The Curbsiders Internal Medicine Podcast #500: COPD Update with Cyrus Askin
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Oct 6, 2025 Dr. Cyrus Askin, a pulmonologist and critical care physician, shares insights on managing COPD. He discusses the latest GOLD updates and emphasizes the importance of spirometry in diagnosing airflow obstruction. Nonpharmacologic strategies, like smoking cessation and pulmonary rehab, are highlighted for improving patient outcomes. Askin also explains the complexities of treatment options, including inhaled corticosteroids guided by eosinophil levels, and introduces new therapies like ensifentrine. His real-world pearls make COPD management practical and effective.
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When To Expand Diagnostic Testing
- Confirm suspected COPD with post-bronchodilator spirometry and consider full PFTs including lung volumes and DLCO when presentation is atypical.
- Order chest CT and alpha-1 antitrypsin testing if no smoking history or unusual features exist.
Start With Plain Films And GOLD Staging
- Use an AP and lateral chest x-ray early in any pulmonary complaint to avoid missing masses or extrinsic compression.
- Use GOLD staging (A/B/E) plus FEV1 grades to guide prognosis and management, not just the FEV1 number alone.
Symptoms And Exacerbations Drive Treatment
- GOLD now uses A/B/E (symptoms and exacerbations) to guide therapy more than FEV1 alone.
- Exacerbation history predicts progression and drives treatment intensity.