Symposium 5： Opportunities and Challenges for Chronic Airway Diseases
Chronic airway diseases, such as COPD, asthma and bronchiectasis were heterogeneous, complex, slowly developing diseases with varying phenotypes and rates of progression. These may range from mild disease with barely noticeable symptoms, to very severe disease with constant symptoms that greatly hinder the life of the patient. Guidelines issued by various medical societies provide guidance on how to diagnose and manage chronic airway diseases’ patients. It is now increasingly recognized that airway diseases management must be individualized, tailored not only to the severity of the disease but to the phenotypic characteristics of each patient. Each of these factors makes it exceedingly challenging to study and develop novel therapies. More opportunities and challenges need to find and overcome for managements of chronic airway diseases.
| Time (GMT+8) |
Topic | Speaker | Country / Region |
|---|---|---|---|
| 08:30-09:00 | Impulse oscillometry: interpretation and clinical application in chronic airway diseases | Prof. Diahn-Warng Perng | Taiwan |
| 09:00-09:30 | Long-term trends of COPD mortality: Gaps and opportunities | Dr. Chia-Hung Chen | Taiwan |
| 09:30-10:00 | The environmental impact of inhalers for asthma: A green challenge and a golden opportunity | Dr. Horng-Chyuan Lin | Taiwan |
Impulse oscillometry: interpretation and clinical application in chronic airway diseases
Abstract:
Small airways refer to an internal diameter of 2 mm or less which are the major sites of inflammation and obstruction in asthma and chronic obstructive pulmonary disease (COPD). In asthma, small airway dysfunction (SAD) assessed by the forced expiratory flow between 25% and 75% of vital capacity percent predicted (FEF25-75%) is associated with asthma symptoms and healthcare utilization. In addition, SAD is present across patients with all severities of asthma and is particularly prevalent in severe diseases observed in a large asthma cohort. In COPD, the presence of SAD in terms of abnormal small airway resistance and reactance is associated with disease severity. Moreover, COPD patients with SAD may have poor spirometric results, more severe lung hyperinflation, and poor quality of life. Impulse oscillation (IOS) uses an oscillation technique that measures lung mechanics in an effort-independent manner to assess respiratory resistance and reactance during tidal breathing by applying different sound waves with various frequencies. Patients with respiratory symptoms and preserved pulmonary function may still have SAD, which can be identified with the aid of IOS in addition to spirometry. IOS has better sensitivity than effort-dependent FEF25-75% to detect SAD in both asthma and COPD. Furthermore, bronchodilator response assessed by forced oscillation, particularly respiratory reactance can detect more subjects with poor asthma control than did spirometry.
Prof. Diahn-Warng Perng
Taiwan
Diahn-Warng Perng is Chief of Clinical Chest Medicine at the Department of Chest Medicine, Taipei Veterans General Hospital, Taiwan. He is Professor of Medicine in National Yang Ming University, Taipei. He had been the Secretary General of Taiwan Society of Pulmonary and Critical Care Medicine. and the Head of COPD Assembly in Asia Pacific Society of Respirology.
Dr. Perng received his medical degree in 1990 and subsequently trained in internal medicine and chest medicine at the Taipei Veterans General Hospital. From 1997 to 2000 he held The Overseas Research Studentship at the University of Southampton, at the completion of which he was awarded a PhD for his thesis on ‘The proinflammatory actions of mast cell tryptase and agonists of protease activated receptor 2 on the human airway epithelium.’
Dr. Perng’s research is focused on understanding the inflammatory mechanisms and the repair process of chronic airway disorders, as well as their modulation associated with therapeutic intervention. He has published numerous papers in peer-reviewed journals, including the JACI-In Practice, Journal of Immunology, the American Journal of Respiratory Cell Biology, the American Journal of Physiology, Chest, Lung, European Respiratory Journal, Critical Care Medicine, Tissue Engineering, Pulm Pharmaco Ther, PLos One, Int J Chron Obstruct Pulmon Dis, Drug Des Devel Ther and Respirology.
Long-term trends of COPD mortality: Gaps and opportunities
Abstract:
Chronic obstructive pulmonary disease (COPD), a progressive lung disease, is characterized by long-term respiratory symptoms and airflow limitation. The burden of COPD is expected to increase in the coming decades due to an aging population and longer exposure to COPD risk factors such as smoking or air pollution. COPD accounts for most of the deaths from chronic lower respiratory diseases, the third leading cause of death worldwide in 2015, when 3.2 million people died from the disease. And also the nineth leading cause of death in the Taiwan in 2022.
In this speech, we will focus on the gaps and opportunities of mortality in COPD.
We want to identify both gaps and opportunities to improve our understanding and decrease the burden of COPD. For example, the gaps relate to the factors beyond cigarette smoking that may be driving mortality. Opportunities include a rationale for a more standardized approach to the classification and management of COPD. Additional opportunities relate to learning from different countries that have had successful declines in COPD mortality, better understanding of the factors that drive COPD incidence and affect severity, determining the factors responsible for increasing mortality among younger women in many countries and identifying interventions that improve quality and duration of life in people with established COPD.
