2) I am very excited to be among the founding faculty in this initiative! FOLLOW US for awesome expert-led education #pulmtwitter!
— pulmmed_ce (@Pulmmed_CE) January 24, 2023
👍@BronchiectasisR @COPDFoundation @EMBARCnetwork @ELF @profJDchalmers @sunjayMD @DrHollyKeir @becleartoday @ephesians_1_7 @NTMinfo @AlibertiStefano
4a) Let’s start with a case! A 40F non-smoker presents with progressive dyspnea over 12 wks & one cup daily of productive sputum. PMHx is significant for asthma in childhood & no FamHx of lung disease. pic.twitter.com/efwBh3W9Ew
— pulmmed_ce (@Pulmmed_CE) January 24, 2023
5a) Answer: D: #Bronchiectasis is a multi-modal diagnosis. CXR has limited sensitivity and specificity when diagnosis bronchiectasis especially in mild disease. Thin-section CT has higher sens/spec of 88% and 74%, respectively.
— pulmmed_ce (@Pulmmed_CE) January 24, 2023
6) You get further history from the patient while ordering your tests. What conditions are associated with bronchiectasis?
— pulmmed_ce (@Pulmmed_CE) January 24, 2023
8) You order a CT scan which is shown below. What are the predominant findings? pic.twitter.com/15cWehCFlb
— pulmmed_ce (@Pulmmed_CE) January 24, 2023
9b) What are some CT signs of #bronchiectasis?
— pulmmed_ce (@Pulmmed_CE) January 24, 2023
A. Bronchoarterial ratio >1
B. Lack of tapering
C. Airway visibility within 1cm of costal pleural surface
D. All of the above
11) You are concerned the patient has #NCFB. Whoa, doc! The patient says she’s never even heard of this. What is #NCFB?! pic.twitter.com/FOm5e6MwUS
— pulmmed_ce (@Pulmmed_CE) January 24, 2023
12b) #NCFB is characterized by a vicious cycle of bacterial infection and excessive #inflammation owing to impairment of airway defence mechanisms, otherwise known as the “Cole’s vicious cycle”. pic.twitter.com/dLNTbsp9bc
— pulmmed_ce (@Pulmmed_CE) January 24, 2023
14) The disease is changing over the last decade—so why is #NCFB prevalence increasing?
— pulmmed_ce (@Pulmmed_CE) January 24, 2023
A. Increasing public and healthcare recognition.
B. Aging population.
C. Improved sensitivity of diagnostics like CT scans (#truthteller).
D. All of the above.
16a) Back to our case. Spirometry shows airflow obstruction without bronchodilator reversibility with normal TLC and increased RV and RV/TLC ratio. You are concerned about #NCFB in this case. pic.twitter.com/vy9uCUEWsd
— pulmmed_ce (@Pulmmed_CE) January 24, 2023
17) Answer: D. All of the above. The #ERS 2017, #BTS 2019 and #Spanish guidelines have similar recommendations but with subtle differences. Notice there are no north American guidelines! Great summary here:
— pulmmed_ce (@Pulmmed_CE) January 24, 2023
🔓 https://t.co/wv8UzcWbmh pic.twitter.com/xJIRc7KNwX
19) So, taken together, what do you think this patient has as the cause of her #NCFB?
— pulmmed_ce (@Pulmmed_CE) January 24, 2023
21) Welcome back to this #tweetorial on #NCFB and #bronchiectasis! I am @Cthornton32 & you are earning FREE CE/#CME! Thanks for joining us.
— pulmmed_ce (@Pulmmed_CE) January 25, 2023
Shout-outs to @NYULangonePCCSM @EMBARCnetwork @ELF @COPDFoundation
23a) Answer: C. #ABPA is a complex allergic disorder caused by immune reactions against Aspergillus fumigatus. Typical clinical presentation is poorly controlled asthma, recurrent pulmonary opacities and #bronchiectasis.
— pulmmed_ce (@Pulmmed_CE) January 25, 2023
24) The patient is now even more confused with this condition she has not heard of! What is the prevalence of #ABPA in #NCFB?
— pulmmed_ce (@Pulmmed_CE) January 25, 2023
26) The patient is quite symptomatic and wishes to pursue treatment. What is first line pharmacotherapy for #ABPA?
