Rescue Inhaler Research Articles

Strategies and tactics to reduce the impact of healthcare on climate change: systematic review

ObjectiveTo review the international literature and assess the ways healthcare systems are mitigating and can mitigate their carbon footprint, which is currently estimated to be more than 4.4% of global...

Improving asthma self-management education through inhaler labeling

ObjectiveImproper use and poor understanding of asthma medications can lead to poorly controlled asthma, emergency department visits, and hospitalizations for children with asthma. Pharmacists play a critical role in improving asthma medication adherence through education on asthma self-management. The use of color-coded labels applied at pharmacies to help patients differentiate between rescue and maintenance inhalers has not been explored. MethodsPharmacies were recruited to join a community pharmacy asthma coalition. Pharmacists provided patient education and labeled inhalers with two types of color-coded stickers. A red sticker labeled “RESCUE” was used for short-acting β-2 agonist medication inhalers. A green sticker labeled “USE EVERY DAY” was used for inhaled corticosteroids (ICS) or combination ICS/long-acting β-2 agonist medication inhalers. ResultsDuring the two years of the pilot program, 25 pharmacy locations participated. Pharmacies labeled over 6000 rescue and 9000 controller medications using color-coded labels. Over 1000 children and 7000 adults were served by the coalition. ConclusionColor-coded asthma medication labels can be successfully utilized by pharmacies. This low-cost tool provides vital information regarding the proper use of asthma medications. InnovationThe color-coded labeling of asthma medications is a novel innovation that can be successfully used by pharmacists to improve asthma self-management education.

Real-World Evaluation of Asthma Severity Following Endoscopic Sinus Surgery in Chronic Rhinosinusitis Patients.

This study aimed to evaluate the impact of endoscopic sinus surgery (ESS) on asthma severity up to 12 months after surgical intervention. Retrospective cohort. Tertiary care center. Patients with a history of asthma and Chronic Rhinosinusitis (CRS) who underwent ESS between 2013 and 2023 were included. Asthma severity was assessed according to current Global Initiative for Asthma (GINA) guidelines, classifying patients into mild, moderate, and severe based on medication requirements. Asthma severity was evaluated up to 3 months prior to ESS and 1-year post-ESS. Patients with aspirin-exacerbated respiratory disease (AERD) were excluded. Statistical analysis was performed using McNemar test and Wilcoxon signed-rank test to assess differences in asthma severity, medication doses, and number of medications. Sixty-five patients were included, of which 44 (67.7%) had CRS with nasal polyps (CRSwNP) and 21 (32.3%) had CRS without nasal polyps (CRSsNP). No significant differences were found in asthma severity pre- and post-ESS (P = .175). Similarly, no differences were found in ICS doses (P = .999), total number of prescribed medications (P = .157) or presence of exacerbations before and after ESS (P = .078). However, a significant increase in time from last rescue inhaler use was noted after ESS, increasing from a median of 6.71 to 23.1 weeks (P = .004). This study is the first to assess the impact of ESS on asthma severity in a real-world setting. Our findings suggest that ESS does not impact asthma severity classification. However, it might provide relief of asthma symptoms in the early postoperative period.

The pharmacist will see you now: Pharmacist prescriptive authority and access to care

AbstractIn 2018, Idaho became the first state to grant broad prescriptive authority to pharmacists for select medications, such as rescue inhalers (a drug to prevent and treat asthmatic symptoms) and insulin pen needles (for people with diabetes). We analyze the impact of this reform on Medicare beneficiaries' access to these time‐sensitive treatments. Our findings reveal increased Medicare Part D claims, 30‐day fills, and 30‐day supplies of albuterol sulfate and insulin pen needles following expanded pharmacist authority. This translates to approximately three additional patients per pharmacist receiving timely care, potentially preventing costly alternatives such as emergency room visits.

Albuterol-budesonide fixed-dose combination rescue inhaler for asthma: a plain language summary of the MANDALA study.

