometry

bronchodilator reversibility

pheno

bronchoscopy

lung mechanics

spirometry alternative

exhaled nitric oxide

refractory asthma