Dr. Chia-Hung Chen
Taiwan
Chia-Hung, Chen received his M.D. in 2008 and PhD degree in Graduate Institute of clinical medicine science in 2017 from the China Medical University. After training residency in Department of Internal Medicine and fellowship in Division of Pulmonary and Critical Care Medicine of the China Medical University Hospital from 2002 to 2007, he became attending physician since 2007. He was an Assistant Professor since 20177 and Associate Professor in China Medical University since 2019 and actively had worked research focused on the interventional pulmonology. He is a member of Taiwan Society of Pulmonary and Critical Care Medicine and the World Association for Bronchology and Interventional Pulmonology. He received the APSR Young Investigator’s award 2006 and Taiwan Society of Pulmonary and Critical Care Medicine, Excellent Award of oral presentation, 2015 and 2016. He has published over 110 peer-reviewed journal articles and 6 book chapters. Now his research interests is focused on interventional pulmonology and airway disease.
The environmental impact of inhalers for asthma: A green challenge and a golden opportunity
Abstract:
Inhalers form the mainstay of treatment for various respiratory illnesses, primarily asthma and chronic obstructive pulmonary disease (COPD). The propellants in metered-dose inhalers (MDIs) are powerful greenhouse gases, which account for the carbon footprint related to the delivery of care. The climate emergency is a healthcare emergency and the impacts on human health are already being seen. To achieve lesser greenhouse gas emissions and net carbon zero, a shift away from metered-dose inhalers which contain powerful greenhouse gases is necessary. Many patients can use dry powder inhalers which do not contain greenhouse gases and are equally effective at managing respiratory diseases, such as asthma and COPD.
Dry-powder inhalers (DPIs) present a viable alternative to MDIs because they have a substantially smaller carbon footprint, and they are similarly effective. An important part of the carbon footprint of MDI prescribing is short-acting beta agonists (SABA). Strategies that replace overuse of reliever MDIs with regimes emphasizing inhaled corticosteroids have the potential to improve asthma control alongside significant reductions in greenhouse gas emissions. Real-world evidence shows that once-daily long-acting combination DPIs can improve compliance and asthma control, but also reduce the carbon footprint. Moreover, based on the GINA, anti-inflammatory reliever (AIR) and maintenance and reliever therapy (MART), which use combination reliever and inhaled steroids in one device (usually a DPI), can simplify therapy and improve asthma control. Most important, both treatment strategies can significantly reduce the greenhouse gas emissions and the carbon footprint of primary care.
The patient–practitioner relationship are important moral aspects of doctors’ management decisions in addition to environmental concerns. By focusing and educating on asthma patients who are currently using high amounts of SABA-containing MDI relievers and prioritizing inhaled steroids via DPIs, there are golden opportunities to make asthma care more effective, safer and greener.
Dr. Horng-Chyuan Lin
Taiwan
Associate Professor in Department of Thoracic Medicine, Lin-Kou Medical Center of Chang Gung Memorial Hospital
July 2003 – July 2005
Chief of Department of Thoracic Medicine II, Lin-Kou Medical Center of Chang Gung Memorial Hospital
August 2005 – Jan 2008
Director of Research, Education and Development Center. Department of Thoracic Medicine, Lin-Kou Medical Center of Chang Gung Memorial Hospital
Since August 2005
Associate Professor of Chang Gung University
Jan 2008 – Jan 2011
Chief of Division of Pulmonary Infectious & Immunological Disease, Department of Thoracic Medicine, Lin-Kou Medical Center of Chang Gung Memorial Hospital
Apr 2015 – Apr 2017
Chairman of Taiwan Asthma Council
Feb 2012 – Aug 2017
Head of Department of Internal Medicine and Thoracic Medicine, Taoyuan Chang Gung Memorial Hospital
Since July 2023
Chief of Department of Thoracic Medicine, Lin-Kou Medical Center of Chang Gung Memorial Hospital
Dr. Hao-Chien Wang
Taiwan
Dr. Hao-Chien Wang is professor of Internal medicine in College of Medicine National Taiwan University and consultant physician in Chest specialty practicing at National Taiwan University Hospital in Taipei city.
Dr. Wang has an outstanding career marked by contributions to academic research, education, training and clinical practice. Dr. Wang’s research focuses mainly on basic and clinical researches on obstructive airway diseases, acute lung injury and chest ultrasonography in diagnosing of pulmonary diseases. He has published more than 120 papers in national and international peer reviewed journals. Furthermore, Dr. Wang is an investigator for several ongoing global clinical studies in the area of respiratory disease including pneumonia, COPD & asthma.
Prof. Shih-Lung Cheng
Taiwan
1. Chief, Department of Pulmonary Medicine, Far Eastern Memorial Hospital
2. Chief, The Center of Evidence-Based Medicine, Far Eastern Memorial Hospital
3. Duputy Director, The airway Assembly, Taiwan Society of Pulmonary and Critical Care Medicine
4. Deputy Head, Asthma Assembly, Asian Pacific Society of Respirology (APSR)
5. Professor, Yuen Ze University
6. Secretary General, Taiwan Respiratory Health Promotion Society
Dr. Wu-Huei Hsu
Taiwan
2. Vice-superintendent, Critical Medical Center, China Medical University Hospital, Taiwan (2020–now)
3. Vice-superintendent, Department of Internal Medicine, China Medical
University Hospital, Taiwan (2018-2019)
4. Chairman, Department of Internal Medicine, China Medical
University Hospital, Taiwan (2008-2017)
5. More than 150 scientific papers (SCI)