What is this summary about?This summary describes the results of a clinical study called MANDALA that was published in the New England Journal of Medicine in 2022. In the MANDALA study, researchers looked at a new asthma rescue inhaler that contains both albuterol and budesonide in a single inhaler (known as albuterol-budesonide, AIRSUPRA™). This summary describes the results for people aged 18 yearsand older who took part in the study.

Real-world effectiveness of mepolizumab in severe asthma and chronic rhinosinusitis in the United States: Impact of comorbidity and sinus surgery.

Trial data demonstrate that mepolizumab, a humanized anti-interleukin 5 monoclonal antibody, is effective for patients with severe asthma and comorbid chronic rhinosinusitis (CRS) with nasal polyps. This real-world, retrospective cohort study investigated mepolizumab for US patients with severe asthma and CRS with/without sinus surgery. IQVIA PharMetrics Plus claims data from baseline and follow-up (12 months before and after mepolizumab initiation) were used to analyze three patient cohorts: cohort 1 (severe asthma only); cohort 2 (severe asthma+comorbid CRS without sinus surgery); and cohort 3 (severe asthma+comorbid CRS+sinus surgery), allowing for cross-cohort comparisons. The analysis included 495, 370, and 85 patients in cohort 1, cohort 2, and cohort 3, respectively. Systemic and oral corticosteroid use was lower for all cohorts after mepolizumab initiation. In cohort 3, asthma rescue inhaler and antibiotic use were lower during follow-up than baseline. Asthma exacerbations were reduced by 28% to 44% comparing follow-up versus baseline, with the largest reduction in cohort 3 (ratio of incidence rate ratio [RR] vs cohort 1: 0.76; p=0.036). Reductions in oral corticosteroid claims were greater following mepolizumab initiation for cohort 3 versus cohort 1 (RR, 0.72; p=0.011) and cohort 2 (RR, 0.70; p<0.01). In cohorts 1 through 3, outpatient and emergency department visits were reduced by 1 to 2 and 0.4 to 0.6 visits annually, asthma-related and asthma exacerbation-related total costs were reduced by $387 to $2580 USD, and medical costs were reduced by $383 to $2438 USD during follow-up. Consistent with trial data, mepolizumab use in real-world practice shows benefits across comorbid patient cohorts with more a pronounced impact in those with severe asthma+comorbid CRS+sinus surgery.

Use of ICS and Fast-Acting Bronchodilators in Asthma: Past, Present, and Future.

Primary care practitioners (PCPs) play a key role in asthma management since most patients with asthma are treated in primary care settings. Despite continual advances in asthma care, important practice gaps remain, and the high burden of asthma exacerbations persists, with 43% of children with asthma and 41% of adults with asthma in the United States experiencing an asthma exacerbation in 2020. Uncontrolled asthma, incomplete assessment of exacerbation and asthma control history, reliance on systemic corticosteroids (SCS) or short-acting beta2-agonist (SABA)-only therapy, and lack of patient adherence to anti-inflammatory maintenance therapies are challenges clinicians face today with asthma care. Inhaled corticosteroids (ICS) have been thought to have slow onset of action; however, recent data indicate that ICS onset of action on bronchial tissue is seconds to minutes through nongenomic effects. A large body of evidence supports the use of ICS + fast-acting bronchodilator treatments when used as needed in response to symptoms to improve asthma control and reduce rates of exacerbations. The symptoms that occur leading up to an asthma exacerbation provide a window of opportunity to intervene with ICS + fast-acting bronchodilators, potentially preventing the exacerbation and reducing the need for SCS. Incorporating patient perspectives and preferences when designing asthma regimens will help patients be more engaged in their therapy and may contribute to improved outcomes. In January 2023, a SABA-ICS combination rescue inhaler was approved by the US Food and Drug Administration (FDA) as the first asthma rescue inhaler for as-needed use to reduce the risk of exacerbations.