— pulmmed_ce (@Pulmmed_CE) January 25, 2023
A. Anti-fungals (itra, vori)
B. Oral glucocorticoids
C. Anti-IgE drugs (ex: Omalizumab)
D. Anti-IL5 drugs (ex: Benralizumab)
28a) You treat the patient for #ABPA for four months and she is in remission but is left with bronchiectasis. One year later the patient returns. Her mMRC is now a 4. She had a recent hospitalisation for #PEx and one other outpatient #PEx.
— pulmmed_ce (@Pulmmed_CE) January 25, 2023
29a) Answer: D. Her #BSI is now severe-high. BSI is a validated prognostic score helped to predict mortality and #PEx longitudinally in #NCFB. Other ones often used include #FACED.
— pulmmed_ce (@Pulmmed_CE) January 25, 2023
30) The patient is now very symptomatic with her #NCFB and wants to know the management plan. TBT to our #Coles hypothesis–management is complex and based on part of the cycle.
— pulmmed_ce (@Pulmmed_CE) January 25, 2023
🔓 https://t.co/FaIuazbQaw pic.twitter.com/jRaZrN5P3O
32) Airway clearance is a cornerstones of therapy in #NCFB but one of the hardest for adherence as it is time consuming. In general, pick the modality that your patient likes and will be able to do both when well and increase when having a #PEx.
— pulmmed_ce (@Pulmmed_CE) January 25, 2023
🔓 https://t.co/dlZijuPRfe pic.twitter.com/vXrsadgZBh
34a) Macrolides, the jewel of respiratory medicine, has been shown to be beneficial in several studies including #BAT, #BLESS and #EMBRACE. In general, azithromycin reduces PEx frequency. #ERS recommends it in those with 3 or more PEx per year.
— pulmmed_ce (@Pulmmed_CE) January 25, 2023
35) While the optimal monitoring of macrolide side-effects is unknown, our small series suggests limited toxicity in most patients without pre-existing cardiac and otologic issues.
— pulmmed_ce (@Pulmmed_CE) January 25, 2023
🔓 https://t.co/ebFycs9YvQ
36b) You can phone a friend for help in these cases! #ID #Resp
— pulmmed_ce (@Pulmmed_CE) January 25, 2023
🔓 https://t.co/sBE8rbJlN4
38a) The lung microbiome is an exciting avenue of research where we use next-generation molecular sequencing of bacteria, fungi and viruses to allow personalization and stratification of patients into their ‘phenotypes’. This is at the cutting edge of #bench to #bedside. pic.twitter.com/jb7Mx9J2wh
— pulmmed_ce (@Pulmmed_CE) January 25, 2023
39a) Eosinophils are everywhere in respiratory medicine and #NCFB is no exception. Eosinophilic bronchiectasis affects approximately 20% of patients! But what about long-term?
— pulmmed_ce (@Pulmmed_CE) January 25, 2023
40a) This is all well and exciting research, but is there any new therapies available now? There sure is! #Brensocatib is the newest kid on the block. This reversible inhibitor of #DPP_1 acts to reduce activation of #neutrophil serine proteases.
— pulmmed_ce (@Pulmmed_CE) January 25, 2023
41) The #ASPEN trial is a phase 3 RCT placebo-controlled study ongoing for subjects with #NCFB anticipated to end in 2024. We can’t wait for the results! https://t.co/e0pHQwJG7V
— pulmmed_ce (@Pulmmed_CE) January 25, 2023
43) Patients and families can access additional resources and support through advocacy organizations such as @EMBARCnetwork: https://t.co/37R8ZMLtJW, @EuropeanLung: https://t.co/XKuuOqM1Zq and @COPDFoundation : https://t.co/zLwel0IcLb
— pulmmed_ce (@Pulmmed_CE) January 25, 2023
45) A whole series of the latest and greatest in #NCFB.
— pulmmed_ce (@Pulmmed_CE) January 25, 2023
🔓 https://t.co/QHFC2nKG91
46) And that's it–you made it! 🆓 CE/#CME! Just go to https://t.co/E4Z4dtukLn to claim your credit. And please FOLLOW @pulmmed_CE for more expert-authored programs! I am @Cthornton32#FOAMed
— pulmmed_ce (@Pulmmed_CE) January 25, 2023