An evaluation of outpatient pediatric asthma prescribing patterns in the United States

Pediatric asthma is often under-diagnosed and under-treated, resulting in a lack of concentration, difficulty sleeping, and tiredness. The Global Initiative for Asthma (GINA) guidelines recommended that children should be prescribed maintenance inhalers along with rescue inhalers. Concurrent use of rescue and maintenance inhalers were considered appropriate use for this study. The aim of the study was to determine the prevalence of inappropriate prescribing patterns against various patient and prescriber demographic factors. A total of 2,264 patients meeting the inclusion criteria for ICD 10 codes, J45.20 - J45.52 and age less than 18 were extracted from the 2018 National Ambulatory Medical Care Survey (NAMCS), which captures ambulatory services offered in physicians’ offices directly engaged in patient care. This data is collected by the National Center of Health Statistics (NCHS), a division of the CDC. The data were analyzed using descriptive analysis, two-tailed t-tests, and ANOVA with an alpha significance level at 0.05. The majority of the pediatric patient population was in the age range of 17-18 years old. Overall, more patients were prescribed inappropriately (68.3%) as compared to appropriate prescribing (31.7%). Inappropriate prescribing was seen more for patients with Medicaid (24.8%) and self-payment (38.2%) as compared to other types of payment (p= 0.052). General practice/ family physicians (35.1%) and nurse practitioners (20.9%) prescribed more inappropriately as compared to other prescribers. (p= 0.001). Patients from the Southern region of the U.S. were prescribed more inappropriately compared to the other regions in the U.S. (p= 0.205). This study concluded that a significant number of pediatric asthma patients across all demographics were not appropriately prescribed inhalers, thus not adhering to GINA guidelines. Appropriate prescribing and adhering to guidelines would prevent morbidity, mortality and improve the patient's quality of life, thereby saving healthcare costs.

The Association of Periconception Asthma Medication Discontinuation with Adverse Obstetric Outcomes.

This study aimed to investigate asthma medication reduction in the periconceptional period as it relates to asthma status and adverse outcomes in pregnancy. In a prospective cohort study, self-reported current and past asthma medications were collected and analyzes compared measures of asthma status in women who discontinued asthma medication in the 6 months prior to enrollment ("step-down") versus those who did not ("no change"). Evaluation of asthma was done at three study visits (one per trimester) and by daily diaries, including measures of lung function (percent predicted forced expiratory volume in 1 and 6 s [%FEV1, %FEV6], peak expiratory flow [%PEF], forced vital capacity [%FVC], FEV1 to FVC ratio [FEV1/FVC]), lung inflammation (fractional exhaled nitric oxide [FeNO], ppb), rate of asthma symptoms (activity limitation, night symptoms, rescue inhaler use, wheeze, shortness of breath, cough, chest tightness, chest pain), and rate of asthma exacerbations. Adverse pregnancy outcomes were also evaluated. Adjusted regression analyses examined whether adverse outcomes differed by periconceptional asthma medication changes. Of 279 participants included in analyses, 135 (48.4%) did not change asthma medication in the periconceptional period, whereas 144 (51.6%) reported a step down in medication. Those in the step-down group were more likely to have milder disease (88 [61.1%] in the step-down vs. 74 [54.8%] in the no change group), exhibited less activity limitation (rate ratio [RR]: 0.68, 95% confidence interval [CI]: 0.47-0.98), and experienced fewer asthma attacks (RR: 0.53, 95% CI: 0.34-0.84) during pregnancy. The step-down group had a nonsignificant increase in overall odds of experiencing an adverse pregnancy outcome (odds ratio: 1.62, 95% CI: 0.97-2.72). Over half of women with asthma reduce asthma medication in the periconceptional period. Although these women typically have milder disease, a step down in medication may be associated with an increased risk of adverse pregnancy outcomes. · Many women reduce their asthma medication in pregnancy.. · Reduction is more common among those with mild disease.. · Medication reduction may lead to adverse pregnancy outcomes..

Budget impact analysis of a digital monitoring platform for COPD

BackgroundChronic obstructive pulmonary disease (COPD) is a progressive debilitating condition with frequent exacerbations that have a high burden for patients and society. Digital tools may help to reduce the economic burden for patients and payers by improving outcomes. The Propeller platform is a digital self-management tool that facilitates passive monitoring of inhaler medication utilization, potentially assisting the healthcare team to identify patients at risk of a COPD exacerbation who may require further intervention. This study estimated the budget impact of Propeller from commercial payer and Medicare fee-for-service payer perspectives.MethodsAn Excel-based model was used to estimate the budget impact of Propeller for COPD patients in commercial and Medicare population sizes of 5 million members. Data on prevalence, baseline healthcare resource utilization (HCRU), and baseline use of rescue and controller inhaler medications with unit costs (adjusted to 2020 US dollars) were obtained from peer-reviewed literature. Data on reductions in HCRU during Propeller usage were based on direct evidence. Estimates for costs of remote monitoring were obtained from publicly available information. All patients were assumed to have insurance claims related to ongoing remote monitoring.ResultsThe estimated number of annual eligible COPD patients for commercial and Medicare was 212,200 and 606,600, respectively. Propeller decreased costs by an estimated $2,475 (commercial) and $915 (Medicare) per enrolled patient. The greatest increase in expenditure was for remote monitoring related expenses. After accounting for estimated reductions in hospitalizations, emergency department visits and short-acting beta-agonist use, total net savings were approximately $1.60 and $1.70 per-member per-month for commercial and Medicare payers, respectively.ConclusionPropeller is projected to be cost saving from both the commercial and Medicare payer perspectives.

Increasing Awareness of Naloxone-Induced Noncardiogenic Pulmonary and Peripheral Edema

AbstractIntroductionNaloxone use has increased in recent years in response to the nation’s opioid crisis. Once only available to health care professionals, it is now obtainable by prescription for persons at risk for substance overdose and their families. Increasing its availability is seen by some as an “over-the-counter solution” to the opioid problem. However, while naloxone has been viewed as relatively safe, with a low side effect profile when appropriately dosed and monitored, it is not without safety concerns that may go unrecognized or misattributed to other causes.MethodsHere we present a case study of a 41-year-old female who presented to our medication-assisted treatment (MAT) clinic complaining of sudden onset weight gain, shortness of breath, upper and lower extremity peripheral edema, tachycardia, insomnia, and nocturnal enuresis. These symptoms made it difficult for her to work at her housekeeping job, resulting in missed workdays. She had seen a primary care provider for her symptoms and been prescribed a rescue inhaler for her shortness of breath. This patient had previously been treated for opioid use disorder with buprenorphine/naloxone and experienced similar symptoms, which disappeared when she relapsed on opioids. However, symptoms reappeared upon resuming her prescribed treatment.ResultsThe patient was identified as experiencing side effects to naloxone, causing noncardiogenic edema. Her MAT medication was switched to buprenorphine. Within two weeks her heart rate had returned to normal, she had lost weight, and she no longer had nocturnal enuresis or needed the rescue inhaler. Her peripheral edema resolved so she was able to walk better and resume work. At the same time, buprenorphine continued to relieve her cravings.There is a dearth of information related to naloxone-induced edema. Our patient had not received a formal evaluation of pulmonary edema, but her pulmonary and cardiac symptoms were consistent with that diagnosis. Although pulmonary edema is mentioned in the product literature, peripheral edema is not. A literature search indicates that the number of case studies on naloxone-induced pulmonary edema have increased since 2018, but only one other case of naloxone-induced peripheral edema was discovered.Conclusions/ImportanceNaloxone is used in a variety of settings by differing types of health care providers. As the number of persons treated with naloxone increases, there will likely be a corresponding increase in incidences of pulmonary and/or peripheral edema as side effects. Providers and patients who are not aware of these manifestations and their relationship to naloxone treatment may easily attribute presenting symptoms to cardiogenic or other causes, as this case illustrates. It is important for providers in all settings to consider new onset shortness of breath and edema within the context of the person’s whole health and to be aware of their implications for mental as well as physical health.FundingNo Funding

Implementation and outcomes of an ambulatory care pharmacist service: Application of an implementation science framework.

As teams work to optimize the pharmacist's role on care teams, it is important to be proactive and strategic during the service creation process. Implementation science frameworks can help guide pharmacists as they work to translate evidence-based interventions into practice. When a care gap in respiratory chronic disease state management in the primary care setting was identified, a team was created to investigate whether an ambulatory care pharmacist service would be a valuable way to address the care gap. This paper outlines the steps taken to scope and implement a new pharmacist service. An implementation science framework, the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, was used to guide the service implementation process. Postimplementation data were collected to assess the impact of the service. A total of 56 patients were managed by the pharmacist in the first year following implementation. Data suggested that the pharmacist service has clinical value based on an improvement in chronic obstructive pulmonary disease (COPD) symptom control, rescue inhaler use, adherence, and inhaler technique. The data also informed postimplementation changes for continuous quality improvement. The use of an implementation science framework to implement a new pharmacist service proved valuable. Although this project focused on addressing a care gap in COPD, implementation science frameworks can and should be used to guide the implementation of a variety of new clinical services to enhance impact and sustainability.

Uncontrolled Asthma Among Children and Its Association With Parents' Asthma Knowledge and Other Socioeconomic and Environmental Factors.

Objective To estimate the frequency of uncontrolled asthma among asthmatic children from Jeddah and to analyze its association with parental asthma knowledge and other socioeconomic and environmental factors. Method A cross-sectional study was conducted at the Pediatrics Departments of King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia, from July to December 2018. It involved the caregivers of 150 children with asthma, who were following at KAUH.A structured questionnaire was administered by a phone interview to collect the following: socioeconomic and environmental factors of asthma, answers to the Arabic version of the Asthma Control TestTM(ACT), and answers to the Arabic version of the caregiver Asthma Knowledge questionnaire (AKq). Result The frequencyof uncontrolledasthma was 32.7% (95%CI:25.2 - 40.8). Parents had myths about asthma such as "children with asthma should use asthma control medications (inhaled corticosteroids) only when they have symptoms" and "it's not good for children to use the inhaler for too long". Besides, we observed mixed results regarding parents' knowledge about the disease, with correct answers ranging from 56.0% to 88.7% depending on the item. Exposure to bakhoor (aromatic woodchips) at home (OR = 0.41, p=0.044), two or more ICU admissions during the past 12 months (OR = 3.30, p=0.030), and using a rescue inhaler even if there's no cough or wheeze when the child gets the flu (OR = 0.22, p=0.001) were the three independent factors of uncontrolled asthma among children. Conclusion Uncontrolled asthma concerns one-third of the asthmatic children following at our centre, representing a less concerning figure compared to the national data. The contribution of parents' knowledge to asthma control did not show significant results, although uncontrolled asthma may represent an opportunity to increase parents' knowledge and awareness. We emphasize the significance of exposure to bakhoor, the use of oral steroids, and the number of ICU admission as strong indicators for uncontrolled asthma in children. An adaptive national strategy should be designed to enable effective and personalized interventions, resources, and objectives for maximized benefits.

Impact of Clinical Pharmacist Practitioner Management of Chronic Obstructive Pulmonary Disease in the Ambulatory Care Setting

Objectives: To evaluate the impact of clinical pharmacist practitioner (CPP) management on potentially inappropriate use of inhaled corticosteroids (ICS) in the ambulatory care setting. Design: Multicenter, prospective quality assurance/improvement (QA/QI) project. Setting: Erie Veterans Affairs Medical Center (VAMC) and surrounding Ashtabula, Crawford, and Venango County Community-Based Outpatient Clinics (CBOCs). Participants: Thirty-five participants with chronic obstructive pulmonary disease (COPD) who met inclusion criteria were included in the project. Interventions: Participants were contacted to schedule an initial sixty-minute telephone visit with a CPP. Exacerbation history, rescue inhaler use, and symptom burden were assessed using the COPD Assessment Test (CAT) and Modified Medical Research Counsel Breathlessness Scale (mMRC) scales. Medication regimens were optimized based on guideline recommendations with an emphasis on appropriate use of ICS. Participants were scheduled for follow-up telephone visits with the CPP every 4 weeks. Main Outcome Measures: The primary project outcome was potentially inappropriate use of ICS without a long-acting muscarinic antagonist (LAMA)/long-acting beta agonist (LABA). Secondary project outcomes included ICS de-escalation, vaccinations, and smoking cessation. Results: The primary outcome of reducing use of ICS without a LAMA/LABA was achieved in thirty-one (88.6%) participants. ICS de-escalation was achieved in twenty-three (65.7%) participants. Rates of recommended vaccinations and smoking cessation with nicotine replacement therapy increased as a result of pharmacist intervention. Conclusion: Pharmacist management of COPD in the ambulatory care setting was associated with a decrease in potentially inappropriate use of ICS and an increase in preventative care measures.

Medication adherence in Medicare-enrolled older adults with asthma and chronic obstructive pulmonary disease before and during COVID-19 pandemic.

Medication adherence in Medicare-enrolled older adults with asthma and chronic obstructive pulmonary disease (COPD) before and during the coronavirus disease 2019 (COVID-19) pandemic is unknown. To evaluate medication adherence and determinants of high adherence before and during the COVID-19 pandemic in this population. Retrospective cohort study. The proportion of days covered (PDC) reflected medication adherence from January to July 2019 and from January to July 2020. Patients <65 years of age, with COPD or asthma alone, or with cystic fibrosis were excluded. Paired t tests were used to assess adherence changes. Logistic regression explored association of age, sex, diagnosis of depression, number of medications, medication-related problems, prescribers, pharmacies, controller medication classes, albuterol rescue inhaler fills, oral corticosteroid fills, and having a 90-day supply with high adherence (PDC ⩾ 80%). This analysis included 989 patients. In this cohort, 61.2% of patients received oral corticosteroids. Over 60% of patients had ⩾3 rescue fills in both 2019 and 2020. Medication adherence to controller medications significantly decreased for all controller medications (p < 0.001) in 2020. In 2019 and 2020, number of controller medication classes and having a 90-day supply were associated with high adherence (p < 0.001). In 2019, variables associated with high adherence also included number of medication-related problems and having ⩾3 albuterol rescue inhalers (p < 0.001). Medication adherence to controllers significantly decreased during the pandemic among older adults with asthma and COPD. Patients with multiple controller classes and a 90-day supply were more likely to be highly adherent. A 90-day supply of medications should be used to facilitate access to medication during the pandemic. Healthcare professionals should assess medication adherence, resolve the barriers of adherence and medication-related problems to achieve desired clinical outcomes among older adults with both asthma and COPD.

Patient experience of moderate asthma attacks: qualitative research in the USA and Germany

BackgroundThere is limited information available on the impact of moderate asthma exacerbations, often called “asthma attacks” (i.e., those not requiring hospitalisation or treatment with systemic corticosteroids) on patients’ lives. This multi-country qualitative study explored the patient experience of these events.MethodsSemi-structured concept elicitation interviews were conducted in the USA and Germany with adult patients with asthma who had experienced a moderate asthma exacerbation in the prior 30 days. Physicians with experience in managing patients with asthma were also interviewed. Interviews explored patients’ experience of symptoms and impact of moderate exacerbations and associated exacerbation triggers and treatment patterns. Physicians were also asked about their interpretation of a clinical definition and treatment of a moderate exacerbation.ResultsTwenty-eight patient (n = 20 in the USA, n = 8 in Germany) and six physician (n = 3 in the USA, n = 3 in Germany) interviews were conducted. During their moderate exacerbation, all patients reported experiencing shortness of breath, which many considered to be severe and the most bothersome symptom. Wheezing was also reported by all patients and considered severe by two thirds of patients. Most patients also reported coughing and chest tightness. All or almost all patients reported that moderate exacerbation caused fatigue/tiredness and impacted their physical functioning, emotional functioning, activities of daily living and work/school life. Most patients reported using rescue or maintenance inhalers to alleviate symptoms of the exacerbation. Conceptual saturation (i.e., the point at which no new concepts are likely to emerge with continued data collection) was achieved. Findings were used to develop a patient-focused conceptual model of the experience of moderate asthma exacerbations, outlining concepts related to triggers, symptoms, impact, and treatment from the patient perspective. Physician data was consistent with patient reports and complemented the conceptual model.ConclusionsFindings from concept elicitation interviews highlight the increased frequency, duration and severity of asthma symptoms and increased rescue medication use during moderate asthma exacerbations compared with the typical daily asthma experience, which have a substantial impact on patients’ lives.

FROM CVID TO AERD: ADDRESSING EPITHELIAL BARRIER DYSFUNCTION FROM NON-TYPE-2 TO HIGH-TYPE-2 AIRWAY INFLAMMATION

<h3>Introduction</h3> We describe two severe asthmatics on opposite ends of the Type 2 inflammatory spectrum. One patient with high Type 2 signature including AERD. The other with low Type 2 inflammation with CVID and infection-driven asthma. Both experienced significant improvement of upper and lower respiratory symptoms with tezepelumab. <h3>Case Description</h3> A 46-year-old male AERD patient suffered from severe asthma and nasal polyposis with anosmia. His symptoms persisted despite high-dose inhaled corticosteroid/long-acting beta₂-agonist, systemic corticosteroids, budesonide saline sinus rinses, and multiple nasal polypectomies, causing a significant impact on QoL. Three months post-tezepelumab treatment resulted in 1,000 mL increase in FEV₁. He no longer needed systemic corticosteroids or use of his rescue inhaler. Anosmia resolved and taste returned. A 14-year-old female CVID patient with low peripheral eosinophil count, low total IgE, allergen skin test negativity, and low FeNO had poorly controlled asthma despite subcutaneous immunoglobulin therapy. Three months post-tezepelumab, her spirometry values normalized for the first time in years. Her FEV₁ increased by 500 mL. After tezepelumab, she was able to resume competitive sports without symptoms, no longer required corticosteroid bursts, and rare rescue inhaler use. <h3>Discussion</h3> These cases illustrate tezepelumab's ubiquitous efficacy of treating respiratory symptoms ranging from AERD to CVID. TSLP released from epithelial barrier disruptions may be a commonality across asthma endotypes. This provides insight about the unified airway and creates exciting new possibilities for the treatment of both Type 2 and non-Type 2 respiratory diseases.

PNEUMORACHIS FROM ASTHMA EXACERBATION: A RARE COMPLICATION

PNEUMORACHIS FROM ASTHMA EXACERBATION: A RARE COMPLICATION

INTERMITTENT OBSTRUCTION: A CASE OF ENCAPSULATED ENDOBRONCHIAL HAMARTOMA EXHIBITING A CUP-IN-BALL EFFECT

INTERMITTENT OBSTRUCTION: A CASE OF ENCAPSULATED ENDOBRONCHIAL HAMARTOMA EXHIBITING A CUP-IN-BALL EFFECT

CHARACTERISTICS OF BLACK AND LATINO PATIENTS WITH SEVERE ASTHMA ON BIOLOGIC THERAPY IN A COMMUNITY CLINIC

CHARACTERISTICS OF BLACK AND LATINO PATIENTS WITH SEVERE ASTHMA ON BIOLOGIC THERAPY IN A COMMUNITY CLINIC